ECG心电图的解读

ELECTROCARDIOGRAMTheFirstAffiliatedHospitalofShantouUniversityMedicalCollege卢成志TheStandard12-leadElectrocardiogram•Howtomeasureeachwave:amplitudeduration25mm/sELECTROCARDIOGRAM•ECGrecordsthechangingpotentialofthefieldimpartedbytheheart.•ECGdosenotrecorddirectlytheelectricalactivityoftheheart.•ECGrecordtheelectricalactivityoftheheartfromthebodysurface.•插入离子通道图片ElectricalbasisandtheoryElectricalbasisandtheory•depolarization•dipole•repolarizationElectricalbasisandtheoryElectricalbasisandtheory•qClinicalelectrocardiolopyelementaryknowledge•Vector•Resultantvector•LoopElectricalbasisandtheoryTheStandard12-leadElectrocardiogram•SAnode•Bachmann•AVnode•Hisbundle•Leftandrightbranchofbundle•PukinjefiberTheStandard12-leadElectrocardiogram•PWave•P-Rinterval•QRSComplex•STsegment•TWave•Q-TintervalTheStandard12-leadElectrocardiogram——RWaveformLeadSystemoftheECG•LimbleadsEinthoventrigoneHexaxialsystemLeadSystemoftheECG•ChestleadsChestleadsLeadSystemoftheECG.Ⅱ.ECGEVALUATION•TheStandard12-leadElectrocardiogram•Howtomeasureeachwave:amplitudeduration25mm/sHowtocalculatetheheartrate•HeartRate=60/R-RdurationMeanQRSaxisCardiacRotation.Ⅲ.NORMALECG•⒈PWave•⒉P-RInterval•⒊QRScomplex•⒋Jpoint•⒌STSegment•⒍TWave•⒎Q-TInterval•⒏UWave.Ⅲ.NOMALECG——PWave•⑴form：I、II、avF、V4-6•⑵duration：0.12s•⑶amplitude:Limbleads0.25mV,Chestleads0.20mV..Ⅲ.NOMALECG——P-RInterval•duration：0.12s~0.20s..Ⅲ.NOMALECG——QRScomplex•⑴duration:0.06~0.10s.•⑵formandamplitude.•⑶Rpeaktime•⑷QWave.Ⅲ.NOMALECG•Jpoint•STSegment•TWave•Q-TInterval•UWaveIV.TheAbnormalECGAtrialandVentricularhypertrophyAtrialandVentricularhypertrophy(一）atrialenlargment•Leftatrialenlargement•Rightatrialenlargement:AtrialandVentricularhypertrophy(一）leftVentricularenlargment•QRSvoltage:①RinV5,62.5mV,②RV5+SV13.5or4.0mV,③RI1.5mV,RinaVL1.2mV,aVF2.0mV,SinV12.4mV,④RI+SIII2.5mV.•leftaxisdeviation•QRSduration0.09ms.•STsegmentandTwaveleftVentricularenlargmentAtrialandVentricularhypertrophy(二）RightVentricularenlargment•①V1leadR/S1,V5leadR/S1,•②Rv1+Sv51.05mV.•③rightaxisdeviation+90°.•④ST-TchangeRightVentricularenlargmentAtrialandVentricularhypertrophy(三）Biventricularenlargement•ApproximatelynormalECG.•LeftorRightVentricularHypertrophyECG•BiventricularHypertrophyECGBiventricularenlargementV.IschemiaandST-TSegment•Forms:•(1)Ischemia:a.subendocardialischemiab.subepicardialischemia•(2)Injury.•clinicalsignificance•differentialdiagnosisIschemiaandST-TSegmentIschemiaandST-TSegmentIschemiaandST-TSegmentIschemiaandST-TSegmentVI.MyocardialInfarction•(一）Formsandmechanism(1)ischemia(2)infury(3）infarctionVI.MyocardialInfarctionVI.MyocardialInfarctionVI.MyocardialInfarctionVI.MyocardialInfarction•（二）EvolutionoftheinfarctionanddurationtheECG(1)initialphase(2)acutephase(3)subacutephase(4)recoveryphaseMyocardialInfarctionVI.MyocardialInfarction•TheECGandlocationofinfarctionMyocardialInfarctionMyocardialInfarctionNonspesificpatternsofinfarction•non-Qwavemyocardialinfarction•infarctioncomplicatedwithotherdiseases•differentialdiagnosis