心电图基础英文版

心电图基础分析中国医科大学盛京医院心电图基础心电图基础心电图基础心电图基础心电图基础P波P波QRS波群QRS波群正常心电图正常心电图变异•QIII正常心电图变异•QSinV2/V3正常心电图变异•假性预激正常心电图变异•SⅠ/SⅡ/SⅢ正常心电图变异•电极位置连错正常心电图变异•STV2抬高正常心电图变异•早期复极肢导低电压•Ⅰ，Ⅱ，Ⅲ导联所有R波，S波总和小于15mm.顺钟向及逆钟向转向心律失常心电图诊断概念•心律失常(cardiacarrhythmia)是指心脏冲动的频率、节律、起源部位、传导速度、激动次序的异常。识别心律失常的基础•Step1:是否有Ｐ波?•Step2:是否有ＱＲＳ波?•Step3:Ｐ波与ＱＲＳ波是否相关?Example窦性心律III度房室传导阻滞心脏传导阻滞分类•部位窦房传导阻滞房内传导阻滞房室传导阻滞室内传导阻滞•程度第一度传导阻滞第二度传导阻滞莫氏Ⅰ型和Ⅱ型第三度传导阻滞ECGⅠ度AVBPR0.20sⅡ度Ⅱ型AVBECGⅢ度AVB房性心律失常•房早•房性心动过速•房扑•房颤房早房早房速房速心房扑动心房颤动(atrialfibrillation)ECG:1.P波消失，呈小而不规则的基线波动(f波),频率350-600次/分2.心室律不规则3.QRS波群形态正常，室内差传时增宽变型阵发性室上性心动过速(paroxysmalsupraventriculartachycardia,PSVT)病因：无器质性心脏病者，与年龄、性别无关表现：特点突然开始与终止，时间不一症状心悸、焦虑、眩晕、晕厥、心绞痛、心衰、休克等体征第一心音强度恒定心率绝对规则阵发性室上性心动过速(paroxysmalsupraventriculartachycardia,PSVT)ECG：1.心率150-250次/分，节律规则2.QRS形态与时限正常，发生室内差异传导或原有束支阻滞时形态异常3.P波为逆行性，常埋于QRS内或其终末部位，P与QRS关系恒定4.起始突然，常由早搏开始PSVT——AVNRTPSVT——AVRTPSVT——AVRT室性心律失常•室性期前收缩•室性心动过速–加速性心室自主心律–尖端扭转型室速•室扑与室颤室性期前收缩(prematureventricularbeats)ECG：1.提前发生的QRS0.12s，宽大畸形，继发ST-T改变2.配对间期恒定3.完全代偿间期室性期前收缩室性心动过速(ventriculartachycardia)ECG：1.3个或以上的室性期前收缩连续出现2.QRS波群形态畸形0.12s,继发ST-T改变3.心室率100-250次/分，心律规则或略不齐4.房室分离，心室激动逆传夺获心房5.心室夺获与室性融合波----确立VT诊断的最重要依据6.单型性室速、多型性室速、双向性室速室性心动过速•ECG：心室扑动与心室颤动ECG•VFL呈正弦波图形，150-300次/分•VF为波形、振幅与频率均及不规则，无法识别QRS、ST与T•心室颤动波振幅0.2mv时，预示存活机会微小临床表现：*意识丧失、抽搐、呼吸停顿甚至死亡。*检查心音消失、脉搏触不到、血压无法测到。心肌梗死心电图冠状动脉的解剖心肌缺血与T波改变心肌损伤与ST改变前间壁心梗•男，51岁•3小时•ECG:V1-V3ST段抬高广泛前壁心梗•a64-year-oldman1-hour•ECG:atrialfibrillation(incompleterightbundle-branchblock).STelevationupto7mminleadsV2toV6,NotchedQRSinV2/V3.NopathologicQwaves.侧壁心梗•a72-year-oldman•4-day•highlateralmyocardialinfarction.•ECG:QrinaVL,withsymmetricTwavesinaVL,I,V5/V6下壁心梗•a63-year-oldwoman•2hours.•ECG:STelevationinIII/aVF(II),STdepressioninI/aVLasmirrorimage.后壁心梗•a60-year-oldman•6-hour•ECG:enormousSTdepression(mirrorimageofposteriorSTelevation)especiallyinV2toV6.HighandbroadRinV3.•a74-year-oldman•5-day•ECG:tallandbroadRwaveinV1andV2(V3),slightSTdepressioninV1toV5,bothcorrespondingtomirrorimageofalterationsintheposteriorleads.See:QSinV7/V8,QrinV9右室心梗•a47-year-oldman.•12-hour•bizarreSTelevation(“monophasicdeformation”)inleadsII,aVF,andIII.Rightprecordialleads:smallqwaveandextensiveSTelevationinrightprecordialleadsV3RtoV6R.左主干闭塞心梗的心电图左主干病变•心电图特征性表现：（1）STaVR抬高STV1抬高（2）伴Ⅰ、Ⅱ、V4、V5、V6导联的ST段下移•敏感性高达80%~90%AMI伴左束支传导阻滞左束支传导阻滞•QRS0.12s•V1,V2主波向下•V5,V6主波向上伴顿挫•I,aVL,V5,V6无起始q波,QRS波增宽多相AMI伴左束支传导阻滞•1.I,aVL,V5,V6出现q波•2.V1-V4r波递增不良•3.Cabrera征：V3-V5S波出现顿挫•a70-year-oldwoman•with21-yearanteriormyocardialinfarction.•ECG:atrialflutterwithirregularconduction.Leftbundle-branchblock(LBBB).PathologicQwaves(inLBBB)inI/aVL,reducedRinV5,rsRsinV6.DecreasingRwavefromV2toV5.•a75-year-oldman•18-yearextensiveanteriormyocardialinfarction(MI).•ECG:sinusrhythm,leftbundle-branchblock.Pathologicnotchinginfiveprecordialleads(V2•toV6),indicateanteriorMI.CabrerasigninV2/V3(notchedSupstroke).谢谢!