心電圖講座(下)課件

1、異常心電圖 心律失常 心肌梗死室上性心律失常房性早搏交界性早搏房顫房撲異位房速和節(jié)律多源性房速陣發(fā)性室上速交界區(qū)節(jié)律和心動過速1、房 早不下傳差異傳導正常傳導左束支不應期右束支不應期2、交界性早搏Atrial fibrillation is the result of multiple wavelets of depolarisation (shown by arrows) moving around the atria chaotically, rarely completing a re-entrant circuit3、房顫 (Af)Af 并III度AVBAtrial flutter i

2、s usually the result of a single re-entrant circuit in the right atrium (top); atrial flutter showing obvious flutter waves (bottom) 4、房撲(AF):5、房性心動過速Atrial tachycardia with 2:1 block in patient with digoxin toxicityMultifocal atrial tachycardia7、陣發(fā)性室上速(PSVT)An atrioventricular nodal re-entrant tach

3、ycardiaTermination of atrioventricular nodal reentrant tachycardiaMechanisms for orthodromic (left) and antidromic (right) atrioventricular re-entrant tachycardia8、交界區(qū)心律和心動多速交界區(qū)逸搏交界區(qū)逸搏心律加速性交界區(qū)心律非陣發(fā)性交界性心動過速室性心律失常室早差傳與室早室速加速性室性自主心律室性逸搏心律室性并行心律1、室性早搏1、室性早搏寬大畸形的原因QRS寬 心肌組織傳導慢于正常傳導系統(tǒng)QRS波很高很深 室早起源于一側(cè)心室，因此

4、該心室除極先于 另一側(cè)心室，沒有來自于對側(cè)的相反的除極2. 差傳與室早的鑒別有無P波；代償間歇是否完全；Long-Short Rule (Ashman Phenomenon)QRS形態(tài)分析提早出現(xiàn)的時間In the above ECG the wide premature QRS is a PVC because of the 0.06s delay from onset of the QRS to the nadir of the S wave (approximately 0.08s). 3、室速4、加速性室性自主心律5、室性逸搏心律6、室性并行心律心肌梗死R波Q波梗死定位前間壁 V1,

5、V2, (V3)前壁 (V2), V3, V4,(V5)廣泛前壁 V1V6, (I, aVL)側(cè)壁 V5, V6, I, aVL前側(cè)壁 V4, V5, V6高側(cè)壁 I, aVL下壁 II, III, aVF后壁 V7, V8, V9右室 V3R, V4R, V5R下壁心梗 陳舊下壁心梗急性下后壁心梗 右室心梗. 右胸導聯(lián)尤其是V4R ST抬高 1mm前間壁心梗高側(cè)壁心梗Non-Q Wave MI心梗時ST-T動態(tài)變化，而未形成病理性Q波 (患者有典型胸痛癥狀和/或心肌特異性酶學升高)雖然臨床希望通過出現(xiàn)特異ST-T改變的導聯(lián)來定位NQMI的部位,但實際上這僅適用于ST段抬高型者Non-Q Wa

6、ve MI動態(tài)ST-T改變可能包括以下形態(tài): 只有ST段下移(常見)只有ST段弓背向上或平直抬高 (不常見) 僅有對稱性T波倒置(常見)以上變化兼而有之Non-Q Wave MIExample: Anterolateral ST-T wave changes實戰(zhàn)演習II度I型AVBRAHAF with slowed ventricular response2nd degree AV block type II (Mobitz)LVH with strainBigeminy of VPVTExtensive anterior myocardial infarctionWPW并AfLVH，LAH，

7、I AVB，RBBBAF, RBBB預激綜合征非陣發(fā)性交界性心動過速，RBBB, VPIII-AVB, ventricular escape rhythm Accelerated ventricular rhythmJunctional rhythmAcute anteroseptal Q wave infarctionSB, AP, RBBBSinus arrest, junctional escapeSinus arrhythmia, AP, LAHB, AMI(anterolateral)OMI(inferior), LAH, RBBBIII AVB, Junctional Escape Rhythm, VPI AVB, OMI(inferior), LBBB, LAHSinus rhythm with 1st degree AV block; occasional PVCAT(2:1)I AVB, RBBB, Sinus pause,LAHB(rate-depe