2019年《心电图基础》ppt课件.ppt
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1、心电图阅读的基础与方法,心率 节律 间期 电轴 肥大 梗死 临床相关性,1912年,Cambridge Instrument,心电图的地位与作用,心电图阅读的基本问题,正常心电图 ? 异常心电图?,正常心电图,异常心电图,Basic Competency in Electrocardiography,(Modified from: ACC/AHA Clinical Competence Statement, JACC 2001;38:2091),NORMAL TRACING Normal ECG TECHNICAL PROBLEM Lead misplaced Artifact SINUS R
2、HYTHMS/ARRHYTHMIAS Sinus rhythm (50-90 bpm) Sinus tachycardia (90 bpm) Sinus bradycardia (50 bpm) Sinus Arrhythmia Sinus arrest or pause Sino-atrial exit block,OTHER SV ARRHYTHMIAS PACs (nonconducted) PACs (conducted normally) PACs (conducted with aberration) Ectopic atrial rhythm or tachycardia (un
3、ifocal) Multifocal atrial rhythm or tachycardia Atrial fibrillation Atrial flutter Junctional prematures Junctional escapes or rhythms Accelerated Junctional rhythms Junctional tachycardia Paroxysmal supraventricular tachycardia,VENTRICULAR ARRHYTHMIAS PVCs Ventricular escapes or rhythm Accelerated
4、ventricular rhythm Ventricular tachycardia (uniform) Ventricular tachycardia (polymorphous or torsades) Ventricular fibrillation,AV CONDUCTION 1st degree AV block Type I 2nd degree AV block (Wenckebach) Type II 2nd degree AV block (Mobitz) AV block, advanced (high grade) 3rd degree AV block (junctio
5、nal escape rhythm) 3rd degree AV block (ventricular escape rhythm) AV dissociation (default) AV dissociation (usurpation) AV dissociation (AV block),INTRAVENTRICULAR CONDUCTION Complete LBBB, fixed or intermittent Incomplete LBBB Complete RBBB, fixed or intermittent Incomplete RBBB Left anterior fas
6、cicular block (LAFB) Left posterior fascicular block (LPFB) Nonspecific IVCD WPW preexcitation pattern,QRS AXIS AND VOLTAGE Right axis deviation (+90 to +180) Left axis deviation (-30 to -90) Bizarre axis (-90 to -180) Indeterminate axis Low voltage frontal plane (0.5 mV) Low voltage precordial (1.0
7、 mV),HYPERTROPHY/ENLARGEMENTS Left atrial enlargement Right atrial enlargement Left ventricular hypertrophy Right ventricular hypertrophy,ST-T, AND U ABNORMALITIES Early repolarization (normal variant) Nonspecific ST-T abnormalities ST elevation (transmural injury) ST elevation (pericarditis pattern
8、) Symmetrical T wave inversion Hyperacute T waves Prominent upright U waves U wave inversion Prolonged QT interval,MI PATTERNS (acute, recent, old) Interior MI Inferoposterior MI Inferoposterolateral MI True posterior MI Anteroseptal MI Anterior MI Anterolateral MI High lateral MI Non Q-wave MI Righ
9、t ventricular MI,CLINICAL DISORDERS Chronic pulmonary disease pattern Suggests hypokalemia Suggests hyperkalemia Suggests hypocalcemia Suggests hypercalcemia Suggests digoxin effect Suggests digoxin toxicity Suggests CNS disease,PACEMAKER ECG Atrial-paced rhythm Ventricular paced rhythm AV sequentia
10、l paced rhythm Failure to capture (atrial or ventricular) Failure to inhibit (atrial or ventricular) Failure to pace (atrial or ventricular),The ectopic atrial rate is 150 bpm. Some of the ectopic P waves are easily seen and indicated by the arrows. Other P waves are burried in the T waves and not s
11、o easily identified. Atrial tachycardia with AV block is often a sign of digitalis intoxication. 3:2 and 2:1 AV block is seen in this example.,心率 节律 间期 电轴 肥大 梗死 临床相关性,心率 节律 间期 电轴 肥大 梗死 临床相关性,心率 节律 间期 电轴 肥大 梗死 临床相关性,心电图讨论,记住,心率 节律 间期 电轴 肥大 梗死 临床相关性,心率 节律 间期 电轴 肥大 梗死 临床相关性,心率 节律 间期 电轴 肥大 梗死 临床相关性,心率 节
12、律 间期 电轴 肥大 梗死 临床相关性,心率 节律 间期 电轴 肥大 梗死 临床相关性,图中箭头所指的是什么?,这是什么图型?,心率 节律 间期 电轴 肥大 梗死 临床相关性,这是什么图型?,心率 节律 间期 电轴 肥大 梗死 临床相关性,问题在哪里?,问题在哪里?,请给出诊断,心率 节律 间期 电轴 肥大 梗死 临床相关性,请给出诊断,心率 节律 间期 电轴 肥大 梗死 临床相关性,这是什么图形?,心率 节律 间期 电轴 肥大 梗死 临床相关性,这是什么图形?,心电图诊断?,心电图诊断?,心率 节律 间期 电轴 肥大 梗死 临床相关性,心电图诊断?,心率 节律 间期 电轴 肥大 梗死 临床相
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