(医学)见习医师心电图教学 基础

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1、Introduction:BasicoftheEKGMackeyMemorialHospital心臟內科楊翔惟Normal12leadcompleteEKGV7~V9??ECGreadingRateRhythm含interval(PR/QRS/QTc)AxisPwavePRsegmentandintervalQRSmorphology,voltage,anddurationST-TsegmentQTcintervalUwaveNormalRangesinMilliseconds:PRInterval120–200msQRSCom

2、plex60–100msQTInterval360–440msNormalECGSTsegmentTPsegmentisusedasthereferencebaselineforSTelevationordepression>>>IfHRisrapid,PRsegmentmaybeused(exceptatrialTwavepresent)TwaveAlwaysuprightinleadI,IIinvertedinAVRNormal:>0.5mm,<6mminlimbleadNormal:asymmetricalnormalabn

3、ormalInwomenTwaveuprightinV5,V6InvertinV1(50%),V2(10%),V3(rare)NormalECGQTintervalHR45~115==>0.46~0.30sec(normallimit)QTc=QT/√RRnormalmen0.39secwomen0.41sec>0.44secabnormalECGreadingRateRhythmAxisPwavePRsegmentandintervalQRSmorphology,voltage,anddurationST-Tsegment

4、QTcintervalUwaveCalculatetheratePacemakerrate:Normalpacemaker(SAnode)---60-100/minJunctionaltissue-------------------40-60/minLowerbundleofHis--------------40-50/minVentricularpacemaker-------------15-40/min(idioventricularrhythm)HR=300/RR間的大格數1500/RR間的小格數10秒的totalhea

5、rtbeats*6ReadingEKGSquaresIntervalsandTimingEachsquare=40ms(0.04秒)Eachinterval=200ms(0.2秒)Quits這張心跳幾下??ECGreadingRateRhythm(含interval(PR/QRS/QTc))AxisPwavePRsegmentandintervalQRSmorphology,voltage,anddurationST-TsegmentQTcintervalUwave分析心律時，要謹記四個問題這是P波嗎？QRS是寬的還是窄的？心律

6、是否規則P波跟後面的QRS是不是有關係？AVblocksAVdissociationleadII的P波一定要向上才算NormalSinusRhythm(NSR)heartrate(HR)在60~99beats/min而且心律需規則SinusbradycardiaHR<60但心律規則SinustachycardiaHR>99但心律規則。對一般成年人來說，如果躺著心跳仍大於160beats/min，那麼通常就不是來自sinus的心律了。Sinusarrhythmia心律不規則，但還是可以看到P波PPintervalvariation>

7、120msSinusRhythmSinusarrhythmiaSupraventricularArrhythmias心室上的心律不整，其來源來自AVnodal以上的地點大部分是narrowQRScomplexAtrialFibrillation(Af,AFib)MultipleAtrialTachycardia(MAT)AtrialTachycardia(AT)AtrialFlutter(AFlutter,AF)PSVT(ParoxysmalSupra-VentricularTachycardia)PrematureBeatsPr

8、ematureAtrialContractions(PAC)：伴隨著窄的QRSPrematureJunctionalContractions(PJC)：伴隨著窄的QRSPrematureVentricularContractions(PVC)：伴隨