《心电图基础》ppt课件

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1、心电图阅读的基础与方法①心率②节律③间期④电轴⑤肥大⑥梗死⑦临床相关性1912年,CambridgeInstrument心电图的地位与作用病史体检辅助检查三大常规、肝肾功能、X线、超声、心电图1、识别各种心律失常（最有价值）2、辅助诊断心房、心室肥大3、反映心肌缺血、心肌梗死4、心电监护5、了解药物的疗效及对心肌的影响6、辅助诊断电解质代谢紊乱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BasicCompetencyinElectrocardiography(Modifiedfrom:ACC/

2、AHAClinicalCompetenceStatement,JACC2001;38:2091)NORMALTRACINGNormalECGTECHNICALPROBLEMLeadmisplacedArtifactSINUSRHYTHMS/ARRHYTHMIASSinusrhythm(50-90bpm)Sinustachycardia(>90bpm)Sinusbradycardia(<50bpm)SinusArrhythmiaSinusarrestorpauseSino-atrialexitblockOTHERS

3、VARRHYTHMIASPAC's(nonconducted)PAC's(conductednormally)PAC's(conductedwithaberration)Ectopicatrialrhythmortachycardia(unifocal)MultifocalatrialrhythmortachycardiaAtrialfibrillationAtrialflutterJunctionalprematuresJunctionalescapesorrhythmsAcceleratedJunctiona

4、lrhythmsJunctionaltachycardiaParoxysmalsupraventriculartachycardiaVENTRICULARARRHYTHMIASPVC'sVentricularescapesorrhythmAcceleratedventricularrhythmVentriculartachycardia(uniform)Ventriculartachycardia(polymorphousortorsades)VentricularfibrillationAVCONDUCTION

5、1stdegreeAVblockTypeI2nddegreeAVblock(Wenckebach)TypeII2nddegreeAVblock(Mobitz)AVblock,advanced(highgrade)3rddegreeAVblock(junctionalescaperhythm)3rddegreeAVblock(ventricularescaperhythm)AVdissociation(default)AVdissociation(usurpation)AVdissociation(AVblock)

6、INTRAVENTRICULARCONDUCTIONCompleteLBBB,fixedorintermittentIncompleteLBBBCompleteRBBB,fixedorintermittentIncompleteRBBBLeftanteriorfascicularblock(LAFB)Leftposteriorfascicularblock(LPFB)NonspecificIVCDWPWpreexcitationpatternQRSAXISANDVOLTAGERightaxisdeviation(

7、+90to+180)Leftaxisdeviation(-30to-90)Bizarreaxis(-90to-180)IndeterminateaxisLowvoltagefrontalplane(<0.5mV)Lowvoltageprecordial(<1.0mV)HYPERTROPHY/ENLARGEMENTSLeftatrialenlargementRightatrialenlargementLeftventricularhypertrophyRightventricularhypertrophyST-T,

8、ANDUABNORMALITIESEarlyrepolarization(normalvariant)NonspecificST-TabnormalitiesSTelevation(transmuralinjury)STelevation(pericarditispattern)SymmetricalTwaveinversionHyperacuteTwavesPromin