心电图、心律失常课件.ppt

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1、ElectrocardiogramJialiZhouDept.CardiovascularMedicineRenminHospitalofWuhanUniversity心电图纸上的每个小方格，横格为0.04s，纵格为0.1mv。P波：在肢体导联中除avR为倒置外，余导联多为直立，或较低平P-R间期：自P波开始至QRS波群开始的时间。正常范围为0.12-0.20s,代表了房室传导时间QRS波群：时间在0.06-0.10s的狭窄范围内ST段：是自QRs波群终了的J点开始至T波开始的一段，ST段平行的压低或斜向下的压低不正常，轻度抬高可见于正常人T波：除在avR导联是例置外，余在R波高于0.5

2、mv时均应直立。(如在I，II导联应直立，avR中应倒置，胸前导联自V4-6均直立)Q-T间期：自QRS波开始至T波终了的间期,代表心室除极,复极时间的总和ArrhythmiaArrhythmia［教学目的、要求］1.了解心律失常分类2.掌握常见心律失常的心电图表现（窦性心律及窦性心律失常，期前收缩，异位心动过速，心房扑动与心房颤动，房室传导阻滞）［教学难点］常见心律失常的心电图表现ClassificationAbnormalorigin--sinusarrhythmia--ectopicrhythm:passivity—escapeprematurecontractiontachyca

3、rdiaflutterandfibrillationAbnormalconduction--physiologicalblock:--pathologicalblock:S-AB;A-VB;LBBB;RBBB--accessorypathway:pre-excitationsyndromeSINUSRHYTHMANDSINUSARRHYTHMIASSinusrhythmfeatures:(1)EveryPwaveisfollowingbyaQRScomplex;(2)PwaveisuprightinleadI,II,aVF,V4-V6,inverseinaVR;(3)P-Rinterv

4、al≥0.12sec;(4)DifferenceofP--Pinterval<0.12secinthesamelead(5)Normalrateis60-100beats/minSinusBradycardia:(1)Sinusrhythm(2)Heartrate<60bpm(R-RintervalorP-Pinterval>1.0sec)Factorsassociatedwithsinusbradycardia(1)PhysiologicLaborersandtrainedathletesEmotionalstatesleadingtosyncope(2)Pathologic-blo

5、ckerHypothyroidism（甲低）SinusTachycardia(1)Sinusrhythm,rate>100bpmTheR-Rinterval(ortheP-Pinterval)<0.60sec.(2)P-RandQ-Tintervalareshorterthanusual(3)ST-Tchanges.Factorsassociatedwithsinustachycardia(1)PhysiologicExerciseStrongemotionAnxietystates(2)PathologicFeverHemorrhage（出血）Anemia（贫血）Myocarditis

6、（心肌炎）Hyperthyroidism（甲亢）SinusarrhythmiaSinusrhythmDifferenceofP--Pinterval>0.12secinthesameleadSinusarrestThePwavemissedforashorttimePrematurecontractions1.PrematureVentricularContraction(1)PrematureQRScomplexisthewiderandthebizarre,DurationofQRS>0.12sec.TwaveindirectionisoppositetoQRScomplex.(2)

7、Ventricularcomplex(QRS)isnotprecededbyaprematureP'wave.(3)Completecompensatorypausebigeminytrigeminy2.AtrialPrematureContractions(1)TheprematureP'wavediffersincontourfromthenormalPwaveinthesamelead.(2)TheP'-Rinterval>0