心電圖易上手

1、心電圖易上手心電圖易上手Seminor ITo Start outSeminor ITo Start outWhats ECG?心臟電活動的三維同步立體攝影Whats ECG?心臟電活動的三維同步立體攝影III AVF（+90） IIIAVLAVR-90180（0）III AVF（+90） IIIAV心電圖易上手When to ECG?要訣：惠而不費立等可取When to ECG?要訣：惠而不費心臟本身病變節(jié)律異常起搏點異常傳導異常血管異常冠脈血壓心肌異常心包異常心臟本身病變節(jié)律異常心臟以外病變肺腦低體溫電解質鉀鈣藥物代謝Call death心臟以外病變肺How to ECG？要訣：無它，唯手

2、熟爾。How to ECG？要訣：無它，唯手熟爾。心電圖易上手心電圖易上手幾種危險的心電圖趕緊叫老大！要訣：幾種危險的心電圖趕緊叫老大！要訣：心電圖易上手心電圖易上手心電圖易上手啥叫易損期？啥叫易損期？心電圖易上手心電圖易上手心電圖易上手心電圖易上手心電圖易上手心電圖易上手實習醫(yī)師應掌握的ECG實習醫(yī)師應掌握的ECG惡性心律失常：竇停、Vf、VT、VF、IIIAVB常見心律失常：PAC，PVC，Af，AVB，WPW，（BBB，PSVT，）心肌缺血：STEMI（演變、定位）電解質紊亂：高鉀/低鉀藥物：洋地黃、長QT、其它：心包炎/積液、肺栓塞惡性心律失常：竇停、Vf、VT、VF、IIIAVBLe

3、ts do it!Lets do it!#101:RBBB型VT，不完全AV脫落，室性融合波#102:RBBB型VT（Brugada標準1）#103:RBBB型VT，LAD#104:RVOT-切口性RBBB型VT（Brugada標準1）#106:RVOT-VT(LBBB,RAD），2:1VA阻滯#107:左側室間隔VT（RBBB-LAD），2:1VA阻滯#108:R on T，尖端扭轉VT（由于普魯卡因酰胺）#113:II度2型AVB，不同的AV下傳比例#114:III度AVB，交界性逸搏，LVH伴勞損（缺血）#101:RBBB型VT，不完全AV脫落，室性融合波How to read？How

4、to read？6 Aspects心率心律電軸轉位缺血和梗死肥厚抽絲剝繭忙而不亂要 訣6 Aspects心率抽絲剝繭要 訣Seminar II：ArrhythmiaThe ones which are most interesting Seminar II：ArrhythmiaThe ones 快 速 心 率300150100756050HR10快 速 心 率3001501007560心電圖易上手心電圖易上手心電圖易上手節(jié)律的基本概念如何判斷竇律： P波 : I, II, aVF, aVR, 0.12, 100 msec, the diagnosis of VT can be made. If

5、 the longest RS interval is 100 msec, the presence or absence of AV dissociation is assessed. If AV dissociation is seen, the diagnosis of VT is made. If the RS interval is 50:1) 18,28.- Findings in lead V6 An rS complex (R wave smaller than S wave) in lead V6 favors VT (likelihood ratio 50:1) 18. I

6、n contrast, an Rs complex (R wave larger than S wave) in lead V6 favors SVT.V1 positive (RBBB) pattern IV1 negative (LBBB) pattern In the patient with a WCT and negative QRS polarity in lead V1, the following associations have been made - Findings in lead V1 or V2 A broad initial R wave of 40 msec d

7、uration or longer in lead V1 or V2 favors VT. In contrast, the absence of an initial R wave or a small initial R wave of less than 40 msec in lead V1 or V2 favors SVT.Two other findings that favor VT are a slurred or notched downstroke of the S wave in lead V1 or V2, and a duration from the onset of

8、 the QRS complex to the nadir of the QS or S wave of 60 msec in lead V1 or V2. In contrast, a swift, smooth downstroke of the S wave in lead V1 or V2 with a duration of 50:1) - Findings in lead V6 The presence of any Q or QS wave in lead V6 favors VT (likelihood ratio 50:1) 18. In contrast, the abse

9、nce of a Q wave in lead V6 favors SVT.V1 negative (LBBB) pattern ISeminor III：心肌缺血和梗死The ones which are most usefulSeminor III：心肌缺血和梗死The ones wh缺血T波改變：正常：III和V1可倒置超急性期T波高尖：局部高鉀冠狀T波ST段壓低：缺血T波改變：損傷ST抬高/ST壓低：原理：從動作電位講起損傷ST抬高/ST壓低：透壁梗死Q波生理性Q波：I、avL、V5、V6病理性Q波：寬0.04，深1/3R波透壁梗死Q波生理性Q波：I、avL、V5、V6心肌梗死的演變超

10、急性期：T波高尖急性期：ST抬高T波倒置Q波形成：恢復期：ST回到基線，T波繼續(xù)倒置室壁瘤心肌梗死的演變超急性期：T波高尖STEMI診斷標準啥叫“相鄰”？STEMI診斷標準啥叫“相鄰”？III AVF（+90） IIIAVLAVR-90180（0）III AVF（+90） IIIAV心電圖易上手心電圖易上手心電圖易上手心電圖易上手心電圖易上手心電圖易上手幾個要注意的問題鏡向變化：注意后壁LBBB：R波進展不良：鑒別：膈肌附近病變、肥厚性心肌病、腦血管意外幾個要注意的問題鏡向變化：注意后壁Lets do it！Lets do it！#19：AMI（前壁），向側壁延展，心尖受累#20：廣泛前壁AMI#21：正常心室率的Af，AMI（ant）#22：AMI（ant），心尖和側壁受累 #23：