首醫(yī)學生心電圖nd課件

1、首醫(yī)學生心電圖nd首醫(yī)學生心電圖nd右房肥大（RAE）P波高尖=0.25 mv （肢導），=0.20 mv（胸導）小兒 =0.20 mv (肢導），=0.15mv（胸導）II、III、aVF明顯P/PR0.11S, 峰距0.04s，嬰兒0.03s嬰幼兒0.09，兒童0.015mm.s倒置電壓0.1mv,時間0.04sP/PR 1.6左房肥大（LAE）P波時間延長、雙峰IIV1IIV1其他由于過勞、精神緊張、胃腸道疾病、膽道感染或植物神經(jīng)紊亂等所引起。出現(xiàn)提前的異常P波，形態(tài)與竇性P不同；常規(guī)心電圖檢查健康學齡兒童2.The frontal plane leads, however, show

2、voltage criteria for LVH and significant ST segment depression in leads with tall R waves.The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves.各類異常旁道參與的傳導LVH & PVCs: Precordial Leads其他藥物如奎尼丁、腎上腺素、銻劑中毒、氨茶堿、咖啡因、某些麻醉藥。觸發(fā)活動早期后除極

3、、晚期后除極起源于心房下部的房性早博LVH - Best seen in the frontal plane leadsLVH - Best seen in the frontal plane leads正常的心電傳導與心電圖形成5 or RI+SII2.左室容量負荷增加VSD、PDA、AR24小時動態(tài)心電圖1850健康兒童有室性早搏新生兒期及少年期(1315歲)最多見II、III、aVF呈巨大R波其他由于過勞、精神緊張、胃腸道疾病、膽道感染或植物神經(jīng)紊亂等首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件左房肥大的臨床意義先天性心臟病左心容量負荷增加VSD、PDA二尖瓣狹窄心肌病心彈、DCM房內(nèi)傳

4、導阻滯左房肥大的臨床意義先天性心臟病雙房肥大兼有LAE和RAE的特點P/PR 1.01.6雙房肥大兼有LAE和RAE的特點首醫(yī)學生心電圖nd課件房室傳導阻滯I、II、III度阻滯II、III、aVF呈巨大R波Right Ventricular Hypertrophy (RVH) & Right Atrial Enlargement (RAE)Right Axis Deviation & RAE (P Pulmonale): Leads I, II, IIIThe frontal plane leads, however, show voltage criteria for LVH and si

5、gnificant ST segment depression in leads with tall R waves.4A連續(xù)的成對早搏LVH with Strain常規(guī)心電圖檢查健康學齡兒童2.正常的心電傳導與心電圖形成心室: 20-40bpm占全部心律失常的377室性早搏的Lown分級觸發(fā)活動早期后除極、晚期后除極起源于心房下部的房性早博ASD、TOF、DORVT波與QRS主波方向相反；室內(nèi)阻滯右束支阻滯、左束支、分支阻滯LVH & PVCs: Precordial Leads陣發(fā)性心動過速室上性、室性左室肥大（LVH）左室高電壓表現(xiàn)RV52.5, RV5+SV13.5 or 4.0(M)

6、RavL1.2 RaVF2.0RI1.5 or RI+SII2.5mvQRS時間達0.100.11s, VATV50.05s心電軸左偏STT改變房室傳導阻滯I、II、III度阻滯左室肥大（LVH）左室高電LVH with StrainLVH with StrainLVH & PVCs: Precordial LeadsLVH & PVCs: Precordial LeadsLVH: Limb Lead CriteriaIn this example of LVH, the precordial leads dont meet the usual voltage criteria or exhi

7、bit significant ST segment abnormalities. The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves. The voltage criteria include 1) R in aVL 11 mm; 2) R in I + S in III 25mm; and 3) (RI+SIII) - (RIII+SI) 17mm (Lewis Index). LVH:

8、 Limb Lead CriteriaIn thiLVH: Limb Lead CriteriaIn this example of LVH, the precordial leads dont meet the usual voltage criteria or exhibit significant ST segment abnormalities. The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall

9、R waves. The voltage criteria include 1) R in aVL 11 mm; 2) R in I + S in III 25mm; and 3) (RI+SIII) - (RIII+SI) 17mm (Lewis Index). LVH: Limb Lead CriteriaIn thiLVH - Best seen in the frontal plane leadsLVH - Best seen in the frontal plane leadsLVH - Best seen in the frontalLVH: Strain pattern + Le

10、ft Atrial EnlargementLVH: Strain pattern + Left Atr首醫(yī)學生心電圖nd課件The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves.LVH with Strain20 mv (肢導），=0.LVH - Best seen in the frontal plane leadsLVH - Best seen in the frontal plane l

11、eads切跡少見多見其他藥物如奎尼丁、腎上腺素、銻劑中毒、氨茶堿、咖啡因、某些麻醉藥。竇房結(jié): 60-100bpmQT 間期360440 毫秒（0.LVH: Strain pattern + Left Atrial Enlargement其他由于過勞、精神緊張、胃腸道疾病、膽道感染或植物神經(jīng)紊亂等所引起。并行心律: 心肌內(nèi)存在一個周圍有傳入阻滯保護不受基礎(chǔ)心律干擾的自律點11s, VATV50.LVH & PVCs: Precordial Leads左室壓力負荷增加AS、CoAThe voltage criteria include 1) R in aVL 11 mm; 2) R in I +

12、 S in III 25mm; and 3) (RI+SIII) - (RIII+SI) 17mm (Lewis Index).Right Ventricular Hypertrophy (RVH) & Right Atrial Enlargement (RAE)Left AtriumP波為逆行性（II、III、aVF倒置，aVR直立）向量6090度），與QRS關(guān)系有3種LVH: Strain pattern + Left Atrial EnlargementThe frontal plane leads, however, show voltage criteria for LVH and

13、significant ST segment depression in leads with tall R waves.1偶發(fā)、單一形態(tài)1RV11.0 (1.5, RV1+SV51.2RavR0.5,R/S1QRS時間正常, VATV10.03s心電軸右偏，90度STT改變右室肥大（RVH）右室高電壓表現(xiàn)RVH with Right Axis DeviationNote the qR pattern in right precordial leads. This suggests right ventricular pressures greater than left ventricula

14、r pressures. The persistent S waves in lateral precordial leads and the RAD are other finding in RVH. RVH with Right Axis DeviationRAE & RVHRAE & RVHSevere RVHRVH features include the marked right axis deviation (+150 degrees), qR complex in lead V1, R:S ratio in V6 6.0 mV雙心室肥大大致正常心電圖，可有QRS增寬或STT改變首

15、醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件心律失常心電圖北京兒童醫(yī)院 杜忠東心律失常心電圖正常心臟的電系統(tǒng)Right VentricleRight AtriumLeft AtriumLeft VentricleSA NodeAV NodePurkinjeFibersBundle ofHis自律性應激性傳導性正常心臟的電系統(tǒng)Right VentricleRight A正常心臟及其電系統(tǒng)各部自律細胞頻率正常范圍竇房結(jié): 60-100bpm房室交界區(qū): 40-60bpm心室: 20-40bpm心房 心室 竇房 (SA) 結(jié)房室 (AV) 結(jié)正常心臟及其電系統(tǒng)各部自律細胞頻率正常范圍心房 心室 正常的

16、心電傳導與心電圖形成竇房結(jié)正常的心電傳導與心電圖形成竇房結(jié)正常的心電傳導與心電圖形成房室結(jié)正常的心電傳導與心電圖形成房室結(jié)希氏束正常的心電傳導與心電圖形成希氏束正常的心電傳導與心電圖形成正常的心電傳導與心電圖形成Right Ventricular Hypertrophy (RVH) & Right Atrial Enlargement (RAE)左室容量負荷增加VSD、PDA、ARRight Axis Deviation & RAE (P Pulmonale): Leads I, II, III室內(nèi)阻滯右束支阻滯、左束支、分支阻滯其他由于過勞、精神緊張、胃腸道疾病、膽道感染或植物神經(jīng)紊亂等所引

17、起。Right AtriumThe frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves.收縮期早搏QRS起點至T終末部的早搏，03相出現(xiàn)提前QRS波群，其前無異位P波；LVH & PVCs: Precordial Leads24小時動態(tài)心電圖1850健康兒童有室性早搏新生兒期及少年期(1315歲)最多見This suggests right ventricular pressures greater

18、 than left ventricular pressures.大致正常心電圖，可有QRS增寬或STT改變Right VentricleLVH: Limb Lead CriteriaIn this example of LVH, the precordial leads dont meet the usual voltage criteria or exhibit significant ST segment abnormalities.Right AtriumLVH: Strain pattern + Left Atrial Enlargement電解質(zhì)紊亂如低鉀和低鎂和缺氧等正常的心電傳

19、導與心電圖形成正常的心電傳導與心電圖形成左束支左后分支左前分支右束支正常的心電傳導與心電圖形成正常的心電傳導與心電圖形成左束支左正常的心電傳導與心電圖形成浦肯野纖維正常的心電傳導與心電圖形成浦肯野纖維正常的心電傳導與心電圖形成正常的心電傳導與心電圖形成正常的心電傳導與心電圖形成正常的心電傳導與心電圖形成正常的竇房結(jié)節(jié)律心房率60100 bpm PR 間期120200 毫秒（0.120.20 秒） QRS 間期60100 毫秒（0.060.10 秒） QT 間期360440 毫秒（0.360.44 秒）正常的竇房結(jié)節(jié)律心房率60100 bpm心律失常分類沖動發(fā)源異常沖動自竇房結(jié)發(fā)出竇性心動過速竇

20、性心動過緩竇性心律不齊竇停搏心律失常分類沖動發(fā)源異常心律失常分類沖動自異位節(jié)奏點發(fā)出被動性異位心律房性逸搏和房性逸搏心律、結(jié)性逸搏和結(jié)性逸搏心律、室性逸搏和室性逸搏心律自動性異位心律期前收縮竇性、房性、結(jié)性、室性陣發(fā)性心動過速室上性、室性非陣發(fā)性心動過速房性、結(jié)性、室性撲動心房、心室顫動心房、心室心律失常分類沖動自異位節(jié)奏點發(fā)出心律失常分類沖動傳導異常干擾及干擾性房室分離心臟傳導異常竇房阻滯房內(nèi)及房間阻滯房室傳導阻滯I、II、III度阻滯室內(nèi)阻滯右束支阻滯、左束支、分支阻滯各類異常旁道參與的傳導沖動發(fā)源和傳導異常共存并行心律，異位心律伴外出阻滯人工心臟起搏參與的心律失常心律失常分類沖動傳導異常

21、快速心律失常發(fā)生機制(Tachy)自律性增強（Automaticity）折返（Reentery)觸發(fā)機制（Triggered activity)早期后除極晚期后除極快速心律失常發(fā)生機制(Tachy)自律性增強（Automat折返條件 環(huán)路功能性或解剖性，如雙徑路、旁道單向傳導阻滯部分傳導延遲快速心律失常發(fā)生機制 折返條件 快速心律失常發(fā)生機制 期前收縮、早搏占全部心律失常的377發(fā)生率常規(guī)心電圖檢查健康學齡兒童2.25.524小時動態(tài)心電圖1850健康兒童有室性早搏新生兒期及少年期(1315歲)最多見分類竇性罕見，功能性多房性室性最常見交界性最少見期前收縮、早搏占全部心律失常的377SVE(P

22、AC)VE(PVC)期前收縮SVEVE期前收縮首醫(yī)學生心電圖nd課件室內(nèi)阻滯右束支阻滯、左束支、分支阻滯P波為逆行性（II、III、aVF倒置，aVR直立）向量6090度），與QRS關(guān)系有3種Right Ventricle舒張期早搏T終末至QRS起點，4相分級 心電圖特點QT 間期360440 毫秒（0.24小時動態(tài)心電圖1850健康兒童有室性早搏新生兒期及少年期(1315歲)最多見LVH: Strain pattern + Left Atrial EnlargementQRS形態(tài)為室上性，或未下傳；LVH: Limb Lead CriteriaIn this example of LVH,

23、the precordial leads dont meet the usual voltage criteria or exhibit significant ST segment abnormalities.正常的心電傳導與心電圖形成占全部心律失常的377LVH: Strain pattern + Left Atrial EnlargementII、III、aVF明顯竇房結(jié): 60-100bpmP在QRS之前，PR0.12s;QRS形態(tài)為室上性，或未下傳；代償間歇可不完整房性期前收縮出現(xiàn)提前的異常P波，形態(tài)與竇性P不同；首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)

24、學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件ASD、TOF、DORV0無室性早搏左室壓力負荷增加AS、CoA室內(nèi)阻滯右束支阻滯、左束支、分支阻滯ASD、TOF、DORVQT 間期360440 毫秒（0.II、III、aVF明顯常規(guī)心電圖檢查健康學齡兒童2.觸發(fā)活動早期后除極、晚期后除極非陣發(fā)性心動過速房性、結(jié)性、室性環(huán)路功能性或解剖性，如雙徑路、旁道25 mv （肢導），=0.P在QRS之后，RP0.The frontal plane leads, however, show voltage criteria

25、for LVH and significant ST segment depression in leads with tall R waves.正常的心電傳導與心電圖形成占全部心律失常的377左室容量負荷增加VSD、PDA、ARLVH: Strain pattern + Left Atrial EnlargementASD、TOF、DORV房性早搏房性早搏起源于心房下部的房性早博起源于心房下部的房性早博起源于心房右房上部的房性早博起源于心房右房上部的房性早博起源于心房下部的房性早博起源于心房下部的房性早博房性二聯(lián)律房性二聯(lián)律有病理意義的房性早搏頻發(fā)持續(xù)存在的房性早搏成對多形性、多源性二、三聯(lián)

26、律運動后出現(xiàn)的房早增多洋地黃應用過程中出現(xiàn)的房早有病理意義的房性早搏頻發(fā)持續(xù)存在的房性早搏首醫(yī)學生心電圖nd課件房室交結(jié)性早搏出現(xiàn)提前QRS波群，形態(tài)與竇性相同或因室內(nèi)差異傳導發(fā)生畸形；P波為逆行性（II、III、aVF倒置，aVR直立）向量6090度），與QRS關(guān)系有3種P在QRS之前，PR0.12s(成人),0.10s(小兒)；P在QRS之后，RP0.12s，兒童0.10s，嬰兒0.08s；T波與QRS主波方向相反；代償間歇完整室性早搏出現(xiàn)提前QRS波群，其前無異位P波；首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件首醫(yī)學生心電圖nd課件室性期前收縮發(fā)生機制自律性增強希氏浦肯野系統(tǒng)、異位觸發(fā)活動早期后除極、晚期后除極折返浦肯野系統(tǒng)、心肌組織、束支和希氏束并行心律: 心肌內(nèi)存在一個周圍有傳入阻滯保護不受基