診斷學Electrocardiography(五年制)培訓課件

診斷學Electrocardiography(五年制)BasicKnowledgeECGwaveformsandintervals2診斷學Electrocardiography(五年制)BasicKnowledgeElectrocardiographicLeadSystem3診斷學Electrocardiography(五年制)ElectricalAxis4診斷學Electrocardiography(五年制)TheQRSmeanAxisNormalrightleftaxisdeviationaxisdeviation5診斷學Electrocardiography(五年制)MeasurementandNormalECG6診斷學Electrocardiography(五年制)MeasurementandNormalECG7診斷學Electrocardiography(五年制)WavesofQRSComplex8診斷學Electrocardiography(五年制)PWaveinNormalECGPwaveduration：＜0.12s(120ms)Pwaveamplitude：＜0.25mV（limb），＜0.20mV（chest）PRinterval：0.12-0.20s9診斷學Electrocardiography(五年制)QRSComplexinNormalECGQRScomplexduration：＜0.11s(0.06-0.10s)10診斷學Electrocardiography(五年制)QRSComplexinNormalECGQRSpatterninleadsV1,V2：rS，noq；

r＜1.0mV，r/S＜1；QRSpatterninleadsV5,V6：qR、qRs、Rs、R；R＜2.5mV,R/s＞1;11診斷學Electrocardiography(五年制)QRSComplexinNormalECGQRSpatterninlimbleads：R(I,II),S(aVR)andr(aVR)＜0.5mV;QRSamplitudeinlimbleads：R(I)＜1.5mV,R(aVL)＜1.2mV,R(aVF)＜2.0mV12診斷學Electrocardiography(五年制)QRSComplexinNormalECGQRSamplitude：limbs:QRS＞0.5mV,chest:QRS＞0.8mV；Q:＜0.03s,＜1/4R13診斷學Electrocardiography(五年制)STSegment,TandUWave

inNormalECGSTsegment:①ST↓＜0.05mV;②ST↑0.2mV(V2,V3);ST↑＜0.1mV(V4～V6,limbleads)Q-Tinterval:0.32-0.44s;QTc=QT/√RR:

≤0.45s(M),0.46s(F)14診斷學Electrocardiography(五年制)

AtrialEnlargementand

VentricularHypertrophy

15診斷學Electrocardiography(五年制)16診斷學Electrocardiography(五年制)RightAtrialEnlargementPwaveinleadV1orV2≥

1.5mmPwaveinleadII,III,andaVF≥2.5mmPwaveispeaked(P"pulmonale")DurationofPwaveisnormal17診斷學Electrocardiography(五年制)18診斷學Electrocardiography(五年制)19診斷學Electrocardiography(五年制)20診斷學Electrocardiography(五年制)LeftAtrialEnlargementLeadIIDurationofPwave≥

0.12sec.Pwavebecomebifid(P"mitrale")Thedistanceoftwopeak≥

0.04sec.LeadV1Pwavebecomebiphasicterminalnegativewave＞1mmdeepand＞40mswide,Ptfv1

≥︱0.04︱mm·sec21診斷學Electrocardiography(五年制)22診斷學Electrocardiography(五年制)23診斷學Electrocardiography(五年制)24診斷學Electrocardiography(五年制)LeftVentricularHypertrophyA.IncreasedvoltageRv5orRv6>2.5mV;RV5+SV1>3.5mV(female),4.0mV(male);

RI>1.5mV;

RaVL>1.2mV;RaVF>2.0mV;RI+SIII>2.5mV;B.Leftaxisdeviation

C.STdepressionandTinversioninV5-6.25診斷學Electrocardiography(五年制)26診斷學Electrocardiography(五年制)27診斷學Electrocardiography(五年制)28診斷學Electrocardiography(五年制)29診斷學Electrocardiography(五年制)RightVentricularHypertrophyA.Increasedvoltage(adultsover30)R/SratioinV1>1.0;R/SratioinV5orV6≤1.0;R/qorR/SratioinaVR

≥1;RV1+SV5>1.05mV(severe>1.2mV);RaVR>0.5mV;B.Rightaxisdeviation≥+900(severe>+1100).C.STdepressionandTinversionV1-2.30診斷學Electrocardiography(五年制)31診斷學Electrocardiography(五年制)32診斷學Electrocardiography(五年制)33診斷學Electrocardiography(五年制)BiventricularHypertrophyA.

NormalECG.B.

Oneventricularhypertrophy.C.

BiventricularHypertrophy.34診斷學Electrocardiography(五年制)

MyocardialInfarction35診斷學Electrocardiography(五年制)MyocardialInfarction

(1)Basicchanges“Hyperacute”TWavesorTwaveinversion.STElevations

PathologicQWaves36診斷學Electrocardiography(五年制)TWaveChanges(MyocardialIschemia)37診斷學Electrocardiography(五年制)STSegmentChanges(MyocardialInjury)38診斷學Electrocardiography(五年制)TheAbnormalQwaveandQSComplex(MyocardialInfarction)39診斷學Electrocardiography(五年制)ECGChangesinMyocardialInfarction40診斷學Electrocardiography(五年制)41診斷學Electrocardiography(五年制)MyocardialInfarction

(1)Basicchanges“Hyperacute”TWavesorTwaveinversion.TallpeakedTwaves,oftenappearastheearliestECGsignofacuteMI,thenTwavedownward.

STElevations.TheSTsegmentelevatedintwoormoreleadsandmaybestraightenedandfusewiththeTwave(mono-phasiccurve)

PathologicQWaves.thesuddendevelopedQwavemayindicateanacuteMI.42診斷學Electrocardiography(五年制)(2)ProgressiveECGchanges43診斷學Electrocardiography(五年制)ProgressiveECGchanges44診斷學Electrocardiography(五年制)

(3)LocalizationofMyocardialInfarction

LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1

V3AnteroseptalV3

V5AnteriorI,aVL,V5

V6LateralV1

V5ExtensiveAnteriorII,III,aVFInferior

V7

V9

posterior

V3R

V4Rrightventricle45診斷學Electrocardiography(五年制)LocalizationofLimbLeads46診斷學Electrocardiography(五年制)

(3)LocalizationofMyocardialInfarction

LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1

V3AnteroseptalV3

V5AnteriorI,aVL,V5

V6LateralV1

V5ExtensiveAnteriorII,III,aVFInferior

V7

V9

posterior

V3R

V4Rrightventricle47診斷學Electrocardiography(五年制)Localizationof

ChestLeads48診斷學Electrocardiography(五年制)

(3)LocalizationofMyocardialInfarction

LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1

V3AnteroseptalV3

V5AnteriorI,aVL,V5

V6LateralV1

V5ExtensiveAnteriorII,III,aVFInferior

V7

V9

posterior

V3R

V4Rrightventricle49診斷學Electrocardiography(五年制)心電圖導聯(lián)與心室部位

及冠狀動脈供血區(qū)域的關(guān)系導聯(lián)心室部位供血的冠脈II、III、aVF下壁右冠或回旋支I、aVL、V5、V6側(cè)壁對角支或回旋支V1～V3前間壁左前降支V3～V5前壁左前降支V1～V5廣泛前壁左前降支