心电图易上手.ppt

1、心电图易上手Seminor I To Start outWhats ECG?心脏电活动的三维同步立体摄影心脏电活动的三维同步立体摄影III AVFIII AVF（+90+90）II IIIAVLAVLAVRAVR-90180180（0 0）When to ECG?要诀：要诀：惠而不费惠而不费立等可取立等可取心脏本身病变 节律异常 起搏点异常 传导异常 血管异常 冠脉 血压 心肌异常 心包异常心脏以外病变 肺 脑 低体温 电解质 钾 钙 药物 代谢 Call deathHow to ECG？要诀：要诀：无它，唯手熟尔。无它，唯手熟尔。几种危险的心电图几种危险的心电图要诀：要诀：啥叫易损期？啥叫易

2、损期？实习医师应掌握的实习医师应掌握的ECG 恶性心律失常：窦停、Vf、VT、VF、IIIAVB 常见心律失常：PAC，PVC，Af，AVB，WPW，（BBB，PSVT，）心肌缺血：STEMI（演变、定位）电解质紊乱：高钾/低钾 药物：洋地黄、长QT、其它：心包炎/积液、肺栓塞Lets do it!#101:RBBB型VT，不完全AV脱落，室性融合波#102:RBBB型VT（Brugada标准1）#103:RBBB型VT，LAD#104:RVOT-切口性RBBB型VT（Brugada标准1）#106:RVOT-VT(LBBB,RAD），2:1VA阻滞#107:左侧室间隔VT（RBBB-LAD）

3、，2:1VA阻滞#108:R on T，尖端扭转VT（由于普鲁卡因酰胺）#113:II度2型AVB，不同的AV下传比例#114:III度AVB，交界性逸搏，LVH伴劳损（缺血）How to read？6 Aspects 心率 心律 电轴 转位 缺血和梗死 肥厚抽丝剥茧抽丝剥茧忙而不乱忙而不乱要要 诀诀Seminar II：Arrhythmia The ones which are most interesting 快快 速速 心心 率率 300150100756050 HR10节律的基本概念节律的基本概念 如何判断窦律：P P波波:I,II,aVFI,II,aVF,aVR,aVR,0.12,0

4、.12,0.25mV,100 msec,the diagnosis of VT can be made.If 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 l

5、ead V6 favors VT(likelihood ratio 50:1)18.In contrast,an Rs complex(R wave larger than S wave)in lead V6 favors SVT.V1 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 4

6、0 msec duration 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 ons

7、et of 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 absence

8、of a Q wave in lead V6 favors SVT.Seminor III：心肌缺血和梗死：心肌缺血和梗死The ones which are most useful缺血 T波改变：正常：III和V1可倒置 超急性期T波高尖：局部高钾 冠状T波 ST段压低：损伤 ST抬高/ST压低：原理：从动作电位讲起透壁梗死Q波 生理性Q波：I、avL、V5、V6 病理性Q波：宽0.04，深1/3R波心肌梗死的演变 超急性期：T波高尖 急性期：ST抬高T波倒置 Q波形成：恢复期：ST回到基线，T波继续倒置 室壁瘤STEMI诊断标准III AVFIII AVF（+90+90）II IIIAVLAVLAVRAVR-90180180（0 0）几个要注意的问题 镜向变化：注意后壁 LBBB：R波进展不良：鉴别：膈肌附近病变、肥厚性心肌病、脑血管意外Lets do it！#19：AMI（前壁），向侧壁延展，心尖受累#20：广泛前壁AMI#21：正常心室率的Af，AMI（ant）#22：AMI（ant），心尖和侧壁受累#23：窦速，RBBB/LAFB，AMI（ant）侧壁受累#24：RAD 2AMI（lat）心尖延展#25：不典型RBBB，前壁ST抬高（ARVD）#26：AMI（下后心尖右室）；V4RST抬高；基线（正常，但S1Q3T3）27 28 29 30 32 33 35