心电图易上手

1、心电图易上手心电图易上手Seminor ITo Start outSeminor ITo Start outWhats ECG?心脏电活动的三维同步立体摄影Whats ECG?心脏电活动的三维同步立体摄影III AVF（+90） IIIAVLAVR-90180（0）III AVF（+90） IIIAV心电图易上手When to ECG?要诀：惠而不费立等可取When to ECG?要诀：惠而不费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本身病变节律异常心脏以外病变肺脑低体温电解质钾钙药物代谢Call death心脏以外病变肺How to ECG？要诀：无它，唯手

2、熟尔。How to ECG？要诀：无它，唯手熟尔。心电图易上手心电图易上手几种危险的心电图赶紧叫老大！要诀：几种危险的心电图赶紧叫老大！要诀：心电图易上手心电图易上手心电图易上手啥叫易损期？啥叫易损期？心电图易上手心电图易上手心电图易上手心电图易上手心电图易上手心电图易上手实习医师应掌握的ECG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、肺栓塞恶性心律失常：窦停、Vf、VT、VF、IIIAVBLe

3、ts do it!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），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）#101:RBBB型VT，不完全AV脱落，室性融合波How to read？How

4、to read？6 Aspects心率心律电轴转位缺血和梗死肥厚抽丝剥茧忙而不乱要 诀6 Aspects心率抽丝剥茧要 诀Seminar II：ArrhythmiaThe ones which are most interesting Seminar II：ArrhythmiaThe ones 快 速 心 率300150100756050HR10快 速 心 率3001501007560心电图易上手心电图易上手心电图易上手节律的基本概念如何判断窦律： 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：缺血T波改变：损伤ST抬高/ST压低：原理：从动作电位讲起损伤ST抬高/ST压低：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波透壁梗死Q波生理性Q波：I、avL、V5、V6心肌梗死的演变超

10、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波继续倒置室壁瘤心肌梗死的演变超急性期：T波高尖STEMI诊断标准啥叫“相邻”？STEMI诊断标准啥叫“相邻”？III AVF（+90） IIIAVLAVR-90180（0）III AVF（+90） IIIAV心电图易上手心电图易上手心电图易上手心电图易上手心电图易上手心电图易上手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、脑血管意外几个要注意的问题镜向变化：注意后壁Lets do it！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：