心电图讲座钟远伦

心电图诊断宜宾市一医院 心内科 钟远伦心脏的特殊传导系统心肌动作电位与心电图心脏除极、复极与心电图各波段的关系示意图QRS波群命名示意图心电图导联体系 肢体导联 I II III a VR a VL a VF 导联轴 每个导联正负极连成的直线心电图测量平均心电轴估测方法示意图图 中箭 头 示 QRS主波方向正常心电轴及其偏移正常人胸导联 R波和 S波振幅变化规律示意图Atrial Enlargement andVentricular Hypertrophy(1) Left Atrial EnlargementLead IIDuration of P wave 0.12 sec. ;P wave become bifid (P “mitrale“);The distance of two peak 0.04sec.Lead V1P wave become biphasic;Ptfv1 - 0.04 mmsecRight Atrial EnlargementLead II P wave is peaked (P “pulmonale“); Amplitude of P wave 0.25 mV in limb leads.Biatrial Enlargement Lead II P wave duration and amplitude both increased.Left Ventricular HypertrophyA. Increased voltage SV1 + R V5 3.5mV (female), 4.0mV (male); Rv5 or Rv6 2.5 mV; RI 1.5mV; RaVL 1.2mV; RaVF 2.0 mV; RI + SIII 2.5 mV;B. Left axis deviation C. ST depression and T inversion in V5-6.Right Ventricular HypertrophyA. Increased voltage (adults over 30) R/S ratio in V1 1.0; R/S ratio in V5 or V6 1.0; R/q or R/S ratio in aVR1; R V1+ S V5 1.05mV (severe1.2mV); RaVR0.5mV;B. Right axis deviation +900 (severe +1100).C. ST depression and T inversion V1-2.Biventricular HypertrophyA. Normal ECG.B. One ventricular hypertrophy.C. Biventricular Hypertrophy.心肌缺血与 ST-T改变 心肌缺血时影响心室复极过程使 ST-T改变 取决于缺血的严重程度、持续时间和缺血部位常见的 ST-T改变类型示意图A 正常的 ST-T形态 B 心房复极向量（ TA向量）引起假性 ST段降低 C 单纯 J点降低 D 缺血型 ST段降低（下斜型） E 缺血型 ST段降