心律失常心电图医学PPTVIP

,心律失常心电图ECG OF CARDIAC ARRHYTHMIAS,心律失常定义,形成或传导异常,心脏激动速率、节律、传导速度与顺序改变,一. 冲动形成异常,（一）窦性心律失常 1. 窦性过速 2. 窦性过缓 3. 窦性停搏 4. 窦性心律不齐,（二）异位心律 1.主动性a.早搏b.阵发性心动过速 c.扑动或颤动 2.被动性 a. 逸搏 b.逸搏性心律,一. 冲动形成异常,窦性心律失常 1. 窦性过速 2. 窦性过缓 3. 窦性停搏 4. 窦性心律不齐,（二）异位心律 1.主动性a.早搏b.阵发性心动过速 c.扑动或颤动 2.被动性 a. 逸搏 b.逸搏性心律,二. 冲动传导异常,(一)传导阻滞 1. 窦房 2. 房内 3. 房室 4. 室内(束支及分支),(二) 折返: 1. 预激综合征 2. 房室结双径路 3. 房扑,Character of Sinus Rhythm,P波： I、 II和avF直立, avR倒置频率：60100次/分P-P间期相差：0.12sP-R间期：0.12s,Classification of arrhythmias,Sinus Arrhythmia,Sinus bradycardiaSinus tachycardiaSinus arrestSinoatrial blockSick sinus syndrome,Sinus bradycardia,Sinus bradycardia,Sinus bradycardia,Sinus tachycardia,Sinus tachycardia,Sinus tachycardia,Sinus Arrhythmia,Sinus Arrhythmia,Sinus Pause (or Arrest),Sinus arrest,Sinoatrial (SA) Block,Sick sinus syndrome,Sick sinus syndrome,Atrial Arrhythmias,Wandering Atrial PacemakerMultifocal Atrial TachycardiaPremature Atrial ContractionAtrial TachycardiaAtrial FlutterAtrial Fibrillation,Wandering Atrial Pacemaker,Multifocal Atrial Tachycardia,Premature Atrial Contraction,Premature Atrial Contraction,Premature Atrial Contraction,Premature Atrial Contraction,Atrial Tachycardia,自律性房速-起源于心房异位起搏点,Atrial Flutter,Atrial Flutter,Atrial Flutter 2：1,Atrial Fibrillation,Atrial Fibrillation,多发子波折返假说,肺静脉驱动伴颤动样传导假说,Mechanism of Atrial Fibrillation,肺静脉左心房折返假说,Preexcitation,Preexcitation,Preexcitation,WPW+AF,Paroxysmal Supraventricular Tachycardia,房室结双径路与Koch三角,房室结细胞：小细胞、紧密无序排列，细胞间连接极少移行细胞：介于结细胞与心房肌细胞之间，有2个移行方向心房肌细胞,Mechanism of SVT,AVNRT,AVRT,左后间隔,17岁男孩,猝死家中。有晕厥史.既往心电图WPW;心脏组织学检查:左后间隔旁道.房侧端宽1mm,穿过外膜脂肪组织,绕外膜侧纤维环边缘走行,在接近心室肌外膜侧时,分出分枝,呈树根状插入心室肌外膜,连接长度6mm.,Circulation 1978;57;870-879,外膜脂肪组织,心房,先天性结构异常为基础,心电异常为临床表现,AVNRT： pseudo r waves,AVRT,AVRT,顺向型,逆向型,Antidromic Reentrant Tachycardia (ART),Ventricular arrhythmia,Idioventricular RhythmAccelerated Idioventricular RhythmPremature Ventricular ContractionVentricular TachycardiaVentricular Fibrillation,Idioventricular Rhythm,室性自主心律 Idioventricular Rhythm,1.88s/32bpm,Accelerated Idioventricular Rhythm,Premature Ventricular Contraction,Multifocal PrematureVentricular Beats,完全/不完全性代偿间歇,Ventricular Tachycardia：Monomorphic,Ventricular Tachycardia：Polymorphic,Fusion and Capture,Fusion and Capture,Torsade de Pointes,Ventricular Fibrillation,Ventricular Fibrillation,Atrioventricular Blocks,First-degreeSecond-degreeThird-degree,First-degree AV Block,First-degree AV Block,Second-Degree AV Block,Second-Degree AV Block,Second-Degree AV Block,Third-Degree AV Block,III度AVB与VVI起搏器,LBBB,RBBB,Bundle Branch Block,RBBB and LBBB,右束支传导阻滞,右束支传