诊断学Electrocardiography(五年制)培训课件

诊断学Electrocardiography(五年制)BasicKnowledgeECGwaveformsandintervals2诊断学Electrocardiography(五年制)BasicKnowledgeElectrocardiographicLeadSystem3诊断学Electrocardiography(五年制)ElectricalAxis4诊断学Electrocardiography(五年制)TheQRSmeanAxisNormalrightleftaxisdeviationaxisdeviation5诊断学Electrocardiography(五年制)MeasurementandNormalECG6诊断学Electrocardiography(五年制)MeasurementandNormalECG7诊断学Electrocardiography(五年制)WavesofQRSComplex8诊断学Electrocardiography(五年制)PWaveinNormalECGPwaveduration：＜0.12s(120ms)Pwaveamplitude：＜0.25mV（limb），＜0.20mV（chest）PRinterval：0.12-0.20s9诊断学Electrocardiography(五年制)QRSComplexinNormalECGQRScomplexduration：＜0.11s(0.06-0.10s)10诊断学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诊断学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诊断学Electrocardiography(五年制)QRSComplexinNormalECGQRSamplitude：limbs:QRS＞0.5mV,chest:QRS＞0.8mV；Q:＜0.03s,＜1/4R13诊断学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诊断学Electrocardiography(五年制)

AtrialEnlargementand

VentricularHypertrophy

15诊断学Electrocardiography(五年制)16诊断学Electrocardiography(五年制)RightAtrialEnlargementPwaveinleadV1orV2≥

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

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

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

≥︱0.04︱mm·sec21诊断学Electrocardiography(五年制)22诊断学Electrocardiography(五年制)23诊断学Electrocardiography(五年制)24诊断学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诊断学Electrocardiography(五年制)26诊断学Electrocardiography(五年制)27诊断学Electrocardiography(五年制)28诊断学Electrocardiography(五年制)29诊断学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诊断学Electrocardiography(五年制)31诊断学Electrocardiography(五年制)32诊断学Electrocardiography(五年制)33诊断学Electrocardiography(五年制)BiventricularHypertrophyA.

NormalECG.B.

Oneventricularhypertrophy.C.

BiventricularHypertrophy.34诊断学Electrocardiography(五年制)

MyocardialInfarction35诊断学Electrocardiography(五年制)MyocardialInfarction

(1)Basicchanges“Hyperacute”TWavesorTwaveinversion.STElevations

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

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

STElevations.TheSTsegmentelevatedintwoormoreleadsandmaybestraightenedandfusewiththeTwave(mono-phasiccurve)

PathologicQWaves.thesuddendevelopedQwavemayindicateanacuteMI.42诊断学Electrocardiography(五年制)(2)ProgressiveECGchanges43诊断学Electrocardiography(五年制)ProgressiveECGchanges44诊断学Electrocardiography(五年制)

(3)LocalizationofMyocardialInfarction

LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1

V3AnteroseptalV3

V5AnteriorI,aVL,V5

V6LateralV1

V5ExtensiveAnteriorII,III,aVFInferior

V7

V9

posterior

V3R

V4Rrightventricle45诊断学Electrocardiography(五年制)LocalizationofLimbLeads46诊断学Electrocardiography(五年制)

(3)LocalizationofMyocardialInfarction

LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1

V3AnteroseptalV3

V5AnteriorI,aVL,V5

V6LateralV1

V5ExtensiveAnteriorII,III,aVFInferior

V7

V9

posterior

V3R

V4Rrightventricle47诊断学Electrocardiography(五年制)Localizationof

ChestLeads48诊断学Electrocardiography(五年制)

(3)LocalizationofMyocardialInfarction

LeadswithAbnormalQWavesinMILeadswithAbnormalQWavesLocationofMIV1

V3AnteroseptalV3

V5AnteriorI,aVL,V5

V6LateralV1

V5ExtensiveAnteriorII,III,aVFInferior

V7

V9

posterior

V3R

V4Rrightventricle49诊断学Electrocardiography(五年制)心电图导联与心室部位

及冠状动脉供血区域的关系导联心室部位供血的冠脉II、III、aVF下壁右冠或回旋支I、aVL、V5、V6侧壁对角支或回旋支V1～V3前间壁左前降支V3～V5前壁左前降支V1～V5广泛前壁左前降支