临床诊断学课件：冬4、Electrocardiography(五年制2014-12讲课幻灯)

1、Electrocardiography(ECG),Basic Knowledge,ECG waveforms and intervals,Basic Knowledge,Electrocardiographic Lead System,Electrical Axis,The QRS mean Axis,Normal right left axis deviation axis deviation,Measurement and Normal ECG,Measurement and Normal ECG,Waves of QRS Complex,P Wave in Normal ECG,P wa

2、ve duration：0.12 s (120 ms) P wave amplitude：0.25mV（limb），0.20 mV（chest） PR interval：0.12-0.20 s,QRS Complex in Normal ECG,QRS complex duration：0.11 s (0.06-0.10 s),QRS Complex in Normal ECG,QRS pattern in leads V1,V2：rS，no q； r1.0 mV，r/S 1； QRS pattern in leads V5, V6：qR、qRs、Rs、R； R 2.5 mV, R/s1;,Q

3、RS Complex in Normal ECG,QRS pattern in limb leads： R (I, II), S (aVR) and r (aVR) 0.5 mV; QRS amplitude in limb leads： R(I) 1.5mV, R(aVL) 1.2 mV, R(aVF) 2.0mV,QRS Complex in Normal ECG,QRS amplitude： limbs: QRS 0.5mV, chest: QRS 0.8mV； Q: 0.03s, 1/4 R,ST Segment, T and U Wave in Normal ECG,ST segme

4、nt: ST0.05mV; ST 0.2mV (V2, V3); ST 0.1mV (V4V6, limb leads) Q-T interval: 0.32-0.44 s; QTc=QT/RR: 0.45 s (M), 0.46 s (F),Atrial Enlargement and Ventricular Hypertrophy,Right Atrial Enlargement,P wave in lead V1 or V2 1.5 mm P wave in lead II, III, and aVF 2.5 mm P wave is peaked (P pulmonale) Durat

5、ion of P wave is normal,Left Atrial Enlargement,Lead II Duration of P wave 0.12 sec. P wave become bifid (P mitrale) The distance of two peak 0.04sec. Lead V1 P wave become biphasic terminal negative wave 1 mm deep and 40 ms wide, Ptfv1 0.04 mmsec,Left Ventricular Hypertrophy,A. Increased voltage Rv

6、5 or Rv6 2.5 mV; R V5 + SV1 3.5mV (female), 4.0mV (male); 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 Hypertrophy,A. 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

7、/S ratio in aVR 1; 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 Hypertrophy,A. Normal ECG. B. One ventricular hypertrophy. C. Biventricular Hypertrophy.,Myocardial Infarction,Myocardial Infarction,(1) Ba

8、sic changes “Hyperacute” T Waves or T wave inversion. ST Elevations Pathologic Q Waves,T Wave Changes (Myocardial Ischemia),ST Segment Changes (Myocardial Injury),The Abnormal Q wave and QS Complex (Myocardial Infarction),ECG Changes in Myocardial Infarction,Myocardial Infarction,(1) Basic changes “

9、Hyperacute” T Waves or T wave inversion. Tall peaked T waves, often appear as the earliest ECG sign of acute MI, then T wave downward. ST Elevations. The ST segment elevated in two or more leads and may be straightened and fuse with the T wave (mono-phasic curve) Pathologic Q Waves. the sudden devel

10、oped Q wave may indicate an acute MI.,(2) Progressive ECG changes,Progressive ECG changes,(3) Localization of Myocardial Infarction,Leads with Abnormal Q Waves in MI Leads with Abnormal Q Waves Location of MI V1 V3 Anteroseptal V3 V5 Anterior I, aVL, V5 V6 Lateral V1 V5 Extensive Anterior II, III, a

11、VF Inferior V7 V9 posterior V3R V4R right ventricle,Localization of Limb Leads,(3) Localization of Myocardial Infarction,Leads with Abnormal Q Waves in MI Leads with Abnormal Q Waves Location of MI V1 V3 Anteroseptal V3 V5 Anterior I, aVL, V5 V6 Lateral V1 V5 Extensive Anterior II, III, aVF Inferior

12、 V7 V9 posterior V3R V4R right ventricle,Localization of Chest Leads,(3) Localization of Myocardial Infarction,Leads with Abnormal Q Waves in MI Leads with Abnormal Q Waves Location of MI V1 V3 Anteroseptal V3 V5 Anterior I, aVL, V5 V6 Lateral V1 V5 Extensive Anterior II, III, aVF Inferior V7 V9 posterior V3R V4R right ventricle,心电图导联与心室部位及冠状动脉供血区域的关系,Localization of Chest Leads,