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1、 ElectrocardiogramJiali ZhouDept.Cardiovascular MedicineRenmin Hospital of Wuhan University心电图纸上的每 个小方格，横格 为0.04s，纵格 为0.1mv。P波：在肢体导 联中除avR为倒 置外，余导联多 为直立，或较低 平P-R间期：自P波 开始至QRS波群 开始的时间。正 常范围为0.12- 0.20s,代表了房 室传导时间QRS波群：时间 在0.06-0.10s 的狭窄范围内ST段：是自QRs 波群终了的J点 开始至T波开始 的一段 ，ST段 平行的压低或斜 向下的压低不正 常，轻度抬高可 见于正
2、常人T波：除在avR 导联是例置外 ，余在R波高于 0.5mv时均应直 立。(如在I， II导联应直立 ，avR中应倒置 ，胸前导联自 V4-6均直立) Q-T间期：自 QRS波开始至 T波终了的间 期 ,代表心室 除极,复极时 间的总和Arrhythmia Arrhythmian教学目的、要求 1.了解心律失常分类 2.掌握常见心律失常的心电图表现（窦 性心律及窦性心律失常，期前收缩，异 位心动过速，心房扑动与心房颤动，房 室传导阻滞） n教学难点 常见心律失常的心电图表现 ClassificationAbnormal origin-sinus arrhythmia -ectopic rhy
3、thm:passivityescapepremature contraction tachycardia flutter and fibrillation Abnormal conduction -physiological block:-pathological block: S-AB; A-VB; LBBB; RBBB-accessory pathway: pre-excitation syndrome SINUS RHYTHM AND SINUS ARRHYTHMIASSinus rhythm features :(1) Every P wave is following by a QR
4、S complex; (2) P wave is upright in lead I, II, aVF, V4-V6, inverse in aVR;(3) P-R interval 0.12sec; (4) Difference of P-P interval 1.0 sec )Factors associated with sinus bradycardia(1) Physiologic Laborers and trained athletesEmotional states leading to syncope (2) Pathologic-blockerHypothyroidism
5、（甲低）Sinus Tachycardia(1) Sinus rhythm, rate 100 bpmThe R-R interval (or the P-P interval) 0.12sec in the same lead Sinus arrest The P wave missed for a short time Premature contractions1. Premature Ventricular Contraction(1) Premature QRS complex is the wider and the bizarre , Duration of QRS 0.12 s
6、ec. T wave in direction is opposite to QRS complex . (2)Ventricular complex (QRS) is not preceded by a premature P wave. (3) Complete compensatory pause bigeminytrigeminy2. Atrial Premature Contractions (1) The premature P wave differs in contour from the normal P wave in the same lead. (2) The P-R
7、interval 0.12s. (3) There may be a noncompensatory pause. Tachycardia1. Paroxysmal supraventricular tachycardia (PSVT)a. Heart rate between 160 250 bpm.b. A precisely regular rhythm with normal QRS.PSVT2. Ventricular Tachycardiaa) The rate is 140200/min and the rhythm is very slightly irregular.b) Q
8、RS complex is the wider and the bizarre , Duration of QRS 0.12 sec.c) P wave dissociated from QRS;The rate of P wave is less than The rate of QRSd) Ventricular capture ;e) Fusion beats are present.VTVTFlutter and Fibrillation 1. Atrial Flutter(1) Absence of normal P waves;(2) P waves replaced by saw
9、-tooth flutter wave (F waves);(3) Flutter waves seen best in leads II, III,aVF;(4) Regular atrial rhythm with a rate of 250-350 bpm.(5) Ventricular response of 1:1,2:1,3:1,4:1 or higher2. Atrial Fibrillation (1) Absence of clear P waves ;(2) P waves replaced by f waves f waves: irregular in size, sh
10、ape, best seen in lead V1；(3) Rate of f waves is 350 600 bpm；(4) Irregularly ventricular rate;(5) Generally, duration of QRS complex 0.20sec in adults PR=0.36s2.Second Degree A-V Block (1) Mobitz type I (Wenckebach phenomenon).n The pattern is a progressive prolongation of the P-R interval until a b
11、eat is dropped. nThe first beat after the pause has the shortest P-R interval, which may or may not be normal.(2) Mobitz type IInThere is a fixed numerical relationship between atrial and ventricular impulses, which may be 2:1 (2 atrial beats to one ventricular beat) or 3:1 or 4:1. 2:13.Third Degree A-V Block(Complete heart block) (1) The atrial and the ventricular rhythms are absolutely, independent of one another.(There is no relationship of P to QRS.) (2) atrial rate ventricular rate. (3) Duration of QRS 0.12 sec. or greater.
