EKG心电图入门基本知识-英文版 留学生-小讲课 -总医院.ppt

ELECTROCARDIOGRAPHY Bian Bo Tianjin Medical University General Hospital Focus of ECG Rate and rhythm Ishemia Hyperthrophy others Questions to answer in order to identify an unknown arrhythmia: 1. Is the rate slow (60 bpm) or fast (100 bpm)? Slow ? Suggests sinus bradycardia, sinus arrest, or conduction block Fast ? Suggests increased/abnormal automaticity or reentry 2. Is the rhythm irregular? Irregular ? Suggests atrial fibrillation, 2nd degree AV block, multifocal atrial tachycardia, or atrial flutter with variable AV block 3. Is the QRS complex narrow or wide? Narrow ? Rhythm must originate from the AV node or above Wide ? Rhythm may originate from anywhere Questions to answer in order to identify an unknown arrhythmia: 4. Are there P waves? Absent P waves ? Suggests atrial fibrillation, ventricular tachycardia, or rhythms originating from the AV node 5. What is the relationship between the P waves and QRS complexes? More P waves than QRS complexes ? Suggests 2nd or 3rd degree AV block More QRS complexes than P waves ? Suggests an accelerated junctional or ventricular rhythm 6. Is the onset/termination of the rhythm abrupt or gradual? Abrupt ? Suggests reentrant rhythm Gradual ? Suggests altered automaticity Steps to Interpreting an ECG Rate Rhythm Axis Intervals (PR, QRS, QTc) Amplitudes, Morphology(P, QRS) ST segments T waves Q waves Rate - Paper Steps to Interpreting an ECG Rate Rhythm Axis Intervals (PR, QRS, QTc) Amlitudes, Morphology(P, QRS) ST segments T waves Q waves Normal Sinus rhythm features (1) Every P wave is following by a QRS complex; (2) P wave is upright in lead I, II, aVF, V4-V6, inverse in aVR; Same morphology (3)?P-R interval: 0.12-0.20sec (4)?Normal rate is 60-100 beats/min Normal Sinus rhythm First Degree A-V Block Prolonged P-R interval: P-R interval 0.20sec. in adults (varies with heart rate)? 1st Degree AV Block Second Degree A-V Block (1) Mobitz type I (Wenckebach phenomenon). The pattern i