陈灏珠--心电图临床应用回顾与展望2018-05复习课程.pptVIP

Ventricular tachycardia A wide QRS tachycardia is VT until proven otherwise (1). Features suggesting VT include:- evidence of AV dissociation independent P waves (shown by arrows here) capture or fusion beats beat to beat variability of the QRS morphology very wide complexes ( 140 ms) the same morphology in tachycardia as in ventricular ectopics history of ischaemic heart disease absence of any rS, RS or Rs complexes in the chest leads (2) concordance (chest leads all positive or negative) short PR interval, less than 3 small squares (120 ms) slurred upstroke to the QRS indicating pre-excitation (delta wave) broad QRS secondary ST and T wave changes Localising the accessory pathway An accessory pathway, bundle of Kent, exists between atria and ventricles and causes early depolarisation of the ventricle. The location of the pathway may be deduced as follows:- LOCATION V1 V2 QRS axis left posteroseptal (type A) +ve +ve left right lateral (type B) -ve -ve left left lateral (type C) +ve +ve inferior (90 degrees) right posteroseptal -ve -ve left anteroseptal -ve -ve normal ?（十三）QRS、ST、T波电交替 ? ST、 T 波电交替 QRS 波电交替 ?（十四）心室电风暴综合征 亦称交感风暴。ACC、AHA、ESC在2006年室性心律失常的诊疗和心脏性猝死预防指南中将其定义为24小时内自发的VT/VF≥2次需要紧急治疗的临床综合征。 见于各种器质性心脏病。促发因素：自律神经影响、心肌缺血、电解质失调、药物影响、心力衰竭等。预警信号：长QT、短QT、J波综合征，墓碑型ST段抬高，瀑布样T波，T波电交替，T波异常高尖，U波异常增高或深倒置，联律间期≤300ms；常有窦性心律增快。 治疗以静脉应用β阻滞剂为主，预防可用ACEI、醛固酮拮抗剂或交感神经节切除术。 心室电风暴综合征 六、心电图新的研究领域 有预测心律失常的价值 QT离散度 P波离散度 反映植物神经系统对心脏的影响 心率变异性 心室复极时间变异性 心率震荡（窦性心率振荡） 从图形研究到大量数据的计算机分析 心电图技术发展虽然历经了110余年的历史，但它在心脏病诊断与新情况发现中仍有无可替代的价值，其运用和发展还有广阔的前景。 谢谢！ Place of Birth: Semarang, Java, then Dutch East IndiesResidence: the NetherlandsAffiliation: Leyden University Semarang, Java, then Dutch East Indies Accepting the prize Einthoven pointed out that the development of electrocardiography had only been made possible by concerted efforts of many workers in this field, among whom he especially mentioned his