典型心电图诊断.pptVIP

典型心电图诊断 心内科：党群 正常时，每次心动周期在心电图上都可以出现P波、QRS波群、T波和U波、P-R段、S-T段和T-P段，P-R间期和Q-T间期及J点 心电图测量 R Rs qRs RS rS rSr’ 平均心电轴估测方法示意图 正常心电图 P波：反映左、右心房去极化过程中的电位和时间变化。 P-R段：反映兴奋通过房室交界区，因其传导非常缓慢，形成的电位变化也很微弱，一般记录不出来而成等电位线。 QRS波群：反映左、右心室去极化过程中的电位和时间变化。 S-T段：表示心室去极刚结束后尚处于缓慢复极的一段短暂时间，即代表心室早期复极的电位和时间变化。 T波：反映心室晚期复极过程中的电位和时间改变。 U波：一般认为是心肌传导纤维的复极所造成，也有人认为是心室的后电位。 Normal ECG (1) P wave: atrial depolarization l??????? Amplitude ? 0.20 mv l??????? Duration ? 0.11 sec l??????? Positive in I, II, aVF, V4-V6; Negative in aVR (2) PR interval: the time for intraatrial, AV nodal, and His-Purkinje conduction, Duration: 0.12 ~ 0.20 sec (3) QRS complex: ventricular depolarization l??The width: 0.06?0.10 sec, ? 0.11 sec. l?From V1 to V6, the R waves gets bigger and bigger, the S waves gets smaller and smaller. l???R/S l in V1, but R/S l in V5 l???R in V5 and V6 2.5 mv, R in V1 1.0 mv l???R in aVR 0.5 mv, l???R in aVL 1.2 mv and R in aVF 2.0 mv l???R in I 1.5 mv l?? Q 0.04 sec in width, 1/4 R in the same lead. 正常人胸导联R波和S波振幅变化规律示意图 (4) ST segment: it reflects Phase 2 of the action potential. l?ST elevation 0.3 mV in V1、V2; 0.5 in V3, 0.10 mV in V4 ? V6 l?ST depression 0.05 mV in any leads (5) T wave: repolarization of ventricles It is upright in all the unipolar leads except aVR, and occasionally V1. T wave 1/10 R in the same lead, maybe 1.2?1.5 mV in the precordial leads (6) QT interval: the duration of depolarization and repolarizaion of ventricles. The normal range is 0.32?0.44 sec. (7) U wave: the wave following the T wave and is usually very small. Its cause is not completely understood. Elevated U wave: low K+ in plasma 正常心电图 心房、心室肥大 Atrial Enlargement and Ventricular Hypertrophy (1) 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