心律失常广医内科医学培训课件.ppt

谢谢！ Thanks for your attention! * We will start by discussing normal impulse formation and then move into common conduction disturbances. * Initiation of the cardiac cycle normally begins with initiation of the impulse at the SA (sinoatrial) node. * After the SA node fires, the resulting depolarization wave passes through the right and left atria, which produces the P-wave on the surface EKG and stimulates atrial contraction. * Following activation of the atria, the impulse proceeds to the atrioventricular (AV) node, which is the only normal conduction pathway between the atria and the ventricles. The AV node slows impulse conduction, which allows time for the atria to contract and for blood to be pumped from the atria to the ventricles prior to ventricular contraction. Conduction time through the AV node accounts for most of the duration of the PR interval. Just below the AV node, the impulse passes through the bundle of His. A small portion of the last part of the PR interval is represented by the conduction time through the bundle of His. * After the impulse passes through the bundle of His, it proceeds through the left and right bundle branches. A small portion of the last part of the PR interval is represented by the conduction time through the bundle branches. * Next the impulse passes through the Purkinje fibers (interlacing fibers of modified cardiac muscle). Conduction time through the Purkinje system is represented by a small portion of the last part of the PR interval. * The impulse passes quickly through the bundle of His, the left and right bundle branches, and the Purkinje fibers, leading to depolarization and contraction of the ventricles. The QRS complex on the EKG represents the depolarization of the ventricular muscle mass. * The Plateau Phase lasts up to several hundred milliseconds. * Repolarization of the ventricles generates a current in the body fluids and produces a T-wave. This takes place slowly, and