医学见习医师心电图教学基础.pptx

Introduction :Basic of the EKGMackey Memorial Hospital心臟內科 楊翔惟Normal 12 lead complete EKGV7~V9 ??ECG reading RateRhythm含interval (PR/QRS/QTc)AxisP wave PR segment and intervalQRS morphology, voltage,and durationST-T segmentQTc intervalU waveNormal Ranges in Milliseconds:PR Interval 120 – 200 msQRS Complex 60 – 100 ms QT Interval 360 – 440 msNormal ECGST segment TP segment is used as the reference baseline for ST elevation or depression If HR is rapid , PR segment may be used (except atrial T wave present )T waveAlways upright in lead I , II inverted in AVRNormal : 0.5mm , 6mm in limb leadNormal : asymmetrical normal abnormalIn women ? T wave upright in V5, V6 Invert in V1(50%), V2(10%), V3(rare)Normal ECGQT intervalHR 45 ~ 115 == 0.46 ~ 0.30 sec ( normal limit ) QTc = QT/ √RR normal men 0.39 sec women 0.41 sec 0.44sec ? abnormalECG reading Rate Rhythm AxisP wave PR segment and intervalQRS morphology, voltage,and durationST-T segmentQTc intervalU waveCalculate the rate HR = 300 / RR 間的大格數 1500 / RR 間的小格數 10秒的total heart beats * 6Pacemaker rate:Normal pacemaker (SA node) --- 60-100 / minJunctional tissue -------------------40-60 / minLower bundle of His -------------- 40-50 /minVentricular pacemaker -------------15-40 / min (idioventricular rhythm)Reading EKG SquaresIntervals and TimingEach square = 40 ms(0.04秒)Each interval = 200 ms(0.2 秒)Quits這張心跳幾下??ECG reading Rate Rhythm (含interval (PR/QRS/QTc)) AxisP wave PR segment and intervalQRS morphology, voltage,and durationST-T segmentQTc intervalU wave分析心律時，要謹記四個問題這是P波嗎？ QRS是寬的還是窄的？ 心律是否規則 P波跟後面的QRS是不是有關係？AV blocksAV dissociation Sinus Rhythmlead II的P波一定要向上才算 Normal Sinus Rhythm(NSR) heart rate(HR)在60~99beats/min而且心律需規則 Sinus bradycardia HR60但心律規則 Sinus tachycardia HR99但心律規則。對一般成年人來說，如果躺著心跳仍大於160 beats/min，那麼通常就不是來自sinus的心律了。 Sinus arrhythmia 心律不規則，但還是可以看到P波PP interval variation 120ms Sinus arrhythmiaSupraventricular Arrhythmias 心室上的心律不整，其來源來自AV nodal以上的地點大部分是 narrow QRS complex Atri