心电图教学课件：ECG-4.pptVIP

Chapter 4 Myocardial ischemia and ST-T change Myocardial ischemia1.ischemia ECG(1).subendocardial ischemiaRepolarization from epicardium to endocardium, when endocardium ischemia, repolarization last long, appear prominent T wave and symmetrical Myocardial ischemia(2). epicardium ischemiaRepolarization sequence change from endocardium to epicardium, appear inverted T wave Myocardial ischemia2.injury ECGEndocardium injury, appear ST segment depressEpicardium injury, appear ST segment elevated Myocardial ischemia3. Clinical significantCoronary heart disease: appear ST segment depressed, inverted T wave, change when angina attack or continuanceHeart infarction: ST elevated or symmetrical inverted T wave Myocardial ischemia3.diagnosisST segment and T wave change not only appear in coronary heart disease but in other disease, such as myocarditis, brain hemorrhage, pericarditis, valve disease, et al.Hypokalemia, hyperkalemia, some medicine, chamber hypertrophy, branch block Myocardial infartcion（一）basic feature and mechanism1. ischemic change: T wave changeWhen ischemia occur in endocardium, appear high T waveWhen ischemia occur in epicardium, appear inverted T wave Myocardial infartcion2.injury changeAppear ST segment elevatedCurrent of injury theoryBlocking of repolarization Myocardial infartcion3.infarction changeAbnormal Q wave: width more than 0.04s and voltage more than ? R waveAppear QS wave Myocardial infartcion(二) infarction ECG and stage1.super acute periodSeveral minutes after infarctionHigh T wave and ST segment slope elevated Myocardial infartcion2.acute periodFrom several hours to several days after heart infarctionST segment elevated, abnormal Q wave and inverted T wave can appear in same time Myocardial infartcion3. subacute periodSeveral weeks to several months after infarctionAbnormal Q waveST segment not depressed and inverted wave become shallow Myocardial infartcion4.recover period 3-6 months or even long time after heart infarctionAbnormal Q wav