心电图教学课件：ECG-Arrhythmia -.pptVIP

Conduction Disturbances 传导异常 传导障碍 意外传导 捷径传导 病理性传导阻滞 生理性干扰脱节 心脏传导阻滞 心脏传导阻滞病因 器质性损害 迷走N张力高 药物性作用 心脏传导阻滞 按发生部位分类 窦房阻滞 房内阻滞 房室阻滞 室内阻滞 心脏传导阻滞 按阻滞程度分类 一度阻滞 二度阻滞 三度阻滞 心脏传导阻滞 按发生情况分类 永久性 暂时性 交替性 渐进性 窦房阻滞(sinoatrial block) 二度二型窦房阻滞 窦性停搏 房内阻滞(intra-atrial block) 以不完全阻滞常见 上房间束阻滞常见，与左房大相鉴别 Atrioventricular conduction block Atrioventricular conduction can be delayed, intermittently blocked, or completely blocked—classified correspondingly as first, second, or third degree block. 1. First Degree A-V Block Prolonged P-R interval: P-R interval 0.20sec. in adults (varies with heart rate) ? 2.Second Degree A-V Block (1) Mobitz type I (Wenckebach phenomenon). The pattern is a progressive prolongation of the P-R interval until a beat is dropped. The first beat after the pause has the shortest P-R interval, which may or may not be normal. (2) Mobitz type II The PR interval is constant until a beat is dropped High degree atrioventricular block, which occurs when a QRS complex is seen only after every three, four, or more P waves, may progress to complete third degree atrioventricular block. There is a fixed numerical relationship between atrial and ventricular impulses, which may be 2:1 (2 atrial beats to one ventricular beat) or 3:1 or 4:1. Third Degree A-V Block (Complete heart block) (1) The atrial and the ventricular rhythms are absolutely, independent of one another. (There is no relationship of P to QRS.) (2) atrial rate ventricular rate. QRS is 0.12 sec. or greater. Causes of atrioventricular conduction block Myocardial ischaemia or infarction Degeneration of the His-Purkinje system Infection—for example, Lyme disease, diphtheria(白喉) Immunological disorders—for example, systemic lupus erythematosus（系统性红斑狼疮） Surgery Congenital disorders 束支与分支传导阻滞 一、右束支传导阻滞（right bundle branch block, RBBB) 二、左束支传导阻滞（left bundle branch block, LBBB) 三、左前分支传导阻滞(left anterior fascicular block) 四、左后分支传导阻滞(left posterior fascicular block) 4. Complete Right B