快速心律判讀準則與方法課件

1、快速心律判讀準則與方法哈醫(yī)大二院心內(nèi)李寧 整理Dynamic Dysrrhythmia1竇房結 房室結 希氏束結間路徑右束枝左束枝浦金纖維23心電圖的基本原理4P波:心房去極化QRS:心室去極化T波:心室再極化U 波: 心室內(nèi) Purkinje fiber 的再極化 5正常的心電圖6快速心律判讀準則與方法1. 心跳數(shù)（快、慢）2. QRS（寬、窄） （wide or narrow QRS）3. P波（P wave）4. 規(guī)則性（Regularity）5. P & QRS 相關性7沒有脈搏(致命的心律)10有脈搏每分鐘心跳數(shù) 100 則為心搏過速每分鐘心跳數(shù) 60 則為心搏過緩112-(1):寬

2、QRS波 (VT, Idioventricular rhythm)2-(2):窄QRS波(Sinus, Atrial, Junctional rhythm, PSVT)快速心律判讀準則與方法12正常(明顯) P波16不同型P波17WANDERING PACEMAKERImpuses originate from varying points in atria Variation in P-wave contour, P-R and P-P intervaland therefore in R-R intervals18不同型P波19沒有或不明顯的P波214-(1):規(guī)則心律 (VT, PSVT

3、, Sinus, Junct-rhythm, Idioventricular rhythm, 1st & 3rd degree A-V block)4-(2):不規(guī)則心律 (Af, MAT, APC, JPC, VPC, 2nd degree A-V block, 分 Mobitz type I & type II)快速心律判讀準則與方法22規(guī)則心律23規(guī)則心律24不規(guī)則心律25快速心律判讀準則與方法 AF (atrial flutter) 心房撲動 (P波呈鋸齒狀) Af ( atrial fibrillation ) 心房顫動 (60/分心跳100/分) (rapid ventricula

4、r response) 心房顫動合併快速心室反應2. Af with SVR (心跳1 mm連續(xù)三個導程PR baselineST-segment deviation= 4.5 mmJ point plus0.04 second3412導程心電圖變化Baseline缺血tall or inverted T wave (infarct),ST segment may be depressed (angina)損傷elevated ST segment, T wave may invert梗塞 (急性)abnormal Q wave,ST segment may be elevated and T wavemay be inverted梗塞 (時間不知）abnormal Q wave,ST segment and T wave returned to normal35前壁心肌梗塞36Acute Anterior Wall MI37下壁心肌梗塞38Acute Inferior Wall MI39Acute myocardial infarction in the presence of left bundle branch block 40Polymorph