ECG心电图的解读9.ppt
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ELECTROCARDIOGRAM
The First Affiliated Hospital of Shantou University Medical College
卢成志
The Standard 12-lead Electrocardiogram
? How to measure each wave: amplitudeduration
ELECTROCARDIOGRAM
? ECG records the changing potential of the field imparted by the heart.
? ECG dose not record directly the electrical activity of the heart.
? ECG record the electrical activity of the heart from the body surface.
Electrical basis and theory
Electrical basis and theory
? depolarization
? dipole
? repolarization
Electrical basis and theory
Electrical basis and theory
? q
Clinical electrocardiolopy elementary knowledge
? Vector
? Resultant vector
? Loop
Electrical basis and theory
The Standard 12-lead Electrocardiogram
? SA node
? Bachmann
? AV node
? His bundle
? Left and right branch of bundle
? Pukinje fiber
The Standard 12-lead Electrocardiogram
? P Wave
? P-R interval
? QRS Complex
? ST segment
? T Wave
? Q-T interval
The Standard 12-lead Electrocardiogram--R Wave form
Lead System of the ECG
? Limb leads
Lead System of the ECG
? Chest leads
Chest leads
.Ⅱ.ECG EVALUATION
?
The Standard 12-lead Electrocardiogram
? How to measure each wave: amplitudeduration
How to calculate the heart rate
? Heart Rate = 60/R-R duration
Mean QRS axis
Cardiac Rotation
.Ⅲ. NORMAL ECG
?⒈ P Wave
?⒉ P-R Interval
?⒊ QRScomplex
?⒋ J point
?⒌ ST Segment
?⒍ T Wave
?⒎ Q-T Interval
?⒏ U Wave
.Ⅲ. NOMAL ECG--P Wave
? ⑴form：I、II、avF、V4-6 ?
? ⑵duration：<0.12s
? ⑶amplitude: Limb leads <0.25mV, Chest leads <0.20mV.
.Ⅲ. NOMAL ECG--P-R Interval
? duration：0.12s~0.20s.
.Ⅲ. NOMAL ECG--QRS complex
? ⑴duration: 0.06~0.10s.
?⑵form and amplitude.
?⑶R peak time
?⑷Q Wave
.Ⅲ. NOMAL ECG
? J point
? ST Segment
? T Wave
? Q-T Interval
? U Wave
IV.The Abnormal ECG
Atrial and Ventricular hypertrophy
(一)atrial enlargment
? Right atrial enlargement:
? Left atrial enlargement
Atrial and Ventricular hypertrophy
(一) left Ventricular enlargment
? QRS voltage: ① R in V5,6>2.5mV, ② RV5+SV1>3.5 or 4.0mV, ③ RI>1.5mV, R in aVL>1.2mV,aVF>2.0mV,S in V1 ?2.4mV, ④ RI+SIII?2.5mV.
? left axis deviation
? QRS duration>0.09ms.
? ST segment and T wave
left Ventricular enlargment
Atrial and Ventricular hypertrophy
(二) Right Ventricular enlargment
? ①V1 lead R/S>1,V5 lead R/S<1,? ②Rv1+Sv5 >1.05mV.
? ③right axis deviation>+90°.
? ④ST-T change
Right Ventricular enlargment
Atrial and Ventricular hypertrophy
(三) Biventricular enlargement
? Approximately normal ECG.
? Left or Right Ventricular Hypertrophy ECG
? Biventricular Hypertrophy ECG
Biventricular enlargement
V.Ischemia and ST-T Segment
? Forms:
? (1) Ischemia: a.subendocardial ischemia b.subepicardial ischemia
?(2) Injury.
? clinical significance
? differential diagnosis
Ischemia and ST-T Segment
Ischemia and ST-T Segment
Ischemia and ST-T Segment
Ischemia and ST-T Segment
VI. Myocardial Infarction
? (一)Forms and mechanism
( 1 )ischemia
( 2 )infury
( 3 )infarction
VI. Myocardial Infarction
VI. Myocardial Infarction
VI. Myocardial Infarction
VI. Myocardial Infarction
? (二)Evolution of the infarction and duration the ECG
( 1 )initial phase
( 2 ) acute phase
( 3 ) subacute phase
( 4 )recovery phase
Myocardial Infarction
VI. Myocardial Infarction
? TheECG and location of infarction
Myocardial Infarction
Myocardial Infarction
Nonspesific patterns of infarction
? non-Q wave myocardial infarction
? infarction complicated with other diseases
? differential diagnosis
ELECTROCARDIOGRAM
The First Affiliated Hospital of Shantou University Medical College
卢成志
The Standard 12-lead Electrocardiogram
? How to measure each wave: amplitudeduration
ELECTROCARDIOGRAM
? ECG records the changing potential of the field imparted by the heart.
? ECG dose not record directly the electrical activity of the heart.
? ECG record the electrical activity of the heart from the body surface.
Electrical basis and theory
Electrical basis and theory
? depolarization
? dipole
? repolarization
Electrical basis and theory
Electrical basis and theory
? q
Clinical electrocardiolopy elementary knowledge
? Vector
? Resultant vector
? Loop
Electrical basis and theory
The Standard 12-lead Electrocardiogram
? SA node
? Bachmann
? AV node
? His bundle
? Left and right branch of bundle
? Pukinje fiber
The Standard 12-lead Electrocardiogram
? P Wave
? P-R interval
? QRS Complex
? ST segment
? T Wave
? Q-T interval
The Standard 12-lead Electrocardiogram--R Wave form
Lead System of the ECG
? Limb leads
Lead System of the ECG
? Chest leads
Chest leads
.Ⅱ.ECG EVALUATION
?
The Standard 12-lead Electrocardiogram
? How to measure each wave: amplitudeduration
How to calculate the heart rate
? Heart Rate = 60/R-R duration
Mean QRS axis
Cardiac Rotation
.Ⅲ. NORMAL ECG
?⒈ P Wave
?⒉ P-R Interval
?⒊ QRScomplex
?⒋ J point
?⒌ ST Segment
?⒍ T Wave
?⒎ Q-T Interval
?⒏ U Wave
.Ⅲ. NOMAL ECG--P Wave
? ⑴form：I、II、avF、V4-6 ?
? ⑵duration：<0.12s
? ⑶amplitude: Limb leads <0.25mV, Chest leads <0.20mV.
.Ⅲ. NOMAL ECG--P-R Interval
? duration：0.12s~0.20s.
.Ⅲ. NOMAL ECG--QRS complex
? ⑴duration: 0.06~0.10s.
?⑵form and amplitude.
?⑶R peak time
?⑷Q Wave
.Ⅲ. NOMAL ECG
? J point
? ST Segment
? T Wave
? Q-T Interval
? U Wave
IV.The Abnormal ECG
Atrial and Ventricular hypertrophy
(一)atrial enlargment
? Right atrial enlargement:
? Left atrial enlargement
Atrial and Ventricular hypertrophy
(一) left Ventricular enlargment
? QRS voltage: ① R in V5,6>2.5mV, ② RV5+SV1>3.5 or 4.0mV, ③ RI>1.5mV, R in aVL>1.2mV,aVF>2.0mV,S in V1 ?2.4mV, ④ RI+SIII?2.5mV.
? left axis deviation
? QRS duration>0.09ms.
? ST segment and T wave
left Ventricular enlargment
Atrial and Ventricular hypertrophy
(二) Right Ventricular enlargment
? ①V1 lead R/S>1,V5 lead R/S<1,? ②Rv1+Sv5 >1.05mV.
? ③right axis deviation>+90°.
? ④ST-T change
Right Ventricular enlargment
Atrial and Ventricular hypertrophy
(三) Biventricular enlargement
? Approximately normal ECG.
? Left or Right Ventricular Hypertrophy ECG
? Biventricular Hypertrophy ECG
Biventricular enlargement
V.Ischemia and ST-T Segment
? Forms:
? (1) Ischemia: a.subendocardial ischemia b.subepicardial ischemia
?(2) Injury.
? clinical significance
? differential diagnosis
Ischemia and ST-T Segment
Ischemia and ST-T Segment
Ischemia and ST-T Segment
Ischemia and ST-T Segment
VI. Myocardial Infarction
? (一)Forms and mechanism
( 1 )ischemia
( 2 )infury
( 3 )infarction
VI. Myocardial Infarction
VI. Myocardial Infarction
VI. Myocardial Infarction
VI. Myocardial Infarction
? (二)Evolution of the infarction and duration the ECG
( 1 )initial phase
( 2 ) acute phase
( 3 ) subacute phase
( 4 )recovery phase
Myocardial Infarction
VI. Myocardial Infarction
? TheECG and location of infarction
Myocardial Infarction
Myocardial Infarction
Nonspesific patterns of infarction
? non-Q wave myocardial infarction
? infarction complicated with other diseases
? differential diagnosis
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