器械检查心电图.pptx

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1、器械检查心电图器械检查心电图QuestionsWhyECGcouldbeservedforthediagnosisofsomediseases?HowdoesECGwork?What is ECG?What isnormalECG?A real case with chest paindiagnosisdiagnosis第1页/共16页A.BasicknowledgeofECGA.BasicknowledgeofECG1.DepolarizationandrepolarizationSinglemyocardialcellAmusclestrip2.Vectorandresultantvect

2、or第2页/共16页3.3.PacingandconductingsystemofthePacingandconductingsystemoftheheartheartSinusnodeInternodaltractsAVnoderight bundle branch(RBB)PurkinjefibersBundleofHisanteriorfascicleleftbundlebranch(LBB)Purkinjefibersposteriorfascicle第3页/共16页4.4.LeadsystemLeadsystemLimbleads:Standardleads:I,II,III Lim

3、b leads:aVR,aVL,aVFHexaxialsystemChest leads:V1,V2,V3,V4,V5,V6,V7,V8,V9第4页/共16页B.NormalECGB.NormalECG PwavePwave PRintervalPRinterval QRScomplexQRScomplex STsegmentSTsegment TwaveTwave QTintervalQTinterval UwaveUwave 第5页/共16页1.1.MeasurementofECGwavesandMeasurementofECGwavesandintervalsintervals ECGp

4、aperECGpaper Measuringheartrate(HR)=60/R-R(bpm)Measuringheartrate(HR)=60/R-R(bpm)regularorirregularrhythmregularorirregularrhythmAmplitudeAmplitudeofwavesorsegment:P,QRS,ofwavesorsegment:P,QRS,S-T,T,US-T,T,U WidthordurationWidthordurationofwaves:P,QRS,T,Uofwaves:P,QRS,T,U Durationofintervals:P-R,Q-T

5、Durationofintervals:P-R,Q-T Shapeofwaves:P,QRS,TShapeofwaves:P,QRS,T第6页/共16页2.2.MeanQRSaxisMeanQRSaxis l normal cardiac axis rangefrom-3090 l significantleftdeviation:-30-90 L rightdeviation:90180Lsignificantrightdeviation:180-903.Clockwiseandcounterclockwiserotation lClockwiserotationCounterclockwi

6、serotation第7页/共16页4.4.NormalECGNormalECG(1)Pwave:atrialdepolarizationlAmplitude0.20mvlDuration0.11seclPositiveinI,II,aVF,V4-V6;NegativeinaVR(2)PRinterval:thetimeforintraatrial,AVnodal,andHis-Purkinjeconduction,Duration:0.120.20sec第8页/共16页(3)(3)QRScomplex:ventricularQRScomplex:ventriculardepolarizati

7、ondepolarizationl l Thewidth:0.06Thewidth:0.06 0.10sec,0.10sec,0.11sec.0.11sec.l l FromFrom V V1 1 toto V V6 6,thethe RR waveswaves getsgets biggerbigger andandbigger,theSwavesgetssmallerandsmaller.bigger,theSwavesgetssmallerandsmaller.l lR/SlinVR/SlinV,butR/SlinV5 5 l lRinVRinV5 5andVandV6 62.5mv,R

8、inV2.5mv,RinV1 11.0mv1.0mvl lRinaVR0.5mv,RinaVR0.5mv,l lRinaVL1.2mvandRinaVF2.0mvRinaVL1.2mvandRinaVF2.0mvl lRinI1.5mvRinI1.5mvl lQ0.04secinwidth,1/4Rinthesamelead.Q0.04secinwidth,1/4Rinthesamelead.第9页/共16页(4)STsegment:itreflectsPhase2oftheactionpotential.lSTelevation0.3mVinV1、V2;0.5inV3,0.10mVinV4V

9、6lST depression 1/10 R in the samelead,maybe 1.21.5 mV in the precordialleads第10页/共16页(6)QT interval:the duration ofdepolarization and repolarizaionofventricles.Thenormalrangeis0.320.44sec.(7)Uwave:thewavefollowingtheTwaveandisusuallyverysmall.Its cause is not completelyunderstood.Elevated U wave:lo

10、w K+inplasma第11页/共16页C.SummaryC.SummaryWhyECGcouldbeservedforthediagnosisofWhyECGcouldbeservedforthediagnosisofsomediseases?HowdoesECGwork?WhatisECG?WhatisnormalECG?1.BasicknowledgeofECG(electrocardiogram)Depolarizationandrepolarization:VectorandresultantvectorPacingandconductingsystemoftheheartLead

11、system:(Limbleads)I,II,III,aVR,aVL,aVF,(Chestleads)V1,V2,V3,V4,V5第12页/共16页2.2.NormalECG:NormalECG:PwavePwave,QRScomplexQRScomplex,TwaveTwave,UwaveUwave,PRintervalPRinterval,QTintervalQTinterval,STsegmentSTsegment,R-R(P-P)R-R(P-P)MeanQRSaxisMeanQRSaxis ClockwiseClockwiseandandcounterclockwiserotation

12、counterclockwiserotationNormalvalueandshape:Normalvalueandshape:l l AmplitudeAmplitudeofofwaveswavesororsegmentsegment:P,P,QRS,QRS,T,UT,UandS-TandS-Tl l WidthordurationWidthorduration ofwavesofwaves:P,QRS,T,U:P,QRS,T,Ul l DurationofintervalsDurationofintervals:P-R,Q-T:P-R,Q-Tl l Shapeofwaves:QRS,TSh

13、apeofwaves:QRS,TClinicalsignificancesofabnormalECGClinicalsignificancesofabnormalECG第13页/共16页TESTinclassroom PleasePleasetranslatetranslatethethefollowingwordsintoChinese:followingwordsintoChinese:第14页/共16页PRACTICE1.MakeanECGbyyourselffirst.2.ReadandmeasureyourECGwithcorrectwayandsteps.3.IsyourECGnormalorabnormal?4.KeepyourECGformemory.ItisthefirsttimeasadoctortomakeECGanddiagnosis!Good beginning is the half of success!Good beginning is the half of success!第15页/共16页感谢您的观看。感谢您的观看。第16页/共16页