见习医师心电图教学基础课件

Introduction:Basic of the EKGMackey Memorial Hospital心臟心臟內內科科 楊翔惟楊翔惟Introduction:Basic of the EKGNormal 12 lead complete EKGNormal 12 lead complete EKG见习医师心电图教学基础课件见习医师心电图教学基础课件见习医师心电图教学基础课件V7V9?V7V9?ECG reading 1.Rate2.Rhythm3.4.5.6.7.8.9.含interval(PR/QRS/QTc)Axis P wave PR segment and intervalQRS morphology,voltage,and durationST-T segmentQTc intervalU waveNormal Ranges in Milliseconds:PR Interval 120 200 msQRS Complex 60 100 ms QT Interval 360 440 msECG reading 1.Rate2.Rhythm3.4.Normal ECGST segment?TP segment is used as the reference baseline for ST elevation or depression If HR is rapid,PR segment may be used(except atrial T wave present)Normal ECGST segment?TP segmenT wave?Always upright in lead I,IIinverted in AVR?Normal:0.5mm,0.46 0.30 sec(normal limit)?QTc=QT/RRnormal men 0.39 secwomen 0.41 sec 0.44sec?abnormalNormal ECGQT interval?HR 45 ECG reading 1.2.3.4.5.6.RateRhythmAxis P wave PR segment and intervalQRS morphology,voltage,and duration7.ST-T segment8.QTc interval9.U waveECG reading 1.2.3.4.5.6.RateRhCalculate the rate?HR=?300/RR 間的大格數?1500/RR 間的小格數?10秒的total heart beats*6?Pacemaker rate:?Normal pacemaker(SA node)-60-100/minJunctional tissue-40-60/minLower bundle of His-40-50/minVentricular pacemaker-15-40/min(idioventricular rhythm)Calculate the rate?HR=?300/Reading EKG SquaresIntervals and TimingEach square=40 ms(0.04秒)Each interval=200 ms(0.2 秒)Reading EKG SquaresIntervals aQuits 這張心跳幾下?Quits 這張心跳幾下?ECG reading 1.2.3.4.5.6.Rate Rhythm (含interval(PR/QRS/QTc)Axis P wave PR segment and intervalQRS morphology,voltage,and durationST-T segmentQTc intervalU wave7.8.9.ECG reading 1.2.3.4.5.6.Rate R分析心律時，要謹記四個問題?這是P波嗎？?QRS是寬的還是窄的？?心律是否規則?P波跟後面的QRS是不是有關係？?AV blocks?AV dissociation 分析心律時，要謹記四個問題?這是P波嗎？?QRS是寬的還是窄Sinus Rhythm?lead II的P波一定要向上才算?Normal Sinus Rhythm(NSR)?heart rate(HR)在6099beats/min而且心律需規則?Sinus bradycardia?HR99但心律規則。對一般成年人來說，如果躺著心跳仍大於160 beats/min，那麼通常就不是來自sinus的心律了。?Sinus arrhythmia?心律不規則，但還是可以看到P波?PP interval variation 120ms Sinus Rhythm?lead II的P波一定要向上才算Sinus arrhythmiaSinus arrhythmiaSupraventricular Arrhythmias?心室上的心律不整，其來源來自心室上的心律不整，其來源來自 AV nodal以上以上的地點的地點?大部分是大部分是 narrow QRS complexAtrial Fibrillation(Af,A Fib)Multiple Atrial Tachycardia(MAT)Atrial Tachycardia(AT)Atrial Flutter(A Flutter,AF)PSVT(Paroxysmal Supra-Ventricular Tachycardia)?Supraventricular Arrhythmias?Premature Beats?Premature Atrial Contractions(PAC)：伴隨著窄的QRS?Premature Junctional Contractions(PJC)：伴隨著窄的QRS?Premature Ventricular Contractions(PVC)：伴隨著寬的QRS?臨床上，比較具有重要意義的是-新出現的PVC，特別是在心肌梗塞後的病人身上。Premature Beats?Premature Atr见习医师心电图教学基础课件Ventricular Arrhythmias?Slow Idioventricular escape rhythm:寬的QRS complex，心室速率約3040 beats/min?AIVR(Accelerated IdioVentricular Rhythm):心室速率40 beats/min，但是不超過110120 beats/min?Ventricular Tachycardia:心室速率超過120130 beats/min?Ventricular Fibrillation:雜亂無章寬的QRS complexVentricular Arrhythmias?Slow Quits Whats the rhythm?Quits Whats the rhythm?ECG reading 1.2.3.4.5.6.Rate RhythmAxis P wave PR segment and intervalQRS morphology,voltage,and durationST-T segmentQTc intervalU wave7.8.9.-30 +105。ECG reading 1.2.3.4.5.6.Ra见习医师心电图教学基础课件Traditional 12-lead ECGTraditional 12-lead ECGRight axis deviation(RAD)右心軸偏轉右心軸偏轉Lead I(-)and Lead AVF(+)Right axis deviation(RAD)右心軸Lead I(+)and Lead AVF(-)Left axis deviation(LAD)左心軸偏轉左心軸偏轉Lead I(+)and Lead AVF(-)Left Extreme axis deviation心軸極度偏轉心軸極度偏轉Extreme axis deviation心軸極度偏轉Quits Whats the axis?A patient of extreme hyperkalemiaQuits Whats the axis?A patECG reading 1.2.3.4.5.6.Rate RhythmAxis P wavePR segment and intervalQRS morphology,voltage,and duration7.ST-T segment8.QTc interval9.U waveECG reading 1.2.3.4.5.6.Rate RNormal ECGP wave?0.08 0.11 sec?Lead I,II always upright ;aVR inverted?Why?PR interval?0.12 0.20sec?shorter in child,longer in the elder3-5小格Normal ECGP wave?0.08 0.11 sRAE1.Tall,wide P wave in the limb leads(2.5mm in lead II)and right precordial leads(1.5mm in V1)2.Often associated with RVHLAE1.P wave duration 0.12s in frontal plane(usually lead II)2.Terminal P negativity in lead V1(i.e.,P-terminal force)duration 0.04s,depth 1 mm.RAE1.Tall,wide P wave in thPR depression in pericarditisPR depression in pericarditisQuits Whats the abnormality?Quits Whats the abnormalityECG reading 1.2.3.4.5.6.Rate RhythmAxis P wave PR segment and intervalCommon QRS morphology,voltage,and duration7.ST-T segment8.QTc interval9.U waveECG reading 1.2.3.4.5.6.Rate RNormal ECGQRS complex小於格1?0.06 0.11 sec(the widest in V1,V2 ;M F )?Axis:-30 +105。(most:+30 +75)?Amplitude:decrease in advanced age(40 y/o)women,white,obesityNormal ECGQRS complex小於格1?0.0Q wave or Delta wave?Q wave or Delta wave?Bundle Branch BlockBundle Branch BlockCRBBB?QRS 0.12 sce?rsR or rSR(initial R 0.05 sec?Wide S in I,V5,V6,CRBBB?QRS 0.12 sce?rsR or rSIncomplete RBBB(QRS120ms)Incomplete RBBB(QRS If HR is rapid,PR segment may be used(except atrial T wave present)Normal ECGST segment?TP segmenT wave?Always upright in lead I,IIinverted in AVR?Normal:0.5mm,0.46 0.30 sec(normal limit)?QTc=QT/RRnormal men 0.39 secwomen 0.41 sec 0.44sec?abnormalNormal ECGQT interval?HR 45 U wave in hypokalemiaU wave in hypokalemiaQuits Whats the abnormality?Quits Whats the abnormalityT H E E N DT H E E N D