窦房传导阻滞与房室传导阻滞课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,临床心电图,窦房传导阻滞与房室传导阻滞,临床心电图,1,心内电图与体表心电图,心脏起搏传导系统某部位的病变可引起该,部位传导异常,部分可由体表心电图诊断,结合心内电图可以对体表心电图所表现,出的传导异常进行更准确的评价。,心内电图与体表心电图,2,心内电图与体表心电图,窦房结电位,心内电图可纪录到窦房结电位。,体表心电图看不到窦房结电位,但规律出,现且电轴正常的窦性P波提示激动起源于窦房,结,心内电图与体表心电图,3,心內电图与体表心电图,心房电位,心内电图心房电位A波对应体表心电图的,P波。,心內电图与体表心电图,4,心内电图与体表心电图,房室结电位,心内电图中心房电位A波至希氏束电位H,波之间的传导时间AH间期代表房室结传导,时间,房室结传导阻滞可引起AH间期延长,体表心电图PR间期与房室结传导相关,心内电图与体表心电图,5,心内电图与体表心电图,希氏束电位,体表心电图看不到希氏束除极电位,但P波下传,QRS波群提示希氏束除极。,心内电图与希氏束除极对应的是微小顿挫波-H,波,H波与心室电位V波之间的间期为HV间期,AH间期与HV间期之和等于PR间期,心内电图与体表心电图,6,心内电图与体表心电图,束支电位,由左束支与右束支除极引起的心室除极,电位V对应体表心电图的QRS波群,心内电图与体表心电图,7,窦房结,希氏束,左束支,房室结,电极导管,右東支,图41心内电图的记录方法利用置于右心房和右心室的多电极导管记录心内电图,窦房结,8,注意:窦房结发出的脉冲电位、右心房内的高大P,波、希氏束的电位及右心室内高大的QRS波群。记,录纸速为100mm/s,600m,体表导联,窦房结,(希氏束,右心室,图42体表导联心电图以及由位于窦房结、希氏束和右心室的心内电极导管同步记录的心内电图,注意:窦房结发出的脉冲电位、右心房内的高大P,9,AH间期,HV间期,图43希氏束电图,AH间期,10,窦房传导阻滞与房室传导阻滞课件,11,窦房传导阻滞与房室传导阻滞课件,12,窦房传导阻滞与房室传导阻滞课件,13,窦房传导阻滞与房室传导阻滞课件,14,窦房传导阻滞与房室传导阻滞课件,15,窦房传导阻滞与房室传导阻滞课件,16,窦房传导阻滞与房室传导阻滞课件,17,窦房传导阻滞与房室传导阻滞课件,18,窦房传导阻滞与房室传导阻滞课件,19,窦房传导阻滞与房室传导阻滞课件,20,窦房传导阻滞与房室传导阻滞课件,21,窦房传导阻滞与房室传导阻滞课件,22,窦房传导阻滞与房室传导阻滞课件,23,窦房传导阻滞与房室传导阻滞课件,24,窦房传导阻滞与房室传导阻滞课件,25,窦房传导阻滞与房室传导阻滞课件,26,窦房传导阻滞与房室传导阻滞课件,27,窦房传导阻滞与房室传导阻滞课件,28,窦房传导阻滞与房室传导阻滞课件,29,窦房传导阻滞与房室传导阻滞课件,30,窦房传导阻滞与房室传导阻滞课件,31,窦房传导阻滞与房室传导阻滞课件,32,窦房传导阻滞与房室传导阻滞课件,33,窦房传导阻滞与房室传导阻滞课件,34,窦房传导阻滞与房室传导阻滞课件,35,窦房传导阻滞与房室传导阻滞课件,36,窦房传导阻滞与房室传导阻滞课件,37,窦房传导阻滞与房室传导阻滞课件,38,窦房传导阻滞与房室传导阻滞课件,39,窦房传导阻滞与房室传导阻滞课件,40,窦房传导阻滞与房室传导阻滞课件,41,窦房传导阻滞与房室传导阻滞课件,42,窦房传导阻滞与房室传导阻滞课件,43,窦房传导阻滞与房室传导阻滞课件,44,窦房传导阻滞与房室传导阻滞课件,45,窦房传导阻滞与房室传导阻滞课件,46,窦房传导阻滞与房室传导阻滞课件,47,窦房传导阻滞与房室传导阻滞课件,48,窦房传导阻滞与房室传导阻滞课件,49,窦房传导阻滞与房室传导阻滞课件,50,窦房传导阻滞与房室传导阻滞课件,51,窦房传导阻滞与房室传导阻滞课件,52,窦房传导阻滞与房室传导阻滞课件,53,窦房传导阻滞与房室传导阻滞课件,54,