心电图教学英文版优质PPT.ppt

心电图教学英文版优质PPT.ppt

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ClinicalElectrocardiographyTeachingCourse,苏州大学附属二院心内科邵春来,GriffithJoyner38yearsolddiedin1998,Vivianfu28yearsolddiedin2003,MarcoPantani35yearsolddiedin2004,心电图学基础

（一）心电发生的原理basicprinciplesoftheelectromechanics,

（1）心肌静止时restingmyocardium（复极状态repolarizationstatus）,

（2）心肌细胞受刺激stimulatedmyocardium（从左到右开始除极depolarizationbeginningfromlefttoright）,（3）除极过程processofdepolarization（depolarizationfromlefttoright）,除极方向（-+）,1.,2.,3.,4.,DeplaorizationSequenceofa“Strip”of5MyocardialCells,Depolarizationprogressingfromlefttoright,2.whendepolarizationspreadsawayfromanylead,itproducesanegative（downward）deflectioninthatlead.,1.whendepolarizationspreadstowardanylead,itproducesapositive（upward）deflectioninthatlead.,3.whendepolarizationspreadsfirstlytowardandthenawayfromanylead,itproducesabiphasicdeflection.,1）Vector,+,+,+,MagnitudeDirectionfrom0,Anarrowrepresentstwophysicalparameters:

@#@directionandmagnitude,2）resultantvector,0,同一轴axile的二个心电向量的方向相同者，其幅度argument相加；@#@,方向相反者则相减。

@#@,ABC,ABC,VectorsmaybesummedbyparallelogrammethodtoproduceResultantVector,=,Translate,=,Summed,ResultantVector,Theintegrationcanonlybeperformedwhenthetwovectorsaregeneratedatthesamemoment.,

（二）心血管传导系统cardiovascularconductionsystem,心脏的传导系统由以下几部分组成,窦房结SAnode结间束internodalatrialpathways房室结AVnode希氏束AVbundle右束支rightbundlebranches左束支leftbundlebranchesPurkinje纤维网Purkinjesystem,SAnode,AVnode,两结之间用vector表示,1,3,4,2,SAnode,AVnode,运用4原则记录心脏的vector传导过程位置不重要,1,2,3,4,不同部位记录电极的电位,Ineachcardiaccycletherearemanyinstantvectorsandifthetipofeachvectorisconnectedtogetheraloopwillbeobtained,whichiscalledasvectorloop,suchasQRSloop.,VariouspatternsoftheECGcanbeobtainedfromthesamevectorloop.Thepatterndependsonthepositionoftheelectrode.,P,T,QRS,Intheheartthevectorloop,infact,isathree-dimensionalvectorloop.,ECG,innature,isdoubleprojectionsofathree-dimensionalvectorloop.,frontalplane,frontalplane,transverseplane,Thethree-dimensionalvectorloopprojectsonasectionofthebodyfirst.Thatisthevectorloopofthissection.,Then,thevectorloopofthesectionprojectsonalead.ThatistheECGofthislead.,（四）心电图导联leadsoftheECG,双极肢体导联bipolarextremity,RA,LA,LL,LARA，LLRA，LLLA,加压肢体导联augmentedextremityleads,aVR,aVL,aVF,包括aVR、aVL、aVF导联,Leadv1:

@#@4thintercostalspacejusttotherightofthesternum,Leadv2:

@#@4thintercostalspacejusttotheleftofthesternum,Leadv3:

@#@alinemidwaybetweenleadV2andV4,Leadv4:

@#@themid-clavicularlinein5thintercostalspace,Leadv5:

@#@theanterioraxillarylineatthesamelevelasleadV4,Leadv6:

@#@themidaxillarylineatthesamelevelasleadV4,angleofLouis,Totallydifferentpatternsofthepotential（ECG）canbeobtainedfromthesamecardiaccycle.Thepotential（ECG）patterndependsonthepositionoftheelectrodes.,Now,youknow,theECGisagraphicrecordingoftheelectricalcurrentsproducedbytheheartmuscleduringtheatrialandventriculardepolarizationandrepolarization.,Insummary,心电图的临床应用ClinicalapplicationoftheECG,

（一）心电图的测量方法determinationmethodoftheECG,StandardizedMethods&@#@Devices,ECGPaperDevicePaperSpeedDeviceCalibrationElectrodePlacement,HorizontalAxis,VerticalAxis,EKGPaper,StandardizedMethods&@#@Devices,ECGGraphPaperVerticalaxis-millivolt1smallbox=1mm=0.1mVHorizontalaxis-time1smallbox=1mm=0.04sec.,StandardizedMethods&@#@Devices,PaperSpeed&@#@CalibrationPaperSpeed-25mm/secstandardCalibrationofVoltageisAutomaticBothSpeedandvoltagecalibrationcanbechangedonmostdevices,Whatistheheartrate?

@#@,（300/6）=50bpm,WhatisQRSAxis?

@#@,TheQRSaxisisdeterminedbyoverlyingacircle,inthefrontalplane.Byconvention,thedegreesofthecircleareasshown.,ThenormalQRSaxisliesbetween-30oand+90o.,AQRSaxisthatfallsbetween-30oand-90oisabnormalandcalledleftaxisdeviation.,AQRSaxisthatfallsbetween+90oand+150oisabnormalandcalledrightaxisdeviation.,AQRSaxisthatfallsbetween+150oand-90oisabnormalandcalledsuperiorrightaxisdeviation.,HexaxialarrayandECGvectorsfromvariousleads.Findnet+orQRSinlead1Findnet+or_QRSinLeadaVFResultantVector.ThisisMeanElectricalAxisofHeartorCardiacVector.,Electricalaxisisabout+60o,Transitionalzone（chestleads）,Representsthelocationofthelead,havingpositiveandnegativedeflectionsofthesamemagnitude.,Clockwise,normal,Counterclockwise,

（二）ComponentsoftheECG,ComponentsoftheECGComplex,PWavefirstupwarddeflectionrepresentsatrialdepolarizationusually0.10secondsorlessusuallyfollowedbyQRScomplex,Whentheatriaareexcited,thisdepolarizingelectricalcurrentcanberecordedbyECG,anditisnamedPwave.,ComponentsoftheECGComplex,QRSComplexCompositionof3WavesQ,R&@#@Srepresentsventriculardepolarizationmuchvariabilityusually0.12sec,ComponentsoftheECGComplex,QWavefirstnegat