常见异常心电图

常见异常心电图 Diagnostic criteria of common abnormal ECG I. myocardial infarction 1. basic graphics: Necrosis Q wave, time > 0.04 seconds, depth > 1/4R. The injury of ST elevation, backgroundsome. Ischemic T wave changes. 2. ECG evolution: Within several hours of onset, there is no abnormal or only towering T wave. A few hours after the onset, ST segment elevation was arched, ST segment and T wave formed by the fusion of one-way curve. There are pathological Q waves within a few hours to two days. This is an acute change, and the pathological Q wave is permanent (sometimes Q wave disappears). The ST segment elevation sustainable several days to about two weeks after the return to baseline level, T wave can be flat or inverted, the subacute phase change. After the onset of weeks and months, T wave was inverted V, inverted T wave could be permanent, or in a few months to several years after the return to normal. 3. ECG localization: anteroseptal V1---V3 Under the wall II, III, avF Extensive anterior wall V1---V5 High side wall I avL anterolateral V5 - V7 I avL Two. ECG manifestation of chronic coronary insufficiency 1. changes of T wave, the first TV1, TV5, and T wave flat (T < 1/10R), bidirectional, or even inverted (QRS wave group based on R can be inverted, such as AVR, V3R, III, V1, V2 can be inverted). 2. ST segment down more than 0.05mv (except AVR). 3. arrhythmia, conduction block. 4. QT interval prolongation (normal heart rate, QT interval, 0.36~0.44 sec). Three. Atrial premature beat: 1. early appearance of atrial P wave, the shape is different from sinus. P '-R interval is more than 0.12 seconds. After 2. atrial P wave, there is a normal morphology of QRS wave group, and the T wave is consistent with the main wave of QRS wave. 3. incomplete compensatory pause. Four. Premature beat at junctional zone 1., the QRS wave group in advance appears to be basically normal. 2. P wave may have three kinds: the first is retrograde P wave (i.e. inverted P wave), and QRS wave group, but the P '-R < 0.12 seconds before the interval of QRS wave and P wave, the R' retrograde '-P interval less than 0.20 sec only QRS wave group without the P wave. T wave and QRS wave of the main wave 3. junction beats. 4. complete compensatory pause. Five. Ventricular premature beat 1., there was no P wave in the QRS wave group. 2. QRS wave group longer than 0.12 seconds. . 3. T wave and QRS wave of the main wave in the opposite direction. 4. complete compensatory pause. Six. Paroxysmal supraventricular tachycardia The equivalent of 1. beats a series of fast atrial premature beat or the border area (3 or more than 3), most frequency of 150~250 / min, the general rules of absolute rhythm. The morphology of the 2. QRS wave group is normal, <0.10s. 3. ST-T does not change, but it changes during the attack. Seven. Ventricular tachycardia The equivalent of 1. of a series of continuous fast ventricular premature beat (3 consecutive times or more than 3 times), most frequency of 150~200 / min, R-R roughly equal, slightly irregular ventricular rhythm. 2. wide QRS wave group, the time is more than 0.12s, T wave and QRS wave group the main wave in the opposite direction. 3. if sinus P wave occurs, It can be found that P wave has no fixed relationship with QRS wave group finger tip. Eight. Atrial flutter 1. there is no P wave on electrocardiogram. 2. can appear jagged F wave, its frequency is 250~350 / min.. The morphology of the 3. QRS wave group is normal, such as the conduction of the atrium to the ventricle is fixed. If 4:1 or 5:1 is considered, the rhythm of the heart is regular. If the conduction is irregular, the rhythm of the heart is irregular. Nine. Atrial fibrillation The 1. P wave disappears, instead of F waves of varying size 2. F wave frequency of 350~600 times / min. 3. QRS slightly has the difference, R-R interval absolute irregular heart rate 80~180 times / min. Ten. Ventricular flutter (omitted) Eleven. Ventricular fibrillation (omitted) Twelve. Atrioventricular block 1. degree I atrioventricular block: QRS wave group appears after sinus P wave The P-R interval was 0.21s (aged >0.22s). 2. 、 type II atrioventricular block type - Venturi phenomenon: 1. P wave regularity. The P-R interval was prolonged until a ventricular leak occurred, and then the P-R interval returned to the shortest and gradually prolonged until ventricular leakage occurred again. This recurring phenomenon is known as the phenomenon of atrioventricular conduction. The proportion of atrioventricular conduction is 3:2, 4:3, 5:4 and so on. 3. type 2 second degree atrioventricular block: P wave regularity of the fixed interval P-R (except leakage stroke), QRS wave is proportional to the gap, the normal form or malformation. The proportion of atrioventricular conduction is 2:1, 3:2, 4:3 and so on. 4., third degree atrioventricular block: P wave and QRS wave group have no fixed relation, P-P and R-R spacing have their fixed law respectively. Atrial rate > ventricular rate, P wave frequency is higher than QRS wave group frequency. The morphology of QRS wave is normal or abnormal. Thirteen bundle branch block 1. left bundle branch block RV5, M type of wave force, and V5, then often without S wave. The V1, V2 S is wide duncuo. The QRS wave is longer than 0.12 seconds to complete left bundle branch block; QRS wave time <0.12 seconds, incomplete right bundle branch block. 2. right bundle branch block The RV1 and M wave force, III, avR sometimes common M wave, S wave was often not. The V5, V6S is wide duncuo. The QRS wave is longer than 0.12 seconds, for CRBBB; such as QRS wave for <0.12 seconds. 3. left anterior fascicular block Left axis of ECG > 45 degrees above. (some scholars think that -30 degrees ~ more typical graphics can be diagnosed) II and avL lead were qR type, but Q wave was not more than 0.02s, R wave was higher, RaVL > R I, and there was no S wave in general I lead. II, III and aVF lead to type rS, S wave is deeper, S III is > S ii. QRS time is normal or slightly extended, mostly in 0.10 ~ 0.11s. Wall aVL leads the exciting time more than 45ms. There was no significant change in QRS wave group in precordial leads. 4. left posterior fascicular block The right axis deviation >90 degrees. II and aVL lead showed rS type, and the second, third and aVF lead showed qR type, and Q wave < 0.02s. S, I, Q, III type. QRS does not increase width or slightly increase width, the time limit is less than 0.12s. The R wave of the second and third leads is relatively higher, R III, > R ii. There was no obvious change in QRS wave in precordial leads, and V1 leads could be QS type, V2 leads can be rS type. Fourteen. Pre excitation syndrome 1. P-R interval shortening is less than 0.12 seconds The initial part of the 2. R wave with triangle wave. Fifteen. Left atrium hypertrophy: 1., I, II, avL, P wave > 0.11 seconds. 2., PV1 two-way inversion, part of the larger. 3. V3 and V5 are Shuangfeng P wave, and Shuangfeng spacing is greater than 0.04 seconds (mitral P wave). Sixteen. Right atrium hypertrophy: 1., II, III, avF, P wave > 0.25mv. 2. PV1 high pointed or bi directional (lung type P wave). 3. if the voltage is less than 0.25mv, but it is the same as the R wave in the lead, it suggests hypertrophy of the right atrium. Seventeen. Left ventricular hypertrophy 1. left axis deviation: > -15~-30 degrees 2. reflects an increase in left ventricular voltage: (1) RV5, RV6 > 2.5, MV, RV5+SV1 > 4, MV (male) (2) RV5, RV6 > 2, MV, RV5+SV1 > 3.5 MV (female) (3) R I > 1.5MV; (4) R, I, +S, III, 2.5mv (5) RavL > 1.2MV (6) RavF > 2.0MV 3. QRS duration of 0.10 seconds, VATV5 > 0.05 seconds (female 0.045 seconds) Note: VAT represents room wall activity time 4. ST-T changes to R wave based lead, ST down is greater than 0.05mv. Eighteen. Right ventricular hypertrophy 1. electric axis right deviation: > 110 degrees 2. reflects an increase in the voltage of the right ventricle: (1) RV1 > 1.0mv (2) RV1+S V5 > 1.2MV (3) R avR > 0.5mv (R > Q) (4) V1 R/S > 1, V5, R/S < 1 3. VATV1 > 0.03 seconds 4. QRS waveform change, V1 is qR, significantly clockwise direction. 5. ST-T change ST V1, AVR down is greater than 0.05mv, STV5 up, and T wave upright. Nineteen. ECG axis 0~90 degrees normal, +30~+90 no offset 0~30 mild left deviation 0~-30, moderate left deviation, -30~-90 significant left deviation +90~+120 mild right deviation, +120~+-180 significant, right deviation +-180~-90 (or +270), severe right deviation Twenty. Premature repolarization syndrome 1. R wave branch and ST segment junction appear J or J wave. 2. ST is horizontal or slanting increased from 0.1 to 0.6mV, elevated ST segment arched downward. 3. ST segment elevation leads to increased T wave symmetry and the ST segment is fused with the T wave. 4. the R wave in the precordial leads is elevated and the S wave is smaller or absent. These changes are more common in V3 ~ V5 lead. 5. T wave inversion often increased in the ST section of the V3 ~ V5 lead. Features: inverted T wave, two branches asymmetric, periodically changed, sometimes shallower or upright. Oral potassium chloride or propranolol can be changed into positive T wave, but the characteristic ST segment of ERS has not changed.