![Page 1: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/1.jpg)
ElectrocardiogramECG
Liaoning Medical University Affiliated First Hospital
He Xin
1
![Page 2: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/2.jpg)
一、 Basic knowledge of ECG
2
![Page 3: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/3.jpg)
Content
3
1 、 Electrophysiology2 、 ECG Waveforms andintervals3 、 ECG Lead system
![Page 4: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/4.jpg)
---Depolarization and repolarization
---Vector and vectorcardiogram
4
1 、 Electrophysiology
![Page 5: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/5.jpg)
Pacing and conducting system of the heart
Sinus node Internodal tracts AV node
right bundle branch (RBB) Purkinje fibers
Bundle of His anterior fascicle left bundle branch (LBB) Purkinje
fibers posterior fascicle
2 、 ECG Waveforms and intervals
5
![Page 6: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/6.jpg)
Componcents of the conduction system
SA Node
Bundle of AV junction
AV NodeBundle of AV
Right BundleBranch
Left BundleBranch
![Page 7: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/7.jpg)
3 、 ECG Lead system
--bipolar leads ( Standard leads ) I, II,
III
--unpolar leads: aVR, aVL, aVF
7
![Page 8: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/8.jpg)
3 、 ECG Lead system
--Chest leads: V1, V2, V3, V4, V5, V6
8
![Page 9: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/9.jpg)
二、 Measurement and Normal ECG
9
![Page 10: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/10.jpg)
1. Measurement of ECGECG paper Paper speed : 25mm/s;Standard calibration : 1mV=10mm
10
![Page 11: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/11.jpg)
60R-R (S)
=HR60
0.80S=75/min
(1) Measuring heart rate (HR)
---Measuring heart rate (HR) = 60/R-R (bpm)---Measuring heart rate (HR) = 60/R-R (bpm)---300/the number of large time units between R----300/the number of large time units between R-
RR---1500/the number of small time units between ---1500/the number of small time units between
R-RR-R11
![Page 12: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/12.jpg)
(2) Amplitude of waves or segment: P, QRS,
S-T, T, U
12
![Page 13: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/13.jpg)
(3) Width or duration of waves: P, QRS, T, U
* Duration of intervals: P-R, Q-T
* Shape of waves: P, QRS, T
13
![Page 14: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/14.jpg)
14
(4) Mean QRS axis ---normal cardiac axis range from -3090 ---significant left deviation: -30-90 ---right deviation: 90180 ---significant right deviation: 180-90
![Page 15: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/15.jpg)
normal Counterclockwise rotationCounterclockwise rotationClockwise rotationClockwise rotation
V5V6V3V4V1V2
(5) Clockwise and counterclockwise rotation ---Clockwise rotation ---Counterclockwise rotation
![Page 16: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/16.jpg)
2 、 Normal ECG
(1) P wave: atrial depolarization ---Amplitude 0.20 mv ---Duration 0.11 sec ---Positive in I, II, aVF, V4-V6; Negative in aVR (2) PR interval: the time for intraatrial, --- AV nodal, and His-Purkinje
conduction, --- Duration: 0.12 ~ 0.20 sec
16
![Page 17: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/17.jpg)
(3) QRS complex: ventricular depolarization
---The width: 0.060.10 sec, 0.11 sec.
---From V1 to V6, the R waves gets bigger and
bigger,the S waves gets smaller and smaller.
--R/S < l in V1, but R/S > l in V5
--R in V5 and V6 < 2.5 mv, R in V1 < 1.0 mv
---R in aVR < 0.5 mv,
R in aVL < 1.2 mv and R in aVF < 2.0 mv
R in I < 1.5 mv
---Q < 0.04 sec in width, < 1/4 R in the same lead.17
![Page 18: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/18.jpg)
18
![Page 19: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/19.jpg)
(4) ST segment: it reflects Phase 2 of the action potential.
---ST elevation < 0.3 mV in V1 、 V2;
< 0.5 mV in V3 ; < 0.10 mV in V4 V6
---ST depression < 0.05 mV in any leads
(5) T wave: repolarization of ventricles
---It is upright in all the unipolar leads except
aVR, and occasionally V1.
---T wave > 1/10 R in the same lead, maybe
< 1.21.5 mV in the precordial leads
19
![Page 20: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/20.jpg)
(6) QT interval: the duration of depolarization
and repolarizaion of ventricles
The normal range is 0.320.44 sec
(7) U wave: the wave following the T wave and is
usually very smal
---Its cause is not completely understood
---Elevated U wave: low K+ in plasma
20
![Page 21: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/21.jpg)
三、 Atrial Enlargement and Ventricular Hypertrophy
21
![Page 22: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/22.jpg)
22
![Page 23: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/23.jpg)
1 、 Atrial Enlargement
(1) Right Atrial Enlargement
Lead II
---P wave is peaked (P "pulmonale");
---Amplitude of P wave ≥0.25 mV in limb leads.
Lead V1
---upright and amplitude ≥0.15 mV;
---biphasic and amplitude ≥0.20 mV
23
![Page 24: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/24.jpg)
24
![Page 25: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/25.jpg)
25
![Page 26: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/26.jpg)
(2) Left Atrial EnlargementLead II
--- Duration of P wave ≥0.12 sec
---P wave become bifid (P "mitrale")
---The distance of two peak ≥ 0.04sec
Lead V1
---P wave become biphasic
---Ptfv1 - 0.04 mm·sec
26
![Page 27: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/27.jpg)
27
![Page 28: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/28.jpg)
28
![Page 29: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/29.jpg)
(3) Biatrial Enlargement Lead II
P wave duration and amplitude
both increased
29
![Page 30: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/30.jpg)
2 、 Ventricular Hypertrophy(1) Left Ventricular HypertrophyA. Increased voltage
---Rv5 or Rv6 > 2.5 mV
SV1 + R V5 >3.5mV (female) or > 4.0mV (male)
---RI >1.5mV ; RaVL >1.2mV ; RaVF >2.0 mV
RI + SIII >2.5 mVB. Left axis deviation C. longer duration of QRS (0.10-0.11s)
D. ST depression and T inversion in V5-6
30
![Page 31: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/31.jpg)
31
![Page 32: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/32.jpg)
32
![Page 33: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/33.jpg)
(2) Right Ventricular HypertrophyA. Increased voltage (adults over 30)
---R/S ratio in V1 ≥ 1.0; R /Rs
---R/S ratio in V5 or V6 ≤ 1.0
---R/q or R/S ratio in aVR≥1
--R V1+ S V5 >1.05mV (severe>1.2mV)
--RaVR>0.5mV
B. Right axis deviation ≥ +900 (severe > +1100)
C. ST depression and T inversion in V1-2
33
![Page 34: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/34.jpg)
34
![Page 35: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/35.jpg)
35
![Page 36: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/36.jpg)
(3) Biventricular Hypertrophy ---Normal ECG.
---One ventricular hypertrophy.
---Biventricular Hypertrophy.
36
![Page 37: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/37.jpg)
四、Myocardial Ischemia and
Myocardial infarction
37
![Page 38: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/38.jpg)
1 、 Myocardial Ischemia
Subendocardial: Upright T wave
Subepicardial: Inverted, diphasic, low T wave
38
![Page 39: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/39.jpg)
1 、 Myocardial Ischemia
Subendocardial: ST segment depression
Subepicardial: ST segment elevation( coronary
spasm)
39
![Page 40: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/40.jpg)
40
![Page 41: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/41.jpg)
41
![Page 42: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/42.jpg)
42
![Page 43: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/43.jpg)
Summary ---ST segment depression
---ST segment elevation
---T wave tall positive
---T wave inversion
These changes are transitory and mostly
synchronous with symptoms
43
![Page 44: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/44.jpg)
2 、 Myocardial infarction (1) Basic changes ---Ischemic T Waves. Tall peaked T waves, often
appear as the earliest ECG sign of acute MI
---Injuried ST-segment Elevations. The ST segment elevated in one or more leads and may be straightened and fuse with the T wave (mono-phasic curve)
---necrotic (Pathologic) Q Waves. the sudden developed Q wave may indicate an acute MI
44
![Page 45: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/45.jpg)
45
![Page 46: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/46.jpg)
(2) Progressive ECG changes---Hyperacute changes---Acute period---Subacute period (T Wave Changes) The elevated ST segments return to the
baseline, and deep symmetrical T waves appear in these leads. Tall, symmetrical, upright T waves will appear in reciprocal leads at the same time
---Old myocardial infarct A definitive diagnosis of old myocardial
infarct depends on the presence of a pathological Q wave
46
![Page 47: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/47.jpg)
47
![Page 48: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/48.jpg)
(3) Localization of the ECG patterns
Leads with Abnormal Q Waves location of MI
V1 V3 Anteroseptal
V3 V5 Anterior
I, aVL, V5 V6 Lateral
V1 V6 Extensive Anterior
II, III, aVF Inferior
48
![Page 49: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/49.jpg)
LOCALIZATION OF MILOCALIZATION OF MI
II IIII IIIIII
aVRaVR aVLaVL aVFaVF
VV11 V V22 VV33 V V44 VV55 V V66
inferior
lateralanteroseptal anterior
Extensive anterior49
![Page 50: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/50.jpg)
Anterior MI
![Page 51: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/51.jpg)
Inferior MI
![Page 52: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/52.jpg)
Lateral MI
![Page 53: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/53.jpg)
五、 Arrhythmia
53
![Page 54: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/54.jpg)
1 、 ClassificationAbnormal origin----sinus arrhythmia *
----ectopic rhythm ---passivity --escape
---initiative --premature contraction *
--tachycardia*
--flutter and fibrillation*
Abnormal conduction ----physiological block:
----pathological block: S-AB; A-VB*; LBBB; RBBB
----accessory pathway: pre-excitation syndrome
54
![Page 55: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/55.jpg)
2 、 Electrophysiology---Automaticity
---Excitability
--Absolute refractory period (200ms)
--Effective refractory period (210ms)
--Ralative refractory period (50-100ms)
---Conductivity
55
![Page 56: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/56.jpg)
3 、 SINUS RHYTHM AND SINUS ARRHYTHMIAS
---Sinus rhythm features
---Sinus Bradycardia
---Sinus Tachycardia
---Sinus arrhythmia
---Sinus arrest
---Sick Sinus Syndrome (SSS)
56
![Page 57: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/57.jpg)
Sinus rhythm features(1) Every P wave is following by a QRS
complex
(2) P wave is upright in lead I, II, aVF, V4-V6, inverse in aVR
(3) P-R interval ≥ 0.12sec
(4) Normal rate is 60-100 beats/min
57
![Page 58: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/58.jpg)
Sinus Bradycardia(1) Sinus rhythm
(2) Heart rate <60bpm
(R-R interval or P-P interval >1.0 sec )
58
![Page 59: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/59.jpg)
Factors associated with sinus bradycardia
(1) Physiologic
Laborers and trained athletes
Emotional states leading to syncope
(2) Pathologic
-blocker
Hypothyroidism
59
![Page 60: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/60.jpg)
Sinus Tachycardia
(1)Sinus rhythm, rate > 100 bpm
The R-R interval (or the P-P interval) <0.60 sec
(2)P-R and Q-T interval are shorter than usual
(3)S-T segment is slight depression, T waves may
be flattened
60
![Page 61: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/61.jpg)
Factors associated with sinus tachycardia
(1) Physiologic Exercise Strong emotion Anxiety states(2) Pathologic Fever Hemorrhage Anemia Myocarditis Hyperthyroidism
61
![Page 62: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/62.jpg)
Sinus arrhythmia
---Sinus rhythm and PR interval,
---Difference of P--P interval > 0.12sec
in the same lead
62
![Page 63: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/63.jpg)
Sinus arrest
The P wave missed for a short time
63
![Page 64: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/64.jpg)
Sick Sinus Syndrome (SSS)
(1) Sinus bradycardia (HR<50/min)
(2) Sinus arrest or SA block
(3) Tachycardia: Atrial tachycardia
Atrial Flutter
Atrial fibrillation
(4) AV block
64
![Page 65: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/65.jpg)
4 、 Premature contractions
--- Premature Ventricular Complex
--- Premature Atrial Complex
--- Premature junctional complex
65
![Page 66: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/66.jpg)
Premature Ventricular Complex(1) Ventricular complex (QRS) is not preceded by a
premature P' wave
(2) Premature QRS complex is the wider
and the bizarre , Duration of QRS> 0.12 sec
T wave in direction is opposite to QRS complex
(3) Complete compensatory pause
66
![Page 67: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/67.jpg)
bigeminy
trigeminy
![Page 68: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/68.jpg)
Premature Atrial Complex (1) The premature P' wave differs in contour from
the normal P wave in the same lead
(2) The P'-R interval >0.12s
(3) There may be a noncompensatory pause
68
![Page 69: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/69.jpg)
Premature junctional complex
(1) A premature normal-appearing QRSpremature normal-appearing QRS complex
(2) The junctional P wave (P’) may be appear before in, and after the QRS
(3) Usually a complete compensatory pause
69
![Page 70: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/70.jpg)
5 、 Tachycardia
Reentry Requires: ---Two conducting pathways
---Unidirectional block in one
---Slow conduction in the other
--Paroxysmal supraventricular tachycardia
--Ventricular Tachycardia
--Nonparoxysmal Tachycardia
--Torsde de pointes70
![Page 71: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/71.jpg)
Paroxysmal supraventricular tachycardia (PSVT)
---Heart rate between 160 – 250 bpm
---A precisely regular rhythm with normal
QRS
71
![Page 72: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/72.jpg)
![Page 73: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/73.jpg)
![Page 74: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/74.jpg)
Ventricular Tachycardia
---The rate is 140200/min and the rhythm is very
slightly irregular
---QRS complex is the wider and the bizarre,
Duration of QRS >0.12 sec
---P wave dissociated from QRS
The rate of P wave is less than The rate of QRS
---Ventricular capture
---Fusion beats are present74
![Page 75: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/75.jpg)
![Page 76: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/76.jpg)
Nonparoxysmal Tachycardia
---Nonparoxysmal junctional Tachycardia
The heart rate is 70130/min
---Nonparoxysmal ventricular Tachycardia
The heart rate is 60100/min
![Page 77: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/77.jpg)
Torsde de pointes
![Page 78: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/78.jpg)
6 、 Flutter and Fibrillation
--- Atrial Flutter
--- Atrial Fibrillation
--- Ventricular Flutter
--- Ventricular fibrillation
![Page 79: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/79.jpg)
Atrial Flutter
---Absence of normal P waves
---P waves replaced by saw-tooth flutter wave (F waves)
---Flutter waves seen best in leads II, III,aVF
---F waves always uniform in size,shape and frequency
and absence of isoelectric line between F waves
---Regular atrial rhythm with a rate of 250-350 /min
---Ventricular response of 1:1,2:1,3:1,4:1 or higher
79
![Page 80: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/80.jpg)
![Page 81: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/81.jpg)
Atrial Fibrillation---Absence of clear P waves
---P waves replaced by f waves
---f waves: irregular in size, shape, best seen in lead V1
---Rate of f waves is 350 - 600/min
---Irregularly irregular ventricular rate
---Generally, duration of QRS complex <0.12sec
81
![Page 82: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/82.jpg)
![Page 83: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/83.jpg)
![Page 84: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/84.jpg)
Ventricular Flutter
Ventricular flutter: It is impossible to separate the QRS complexes
from the ST segment and the T waves
84
![Page 85: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/85.jpg)
Ventricular fibrillation
Ventricular fibrillation: The ECG shows fine or coarse waves that are rapid, and irregular in size, shape, and width
85
![Page 86: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/86.jpg)
7 、 Conduction Disturbances---A-V Block
--- Complete Right Bundle Branch Block
--- Complete Left Bundle Branch Block
--- Wolff-Parkinson-White Syndrome(pre-excitation syndrome)
![Page 87: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/87.jpg)
A-V Block First Degree A-V BlockProlonged P-R interval:
P-R interval > 0.20sec. in adults (varies with
heart rate)
87
![Page 88: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/88.jpg)
Second Degree A-V BlockMobitz type I (Wenckebach phenomenon)
---The pattern is a progressive prolongation of
the P-R interval until a beat is dropped
---The first beat after the pause has the shortest
P-R interval, which may or may not be normal
88
![Page 89: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/89.jpg)
![Page 90: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/90.jpg)
Second Degree A-V BlockMobitz type II
There is a fixed numerical relationship between atrial
and ventricular impulses, which may be 2:1 (2 atrial
beats to one ventricular beat) or 3:1 or 4:1
90
![Page 91: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/91.jpg)
Third Degree A-V Block (Complete heart block)
---The atrial and the ventricular rhythms are
absolutely, independent of one another
(There is no relationship of P to QRS.)
---atrial rate > ventricular rate
QRS is 0.12 sec. or greater
91
![Page 92: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/92.jpg)
![Page 93: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/93.jpg)
Complete Right Bundle Branch Block
---Right axis deviation
---QRS≥0.12 sec
---rsR’ pattern (M pattern ) in V1 or V2
---Wide and slurred S wave in leads 1, V5
and V6
---ST-T changes in leads V1 and V2
93
![Page 94: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/94.jpg)
![Page 95: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/95.jpg)
Complete Left Bundle Branch Block
---Left axis deviation
---A wide, slurred R in I,V5 ,V6. The wide,
aberrant QRS , QRS≥0.12 sec
---The QRS in V1 may be QS or rS type
---ST-T changes
95
![Page 96: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/96.jpg)
![Page 97: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/97.jpg)
Wolff-Parkinson-White Syndrome(pre-excitation syndrome)
---P-R interval <0.12 sec
---QRS complex interval >0.12 sec
---Delta wave in the lower third of
theascending limb of the R wave
---ST-T changes
97
![Page 98: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/98.jpg)
![Page 99: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/99.jpg)
WPW Type AWPW Type A
characterized by dominantly upright QRScomplexes in the right precordial leads,resulting in tall delta-R waves in leads V1and V2
![Page 100: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/100.jpg)
WPW Type BWPW Type Bcharacterized by dominantly negative QRScomplexes in the right precordial leads, withtall delta-R waves in leads V5 and V6
![Page 101: Electrocardiogram ECG Liaoning Medical University Affiliated First Hospital He Xin 1](https://reader038.vdocument.in/reader038/viewer/2022110209/56649dff5503460f94ae6bf0/html5/thumbnails/101.jpg)
THANK YOU !