《临床实用心电图实例分析与解读》心电图基本能力

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心电图基本能力

ECG描记正常

• 正常ECG

技术问题

• 导联错误
• 干扰

窦性心律/窦性心律失常

• 窦性心律
• 窦性心动过速
• 窦性心动过缓
• 窦性心律失常
• 窦性停搏
• 窦房阻滞, Ⅰ型
• 窦房阻滞, Ⅱ型

其他室上性心律失常

• 房性期前收缩(未下传)
• 房性期前收缩(正常传导)
• 房性期前收缩(伴差异传导)
• 异位房性心律或房速(单点)
• 多点房性心律或房速
• 心房纤颤
• 心房扑动
• 交界性期前收缩
• 交界性逸搏及交界性逸搏心律
• 加速性交界性逸搏心律
• 交界性心动过速
• 阵发性室上性心动过速

室性心律失常

• 室性期前收缩
• 室性逸搏及室性逸搏心律
• 室性心动过速(单型)
• 室性心动过速(多型或尖端扭转型室速)
• 心室颤动

房室传导

• 1度房室传导阻滞
• 2度Ⅰ型房室传导阻滞(文氏型)
• 2度Ⅱ型房室传导阻滞(莫氏型)
• 高度房室传导阻滞
• 3度房室传导阻滞(伴交界性逸搏心律)
• 3度房室传导阻滞(伴室性逸搏心律)
• 房室分离(逸博)
• 房室分离(夺获)
• 房室分离(房室传导阻滞伴逸搏)

室内传导

• 完全性左束支传导阻滞(持续或一过性)
• 不完全性左束支传导阻滞
• 完全性右束支传导阻滞(持续或一过性)
• 不完全性右束支传导阻滞
• 左前分支阻滞(LAFB)
• 左后分支阻滞(LPFB)
• 非特异性室内传导延缓(IVCD)
• 预激综合征(WPW)

QRS电轴与电压

• 电轴右偏(+90°至+180°)
• 电轴左偏(-30°至-90°)
• 奇异电轴(-90°至-180°)
• 不确定的电轴
• 肢体导联低电压(<0.5 mV)
• 胸导联低电压(<1.0 mV)

肥厚/增大

• 左房增大
• 右房增大
• 双房增大
• 左室肥大
• 右室肥大
• 双室肥大

ST-T异常, U波异常

• 早期复极(正常变异)
• 非特异性ST-T 异常
• ST段抬高(透壁性损伤)
• ST段抬高(心包炎)
• 对称性T波倒置
• 超急性T波
• 显著直立的U波
• U波倒置
• Q-T间期延长

心肌梗死(急性, 近期, 陈旧)

• 前壁梗死
• 下后壁梗死
• 后壁梗死
• 前间壁梗死
• 前壁梗死
• 前侧壁梗死
• 广泛前壁梗死
• 高侧壁梗死
• 非Q波梗死
• 右室梗死

临床问题

• 慢性阻塞性肺疾病
• 低血钾
• 高血钾
• 低钙血症
• 高钙血症
• 地高辛作用
• 地高辛中毒
• 中枢神经系统病变

起搏ECG

• 心房起搏心律
• 心室起搏心律
• 房室顺序起搏心律

Basic Competency in Electrocardiography

NORMAL TRACING

• Normal ECG

TECHNICAL PROBLEM

• Lead misplaced
• Artifact

SINUS RHYTHMS/ARRHYTHMIAS

• Sinus rhythm
• Sinus tachycardia
• Sinus bradycardia
• Sinus Arrhythmia
• Sinus arrest or pause
• Sinoatrial block, type I
• Sinoatrial block, type II

OTHER SV ARRHYTHMIAS

• PAC’s (nonconducted)
• PAC’s (conducted normally)
• PAC’s (conducted with aberration)
• Ectopic atrial rhythm or tachycardia (unifocal)
• Multifocal atrial rhythm or tachycardia
• Atrial fibrillation
• Atrial flutter
• Junctional prematures
• Junctional escapes or rhythms
• Accelerated Junctional rhythms
• Junctional tachycardia
• Paroxysmal supraventricular tachycardia

VENTRICULAR ARRHYTHMIAS

• PVC’s
• Ventricular escapes or rhythm
• Accelerated ventricular rhythm
• Ventricular tachycardia (uniform)
• Ventricular tachycardia (polymorphous or torsades)
• Ventricular fibrillation

AV CONDUCTION

• 1^st degree AV block
• Type I 2^nd degree AV block (Wenckebach)
• Type II 2^nd degree AV block (Mobitz)
• AV block, advanced (high grade)
• 3^rd degree AV block (junctional escape rhythm)
• 3^rd degree AV block (ventricular escape rhythm)
• AV dissociation (default)
• AV dissociation (usurpation)
• AV dissociation (AV block)

INTRAVENTRICULAR CONDUCTION

• Complete LBBB, fixed or intermittent
• Incomplete LBBB
• Complete RBBB, fixed or intermittent
• Incomplete RBBB
• Left anterior fascicular block (LAFB)
• Left posterior fascicular block (LPFB)
• Nonspecific IV conduction delay (IVCD)
• WPW preexcitation pattern

QRS AXIS AND VOLTAGE

• Right axis deviation (+90° to +180°)
• Left axis deviation (-30° to -90°)
• Bizarre axis (-90° to -180°)
• Indeterminate axis
• Low voltage frontal plane (<0.5 mV)
• Low voltage precordial (<1.0 mV)

HYPERTROPHY/ENLARGEMENTS

• Left atrial enlargement
• Right atrial enlargement
• Biatrial enlargement
• Left ventricular hypertrophy
• Right ventricular hypertrophy
• Biventricular hypertrophy

ST-T, AND U ABNORMALITIES

• Early repolarization (normal variant)
• Nonspecific ST-T abnormalities
• ST elevation (transmural injury)
• ST elevation (pericarditis pattern)
• Symmetrical T wave inversion
• Hyperacute T waves
• Prominent upright U waves
• U wave inversion
• Prolonged QT interval

MI PATTERNS (acute, recent, old)

• Interior MI
• Inferoposterior MI
• Inferoposterolateral MI
• Posterior MI
• Anteroseptal MI
• Anterior MI
• Anterolateral MI
• Extensive anterior MI
• High lateral MI
• Non Q-wave MI
• Right ventricular MI

CLINICAL DISORDERS

• Chronic pulmonary disease pattern
• Suggests hypokalemia
• Suggests hyperkalemia
• Suggests hypocalcemia
• Suggests hypercalcemia
• Suggests digoxin effect
• Suggests digoxin toxicity
• Suggests CNS disease

PACEMAKER ECG

• Atrial-paced rhythm
• Ventricular paced rhythm
• AV sequential paced rhythm
• Failure to capture (atrial or ventricular)
• Failure to inhibit (atrial or ventricular)
• Failure to pace (atrial or ventricular)