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( )

( )

:\

( )

( )

re-entry
11



, re-entry

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(V7T

( )

Easy ECG
Interpretation Differential Diagnoses

Hans-Holger Ebert, MD
Private Practice
Riesa
Germ any

Thieme

2010

612.172.4
54.101:53.4
-132


1 ,
, ,


( 1 )

.. ( 1, 2,4), E.JI. ( 3), .. ( 3),
.. ( ), .. ( 5)

-132

, .-.
: , [] / .-. ;
. . ; . .. . .: , 2010. 280 . : . : 17,5 .
ISBN 978-5-98657-020-4.
,
. ,
,
. , 230
, .
, . . ,
, .
, , , ,
. ,
, .
612.172.4
54.101:53.4

.
.
.

, ,

.

. ,
,

,
, , ,
.
,

ISBN 978-5-98657-020-4 (.)


ISBN 978-3-13-135641-3 (.)

.
.
, ,

, .

,
.
.
, , ,
.
, ,
, ,
.

Georg Thieme Verlag, 2005


, 2010


Thomas Reimann
.
Hans Volkmann
( Erzenbrigsklinikum
Annaberg-Buchholz) S.G. Spitzer
(
,
, )
.
,

,
,

.

Hans-Holger Ebert
, 2004 .

,

, , ?
Hans-Holger Ebert,
,

,
.

,

.


.
Konrad Spang
1957 .:


.
.
,
...


.


,

.
,

.
, ,
,
,

, .

Hans Volkmann


Erzgebirgsklinikum Annaberg

..............................11

1.1 ......................................... 12
1.2
.................................................................... 13
1.3 ..............................................14
1.4 -............................................................... 15
1.5 .........................................................16
1.6 ..........................................17
1.7
....................................................... 18
1.8 ... 19
1.9 ............................................20
2


............................... 21

2.1 .......................................22
2.2
...........................................23
2.3
( ) .............................................................. 24
2.4 -............................. 25
2.5 ..................26
2.6 ....................................27


.....................................31

3.1
3.2
3.3
3.4
3.5
3.6
3.7
3.8

.......................................... 32
- .................. 64
........... 98
............114
.....................................130
.........136
...........................139

..........................................................142
.........146
..........................152

re-entry....................................................................161
................179
........................ 185
..............................193
..........................195

3.9
3.10
3.11
3.12
3.13
3.14
3.15
4


...............................197

4.1

..............198

4.2 -
.... 200
4.3 ............ 205
4.4 ..................206
4.5
............................................................221
4.6 -
.....................222
4.7
S T ......................................................225
4.8 S T ........ 226

5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
5.12

................ 227

5.1 .........228
5.2
...........................................232
5.3
.............................................................. 234

5.13

...........................235
..........239
... 240
.................................................242

.........................................243
........................................... 245

Q T .....................................................246
,
............... 248


..................................................................261
...................... 264

...................................................................267
.......................................269

WPW

10

Wolf-Parkinson-White

1.1

12

'

1.2

13

1.3


/: 10-20 ,
:
, ,

:
( 50-59% ,
20-38% , 3-30%
)
:

:

14

:

re-entry

/: 1x3x5

:
,
(
)
: -
( 90% ,
1 0 % )

:

:

:
,
(0,2 /)

15

1.5

/: 10-20
: -,
,

: -
( 90%
10%)
:

:

16

:
-

: ,


:

:

:
:

1 .6

17

1 .7

/:
:
- ( -)

18

:
;
- re-entry

/:
:

:
-

:
;
-
re-entry

1.8

19

1.9

/:
: ,

:
:

re-entry

20

2.1

22


( )
-
(QRS)

**

............. ...........


.
1 : 1 .
.

2.2


( )

Hh

-
(QRS)


( ) ( . ) .

.

( ).

23

2.3

( )


( )
-

i
\

1
\

*4

(QRS)

, ,
. ( ^ )
( \ ) .

24

II
( ).
;
( .

2.4


( )
\

-,
.
. QRS
-, QRS .
( \ ) ,
( \ ) .

-
(QRS)

25

2 .5

____________________________________________________________________________________
( )_______________________________________________________________________________
-___________________________________________________________________________________________
(QRS)
\

QRS ( \ ) .

26

, ,

2 .6


( )
-

>

.............

" .....

(QRS)

-
( ).

( ^ " ) .

; ()
( / ), ( ).

27

2.6


( )
-
(QRS)

:;

\ \

re-entry ( t j ) .
(, ) (] [).

()

'<

, re-entry (,
), , re-entry,
( 4 B B v - ) .

: (( .

2 .6


, , .

29

2 .6

3.1

= 51 , RR = 1250

32

- , ,
, ,
, , ,
( )
-


-
60

- ,
(, ),

- ,

3.1


-
- - 2-
( /)
-

f

= 44 , RR = 1350

33

3.1

= 50 , RR = 1200

34


-
- - 2-
2 :1
( /)
-

f

3.1

35

3.1

36

>

- ;

()

- ,

;

- ;
>

3.1

-
- ,
-

- ,
- ,

-
QRS
QRS

37

3.1


-
( )
-

f
- -
( )

3.1

v i - *. ^ --------------------- -

--------------

------- 1 --------- ------------- V'

-
;
,

-

- ,

- ,

-
, ,

-
QRS
- ST

V2 ---------- ------- -------------------

3.1

V2

f--------

V3

40

V4


V5

V6
50 /

-
( ), -
2- ( )
-

f
- -

3.1

- ,
, , ,
, ,


-
-

- < 2

-
- ,
;

2- ,

41

3.1

2- ,
V1

V2

V3

42

V4


V5

V6

50 /

-
- - 2-
( ), -
3-
- - 2-
2 :1
( /)
-

f

3.1

-
-
, , ,
..
- (. 5.11 ,
)


-
-

- = 2

2- ,

43

3.1

2- ,

44

-
-
,
-


-
-

- = 2

3.1

2- ,

III

aVL


aVF

vi
25 /

-
- - 2-
( ), -
3-
- - 2-
2 :1
( /)
-

f

aVR

45

3.1

3-

46

- ,
, , , ,
,


-
-
- > 2

-
-
, ,

3.1


aVL

aVF

25 /

-
- - 2-
( /)
- - 2-
2 :1
( /)
-

f

3-

47

3.1

3-

48

25 /

-
- - 2-
( /)
- - 2-
2 :1
( /)
-

f

3.1

-
;


( )

-
- (
)
-

- ,

49

3.1

Q.

50

3.1

-

-

-
(

)

- (
, -)
-
(
,
..)

51

3.1

52

aVF

-
,

3.1

25 /

53

3.1

25 /
------------------ *

( )
-

54

(QRS)

------- --------- *

-------- --------- * ;------- -------- ;-------------- *

- (

)

-

-

( !)

3.1


-
-
(
)
V6

25 /

55

3.1

= 38 , RR = 1580

56

-

-
-

-

- ,

- ,

3.1

= 38 , RR = 1580
I

aVR

aVL

aVF
50 /

-
( ), -
2-/-
-

f
- -
( )

in

57

3.1

5!

50 /

-
( ), -
2-/-
-

f
- -
( )

3.1

= 55 , RR =1090
I

II

aVL

aVF

50 /

-
( ), -
2-/-
-

f
- -
( )

aVR

59

3.1

= 55 , RR = 1090
V1

V2

' I ' u

V3

V4


V5

V6

50 /

-
( ), -
2-/-
-

f
- -
( )

3.1

, i

t !

,1

^_

50 /

rf

i f

1'

( )
(QRS)

-
;
-
PQ -

-
,
- ,

- ,

-
II III
- PQ

- ,
-
,

61

3.1

aVR

62

aVL

aVF

50 /

-
( )
-
f

- -
( )
-

3.1

= 66 , RR = 900
V1

V2

V4

V6

I
50 /

-
( )
-
f

- -
( )

V3

63

3.2

- 1-

64

- -

- ,
- , , ,


-
- PQ > 200

- ,
- ,

3 .2

aVR

j>

50 /

-
2 : 1 3 :1
- -

-- 2-
( )
-

- 1-

65

3.2

- 1-

V1

V2

V3

66


- -

-- 2-
( )
-

V5

50 /

3.2

- 1-

'4

aVR

aVL

Ss
...

aVF

\: .

V1

V4

f
j

2
\

V5

11'

V3

50 /

'

V6



:
- -

-- 2- 3-
-

III

67

3.2

- 1-



:
- -

-- 2- 3-
-

3.2

- 2- ,

-
(QRS)

\
\

VS

N.

\
/

/ \

\
Vi

-
-
-

- ,
- , , ,


-
- PQ
QRS
- < 2 RR

- ,

-

-

50 /

v
( )\

69

3.2

- 2- ,

670

720

( )

70

-__________________ \_____________n ____________________________ 4 s

\____________v ____________\ ___________

-
-
-

- ,
- , , ,


-
- PQ
QRS
- < 2 RR

- ,

-

-

3.2

aVF

- ,
-
- - 2-
( )
- - 3-
- - 2-
-

-6 2- ,

71

3.2

- 2- ,

mi

72

aVR

aVL
"V '

aVF
25 /

- ,
-
-- 2-
( )
-- 3-
- - 2-
-

3.2

-
-
-

- , , ,
-
- ,

- :
,
PQ

-
(

)

- 2- 2 : 1

73

3 .2

- 2- ,

74

-
-
-

- , , ,
-
- ,

-
-
-
PQ
- = 2 RR

-
(
)

3.2

- 2- 2 : 1

= 84 , = 42


- ,
-
-- 3-
- - 2-
-

50 /

75

3.2

- 3-

76

-
-
-

-
; -

-
,
QRS;

- -,
2-4 ,

3.2

-
-

- ,

-
,
,

- 3-

77

3.2

78

(
-_____________ \_________ \_________________\______________ \_____ _________ \_____________ \__
(QRS)______ J| ________________________________________ ^

-
-

- ,
- , , , ,


-
- QRS;


2- ( )

-
(
)
- ,

3.2

- 3-


( )
-

(QRS)

.1=
1 ! liliiilii
III f i liiiiii II! ::::::::

;: 1 i l t l 1
1
L III

_J1
, L
IT
!
!
1

1:
mJ

-
-
-

- ,
- , , , ,

-

-
,
QRS;

QRS

-
(
)
- ,

mm i
iilii
-r:--1

.:
pljjjj^r i i :.!ii j
i i p i iii m iilii! .
j
4-

79

3.2

- 3-

= 90 , = 40


- ,
-
-- 2-
( /)
- - 2-
-

3.2

- 3-

= 90 , = 40
V1

V2


- ,
-
-- 2-
( /)
- - 2-
-

V5

50 /, QRS = 100

V3

81

3.2

- 3-

::
17
1
J L---- :
:\: iI
J i

1-
:
*?? - !;!|

12

( )
-
(QRS)

\
....... %

-
-
-

- ,
- , , , ,

-
,
QRS;

QRS

-
- ,

3.2

- 3-

= 100 , = 42

aVR

aVL

aVF

25 /, QRS = 140 mc

-- 2-
( /)

- - 2-

-

3.2

- 3-

= 100 , = 42

84


-- 2-
( /)

- - 2-

-

25 /, QRS = 140

3.2

- 3-


-- 2-
( )

- -

(
)

25 /

= 170 , = 44

:5

3.2

- 3-

50 /

( )

16

-h i

-
(QRS)

-
-
-

- ,
- , , , ,

-
- ,

-
(
)

3.2

- 3-

II

aVR

aVL


-
( )
-

aVF
50 /

III

3.2

- 3-

-
-
-

- ,
- , , , ,

-
;

-
;

,

3.2

-
-

- ,

-,
- ,
- ,

-
- QRS
- < 2 RR

, -

3.2

, -,
- 1-


-- 2-
( /)
- - 2-
-

3.2


-- 2-
( /)
- - 2-
-

50 /

91

3.2

92

-
-

- ,

- ;
-,

-,
- ,
- ;

3.2

V2

V4

- , -
- ,
-
- -
3-
-

V5

V6
50 /

V3

93

3.2


= 32-51


( P)

94

-
(QRS)

f f f
t t f ft t ft? f t t t f t t t t tt ff ft ft
H * 4 4 + '
MMK MMM MM\ MMMMMMMMMMMM MM
(
...1 1
\
M
M

-
-

- ,

- (. -)


- f

- ,
-

3.2


- , -
-
-
-
-
3-

25 /

= 38

95

3 .2

f f f i t f f f f

i f f f f f f t f f f f t t t J + t ft

96

-
(QRS)

-
-

- ,

- (. -)

- f

- ,
-

3.2


( )
-
^

^

1^.
^
^
i ^
^ \ ^ ^ ^ % \

(QRS)

-
-

- ,

- (. -)

- ,
-

97

3.3

50 /
( )

98

- ,
()

-,
-
( ;
,
)

( )
- QRS >0,12 ;
( ST )
-
- QRS: V1/2 rSR, V 5 /6 -q R S , S
, R 40 I V6
- > 0,05 (50 ) V1

- ;

3.3


-

-
- W PW

50 /

3.3

100

aVR

-

-
- WPW

aVL

aVF
50 /

3.3

aVR

-

-
- WPW

aVL

aVF
50 /

III

101

3.3

50 /

( )

102

-_______________
(QRS)
(QRS)

- ,
()

- ,
-
( ;
,
)

( )
- QRS 0,11-0,12 ;
( ST )
-
- QRS: V1/2 - rSR, V 5 / 6 - qRS
- > 0,05 (50 ) V1

- ;

3.3


-

-
- WPW

50 /

103

3.3

V1

V2

V3

ill

10 4

V4

aVR

aVL

V5
aVF

V6
50 /

-

-
- WPW

3.3

-
, ()

- ,
- (:
; :
, ,
)


- (. . 98)
PQ > 0,20

- ;

- 1-

10 5

3.3

- 1-

106


-

-
- WPW

50 /

3.3

- ,
-
( , )

- ;

10 7

3.3

III

108

aVR

aVL

-
( )
QRS

aVF
25 /

3.3

V1

V2

V4


V5

-
( )

QRS

V6

50 /

V3

10 9

3.3


( )
Ml

,= :
:

" ,

*
h

_/

25 /

110

( )
-
| (QRS)
| (QRS)


Ilia
v fY V V

t i t! ^ i i '
^

* N J r

|\|

V.

V %

>

-,
-
( , )

-
( --),

- ;

3.3


( )

aVR

aVL

-
( )
QRS

25 /

in

111

3.3

-
(QRS)

112

.
.

.
.

..V .

...

.'

* hJ,

>

..............................................

-
, ()

- ,
- (
;
, )

- /

-
-

- ,

,

-

3.3


-
(
)
QRS

50 /

11 3

3 .4

114

- , ( ),
, , ,
, ,

( )

- ,

-
() ;

;

(< 35% )
-

-Q R S > 0,12 ;
( ST )
-

- QRS: V1/2 - Q S , V 5 /6 R', R
l/aVL, q I, V5/6
- >
0,06 (60 ) V5/6

3.4

50 /


:
-
3 :1
- -
- - 2- 3-
-

11 5

3 .4

- 1-

:;;.;;;:

| | | | |

::

50 /

116

( )
-
(QRS)
(QRS)

\
...................

...;;:.

V
\

.... ...................

.................

v
.

-
-



- , ( ), ,
, , ,
,

- ,
- ()
.


-

3 .4

- 1-

II



:
-
3 :1
- -

-- 2- 3-
-

III

117

3 .4

- 1-

V1

V2

118

V3

'R
I* '

L-i

i
\ 'F
tHf?

50 /


:
-
3 :1
- -
-- 2- 3-
-

3 .4

-
-

-

-

-
- PQ
- = 2 RR

- , ,

- ,

-
(
)

- 2- ,

11 9

3 .4

-
()

120

-
-

- , ,

- ,


-
- QRS;
-
2- ( ),
-

-
(
)
- ,

3 .4

50 /


:
-

- -
-
,

121

3 .4

50 /
( ) I

I-

122

(QRS)
(QRS)

I
1*

________

J>

%>___________ % ___________ % ________


-

- -

- , ( ),
, , ,
, ,

- ,

-
()
.

3 .4

50 /


:
-
3 :1
-

123

3 .4


( )

124

-
(QRS)
(QRS)

-,
-

- ,

-
( --),

3 .4


( )


-
( )
QRS

25 /

III

125

3.4

126

- , ,
, ,
, ,
,


- QRS < 0,12 ;
( ST )
-
( -45 -90)
- QRS: S V6, R
I, aVL
- > 45 aVL

- ,

3 .4





WPW

12 7

3 .4

II

III

12 8

, (QRS)
, (QRS)

\ .......

N
*

S I
V
V

- , ,
, , , ,
,


-Q R S < 0,12 ;
( ST )
-
( 90 180)
- QRS: Q V5/6, rs rS
I, , aVL, qR III, aVF

- ,

3 .4

aVF

---- ~----- |------

50 /

V6

------ ----- v/





WPW

12 9

3 .4

130


-
-
-
-
- WPW

3.5

()

131

3.5

- 1-

132


-- 1-

-- 1-

50 /

3.5


-


-

50 /

133

3 .5


- 1- ,

I
II

III

134

aVR

aVL


-

-
1 -

aVF

50 /

3.5


- 1- ,

V1

V2

V4

V5

-

-

V6

50 /

V3

13 5

3 .6

136

-
re-entry
- -

- : , ,
,
- :

- ,

-

- (
)
- -
QRS

3.6

137


( )
-

13 8

3 .7

+
4>

<>
\

+
\

-

- ,
:



- , , ,

-
( 7 0% , 30% )
- ( 1C III)
- (-,
, )


^
( )
-
(QRS)

139

3 .7

RR ()

140


( )
-
(QRS)

-
RR ( ,
)
-
RR ( ,
)
- PQ

-
100-250
- 1 : 1

- II, III aVF

,

I aVL

3 .7

( )


-
- -
re-entry
-
WPW
-
50 /

= 147 , = 147

141

3 .8

() U

142

-
(QRS)

- Re-entry
(,
, ,
, )
-

- : , ,
, ,
- :


- :

-
200 300

-
-
-

-

3 .8

- ()
= 240 , = 120 2 : 1

aVf

V6

25 /

JU

-
-

- -
re-entry
-
WPW
-
-

3 .8

- ()

= 216 , = 108

144

50 /


-
-

- -
re-entry
-
WPW
-
-

3 .8

-
( )
= 208 , = 104
-V ACT ,

1 /L

~ j U
rTT[~

hi
aVR

aVF

50 /

-
-

- -
re-entry
-
WPW
-
-

145

3 .9

- 2 : 1
( )


( )

146

-
(QRS)

0<J0U<JU0U<J0UUUU0
\

- re-entry
;

- : , ,
,
- :

- :
II, III
-
- 250
350

- /

-
-

3 .9

50 /

-
-

--
re-entry
-
WPW
-
- /re-entry

-
( )

14 7

3 .9

- 1 : 1 ,

148


-
-

-
WPW
-
WPW

/

3 .9

-
( )

-
(QRS)

- re-entry
;

- : , ,
,
- :

- : (

) II, III
-
250-350

- /

-
-


( )

14 9

3 .9

-
( )

= 340 , = 170

V 1

V2

-w.

V:

V3

15 0

50 m m / c

' t 4

V5
1 ~ 1 :i ~

j V." l

_ aVF

aVL
ill:::-!

- 1 i

I ;
if, - -

wmm

- '

]
V

-
-

--
re-entry
-
WPW
- /re-entry

3.9

-
( )

151

3 .1 0

152

- re-entry

-

-
-

- ,
f
- ,

( RR)

-

- ; , ,
( , ),
,
(
),
- ! ,
,
, ,
, , /
- :
( )

- :

- |


- :
,

3 .1 0

: < 50 ,
< 1
( < 7 )
:
( )
:
IA, IC III
:
( ):
- IC ( -):


- :

- :
- II (-)

:
- - ( )
- (,
)
- (, )
-
:
- -

- -

153

3 .1 0



:
48

:

3 2 ,0-3,0
( 2,5);

.
:
( 2,0-3,0, 2,5)
( ,
!)


:
, , ,

:
> 75 , ,
, < 35%,

: ,
65-74 , ,



( CHADS2)

> 75

1'
1
1 .

81-325 /

81-325 /

( 2,0-3,0,
2,5)

( 2,0-3,0,
2,5)

Nach Fuster et a!. ACC/AHA/ESC 2006 Guidelines for Management


of Patients With (J Am Coll Cardiol 2006;48:854-906)

15 4

3 .1 0

- re-entry
;

-
-


-
RR

- : ,
60
-

-

- .

- : /,
, , -
- :


-
RR

- 48

- ( IC III),

15 5

3 .1 0

15 6


-
-

--
re-entry
-

3 .1 0

50 /

-
-

- -
re-entry
-
re-entry
WPW
-

= 190-200

157

3 .1 0

-i I: I:-1 >
' 4

<*

_____
( )*

158

fat \l /

|1
50 /

I I . [ , j::;
1 1
' V
! .i
j |_
~~^fW I

. I

I :

!'

4- - .
~1
: i "II

* ++ + + ++++++++ +++

-____________
(QRS)

- re-entry

-
-

-

RR
- f

-
- : , ,
,
- :

-


;

-

3 .1 0

-
-
-
-
-

- ( )
- :

- : -,

- -

- f
- RR

-
- :
, ,

-

15 9

3 .1 0

________________________ _____

160

( )
\
-
(QRS)

_____

_____

-
- -

-
-


-
RR
( )

a m i
4 *

-
- -1 -
-

3.11

re-entry

- re-entry ( )

( ^ )
( \ )
(QRS)


( \ ) ;


( );


( -_),

re-entry

- -

(
)

- :
( -
)
- :
( IC, III, IV)
- : 12-18

( )

161

3.11

re-entry

- re-entry ( )

16 2

- re-entry


(
QRS); re-entry

-
;
QRS
(rSr V1)

3.11

re-entry

- re-entry ( )

= 176 ,
RR = 340


I !

--

II

iii

b J.iJ

*;{

III

aVR

aVR
:

, j/jv T ;

aVL
4VL ,

aVF
aVF ;

jiJjh-L:.
50 /


-
re-entry
WPW
--
re-entry
( )
-
( 2 :1 ; 1 : 1)
-

- /re-entry

III

163

3.11

re-entry

- re-entry ( )

= 176 ,
RR = 340

V1

V2


V[5

V6

50 /

-
re-entry
WPW
--
re-entry
( )
-
( 2 :1 ; 1 :1 )
-

- /re-entry

3.11

re-entry

- re-entry ( )


-
-
-

-
WPW

3.11

re-entry

- re-entry ( )
= 240 , RR = 250

50 /

( )

166


( \ )

(QRS)

- -
re-entry,
( )
,

- -

(
)


-
; ()
QRS (
PR < RP)

-
( )
- ( IC, III, IV)
- : 12-18

3.11

re-entry

re-entry WPW

-
,
-, ,

re-entry

-
,

- ()
QRS ( PR > RP)

- :
- (.
WPW)
- : 12-18

= 182 , RR = 330

167

3.11

re-entry

re-entry WPW

= 187 , RR = 320

168

- () W PW =

-
(
-);
-
-

,
-
re-entry

- ()
QRS ( PR > RP)

. . 167

. . 167

3 .1 1

re-entry

re-entry WPW


--
re-entry ( )
-
( 2 :1 ; 1 :1 )
-

- /re-entry

169

3.11

re-entry


re-entry WPW

RR = 300

17 0

RR = 300

- ,
,
QRS;

-
,

-
(
)
-

3.11

re-entry

re-entry
WPW,

1. ,
,
QRS.

,

,
, re-entry ,

= 164 , RR = 360

RR ,
.
2.
,
re-entry;
, RR ,
(

)

= 139 , RR = 430

171

3.11

re-entry

re-entry WPW

= 139 , RR = 430

17 2

= 164 , RR = 360

3.11

re-entry

WPW

= 200

H i

I I

25 /

- ()()
( ()
(QRS)

\ \ \ \


-


;
!

-
,

> < > < |> ^ < > < 3 < >

UHU
{ { { [{{{
\\\\\\\\\\\\\

- :
- ( IC, III,
)
- :
(. )

( ) > < } > < < >

173

3.11

re-entry

WPW

17 4

50 /


- torsade de pointes
-
-
- ( )
- (

)

3.11

re-entry

re-entry WPW

( )

:)

(QRS)

- -
;
-
re-entry

-

( )

- :
- ( IC,
III, )
- : 12-18

-
!
( :

175

3.11

re-entry

re-entry WPW
= 167 , F

360

176

aV R

aVF

50 /


-
-


-

3.11

re-entry

50 /
( )

(QRS)

- re-entry
-
-

-
()

- :
( )
- (.
WPW)

-

- QRS

- ( )
( ? )

177

3.11

re-entry

re-entry

= 141 , RR = 425

178


-
-


-
re-entry
WPW

3 .1 2

- , re-entry
re-entry (,
..)

-
-

-
QRS
(2 RR)
-

17 9

3 .1 2


( )

(QRS)

18 0

3 .1 2


( )
(QRS)

181

3.1 2


( )

(QRS)

182


-J.j ;HI_Jj__

* | "

1 1
' I

J
I y:jrf

~ " ^

'

ill

iliip :

v- /

-
(Q RS)

eimm_

------------------
\
/

------------------ f
/

\
\

--------------------- --

.......V

.....................

3 .12


( )
(QRS)


( )
-
(QRS)

183

3 .12

184

0
I
II
IIIA
IIIB
IVA
IVB


30

30




(> 3
)
R-- (
)

3 .13



= 139 , RR = 430

4. V 3

.
v f r


( )
-
(QRS)

-.
\

-----

1
\

-
-
( IB, )

-
re-entry


- QRS


-
-
-
,

V2

185

3 .13


,

()

-


- QRS
-
( )
- V 1 : QS ( )
- R II III
- R rS I

186



( )

-

- QRS
-

-
( )

- re-entry

- QRS
- , 120
-

-
( )

3 .13

aVR

-

-

-


aVL

50 /

= 272 , RR =220

187

3 .13

V3

188

V4

V5

-

-

3 .13

-
(,
, / ..)

-
-

- - (
)
- (/ )

-

- ;

= 154 , RR = 390

189

3 .1 3

RR = 390

190

50 /

-

-

3.1 3

191

3.13

torsade de pointes

------------------------------ --------* -------- -------- -------- -------- -------- -------- -------- ------ ___________ ______ \ ______ \ ______ ______ ______ ______ \ ______ ______

192

<)
(QRS)

V V V V V V V V.V

- /
QT
-

-, ,
-


-
( .. )
- -
- -

3 .1 4

(QRS)

*1


- re-entry?
- ?

-

-
- 240-300

-
- ()

- (
)

-
- -
;


( )
-

193

3 .1 4

= 300 ,
RR = 200

194

50 /


-
-


-
W PW
- re-entry
50 /

3 .1 5


( )
|

E,

- re-entry?
- ?

-

-
- > 300

....
.... I 1............
" .....................

-
- ()

- (
)

-
- -
;

-
/

195

3 .1 5

/ \ /\ /\

V1

II

ill

19 6

aVR

aVL

aVF

aVIv W IA^

vwvW\/\a/V\/

V5

/ V ^y% w W W V 4*A A

V6


-
-
1 :1
WPW

4.1

() [1]
: ,
, -

198

- :
: [2]
[3]
[4]
- :
[5]
(1-3) [6]

() [7]
: ,
,
, , -

:
- : [8]
- : [9]

4.1

() [4]
: ,
, -
:
- , : [5]
- , : [6]
- :
( )

( ) [1]
: ,

:
- : [2]
- : [3]

199

4.2

200

-
() .


.

.


- , ,

- : 4TKA/AKLU
-: , -,
, ,



- ST
( 0,1
, 0,2 )
-
()

4.2

201

4.2

20 2

V1

V1

V2

V2

V3

V3

V4

V4

V5

V5

V6

V6


- ,
- ,
- , WPW
- ,

l"
ib

V4

V1

STV3

4.2

20 3

4.2

; ,1
! 0,8

204

-0 ,3

0,2

0,1

III


- ST
( I 0,1
, 0,2 )
-
()

4 .3

,


, ,

-- -

( )

ST

(
)

- ST

I

ST


+
= /
(+ GP /
?)

I

ST


+
+ GP lla/lllb

:
4-
+
, -,
,

=

+ GP lla/lllb

, (9-12 ), , -,

* .

' ;i

20 5

4 .4

206

- :
( Q)
- :

;
,
, ST
- :

( )

-

- ST:
ST
>0,1
> 0,2 ,

-
- , , ,

- , ,
(,
)
- , 2 3

- ,
-, ,
- ,

- ,


- : ///
- : , , ,
-


- -,
- ,
-

4 .4

1.
(
)
2. ST
( ,
)

4* -

3. ( )

4. Q ( )

2-3

4-6

N t

5. ST ( )
6 . ( )

2-3

4 \|
\
\|

/ J \

207

4 .4

208



.

;

Q.




4 .4

() .
, , ,
, .
ST.
,
. ST,
, ( ST
,
). ST . 224

ST

209

4 .4

,
,
.
> 0,5 V2-V4(5)

210

4 .4


- : I, II, V2-5

- (
)

211

4 .4

21 2

aVR

aVL

aVF


- : (I, II), (V1), V2-4

4 .4


- : I, (II), aVL, (V1), V2-5, (V6)
- ST

21 3

4 .4

214


- : I (II), aVL, (V1), V2-5, (V6), NA, NI

-

4 .4


- : I, aVL, (V3)4-6

215

4 .4

216


- : II, III, aVF, V5-7

-

4 .4

'I

;|wm

I
1
"!
___

- : aVF, V8-9

-

V2

217

4 .4


V1

V2

218

III

Vr5

aVR
V7

aVL

V8

aVF

V9


- : II, III, V(6)-7-9
- rV3-rV5

-

4 .4

V1

219

4 .4

220

4 .5

15

221

4 .6

22 2

- ST
V3-5
(
)

4 .6

22 3

4 .6

224

V 3L1__________| _______

V4


-
(III)
- ST

(I, V3-5)

4 .7

ST

J ( )

< 40
> 40

V2-3 > 0,25 , > 0,1

V2-3 > 0,15 , > 0,1

/
/

V7-9 > 0,05


VR3-VR4 > 0,05

V2-3 >0,20 , > 0,1

I ( )
/

V2-3 > -0,05 , > -0,1

: ST > 0,1 8 ST aVR/V1


.

-
ST
,
- J
( QRS
ST)

22 5

4 .8

ST

ST

-

(. . 225)
-
()

226


ST > 0,1
QRS (
ST)!
ST> -0,1 m B b V 1 -3

S ( ST)!
ST > 0,5
QRS (
ST)!

5.1

'

228

50 /



:




,



-

- QRS (QRS 0,11 ;

V5/6 > 0,05 ),
q
- R/S (. )
-
( ,
ST), QT
-
!
-

35 (. )
- ST

-

5.1


- (S V1 + R V5 > 3,5 )
25-43% , 95%
- (R I + S III - R III - S I > 1,7 )
- (R aVL + S V3 > 35 )
- -:
(R S
> 2,0
S V1-3 > 2,5 , R V4-6 > 2,5 )
3

( -30)
2
ST-T
1-3
QRS
(> 0,09 ,
V5/6 > 0,05 )
1
(P-mitrale)
3
5

- , , ,
,
,
(, ,
)


-
-
- ,
-

5 0-55% ; 95-98%

229

5.1


(
)


(
)

- R
-
( ST, V5-6)

- Q 1, aVL, V5-6
- R V1-2
- V5-6

&

(
230


V1/2

V5/6


V1/2

V5/6

'IT ~

5.1


-
-

- :
QRS > 160
S V1/2 + R V6 > 4,5
(
)

III

aVL

n
V5

aVF
V6
50 /

aVR

231

5.2

232

- 1 , 1 1 , 1 4 15
,
(> 200 )

-
(. 5.1 )
-
(
)

-
, ,

,

- ,
,

-

- -,
()
-
-:
,
- ()
- -



,

( )

5.2

23 3

5.3

- ,

,


- ST ( 40% )
- II, III, aVF
(10-40% )
- QT
-

III

-
( - )

234

V5

- :
- :
( )
- :
- -
- (
)

5 .4

- (, , ,
)
-
( )
-
-


- ST
S (
)
- ,

-

-
-
- ,

-


-

23 5

5 .4

236

5 .4

in

237

5.4

-
,

-:
(
), -,

238

- , , (
Borrelia), , ,
-
-

-
-
- ,

5.5

50 /

- (
,
,
, ..)
-
-

-


- P-pulmonale (
II, III > 0,3 )
- -
(RV1 + SV5 > 1,05 )
-

in

239

5.6


-

- Sl-qlll
- S V5 V6
- ST
V1-3
III,
- P-pulmonale
-

240

-
,

-
-

5 .6


-


-

50 /

241

5.7


-
- R
,
rS
-

V4

24 2

V5_.

aVf

-
,

-
( ,
)
- ,

-


-
(V1-3)
- , -
( QRS)
- (
)

- ,
, -
- .

5 .8

24 3

5.8

244


-
-
-
-
-

5 .9


V1
V2

V3
V4
V5 s A j
V6


- :
1: ST J
ST > 0,2 V1-2 (V3),
2: ST >0,1 ,

3: ST <0,1 ,

-
(, , )
- ( ,
)

-
- -
( ,
)
-

50 /

- SCN5A
( )

in

24 5

5.10

QT

-:

(5 )
- :

QT

U

(Torsade de pointes)

-
-,


- -

QT

QT
- - ( , )
- --
(- ,
)


QT
- :
IA ()
III (, )
-
-
- ,
-
- ,



- !!!
-

5.10

247

5.11

IA (, )

IA
, ,


-
,
( 0),
1 (
) 4
,

-



QRS
ST
QT

5.11

50 /

IA (, )

249

5.11

IB (, )

IB
, ,

-
-
-
( I)

-

250

5.11

IC (, )
iJ -

IC
, ,


- ,

( I);

-

50 /

- PQ
- QRS
- PQ

in

251

5.11

IC (, )
QRS ( S)

25 2

5.11

II (-)

ft

V1

-
-1-

II
III

V3

-
,


(
)


aVR

aVL |\

50 /

- ,
- 1 -
- ST

25 3

5.11

III (, )

III
, (,
)


- :
D- ( III
)
L- ( II,
- )


- 3
( ),

254

-
-
QT!
- QRS
ST

5.11

25 5

5.11

III (, )

III
, (, )


-

III


-
3 ( )
-
1
-
-

- -

256

-

-

-
;

-

5.11

III (, )

aVR

aVL

aVF


-
- PQ
- QT
- QRS
ST

-
()
- ( 3
!;
)
- ( )
-
()
()
- ,

( , )
-
(,
)
- (, )
- , (, )

257

5.11

-
(1)
-


-
( )
-


- ,
-

258

-

re-entry

-

5.11


- -1 -,


(
)

50 /

-
- PQ
- ST,

259

5.11


- ---,


-
-


- ST

260

5.12

-
, ,
- ,
( ,
, ),

-
-


-

- /
-
- 3
-

1I

4 \

I 1


- QRS

- ST
- QT
- U

261

5 .12

- ,

- ,
-
-


-

- /
-

- 3
-

26 2

-
( )
- QRS
- ST
- QT
( QRS
)

5 .12

- -
( , , ),
, , ,
,

- 2

- QT
( )

- ,
D

- 2

- QT
( )

263

5 .13

P-pulmonale

sine

:0;35

264

P-mitrale

50 /

-
II, III > 0,3

-
I II > 0,11
-
I, II
-
> 0,03
-


V1
> -0 ,1 5

0,14
0,05

5 .1 3


P-biatriale


- II, III > 0,3
- > 0,11
-
-
V1

V1

in

26 5

5 .13

,
,
,


-

- > 0,11
-


V1

-
II, III
-
aVR
-

PQ

266

50 /

V1


Block , et al. Richtlinien fur die Durchfuhrung der nicht invasiven
Diagnostikvon Rhythmusstorungen, Z Kardiol 1999; 88:51-60.
Braunwald E, et al. Heart disease, 5th ed., Philadelphia, Toronto,
Montreal, Sydney, Tokyo: Saunders, 1997.
Braunwald E, et al. Essential Atlas of Heart disease, Philadelphia:
Appleton & Lange, 1997.
Cosio FC, etal. Living Anatomy of the Atrio-ventricular Junctions,
J Cardiovasc Electro-physiol 1999; 10:1162-1170.
Crawford MH, et al. ACC/AHA Guidelines for ambulatory Elec
trocardiography, JACC 1999; 34:912-948.
Erbel R, et al. Richtlinien der interventionellen Koronartherapie,
Z Kardiol 1997; 86:1040-1062.
Fuster V, Priori S, Smith SC, et al. /AHA/ESC 2006 Guide
lines for Management of Patients With Atrial fibrillation. J Am
Coll Cardiol 2006;48:854-906.
Gibbons RJ, et al. ACC/AHA/ACP-ASIM Guidelines for the
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A Scientific Statement From the American Heart Association
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P-biatriale 265
P-mitrale 264
P-pulmonale 264
QRS 25, 26
Re-entry 28
R-- 184
ST , 209
Torsade de pointes 192
WPW
168
167
173,
174

-
1- 64-68

134,135
67, 68,
116-118
105,106
134,135
133
2- 69-75
2 :1 73, 75
69-72
74
119
3- 76, 77
86-88

88
,
76, 77

270

78
120
82-85
85
79-81
-
37
38
-,
- 3- 79-81
57, 58
56
3- 46-48
-
13
25

97
96
. -
- re-entry
166
161-165
165
258
256, 257
, 213
248-257
IA 248, 249
IB 250
IC 251, 252
, II 253
III 254-257
re-entry
177,178


W PW 175,176
243, 244

198
199
199
198
- 259
- 253

191

180
181
137
131,133

220

- re-entry 165,166
231
128-130
126,127
,
121

- 1- 67, 68,116-118
- 2- , 119
re-entry
WPW 84
- 120
122,123
114,115


124,125

102-104
108,109

219
131,133
98-101
134,135
112,113
- 1- 105,106
107-109,148,170
re-entry
WPW 170
108,109
110,111
107-109
159
.
94

253
203
,
69-72
41,42
266

, 128-130


- 1- 132
131,133
133
134
126,127
262
263
232,
233

228-231
229
231
230
239
230
261
263

183
138
- 92, 93
184

242

26
26
24
265
145
-- 247
230
243, 244

27 2


-
1- 65-68,106,132,134,135
2- 71, 72, 75
3- 80, 81, 83-85, 87
- 38
- re-entry 163-165
re-entry
178
re-entry
WPW 176
244
131,133
115,117,118,121,123,
125,127,129
99-101,103,104,106,
108,109,111,113,131,133-135

129,130,135
127,131-134
233
229
187,188,190
188
134,135, 222
90
93
62, 63
re-entry
WPW 169

57, 58
52, 53, 55
236, 237
141


-
59, 60

2- 42, 45
3- 47, 48
33, 34
- 202, 222
194
143-145,147,148,150

40
196

95
156
121,123,125
111,113
157
W PW 174
241

186-191
186-188
187

186,188
186

185
185,189
189-191
179-184
180,181
181

179
182
186
184
183
184
180
26
183
3

- 3- 82-85
85
-
- 3- 79-81

57, 58
56
3- 46-48
39,40
39, 40
Q, 208
23-25
264-266
162,166-168

182
.
210
198-226
216
217-219

273


221
219
218
185
194
ST 209
210
206-220
211, 212, 220
212
215
211, 213, 214
- 222-224

220
134,135
- 3- 76, 77
Q 208
207
()
205
, 221
- 199-204
202, 204
204
202
203
203
.
50,154
154
167,168
171,172

274

184

36

198
198

183
138
- 91

torsade de pointes 192


-
1- 64,105,116
2- 69, 70, 73, 74,119
3- 76, 77, 79, 82, 86 88
78,120
- re-entry 161,166
re-entry
177
re-entry
W PW 175
243
114,116,119,120,122,
124
98,102,105,107,110,
112

128
126
232
229
239


185,189,192
179
206
238
89,92,136
92
61
re-entry
W PW 167
51, 54, 56
205
235
139
234
245
QT 246

2- 41, 44
3- 46
35
32, 37
- 200
193
142,146,149

39
195
155
94
49
122,124
110,112
- 96,97
159
- 160

158,173
240

/1
178
250
235-238
12
265
,
74
116
43-45

137
138
- 92,93
137

136

107-109
108,109
36
- 89, 90,92, 93
- 1- 90
92, 93
28
138
- 91
27
131,133
266
. -; ;

275


; ;

,
51-53
61-63, 266
16,17
. ;

13,19
13, 20
13,18
199
re-entry
WPW 167-172

172
171
171,172
WPW 168
WPW 167
170

57, 58

51-53
54, 55
56
205

235-237

276

139-141
141
- 3-
85

,
97
,
96
- 25
28
182
182
182
22, 23
, 13
234
13,16

59,60

182
182
-
59,60
- 247

260
259

W PW 167-176
219
245


-- 247
54, 55
205
234
- 247
QT 246, 247

2- 41-45
41,42
43-45
3- 46-48
47,48
32-34
- 37
32-63
38-40
14
13

49
23
39,40
230
254, 255
27
- .
()

torsade de pointes 192


- re-entry
166
161-165
165

re-entry
177,178
WPW 175,176

187

186,188
186

185
185,189
189-191
re-entry
W PW 167-172
171,172
W PW 168
WPW 167
170,171
172

141
139-141
- 3- 85
121,
157,158, 173,174
193,194
194

-
142-145
143,144

145
-

277


149,150
146,147,151
1 :1 148
2 :1 146
12

180
137
195,196

94,95

49
215
155
153
153
153
154
50,153
153
156
159

121
122,123
124,125

112,113
110,111
- 96,97
- 160
121,157,158

278

W PW 173,174
251,252
X
248, 249


189-191
189
,
-
1- 64,105,116
2- 69, 70, 73, 74,119
3- 76, 77, 79, 82, 86, 88
78,120
- re-entry 162,166
re-entry
177
re-entry
W PW 175
243
114,116,119,120,122,
124, 231
98,102,105,107,110,
112,170

128
126
262
263
232
228, 230, 231


239
261
263
242
185,186,189,192
179
264-266
,
248-260
258

IA 248, 249
IB 250
IC 251, 252
II 253
III 254-257
- 259
260
185, 211-218, 224

36
238
89,92,136
92
61
re-entry
WPW 167,168,170
51, 54, 56
205
235
140
234
245
234
QT 246


2- 41, 43, 44
3- 46
35
32, 37
- 201, 204, 224
torsade de pointes 192
193
142,146,149

39
195
152,155
94
49
122,124
110,112
215
- 96,97
159
- 160
158,173
240
. ;

,
28
28
208
50,153
, 240, 241
110,111,124,125

27 9

-
:
,

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.., . ., ..,
.., ..

129085, , . , 4
.: (495) 689-62-64, : (495) 689-31-24
e-mail: mail@logobook.ru
www.logobook.ru

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