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Эберт Г.-Х. Простой анализ ЭКГ. 2010
Эберт Г.-Х. Простой анализ ЭКГ. 2010
( )
( )
:\
( )
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re-entry
11
, re-entry
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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
, .
, . . ,
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612.172.4
54.101:53.4
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.
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Thomas Reimann
.
Hans Volkmann
( Erzenbrigsklinikum
Annaberg-Buchholz) S.G. Spitzer
(
,
, )
.
,
,
,
.
Hans-Holger Ebert
, 2004 .
,
, , ?
Hans-Holger Ebert,
,
,
.
,
.
.
Konrad Spang
1957 .:
.
.
,
...
.
,
.
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,
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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 - *. ^ --------------------- -
--------------
-
;
,
-
- ,
- ,
-
, ,
-
QRS
- ST
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
-
-
-
- ,
- , , ,
-
- 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)
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
/
/
I ( )
/
-
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
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Rubin E, Farber JL, et al. Pathology, Philadelphia: Lippincott,
1988.
Schlandt RC, et al. Guidelines for electrocardiography, JACC
1992,19: 473-481.
Singer I, et al. Interventional Electrophysiology, Baltimore: Wil
liams & Wilkins, 1997.
Zipes D, etal. /AHA Task force report: Guidelines for Clinical
intracardiac Electrophysiological and Catheter Ablation Proce
dures, JACC 1995: 26: 555-573.
268
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
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
- .
()
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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