Открыть Электронные книги
Категории
Открыть Аудиокниги
Категории
Открыть Журналы
Категории
Открыть Документы
Категории
indd II
ECG
in 10 Days
David R. Ferry, MD, FACC
Chief, Cardiology Section
Loma Linda VA Healthcare System
Associate Professor of Medicine
Loma Linda University School of Medicine
Loma Linda, California
21.04.2009 13:09:4
cg_03.indd III
10-
.
2- ,
. .
2009
21.04.2009 13:09:4
cg_03.indd IV
612.172.4
54.101
43
43
. .
. 10- / . ; . .
. . . . 2- ., . . .:
, 2009. 628 .: .
10- ,
, ,
.
.
.
.
.
21.04.2009 13:09:4
cg_03.indd V
Table
of Contents
1.
2.
VI
VIII
IX
X
1
37
3.
- -
94
4.
151
5.
reentry
194
6.
246
7.
287
333
379
444
484
8.
9.
10.
21.04.2009 13:09:4
cg_03.indd VI
, 2 , 10 ,
- . , . 4 10 15 . ,
,
- ,
.
.
, ,
,
. : -,
, , .
, McGraw-Hill .
. , , , .
20 . 29 100
, 280 . ,
. ,
,
. 12 , . .
. , , .
,
, .
VI
21.04.2009 13:09:4
cg_03.indd VII
,
. Apple Macintosh G5, Adobe PhotoShop CS2
Wacom graphics tablet.
600 , .
, , ,
.
. ,
VII
21.04.2009 13:09:4
cg_03.indd VIII
, , , , , , . , ,
. -
, , , , . , . , . McGraw-Hill
- ITC
, . , , , - .
- . .
VIII
21.04.2009 13:09:4
cg_03.indd IX
. , . 5 8.
, . , . 100
, .
! , 1, .
:
, , .
,
. . , :
david.ferry@med.va.gov
IX
21.04.2009 13:09:4
cg_03.indd b:2
. 10-
Left Atrium
A-
SA node
Right Atrium
Left
Bundle
Branch
Intra-atrial Fibers
Left Anterior
Fascicle
Left Posterior
Fascicle
A-
AV Node
of His
Bundle
Left Ventricle
h
e Branc
Right Bundl
cle
Right Ventri
() .
1. A- .
2. - :
a. , .
. , , , .
.
1. .
2. .
3. .
III. ().
A. .
.
.
,
, .
.
1. .
2. PR - .
3. QRS .
4. .
5. U .
21.04.2009 13:09:4
cg_03.indd b:3
1.
QRS duration
QRS
QRS
QRS Complex
ST segmentST
T wave T
P wave
U wave U
PR
PR interval
QT interval QT
. D.
.
The
ECG
paper
1. 1.
on
1
The
ECG is recorded
moving paper
ruled
at 1 mm
intervals
with
darker
5
lines every
mm. 5 .
2. 2.
25 /,
At the standard
paper
speed of 25 mm/sec,
each
I mm
horizontally 3.
represents
40 ,
5
200 .
40 msec
and
each 5 mm
interval
200msec.
10 each
1
.
3.In
the vertical
dimension,
10 mm represents
0.1 mv of electrical
potential.
40
40 msec
200msec
200
1000
1000 msec
1
1.0 mv
IV.
IV. .
. A.
There
are six
standard leads
(the limb(
leads)
that depict
cardiac ),
.
electrical
events from
six angles
in the frontal
or vertical
plane.
.
B.
There
are six
precordial
leads (the
chest leads)
that
depict electrical
,
events in .
the horizontal plane.
21.04.2009 13:09:4
cg_03.indd b:4
. 10-
ELECTROCARDIOGRAPHIC LEADS
aVR
II
aVL
III
aVF
Modified from
Electrocardiography by
Stephen Scheidt
S. Scheidt.
BasicBasic
Electrocardiography;
.
21.04.2009 13:09:4
cg_03.indd b:5
1.
V.
. P, QRS T ,
.
1. ,
, , .
05
10
20
30
45
6080
60
50
30
40
21.04.2009 13:09:4
cg_03.indd b:6
. 10-
2.
80
10
40
3.
3. The
loop
can be superimposed
on the frontal
plane axis.
a.
.
QRS I. I
.
, .
21.04.2009 13:09:4
cg_03.indd b:7
1.
I Q
I
QRS
I
aVF
0 ( ), QRS
+- I, R aVF.
I
21.04.2009 13:09:4
cg_03.indd b:8
. 10-
III,
S
III R
III
III
axis
()
B. The
electrical
is the
sum of all the
vectors in
that plane.
.
1. The normal QRS axis is between 30 and +90.
1.
the
30QRS
+90
. is normal is to examine Leads
2. An
easy
way to determine
axis
2.
,
,
I and aVF, and, if necessary, Lead II.
I VF , , II.
21.04.2009 13:09:4
cg_03.indd b:9
1.
QRS aVF,
aVF, ,
QRS
I,
I, ,
60
,
QRS aVF,
aVF, ,
QRS
I,
I, ,
60
I
21.04.2009 13:09:4
10
. 10-
QRS I,
I, ,
,
120
QRS aVF,
aVF, ,
QRS I,
I,
,
QRS
I,
I, ,
cg_03.indd b:10
220
21.04.2009 13:09:4
cg_03.indd b:11
1.
11
0 30
II
,
20
II
II
3.
.
3. Summary
and examples
of QRS axes.
Normal
Normal
Left Axis
Deviation
Right Axis
Deviation
Right Superior
Axis Deviation
Lead I
Lead aVF
aVF
Lead II II
21.04.2009 13:09:4
cg_03.indd b:12
. QRS I, aVF.
1-01
12
. 10-
21.04.2009 13:09:4
cg_03.indd b:13
1-02
1.
13
21.04.2009 13:09:5
cg_03.indd b:17
1.
.
17
, .
C.
The chest leads are constructed similarly from the vector loop viewed in
the horizontal plane.
21.04.2009 13:09:5
cg_03.indd b:18
18
. 10-
.
.
D. The P wave axis
1. (1575) - 1. The normal P wave axis is quite restricted in its range (1575)
- .
because of the location of the SA node in the upper right corner of
2. I aVF P .
2.
II
aVF
VI. Determining
heart.
rate
VI.
A. , ()
A. If the rhythm
is regular, the rate can be determined by the distance
.
between
complexes.
, 6 10.
B.
VII. .
. :
1. .
VII. Sinus rhythm
2. .
3. A.
60 100 ./.
Sinus rhythm is defined as:
. ,
P QRS, 1.
Regularly
recurring P waves of the same morphology
.
2.
3.
B.
21.04.2009 13:09:5
cg_03.indd b:19
5
, 60 ./
6
, 50 ./
2
, 150 ./
3
, 100 ./
, 6
10 ( 9 6 , 90 ./)
4
, 100 ./
, 300 ./
1.
19
21.04.2009 13:09:5
cg_03.indd b:49
2.
.
49
QRS
I V6
I V6
I V6
I V6
010
2040
4060
6080
21.04.2009 13:10:2
cg_03.indd b:97
3. - -
97
3-013-01
DAY
II
AH V
II ( 400 )
PR, - 1- . AH V.
-.
21.04.2009 13:11:3
cg_03.indd b:107
3. - -
107
IV. -.
. , -,
-; - 1- , - 2- II -
3- ( 3-10, 3-11,
3-12).
- 2- I P PR.
( 3-13, 3-14).
-
. , -
.
-
.
V.
21.04.2009 13:11:4
cg_03.indd b:157
4.
157
III. .
R,
ST
13-
Q
,
R,
23
Q, ST ST
,
,
T
T
1-
Q,
c R
- Q ,
R,
T
21.04.2009 13:12:5
cg_03.indd b:158
158
. 10-
21.04.2009 13:12:5
cg_03.indd b:334
334
. 10-
V1V2, V6?
-?
RS > 100 ?
- RS
?
QRS (> 120 )
-.
1. - .
2. - 20 %
.
3. -:
. ,
.
. II, III,
aVF, V2.
. V3R .
. S5 ( )
, I .
21.04.2009 13:18:1
cg_03.indd b:335
8.
335
RS = 150
RS = 70
.
.
.
- .
- ,
.
21.04.2009 13:18:1
cg_03.indd b:466
466
. 10-
III. .
.
( ).
.
.
.
1. , .
2. ( 10-16).
.
1. , 1 .
2. ,
( 10-17).
21.04.2009 13:22:2