Electrocardiogram

Second Affiliated Hospital of

Chongqing Medical University

cardiology
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qizhou
1

Arrhythmias
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Nine escape and escape rhythm

High pacemaker lesions or suppressed the emergence of arrest
or rhythm slowed down, or when due to conduction
disturbances (eg atrioventricular block, etc.) or other causes
long interval (eg after premature compensatory pause) as a
protective measures, low pacemaker will send a series of
impulse or excitement said atrial or ventricular escape (occurs
only 1 to 2) or escape rhythm (3 or more consecutive).
Press Sites of different points: atrial, atrioventricular junction
and ventricular escape. Its characteristic QRS complex similar
to each respective beats, the difference between the two is the
case of premature beats occurred early, active rhythm, and then
after a long escape intermittent, is a passive rhythm. In
atrioventricular junctional escape the most common, followed
by ventricular escape, room escape rare.
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 Nodal escape and escape rhythm

QRS complex was borderline pulse characteristics, the
frequency is generally 40 to 60 beats / min. More common in
sinus arrest or third degree atrioventricular block and so on.

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Section 3: atrial, ventricular

hypertrophy
Atrial hypertrophy
(A) Right atrial hypertrophy
1 limb leads p-wave amplitude
0.25mV

2 Pv1 0.15mv; if p wave was

the two-way amplitude arithmetic
and 0.2mV
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 Left atrial hypertrophy

P wave broadening
0.12 s
P wave broadening
bimodal peak from 0.04s
P wave terminal force
(PtfV1) absolute value
0.04mm s

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mitral

V1

mms
6

 Ventricular hypertrophy
ECG diagnostic criteria for left ventricular hypertrophy
1 left ventricular high voltage performance
(1) RV5 (or V6)> 2.5mv
On the basis
Having
left
ventricular
high
Or RV5 + SV1> 4.0mv (M) 3.5mv (female)
(2) X> 1.5mv
of left ventricular
voltage,
but 1.2mv
also has the ST(3) RaVL>
4) RaVF> 2.0mv
high voltage on an
T changes
known as left
(5) RI + Sare
> 2.5mv
index plus any
2 left axis deviation
ventricular
hypertrophy
3 QRS time> 0.10s, but generally <0.12s
other, you can be
4 ST-T changes: the R-wave lead-based T wave flat, two-way or upside
with
strain.
down,
and may be associated with ST-segment depression.

diagnosed.

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 Right ventricular hypertrophy ECG

diagnostic criteria
4 aVR lead R / S or R / Q1 (or R0.5mV);

1 3 ;
5 V1 leads to qr or qR wave;

V1
V5leads
1.05mV;
ST-T changes:
right chest
(V1) T-wave two-way, upside down,
ST segment depression. Above ECG changes accompanied by
ST-T changes called right ventricular hypertrophy with strain

90
V1

V1

V1
aVR

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aVR

Exercise

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Right ventricular hypertrophy

with strain

 Both atria hypertrophy and bilateral

ventricular hypertrophy
1 Vector sides cancel each other out, abnormal ECG
is not displayed;
2 ECG only one side of the mast of performance;
3 ECG sides mast performance

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Section IV myocardial ischemia and

ST-T changes

1 Ischemic ECG changes
2

(1) subendocardial myocardial ischemia,

ischemic area for leads appear tall T wave

(2) under the epicardial myocardial ischemia,

ischemic area for leads appear inverted T
waves

Injury Blood ECG changes

ST segment depression and ST-segment

elevation

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 Clinical Significance
1 myocardial ischemia ECG showed ST segment can only be changed or T
wave changes, can also occur ST-T changes, about 10% of coronary heart
disease patients without ECG ST-T changes in angina attack
2 continuous and relatively constant ischemic ST segment depression (ST
segment horizontal or oblique down 0.05mV) and / or T wave flat, twoway positive and negative inversion, common in chronic coronary
insufficiency
3 crown T (inverted deep sharp, two-limb symmetrical T-wave) reflected
lower epicardial or transmural myocardial ischemia and myocardial
ischemia, myocardial infarction also seen in subendocardial and transmural
myocardial infarction
4 variant angina symptoms were often accompanied by ST-segment
elevation and T-wave towering

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 Differential Diagnosis
In addition to causing heart disease, as well as ST-T changes the
following diseases:
1 cardiomyopathy, myocarditis, valvular heart disease, pericarditis
and other cardiovascular disease
2 hypokalemia, potassium and other electrolyte imbalance
3 of drugs (such as digitalis, quinidine, etc.) influence
4 autonomic nervous system dysregulation
5 ventricular hypertrophy, bundle branch block, WPW syndrome
can cause secondary ST-T changes

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Section5 Myocardial Infarction

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 Graphics and basic mechanisms:

animal experiments
ischemia
Comparison

Clinching

Clinching

Loose clamp

Clinching

injury

Loose clamp

necrosis

Comparison

Clinching
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Clinching

Loose clamp
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A basic pattern and mechanism? 1 ischemic

changes T wave abnormalities
Myocardial ischemia, myocardial aerobic metabolism to reduce
energy supply reduced to prolonged repolarization, especially the third
phase delay, resulting in Q-T extended.

Epicardial myocardial
ischemia:
Faced with
ischemic area

Repolarization

epicardial leads T
wave inversion.
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A basic pattern and mechanism? 1 ischemic

changes T wave abnormalities
Endocardial
myocardial ischemia

Faced
with epicardial
leads appear tall
upright T wave on the
electrocardiogram.

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 Basic graphics and mechanism

1 ischemic changes T wave abnormalities?
2 Injury changes ST segment deviation
When epicardial myocardial injury, the face of the outer
membrane surface area of the lead S-T segment elevation
convex upward, forming a single curve was significantly
elevated (mono-phasic curve). S-T segment elevation
mechanism available "injury current" theory or "blocked
depolarization wave" theory to explain.
damage

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 Injury current theory

Resting

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Depolarization

After repolarization

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 Depolarization wave
hindered doctrine
Resting

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Depolarization

After repolarization

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 Necrotic changes pathologic Q waves

After departing from the
vector to form a myocardial
necrosis necrotic area. It leads
the outer membrane surface
of the necrotic area appears
abnormal Q wave or QS
wave.

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SIGNIFICANCE OF THREE ECG waveform

Ischemic T wave changes:
The most common, but poor
diagnostic specificity.
Injury changes: In
addition seen in myocardial
infarction, but also appeared in
severe angina (variation angina,
acute pericarditis, early
repolarization syndrome).
Necrotic changes: the most
reliable diagnosis of myocardial
infarction.
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2 Graphic evolution of myocardial infarction and staging

Comparison
Early
(Hyperacute)
MI
occurred
after a few
minutes or
hours
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Acute phase
Start hours or days
after myocardial
infarction, for
several weeks

Near term
(subacute)
Sub-acute phase
of myocardial
infarction
occurs after a
few weeks to
several months

Of old

It appears in
the March-June
after
myocardial
infarction
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 Graphic evolution of myocardial infarction

and staging

Comparison
Early
(Hyperacute)

S-T segment
elevation, Twave towering,
non-Q-wave
formation.
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Acute phase
Pathologic Q waves,
ST elevation arched,
and then gradually
decline, may be
associated with the
terminal portion of
the T-wave
inversion.

Near term
(subacute)
Q wave
persists, ST
returned to
baseline, T
inversion
symmetry,
gradually
deepened,
then faded

Of old
Q wave
persists, T
wave has
returned to
normal, or is
still upside
down but
stopped
evolving.
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 Diagnosis of myocardial
infarction
V1 V2 V3 Anteroseptal
V3 V4 V5 (limitations) of the front wall
aVF lower wall
aVL V5 V6 V7 front wall
V7 V8 V9 posterior wall

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 Graphic change atypical myocardial

infarction
1, non-transmural myocardial infarction:
subendocardial myocardial infarction, also known
as: acute manifestations of ST segment depression,
non-Q-wave appeared, emerged after coronary T
wave evolution with Q-wave myocardial infarction.

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 Graphic change atypical myocardial

infarction

2, myocardial infarction, ventricular

aneurysm: ST segment elevation persists
for six months or more

3, right ventricular myocardial infarction:

ECG manifestations V3R to V6R leads ST
segment elevation 0.1mv.
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5 diagnosis of myocardial
infarction
The need for regular and positioning

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Acute anterior
myocardial infarction

28

diagnosis of myocardial
infarction

Acute inferior wall myocardial

infarction

The need for regular and positioning

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diagnosis of myocardial
infarction

Sub-acute inferior wall

myocardial infarction

The need for regular and positioning

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 Differential Diagnosis
1

ST segment elevation alone can also be found early repolarization

syndrome, pericarditis, variant angina, without the Q wave and ST-T
dynamic evolution

2 infection, cerebral vascular accident, also a brief "QS" or "Q"

wave, but the lack of typical evolution

lead can occur when the 3-bit Q-wave heart cross, but lead
normal

4 left ventricular hypertrophy, left bundle branch block, V1, V2 lead

may be in the QS

5 right ventricular hypertrophy, cardiomyopathy may also occur Q

wave

Acute myocardial infarction characteristic changes: pathological

Q waves, ST segment elevation and inverted T wave three
simultaneously, and there is a certain evolution
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classroom exercises
ECG and diagnostics based on?

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classroom exercises
ECG and diagnostics based on?

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classroom exercises
ECG and diagnostics based on?

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classroom exercises
ECG and diagnostics based on?

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classroom exercises
ECG and diagnostics based on?

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