ECG基础知识课件

心电图基础知识*心脏及电生理概况*心电图及其导联内容*心电图形成学说*分析正常和异常心电图WelcometoIndicationsandModeSelection,acoursemoduleinCorePace.TheIndicationsandModeSelectionmoduleaddressesestablishedandnewindicationforpacemakerimplantation.Italsoprovidesguidanceinchoosingtheappropriatemodeforoptimalpacingtherapy.心脏概述 心脏是通过心肌节律性地收缩和舒张，使血液循环流动的动力装置。 心肌的收缩反应是由肌膜的兴奋和特殊的传导系统产生并传播的。 心肌细胞的生物电活动，是心肌兴奋和传导的基础。Uponcompletionofthismodule,theparticipantshouldbeabletoaccomplishtheaboveobjectives.心脏各腔形态结构Uponcompletionofthismodule,theparticipantshouldbeabletoaccomplishtheaboveobjectives.心脏传导系统 心脏传导系统是由特殊分化的心肌细胞构成，产生并维持心脏正常的节律，保证心房、心室收缩和舒张的协调。 心脏传导系统包括窦房结、结间束、房室结、希氏束、束支、蒲肯野氏纤维。Uponcompletionofthismodule,theparticipantshouldbeabletoaccomplishtheaboveobjectives.窦房结窦房结是正常心脏兴奋的起源，位于右心房的上腔静脉入口处、界嵴上方的心外膜下1厘米，呈扁椭圆形。Initiationofthecardiaccyclenormallybeginswithinitiationoftheimpulseatthesinoatrial(SA)node.Aresultingwaveofdepolarizationpassesthroughtherightandleftatria,whichproducesthePwaveonthesurfaceECGandstimulatesatrialcontraction.结间束结间束是心房内联系窦房结与房室结的特殊传导纤维。结间束分为前结间束、中结间束、后结间束。Initiationofthecardiaccyclenormallybeginswithinitiationoftheimpulseatthesinoatrial(SA)node.Aresultingwaveofdepolarizationpassesthroughtherightandleftatria,whichproducesthePwaveonthesurfaceECGandstimulatesatrialcontraction.房室结房室结是心房与心室之间激动传导的连接部。Followingactivationoftheatria,theimpulseproceedstotheatrioventricular(AV)node,whichistheonlynormalconductionpathwaybetweentheatriaandtheventricles.TheAVnodeslowsimpulseconductionwhichallowstimeforcontractionoftheatriaandthepumpingofbloodfromtheatriatotheventriclespriortoventricularcontraction.ConductiontimethroughtheAVnodeaccountsformostofthedurationofthePRinterval.房室束房室束又称希氏束，是心房与心室间正常传导激动的唯一途径。JustbelowtheAVnode,theimpulsepassesthroughthebundleofHis.AsmallportionofthelastpartofthePRintervalisrepresentedbytheconductiontimethroughthebundleofHis.束支LBB（左后束支）LBB（左前束支）RBB（右束支）AftertheimpulsepassesthroughthebundleofHis,itproceedsthroughtheleftandrightbundlebranches.AsmallportionofthelastpartofthePRintervalisrepresentedbytheconductiontimethroughthebundlebranches.心肌细胞内外电位差的测定心肌细胞的膜电位为-80~-90mv静止状态下心肌细胞内外离子分布细胞内外离子比例：K38/1，Na1/36心肌细胞的动作电位Phase1Phase2Phase3Phase4Phase0excitationthresholdTimeVoltage(mV)200-70-90离子运动去极化0&1复极化3静息4Na+Na+Ca++K+K+K+Ca+Na+Actionpotentialisthecycleofelectricalactivityinamyocardialcell.Ithasthreegeneralphases.Depolarizationisthestimulationphase.Sodiumionsrushintothecell,creatingapositivechargeandastrongelectriccurrent(voltagespikeonthegraph).Whenonecelldepolarizes,theadjacentcellsarestimulatedtodepolarize.Thus,aheartcontractionisawaveofpositiveelectricalchargesmovingthroughthemyocardium.Repolarizationistherecoveryphase.Ionsreturntotheirstartingpoint,andthemyocardialcelltoitsnegatively-chargedstate.Duringthistime,thecelldoesnotrespondtostimuli(itdoesnotdepolarize)andissaidtoberefractory.Restingisthephaseofelectricalstability.Duringtherestingphase,theinsideofacellhasanegativechargeandnoelectricalimpulsesareconducted.Somemyocardialcells(pacemakercells)donotrest.Ionsleakoutandgraduallyincreasetheinternalvoltageofthecell.Whenthevoltageishighenough(atitsthreshold),thenextdepolarizationwavebegins.Thisiscalledautomaticity,theabilityofthenormalhearttodepolarizespontaneouslyatregularintervals.NotesThethreephasesofelectricalactivityinthemyocardialcellaredepolarizationrepolarization,andrestingpotential.心肌细胞的生物电现象 静息状态：细胞膜两侧呈极化状态，膜内电位比膜外低90mv。 除极过程：在1～2ms内，由于外来刺激，膜内电位由－90mv上升至＋30mv,即膜的极化倒转。 复极过程：细胞在除极后，经过4个阶段，恢复至静息状态。 机制：离子在膜两侧浓度的不均匀，驱动相应离子经膜的特殊离子通道跨膜扩散。Uponcompletionofthismodule,theparticipantshouldbeabletoaccomplishtheaboveobjectives.心电传导途径Anelectricalimpulsestartsatthesinoatrialnode,pausesattheatrioventricularnode,thenproceedsrapidlyalongtheconductionpathwaytotheventricles.Thesinoatrial(SA)nodeisatthejunctionoftherightatriumandsuperiorvenacava.Itisaclusterofcellsthatgenerateselectricalimpulsesonitsownatarateneededtopumpsufficientbloodtothebody.Anelectricalimpulseproceedsoutwardfromthesinoatrialnode,producingadepolarizationwaveandatrialcontraction.Theatrioventricular(AV)nodeisinthelowerportionoftherightatrium,neartheventricularseptum.Whenadepolarizationwavereachesthisjunction,thereisaslightpause.Thisgivestheatriatimetocompletelycontractandfilltheventricleswithblood.Thedelaymechanismprovidesatrioventricularsynchrony.TheHisbundledescendsintotheventricularseptum,dividesintobranches,andterminatesinPurkinjefibers,whichpenetratetheventricularmyocardium.Afterleavingtheatrioventricularnode,electricalimpulsestravelrapidlyalongthesefibers,producingstrongventricularcontractionsandtheforcefulexpulsionofbloodfromtheheart.NotesTheconductionsystemcontrolsthespeedandrhythmofaheartcontraction.体 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 心电图的形成 心电图是心脏的电量变化，通过人体导电组织和体液，在身体表面的反映。 心电图是将测量电极放置在人体表面的一定部位，记录出的心脏电活动的表现。 心电图反映心脏兴奋的产生、传导和恢复过程中的生物电变化，与心脏的机械收缩活动无直接关系。Uponcompletionofthismodule,theparticipantshouldbeabletoaccomplishtheaboveobjectives.典型心电图测量系统电极导联线测量主机Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.心电图机器构造12导联心电图导联体系 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 导联 加压肢体导联 胸壁导联Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.标准导联 导联I：左手正极,右手负极Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.标准导联导联Ⅱ：左足正极,右手负极Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.标准导联导联Ⅲ：左足正极,左手负极Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.加压单极肢体导联aVR导联aVL导联aVF导联Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.胸导联胸导联电极位置Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.额面的导联Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.横面的导联Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.横面的导联Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.心脏的电激动和心电图波形的对应关系心脏的不应期正常的心脏功能窦房结Initiationofthecardiaccyclenormallybeginswithinitiationoftheimpulseatthesinoatrial(SA)node.Aresultingwaveofdepolarizationpassesthroughtherightandleftatria,whichproducesthePwaveonthesurfaceECGandstimulatesatrialcontraction.P波 反映左右心房的去极化过程 波形小而圆钝，历时0.08~0.11S，波幅不超过0.25mv 各导联P波的形态 aVR－倒置,aVF－绝大多数直立 aVL－有时直立，有时倒置 V1、V2－可能直立，可能双向 其它胸导联－小而直立Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.正常的心脏功能房室结Followingactivationoftheatria,theimpulseproceedstotheatrioventricular(AV)node,whichistheonlynormalconductionpathwaybetweentheatriaandtheventricles.TheAVnodeslowsimpulseconductionwhichallowstimeforcontractionoftheatriaandthepumpingofbloodfromtheatriatotheventriclespriortoventricularcontraction.ConductiontimethroughtheAVnodeaccountsformostofthedurationofthePRinterval.正常的心脏功能希氏束JustbelowtheAVnode,theimpulsepassesthroughthebundleofHis.AsmallportionofthelastpartofthePRintervalisrepresentedbytheconductiontimethroughthebundleofHis.正常的心脏功能左束支左后分支左前分支右束支AftertheimpulsepassesthroughthebundleofHis,itproceedsthroughtheleftandrightbundlebranches.AsmallportionofthelastpartofthePRintervalisrepresentedbytheconductiontimethroughthebundlebranches.P－R间期 12导联中最先P波开始至下一组最先出现QRS波群开始的时间 正常窦性心律 P－R间期介于0.12~0.20sWewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.正常的心脏功能浦肯野纤维NexttheimpulsepassesthroughthePurkinjefibers(interlacingfibersofmodifiedcardiacmuscle).AsmallportionofthelastpartofthePRintervalisrepresentedbytheconductiontimethroughthePurkinjesystem.正常的心脏功能TheimpulsepassesquicklythroughthebundleofHis,theleftandrightbundlebranches,andthePurkinjefibersleadingtodepolarizationandcontractionoftheventricles.TheQRScomplexontheECGrepresentsthedepolarizationoftheventricularmusclemass.QRS波 左右两心室去极化过程的电位变化 第一个向下的波为Q波，而后高尖向上的波是R波，最后向下的波是S波。 幅度较小用小写，如q、r、s；幅度较大用大写，如Q、R、S QRS波历时0.06~0.12s。Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.QRS波形态 aVR导联的QRS波几乎完全是向下的，如rS、rSr’或Qr型 aVL、aVF变化大Wewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.正常的心脏功能TheTwaveontheECGrepresentstherepolarizationandrelaxationoftheventricles.AtrialrepolarizationandrelaxationoccursduringtheQRScomplex.T波 左右两心室复极过程中的电位变化 波幅一般为0.1~0.8mvWewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.心脏的电激动和心电图波形的对应关系心电图记录纸 纵轴代表电压幅度，每小格相当于0.1mv 横轴代表时间。如记录纸的移动速度为25mm/s，每小格相当于0.04S间期常以毫秒表示 1毫秒=1/1,000秒1mm=0.1mv0.5mvPartofunderstandingtimingintervalsrequiresanacquaintancewithmilliseconds.Manyhealthcareprofessionalsareaccustomedtomeasuringintervalsinseconds.Timingintervalsinpacing,however,arealwaysmeasuredinmilliseconds.Theexceptiontothisislowerandupperrates,whichareusuallyexpressedinbeatsperminute/bpm.Thegraphicaboveshowsintervalsinmillisecondsofanormalsinusbeat.Theentiregraphrepresents1000millisecondsoronesecondoftime.ThesmallestboxontheECGrepresents40millisecondsor.04seconds.Themediumboxrepresents200millisecondsor.2seconds.电压的测量正向波的振幅从等电位线上缘算起到波峰的顶点。负向波的振幅从等电位线下缘算起到波底，等电位线应以T-P段为准，因该段时间内心脏无电流活动。心率 心率是心电图P－P或R－R的距离 单位：次/分钟（bpm） 心率计算方法 若间距为4个大格和1个小格 0.2×4+0.04×1=0.84s 心率为60/0.84=71.4，即71bpmWewillstartbydiscussingnormalimpulsefomationandthenmoveintocommonconductiondisturbances.AsabnormalconductionisdiscussedwewillcorrelatetheAHA/ACCguidelinesforpacemakerimplantationrelatedtothatparticularrhythm.频率与间期的相互换算 频率换算成间期（毫秒）： 60,000/频率(bpm)=间期（毫秒） 例如：60,000/100bpm=600毫秒 间期换算成频率(bpm): 60,000/间期（毫秒）=频率(bpm) 例如：60,000/500毫秒=120bpmThewaytoconvertbpmtomillisecondsistodividetherateinto60,000(thenumberofmillisecondsinoneminute).Convertinganintervalinmillisecondstoarateinbpmisdonebydividing60,000bythemillisecondinterval.心律 正常心律： 在一段时间内心率大致匀齐相等，有P、QRS、T波 心脏搏动由窦房结控制Thewaytoconvertbpmtomillisecondsistodividetherateinto60,000(thenumberofmillisecondsinoneminute).Convertinganintervalinmillisecondstoarateinbpmisdonebydividing60,000bythemillisecondinterval.正常的窦房结节律 心房率：60-100bpm PR间期：120-200毫秒（0.12-0.20秒） QRS间期：60-100毫秒（0.06-0.10秒） QT间期：360-440毫秒（0.36-0.44秒）正常的窦房结节律窦性心动过速 窦房结频率持续超过100bpm，参数包括： P波形态正常 PR间期在0.12~0.20s以内SinusbradycardiaoccurswhentheSAnodefiresataslow(<60bpm)rate.窦性心动过缓 窦房结频率持续缓慢，此波形上的参数包括： P波频率在60bpm以下 PR间期在0.12s以上SinusbradycardiaoccurswhentheSAnodefiresataslow(<60bpm)rate.窦性心律不齐 包括： P波间隔不匀齐，P－P间隔相互差异在0.12s以上。 PR间期在0.12~0.20s之内。SinusbradycardiaoccurswhentheSAnodefiresataslow(<60bpm)rate.窦性停搏 窦房结放电故障导致心房去极化缺乏和周期性心室心搏停止 频率=75bpm PR间期=180毫秒（0.18秒） 2.8秒停搏SinusarrestoccurswhenthereisapauseintherateatwhichtheSAnodefires.Withsinusarrestthereisnorelationshipbetweenthepauseandthebasiccyclelength.慢快综合征 要点 在窦性心动过缓中，有阵发性心房颤动、心房扑动、房性心动过速、交界性或室性心动过速SAexitblockoccurswhentheSAnodefires,buttheimpulsedoesnotconducttothepathwaysthatcausetheatriumtocontract.InSAexitblockthereisarelationshipbetweenthepatternandthebasiccyclelength(becausethesinusnodecontinuestofireregularly),approximatelytwo,butlesscommonlythreeorfourtimesthenormalP-Pinterval.房室传导阻滞 I度房室阻滞 II度房室阻滞 Mobitz类型I和II III度房室阻滞 双束支和三束支阻滞AVblockcanmanifestinthefollowingwayslistedabove.Iº房室传导阻滞 房室传导延迟，而且PR间期延长（>200毫秒或0.2秒） 心房率正常，心室率正常，节律规则 QRS正常 P波存在 PR间期异常AVblockcanbedescribedasaprolongationofthePRinterval.ThePRintervalistheintervalfromtheonsetofthePwavetotheonsetoftheQRScomplex.First-degreeAVblockisdefinedbyaPRintervalgreaterthan0.20seconds(200msec).First-degreeAVblockcanbethoughtofasadelayinAVconduction,buteachatrialsignalisconductedtotheventricles(1:1ratio).IIºI型房室传导阻滞（莫氏I型/文氏现象） PR间期逐渐延长直到心室跳动下降 心室率不规律，心房率正常 心房节律规则，心室节律不规则 QRS正常 P存在 PR间期=逐渐延长直到P波不能传导Second-degreeAVblockischaracterizedbyintermittentfailureofatrialdepolarizationstoreachtheventricle.Therearetwopatternsofsecond-degreeAVblock.Thefirst,TypeI,ismarkedbyprogressiveprolongationofthePRintervalincyclesprecedingadroppedbeat.ThisisalsoreferredtoasWenckebachorMobitzTypeIblock.TheAVnodeismostcommonlythesiteofMobitzIblock.TheQRSdurationisusuallynormal.IIºII型房室传导阻滞（莫氏II型） 有规律减少的心室跳动 2:1阻滞（2个P波至1个QRS复合波） 心室率：心房率=1：2或1：3 心室节律、心房节律规则 QRS形态正常、QRS有阻断 PR正常MobitzTypeIIsecond-degreeAVblockreferstointermittentdroppedbeatsprecededbyconstantPRintervals.TodifferentiateMobitzIfromMobitzII,notethePRintervalinthebeatsprecedingandfollowingthedroppedbeat.IfadifferencebetweenthesetwoPRintervalsismorethan0.02seconds(20msec),thenitisMobitzI.Ifthedifferenceislessthan0.02seconds,thenitisMobitzII.Theinfranodal(Hisbundle)tissueismostcommonlythesiteofMobitzIIblock.Note:Advancedsecond-degreeblockreferstotheblockoftwoormoreconsecutivePwaves(i.e.,3:1block).IIIº房室传导阻滞 从心房到心室没有脉冲传导 心室率20－60bpm QRS形态正常或宽大畸形 P波(或F/f波)存在，心房率可能正常,PP间隔规则 PR间期不确定Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.双束支阻滞右束支阻滞和左后半支传导阻滞Bifascicularblockisdefinedasoneofthefollowing: Rightbundlebranchblockandleftposteriorhemiblock(highlightedinred) Rightbundlebranchblockandleftanteriorhemiblock CompleteleftbundlebranchblockBifascicularblockismarkedbyprolongedQRS(>120msor.12secondsorlonger).双束支阻滞右束支阻滞和左前半传导支阻滞Bifascicularblock Rightbundlebranchblockandleftanteriorhemiblock(highlightedinredandyellow)双束支阻滞完全左束支阻滞Bifascicularblock Completeleftbundlebranchblock(highlightedred)三束支阻滞 右束支的完全阻滞和左束支的两部分的完全和不完全阻滞TrifascicularBlockhastheappearanceofAVnodalblock.Combinationsthatconstitutetrifascicularblockare: Rightbundlebranchblock,completeleftanteriorfascicularblockandcompleteleftposteriorfascicularblock. Combinationofcompleteblockinoneortwosubdivisionsofthecommonbundleandincompleteblockinoneortwosubdivisions.束支阻滞的心电图波形房性早搏 异位心房起搏早于自窦房结期望起搏的时间，传导正常 心率：心室、心房正常 节律：除早搏外均正常 QRS：正常 P波：早搏可有不同形状 PR：正常、早搏可有不同Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.阵发性房性心动过速 心房内异位自律性心动过速和心房内折返性心动过速 心率：150～250bpm 节律：正常 QRS：正常（60～120ms） P波：存在，通常与窦性P波不同 PR：可能缩短Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.心房扑动 心房内存在一个微折返环，使整个心房大范围折返 没有P波，代之以形态、大小规则的，间距、振幅相等的F波，其频率为250～350bpm。F波宽大，呈锯齿形，其升支短，降支长，无等电位线，一般在Ⅱ、Ⅲ、aVF导联最清楚 心室率决定于房室传导比例(可能为2：1~7：1，或慢而不规则)Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.心房颤动心房内存在数量不等的微折返环，造成心房肌纤维作不规则、不协调、快速而微弱的蠕动，心室的激动是由部分心房激动下传引起的。心房颤动 没有P波，代之以大小不等、形态不一、间距不均的f波 F波的频率为350～600bpm 心室率不齐 QRS波间距不等，电压和形态有变异Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.阵发性交界性心动过速 房室交界区有短暂的、反复的自主性增强的快速心律 心率：150～250bpm 节律：正常 QRS：正常 P波：逆行型P波，QRS之前或之后 PR：<120msThird-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.室性早搏 室性早搏异位节奏点位于心室 期前出现QRST波群，前面无P波 期前的QRST形状多样，QRS多在0.12s以上 室性早搏后往往有一个完全性代偿间歇Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.室速 连续3个以上室性早搏形成的异位心律 心率：心室150～250bpm 节律：规则或轻微不规则 QRS：增宽>120ms P波：无 PR：无Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.室扑 快速心室异位心律 心率：心室250～350bpm，呈ju齿波 节律：规则 QRS：增宽>120ms P波：无 PR：无Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(ajunctionalrhythm)and<40bpmifinitiatedbythePurkinjefibers.室颤 心室多异位快速心律 心率：心室350～500bpm 节律：无规则 QRS：不定 P波：无 PR：无Third-degreeAVblockisalsoreferredtoascompleteheartblock.ItischaracterizedbyacompletedissociationbetweenPwavesandQRScomplexes.TheQRScomplexesarenotcausedbyconductionofthePwavesthroughtheAVnodetotheventricles,butrathertheQRSisinitiatedatasitebelowtheAVnode(suchasintheHisbundleorthePurkinjefibers).This揺scaperhythm?isnormally40?0bpmifinitiatedbytheHisbundle(aj