basic cardiac electrophysiology and ecg concepts_20120916_南區
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Basic Cardiac Electrophysiology and ECG Concepts
李坤泰 醫師
高雄醫學大學附設中和紀念醫院心臟血管中心
Taiwan Heart Rhythm Society - Allied Professional Education Program2012/09/16Kaohsiung
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Ion Channels
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Measurement of Action Potential
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Action Potential
Rapid depolarization
Early repolarizationPlateau
Final rapid repolarization
Resting membrane potential
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Action Potential in Different Cells
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Electrical Recording in Heart
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Conduction System
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Willem Einthoven (Semarang, 21 May 1860 – Leiden, 29 September 1927) was a Dutch doctor and physiologist. He invented the first practical electrocardiogram (ECG or EKG) in 1903 and received the Nobel Prize in Medicine in 1924 for it.[1]
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向量
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心電圖記錄紙
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為何須 12 導極 ?
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12 導極
Lead I=L-R Lead II=F-R Lead III=F-L
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Einthoven Triangle
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Unipolar Leads
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胸 前 導
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12 導極
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波的定義
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波的定義• P 波 : 心房去極化 ; 高寬不超過 2.5mm• PR 區間 : 心房去極化到心室去極化開始 ;
包含房室結傳導延遲時間 ;0.12-0.2 秒• QRS 波組 : 心室去極化 ;0.06-0.1 秒• ST 段 : 心室去極化結束到心室再極化開始• T 波 : 心室再極化 • QT 區間 : 心室去極化開始到心室再極化結
束 QTc: QT/√RR; ( 女 > 男 )<0.44 秒
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竇性節律 (Sinus Rhythm)
Lead II 為正波
Lead aVR 為負波
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心率
口訣 :300,150,100,75,60,50
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Calculation of Axis
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Calculation of Axis
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心軸 (Axis)
-30°
110°
左偏軸
右偏軸
Lead I
Lead aVF
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Vector of Ventricular Depolarization
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Information from ECG
• Structure abnormality• Arrhythmias• CAD• Electrolyte imbalance• Effects of Medications
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心房擴大 (Atrial Enlargement)
右心房擴大 :P 波振幅增大
左心房擴大 :P 波寬度增大
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左心室肥厚
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左心室肥厚
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右心室肥厚
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心室肥大
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左 , 右束支傳導阻滯
RBBB LBBB
Complete block: QRS>0.12 sec
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Serial changes of ECG in AMI
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高血鉀
8.6 mEq/L
5.8 mEq/L
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低血鉀
1.5 mEq/L
3.7 mEq/L
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高 , 低血鈣
QT 延長
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低體溫Osborn wave
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毛地黃效應
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Thanks For Your Attention !!