electrocardiography (ecg, ekg). a typical electrocardiogram: important deflections and intervals
TRANSCRIPT
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Electrocardiography (ECG, EKG)
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A typical electrocardiogram:important deflections and intervals
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Cardiac Action Potential 과 EKG 와의 관계
P: atrial depolarization
QRS: ventricular depol.
T: ventricular repol.
PR interval: AV conduction timeQT interval: APD
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세포내 기록과 세포외 기록과의 관계
기록전극으로 다가오는depolarization
positive deflection
기록전극에서 멀어지는depolarization
negative deflection
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T-wave 의 해석
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개구리 심장의 기저부 가온 a: 정상 b: 기저부 가온
개구리 심장의 심첨부 가온 a: 정상 b,c: 심첨부 가온 d: 회복
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Electrical heterogeneity within the ventricular wall
Epicardial cell
M cell
Endocardial cell
-Smaller IKs
-Larger late INa
-Larger INa/Ca
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Electrical heterogeneity within the ventricular wall
Epicardial cell
M cell
Endocardial cell
-Smaller IKs
-Larger late INa
-Larger INa/Ca
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Long Q-T Syndrome
심전도상 QT 분절이 길어져 있고 심실빈맥 , 심실세동 , 실신 (syncope), 급사 등을 유발하는 상염색체 우성 질환 . ( 특히 Torsade de pointes type의 부정맥 )
최근의 분자생물학적 연구에서 이 증후군의 유전자 돌연변이 종류가 밝혀지며 이들이 심근세포의 이온 통로를 encode 하는 유전자임이 밝혀짐 .
QT interval: APD
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Mutations in Long QT Syndrome
1) LQT-1: 11 번 염색체의 KvLQT1(KCNQ1):IKs
2) LQT-2: 7 번 염색체의 HERG :IKr
3) LQT-3: 3 번 염색체의 SCN5A :INa
4) LQT-4: 4 번 염색체 ( 유전자 확인 안됨 )
5) LQT-5: 21 번 염색체의 KCNE1(MinK): IKs
6) LQT-6: KCNE2(MiRP1): IKr
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후천성 LQT 증후군
항히스타민제 , 항생제 등에 의하여 발생
이들 약물들은 HERG 통로를 억제함이 밝혀지고 있어서 , 선천성 LQT 증후군 중의 한 형태와 후천성 LQT 증후군의 생리학적인 기전이 같음을 알게 되었다 .
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Ionic Mechanism of Delayed Repolarization in LQT
Na channel 의 Inactivation 장애 - 내향전류의 증가
K channels (IKr 과 IKs) 의 기형 - 외향전류의 감소
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Early Afterdepolarization
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Transmural dispersion of repolarization
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Electrical heterogeneity leads to phase 2 reentry:as a mechanism of extrasystolic activity
Epicardial cell
M cell
Endocardial cell
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Phase 2 reentry-initiated circus movement tachycardia
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EKG is an electrical “view” of three
dimensional structure
Use multiple leads
- Limb lead : standard augmented- Precordial lead : V1 - V6
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Standard Limb Lead
Einthoven’s triangle
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Limb Lead : Standard: Lead I, II, III (bipolar) Augmented: aVR, aVL, aVF (unipolar)
심장을 frontal plane 에서 봄
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저분극과 재분극이 일어나는 순서
각 시점에서의vector 방향
각 시점에서의EKG
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Mean Electrical Axis
Normal axis:
Right axis deviation
Left axis deviation
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Precordial Lead
심장을 transverse plane 에서 봄
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Transitional zone: 정상에서 V3, V4
V1, V2 로 이동 :Counterclockwise rotation
V5, V6 로 이동Clockwise rotation
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EKG reading
기록조건 : y-axis: 10 mm /1 mV x-axis: 25 mm /1 s
Reading:
1. Rate: normal/tachycardia/bradycardia2. Rhythm: normal/arrhythmia3. P wave <0.1 s, <2.5 mm4. P-R interval <0.2 s5. QRS complex <0.09 s, <35 mm6. ST segment: isoelectric/elevation/ depression 7. T-wave: normal/ inversion
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Pathophysiology of Diseases
1. Arrhythmia ( 부정맥 )
2. Ischemic Heart Disease ( 허혈성 심질환 )
3. Heart Failure ( 심부전 )
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Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
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First degree(PR interval>0.2 s
Second degree(2:1, 3:1, 3:2)
Third degree(complete)
AV block
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His bundle electrogram
A-H intervalH-V interval
His bundle activity
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Premature atrialdepolarization
Premature ventriculardepolarization
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Supraventricular tachycardia
Ventricular tachycardia
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Atrial fibrillation
Ventricular fibrillation