心電圖的診斷學

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翔

有了對於心電圖中PQRST等波的生理學概念後，建立在病理學的上，可以看懂這份判讀入門，期望提供醫學院學生快速判讀EKG的方法，

Health & Medicine

心臟肥大
心房肥大
左心房肥大 P波變寬且有切跡明顯的兩雙峰
右心房肥大 P波高尖，時間不變
心室肥大
左心室肥大
V1向下的波增加；V5向上的波增加
R V5+S V1＞男生4.0mV；女生3.5mV
右心室肥大
V1向上的波增加；V5向下的波增加
S V5+R V1>1.05mV（重症>1.2mV）
雙心室肥大
心律不整
衝動起源異常
竇性
竇性心律正常的心律
竇性心動過緩間格>5大格
竇性心動過速間格<3大格
竇性心律不齊多與呼吸有關，無臨床意義
停搏
異位起搏點（被動性）
逸搏與逸搏心律
房性
交界性
室性
早搏（早期收縮）
依原發部位區分
房性早搏（心房早搏）
交界性早搏（房室早搏）
室性早搏（心室早搏）
依照出現頻率區分
偶發性頻率＜5次/分
頻發性頻率>5次/分
多發性很少用這個詞於頻率上
依病變類型區分
功能性病變
因大腦皮層功能失調，導致自主神經功能紊亂而產生的一
系列臨床癥狀
器質性病變
多種原因引起機體某一器官或某一組織系統發生的疾病，
而造成該器官或組織系統永久性損害
依異位節律源的數量區分
單源性由單一異位節律源引起
多源性（多發性）由2個以上的異位節律源引起
依照規律性區分
二聯律（二重脈） 1正常+1早搏
三聯律（三重脈） 2正常+1早搏
依照早搏連續發生次數區分
聯發連續2個早搏
陣發性（短陣）連續≧3個的早搏
連續≧3個的早搏，即可稱為「心動過
速」；而心動過速在嚴重一點就是
「撲動」跟「顫動」了
心動過速連續≧3個的早搏
房性
交界性
室性
撲動與顫動
撲動規則性的Ｆ波
心房撲動
心室撲動
顫動不規則的f波
心房顫動
心室顫動
衝動傳導異常
生理性傳導障礙干擾與房室分離（包括心臟各部位）
病理性傳導障礙
竇房傳導阻滯
房內傳導阻滯
房室傳導阻滯
I度 P-R間期延長
II度
Mobitz Type I P-R Interval逐漸延長，QRS Complex會漏掉
Mobitz Type II P-R Interval的時間是保持恆定，QRS Complex會漏掉
III度 P Wave與QRS Complex相互無關，保持各自的節律
I度：雖然傳導變慢了，但是沒有衝動被遺漏
II度：不只傳導變慢了，衝動也會遺漏
III度：完全被阻斷
室內（束支）傳導阻滯
右束支傳導阻滯 V1有Rabbit Shape（Ｍ）；V6有Slurred S（Ｗ）
左束支傳導阻滯 V6有Rabbit Shape（Ｍ）；V1有QS或RS(W)
意外傳導
超長傳導
裂隙現象
維登斯基現象
捷徑傳導 WPW Syndrome QRS Wave前出現δ Wave
浮動主題

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心電圖的診斷學

1. 心臟肥大心房肥大左心房肥大 P波變寬且有切跡明顯的兩雙峰右心房肥大 P波高尖，時間不變心室肥大左心室肥大 V1向下的波增加；V5向上的波增加 R V5+S V1＞男生4.0mV；女生3.5mV 右心室肥大 V1向上的波增加；V5向下的波增加 S V5+R V1>1.05mV（重症>1.2mV）雙心室肥大心律不整衝動起源異常竇性竇性心律正常的心律竇性心動過緩間格>5大格竇性心動過速間格<3大格竇性心律不齊多與呼吸有關，無臨床意義停搏異位起搏點（被動性）逸搏與逸搏心律房性交界性室性早搏（早期收縮）依原發部位區分房性早搏（心房早搏）交界性早搏（房室早搏）室性早搏（心室早搏）依照出現頻率區分偶發性頻率＜5次/分頻發性頻率>5次/分多發性很少用這個詞於頻率上依病變類型區分功能性病變因大腦皮層功能失調，導致自主神經功能紊亂而產生的一系列臨床癥狀器質性病變多種原因引起機體某一器官或某一組織系統發生的疾病，而造成該器官或組織系統永久性損害依異位節律源的數量區分單源性由單一異位節律源引起多源性（多發性）由2個以上的異位節律源引起依照規律性區分二聯律（二重脈） 1正常+1早搏三聯律（三重脈） 2正常+1早搏依照早搏連續發生次數區分聯發連續2個早搏陣發性（短陣）連續≧3個的早搏連續≧3個的早搏，即可稱為「心動過速」；而心動過速在嚴重一點就是「撲動」跟「顫動」了心動過速連續≧3個的早搏房性交界性室性撲動與顫動撲動規則性的Ｆ波心房撲動心室撲動顫動不規則的f波心房顫動心室顫動衝動傳導異常生理性傳導障礙干擾與房室分離（包括心臟各部位）病理性傳導障礙竇房傳導阻滯房內傳導阻滯房室傳導阻滯 I度 P-R間期延長 II度 Mobitz Type I P-R Interval逐漸延長，QRS Complex會漏掉 Mobitz Type II P-R Interval的時間是保持恆定，QRS Complex會漏掉 III度 P Wave與QRS Complex相互無關，保持各自的節律 I度：雖然傳導變慢了，但是沒有衝動被遺漏 II度：不只傳導變慢了，衝動也會遺漏 III度：完全被阻斷室內（束支）傳導阻滯右束支傳導阻滯 V1有Rabbit Shape（Ｍ）；V6有Slurred S（Ｗ）左束支傳導阻滯 V6有Rabbit Shape（Ｍ）；V1有QS或RS(W) 意外傳導超長傳導裂隙現象維登斯基現象捷徑傳導 WPW Syndrome QRS Wave前出現δ Wave 浮動主題