First clarify the rhythm and rate, then look at conduction and interval
Third, check the bypass preexcitation sign, fourth, measure high and low ST
Fifth, examine the loss of R pathological Q. Sixth, observe the T waveform variation.
Seven defining ventricular large left or right, eight diagnose atrial large II, V1P
Nine product axial left, center, right, can look at aVF and I
The tenth step to exclude other causes, do not forget to link to clinical
Sinus rhythm: II P standing, avr P inverted, P-R interval > 0.12 seconds.
Arrhythmia analysis method: P-P, R-R, P-R, three laws should be sorted out.
Width and frequency are the most important, wide, narrow, fast, slow is the law, top-down is the right way.
Sinus tachycardia: sinus P interval, less than 3 tachycardia (sinus P wave PP or RR interval is less than 3 big frames. That is, heart rate > 100 beats/min is considered tachycardia)
Sinus bradycardia: sinus P interval, over 5 bradycardia (sinus P wave PP or RR interval more than 5 major frames, i.e. heart rate < 60 beats/min is bradycardia)
Sinus normal rhythm: sinus P interval, 3-5 frames of rhythm (sinus P-wave PP or RR interval of 3-5 frames, i.e., a rhythm of 60-100 beats/min is considered normal)
P – R interval: 0.12 seconds, 3 small frames of 0.12 seconds, this number is too important!
P – R shorter than 0.12 seconds, it is likely that the pre-excitation signs, bypass conduction took a shortcut.
Cross-rhythm should be considered, and a small AV node should be thought of.
0.20 seconds, four small frames of 0.20 seconds, this number should be remembered.
P-R >0.20 sec, AV block is degree I, clear measurement of lead II.
QRS wave group: 0.12 seconds, an important indicator, divides QRS into wide and narrow bars. The normal supraventricular rhythm is narrower than 0.12 seconds of narrow bars. The normal QRS wave group, is narrower than 0.12 seconds of narrow bars.
Narrow bar, narrow bar, heart function is okay, from the diagnosis and treatment, no need to be anxious.
If the QRS wave group is wider than 0.12 seconds, the QRS wave group is called a wide bar.
A ventricular rhythm is a wide bar. The danger is great and must be taken seriously.
Wide bars are an alarm, the less you see them, the better.
Continuous ventricular premature is ventricular tachycardia, and occasional wide bars identify ventricular premature.
Ventricular flutter and ventricular fibrillation are the big tooth line and the small tooth line.
High-frequency, easy to change flutter, fibrillation wave, the heart pumping blood suddenly reduced, rescue must fight for minutes and seconds.
Wide bars wider than 0.12 seconds, supraventricular rhythm can also be seen: bundle branch block, intraventricular differential conduction, pre-excitation syndrome …….. Wide supraventricular strips are really common. Need to identify carefully: ventricular, supraventricular wide bars?
Bundle branch block: M wave followed by T inversion, characteristic appearance of bundle branch block. Right bundle block is seen in V1, left bundle block in V5. Complete block is QRS wide, incomplete block is narrow strip.
Notes.
Complete left anterior branch block: left anterior branch block axis is left deviated, qR waveform L and I leads are seen. rS pattern is seen in F and III, narrow strip and T station are diagnostic.
Left posterior branch block: left posterior branch block is rare, waveform opposite to left anterior half.” L” I is “rS” type, “qR” waveform in AVF and III. left posterior branch block axis to the right, the same is narrow bar, T wave station.
Bilateral bundle branch block: is a right bundle branch block pattern, there is also a left deviation of the electrical axis, the diagnosis of the right bundle combined with the left anterior half. It is a right bundle branch block graphic, and there is also an electrical axis right deviation, diagnosing right bundle combined with left posterior half.
Pre-excitation syndrome (-): – redundant atrioventricular bypass, preemptive conduction excitation: normal atrioventricular pathway, normal conduction excitation, conduction excitation in the ventricular muscle, it is called pre-excitation syndrome.
Pre-excitation syndrome is divided into three categories, and each of the three categories has characteristics: short PR, wide QRS, coarse and blunt onset of pre-excitation wave type DD typical W-P-W syndrome; atrioventricular bypass if on the left, the main wave of the chest conduction upward is type A. Atrioventricular bypass if on the right, V1 main wave down is type B. Occult bypass reverse conduction, tachycardia foldback type. Paroxysmal atrial fibrillation, supraventricular tachycardia, the only clue to break this type. Narrow strip with no preexcitation wave, L-G-L sign called short P-R sign. The junctional rhythm is often wrongly defined. Wide bars with preexcitation waves, PR not short Mahaim sign. Tachycardia with left bundle block must be distinguished from ventricular tachycardia. Pre-excitation syndrome with bypass additions, a sign seen more often in healthy people. Also known as large pseudo-differential, often masking ventricular block and infarction. The danger causes arrhythmias, which can be ablated by catheter radiofrequency.
Pre-excitation syndrome (II): Pre-excitation syndrome, classical features have three points, W-P-W are accounted for all, one has PR short, two has QRS wide, three has pre-excitation wave DDD start coarse blunt obvious.
There are unique, three, L-G-L signs can be diagnosed. The L-G-L sign is diagnostic.
There is no one with two or three, Mahaim’s sign is difficult to exclude.
ST segment: normal ST segment, not horizontal in a curve, and T should not be at an acute angle, floating up and down in the isotropic line. Lowering can not exceed half a frame, elevation 1 frame is the upper limit; special elevation up to 3 frames, only V1-V3.
ST-segment elevation: If the ST-segment is elevated, arch-back up is the worst, ventricular wall tumors are often seen, and infarction is the first thing to think of. Arch dorsal down must be differentiated: tachycardia, pericarditis, and many normal variants.
ST segment drop: ST drop more than two leads, horizontal or downward sloping type change, myocardial ischemia, hypokalemia, rare and early detection.
Clinical diagnosis of myocardial infarction: typical clinical manifestations, ST., T, Q dynamic evolution, myocardial enzymatic changes, three with two can be diagnosed.
Myocardial infarction evolution chart: typical infarct chart evolution, showing at least two leads. The base is narrow, symmetrical, wave tops, and alarm T waves are seen first. It is accompanied by ST hypo, which persists briefly and is difficult to see. The T waves are variable with the disease and are difficult to detect early. This phase is called super-acute phase, the onset of which has not yet passed half a day. Myocardial ischemia gradually worsens, and the injury pattern becomes visible. the ST segment arch back elevation, more than 1 frame can be diagnosed. It is easy to diagnose but late because it forms a single curve with T. This period lasts for only a few days and changes from good to bad. Early detection is the key. Treatment delay now Q wave deep Q more than 1 frame wide, red flags flying typical chart, myocardial infarction has been inevitable. Scramble to rescue, hate not found early.
Q wave: Q width should not exceed 1 frame, depth less than 1/4 R wave. v1, v2 no Q wave, QS wave can be seen. v5, v6 are q wave, iii, l are exceptions, deep Q wave is visible respectively.
Left atrial hypertrophy: left atrial hypertrophy, V1 look at P wave, negative P depth, greater than 1 small frame, negative look at width, also more than 1 small frame, II look at P wave, width more than 3 frames, tangential trace more than 1 frame.
Right atrial hypertrophy: right atrial hypertrophy P hyperacute, II amplitude over 2 and a half frames. Bidirectional P waves looking at V1, with downward amplitude exceeding 1½ frames.
Left ventricular hypertrophy: left ventricular hypertrophy RV5 high, RV5 plus SV1 put 40 super, electric axis left deviation for reference, ST low, T flat inversion.
Right ventricular hypertrophy: right ventricular hypertrophy RV1 high, TV1 plus SV5 put 12 ultra. The electrical axis is obviously deviated to the right, SV1 disappears or becomes smaller, ST is low, T is flat and inverted.
Bilateral ventricular hypertrophy: biventricular large complex, the diagnosis is often difficult to under, offset each other when normal, most of the performance of a large side. Sometimes the animals are very obvious, showing bilateral hypertrophy.
T wave: normal T wave with the main wave, TAVR is inverted, I , II ,V3-6, up at least six. The rest of the leads T good change, the amplitude must exceed 1/10R wave
T-wave hypoplasia or inversion: T-wave hypoplasia of less than 2 frames, or less than 1/10 R-wave, with changes in the super two leads, accompanied by ST-segment hypo. Pericarditis or hypokalemia, myocardial ischemia low T-wave, T-over low flat disease overweight, T-wave deep inversion critical wave.