Arrhythmia: ECG-Tachycardia_20120909_中區
-
Upload
taiwan-heart-rhythm-society -
Category
Health & Medicine
-
view
826 -
download
2
Transcript of Arrhythmia: ECG-Tachycardia_20120909_中區
![Page 1: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/1.jpg)
ECG readingTachyarrhythmia
慈濟醫院台北分院 鄭詩 醫師璁
![Page 2: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/2.jpg)
心律不整
• 心跳過快、過慢、忽快忽慢,暫時停止跳動• 臨床上最常發生的症狀是心悸、胸悶、胸痛、
突然感覺心臟的跳動和撞擊,甚至會有暈眩、昏厥、呼吸困雞的情形
• 心律不整嚴重者甚至會發生血壓下降、冒冷汗、休克、心跳停止、猝死等心臟科急 症。
![Page 3: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/3.jpg)
原因 生理性的心律不整 心臟本身的疾病,有些是先天性心臟的問題,也
有些是後天因為心血管疾病所導致的心律不整。 心理性心律不整多起因於興奮、緊張、壓力、情
緒失控等原因。 外物所導致的心律不整,即是因為長期服用利尿
劑、減肥 藥、安非他命,甚至喝含有咖 因的飲啡料等,此外如嘔吐、腹瀉、脫水等導致電解質異常時都會造成心律不整,
![Page 4: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/4.jpg)
• 心搏過慢,– 由於全身循環的血液量來自於心跳次數,嚴重
的心跳太慢,只能靠人工心跳節律器加以矯治 :• 心搏過速,
– 亦即成人心跳每分鐘多於一百下,是最常見的心律不整,有可能發生危險。
![Page 5: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/5.jpg)
分鐘心跳數 每 > 100 則為心搏過速
分鐘心跳數 每 < 60 則為心搏過緩
![Page 6: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/6.jpg)
竇房結 房室結 希氏束
右束枝 左束枝
浦金纖維
![Page 7: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/7.jpg)
Mechanisms of Arrhythmogenesis
![Page 8: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/8.jpg)
Increased/Abnormal Automaticity
Sinus tachycardia
Junctional tachycardia
Ectopic atrial tachycardia
www.uptodate.com
![Page 9: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/9.jpg)
Mechanism of Reentry
![Page 10: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/10.jpg)
Mechanism of Reentry
![Page 11: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/11.jpg)
Reentrant Rhythms
• AV nodal reentrant tachycardia (AVNRT)
• AV reentrant tachycardia (AVRT)– Orthodromic– Antidromic
• Atrial flutter
• Atrial fibrillation
• Ventricular tachycardia
![Page 12: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/12.jpg)
Mechanism of AVNRT
![Page 13: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/13.jpg)
Example of AVNRT
![Page 14: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/14.jpg)
Mechanism of orthodromic AVRT
![Page 15: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/15.jpg)
Mechanism of antidromic AVRT
![Page 16: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/16.jpg)
![Page 17: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/17.jpg)
![Page 18: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/18.jpg)
![Page 19: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/19.jpg)
快速心律判讀準則與方法快速心律判讀準則與方法
1. 心跳數(快、慢)2. QRS( 、窄)寬3. P波( P wave)4. 規則性( Regularity)5. P & QRS 相關性
![Page 20: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/20.jpg)
What is the heart rate?
(300 / 6) = 50 bpm
www.uptodate.com
![Page 21: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/21.jpg)
What is the heart rate?
(300 / ~ 4) = ~ 75 bpm
www.uptodate.com
![Page 22: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/22.jpg)
What is the heart rate?
(300 / 1.5) = 200 bpm
![Page 23: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/23.jpg)
寬 QRS波
(VT, Idioventricular rhythm)
窄 QRS波
(Sinus, Atrial, Junctional rhythm, PSVT)
![Page 24: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/24.jpg)
竇房結 房室結 希氏束
右束枝 左束枝
浦金纖維
![Page 25: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/25.jpg)
Waveforms and Intervals
![Page 26: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/26.jpg)
寬寬 QRSQRS 波波 (Ventricle)(Ventricle)
![Page 27: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/27.jpg)
窄窄 QRSQRS 波波 (SA, A, AV)(SA, A, AV)
![Page 28: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/28.jpg)
沒有脈搏沒有脈搏 (( 致命的心律致命的心律 ))
![Page 29: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/29.jpg)
Torsade de Pointes
EKG Characteristics: Irregular wide-complex tachycardia
The morphology, amplitude, and axis of the QRS complexes cycle through a sinusoidal pattern
No discernable P waves
![Page 30: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/30.jpg)
規則心律規則心律
![Page 31: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/31.jpg)
規則心律規則心律
![Page 32: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/32.jpg)
不規則
![Page 33: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/33.jpg)
快速心律判讀準則與方法
1. 心跳數(快、慢)2. QRS ( 、窄)寬
( wide or narrow QRS )3. P 波( P wave )4. 規則性( Regularity )5. P & QRS 相關性
![Page 34: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/34.jpg)
![Page 35: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/35.jpg)
![Page 36: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/36.jpg)
Attack
![Page 37: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/37.jpg)
30 minutes later
![Page 38: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/38.jpg)
Recovery
![Page 39: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/39.jpg)
Flutter 2:1
![Page 40: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/40.jpg)
Atrial Flutter
Most cases of atrial flutter are caused by a large reentrant circuit in the wall of the right atrium
EKG Characteristics: Biphasic “sawtooth” flutter waves at a rate of ~ 300 bpm
Flutter waves have constant amplitude, duration, and morphology through the cardiac cycle
There is usually either a 2:1 or 4:1 block at the AV node, resulting in ventricular rates of either 150 or 75 bpm
www.uptodate.com
![Page 41: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/41.jpg)
Unmasking of Flutter Waves
In the presence of 2:1 AV block, the flutter waves may not be immediately apparent. These can be brought out by administration of adenosine.
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005.
![Page 42: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/42.jpg)
![Page 43: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/43.jpg)
Af CRBBB
![Page 44: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/44.jpg)
Polymorphic VT
![Page 45: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/45.jpg)
WPW
![Page 46: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/46.jpg)
Preexcitation
ECG Characteristics of WPW:
1. Short PR interval
2. QRS prolongation
3. Delta wave
The most common form of preexcitation is called Wolfe-Parkinson-White (WPW) syndrome, in which a direct atrioventricular connection allows the ventricles to begin depolarization while the standard action potential is still traveling through the AV node.
![Page 47: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/47.jpg)
Short run AT
![Page 48: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/48.jpg)
![Page 49: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/49.jpg)
Af_RBBB_AMI
![Page 50: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/50.jpg)
AF_CAVB
![Page 51: Arrhythmia: ECG-Tachycardia_20120909_中區](https://reader034.fdocuments.net/reader034/viewer/2022052311/559c44b01a28abd70b8b4693/html5/thumbnails/51.jpg)
~ 感恩您 ~