ECG readingTachyarrhythmia

慈濟醫院台北分院 鄭詩 醫師璁

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。

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，

• 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。

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

竇房結 房室結 希氏束

右束枝 左束枝

浦金纖維

Mechanisms of Arrhythmogenesis

Increased/Abnormal Automaticity

Sinus tachycardia

Junctional tachycardia

Ectopic atrial tachycardia

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Mechanism of Reentry

Mechanism of Reentry

Reentrant Rhythms

• AV nodal reentrant tachycardia (AVNRT)

• AV reentrant tachycardia (AVRT)– Orthodromic– Antidromic

• Atrial flutter

• Atrial fibrillation

• Ventricular tachycardia

Mechanism of AVNRT

Example of AVNRT

Mechanism of orthodromic AVRT

Mechanism of antidromic AVRT

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

What is the heart rate?

(300 / 6) = 50 bpm

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What is the heart rate?

(300 / ~ 4) = ~ 75 bpm

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What is the heart rate?

(300 / 1.5) = 200 bpm

寬 QRS波

(VT, Idioventricular rhythm)

窄 QRS波

(Sinus, Atrial, Junctional rhythm, PSVT)

竇房結 房室結 希氏束

右束枝 左束枝

浦金纖維

Waveforms and Intervals

寬寬 QRSQRS 波波 (Ventricle)(Ventricle)

窄窄 QRSQRS 波波 (SA, A, AV)(SA, A, AV)

沒有脈搏沒有脈搏 (( 致命的心律致命的心律 ))

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

規則心律規則心律

規則心律規則心律

不規則

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

Attack

30 minutes later

Recovery

Flutter 2:1

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

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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.

Af CRBBB

Polymorphic VT

WPW

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.

Short run AT

Af_RBBB_AMI

AF_CAVB

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