《窄QRS心动过速心电图诊断及鉴别诊断.ppt》由会员分享，可在线阅读，更多相关《窄QRS心动过速心电图诊断及鉴别诊断.ppt（35页珍藏版）》请在三一办公上搜索。
1、窄QRS心动过速 心电图诊断及鉴别诊断,第二军医大学长征医院 赵 学,窄QRS心动过速类型,房室折返性心动过速（AVRT)60-70%房室结折返性心动过速（AVNRT）30-40%房性心动过速（AT）5-10%IART SART 异位AT,PSVT,SNRT,AVRT,AVNRT,IART,SF-AVNRTFS-AVNRTSS-AVNRT,O-AVRTA-AVRT,房波形态与心房激动起源,左右心房(aVL、V1)aVL：P波负向：左房房速或起源 V1：P波负向：右房房速或起源心房上下(II、III、aVF)P波直立：房上部房速或起源 P波负向：房下部房速或起源,F-S型AVNRT,V1:P波?
2、I、aVL:P波正向II、III、aVF:P波负向,激动起源右房后下部,SF-AVNRT 2:1,I、aVL:P波正向 V1:P波负向II、III、aVF:P波负向,激动起源右心房下部,AVRT（右后隔AP）,aVL:P波正向 V1:P波负向II、III、aVF:P波负向,激动起源右房下部,AVRT（左后隔AP）,I:P波负向 V1:P波正向II、III、aVF:P波负向,激动起源左房下部,PJRT（左后隔慢AP）,I:P波负向 V1:P波正向II、III、aVF:P波负向,激动起源左房下部,AT（后间隔部位）,aVL、I:P波正向 V1:P波负向II、III、aVF:P波负向,激动起源右房下
3、部,aVL、I:P波正向 V1:P波负向II、III、aVF:P波正向,激动起源右房上部,AVRT（右前AP）,I:P波负向 V1:P波正向II、III、aVF:P波负向,CS,AVRT（左后侧慢AP）,激动起源左房后下部,aVL:P波负向 V1:P波正向II、III、aVF:P波正向,激动起源左房前上部,AVRT（左前外侧AP）,房室关系与PSVT类型,房室1:1RP/RR1或RP PR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RP PRAVRT（慢AP参与）FS-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞
4、IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAVRT不并存房室或室房阻滞,RP/RR1或RP PR,RP,PR,AVRT（左前外侧AP）,RP/RR1或RP PR,SS-AVNRT,RP,PR,房室关系与PSVT类型,房室1:1RP/RR1或RP PR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RP PRAVRT（慢AP参与）FS-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAV
5、RT不并存房室或室房阻滞,RP/RR1或RP PR,PJRT（左后隔慢AP）,PR,RP,RP/RR1或RP PR,F-S型AVNRT,PR,RP,RP/RR1或RP PR,RP,RP,IART,房室关系与PSVT类型,房室1:1RP/RR1或RPPR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RPPRAVRT（慢AP参与）FS-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAVRT不并存房室或室房阻滞,P与QPS重叠,SF-
6、AVNRT,房室关系与PSVT类型,房室1:1RP/RR1或RPPR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RPPRAVRT（慢AP参与）FS-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAVRT不并存房室或室房阻滞,房室文氏阻滞,IART,P,P,P,P,P,P,P,P,房室关系与PSVT类型,房室1:1RP/RR1或RPPR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RPPRAVRT（慢AP参与）FS
7、-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAVRT不并存房室或室房阻滞,IART房室2:1,房室2:1阻滞,SF-AVNRT 2:1,激动起源右心房下部,房室2:1阻滞,心室超速刺激对心动过速的影响S1 S1 超速起搏不夺获心房 房速夺获心房,但停止心室起搏后心房激动呈 A-A-V关系(A-A与其前后的V波明确分开)房速超速起搏拖带心动过速并有QRS融合波者=AVRT,可排除AVNRT与AT,IART,心室刺激不夺获心房,房室关系与PS
8、VT类型,房室1:1RP/RR1或RPPR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RPPRAVRT（慢AP参与）FS-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAVRT不并存房室或室房阻滞,房室不等比阻滞,IART,房室不等比阻滞,IART,房室关系与PSVT类型,房室1:1RP/RR1或RPPR顺向型AVRTSS-AVNRTIART（少见）RP/RR1或RPPRAVRT（慢AP参与）FS-AVNRTIART和SNRTP与QPS重叠SF-AVRTIART（少见）SNRT（少见）,房室阻滞房室文氏阻滞IARTSNRT房室2:1SF-AVNRTIART和SNRT房室不等比阻滞IARTSNRTAVRT不并存房室或室房阻滞,PSVT的鉴别流程,宽QRS,窄QRS,VT or SVT,SVT,SVT,典型BBB,VT or 预激,Bragada,预激性心速,Antunes,SVT,ATorSNRT,不等比AVB,RPPR,AVRTorAVNRT,PJRTorAVNRT,P重于R,AVNRT,谢谢,
