心电图课件PPT

What is your diagnosis?
Non-sinus P wave
➢ Though the P wave is upright in lead Ⅱand inverted in lead aVR, its morphology is different from normal sinus P wave .
Whether there is non-sinus P wave ?
Atrial premature contraction
➢ P’ wave that occurs prematurely is different from sinus P wave morphologically.
➢ P’ waves are usually followed by QRS complexes with normal morphology and duration (normal anterograde conduction); a few P’ waves are followed by wide, bizarre QRS complexes (aberrant conduction); a few other P’ waves are followed by no QRS complexes (non-conduction).
➢ P wave in sinus rhythm appears small ,rounded, and upright in leads Ⅰ, Ⅱ, aVF, V4 to V6.
➢ Sinus P wave is inverted in lead aVRHale Waihona Puke Baidu ➢ In Other leads it can be upright, inverted, or biphasic (half upright, half inverted). ➢ Normal duration of sinus P wave should be less than 0.12s, and amplitude of P
Abnormality in frequency of sinus P wave
The frequency of normal P wave is 60 to100 bpm
Abnormality in frequency of sinus P wave
Sinus Tachycardia
➢Sinus rhythm. ➢The frequency of P wave is more than 100 bpm and maybe higher in children
Abnormality in voltage or duration of sinus P wave
Compositions of normal sinus P wave
Abnormality in voltage of sinus P wave (Right atrial enlargement)
What is your diagnosis?
Abnormality in duration of sinus P wave (Left atrial enlargement)
➢P wave in leadsⅠ, Ⅱ, aVR, aVL is widened to over 0.12 s (P mitrale) ➢P waves are mostly double-peaked. The second peak is often bigger than the first one ➢In lead V1 the P wave appear biphasic. The terminal negative portion were apparently widened (>40ms) and deepened (>1mm), which makes the Ptf-V1 ≤-0.04mm·s (Ptf-V1 is the terminal vector in lead V1 , the cross product of the negative depth (mm) and duration (s) of the P wave in lead V1)
Abnormality in frequency of sinus P wave
Sinus Bradycardia
➢Sinus P wave is present ➢ The frequency of P wave is less than 60 bpm ➢ It may be accompanied by sinus arrhythmia
Graphics-sequenced interpretation of ECG
Step Two
Analyze P wave
Sinus P Wave
Cause of the morphology of sinus P wave
Characteristics of normal sinus P wave
➢ Manifestation of non-sinus P wave: The P wave is inverted in lead Ⅱ and upright in lead aVR. It is generated by the impulse conducted retrogradely from the atrioventricular node, then excites the atria and produces the P wave (retrograde P wave).
wave less than 0.25 mV in limb leads or amplitude less than 0.2 mV in chest leads.
Sinus P wave or not?
Abnormality in frequency of sinus P wave
The frequency of normal P wave is 60 to100 bpm
➢In leads Ⅱ, Ⅲ, aVF, P wave is abnormally tall and peaked, and the voltage exceeds 0.25 mV (P pulmonale) ➢Electrical axis of P wave often exceeds 70° ➢The duration of the P wave is still within normal range