ECG
.pdf
"#$.
%& 1: * * & / & * 1 *- 4 & ). " * & & 4& ' &* / * - ) ';& ) ) * & & * , * &*- / * & : ( .1-2).
& * * & ) * 4 & &
– )& * 4 & ' ):&/ <=, ) / & & – / & ' ):&/ <=, *& *& ) & &( . 1-2).
+ % & ) % , ) $#< ( & & ,. O & , -& ( .1-3).
) " ! + &! + / !($ "/, & - < '? & ( ), $# < ( & -? ' ) & & .
. 1-2. & & (V),
& ( (+ ) ( (+ )
% = % |
|
|
|
& , ( |
||||||||||||||||||
& ( * & $" |
|
|
|
|
|
|
|
|
||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
+ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
+ |
|
|
_ |
|
|
|
+ |
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||
|
|
|
+ |
|
|
|
|
+ |
|
V |
|
+ |
|
|
|
|
||||||
|
|
|
|
|
|
|
+ |
|
|
|
|
|
||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
+ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
|
|
|
|
|
|
|
|
|
+ |
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|||||||||||||||
.1-3. / & $" |
< |
|||||||||||||||||||||
< ( & ) )
20
+ & (* < & |
& ' & % |
' (' * 5 # ++ !( + + ! !( (). C &- |
|
? & & |
& ! 5 |
"5, ( & !$ * "/ 5\$ ).
@ A "#@ % #B#"C # "D#= A(E## < = - %#$F %($ A(%# A(F G "#@ % A %.
& * & ' * & ' ) ) ) - * + + ) / , & ) )10 & * & ) 4& ).
& * & ' - : ;& & ' & & - ; .
& * & ' * ) ) ) ), & ) )10 & + ) + & ( .1-3).
" & ) ):/ ' & & & < .
& ' & - ) ' & & & '+ & & '+ * & , '& & ' ' :)4 & & / .
& & ) )10 & – & ' & < & / &- & & & *& :)4 & & / .
"#$.
H & ):/ QRS I III & & + 4 & *' :)4 & 4& )-
:
&44& ) *& & ( ):/' qI rIII );
* & )0& & & 4& ) ( & )& ):&/ QRS, * & , RI );
* & )0& & : '+ & 4& ) ( ):/' S I, III ).
* :)4 & 4& ) - * & / ) )& , < = & & – & & RS-T.
% " A .
&* / * + * ).
A&* / - * ).
21
* " 2. %%% 8
2.1. O*? $"
' < , ) ) -* ' .
- I - - - - + + + + + I - II |
- |
|
|
|
- |
|
- |
|
|
|
-+ |
|
++ |
|
+ |
|
+ II |
I . : |
II .: |
(+) |
(-) |
(-) |
(+) |
- --- III 
-
++
+
+III
III .:
(-)
(+)
.2-1. P $ & , & ' & %
"#$.
& ) ) & ) & * & & : & * 4& & = 1mV, ' ' 10&& & & & )10& & ' 10 .
# ( $" < * – 25, 50, 100 . -1, ! !$ - # / * 25 ++. -1. + < & <-(!($ «+») ) "/!($ («-») ) . F , - '? & ) & ( & /5 ! #.
+ * % ( 12 & $": 3 – - & % , 3 - ' , 6 – .
2.2. # & % (* )
P & % * ( ' & -$ & , & ) % , &
& |
|
|
& . C , |
? ( ) % |
|
& - |
|
< ' |
' & ( .2-1). |
||
22
# % & * & & &( .2-2).
.2-2. P & & %
"#$.
< * &/ )& * 4 & )1 ) & & , * '- 1 * 4 & '& ):/' (R,T, P), & * & / / & )1 ) - )1 / & '& ):/' Q, S ( T P).
2.3. & % ( )
C & (" * ,1942) !($ K" & & ( % : & , && , K" '^ ! !!($ - *` & & * , ( % , % . & %-
: |
|
|
|
aVR |
|
& |
& ; |
aVL |
|
& |
& ; |
aVF |
|
& |
& . |
$% |
& |
< ' ( & ) ) |
' % ( *` |
) ) . 2-3. |
|
.2-3. A & & %
23
2.4.\ &
#& ? & &-% * ( = & ' Bayley ( .2-4).
|
|
|
|
(- 900) |
|
|
|
|
|
|
- aVF |
(- 600) |
|
|
|
|
(- 1200) |
|
|
|
|
|
(- 1500) |
+ aVR |
|
+ aVL |
(- 300) |
|
|
(± 1800) |
- I |
|
+ I |
( 00) |
|
|
(+ 1500) |
- aVL |
|
- aVR |
(+ 300) |
|
|
|
(+ 1200) |
+aVF |
(+ 600) |
|
|
|
|
|
|
|
|
|
|
|
|
(+ 900) |
|
|
|
. 2-4. \ & |
Bayley |
||||
|
O (& * % |
( % |
$# |
|||
& |
, < ) % |
($O#). - |
||||
& |
& & < & . |
|
||||
2.5. " |
& ( ) |
|
|
|||
" ' & (+ , 1932-1948) – ' ( & < & ( < ) ) & (-% & ( *`- ) ) , * ( '. O* % ( = & , '? $# & & & ( -( . 2-5, * .2-1).
.2-5. < & & (
24
'" ) 2-1. < = ( & ) ) &&
(& |
< & |
) |
||
& |
|
|
|
|
V1 |
G & < * |
& ' |
||
|
|
|
||
V2 |
G & < * |
& ' |
||
|
|
|
||
V3 |
! < V2 V4, |
& 4 * - |
||
|
& |
|
||
|
|
|
|
|
V4 |
+ < * |
|
& - |
|
|
'% % |
|
|
|
|
|
|
||
V5 |
& V4, |
& = % |
||
|
|
|
|
|
V6 |
& V4, V5, |
& = %- |
||
|
|
|
|
|
|
|
|
|
|
P * ( , * = % 12 $"- &-(3 % , 3 ' 6 & ).
2.6. $"- &
= & ( < ) % &( & $"- & , "-
5 # V '\ !# (L " " * )$ ! , K"
( * .2-2, 2-3).
'" ) 2-2. & $"
|
< & ) |
%= ' - |
|
& |
|
|
|
|
|
|
|
Z ! , !( |
|
Z !-' * "/!(L |
|
V( )7 |
|
" " , |
|
/ = % , & 6 / |
& " , - |
||
|
|||
V( )8 |
F % , & 6 / |
V + % |
|
|
|
* !$ ! "- |
|
V( )9 |
C & * , & 6 / |
||
, & " . |
|||
|
|
||
|
|
|
|
( , !( |
> ( ' ( V1-V6, 1-2 <- |
,! - |
|
! # |
* & = * % & |
, (L & !$ |
|
|
|
+ ( - |
|
|
|
L " - |
|
|
|
! '$ |
|
|
|
! , '" |
|
|
|
!. . . |
25
+ % . 2-2
|
< & ) |
%= ' - |
||
& |
|
|
|
|
8 &! , !( |
> ( ' ( V1-V6, 1-2 <- |
"# ,! |
||
! # |
* < |
* % & |
% L V !$ |
|
|
|
|
|
'" |
V( )3R -V( )6R |
+ & & , & - |
J |
||
|
( % V( )3 |
-V( )6 |
(L " |
|
|
|
|
|
) . |
|
|
|
|
,! % |
|
|
|
|
, & "- |
|
|
|
|
. |
S5 |
!($ – , II / . |
"# (# " ! # *. |
||
( ( ' )- |
6 " ($ – % & |
& |
« », " L$ |
|
& - |
& . $ ! &! L !- |
JJ !) |
||
% ) |
! #L ' . # V=25 |
*. « » 12 !- |
||
|
50 / ., |
( & < $"- |
!(L ! #L. |
|
|
( * & 1mV=20++. |
|
||
|
'" ) 2-3. & $" |
)* ( & |
|||||
|
$", ( >!), ( ' |
|
|
|
|||
|
|
|
|
|
|
||
|
O & )* |
< & |
) |
|
%= ' - |
||
|
|
|
|
|
|
|
|
|
> ( ' )- |
$ , & & & - |
, (L *+- |
||||
|
- |
( & ) – & & & - |
! !$: |
||||
|
& |
< * & ' - |
|
( |
|||
|
|
. |
|
|
|
|
«D» |
|
|
$ & (( &- |
- * - |
||||
|
|
) – & ( ' V4 (& = ). |
|
& |
|||
|
|
$ & (< &- |
|
« » |
|||
|
|
) – & < & , % |
(- |
& - |
|||
|
|
) , ( = %- |
|
& |
|||
|
|
. |
|
|
|
«I» |
|
|
|
[ '% & < : |
|
|
|
||
|
|
|
I ! # - |
|
|
|
|
|
|
|
& |
|
|
|
|
|
|
|
Dorsalis (D) |
|
|
|
|
|
|
II ! # – Anterior ( ) |
|
|
|
||
|
|
|
III ! #- Inferior (I) |
|
|
|
|
|
|
|
|
|
|||
|
2.7. O < $" * & |
< % |
|
|
|||
|
|
|
|
|
|
|
|
|
|
V1,V2 |
– |
% |
|
|
|
|
|
V3,V4 |
– |
|
|
|
|
|
|
V5,V6 |
– |
* & |
|
|
|
|
|
V1-V4 |
– |
% |
|||
26
V3 -V6 |
– |
* & |
I, aVL |
– |
& * & |
II, III, aVF |
– |
< |
2.8. C & )
2.8.1.+%
& $" & * :
|
< , = & ; |
|
< % ) % ; |
|
& ) . |
%= ) & < < : |
|
|
< ) & * (< ; |
|
( % & ' % & . |
%= : |
|
|
) $"- ; |
|
& < % < & NaCl. |
2.8.2. / 0
'" ) 2-4. C '% & & )
< (& ) |
h& '% & |
|
|
O & |
% |
|
|
C & |
|
|
|
F & |
W |
|
|
F & |
/ |
|
|
C & (( ( ) |
G |
|
|
" |
& |
|
|
V1 |
|
|
|
V2 |
W |
|
|
V3 |
/ |
|
|
V4 |
% & |
|
|
V5 |
G |
|
|
V6 |
# & |
|
|
C % ( $" & & & -) % . O* % & & ! ! " ! 1mV=10++, = * = ( * & $" < *
27
= (1mV=5 ), - & % (1mV=15 20 ).
2.8.3 # # % &)*
" "/! / * :
& % - I, II, III;
& - aVR, aVL, aVF;
& - V1 - V6.
+< & ( & 4 &,
& < * 25 ++. -1. + % < -( & 50 ++. -1. C ( $" ' 25 / -
1++=0,04 (40+ ); ( $" ' 50 / -1++=0,02 (20+ ).
8 ' + &!$ " ! '" ! * ( 5 :
A>O ,
& ( ,
& & ,
* * ( ,
(,
& .
C ( & = ( ( ( ' & ' * .
2.9.A * & $"
A * = ' % & ( < )-. O (& ' & & ) %-= ( ' ' % , ? - = ), * % $"- & * < &- ' . * & ' : * ( %-( , * * j- &, * -. & $" < : -% & $" k , % ? & ' ) % ' ' (GC$#), ) ' % "& .
28
* " 3. % 8 % 8 8 % G8 ?
3.1. O*? ) & $"
$" ( ( * &, & & &, < ' -& & (* < ( .3-1).
. 3-1. # ) & $"
Z ' ) - d0,10 (100 ).
! " PQ - % ( * % QRS 0,12-0,20 (120200 ), ( & G##.
,+ ! PQ - ( * % QRS.
Z ' ) Q – " "/! /d0,03 (30 ), + " d0,3+ .
C $O# & & - & I aVL & ( % ( * q.
+ $O# - ( % ( * q & |
II, III, aVF. - |
< $O# - ( * q * & |
& & - |
% . + ( * q & & V1-V2. Z ' ) R - < ( * QRS.
Z ' ) S - ( * QRS, ( * R.
( *d0,06 (60 ). + & |
% * |
( * S ( & $O#. + |
& * = ( * S & V1- |
V2. |
|
+ " QRS. : 1) & d0,10 (100 ). 2)QRS 0,10 0,11 (100-110 ) - * & & < .". 3) QRSp0,12 (120 ) - * & & . .". @-QRS: ( & < & I, II, III q0,5 +, & & q0,6 +.
Z ' ) - % ? & QRS, & ? ( * P * , % ? . + " & "/!($ * ' )
29