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征解48答案:1.窦性心律;2.陈旧性下壁心肌梗死;3.室内传导阻滞;4.多源性、插入性室早。诊断要点:与此前心电图大比武专栏的病例不同,本图为1例异常心电图兼有简单心律失常病例,诊断相对容易,故仅标一个星号。一、窦性心律过缓:本图存在窦性心动过缓,心率48bpm伴心律不齐,心律不齐系两种形态畸形的室早引起(室早QRS波时限160ms),其他QRS波前均有P波,经120ms稳定的PR间期后,跟随宽120ms的QRS波。P波在Ⅰ、Ⅱ、aVF、V_4~V_6导联直立。窦律时宽QRS波的形态无特殊,属于室内传导阻滞伴电轴正常(0~90°),且Ⅱ、Ⅲ、aVF导联存在Q波伴T波倒置,提示存在陈旧性下壁心梗;QT/QTc正常(440/390ms)。二.多源性室早:本图有两个前无P波而提前出现的宽QRS波,QRS波形态不一且畸形,属于多源性室早,两个室早的联律间期分别为440ms和
Sign solution 48 answers: 1. Sinus rhythm; 2. Old inferior myocardial infarction; 3. Indoor conduction block; 4. Multi-source, interventricular premature. Diagnostic points: ECG with the previous column with different cases, the picture is an abnormal ECG in both simple arrhythmia cases, the diagnosis is relatively easy, it is only marked with an asterisk. First, the sinus bradycardia: There is sinus bradycardia in this chart, heart rate 48bpm with arrhythmia, arrhythmia Department of morphology caused by two early room early (early ventricular QRS wave limit 160ms), other QRS wave front There P wave, after 120ms stable PR interval, followed by 120ms wide QRS wave. P wave in Ⅰ, Ⅱ, aVF, V_4 ~ V_6 lead upright. Sinus rhythm wide QRS wave morphology is no special, belonging to the indoor conduction block with normal electrical axis (0 ~ 90 °), and Ⅱ, Ⅲ, aVF lead Q waves with T-wave inversion, suggesting the presence of old inferior heart Terrier; QT / QTc normal (440 / 390ms). Multi-source ventricular early: The figure there are two before the absence of P wave and wide QRS wave appeared early, QRS wave morphology and deformity, belonging to multi-source ventricular early, two ventricular intercourse early For 440ms and