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1
2
o 2.1 ()
o 2.2 ()

2.3 ()
o 2.4 ()
3

3.1 ()
o 3.2 ()
o 3.3 ()
o 3.4 ()
o 3.5 ()
4

()
()
()

()

1.

2.

3.

()

()

(
)

()

30%
12
10 30 60
primary PTCA 3

ICU

3 -
1. ST
2. ST
3. Q

 1 ST

()

(ion channel)( 2)

()()
(pump) 0 4 5 ( 3)
0 (depolarization)
(repolarization) 2 3 (pacemaker)

 2 (Purknjie )

 3 ()

1. 0
10 (Na+ channel)
-92mm()
(Vmax)I
(tetrodotoxinTTX)
2. 1

3. 2

4. 3
L
III (
)
5. 4
4 If

(pacemaker) 4
atropine

()
stress nitroglycerin
10
-
( 4)

1.
2. (spasm)(
+)()

ST
T ST

()

aVR ST
PR ( 5)

1. ST
2. PR
3. ST T

(intraventricular conduction disturbance) QRS

1. 3 ()
2. Purkinjie
8
(amyloidosis)

 6 (vector)

()
(left ventricular hypertrophy)
1. QRS
2. ST-T
3. QRS
QRS
V5V6 (IaVL )
ST strain
( 7 8)V5V6 T ST-T

8 ()

Sinus rhythm with ventricular extrasystoles

()

(sinus rhythm)
(ventricular extrasystoles)
(normal axis)
QRS T

()

Old inferior myocardial infarction

()

(sinus rhythm)
(normal axis)
LandsIIIIIVF Q

LandsIIV6 T (biphasic T waves)LandsIIIVF T (inverted

T waves )
Lands V1-V2 T (markedly peaked T waves)

()
(inferior leads) T Q
(anterior leasds) T (ischemia)
T (normal variant)

10

() Complete (third degree) heart block

()

(Complete heart block)

45/min

()
P QRS P 70/min
QRS 45/min(ventricular escape rhythm) QRS
T

 11 ()

Acute anterior myocardial infarction ()

(sinus rhythm)
(normal axis)
Leads V2-V4 Q
Leads V2-V4 ST (raised ST segment)
Leads IVLV2-V6 T (inverted T waves)

()

 12

Atrial fibrillation with digoxin effect

()

60-65/min
(normal axis)
QRS (normal QRS complexes)
lead V2 U
ST (downward-stoping) leads V5-V6

()
ST ( reverse tick)
Lead V2 U (hypolalemia)

 13

()Junctional (atrioventricular nodal re-entry)

tachycardia
()

(narrow-complex tachycardia) 200/min

P
(normal axis)
QRS
QRS ST T

()
(supraventricular tachycardia) P
(junctional tachycatdia) PSVT

 14 ()

Anterolateral ischemia
()

(sinus rhythm)
(normal axis)
QRS (normal QRS complexes)
ST leads V3-V4 ST leads V5-V6 ST

()
(anterior and lateral ischemia)
(unstable angina)

 15

(a) Atrial fibrillation with complete block (b)

(2:1) Second degree(2:1) block (c)() Complete
(third degree) block

()
(a) P (irregular baseline) QRS

(b) P PR 2:1
(2:1 block)R P QRS
(c)P QRS (complete heart
block)
()
(single lead ECG)

 16 (a) Atrial fibrillation with complete block(b)

(2:1) Second degree(2:1) block(c)() Complete (third
degree) block

Severe right ventricular hypertrophy

()

(sinus rhythm)
P lead II
(right axis deviation)
Lead V1 R
Lead V6 S
Leads IIIIIVFV1-V3 T

()
1.2. lead V1 R
3.(leads IIIIIVFV1-V3) T
(pulmonary hypertension)(pulmonary
embolism)
1.(heave)2. 3.

flicking A wave

 17

Atrial fibrillation and left bundle branch

block
()

40/min

(left axis deviation)

(left bundle branch block)

()
(LBBB)
(His bundle)

18

Sinus rhythm with atrial extrasystoles

()

(sinus rhythm)

P ( leads V2
V3 )
(compensatory pause)
(normal axis)
Lead III RSR QRS
ST T

()

 19

2 (2:1) Second degree (2:1) heart block

()

2 (2:1)
PR (440ms)
40/min
QRS T

()
PR ()
P (non-conducted P wave)
T QRS
T

 20 2 (2:1)

2:1 Atrial flutter with 2:1 block

()

(atrial flutter) 2:1 ( leads IIVRVF )

(normal axis)
QRS T

()

 21 2:1

Acute inferior myocardial ingarction

()

(sinus rhythm)
(normal axis)
Q leads III
Leads IIIIIVF ST T
Lead VL T (T wave inversion)
Leads V2V3 ST

()
( lead VL )
Q

22

Wolff-Parkinson-White type A Wolff-Parkinson-White syndrome

type A
()

(sinus rhythm)

(right axis deviation)

PR (112ms)
QRS (124ms)
QRS (delta )
Lead V1 R
T (T wave inversion)

()
Wolff-Parkinson-White (left-sided accessory
pathway) type ALead V1
R T

23 Wolff-Parkinson-White type A

Sinus rhythm with first degree block

()

(sinus rhythm)
PR 280ms(leads V1 V2 )
(normal axis)
QRS (normal QRS complexes)
ST T

()

24

Acute anterolateral myocardial inforction

()

(sinus rhythm)

(ventricular extrasystole)
(normal axis)
Leads V2-V3 Q VLV4 Q
Leads IVLV3-V5 ST

()
lead V3 Q
1

 25

Left ventricular hypertrophy

()

48/min
(normal axis)
QRS lead V5 R 30mmlead V2 S
25 mm
Leads IVLV5-V6 T

()

 26

Sinus rhythm with left bundle branch

block
()

(sinus rhythm)

QRS (140ms)
Lead V6 M QRS
Leads IVLV6 T

()
(left bundle branch block)

 27

Second degree atrioventricular

block and right bundle branch block
()

(sinus rhythm)

(2:1) lead V3
30/min
(conducted beat)PR
(normal axis)
QRS (160ms)
Leads V1-V3 RSR lead V6 S
Leads V3-V6 U

()

 28

Normal ECG with sinus arrhythmia

()

(sinus rhythm)
(sinus arrhythmia)
(normal axis)
QRS (normal QRS complexes)
ST T

() QRS

lead V1V2V3 V4V5V6 (95/min vs 70/min)

()
(atrial extrasystoles) P
P

 29

Q Acute anterior non-Q wave myocardial

inforction
()

(sinus rhythm)

(normal axis)
QRS (normal QRS complexes)
Leads V2V3V5 T (biphasic T wave)
Leads V4 T (inverted T wave)

()
Q

 30 Q

Left bundle branch block

supraventricular extrasystoles
()

(sinus rhythm)
()
(normal axis)
QRS (140ms)
Leads V4-V6 M QRS
Leads IVLV4-V6 T

()
(LBBB)

 31

Atrial
fibrillation with an uncontrolled ventricular rateand digoxin effect
()

(atrial fibrillation)

75-200/min
(normal axis)
QRS (normal QRS complexes)
ST (downward-sloping ST segment depression) leads
V5V6

()
ST

 32

Old inferior and acute

anterior myocardial infarction
()

(sinus rhythm)

(normal axis)
Leads IIIII VF Q
(anterior leads) QRS
Leads V1-V6 ST

()
leads IIIII VF Q
leads V1-V6 ST

 33

Sinus rhythm with right bundle

branch block
()

(sinus rhythm)

(normal axis)
QRS 140ms
Lead I RSR
Lead V6 S (slurred)
ST T

()
(RBBB)

 34

2:1 Atrial flutter with 2:1 conduction

()

(atrial flutter)
140/min
(left axis deviation)
lead V6 S QRS

()
2:1 QRS
lead V6 S

 35 2:1

ST/T Sinus tachycardia with

widespread ST/T changes suggesting pulmonary embolism
()

140/min

(normal conduction)
(normal axis)
QRS (normal QRS complexes)
Leads V1-V4 ST
T T (Biphasic or
inverted T wave)

()
QRS ST T
leads V1-V3

 36 ST/T

Q First degree block and

anterior non-Q-wave infarction
()

(sinus rhythm)

PR (480ms)
(normal axis)
QRS (normal QRS complexes)
Leads V1-V3 T (T wave inversion)

()
Q T
leads V1-V3lead V4

 37 Q

Atrial fibrillation and possible

old anterior myocardial infarcion
()

(atrial fibrillation)

50-70/min
(normal axis)
R (poor R wave progression)lead V3 R lead V4 R

ST T

()
Leads V3 V4 R

 38

Ventricular tachycardia
()

(broad-complex tachycardia) 250/min

QRS
QRS (200ms)
QRS

()

QRS

 39

Acute inferior myocardial infarction

()

(sinus rhythm)
(normal axis)
Leads IIIIIVF Q
Leads IIIIIVF ST T (biphasic T waves)
Lead VF ST
QRS ST T

()
Q

 40

Wolff-Parkinson-White type B Wolff-Parkinson-White syndrome

type B
()( 0.5cm = 1 mv)

50/min

PR (very short PR interval)

(normal axis)
QRS delta
QRS (200ms)
(lateral leads) QRS
Leads IVFIIIVFV5-V6 T

()
Wolff-Parkinson-White type B
QRS T
(pre-excitation syndrome)

 41 Wolff-Parkinson-White type B

Severe anterolateral ischemia

()

(sinus rhythm)
(normal axis)
QRS (normal QRS complexes)
Leads V2-V4 ST 8mm(horizontal ST segment
depression) ST (downward-sloping ST
segment depression)

()
()

 42

(21)
Second degree (21) blockleft anterior hemiblockand probable old anterior
infarction
()

(sinus rhythm)
(21 block)
(left axis deviation)
R (poor progression)
T (normal T wave)

()
(45/min)
(left anterior hemiblock)
R (V3 R V4 R
V5 R )

 43 (21)

Left
ventricular hypertrophy on voltage criteriabut probably normal
()

(sinus rhythm)

(normal axis)
R (tall R waves)lead V6 R 28mmlead V5 R 32mm
Lead V3 R
ST T

()
(voltage criteria)
(1)lead V5 V6 R >25mm(2)V1 V2 S V5 V6 R >35mm
T
(normal variant)Lead V3 R

Lead V3

 44

Anterolateral myocardial infarction of

uncertain age
()

100/min

(normal axis)
Leads IVLV2 V5 Q
Leads IVLV2 V6 ST
Leads V6 T (T wave inversion)

()
ST Q

(left ventricular aneurysm)

 45

ST ST segment depression due to ischemia

()

(sinus rhythm)
(normal axis)
QRS (normal QRS complexes)
Leads III VL ST
Leads V4 V6 ST 2-3mm()

()
Leads III VL ST leads V4 V6 ST
leads V4 V6 ST
(horizontal depression) 2mmLead V6 ST

 46 ST

Mobitz type 2
Mabitz type 2 (second degree) block and left anterior hemiblock; probably old anterior
infarction
()

(sinus rhythm)
(Mobitz type 2 leads III)
50/min
PR
(left axis deviation)
QRS (160ms)
R
Lead V6 S

()
Mabitz type 2 ()
R
Lead V6 S (intraventricular conduction delay)

 47 Mobitz type 2

Wolff-Parkinson-White Wolff-Parkinson-White syndrome

()

(sinus rhythm)
(normal axis)
PR lead V5
Lead V1 R (dominant R waves)
QRS delta
Leads V1 V3 T (inverted T wave)

()
Wolff-Parkinson-White PR
QRS (left-sided accessory
pathway) type A

 48 Wolff-Parkinson-White

1.
2. 150
3. http://bioop.com/instrument/20070207/16277.html
4.
http://tw.myblog.yahoo.com/jw!dCxeWguGGRn95oopsYbWFh4nbQ--/article?mid
=4186