The electrocardiogram P wave morphology diagnosis

Date of publication:2009-11   Press: Media Limited by Share Ltd publication Gong Rentai, Zhang Songwen era, Anhui science and Technology   Author:Gong Rentai, Zhang Songwen   Pages´╝Ü325  

Electrocardiography process has gone through 100 years of development, and for electrocardiology has rich connotations, the most vitality and innovative "". As ECG heart electrical foundation discipline, is still the most basic and most important part of electrocardiology. It has achieved fruitful results, made outstanding contributions to the development of the whole medical cardiology. For its merits, no matter how evaluation can not be overemphasized. But needless to say, the ECG waveform in the study, is not quite satisfactory. Work not decorative, research of P wave is a weak link. In early 1976 the famous master of electricity James, heart Scherf noted in a paper: atrial electrograms in cardiology diagnosis, is easy to be neglected area. From the ECG waveform sequence, P wave is "P-QRS-T (U)" at the beginning, it was a common saying "everything is hard in the beginning". Why is difficult, difficult in what place, how to solve problem, where to start, we think seriously comb P wave morphology status, should be the first step, but also very important. Exploration status can be deeply involved, hit the mark, the future, the pursuit of development, open up the road ahead. Therefore, we summarized the germination of P wave morphology. In support of the second people's Hospital of Hefei city leadership. In Hefei Municipal Science and Technology Bureau of the enthusiastic support, in the Anhui science and Technology Press help. After 1 years of efforts of all writers, book finally and the majority of peers. The changed P wave morphology is very common, category is very complicated, and the research on the P wave morphology has not been attached great importance to. To collect the materials do not, at present by the scientific development restrictions, such as sinus node electrogram has not been widely used in clinical application, many problems are still blind. Atrial fibrillation and F wave and F wave of atrial flutter atrial activation should belong to the waveform, related to the content of the book is too broad, not included in the scope of discussion and the elaboration, we can only choose some P wave morphology common slightly with the characteristics of images and data classification is discussed, and the level is limited, therefore the contents of this book certainly exist deficiencies, hope the readers feel.

ECG is the most effective and practical method for the diagnosis of arrhythmia, there is no other diagnosis methods can replace and exceed it. For the analysis and identification of ECG P wave morphology is the key step in diagnosis of cardiac arrhythmia, but so far the research is still on the P wave is weak, often easily overlooked. "The electrocardiogram P wave morphology diagnosis" this is the first analysis of the P wave of monographs, fills up the blank of body surface ECG diagnosis of atrial.
Catalogue of books

The first chapter is the first overview section second atrial anatomical structure and intra atrial conduction system in section third of atrial depolarization vector and P wave section fourth P wave polarity and lead system. In the fifth part the atrial repolarization wave Ta second chapter sinus P wave section second sinus P wave axis and normal sinus the P wave section third mitral P wave section fourth pulmonary P wave section fifth congenital P wave section sixth P wave alternans seventh Bell's phenomenon eighth sinus extrasystole with sinus node reentrant tachycardia ninth Beckoning sinus rhythm in parallel section tenth hyperkalemia and sinoventricular conduction section eleventh interference sinoatrial from chapter third real P'wave section second premature atrial contraction section third atrial tachycardia in fourth day Beckoning chaotic atrial rhythm section fifth atrial parasystolic rhythm section sixth left atrial rhythm section seventh atrial escape and escape rhythm section eighth atrial separation the fourth chapter intra atrial conduction block in the first section outlines the second intra atrial conduction block Wenckebach phenomenon in section third and left atrial conduction Wenckebach phenomenon fourth single atrial activation. The fifth chapter retrograde P wave section second festival originated from the atrioventricular junctional area of retrograde P wave third Festival originated from ventricular retrograde P wave section fourth bypassed by inverse retrograde P wave section fifth venturi type atrial echo sixth positive atrial echo chapter sixth other section second real fusion wave section third wandering rhythm and P wave section fourth esophageal lead and P wave section fifth atrial standstill sixth P > QRS seventh section of chest wall impingement references
Chapter excerpt

Illustration: P wave morphology, P wave is atrial depolarization and the formation of. The front has been changed for discussions on various sinus P wave, P wave of real. Moto Akinori on the intra atrial conduction abnormalities for further discussion. Atrial conduction abnormalities, from the origin of the sinus. The origin of atrial ectopic P wave is different from the sinus, the intra atrial conduction, surely because it is located in the abnormal parts different from the sinus atrial conduction abnormalities were, when expected. The characteristics of atrial, atrium is the formation of the main P wave. It has the following characteristics: (1) atrial tissue in anatomy is almost composed of single atrial cells, only a small number of Purkinje cells, unlike ventricular has relatively perfect and a PU system. In general, exciting conduction velocity in the atrium, with intraventricular conduction system into a slow depolarization time is relatively long. (2) the atrial muscle in the organizational structure of thin, but different atrial sites of uneven thickness, the difference is big, the real pressure is ventricular cavity is low. When the changes of hemodynamics of the whole heart, the most easily affected atrial, and atrial dilatation change, occurrence of geometry. At this time, can form more reentrant pathway, heterogeneity of EMG activity also increased. (3) atrial blood supply, compared with ventricular muscle is not rich, the atrial muscle more susceptible to ischemic change, resulting in different degrees of fibrosis. (4) atrial muscle cells smaller, fiber arranged relatively disordered, connecting part of the larger, formed the electrophysiological characteristics of atrial muscle and excited spatial dispersion more unequal. (5) in the atrium of autonomic nerve endings rich, easy to be autonomic, sympathetic excitement can make the atrial muscle self-discipline increases, the excitement of the parasympathetic nerve is caused by the electrical activity of the reentry. (6) a few scholars believe that the intra atrial conduction system of the part of the organization is not, first excited because right atrial muscle formed the special geometry structure. The right atrium is actually a multiple orifice balls, each ball hole of the atrium is divided into several bands of muscle, the muscle in a parallel arrangement has better muscle fiber excitability and conduction, so it can produce preferential conduction. Excitement, wherever located, on the formation of P wave, the inevitable and excitement into the atrium in the room of the conduction path (regardless of whether or not to admit the conduction system), the conductivity of the excitability. In spite of the morphology has not yet confirmed conduction system. But most believe there is 3 nodes beam, 2 beam (room is divided into 4). In the 3 nodes beam, anatomical position before, in the internodal tract is relatively stable, with great variation between beam.
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