Abnormal electrocardiogram

Introduction The electrocardiogram refers to the pattern in which the heart is excited by the pacemaker, the atria, and the ventricle in each cardiac cycle, accompanied by changes in the bioelectricity of the electrocardiogram, and various forms of potential changes are extracted from the body surface by the electrocardiograph. ECG). An electrocardiogram is an objective indicator of the process of cardiac excitability, transmission, and recovery.

Cause

When there is arrhythmia, ventricular atrial hypertrophy, myocardial infarction, myocardial ischemia and other long-term heavy physical activities, excessive mental stress and irregular life, continuous work for a long time. In addition to the usual changes in heart disease, and often affected by endocrine, metabolic and autonomic nervous system activities, abnormal electrocardiograms appear.

an examination

Related inspection

ECG chest CT examination

1, atrial hypertrophy: divided into left and right atrial hypertrophy or double atrial hypertrophy, ECG features P wave abnormalities, more common in chronic pulmonary heart disease, rheumatic mitral stenosis or a variety of causes of atrial muscle thickening, The chamber is enlarged.

2, ventricular hypertrophy: divided into left and right ventricular hypertrophy or biventricular hypertrophy, ECG features QRS wave abnormalities, more common in rheumatic heart disease, chronic pulmonary heart disease, congenital heart disease, hypertension or various causes The resulting ventricular muscle thickening, ventricular cavity enlargement.

3, myocardial ischemia: ECG features ST segment and T wave abnormalities, referred to as ST-T changes, seen in chronic coronary insufficiency, angina pectoris and so on.

4, myocardial infarction: divided into acute and old, acute myocardial infarction ECG features QRS wave, ST-T significantly changed, ST-T of old myocardial infarction returned to normal, leaving only necrotic Q wave.

5, arrhythmia: normal people's heart rhythm is sinus rhythm, rhythm is balanced, the frequency is 60 to 100 times per minute. Arrhythmia occurs if an abnormality occurs in the sinus node or conduction system of the heart.

6, sinus arrhythmia: sinus heart rate more than 100 times per minute for sinus tachycardia, common in exercise or mental stress, fever, hyperthyroidism, anemia and myocarditis. Sinus heart rate is less than 60 times per minute for sinus bradycardia, which is common in hypothyroidism, intracranial hypertension, the elderly and some drug reactions. The electrocardiogram of sinus arrhythmia is characterized by abnormal PR interval and has little clinical significance.

7. Pre-systolic contraction: referred to as premature beats, refers to the heartbeat that occurs before the normal cardiac cycle. After that, there is often a long interval called compensatory interval, which is divided into three types: atrial, borderline and ventricular. The electrocardiogram showed changes in P wave, QRS wave, and ST-T, with complete or incomplete compensatory pauses. Occasional pre-contraction can be seen in normal people, but frequent ventricular premature beats or the formation of two-law, triple-law is more common in a variety of heart diseases.

8, ectopic tachycardia: divided into two types of paroxysmal and non-paroxysmal, and is divided into supraventricular or ventricular tachycardia, in addition to fast frequency, irregular rhythm, the former ECG morphology is more normal, after The QRS wave is broadly deformed and is more common in organic heart disease. Non-organic heart disease can also occur.

9, flutter and tremor: divided into two major categories of atrial and ventricular. Atrial flutter and tremor are ectopic rhythms with a frequency of 250 to 600 beats per minute. P waves disappear and are replaced by abnormal "F" waves, which are more common in degenerative changes in the elderly, hypertension, coronary heart disease, and pulmonary heart disease. , armor and so on. Ventricular flutter and tremor are malignant arrhythmias, and patients are in danger of life and must fight against time to save.

Differential diagnosis

Differential diagnosis of abnormal ECG:

1. Acute myocardial infarction: QRS and ST-T wave changes on the electrocardiogram, myocardial necrosis due to coronary artery occlusion of myocardial blood flow, may affect life due to arrhythmia, heart rupture, heart failure, should be urgently protected Treatment and observation, especially in the golden period, to the hospital, early delivery of appropriate drugs and medical treatment, such as clot lysis drugs, emergency cardiac catheter coronary angiography and stenosis of coronary artery catheterization and stent placement or emergency coronary bypass surgery, To avoid further myocardial necrosis, try to preserve myocardial function, and urgently prevent and treat complications.

2. Old myocardial infarction: once myocardial necrosis, may have a small range or clinical symptoms are not obvious, especially in the elderly or severely diabetic patients with painless myocardial infarction, so that the symptoms of myocardial infarction are not felt without myocardial infarction The medical history usually indicates a problem with the coronary arteries, and other necessary examinations and necessary treatments should be performed by the cardiologist.

3. Myocardial hypoxia: may be due to coronary artery stenosis, may also be due to severe anemia, aortic stenosis, hypertrophy of the heart muscle, hyperthyroidism or drugs and other problems, causing changes in myocardial blood flow or perfusion caused by ECG changes, The etiology should be evaluated by a cardiologist, and if necessary, further exercise of electrocardiogram, myocardial perfusion imaging, cardiac ultrasound, cardiac catheterization, etc. to identify whether there is coronary artery disease and other causes of myocardial hypoxia, and further treatment as needed. Subjects should quit smoking, moderate exercise, reduce oily foods, lose weight, control blood pressure and blood sugar to reduce the risk factors of coronary atherosclerotic stenosis.

4. Non-specific ST-T changes: ST or T wave changes on the ECG, but have not reached the criteria for determining myocardial hypoxia, may be caused by coronary artery disease, drugs, metabolic diseases, other cardiopulmonary diseases, etc., may also be temporary No clinical significance, once again check it is normal. Simple electrocardiography can not confirm the diagnosis. It is recommended that the cardiologist evaluate and analyze the disease history, clinical symptoms, risk factors and other examinations of the subject, and if necessary, further examination. Especially those with clinical symptoms should go to the hospital immediately, but if there is no special clinical significance, you should avoid excessive anxiety or accept excessive invasive examination.

5. Arrhythmia: The normal heart ECG is affected by whether the body is deformed, the heart conducts the electric axis, the size of the chest, the lung disease, and obesity. In general, the rules are bounced at a speed of 60 to 100 beats per minute. The so-called arrhythmia, which is the change of heartbeat irregularity or speed, or the starting point of starting the heartbeat is not inspired by the normal sinus node. It may be a normal physiological phenomenon, or it may be affected by systemic physical diseases, drugs, endocrine, or nervous system. Therefore, it is necessary to decide the treatment according to individual conditions by the cardiologist.

6. Sinus bradycardia: The number of heartbeats initiated by the sinus node is less than 60 per minute. It may be a normal physiological phenomenon, especially for athletes or general sports people. When a young person is at rest, the heart rate is less than 60 per minute. . In addition, some people taking drugs, especially hypertensive patients taking beta-receptor antagonist antihypertensive drugs, anti-Bakinson drugs, foxglove cardiotonic, anti-depressants, morphine, etc., will slow down the heart. This is also the case with hypothyroidism, hypothermia, and elevated brain pressure. Myocardial hypoxia, myocardial infarction, myocarditis, or degenerative sinus node lesions in the elderly can also cause heartbeat to slow down. Therefore, asymptomatic health examiners, simple sinus bradycardia and no other combined ECG abnormalities, but also no clinical symptoms such as dizziness, fainting, temporary loss of consciousness, especially young and healthy people, may be physiological phenomena, observation can. If you have clinical symptoms or other ECG abnormalities, you should check with a cardiologist.

7. Sinus heartbeat speed: The number of heartbeats initiated by the sinus node is more than 100 times per minute. If a healthy person is under tension, fear, stress, etc., or when exercising, the heart rate may be greater than 100 or more. Drugs, smoking, coffee and other stimuli, heartbeat will also increase, and fever, physical illness, lack of body fluids, shock, hypoxia, anemia, hyperthyroidism and other non-cardiac diseases will also be too fast, heart stagnation heart failure Heart disease such as myocardial hypoxia and myocardial infarction will also increase heart rate. Therefore, general health examiners can observe if they have no clinical symptoms. However, if there is a suspected disease, you should consult a physician for further evaluation.

8. Sinus arrhythmia: Under normal conditions, the sinus node release message is slightly different. When the difference is greater than 0.16 ,, it is called sinus arrhythmia. Normal young people or children are common normal phenomena, but can be affected by drugs such as B-type antagonists, digitalis, morphine and the like. If this type of arrhythmia does not change with your breathing, you should pay attention to whether there is an acute illness, heart disease or brain disease, especially heart rate changes caused by abnormal brain pressure.

9. Atrial premature contraction: The heartbeat start pulse is called by the atrium outside the sinus node rather than the original sinus node. It may appear in normal healthy people, especially in drinking, coffee, nicotine, anxiety, The situation of fatigue. However, if there are clinical symptoms and the frequency of occurrence increases, it is necessary to pay attention to whether there is atrial hypertrophy, myocardial hypoxia or infarction, pulmonary embolism, hypoxemia (such as smoking), chronic lung disease should go to the hospital for examination.

10. Sinus node conduction obstruction: P wave appears on the ECG without RS wave, indicating that the pulse can not be transmitted, may be caused by athletes, vagus nerve excitation, too sensitive to the head sinus, coronary artery disease, acute myocarditis, myocardial disease, Foxglove or quinine drug overdose, hyperkalemia, hypercapnia, hypoxemia, hypothermia, etc.; and in the elderly, need to pay attention to whether the cause of sinus sinus syndrome. Especially for elderly health examiners, if sinus node conduction obstruction and heartbeat is too slow, clinical symptoms such as dizziness, dizziness, falls, temporary loss of consciousness, etc., especially pay attention to severe sinus node disease syndrome (Sick Sinus Syndrome) should be performed by a cardiologist on cardiac electrophysiology and if necessary, a device rhythm regulator. Most asymptomatic health examiners, if there is no special risk factor for coronary artery disease or cardiopulmonary disease, observation and tracking is the most ideal advice, and anxiety is needed.

11. Multi-source atrial tachycardia: This kind of abnormal electrocardiogram is not common in general adult labor health check, and usually occurs in elderly people with severe diseases, especially those with chronic obstructive pulmonary disease. If the subject has smoking and Obvious cough, cough, difficulty breathing, and when there is abnormal ECG, it is recommended to quit smoking immediately and receive medical treatment. In addition, this disease may also be caused by foxglove poisoning, septic heart failure, coronary artery disease, hypertensive heart disease, hypokalemia, and pulmonary embolism.

12. Ectopic atrial rhythm: Occasionally appear in healthy people, but usually indicates heart disease, especially in patients with heart failure. Therefore, if the subject has abnormal electrocardiogram and symptoms, it is recommended to check the cardiologist.

13. Atrial fibrillation, atrial flutter: This abnormal heart rhythm usually has palpitations, less common in general labor or health checkers, and generally indicates heart disease, especially in the elderly. Often there will be atrial fibrillation or fluttering heart disease for atrial enlargement, wind-induced heart valve disease, especially mitral stenosis, coronary artery disease, myocardial infarction, hypertensive heart disease, myocardial disease, quinine overdose, WPW Symptoms such as syndromes, and occasional paroxysmal atrial fibrillation or fluttering diseases occur in pulmonary embolism, severe lung disease, especially acute exacerbation of chronic obstructive pulmonary disease. Occasionally, people with no cardiopulmonary disease cause unexplained atrial fibrillation due to alcohol stimulation or occasional paroxysmal atrial fibrillation due to excessive coffee, smoking, hyperactivity, excitement, or excessive physical fatigue. Therefore, if the ECG has this change, it should be reviewed by a cardiologist as soon as possible to check the cause and make the necessary treatment.

14. Rotation of the heart counterclockwise: The heart is called when the space in the chest is rotated more than the normal person. It is generally not clinically meaningful.

15. Mandrel left or right: When there is shaft deflection on the ECG, the cardiologist should be asked to do the necessary examinations, including cardiac ultrasound, exercise ECG, and cardiac catheterization for detailed differential diagnosis.

16. Atrioventricular conduction obstruction: is a kind of cardiac conduction potential from the atrium through the atrioventricular node conduction to the ventricle between the lag, the first level of obstruction can occur when the physiological vagus nerve is strong, this time often with sinus bradycardia . Infarction of the inferior wall of the myocardium and atrioventricular node ischemia, myocardial infarction and ventricular septal necrosis, fibrosis or calcification of atrioventricular nodal degeneration, metabolic disease or tumor invasion invading the atrioventricular node, myocarditis, rheumatic heart Diseases, B-shaped antagonists, foxglove and other drugs can also cause atrioventricular conduction obstruction. The first level of obstruction generally does not affect the heart function, so the cardiologist can identify and analyze the underlying disease and thus exclude it. There are two types of second-level atrioventricular conduction obstruction. The first type is usually caused by drugs, especially foxglove, B-shaped antagonist, first-type arrhythmia, Verapamil, Diltiazem in calcium blockers, and occasionally It occurs when the vagus nerve system is too strong, but it also occurs during myocardial hypoxia, degenerative conduction system diseases, myocardial disease, myocarditis, hypoxemia, and recent cardiac surgery. Therefore, it is necessary to observe and find out the causes. The second type of second degree atrioventricular block must be caused by pathological diseases and will not occur under physiological conditions. It should be monitored immediately by ECG monitor and should be taken care of in the intensive care unit and actively seek out the cause. In particular, myocardial infarction combined with second type of atrioventricular conduction obstruction, should pay close attention and immediately use the rhythm regulator if necessary. In addition, invasive disease invaded to cardiac conduction system, hypertension, myocardial disease, acute myocarditis, syphilitic heart disease, ironosis, septic heart failure, cardiac surgery, etc. may also occur in the second type of atrioventricular conduction obstruction. Third-degree atrioventricular node conduction obstruction, atrial and ventricular potential dissociation, mainly occurs in acute myocardial infarction and large-scale necrosis of the anterior wall. If such an abnormal electrocardiogram is found, the device rhythm regulator should be considered. Other cardiac conduction system lesions, degenerative infiltration, fibrosis or calcification, degenerative invasive or calcified diseases, myocardial disease and other factors caused by third-degree atrioventricular node conduction obstruction, requiring professional diagnosis and diagnosis of cardiac specialists Treatment, in some cases requires urgent care.

17. Right bundle branch conduction obstruction: due to conduction of conduction to the right heart, such as myocardial infarction or hypoxia, myocarditis invasive heart disease (tumor or starch-like deposition), degenerative sclerosing lesion or right The ventricle causes an increase in pressure load due to factors such as acute pulmonary embolism, an atrial septal defect causes an increase in chronic right ventricular fluid load, and a heart or lung disease such as hypertensive heart disease. However, in some young people, there may be no heart disease and there is impediment to the right bundle. Therefore, health check labor, especially for young people, can be assessed by a cardiologist before observing the follow-up. However, some symptomatic, older, potentially dangerous disease factors, hypertension, chronic obstructive pulmonary disease, coronary artery disease risk factors should be identified by cardiologists to improve the etiology and behavior, control blood pressure and blood sugar, etc. Other necessary medical care.

18. Left bundle branch conduction obstruction: This conduction obstruction, with the exception of a small number of people, mostly combined with heart disease, especially coronary artery disease and various pressure overload or increased fluid load caused by left ventricular hypertrophy Disease, primary sclerosing, degenerative conduction system disease, myocarditis, various invasive heart disease, etc., so if the subject's electrocardiogram finds obstruction of the left bundle, especially the new cases that were not found before, merge Chest tightness, chest pain, dyspnea, dyskinesia, weakness, fatigue, etc., physical examination also has lung wetness, heart murmur or other myocardial hypoxia, heart failure doubts, should be heart surgery for heart ultrasound, exercise ECG Various examinations such as cardiac catheterization to assess the cause and severity of heart disease and the necessary treatment. If there are no obvious underlying diseases, it is recommended to track them regularly. However, smoking should be stopped, weight loss of fatty foods, blood pressure, blood sugar and blood lipids should be controlled to reduce the risk factors affecting heart health.

19. Ventricular premature contraction: This ECG abnormality is caused by ventricular ectopic potential. The ventricular premature contraction will see a QRS wave change in the ECG. It is generally divided into: 0th degree, ventricular premature contraction; first degree Occasionally, it occurs alone, less than 30 per hour; second degree, often occurs, more than one per minute; third degree, polymorphic ventricular premature contraction (R-ON-T phenomenon). In healthy people or mitral valve prolapse, the most common abnormal ECG is ventricular premature contraction; in addition to mental stress anxiety, stress, exercise, increased age, alcohol, coffee, tobacco, pseudo-autonomic stimulants, anti-heart rhythm Incomplete medicine, anesthetics, etc., will increase the incidence of ventricular premature contraction; in addition to hypoxemia, hypokalemia, hypomagnesemia, myocardial hypoxia infarction, myocarditis, myocardial lesions, mitral valve prolapse, other hearts Valvular disease and septic heart failure can also occur. Therefore, in general, healthy and asymptomatic young people, such as undoubtedly considering special causes, simple ventricular premature contraction only needs to track and improve living habits. However, if there are underlying causes, symptoms or arrhythmia, or other ECG lesions, or high-intensity ventricular premature contractions, the cause and treatment should be examined in detail, especially in the R-ON-T phenomenon. The risk of overspeed or atrial fibrillation should be closely monitored and controlled.

20. Atrial enlargement or hypertrophy: such as right atrial enlargement may be due to tricuspid or pulmonary valve regurgitation or stenosis, pulmonary embolism, pulmonary hypertension or chronic lung disease caused by pulmonary heart disease, health checkers if long-term smoking, chronic cough, difficulty breathing When you combine the electrocardiogram with right atrial hypertrophy, you should quit smoking as soon as possible. The most obvious cause of left atrial hypertrophy is mitral stenosis or reflux, others include aortic valve disease, left ventricular hypertrophy, chronic left ventricular failure, etc., patients with chronic high cardiac pressure may cause left ventricular hypertrophy and left atrial hypertrophy, if high When blood pressure is combined with an abnormal ECG, blood pressure should be controlled more strictly.

21. Ventricular enlargement or hypertrophy: The contractile force of the heart during systole causes the blood to flow into the blood vessels and circulates to the whole body or the lungs. If the pressure load increases during the long-term systolic period, the ventricular wall muscle hypertrophy is caused; and during the diastolic phase, The ventricular cavity receives blood from the atria, and if the blood in the ventricular chamber is too much and the fluid load is increased, the heart will expand. The electrocardiogram recorded ventricular hypertrophy is expressed by the increase of the potential electric wave on the electrocardiogram, but the increase of QPS wave potential on the electrocardiogram is not necessarily a certain ventricular hypertrophy. In addition, the younger person may be thinner and the heart is close to the chest wall and the higher potential is recorded. Therefore, there are suspected ventricular hypertrophy, it is recommended to further perform cardiac ultrasound examination to determine the cause and cardiac function. As for the young people without symptoms, in addition to controlling blood pressure, pay special attention to congenital myocardial hypertrophy because of this disease. Yisheng's heart rhythm is not complete and it is sudden and violent in sports. The cause of left ventricular hypertrophy or enlargement, in addition to hypertension, may be aortic stenosis, aortic valve disease, ventricular sac defect, mitral insufficiency reflux, arterial catheter and other diseases. Among the causes of ECG left ventricular hypertrophy in asymptomatic labor health examinations, the most common cause is hypertension and thin chest wall, most of which need only be tracked. However, if you have chest tightness, chest pain, difficulty breathing, walking, and heart murmur, it should be further examined and treated by a cardiologist. Of course, smoking should be stopped and high blood pressure should be controlled. Right ventricular hypertrophy is less common in labor health examinations, which may be caused by tricuspid atresia, atrial or ventricular sac defect, pulmonary valve disease, pulmonary embolism, pulmonary hypertension, etc., especially pay attention to some chronic lung diseases, such as Chronic obstructive pulmonary disease caused by smoking, pneumoconiosis or other causes of pulmonary dysfunction caused by increased pressure load on the right ventricle output to the pulmonary artery, causing ventricular wall muscles of the right ventricle with rSs characteristics on the chest lead of the electrocardiogram V1 Hyperplasia, if you have such doubts, you should go to the lung disease check. In short, when the ventricular hypertrophy or enlargement is presented on the electrocardiogram alone, and there is no symptom of related heart failure or abnormal pulmonary function, it may be a physiological or physical factor that causes a higher cardiac potential recorded on the electrocardiogram, but it may also be Potential diseases, so you don't need to be too anxious first, but you should also discuss the problem with your cardiologist appropriately, or use a cardiac ultrasound or other related test to confirm whether there is atrial hypertrophy (amount of cardiac muscle thickness) or enlargement (quantity of heart chamber) Size) and assessment of cardiac function and the goodness of the heart valve, appropriate medical treatment according to the cause.

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