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患者女性,68岁。反复发作性头晕伴黑朦半年,休息后可自行缓解。临床诊断:冠心病,病窦(SSS)。此次因突然感心慌、头晕、黑朦继而晕倒入院。心电图示多数窦性P波按序出现,P—P间距1.16～1.46s,P_2～P_3长达2.46s正好是短P—P间距的2倍。P—R间期恒定0.27s。P_7未下传心室。心室率平均42次/min。心电图诊断:窦缓伴窦不齐;Ⅰ°房室传导阻滞,窦房和房室双层平面Ⅱ°Ⅱ型传导阻滞。 讨论 心脏传导阻滞包括窦房、房室、束室、束支和分支阻滞。在分析时不仅要区分真正的传导阻滞和功能性引起者,还要对阻滞程度作出分度,特别重要的是应该对阻滞平面作推断。尽管体表心电图无法进行精确定位,但仍有不少线索可供参考。这对预后判断、治疗决策都有重要意义。
Patient female, 68 years old. Repeated episodes of dizziness with darkness six months, after the rest can relieve itself. Clinical diagnosis: coronary heart disease, sick sinus (SSS). The sudden feeling of panic, dizziness, darkness and then fainted hospital. Electrocardiogram showed the majority of sinusoidal P waves appear in order, P-P spacing of 1.16 ~ 1.46s, P_2 ~ P_3 up to 2.46s just short P-P spacing of 2 times. P-R interval is constant 0.27s. P_7 Room was not downloaded. Ventricular rate average 42 times / min. Electrocardiogram diagnosis: sinus bradyarrhythmia; Ⅰ ° atrioventricular block, sinoatrial and atrioventricular plane Ⅱ ° Ⅱ type Ⅱ block. Discussion Heart block includes sinoatrial, atrioventricular, bundle chamber, bundle branch, and branch block. In the analysis, we should not only distinguish between true conduction block and functional cause, but also classify the degree of block. In particular, it is important to infer the block plane. Although the surface ECG can not be pinpointed, there are still many clues for reference. This is a prognostic judgment, treatment decisions are of great significance.