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异常Q波分为梗死性Q波和非梗死性Q波。
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/d3c74307-a9ff-43ce-92ef-51c2467283df.jpg)
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图5-2 A胸导联电极位置错放描记心电图
(V1、V2导联位置错放)
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V1~V4导联R波递增不良或R波反向递增,即RV1>RV2、RV2>RV3、RV3>RV4、RV4>RV5。(见图8)
相邻两个导联的R波振幅相差>50%,如RV3>1/2RV4。
同一导联的R波振幅在不同次心电图记录中呈进行性降低或消失。
V1、V2导联R波增大时可能为正后壁心肌梗死的镜像观,需常规加做V7~V9导联。(见图9)
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图7 等位性Q波形成示意图
7-1图显示顿抑存活心肌电功能恢复,面对电极的向量形成r波
7-2图显示顿抑存活心肌与坏死心肌相对位置不同而形成多种形态QRS波
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/9afa38b1-4d1d-431a-beb3-ddacaac6939c.jpg)
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图9 陈旧性下壁心肌梗死伴V1导联R波高
及V5、V6导联梗死性Q波
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/cd7f39ea-a45c-46b0-aeb2-3b73ea461795.jpg)
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图14 完全性右束支阻滞、左前分支阻滞
伴陈旧性前间壁心肌梗死
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/7a69e20f-eb5d-4ff8-87d4-38e50d956480.jpg)
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图16
患者男,34岁,体检发现心电图显示PR间期缩短伴QRS波起始预激波,V1~V6导联QRS波主波及预激波方向向上,Ⅲ、avF导联呈QS型
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/5178f8e5-5622-46da-b343-d39b9a557885.jpg)
图17
患者女,43岁,心电图显示PR间期缩短伴QRS波起始预激波,V1导联QRS波主波及预激波方向向下,Ⅱ、Ⅲ、avF导联有非梗死性Q波
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/76cfd16a-65c9-4545-8031-5be86e0b3735.jpg)
图18
患者男,46岁,因酒后心慌、胸闷就诊,心电图显示PR间期缩短伴QRS波起始预激波,V1~V4导联QRS波主波及预激波方向向上,而Ⅰ、avL、Ⅱ、Ⅲ、avF、V5、V6导联均有非梗死性Q波
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/c9277000-9366-4cab-8f73-f8d3fb91d8c3.jpg)
图19-1
患者男,48岁,因急性胰腺炎就诊,心电图示右位心(左右手正常连接)
![病理性Q波16种鉴别诊断](https://img-a.haoyishu.com/article/content/8744/d36d43dc-8f38-4d13-bed9-cc646d44821f.jpg)
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图20
女,73岁,植入双腔起搏器一年后随访心电图
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