심전도 홀로서기 (4판) > Cardiology

심전도 홀로서기(4판)

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머리말

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심전도는 한 세기가 넘게 가장 오래된 심장 검사법이나 지금도 가장 많이 시행되고 있는 필 수 검사이다. 심전도는 휴대와 이동이 가능하고 심장 상태를 고통 없이 실시간으로 감시할 수 있기 때문에 신체 부착 또는 내장형으로까지 개발되어 진료 현장을 벗어나 일상생활에서 건강 관리나 심장병 조기 진단이나 심장 사고의 사전 예측의 도구로까지 이용되고 있다.

심전도는 급속히 발전하는 분야는 아니지만 배우는 학생들에게는 언제나 제일 난해한 과목 의 하나로 손꼽히고 있다. 의료진에게도 심전도 판독은 영상 검사나 검사실 검사와 달리 체계 적인 분석과 논리적인 판단을 요구하기 때문에 큰 부담이 된다. 심전도 판독의 부담을 덜어주 기 위해 1990년대부터 심전도에 자동진단기능이 내장되기 시작했고 지금은 성능이 심장내과 전임강사 수준으로 향상되었다. 4차 혁명의 시대를 맞아 심전도가 인공지능까지 갖게 되면 심 전도 판독 능력은 유능한 교수 수준을 능가할 수 있다. 이러한 시대가 오면 심전도 공부가 필 요 없다고 생각할 수도 있다. 그러나 심전도 공부는 계속될 것이고 계속 되어야 한다. 심전도 공부는 심전도 선이 그리는 파형이나 간격 이상의 유형을 파악하여 진단을 이끌어내는 기법 을 공부하는 데 그치지 않기 때문이다. 심전도 공부는 세포막 이온 통로를 드나드는 이온의 분 자 수준에서 활동으로부터 혈액 순환의 원동력을 만들어내는 박출 기관으로서 심장에 이르기 까지 심장의 정상 생리 및 병태 생리를 이해하고 논리적인 추론 능력을 길러준다. 따라서 심전 도 공부는 앞으로도 계속해야 할 가치가 있다.

심전도 홀로서기는 심전도를 처음 공부하는 학생이나 기초를 보강하여 홀로서기에 도전하 는 의료인들의 심전도 공부에 도움을 드리고자 2006년에 초판을 선보였다. 그동안 뜨거운 호 응에 힘입어 계속 개정판을 냈고 4판에 이르렀다. 여기까지 올 수 있도록 사랑과 격려를 아끼 지 않은 선후배 동료 여러분의 뜨거운 사랑과 격려에 진심으로 감사드린다. 이번 4판 개정판 에는 지난 30여 년간 심전도 연구와 교육에 전념한 저의 모든 지식과 경험을 남김없이 다 쏟아 넣었다. 완전무결을 바랐으나 흠과 티가 없지는 않겠지만 여러분의 심전도 공부에 친절한 길 잡이가 되어 여러분 모두 심전도 홀로서기의 꿈을 이룰 수 있기를 간절히 바란다.

2020년 5월

학마을 연구실에서

조정관

1. 심전도 ·····························································1

2. 심전도 파의 생성 원리 ···············································3

3. 심전도 유도 ························································8

4. 심전도 기록의 표준 ················································20

5. 심전도 기록의 오류와 잡신호 ········································22

◈ 자율평가문제 ···················································27

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2 장 심장의 구조와 전기생리 / 29

1. 심장의 전기생리학적 구조 ··········································29

2. 심장의 자극 생성 및 전달 조직(자극전도계) ···························30

3. 심장세포의 전기생리학적 특성 ······································34

4. 심장세포의 활동전위 ···············································34

5. 심방과 심실의 특이한 탈분극 과정 ···································36

◈ 자율평가문제 ···················································38

3 장 정상 심전도 파와 간격 / 41

1. 정상 심전도 파와 간격 ··············································41

2. 특수 심전도 파 ····················································43

3. 심전도 파와 분절의 생성기전 ········································44

4. 심전도 파와 간격의 정상 기준(100의 법칙) ····························53

◈ 자율평가문제 ···················································55

차 례

4 장 심전도 파와 분절의 이상 / 57

1. P파의 이상 ························································57

1) 구조적인 P파 이상 ···············································57

2) 근원적인 P파 이상 ···············································60

2. QRS파의 이상 ·····················································64

1) 폭이 좁은 경우 ··················································64

2) 폭이 넓은 경우 ··················································66

3) 심실 후흥분파: 입실론파 ··········································77

3. PR간격의 이상 ·····················································78

방실전도지연, 조기흥분

4. J점의 이상(조기재분극) ·············································78

1) 1형(측벽형) ·····················································79

2) 2형(하벽형) ·····················································79

3) 3형(범발형) ·····················································80

4) 4형(Brugada 증후군) ·············································80

5. ST절의 이상 ·······················································81

1) ST절 상승 ·······················································81

2) ST절 하강 ·······················································84

6. T파의 이상 ························································86

7. U파의 이상 ························································90

8. QT간격의 이상·····················································90

9. 전해질 불균형에 의한 심전도 변화 ···································90

◈ 자율평가문제 ···················································94

5 장 심장 율동 이상 (부정맥) / 97

I 정상 율동 / 97 1. 정상 동율동 ·······················································97

2. 비동성 정상 율동 ··················································98

II 서맥성 부정맥(느린맥) / 100

1. 동기능부전 ······················································100

2. 방실전도차단 ····················································103

III 빈맥성 부정맥(빠른맥) / 110

1. 심실상성 빈맥 ····················································110

2. 심실성 빈맥 ······················································125

IV 조기박동 또는 기외수축 / 139

1. 심방 조기박동 ····················································139

2. 접합부 조기박동 ·················································140

3. 심실 조기박동 ····················································141

V 부정맥의 임상적 의미 / 145

1. 치료가 필요 없는 부정맥 ···········································145

2. 치료가 필요한 병적인 부정맥 ·······································146

◈ 자율평가문제 ··················································148

차 례

6 장 심전도 징후 및 현상 / 151

1. 심전도 징후 ······················································151

2. 심전도 현상 ······················································156

◈ 자율평가문제 ··················································168

7 장 심전도 판독의 순서와 기법 / 171

1. 기록의 기준과 질의 평가 ···········································172

2. 심장 율동의 분석 ·················································176

3. 파와 분절의 분석 ·················································214

4. 심전도 분석의 이중 선회법 ·········································265

5. 심전도 분석 결과 서술 방법 ········································266

◈ 자율평가문제 ··················································270

8 장 심전도 홀로서기 연습 / 275

참고 문헌 ··························································338

찾아 보기 ··························································333

INDEX ·····························································339

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