--Electrocardiograma
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Transcript of --Electrocardiograma
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El corazón se contrae gracias a una corriente transmembranal que permite la salida de calcio del retículo endoplasmico
La corriente va desde la aurícula al ventrículo
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Mayor voltaje onda S en V1 Mayor voltaje onda R en v5 – v6 Índice de Sokolow:
S en v1 + R en v5 – v6: >/= 35 mm
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Criterio de Roman y Massie:R mayor que S en v1
S mayor que R en v5 – v6
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QRS ancho (>0.12 seg) en v1 QRS mellado Onda T negativa en v1
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QRS ancho (>0.12 seg) en v5 – v6 QRS mellado Onda T negativa en v5 – v6
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V1 V2 V3 V4 V5 V6
ANTEROSEPTAL
ANTEROSEPTAL
ANTEROLATERAL
ANTEROLATERAL
ANTERIOR EXTENSO ANTERIOR EXTENSO
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ST: lesión Q: necrosis T negativa: Isquemia
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• AMPLITUD O VOLTAJE = HIPERTROFIAS• DURACION O ANCHO = BLOQUEOS • Q PATOLOGICA + ST NORMAL = INFARTO ANTIGUO• Q PATOLOGICA + ST ASCENDIDO = INFARTO EN EVOLUCION • INFARTO DE PARED DIAFRAGMATICA : D2 – D3 – aVF
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Alteración del ritmo normal
Ritmo normal:1. Regular2. Frecuencia ente 60 y 100 x`3. Origen en el nodo sinusal4. Conducción normal
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1. Nodo sinusal2. Aurículas3. Unión
auriculoventricular4. Ventrículos
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TAQUICARDIA SINUDAL
BRADICARDIA SINUSAL
ARRITMINA SINUSAL
PARO SINUSAL
Frecuencia mayor a 100 lpm
Frecuencia menor a 60 lpm
Que sea variable Que se detenga
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CALCULO DE LA FRECUENCIA CARDIACASi la distancia entre dos complejos es de dos cuadros (300/2) = 150 x´Si la distancia entre dos complejos es de tres cuadros (300/3) = 100 x´Si la distancia entre dos complejos es de cuatro cuadros (300/4) = 75 x
1 seg= 25 cuadritos pequeños o 5 cuadros grandes
1500/ cuadritos pequeños entre R-R
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ARRITMIA SINUSAL La frecuencia varia cíclicamente Fisiológica reflejos respiratorio de Bainbridge (arritmia respiratoria)
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PARO SINUSAL Cuando el nódulo sinusal se detiene
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EXTRASISTOLES AURICULARES
TAQUICARDIA AURICULAR PAROXISTICA
FLUTTER O ALETEO AURICULAR
FIBRILACION AURICULAR
Impulso auricular ectópico interfiere con el ritmo sinusal
La aurícula es activada a una frecuencia muy alta 160 a 220 x´
Actividad ectópica auricular alcanza frecuencias entre 250 a 350 x´
Actividad eléctrica mayor que el flutter
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EXTRASISTOLES AURICULARES ser anticipadosOnda P (sinusal)QRS (sinusal
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TAQUICARDIA AURICULAR PAROXISTICAOndas P no son claramente visibles 160 – 220 x´QRS morfología fina (origen supra ventricular)
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FLUTTER AURICULAR Onda p se transforman en ondas F ondas de sierra
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FLUTTER AURICULAR4x1 (QRS 65X´)
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FIBRILACION AURICULARIrregularidad del complejo QRS
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ESCAPES DE LA UNIÓN
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RITMOS DE LA UNIÓN
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EXTRSASISTOLES DE LA UNIÓN
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RITMO IDIOVENTRICULAR
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EXTRASISTOLES VENTRICULAES
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BIGEMINISMO : intoxicación digitalica
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TAQUICARDIA VENTRICULAR: 3 o mas extrasistoles
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El tiempo de la conducción auriculoventricular se mide en el intervalo PR o PQ (0.12 a 0.20 seg 3 a 5 cuadritos)
1. Bloqueos auriculoventriculaes2. Pre excitación (PR corto)
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BLOQUEO AV PRIMER GRADO
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BLOQUEO AV SEGUNDO GRADO – MOBITZ I
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BLOQUEO AV SEGUNDO GRADO – MOBITZ II
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BLOQUEO TERCER GRADO – COMPLETO
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1. Ritmo2. Frecuencia3. Eje4. Onda P5. Intervalo PR6. QRS7. Segmento ST y onda T8. Intervalo QT
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SINUSAL O NO SINUSAL
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Extrasístoles: descargas que rompen las equidistancias R-R
Se pueden clasificar como supra ventriculares y ventriculares
EXTRASISTOLES VENTRICULARES EXTRASISTOLES SUPRAVENTRICULARES
• QRS ancho (>0.12 seg)• P normal• Latido extra • Puede tener pausa compensadora
• QRS estrecho (<0.12 seg – 3 cuadritos)
• P normal • Latido extra
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SI NO ES SINUSAL: ARRITMIAS
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No hay onda P RR irregular QRS estrecho FC rapida
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FC rápida QRS estrecho No hay onda P (múltiples) RR equidistantes ocasionalmente Ondas F dientes en sierra
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QRS ancho Mas de 3 extrasístoles ventriculares seguidas Solo QRS y organizado
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QRS anchos Desorganizados
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1. TVSP 2. FIBRILACION VENTRICULAR
3. AESP4. ASISTOLIA
SE DESFIBRILA
SE DESFIBRILA
NO SE DESFIBRILA
NO SE DESFIBRILA
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En ritmo sinusalContar el numero de cuadros grandes entre R-R
y dividir ese # en 300
No ritmo sinusalEn 15 cuadros grandes, contar el numero de R
que hay, y multiplicar ese # x 20
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2.5 cuadritos de ancho y de alto Anormalidades en auricular Onda P picuda : 3,00 (pulmonar)Crecimiento aurícula derechaHipertensión o tetralogía de Fallot Onda p melladaCrecimiento aurícula izquierdaHTA, valvulopatias, enf coronaria
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Que tan rápido pasa la señal desde la aurícula al ventrículo
Normal 0,12 a 0,20 seg (3 a 5 cuadritos)Prolongado= bloqueo AVAcortado= pre-excitación
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Todas las P conducen QRS
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No todas las P conducen QRS PR prolongado cada vez mas hasta que no
conduce No necesita marcapasosMOBITZ I
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No todas las P conducen QRS PR prolongado Necesita marcapasosMOBITZ II
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Bloqueo AV completo P tiene su propio ritmo, sin relación con QRS Nodo AV no funciona Necesita marcapasos
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PR acortado
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Conducción en el ventrículo Normal 0.10 seg Si esta prolongado hay un bloqueo de rama Derecha (v1 – v2)Izquierda (v5- v6)
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Con la línea isoeléctrica Punto I
CAUSAS INFRADESNIVEL Lesion subendocardica (isquemi)
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V1 Y V2: cara septal V3 Y V4: cara anterior V5 Y V6: cara lateral DII, DIII, aVF: cara inferior DI, aVL: cara lateral alta
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Es asimétrica Cuando es simétrica: invertida: isquemia
subendocardia Si es simétrica positiva: Hipercalemia