Post on 06-May-2017
ELECTROFISIOLOGIA Y ARRITMIAS
CARDIACAS.
JOSE FERNANDO GOMEZ GONZALEZ.MEDICINA CRITICA Y CUIDADO INTENSIVO.
“SANTA CATERINE EXORCIZANDO A UNA MUJER POSEÍDA” Girolano di Benvenuto. Museo de arte de Denver. 1500-1510.
Figure 21-1 Conduction pathways through the heart. A section through the long axis of the heart is shown.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
Figure 21-2 Cardiac action potentials. The distinctive shapes of action potentials at five sites along the spread of excitation are shown.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
EXCITACION CARDIACA.
DESPOLARIZACION CARDIACA.
SECUENCIA DE DESPOLARIZACION DEL MIOCARDIO.
Figure 21-5 Sequence of depolarization in cardiac tissue.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
Haga clic en el icono para agregar una imagen
“CRISTO EL MÉDICO” Atribuido a Werner van den Valckert. Siglo XVII.
Figure 21-7 Components of the ECG recording.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
COMPONENTES DEL TRAZADO.
ELECTROCARDIOGRAMA.
Figure 21-8 The ECG leads.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
ELECTROCARDIOGRAMA.
Figure 21-9 Axes of the limb leads. A, The frontal plane limb leads behave as if they are located at the shoulders (RA, right arm; LA, left arm) and groin (LL, left leg). Leads I, II, and III are separated from one another by 60 degrees. The augmented leads, referenced to the center of the heart, bisect each of the 60-degree angles
formed by leads I, II, and III. B, Translating each of the six frontal leads so that they pass through a common point defines a polar coordinate system, providing views of the heart at 30-degree intervals.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
ELECTROCARDIOGRAMA.
DERIVADAS DERECHAS.
DERIVACIONES POSTERIORES.
“EL NIÑO ENFERMO” Arturo Michelena. 1863-1898.
TRAZADO EKG.
ONDAS EKG.
VALORES NORMALES P: PRECEDE A TODOS LOS QRS, SON
TODAS IDÉNTICAS, NO DEBEN MEDIR MAS DE 2 CUADRITOS O 0.08 S.
PR: NO DEBE MEDIR MAS 5 CUADRITOS O 0.20 S.
QRS: NO DEBEN MEDIR MAS DE 3 CUADRITOS O 0.12 S
FC: NO DEBE SER MENOR A 60x’, NI MAYOR A 100x’.
Figure 21-11 A normal 12-lead ECG recording. The recordings were obtained synchronously, three leads at a time (I, II, and III simultaneously; aVR, aVL, and aVF simultaneously; V1, V2, and V3 simultaneously; and V4, V5, and V6 simultaneously). A 1-mV, 200-ms calibration pulse is visible on the left of each of the three rows. The
leads are marked on the traces. (We thank the Division of Cardiology, University of Maryland School of Medicine, for obtaining this ECG recording from the author.)
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
CALCULO DE FRECUENCIA CARDIACA.
FC EN RITMO IRREGULAR.
The best method for measuring irregular rates with varying R-R intervals is to count the number of R waves in a 6-sec strip and multiply by 10. This gives the average number of bpm.
PROGRESION DE LA R.
EJE CARDIACO.
Figure 21-12 Estimation of the ECG axis in the frontal plane.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
Figure 21-13 Two-cell model of a myocardial infarction. A, The damaged cell B (blue record) has a lower resting potential, but the plateau of its action potential is at the same level as the normal cell A (green record). B, After the records in A are subtracted, the apparent elevation of ST segment is the same as the difference in resting
potentials; the TP and PR regions are actually depressed.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
Figure 21-14 Pathological ECGs. In E, right bundle branch block is visible in the V1 or V2 precordial leads; left bundle branch block is visible in the V5 or V6 leads. (Data from Chernoff HM: Workbook in Clinical Electrocardiography. New York, Medcom, 1972.)
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
Figure 21-15 Abnormal conduction.
Downloaded from: StudentConsult (on 4 July 2010 06:43 PM)© 2005 Elsevier
“LA VISITA DEL DOCTOR” Frans van Miers (El Viejo). Museo Kunsthistorisches, Vienna. 1657.
QUE ES TAQUICARDIA?
QUE ES BRADICARDIA?
INTERPRETE EL TRAZADO…
TRAZADO NORMAL.
“EL PRIMER HERIDO EN EL HOSPITAL DE LONDRES” Jhon Lavery. Museo y galerías de arte Dundee, Dundee (Escocia) 1914-1915.
INTERPRETE EL TRAZADO…
BRADICARDIA SINUSAL.
INTERPRETE EL TRAZADO…
TAQUICARDIA SINUSAL.Rate: Fast (100 bpm)Rhythm: RegularP Waves: Normal (upright and uniform)PR Interval: Normal (0.12–0.20 sec)QRS: Normal (0.06–0.10 sec)
INTERPRETE EL TRAZADO…
FIBRILACION AURICULARRate: Normal (60–100 bpm)Rhythm: IrregularP Waves: At least three different forms, determined by the focus in the atriaPR Interval: Variable; determined by focusQRS: Normal (0.06–0.10 sec
INTERPRETE EL TRAZADO…
TAQUICARDIA SUPRAVENTRICULAR.Rate: 150–250 bpmRhythm: RegularP Waves: Frequently buried in preceding T waves and difficult to seePR Interval: Usually not possible to measureQRS: Normal (0.06–0.10 sec) but may be wide if abnormally conducted through ventricles
INTERPRETE EL TRAZADO…
TAQUICARDIA SUPRAVENTRICULAR PAROXISTICA.
INTERPRETE EL TRAZADO…
FLUTTER ATRIAL.Rate: Atrial: 250–350 bpm; ventricular: slow or fastRhythm: Usually regular but may be variableP Waves: Flutter waves have a saw-toothed appearancePR Interval: VariableQRS: Usually normal (0.06–0.10 sec), but may appear widened if flutter waves are buried in QRS
INTERPRETE EL TRAZADO…
FIBRILACION AURICULAR.
INTERPRETE EL TRAZADO…
SINDROME DE WOLF PARKINSON WHITE. ONDA DELTA
INTERPRETE EL TRAZADO…
RITMO DE LA UNION ACELERADO.
DONDE ESTA LA ONDA P ???
INTERPRETE EL TRAZADO…
RITMO IDIOVENTRICULAR.Rate: 20–40 bpmRhythm: RegularP Waves: NonePR Interval: NoneQRS: Wide (0.10 sec), bizarre appearance
INTERPRETE EL TRAZADO…
CONTRACCIONES VENTRICULARES PREMATURAS.
INTERPRETE EL TRAZADO…
BIGEMINISMO.
INTERPRETE EL TRAZADO…
TRIGEMINISMO.
INTERPRETE EL TRAZADO…
TAQUICARDIA VENTRICULAR.Rate: 100–250 bpmRhythm: RegularP Waves: None or not associated with the QRSPR Interval: NoneQRS: Wide (0.10 sec), bizarre appearance
INTERPRETE EL TRAZADO…
TORSIDA DE PUNTAS.Frequent causes are drugs that prolong QT interval and electrolyte abnormalities such as hypomagnesemia.
INTERPRETE EL TRAZADO…
FIBRILACION VENTRICULAR.
INTERPRETE EL TRAZADO…
ASISTOLIA.
INTERPRETE EL TRAZADO…
BLOQUEO AV DE PRIMER GRADO. PR > 0,20 sg.
INTERPRETE EL TRAZADO…
BLOQUEO AV DE SEGUNDO GRADO (MOBITZ I – WENCKEBACH ).
INTERPRETE EL TRAZADO…
BLOQUEO AV DE SEGUNDO GRADO (MOBITZ II).
Conduction ratio (P waves to QRS complexes) is commonly 2:1, 3:1, or 4:1.
INTERPRETE EL TRAZADO…
BLOQUEO AV DE TERCER GRADO.
INTERPRETE EL TRAZADO…
ESPIGA DE MARCAPASO.
TRATAMIENTO….
MASAJE CAROTIDEO.
TERAPIA ELECTRICA.
PRINCIPALES FARMACOS.
EJERCICIOS
GRACIAS POR SU ATENCION