38122242 ekg patologica
DESCRIPTION
ekgTRANSCRIPT
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EKG PATOLOGICA
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SCHEMA RAPIDA DE INTERPRETARE A EKG
1. FRECVENTA
2. RITMUL
3. AXA
4. HIPERTROFIE
5. INFARCT
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1. FRECVENTA
• MODIFICARI DE FRECVENTAI. BRADICARDIE
frecvente lente < 60 batai/minut* ritm jonctional
II. TAHICARDIEfrecvente rapide > 100
batai/minut( 100 – 150 / min )
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I. BRADICARDIE SINUSALA
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Bradicardie sinusala
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RITM JONCTIONAL
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II. TAHICARDIE SINUSALA
- frecventa rapida intre 100 si 150/minut
- unde P identice inainte de fiecare complex QRS
- ritm regulat
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Tahicardie sinusala
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2. RITM
• TULBURARI DE RITM
I. RITM NEREGULAT
II. EXTRASISTOLE
III. RITMURI RAPIDE
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I . RITM NEREGULAT
1.1. ARITMIA SINUSALAARITMIA SINUSALA- unda de stimulare ia nastere in
NSA dar impulsurile sunt eliberate la intervale variabile
- unde P identice- distante R-R inegale- se intalneste in mod normal la copii- la adulti, adesea se datoreaza bolii
nodului sinusal (sick sinus syndrome)
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ARITMIE SINUSALA
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ARITMIA SINUSALA
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2.2. RITM VAGABOND RITM VAGABOND ( wandering pacemaker )( wandering pacemaker )
- acest ritm apare ca urmare a schimbarii pozitiei pacemaker-ului
- unde P diferite ca forma in functie de sediul pacemaker-ului
- distante R-R inegale
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WANDERING PACEMAKER
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RITM VAGABOND
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3. 3. FIBRILATIA ATRIALAFIBRILATIA ATRIALA
- se datoreaza descarcarii a numeroase focare atriale ectopice si numai din intamplare unul dintre impulsuri ajunge la NAV
- nu exista unde P
- exista mici unde de fibrilatie ( f )
- distante R-R inegale
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FIBRILATIA ATRIALA
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FIBRILATIA ATRIALA
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II. EXTRASISTOLE
Sunt batai care apar mai precoce decat normal.
Se datoresc unor descarcari premature a diferitelor focare ectopice atriale sau ventriculare.
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1.1. EXTRASISTOLA ATRIALA EXTRASISTOLA ATRIALA-un focar atrial ectopic
genereaza unde P anormale,
precoce urmate de cate un
QRS normal. Impulsul nu ia
nastere in NSA deci nu se
aseamana cu celelalte unde
P. In schimb, NAV capteaza
si transmite impulsul normal.
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EXTRASISTOLA ATRIALAEXTRASISTOLA ATRIALA
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2.2. EXTRASISTOLA NODALA EXTRASISTOLA NODALA
- un focar ectopic al nodului
atrio-ventricular genereaza un
QRS precoce, neprecedat de unda P
sau precedat de unda P negativa
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3. 3. EXTRASISTOLA VENTRICULARAEXTRASISTOLA VENTRICULARA
EsV ia nastere intr-un focar ectopic al unui ventricul. Se caracterizeaza printr-un complex QRS larg si precoce urmat de o pauza compensatorie.
In contrast cu EsV, EsA sunt urmate de o pauza care nu
este compensatorie.
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EXTRASISTOLA VENTRICULARAEXTRASISTOLA VENTRICULARA
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EsV se cupleaza uneori cu una sau mai multe batai normale si acest aspect se produce regulat. Cand se cupleaza o EsV cu o bataie normala este vorba de bigeminism, cu doua batai trigeminism etc.
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Bigeminism
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Trigeminism
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Un focar ventricular ectopic se poate descarca o singura data sau din contra sa produca o serie de impulsuri succesive care realizeaza o salva de extrasistole.
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EsV multifocale se datoresc focarelor ectopice ventriculare multiple. EsV multifocale au morfologie diferita.
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III. RITMURI RAPIDE
1.1. TAHICARDIA PAROXISTICATAHICARDIA PAROXISTICA
Inseamna o frecventa rapida
( tahicardie ) cu debut brusc
( paroxistica ).
Frecventa cardiaca in TP
este de 150 – 250/minut.
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TAHICARDIA PAROXISTICA ATRIALATAHICARDIA PAROXISTICA ATRIALA
- se datoreaza unei descarcari rapide si bruste a unui focar ectopic atrial.- este o succesiune normala de unde P si complexe QRS cu o frecventa foarte rapida
- TPA poate sa se produca la o frecventa atat de rapida incat undele P se amesteca cu undele T ceea ce da aspectul unei unde unice.
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TAHICARDIA PAROXISTICA NODALATAHICARDIA PAROXISTICA NODALA
- se datoreaza unui focar ectopic situat in NAV
- este o succesiune de complexe QRS neprecedate de unda P cu o frecventa foarte rapida.
- TPA si TPN sunt denumite in ansamblu tahicardie paroxistica supraventriculara
( TPSV )
- diagnosticul TPA sau TPV nu este esential, ele se trateaza la fel.
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TAHICARDIA PAROXISTICA TAHICARDIA PAROXISTICA VENTRICULARAVENTRICULARA
- este declansata de un focar ectopic ventricular
- seamana cu o succesiune rapida de EsV
- frecventa rapida ( 150 – 250/minut )
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2.2. FLUTTER ATRIAL FLUTTER ATRIAL
- ia nastere intr-un focar ectopic atrial unic
- undele de flutter ( F ) survin in succesiune rapida si sunt identice
- sunt comparate cu dintii de fierastrau
- ritmul este in general regulat
- frecventa undelor de flutter este cuprinsa intre 250 – 350/minut
- impulsul atrial va stimula periodic NAV ceea ce inseamna ca va exista o serie de unde F inaintea fiecarui complex QRS
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FLUTTER ATRIALFLUTTER ATRIAL
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3. 3. FLUTTER VENTRICULARFLUTTER VENTRICULAR
- este produs de un focar ectopic ventricular unic
- undele sinusoidale regulate se succed cu o frecventa intre 200 – 300/minut
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4.4. FIBRILATIA ATRIALA FIBRILATIA ATRIALA
- se datoreaza numeroaselor focare ectopice atriale care se descarca cu frecvente diferite antrenand un ritm haotic , neregulat
- nu exista unde P ci unde f (de fibrilatie)
- numai din intamplare un impuls atrial va stimula nodul AV
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FIBRILATIA ATRIALAFIBRILATIA ATRIALA
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5. FIBRILATIE VENTRICULARA5. FIBRILATIE VENTRICULARA
-se datoreste stimulilor ce iau nastere in focare ectopice ventriculare multiple antrenand contractii haotice
- activitatea electrica este complet anarhica
- amplitudinea deflexiunilor diminua pe masura ce inima moare
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FIBRILATIE VENTRICULARAFIBRILATIE VENTRICULARA
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EXERCITII
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?
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FLUTTER ATRIAL
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?
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FLUTTER VENTRICULAR
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?
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1. TAHICARDIE SINUSALA
2. TAHICARDIE SUPRAVENTRICULARA
3. TAHICARDIE VENTRICULARA
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EsA
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?
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EsN
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EsA
EsN
EsV - bigeminism
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RITM SINUSAL NORMAL
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ARITMIE SINUSALA
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TAHICARDIE SINUSALA
TAHICARDIE VENTRICULARA
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BRADICARDIE SINUSALA
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WANDERING PACEMAKER
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EXTRASISTOLE VENTRICULARE
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FIBRILATIE ATRIALA
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FIBRILATIE VENTRICULARA
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•TULBURARI DE CONDUCERE
1. BLOC SINOATRIAL
2. BLOCURI ATRIOVENTRICULARE
3. BLOCURI DE RAMURA
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1. BLOC SINOATRIAL
- NSA este blocat temporar
- pacemaker-ul normal al cordului se blocheaza temporar cel putin in timpul unui ciclu dar apoi isi reia activitatea de stimulare.
- undele P inainte si dupa bloc sunt identice
( toate iau nastere in NSA )
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2. BLOCURI ATRIOVENTRICULARE
BAV gradul IBAV gradul I- impulsul intarzie la nivelul NAV mai
mult decat normal ( 0,1 sec )
- intervalul PQ/PR > 0,20 sec
- de indata ce NAV este stimulat, depolarizarea ventriculara se produce normal
- secventa QRS – T normala
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BLOC AV GRADUL IBLOC AV GRADUL I
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BAV gradul II
Un bloc AV apare atunci cand sunt necesare mai mult de 2 impulsuri atriale pentru a declansa un raspuns ventricular.
Asta inseamna ca doua sau mai multe unde P preced un complex QRS
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BAV gradul II Mobitz IBAV gradul II Mobitz I( perioada Wenc( perioada WencKKebachebach ) )
- apare cand intervalul PR se alungeste progresiv pana apare un “P blocat”
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BAV gradul II Mobitz IBAV gradul II Mobitz I
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BAV gradul II Mobitz IIBAV gradul II Mobitz II
- se constata absenta ocazionala a unui complex QRS dupa o unda P normala
- intervalele PR sunt normale
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BAV BAV gradul gradul IIIIII
- apare atunci cand niciunul dintre impulsurile atriale nu stimuleaza NAV
- ventriculele nestimulate pun in actiune un pacemaker ectopic de la nivelul lor care va descarca impulsuri cu frecventa ~ 30/min
- in BAV grd III se constata ca frecventa atriala ( undele P ) difera de cea ventriculara ( complexele QRS ). Aceasta se numeste disociatie atrioventriculara.
- In BAV gradul III pulsul este atat de lent incat fluxul sangvin cerebral este diminuat si pacientul poate prezenta pierderea constientei
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BAV COMPLETBAV COMPLET
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Bloc AV gradul I
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3.3. BLOCURI DE RAMURA BLOCURI DE RAMURA- se datoreaza unui blocaj al impulsului in
ramurile dreapta si stanga a fasciculului Hiss- ramura dreapta trimite stimulul de
depolarizare la ventriculul drept iar ramura stanga la ventriculul stang. Acest lucru se realizeaza in mod normal simultan.
- un bloc al unei ramuri determina o intarziere a transmiterii impulsului de partea respectiva. Deoarece ventriculele nu se mai depolarizeaza simultan , QRS –ul va avea aspect largit > 0,12 sec. Depolarizarea fiecarui ventricul se realizeaza separat astfel ca pe EKG apar doua unde R care se noteaza R si R
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Daca gasim un QRS largit peste 0,12 sec pe EKG inseamna ca exista un bloc de ramura.
Cautam aspectul R- R in precordiale.
- R- R in precordialele drepte (V1 si V2)
- axa la dreapta BRD
- ST si T in sens opus QRS
- R- R in precordialele stangi ( V5 si V6 )
- axa la stanga BRS
- ST si T in sens opus QRS
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BLOC DE RAMURA DREAPTABLOC DE RAMURA DREAPTA
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BLOC DE RAMURA STANGABLOC DE RAMURA STANGA
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BLOC DE RAMURA DREAPTABLOC DE RAMURA DREAPTA
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BLOC DE RAMURA STANGABLOC DE RAMURA STANGA
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SDR DE PREEXCITATIESDR DE PREEXCITATIE ( WOLFF-PARKINSON-WHITE ) ( WOLFF-PARKINSON-WHITE )
- reprezinta o depolarizare prematura a ventriculelor
- pe EKG se inscrie un interval PR scurtat si unda delta
- la indivizii cu sdr WPW exista un fascicul accesoriu care elimina intarzierea obisnuita de 0,1 sec a impulsului la nivelul NAV
- acesti indivizi pot dezvolta usor TPSV
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SDR DE PREEXCITATIESDR DE PREEXCITATIE( WOLFF-PARKINSON-WHITE )( WOLFF-PARKINSON-WHITE )
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EXERCITII
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?
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BLOC SINOATRIAL
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?
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BAV gradul II Mobitz I
BAV gradul II Mobitz II
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?
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BAV gradul I
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MOBITZ I
BSA
MOBITZ II
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?
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EXTRASISTOLA ATRIALA
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TAHICARDIE SINUSALA
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SDR DE PREEXCITATIE
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?
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EXTRASISTOLE VENTRICULARE
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?
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BAV gradul III ( complet )
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FIBRILATIE ATRIALA
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TAHICARDIE SUPRAVENTRICULARA
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TAHICARDIE VENTRICULARA
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RITM JONCTIONAL
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BRD
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BRS
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?
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FLUTTER VENTRICULAR
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BLOC SINOATRIAL
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FIBRILATIE VENTRICULARA
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EXTRASISTOLA ATRIALA
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FLUTTER ATRIAL