anatomia electrofisiologia
TRANSCRIPT
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TEMAS1. ANATOMIA Y FISIOLOGIA
2. ELECTROFISIOLOGIA
CELULAR
3. EKG NORMAL
4. DILATACION AURICULAR
5. HIPERTROFIA VENTRICULAR
6. BLOQUEOS DE RAMA
7. BLOQUEOS AV
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CICLO CARDIACO
SISTOLE
1. Fase de contracción isovolumetrica
2. Fase de expulsión rápida
3. Fase de expulsión lenta
4. Fase de relajación isovolumetrica
DIASTOLE
1. Fase de llenado ventricular rapido
2. Fase de llenado ventricular lento
3. Fase de contraccion auricular
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ANATOMIA SISTEMA DE
CONDUCCION
1. NODULO SINUSAL(KEITH Y FLAK)
2. HACES INTERNODALES
ANTERIOR(BACHMAN)
MEDIO(WENCKEBACH) POSTERIOR
(THOREL)
3. UNION AURICULO-
VENTRICULAR(ASCHOW TAWARA)
4. HAS DE HIS
5. RAMA DERECHA DEL HAS DE HIS
6. RAMA IZQUIERDA DEL HAS DE HIS
FASCICULO ANTERO SUPERIOR Y
FASCICULO POSTEROINFERIOR
7. SISTEMA DE PURKINJE
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SISTEMA DE CONDUCCION
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NODULO SINUSAL
1. ES EL MARCAPASO CARDIACO
PRINCIPAL
2. SITUADO EN LA AD A LA DERECHA
DE LA DESEMBOCADURA VCS
3. TIENE TRES TIPOS DE CELULAS LAS
NODALES O TIPO P LAS
TRANSICIONALES O TIPO T Y LAS
AURICULARES
4. LAS TIPO P SON LAS CELULAS
MARCAPASO POR EXCELENCIA
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IRRIGACION
DEL SISTEMA
DE
CONDUCCION
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DA irriga 40% del corazón(pared anterior del VI y reg. anterior septum)Circunfleja irriga pared lateral y una parte de región post del VI
Coronaria derecha irriga VD ,post del septum, inferior post del VI ,el nodo 90%,el seno 45 a 55%
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ARTERIAS CORONARIAS Y
SISTEMA DE CONDUCCION
1. CORONARIA DERECHA NODO
SINUSAL 60% Y AV 80%
2. CIRCUNFEJA NS 40% N AV 20%
3. DESCENDENTE ANTERIOR Y
DESCENDENTE POSTERIOR HAS DE
HIS FASCICULO POSTERIOR HAS DE
HIS
4. DESCENDENTE ANTERIOR
FASCICULO ANTERIOR DEL HAS DE
HIS
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INERVACION
DEL
SISTEMA
DE
CONDUCCION
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SISTEMA PARASIMPATICO
Acetil Colina
Acciones Disminuyen
Gasto cardiaco
Cronotrópica -FC
Batnotropica – conducti
bilidad
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SIMPÁTICO
• Mediadores naturales
Catecolaminas, Epinefrina (suprarrenal),
norepinefrina (terminaciones nerviosas)
• Mediadores sintéticos
Dopamina dobutamina
Acciones
Aumento del Gasto cardíaco
• Inotrópica + aumenta la contractilidad,
• Crono tropo+ aumenta la FC
• Batnotropica + aumenta la conductibilidad
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ELECTROFISIOLOGIA
CELULAR
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AUTOMATISMO NODO Y SENO
1. Capacidad de la célula cardiaca para
iniciar su propia despolarización se debe
al ingreso de CA en una célula de
marcapaso normal revirtiendo la
negatividad intracelular
2. Las células del marcapaso SENO y NODO
poseen despolarización diastólica
espontanea(fase 4) son pobres en canales
de Na
3. El ascenso lento(fase 4) debe al ICa
4. La repolarización a la inactivación del ICa
y activación del IK
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EXCITABILIDAD1. Propiedad de una célula cardiaca para
responder a un estimulo
2. La intensidad de dicho estimulo debe ser
suficiente para reducir el potencial de
reposo alcanzar el potencial umbral y
desarrollar el potencial de acción
3. Si la célula responde solo a estimulos
intenso la célula es poco excitable
4. Si la célula responde a estímulos menores
la célula es muy excitable
5. Las células marcapaso del NSA son
autoexcitables
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CONDUCTIVIDAD
1. Esta determinada por la velocidad de
ascenso de la fase 0 y depende de mayor
negatividad y la disponibilidad de Na
2. Existencia de discos intercalares entre las
células fluyen iones entre ellas a nivel
longitudinal no transversal esto es la
conducción anisotropíca, donde mas
discos existen es en el Purkinje (la
estructura de mayor negatividad) de allí es
el tejido de máxima velocidad
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Conducción anisotrópica
La conducción es más rápida en sentido
longitudinal, que en sentido transversal.
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Conducción isotrópica
La conducción tiene la misma velocidad en todos los sentidos.
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CONDUCTIVIDADCONDUCCION ANISOTROPICA MAS VELOCIDAD(6 VECES)
LONGITUDINAL QUE TRANSVERSAL POR TENER MAS DISCOS
INTERCALARES
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Mm/seg
Aurículas 1000,Union AV 200,His 1000 a
1500,Purkinje 3000-4000,Ventriculos 300-
500
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REFRACTARIEDAD1. PROPIEDAD QUE TIENE LA CELULA DE NO
RESPONDER NORMALMENTE ANTE UN
ESTIMULO NORMAL
2. PRR LA CELULA RESPONDE ANTE UN
ESTIMULO DE MAYOR INTENSIDAD DEL
NORMAL(PORCION DESCENDENTE ONDA
T)
3. PRA LA CELULA NO RESPONDE A NINGUN
ESTIMULO TENGA ESTE LA INTENSIDAD
QUE TENGA(ONDA Q HASTA CUSPIDE
ONDA T)
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ELECTRO
FISIOLOGIA
CELULAR
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CONCEPTOS1. SISTOLE ELECTRICA Y SISTOLE MECANICA
2. DESPOLARIZACION
3. REPOLARIZACION
4. POTENCIAL DE REPOSO O TRANSMENBRANA
5. POTENCIAL UMBRAL
6. POTENCIAL DE ACCION
7. EQUILIBRIO IONICO ELECTRICO
8. EQUILIBRIO OSMOTICO
9. CANALOPATIAS-PROTEINAS SELECTIVAS-CANALES
10.VOLTAJEDEPENDIENTES
11.TIEMPODEPENDIENTES
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SISTOLE ELECTRICA
1. SON LOS CAMBIOS ELECTRICOS QUE
PRECEDE LA SISTOLE MECANICA
2. NODO SINUSAL-HACES
INTERNODALES-AURICULAS-NODO
AV-VENTRICULOS-HAS DE HIS-RDHH-
RIHH-RIAS-RIPI-PURKINJE
3. RESPUESTA RAPIDA CANALES DE
SODIO MIOCARDIO ATRIAL-
VENTRICULAR Y PURKINJE
4. RESPUESTA LENTA CANALES DE
CALCIO NODO SINUSAL Y AV
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SISTOLE ELECTRICA Y
MECANICA
NODO SINUSAL- AV-HIS-RAMA
DERECHA IZQUIERDA-FASCICULOS AS
PI –PURKYNJE
DESPOLARIZACION Y
REPOLARIZACION DE LA CELULA
POTENCIAL DE REPOSO Y DE ACCION
SISTOLE MECANICA-CONTRACCION
DEL MIOCITO
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SISTOLE ELECTRICA
1. SON LOS CAMBIOS ELECTRICOS QUE
PRECEDE LA SISTOLE MECANICA
2. NODO SINUSAL-HACES
INTERNODALES-AURICULAS-NODO
AV-VENTRICULOS-HAS DE HIS-RDHH-
RIHH-RIAS-RIPI-PURKINJE
3. RESPUESTA RAPIDA CANALES DE
SODIO MIOCARDIO ATRIAL-
VENTRICULAR Y PURKINJE
4. RESPUESTA LENTA CANALES DE
CALCIO NODO SINUSAL Y AV
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POTENCIAL DE REPOSO
• LO MIDE UN GALVANOMETRO
• INTRACELULAR NEGATIVO (potasio,
proteínas intracelulares)
• EXTRACELULAR POSITIVO( sodio,
calcio cloro)
• EQUILIBRIO IONICO Y OSMOTICO
• TRANSFERENCIAS A TRAVES DE LA
MENBRANA CELULAR POR
INTERMEDIO DE
CANALES(PROTEINAS)-VOLTAJE
DEPENDIENTES Y TIEMPO
DEPENDIENTES
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CELULA POLARIZADA
COMPOSICION DE
ELECTROLITOS
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+ + + + + + + + + + + + ++++
+ +
+ +
+ +
+ +
+ +
+ + + + + + + + + + + + + + +
- - - - - - - - - - - - - - -
- A-, K+(150), Na+ (10), -
- Mg++(40) -
- - - - - - - - - - - - - - -
0
-90 mV
Reposo
- - - - - - - - - + + + + + +
- +
- +
- +
- +
- +
- - - - - - - - - + + + + + +
+ + + + + + + - - - -
+ K -
+ Proteínas -
+ + + + + + + - - - -
0
-90 mV
Despolarización
+
K+ (5), Na+ (140), Mg++ 2,5, Cl- (103), Ca++ (5)
Célula polarizada
Estimulo
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DESPOLARIZACION
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LEYES DE LA DESPOLARIZACION
1. EL VECTOR SE REPRESENTA COMO
UNA FLECHA EN QUE LA CABEZA ES
POSITIVA Y LA COLA NEGATIVA
2. VA DE ENDOCARDIO A PERICARDIO
3. CUANDO EL VECTOR SE
ACERCA(CABEZA POSITIVA) A LA
DERIVACION DARA UNA ONDA
POSITIVA
4. CUANDO EL VECTOR SE ALEJA(COLA
NEGATIVA) DE UNA DERIVACION DARA
UNA ONDA NEGATIVA
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REPOLARIZACION
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+ + + + + + Na - - - - - -
+ -
+ -
+ -
+ -
+ -
+ + + + + + + + + - - - - - -
PAT
- - - - - - - - - - + + + +
- K +
- Proteínas +
- - - - - - - - - - + + + +
Repolarización
0
-90 mV
+
+ + + + + + + + + + + + ++++
+ +
+ +
+ +
+ +
+ +
+ + + + + + + + + + + + + + +
- - - - - - - - - - - - - - -
- A-, K+(150), Na+ (10), -
- Mg++(40) -
- - - - - - - - - - - - - - -
0
-90 mV
Célula polarizada
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LEYES DE LA REPOLARIZACION
1. EL VECTOR SE REPRESENTA COMO
UNA FLECHA EN QUE LA CABEZA ES
NEGATIVA Y LA COLA ES POSITIVA
2. VA DE EPICARDIO A ENDOCARDIO
3. CUANDO EL VECTOR SE
ACERQUE(CABEZA NEGATIVA) A UNA
DERIVACION DARA UNA ONDA
NEGATIVA
4. CUANDO EL VECTOR SE ALEJE DE UNA
DERIVACION DARA UNA ONDA
POSITIVA
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CORRIENTES DE
ELECTROLITOS
I Na DESPOLARIZACION
entrada rápida de sodio responsable de la fase 0 estos canales miocardio auricular-ventricular y purkinje estos canales se activan en -65 mvolt y se desactivan en + 35
mvolt en -65 mvolt y se desactivan a +35 mvolt
I Ca
en nódulo sinusal y AV son corrientes de entrada de calcio
IK
corriente de repolarización o de salida de K
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POTENCIAL DE ACCION
RESPUESTA RAPIDA
ACTIVACION CANALES
RAPIDOS DE NA
MIOCARDIO ATRIAL
VENTRICULAR PURKINJE
FASES O-1-2-3-4
POTENCIAL DE REPOSO-80-90
RESPUESTA LENTA
ACTIVACION CANALES LENTOS
DE CA
NODULO SINUSAL Y AV
FASES 0-3-4
POTENCIAL DE REPOSO -50 -60 V
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A B
C D
E
Potencial de Acción Transmembrana
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POTENCIAL DE ACCION RAPIDO
DESPOLARIZACION
FASE 0
REPOLARIZACION
FASE 1
FASE 2
FASE 3
REPOSO
FASE 4
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FASE 0
ENTRADA MASIVA DE SODIO
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FASE 1
SALE K ENTRA CL
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FASE 2
SALE K ENTRA NA Y CA
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FASE 3
SALIDA MASIVA DE K
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FASE 4
SACA NA ENTRA K
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RESUMEN
• FASE 0 ENTRADA MASIVA DE NA
• FASE 1 SALE K ENTRA CL
• FASE 2 SALE K ENTRA NA Y CA
• FASE 3 SALIDA MASIVA DE K
• FASE 4 ENTRA K SALE NA
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POTENCIAL DE ACCION
CANALES LENTOS
1. FASE 0 INGRESO DE CALCIO
CANALES LENTO POLARIZACIOON
TARDIAS
2. NO HAY FASE 1 NI 2
3. FASE 3 REPOLARIZACION TARDIA
SALIDA DE CA
4. FASE 4 DESPOLARIZACION
DIASTOLICA INGRESO DE CALCIO Y
SODIO
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Fase 0 : El NSA estimula a las aurículas para que alcancen el PU y cuando se llega -65 mV,
los canales de Na+ se abren súbitamente lo cual ocasiona el ascenso rápido de la fase 0 en
las células auriculares; este ascenso es mas rápido cuanto mas negativo es el potencial de
reposo. tambien ingresa Ca++ por los canales de Ca++, En las células
ventriculares la fase 0 dura de 1-3 mseg, en ese tiempo el PA cambia de -90 mV a +40 mV.
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Fase 1: Es el inicio de la repolarización. Resulta de la
inactivación del INa+ y ICa++, y de la perdida de K+ intracelular.
El PA cae a 0 mV en las células ventriculares.
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Fase 2: Es la fase mas larga, llamada tambien meseta o plateau debido a que las corrientes
de ingreso y salida están equilibradas, particularmente en el sistema His-Purkinje. Hay un
ingreso lento de Na+ y Ca++, asociada a una salida progresiva de K+, cuando esta ultima
supera a la primera cesa la contracción y empieza la relajacion. Las corrientes de salida de
K+ están reguladas para lograr un periodo refractario absoluto protector, durante esta los
miocardiocitos no responden a ningún estimulo por fuerte que sea.
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Fase 3: Es la fase de repolarización rápida y tardía. La salida de K+ supera al ingreso de
Na+, y se cierran los canales lentos de Ca++, acelerándose la repolitización. El interior de
la célula se hace mas negativo, permitiendo que la célula se torne excitable. Al finalizar
esta fase las células ventriculares conducen mejor de lo se preveía, o no ocurre el bloqueo
esperado, pudiendo ser excitadas por un estimulo débil, es el periodo de conducción
supernormal.
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Fase de reposo
Fase 4: Al inicio hay un excedente de K+ extracelular y de Na+ intracelular. El PT del miocardio
ventricular esta entre -85 y -90mV; al empezar la fase 4 se activan las If, las cuales hacen que las
células marcapasos se tornen gradualmente menos negativas, hasta que alcanzan el PU y se
despolarizan espontáneamente. En esta fase todas las células cardiacas son excitables.
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CLASIFICACION
ANTIARRITMICOS
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SISTEMA DE CONDUCCION
ANATOMIA Y FISIOLOGIA
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