ekg en sica e ima
TRANSCRIPT
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CARDIOPATÍCARDIOPATÍA A
ISQUÉMICAISQUÉMICA
Dra. Sara Ramírez FloresDra. Sara Ramírez FloresCardiologíaCardiología
HCFAPHCFAP
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EKG NORMALEKG NORMAL
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Placa ateromatosa intramuralPlaca ateromatosa intramural
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Trombo intramuralTrombo intramural
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Trombo intraluminalTrombo intraluminal
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Trombo oclusivoTrombo oclusivo
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Progresión del tromboProgresión del trombo
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OCLUSIÓN POR BALÓN DE UNA ARTERIA OCLUSIÓN POR BALÓN DE UNA ARTERIA CORONARIACORONARIA
CAMBIOS SECUENCIALES
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V1V1 V2V2 V3V3 V4V4 V5V5 V6V6
II AVLAVL
IIII IIIIII AVFAVF
SEPTUM
ANTERIOR LATERAL
INFERIOR
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CAMBIOS EN EKGCAMBIOS EN EKG
SUBENDO CÁRDICAO n d a T alta, p icu d a y s im étrica
SUBEPICÁRDICAO n d as T n eg ativas y s im étricas
o ap lan ad as
IS Q U E M IA
SUBENDO CÁRDICADep resión h orizon tal y d escen d en te
d el seg m en to ST.
SUBEPICÁRDICAAscen so localizad o d el
seg m en to ST
L E S IÓ N M IO C Á R D IC A
INFARTO TRANSMURAL (Q )O n d a Q p atológ icas
>0,04 seg>25% on d a R
INFARTO NO QAlteracion es en ST-T
Movim ien to b ioq u ím ico.
N E C R O S IS M IO C Á R D IC A
C A M B IO S E .C .G .
3
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ISQUEMIA
ONDAONDA T T
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ISQUEMIA ISQUEMIA SUBENDOCARDICASUBENDOCARDICA
T picudas simétricasT picudas simétricas
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ISQUEMIA ISQUEMIA SUBENDOCARDICASUBENDOCARDICA
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ISQUEMIA ISQUEMIA SUBENDOCARDICASUBENDOCARDICA
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ISQUEMIA ISQUEMIA SUBEPICARDICASUBEPICARDICA
T Negativas simétricasT Negativas simétricas
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Isquemia subepicárdicaIsquemia subepicárdica
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ISQUEMIA ISQUEMIA SUBEPICARDICASUBEPICARDICA
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Isquemia Isquemia Subepicardica Subepicardica
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ISQUEMIA SUBEPICARDICAISQUEMIA SUBEPICARDICA
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ISQUEMIA SUBEPICARDICAISQUEMIA SUBEPICARDICA
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LESIÓN LESIÓN O O
INJURIAINJURIA
SEGMENTO SEGMENTO STST
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LESIÓN LESIÓN SUBENDOCÁRDISUBENDOCÁRDI
CACA
Infradesnivel STInfradesnivel ST
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LESION SUBENDOCARDICALESION SUBENDOCARDICAANTEROLATERALANTEROLATERAL
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LESION LESION SUBENDOCARDICASUBENDOCARDICAANTEROLATERALANTEROLATERAL
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LESIÓN LESIÓN SUBEPICARDICSUBEPICARDIC
AA
Supradesnivel ST
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Lesión subepicárdica Lesión subepicárdica septoanteriorseptoanterior
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Lesión subepicárdica Lesión subepicárdica septoanteriorseptoanterior
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Lesión subepicárdica Lesión subepicárdica inferiorinferior
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Lesión subepicárdica Lesión subepicárdica inferiorinferior
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Lesión subepicárdica Lesión subepicárdica anterolateralanterolateral
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Lesión subepicárdica Lesión subepicárdica inferiorinferior
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LESION SUBEPICARDICA INFERIORLESION SUBEPICARDICA INFERIOR
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Lesión subepicárdica Lesión subepicárdica inferiorinferior
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Lesión subepicárdica Lesión subepicárdica septoanteriorseptoanterior
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Lesión subepicárdica Lesión subepicárdica inferiorinferior
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NECROSISNECROSIS
ONDA Q
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NECROSISNECROSIS
> 25% del complejo QRS Ancho mayor de
40 ms
Voltaje Q > 25% onda R
Ancho Q > 40 ms
Q patologica
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Infarto TansmuralInfarto Tansmural
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INFARTO DEL VENTRICULO INFARTO DEL VENTRICULO DERECHODERECHO
En IMA de cara inferior cara inferior , solicitar derivaciones derechas (V3R, V4R) , y buscar elevación del ST en V3R y V4R : Infarto del ventrículo derecho
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INFARTO CARA POSTERIORINFARTO CARA POSTERIOR
En IMA posteriorposterior se ve una R alta en V1 y un infradesnivel en V1 y V2
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INFARTO CARA INFARTO CARA POSTERIORPOSTERIOR
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NECROSIS
ANTIGUA
NECROSIS
RECIENTE
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Infarto cara inferiorInfarto cara inferior
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Infarto cara inferiorInfarto cara inferior
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Infarto cara inferiorInfarto cara inferior
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Infarto cara inferiorInfarto cara inferior
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Infarto cara inferiorInfarto cara inferior
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Infarto cara inferiorInfarto cara inferior
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Infarto cara inferiorInfarto cara inferior
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Infarto cara septoanteriorInfarto cara septoanterior
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Infarto cara anteriorInfarto cara anterior
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Infarto cara anterolateralInfarto cara anterolateral
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Infarto cara septoanteriorInfarto cara septoanterior
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Infarto cara septal antiguo Infarto cara septal antiguo
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Infarto cara septal - anteriorInfarto cara septal - anterior
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Infarto cara septal - anteriorInfarto cara septal - anterior
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Infarto cara septal - anteriorInfarto cara septal - anterior
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Infarto cara lateralInfarto cara lateral
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Infarto cara septal – anterior lateralInfarto cara septal – anterior lateral
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Localización EKG por Localización EKG por CarasCaras
Anterior V1 V4Anterior V1 V4 Inferior II, III, AVFInferior II, III, AVF Lateral Lateral
I,AVL,V5,V6I,AVL,V5,V6 Posterior V1 V3Posterior V1 V3
V7 V9 V7 V9 V. Derecho V3R,V. Derecho V3R,
V4RV4R
Elev STElev ST Elev STElev ST Elev STElev ST Dism STDism ST Elev STElev ST Elev STElev ST
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Oclusión Coronaria: Evolución del Infarto
Progresion de la necrosis miocardica desde el momento de la oclusion
Adapted from Saltissi S, Mushahwar SS. Postgrad Med J. 1995;71:534-541, with permission.
4 h30 min 6 - 12 h
Miocardio normal
Miocardio isquemico, pero viable
Necrosis subendocardica
Normal miocardio
Infarto completo en toda el area en riesgo
Miocardio normal
Necrosis extendiendo hacia subepicardio
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ST No elevadoST No elevado ST ElevadoST Elevado
Sindrome Coronario AgudoSindrome Coronario Agudo
Angina InestableAngina Inestable IMA no QIMA no Q IMA QIMA Q
NSTEMINSTEMI
Infarto de MiocardioInfarto de Miocardio
Dolor anginosoDolor anginoso
TROMBOPOR. PLAQUETAS TROMBO
POR. FIBRINA
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SUBENDO CÁRDICAO n d a T alta, p icu d a y s im étrica
SUBEPICÁRDICAO n d as T n eg ativas y s im étricas
o ap lan ad as
IS Q U E M IA
SUBENDO CÁRDICADep resión h orizon tal y d escen d en te
d el seg m en to ST.
SUBEPICÁRDICAAscen so localizad o d el
seg m en to ST
L E S IÓ N M IO C Á R D IC A
INF ARTO TRANSMURAL (Q )O n d a Q p atológ icas
>0,04 seg>25% on d a R
INF ARTO NO QAlteracion es en ST-T
Movim ien to b ioq u ím ico.
N E C R O S IS M IO C Á R D IC A
C A M B IO S E .C .G .
CARDIOPATIA CARDIOPATIA ISQUEMICA Y ISQUEMICA Y
ELECTROCARDIOGRAMAELECTROCARDIOGRAMA