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EKG PATOLOGICA

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SCHEMA RAPIDA DEINTERPRETARE A EKG

1. FRECVENTA

2. RITMUL3. AXA4. HIPERTROFIE

5. INFARCT

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1.FRECVENTA

MODIFICARI DE FRECVENTA

I. BRADICARDIEfrecvente lente < 60 batai/minut

* ritm jonctional

II. TAHICARDIE

frecvente 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 rapidaintre 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 NEREGULATII. EXTRASISTOLE

III. RITMURI RAPIDE

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I . RITM NEREGULAT

1. ARITMIA SINUSALA

- unda de stimulare ia nastere in NSAdar impulsurile sunt eliberate la intervalevariabile

- 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. RITM VAGABOND( wandering pacemaker )

- acest ritm apareca urmare a schimbariipozitiei pacemaker-ului

- unde P diferiteca forma in functie desediul pacemaker-ului

- distante R-R

inegale

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WANDERING PACEMAKER

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RITM VAGABOND

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3. FIBRILATIA ATRIALA

- se datoreazadescarcarii a numeroasefocare atriale ectopice sinumai din intamplare unul

dintre impulsuri ajunge laNAV- 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 maiprecoce decat normal.

Se datoresc unor descarcaripremature a diferitelor focareectopice atriale sau ventriculare.

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1. 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 seaseamana cu celelalte undeP. In schimb, NAV capteazasi transmite impulsul normal.

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EXTRASISTOLA ATRIALA

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2. EXTRASISTOLA NODALA

- un focar ectopic al noduluiatrio-ventricular genereaza unQRS precoce, neprecedat de unda Psau precedat de unda P negativa

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3. EXTRASISTOLA VENTRICULARA

EsV ia nastere intr-un focar ectopic al unuiventricul. Se caracterizeaza printr-un complex QRS largsi 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 VENTRICULARA

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EsV se cupleaza uneori cu una saumai multe batai normale si acest aspect seproduce regulat. Cand se cupleaza o EsV cuo bataie normala este vorba de bigeminism,cu doua batai trigeminism etc.

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Bigeminism

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Trigeminism

Un focar ventricular ectopic se poate

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Un focar ventricular ectopic se poatedescarca o singura data sau din contra saproduca o serie de impulsuri succesive care

realizeaza o salva de extrasistole.

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EsV multifocale se datoresc focarelorectopice ventriculare multiple. EsV multifocale au

morfologie diferita.

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III. RITMURI RAPIDE

1. TAHICARDIA PAROXISTICA

Inseamna o frecventa rapida( tahicardie ) cu debut brusc( paroxistica ).

Frecventa cardiaca in TPeste de 150 250/minut.

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TAHICARDIA PAROXISTICA ATRIALA

- se datoreaza unei descarcari rapide si brustea 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 derapida incat undele P se amesteca cu undele Tceea ce da aspectul unei unde unice.

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TAHICARDIA PAROXISTICA NODALA

- se datoreaza unui focar ectopic situat in NAV- este o succesiune de complexe QRSneprecedate de unda P cu o frecventa foarterapida.

- TPA si TPN sunt denumite in ansamblutahicardie paroxistica supraventriculara

( TPSV )- diagnosticul TPA sau TPV nu este esential,

ele se trateaza la fel.

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TAHICARDIA PAROXISTICAVENTRICULARA

- este declansata de un focar ectopicventricular

- seamana cu o succesiune rapida de

EsV- frecventa rapida ( 150 250/minut )

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2. FLUTTER ATRIAL

- ia nastere intr-un focar ectopicial unic

- undele de flutter ( F ) survin inccesiune rapida si sunt identice

- sunt comparate cu dintii derastrau

- ritmul este in general regulat- frecventa undelor de flutter este

prinsa intre 250 350/minut- impulsul atrial va stimula periodic

V ceea ce inseamna ca va exista orie de unde F inaintea fiecarui complexS

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FLUTTER ATRIAL

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3. FLUTTER VENTRICULAR

- este produs de un focar ectopicventricular unic

- undele sinusoidale regulate se

succed cu o frecventa intre 200 300/minut

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4. FIBRILATIA ATRIALA

- se datoreaza numeroaselor focareectopice atriale care se descarca cu frecventediferite 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 ATRIALA

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5. FIBRILATIE VENTRICULARA

-se datorestestimulilor ce iau nastere infocare ectopice ventricularemultiple antrenand contractii

haotice- activitatea electricaeste complet anarhica

- amplitudineadeflexiunilor diminua pemasura ce inima moare

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FIBRILATIE 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

SUPRAVENTRICULARA3. TAHICARDIE VENTRICULARA

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?

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EsA

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?

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EsN

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EsAEsNEsV - bigeminism

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?

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RITM SINUSAL NORMAL

?

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?

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ARITMIE SINUSALA

?

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?

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TAHICARDIE SINUSALATAHICARDIE VENTRICULARA

?

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?

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BRADICARDIE SINUSALA

?

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?

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WANDERING PACEMAKER

?

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?

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EXTRASISTOLE VENTRICULARE

?

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?

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FIBRILATIE ATRIALA

?

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?

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TULBURARI DE CONDUCERE

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TULBURARI DE CONDUCERE

1. BLOC SINOATRIAL

2. BLOCURI ATRIOVENTRICULARE3. BLOCURI DE RAMURA

1 BLOC SINOATRIAL

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1. BLOC SINOATRIAL

- NSA este blocat temporar- pacemaker-ul normal al cordului se

blocheaza temporar cel putin in timpul unui cicludar apoi isi reia activitatea de stimulare.

- undele P inainte si dupa bloc sunt identice( toate iau nastere in NSA )

2 BLOCURI ATRIOVENTRICULARE

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2. BLOCURI ATRIOVENTRICULARE

BAV 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

BLOC AV GRADUL I

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BLOC AV GRADUL I

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BAV d l II

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BAV gradul II

Un bloc AV apare atunci cand suntnecesare mai mult de 2 impulsuri atrialepentru a declansa un raspuns ventricular.

Asta inseamna ca doua sau mai multeunde P preced un complex QRS

BAV gradul II Mobitz I

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BAV gradul II Mobitz I( perioada WencKebach )

- apare cand intervalul PR se alungesteprogresiv pana apare un P blocat


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g adu ob t

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BAV grad l II Mobit II

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BAV gradul II Mobitz II

- se constata absenta ocazionala aunui complex QRS dupa o unda P normala

- intervalele PR sunt normale

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BAV gradul III

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BAV gradul III

- apare atunci cand niciunul dintre impulsurileatriale nu stimuleaza NAV- ventriculele nestimulate pun in actiune un

pacemaker ectopic de la nivelul lor care va descarcaimpulsuri cu frecventa ~ 30/min

- in BAV grd III se constata ca frecventa atriala( undele P ) difera de cea ventriculara ( complexeleQRS ). Aceasta se numeste disociatie atrioventriculara.

- In BAV gradul III pulsul este atat de lent incatfluxul sangvin cerebral este diminuat si pacientul poateprezenta pierderea constientei

BAV COMPLET

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BAV COMPLET

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Bloc AV gradul I

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3 BLOCURI DE RAMURA

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3. BLOCURI DE RAMURA

- se datoreaza unui blocaj al impulsului inramurile dreapta si stanga a fasciculului Hiss

- ramura dreapta trimite stimulul dedepolarizare la ventriculul drept iar ramura stangala ventriculul stang. Acest lucru se realizeaza in

mod normal simultan.- un bloc al unei ramuri determina o

intarziere a transmiterii impulsului de partearespectiva. Deoarece ventriculele nu se mai

depolarizeaza simultan , QRS ul va avea aspectlargit > 0,12 sec. Depolarizarea fiecarui ventriculse realizeaza separat astfel ca pe EKG apar douaunde R care se noteaza R si R

Daca gasim un QRS largit peste 0,12 sec peEKG inseamna ca exista un bloc de ramura.

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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

BLOC DE RAMURA DREAPTA

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BLOC DE RAMURA STANGA

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SDR DE PREEXCITATIE( WOLFF-PARKINSON-WHITE )

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( 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 aimpulsului la nivelul NAV

- acesti indivizi pot dezvolta usor TPSV

SDR DE PREEXCITATIE( WOLFF PARKINSON WHITE )

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( 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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?

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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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TAHICARDIE SINUSALA

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SDR DE PREEXCITATIE

?

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?

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EXTRASISTOLEVENTRICULARE

?

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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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BRS

?

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FLUTTER VENTRICULAR

?

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BLOC SINOATRIAL

?

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?

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?

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FLUTTER ATRIAL

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HIPERTROFIE

SIINFARCT

4. HIPERTROFIE

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Hipertrofia unei cavitati inseamna ocrestere a grosimii peretelui acelei cavitati.

HIPERTROFIE ATRIALA

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Pentru evidentierea hipertrofieiatriale se examineaza unda P. Daca

unda P este inalta > 2,5 mV saumasoara > 3 patrate mici ( > 0,12sec ) atunci exista hipertrofie atriala.

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HIPERTROFIE ATRIALASTANGA

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HAS

Aspect bifid alundei P cu primacocoasa mai joasa si adoua mai inalta. Bazaundei P depaseste 0,12sec. Se mai numesteP mitral sau P bifid sise intalneste in stenozamitrala

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HIPERTROFIA VENTRICULARADREAPTA

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HVD

- unda R mare in V1si V2

- unda R diminuaapoi progresiv spre V4- complex QRS larg( 0,12 sec )

- deviatie axialadreapta

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HAD si HVD

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HIPERTROFIA VENTRICULARASTANGA

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HVS- S in V1 + R in V5 35 mm

= indicele Sokolov - Lyon

- deviatie axiala stanga- complex QRS larg( 0,12 sec )

- unda T inversata

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5. INFARCT

Infarctul miocardic este

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Infarctul miocardic este

consecinta unei obstructii a uneiartere coronare.

Ventriculul stang care areperetele cel mai gros are nevoiede o irigatie sangvina

importanta si este primul caresufera de pe urma diminuariicirculatiei coronare.

Zona infarctata este din

punct de vedere electric moartasi nu poate conduce impulsurielectrice.

TRIADA CLASICA AINFARCTULUI

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ISCHEMIE

( T negativ )

LEZIUNE(ST supradenivelat)

NECROZA( Q patologic )

DIAGNOSTICUL POZITIV ALINFARCTULUI DE MIOCARD

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Diagnosticul pozitiv al infarctului de miocardse pune pe existenta celor trei criterii :

1 ) necroza : unda Q patologicalargime = 0,04 sec

adancime = 1/3 1/4R

2 ) leziune : ST supradenivelat, cu formaarcuata, concava spre linia izoelectrica a traseului

3 ) ischemie : T negativ, amplu

DIAGNOSTICUL TOPOGRAFIC ALINFARCTULUI MIOCARDIC

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I. ANTERIOR : Q patologic in V1, V2, V3, V4

I. LATERAL : unde Q patologice in DI , aVL

I. INFERIOR : Q patologic in DII, DIII, aVF

I. POSTERIOR : unda R mare in V1, V2subdenivelare ST in V1, V2

INFARCT ANTERIOR : Q patologic inV1, V2, V3

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INFARCT LATERAL : unde Q patologicein DI , aVL

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INFARCT INFERIOR : STsupradenivelatin DII, DIII, aVF

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INFARCT POSTERIOR:unda R mare inV1,V2subdenivelare ST in V1, V2

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DIAGNOSTICUL EVOLUTIV ALINFARCTULUI MIOCARDIC

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Se disting 4 stadii :Stadiul I ( precoce )

faza supraacuta

Stadiul II ( intermediar ) faza acutaStadiul III ( tardiv )

faza de rezolutie

Stadiul IV ( cicatricial ) faza cronica

Stadiul I( precoce , supraacut )

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- apare in primele 24 36de ore de la debut

- supradenivelare foarteampla de ST

- segmentul ST pleaca dinvarful undei R

- unda S nu mai existaeste contopita cu unda T carenici ea nu se mai distinge

( unda in dom )- apare Q patologic

Stadiul II( intermediar , acut )

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- apare in prima saptamana dela debut

- aspect EKG caracteristic :unda Q patologica,segmentul ST supradenivelatsi unda T negativa

- pe zi ce trece, segmentul STcoboara tot mai mult spre

linia izoelectrica iar unda Tdevine tot mai ampla

Stadiul III( tardiv, de rezolutie )

apare la 1 3 sapt de la

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- apare la 1 3 sapt de la

infarct- pe EKG coexista unda Q

patologica si unda T negativa,ampla

( T coronarian )- segmentul ST devineizoelectric

- dupa 3 saptamani, unda T

negativa incepe sa semicsoreze treptat

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Stadiul IV( cronic, cicatricial )

- persista indefinitdupa vindecarea clinicaa infarctului

- pe EKG apare doarunda Q patologica

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ANGINA PECTORALA

DGN electrocardiografic

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DGN electrocardiografic

- Modificari de tip ischemic: subdenivelare ST

- Unda T turtita, uneorinegativa

- In unele cazuri aspectulEKG de angina pectoralaapare numai dupa probade efort

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EXERCITII

?

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BLOC SINOATRIAL

?

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?

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BAV gradul I

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MOBITZ I

BSA

MOBITZ II

?

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TAHICARDIE SINUSALA

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SDR DE PREEXCITATIE

?

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EXTRASISTOLE

VENTRICULARE

?

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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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FLUTTER VENTRICULAR

?

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BLOC SINOATRIAL

?

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?

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FLUTTER ATRIAL

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INFARCT LATERAL

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HAD si HVD

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HVS

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INFARCT INFERIOR

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HAD

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INFARCT ANTERIOR

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ANGINA PECTORALA

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HAS

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Click to edit Master subtitle style

HEMIBLOC ANTERIOR

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HEMIBLOC POSTERIOR

E-K-G !!!!!

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Transcript of E-K-G !!!!!