TRAZOS DE ECG
Dr. Ivan De Paz
Clase de internos
Ritmo sinusal
Fibrilacion Atrial
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A-FIB ARITHMATIC
Alcohol
Rheumatic heart disease
Ischemic heart disease
Thyrotoxicosis
Hypertension
Mitral stenosis/MI
Atrial septal defect/atrial mixoma
Theophylline
Ideopathic/infective endocarditis
Cardiomyopathy
Part 8: ACLS. American Heart Association 2010.
Taquicardia Ventricular
Fibrilacion Ventricular
Reglas• No hay regularidad del ritmo• No se puede medir la frecuencia• No hay ondas P• No hay QRS
Hipovolemia
Neumotorax Taponamiento
Obstruccion Hipoxia
TEP
AESP
Part 8: ACLS. American Heart Association 2010.
CAUSAS DE PCR
H T
HipoxiaHipovolemiaHidrogeniones (acidosis)Hipo/hiperkalemiaHipotermia
ToxinasTaponamientoNeumotórax a TensiónTrombosis pulmonarTrombosis coronariaTrauma
Taquicardia Supraventricular
SUPRADESNIVELES DEL ST
• Early repolarization• LBBB• Electrolytes• Ventricular Hypertrophy• Aneurysm• Treatment (pericardiocentesis)• Infarction• Other (hipothermia, brugada)• Non occlusive vasospasm
Introduccion
• El segmento ST del ciclo cardiaco representa el periodo entre la despolarizacion y repolarizacion del ventriculo izquierdo
• En condiciones normales el segmento ST es isoelectrico con relacion al PR
Variable Shapes Of ST Segment Elevations in AMI
Goldberger AL. Goldberger: Clinical Electrocardiography: A Simplified Approach. 7th ed: Mosby Elsevier; 2006.
Morphology of STE
• Concave shape STE – non AMI causes• AMI causes – usually demonstrate
convex/straight STE
J point
Apex of T wave
Concave STE
Convex STE
Distribution
• STE due to AMI usually demonstrate regional or territorial pattern– Examples:– Anterior MI – V3-V4– Septal MI – V2-V3– Anteroseptal MI – V1/2 – V4/5– Lateral MI – V5/V6– Inferior MI – II, III, aVF
• Diffuse STE – non AMI causes, e.g. pericarditis
IAM CARA DIAFRAGMATICA
Notching or slurring of J point
Concave STE
Repolarizacion Precoz
Large amplitude T wave
Pericarditis
Goldberger AL. Goldberger: Clinical Electrocardiography: A Simplified Approach. 7th ed: Mosby Elsevier; 2006.
1. STE in pericarditis – concave; AMI – obliquely flat or convex
2. STE in pericarditis – diffuse; AMI – territorial
3. PR Depression – pericarditis; Q in AMI
4. T inversion in pericarditis occurs only after ST normalized; T inversion accompanies STE in AMI (co-exist)
Differentiating ECG Changes of AMI vs Pericarditis
Stage 1 Pericarditis
PR Depression
Stage 2 Pericarditis
Stage 3 Pericarditis
ST Elevation morphologies in Brugada Syndrome
RBBB with RSR pattern rather than rSR pattern and there is associated STE
Hipertrofia de VI
Hipertrofia de VD
Bloqueo AV primer grado
Bloqueo AV II Grado Mobitz Tipo I
BAV II Grado Mobitz II
Bloqueo AV III Grado
Cubeta Digitalica
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Marcapasos funcional
GRACIAS POR SU ATENCION