TRAZOS DE ECG

Dr. Ivan De Paz

Clase de internos

Ritmo sinusal

Fibrilacion Atrial

4

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

32

Marcapasos funcional

GRACIAS POR SU ATENCION