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Blocurile cardiace
Profesor universitar,doctor habiltatLiviu Grib
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Blocurile cardiace sunt tulburări în conducerea impulsului, tranzitorii sau permanente, datorate unor anomalii funcţionale sau organice.
Blocul poate apare în orice parte a inimii unde există o conducere a impulsului electric.
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1. Blocuri sinoatriale (SA) Gradul I Gradul II
Tipul I (Mobitz I) Tipul II(Mobitz II) Gradul III (bloc total)2. Blocuri intraatriale 3. Blocuri atrioventriculare (AV) Gradul I Gradul II Tipul I (Mobitz I) Tipul II(Mobitz II) Gradul III (bloc total)
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4. Blocul intraventricular
Blocul de ramură dreaptă a f. Hiss
Blocul de ramură stângă a f. Hiss
hemibloc stâng anterior
hemibloc stâng posterior
Bloc bifascicular
Bloc trifascicular
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Nodul SA
Nodul AV
Fascicul His
Fibrele Purkinje
ram drept f. His
ram stâng f. His
Septul interventricular
Septul interatrial Fasciculul Bachmann
FasciculThorel
FasciculWenckebah
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1. Blocuri acute boala coronariană:
infarctul miocardic acut (inferior-BAV cu sediu nodal, anterior-BAV cu sediu infranodal)
angina Printzmetal; post operator
protezare valvulara CIV
boli infecţioase: endocardite bacteriene RAA Infecții virale Rickeţioze Difterie
medicamente: beta blocante Digitalice Amiodarona Verapamil antiaritmice clasa I
stimulare vagală
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2. Blocuri cronice I. Congenitale II. Dobândite Cardiopatii
valvulopatii degenerative (aortice) CMH obstructivă CMP fără obstrcucție
Postoperator protezare valvularăCIV
Manevre terapeutice întreruperea propagării impulsului pe fasciculul His
stimulare vagală cronică (sportivi antrenaţi) III. Ideopatice leziuni degenerative (cele mai frecvente).
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Blocul sino-atrial• o tulburare de conducere la nivel sino-atrial depolarizarea
nodului sinusal fiind întârziată sau chiar neputând fi transmisă miocardului atrial.
• Blocul sino-atrial de gradul I, deci întârzierea transmiterii depolarizarii de la nodul sinusal la atriu, evident nu poate fi diagnosticat pe ECG de suprafaţă.
• Blocul sino-atrial de gradul II, blocarea intermitentă a depolarizarii la nivel sino-atrial. Blocul sino-atrial de gradul II 2:1 persistent se suprapune perfect pe o bradicardie sinusală cu frecvenţă la jumătate din ritmul nodului sinusal. Poate fi asimptomatic, poate apărea nocturn la tineri şi sportivi.
• Blocul de gradul III presupune blocarea transmiterii, deci înlocuirea ritmului sinusal cu un alt ritm de scăpare (de exemplu, atrial inferior sau jonctional).
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BAV gr.I. Fiecare undă P este urmată de complexe QRS, dar intervalul PR este alungit -
0,26”
Blocul atrioventricular
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BAV gr.II cu bătăti omise intermitent, tip Mobitz I, PR-ul iniţial de 0,08” se alungeşte progresiv la 0,16”, pentru ca cea de a 3-a
undă P’ să fie blocată (neurmată de complex QRS). În continuare ciclul se reia
Blocul atrioventricular
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BAV gr.II cu bătăi omise intermitent PR-ul este constant înainte de unda P blocată
(5)
Blocul atrioventricular
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BAV gr.II 2:1Fiecare a doua undă P nu este urmată de complex QRS
Blocul atrioventricular
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BAV gr.II de grad înalt (avansat) 3/1 tip B
BAV gr.III suprahisian cu RIJV, cu complexe QRS suple, frecvenţa 48/min. Se evidenţiază şi disociaţia A-V
Blocul atrioventricular
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I
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