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ELECTROCARDIOGRAMA
CURSO CIMICLINICA MEDICA “2”
PROF. DR. CARLOS DUFRECHOU
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OBJETIVOS:
• Frecuencia cardíaca• Ritmo sinusal. Fibrilación auricular.• Eje eléctrico• Alt. PR: Bloqueo AV• Alt QRS: HVI. Bloqueo de rama • Alt ST: IAM
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Tira papel ECG
seg
mm, (voltios)
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IMPULSO CARDIACO
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• ONDA P• INTERVALO PR• ONDA QRS• SEGMENTO ST• ONDA T• INTERVALO QT
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Derivadas monopolares: DI, DII, DIII, aVR, aVL, aVF
Derivadas bipolares: V1, V2, V3, V4, V5, V6
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P: 0,04seg (ancho) 1mV (alto)
PR: 0,12 – 0.20seg ST: isoeléctrico
QRS: 0,04 – 0,12 seg R + , Q y S –
“VALORES NORMALES”
T: siempre es positiva
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“Caras” cardíacas
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La FRECUENCIA CARDÍACA normal en reposo depende de la edad:
- Recién nacidos: 100-160 latidos/minuto.
- Niños de 1 a 10 años: 70-120 latidos/minuto.
- Niños de >10 años y adultos: 60-100 lat./min.
- Atletas entrenados: 40-60 latidos/minuto.
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Frecuencia cardiaca
50 436075100150300
Distancia entre las ondas R de 2 latidos consecutivos
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EJERCICIOS
CALCULO DE LA FC
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IMPULSO CARDIACO
RITMO SINUSAL
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Ritmo cardiaco
El normal es el ritmo sinusal:
• Cada P va seguida de un QRS. • P positiva en D II. • P negativa en AVR.
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Extrasistolia supraventricularExtrasistolia supraventricular
- Son latidos anticipados.- Tienen siempre onda P (diferente P sinusal)- QRS fino- No tienen pausa compensadora.
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Extrasistolia Extrasistolia supraventricularsupraventricular
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Extrasistolia Extrasistolia ventricular ventricular
- Son latidos anticipados- No tienen onda P - El QRS es ancho- Suelen tener pausa compensadora.
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EVs pareados
3 EVs polimorfos (o politópicos)
Tipo BRD
Tipo BRI
Extrasistolia ventricularExtrasistolia ventricular
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FIBRILACION AURICULAR
DIAGNOSTICO:
- NO HAY ONDAS P
- ONDAS f
- RR IRREGULAR
- LINEA DE BASE IRREGULAR
EXAMEN FÍSICO: “ARRITMIA COMPLETA”
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Cálculo del eje:
Derivadas: DI y AVF
Eje normal en el adulto: entre –30º y +90º
AVR
AVL
AVF
I
IIIII
V1V2 V3 V4 V5
V6
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Eje eléctrico
“positivo” “negativo” “isoeléctrico”
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Cálculo del eje:
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EJERCICIOS
Determinación del Eje Eléctrico
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Conducción eléctricacardiaca
Bloqueo aurículo-
ventricular
1er grado2do grado3er grado
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BLOQUEO AV
• BAV 1er grado: PR > 0,20 seg
• BAV 2do grado: no todas las ondas P van seguidas de un QRS. Puede existir prolongación progresiva PR hasta que falta.
• BAV 3er grado (BAV completo): disociación entre aurículas y los ventrículos.
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ECG BAV 1er gradoOnda P
PR
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Conducción eléctricacardiaca
Bloqueos de rama:Bloqueo de rama derecha Bloqueo de rama izquierda
QRS ancho (> 0,12 seg)
RR’
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ECG: HVI
•Indice de Sokoloff: R V5 + S V1 ≥ 35 mm.
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Onda Q
• Cuando es “significativa” indica secuela IAM transmural.
Q más 1/3 total QRS Q mayor 0,25 mm. En dos o más derivadas
que representen la misma “cara” cardíaca.
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Alteraciones del segmento ST
• Supradesnivel ST significativo (más 2mm, en “lomo de delfín”-CONVEXO) indica IAM de tipo transmural (IAM con supraST)
• Infradesnivel ST significativo (más 1,0mm) indica lesión miocárdica y puede corresponder a un IAM de tipo subendocárdico (IAM sin supraST)
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