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1. MOARTEA SUBITA
2. SINCOPA
3. ARITMII VENTRICULARE MALIGNE
4. TULBURARILE DE CONDUCERE
DE
GRAD INALT
1. MOARTEA SUBITA
2. SINCOPA
3. ARITMII VENTRICULARE MALIGNE
4. TULBURARILE DE CONDUCERE
DE
GRAD INALT
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1. MOARTEA
SUBITA
1. MOARTEA
SUBITA
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Definitie, incidentaDefinitie, incidentaMoartea naturala neasteptata datorata unei cauze cardiace sau extracardiace produsa in interval de < 1h de la debutul simptomelor
Intre 300 si 400.000 decese subite / an in SUA
In studii necroptice: etiologie cardiaca la 60-80% din cazuri
MS: poate fi prima manifestare de boala cardiaca sau de BC 50% din mortalitatea prin BC este subita
Incidenta MS cardiace: 1.9% la M
0.9% la F
Mult mai redusa in societatile in curs de dezvoltare
Incidenta MS post IM: 7% la M, 6% la F la 6 ani dupa IM
Incidenta creste cu varsta
MS mai frecventa la rasa neagra
Moartea naturala neasteptata datorata unei cauze cardiace sau extracardiace produsa in interval de < 1h de la debutul simptomelor
Intre 300 si 400.000 decese subite / an in SUA
In studii necroptice: etiologie cardiaca la 60-80% din cazuri
MS: poate fi prima manifestare de boala cardiaca sau de BC 50% din mortalitatea prin BC este subita
Incidenta MS cardiace: 1.9% la M
0.9% la F
Mult mai redusa in societatile in curs de dezvoltare
Incidenta MS post IM: 7% la M, 6% la F la 6 ani dupa IM
Incidenta creste cu varsta
MS mai frecventa la rasa neagra
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Factorii de risc pentru MS cardiaca in populatia generala
Factorii de risc pentru MS cardiaca in populatia generala
Majoritatea MS se produc la pacientii cu BC: FR sunt similari cu cei ptr BC
FR in studiul Framingham: Varsta TA sistolica Prezenta HVS pe ECG Blocurile intraventriculare Tulburarile nespecifice de repolarizare pe ECG Colesterolul crescut Intoleranta la glucoza Reducerea capacitatii vitale la probe respiratorii Fumatul Greutatea corporala crescuta Cresterea FC
Identifica 53% din M si 42% din F la risc ptr MS
Majoritatea MS se produc la pacientii cu BC: FR sunt similari cu cei ptr BC
FR in studiul Framingham: Varsta TA sistolica Prezenta HVS pe ECG Blocurile intraventriculare Tulburarile nespecifice de repolarizare pe ECG Colesterolul crescut Intoleranta la glucoza Reducerea capacitatii vitale la probe respiratorii Fumatul Greutatea corporala crescuta Cresterea FC
Identifica 53% din M si 42% din F la risc ptr MS
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Cauzele de MS cardiacaCauzele de MS cardiacaAnomalii coronare: IMA, CI Anomalii congenitale coronare Arterita coronara: PAN, lues, etc Disectia spontana Puntile miocardice si spasm coro
HVS: HTA CMH HT pulmonara primitiva
Boli miocardice si IC: ICC din CMD Miocardita acuta
Boli inflamatorii, infiltrative, neo: Miocardite, sarcoid, amiloid,
ARVD, boli neuromusculare, neo
Anomalii coronare: IMA, CI Anomalii congenitale coronare Arterita coronara: PAN, lues, etc Disectia spontana Puntile miocardice si spasm coro
HVS: HTA CMH HT pulmonara primitiva
Boli miocardice si IC: ICC din CMD Miocardita acuta
Boli inflamatorii, infiltrative, neo: Miocardite, sarcoid, amiloid,
ARVD, boli neuromusculare, neo
Boli valvulare: Stenoza aortica Prolapsul valvular mitral EI, disfunctia de proteze
Boli congenitale Stenoza pulmonara, Eisenmenger CC corectate chirurgical
Anomalii electrofiziologice Sdr. Lev-Lenegre Sdr. de QT lung; Sdr. WPW
Commotio cordisTamponada cardiacaTEPTromboza intracardiaca acutaEfortul extenuant
Boli valvulare: Stenoza aortica Prolapsul valvular mitral EI, disfunctia de proteze
Boli congenitale Stenoza pulmonara, Eisenmenger CC corectate chirurgical
Anomalii electrofiziologice Sdr. Lev-Lenegre Sdr. de QT lung; Sdr. WPW
Commotio cordisTamponada cardiacaTEPTromboza intracardiaca acutaEfortul extenuant
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2. SINCOPA2. SINCOPA
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Definitie, caracteristici, incidenta
Definitie, caracteristici, incidenta
Pierderea brusca si temporara a starii de constientaIncidenta: 3% la M, 3.5% la F Incidenta creste cu varsta
Clasificarea sincopei: Non cardiaca Cardiaca De cauza nedeterminata
Expresie a unor procese patologice foarte variate: Benigne moarte subita Mortalitatea c.m. mare: sincopa cardiaca
Pierderea brusca si temporara a starii de constientaIncidenta: 3% la M, 3.5% la F Incidenta creste cu varsta
Clasificarea sincopei: Non cardiaca Cardiaca De cauza nedeterminata
Expresie a unor procese patologice foarte variate: Benigne moarte subita Mortalitatea c.m. mare: sincopa cardiaca
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Clasificarea sincopei non cardiace
Clasificarea sincopei non cardiace
Neurocardiogenica
Ortostatica
Hipersensibilitatea sinusului carotidian
Cerebrovasculara
Epilepsia
Conjuncturale: Tuse, deglutitie
Valsalva, mictiune, defecatie
Plonjare in apa rece
Postprandial
Neurocardiogenica
Ortostatica
Hipersensibilitatea sinusului carotidian
Cerebrovasculara
Epilepsia
Conjuncturale: Tuse, deglutitie
Valsalva, mictiune, defecatie
Plonjare in apa rece
Postprandial
Metabolica, medicamentoasa Hipoxie Hipoglicemie Hiperventilatie, atac de panica Alcool
Alte forme de sincopa sau conditii asemanatoare: Sdr. vertiginos Migrena Cauze psihiatrice
Metabolica, medicamentoasa Hipoxie Hipoglicemie Hiperventilatie, atac de panica Alcool
Alte forme de sincopa sau conditii asemanatoare: Sdr. vertiginos Migrena Cauze psihiatrice
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Sincopa neuro-cardiogenica
Sincopa neuro-cardiogenica
Incapacitatea de a mentine TA si FC in
ortostatism
Cresterea catecolilor plasmatici la
schimbarea pozitiei: vasodilatatie si
bradicardie PARADOXALE
hipoTA, hipoperfuzie cerebrala si
anoxie = SINCOPA
Eveniment unic, in succesiune scurta
sau recurenta pentru toata viata
Forme maligne: asistola prelungita,
traumatisme, ischemie miocardica si
cerebrala prelungita
Test diagnostic: “tilt test” 60-80 +/-
PIV cu isuprel
Incapacitatea de a mentine TA si FC in
ortostatism
Cresterea catecolilor plasmatici la
schimbarea pozitiei: vasodilatatie si
bradicardie PARADOXALE
hipoTA, hipoperfuzie cerebrala si
anoxie = SINCOPA
Eveniment unic, in succesiune scurta
sau recurenta pentru toata viata
Forme maligne: asistola prelungita,
traumatisme, ischemie miocardica si
cerebrala prelungita
Test diagnostic: “tilt test” 60-80 +/-
PIV cu isuprel
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Sincopa neurocardiogenica: tratament
Sincopa neurocardiogenica: tratament
Evitarea deshidratarii, a ortostatismului prelungit nemiscat, alte situatii provocatoare cunoscute
Expansiune volemica: liberalizarea aportului de sodiu
Ciorapi compresivi la membrele inf.
Fludrocortisone acetat: 0.1-1 mg/zi
Betablocantele: Utile la cei care au sincopa la infuzie de izoprenalina
Agenti anticolinergici: ex. atropina, plasture cu scopolamina, disopiramida
Inhibitorii captarii serotoninei: fluoxetina si sertralina
Metilxantinele: teofilina 6-12 mg/kc/zi
Pacemaker definitiv tip DDDR La cei cu bradicardie severa persistenta
Evitarea deshidratarii, a ortostatismului prelungit nemiscat, alte situatii provocatoare cunoscute
Expansiune volemica: liberalizarea aportului de sodiu
Ciorapi compresivi la membrele inf.
Fludrocortisone acetat: 0.1-1 mg/zi
Betablocantele: Utile la cei care au sincopa la infuzie de izoprenalina
Agenti anticolinergici: ex. atropina, plasture cu scopolamina, disopiramida
Inhibitorii captarii serotoninei: fluoxetina si sertralina
Metilxantinele: teofilina 6-12 mg/kc/zi
Pacemaker definitiv tip DDDR La cei cu bradicardie severa persistenta
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Sincopa (hipoTA) ortostatica
Sincopa (hipoTA) ortostatica
Sincopa determinata de trecerea in ortostatism prin scaderea brusca a TACauze: “pooling” venos sau depletie
volemicaDecubit dorsal prelungitSarcina luna marePierderea de sangeDeshidratarea
Medicamentoasa:Blocanti alfa adrenergiciIECANitrati Blocante canale de calciuFenotiazine, tranchilizanteAnti parkinsoniene
Sincopa determinata de trecerea in ortostatism prin scaderea brusca a TACauze: “pooling” venos sau depletie
volemicaDecubit dorsal prelungitSarcina luna marePierderea de sangeDeshidratarea
Medicamentoasa:Blocanti alfa adrenergiciIECANitrati Blocante canale de calciuFenotiazine, tranchilizanteAnti parkinsoniene
Neurogenica
Diabet zaharat
Neuropatia alcoolica
amiloidoza
Boli demielinizante de
maduva
Parkinson, scleroza multipla
Tabes, siringomielie
Tratament: functie de cauza
Expansiune volemica
Simpatomimetice,
vasoconstrictoare
Pacing atrial
Neurogenica
Diabet zaharat
Neuropatia alcoolica
amiloidoza
Boli demielinizante de
maduva
Parkinson, scleroza multipla
Tabes, siringomielie
Tratament: functie de cauza
Expansiune volemica
Simpatomimetice,
vasoconstrictoare
Pacing atrial
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Hipersensibilitatea sinusului carotidian
Hipersensibilitatea sinusului carotidian
Asistola prin BSA complet sau oprire SA la CSC
BAV nu se observa din cauza lipsei activitatii SA
2 tipuri: Cardioinhibitor (asistola V >
3 sec la CSC) Vasodepresor ( TA > 50
mmHg fara BS)
Asociat cu boala coronara
Tratament: PM ptr forma
cardioinhibitorie Oprirea medicatiei bradic. Iradiere SC sau denervare Droguri care retin Na+
Asistola prin BSA complet sau oprire SA la CSC
BAV nu se observa din cauza lipsei activitatii SA
2 tipuri: Cardioinhibitor (asistola V >
3 sec la CSC) Vasodepresor ( TA > 50
mmHg fara BS)
Asociat cu boala coronara
Tratament: PM ptr forma
cardioinhibitorie Oprirea medicatiei bradic. Iradiere SC sau denervare Droguri care retin Na+
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Sincopa cerebrovascularaSincopa cerebrovasculara
La cei cu stenoze critice ale ramurilor arcului aortic sau ale carotidelor comune - interne sau ale arterelor vertebrale Sdr. de arc aortic: boala Takayasu Sdr. de furt al arterei subclavii Stenozele carotidiene aterosclerotice Spondiloza cervicala severa la miscarile de
lateralitate sau extensie dorsala a capului (compresie de artere vertebrale)
Accidentele vasculare cerebrale ischemice embolice, mai ales in sistemul vertebrobazilar Asociate cu vertij, diplopie, disartrie, ataxie
Tratament: Tromb-endarterectomie in obstructiile
aterosclerotice Anticoagulante / antiagregante in manifestarile
embolice
La cei cu stenoze critice ale ramurilor arcului aortic sau ale carotidelor comune - interne sau ale arterelor vertebrale Sdr. de arc aortic: boala Takayasu Sdr. de furt al arterei subclavii Stenozele carotidiene aterosclerotice Spondiloza cervicala severa la miscarile de
lateralitate sau extensie dorsala a capului (compresie de artere vertebrale)
Accidentele vasculare cerebrale ischemice embolice, mai ales in sistemul vertebrobazilar Asociate cu vertij, diplopie, disartrie, ataxie
Tratament: Tromb-endarterectomie in obstructiile
aterosclerotice Anticoagulante / antiagregante in manifestarile
embolice
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Boli convulsivanteBoli convulsivante
Accesul de grand-mal: Aura, debut brutal, pierdere de fecale, urina
Absenta modificarilor hemodinamice (hipo TA, aritmii)
Prezenta starii postcritice (confuzie, somnolenta)
Convulsiile de lob temporal: forma frecvent confundata cu sincopa obisnuita
Episoade de petit-mal (absenta si convulsiile akinetice) greu de diferentiat de sincopa
Dg: EEG
Tratament specific anticonvulsivant
Accesul de grand-mal: Aura, debut brutal, pierdere de fecale, urina
Absenta modificarilor hemodinamice (hipo TA, aritmii)
Prezenta starii postcritice (confuzie, somnolenta)
Convulsiile de lob temporal: forma frecvent confundata cu sincopa obisnuita
Episoade de petit-mal (absenta si convulsiile akinetice) greu de diferentiat de sincopa
Dg: EEG
Tratament specific anticonvulsivant
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Sincopa cardiacaSincopa cardiacaBoli obstructive ale fluxului: Cord stang:
Stenoza aorticaCM hipertroficaDisfunctia de proteze mecaniceMixomul atrial stangStenoza mitrala
Cord drept:Sdr. EisenmengerTetralogia FallotTEPStenoza pulmonaraHTP primitivaTamponada cardiaca
Boli obstructive ale fluxului: Cord stang:
Stenoza aorticaCM hipertroficaDisfunctia de proteze mecaniceMixomul atrial stangStenoza mitrala
Cord drept:Sdr. EisenmengerTetralogia FallotTEPStenoza pulmonaraHTP primitivaTamponada cardiaca
Aritmii: Boala de nod sinoatrial BAV gr II tip 2 sau gr III
paroxistice Pacemaker artificial:
Sdr. de pacemakerDisfunctia de pacemakerTahiaritmiile induse de pacemaker
Tahiaritmiile paroxistice SV Tahiaritmiile ventriculare
maligne
Aritmii: Boala de nod sinoatrial BAV gr II tip 2 sau gr III
paroxistice Pacemaker artificial:
Sdr. de pacemakerDisfunctia de pacemakerTahiaritmiile induse de pacemaker
Tahiaritmiile paroxistice SV Tahiaritmiile ventriculare
maligne
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Stenoza aortica stransaStenoza aortica stransa
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CMHO
CMHO
preoperatorpreoperator postoperator postoperator
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Mixom atrial stangMixom atrial stang
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Proteza aortica tip Bjork trombozata
Proteza aortica tip Bjork trombozata
Proteza normofunctionalaProteza normofunctionala Proteza Bjork in pozitie aorticatrombozata
Proteza Bjork in pozitie aorticatrombozata
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Stenoza mitralaseveraStenoza mitralasevera
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M, 56 ani; BAV gr III paroxistic cu sincopaM, 56 ani; BAV gr III paroxistic cu sincopa
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Reluarea spontana a RS: BRD majorReluarea spontana a RS: BRD major
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Principalele cauze de sincopa pe grupe de varsta
Principalele cauze de sincopa pe grupe de varsta
Copii, adolescenti,
adulti tineriNeurocardiogenica
Cardiaca: TSV: WPW
TV: Sdr. de QT lung,
CM, cardiopatii
congenitale, post
chirurgie ptr CC
BAV: congenital, post
chirurgie ptr CC
boli convulsivante
Copii, adolescenti,
adulti tineriNeurocardiogenica
Cardiaca: TSV: WPW
TV: Sdr. de QT lung,
CM, cardiopatii
congenitale, post
chirurgie ptr CC
BAV: congenital, post
chirurgie ptr CC
boli convulsivante
AdultiNeurocardiogenica
Ortostatica
Cardiaca: Aritmica
obstructiva
boli convulsivante
Medicamente
AdultiNeurocardiogenica
Ortostatica
Cardiaca: Aritmica
obstructiva
boli convulsivante
Medicamente
VarstniciCardiaca: Aritmica
obstructiva
Ortostatica
Neurocardiogenica
Medicamente
Cerebrovasculara
Hipersensibilitate
de sinus carotidian
boli convulsivante
Cauze combinate
VarstniciCardiaca: Aritmica
obstructiva
Ortostatica
Neurocardiogenica
Medicamente
Cerebrovasculara
Hipersensibilitate
de sinus carotidian
boli convulsivante
Cauze combinate
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3. ARITMII
VENTRICULARE
MALIGNE
3. ARITMII
VENTRICULARE
MALIGNE
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3A. TAHICARDIA VENTRICULARA:
definitie si caractere ECG
3A. TAHICARDIA VENTRICULARA:
definitie si caractere ECGTahiaritmie regulata
C.p. 3 depolarizari ventriculare succesive cu frecventa >
120/min
Durata variabila: 3 QRS > 30 sec (ore)
QRS > 120 msec: ASPECT MONOMORF sau POLIMORF
ST-T in opozitie de faza cu QRS
Activare atriala indepedenta sau conducere VA retrograda
Capturi ventriculare; batai de fuziune
RISCURI:
Degradare hemodinamica
Degenerare in FV
Tahiaritmie regulata
C.p. 3 depolarizari ventriculare succesive cu frecventa >
120/min
Durata variabila: 3 QRS > 30 sec (ore)
QRS > 120 msec: ASPECT MONOMORF sau POLIMORF
ST-T in opozitie de faza cu QRS
Activare atriala indepedenta sau conducere VA retrograda
Capturi ventriculare; batai de fuziune
RISCURI:
Degradare hemodinamica
Degenerare in FV
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Tahicardia ventricularaTahicardia ventriculara
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Mecanismele de producere ale TV
Mecanismele de producere ale TV
REINTRARE (TV monomorfa): Postinfarct
POSTDEPOLARIZARI PRECOCE SI TARDIVE
(TV polimorfa) TV digitalice
Sdr. de QT lung congenital
chinidina
AUTOMATISM ANORMAL: IMA reperfuzat: TV neparoxistica (RIVA)
Nu produce sincopa
REINTRARE (TV monomorfa): Postinfarct
POSTDEPOLARIZARI PRECOCE SI TARDIVE
(TV polimorfa) TV digitalice
Sdr. de QT lung congenital
chinidina
AUTOMATISM ANORMAL: IMA reperfuzat: TV neparoxistica (RIVA)
Nu produce sincopa
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3 tipuri de TV3 tipuri de TV
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Tahicardia
ventriculara
:
diagnostic
Tahicardia
ventriculara
:
diagnostic
Disociatie AV
Batai de fuziune
Capturi ventriculare
Disociatie AV
Batai de fuziune
Capturi ventriculare
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Diferentierea TV de TSV cu complexe largi
Diferentierea TV de TSV cu complexe largi
Tahiaritmii cu QRS largi: TV TSV + BR pre-
existent
TSV cu aberanta de conducere TSV + WPW
Dg. dif. posibil pe ECG standard la > 90% din cazuri
Criterii ECG de diferentiere TV – TSV cu QRS largi:
1. Batai de fuziune; capturi V
2. Disociatia AV
3. Conducere retrograda VA (P retrograde)
4. QRS > 140 msec (160 msec = TV cert)
5. Morfologie unica a QRS in precordiale = TV
Tahiaritmii cu QRS largi: TV TSV + BR pre-
existent
TSV cu aberanta de conducere TSV + WPW
Dg. dif. posibil pe ECG standard la > 90% din cazuri
Criterii ECG de diferentiere TV – TSV cu QRS largi:
1. Batai de fuziune; capturi V
2. Disociatia AV
3. Conducere retrograda VA (P retrograde)
4. QRS > 140 msec (160 msec = TV cert)
5. Morfologie unica a QRS in precordiale = TV
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Tratament curativTratament curativTV fara decompensare hemodinamica: AA Xilina, procainamida, amiodaron, bretiliu tosilat IV
TV digitalice: fenitoina, xilina +/- AC anti-digitalici
TV cu hipoTA, IVS, angina, hipoperfuzie cerebrala: SEE: sincron > 50 J
Alternative: “Overdrive pacing”
“thump version”
Tratamentul cauzelor corectabile sau producatoare: Ischemia acuta
Hipo K, hipo Mg
BS excesiva
TV fara decompensare hemodinamica: AA Xilina, procainamida, amiodaron, bretiliu tosilat IV
TV digitalice: fenitoina, xilina +/- AC anti-digitalici
TV cu hipoTA, IVS, angina, hipoperfuzie cerebrala: SEE: sincron > 50 J
Alternative: “Overdrive pacing”
“thump version”
Tratamentul cauzelor corectabile sau producatoare: Ischemia acuta
Hipo K, hipo Mg
BS excesiva
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Oprirea TV prin “overdrive pacing”
Oprirea TV prin “overdrive pacing”
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Tratamentul profilacticTratamentul profilactic
TVNS asimptomatica pe cord normal sau patologic: -
blocante (FE > 40%) sau amiodaron
NU flecainida, encainida, sotalol dupa CAST
TVNS cu deteriorare hemodinamica sau TVS:
Amiodaron.
Ablatie prin RF a focarelor endocardice
DEFIBRILATOR IMPLANTABIL
+ /- chirurgia AA (anevrismectomie, CABG)
TVNS asimptomatica pe cord normal sau patologic: -
blocante (FE > 40%) sau amiodaron
NU flecainida, encainida, sotalol dupa CAST
TVNS cu deteriorare hemodinamica sau TVS:
Amiodaron.
Ablatie prin RF a focarelor endocardice
DEFIBRILATOR IMPLANTABIL
+ /- chirurgia AA (anevrismectomie, CABG)
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Torsada varfurilorTorsada varfurilor
cu QT lung sau cu QT normal
Cauze: sdr. de QT lung hipo K, hipo Mg AA Ia si III
produsa prin postdepolarizari
TV rapida, degenereaza in FV
Tratament: MgSO4 IV Overdrive pacing xilina, fenitoina QT lung: beta-blocante, stelectomie, DI.
cu QT lung sau cu QT normal
Cauze: sdr. de QT lung hipo K, hipo Mg AA Ia si III
produsa prin postdepolarizari
TV rapida, degenereaza in FV
Tratament: MgSO4 IV Overdrive pacing xilina, fenitoina QT lung: beta-blocante, stelectomie, DI.
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3C. Fibrilatia ventriculara
3C. Fibrilatia ventriculara Unde fibrilatorii de amplitudine diferita, in absenta complexelor QRS
Asistola mecanica urmata de asistola electrica
Colaps, stop respirator si deces in 3-5 minute de la instalare in absenta CPR
Cauze: Ischemia acuta din IMA aritmii V spontane severe Cardiomiopatii (CMHO !) FA din WPW CHT cu HVS hipoxia din BPOC Iatrogen: medicamente, diselectrolitemii, cateterism cardiac Sdr. de QT lung cu TdP SEE nesincron
Precedata sau nu de TV
Tratament: SEE 200-300 J CPR, IOT Bicarbonat EV daca CPR > 60 sec Lidocaina, bretiliu, amiodaron EV Corectarea cauzei
Profilactic: DI sau amiodaron
Unde fibrilatorii de amplitudine diferita, in absenta complexelor QRS
Asistola mecanica urmata de asistola electrica
Colaps, stop respirator si deces in 3-5 minute de la instalare in absenta CPR
Cauze: Ischemia acuta din IMA aritmii V spontane severe Cardiomiopatii (CMHO !) FA din WPW CHT cu HVS hipoxia din BPOC Iatrogen: medicamente, diselectrolitemii, cateterism cardiac Sdr. de QT lung cu TdP SEE nesincron
Precedata sau nu de TV
Tratament: SEE 200-300 J CPR, IOT Bicarbonat EV daca CPR > 60 sec Lidocaina, bretiliu, amiodaron EV Corectarea cauzei
Profilactic: DI sau amiodaron
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Tratamentul profilactic: DITratamentul profilactic: DIIndicatii:
TV recurenta instabila hemodinamic; FV
TV reproductibila la SEF
Rezistenta la 2 AA si / sau chirurgie AA
FE > 30%; NYHA < III
Avantaje tehnice:
Pacing anti-tahi si anti-bradi
Conversie – defibrilare cu energie
Stocarea ECG
mortalitatea fata de amiodaron in AV maligne simptomatice:
MADIT, AVID, CABG Patch Trial (1997)
Indicatii:
TV recurenta instabila hemodinamic; FV
TV reproductibila la SEF
Rezistenta la 2 AA si / sau chirurgie AA
FE > 30%; NYHA < III
Avantaje tehnice:
Pacing anti-tahi si anti-bradi
Conversie – defibrilare cu energie
Stocarea ECG
mortalitatea fata de amiodaron in AV maligne simptomatice:
MADIT, AVID, CABG Patch Trial (1997)
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4. TULBURARILE DE
CONDUCERE AV
DE GRAD INALT
4. TULBURARILE DE
CONDUCERE AV
DE GRAD INALT
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Etiologie: cauzele de mai jos pot produce orice grad de BAV
Etiologie: cauzele de mai jos pot produce orice grad de BAV
Iatrogen: Digitalice Beta-blocante Calciu-blocante Antiaritmice (III)
Boala coronariana: IMA Boala ischemica cronica
Idiopatice-degenerative: Boala Lenegre Boala Lev
Boli congenitale: BAV congenital izolat DSA ostium primum Transpozitia marilor vase
Valvulopatii calcificate Ao sau Mi
Iatrogen: Digitalice Beta-blocante Calciu-blocante Antiaritmice (III)
Boala coronariana: IMA Boala ischemica cronica
Idiopatice-degenerative: Boala Lenegre Boala Lev
Boli congenitale: BAV congenital izolat DSA ostium primum Transpozitia marilor vase
Valvulopatii calcificate Ao sau Mi
Boli miocardice infiltrative: Amiloidoza, hemocromatoza,
sarcoidoza, leucoze, Hodgkin
Diselectrolitemii: Hiper K, hiper Mg
Miocardite: RAA B. Chagas, B. Lyme
Cardiomiopatii: Restrictive, dilatative
Endocardita infectioasaColagenoze (LES, PSS, SA, Reiter)Traumatice, chirurgicaleBoli neuromiopatice (distrofie musculara progresiva)
Boli miocardice infiltrative: Amiloidoza, hemocromatoza,
sarcoidoza, leucoze, Hodgkin
Diselectrolitemii: Hiper K, hiper Mg
Miocardite: RAA B. Chagas, B. Lyme
Cardiomiopatii: Restrictive, dilatative
Endocardita infectioasaColagenoze (LES, PSS, SA, Reiter)Traumatice, chirurgicaleBoli neuromiopatice (distrofie musculara progresiva)
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BAV grad II cu conducere 2/1
BAV grad II cu conducere 2/1
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BAV grad II “de grad inalt”:cu conducere 3/1, 4/1
BAV grad II “de grad inalt”:cu conducere 3/1, 4/1
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BAV grad III: ritmul de inlocuire
BAV grad III: ritmul de inlocuire
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Ritm idioventricularRitm idioventricular
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Blocurile bi- si trifasciculare
Blocurile bi- si trifasciculare
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Indicatiile ptr implantarea de PM definitiv
Indicatiile ptr implantarea de PM definitivClasa I
1. BAV complet, simptomatic (include sincopa, ICC, angina sau starea confuzionala)
2. Pauze de > 3 sec sau ritm de scapare de < 40 /min la pts asimptomatici cu BAV complet
3. BAV grad II simptomatic (indiferent de sediul blocului)
Clasa II1. BAV complet, asimptomatic cu ritm de scapare >40/min2. BAV grad II tip Mobitz II asimptomatic 3. BAV grad II tip Mobitz I, asimptomatic, intra-His sau infra-Hisian
Clasa III1. BAV grad I2. BAV grad II tip I asimptomatic la nivel NAV.
Clasa I1. BAV complet, simptomatic (include sincopa, ICC, angina sau
starea confuzionala)2. Pauze de > 3 sec sau ritm de scapare de < 40 /min la pts
asimptomatici cu BAV complet3. BAV grad II simptomatic (indiferent de sediul blocului)
Clasa II1. BAV complet, asimptomatic cu ritm de scapare >40/min2. BAV grad II tip Mobitz II asimptomatic 3. BAV grad II tip Mobitz I, asimptomatic, intra-His sau infra-Hisian
Clasa III1. BAV grad I2. BAV grad II tip I asimptomatic la nivel NAV.
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Codurile de caracterizare a PM definitive
Codurile de caracterizare a PM definitive
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PM permanent bicameralPM permanent bicameral