ecg blocurile de ramura
DESCRIPTION
ECG Blocurile de ramura. Generalitati. Blocul de ramura = intreruperea conducerii impulsului pe una dintre diviziunile fasciculului Hiss. Blocul complet de ramura stanga. Criterii de diagnostic ECG: Ritm sinusal , sau supraventricular Complex QRS >/= 0.12 secunde – 0.16 secunde - PowerPoint PPT PresentationTRANSCRIPT
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ECGBlocurile de ramura
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Generalitati
• Blocul de ramura = intreruperea conducerii impulsului pe una dintre diviziunile fasciculului Hiss
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Blocul complet de ramura stanga
• Criterii de diagnostic ECG:– Ritm sinusal, sau supraventriculara. Complex QRS >/= 0.12 secunde – 0.16 secundeb. Morfologie QRS “in platou” in derivatiile stangic. Ax QRS normal sau deviat la stangad. Timp de aparitie a deflexiunii intrinsecoide >0.044
sec in derivatiile stangie. Absenta undei Q in DI, aVL (V5, V6)f. Modificare ST-T in sens invers undei dominante a QRS
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Semnificatie clinica• BRS complet semnifica – in linii generale – ischemie miocardica• BRS complet acut simptomatic trebuie interpretat ca infarct
miocardic cu supradenivelare de segment ST si tratat ca atare!• BRS complet vechi are – cel mai probabil – etiologie ischemica.• BRS complet vechi simptomatic cu ST-T in acelasi sens cu unda
dominanta a QRS semnifica ischemie miocardica acuta• BRS complet poate sa fie dependent de frecventa; poate sa
apara la frecvente crescute ale ritmului, semnificand ischemie miocardica; BRS - mai rar – si in situatii dierite de ischemia miocardica (cardiomiopatii)
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Diagnosticul de BRS+HVS
• Tulburarea depolarizarii din BRS altereaza criteriile ECG de hipertrofie stanga concomitenta
• HVS in prezenta BRS va determina alungirea QRS mai mult de 0.16 secunde
• Criteriile de voltaj pentru HVS au valoare diagnostica mai redusa in prezenta BRS major, dar vor fi luate in considerare, daca QRS>0.16 secunde
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Blocul complet de ramura dreapta
• Criterii de diagnostic ECG:– Ritm sinusal, sau supraventricular• A. Complex QRS>/= 0.12 secunde• B. Morfologie QRS RsR’, rsR, rSR’’ in V1, V2, S profunde
in DI| si V6• C. Timp de aparitie al deflexiunii intrinsecoide in V1,
V2>0.035 sec• D. Ax QRS indiferent (functie de conditiile asociate)• E. Modificare ST-T in sens invers undei dominante a
QRS
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Semnificatie clinica
• Ramul drept are lungime mai mare si diametrul mai mic decat ramul stang; ramul drept are o situatie subendocardica si prin trabecula marginala, situatie care-l expune intens traumelor mecanice si hemodinamice din ventriculul drept; ramul drept beneficiaza de perfuzie inferioara, comparativ cu perfuzia (dublu vasculara) a ramului stang.
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Semnificatie clinica 2
• Aceste conditii determina aparitia BRD complet nu numai in context ischemic, exceptand situatia BRD acut simptomatic, care in functie de contextul clinic, ca ischemie miocardica acuta
• BRD complet este asociat frecvent cu bolile pulmonare cronice sau cu afectiunile cordului stang cu hipertensiune arteriala pulmonara, precum si unor cardiopatii congenitale si cardiomiopatii primitive
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Blocurile de ramura
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Blocul fascicular antero-superior
• Criterii de diagnostic ECG:Complex QRS<0.12”(in absenta BRD complet!)– A. Deviatie axiala stanga la > -45 grade, fara alta
cauza de deviatie axiala (BRS complet, HVS, sd. De preexcitatie, IM inferior(!))
– B. Complex dominant negativ I DII– C. Aspect qR, cu TADI>0.04 “ in aVL
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Semnificatie clinica
• Poate fi prezent la indivizi asimptomatici, fara o cardiopatie detectabila
• Se asociaza cu boala cardiaca ischemica: la un pacient simptomatic, BFAS va fi interpretat ca semn de ischemie miocardica acuta
• Mai rar, poate fi intalnit in cardiomiopatii
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Blocul fascicular stang posterior
• Complex QRS<120 msec• Deviatie axiala dreapta > +100 grade, fara alta
cauza de deviatie axiala dreapta (BRD complet, HVD/fortare VD, sindroame de preexcitatie, infarctul miocardic anterior);
• Aspectul complexului QRS in DI si aVL este de tip rS; in DII, DIII, aVF undele R sunt ample
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