ekg taller
TRANSCRIPT
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@emrodelo
#ElectroUNIMAG
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Objetivos
• Conceptos Basicos• FREHI2• Ejemplos• Talleres y casos clinicos• Conclusiones
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Electrocardiógrafo
Amplificador
Galvanómetro
Sistema inscripción
Sistema de calibración
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1 mm
5 mm
0.04 s 0.20 s
1 seg
1cm: 1 mV
1 mm: 0,1 mV
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Lectura del EKG normal:Lectura del EKG normal:Nomenclatura de las Ondas
Despolarización ventrículos
Despolarización aurículas
Repolarización ventrículos
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• Cada que un ELECTRODO POSITIVO percibe una ONDA DE DESPOLARIZACIÓN
CONTRACCIÓNDESPOLARIZACIÓNDESPOLARIZACIÓN
“POLARIZADO”“POLARIZADO”
TRAZO POSITIVO
TRAZO POSITIVO
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Derivaciones del EKG: 12
BIPOLARES +/-
MONOPOLARES +
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Triángulo de Einthoven
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DERIVACIONES DEL PLANO FRONTAL
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SISTEMA HEXAXIAL DE BAILEYSISTEMA HEXAXIAL DE BAILEY
• Sistema de 6 porciones de 60º
• Sirve para calcular el eje eléctrico en el plano frontal
• Es la combinación de las derivaciones monopolares y bipolares
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Derivaciones precordiales
• Electrodos que “rodean” al corazón
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DERIVACIONES DEL PLANO HORIZONTAL O PRECORDIALES
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Incrementa el registro de la actividad del Ventrículo IZQ
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Dirección del flujo de corriente eléctrica
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ONDA P• Despolarización auricular• Redonda• Duración: 0.10 seg (2.5 mm)• Voltaje máx: 0.25mV (2.5 mm)• Positiva en casi todas las derivaciones
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Complejo QRS• Despolarización ventrículos• Redonda• Duración: 0.6-10 seg (2.5 mm)• Altamente variable
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Onda T• Repolarización ventrículos• Positiva en casi todas las
derivaciones• Excepto en:
– aVR, donde es negativa
Positiva, de escaso voltajeObservable en derivaciones precordialesLe sigue a la TRepolarización músculos papilares
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GRACIAS
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FREHI2F recuenciaR itmoE jeH ipertrofiaI squemiaI nfarto
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Frecuencia ( SINUSAL )
• Se calcula 1500/Distancia R - R.
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Frecuencia
• Forma práctica: desciende por cada 5 mm: 300,150, 100, 75, 60, 50, 43, 37.
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Frecuencia ( No Sinusal )
FC R No Sinusal: R en 3s x 20 Numero ondas R en 3 segundosMultiplicar por 20
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FREHI2F recuenciaR itmoE jeH ipertrofiaI squemiaI nfarto
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RITMO Definicion: Presencia de Onda P seguido de complejo QRS y
onda T. En 2 o mas derivaciones II largo preferencialmente.
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Bloqueo de rama
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TRANSTORNO DE LA CONDUCCION• Bloqueo de Rama Derecha.
Ensancha el complejo QRS.Se da en DI con T negativa, puede verse en DII y aVL.a) Vector inicial no se afecta.b) S terminal ancha en VII.Completo. Por la anchura del complejoQRS 0,10Complejo con rSR´
• Bloqueo de rama Izquierda. Tabique se despolariza de Der. a izq., por tanto desaparece onda R en VI.
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BLOQUEO AV
• Primer grado: PR alargado.
• Segundo grado: a) Tipo I (Mobitz 1): PR alargado progresivamente hasta que no conduce.b) Tipo II (Mobitz 2): Ausencia súbita de QRS, sin alargamiento de PR.
• Tercer grado:Bloqueo AV completoP disociado de QRS.PR no existe, RR regulares.
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Intervalo QT: √ Fórmula de Bazzet:
√ Fórmula de Rautaharju:
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FREHI2F recuenciaR itmoE jeH ipertrofiaI squemiaI nfarto
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Crecimientos auriculares
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• Hipertrofia ventricular derecha:Proporción R/S V1 > 1
R alta en V1 V2 : mayor de 2mV Desviacion del eje a la derecha
Bloqueo completo de rama derechaDepresion del ST e inversion de onda t en V1 y V2
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• Hipertrofia ventricular izquierda:Sokolow Lyon:S de V1 o V2 + R V5 o V6 > 35mm
Desviacion del Eje hacia la izquierda Onda R en AVL mayor 11 mV
R de DI + S de DIII > 25mm.
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Hipertrofia ventricular izquierdaCriterios básicos
Aumento del voltaje en las derivaciones izquierdas.
Desplazamiento gradual de los segmento ST y de la onda T en dirección opuesta al QRS.
Patrón rS en V1 y V2 con ondas S profundas en dichas derivaciones.
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Hipertrofia ventricular izquierdaCriterios básicos
En ocasiones la onda R puede estar ausente. Dicha ausencia puede ser interpretada de forma errónea como una necrosis anteroseptal .
El diagnóstico de HVI en el adulto esta reforzado por el registro de una deflexión intrinsecoide retardada en V5 o V6 > o = 0.05 seg.
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Hipertrofia Ventricular izquierdaCriterios de voltaje del QRS
• R en DI + S en DIII > o = 25 mm (este parámetro se denomina índice de Ungerleider).
• R o S en cualquier derivación de las extremidades > o = 20 mm.• R en aVL > o = 13 mm.• R en V5 o V6 > o = 30 mm.• S en V1 + R en V5 o V6 > o = 35 mm (este parámetro se denomina
índice de Sokolow-Lyon.
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Hipertrofia ventricular izquierda
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FREHI2F recuenciaR itmoE jeH ipertrofiaI squemiaI nfarto
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EJE
• Regla rapida• Si I y II son positivas , el eje es normal• Si I y AVF miden igual el eje es de 45 Grados• Si todas las derivadas unipolares son isobifasicas el eje es
indeterminado
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FREHI2F recuenciaR itmoE jeH ipertrofiaI squemiaI nfarto
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Isquemia Subepicardica
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Isquemia subendocardica
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Infarto con ST
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Necrosis