hipertrofie si infarct
TRANSCRIPT
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HIPERTROFIE SI
INFARCT
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4.4. HIPERTROFIE HIPERTROFIE
Hipertrofia unei cavitati inseamna o crestere a grosimii peretelui acelei cavitati.
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HIPERTROFIE ATRIALAHIPERTROFIE ATRIALA
Pentru evidentierea hipertrofiei atriale se examineaza unda P. Daca unda P este inalta > 2,5 mV sau masoara > 3 patrate mici ( > 0,12 sec ) atunci exista hipertrofie atriala.
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HIPERTROFIE ATRIALAHIPERTROFIE ATRIALADREAPTADREAPTA
HADHAD
Unda P este ampla > 2,5 mV, cu baza normala ( “P pulmonar” )in cazul suprasolicitarii de volum a inimii drepte
( CPC )
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HIPERTROFIE ATRIALAHIPERTROFIE ATRIALASTANGASTANGA
HASHAS
Aspect bifid al undei P cu prima cocoasa mai joasa si a doua mai inalta.
Baza undei P depaseste 0,12 sec.
Se mai numeste “P mitral” sau P bifid si se intalneste in stenoza mitrala
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HIPERTROFIA VENTRICULARA HIPERTROFIA VENTRICULARA DREAPTADREAPTA
HVDHVD
- unda R mare in V1 si V2- unda R diminua apoi progresiv spre V4- complex QRS larg( 0,12 sec )- deviatie axiala dreapta
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HAD si HVD
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HIPERTROFIA VENTRICULARA HIPERTROFIA VENTRICULARA STANGASTANGA
HVSHVS
- S in V1 + R in V5 ≥ 35 mm
= indicele Sokolov - Lyon
- deviatie axiala stanga
- complex QRS larg
( 0,12 sec )
- unda T inversata
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5. 5. INFARCTINFARCT
Infarctul miocardic este consecinta unei obstructii a unei artere coronare.
Ventriculul stang care are peretele cel mai gros are nevoie de o irigatie sangvina importanta si este primul care sufera de pe urma diminuarii circulatiei coronare.
Zona infarctata este din punct de vedere electric moarta si nu poate conduce impulsuri electrice.
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TRIADA CLASICA A INFARCTULUI
ISCHEMIE
( T negativ )
LEZIUNE
(ST supradenivelat)
NECROZA
( Q patologic )
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DIAGNOSTICUL POZITIV AL DIAGNOSTICUL POZITIV AL INFARCTULUI DE MIOCARDINFARCTULUI DE MIOCARD
Diagnosticul pozitiv al infarctului de miocard se pune pe existenta celor trei criterii :
1 ) necroza : unda Q patologicalargime = 0,04 secadancime = 1/3 – 1/4R
2 ) leziune : ST supradenivelat, cu forma arcuata, concava spre linia izoelectrica a traseului
3 ) ischemie : T negativ, amplu
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DIAGNOSTICUL TOPOGRAFIC AL INFARCTULUI MIOCARDIC
I. ANTERIOR : Q patologic in V1, V2, V3, V4
I. LATERAL : unde Q patologice in DI , aVL
I. INFERIOR : Q patologic in DII, DIII, aVF
I. POSTERIOR : unda R mare in V1, V2 subdenivelare ST in V1, V2
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INFARCT ANTERIOR : INFARCT ANTERIOR : Q patologic in V1, V2, V3
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INFARCT LATERAL : INFARCT LATERAL : unde Q patologice in DI , aVL
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INFARCT INFERIOR : INFARCT INFERIOR : ST supradenivelat in DII, DIII, aVF
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INFARCT POSTERIOR:INFARCT POSTERIOR:unda R mare inV1,V2 subdenivelare ST in V1, V2
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DIAGNOSTICUL EVOLUTIV AL INFARCTULUI MIOCARDIC
Se disting 4 stadii :Stadiul IStadiul I ( precoce )
– faza supraacutaStadiul IIStadiul II ( intermediar )
– faza acutaStadiul IIIStadiul III ( tardiv )
– faza de rezolutieStadiul IVStadiul IV ( cicatricial )
– faza cronica
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Stadiul IStadiul I ( precoce , supraacut )
- apare in primele 24 – 36 de ore de la debut
- supradenivelare foarte ampla de ST
- segmentul ST pleaca din varful undei R
- unda S nu mai exista este contopita cu unda T care nici ea nu se mai distinge ( unda in dom )
- ± apare Q patologic
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Stadiul IIStadiul II
( intermediar , acut )
- apare in prima saptamana de la debut
- aspect EKG caracteristic : unda Q patologica, unda Q patologica, segmentul STsegmentul ST supradenivelat supradenivelat si unda T negativasi unda T negativa
- pe zi ce trece, segmentul ST coboara tot mai mult spre linia izoelectrica iar unda T devine tot mai ampla
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Stadiul IIIStadiul III ( tardiv, de rezolutie )
- apare la 1 – 3 sapt de la infarct- pe EKG coexista unda Q patologica si unda T negativa, ampla ( T coronarianT coronarian )- segmentul ST devine izoelectric- dupa 3 saptamani, unda T negativa incepe sa se micsoreze treptat
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Stadiul IVStadiul IV
( cronic, cicatricial )
- persista indefinit dupa vindecarea clinica a infarctului
- pe EKG apare doar unda Q patologicaunda Q patologica
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ANGINA PECTORALA
DGN electrocardiografic
- Modificari de tip ischemic : subdenivelare ST
- Unda T turtita, uneori negativa
- In unele cazuri aspectul EKG de angina pectorala apare numai dupa proba de efort
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EXERCITII
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?
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BLOC SINOATRIAL
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BAV gradul II Mobitz I
BAV gradul II Mobitz II
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BAV gradul I
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MOBITZ I
BSA
MOBITZ II
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EXTRASISTOLA ATRIALA
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TAHICARDIE SINUSALA
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SDR DE PREEXCITATIE
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EXTRASISTOLE VENTRICULARE
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BAV gradul III ( complet )
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FIBRILATIE ATRIALA
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TAHICARDIE SUPRAVENTRICULARA
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TAHICARDIE VENTRICULARA
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RITM JONCTIONAL
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BRD
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BRS
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FLUTTER VENTRICULAR
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BLOC SINOATRIAL
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FIBRILATIE VENTRICULARA
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FLUTTER ATRIAL
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INFARCT LATERAL
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HAD si HVD
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HVS
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INFARCT INFERIOR
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HAD
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INFARCT ANTERIOR
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ANGINA PECTORALA
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HAS
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INFARCT POSTERIOR
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HEMIBLOC ANTERIOR
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HEMIBLOC POSTERIOR