Descripción: Métricas para medir la publicidad online.
medico hummanitario
Descripción: nefrologia
Descripción: endocriniologia
Full description
Descripción: 1.- Lectura de EKG
EKG trake, Kardiologija, Interna medicina
EKG
Mejores médicos.
EXTERNADO MÉDICO 2018: ESTUDIO DEL EKG MD. MANOLO BRICEÑO ALVARADO C I RU G IA D E T ÓR AX Y C A R D IO VA S CU L A R H OS PI TA L N AC IO NA L G UI LL ER MO A LM EN AR A H OS PI TA L N AC IO NA L C AY ET AN O H ER ED IA
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Mejores médicos.
ELECTROFISIOLOGÍA CARDIACA
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ELÉCTRICO
HEMODINÁMICO
ENFOQUEMOS NUESTRO ESTUDIO
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DIFERENCIA DE POTENCIALES K+ F.1
Ca++ F.0
Ca++/K + F.2
K+ F.3
K+ F.3
Na+ F.4 -55 a -60 mV
Na+ F.0 -85 a -90 mV
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CONTROL DE LA EXCIT E XCITACIÓN ACIÓN Y LA CONDUCCIÓN DEL CORAZÓN Marcapaso normal
Nodulo sinusal
Marcapaso ectópico
Nodo AV y FP
Frecuencia de las descargas Nódulo sinusal
70 – 80 por minuto
Nódulo A-V
40 – 60 por minuto
Fibras de purkinje
15 – 40 minuto
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PROPIEDADES DEL CORAZÓN
BATM A N EXC ITA DO CONDUCE DROGA DO SU AUTO CROMADO C O N INODORO
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El po potencial tencial de ac a c c ión se se reg egis istr tra a en una úni únicc a c élul élula a usando us ando elec electr trod odo o
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Misma carga : Positivo Diferente carga: Negativo
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Mejores médicos.
Der eriiva c ión D I Tiiene el elec T electtrod odo o pos p osiitivo en b ra zo iz izqui quier erd do y el nega negattivo en e n bra bra zo d er erec ec ho.
-
+ DI
Mejores médicos.
-180°
+0 °
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Mejores médicos.
Derriva De vacc ió n DII DIII Tiene el el Ti elec ec trod odo o pos po sitivo en la pi p ier erna na izq ui uie erd a y el nega neg a ti tivo vo en el e l bra bra zo izq ui uier erd d o.
-60°
D III
+
Mejores médicos.
+120°
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Mejores médicos.
D II
aVF
aVR
D III
aVL
DI
DI
aVL
aVR D III
aVF
D II
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Mejores médicos.
Mejores médicos.
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Mejores médicos.
HEMIBLOQUEOS En ellos no se observan retardos en la conducción intraventricular.
Mejores médicos.
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Mejores médicos.
Mejores médicos.
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Mejores médicos.
Paso 3: Bradicardias
Mejores médicos.
ó ó
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BRADICARDIA SINUSAL Gente joven y deportista. Paci cien ente tes s qu que e es está tán n ba bajo jo tr trat atam amie ient nto o co con n cr cron onot otro ropo pos s ne nega gati tivo vos s > Pa (betabloqueantes, (betabloqueante s, digoxina, verapamilo, diltiazem, ivabradina …). > Otras afecciones cardiacas: hipotiroidismo, fiebre tifoidea (bradicardia relativa) >
Mejores médicos.
SD. NODO SINUSAL ENFERMO Este síndrome incluye varias alteraciones del ritmo: Bradica Brad icardia rdia sin sinusal usal que no corresponde a la situación fisiológica del paciente y que no está causada por fármacos.
Para Pa rada dass si sinu nusa sales les o bl bloq oque ueo o si sino noaur auric icul ular ar.. Síndrome
de
bradicardia-taquicardia,
que por electrocardiográficas merece la pena detenerse en él.
sus
manifestaciones
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Mejores médicos.
Mejores médicos.
BLOQUEO AV • Primer grado: PR alargado. • Segundo Segundo grado: grado:
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Mejores médicos.
BLOQUEOS AV Causas más frecuentes: • Cambios esclerodegen esclerodegenerativos. erativos. • Cardiopatía isquémica. • Fármacos antiarrítmicos.
Mejores médicos.
La conducción puede estar retrasada o enlentecida:
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Mejores médicos.
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Mejores médicos.
EL BLOQUEO AV COMPLETO Forma de disociación AV. AV. En el bloqueo AV completo, la actividad auricular suele tener su origen en el nódulo sinusal. El ritmo de escape que controla los ventrículos se localiza por debajo del bloqueo. La frecuencia es siempre inferior a la del ritmo auricular y el ritmo es regular puesto que se trata de un ritmo de escape. La frecuencia y morfología del QRS determina la localización del escape: a. b.
FC en torno a 50 lpm y QRS estrecho > ritmo r itmo de escape nodal. FC < 35-40 lpm y QRS ancho > escape ventricular. ventricular.
Mejores médicos.
¿CUÁNDO UNA FA PUEDE VOLVERSE RÍTMICA?
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Mejores médicos.
Bradicardias sintomáticas o pausas sinusales de más de 3 segundos de duración. > Bloqueo AV de segundo grado tipo Mobitz I sólo si son sintomáticos. > Bl Bloq oque ueo o AV de se segu gund ndo o gr grad ado o ti tipo po Mo Mobi bitz tz II II,, au aunq nque ue asintomático. > Bloqueo AV de tercer grado, grado, aunque asintomático. asintomático. > Pacientes sintomáticos con bloqueos bi o trifasciculares: es preciso realizar estudio electrofisiológico. Si en éste, el intervalo HV (His-Ventrículo) es mayor de 100 mseg, está indicado implantar marcapasos. > Bloqueo alternante alternante de rama, consistente consistente en que un pacie paciente nte con bloqueo de rama derecha (p.ej.) (p.ej.) desarrolla con el tiempo un bloqueo de rama izquierda, o viceversa. >
INDICACIONE S DE MARCAPASO
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Mejores médicos.
Mejores médicos.
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Mejores médicos.
PREEXCITACION • S Sínd índrom romee •
Mejores médicos.
de Wol Wolffff-Par Parkin kinsonson-
White. Es un síndrome electrocardiográfico caracterizado por un intervalo PR corto (< 0.12 seg), un com co mpl plej ejoo QRS pr prol olon onga gado do (> 0.12 seg), una onda delta y como norma un intervalo PJ normal.
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Mejores médicos.
Paso 4: Taquicardias
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Mejores médicos.
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Mejores médicos.
CLASIFICACIÓN CLASIFICAC IÓN DE LAS ARRITMIAS ARRITMIAS DEPEN ARRITMIAS DEPENDIENT DIENTES ES DEL NODO SINUSAL • Ta Ta quica quicarrdia si sinus nusa al •Bra d ic a rd ia sinus nusa al •Arritmia sinusal •Paro sinusal •Síndr ndrome ome d el nod no d o sinus nusa a l enfer enfermo mo DEPENDIENTE DEL TERRITORIO AURICULAR (COMPLEJOS QRS NORMALES) •Fibrilación auricular •Flu Flutte tterr aur auricu icular lar • Ta Ta quica rdia aur a uriic ul ula a r mú múlltiple •Taquicardia paroxística supraventricular •Extr tra a sís ísto toles les aur a uric icula ularre s
Mejores médicos.
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Mejores médicos.
RITMO SINUSAL
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Mejores médicos.
BRADICARDIA SINUSAL
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Mejores médicos.
PARO SINUSAL
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Mejores médicos.
DEPENDIENTES DEL TERRITORIO AURICULAR
FIBRILACIÓN AURICULAR
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Mejores médicos.
TAQUICARDIA AURICULAR
TAQUICARDIA I AURICULAR MULTIFOCALL
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TRAV OTODRÓMICO
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DEPENDIENTE DEL TERRITORIO VENTRICULAR CONTRACCIÓN VENTRICULAR PREMATURA O EXTRASÍSTOLE VENTRICULAR
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