Professional Documents
Culture Documents
Derivaciones. Vectocardiografa.
Valor semiolgico del EKG y aplicacin prctica.
ANATOMA MACROSCPICA
Circulacin
Cayado artico
pericardio
AI
AD VD
pericardio
VI
pice
VENTRICULO DERECHO
Vlvula PULMONAR
Vlvula TRICSPIDE
C. tendinosa
A
M
P
A
Vlvula BICSPIDE O MITRAL
M
P
Vlvula TRICSPIDE
ANATOMA MICROSCPICA
Estructura: Fibras ramificadas Propiedades elctricas Gap junction Potencial de accin accin largo Automatismo Acople E-C Ca++ desde LEC
Clula cardiaca
Canal de Ca++ L
Sarcmera
Excitabilidad Cardiaca
- 90mV
(Es, Vm)
Canales de Calcio
Tipo L: Inicialmente
encontrado en corazn y neuronas perifricas. Bloqueado por DHP y verapamil. Encontrado en casi todo tejido excitable y no excitable. Controla liberacin de NT y hormona y la contraccin cardiaca.
Bases inicas
Ito: Transient outward potassium current Slow (Ito , slow;Kv1.4 ) y fast (Ito , fast;Kv4.2,/4.3) IK: canal de potasio
isi Na
L>T
Ito
IK, IK1
Cambios en fase 4 y Vm
Efectos del SNA
Ach vagal
m de fase 4 (a-b) Es (hiperpolariza)
Principios de Electrocardiografa
The Nobel Prize in Physiology or Medicine 1924
1878 British physiologists John Burden Sanderson and Frederick Page record the heart's electrical current with a capillary electrometer and shows it consists of two phases (later called QRS and T). Burdon Sanderson J. Experimental results relating to the rhythmical and excitatory motions of the ventricle of the frog. Proc R Soc Lond 1878;27:410-414 1887 British physiologist Augustus D. Waller of St Mary's Medical School, London publishes the first human electrocardiogram. It is recorded with a capilliary electrometer from Thomas Goswell, a technician in the laboratory. Waller AD. A demonstration on man of electromotive changes
accompanying the heart's beat. J Physiol (London) 1887;8:229-234
1889 Dutch physiologist Willem Einthoven sees Waller demonstrate his technique at the First
International Congress of Physiologists in Bale. Waller often demonstrated by using his dog "Jimmy" who would patiently stand with paws in glass jars of saline.
meeting of the Dutch Medical Association. (Later he claims that Waller was first to use the term). Einthoven W: Nieuwe methoden voor clinisch onderzoek [New
methods for clinical investigation]. Ned T Geneesk 29 II: 263-286, 1893
Sistema de conduccin
Polaridad de la clula
Electrocardiograma
Ondas de despolarizacin y repolarizacin; registro de la actividad elctrica del corazn a distancia. Derivaciones: Bipolares: frontales (DI,DII, DIII) Unipolares: precordiales V1-V6 Aumentadas; aVF, aVL, aVR
ELECTROCARDIOGRAFA BSICA
Ritmo Sinusal P (+) II y (-) aVR PQ constante ( 3 - 5 mm ) FC: 60 - 100 lpm Intervalo PP ( RR ) constante Morfologa de P constante en cada derivacin
DI DII DIII
BD -
BI +
-
PI
+ +
Derivaciones unipolares
Precordiales
Anatoma bsica
Eje hexaxial
AVF
Velocidad:
d/t
25 mm/seg
1.0
ECG
25 mm/seg
0.5
segmento PR 0,1 segmento ST
P=0.08
T=0.16
U
Intervalo PR 0.6-1
Q
S
Intervalo QT = 0.29-0.42
-0.5
ECG NORMAL
fc
Onda P normal No ms de 2,5 mm de alto Duracin de 0,08- 0,11 seg. Aumentada: hipertrofia atrial (>3 mm) Causas: incompetencia tricuspdea con regurgitacin Intervalo QT: 0.40 seg Intervalo PR: 0,18 seg
Complejo QRS normal Duracin de 0,08- 0,10 seg Onda Q aumentada: infarto Onda R >35 mm hipertrofia VI; regurgitacin mitral
Vectocardiografa
Determinacin del eje de despolarizacin
-12 +3 -9
+9 -3 +6
Eje cardiaco
Eje a la izq