Arritmias Cardiacas II-A

1 Dr. Carmen Carrillo Cabán, MS IV

2

• Discuss concepts EKG, depolarization, repolarization and

• Identify the electrocardiographic waves P,Q,R,S,T, ST, PR segments and QT,PR and ST intervals.

• Analyzed the characteristics of any disritmia and the MD management.

Dr. Carmen Carrillo Cabán, MS IV

3

• Disritmia- anormal electric conduction of the heart.

• Depolarization- when the cardiac muscle cells changed of the intracellular condition with large negative charge to a state of large positive charge.

(systole)

• Repolarization- process in that the cardiac muscle cells return of one intracellular condition with large negative charge or its estate of repose. (diastole)


4

• P wave- initiates of atrial depolarization

• PR Interval- time that occur the atrial depolarization and time that retain the AV nodule impulses. Measure of P to QRS.

• Q wave- First negative deflection after P wave, time 0.03 sec and include 25 % of the R wave.

• R wave- first positive deflection, after P wave.

• S wave- first negative deflection after R.


5

• QRS- ventricular depolarization, duration < 0.12 sec. Measure Q to S.

• ST Segment- synchronic grade of ventricular depolarization to repolarization.

• Measure of S wave final to T wave starts.

• T wave- ventricular repolarization


6

• U wave- reflexes the repolarization of the

Purkinje fibers. Present in Hypokalemia.

• QT Interval- represents the total time of

ventricular depolarization and repolarization,

Duration: 0.32 – 0.40 seconds

• When its prolonged indicates torsade's the

pointes. Measure Q initiates to final of a T

wave.


9 http://lifeinthefastlane.com/ecg-library/basics/pr-segment/


10 http://www.bem.fi/book/15/fi/1504.gif Dr. Carmen Carrillo Cabán, MS IV

11

http://4.bp.blogspot.com/- dBSEJFB51U/TZqPOJzcboI/AAAAAAAAARI/21Kdu343WCs/s320/stelevation.jpg


http://4.bp.blogspot.com/-

http://4.bp.blogspot.com/-

Count big squares between two R waves

(R-R interval) and divide between 300.


Six seconds or rule of tens(10)

Count the number of QRS complex in a 6 sec.

period and multiply per ten. Its useful for regulars rhythms.

17

• http://sapiensmedicus.org/wp-content/uploads/2014/04/FrecuenciaCardiacaECG.jpg


18

• Establish:

1. Ventricular frequency

2. Ventricular rhythm.

3. QRS duration and morphology.

4. Identify the morphology of P waves.

5. Measure the auricular rhythm and Frequency.

6. Measure the PR interval, if are consistent or irregulars.

7. Determine the P:QRS ratio


• Cardiac rhythm: regular

• Frequency: 60 – 100 bpm

• Auricular Frequency: 80 bpm

• Ventricular Frequency: 90 bpm

• PR Interval: normal

• P wave: one P before QRS

• PR Interval : 0.12 - 0.20 sec

• QRS interval: 0.06 - 0.10 sec

• Etiology: normal conduction

• Treatment: Not require


21

• HR_____________

• Rhythm _________________

• Atrial Frequency:_____________

• Ventricular Frequency: ________________


Characteristics sinus bradycardia


• Frequency: < 60 bpm


• Ventricular Frecuency:90 bpm

• PR Interval: 0.12- 0.20 sec


• PR Interval PR: 0.12 - 0.20 sec



• Vagal stimulation

• PIC

• Synusal node ischemia

• Secondary effects to medications(digoxin)

• Normal in athletes


• Asymptomatic: No treatment, only observation.

• Symptomatic: (hipoperfusion, hypotension,

weakness, chest pain, conscious alterations)

• Oxygen, EKG

• Atropine 0.5mg – 1mg in I.V. bolus, repeat q

3- 5 min., max. 3 mg

• If atropine is ineffective: dopamine infusion 2-

10 mcg\kg I.V.\min., or adrenaline 2-20

mcg\kg\min. I.V.

• Transvenous Pacemaker


25


• Frequency: >100 bpm

• Auricular Frequency: >100 bpm

• Ventricular Frequency:>100 bpm



• PR Interval PR: 0.12 - 0.20 sec


• QRS: stretch


• Pain

• Fever

• Hemorrhage

• shock

• Anemia

• Anxiety

• Exercise

• Acute Cardiac Insufficiency

• Drugs: aminophylline, dopamine, nitroglycerine,

adrenaline y atropine and others.


Treatment synusal tachycardia

• Physical examination

• Eliminate the cause.

• Calcium channel blockers


28

• Cardiac rhythm: irregular increase with inspiration and

decrease with expiration.

• Frequency: 60-100 bpm

• Auricular Frequency: 60-100 bpm

• Ventricular Frequency: 60- 100 bpm



• PR Interval : 0.12 - 0.20 sec


• Treatment: None


• Cardiac rhythm: variable, irregular

• Frequency: determinate by the subjacent rhythm, relationship

with sinus node.

• PR Interval: 0.12 – 0.20 sec., more long or short or equal than

one sinus beat.

• P wave: present with different morphology than others P

waves, inverted or masked T wave.

• QRS interval: 0.06- 0.10 sec.

• Etiology: emotional problems, caffeine and nicotine

consumption, digitalis, mitral valve insufficiency and cardiac

insufficiency

• Treatment: if frequents treat the cause


32

• Auricular Frequency: 250-400\min. Therapeutic blocked AV

node.

• Ventricular frequency: 75-150\min.

• Auricular Rhythm : regular

• Ventricular Rhythm : regular and others time irregular

• P wave: saw-toothed appearance, F waves.

• PR Interval : if multiple P waves are present, difficult to

determiner

• QRS interval: abnormal, normal or absent

• P QRS ratio: 2:1, 3:1 ó 4:1

• Treatment: diltiazem, verapamil, beta blockers, digitalis IV. To

decrease ventricular frequency.

• Amiodarone. If patient do not respond to medications;

cardioversion Dr. Carmen Carrillo Cabán, MS IV

33

• Cardiac rhythm: irregular

• Auricular Frequency: 300-600 bpm

• Ventricular Frequency: 120-200 bpm

• P wave: not identify, F waves

• P QRS ratio: to much P for one QRS

• PR Interval : no measure



Tx. FA

• Digitalis

• Verapamil

• Diltiazem

• Propranolol

• Quinidine

• Procainamide

• ASA, warfarine

• Cardioversion

35

• Corvert IV

• Adenosine

• Flecainidine

• Sotalol

• Amiodarone

• Other antidisritmics

• Pacemaker, surgery

(ablation) if patient do not

respond to tx.


36



• PR Interval: long

• P wave: visible or absents; different from sinus rythm

• P QRS ratio: 1:1 if P waves and visible

• QRS interval:0.04 – 12 sec.

• Etiology: caffeine, emotional alterations, nicotine, digitalis, mitral

valve prolapse and Cardiac Insufficiency, related with sudden

interruption of auricular repetitive ectopic focus and sudden

sensation of impulse.

• Treatment: vagal maneuver or carotid massage, adenosine,

verapamil or cardioversion synchronized.(50J)


41


• Frequency: 100- 200 bpm

• Auricular Frequency: no measurable


• P wave: difficult to detect

• PR Interval : no measure

• QRS interval: 0.12 or more, wide and aberrant

• Treatment: amiorodarone, lidocaine, cardio version, if

patient is unconscious and do not has a pulse;

defibrillate


43

Ventricular and auricular rhythms: irregular and

chaotic

Ventricular frequency: > 300 bpm

Characteristics: No palpable or audible pulse,

apnea

Treatment: Defibrillation, CPR


44

Cardiac rhythm: absent

Auricular frequency: none

Ventricular Frequency: none

Tx. CPR, intubation


46

Frequency and ventricular and auricular rhythm depends of the

subjacent rhythm.

Morphology and duration of QRS: normal or abnormal

P wave: before QRS with synusal rhythm

PR Interval: 0.20 sec or more, measure of RR interval is constant

Ratio P:QRS: 1:1

Treatment: observation


47


• Frequency: depend the subjacent rhythm


• Ventricular Frequency: 60 bpm

• PR Interval: is lengthened with each succeeding complex until a P-

wave does not lead to a QRS missing, which makes the irregular PR

interval.

• P wave: before QRS

• P QRS ratio: 3:2, 4:3, 5:4

• Treatment: pacemaker


48

•Cardiac rhythm: irregular

•Frequency: depend the subjacent rhythm

•Auricular Frequency: 70 bpm

•Ventricular Frequency: 30 bpm

PR Interval: irregular.

P wave: before QRS

•P: QRS ratio: 2:1, 3:1,4:1, 5:1

•Treatment: pacemaker


49

Treatment: pacemaker


51

http://cdn.medgadget.com/wp-content/uploads/2012/05/Reocor-external-pacemaker.jpg


54

• Davis, D.(1992). Interpretación de la arritmia, Editorial médica Panamericana.

• Haddix,K.,DeiTos,P.(2001).Electrocardiography for Health Personnel. Glencoe, McGraw-Hill, Interamericana.

• http://www.med.nyu.edu/content?ChunkIID=103804

• Roy, P.(2004) An Atlas of Heart Rhythms, CD Room.


• http://www.hxbenefit.com/wp-content/uploads/2012/07/Atrial-flutter-

Picture.gif

http://www.med.nyu.edu/content?ChunkIID=103804

Arritmias Cardiacas II-A

Documents

Transcript of Arritmias Cardiacas II-A