JOSE FERNANDO GOMEZ GONZALEZ.

MEDICINA CRITICA Y CUIDADO INTENSIVO.

SANTA CATERINE
EXORCIZANDO A UNA
MUJER POSEDA
Girolano di Benvenuto.
Museo de arte de Denver.
1500-1510.
Figure 21-1 Conduction pathways through the heart. A section through the long axis of the heart is shown.
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Figure 21-2 Cardiac action potentials. The distinctive shapes of action potentials at five sites along the spread of excitation are shown.
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EXCITACION CARDIACA.
DESPOLARIZACION
CARDIACA.
SECUENCIA DE
DESPOLARIZACION DEL
MIOCARDIO.
Figure 21-5 Sequence of depolarization in cardiac tissue.
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CRISTO EL
MDICO
Atribuido a
Werner van den
Valckert. Siglo
XVII.

Figure 21-7 Components of the ECG recording.
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COMPONENTES DEL
TRAZADO.
ELECTROCARDIOGRAMA
.
Figure 21-8 The ECG leads.
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ELECTROCARDIOGRAMA
.
Figure 21-9 Axes of the limb leads. A, The frontal plane limb leads behave as if they are located at the shoulders (RA, right arm; LA, left arm) and groin (LL, left leg).
Leads I, II, and III are separated from one another by 60 degrees. The augmented leads, referenced to the center of the heart, bisect each of the 60-degree angles
formed by leads I, II, and III. B, Translating each of the six frontal leads so that they pass through a common point defines a polar coordinate system, providing views of
the heart at 30-degree intervals.
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ELECTROCARDIOGRAMA
.
DERIVADAS DERECHAS.
DERIVACIONES
POSTERIORES.
EL NIO
ENFERMO
Arturo
Michelena.
1863-1898.

TRAZADO EKG.
ONDAS EKG.
VALORES NORMALES
P: PRECEDE A TODOS LOS QRS, SON
TODAS IDNTICAS, NO DEBEN MEDIR
MAS DE 2 CUADRITOS O 0.08 S.

PR: NO DEBE MEDIR MAS 5 CUADRITOS
O 0.20 S.

QRS: NO DEBEN MEDIR MAS DE 3
CUADRITOS O 0.12 S

FC: NO DEBE SER MENOR A 60x, NI
MAYOR A 100x.
Figure 21-11 A normal 12-lead ECG recording. The recordings were obtained synchronously, three leads at a time (I, II, and III simultaneously; aVR, aVL, and aVF
simultaneously; V1, V2, and V3 simultaneously; and V4, V5, and V6 simultaneously). A 1-mV, 200-ms calibration pulse is visible on the left of each of the three rows. The
leads are marked on the traces. (We thank the Division of Cardiology, University of Maryland School of Medicine, for obtaining this ECG recording from the author.)
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CALCULO DE FRECUENCIA
CARDIACA.
FC EN RITMO
IRREGULAR.
The best method for measuring irregular rates with varying R-R
intervals is to count the number of R waves in a 6-sec strip and
multiply by 10. This gives the average number of bpm.

PROGRESION DE LA R.
EJE CARDIACO.
Figure 21-12 Estimation of the ECG axis in the frontal plane.
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Figure 21-13 Two-cell model of a myocardial infarction. A, The damaged cell B (blue record) has a lower resting potential, but the plateau of its action potential is at the
same level as the normal cell A (green record). B, After the records in A are subtracted, the apparent elevation of ST segment is the same as the difference in resting
potentials; the TP and PR regions are actually depressed.
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Figure 21-14 Pathological ECGs. In E, right bundle branch block is visible in the V1 or V2 precordial leads; left bundle branch block is visible in the V5 or V6 leads. (Data
from Chernoff HM: Workbook in Clinical Electrocardiography. New York, Medcom, 1972.)
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Figure 21-15 Abnormal conduction.
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LA VISITA DEL
DOCTOR Frans van
Miers (El Viejo). Museo
Kunsthistorisches,
Vienna. 1657.
QUE ES TAQUICARDIA?
QUE ES
BRADICARDIA?
INTERPRETE EL
TRAZADO
TRAZADO NORMAL.
EL PRIMER HERIDO EN EL HOSPITAL
DE LONDRES Jhon Lavery. Museo y
galeras de arte Dundee, Dundee
(Escocia) 1914-1915.
INTERPRETE EL
TRAZADO
BRADICARDIA SINUSAL.
INTERPRETE EL
TRAZADO
TAQUICARDIA SINUSAL.
Rate: Fast (100 bpm)
Rhythm: Regular
P Waves: Normal (upright and uniform)
PR Interval: Normal (0.120.20 sec)
QRS: Normal (0.060.10 sec)
INTERPRETE EL
TRAZADO
FIBRILACION AURICULAR
Rate: Normal (60100 bpm)
Rhythm: Irregular
P Waves: At least three different forms, determined by the focus in
the atria
PR Interval: Variable; determined by focus
QRS: Normal (0.060.10 sec
INTERPRETE EL
TRAZADO
TAQUICARDIA
SUPRAVENTRICULAR.
Rate: 150250 bpm
Rhythm: Regular
P Waves: Frequently buried in preceding T waves and difficult to
see
PR Interval: Usually not possible to measure
QRS: Normal (0.060.10 sec) but may be wide if abnormally
conducted through ventricles
INTERPRETE EL
TRAZADO
TAQUICARDIA
SUPRAVENTRICULAR
PAROXISTICA.
INTERPRETE EL
TRAZADO
FLUTTER ATRIAL.
Rate: Atrial: 250350 bpm; ventricular: slow or fast
Rhythm: Usually regular but may be variable
P Waves: Flutter waves have a saw-toothed appearance
PR Interval: Variable
QRS: Usually normal (0.060.10 sec), but may appear widened if
flutter waves are buried in QRS
INTERPRETE EL
TRAZADO
FIBRILACION AURICULAR.
INTERPRETE EL
TRAZADO
SINDROME DE WOLF
PARKINSON WHITE. ONDA DELTA
INTERPRETE EL
TRAZADO
RITMO DE LA UNION
ACELERADO.
DONDE ESTA LA ONDA P ???
INTERPRETE EL
TRAZADO
RITMO IDIOVENTRICULAR.
Rate: 2040 bpm
Rhythm: Regular
P Waves: None
PR Interval: None
QRS: Wide (0.10 sec), bizarre appearance
INTERPRETE EL
TRAZADO
CONTRACCIONES
VENTRICULARES
PREMATURAS.
INTERPRETE EL
TRAZADO
BIGEMINISMO.
INTERPRETE EL
TRAZADO
TRIGEMINISMO.
INTERPRETE EL
TRAZADO
TAQUICARDIA VENTRICULAR.
Rate: 100250 bpm
Rhythm: Regular
P Waves: None or not associated with the QRS
PR Interval: None
QRS: Wide (0.10 sec), bizarre appearance
INTERPRETE EL
TRAZADO
TORSIDA DE PUNTAS.
Frequent causes are drugs that prolong QT interval and
electrolyte abnormalities such as hypomagnesemia.
INTERPRETE EL
TRAZADO
FIBRILACION VENTRICULAR.
INTERPRETE EL
TRAZADO
ASISTOLIA.
INTERPRETE EL
TRAZADO
BLOQUEO AV DE PRIMER
GRADO.
PR > 0,20 sg.
INTERPRETE EL
TRAZADO
BLOQUEO AV DE SEGUNDO
GRADO (MOBITZ I
WENCKEBACH ).
INTERPRETE EL
TRAZADO
BLOQUEO AV DE SEGUNDO
GRADO (MOBITZ II).
Conduction ratio (P waves to QRS complexes) is commonly 2:1, 3:1, or 4:1.
INTERPRETE EL
TRAZADO
BLOQUEO AV DE TERCER
GRADO.
INTERPRETE EL
TRAZADO
ESPIGA DE MARCAPASO.
MASAJE CAROTIDEO.
TERAPIA ELECTRICA.
PRINCIPALES
FARMACOS.