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Diagnosticul ECG al suprasarcinilor atriale si hipertrofiilor ventriculare

Diagnosticul ECG al suprasarcinilor atriale si hipertrofiilor ventriculare. Traseu normal (!). Suprasarcina atriala dreapta – “P pulmonar ”. Ax p deviat la dreapta , la > +80 grade Durata P </= 0.11 sec (D II, V1) Amplitudinea P > 3 mm (D II)

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Diagnosticul ECG al suprasarcinilor atriale si hipertrofiilor ventriculare

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  1. Diagnosticul ECG al suprasarciniloratrialesihipertrofiilorventriculare

  2. Traseu normal (!)

  3. Suprasarcinaatrialadreapta – “P pulmonar” • Ax p deviat la dreapta, la > +80 grade • Durata P </= 0.11 sec (D II, V1) • Amplitudinea P > 3 mm (D II) • Componentapozitiva a P in V1 > 1 mm/> 0.04 sec • *Asocierefrecventa cu semne de hipertrofieventricularadreapta.

  4. P pulmonar; extrasistolaatriala

  5. HAD si HVD intr-un caz de TEP repetitiv

  6. Semnificatieclinica • HAD, frecventasociata cu HVD apare in: • Bolilepulmonarecronicehipoxemiante • Cardiopatiilevalvularemitrale • Cardiomiopatiiledilatative • Embolismulpulmonar • Cardiopatiicongenitale

  7. Suprasarcinaatrialastanga – “P mitral”

  8. Criterii ECG - HAS • Ax P < +15 grade • Durataundei P (D II) > 0.11 sec • Unda P (D II) bifida, cu a al II-lea varf > decatprimulsidurata inter-varfuri > 0.04 sec • In V1: • Durata P > 0.11 sec • Deflexiuneanegativa a P > 0.1 mV si > 0.04 sec

  9. HAS – Stenozamitralastransa

  10. Semnificatieclinica • Valvulopatiilemitrale/aortice • Cardiomiopatiidilatative • Hipertensiuneaarteriala • Alteafectiuni care determinacrestereapresiunilor de umplere a VS • Cardiopatiicongenitale

  11. Hipertrofiaventriculara • Criteriile de diagnostic ECG ale HV au sensibilitatediferita in functie de ventricululafectat • Preziacriteriilorestemai mare pentru HVS decatpentru HVD, din ratiuni legate de forma cavitatilor, de dimensiuneaperetilorsi de pattern-ul de depolarizare. • Criteriul de amplitudineestedefinitorpentrudiagnosticul HV.

  12. Hipertrofiaventricularastanga – criterii ECG • Dupa Te Chuan Chou et. co. (Chou’s Electrocardiography in Clinical Practice) • Sokolow-Lyon: valabile la QRS<0.12 sec: • Criterii HVS in derivatiilemembrelor: • R (D I)+ S (D III) > 25 mm • R (aVL) > 11 mm • R (aVF)> 20 mm • S (aVR) > 14 mm

  13. Criterii HVS - continuare • Dupa Te Chuan Chou et. co. (Chou’s Electrocardiography in Clinical Practice) • Criterii HVS in derivatiileprecordiale: • SV1 + RV6 > 35 mm • SV2 + RV6 > 43 mm • SV1 > 24 mm • RV6 > 28 mm

  14. Criterii HVS - continuare • Indicele Cornell: R (aVL) + SV3 > 20 mm (femei) >28 mm (barbati)

  15. Criterii HVS - continuare • Criteriiasociate: • Deviatieaxialastanga a QRS in plan frontal • Timpul de aparitie a deflexiuniiintrinsecoide > 0.05 sec in V5 sau V6 • Modificareasegmentului ST in sensinversundeidominante a QRS in D I, aVL, V5 si V6

  16. ScorulRomhilt – Estes de HVS(>/= 4 pct = HVS) • Amplitudine • R sau S > 20 mm (deriv. mb.) • S>30 mm V1,V2 • R>30 mm V5, V6 3 pct • Modificari ST-T • Faradigoxin 3 pct • Cu digoxin 1 pct • HAS 3 pct • Deviatieaxialastanga > -30 grade 2 pct • Durata QRS > 0.09 sec 1 pct • TADI > 0.05 sec in V5 si V6 1 pct

  17. HVS – suprasarcina de presiune

  18. Semnificatieclinica • HVS de presiune vs. HVS de volum • Presiune • HTA • Stenozaaortica • Coarctatie de aorta • Volum • Insuficientamitrala • Insuficientaaortica • Boalacardiacaischemica • Cardiomiopatiilehipertrofice primitive • Pseudo-hipertrofie VS

  19. Hipertrofiaventricularadreapta Dupa Te Chuan Chou et. co. (Chou’s Electrocardiography in Clinical Practice)

  20. HVD – transpozitienecorectata de vase mari

  21. HVD – stenozamitralastransa

  22. Semnificatieclinica • Cordulpulmonarcronic • Bolilevalvularemitralesipulmonare • Cardiopatiilecongenitale • Hipertensiuneaarterialapulmonaraprimitiva • Cardiomiopatii

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