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Physiologic curve

Physiologic curve. calibration mark. rhytm regularity heart rate electrical axis deviation waves and intervals analysis. Rhytm. Sinus rhytm 60 – 90 / min Junctional (Nodal) 40 – 60 / min Idioventricular 30 – 40 / min Atrial fibrilation Atrial flutter.

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Physiologic curve

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  1. Physiologic curve calibration mark • rhytm • regularity • heart rate • electrical axis deviation • waves and intervals analysis

  2. Rhytm Sinus rhytm 60 – 90 / min Junctional (Nodal) 40 – 60 / min Idioventricular 30 – 40 / min Atrial fibrilation Atrial flutter the most frequent rhytm pathologies

  3. Regularity Regular – the R-R intervals are constant Irregular – variable R-R intervals – respiratory sinus arrhytmia The most frequent pathologies: atrial fibrilation extrasystolas Heart rate Normal range 60 – 90 Tachycardia  90 Bradycardia  60

  4. normal -30° - +105° right axis deviation left axis deviation Heart axis - is an average of all depolarizations in the heart - direction of depolarization (vector) of the QRS complex - the left ventricle is thicker so the mean QRS vector is down and to the left - the QRS axis may shift due to physical change in the position of the heart, chamber hypertrophy, or conduction block

  5. Spikes, waves and intervals

  6. Spikes and waves analysis wave P - 2,5 mm, 0,1 s - aVR always, leads III and V1 sometime negative - sinus rythm, II negat → junction P pulmonale– tall, narrow, peaked above 2,5 mm P mitrale – broad, bifid

  7. Spikes and waves analysis PQ interval – isoelectric, 0,12-0,2 s – changes with the hear rate prolongation up to 0,2 s - AV block of 1st degree QRS complex– depolarization of ventricles voltage criteria (hypertophy x obesity, exsudate) abnormál shape (bundle branch blocks, extrasystolas) pathologic Q (myocardial infarction)

  8. Spikes and waves analysis ST interval– isoelectric pathology – elevation, depression

  9. Spikes and waves analysis Wave T – repolarization of ventricles coronary T hyperkalemia hypokalemia

  10. Spikes and waves analysis Interval QT – prolongation: hypocalcemia hypokalemia - shortening: hypercalcemia hyperkalemia digitalis toxicity

  11. Right ventricular hypertrophy • right axis deviation • signs of cardiac overload • right bundle branch block • P-pulmonale

  12. Left ventricular hypertrophy  left axis deviation  voltage criteria: Sokolow-Lyon index S in V1 + R in V5 or V6 (whichever is larger) ≥ 35 mm Lewis index R I + S III ≥ 25 mm

  13. Left ventricular hypertrophy with signs of cardiac overload  overload - descendent depression of ST and negative T in I, aVL, V5 and V6

  14. Current of injury Current of injury Current of injury Current of injury Ischemic changes in ECG, myocardial infarction

  15. Initial ECG classification of myocardial infarction STEMI „ST elevation MI“ NSTEMI „nonST elevation MI“

  16. NSTEMI - subendocardial ischemia  descendent depression of ST  0.08 s in width and 1 mm in amplitude

  17. NSTEMI  subendocardial ischemia  coronary T wave, ST depression

  18. STEMI – myocardial infarction  pathologic Q wave deflection amplitude of 1/4 or more of the subsequent R wave or being > 0.04 s in width and > 2 mm in amplitude  ST elevation  negative T

  19. STEMI – anterior wall myocardial infarction  Pardee wave (elevation of ST)

  20. Evolution of STEMI

  21. reentry ARRHYTMIAS • Mechanisms of arrhytmias: • Abnormal impulse formation • Abnormal conduction • 3. Combination of both • - irregular heartbeat • tachyarrhytmia – rate > 100/min • bradyarhytmia – rate < 60/min

  22. Incomplete compensatory pause (supraventricular arrhytmia) Complete compensatory pause (ventricle extrasystole)

  23. Nodal rhytm  absence of P waves

  24. WPW syndrome (Wolf-Parkinson-White)  ventricular pre-excitation  PQ  0,12 s  typical delta wave

  25. Atrial fibrilation  irregullar formation of impulses in atria 300-600/min  irregular QRS complexes  absence of P waves  flutter like waves f

  26. Atrial flutter  atrial rate of 240 to 340 beats/minute  repeated loop of electrical activity  sawtooth pattern of the P waves

  27. Premature ventricular complexes PVCs (extrasystoles)  ectopic impulses originating from an area distal to the His Purkinje fibres  unifocal PVCs are triggered from a single site in the ventricle  complexes have different configurations >0,11s in width  is usually followed by a complete compensatory pause

  28. Premature ventricular complexes – ventricular bigeminy  Depending whether there are 1, 2, or 3 normal beats between each PVC, the rhythm is called bigeminy, trigeminy, or quadrigeminy  Causes: high blood pressure, low blood oxygen, low blood levels of potassium, and some medications (digitalis toxicity)

  29. PVCs – groups of subsequent extrasystoles

  30. Ventricular tachycardia  series of three or more ventricular complexes occurring at a rate of 100 to 250 bpm  atrioventricular dissociation is usually seen  wide QRS complexes (usually >120 ms) with T-wave polarity opposite that of the major QRS deflection;

  31. Ventricular fibrillation  abnormally irregular heart rhythm caused by rapid, uncoordinated fluttering contractions of the ventricles  mechanically this results in an arrested cardiac pump function and immediate death

  32. First-degree atrioventricular block  PR constant prolongation  disease of the conduction system in which the PR interval is lengthened  0.20 

  33. Second-degree AV block Type 1Mobitz I/ Wenckebach periodicity  almost always a disease of the AV node  is characterized by progressive prolongation of the PR interval on consecutive beats followed by a blocked P wave (i.e., a 'dropped' QRS complex)  pattern n: (n-1)

  34. Second-degree AV block Type 2Mobitz II  intermittent non-conducted P waves without progressive prolongation of the PR  the P waves ‘march through’ at a constant rate

  35. Third degree AV block  complete heart block  the atrial activity is dissociated from ventricular activity  regular P to P interval, regular R to R,  clinically: bradycardia, hypotension, hemodynamic instability

  36. Right bundle branch block  defect in the heart's electrical conduction system  the right ventricle is not directly activated by impulses travelling through the right bundle branch  QRS duration must be more than 100 ms (incomplete block) or more than 120 ms (complete block)  terminal R wave in lead V1 (e.g. R, rR', rsR', rSR' or qR)

  37. Leftt bundle branch block  activation of the left ventricle is delayed  QRS duration must be ≥ 0.12 s  should be a QS or rS complex in lead V1  RsR' wave in lead V6.

  38. Projekce svodů

  39. Přehled svodů užívaných v EKG I - + aVR aVL - - II III + + uzemnění aVF 12 – ti svodové EKG: • 3 bipolární končetinové svody I, II, III tzv. Einthovenův trojúhelník • 3 unipolární zesílené svody aVR, aVL, aVF proti Goldbergově svorce • 6 unipolárních hrudních svodů V1-6 proti Wilsonově centrální svorce

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