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Argumentarea temei
Stefan, n vrst de 38 de
ani, cu o profesie
solicitant, sedentar simte
n timpul serviciului o
durere intens n piept,
transpiraii i greutate la
respiraie.
Sursa: http://www.online-med
ical-advice.com/chest-pain.h
tml
.
Imagine reprodus n scop
didactic
Raspundeti
sinus rhythm
about 77/min
normal conduction
intermediate axis
normal p wave morphology
Electrocardiograma reprezint
nregistrarea grafic a diferentelor de
potential generate n timpul activitii
electrice cardiace.
Vectocardiograma - VCG reprezint
nregistrarea vectorilor instantanei de
depolarizare i repolarizare n spaiu.
Prin unirea vrfurilor vectorilor
multipli instantanei, n spaiu, se
obine o bucl spaial de
vectocardiografie.
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de
de
de
de
depolarizare atrial
depolarizare septal
depolarizare ventricular
repolarizare ventricular
Depolarizarea i repolarizarea
ventricular
DEPOLARIZAREA SI REPOLARIZAREA
VENTRICULARA
Depolarizarea ventricular ncepe cu:
Depolarizarea septului care are directia:
Vectorul rezultant al depolarizarii septale va fi orientat de la
stnga la dreapta (vector 1)
Urmeaz depolarizarea ventricular, mai intai vrful, apoi peretii
laterali i n final se depolarizeaz baza ventriculelor.
Depolarizarea pereilor ventriculari se face
de la endocard la epicard, cu vectori
orientati:
de la stnga la dreapta i de sus n
jos pentru ventriculul drept (vector
2)
de sus n jos i de la dreapta la
stnga pentru ventriculul stng
(vector 3).
Vectorul mediu rezultant al depolarizarii
ventriculare este orientat de la dreapta la
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REPOLARIZAREA VENTRICULARA
Depolarizarea ventriculara s-a fcut de la endocard spre
epicard, sub forma de dipoli care au sensul de la A la B. Un
electrod plasat pe membre va privi fata epicardica, deci va fi
plasat n camp electric pozitiv
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DERIVATIILE
ECG
DERIVATIILE
ECG
Reamintiiv!
Planul sagital este paralel cu
sutura sagitala i mparte un
segment de corp sau corpul n
partea stang i partea
dreapt.
Planul frontalsau coronal
divizeaza un segment sau
corpul n ventral i dorsal sau
anterior i posterior.
Planul orizontal sau
transversal (numit i plan
axial sau cross-section),
mparte un segment sau corpul
n sus i jos (cap-coad).
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DERIVATIILE BIPOLARE
STANDARD
Derivaiile
bipolare - au fost imaginate de Einthoven.
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Axul derivaiei bipolare este o linie imaginar care unete
Triunghiul
echilateral
format de cele 3
derivatii =
triunghiul
Einthoven.
Derivaiile unipolare
Derivaiile unipolare au un singur electrod explorator,
iar cel de-al 2-lea este
indiferent.
Regula general de formare:
electrodul explorator se leag intotdeauna la borna pozitiv a
galvanometrului
electrodul indiferent se leag la borna negativ si este plasat la
distan fa de cord, ct mai la periferia cmpului electric.
linia derivaiei unipolare este o linie imaginar care unete
electrodul explorator cu centrul electric cardiac (cu borna
centrala).
25
Sistem triaxial
hexaxial
Sistem
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http://www.ndsu.
edu/pubweb/~gri
er/eheart.html
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Derivaiile V1 i
V2 sunt situate n
dreptul inimii
drepte;
V3 i V4 n
dreptul septului;
V5, V6 n dreptul
inimii stngi
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37
INREGISTRAREA UNEI
ELECTROCARDIOGRAME
Un electrocardiograf este un galvanometru modificat care
nregistreaz cu vitez mare variaiile de curent electric generate
de inim, pe care le amplific si le transform n deplasri
mecanice.
n principiu un astfel de aparat este alctuit din:
electrozi i cabluri care stabilesc legtura dintre cmpul electric
cardiac i aparat;
sistemul de amplificare electronic;
comutatori de derivaii;
sistemul de nregistrare care difer dup tipul aparatului - pe
hrtie termosensibil, mecanosensibil, cu cerneal, pe un tub
catodic, pe ecranul unui computer;
un sistem de derulare a hrtiei.
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n funcie de
numrul de
canale,
electrocardiogr
afele pot fi:
cu 3 canale
cu 6 canale
cu 12 canale
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izoelectric, de
referin!
Intervalul:
intervalul PQ
sau PR cuprinde
cuprinde
segmente i unde.
unda P si segmentul PQ. Se mai
numeste si atriograma.
intervalul QT cuprinde
complexul QRS, segmentul ST si
unda T. Semnifica depolarizarea si
repolarizarea ventriculara. Se mai
numeste si ventriculograma;
intervalul RR constituie un ciclu
cardiac
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Hrtia ECG
De regula, hartia ECG are
un caroiaj caracteristic,
standardizat. Fiecare
casuta mic este un patrat
cu latura de 1 mm.
Csuele mari (care au 5
csue mici) au 5 mm.
Exista si hartie la care o
casuta are 2 mm.
Ea curge din aparat cu o
vitez de 25 mm/secund,
mai rar de 50 mm/sec.
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Determinarea voltajului (a
amplitudinii) si a duratei undelor pe
un traseu ECG
Orice electrocardiograf este dotat cu un sistem de
etalonare, care ne spune care este relatia dintre voltaj si
amplitudinea n mm a unei unde.
Standard, n ECG, la 1 mV corespund 10 mm.
1 mV = 10 mm. Deci, 1 mm
= 0,1 mV
Pentru a determina amplitudinea
unei unde se determin numarul de
casute pe verticala si se transforma
in mV, conform relatiei de mai sus.
De exemplu, unda P de pe traseul
din dreapta se nscrie pe 3 casute.
Are, deci 3 mm, adica 0,3 mV
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Sursa: http://en.wikipedia.org/wiki/Electrocardiography
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Interpretarea unei
electrocardiograme
I. Stabilirea ritmului cardiac
II. Stabilirea FC
III. Stabilirea axului electric
IV. Analiza morfologic i cronologic a
traseului ECG
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I.
sinusal.
Frecvena cardiac se poate aprecia i printr-o metod mai rapid, dar mai imprecis.
Se identific o und R care se suprapune peste o linie vertical groas a traseului
n
condiii
n 150,
repaus
este
de liniile
70-75
b/min
ECG.
Apoi se normale,
numr 300,
100,frecvena
75, 60, 50 cardiac
pentru fiecare
dintre
groase
adulti Frecvena
si mai crescuta
la copii:
nn=
copil
peste 1
anse
carela
urmeaz.
se determin
n funcie
de 130-150;
unda R imediat
urmtoare,
care
suprapune peste=100-130;
una dintre liniile
groase
ale5
graficului
sau ntre b/min
acestea.
copil
peste
ani =100-110
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TAHICARDIA SINUSAL
Accelerarea frecvenei cardiace > 100 b/min
TAHICARDIA SINUSAL
= Accelerarea frecvenei cardiace > 100 b/min
Cauze generale: stimularea simpatic, emoii, efort fizic, febr,
droguri, hipertiroidism, anemii, hemoragii, infectii, patologie
cardiac (vezi si Factorii care influenteaza RECVENTA DE GENERARE A STIMULILOR,
adica functia cronotropa, curs 3)
Miguel Indurain
(born July 16, 1964, Villava, Navarre) is a retired
Spanish road racing cyclist. He is best known for
winning the Tour de France from 1991 to 1995,
becoming only the fourth person to win the event
five times, and the first to win five in a row.[1]
Indurain's ability and physical size1.88 m (6 ft 2
in) and 80 kg (176 lbs)earned him the nickname "
Migueln" or "Big Mig". He was so popular that a
Homo heidelbergensis cranium found in Atapuerca
in 1992, when he also won the Giro, was nicknamed
Migueln in his honour.
Physical advantages
At the top of his career, Miguel Indurain had a physique that was not only superior when
compared to average people, but also when compared to his fellow athletes. His
blood circulation had the ability to circulate 7 litres of oxygen around his body per minute,
[2] compared to the average amount of 3-4 litres of an ordinary person and the 5-6 litres of
his fellow riders. Also, Indurain's lung capacity was 8 litres, compared to an average of 6
litres. In addition, Indurain's resting pulse was as low as 28 BPM, compared to a normal
human's 60-80 bpm , which meant his heart would be less strained in the tough mountain
stages.[3] His VO2 max was 88 ml/kg/min; in comparison, Lance Armstrong's was 82 55
ml/kg/min and Greg LeMond's was 92.5 ml/kg/min.
Lance Armstrong
(born Lance Edward Gunderson September 18, 1971) is an
American professional road racing cyclist for UCI ProTeam
Team Astana. He won the Tour de France a record-breaking seven
consecutive years, from 1999 to 2005. He is the only individual to
win seven times, having broken the previous record of five wins,
shared by Miguel Indurain (consecutive) and Bernard Hinault,
Eddy Merckx and Jacques Anquetil. He has survived testicular
cancer, a germ cell tumor that metastasized to his brain and lungs, in
1996. His cancer treatments included brain and testicular surgery
and extensive chemotherapy, and his prognosis was originally poor.
Physical attributes
Armstrong has an aerobic capacity of 133.8 mL/kg/min[citation needed], much higher than the
average person (40-50), higher than some other elite cyclists, such as Miguel Indurain (88.0, although
reports exist that Indurain tested at 92-94). or Greg LeMond (92.5)[6]. His heart is 30 percent larger
than average; however, an enlarged heart is a common trait for many other athletes. He has a resting
heart rate of 32-34 beats per minute (bpm) with a maximum heart rate of 201 bpm.[7] Armstrong's
most unusual attribute may be his low lactate levels. During intense training, the levels of most racers
range from 12 L/kg to as much as 20 L/kg; Armstrong is below 6 L/kg. This ability of lactate
removal is most likely attributable to many years of hard training. Therefore, lactic acid buildup (or
acidosis) does not occur as easily in his body. Acidosis, and lactate in general, does not cause fatigue
but is a good, testable, marker for the cause of muscular fatigue muscle cell depolarization. Some
have theorized that his high pedaling cadence is designed to take advantage of this low lactate level.
In contrast, other cyclists rely on their power to push a larger gear at a lower rate.
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ARITMIA SINUSAL
La copiii i tinerii sntoi, frecvena cardiac variaz
cu fazele respiraiei: crete n inspir i scade n expir,
fenomen mai evident la respiraiile profunde, adnci.
Explicaie. n timpul inspirului, impulsurile provenite de
la receptorii de intindere din plamni conduse de nervii
vagi determin depresia ariei cardio-inhibitoare din
bulb. n acest moment, cordul scap de sub aciunea
frenatoare a centrului cardio-inhibitor mediat de vag
i frecvena cardiac crete.
Acest tip de aritmie se numeste aritmie respiratorie i
se datoreaz fluctuaiilor de tonus parasimpatic.
Un cord far variabilitate a frecvenei cardiace este un
cord care i-a pierdut rezerva funcional de adaptare
la condiii de lucru diferite.
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