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ECG Blocurile de ramura

ECG Blocurile de ramura. Generalitati. Blocul de ramura = intreruperea conducerii impulsului pe una dintre diviziunile fasciculului Hiss. Blocul complet de ramura stanga. Criterii de diagnostic ECG: Ritm sinusal , sau supraventricular Complex QRS >/= 0.12 secunde – 0.16 secunde

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ECG Blocurile de ramura

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  1. ECGBlocurile de ramura

  2. Generalitati • Blocul de ramura = intrerupereaconduceriiimpulsuluipeunadintrediviziunilefasciculului Hiss

  3. Bloculcomplet de ramurastanga • Criterii de diagnostic ECG: • Ritmsinusal, sausupraventricular • Complex QRS >/= 0.12 secunde – 0.16 secunde • Morfologie QRS “in platou” in derivatiilestangi • Ax QRS normal saudeviat la stanga • Timp de aparitie a deflexiuniiintrinsecoide >0.044 sec in derivatiilestangi • Absentaundei Q in DI, aVL (V5, V6) • Modificare ST-T in sensinversundeidominante a QRS

  4. Semnificatieclinica • BRS completsemnifica – in liniigenerale – ischemiemiocardica • BRS completacutsimptomatictrebuieinterpretat ca infarct miocardic cu supradenivelare de segment ST sitratat ca atare! • BRS completvechiare – celmaiprobabil – etiologieischemica. • BRS completvechisimptomatic cu ST-T in acelasisens cu undadominanta a QRS semnificaischemiemiocardicaacuta • BRS completpoatesa fie dependent de frecventa; poatesaapara la frecventecrescute ale ritmului, semnificandischemiemiocardica; BRS - mairar – si in situatiidierite de ischemia miocardica (cardiomiopatii)

  5. Diagnosticul de BRS+HVS • Tulburareadepolarizarii din BRS altereazacriteriile ECG de hipertrofiestangaconcomitenta • HVS in prezenta BRS vadeterminaalungirea QRS maimult de 0.16 secunde • Criteriile de voltajpentru HVS au valoarediagnosticamairedusa in prezenta BRS major, darvorfiluate in considerare, daca QRS>0.16 secunde

  6. Bloculcomplet de ramuradreapta • Criterii de diagnostic ECG: • Ritmsinusal, sausupraventricular • A. Complex QRS>/= 0.12 secunde • B. Morfologie QRS RsR’, rsR, rSR’’ in V1, V2, S profunde in DI| si V6 • C. Timp de aparitie al deflexiuniiintrinsecoide in V1, V2>0.035 sec • D. Ax QRS indiferent (functie de conditiileasociate) • E. Modificare ST-T in sensinversundeidominante a QRS

  7. Semnificatieclinica • Ramuldrept are lungimemai mare sidiametrulmaimicdecatramulstang; ramuldrept are o situatiesubendocardicasiprintrabeculamarginala, situatie care-l expuneintenstraumelormecanicesihemodinamice din ventricululdrept; ramuldreptbeneficiaza de perfuzieinferioara, comparativ cu perfuzia (dubluvasculara) a ramuluistang.

  8. Semnificatieclinica 2 • Acesteconditiideterminaaparitia BRD completnu numai in context ischemic, exceptandsituatia BRD acutsimptomatic, care in functie de contextul clinic, ca ischemiemiocardicaacuta • BRD completesteasociatfrecvent cu bolilepulmonarecronicesau cu afectiunilecorduluistang cu hipertensiunearterialapulmonara, precumsiunorcardiopatiicongenitalesicardiomiopatii primitive

  9. Blocurile de ramura

  10. Blocul fascicular antero-superior • Criterii de diagnostic ECG: Complex QRS<0.12”(in absenta BRD complet!) • A. Deviatieaxialastanga la > -45 grade, faraaltacauza de deviatieaxiala (BRS complet, HVS, sd. De preexcitatie, IM inferior(!)) • B. Complex dominant negativ I DII • C. Aspect qR, cu TADI>0.04 “ in aVL

  11. Semnificatieclinica • Poatefiprezent la indiviziasimptomatici, fara o cardiopatiedetectabila • Se asociaza cu boalacardiacaischemica: la un pacientsimptomatic, BFAS vafiinterpretat ca semn de ischemiemiocardicaacuta • Mai rar, poatefiintalnit in cardiomiopatii

  12. Blocul fascicular stang posterior • Complex QRS<120 msec • Deviatieaxialadreapta > +100 grade, faraaltacauza de deviatieaxialadreapta (BRD complet, HVD/fortare VD, sindroame de preexcitatie, infarctulmiocardic anterior); • Aspectulcomplexului QRS in DI siaVLeste de tip rS; in DII, DIII, aVFundele R sunt ample

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