Electrocardiograma Nº2

ecg2

Apreciados colegas y relacionados estoy haciendo un esfuerzo por cumplir conmigo mismo y luego con ustedes. Para la proxima semana les muestro el programa que consegui en la red que me permite extraer texto de las imagenes Si a alguien le interesa, es libre y funciona en un 90 % , lo que es bastante bueno, ese 10 % tienes que editarlo, por los momentos solo reconoce el ingles pero hay un parche para extraer texto en español Se llama Softi freeOCR. Pesa poco 4,5 mb Hoy llovio aqui en Puerto La Cruz Salud y suerte Ah logre gestionar un blog en WordPress aqui les va la direccion( https://electrocardiografia.wordpress.com/ Seguramente tendran que escribirla manualmente en el navegador, creo que aun no esta indexada en los diferentes buscadores) por si alguien no visualiza este Blogspot
Gracias por la atencion y la paciencia Alguien de la Cleveland Clinic dijo en estos dias que los medicos pensamos en relacion a la medicina casi de la misma forma: nos gusta investigar a cualquier nivel, nos gusta ser acertivos y esto que hoy continuo haciendo por estas dos semanas puede no enseñar nada nuevo pero divierte, el lo hace pero a otro nivel. Gracias por ser pacientes.

Este es la interpretacion del electrocardiograma de la semana anterior:The critical finding in this tracing is the presence of a second P wave buried in theterminal portion of the QRS complex. Its recognition leads to the correct diagnosis of a supraventricular tachyarrhythmia, in this case an ectopic atrial tachycardia, with 2:1 block The failure to conduct 1:1 is due to PP interval that is shorter than the refractory period of some part of the AV conduction system, and is therefore physiologic rather than pathologic- Prominent S waves in V2 and V3 along with typical ST and T-wave changes in V4-V6 suggest left ventricular hypertrophy with repolarization abnormalities, although the ST and T.wave changes could be due to other causes

The presence of the second P wave is suggested by the terminal slurring of the QRS, seen most clearly in lead V1- In leads I and ll it consists of a rounding of the terminal ORS and early ST segment- In lead V1 it simulates a terminal R”- In both leads the morphology of the deflection is similar to the morphology of the more visible P wave in that lead, particularly in lead V1 where the visible P wave is quite prominent. The pseudo-R’ in lead V1 suggests incomplete right bundle branch block. However, this diagnosis is not supported in the absence of changes in other leads such as a slurred S in I or V6. A pseudo-R’ in V1 in the absence of confirmatory findings in other leads should alert the reader to a possible 2:1 block. Measurement of the timing of these deflections also demonstrates that they occurexactly halfway between the more visible P waves. ln at least one lead of an abnormal tracing it is often possible to identify a deflection halhway between the P waves. AP wave should be visible in multiple leads and bear some resemblance to the more visible P wave in that lead. Comparison of serial tracings can be very helpful in assessingthese suspicious alterations of the terminal QRS complex if the changes are absent during sinus rhythm. Recognition of P waves that are superimposed on the QRS complex or the ST segment during a tachycardia is a common problem in ECG interpretation- In addition to atrial tachycardia, superimposition of the P wave on the QRS complex occurs in atrial flutter, and AV nodal reentry tachycardia where the imposition is often more complete and the P wave much more subtle- Atrial flutter with 2:1 block is unlikely here due to the activation pattern of the atrium, and the absence of the classic “sawtooth” waves in the inferior leads though atypical flutter lacks these attributes

References:

Bar FVV, Brugada P, Dassen VVRM, \N’eIIens

Differential dia nosis of tach cardia

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