atelier ecg
DESCRIPTION
ATELIER ECG. Boala cardiaca ischemica Tromboembolism pulmonar Pericardita Diselectrolitemii. IM acut, in evolutie sau recent. Crestere si / sau scadere tipica a markerilor biochimici de necroza miocardica la care se asociaza cel putin un criteriu din simptome de ischemie - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/1.jpg)
ATELIER ECG
Boala cardiaca ischemica Tromboembolism pulmonar Pericardita Diselectrolitemii
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IM acut, in evolutie sau recent
1. Crestere si/sau scadere tipica a markerilor biochimici de necroza miocardica la care se asociaza cel putin un criteriu dina. simptome de ischemieb. aparitia de unde Q patologice pe ecgc. modificari ecg sugestive pentru ischemie ( supradenivelare sau
subdenivelare de ST)d. evidenta imagistica de pierdere noua de viabilitate miocardica
sau anomalii nou aparute de motilitate parietala
2. Descoperiri anatomopatologice de IM acut
Oricare din urmatoarele criterii satisface diagnosticul
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IM cicatrizat sau in curs de cicatrizare
1. Aparitia de unde Q noi, patologice pe ecg seriate . Pacientul poate sau nu sa-si reaminteasca simptomele; markerii biochimici de necroza miocardica pot fi normali in functie de timpul scurs de la debutul infarctului
2. Descoperiri anatomopatologice de infarct cicatrizat sau in curs de cicatrizare
Oricare din cele 2 criterii satisface diagnosticul
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IM cu supradenivelare de ST (STEMI)
Supradenivelare ST in derivatii diferite depinzand de localizare Modificarea precoce (nu se observa frecvent) – unde T simetrice, hiperacute(cu
amplitudine >50% din R in aceeasi derivatie) in cel putin 2 derivatii contigue, care reflecta cresterea concentratiei plasmatice de potasiu
Apoi apare supradenivelare ST cu urmatoarele etape: - initial supradenivelare punct J si ST isi pastreaza configuratia concava - in timp supradenivelarea ST devine mai pronuntata si isi schimba morfologia
devenind mai convex - unda T devine inglobata in ST
- apare unda Q initiala si unda R isi pierde amplitudinea pe masura ce ST se supradeniveleaza
In timp - ST se intoarce gradat la linia izoelectrica - amplitudinea R se reduce marcat - unda Q se adanceste - unda T devine inversata
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STEMI
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IM fara supradenivelare de ST (NSTEMI)
In IM fara supradenivelare ST :
aplatizare sau inversare de unda T care precede tipic subdenivelarea ST
unda Q tipic lipseste dar poate apare
durata modificarilor ST-T este variabila
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Aspect ECG
Ischemie miocardica acuta in absenta BRS si HVS
Supradenivelare ST - supradenivelare ST noua la punctul J in 2 derivatii contigue de 0,2 mV la
barbat sau de 0,15 la femeie in V2-V3 si /sau de 0,1 mV in alte derivatii
Subdenivelare ST si modificari ale undei T – subdenivelare nou aparuta orizontala sau descendenta de ST de 0,05 mV in 2
derivatii contigue; si/sau inversarea undei T de 0,1 mV in 2 derivatii contigue cu unda R proeminenta sau R/S >1
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Aspect ECG
Infarct miocardic in antecedente Orice unda Q in V2- V3 de 0,02 s sau complex QS in V2 si V3
Orice unda Q de 0,03 s si 0,1 mV adancime sau complex QS in DI, DII, aVL ,aVF sau V4-V6 in orice 2 derivatii contigue (DI, aVL, V6; V4-V6; DII, III, aVF)
Unda R de 0,04 s in V1-V2 si R/S>1 cu T pozitiv concordant in absenta unui defect de conducere
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Electrofiziologie~ischemia~
Prelungire a duratei PA ( faza 3 de repolarizare rapida)
Vectorul T va fi orientat de la tesutul ischemic la zonele normale
Derivatiile care privesc zona ischemica - T negative adanci, ascutite si simetrice
Derivatiile care privesc zona normala - T pozitive, ample, ascutite, simetrice
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Electrofiziologie~leziune~
Pompa ionica de K isi reduce activitatea , K intracelular scade si in diastola spatiul extracelular al celulei lezate devine relativ electronegativ in raport cu cel al zonei normale
Apare un curent diastolic de leziune ce determina subdenivelare TQ (ecg epicardica) si supradenivelare relativa ST
Apare si curent sistolic de leziune care determina supradenivelarea reala a a ST
Vectorul ST este orientat de la miocardul normal la cel lezat
Derivatiile care privesc zona lezata inregistreaza supradenivelare ST, cele care privesc zona normala - subdenivelare ST
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Electrofiziologie~necroza~
Reducerea sau disparitia fortelor electrice de depolarizare din zona necrozata
Scaderea amplitudinii undei R sau aparitia undei Q in derivatiile orientate spre zona necrozata
Semne ECG– directe (in derivatiile orientate spre zona de infarct)– indirecte (in derivatii opuse)“in oglinda”
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STEMI
Ocluzie IVA proximal de prima septala si prima diagonala - supradenivelare ST in aVR si aVL - supradenivelare in V1(>2 mm) si V2-V4 - subdenivelare ST in DII, DIII, aVF - ST isoelectric sau subdenivelat in V5 si V6* Poate sa apara BRD
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Ocluzie IVA distal de prima septala, proximal de prima diagonala
- supradenivelare ST in DI si aVL - supradenivelare ST in V2 la V6 dar nu in V1
- subdenivelare ST in DIII - ST isoelectric in DII
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Ocluzie IVA distala - supradenivelare ST in V3 la V6 - supradenivelare in derivatiile inferioare (DII max) - subdenivelare in aVR
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Ocluzie IVA distal de prima diagonala , proximal de prima septala
- supradenivelare ST V1 la V4 - supradenivelare ST in derivatiile inferioare ( max DIII) - subdenivelare ST in aVL
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Ocluzie CD - supradenivelare ST in DIII >DII - subdenivelare ST in DI proximal supradenivelare ST >1 mm cu T pozitiv in V4R (este
implicat si VD) distal ST isoelectric cu T pozitiv in V4R
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Ocluzie circumflexa - supradenivelare ST in DII >DIII - ST isoelectric sau supradenivelat in DI - ST isoelectric sau subdenivelat cu unde T
negative in V4R• Extensie la peretele posterior - subdenivelare ST in derivatiile precordiale• Extensie la peretele lateral - supradenivelare ST in DI, aVL, V5 si V6
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Ocluzie de trunchi comun (left main)
Ischemie in teritoriul LAD si circumflexa- supradenivelare ST aVR, V1 (aVR > V1)- subdenivelare ST in DII si aVF (ischemie bazala)- subdenivelare ST in V2-V6
* Pot apare tulburari de conducere pe ramul drept
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IMA in prezenta BRS
secventa repolarizarii este alterata in BRS , cu vectorii ST si T fiind directionati in opozitie fata de QRS ;
aceste modificari pot masca subdenivelarea ST si inversarea undei T induse de ischemie
Criteriile ECG de diagnostic IM acut in prezenta BRS sunt:- supradenivelare ST >1 mm concordanta cu QRS , cu T pozitiv in DI, aVL, V5 si V6 (5 pct)- subdenivelare ST > 1 mm in V1, V2 sau V3 (3 pct)- supradenivelare ST >5 mm discordanta cu QRS in V2 la V4 (2 pct)
* Pentru specificitate de 90% scorul minim total ar trebui sa fie de 3 pct
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IM in prezenta BRS
Prezenta q in DI, aVL, si V5 sau V6 sugereaza IM anteroseptal
Persistenta supradenivelarii ST in DII, DIII si aVF sugereaza IM posteroinferior
Incizura pe panta ascendenta a undei S largi in derivatiile precordiale V3-V4 ( semn Cabrera) sau pe panta ascendenta a R in V5 sau V6 ( semn Chapman)
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IM in prezenta pacing-ului ventricular
Problema similara cu BRS preexistent ritmul de pacing de obicei asociat cu pattern de BRS
Singurul criteriu cu inalta specificitate si importanta statistica pentru diagnosticul de IMA : - supradenivelare de ST ≥ de 5 mm in derivatiile cu QRS negativ
– supradenivelare ST ≥1 mm in derivatiile cu polaritate QRS concordanta
– subdenivelare ST ≥ 1mm in V1, V2 sau V3
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IM anterior:- pierderea undei R din V1-V3
- supradenivelare ST din V2-V4 -T inversat in DI, aVL si V2-V5- bradicardie sinusala (betablocant)
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IM anterior in evolutie (stadiu tardiv) - pattern QS in V1-V3 - T inversat in V2-V4 - supradenivelarea ST aproape disparuta
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IM acut inferior- Q si supradenivelare ST in DII, DIII, aVF- Supradenivelare ST in V4R, V5R, V6R (implicare de VD)- Subdenivelare ST in DI, aVL – modificari reciproce
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IM anterior cu probabil anevrism ventricular - persistenta supradenivelarii ST in V1- V4 ≥3-4 saptamani este un semn relativ specific dar nu inalt sensibil de anomalie de motilitate parietala si uneori de formare de anevrism
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Ischemie difuza subendocardica - subdenivelare ST in DI, DII, aVL , aVF si V2-V6 - supradenivelare ST in aVR - PR prelungit (0,28 sec)
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IM acut anterior - Q si supradenivelare ST in V2-V4 - supradenivelare ST in DI si aVL - BRD
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Tromboembolism pulmonar (TEP)Sunt necesare trasee seriate
Confera un inalt grad de suspiciune , confirmare prin alte metode
Semnele ECG nu sunt 100% diagnostice : aritmiimodificari unda P modificari complex QRS modificari ST-T
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TEP
AritmiiSunt rezultatul insuficientei de VD si dilatatiei acute de AD si VDTahicardie sinusalaFibrilatie atrialaFlutter atrialExtrasistole atriale si ventriculare drepte
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TEP
Anomalii unda P
- P pulmonar (unde P inalte ≥ 2,5 mm in DII, DIII, aVF)
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TEP
Anomalii complex QRSdeviere axiala dreaptarotatie oraraQ in DIII si aVF ( daca apare QS in V1 indice de
suspiciune crescut)QS in V1 (daca apare Q in DIII si aVF indice de
suspiciune crescut)S in DI si aVL(activare intarziata a VD) - tulburare de conducere intraventriculara dreapta
completa sau incompleta (functie de gradul obstructiei) si cu supradenivelare ST cu T pozitiv
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TEP
Modificari ST-T - Supradenivelare ST in V1 si aVR - T negative, simetrice in derivatiile precordiale (se
dezvolta in 24-48 h de la evenimentul acut si persista cateva saptamani)
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TEP – faza subacuta
Rezolutia tulburarilor de conducere intraventriculare drepte
Axa poate reveni la normal
Aparitia undelor T negative in derivatiile precordiale pana la V5 / V6 si DIII , aVF
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TEP
Femeie de 58 aniRitm sinusal 93/minP pulmonar derivatii inferioare si V1-V3. AQRS +140Microvoltaj periferic QRS SI dar nu si QIII.BRD incomplet Rotatie orara in precordialerS din V1-V6
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Femeie de 34 ani- Tahicardie sinusala ,
104/min- P negativ in V1 (semn de
incarcare atriala dreapta)- AQRS +75- SI/QIII- BRD incomplet- Rotatie orara- usoara supradenivelare ST
in V1- V3- subdenivelare ST in V5-V6
TEP
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Barbat 60 ani:- Tahicardie sinusala ( 120/min) - P pulmonar DII, aVF- AQRS +100- SI/RsIII (echivalent in acest caz cu SI/QIII
datorita rotatiei extreme a inimii)- Qs in V1- QS in V2- rotatie orara in precordiale - supradenivelare ST de 0,5 - 1mm in V1-V2- T negativ in V2
TEP
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Diagnostic diferential supradenivelare ST
STEMI Angina Prinzmetal’s (regresie in 15-20 minute) Repolarizare precoce – fara evolutie, subiecti sanatosi, adesea tineri Vagotonie (mai ales in bradicardie) Pericardita stadiul 2 ( amplitudine < 2 mm) ( nu apar unde Q) Imagine in oglinda a supraincarcarii ventriculare; amplitudinea inalta
asociata cu HVS Sindrom Brugada (amplitudine pana la 3 mm in V2 , mai putin in V1-
V3, combinat cu pattern de BRD incomplet
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Pericardita acuta
Stadiul I : subdenivelare PQ Stadiul acut II: supradenivelare ST (plus subdenivelare
PQ in aproximativ 50%), unde T pozitive Stadiul III intermediar : ST si PQ isoelectric, unde T
aplatizate Stadiul IV subacut : unde T negative, ST si PQ
isoelectric4. Stadiul V : ECG normal*nu apar unde Q, modificari reciproce, nu respecta
distributia coronarelor! echo
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Pericardita
Barbat 53 ani la 6 h dupa debutul unei dureri acute toraciceStadiul acut, precoce de pericardita cu subdenivelare PQ in DI, DII, aVF si V1-V6
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Pericardita
Barbat 74 ani cu embolie pulmonara subacuta si mici revarsate pleural si pericardic - axa QRS +30 - supradenivelare ST in aVL, DI, DII si aVF - usoara supradenivelare in V2-V6 - subdenivelare PQ in DI, DII, aVF si V3-V6
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Pericardita
Barbat 62 ani - AQRS +50 - supradenivelare ST in DI, DII, aVF, DIII si V4-V6 - subdenivelare minima PQ in V4-V5 si in unele derivatii membre - PQ scurt
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Diagnostic diferential unda T negativa
Non-STEMI Ischemie fara infarct Supraincarcare ventriculara Varianta normala Sindrom X Pericardita (stadii 3 si 4) Miocardita Anemie severa Ortostatism Medicamente Pancreatita
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Diagnostic diferential R inalt in V1
Infarct posterior T in V1-V2; unda Q si ST V7-V9
HVD (V7-V9 normal)
Hipertrofie septala ventriculara (unde Q asociate; HVS; V7-V9 normale)
BRD (QRS larg; S larg in V1, V6; V7-V9 normale
Sindrom Wolff-Parkinson-White (PR scurt; unda delta; V7-V9 normale)
Varianta normala ( fara alte anomalii)
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Barbat 70 ani cu boala coronariana si emfizem pulmonar; durere toracica aparuta cu 20 minute inainte de EcgECG: unde T negative, simetrice in V2- V6 BAV grad I microvoltaj periferic Coro: stenoza 90%LAD proximal
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Femeie de 52 ani cu HTA si boala valvulara aortica; coronare normale ECG: R inalt V4-V6 subdenivelare ST si T negative asimetrice in DI, DII, aVL, aVF si V4-V6
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Barbat 51 ani cu IM anteroseptal debutat de 3 h. ECG: supradenivelare ST (pana la 7 mm) in V1-V3Coro: stenoza 90% LAD distal de prima diagonala
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Barbat 42 ani cu IM anteroseptal de 1 ziECG: QS in V1-V2 si R minim in V3-V4 (cu incizura) supradenivelare ST in V1-V5 unde T negative in V3/V4 Coro:stenoza 99% LAD si prima diagonala
![Page 62: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/62.jpg)
Barbat 94 ani cu IM anteroseptal vechi de 2 zileECG: Qr in V2/V3 usoara supradenivelare ST T negative, simetrice in V2-V4 si aVL
![Page 63: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/63.jpg)
Barbat 63 ani cu IM anteroseptal vechi de 1 an ECG: QS in V2, Qr in V3, QRS cu incizura in V4(V3) supradenivelare minima in derivatiile anteroseptale unde T negative, simetrice in V2-V6 si derivatiile membrelorCoro: 50% stenoza LAD
![Page 64: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/64.jpg)
Barbat 64 ani cu IMA anterior extensiv de 1 hECG: Fibrilatie atriala BRD incomplet supradenivelare ST pana la 7 mm V2-V6 Unde T inalte si largi fara unde Q patologice. Coro: ocluzie de LAD
![Page 65: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/65.jpg)
Barbat 36 ani cu IMA anterolateral vechi de 3 hECG: tahicardie sinusala QS in V2/V3, Q relativ adanci si largi in V4, DI si aVL supradenivelare ST pana la 5 mm V1-V5Coro: ocluzie de LAD mijlocie
![Page 66: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/66.jpg)
Barbat 66 ani cu IM anterolateral vechi de 4 saptamaniECG:fibrilatie atriala QS in V2 - V3 Q in DI si aVL Reducerea amplitudinii R in V4-V6 usoara supradenivelare in V2-V4, DI si aVL. Coro: 90% stenoza de LAD si CX
![Page 67: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/67.jpg)
Barbat 63 ani cu IM anterolateral vechi de 15 ani cu anevrismECG: QS in V2- V6 microvoltaj periferic Q in DI, DII, DIII, aVF fara importanta rsr’ in aVL usoara supradenivelare ST in V1-V5 unde T negative in derivatiile inferioare (asimetrice) si V6 (simetrice).
![Page 68: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/68.jpg)
Femeie de 78 ani cu IM lateral inalt /posterior de 2 zile cauzat de disectia periinterventionala a CX si IM anteroseptal vechi de 8 luniECG: tahicardie sinusala BFAS supradenivelare ST doar in aVL (si aVR) cu imagine in oglinda – subdenivelare ST in DII, aVF, DIII si V3-V6 QS in V1-V2 QT prelungitCoro:LAD ocluzie, CX subocluzie
![Page 69: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/69.jpg)
Barbat de 72 ani cu IM lateral inalt de 4 zileECG: Qr in aVL T simetrice in aVL, DI, V5/V6
![Page 70: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/70.jpg)
Femeie de 63 ani cu IMA inferior, durere toracica de 2 hECG: supradenivelare ST in DIII, aVF, DII subdenivelare ST in DI, aVL(imagine in oglinda) Coro: 90%stenoza CD
![Page 71: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/71.jpg)
Femeie de 72 ani cu IMA inferior de 24 h ( si IM vechi anteroseptal?) ECG: BAV grd I Q,supradenivelare ST si T negativ in DII, aVF si DIII progresie lenta R in V2-V4 Unde T negative V5-V6Coro: boala trivasculara, ocluzie CD si LAD
![Page 72: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/72.jpg)
Barbat de 67 anicu IM inferior vechi ECG:Q in DII, aVF nesemnificative(cu reducerea R) QS in DIII T negative simetrice in DIII, aVFCoro:boala tricoronariana
![Page 73: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/73.jpg)
Barbat de 59 ani cu IM inferior vechi de 3 aniECG: Q in derivatiile inferioare T negativ in DIII, aVF QRS cu incizura in derivatiile inferioare. Coro: >50% stenoza de CD si LAD
![Page 74: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/74.jpg)
Barbat de 74 ani cu IM posterior vechi de 5 zilECG: R inalt in V1, V2, V3 usoara subdenivelare ST in V1-V5 (imagine in oglinda) QS in V7/V8, Qr in V9
![Page 75: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/75.jpg)
Varianta normala
Barbat 56 ani sanatosECG: supradenivelare ST (pana la 4 mm) in V1-V6 si minim in DI, DII, aVL
![Page 76: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/76.jpg)
Barbat d 70 ani cu infarct vechi anterior extensiv BRD cu Q patologic in V1-V5 si T negativ
![Page 77: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/77.jpg)
Femeie de 82 ani cu angina de 2 saptamani si IM anterior de 6 hECG: subdenivelare ST in V3-V6 ( 7 mm in V5) si DI, DII, aVF, aVL T negative sau bifazice fara Q (exceptie DIII) QRS pozitiv, ciudat , izolat in V2
![Page 78: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/78.jpg)
Barbat de 57 ani cu IM anterolateral vechi de 9 aniECG: fara Q patologic rsr s in DI. ′ ′ Progresie lenta R V3-V6 rSr in V6.′ T negative simetrice in V5-V6, DI, aVLCoro:boala tricoronariana severa
![Page 79: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/79.jpg)
Barbat de 68 ani cu NONSTEMI de 16 hECG:fara Q patologic T negative in derivatiile precordiale si ale membrelor (exceptie aVR, aVL) Coro: 90% stenoza de LAD dominanta
![Page 80: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/80.jpg)
Barbat de 40 ani cu CMHO (gradient sistolic mediu de 50 mmHg)ECG (calibrare la ½ in precordiale):- Dilatare atipica de AS (P pseudopulmonar)- Q in V3- V4- Indice Sokolow pozitiv (44 mm)- Supradenivelare ST in V1-V4(pana la 4 mm)
![Page 81: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/81.jpg)
Barbat de 22 ani cu CMHO severa ECG (50 mm/s): ritm sinusal AQRS-130. unda S gigante in V2/V3 QS in DI, DII, V4-V6 (ca in IM lateral, dar cu unde T pozitive discordante)
![Page 82: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/82.jpg)
Supradenivelare difuza de ST, concava vizibila mai ales in DII, DIII, aVF si V2-V6Deviere subtila de PR (pozitiva in aVR, negativa in alte derivatii)
![Page 83: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/83.jpg)
QT scurt (hipercalcemie)
![Page 84: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/84.jpg)
Hiperpotasemie
![Page 85: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/85.jpg)
- apar cand K seric >6,5 mmol/l Cardiace – modificari ECG unde T inalte, ascutite QT scurt PR prelungit QRS largit aplatizare unda P Pot apare :bloc total, asistola, FV
![Page 86: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/86.jpg)
ECG -hipopotasemie
aplatizare unda T unda U proeminenta subdenivelare ST unde P inalte prelungire PR QT prelungit
![Page 87: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/87.jpg)
![Page 88: ATELIER ECG](https://reader036.vdocuments.mx/reader036/viewer/2022081415/5681634e550346895dd3ed05/html5/thumbnails/88.jpg)
Hipocalcemie QT lung