Extrasistolele ventriculare
Tahicardia ventriculara
Fibrilatia ventriculara
RIVA
Extrasistolele ventriculare
Def. Depolarizari ventriculare premature.
Clasificare:
1. Dupa forma: monomorfe/polimorfe
2. Dupa tendinta la sistematizare /fen repetitive :
-nesistematizate sau sistematizate: bigeminism/ trigeminism/
quadrigeminism/
-izolate/ cuplate (duplete, triplete)
1. Dupa moment aparitie: precoce (fen. R/T)/ tardive (complexe de fuziune)/
interpolate
2. Dupa frecventa: cls. 0, I (<1/h), II (1-9/h), III (9-29/h), IV (>30/h)
Etiologie:
-
EKG
ritm nereg dat ESV
unda P nu este in relatie cu ESV, exc cond retrograda
QRS precoce, larg (> 0.12 sec), deformat, aspect BRD/BRS atipice
modif. sec de faza terminala
Tratament
-
cord normal :
-
asimptomatici: fara
Tahicardia ventriculara
Def. clasic: > 3 complexe QRS consecutive cu origine ventriculara,
frecventa > 100/min.
Clasificare:
Dupa durata :
nesustinuta < 30 s
sustinuta >30 s/degr hemodinamica
Dupa morfologie:
Monomorfa
Polimorfa
Forma speciala: torsada varfurilor
caract. clinice:
-
TV idiopatica VS
fasc antero-superior
apical
caractere clinice
-
TV paroxistica/sustinuta
forma incesanta
In TV idiopatica:
Cronic:
-------Tratamentul bolii de baza (!CI )
------- Tratamentul specific antiaritmic
Antiaritmice: amiodarona / sotalol
Defibrilator implantabil:
Indicatii :
-
CMD cu FE <35%
Ablatie (radiofrecventa)
Indicatii:
TV idiopatica simptomatica
Sd. QT lung
Poate fi:
Congenital ( alungire QT, +/- modif morfo ST-T, + sincope/MS),
- mutatii genice la niv gene ce codifica unele
canale
ionice)
Mecanism TV : hipersimpaticotonie la majoritatea
Dobandit:
1. Medicamente (antiaritmice Ia, III, adenozina, ADT,
fenotiazine, haloperidol, antihistaminice nesedative,
cisaprid, papaverina, eritromicina, antifungice)
2. Diselectrolitemii (hipoK, hipoMg)
3. Bradiaritmii (BAV, BNS)
4. B. cerebrovasc (hemoragie subarahnoidiana, AVC)
5. Hipotiroidism
LQTS
anomalii repolarizare + tahiaritmii ventriculare severe prin
postpotentiale precoce
% cazuri
Mutation
Notes
LQT1
The current through the heteromeric channel (KvLQT1 + minK) is known as IKs.
alpha subunit of the slow delayed
rectifier potassium channel (KvLQT1 amount of repolarizing current. This repolarizing current is required to terminate t
or KCNQ1)
action potential duration (APD). These mutations tend to be the most common ye
LQT2
Current through this channel is known as IKr. This phenotype is also probably ca
LQT3
LQT4
LQT5
LQT6
LQT7
LQT4 is very rare. Ankyrin B anchors the ion channels in the cell.
-
potassium channel KCNJ2 (or Kir2.1) The current through this channel and KCNJ12 (Kir2.2) is called IK1. LQT7 leads
LQT8
LQT9
Caveolin 3
LQT10
SCN4B
LQT11
AKAP9
LQT12
SNTA1
LQT13
GIRK4
Torsada varfurilor
EKG:
-apare pe fond bradicardic, precedata frecvent de bigeminism si de
modif morfologice unda T , QT
prelungit (frecvent
>0.5 sec)
-salve de cate 6-10 QRS largite, cu/fara interval liber, cu varful orientat
alternativ sus-jos; frecventa 200-250/min
Tratament:
Acces:
intrerupere medicatie cu potential de alungire QT
sulfat Mg IV
antiaritmice clsIb;
evtl ICD
Sd. QT dob: trat cauza
Fibrilatie ventriculara
Def. Activare cardiaca rapida, nesistematizata, haotica, asincrona,
ineficienta hemodinamic.
Clasificare:
FV pe cord normal
Etiologie:
Clinic:
- frecvent debut brutal cu lipotimie-sincopa
- TA si puls nedecelabil
- zg cardiace absente
- teg reci, cianotice
EKG:
manevre de RCP
RIVA
Def. > 3 complexe QRS cu origine ventriculara, cu frecventa 50-100/min,
frecvent cu interval lung de cuplare (in reperfuzie)
Etiologie:
1. Reperfuzie
2.
Necroza miocardica
3.
Toxicitate digitalica
4.
Abuz cocaina
Clinic:
de obicei bine tolerate hemodinamic, autolimitat
EKG:
- ritm regulat/ neregulat
-frecventa > decat ritm idioventricular, dar < decat TV
-disociatie A-V, cu fuziuni (frecvente), capturi
-QRS largi, deformate
- instalare gradata, cu interval lung de cuplare
- terminare gradata
Tratament:
RIVA de reperfuzie: fara tratament
rar: Instabilitate hemodinamica: tahicardizare
(pacing atrial/ atropina)