SISTEMA CARDIOVASCULAR
E
GERAÇÃO DO E.C.G.
PROF. SERGIO F. PICHORIM
Cap 4 do Webster,
Cap 16 do Guyton,
Malmivuo
extras.
© From J. G. Webster (ed.), Medical instrumentation:
application andedesign.
3 ed. New York: John Wiley & Sons, 1998.
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CABEÇA
CARÓTIDA
PULMÕES
CAVA
LADO
DIREITO
Pequena
circulação
LADO
ESQUERDO
AORTA
CORONARIANA
Grande Circulação
FIGADO
INTESTINO
RINS
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
CORPO
SISTEMA CARDIOVASCULAR
• Função
• Complexidade do Controle
–
–
–
–
Vascularização diferente
Regulação térmica variável
Taxa metabólica variável
Regiões prioritárias
∴ Æ Débito Cardíaco Variável
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
SISTEMA CARDIOVASCULAR
• Fluxo = ∆ Pressão
Resistência
• Circuito Equivalente Simplificado
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
SISTEMA CARDIOVASCULAR
• Níveis das pressões
•
•
•
•
•
Aorta = 100 mmHg
Arteríolas = 85 mmHg
Capilares = 30 mmHg
Veias = 10 mmHg
Cava = 0 mmHg
• Circuito Equivalente Completo
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
Feixes de His
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
Propagação do PA
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
EXEMPLOS DE ECG
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
Figure 4.14 The cellular architecture of myocardial fibers
Note the centroid nuclei and transverse intercalated disks between cells.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
Figure 4.15 Isochronous lines of ventricular activation of the human heart
Note the nearly closed activation surface at 30 ms into the QRS complex.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
EXEMPLOS DE ANOMALIAS E SEUS ECGs
Figure 4.17 Atrioventricular
block (a) Complete heart
block. Cells in the AV node
are dead and activity cannot
pass from atria to ventricles.
(B) AV block wherein the
node is diseased (examples
include rheumatic heart
disease and viral infections of
the heart). Although each
wave from the atria reaches
the ventricles, the AV nodal
delay is greatly increased.
This
is first-degree heart
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3
block.
rd
ed. New York: John Wiley & Sons, 1998.
ÁREA INFARTADA Î ISQUEMIA
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.
Figure 4.21 (a) Action potentials recorded from normal (solid lines)
and ischemic (dashed lines) myocardium in a dog. Control is before
coronary occlusion. (b) During the control period prior to coronary
occlusion, there is no ECG S-T segment shift; after ischemia, there is
© From a
J. G.
Webster (ed.), Medical instrumentation: application and design. 3 ed. New York: John Wiley & Sons, 1998.
such
shift.
rd
Figure 4.20 (a) Atrial fibrillation. The atria stop their regular beat and begin a
feeble, uncoordinated twitching. Concomitantly, low-amplitude, irregular waves
appear in the ECG, as shown. This type of recording can be clearly distinguished
from the very regular ECG waveform containing atrial flutter.
(b) Ventricular fibrillation. Mechanically the ventricles twitch in a feeble,
uncoordinated
no blood
being
theJohn
heart.
The
© From J. G. Webster fashion
(ed.), Medicalwith
instrumentation:
application
andpumped
design. 3 ed.from
New York:
Wiley &
Sons, ECG
1998. is
likewise very uncoordinated, as shown
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EXEMPLO DE DIFRILAÇÃO
Gerado
pelo(ed.),
simulador
de ECG-PLUS
da
empresa
BIO-TEK
© From J. G. Webster
Medical instrumentation:
application and design.
3 ed.
New York: John
Wiley & Sons, 1998.
rd
FIM
© From J. G. Webster (ed.), Medical instrumentation: application and design. 3rd ed. New York: John Wiley & Sons, 1998.