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๐Ÿ‘ˆ๐Ÿปโœ… ๐Ÿซ€ STEMI ECG Evolution: A Timeline #Cardiology #ECG #STEMI #MI #HeartAttack #CardioEd #MedEd #EKG

22,409 views โ€ข 8 months ago โ€ขvia X (Twitter)

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๐Ÿซ€โ™’๏ธ๐—ฅ๐—ถ๐˜๐—บ๐—ผ๐˜€ ๐—ฑ๐—ฒ๐—น ๐—˜๐—–๐—š ๐—พ๐˜‚๐—ฒ ๐˜๐—ผ๐—ฑ๐—ผ ๐—ฐ๐—น๐—ถฬ๐—ป๐—ถ๐—ฐ๐—ผ ๐—ฑ๐—ฒ๐—ฏ๐—ฒ ๐—ฟ๐—ฒ๐—ฐ๐—ผ๐—ป๐—ผ๐—ฐ๐—ฒ๐—ฟ ๐—ฑ๐—ฒ ๐˜‚๐—ป ๐˜ƒ๐—ถ๐˜€๐˜๐—ฎ๐˜‡๐—ผ๐Ÿ‘€ โฌ‡๏ธโฌ‡๏ธโฌ‡๏ธโฌ‡๏ธ ๐Ÿ“ŒEl ๐™€๐˜พ๐™‚ sigue siendo una de las herramientas diagnรณsticas mรกs poderosas y subestimadas. ยฟSabes diferenciar estos 4 ritmos en segundos? ๐Ÿ‘‡ โœ… ๐™๐™ž๐™ฉ๐™ข๐™ค ๐™จ๐™ž๐™ฃ๐™ช๐™จ๐™–๐™ก ๐™ฃ๐™ค๐™ง๐™ข๐™–๐™ก โ†’ ๐™Š๐™ฃ๐™™๐™– ๐™‹ antes de cada QRS โ†’ FC 60โ€“100 lpm โ†’ Intervalo PR constante (120โ€“200 ms) ๐˜“๐˜ข ๐˜ญ๐˜ชฬ๐˜ฏ๐˜ฆ๐˜ข ๐˜ฃ๐˜ข๐˜ด๐˜ฆ ๐˜ฅ๐˜ฆ ๐˜ค๐˜ฐ๐˜ฎ๐˜ฑ๐˜ข๐˜ณ๐˜ข๐˜ค๐˜ช๐˜ฐฬ๐˜ฏ ๐˜ฑ๐˜ข๐˜ณ๐˜ข ๐˜ต๐˜ฐ๐˜ฅ๐˜ฐ ๐˜ญ๐˜ฐ ๐˜ฅ๐˜ฆ๐˜ฎ๐˜ขฬ๐˜ด๏ผŽ โšก ๐™๐™ž๐™—๐™ง๐™ž๐™ก๐™–๐™˜๐™ž๐™คฬ๐™ฃ ๐˜ผ๐™ช๐™ง๐™ž๐™˜๐™ช๐™ก๐™–๐™ง โ†’ ๐˜ผ๐™ช๐™จ๐™š๐™ฃ๐™˜๐™ž๐™– de ondas P definidas โ†’ Lรญnea de base irregularmente irregular โ†’ QRS estrecho (salvo aberrancia) ๐˜“๐˜ข ๐˜ข๐˜ณ๐˜ณ๐˜ช๐˜ต๐˜ฎ๐˜ช๐˜ข ๐˜ด๐˜ฐ๐˜ด๐˜ต๐˜ฆ๐˜ฏ๐˜ช๐˜ฅ๐˜ข ๐˜ฎ๐˜ขฬ๐˜ด ๐˜ง๐˜ณ๐˜ฆ๐˜ค๐˜ถ๐˜ฆ๐˜ฏ๐˜ต๐˜ฆ. Siempre descartar en palpitaciones + pulso irregular. ๐Ÿ“ˆ ๐™๐™ก๐™ช๐™ฉ๐™ฉ๐™š๐™ง ๐˜ผ๐™ช๐™ง๐™ž๐™˜๐™ช๐™ก๐™–๐™ง โ†’ Patrรณn en โ€œ๐™™๐™ž๐™š๐™ฃ๐™ฉ๐™š๐™จ ๐™™๐™š ๐™จ๐™ž๐™š๐™ง๐™ง๐™–โ€ (ondas F a 300 lpm) โ†’ Conducciรณn 2:1, 3:1 o 4:1 โ†’ Bloqueo AV regular Clave: ๐˜ฃ๐˜ถ๐˜ด๐˜ค๐˜ข ๐˜ญ๐˜ข๐˜ด ๐˜ฐ๐˜ฏ๐˜ฅ๐˜ข๐˜ด ๐˜ ๐˜ฆ๐˜ฏ ๐˜‹๐˜๐˜, ๐˜‹๐˜๐˜๐˜, ๐˜ข๐˜๐˜. โš ๏ธ ๐™๐™–๐™ฆ๐™ช๐™ž๐™˜๐™–๐™ง๐™™๐™ž๐™– ๐™Ž๐™ช๐™ฅ๐™ง๐™–๐™ซ๐™š๐™ฃ๐™ฉ๐™ง๐™ž๐™˜๐™ช๐™ก๐™–๐™ง (๐™๐™Ž๐™‘) โ†’ FC > 150 lpm โ†’ QRS estrecho y regular โ†’ Inicio y fin bruscos ๐˜”๐˜ข๐˜ฏ๐˜ช๐˜ฐ๐˜ฃ๐˜ณ๐˜ข๐˜ด ๐˜ท๐˜ข๐˜จ๐˜ข๐˜ญ๐˜ฆ๐˜ด como primer paso. Si persiste โ†’ ๐™–๐™™๐™š๐™ฃ๐™ค๐™จ๐™ž๐™ฃ๐™–. ๐Ÿ’ฅ ๐™๐™–๐™ฆ๐™ช๐™ž๐™˜๐™–๐™ง๐™™๐™ž๐™– ๐™‘๐™š๐™ฃ๐™ฉ๐™ง๐™ž๐™˜๐™ช๐™ก๐™–๐™ง (๐™๐™‘) โ†’ QRS ancho (> 120 ms) y regular โ†’ FC 100โ€“250 lpm โ†’ Disociaciรณn AV (signo clave) Regla: ๐™Œ๐™๐™Ž ๐™–๐™ฃ๐™˜๐™๐™ค + ๐™ง๐™–ฬ๐™ฅ๐™ž๐™™๐™ค = TV hasta demostrar lo contrario. No la trates como TSV. ๐ŸŒ€ ๐™๐™ค๐™ง๐™จ๐™–๐™™๐™š ๐™™๐™š ๐™‹๐™ค๐™ž๐™ฃ๐™ฉ๐™š๐™จ โ†’ TV polimรณrfica que โ€œgiraโ€ alrededor de la lรญnea base โ†’ Asociada a QT largo (congรฉnito o adquirido) โ†’ Puede degenerar en FV ๐˜š๐˜ช๐˜ฆ๐˜ฎ๐˜ฑ๐˜ณ๐˜ฆ ๐˜ณ๐˜ฆ๐˜ท๐˜ช๐˜ด๐˜ข ๐˜ง๐˜ขฬ๐˜ณ๐˜ฎ๐˜ข๐˜ค๐˜ฐ๐˜ด: antiarrรญtmicos, antipsicรณticos, antibiรณticos. Tx: Sulfato de Magnesio IV. โ›” ๐™๐™ž๐™—๐™ง๐™ž๐™ก๐™–๐™˜๐™ž๐™คฬ๐™ฃ ๐™‘๐™š๐™ฃ๐™ฉ๐™ง๐™ž๐™˜๐™ช๐™ก๐™–๐™ง (๐™๐™‘) โ†’ Actividad elรฉctrica ๐™˜๐™–๐™คฬ๐™ฉ๐™ž๐™˜๐™–, ๐™จ๐™ž๐™ฃ ๐™Œ๐™๐™Ž definido โ†’ Sin gasto cardรญaco = paro cardiorrespiratorio โ†’ ๐˜ฟ๐™š๐™จ๐™›๐™ž๐™—๐™ง๐™ž๐™ก๐™–๐™˜๐™ž๐™คฬ๐™ฃ ๐™ž๐™ฃ๐™ข๐™š๐™™๐™ž๐™–๐™ฉ๐™– Cada minuto sin descarga = 10% menos de sobrevida. No hay tiempo que perder. ๐Ÿ”’ ๐˜ฝ๐™ก๐™ค๐™ฆ๐™ช๐™š๐™ค๐™จ ๐˜ผ๐™‘ 1๏ธโƒฃ๐Ÿญยฐ ๐™œ๐™ง๐™–๐™™๐™ค โ†’ PR > 200 ms, constante. Benigno. 2๏ธโƒฃ๐Ÿฎยฐ ๐™œ๐™ง๐™–๐™™๐™ค ๐™ˆ๐™ค๐™—๐™ž๐™ฉ๐™ฏ ๐™„ (๐™’๐™š๐™ฃ๐™˜๐™ ๐™š๐™—๐™–๐™˜๐™) โ†’ PR se alarga hasta que falla un QRS. Vagal. 2๏ธโƒฃ๐Ÿฎยฐ ๐™œ๐™ง๐™–๐™™๐™ค ๐™ˆ๐™ค๐™—๐™ž๐™ฉ๐™ฏ ๐™„๐™„ โ†’ PR fijo, QRS cae sin aviso. โš ๏ธ Riesgo de progresiรณn. 3๏ธโƒฃ๐Ÿฏยฐ ๐™œ๐™ง๐™–๐™™๐™ค (๐™˜๐™ค๐™ข๐™ฅ๐™ก๐™š๐™ฉ๐™ค) โ†’ P y QRS sin relaciรณn. ๐˜”๐˜ข๐˜ณ๐˜ค๐˜ข๐˜ฑ๐˜ข๐˜ด๐˜ฐ๐˜ด ๐˜ถ๐˜ณ๐˜จ๐˜ฆ๐˜ฏ๐˜ต๐˜ฆ๏ผŽ ๐Ÿ’€ ๐˜ผ๐™จ๐™ž๐™จ๐™ฉ๐™ค๐™ก๐™ž๐™– โ†’ ๐™‡๐™žฬ๐™ฃ๐™š๐™– ๐™ž๐™จ๐™ค๐™š๐™ก๐™šฬ๐™˜๐™ฉ๐™ง๐™ž๐™˜๐™–. Sin actividad elรฉctrica ni mecรกnica. โ†’ Confirmar en 2 derivaciones โ†’ RCP + adrenalina. ๐˜•๐˜ฐ ๐˜ฆ๐˜ด ๐˜ฅ๐˜ฆ๐˜ด๐˜ง๐˜ช๐˜ฃ๐˜ณ๐˜ช๐˜ญ๐˜ข๐˜ฃ๐˜ญ๐˜ฆ. El pronรณstico mรกs sombrรญo del paro. La prevenciรณn y el reconocimiento precoz lo son todo. ๐Ÿ“Œ ๐™๐™š๐™œ๐™ก๐™– ๐™ง๐™–ฬ๐™ฅ๐™ž๐™™๐™–: โ€ข๐™„๐™ง๐™ง๐™š๐™œ๐™ช๐™ก๐™–๐™ง + ๐™จ๐™ž๐™ฃ ๐™‹ โ†’ ๐™๐˜ผ โ€ข๐˜ฟ๐™ž๐™š๐™ฃ๐™ฉ๐™š๐™จ ๐™™๐™š ๐™จ๐™ž๐™š๐™ง๐™ง๐™– โ†’ ๐™๐™ก๐™ช๐™ฉ๐™ฉ๐™š๐™ง โ€ข๐™๐™–ฬ๐™ฅ๐™ž๐™™๐™ค + ๐™ง๐™š๐™œ๐™ช๐™ก๐™–๐™ง + ๐™Œ๐™๐™Ž ๐™š๐™จ๐™ฉ๐™ง๐™š๐™˜๐™๐™ค โ†’ ๐™๐™Ž๐™‘ โ€ข๐™Œ๐™๐™Ž ๐™–๐™ฃ๐™˜๐™๐™ค + ๐™ง๐™–ฬ๐™ฅ๐™ž๐™™๐™ค โ†’ ๐™๐™‘ โ€ข๐™Œ๐™ ๐™ก๐™–๐™ง๐™œ๐™ค + ๐™œ๐™ž๐™ง๐™ค โ†’ ๐™๐™ค๐™ง๐™จ๐™–๐™™๐™š โ†’ Mgยฒโบ โ€ข๐˜พ๐™–๐™ค๐™จ ๐™จ๐™ž๐™ฃ ๐™Œ๐™๐™Ž โ†’ ๐™๐™‘ โ†’ ยกDefibrilar YA! โ€ข๐™Ž๐™ž๐™ฃ ๐™ฃ๐™–๐™™๐™– โ†’ ๐˜ผ๐™จ๐™ž๐™จ๐™ฉ๐™ค๐™ก๐™ž๐™– โ†’ ๐™๐˜พ๐™‹ + adrenalina โ€ข๐™‹๐™ ๐™ฆ๐™ช๐™š ๐™›๐™–๐™ก๐™ก๐™– โ†’ ๐˜ฝ๐™ก๐™ค๐™ฆ๐™ช๐™š๐™ค ๐˜ผ๐™‘ โ†’ evalรบa grado ๐Ÿง ๐™‚๐™ช๐™–๐™ง๐™™๐™– ๐™š๐™จ๐™ฉ๐™š ๐™๐™ž๐™ก๐™ค ๐™ฅ๐™–๐™ง๐™– ๐™ฉ๐™ช ๐™œ๐™ช๐™–๐™ง๐™™๐™ž๐™– ๐Ÿฅ โ€ผ๏ธSi te sirve: โค๏ธ Me gusta | ๐Ÿ” Repost | โž• Follow para mรกs #MedED en #ClubCrit ๐Ÿ˜„๐Ÿง ๐Ÿซถ ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ ๐Ÿ“š๐Ÿ“–#ClubCrit #EKG #ECG #Arritmias #CardioX #Cardiologรญa #icu #intensivecare #diagnosis #management #POCUS #VExUS #MedicinaBasadaEnEvidencia #Terapia #MedEd #Medicina #FOAMed #FOAMcc #CuidadoCrรญtico #MedX #EducaciรณnMรฉdica #MedIntensiva #MedXCommunity #MedicinaCrรญtica #MedED #CritCare #ICUManagement #MustRead #LecturaRecomendada

Dr.Marlon Villanuevaโ„ข ๐Ÿฉบ ๐•

96,631 views โ€ข 5 months ago

How the ๐Ÿ†…๐Ÿ…ด๐Ÿ…ฝ๐Ÿ†ƒ๐Ÿ†๐Ÿ…ธ๐Ÿ…ฒ๐Ÿ…ป๐Ÿ…ด contracts.. . . . ๐Ÿ’—Another great thing I picked up from Cardiothoracic surgery was understanding how the ventricles contract. The ventricle Is such a complex structure that we are learning more and more about. One thing that has helped us understand this complex structure is strain imaging and 3D echocardiography. We have learned that the ventricle contracts in 4 ways: contraction (radial) motion but it also has a twisting (torsional and circumferential) and shortening (longitudinal) motion. . . . ๐Ÿ‘๐ŸฝThe surgeon I always work with often described the hearts motion as โ€œwringing of a towel.โ€ This can be seen in the video above. The understanding of the multiple different motions of the heart has allowed us to better understand intrinsic myocardial disease and pick up disease earlier in its process allowing us to add disease modifying agents to slow and sometimes reverse the negative remodeling of the heart. . . . ๐Ÿ’“So next time you think of your heart pumping donโ€™t think of it in one motion (squeeze) but rather a Towel being wrung of water. The heart is such an amazing organ and we are just now really beginning to understand itโ€™s truly complex physiology! . . . Have a great day! . . . . #Medicalschool #medschool #cardiologia #doctors #cardiotwitter #meded #EKG #Medstudent #cardiology #internalmedicine #patient #hospital #radiology #physiology #paschool #foamed #echo #physicalexam #anatomy #scrubs #surgery #pastudent #nursingstudent #nursing #PA #DO #Echocardiogram #MD #USMLE

Jay Mohan, D.O., FACC, FSCAI, FASE, RPVI

37,193 views โ€ข 2 years ago