Contenidos

Otras alteraciones

La isquemia puede provocar muchas otras alteraciones, incluyendo las siguientes.


13.7.1. Alteraciones de la onda p
 
Pueden verse en el infarto auricular agudo (repolarización auricular) y crónico (muescas en la onda P, etc.) (Caps. 9 y 20) (Fig. 9.30).


13.7.2. Distorsión del complejo Qrs
 
Se observa especialmente en la isquemia transmural severa muy aguda (grado III de isquemia). En este caso la elevación del ST arrastra hacia arriba la onda S (véase antes) (Cap. 20) (Fig. 20.4).
 

13.7.3. Arritmias

Las arritmias más frecuentes que aparecen en la isquemia aguda  son  diferentes  tipos  de  bradiarritmias  (bradicardia sinusal y bloqueo AV), (especialmente en la oclusión de la CD antes de la arteria nodo AV), taquiarritmias (especialmente fibrilación auricular (FA) y arritmias ventriculares).
La FV en la fase aguda de la CI, suele aparecer sin taquicardia ventricular previa (Fig. 16.31) y en  la  fase  crónica suele aparecer con TV previa (Fig. 16.34 A). Desgraciadamente, si se presenta fuera de la  Unidad  Coronaria, provoca la MS.
También aparecen bloqueos intraventriculares, especialmente BRD cuando la oclusión de la DA es proximal a la primera rama septal, que irriga la rama derecha. El BRI aparece con menor frecuencia porque recibe doble irrigación (DA y Cx). Para más información ver caps. 14, 15, 16 y 20 (Bayés de 
Luna-Fiol, 2008; Bayés de Luna, 2011).
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