La ECG en la cardiopatíaisquémica crónica estable

Cambios morfológicos y arritmias (véase el ECG en el infarto   crónico   con   y   sin   «factores   de   confusión») .
Los pacientes con cardiopatía isquémica crónica con o sin IM previo pueden presentar un ECG basal normal o diferentes cambios del QRS (Q de necrosis o QRS fragmentado), y/o del ST/T (ST elevado o descendido) y onda T aplanada/negativa.
Es un signo  de buen  pronóstico que  la T negativa  que aparece después de un infarto Q (cambio postisquémico) desaparezca con el tiempo (Fig. 20.36), pero muy a menudo los cambios de la onda T, e incluso a veces del ST, persisten muchos años. Sobre todo en presencia de descenso del ST, es aconsejable realizar una prueba de esfuerzo.
Finalmente, la persistencia de un ST elevado mucho después de un infarto Q es sospechosa de aneurisma ventricular (Fig. 20.33 C).
A menudo aparecen diferentes tipos de bloqueos ventriculares como consecuencia de la cardiopatía isquémica, lo cual puede ser un signo de mal pronóstico (ver antes).
Respecto a las arritmias (Caps. 14 a 18), la presencia de extrasístoles ventriculares, especialmente frecuentes, y salvas de TV es un marcador de riesgo, sobre todo en presencia de disfunción ventricular (Bayés-Fiol, 2008; Bayés de Luna, 2011). Ya hemos discutido (véase isquemia y MS, y 20.2) la importancia de la isquemia en la fase aguda y crónica de la cardiopatía isquémica en la presentación de arritmias ventriculares malignas y MS. Por último, la incidencia de arritmias auriculares, especialmente de FA, es relativamente frecuente, y es también un marcador de mal pronóstico.

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