Aprende a leer un electrocardiograma fácilmente

Adentrarse en la lectura de un electrocardiograma (EKG) es más que descifrar líneas en un papel; es adquirir el poder de percibir el lenguaje oculto del corazón. Este conocimiento no solo es esencial para profesionales médicos, sino también para cualquier persona interesada en comprender la salud cardíaca. Con el EKG, la clave para salvar vidas y tomar decisiones críticas se encuentra en entender los sutiles patrones que revelan el ritmo cardíaco y posibles irregularidades.

Al saber leer correctamente un Electrocardiograma o EKG salvas vidas, ya que nos permite identificar rápidamente ritmos que pueden llevar a la muerte y tomar las acciones necesarias.

Interpretando el Corazón: Una Habilidad Vital

Las líneas y curvas de un EKG son mucho más que simples trazos; son la narrativa visual de la actividad eléctrica del corazón. Cada onda y complejo tiene una historia que contar, desde el latido regular en reposo hasta las señales de posibles arritmias. En esta guía, te sumergirás en la anatomía del EKG, descifrando cada componente para comprender no solo lo que muestra el papel, sino también lo que implica para la salud del corazón. ¡Empecemos!

Primera parte: datos y calibración

  1. Revisar que sean los datos de nuestro paciente (nombre, edad, sexo), conocer los síntomas principales y la historia clínica.
  2. Comprobar que esté calibrado: en el electrocardiograma la velocidad debe ser 25mm/s y la estandarización de 1mV.
  3. Revisar que esté bien tomado: la derivada aVR debe ser negativa y DII positiva o isoeléctrica

Segunda parte: ritmo, regularidad, frecuencia cardíaca y eje

  1. Reconocer el ritmo:
    • Para confirmar que se trata de un ritmo sinusal normal, debemos buscar la presencia de ondas P antes de complejos QRS en todas las derivadas, el complejo QRS debe medir menos de 0.12 segundos y la frecuencia cardíaca debe ir entre 60 – 100 lpm en reposo.
  2. Reconocer si el ritmo es regular o irregular:
    • Para que un ritmo sea considerado regular debemos confirmar que la distancia entre los complejos R-R es la misma en todas las derivadas. Si encuentras un ritmo irregular, sospecha de fibrilación auricular (FA) hasta demostrar lo contrario.
  3. Hallar la frecuencia cardíaca:
    • Ritmo regular: dividir 1500 entre el número de cuadrados pequeños entre los complejos R-R
    • Ritmo irregular: calcular el #QRS en 6 segundos y multiplicarlos por 10.
  4. Ubicar el eje cardíaco de acuerdo con las derivadas I y AVF. Recuerda que el eje cardíaco normal se encuentra en el primer cuadrante (inferior izquierdo), entre -30 y +120 grados. La hipertensión arterial suele desviar el eje cardíaco hacia la izquierda (cuarto cuadrante/superior izquierdo) como consecuencia de la hipertrofia ventricular izquierda. La hipertensión pulmonar y todas sus causas desvían el corazón hacia la derecha (segundo cuadrante/inferior derecho).

Tercera parte: ondas, segmento e intervalos

  1. Onda P: debe durar menos de 2,5 cuadrados pequeños tanto de ancho como de alto
  2. Intervalo PR: desde el inicio de la onda P hasta antes del inicio del complejo QRS. Dura normalmente 0.12 – 0.20 segundos o 3-5 cuadrados pequeños en pacientes adultos.
  3. Complejo QRS: debe durar menos de 0.12 segundos o menos de 3 cuadrados pequeños
  4. Segmento ST: debe ser una línea isoeléctrica (línea plana). Si observamos elevación o depresión de este segmento del electrocardiograma, podríamos sospechar de isquemia cardíaca. Siempre correlacionar con la historia clínica.
  5. Onda T: suelen medir 1/3 de la onda R en amplitud (altura) y son asimétricas. Las ondas T picudas, altas, simétricas son clásicas de hiperkalemia o hiperpotasemia.
  6. Intervalo QT: Aprenderemos a corregirlo en una próxima edición. Se considera normal de 0.40 a 0.44 segundos aprox. Se considera elevado en varones por encima de 0.45 y en mujeres por encima de 0.47 segundos.

¡Explora más en AMIR! Descubre Recursos y Educación en Urgencias y Emergencias

Has dado el primer paso para adentrarte en el fascinante mundo de la interpretación de electrocardiogramas. Si deseas ampliar tus conocimientos y explorar más en el ámbito de urgencias y emergencias médicas, te invitamos a visitar nuestra web de AMIR LATAM.

Descubre una amplia gama de recursos educativos y herramientas que te ayudarán a perfeccionar tus habilidades y conocimientos en este campo crucial de la medicina. ¡No te pierdas la oportunidad de potenciar tu carrera y contribuir al salvamento de vidas! Visita nuestra sección de blog para acceder a más guías y artículos especializados. ¡El conocimiento es clave para marcar la diferencia en el cuidado de la salud!

 

Alexandro Berrospi San Martín

Coordinador Académico del Grupo AMIR en Perú

Médico cirujano graduado de la Universidad Peruana de Ciencias Aplicadas (UPC) | Teacher assistant de la carrera de medicina en UPC | Creador de contenido médico @doctorospi

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