[et_pb_section fb_built=\u00bb1″ custom_padding_last_edited=\u00bbon|desktop\u00bb admin_label=\u00bbHeader\u00bb _builder_version=\u00bb4.16″ background_enable_image=\u00bboff\u00bb background_size=\u00bbcontain\u00bb background_position=\u00bbtop_right\u00bb custom_padding=\u00bb11px||31px||false|false\u00bb custom_padding_tablet=\u00bb2px|0px|50px|0px|false|false\u00bb custom_padding_phone=\u00bb3px|0px|50px|0px|false|false\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row _builder_version=\u00bb4.16″ max_width=\u00bb1280px\u00bb custom_margin=\u00bb-11px|auto||auto||\u00bb custom_padding=\u00bb8px||2px|||\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb collapsed=\u00bbon\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.20.1″ _module_preset=\u00bbdefault\u00bb text_font=\u00bb|700|||||||\u00bb text_font_size=\u00bb16px\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
Acceso abierto<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=\u00bb4.16.0″ _dynamic_attributes=\u00bbcontent\u00bb text_font=\u00bbEB Garamond||||||||\u00bb text_text_color=\u00bb#000000″ text_font_size=\u00bb50px\u00bb text_line_height=\u00bb1.3em\u00bb header_font=\u00bbEB Garamond||||||||\u00bb header_font_size=\u00bb54px\u00bb header_line_height=\u00bb1.3em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_font_size=\u00bb16px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb max_width=\u00bb900px\u00bb text_font_size_tablet=\u00bb\u00bb text_font_size_phone=\u00bb15px\u00bb text_font_size_last_edited=\u00bbon|tablet\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb header_font_size_tablet=\u00bb50px\u00bb header_font_size_phone=\u00bb32px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF90aXRsZSIsInNldHRpbmdzIjp7ImJlZm9yZSI6IiIsImFmdGVyIjoiIn19@[\/et_pb_text][et_pb_blurb title=\u00bb Daniela Degano (1), Hector A. Bonaccorsi (2)\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bb||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n
(1) M\u00e9dica Residente del Servicio de Cardiolog\u00eda [\/et_pb_blurb][et_pb_text _builder_version=\u00bb4.20.2″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb13px\u00bb text_line_height=\u00bb1.6em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Citaci\u00f3n sugerida: Degano D, Bonaccorsi HA. Ondas Q en disfunci\u00f3n ventricular reversible. Anuario (Fund. Dr. J. R. Villavicencio) 2023;30. Disponible en: https:\/\/villavicencio.org.ar\/anuario\/30-ondas-q-en<\/a> Este es un art\u00edculo de acceso abierto distribuido bajo los t\u00e9rminos de Creative Commons Attribution License (https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/deed.es), esto permite que Ud. lo use, lo distribuya y lo adapte, sin prop\u00f3sitos comerciales, siempre que se cite correctamente el trabajo original. Si crea un nuevo material con \u00e9l, debe distribuirlo con la misma licencia.<\/span><\/p>\n [\/et_pb_text][et_pb_button button_url=\u00bb\/anuario\/30\/ondas-q-en.pdf\u00bb url_new_window=\u00bbon\u00bb button_text=\u00bbDescargar art\u00edculo\u00bb button_alignment=\u00bbright\u00bb _builder_version=\u00bb4.18.1″ custom_button=\u00bbon\u00bb button_text_size=\u00bb12px\u00bb button_text_color=\u00bb#3cbebe\u00bb button_bg_color=\u00bbrgba(60,190,190,0.1)\u00bb button_border_width=\u00bb10px\u00bb button_border_color=\u00bbrgba(0,0,0,0)\u00bb button_border_radius=\u00bb100px\u00bb button_letter_spacing=\u00bb1px\u00bb button_font=\u00bb|700||on|||||\u00bb custom_padding=\u00bb10px|20px|10px|20px|true|true\u00bb button_letter_spacing_hover=\u00bb1px\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb button_text_size__hover_enabled=\u00bboff\u00bb button_one_text_size__hover_enabled=\u00bboff\u00bb button_two_text_size__hover_enabled=\u00bboff\u00bb button_text_color__hover_enabled=\u00bboff\u00bb button_one_text_color__hover_enabled=\u00bboff\u00bb button_two_text_color__hover_enabled=\u00bboff\u00bb button_border_width__hover_enabled=\u00bboff\u00bb button_one_border_width__hover_enabled=\u00bboff\u00bb button_two_border_width__hover_enabled=\u00bboff\u00bb button_border_color__hover_enabled=\u00bboff\u00bb button_one_border_color__hover_enabled=\u00bboff\u00bb button_two_border_color__hover_enabled=\u00bboff\u00bb button_border_radius__hover_enabled=\u00bboff\u00bb button_one_border_radius__hover_enabled=\u00bboff\u00bb button_two_border_radius__hover_enabled=\u00bboff\u00bb button_letter_spacing__hover_enabled=\u00bbon\u00bb button_letter_spacing__hover=\u00bb1px\u00bb button_one_letter_spacing__hover_enabled=\u00bboff\u00bb button_two_letter_spacing__hover_enabled=\u00bboff\u00bb button_bg_color__hover_enabled=\u00bboff\u00bb button_one_bg_color__hover_enabled=\u00bboff\u00bb button_two_bg_color__hover_enabled=\u00bboff\u00bb][\/et_pb_button][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbCourses\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb collapsed=\u00bbon\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.16″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La aparici\u00f3n de nuevas ondas Q en el electrocardiograma de un paciente, suele ser interpretada como infarto de miocardio. Sin embargo, existen algunas situaciones menos frecuentes en las cuales aparecen ondas Q por otras causas como la isquemia severa sin muerte celular. En relaci\u00f3n con la cirug\u00eda cardiaca, aunque no hemos encontrado casos descriptos previamente, tambi\u00e9n es posible la aparici\u00f3n y desaparici\u00f3n de ondas Q en el postoperatorio inmediato, como el caso que describimos a continuaci\u00f3n. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Ondas Q, disfunci\u00f3n ventricular, cirug\u00eda de revascularizaci\u00f3n mioc\u00e1rdica.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n The appearance of new Q waves in a patient’s electrocardiogram is usually interpreted as a myocardial infarction. However, there are some less frequent situations in which Q waves appear due to other causes, such as severe ischemia without cell death. In relation to cardiac surgery, although we have not found previously described cases, the appearance and disappearance of Q waves in the immediate postoperative period is also possible, as in the case described below. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Q waves, ventricular dysfunction, coronary artery bypass graft surgery.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n La aparici\u00f3n de nuevas ondas Q en el electrocardiograma de un paciente, suele ser interpretada como infarto de miocardio. En la mayor\u00eda de los casos esto es cierto, dada la prevalencia de la enfermedad coronaria en la poblaci\u00f3n general. Sin embargo, existen algunas situaciones menos frecuentes en las cuales aparecen ondas Q no producidas por el infarto, como miocarditis, sobrecarga de ventr\u00edculo derecho, hiperkalemia, hipertrofia ventricular izquierda, cardiomiopat\u00edas, bloqueo de rama izquierda, etc.1<\/sup>\u00a0La isquemia severa sin muerte celular, debido a la p\u00e9rdida del potencial el\u00e9ctrico, tambi\u00e9n puede dar lugar a aparici\u00f3n transitoria de ondas Q.2<\/sup> [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Presentar el caso cl\u00ednico de un paciente que present\u00f3 ondas Q transitorias asociadas a isquemia severa con disfunci\u00f3n ventricular reversible, en el postoperatorio inmediato de una cirug\u00eda card\u00edaca.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Paciente de 66 a\u00f1os de edad, diab\u00e9tico tipo II insulino requiriente, obeso grado II, sedentario, sin antecedes previos de enfermedad cardiovascular. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n En el caso cl\u00ednico presentado aparecieron ondas Q en derivaciones de la cara \u00ednfero-posterior que 8 d\u00edas despu\u00e9s desaparecieron al recuperarse all\u00ed las ondas R. Esto se asoci\u00f3 a la mejor\u00eda de la disfunci\u00f3n ventricular, la cual podr\u00eda ser considerada \u00abatontamiento\u00bb mioc\u00e1rdico, dada la evoluci\u00f3n del paciente. Por tanto, el \u00abatontamiento el\u00e9ctrico\u00bb acompa\u00f1\u00f3 al \u00abatontamiento contr\u00e1ctil\u00bb. [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n En el postoperatorio inmediato de cirug\u00eda card\u00edaca la onda Q puede aparecer por isquemia severa, asociada a disfunci\u00f3n ventricular, y desaparecer junto a esta \u00faltima.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Los autores declaran no tener conflicto de intereses.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.18.0″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Agradecemos al Dr. Facundo Piatti, y al servicio de Terapia Intensiva del Sanatorio Parque.<\/p>\n [\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00bb4.16″ locked=\u00bboff\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bbEB Garamond|700|||||||\u00bb text_text_color=\u00bbrgba(0,0,0,0.02)\u00bb text_font_size=\u00bb80px\u00bb text_line_height=\u00bb0em\u00bb header_2_font=\u00bbEB Garamond||||||||\u00bb header_2_font_size=\u00bb50px\u00bb header_2_line_height=\u00bb1.3em\u00bb text_orientation=\u00bbcenter\u00bb text_font_size_tablet=\u00bb50px\u00bb text_font_size_phone=\u00bb30px\u00bb text_font_size_last_edited=\u00bbon|desktop\u00bb header_2_font_size_tablet=\u00bb40px\u00bb header_2_font_size_phone=\u00bb30px\u00bb header_2_font_size_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n FIGURAS<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00bb4.16″ locked=\u00bboff\u00bb collapsed=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_blurb title=\u00bbFigura 1 – Electrocardiograma preoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q1.jpg\u00bb title_text=\u00bbondas-q1″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 2 – Electrocardiograma al ingreso a la sala de cuidados intensivos\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q2.jpg\u00bb title_text=\u00bbondas-q2″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 3 – Electrocardiograma de la 1era hora de postoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se observa franco infradesnivel del segmento ST en cara anterior.<\/p>\n [\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q3.jpg\u00bb title_text=\u00bbondas-q3″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 4 – Electrocardiograma de la 3er hora de postoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se observa franco supradesnivel en cara \u00ednfero-posterior e infradesnivel en cara anterior<\/p>\n [\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q4.jpg\u00bb title_text=\u00bbondas-q4″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 5 – Electrocardiograma al reingreso a la sala con asistencia de oxigenaci\u00f3n por membrana implantado\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q5.jpg\u00bb title_text=\u00bbondas-q5″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 6 – Electrocardiograma del 4to d\u00eda de postoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n Se observan ondas Q (QS) en cara \u00ednfero-posterior (II, III, aVF y V6). [\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q6.jpg\u00bb title_text=\u00bbondas-q6″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][et_pb_blurb title=\u00bbFigura 7 – Electrocardiograma del 12mo d\u00eda de postoperatorio\u00bb use_icon=\u00bbon\u00bb font_icon=\u00bbZ||divi||400″ icon_color=\u00bb#3cbebe\u00bb icon_placement=\u00bbleft\u00bb content_max_width=\u00bb1100px\u00bb image_icon_width_last_edited=\u00bboff|desktop\u00bb _builder_version=\u00bb4.18.1″ header_font=\u00bb|600|||||||\u00bb header_font_size=\u00bb18px\u00bb header_line_height=\u00bb1.6em\u00bb body_font=\u00bb||||||||\u00bb body_font_size=\u00bb15px\u00bb body_line_height=\u00bb2em\u00bb header_font_size_tablet=\u00bb\u00bb header_font_size_phone=\u00bb15px\u00bb header_font_size_last_edited=\u00bbon|phone\u00bb body_line_height_tablet=\u00bb\u00bb body_line_height_phone=\u00bb1.6em\u00bb body_line_height_last_edited=\u00bbon|phone\u00bb image_max_width_phone=\u00bb50px\u00bb image_max_width_last_edited=\u00bboff|desktop\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]Reaparece la onda R en cara \u00ednfero-posterior (II, III, aVF y V6).[\/et_pb_blurb][et_pb_image src=\u00bbhttps:\/\/villavicencio.org.ar\/anuario\/wp-content\/uploads\/2022\/11\/ondas-q7.jpg\u00bb title_text=\u00bbondas-q7″ align=\u00bbcenter\u00bb _builder_version=\u00bb4.18.1″ border_radii=\u00bbon|39px|39px|39px|39px\u00bb border_width_all=\u00bb5px\u00bb box_shadow_style=\u00bbpreset2″ global_colors_info=\u00bb{}\u00bb][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=\u00bb1″ admin_label=\u00bbCourses\u00bb _builder_version=\u00bb4.16″ custom_padding=\u00bb1px|0px|62px|0px|false|false\u00bb collapsed=\u00bbon\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_row custom_padding_last_edited=\u00bbon|phone\u00bb _builder_version=\u00bb4.17.4″ background_color=\u00bb#ffffff\u00bb max_width=\u00bb1280px\u00bb custom_padding=\u00bb12px|40px|12px|40px|true|false\u00bb custom_padding_tablet=\u00bb\u00bb custom_padding_phone=\u00bb|20px||20px||true\u00bb animation_style=\u00bbzoom\u00bb animation_intensity_zoom=\u00bb2%\u00bb border_radii=\u00bbon|12px|12px|12px|12px\u00bb box_shadow_style=\u00bbpreset1″ box_shadow_vertical=\u00bb50px\u00bb box_shadow_blur=\u00bb80px\u00bb box_shadow_color=\u00bbrgba(15,19,25,0.1)\u00bb use_custom_width=\u00bbon\u00bb custom_width_px=\u00bb1280px\u00bb global_colors_info=\u00bb{}\u00bb][et_pb_column type=\u00bb4_4″ _builder_version=\u00bb4.16″ custom_padding=\u00bb|||\u00bb global_colors_info=\u00bb{}\u00bb custom_padding__hover=\u00bb|||\u00bb][et_pb_text _builder_version=\u00bb4.18.1″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb12px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb locked=\u00bboff\u00bb global_colors_info=\u00bb{}\u00bb]<\/p>\n 1.\tMirvis DM, Goldberger AL, editors. Electrocardiography. En: Bonow RO, Mann DL, Zipes DP, Libby P. Braunwald’s Heart Disease: A textbook of Cardiovascular Medicine. 9th ed. Filadelfia: Elsevier Saunders; 2012. p. 149-159. La aparici\u00f3n de nuevas ondas Q en el electrocardiograma de un paciente, suele ser interpretada como infarto de miocardio. Sin embargo, existen algunas situaciones menos frecuentes en las cuales aparecen ondas Q por otras causas como la isquemia severa sin muerte celular. En relaci\u00f3n con la cirug\u00eda cardiaca…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[16,17],"tags":[25],"class_list":["post-1119","post","type-post","status-publish","format-standard","hentry","category-16","category-presentacion-de-casos-clinicos-30","tag-anuario-30-2023"],"_links":{"self":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/1119","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/comments?post=1119"}],"version-history":[{"count":11,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/1119\/revisions"}],"predecessor-version":[{"id":1409,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/posts\/1119\/revisions\/1409"}],"wp:attachment":[{"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/media?parent=1119"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/categories?post=1119"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/villavicencio.org.ar\/anuario\/wp-json\/wp\/v2\/tags?post=1119"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
(2) Doctor en Medicina
Instituto Cardiovascular de Rosario (Bv. Oro\u00f1o 450, Rosario, Argentina)
Correspondencia a: danidegano01@gmail.com<\/a>
Fecha de publicaci\u00f3n: 08\/11\/2022<\/p>\n
ARK: http:\/\/id.caicyt.gov.ar\/ark:\/s2796762X\/b8qbkfo0d<\/a><\/span><\/p>\nResumen<\/h3>\n
Paciente de 66 a\u00f1os de edad, a qui\u00e9n se le realiz\u00f3 cirug\u00eda de revascularizaci\u00f3n mioc\u00e1rdica. A la hora de su ingreso comenz\u00f3 a presentar alteraciones del segmento ST en el electrocardiograma. Present\u00f3 luego asistolia y se decidi\u00f3 implantarle asistencia circulatoria con membrana de oxigenaci\u00f3n extracorp\u00f3rea (ECMO) y re-explorarlo quir\u00fargicamente. Desde su reingreso a cuidados intensivos se registraron ondas Q (QS) en cara infero-posterior.
Al d\u00eda 12mo<\/sup> de posoperatorio mejor\u00f3 la funci\u00f3n ventricular por ecocardiograma y el electrocardiograma de ese d\u00eda volvi\u00f3 a mostrar ondas R (rS) en cara infero-posterior.
Se consider\u00f3 que el \u00abatontamiento el\u00e9ctrico\u00bb acompa\u00f1\u00f3 al \u00abatontamiento contr\u00e1ctil\u00bb.
Por tanto, en el postoperatorio inmediato de cirug\u00eda card\u00edaca la onda Q puede aparecer por isquemia severa, asociada a disfunci\u00f3n ventricular, y desaparecer junto a esta \u00faltima.<\/p>\nPalabras clave<\/h3>\n
Q waves in reversible ventricular dysfunction after cardiac surgery<\/strong><\/h2>\n
Abstract<\/h3>\n
A 66-year-old patient underwent myocardial revascularization surgery. At the time of his admission, he began to present ST-segment alterations in the electrocardiogram. He then presented asystole and it was decided to implant circulatory assistance with extracorporeal membrane oxygenation (ECMO) and re-explore him surgically. Since his readmission to intensive care, Q waves (QS) were recorded in the inferior-posterior face.
At day 12 of the postoperative, ventricular function improved by echocardiogram and the electrocardiogram of that day again showed R waves (rS) in the inferior-posterior face.
It was considered that ‘electrical stunning’ occured along with ‘contractile stunning’.
Therefore, in the immediate postoperative period of cardiac surgery, the Q wave may appear due to severe ischemia, associated with ventricular dysfunction, and disappear together with the latter.<\/p>\nKeywords<\/h3>\n
Introducci\u00f3n<\/h3>\n
En relaci\u00f3n con la cirug\u00eda cardiaca se ha descripto la desaparici\u00f3n de ondas Q, asociadas a disfunci\u00f3n ventricular, ambas presentes antes de la intervenci\u00f3n, luego de realizarse la revascularizaci\u00f3n mioc\u00e1rdica.3<\/sup>\u00a0Aunque no hemos encontrado casos descriptos previamente, tambi\u00e9n es posible la aparici\u00f3n y desaparici\u00f3n de ondas Q en el postoperatorio inmediato de una cirug\u00eda cardiovascular, como el caso que describimos a continuaci\u00f3n.<\/p>\nObjetivos<\/h3>\n
Presentaci\u00f3n del caso<\/h3>\n
Present\u00f3 angina de pecho en clase funcional I, de dos a\u00f1os de duraci\u00f3n, que en los \u00faltimos dos meses, evolucion\u00f3 a clase funcional II-III, por lo que fue evaluado, en forma ambulatoria, mediante cinecoronariograf\u00eda, donde se evidenci\u00f3 compromiso de tronco y tres vasos coronarios con lechos distales de mala calidad y ecocardiograma que inform\u00f3 fracci\u00f3n de eyecci\u00f3n del ventr\u00edculo izquierdo (Fey) conservada, con hipoquinesia inferior e inferoapical. En la Figura 1 se muestra el electrocardiograma (ECG) prequir\u00fargico.
Por lo anteriormente descripto, se le realiz\u00f3 cirug\u00eda de revascularizaci\u00f3n mioc\u00e1rdica con confecci\u00f3n de puentes con arteria mamaria izquierda a arteria descendente anterior secuencial a arteria diagonal, con arteria mamaria derecha a arteria circunfleja y con vena safena a arteria descendente posterior de coronaria derecha. No present\u00f3 complicaciones intraoperatorias.
A su ingreso a la unidad de cuidados intensivos el ECG mostr\u00f3 cambios m\u00ednimos (Figura 2), sin embargo en el ECG que se realiz\u00f3 a la hora de su llegada se constat\u00f3 infradesnivel del segmento ST de 2 mm de V1 a V3 (Figura 3). Se comenz\u00f3 administraci\u00f3n endovenosa de nitroglicerina.
A las 2 horas de su ingreso a cuidados intensivos se evidenci\u00f3 bradicardia e hipotensi\u00f3n arterial s\u00fabita con requerimiento de drogas inotr\u00f3picas (dopamina, dosis m\u00e1xima 14 mcg\/kg\/min) y fluidoterapia, con mala respuesta cl\u00ednica. Los valores de la fracci\u00f3n mioc\u00e1rdica de la creatinfosfoquinasa (CPK-MB) y de la troponina T ultrasensible (TnTs) no se hallaron elevados hasta ese momento. A los 30 minutos del deterioro hemodin\u00e1mico el paciente present\u00f3 asistolia por lo cual se realiz\u00f3 reanimaci\u00f3n cardiopulmonar, recobrando el ritmo propio a los 3 min.
A las 3 horas de su ingreso en el ECG se agreg\u00f3 supradesnivel del segmento ST de 2 mm en DII, DIII, aVF y V6, al infradesnivel que ya presentaba de V1 a V3 (Figura 4). Por su condici\u00f3n se prefiri\u00f3 implantarle asistencia circulatoria mec\u00e1nica con membrana de oxigenaci\u00f3n extracorp\u00f3rea (ECMO) veno-arterial y re-explorarlo quir\u00fargicamente, en vez de realizarle una coronariograf\u00eda de urgencia. En la reintervenci\u00f3n se evidenci\u00f3 oclusi\u00f3n del puente de la arteria mamaria izquierda a la arteria descendente anterior, a nivel de su anastomosis distal, por lo que se realiz\u00f3 un puente venoso a dicha arteria.
Al reingreso del paciente a la sala de cuidados intensivos, el ECG mostr\u00f3 supradesnivel del ST en cara inferior y en V5 y V6 (Figura 5). Desde el punto de vista hemodin\u00e1mico se lo consider\u00f3 un shock cardiog\u00e9nico con vasodilataci\u00f3n por lo cual se lo trat\u00f3 con drogas inotr\u00f3picas y vasopresoras (dopamina, dosis m\u00e1xima 14 mcg\/kg\/min y noradrenalina, dosis m\u00e1xima 0,15 mcg\/kg\/min).
Los valores de CPK-MB y de TnTs comenzaron a aumentar luego de la reoperaci\u00f3n, alcanzando su m\u00e1ximo el primer d\u00eda posoperatorio: CPK-MB 584 U\/l (l\u00edmite superior de valor normal (LSVN) 25 U\/l) y TnTs 9403 pg\/ml (LSVN 14 pg\/ml).
Si bien desde el reingreso a la sala, luego de la reoperaci\u00f3n, se registran ondas Q (QS) en cara inferior en el ECG del paciente, al 4to<\/sup> d\u00eda posoperatorio se agrega onda Q (QS) en V6, con microvoltajes en todas las derivaciones (Figura 6). La asistencia circulatoria mec\u00e1nica se retir\u00f3 al 3er<\/sup> d\u00eda de postoperatorio.
Al 7mo<\/sup> d\u00eda del posoperatorio se realiz\u00f3 un ecocardiograma de control que mostr\u00f3 Fey 35% con hipoquinesia global m\u00e1s marcada inferior y apical. En ese momento se encontraba tratado con dopamina (3 mcg\/kg\/min).
El balance h\u00eddrico acumulativo m\u00e1ximo (sin contar p\u00e9rdidas insensibles) fue de 11 litros.
Se realiz\u00f3 un ecocardiograma de control al d\u00eda 12mo<\/sup> de posoperatorio que mostr\u00f3 Fey 45%. Aquinesia inferobasal, inferomedial y septum basal posterior con hipoquinesia septoapical, apical e inferoapical. El ECG de ese d\u00eda volvi\u00f3 a mostrar ondas R (rS) en DII, DIII, aVF y en V6 (Figura 7).<\/p>\nDiscusi\u00f3n<\/h3>\n
Es altamente probable que el paciente, adem\u00e1s, haya desarrollado alg\u00fan grado de necrosis en cara inferior y apical (mostr\u00f3 biomarcadores elevados y alteraciones nuevas de la motilidad parietal), lo cual es esperable luego de una isquemia mioc\u00e1rdica severa.
Dado que al paciente, luego de la isquemia severa, le fue revascularizada la arteria descendente anterior (DA) con un puente venoso, se podr\u00eda especular que la desaparici\u00f3n de las ondas Q se debi\u00f3 al rescate de un territorio en proceso de necrosis debido al retorno del flujo sangu\u00edneo.3<\/sup>\u00a0Sin embargo, la variante anat\u00f3mica de la DA de este paciente no irrigaba la cara inferior, sino que se deten\u00eda a nivel del \u00e1pex card\u00edaco.
Es interesante destacar que durante el per\u00edodo de isquemia aguda y disfunci\u00f3n ventricular del postoperatorio inmediato, el paciente present\u00f3 microvoltajes en su ECG, los cuales se recuperaron, al menos en las derivaciones de los miembros, al 12mo<\/sup> d\u00eda de la cirug\u00eda. En este caso coexistieron al menos tres causas ostensibles para desarrollar microvoltajes: atontamiento mioc\u00e1rdico, infarto agudo de miocardio y aumento del agua corporal.4<\/sup><\/p>\nConclusiones<\/h3>\n
Conflicto de intereses<\/h3>\n
Agradecimientos<\/h3>\n
Figuras<\/h2>\n
<\/strong><\/p>\nBibliograf\u00eda<\/h3>\n
\n 2.\tBashour TT, Kabbani SS, Brewster HP, et al. Transient Q waves and reversible cardiac failure during myocardial ischemia: electrical and mechanical stunning of the heart. Am Heart J. 1983;106:780-3.
\n 3.\tBarold SS, Falkoff MD, Ong LS, et al. Significance of transient electrocardiographic Q waves in coronary artery disease. Cardiol Clin. 1987;5:367-80.
\n 4.\tSansevero MA, Bravino MF, Bonaccorsi HA. Microvoltaje electrocardiogr\u00e1fico y shock postcardiotom\u00eda. Anuario (Fund. Dr. J.R. Villavicencio). 2022[citado 29\/07\/2022];29:50-53. Disponible en: http:\/\/www.villavicencio.org.ar\/PORTAL\/index.php?sis=2&ubq=4&scc=11&men=35[\/et_pb_text][et_pb_text _builder_version=\u00bb4.16″ text_font=\u00bb||||||||\u00bb text_font_size=\u00bb15px\u00bb text_line_height=\u00bb2em\u00bb header_font=\u00bb||||||||\u00bb header_2_font=\u00bb||||||||\u00bb header_3_font=\u00bbEB Garamond||||||||\u00bb header_3_font_size=\u00bb24px\u00bb header_3_line_height=\u00bb1.4em\u00bb header_4_font=\u00bb|700||on|||||\u00bb header_4_text_color=\u00bb#ffdaa4″ header_4_font_size=\u00bb12px\u00bb header_4_letter_spacing=\u00bb2px\u00bb header_4_line_height=\u00bb2em\u00bb text_line_height_tablet=\u00bb\u00bb text_line_height_phone=\u00bb1.6em\u00bb text_line_height_last_edited=\u00bbon|phone\u00bb global_colors_info=\u00bb{}\u00bb][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"