Loading...

Srdeční rytmus určuje skupina buněk s nejrychlejší změnou spontánního klidového napětí, kteréprvní dosáhne prahu pro akční napětí. Za normálních okolností vzniká vzruch v sinoatrialnímuzlu, a proto mluvíme o sinusovém rytmu. Vzruch zde vzniká s frekvencí 60-90/min. Buňky se spontánní depolarizací se nacházejí i mimo SA uzel. Místa, kde může vzruch vznikat,se označují jako centra náhradní automacie. Sekundárním pacemakerem (centrem) je pak AV uzel(oblast AV junkce) a terciárním pacemakerem jsou komory. Vlastní rytmus těchto center klesáod síní ke komorám. Frekvence tvorby vzruchů je v oblasti AV junkce 40-60/min., v komorách30-40/min.

Náhradní místa automacie jsou pod neustálým vlivem SA uzlu, který vybíjí a potlačuje jejichspontánní automatickou činnost. Rytmus srdce je řízen vždy centrem s nejrychlejší spontánnífrekvencí. Proto náhradní centra automacie se mohou uplatnit teprve tehdy, když ustane vlivnadřazeného SA uzlu.

Patologicky nemusí vzruch vznikat v primárním, sekundárním ani terciárním centru, ale vzruchyvznikají v oblasti patologických ohnisek v síních s rychlým sledem impulsů nebo se může jednato mechanismus krouživé kontrakce na bázi fenoménu reentry (fenomén návratných vzruchů).Takto je tomu u fibrilace síní, která je charakterizována zcela nepravidelnou činností srdce.Frekvence vzruchů tvořených v síni je až 600/min., ale na komory se převede podle bloku v AVuzlu jen daleko menší počet vzruchů (většinou 80-90/min.).

 Přehled srdečních rytmů a hlavních patologických frekvencí

1. Sinusový rytmus – základní rytmus zdravého srdce, charakterizován nálezem vlny P, která v pravidelných intervalech předchází komplex QRS. Je nejčastějším srdečním rytmem. Vzruchy vznikají v SA uzlu normálně s frekvencí 60-90/min.

2. Junkční (nodální) rytmus – vzruchy vznikají v oblasti AV junkce.
Podle frekvence je tzv. -pasivní junkční rytmus- 40-60/min.
-aktivní junkční rytmus – nad 60/min.

Podle tvaru a lokalizace vlny P se rozděluje junkční rytmus na:
a) horní nodální rytmus (rytmus koronárního sinu) – jde o ektopický síňový rytmus, který vzniká v automatických buňkách vodivé dráhy spojující SA uzel s AV uzlem v místě vyústění koronárních žil do pravé síně. Vlny P jsou ve svodu II, III, aVF a ve V5,6 negativní a předcházejí vždy komorový komplex. Interval PQ je zkrácený nebo normální.
b) střední nodální rytmus – vlna P je skryta v komorovém komplexu, a proto se nedá na EKG křivce rozeznat. Na rozdíl od fibrilace síní je zde akce pravidelná.
c) dolní nodální rytmus – činnost srdce je řízena terciárním pacemakerem z komor o frekvenci 30-40/min.

Různé typy nodálního rytmu: a) horní, b) střední, c) dolní.Šipka ukazuje vlnu P, která je u b) skryta v komorovém komplexu

3. Idioventrikulární rytmus – činnost srdce je řízena terciárním pacemakerem z komor frekvenci 30-40/min.

4. Fibrilace síní – po sinusovém rytmu nejčastějším nálezem na EKG je fibrilace síní, kdy vzruchy vznikají zcela kdekoliv v síni, a také zcela nepravidelně jsou převáděny na komory. Frekvence vzruchů vznikajících v síních je až 600/min., ale AV uzel chrání komory před vyčerpáním    a působí jako fyziologický blok, a proto frekvence komor je často normální (60-90/min.). Typické pro fibrilaci síní je nepřítomnost vlny P, nepravidelná srdeční akce a přítomnost fibrilačních vlnek (viz kapitola „Supraventrikulární arytmie“). Při zcela nepravidelné akci je vždy nutné pomýšlet jako první na fibrilaci síní.

 5. Flutter síní – nálezem je častější než junkční rytmus, akce je často pravidelná a je nález pravidelných jasných flutterových síňových vlnek.

Comments(41)

  • 27. 7. 2021, 7:20  Odpovědět

    When I initially commented I clicked the „Notify me when new comments are added“ checkbox and now each time a comment is
    added I get three e-mails with the same comment. Is there any way you can remove me from that service?
    Cheers!

  • 29. 7. 2021, 21:56  Odpovědět

    Hi, I do think this is an excellent blog. I stumbledupon it 😉 I will come back once again since I
    saved as a favorite it. Money and freedom is the greatest way to change, may you be
    rich and continue to help others.

  • 30. 7. 2021, 4:06  Odpovědět

    I like the helpful info you provide in your articles. I will bookmark your weblog and check
    again here regularly. I’m quite certain I’ll learn plenty of new
    stuff right here! Good luck for the next!

  • 30. 7. 2021, 5:10  Odpovědět

    I don’t commonly comment but I gotta tell regards for the post on this special one :D.

    My webpage :: DFine8

  • 30. 7. 2021, 12:21  Odpovědět

    This is a great tip particularly to those new to the blogosphere.
    Brief but very precise info… Appreciate your sharing this one.

    A must read article!

  • 30. 7. 2021, 16:06  Odpovědět

    You ought to be a part of a contest for one of the highest quality sites
    on the internet. I most certainly will highly recommend this site!

  • 30. 7. 2021, 16:26  Odpovědět

    I do not even know how I stopped up riցһt here,
    however I thought tһis suƅmіt used to be good.
    Ι don’t know who you might be bᥙt сertainly yoᥙ are going
    to a well-known bloger if yyou happen to aren’t already.
    Cheers!

  • Hi my loved one! I wish to say that this post is awesome, great written and come with approximately all important
    infos. I would like to look extra posts like this .

  • 30. 7. 2021, 21:00  Odpovědět

    I like the valuable info you provide in your articles.
    I will bookmark your blog and check again here regularly.

    I am quite sure I will learn a lot of new stuff right here!
    Best of luck for the next!

  • 30. 7. 2021, 21:04  Odpovědět

    When I originally commented I seem to have clicked on the -Notify me when new comments are added- checkbox and
    now every time a comment is added I receive 4 emails with the
    same comment. Is there an easy method you are able to remove me from that service?
    Thanks a lot!

    Feel free to surf to my blog post; Rhino Spark

  • I rarely comment, but I browsed a few of the comments
    on Srdeční rytmus – Anesteziologie, resuscitace a intenzivní medicína.
    I do have a few questions for you if it’s okay. Is it just me or does it give the impression like some of the responses come across like they are coming from brain dead visitors?
    😛 And, if you are writing on other online social sites, I
    would like to keep

  • 31. 7. 2021, 2:33  Odpovědět

    Excellent websitе. A ⅼot of helρful info here.
    I’m sending it tߋ seѵeral buddiеs ans als᧐ ѕharing in delicious.
    And obvіously, thank you on your sweat!

  • 31. 7. 2021, 2:54  Odpovědět

    If some one desires expert view on the topic of running a blog afterward i propose him/her to visit this website, Keep up the
    fastidious job.

    Here is my web site; forum.pplo.kg

  • 31. 7. 2021, 7:19  Odpovědět

    As the admin of this web page is working, no question very shortly it
    will be famous, due to its feature contents.

    my web-site – Oracle Leaf Gold CBD

  • 31. 7. 2021, 7:21  Odpovědět

    I like it when people come together and share
    ideas. Great website, keep it up!

    My web-site :: forum.techzooka.com

  • 31. 7. 2021, 9:03  Odpovědět

    Wonderful goods from you, man. I’ve understand your stuff previous to and you are just extremely
    magnificent. I actually like what you’ve acquired
    here, certainly like what you’re saying and the way in which you
    say it. You make it enjoyable and you still take care
    of to keep it sensible. I cant wait to read far more from you.

    This is actually a wonderful web site.

    Have a look at my

  • 31. 7. 2021, 12:08  Odpovědět

    Thanks for sharing your thoughts on having sex.

    Regards

    Take a look at my web-site :: Mermber XXL

  • 31. 7. 2021, 14:49  Odpovědět

    Hmm it looks like your site ate my first comment (it was extremely long) so I guess I’ll just sum it up what I wrote and say, I’m thoroughly
    enjoying your blog. I as well am an aspiring blog blogger but I’m still new to everything.
    Do you have any tips for beginner blog writers? I’d really appreciate it.

    Here is my web site: <a href="http://blakeottinger.com/fluxbb/profile.php?id=574403&quot;

  • 31. 7. 2021, 15:50  Odpovědět

    Some really nice and utilitarian info on this site, as
    well I believe the layout has fantastic features.

    my site :: forum.hostpoco.com

  • 31. 7. 2021, 17:01  Odpovědět

    Great blog! Is your theme custom made or did you download
    it from somewhere? A theme like yours with a few simple
    tweeks would really make my blog stand out. Please let
    me know where you got your theme. Thanks a lot

    Feel free to visit my page – Mack And Sons CBD Oil
    (vip5.moisait2021.ru)

  • 31. 7. 2021, 19:43  Odpovědět

    This is a very good tip particularly to those new to the blogosphere.
    Brief but very accurate info? Thanks for sharing this one.
    A must read article!

    Review my web blog – Allura Fresh Cream Reviews

  • Howdy just wanted to give you a quick heads up.
    The words in your content seem to be running off the screen in Internet explorer.

    I’m not sure if this is a format issue or something to do with internet browser compatibility
    but I thought I’d post to let you know. The layout look great though!
    Hope you get the problem solved soon. Kudos

    Also visit my homepage :: <a href="https://

  • 1. 8. 2021, 4:35  Odpovědět

    Yes! Finally someone writes about goldstrike casino.

  • 1. 8. 2021, 19:49  Odpovědět

    Howdy are using WordPress for your site platform? I’m new to the blog world but I’m
    trying to get started and create my own. Do you need any html coding expertise to
    make your own blog? Any help would be really appreciated!

  • 1. 8. 2021, 21:39  Odpovědět

    I’m really impressed with your writing skills and also with the layout
    on your blog. Is this a paid theme or did you modify it yourself?
    Anyway keep up the nice quality writing, it is rare to
    see a great blog like this one nowadays.

  • 28. 8. 2021, 7:48  Odpovědět

    Good day very nice site!! Guy .. Beautiful .. Wonderful ..
    I’ll bookmark your web site and take the feeds also? I am glad to find so many useful info right here within the put
    up, we’d like work out extra techniques in this regard, thanks for sharing.

    . . . . .

  • 30. 8. 2021, 3:59  Odpovědět

    Whats up very nice web site!! Guy .. Excellent .. Amazing ..
    I will bookmark your website and take the feeds also? I’m glad to seek out so many useful information here in the submit, we need develop extra strategies
    on this regard, thank you for sharing. . . . . .

  • 1. 9. 2021, 0:47  Odpovědět

    Very quickly this web site will be famous amid all
    blog visitors, due to it’s fastidious content

  • 1. 9. 2021, 13:58  Odpovědět

    Great blog you have here but I was wanting to know if you knew of any user discussion forums that cover the
    same topics discussed here? I’d really love
    to be a part of community where I can get comments from other
    experienced individuals that share the same interest.

    If you have any recommendations, please let me know.
    Cheers!

  • 1. 9. 2021, 16:29  Odpovědět

    After I originally left a comment I seem to have clicked on the -Notify me when new comments are added- checkbox and
    now whenever a comment is added I recieve four emails with
    the exact same comment. There has to be a means you can remove me from that service?
    Thank you!

  • 2. 9. 2021, 16:56  Odpovědět

    If some one wants to be updated with hottest technologies after
    that he must be pay a quick visit this web site and be up to date every day.

  • 4. 9. 2021, 6:43  Odpovědět

    Hello my loved one! I want to say that this post is awesome, great written and come
    with almost all important infos. I would like to look more posts
    like this .

  • 5. 9. 2021, 12:24  Odpovědět

    Hello there! Quick question that’s completely off topic.
    Do you know how to make your site mobile friendly?
    My website looks weird when viewing from my iphone4.
    I’m trying to find a theme or plugin that might be able to correct this problem.
    If you have any recommendations, please share.

    Many thanks!

  • 6. 9. 2021, 3:34  Odpovědět

    Good day! This is my first visit to your blog! We
    are a collection of volunteers and starting a new project in a community in the same niche.

    Your blog provided us valuable information to work on. You have done a outstanding job!

  • 10. 9. 2021, 3:02  Odpovědět

    I seriously love your blog.. Excellent colors & theme.
    Did you build this website yourself? Please reply back as I’m trying to create my own personal site and would
    like to know where you got this from or what the theme is named.
    Kudos! asmr https://app.gumroad.com/asmr2021/p/best-asmr-online asmr

  • 11. 9. 2021, 0:31  Odpovědět

    Post writing is also a fun, if you know then you
    can write otherwise it is complicated to write. quest bars http://bit.ly/3C2tkMR quest bars

  • 11. 9. 2021, 23:04  Odpovědět

    Hi there, just wanted to mention, I liked this post.
    It was helpful. Keep on posting! cheap flights http://1704milesapart.tumblr.com/ cheap flights

  • 12. 9. 2021, 10:02  Odpovědět

    Write more, thats all I have to say. Literally, it seems as though you
    relied on the video to make your point. You clearly know what youre talking
    about, why throw away your intelligence on just posting videos to your blog when you could be giving us something enlightening to read?
    quest bars https://www.iherb.com/search?kw=quest%20bars quest bars

  • 13. 9. 2021, 4:08  Odpovědět

    Excellent goods from you, man. I’ve understand your stuff previous to and you are just extremely great.
    I really like what you’ve acquired here, really like what you are saying and the way in which you say
    it. You make it entertaining and you still care for to
    keep it smart. I cant wait to read much more from you. This is
    really a wonderful web site. scoliosis surgery https://0401mm.tumblr.

  • 13. 9. 2021, 23:12  Odpovědět

    I don’t even understand how I stopped up here, however I believed this put up was once great.
    I do not understand who you are but certainly you’re going to a
    famous blogger if you happen to aren’t already.
    Cheers! scoliosis surgery https://coub.com/stories/962966-scoliosis-surgery scoliosis
    surgery

  • 15. 9. 2021, 0:57  Odpovědět

    Good day! I could have sworn I’ve been to this blog before but after reading through some of the post I realized it’s new to me.
    Nonetheless, I’m definitely happy I found it and I’ll be bookmarking and checking back often! ps4 games https://bit.ly/3z5HwTp ps4

Leave a Comment