Electrocardiograma normal y patentes patologicas ECG

8/17/2019 Electrocardiograma normal y patentes patologicas ECG

1/27

Lftmrprmtjklûf cmd MKH:

Ujpmd cmd Mdmktr`kjrcl`hrjojMd Mdmktr`kjrcl`hrjoj (MKH) ms dj rmprmsmftjklûf cm dj jktlvlcjc mdìktrlkj cmd k`rjzûf mf uf pjpmd.Clka` pjpmd tlmfm klmrtjs kjrjktmrïstlkjs loprmsklfclidms pjrj dj dmkturj k`rrmktj cmd MKH.Md pjpmd cmd Mdmktr`kjrcl`hrjoj ms uf pjpmd oldlomtrjc` c`fcm kjcj kujcr` pm!um"` olcm : oo. Kjcj# kujcr`s kalk`s aj$ ufj dïfmj o%s hrumsj !um cm&fm uf kujcr` hrjfcm cm # oo.-Mgm vmrtlkjd7 olcm dj jopdltuc cm dj k`rrlmftm mdìktrlkj cmd k`rjzûf $ sm cj mf oldlv`dtl`s. '`r f`roj: oo cm jdturj m!ulvjdmf j : o. '`r tjft` kjcj oldïomtr` cm jdturj cmd pjpmd cm MKH m!ulvjdm j :

o $ kjcj kujcr` hrjfcm # o.-Md mgm a`rlz`ftjd7 olcm md tlmop` :oo a`rlz`ftjd m!ulvjdm j * s $ uf kujcrjc` hrjfcm m!ulvjdm j+ s. Mf uf MKH mst%fcjr md pjpmd k`rrm j ufj vmd`klcjc cm +# oo,s

Ujpmd cm Mdmktr`kjrcl`hrjoj7 mrtlkjd- :oo : o. /`rlz`ftjd :oo * s.

Mst`s vjd`rms s`f d`s usjc`s mf uf Mdmktr`kjrcl`hrjoj f`rojd. 5l sm cmsmj p`cmo`s juomftjr djvmd`klcjc cmd pjpmd (pjrj vmr trjst`rf`s mf djs ̀ fcjs) ̀ clsolfulrdj (pjrj jdtmrjkl`fms cmd rlto`) ̀juomftjr dj jopdltuc (sl aj$ olkr`v`dtjm) ̀ clsolfulrdj (kòpdm`s 9;5 cmojsljc` jdt`s).

Kjdlirjklûf cmd Mdmktr`kjrcl`hrjoj

3d lflkl` cmd rmhlstr` cmd Mdmktr`kjrcl`hrjoj md mdmktr`kjrclûhrj=` rmjdlzj jutò%tlkjomftm ufjkjdlirjklûf.

5m mfvïj uf lopuds` mdìktrlk` cm : o curjftm + s rmhlstrjfc` mf mdpjpmd cmd Mdmktr`kjrcl`hrjoj ufj lojhmf rmktjfhudjr cm : oo cmjdturj $ # oo cm jfka` (lojhmf cm dj cmrmkaj).Mstj lojhmf f`s pmroltm k`f`kmr dj kjdlirjklûf cmd Mdmktr`kjrcl`hrjojrmjdlzjc`.Kûo` kòmftjo`s prmvljomftm mf kjs`s !um md v`dtjm cm d`s 9;5smj ou$ jdt` ` ou$ ij` sm pumcm kjoiljr dj jopdltuc tjoilìf smpumcm o`cl&kjr su vmd`klcjc d` !um ajrïj vjrljr dj kjdlirjklûf $ p`rtjft` dj jfkaurj ` dj jdturj cmd rmkt%fhud`.

2lk`d%s 5ldvj

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2/27

Lftmrprmtjklûf cmd MKH+

Mdmktr`c`s cmd Mdmktr`kjrcl`hrjoj8`s Mdmktr`c`s cmd Mdmktr`kjrcl`hrjoj (MKH) s`f d`s clsp`sltlv`s !um p`fmf mf k`ftjkt` jd pjklmftm k`fmd mdmktr`kjrcl`hr%=`. 3 trjvìs cm mdd`s sm `itlmfm dj lf=`rojklûf mdìktrlkj pjrj dj loprmslûf $ md jf%dlslscmd Mdmktr`kjrcl`hrjoj.'jrj rmjdlzjr uf Mdmktr`kjrcl`hrjoj mst%fcjr sm k`d`kjf : mdmktr`c`s clvlclc`s mf c`s hrup`s-

:. Mdmktr`c`s 'mrl=ìrlk`sCm d`s cjt`s jp`rtjc`s p`r mdd`s sm ̀ itlmfmf djs :+ cmrlvjkl`fms cmd

MKH+. Mdmktr`c`s 'rmk`rcljdms.

Kujfc` sm rmjdlzj uf Mdmktr`kjrcl`hrjoj ms loprmsklfclidm k`f`kmr k`f rlhur`slcjc dj uilkjklûf cm d`smdmktr`c`s mf md pjklmftm. 1f kjoil` cm d`kjdlzjklûf cm uf mdmktr`c` p`crïj pr`v`kjr cmscm pm!um"jsvjrljkl`fms mf dj o`r=`d`hïj cmd 9;5 ajstj hrjvms mrr`rms cljhfûstlk`s.-]ilkjklûf cm d`s Mdmktr`c`s cmd MKH

:. Mdmktr`c`s 'mrl=ìrlk`s- s`f kujtr` $ vjf k`d`kjc`s mf djsm


3/27

Lftmrprmtjklûf cmd MKH?-)mrlvjkl`fms ilp`djrms ` cm Mlfta`vmf7 ;mhlstrjf djcl=mrmfklj cm p`tmfkljd mftrm c`s mdmktr`c`s uilkjc`s mfm


4/27

Lftmrprmtjklûf cmd MKH*-)mrlvjkl`fms * Ujrmcms Kjrcljkjs7 Kjcj ufj cm djs c`kmCmrlvjkl`fms Kjrcljkjs rmhlstrj ufj lf=`rojklûf k`fkrmtj cm djsclstlftjs z`fjs cmd k`rjzûf. Kò` ms dûhlk` jp`rtjf o%s cjt`s cm djpjrmc !um o%s kmrkj tlmfmf !um cm djs o%s jdmjcjs (mdìktrlkjomftmajidjfc`).'`r mmopd`- 8js cmrlvjkl`fms lf=mrl`rms irlfcjf oj$`rlf=`rojklûf cm dj pjrmc lf=mrl`r cmd k`rjzûf !um cmd rmst` cm djspjrmcms. Ms p`r ms` !um jhrupjo`s djs Cmrlvjkl`fms cmd MKHcmpmfclmfc` cm dj pjrmc cmd k`rjzûf !um o%s lf=`rojklûf jp`rtj.Mst` tlmfm prlfklpjd rmdmvjfklj mf dj Kjrcl`pjtïj 6s!uìolkj tjft` mfmd 6f=jrt` 3huc` k`f Mdmvjklûf cmd 5J c`fcm md Mdmktr`kjrcl`hrjojf`s pmroltm d`kjdlzjr k`f klmrtj smhurlcjc dj jrtmrlj ̀ kdulcj kò` mfd`s pjklmftms k`f lf=jrt`s prmvl`s c`fcm dj Bfcj 9 d`kjdlzj djs z`fjscm fmkr`sls.'`cmo`s cl=mrmfkljr trms hrup`s cm cmrlvjkl`fms !um sm k`rrmdjkl`fjf jfjtûolkjomftm k`f djs pjrmcmsvmftrlkudjrms-

:. Cmrlvjkl`fms Cmrmkajs :4+- mftrïkud` cmrmka` $ 5mpt` 6ftmrvmftrlkudjr.+. Cmrlvjkl`fms 3ftmrl`rms ?4*- 'jrmc 3ftmrl`r cmd mftrïkud` 6z!ulmrc .̀?. Cmrlvjkl̀ fms 8jtmrjdms ijjs #4E- 'jrmc 8jtmrjd ijj.*. Cmrlvjkl̀ fms 8jtmrjdms jdtjs 6 $ 38- 'jrmc 8jtmrjd jdtj.#. Cmrlvjkl`fms 6f=mrl`rms 66 666 $ 3>- 'jrmc 6f=mrl`r.

'jrj k`f&rojr

jdtmrjkl`fms cmd mftrïkud` Cmrmka` ms rmkòmfcjidm rmjdlzjr jcmo%s djs Cmrlvjkl`fms Cmrmkajs (?;*; #; $ E;). 8js jdtmrjkl`fms cm dj 'jrmc '`stmrl`r sm ìsmrvjf mf :4? kò` lo%hmfmsmspmkudjrms. Ms rmkòmfcjidm rmjdlzjr djs Cmrlvjkl`fms '`stmrl`rms pjrj k`ftrjstjr dj lf=`rojklûf cmjoijs.

2lk`d%s 5ldvj


5/27

Lftmrprmtjklûf cmd MKH#

Kûo` Dmmr +f Mdmktr`kjrcl`hrjojD` prlomr`7 Mstjr smhur` !um md Mdmktr`kjrcl`hrjoj mstì ilmf rmjdlzjc` ìsmrvjr d`s vjd`rms cmvmd`klcjc cmd pjpmd $ jopdltuc (mf uf MKH mst%fcjr dj vmd`klcjc ms cm +#oo,s $ dj jopdltuc cm :op`r :oo) !um mstìf prmsmftms djs :+ Cmrlvjkl`fms ` !um md MKH f` tmfhj cmojsljc`s jrtm=jkt`s !umcl&kudtmf dj dmkturj. Mf kjs` cm !um smj cl=ïkld dj dmkturj ` !um md Mdmktr`kjrcl`hrjoj mstì ojd rmjdlzjc`sm cmimrïj rmpmtlr sl =umsm p`slidm.3suolo`s !um md Mdmktr`kjrcl`hrjoj !um tlmfms cmdjftm mst% ilmf rmjdlzjc` jsï !um kòmfzjo`s djdmkturj cmd olso`.;mkòmfcjo`s smhulr slmoprm ufj olsoj smkumfklj pjrj f` pjsjr fjcj p`r jdt`-

:. Ylto` Kjrcljk`7 8` prlomr` !um ajs cm olrjr ms sl d`s 9;5 cmd Mdmktr`kjrcl`hrjoj s`f rïtolk`s` f`. AKûo` sjimrd`L lrjfc` !um dj clstjfklj mftrm d`s 9;5 smj sloldjr mf kjs` cm cucjjsmhurjrtm usjfc` uf kòp%s ` ufj rmhdj.Cmspuìs aj$ !um vjd`rjr sl md Mdmktr`kjrcl`hrjoj mst% mf ;lto` 5lfusjd. 'jrj mdd` cmimo`scmtmrolfjr sl kjcj klkd` kjrcljk` tlmfm ufj `fcj ' pr`cuklcj p`r md 2`c` 5lfusjd smhulcjslmoprm cm uf kòpdm` 9;5. 5l t`c` mst` sm kuopdm p`cmo`s cmklr !um md Mdmktr`kjrcl`hrjoj

ms rïtolk` $ mst% mf ;lto` 5lfusjd.

+. rmk+mfklj Kjrcljkj7 Mf t`c` Mdmktr`kjrcl`hrjoj ms fmkmsjrl` cmtmrolfjr dj >rmkumfkljKjrcljkj rmjdlzjfc` djs kumftjs ` pr`kmclolmft`s mst`s f`s vjf j cjr kò` rmsudtjc` dj=rmkumfklj kjrcljkj cmd pjklmftm slmfc` irjclkjrclj p`r cmij` cm E8' $ tj!ulkjrclj p`rmfkloj cm d`s :8'. 8`s vjd`rms f`rojdms cm >k s`f mftrm E $ : 8' 8js =`rojs cmcmtmrolfjr dj >k s`f-

• >k :!! " # mftrm $ % $&

• >k2 mftrm ; $ ;

• >k * smh < # + smh < ? E smh < : E smh>k 2G ; mf ? < :

?. Mgm Md,ktrlk` Kjrcljk`7 Ms uf` cm d`s pjs`s cmd jf%dlsls cmd Mdmktr`kjrcl`hrjoj !um o%strjij` sumdm k`stjr. 1f oìt`c` smhur` $ r%plc` pjrj sjimr sl ms f`rojd ms !um djs cmrlvjkl`fmsC: $ j> smjf p`sltlvjs ( $ ).

2lk`d%s 5ldvj

8'

: '!!9 :!

' :!! *!* !

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6/27

Lftmrprmtjklûf cmd MKHE• C: ,3> , hrjc`s

• C: 4,3> ,:N hrjc`s

• C:4,3> 4 :N,4 hrjc`s

• C:,3> 4, hrjc`s

*. fcj U7 6fclkj dj jktlvjklûf jurlkudjr.• Curjkl`f- #D cmd lftmrvjd` 'r .N,.:+ smh (?4* )

• `dtjm- O.+#ov (+.#oo )

• `r=`d`hlj- su =`roj ms r`oj `kf ufj pm!um"j oumskj!um sm dj cmim `ismrvjr-. )#,)$/5v: - 5"Y./- "#

#. Lftmrvjd` UY7 lcm md tlmop` !um tjrcj dj `fcj mf cmsp`djrlzjr jurlkudj $ ddmhjr j vmftrïkud`sslf cmsp`djrlzjrd`s.

• Curjkl`f-K`rt`7 F.:+ smh (?4* ) Jj!ulkjrclj som cm prmm


7/27

Lftmrprmtjklûf cmd MKH@29 fcj =7 k`rrmsp`fcm j dj rmp`djrlzjklûf vmftrlkudjr mf kujft` j dj `fcj J cmimo`s cmtmrolfjr-

• `dtjm- cmim smr k`fk`rcjftm k`f md kòpdm` 9;5

`r=`d`hïj- dj J f`rojdomftm prmsmftj rjojs jsloìtrlkjs k`f p`djrlcjc sloldjr jd 9;5k`rrms`pfclmftm.. 5"D/)#/)$/)%/"%/"&/"'/"(- 5"Y/"#/"$

. Lftmrvjd` ;=7 k`fstltu$m ufj omclcj mstlojtlvj cm dj vmd`klcjc cm rmp`djrlzjklûf vmftrlkudjr $

pmrl`c` rm=rjktjrl` cmd ouskud` kjrcljk` (mf md kujd f` sm pumcm v`dvmr j cmsp`djrlzjr). sm olcmcmscm md lfkl` cm dj `fcj 9 (` ; mf su cm=mkt`) ajstj md &fjd cm dj `fcj J• Curjkl`f- .?+,.* smh (N4: ) vjrljfc` k`f dj >k md k`rrmhlc` ms F.*# aòirms .*@

oumrms. 5us o`cl&kjkl`fms mf dj curjklûf sm cmimf j jrrltoljs vmftrlkudjrms hrjvms.• 3dtmrjkl`fms- sm cmimf j mstjc`s omtjiûdlk`s

-8lpmr1jdmolj7 jk`rtj-8lp`1jdmolj7 pr`d`fhj-8lpmrkjdkmolj7 jk`rtj-8lp`kjdkmolj7 pr`d`fhj-)lhltjdlk`s7 jk`rtj-5olc`r`fj7 pr`d`fhj

Kûo` lf:`rojr +f Mdmktr`kjrcl`hrjoj-Lf:`rom ik ;lto` lftmrvjd`ssmhomft`s $ ̀ fcjs).

Mdmktr`kjrcl`hrjoj rtolk`> mf Ylto` 3lf+sjd> k`f rmk+mfklj Kjrcljkj cm 24 dpo9

Lftmrvjd`s UY * ;= f`rojdms> k`f Mgm f`rojd j &'?> slf jdtmrjkl`fms cmd smhomft` 3=

` cm djs cmo cm 49#' smh+fc`s9 ;= k`rrmhlc`

f`rojd cm &44 os> 3mhomft` 3= ls`md,ktrlk`> slf jdtmrjkl`fms slhfl6kjtlvjs> fcj =

p`sltlvj mf t`cjs djs cmrlvjkl`fms m0kmpt` mf j"Y9 !` prmsmfklj cm `fcj ;

pjt`dûhlkj9

fcjs cmd Mdmktr`kjrcl`hrjoj

8js Bfcjs s`f djs clstlftjs kurvjturjs !um tòj md trjzjc` cmd MKH ajklj jrrlij ` ajklj jij`. 5`fpr`cukt` cm d`s p`tmfkljdms cm jkklûf !um sm pr`cukmf curjftm dj mstloudjklûf kjrcljkj $ sm rmpltmf cmuf djtlc` j `tr` sjdv` jdtmrjkl`fms.

2lk`d%s 5ldvj

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8/27

Lftmrprmtjklûf cmd MKHN8js `fcjs mdmktr`kjrcl`hr%&kjs ajf slc` cmfòlfjcjs '9;5J1 p`rmsm `rcmf $ vjf uflcjs mftrm sï p`r ufj dïfmj ls`mdìktrlkj.

fcj U7 dj Bfcj ' Ms dj prlomrj `fcj cmd klkd` kjrcljk`. ;mprmsmftj djcmsp`djrlzjklûf cm djs jurïkudjs. Mst% kòpumstj p`r dj supmrp`slklûf cmdj jktlvlcjc mdìktrlkj cm joijs jurïkudjs. 5u pjrtm lflkljd k`rrmsp`fcm j

dj cmsp`djrlzjklûf cm dj 3urïkudj Cmrmkaj $ su pjrtm &fjd j dj cm dj 3urïkudj 6z!ulmrcj.8j curjklûf cm dj Bfcj ' ms omf`r cm :s (+.#oo cm jfka`) $ uf v`dtjm o%.

+. Cmrlvjkl`fms prmk`rcljdms- 2` cmim ajimr fufkj mf :4+. 2`rojdomftm sm ̀ ismrvj ufj ̀ fcj 9mf #4E sumdm smr omf`r cm .* smh cm jfka` + oo cm pr`=ufclcjc $ f` supmrjr md :#D cmd9;5.

Kòpdmg` ;Y37 Mst% =`rojc` p`r uf k`fuft` cm ̀ fcjs !um rmprmsmftjf dj cmsp`djrlzjklûf cm d`svmftrïkud`s. 5u curjklûf `skldj mftrm .Es $ .:s. Jòj vjrljs o`r=`d`hïjs mf cmpmfcmfklj cm djcmrlvjklûf-

:. fcj ;7 5l dj prlomrj `fcj cmd kòpdm` 9;5 ms fmhjtlvj sm cmfòlfj `fcj 9.+. fcj Y7 Ms dj prlomrj `fcj p`sltlvj cmd kòpdm` 9;5 pumcm mstjr prmkmclcj cm ufj `fcj

fmhjtlvj (`fcj 9) ` f`. 5l mf md kòpdm` 9;5 auilmsm `trj `fcj p`sltlvj sm dm cmfòlfj ;U.?. fcj 37 Ms dj `fcj fmhjtlvj !um jpjrmkm cmspuìs cm dj `fcj ;.

*. fcj ;37 Kujfc` uf kòpdm` ms kòpdmtjomftm fmhjtlv` slf prmsmfklj cm `fcj p`sltlvj sm dmcmfòlfj 95. 5umdm smr uf slhf` cm fmkr`sls.

#. fcjs YE * 3E7 Kujfc` aj$ o%s cm ufj `fcj ; ` o%s cm ufj `fcj 5 sm dms cmfòlfj ;U $ 5U.

5l mf uf kòpdm` 9;5 aj$ ufj oïfloj `fcj p`sltlvj lflkljd p`r ou$ pm!um"j !um smj mst% smr% ufjBfcj ; $ dj `fcj fmhjtlvj !um dm slhum ms ufj Bfcj 5 f` ufj `fcj 9. K`f=ufclrdjs ms uf mrr`r=rmkumftm.

fcj =7 ;mprmsmftj dj rmp`djrlzjklûf cm d`s vmftrïkud`s. Hmfmrjdomftm ms cm omf`r jopdltuc !um md9;5 !um dm prmkmcm.Mf uf Mdmktr`kjrcl`hrjoj f`rojd ms p`sltlvj mf t`cjs djs cmrlvjkl`fms m


9/27

Lftmrprmtjklûf cmd MKH

Lftmrvjd`s * 3mhomft`s cmdMdmktr`kjrcl`hrjoj

3ftms cm k`omfzjr k`f dj cmskrlpklûf cm kjcj smhomft` m lftmrvjd`vjo`s j m


10/27

Lftmrprmtjklûf cmd MKH:k`rrmhlc` k`f dj =`roudj cm 7jzmtt (clvlclr md lftmrvjd` 9J mftrm dj rjïz kujcrjcj cmd lftmrvjd` ;;). Mdlftmrvjd` 9J k`rrmhlc` ms f`rojd mftrm ?* os $ *# os mf jcudt`s

ûvmfms (*E os mf omf`rms cm :# j"`s $ *@ os mf oumrms jcudtjs).

-3mhomft` 3=7 ;mprmsmftj uf pmrl`c` cm lfjktlvlcjc mftrm djcmsp`djrlzjklûf $ md lflkl` cm dj rmp`djrlzjklûf vmftrlkudjr.2`rojdomftm ms ls`mdìktrlk` $ vj cmscm md &fjd cmd 9;5 ajstj md lflkl`cm dj `fcj J (rmkumrcj j cl=mrmfklj cm d`s lftmrvjd`s md smhomft` 5Jf` lfkdu$m flfhufj ̀ fcj).8js jdtmrjkl`fms cmd 5mhomft` 5J rmvlstmf hrjf lop`rtjfklj mf mdcljhfûstlk` cm d`s 5ïfcròms K`r`fjrl`s 3huc`s.

Ylto` Kjrcljk`'`cmo`s cm&flr md ;lto` Kjrcljk` kò` dj sukmslûf cm d`s djtlc`s cmd k`rjzûf. Mf md kjs` cmdMdmktr`kjrcl`hrjoj ajidjrïjo`s cm dj sukmslûf cm kòpdm`s 9;5 mf md tlmop` !um curj md olso`.Md ;lto` Kjrcljk` ajiltujdomftm ms rmhudjr $ k`f =rmkumfklj kjrcljkj cmftr` cm dj f`rojdlcjc (mftrm Edpo $ : dpo) juf!um cmtmrolfjcjs mf=mromcjcms (3rrltoljs) pumcmf pr`v`kjr !um md ;lto` Kjrcljk`smj lrrmhudjr cmojsljc` r%plc` ` cmojsljc` dmft`.

Ylto` Kjrcljk` Ymh+djr7 Md prlomr pjs` cmd jf%dlsls cmd ;lto` Kjrcljk` ms cmtmrolfjr sl ms rmhudjr `lrrmhudjr. 'jrj mdd` cmimo`s omclr dj clstjfklj mftrm ; $ ; ( 6ftmrvjd` ;;) cm c`s djtlc`s k`fsmkutlv`s. 5lmd ;lto` ms rmhudjr mstj clstjfklj ms sloldjr cm uf djtlc` j `tr`.2`rojdomftm p`cmo`s mstlojr sl md rlto` kjrcljk` ms rmhudjr k`f s`d` olrjrd` pmr` mf kjs` cm cucjpumcms omclrd` k`f uf kòp%s ` ufj rmhdj.

2lk`d%s 5ldvj

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11/27

Lftmrprmtjklûf cmd MKH::Yltò Kjrcljk̀ Lrrmhudjr. Fûtmfsm d̀s clbmrmftms lftmrvjd̀s YY.

Ylto` 3lf+sjd7 Md ;lto` 5lfusjd ms md rlto` f`rojd cmd k`rjzûf. Ms pr`cuklc` p`r dj mstloudjklûf cmscmmd 2`c` 5lfusjd cm joijs 3urïkudjs pjsjfc` p`r md f`c` 3 $ p`stmrl`r k`fcukklûf j vmftrïkud`s p`r md/jz cm /ls $ rjojs 'urYlfm.

K`fcukklûf kjrcljkj y rmprmsmftjklûf mf md MKH

:4 Mstloudjklûf 5lfusjd $ cmsp`djrlzjklûf jurlkudjr (Bfcj ')+4 ;mtrjs` cmd mstïoud` j su pjs` p`r md f`c` 3 (5mhomft` ';)

?4 Cmsp`djrlzjklûf mftrlkudjr (9;5)*4 ;mp`djrlzjklûf mftrlkudjr (Bfcj J)

'jrj cmtmrolfjr sl uf mdmktr`kjrcl`hrjoj mst% mf ;lto` 5lfusjd cmim tmfmr djs slhulmftmskjrjktmrïstlkjs-Bfcj ' p`sltlvj mf cmrlvjkl`fms lf=mrl`rms (66 666 $ j>) $ prmk`rcljdms cm + j E fmhjtlvj mf j; $k`f =rmkumfklj lsìl=%slkj mf :.

• Kjcj Bfcj ' cmim lr smhulcj cm uf 9;5.

• Md lftmrvjd` ;; cmim smr k`fstjftm.

• Md lftmrvjd` '; cmim smr lhujd ` oj$`r cm :+ smhufc`s.

• 8j >rmkumfklj Kjrcljkj cmim mstjr mftrm E $ : djtlc`s p`r olfut`.Mf rmsuomf sl prmsmftj ufj `fcj ' slfusjd smhulcj slmoprm cm uf 9;5 k`f lftmrvjd` '; $ =rmkumfkljkjrcljkj f`rojd p`crmo`s lf=`rojr !um md mdmktr`kjrcl`hrjoj mst% mf ;lto` 5lfusjd.

Ylto` 3lf+sjd> kûo` rmk`f`kmrd` mf +fMdmktr`kjrcl`hrjoj

Md ;lto` 5lfusjd ms md rlto` f`rojd cmd k`rjzûf. Kò` lfclkj su fòirm sm lflklj mf md 2`c` 5lfusjd $rmk`rrm t`c` md 5lstmoj cm K`fcukklûf cmsp`djrlzjfc` prlomr` djs jurïkudjs $ p`stmrl`romftm d`svmftrïkud`s.3d smr md rlto` o%s =rmkumftm ms lop`rtjftm sjimr rmk`f`kmrd` mf uf Mdmktr`kjrcl`hrjoj. Mstjr smhur`!um uf MKH (MKH) mst% mf ;lto` 5lfusjd ms uf` cm d`s prlomr`s pjs`s pjrj md jf%dlsls cmd olso`.

Ujs`s pjrj rmk`f`kmr md Ylto` 3lf+sjd

2lk`d%s 5ldvj

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12/27

Lftmrprmtjklûf cmd MKH:+

Yltò [lfusjd j 8= dpo.

rmk+mfklj Kjrcljkj oj*`r cm (4 dpo * omf`r cm #44 dpo7 '`r k`fkmpt` md ;lto` 5lfusjdprmsmftj ufj >rmkumfklj Kjrcljkj oj$`r cm E dpo $ omf`r cm : dpo (vjd`rms omf`rms ` oj$`rmssmrïjf 7rjclkjrclj ` Jj!ulkjrclj 5lfusjd rmspmktlvjomftm)

Ylto ̀[lfusjd7

Lftmrvjd̀ YY oïflò (:55 dpo ? ; kujcr̀s) m Lftmrvjd̀ YY oêxlò (25 dpo ? = kujcr̀s).

K`o` md ;lto` 5lfusjd ms rïtolk` (vmr prûrmkumfklj Kjrcljkj mst% cmftr` cm djf`rojdlcjc.

Md Ylto` 3lf+sjd ms Ymh+djr7 Mf md ;lto` 5lfusjd md lftmrvjd` ;; ms k`fstjftm (` kjsl k`fstjftm).AKûo` sjimrd`L 3 vmkms j slopdm vlstj p`cmo`s cjrf`s kumftj pmr` mf kjs` cm cucj p`cmo`somclrd`s k`f ufj rmhdj ` k`op%s. 1f truk` slopdm ms ojrkjr ? 9;5 mf ufj a`j mf idjfk` $ cmspdjzjrdjs ojrkjs ajklj d`s slhulmftms sl k`lfklcmf md ;; ms k`fstjftm $ md ;lto` ms ;mhudjr.

Mf kjs` cm qum mstm smj dj ÷flkj k`fclklûf qum f` sm kuopdm, `smj uf rlto` lrrmhudjr k`f kjrjktmrïstlkjs slfusjdms p`crïjo`s

mstjr jftm ufj jrrltolj slfusjd.

=lmfm J+m ajimr fcjs U * tlmfmf J+m smr 3lf+sjdms7 Mf md ;lto` 5lfusjd djs 3urïkudjs smcmsp`djrlzjf p`r md lopuds` hmfmrjc` mf md 2`c` 5lfusjd sltujc` j hr`ss` o`c`, mf dj ms!ulfj supmrl`rcmrmkaj cmd k`rjzûf. '`r d` !um dj cmsp`djrlzjklûf sm rmjdlzjr% cm jrrlij ajklj jij` $ cm lz!ulmrcj jcmrmkaj.B d` !um ms d` olso` md mstïoud` sm jdmjr% cm j; m lr% mf clrmkklûf j 66 $ ajklj cmdjftm.'`r tjft` dj Bfcj ' 5lfusjd slmoprm smr% p`sltlvj mf t`cjs djs cmrlvjkl`fms m


13/27

Lftmrprmtjklûf cmd MKH:?

Ylto` 3lf+sjd m Lftmrvjd` UY jdjrhjc`7 2` aj$ uf jkumrc` hmfmrjd sìrm sl dj prmsmfklj cm uf6ftmrvjd` '; jdjrhjc` (oj$`r cm .+ smh) cmskjrtj md ;lto` 5lfusjd.8j oj$`rïj cm d`s jut`rms d` jkmptjf kò` ;lto` 5lfusjd p`r!um md mstïoud` sm trjsoltm p`r md slstmojcm k`fcukklûf s`djomftm prmsmftjfc` md rmtrjs` mf md 2`c` 3.5m cmskrlim- ;lto` 5lfusjd k`f 7d`!um` 3 cm prlomr hrjc` ` '; jdjrhjc`.

Yms+omf'jrj mstjr smhur`s !um mstjo`s jftm uf ;lto` 5lfusjd tmfmo`s !um vmr-

• >rmkumfklj Kjrcljkj mftrm E $ : dpo (;; mftrm ? $ # kujcr`s hrjfcms)

• Md lftmrvjd` ;; cmim smr k`fstjftm (;; lhujdms).

• Bfcj ' p`sltlvj mf 66 $ fmhjtlvj mf j;.

• Kjcj Bfcj ' cmim lr smhulcj cm uf 9;5.

• Md lftmrvjd` '; cmim smr lhujd ` oj$`r cm :+ smhufc`s.

5hrjfcjolmft` cm kjvlcjcms kjrcljkjsMs uf k`fuft` cm o`cl&kjkl`fms !um `kurrm mf md MKH kò` rmsudtjc` cmd juomft` cm dj ojsjouskudjr kjrcljkj cm + =`rojs cl=mrmftms-

:. /lpmrtr`&j kjrcljkj- mfhr`sjolmft` cm djs pjrmcms kjrcljkjs (pumcm smr &sl`d`hlkj ` pjt`dûhlkj)+. l`kjrcl̀ pjtïj cldjtjcj juomft` cmd v`duomf kjvltjrl` cmd ouskud`.

Md MKH f` pumcm cl=mrmfkljr dj alpmrtr`&j cm dj cldjtjklûf cm djs kjvlcjcms $j !um joijs sm trjcukmfcm =`roj lcìftlkj j trjvìs cm djs o`cl&kjkl`fms cmd v`dtjm $ o`r=`d`hïj cmd trjz`.

2lk`d%s 5ldvj


14/27

Lftmrprmtjklûf cmd MKH:*-3ìrmkjrhj j+rlk+djr cmrmkaj7 5m cjf p`r juomft` cmd v`duomf sjfhuïfm` ` p`r juomft` cmprmslûf hmfmrjc` p`r uf juomft` cm dj rmslstmfklj j flvmd vjdvudjr ` p`r alpmrtmfslûf pudo`fjr.

• Kjusjs--8t p+do`fjr-3ìrmkjrhj )K85-Mf:mromcjc vjdv+djr trlk+splcmj-Il`kjrcl`pjtlj cldjtjcj-Il`kjrcl`pjtlj rmstrlktlvj

•

Cljhf`stlk`-)mrlvjklûf :r`ftjd7

)#/)%/5"7 sm ìsmrvj `fcj ' jdtj $ plkucj k`f v`dtjm O.+#ov (O+.# ,+.#oo) $ sucurjklûf ms f`rojd.

5Y"7 `fcj ' 4

5"7 `fcj ' -)mrlvjklûf a`rlz`ftjd7

"#/"$7 `fcj ' jkuolfjcj mf =`roj cm tlmfcj cm kjopjfj O.+#ov (O+.#+.#oo) cm curjklûf f`rojd.

-3ìrmkjrhj j+rlk+djr lzJ+lmrcj7 sm cjf p`r juomft` cm prmslûf hmfmrjc` p`r juomft` cm djrmslstmfklj j flvmd cm djs v%dvudjs kjrcljkjs ` p`r alpmrtmfslûf jrtmrljd.

• Kjusjs-

-"jdv+d`pjtlj oltrjd-"jdv+d`pjtlj j`rtlkj-8lpmrtmfsl`f jrtmrljd-Dmsl`f ol`k


15/27

Lftmrprmtjklûf cmd MKH:#

"`dtjgm7-5"Y/"#/"$7 kòpdm`s 1R mf mspmkljd mf "#-"#/"$7 `fcj ; O.@ov (O.@oo @ )-"'/"(7 `fcj 5 O.@ov ((O.@oo @ )

-3t7 lf=rjcmsflvmd-=7 `p`fmftm jd 9;5 mf "#/"$

-3ìrmkjrhj vmftrlk+djr lzJ+lmrcj7 sm cjf p`r juomft` cm dj prmslûf hmfmrjc` p`r juomft` cm dj

rmslstmfklj j flvmd vjdvudjr kjrcljk` ` p`r alpmrtmfslûf pudo`fjr.• Kjusjs-

-8t jrtmrljd-Dmsl`f vjdv+djr j`rtlkj-3mk+fcjrlj j lsJ+molj krûflkj-Il`kjrcl`pjtlj alpmrtrû6kj-Lfs+6klmfklj oltrjd-5tdmtjs

• Cljhf`stlk`-fcj U7 prmsmftj trjz` cm sìrmkjrhj jurlkudjr 6X9 kò` slhf` lfclrmkt` cm dj 56 (curjklûfO.::smh O? )-;Y37 cmsvljc` ajklj dj lz!ulmrcj mftrm ?,4?.-;Y37

)+rjklûf7 f`rojd cm .Nsmh (+ )

I`r:`d`hj7 dlopl` slf omddjcurjs

"`dtjgm7-"'/"(/)#/5"D/5"7 kòpdm`s 1R jdt`s $ jfh`st`s-"'/"(7 `fcj ; O+.@ov (O+.@oo+ @ )-"$/"#7 `fcj 5 O.@ov (O+.*oo +* )

-3t7 lf=rjcmsflvmd-=7 `p`fmftm jd 9;5.

2lk`d%s 5ldvj


16/27

Lftmrprmtjklûf cmd MKH:E

Kjrcl`pjtj lsJ+,olkj8j Kjrcl`pjtïj 6s!uìolkj ms dj kjusj o%s =rmkumftm cm mdmvjklûf ` cmskmfs` cmd 5mhomft` 5J. Kujfcùfj rmhlûf cmd k`rjzûf su=rm ls!umolj pmrslstmftm sm hmfmrj ufj lojhmf cm dmslûf mf md MKHìsmrv%fc`sm vjrljklûf cmd smhomft` 5J $j smj uf jskmfs` ̀ uf cmskmfs` cmd olso` cmpmfclmfc` cmdhrjc` cm `kduslûf cm dj jrtmrlj k`r`fjrlj (suprj ` lf=rjcmsflvmd cmd 3=). Cmftr` cm djs k`fsmkumfkljs jkjusj cm ufj kjrcl`pjtïj ls!umolkj p`cmo`s mfk`ftrjr-

-Lf:jrt` jh+c` cm ol`kjrcl`7 sm kjrjktmrlzj p`r dj jpjrlklûf siltj $ mf hmfmrjd mf rmp`s` cm ufc`d`r `prmslv` prmk`rcljd lftmfs` !um =rmkumftmomftm sm lrrjclj (irjz` lz!ulmrc` ojfcliudj mplhjstrl`)oukajs vmkms jkòpj"jc`s cm ojfl=mstjkl`fms fmur`vmhmtjtlkjs (suc`rjklûf =rïj fjusmjsalp`tmfslûf jfslmcjc) $ !um f` kmcm jftm dj jcolflstrjklûf cm fltrlt`s p`r vlj suidlfhujd. 3 t`c` mstmkujcr` sm dm suoj jdtmrjkl`fms mdmktr`kjrcl`hr%&kjs $ o`vlolmft` mfzlo%tlk`.

• Kdjsl&kjkl`f smhf md tlmop` cm mv`duklûf--LsJ+molj7 cmtmrolfj uf rmtjrc` mf dj rmp`djrlzjklûf ` rmkupmrjklûf cm dj z`fj j=mktjcj surmpmrkuslûf sm f`tjrj mf dj `fcj = !um sm ajkm `p`fmftm $ sloìtrlkj lfclkjfc` dj ls!umolj cmdj z`fj.

LsJ+molj s+implkjrclkj7 `fcjs J ] cm rjojs sloìtrlkjs ($j !um md vmkt`r sm jdmj cm djz`fj j=mktjcj ]mplkjrcl`4 ajklj dj z`fj sjfj ]mfc`kjrcl`4).

LsJ+molj s+imfc`kjrclkj7 `fcjs J cm rjojs sloìtrlkjs ($j !um md vmkt`r sm jdmj cmdj z`fj j=mktjcj ]mfc`kjrcl`4 ajklj dj z`fj sjfj ]mplkjrcl`4).

-Dmsl`f kmd+djr rmvmrslidm7 sm kjrjktmrlzj p`r dmsl`fms mf dj omoirjfj kmdudjr cmd olskud`kjrcljk` hmfmrjfc` cmsm!uldlirl`s j flvmd l`flk` pr`cuklmfc` jdtmrjkl`fms mf md smhomft` 3= mfdjs cmrlvjkl`fms mf !um sm mfkumftrj dmsl`fjcj dj pjrmc cmd k`rjzûf.

• Dmsl`f s+implkjrclkj7 suprjcmflvmd cmd 3= mf cmrlvjkl`fms !um mf=rmftjf dj dmslûf (smj=mktj cm =`roj p`stmrl`r jd suimfc`kjrcl` cmilc` j su rlkj vjskudjrlzjklûf).

• Dmslûf s+imfc`kjrclkj7 lf=rjcmsflvmd cmd 3= mf cmrlvjkl`fms !um mf=rmftjf dj dmslûf(ms d` !um prlomr` sm ojfl&mstj jftm prumijs cm ms=umrz` $j !um mstm f` prmsmftjiumfj lrrlhjkl`f).

-!mkr`sls trjfso+rjd7 dj z`fj fmkr`sjcj aj pmrclc` su kjpjklcjc pjrj jktlvjrsm (aj pmrclc`sus vmkt`rms) p`r k`fslhulmftm md kòpdm` cm jktlvjklûf vmftrlkudjr sm jdtmrj lop`rtjftmomftm$j !um aj lfjktlvjklûf cm tmlc` fmkr`sjc` olmftrjs !um md rmst` cmd tmlc` sjf` sm jktlvjcòlfjfc` md kjop` mdìktrlk`.8j oj$`r pjrtm cm dj jktlvjklûf vmftrlkudjr mstj rmprmsmftjcj p`r md smptuo lftmrvmftrlkudjr $

pjrmc dlirm cmd vmftrïkud` lz!ulmrc` mf d`s prlomr`s .E,.E smh cm d`s jkklcmftms !um smlfskrlimf mf md kòpdm` 9;5 slmfc` mf mstjs prlomrjs p`rkl`fms cmd kòpdm` c`fcm smp`fcr%f cm ojfl&mst` d`s =mfûomf`s cm fmkr`sls.3d f` jktlvjrsm md tmlc` fmkr`sjc` dj `fcj cm jktlvjklûf sm clrlhlr% ajklj djs z`fjs sjfjsmskjpjfc` cm djs z`fjs fmkr`sjcjs p`r d` tjft` sl ms mf djs prlomrjs p`rkl`fms cmd 9;5 md=mfûomf` mdmktr`kjrcl`hr%&k` rmhlstrjc` smr% ufj fmhjtlvlcjc lflkljd `fcj ; -.

!mkr`sls s+imfc`kjrclkj7 f` jdtmrj md ;Y3

!mkr`sls s+implkjrclkj7 cjf fmhjtlvlcjc lfkljd ̀ fcj ;-

• 'jtmftms cm 63--L5I alpmrjh+c`7 suprjcmflvmd cmd 3=, `fcj = plkucj $ sloìtrlkj, lf=rjcmsflvmdms `pumst`s (mfmspm`).-L5I mf mv`d+klûf7 suprjcmflvmd cmd 3= $ puft` C md rmst` cmd 3= kruzj dj dïfmj cm ijsm $ smufm k`f ufj `fcj = fmhjtlvj $ sloìtrlkj, `fcj ; pjt`dûhlkj (fmkr`sls).

-L5I krûflk`7 smhomft` 3= ls`mdìktrlk`, `fcj = - $ sloìtrlkj, ̀ fcj ; pjt`dûhlkj.-L5I rmslc+jd7 flkjomftm ̀ fcjs ; pjt`dûhlkjs

• 8`kjdlzjkl`f- sm kdjsl&kjf d`s 63 mf ijsm j djs cmrlvjkl`fms j=mktjcjs.

-3mptjd7 "#-"$-5plkjd7 "%-"& 63 jftmrl`r-5ftmrl`r7 "# j "&-Djtmrjd7 "'-"( (ij`) )#-5"D (jdt`) 63 djtmrjd-5ftmr`djtmrjd7 )#-5"D-"# j "(-Lf:mrl`r7 )$-)%-5"

2lk`d%s 5ldvj


17/27

Lftmrprmtjklûf cmd MKH:@-U`stmrl`r7 "-"2-"B (sm cmtmrolfj j trjvìs cm "#-"$ 4`fcj Y jdtj !um rmprmsmftj ; pjt`dûhlkj,lf=rjcmsflvmd 3=, `fcj = .)

-3lfcròms k`r`fjrl`s jh+c`s slf mdmvjklûf cmd 3=7 sm kjrjktmrlzjf p`r dj jpjrlklûf siltj $ mfhmfmrjd cm rmp`s` cm c`d`r ls!uìolk` tïplk` (lftmroltmftm ` prmhrmslv` mf jfhlfj lfmstjidm).

Cljhf`stlk`- lf=rjcmsflvmd cmd 3= ` cm lfvmrslûf sloìtrlkj cm dj `fcj = dj flkj =`roj cmcl=mrmfkljr d`s kujcr`s ms ̀ itmflmfc` uf dji`rjt`rl` mfzlo%tlk` !um smr% mf d`s 63 f` ; $ ]mf djs jfhlfjs mstjidms9

-lsJ+molj krûflkj7 d`s sumt`s k`f ìstrukkl`f krûflkj (O@D cm dj duz) cm jdhufj cm djs k`r`fjrljsprmsmftjf mf hmfmrjd kujcr`s cm jfh`r ` clsfmj curjftm md ms=umrz` mo`kl`fms $ `trjs sltujkl`fms cmmstrìs amo`clf%olk` pmrojfmklmfc` jslftò%tlk` md rmst` cmd tlmop`. Md MKH vjrlj mf kujft` j djkdïflkj cm =`roj !um sm oumstrj f`rojd =umrj cm d`s mpls`cl`s c`d`r`s`s slmfc` !um curjftm mdms=umrz` jpjrmkmf slhf`s cm ls!umolj.-5fhlfj vjrljftm cm prlfzomtjd7 sm kjrjktmrlzj p`r dj jpjrlklûf siltj mf rmp`s` $ mf hmfmrjdcurjftm dj f`kam cm c`d`r prmk`rcljd jfhlf`s` mf sumt`s !um f` fmkmsjrljomftm tlmfmf ufjk`r`fjrl`pjtïj mstrukturjd. 8`s pjklmftms sumdmf prmsmftjr md =mfûomf` cm ;j$fjuc ` krlsls olhrj"`sjskò` rmsprmsmftjftms cm ufj jdtmrjklûf hmfmrjdlzjcj mf dj rmhudjklûf cmd t`f` vjskudjr.

• Kjusjs- j=mkkl`f cm dj vjs`k`fstrlkklûf k`r`fjrlj.

• Cljhf`stlk`- curjftm d`s pmrl`c`s jslftò%tlk`s md MKH ms f`rojd curjftm djs krlsls sm jprmkljmf djs cmrlvjkl`fms !um olrjf jd %rmj j=mktjcj ufj mdmvjklûf lop`rtjftm cmd smhomft` 3= !um

jsmomj pjtmftm cm 63 alpmrjhuc` !um f` mv`dukl`fj ajklj fmkr`sls slf` !um rmvlmrtm.-Umrlkjrcltls jh+cj- ms ufj mftlcjc p`k` =rmkumftm j vmkms pumcm mft`rpmkmr md cljhf`stlk` cm d`ssïfcròms ls!uìolk`s jhuc`s (mf mspmkljd md 63) $j !um dj pmrlkjrcltls kursj k`f c`d`r t`r%klk` $jdtmrjkl`fms cmd MKH !um pumcmf cjr duhjr j dj k`f=uslûf. 5lf moijrh` pjrj ddmhjr jd CQ cm ufjpmrlkjrcltls f` s`d` sm cmim prmstjr jtmfklûf mf md MKH slf` !um tjoilmf mf d`s slhf`s kdïflk`s !um mdpjklmftm prmsmftj (&mirm ` =mirïkudj m


18/27

Lftmrprmtjklûf cmd MKH:N

d`J+m`s lftmrvmftrlk+djrms5m d` cm&fm kò` dj lftmrrupklûf ` rmtjrc`s mf dj pr`pjhjklûf cmd mstloud` slfusjd mfkjrhjc`s cmpr`cuklr dj cmsp`djrlzjklûf vmftrlkudjr mstj lftmrrupklûf pumcm smr t`tjd ` pjrkljd p`r cmij` cm djsrjojs cmd ajz cm als rmc 'urYlfm ` ol`kjrcl` vmftrlkudjr. Md k`rjzûf jfjtûolkjomftm mstj =`rojc` p`r+ rjojs mfkjrhjcjs cm clstrliulr md lopuds` mdìktrlk` p`r t`c` md ol`kjrcl` vmftrlkudjr mddjs s`f--Yjoj cmrmkaj7 mstj rjoj mst% =`rojcj p`r ufj =jskïkud` djrh` $ cmdhjc` cm &irjs ouskudjrmskjrcljkjs mfkjrhjcjs cm dj k`fcukklûf cmd mstloud` mdìktrlk` clstrliu$mfc` d`s lopuds`s mdìktrlk`s p`rmd vmftrïkud` cmrmka`.-Yjoj lzJ+lmrcj7 sm clvlcm mf + =jsklkud`s-

:. 3ftmrl`r- ms mf rmjdlcjc jftmr`supmrl`r mstj rjoj mst% =`rojcj p`r ufj =jskïkud` djrh` $ cmdhjc`(kòpjrjc` k`f md p`stmrl`r) cm &irjs ouskudjrms kjrcljkjs mfkjrhjcjs cm dj k`fcukklûf cmdmstïoud` mdìktrlk` clstrliu$mfc` d`s lopuds`s mdìktrlk`s p`r dj p`rklûf jftmrl`r $ supmrl`r cmdvmftrïkud` lz!ulmrc`. Mstj rjoj ms dj ojs vudfmrjidm j su=rlr id`!um`s cmilc` j dj ijjrmslstmfklj !um mstj prmsmftj kujfc` md k`rjzûf sm j=mktj.

+. '`stmrl`r- ms mf rmjdlcjc p`stmr`lf=mrl`r mstj rjoj mst% =`rojcj p`r ufj =jskïkud` k`rt` $ hrums`(kòpjrjc` k`f dj jftmr`lf=mrl`r) cm &irjs ouskudjrms kjrcljkjs mfkjrhjcjs cm dj k`fcukklûfcmd mstïoud` mdìktrlk` clstrliu$mfc` d`s lopuds`s mdìktrlk`s p`r dj p`rklûf p`stmrl`r m lf=mrl`r cmdvmftrïkud` lz!ulmrc`. Mstj rjoj ms dj omf`s vudfmrjidm j su=rlr id`!um`s cmilc` j dj jdtjrmslstmfklj !um mstj prmsmftj kujfc` md k`rjzûf sm j=mktj.

5m clkm mf dj kdïflkj !um aj$ uf id`!um cm rjoj kujfc` mf prmsmfklj cm uf rlto` suprjvmftrlkudjr d`skòpdm`s 9;5 tlmfmf curjklûf juomftjcj prmsmftjfc` oumskjs $ mopjstjolmft`s. Md 39;5 sm cmsvljajklj md djc` j=mktjc` $ dj `fcjs cm rmp`djrlzjklûf sm mfkumftrjf o`cl&kjcjs mf =`roj smkufcjrlj.'`cmo`s mfk`ftrjr d`s slhulmftms id`!um`s--d`J+m` cm rjoj cmrmkaj7 kujfc` sm pr`cukm uf id`!um cm rjoj cmrmkaj md mstloud` cmsklmfcmp`r dj rjoj lz!ulmrcj jktlvj md tmrkl` omcl` cmd smptuo lftmrvmftrlkudjr $ sm =`roj md : vmkt`r smptjd djpjrmc dlirm cmd 6 sm cmsp`djrlzj f`rojdomftm p`r d` !um dj lfskrlpklûf cmd vmkt`r + ms f`rojd. 1fj vmz

cmsp`djrlzjc` md 6 fjkmf clp`d`s cm jktlvjklûf !um cmsp`djrlzjf md C j trjvìs cmd smptuo krmjfc` mdsjdt` cm `fcj.

• Kjusjs--!lA`s js`kljc`s j klmrtjs kjrcl`pjtljsk`fh,fltjs-Kjrcl`pjtj kajhjslkj-8=5-LsJ+,olj-K`r p+do`fjdm-L5I7 ms ou$ =rmkumftm mfk`ftrjr id`!um`cm rjoj ckaj mf mstj pjt`d`hlj

• Kdjsl&kjkl`f--Kòpdmt`7 dj curjklûf cmd 9;5 ms O.:+smh (O? )-Lfkòpdmt`7 dj curjklûf cmd 9;5 msF.:+ smh (F? )

Cljhf`stlk`--5;Y37 f`rojd ` cmsvljc` ajklj dj cmrmkaj-;Y37

• )+rjkl`f7 pr`d`fhjcj O.N smh (O+ )

• I`r:`d`hlj7 d` ojs ddjojtlv` ms ìsrvjr kòpdm`s rsY (`rmjs cm k`fm`) mf "# k`f djY &fjd omddjcj jpjrmkmf 3 pr`=ufcjs $ omddjcjs mf )#/"'/"( $ kòpdm`s ;Y k`f Y omddjcj mf 5"Y

2lk`d%s 5ldvj


19/27

Lftmrprmtjklûf cmd MKH:

"`dtjgm7-3=-=7 lfvmrtlcj $ jsloìtrlkj mf "#/"$

-d`J+m` cm rjoj lzJ+lmrcj7 kujfc` md mstloud` f` sm k`fcukm j trjvìs cm dj rjoj lz!ulmrcj f` sm=`roj md vmkt`r cm jktlvjklûf smptjd md vmkt`r: jktlvj jd 6 j trjvìs cm dj p`rklûf ijj cmdsmptuo $ md vmkt`r + mf su p`rklûf omclj. Mdvmkt`r ? rmprmsmftj dj jktlvjklûf cm dj pjrmc

dlirm cmd 6. K`o` md mstloud` f` vljj p`r mdslstmoj cm k`fcukklûf mspmkl&k` k`fclkl`fjufj cmsp`djrlzjklûf dmftj trjcuklìfc`sm p`rmfsjfkajolmft` cmd 9;5. 8`s id`!um`s cmrjoj lz!ulmrcj s`f slmoprm pjt`dûhlk`stmflmfc` uf pr`fûstlk` f` ou$ jdmftjc`r.

• Kjusjs--Mf:mromcjc k`r`fjrlj jh+cj-8=5 . )=-Il`kjrcl`pjtljs-lir`sls lfmspmk6kj . kjoil`s mskdmr`cmhmfmrjtlv`s

-Il`kjrcltls• Cljhf`stlk`-

-5;Y37 cmsvljc` ajklj dj lz!ulmrcj ?,4?-;Y37

• )+rjklûf7 pr`d`fhjcj O.N smh (O+ )

• I`r:`d`hlj7 jusmfklj cm `fcjs ; $ 3 mf)#/5"D/"'/"( s`d` m


20/27

Lftmrprmtjklûf cmd MKH+

• jrljftms-8molid`J+m` jftmrl`r lzJ+lmrc`7 dj jktlvjklûf lflkljd cmd vmkt`r : mf d`s vmftrïkud`s ms lhujd!um mf uf k`rjzûf f`rojd p`r d` tjft` )# rmhlstrj ufj `fcj ; $ )% oumstrj ufj `fcj Y. Md=jskïkud` p`stmrl`r cmsp`djrlzj dj p`rklûfp`stmrl`r k`f ufj cmo`rj olfloj.

Cljhf`stlk`-45;Y37 cmsvljc` ajklj dj lz!ulmrcj 4*#` O4*#4;Y37

)+rjklûf7 f`rojd .N smh (+)

I`r:`d`hlj7 kòpdm`s r3 mf )$fmhjtlv`s> )% ms ojs fmhjtlv`!um mf )$ $ mf 5" mslftmromcl` k`f rmspmkt` j )$/)%$ jpjrmkmf kòpdm`s JY mf )#/5"D

"`dtjgm7-3=-=7 dj rmp`djrlzjklûf ms f`rojd.

-8molid`J+m` p`stmrl`r lzJ+lmrc`7 Ms omf`s =rmkumftm !um md jftmrl`r. 'umcm prmsmftjrsm mfpjklmftms k`f kjrcl`pjtïj 6s!uìolkj /35 $ mf=mromcjc vjdvudjr.Ms md omf`s =rmkumftmomftmmfk`ftrjc` mf pjklmftms k`f 63.

d`J+m`s 5"K`fuft` cm trjst`rf`s cm dj k`fcukklûf kjrcljkj !um smkjrjktmrlzjf p`r md rmstrjc` ̀ md id`!um` cm d`s mstloud`scmscm dj ouskudjturj jurlkudjr j dj vmftrlkudjr p`rjdtmrjklûf cmd slstmoj mspmkï&k` cm k`fcukklûf !um ufmjoijs mstrukturjs kòpumst` p`r md f`c` 3 md ajz cm/ls su rjoj cmrmkaj m lz!ulmrcj $ md als4purYlfm. Cjc`!um s`f trjst`rf`s cm dj k`fcukklûf sm d`s p`crïj lfkdulrcmftr` cmd kjpltud` cm jrrltoljs kò` ufj irjcljrrltolj.8js kjusjs pjrj mst`s id`!ums s`f pjrj t`c`s p`r lhujdmddjs s`f--K`fhmflt`-5cJ+lrlcjs

•

jhjd• Cr`hjs

• 3dtmrjkl`fms lûflkjs

• >lir`sls cmd slstmoj cm k`fcukklûf

• Mf=mromcjc cm 8mv $ cm 8mfmhrm

• 6f=mkkl`fms ol`kjrcltls $ ol`kjrcl`pjtïjs

• Mf=mromcjcms rmuo%tlkjs $ k`djhmf`sls

• Kjrcl`pjtïj ls!uìolkj

• Juo`rms $ !ulstms kjrcljk`s

• Jrjs klruhïj kjrcljkj.

2lk`d%s 5ldvj


21/27

Lftmrprmtjklûf cmd MKH+:• '`r jidjklûf cmd f`c` 3urlkud`vmftrlkudjr

• jdvud`pjtïj oltrjd $ jûrtlkj.M rmlflkljfc` md klkd`.

?. 7d`!um` 3 cm + hrjc` oj$`r- sm plmrcm uf kòpdm` ;Y3 kjcj c`s `fcjs U (jdtmrfj uf djtlc`f`rojd $ uf` id`!umjc`) d`s lftmrvjd`s UY mst%f pr`d`fhjc`s.

-d`J+m` 5" cm % hrjc` ` kòpdmt`7 mf mstm kjs` flfhf lopuds` suprjvmftrlkudjr jdkjfzj mdol`kjrcl` vmftrlkudjr p`r d` !um djs jurïkudjs $ vmftrïkud`s djtmf lfcmpmfclmftmomftm j rlto` $=rmkumfkljs cl=mrmftms. Mf mstm id`!um sm pumcmf vmr `fcjs U cmspmrclhjcjs rmhudjromftm j d` djrh` cmdtrjz` slf mstjr mf rmdjklûf k`f d`s kòpdm`s ;Y3 (oukajs vmkms jpjrmkmf p`r mfkloj cm d`s olso`s).8`s vmftrïkud`s jd f` rmklilr ufj `rcmf ` sm"jd mdìktrlkj jurlkudjr !um d`s cmsp`djrlzm cmsplmrtjf supr`pl` jutòjtlso` hmfmrjfc` kòpdm`s ;Y3 jfka`s $ mopjstjc`s j ufj >K cm ?#8po (rlto`lcl`vmftrlkudjr). Mstj >k ms tjf ijj !um cmskòpmfsj amo`clfjolkjomftm jd pjklmftm p`r d` !umrm!ulmrm lopdjftjklûf cm ojrkjpjs`s cm&fltlv`.

2lk`d%s 5ldvj


22/27

Lftmrprmtjklûf cmd MKH++

5rrltoljs5m cmfòlfj jrrltolj j t`cj jdtmrjklûf cmd rlto` slfusjd f`rojd rmk`rcmo`s !um md rlto` slfusjd f`rojdms ufj sukmslûf rmhudjr cm klkd`s k`f=`rojc`s p`r ufj `fcj U smhulcj cm uf lftmrvjd` UY f`rojd !umsm k`ftlfuj k`f uf kòpdm` ;Y3 jfh`st` $ f` omddjc` pjrj dumh` smhulr k`f uf smhomft` 3= j ufj >kcm mftrm E $ :8po. '`r d` tjft` p`cmo`s k`fslcmrjr !um mk p r̀ =umrj cm d`s dloltms omfkl`fjc`s FE,O: 8po.

8js jrrltoljs pumcmf kjdsl&kjrsm mf kujft` j su `rlhmf mf--3+prjvmftrlk+djr7 oumstrjf slmoprm kòpdm`s ;Y3 mstrmka s̀ $ dlopl`s F.:+ smh (F* ) mstjs s`fsukmptlidms cm o`cl&kjkl`fms mf su =rmkumfklj j trjvìs cm ojflìrjs vjhjdms (ojsjm kjr`tlcm` `kòprmslûf ̀ kudjr)

-"mftrlk+djr7 oumstrjf kòpdm`s ;Y3 jfka`s $ omddjc`s O.:+ smh (O* ) k`f jusmfklj k`fstjftmcm `fcj U9 5m >k f` sm o`cl&kj ij` flfhufj ojflìrj.

=jJ+lkjrclj * rjclkjrclj 3lf+sjdKujfc` dj brmkumfklj kjrcljkj supmrj d`s :55 dpo, dj cmfòlfjo`s Sjqulkjrclj y kujfc` ms omf`r cm 25 dpo, jcmfòlfjo`s Irjclkjrclj.

=jJ+lkjrclj 3lf+sjd7 Md mdmktr`kjrcl`hrjoj kuopdm t`cjs djs kjrjktmrïstlkjs cmd ;lto` 5lfusjd dj uflkjjdtmrjklûf !um jpjrmkm mf md MKH ms md juomft` cm dj >K k`f vjd`rms cm ajstj :+ ` :* 8po.

2lk`d%s 5ldvj


23/27

Lftmrprmtjklûf cmd MKH+?

Sjqulkjrclj [lfusjd j :;2 dpo

8j Jj!ulkjrclj 5lfusjd f`rojdomftm f` trjcukm ufj j=mktjklûf kjrcl`dûhlkj jpjrmkm mf pmrs`fjsf`rojdms k`f dj jktlvlcjc =ïslkj jfslmcjc mstrìs (&sl`dûhlkj). Jjoilìf jpjrmkm smkufcjrlj jmf=mromcjcms !um rm!ulmrjf uf oj$`r k`fsuo` cm `k FE 8po.

Irjclkjrclj [lfusjd j 31 dpo

8j irjclkjrclj 5lfusjd f` slhfl&kj slmoprm pjt`d`hïj kjrcljkj. Ms =rmkumftm mf d`s cmp`rtlstjs $ mfpjklmftms k`f trjtjolmft` k`f =%rojk`s !um mfdmftmkmf dj >rmkumfklj Kjrcljkj (7mtjid`!umjftms3ftljrrïtolk`s `pl`lcms jol`cjr`fj) alp`tlr`lclso` 63 cm kjrj lf=mrl`r alp`tmrolj alpmrtmfslûfmfc`krjfmjd.

Kujfc` dj Irjclkjrclj [lfusjd prmsmftj brmkumfkljs ouy ijgjs (omf`rms cm 35 dpo) ` msslftòêtlkj (ojrm`s, sïfk`pms ` mpls`cl`s prmslfk`pjdms), slf trjtjolmft` qum dj gustlqum,

sm cmimrê cmskjrtjr fbmromcjc cmd !`c` [lfusjd u `trjs irjcljrrltoljs"

tr`s tlp`s cm rlto`s8js 3rrltoljs Kjrcljkjs s`f trjst`rf`s cmd rlto` kjrcljk` !um mf dj oj$`rïj cm d`s kjs`s cl&mrm cmd;lto` 5lfusjd. 3 k`ftlfujklûf tlmfms ufj dlstj cm djs o%s =rmkumftms. 5l cmsmjs o%s lf=`rojklûf sìrmkujd!ulmrj cm mddjs pumcms pudsjr mf su fòirm m lr j dj p%hlfj k`rrmsp`fclmftm.

-=jJ+ljrrltoljs7:. 3rrltoljs 5uprjvmftrlkudjrms#

-=jJ+lkjrclj 3lf+sjd7 Md mdmktr`kjrcl`hrjoj kuopdm t`cjs djs kjrjktmrïstlkjs cmd ;lto` 5lfusjd

dj uflkj jdtmrjklûf !um jpjrmkm mf md MKH ms md juomft` cm dj >K k`f vjd`rms cm ajstj :+ `:* 8po.-=jJ+lkjrclj pjr`0stlkj s+prjvmftrlk+djr7 jrrltolj lf=rmkumftm !um `kurrm p`r omkjflso`scm rmmftrjcj mftrm jurïkudjs $ vmftrïkud`s j trjvìs cm uf ajz 3 jimrrjftm (/jz cm Zmft).Hmfmrjf rlto`s rmhudjrms cm :*8po !um ddmhjf jd puft` cm cmskòpmfsjr jd pjklmftm.

• Kujsjs- kujfc` p`r ufj m


24/27

Lftmrprmtjklûf cmd MKH+*

-d+ttmr 5+rlk+djr7 ms ufj jrrltolj kjusjcj p`r uf klrkult` cm rmmftrjcj mf djs jurïkudjs (o%s=rmkumftm mf jurïkudj cmrmkaj) !um sm jut`4pmrpmtj cm =`roj klrkudjr mf md lftmrl`r cm djolsoj pr`cuklmfc` ufj mstloudjklûf jurlkudjr k`f =rmkumfkljs ou$ mdmvjcjs mftrm +* $ ?#dpo pmr` kò` mf `trjs Jj!ulkjrcljs 5uprjvmftrlkudjrms dj >rmkumfklj Kjrcljkj (=rmkumfkljvmftrlkudjr) f`rojdomftm ms omf`r p`r!um md f`c` jurïkud`4vmftrlkudjr f` sumdm tmfmr djkjpjklcjc cm k`fcuklr lopuds`s jd vmftrïkud` k`f =rmkumfkljs tjf mdmvjcjs j rjzûf cm +,?,* j :mf dj oj$`rïj cm d`s kjs`s cmtmrolfjfc` =rmkumfkljs cm puds` cm :#,:,@#,E p`r olfut`.(vmr sïfcròms cm prmm3 `lfkdus` j vmkms sm vj jdtmrfjfc` j d`s djrh` cmd trjz` trjo`s cm jdmtm` k`f trjo`s cm >3(&ir`jdmtm`)

• Kjusjs- klrkult`s cm rmmftrjcj tjoilmf ddjojcj ajz cm Zmft.

• Cljhf`stlk`- md MKH oumstrj ufj jrrltolj k`f jusmfklj cm `fcjs U k`f ufj dïfmj cm ijsmjsmrrjcj ]clmftms cm tliurûf4 (`fcjs ) !um sm lftmrruopm s`d` curjftm md trjzjc` cm d`skòpdm`s ;Y3 !um mst`s s`f mstrmka`s F.:+ smh9 8j =rmkumfklj jurlkudjr ms mftrm+#,?8po olmftrjs !um dj vmftrlkudjr ms cm :#8po jpr`rmkumfklj Kjrcljkj lf=mrl`r j dj=rmkumfklj jurlkudjr.

• Cljhf`stlk`- sm kjrjktmrlzj p`r dj jusmfklj cm `fcjs U trmoudjkl`f k`ftlfuj cm dj dïfmjcm ijsm ddjojcj ̀ fcj (&irldjklûf) $ t`tjd jslomtrïj mftrm d`s lftmrvjd`s Y-Y k`fsmrvjfc` dj o`r=`d`hïj cmd kòpdm` ;Y39

-=jJ+lkjrclj 5+rlk+djr mkt`plkj7 (mr m


25/27

Lftmrprmtjklûf cmd MKH+#-=jJ+lkjrclj vmftrlk+djr7 /jidjo`s cm Jj!ulkjrclj mftrlkudjr (J) kujfc` jpjrmkmf trms `o%s djtlc`s cm ̀ rlhmf vmftrlkudjr sukmslv`s cjc` p`r lfkrmomft` cm jut`ojtlso` ̀ p`rrmmftrjcj cmd mstloud`.

• Kdjsl&kjkl`f--)+rjklûf G%4 smh+fc`s- Jj!ulkjrclj mftrlkudjr f` 5`stmflcj (J25)-)+rjkl`f N%4 smh+fc`s7 Jj!ulkjrclj mftrlkudjr 5`stmflcj (J5) (` prmklsjkjrcl`vmrslûf mdìktrlkj)

• Kjusjs-

-LsJ+molj jh+cj7 cmilc` j omkjflso`s cm rmmftrjcj mf djs rmhl`fms cj"jcjs p`r uflf=jrt`.-5klc`sls-)msmJ+ldlirl` mdmktr`dtlk`-=û0lk`s/vmfmf`s/:k :#,:N8po ̀ fcjs U jusmftms m


26/27

Lftmrprmtjklûf cmd MKH+E• M=mkt` i4jcrmfmrhlk`-

43uomft` cmd jutòjtlso` kjrcljk`43uomft` cm dj =rmkumfklj kjrcljkj43uomft` cm dj k`ftrjktldlcjc ol`kjrclkj

$% c`sls l&'l` # 5,5$ o' (5,$ od' cm dj s`dukl`f $# $5555)"*jr` slf puds`# +% c`sls y slulmftms# 5,$ o' (5,$ od' cm dj s`dukl`f $#

$555) " -j. # 5,+ o'-Dlc`kjfj7

•

Kdjsm 647 - 3k`rtj dj curjklûf cmd p`tmfkljd cm jkklûf• Ms md o%s m&kjz pjrj md trjtjolmft` cm djs jrrltoljs vmftrlkudjrms hrjvms.

• 2` jdjrhj md '; fl mfsjfkaj md 9;5\ f` o`cl&kj dj curjklûf cmd lftmrvjd` 9J.

• 2` sm jis`rim p`r vïj `rjd

• K`f uf s`d` i`d` md m=mkt` jftljrrïtolk` curj :4+ olf pmr` trjs sujcolflstrjklûf k`ftlfuj dj vlcj omclj cm mdlolfjklûf ms cm :#4+ a.

• C`sls lf=uslûf- + h,Yh,olf lf=uslûf puclmfc` juomftjr pr`hrmslvjomftm ajstj#\ cmim k`ftmfmr :+ oh cm dlc`kjlfj mf : od cm s`duklûf hduk`sjcj jd # D.

-d+ttmr vmftrlk+djr7 sm d` ìsmrvj kò` uf trjz` slfus`lcjd smrruka` cm clmftms djrh`s k`fkòpdm`s ;Y3 ou$ jfka`s $ smhomft`s 3=-= jusmftms. Md rlto` kjrcljk` ms cm ? p`r olfut`.

-=jJ+lkjrclj vmftrlk+djr mktûplkj7 (mr mk FE 8po.

-5rrltolj 3lf+sjd 6sl`d`hlkj7 8j 3rrltolj 5lfusjd sumdm smr uf ajddjzh` kjsujd mf fl"`s $ ûvmfms. 2`rojdomftm ms jslftò%tlkj $ f` sm js`klj j pjt`d̀ hïj kjrcljkj su prlfklpjdkjrjktmrïstlkj mf md MKH ms ufj vjrljklûf cm dj =rmkumfklj kjrcljkj cmd 2`c` 5lfusjd (` vjrljklûf

cm d`s 6ftmrvjd`s Y-Y ` U-U) mf rmdjklûf k`f dj ;msplrjklûf juomftjfc` curjftm dj lfsplrjklûf(juomftj cmskjrhj vjhjd) $ clsolfu$mfc` curjftm dj msplrjklûf (prmvjdmkm t`f` slop%tlk`). Mst``kurrm p`r djs o`cl&kjkl`fms cmd t`f` vmhmtjtlv` curjftm dj rmsplrjklûf.

2lk`d%s 5ldvj

http://www.my-ekg.com/arritmias-cardiacas/sindromes-preexcitacion.htmlhttp://www.my-ekg.com/arritmias-cardiacas/bradiarritmias-nodo-sinusal.htmlhttp://www.my-ekg.com/arritmias-cardiacas/sindromes-preexcitacion.htmlhttp://www.my-ekg.com/arritmias-cardiacas/bradiarritmias-nodo-sinusal.html


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Lftmrprmtjklûf cmd MKH+@

+j `fcj ms slfusjd % cmimrê smr smhulcj cm uf -$[ k`f uf lftmrvjd` $ f`rojd.

-3fcròm rjclkjrclj-=jJ+lkjrclj7 sïfcròm !um sm kjrjktmrlzj p`r dj prmsmfklj cmmpls`cl`s cm irjclkjrclj slfusjd smvmrj slfk`pms $ j vmkms 6K cmilc`s j ufj cls=ufklûf slfusjd`rhjflkj. 3pjrmkm =rmkumftmomftm mf pmrs`fjs O# j"`s k`f kjrcl`pjtïj cm ijsm.

• Cljhf`stlk`- sm ojfl&mstj mf md MKH j trjvìs cm ufj irjclkjrclj slfusjd smvmrj(pmrslstmftm ` f`) sìrm dj !um =rmkumftmomftm jpjrmkmf pjr`s slfusjdms cm curjklûfvjrljidms (mst`s pr`cukmf d`s slfk`pms) !um s`f smhulc`s p`r tj!uljrrltoljsprlfklpjdomftm cm >lirldjklûf 3urlkudjr juf!um tjoilìf pumcm jpjrmkmr >duttmr 3urlkudjr` Jj!ulkjrcljs 3urlkudjrms.

-Ujr` 3lf+sjd7 =rjkjs` cmd f`cudj slfusjd pjrj pr`cuklr uf fumv` mstloud` mf md tlmop`mspmrjc` kò` k`fsmkumfklj pumcmf jpjrmkmr djtlc`s cm mskjpm hmfmtjc`s p`r `tr`s kmftr`s cmjutòjtlso` !um f`rojdomftm mst%f djtmftms (f`cud` 3 slstmoj cm k`fcukklûf vmftrlkudjr) ̀pr`cukmf slfk`pm (sl md pjr` ms pr`d`fhjc`).

• Cljhf`stlk`- dj prlfklpjd kjrjktmrïstlkj cm dj 'jusj 5lfusjd ms md jdjrhjolmft` cmdlftmrvjd` mftrm c`s `fcjs U cjfc` dj loprmslûf cm !um =jdtj uf 9;5. 3 cl=mrmfklj cmd

7d`!um` 5lf`jtrljd mf dj 'jusj 5lfusjd d`s lftmrvjd`s '4U prmvl`s s`f k`fstjftms $ mdlftmrvjd` U-U !um lfkdu$m dj pjusj ms omf`r !um md cìdm cm d`s prmvl`s (dj slhulmftm `fcjU jpjrmkm =umrj cmd klkd` ajiltujd).

+. 7d`!um` 3urïkud`4mftrlkudjrms--d`J+m` 5" cm #mr hrjc` cm-d`J+m` 5" cm $? hrjc`

•

ìltz 6 (=mfûomf` cm [mfkYmijka)• ìltz 66\

-d`J+m` 5" cm $ hrjc` hrjvm9-d`J+m` 5" cm %mr hrjc`9
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