PQRST P : Depolarization & contraction of atria. QRS complex: represent depolarization & contraction of ventricle.

T : repolarization of

QRS : phc hp xung lan n tm tht P- Q : total electrical activity of ventricle. ST segment: the G point RR interval : rate of ventricular contraction PP interval: Rate of atrial contraction - Generally PP = RR; - PQRST : form the iso-baseline

3 thi k pht in ch yu : kh cc nh ( tht( QRS), v ti cc tht ( sng T) V do 3 trc in tng ng ca 3 thi k .Nhng qu trnh in hc ch yu ca tim nn trc trung bnh ca tim hay cn gi l trc in

sng P), kh cc ta c th v c v kh cc tht l QRS c gi l trc tim

Time & ECG determination - Tnh QTc chnh xc -> check prolong QT ( QT ko di) QT> 0.5 RR -> coi nhu prolonged QT (Nhp QT b di) PR interval : QRS QT 3-5 ss <= 3ss (small square) < 11ss

=> reference link Youtube: ECGTeacher.com section part

Main components of conducting system in heart : -SA -AV - Bunch of His - RBB (BB Bundle Branches: b nhnh) -LBB

In ECG:

BO CO: CC BNH V TIM

* i tng : Hin tng lch trc tri v trc phi . * Nguyn nhn Lch trc tri: -Block phn nhnh tri trc
- Block nhnh T - Ph i tht T - Nhi mu c tim vng di - C honh b nng ln.

Lch trc phi:

- Ph i tht P. - Block phn nhnh tri sau.

- NMCT vng bn - Bnh phi tc nghn mn tnh (thng khng >+110 ).

Tn hiu kh cc (depolarization signal) vs Tn hiu ti cc (Repolarization signal) Sng trn ng ng in tng ng vi qu trnh kh cc (polarization) tin n in cc cn o. Depolarization i ra khi in cc -> sinh ra sng di ng ng in. (isoelectric) i vo -> sng trn ng ng in Repolarization (ti cc) c cc ngc li so vi qu trnh kh cc. i vo -> sng di ng ng in i ra -> sng trn ng ng in

Clip section 1 part 2 : ti sao qu trnh kh cc li i khi o trnh V6? Ti sao qu trnh ti cc tn hiu ti cc li i vo V1?

- Bin ca tn hiu in tim o c trn paper t l vi khi lng ca c to ra s kh cc . The more muscle present , the more electrical signal the ECG machine detects Tm tht tri nng hn tm tht phi -> tm tht tri chim u th hn trong vic to ra tn hiu in tm tht. - Sau khi kh cc xong, qu trnh ti cc ti tm tht din ra. - ng ngang : khng c qu trnh kh cc hoc ti cc no xy ra. Tip sau s n qu trnh ti cc tm tht.

- Kh cc tm nh to ra tn hiu in yu, kh cc tm tht to ra tn hiu in r rt hn. - Nhp tim chy 25mm /s - 1 vung to l 5 mm ,=> 0.2 s , 1 vung nh l 1mm ,=> 0.04 s HR = heart rate Nhp tim khng ging nhau do qu trnh th ra v ht vo ( expiration vs inspiration) - S dng RR interval technique ( khong cch gia 2 nh RR) - m 30 to do nhp tim th ra ht vo khc nhau

Section1 part 5: * Cc tham s lin quan ca th ECG: - Hu nh s hn lon lin quan n nhp tim PQ PR : 3-5 small square ()

- QRS <= 3 ss - QT : HR =60 bpm ( beat per minute) QT < 0.44s ; QT < 11 ss ( small square) - QT thay i khi nhp tim thay i. Khi nhp tim tng ln th on QT s ngn li. Vi nhp tim cao hn => c th b m ln vi ng ngang ( mix the underline interval). * Xc nh di QTc (ng) =

Trong QT l QT nhn thy trn thit b o RR: khong cch gia 2 nh S. QT <= 11ss

* Section 2 part 2 : - Tn hiu kh cc lc u to ra nh QRS nhn ln - Tn hiu kh cc sau 1 lc to ra on sng RS lm xung t ( do vector ca tn hiu ny nh). - Vector tn hiu kh cc gc i vo in cc ty gc s to ra cc tn hiu in khc nhau. - Tn hiu o c trn bng : + Vector tng hp in gc so vi cc trc in cc chun.

* Section 2 part 3: - Deviation of cardiac axis: + Qu trnh hnh thnh tng hp vector kh cc tm tht. The direction of total frontal QRS vector Chiu ca frontal QRS vector chim u th do qu trnh kh cc c tm tht tri c khi lng ln. (large left ventricular muscle mass)

The pattern of depolarization of the left ventricle is intern dictated by the precise anatomy of the intraventricular conducting system. - Ta gi s rng cc b c l cc thc th n nh trn hnh v. - Quan tm n cc b nhnh bn tri. * Xt v mt gii phu ca tm tht tri: - Sau khi i qua cc b His ra 2 b nhnh, cc b nhnh bn tri ( bn thn chng ) chia ra lm 3 (distinct collection of conducting fiber) si dn: + Acceptor branch ( pha di) + Anterior fascicle (b c pha trc) ( v mt tn hiu in) + Posterior fascicle. (b c pha sau, n sau thi gian) - Cc b c pha trc tri kh cc to ra cc tn hiu nh hnh v (vng cung) sau b c kh cc tr to ra cc tn hiu di chuyn trn mt phng nh hnh v. ( The anterior fascicle depolarized the lateral ) - S kh cc ny to ra vector tng hp tn hiu in tm tm tht tri nh hnh v ( min 5:01). Vector tng hp ny c gc xp x 60 so vi trc in cc chi I. * Ch n chiu chy ca 2 vector kh cc: + anterior s chy t ngoi xung + Posterior s chy t trong ra ngoi + 2 tn hiu ny gp nhau ti ch ni cc mch mu => to ra vector in tng hp ca tn hiu kh cc tm tht tri. - V d v trng hp b c kh cc trc gp s c khng th dn xung in c( min 6:25): => Hnh dng ca vector kh cc thay i (min 6:33) Khi m b c kh cc trc (anterior fascicle) thay i => tn hiu in kh cc ca b c sau (posterior fascicle) s trn qua mt phng tim, i n cc mch mu ni gia b c sau v trc, ri i ln mch mu ca b c trc= > s thay i trong tng hp vector in => Trc tim (cardiac axis) s b lch.( lch trc tri LAD left axis deviation ) - V d tip theo v trng hp b c sau (posterior fascicle) b gin on:

Tng t tn hiu in tim ca b c trc s i qua vng nh hnh trn, qua ch tip gip mch mu gia b c trc v c sau, i xung di . th vector tng hp lc ny s ch ra rng trc tim b lch phi ( RAD). - Nhiu bnh tim thng thng gy tn thng n h thng dn ti tm tht tri => lch trc tim tri hoc lch trc tim phi trn in tm .

* Section 2 part 4: how to identify Axis deviation => Identification of RAD & LAD : - Min 0:37 vector kh cc tm tht tri ( do vector kh cc tm tht tri l tn hiu in ch yu c th hin trn ECG). - Khong di chuyn thng thng ca vector in tim tng hp T aVF -> aVL ngc chiu kim ng h.

Cc trc in cc chun ca in tm .

http://www.youtube.com/watch?v=lFqVb6TLEBs * Tn hiu ECG khi bnh thng : o cc o trnh I II III:

* Tn hiu ECG hin th khi vector in tng hp dch dn ln gc tri:

* Tn hiu in tim i gn n aVL vn nm trong di bnh thng:

* Tn hiu in tim aVL:

Sng R v S o trnh 2 bng nhau v bin . * Vector tng hp in tim b lch tri:

- Nguyn nhn: do b dn trc tm tht tri (anterior fascicle) khng dn c in.

Tn hiu bt thng o c o trnh chi II v III l do b dn sau truyn qua vng tip gip, ln b dn trc to thnh. * Vector tng hp in tim b lch phi:

( gii thch tng t ) * So snh tn hiu in o trnh I,II,III trong 3 trng hp: + Lch phi +Bnh thng

+ Lch tri.

Nhn xt: - Phc hp QRS trong c 2 trng hp lch tri v lch phi u rng hn so vi phc hp QRS trng thi thng thng. - Tn thng ln cc b nhnh tm tht tri thng gy ra hin tng lch trc. Kt qu l s kh cc ti y b tr ca vng ni cc mch mu b nh hng . - Trong cc qu trnh lch trc : phc hp QRS thng c xu hng rng hn gii hn khong 0.1-0.12s . - Cc thnh phn cc dng v m ca QRS khi lch trc thng tch bit r rng hn trong trng hp bnh thng. - Nn ghi nh cc mu hin tng QRS thay i trong 2 trng hp lch trc tri v lch trc phi.

------Prolong QT : nhp tim on QT b di. Drogue : hnh phu.

Chapeter 3: Bioelectric potential.

1. Content overview: Behavior of excitable cell - in th , dng in m t bo b kch thch gy ra. - in p v dng trong cc gii php m rng. - Dng in l do s khuch tn cc ht mang in v tc ng ca trng in t. * Ion gy ra in trong t bo : Na+ v K+ (sodium & potassium)

1. Current in solutions: Dng ht mang in trong m sng l ion tan trong cht in phn c. - Cc ion mang in tn ti trong v ngoi mng t bo, c bit l ion Na v K=> cho php dng in chy trong ni bo v ngoi bo. - S lin cnh nhau xut hin ngay lp tc khi nghin cu chuyn ng ca ion. Mole: lng cht nguyn cht / gram. - Dng chy: phn t gram / second mole per second - Flow: s Culong trn 1 n v thi gian hoc Ampe - Thng lng flux: ampe / 1 n v din tch. K hiu j: thng lng ca s mol

K hiu J: thng lng ca s chuyn dch dng in. - Cng thc Faraday trang 57 ebook : dng chuyn i dng in t cc ht nguyn t, phn t ra n v dng in bnh thng (ampe). 2. Thnh phn cu to ion: - Nng ion ca th tch ni bo hay ngoi bo u cho php 1 dng in ng k chy vo c 2 ni. - T bo b kch thch : Nng K ni bo >> nng K ngoi bo - Nng Na + cl- ngoi bo >> nng Na + Cl ni bo

3. Lu vi ion ca cc loi: S dch chuyn ion c chung bn cht vt l v ton, bt k loi ion no. Nhiu gi tr khc c th thay i.

4. Phng trnh Nernst- Planck - Dng chy ion: chnh lch nng hoc chnh lch in p a. Khuch tn v h s khuch tn: - Khuch tn : Nng lng nhit ca phn t. => l hin tng mng li nhiu dng chy xung quanh ni c nng cao => gim nng gradient. - Khuch tn khng phi l hin tng v mt in - Hng s Fick: tng nh theo nng khuch tn C. D (hng s Fick) = lv/3 L: qung ng di chuyn khi khng c vt cn V: vn tc trung bnh ca phn t.

5. linh ng:

Lc gy ra bi 1 trng in t c th di chuyn ion. Vn tc ny c k hiu l up gi l linh ng.

--------------Jargon: Nomenclauture: Composition : Electrolyte : Solution : Mole: Flux: Embody : Squid: Danh php. Thnh phn cu to, kt cu Cht in phn S ha tan, dung dch, trng thi c ha tan Phn t gam Thng lng hin thn, tiu biu. Mc ng