CHNG 9

IN TM BNH TM PH

TS. L CNG TN
BM NI HYK PHM NGC THCH

THNG 7 - 2014

1. TM PH MN
1.1. NGUYN NHN
Tm ph mn c th do nhiu nguyn nhn

gy ra nh: x phi, hen ph qun mn

Nhng nguyn nhn thng gp nht l

chng kh ph thng do bnh phi tc nghn mn

tnh (COPD).

1. TM PH MN
1.2. C CH THAY I ECG
Thay i in tm xy ra trong COPD l do:
-S hin din ca kh ph thng tin trin tng dn
trong lng ngc.
-Nhng nh hng lu di ca s co mch phi
thiu oxy ln bn phi ca tim, lm tng p ng
mch phi v ph i tm tht phi v tm nh phi
tip theo (tc l tim phi).

1. TM PH MN
1.2.1. nh hng ca kh ph thng ln tim
- S n cng ca phi gy nn chn p tim v h thp c
honh ko di xoay trc tim theo chiu dc.
- Do cu trc c nh ca tim vi cc mch mu ln, tim
xoay chiu kim ng h trong mt phng ngang, vi
chuyn ng tm tht phi ra trc v di chuyn tm tht
tri ra sau.
- S hin din ca p lc khng kh tng ln tim v in
cc ghi lm gim dn truyn, dn n gim bin ca
phc b QRS.

1. TM PH MN

Phi cng gin v nh hng tim theo chiu dc

1. TM PH MN
1.2.2. nh hng n mch mu phi

-Thiu oxy mu mn tnh gy co mch phn x trong cc

tiu ng mch phi ("co mch phi thiu oxy"), hu qu

gy tng p lc ng mch phi.

-Ph hy cc m phi vi s mt mt ca cc mao mch
phi tng lm tng sc khng ca ging mch mu
phi bng cch gim din tch b mt hiu qu ca n.
-Theo thi gian, ng mch phi tng p lc mn tnh dn
n ph i tht phi v tm nh phi b.

1. TM PH MN
1.3. iN TM : Cc thay i ECG trong kh ph thng:
-Trc sng P sang phi: vi sng P ni bt cc chuyn o
di v sng P dt hoc o ngc DI v aVL.
-Trc QRS sang phi >+90
-Tng bin kh cc nh gy on PR v ST "vng" di
ng ng in

1. TM PH MN
-in th QRS thp, c bit l trong cc chuyn o trc tim tri
(V4 - 6).
-Tim xoay chiu kim ng h vi vng chuyn tip dch sang tri
(V5: sng S u th, V1 V3: sng R nh hoc mt cc chuyn
o trc tim phi).

Trc tim bnh thng

Xoay chiu kim ng h

1. TM PH MN
Vi s tin trin ca h tim phi, c th thy
nhng biu hin sau:
-Ph i tm nh phi (P ph).
-Ph i tht phi.
-Block nhnh phi (thng l do ph i tht phi)
-Ngoi tm thu trn tht, nhp nhanh nh a (lm
tng t l t vong bnh nhn COPD).

1. TM PH MN

- P ph >2,5 mm DII, DIII, aVF, trc sng P: phi (P m aVL). Trc QRS +90
-Tim xoay chiu kim ng h vi vng chuyn tip dch sang tri
(Sng S u th V5:, Sng R vng mt V1 - V3).
-in th thp ca cc chuyn o bn tri (DI, aVL, V5-6).
-Nhp nhanh xoang c th do kh th, thiu oxy hoc do thuc (salbutamol,
theophylline).

1. TM PH MN

Tng t trng hp trc

1. TM PH MN

ECG ny c nhp nhanh nh a

2. TM PH CP
Mt s gia tng p lc cp tnh mc nng trong
vng tun hon nh ngay lp tc s dn n tnh trng
qu ti v dn bung tht phi v do lm tim xoay theo
chiu kim ng h.
2.1. Nguyn nhn:
-Thng gp nht l tc mch mu phi, rt him hn l
tc mch mu phi do m hoc do kh.
-Vim phi nng.
-Cn hen ph qun c tnh, trn kh mng phi t pht v
mt s nguyn nhn khc.

2. TM PH CP
2.1. THAY I IN TM
2.1.1. Cc chuyn o ngoi bin
-Sng P DII c th cao, nhn: du hiu ln nh phi.
-Trc tim thng chuyn phi so vi trc khi b tm ph
cp. Mt s t trng hp c th thy trc chuyn tri hay
gi l "trc tri gi".
-Tam chng SI QIII TIII :
+ Sng S su DI
+ Sng Q su DIII thnh dng qR (khng bao gi
c dng QS)
+ Sng T m, i xng DIII.

2. TM PH CP
2.1.2. Cc chuyn o trc tim
-Block nhnh phi hon ton hoc khng hon ton mi
xut hin.
-Sng R chim u th V1, biu hin ca dn bung tht
phi cp tnh.
-Vng chuyn tip dch sang tri: vi sng S su V5-V6
(dng rS), tim xoay theo chiu kim ng h do gin bung
tim phi.
-Sng T m, i xng v c th ST chnh ln/chnh
xung V1-V3 (do tng p lc y tht P)
2.1.3. Thng c nhp xoang nhanh, rung nh, cung
nh .

2. TM PH CP

-Nhp xoang nhanh 150 ck/ph.

-Block nhnh phi hon ton
-Sng T m V1 - V3 v DIII.

2. TM PH CP

-Block nhnh phi hon ton . Trc lch phi, gc 180

-Tam chng SI QIII TIII . Sng T m V1 - V3 v DIII.
-Tim xoay chiu kim ng h vi sng S ti V6.

2. TM PH CP

-Trc in tim lch phi.

-Sng T m V1 - V3 v DIII.
- Tim xoay chiu kim ng h vi sng S ti V6.

2. TM PH CP

-Nhp xoang nhanh 120 ck/ph.

-Block nhnh phi hon ton
-Sng T m V1 - V3 v DIII.

2. TM PH CP

Block nhnh phi hon ton

Trc in tim lch tri (c th "trc gi tri").