BI TP RI LON DN

TRUYN

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BLOCK NH THT V BLOCK NHNH (ATRIOVENTRICULAR AND

BUNDLE BRANCH BLOCKS)
BLOCK NH THT 1 (FIRST DEGREE AV BLOCK)

Nhp tim: ph thuc vo nhp bn di ca Nhp iu: u

bnh nhn
Sng P: bnh thng (dng PR: ko di (>0.20 giy) QRS: bnh thng (0.06
v ng nht) 0.10 giy)

Lm sng: Block nh tht 1 thng lnh tnh, nhng nu n th pht sau nhi mu c tim cp th c th
dn n nhng dng block nh tht nng hn
Block nh tht thng do cc thuc lm ko di thi gian dn truyn nh tht; nhng thuc ny bao gm
digoxin, chn canxi, chn beta.

BLOCK NH THT 2 MOBITZ 1 HOC WENCKEBACH (SECOND DEGREE AV BLOCK MOBITZ 1 OR

WENCKEBACH)
- Khong PR ko di dn cho n khi 1 sng P b block v khng to to phc b QRS.
- Sau , qu trnh ny li tip tc

Nhp tim: ph thuc vo nhp tim bn di Nhp iu: nh: u, tht: khng u
ca bnh nhn
Sng P: bnh thng (dng PR: QRS: bnh thng (0.06
v ng nht), nhiu sng P 0.10 giy)
hn phc b QRS
Lm sng: Nhp tim dng ny thng do cc thuc nh thuc chn beta, digoxin, hoc thuc chn canxi.
Thiu mu do tc ng mch vnh phi cng l mt nguyn nhn c th gp.

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BLOCK NH THT 2 MOBITZ II

- T l dn truyn (conduction ratio) (t l gia s lng sng P v s lng phc b QRS) thng
l 2:1, 3:1, 4:1, hoc thay i
- Cc phc b QRS thng gin rng v dng block ny thng i km vi block nhnh

Nhp tim: nhp nh: 60 100 ln/pht, tht: Nhp iu: nh u, cn tht th c th u
chm hn nhp nh hoc khng u
Sng P: bnh thng (dng PR: bnh thng, hoc ko QRS: c th bnh thng,
tnh v ng nht); nhiu di nhng c nh nhng thng gin rng
sng P hn phc b QRS (>0.10 giy) nu i km vi
block nhnh.

Lm sng: c th dn n nhp chm v gim cung lng tim, c th dn n block nh tht hon ton.
Nhp tim nh th ny thng i km xut hin trong thiu mu c tim hoc nhi mu c tim

BLOCK NH THT 3 (THIRD DEGREE AV BLOCK)

- Qu trnh dn truyn in th t nh xung tht bin mt hon ton do blokc ti v tr nt nh
tht hoc di nt nh tht. Dng block ny cn c gi l phn ly nh tht. Mt tn khc ca
dng block ny l block nh tht hon ton

Nhp tim: nh: 60 100 ln/pht, tht: 40 60 Nhp iu: thng u, nhng nh v tht
ln/pht nu pht nhp cho tht l ti b hot ng c lp vi nhau
ni, < 40 ln/pht nu pht nhp cho tht l
ti tm tht
Sng P: Bnh thng (dng PR: thay i QRS: bnh thng nu nh
v ng nht), nhng cng pht nhp cho tht l ti b
c th b chn vo bn trong ni, gin rng nu pht
phc b QRS hoc sng T nhp cho tht l ti tm tht

Lm sng: Block nh tht 3 thng gp trong trng hp thiu mu do tc ng mch vnh tri

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Bi tp

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p n
7.1.
Nhp tim: Nh: 125 ln/pht, tht:
44 ln/pht
Nhp iu: Nh u, tht khng u
Sng P: Bnh thng
Khong PR: 0.12 giy v c nh
QRS: 0.10 giy
Chn on: Block nh tht 2,
Mobitz II, dn truyn 3:1

7.2.
Nhp tim: 80 ln/pht
Nhp iu: Khng u
Sng P: Bnh thng
Khong PR: 0.32 giy
QRS: 0.10 giy
Chn on: Block nh tht 1 vi
ngoi tm thu b ni ti
nhp s 6

7.3.
Nhp tim: 60 ln/pht
Nhp iu: Khng u
Sng P: Bnh thng
Khong PR: Ko di dn ra
QRS: Rng > 0.10 giy
Chn on: Block nh tht 2
Mobitz 1 (Wenckebach)
vi phc b QRS gin
rng

7.4.
Nhp tim: 70 ln/pht
Nhp iu: Khng u
Sng P: Bnh thng
Khong PR: Ko di dn ra
QRS: 0.10 giy

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Chn on: Block nh tht 2

Mobitz I (Wenckebach)

7.5.
Nhp tim: 40 ln/pht
Nhp iu: Khng u
Sng P: Bnh thng
Khong PR: 0.16 giy v c nh
QRS: 0.08 giy
Chn on: Block nh tht 2
Mobitz II vi sng T o
ngc

7.6.
Nhp tim: 56 ln/pht
Nhp iu: u
Sng P: Bnh thng nhng
khng lin quan g n
phc b QRS
Khong PR: Thay i
QRS: Gin rng > 0.10 giy,
dng mc
Chn on: Block nh tht 3 km
block nhnh

7.7
Nhp tim: 65 ln/pht
Nhp iu: u
Sng P: Bnh thng
Khong PR: 0.20 giy
QRS: 0.16 giy vi dng mc
Chn on: Nhp xoang bnh thng
vi block nhnh

7.8
Nhp tim: 90 ln/pht (nu tnh c
ngoi tm thu tht),
nhp tim bn di l 94
ln/pht
Nhp iu: Khng u

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Sng P: Bnh thng

Khong PR: 0.28 giy
QRS: 0.10 giy
Chn on: Nhp xong bnh thng
vi block nh tht 1
km ngoi tm thu tht
a ti nhp th 4, 7 v
9

7.9
Nhp tim: 56 ln/pht
Nhp iu: u
Sng P: Bnh thng nhng
khng lin quan g n
phc b QRS
Khong PR: Thay i
QRS: 0.10 giy
Chn on: Block nh tht 3

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