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    6 views15 pages

    15 Dien Tam Do Trong 1 So Benh Ly Khac 1600

    Uploaded by

    ngo magic

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 15
    uy khoa cap nhat https://www.facebook.com/groups/489022: DIEN TAM BO TRONG MOT SO BENH LY KHAC 4. THUYEN TAC PHO! CAP 1.1. Dac diém dién tam dd Thuyén tac phdi cp cé thé cd mét hoac nhidu dau hiéu sau: ¢ Nhip nhanh xoang (44%) « Block nhanh phai (18%) + Dau higu tang ganh that phai (lién quan dén tang dp dong phdi nang): song T dao ngugrc & cac chuyén dao truoc ngwe bén phai (V1-4) + thanh diroi (Dil, Dill, aVF) (34%) Truc léch phai (16%) Song R wu thé & V1 (gin that phai) Lon nhi phai (P phé): sng P & Dil > 2,5 mm (9%) Dau hiéu S, Q,, T,, (ddu hiéu kinh dién): séng $ sau & DI, song Q 6 Dil, song T dao ngug'c & Dill (20%) Tim xoay theo chiéu kim déng hd: chuyén dao chuyén tiép (R/S = 1) doi vé phia V6 voi song S wu thé & V6 Réi loan nhip nhanh tai nhi: rung nhi, cudng nhi, nhip nhanh nhi (8%) Thay ddi ST-T khéng dac hiéu, bao gém ST chénh [én va chénh xudng (50%) 1.2. Dac diém dién tam dé Cac bién déi DTD trén khéng hoan toan d&c hiéu cho huyén tac phdi cap. C6 thé gap trong cac trong herp tam phé cap (viém phdi nang, dot cAp COPD/hen phé quan, tran khi mang phdi,...) hay tam phé man (COPD, xo’ phdi, bénh phai m6 ké, ngung thé khi ngii tac nghén....). zalo nhom duy nhat 0528112107] 159 uy khoa cap nhat https://Wwww.facebook.com/groups/4890s2 160 || Sétay dién tam dd LAA Weep WR] Wy Bee a wt pepe SAL | VIA Ba IL DAY eV IO et Hinh 15.1. DTD ctia mét bénh nhan né& 52 tudi vi thuyén tac phi dién réng hai bén (nhip nhanh xoang, block nhanh phai hoan toan, song T dao ngugc & V1-3 va DII!) je si) mye ‘é tea ete trchta CT) a) CANO eo Hinh 15.2. DTD clia mét bénh nhan nam 66 tudi bi thuyén tac phdi dién rong hai bén sau phdu thuat thay khop hang (block nhanh phai hoan toan, truc l@ch phai, dau hiéu $, Qu, Ty» song T dao nguoc 6 V1-4 va D,,) zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/489029" Dign tam dé trong mot sé bénh ly khac || 161 2. KHi PHE THONG 2.1. Dac diém dién tam dd * Truc cll séng P va phirc b6 QRS léch phai Dién thé QRS thdp (< 5 mm & chuyén dao chi, < 10 mm & chuyén dao truéc ngye), nhat la & chuyén dao trvéc nguc bén trai (V4-6) Dau hiéu chuyén sang tam phé man: ddu P phé cia lon nhi phai, lon that phai, block nhanh phai, tim xoay theo chiéu kim déng hd voi chuyén dao chuyén tiép (R/S = 1) doi vé phia V6, co thé mat séng R & cac chuyén dao V1-3 ST chénh xuéng 6 Dil, Dill, aVF Réi loan nhip, thong gap nhip nhanh nhi da 6 Chuy&n dao T T af chuyén tiép TT T ee a @eo+ ® @ Chuyén ot @+ dao ol © _| shuyén tiép Hinh 15.3. Dich chuyén chuyén dao chuyén tiép khi tim xoay theo chiéu kim déng hd? zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/4800s» 162 || Sé tay dién tam dd I ied a py OOP PETV A AL ALL aa ales ok RR aie nna Heb a win Serrano ere EE et that aLaLeLaaLaLALaLaL ala aLaLaLaLalaLaleLal aval ab Hinh 15.4. DTD cia mét bénh nhan nam 78 tudi duoc chan doan bénh phdi tac nghén man tinh (truc léch phai; P > 2,5 mm; tim xoay theo chidu kim déng hd voi chuyén dao chuyén tiép doi sang V5, mat song R tlr V1-3, dién thé thép chuyén dao bén trai (DI, aVL, V5-6)) 3. VIEM MANG NGOAI TIM CAP 3.1. Dac diém dién tam dé DTD trong viém ngoai tim cap thay ddi qua bén giai doan: ¢ Giai doan 1: =» ST chénh lén lan téa & nhiéu chuyén dao * ST luén chénh xuéng & aVR, thudng & V1 va thinh thoang & V2 = QRS khéng thay ddi, hoac gidm dién thé (khi cd tran dich) * Doan PR chénh xuéng + Giai doan 2: ST vé dang dién sau vai ngay * Giai doan 3: Song T dao ngugc lan téa ° Giai doan 4: DTD tré’ vé giai doan truéc vim mang ngoai tim zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/489 Digén tam dé trong mét sé bénh ly khac || 163 3.2. Chan doan phan biét Can phan biét ST chénh lén trong viém mang ngoai tim cap véi ST chénh én trong nhdi mau co tim va tai cyc som: * Nhéi mau co’ tim: ST chénh |én theo dinh khu vung co tim bi nhdi mau, ST chénh |én dang vém (Convex), khac véi viém ngoai tim cAp thi ST chénh |én lan toa va dang l6m (Concave) (xem thém bai “H6i chteng mach vanh cAp”). * Tai ce sém: ti 6 dd chénh clia doan ST/chiéu cao séng T < 0,25 trong tai ce sém va > 0,25 trong viém mang ngoai tim cp (xem thém bai “Rdi loan nhip di truyén’). ol. ~~ apy aR phil. I pep JI ys faacih 9 phd j Hinh 15.5. DTD viém mang ngoai tim cp giai doan 1 vdi hinh Anh ST chénh [én dang l6m lan téa va PR chénh xudng nhiéu chuyén dao (DI, Dil, Dill, aVF, V4-6), ST chénh xuéng va PR chénh lén & aVR va V1 zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/489002 164 || Sé tay dién tam ad 4. TRAN DICH MANG NGOAI TIM LUQ'NG NHIEU 4.1. Dac diém dién tam dd * Dién thé thap ¢ Nhip tim nhanh * So le dién thé ¢ Nhip cham d6t ngét kem phan ly dién co’ ggi y chén ép tim cap do v& tim BE peepee Il Beach sab pyle AAAI Bt ttn Lend LA 7 Tae eee eee eee ee io a aN Hinh 15.6. DTD cua mét bénh nhan tran dich mang ngoai tim Iwong nhiéu gay chén ép tim (nhip nhanh xoang 136 lan/phut, dién thé thap va hinh anh so le dién thé voi QRS bién do thdp xen ké QRS bién d6 cao) 5. TANG KALI MAU 5.1. Dac diém dién tam 46 Bang 15.1. Cac bién déi DTD theo mirc dé tang kali mau Nong do kali by A Thay doi DTD mau (mmol/L) 5,5-6,5 Song T cao nhon + Sdng P réng/det 6,5-7,0 + Khoang PR kéo dai * Song P dan bién mat zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/489029 Dign tam dé trong mét sé bénh ly khac || 165 Nong dé kali Thay doi DTD mau (mmol. * Réi loan nhip cham (nhip cham xoang, block nhi that cao d6 voi nhip thoat b6 néi hoc nhip thoat that, rung nhi dap 7,0-9,0 ng that cham) Block d&n truyén ndi that (block nhanh, phan nhanh) * QRS gian réng va di dang + Xuat hién séng hinh sin » V6 tam thu >9,0 Rung that Hoat d6ng dién v6 mach véi phtvc bd nhip gian réng, di dang deat Hinh 15.7. DTD cla mét trvong hop co néng dé kali mau 7,0 mmol/L, véi hinh anh séng T cao nhon, déi xteng zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/48900 166 || Sé tay dién tam ad mi eA aR Ll aN LSS ITO Nee VI S| Hinh 15.8. DTD ctia mét trvong hop cd ndng dé kali mau 9,0 mmol/L, voi khodng PR kéo dai, phirc b6 QRS gin réng va di dang : NNN FN TEN NA NO nh RNIN Pr rN NN e_— 7 Paps fa fos Hinh 15.9. DTD cia mét trvdng hop cd ndng dé kali mau 9,4 mmol/L; ghi nhan hinh anh séng hinh sin 5.2. Chan doan phan biét Can phan biét sdng T cao trong tang kali mau voi song T cao téi cp trong hdi ching vanh cap. zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/48902 Dién tam dé trong mét sé bénh ly khac || 167 Tang kali mau Thiéu mau cyc b6 co tim téi cAp v3 Fes E pa - it dal [sk A HL im Déi xteng, day hep, dinh Béi xing, day r6ng, dinh khéng nhen, than manh khanh nhgn, than bau khéng cé dang hinh tap Iéu hinh tap Iéu (dean QT cé xu huwéng kéo dai) Hinh 15.10. Phan biét song T tang kali mau va s6éng T téi cAp trong thiéu mau cuc bé co’ tim cAp 6. HA KALI MAU 6.1. Dac diém dién tam dd * Tang bién dé séng P * Kéo dai khoang PR * ST chénh xuéng lan téa va song T det/dao nguoc * Song U xuat hién ro (nhat la & chuyén dao true ngyc V2-3) * C6 thé QT dai do séng U [An vao séng T (= khoang QU dai) * Khi ha kali mau nang, DTD c6 thé co: =» Ngoai tam thu trén that va tai that = Nhip nhanh trén that: rung nhi, cudng nhi, nhanh nhi * C6 thé tién trién dén rdi loan nhip that de doa tinh mang (nhanh that, rung that, xodn dinh) zalo nhom duy nhat 0528112107 uy khoa cap nhat https://www.facebook.com/groups/480022. 168 || Sé tay dién tam ad SéngU | ij fl ua ou i, us i f RAIA IN i cA i oe I ‘S6ng T dao ngugce Khoang QU Hinh 45.41. Dac diém DTD trong ha kali mau i es a aH et dE, ~~ i f joe ~ Pipa fam ek {\ \ AA 2 Wy (ail {| PR fet i pret LLL LL EL LAL LL Hinh 15.12. DTD cla mét trvdng hop kali mau 1,1 mmol/L; ST chénh xuéng lan téa, T dao nguoc, séng U Ién va khoang PR kéo dai zalo nhom duy nhat 0528112107 | uy khoa cap nhat https://www.facebook.com/groups/489 Dign tam d6 trong mét sé bénh ly khac || 169 tee. de. 28 2.5 2.0 1.7 Giam kali mau 65 7.0 8.0 9.0 Tang kali mau Hinh 15.13. Dac diém DTD trong cac trudng hop réi loan kali mau 7. TANG CALCI MAU 7.1. Dac diém dién tam dd * BAt thudng chinh la khoang QT rit ngan * Swon lén cia séng T dng dirng, cé thé cd séng T hai pha * Truong hyp tang calci mau nang, co thé thay sdng Osborn (séng J) * Cé thé cé réi loan nhip that, rung that gay ngung tim zalo nhom duy nhat 0528112107 u y khoa cap nhat https://www.facebook.com/groups/489 170 || Sé tay dién tam a6 Hinh 15.14. DTP mét trvong hop tang calci mau nang (Ca*: 6,1 mmol/L); ghi nhan QT ngan (QTc = 344 ms), s6ng T voi son lén dung dirng va cé dang hai pha, kem song J thay rooV1 8. HA CALCI MAU 8.1. Dac diém dién tam dé * Khoang QT dai, chi yéu do kéo dai khoang ST * Song T c6 thé dao ngugc 6 vai chuyén dao Pale A fl arate taba bene rn P aRgy kee nat | lp

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