Ty khoa cap nhat https://Wwww.facebook.com/groups/48902% NGOAI TAM THU Ngoai tam thu la mét trong nhtrng dang réi loan nhip tim thong gap trén lam sang. Réi loan nhip nay dac trung boi sw xuat hién cla cdc nhip ngoai lai dén som, khién nhip tim tré nén khong déu. Cac 6 phat nhip ngoai lai nay cé ngudn géc ngoai nut xoang; cé thé dén tlr that, nhi hoac bé néi. 4. NGOAI TAM THU THAT 4.1. Dac diém dién tam dd * Nhip dén som Phtrc b6 QRS gian rng (2 0,12 giay), bién dang + Bién déi dao ngugc doan ST va song T tht phat « Khoang nghi bu hoan toan: RR’R = 2RR + D&n truyén ngugc lén nhi cé thé cé hay khéng hién dién Nghi bi hoan toan R R RR. f J\ y VN ‘ST chénh xuéng, T am thir phat QRS dén sém, gian rong, bién dang Hinh 9.1. Cac dac diém DTD ctia ngoai tam thu that zalo nhom duy nhat 0528112107 87a y khoa cap nhat https://www.facebook.com/groups/48902% 88 || Sé tay dién tam ad Bang 9.1. Dac diam DTD cla céc dang ngoai tam thu that Dinh danh Ngoai tam thu that xuat phat tty that trai 3) Ngoai tam thu that xudt phat Hinh dang S6 lwong ngoai tam thu that tir that phai Ngoai tam thu that don dang (don 6) Ngoai tam thu that da dang (da 6, hoac don 6 nhwng dan truyén trong that khéc nhau) Ngoai tam thu that don déc Ngoai tam thu that nhip déi Ngoai tam thu that nhip ba Ngoai tam thu that nhip bén Ngoai tam thu that cap déi Con nhanh that ng&n (nhanh that khong bén bi) Nhip tu that Dac diém DTD QRS 6 V1 duong (dang R hoac qR) QRS 6 V1 am (dang rS hoac QS) Hinh dang QRS cé dinh Hinh dang QRS bién déi Chi co mét ngoai tam thu that trong sudt dai DTD Tuong tng voi mét nhip binh thuong thi co mét ngoai tam thu that Tuong tng voi hai nhip binh thuong thi co mét ngoai tam thu that Tuong tng voi ba nhip binh thuong thi cd mét ngoai tam thu that C6 hai ngoai tam thu that lién tiép nhau Co tie 3 — 30 ngoai tam thu that lin tiép nhau voi tan s6 > 100 ldn/phut Co tl 3 — 30 ngoai tam thu that lién tiép nhau voi tan sé < 100 lAn/phuit zalo nhom duy nhat 0528112107ny khoa cap nhat https:/Avww.facebook.com/groups/48902 Ngogi tam thu || 89 adap ppt teal da J sll Weta rel Lp I slab L. tl tA Lh A Hinh 9.2. DTD ghi nhan ngoai tam thu that nhip déi, don dang, xuat phat tl that trai ph pl ph Hinh 9.3. Ngoai tam thu that nhip 3, don dang pet Be ne oe be Ll See ala a Hinh 9.5. DTH ngoai tam thu that cap déi, don dang, tlr that phai zalo nhom duy nhat 0528112107y khoa cap nhat https://www.facebook.com/groups/489022: 90 || Sé tay dién tam 46 aay Hinh 9.6. Ngoai tam thu that da dang i yy Mey 5 | $4 A ey | p= Hinh 9.7. PTD ghi nhan con nhanh that ngan (4 - 5 ngoai tam thu that lién tip voi tan s6 > 100 [An/phtit) 2. NGOAI TAM THU BO NOI Dac diém dién tam dd * Nhip dén som voi phirc b6 QRS hep + Séng P’ dan truyén ngugc c6 thé xuat hién truéc, sau hodc l&n vao phtrc b6 QRS | Néu song P di trvéc QRS: khoang P’R thong ng&n (< 0,12 giay) * Séng P’ thuéng Am & DIl, Dill va aVF; duong & aVR; det & Di va V5 * Thdi gian nghi bu co thé hoan toan aa ee ek Hinh 9.8. PTD ngoai tam thu bé néi (nhip dén som cd QRS hep, kh6ng thay s6ng P do lan vao QRS) zalo nhom duy nhat 0528112107y khoa cap nhat https://www.facebook.com/groups/4890' Ngoai tam thu || 91 3. NGOAI TAM THU NHI 3.1. Dac diém dién tam dé E Nhip dén sém voi séng P’ bién dang (P’ nhi) * Theo sau P’ la phivc b6 QRS binh thuong (< 0,12 gidy); triv trong hop ngoai tam thu nhi d&n truy€n léch huéng, phtrc bd QRS sé gian rong (2 0,12 giay) va cé dang block nhénh | « Khéng c6 QRS theo sau P’ thi la ngoai tam thu nhi bi block ¢ Khoang nghi bu thuéng khéng hoan toan: PP’P < 2PP e Luuy: = Séng P’ cé thé dao nguoc kém PR ng&n do ngoai tam thu nhi khdi phat & vi tri gan ndit nhi that (ngoai tam thu nhi thap) = Sd6ng P’ c6 thé 4n trong song T truéc do, tao nén hinh dang sdéng T cé khdc (cd thé nham In voi ngoai tam thu bd ndi) Ngogi tam thu nhi + + + + } (Nhat | nL oy | ‘| Al aL el i Many Uf un | ANA JAY TANS AL al PPP <2PP Sng tinh sone in (Nght bo Kndng hodn ton) Hinh 9.9. Dac diém PTD cia ngoai tam thu nhi Hinh 9.10. Ngoai tam thu nhi bj block (séng P’ bién dang dén som, theo sau khéng cd phtrc b6 QRS, nghi bu khéng hoan toan; dé chan doan nham voi block nhi that d6 II Mobitz 2) zalo nhom duy nhat 0528112107y khoa cap nhat https://www.facebook.com/groups/489022: 92 || Sé tay dién tam 4 Hinh 9.11. DTD clia mot bénh nhan nam 65 tudi dén khdm strc khde dinh ky. Khoanh tron xanh: ngoai tam thu nhi dn truyén binh thuéng (song P’ bién dang dén som, theo sau la phtrc bé QRS binh thuéng). Khoanh tron dé: ngoai tam thu nhi dan truyén léch hung (song P’ bién dang dén som, theo sau la phtrc bé QRS gidn rong, dé chan doan nham voi ngoai tam thu that) M1 Ngoai tam thu nhi Ee LTTE 4 Ngogi tam thu that 1d. jeer ap pe TY | Hinh 9.12. Ngoai tm thu nhi voi séng P’ an vao trong song T zalo nhom duy nhat 0528112107ry khoa cap nhat https://www.facebook.com/groups/48902" NHIP NHANH TREN THAT XUAT PHAT TU NHI 4. NHIP NHANH XOANG 1.1. Dac diém dién tam dé + Nhip xoang vi tan sé tim khi nghi > 100 lAn/phut & ngudi lon hoge trén nguéng binh thudng 6 tré em * Tn sé tim binh thwong 6 tré em: * So sinh: 110 — 150 lan/phut * 0—5 thang: 90 - 150 lan/phut * 6 — 12 thang: 80 — 140 lAn/phut + 1-3 tudi: 80 - 130 ln/phut » 3-5 tudi: 80 — 120 lAn/phut * > 6 tudi: 60 — 100 lAn/phut paar piety fl APA LALA LLL LLL LLL: Hinh 10.1. DTD cua mét bénh nhan n& 43 tudi nhap vién vi sét cao, cho thy hinh anh nhip nhanh xoang véi tan sé 166 lan/phut zalo nhém duy nhAt 0528112107 | 83