uy khoa cap nhat https://www.facebook.com/groups/48902% LON NHI — LO'N THAT 4. LON NHI TRAI >0,11s Hinh 2.4. Hinh anh DTD lén nhi trai voi song P & DIl cé dang hai dinh, thdi gian séng P > 0,11 s; khoang cach hai dinh > 0,04 s Hinh 2.2. Hinh anh PTD lon nhi trai voi hinh dang séng P 6 V1 co dang hai pha, pha am sau > 1 mm va réng > 0,04 s 1.1. Dac diém dién tam dé * O'chuyén dao Dil: * Séng P cd thoi gian > 0,11 giay » S6ng P cé dang hai dinh (lung lac da), voi knoang cach hai dinh > 0,04 giay ° O'chuyén dao V1: = Song P cod dang hai pha = Pha 4m 6 thoi gian > 0,04 gidy va sau > 1 mm 1.2. Nguyén nhan * Khi don déc: thuong gap trong hep van hai la zalo nhom duy nhat 0528112107 || 13ar mh OOH my eg OK KDA uy khoa cap nhat https://www.facebook.com/groups/489022: 14 || Sé tay dién tam a6 * Khi phdi hop voi phi dai that trai: * Tang huyét ap = Hep van d6éng mach cht = Ho van hai la = Bénh co tim phi dai Scie ye tet = ppp fl tbh eh tte LS set tah fb bbl | Hinh 2.3. DTD én nhi trai cla mot bénh nhan ni 67 tudi, tién c&n tang huyét ap lau nam 2. LO'N NHi PHAI Hinh 2.4. Hinh anh DTD lon nhi phai voi P cao > 2,5 mm @ DII; DIIl; aVF (phai); hoac pha duong ctia P cao > 1,5 mm 6 V1; V2 (trai) . zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/4890: Lon nhi-lén that || 15 2.1. Dac diém dién tam dé * Ochuyén dao Dil, Dill va aVF: song P cé bién dé = 2,5 mm » Ochuyén dao V1, V2: bién dé pha duong clia séng P>1,5mm + “P phé” (P pulmonale): séng P cao, nhon, truc léch phai « “P bam sinh” (P congenitale): song P cao, nhon, truc léch trai 2.2. Nguyén nhan Nguyén nhan chi yéu do tang 4p phdi do: * Bénh phéi man (bénh tam phé) e Hep van ba la * Bénh tim bam sinh (hep van dong mach phéi, te chung Fallot) * Tang dp d6ng mach phéi nguyén phat. eae ee os fl feild Sl Hinh 2.5. DTD lén nhi phai cia mét bénh nhan nam 65 tudi bénh phdi tac nghén man tinh 3. LO'N HAI NHI 3.1. Dac diém dién tam dd * Séng P @ Dil: bién dé 2 2,5 mm VA thoi gian 2 0,12 giay » Song P& V1 hoac V2: bién 46 pha duong 2 1,5 mm VAbién d6 pha 4m 2 1 mm VA thoi gian pha am = 0,04 giay » Tiéu chuan két hop: song P co bién do = 1,5 mm o V1 hoac V2 VA song P cé khaéc kém thdi gian song P > 0,12 gidy & cdc chuyén dao chi, V5 hodc V6 zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/489022" 16 || Sé tay dién tam ad norenen ct biba | rad Ey yy ak Wn he il shed yy mpd I Hinh 2.6. DTD |6n hai nhi voi song P cao > 2,5 mm va rong > 0,12 giay & Dll; song P & V2 cao > 1,5 mm; pha am song P. 6 V1 sau > 1mm va réng > 0,04 gidy Bang 2.1. Dac diém séng P cia lon nhi phai, lon nhi trai va lon hai nhi trén Dil va V1 eee Nhi trai NTT IE et? Dil Hinh dang hai Hinh dang R6ng 2 0,12 dinh caonhon, giay va bién d6 6 jay bién do 22,5mm Re 20,12 : aug oy 22,5mm V1 Pha am sau Pha dwong Pha duong cao voi bién dé >15mm >1,5mmva > 1mm; réng phan 4m réng > 0,04 giay > 0,04 giay; bién dé > 1mm i) al Binh thwong f™N SN Lonnhiphai = OM S| _/\ Lon nhi trai S~\. “NS - Lon hai nhi S[~\ S\- Hinh 2.7. So sanh dac diém séng P trén chuyén dao Dil va V1 trong cac trong hgp Ién nhi trai, Ion nhi phai va !on hai nhi zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/4890: Lén nhi-lén that || 17 4. DAY THAT TRAI 4.1. Dac diém dién tam dd + Tiéu chuan dién thé = Chuyén dao chi ° RDI + SDIII > 25 mm; hodc ° RaVL> 11 mm; hodc ° RaVF > 20 mm; hoac ° SaVR> 14mm « Chuyén dao trudéc nguc ° RO V4, V5 hodc V6 > 26 mm; hodc ° Tiéu chudn Sokolow — Lyon: SV1 + RV5 (RV6) 2 35 mm; hoac ° Song R cao nhat + séng S sau nhat & cdc chuyén dao trudc ngyc > 45 mm = Tiéu chudn Cornell ° RaVL + SV3 > 28 mm (& nam), 20 mm (8 ni?) * Tiéu chuan khéng dién thé * Thdi gian xuat hién nhanh néi dién (VAT ctia séng R) > 0,05 giay & chuyén dao V5 hoadc V6 = Doan ST chénh xudng va song T am & cac chuyén dao bén trai (kiéu hinh tang ganh that trai) + Tiéu chudn Romhilt - Estes (Bang 2.2) Bang 2.2. Tiéu chudn Romhilt — Estes UCR e Ty Pye) R hode S & chuyén dao chi 2 20 mm ho&c 3 So V1, V2 230 mm hodc R& V5, V6 = 30 mm zalo nhom duy nhat 0528112107ny khoa cap nhat https://www.facebook.com/groups/489022 18 || Sé tay dién tam 46 ST-T bién d6i thir phat (doan ST va song T thay déi ngue chiéu voi ARS) Khéng uéng digitalis Cé udng digitalis Truc léch trai = -30° Thoi gian QRS = 0,09 gidy Thoi gian xuat hién nhanh néi dién & V5 hoac V6 (VAT) 2 0,05 gidy Len nht trai 3 Pha 4m ctia séng P & V1 cé bién d6 = 1 mm va thdi gian 2 0,04 giay T6i da 13 diém Day that trai: 2 5 diém C6 thé day that trdi: 4 diém aan aw ft he ry 3 ny ay fp lis : A_ A Saar et JA at. i Sori Hinh 2.8. DTD day that trai cla mét bénh nhan nam 56 tudi mac bénh co tim phi dai (thda tiéu chuan Sokolow-Lyon SV1 + RV6 > 35 mm; VAT song R & V5-V6 > 0,05 s; dau tang ganh tam thu that trai voi ST chénh xudng va T 4m @ DI, aVL va V5-V6; truc léch trai) zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/4890: Lén nhi-ién that || 19 Hinh 2.9. Hinh anh DTD day that trdi & nam theo tiéu chudn Cornell: RaVL + SV3 = 39 mm > 28 mm; ngoai ra cdn cé séng SdaVR> 14mm Bang 2.3. Bién d6i ST-T tht phat cia phi dai that trai (d4u hiéu tang ganh) Tang ganh tam thu Tang ganh tam truong * Tang bién d6 QRS G « V5, V6 * Tang thoi gian xuat hién nhanh néi dién V5, V6 (VAT) * ST chénh xuéng 6 V5, V6 . * T dao & chuyén dao ngwe trai 4.2. Nguyén nhan Tang huyét ap Hep van d6ng mach chu Ho& van déng mach chi Ho van hai la Hep eo déng mach chu Bénh co tim phi dai Cac bénh ly co tim gay day thanh that trai. zalo nhom duy nhat 0528112107 Sdéng R cao 6 V5, V6, DI, aVL Séng S sau & V2, V3 Séng Q sau hep 6 V5, V6 ST chénh lén nhe (< 1 mm) & V5, V6 Séng T cao, déi xteng & chuyén dao ngve traiiy khoa cap nhat https://www.facebook.com/groups/489022! 20 || Sé tay dign tam ad 5. DAY THAT PHAI 5.1. Dac diém dién tam dé + Tiéu chuan chan doan * Truc dién tim léch phai 2 110° = Song R wu thé @ V1 (27 mm hoac ti sé R/S > 1) = Séng S wu thé & V5, V6 (2 7 mm hoac ti sd R/S < 1) = Tiéu chudn Sokolow-Lyon phai: RV1 + SV5/SV6 2 11 mm = Phwc bd rS tle V1 dén V6 (xoay theo chiéu kim déng hd) voi truc léch phai Tiéu chudn goi y » Lon nhi phai (P phé) * Song S sau & cdc chuyén dao thanh bén (DI, aVL, V5-V6) = Kiéu hinh tang ganh that phai voi ST chénh xuéng va/ | hoac T am & cac chuyén dao true ngyc phai (V1-V4) va chuyén dao thanh dui (Dil, Dill, aVF) » DAu higu $1 S2 3: truc I&ch phai kém séng S$ wu thé & | DI, Dil, DIlI » Thoi gian VAT > 0,035 gidy (& chuyén dao V1, V2) Bang 2.4. Dau hiéu tang ganh tam thu va tam trong & bénh nhan phi dai that phai Tang ganh tam thu Tang ganh tam truong R cao + ST chénh xudng va/hoac rsR’é V1 T Am & cdc chuyén dao ngwe phai 5.2. Nguyén nhan * TAng ap phdi ¢ Hep van hai la * Thuyén tac phdi * Bénh phdi man (bénh tam pha) zalo nhom duy nhat 0528112107oa cap nhat https://www.facebook.com/groups) Lon nhi-lon that || 21 * Bénh tim bam sinh (hep van déng mach phdi, tt chteng Fallot) * Bénh co’ tim loan s&n that phai. =) ape i yw ni ii [| II ool A ep pp te [| LL dep apna at ada | } Hinh 2.10. Hinh anh DTD day that phai cla mét bénh nhan 70 tudi bi bénh phdi tac nghén man tinh (tiéu chudn Sokolow-Lyon phai RV1 + SV6 = 20 mm > 11 mm; RV1=12 mm >7 mm; SV6 = 8mm > 7 mm; truc Ich phai; dau tang ganh tam thu voi ST chénh xudng va T 4m & cac chuyén dao V1-4) A. Day that trai B. Day that phai v1 v4 V1 v4 “Ty | T v6 v3 V6 Hinh 2.11. So snh dac diém DTD ctia day that trai va day that phai zalo nhom duy nhat 0528112107a y khoa cap nhat https://www.facebook.com/groups/489022! 22 || Sé tay dién tam dd 6. DAY HAI THAT 6.1. Dac diém dién tam dd DTD c6 dé nhay thap trong chan doan day hai that, do can bang dién thé cdc dau hiéu phi dai that trai va that phai co thé lam mat di cac dau hiéu chan doan dva trén tiéu chuan bién do. * Khi co day that trai, kem theo dau hiéu goi y day that phai: = Léon nhi phai = Truc léch phai = Phirc bé QRS cao, hai pha & nhiéu chuyén dao = Song S sau 6 V5-6 * Khi c6 day that phai, kem theo dau hiéu goi y day that trai: * Lon nhi trai = Truc léch trai = Sdng R cao va séng S sau & V2-5 = Bién d6 QRS > 50 mm * Tiéu chuan Katz-Wachtel (thuéng gap & tré em voi bénh tim bam sinh) » Phirc b6 QRS Ién, hai pha (s6ng R cao + séng S sau) 0 V2-5 * Téng bién dd R+S>50mm zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/4890: Lén nhi-lén that || 23 Apres fei =p “ff tea. i aly aus tL hos, Hinh 2.12. Hinh anh DTD day hai that (phtrc bd QRS én, hai pha & V2-5; day that trai voi Sokolow-Lyon trai SV1 + RV5 > 35 mm kém dau tang ganh that trai T Am & V4-6; song S sau & V5 goi ¥ 06 day that phai kém theo) zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/489022 DIEN TAM DO TRONG HOI CHUNG MACH VANH CAP 1. NHUNG THAY DO! DIEN TAM DO TRONG HOI CHUNG MACH VANH CAP 1.1. Thiéu mau cuc bd cap 1.1.1. Doan ST chénh xuéng ST chénh xuéng di ngang hoac di xuéng = 0,5 mm tai it nhat 2 chuyén dao lién tiép (ESC/ACC/AHA/WHF 2018) Binh thuong ST chénh xuéng Hinh 3.1. Dau hiéu ST chénh xuéng Bang 3.1. Cac kiéu hinh ST chénh xuéng ST chénh xu6ng | ST chénh xu6ng | ST chénh xu6ng Tmt) Cialis) di ngang (kh6ng dac hiéu) | (dac higuhon) | (dac hiéu hon) | zalo nhom duy nhat 0528112107