oa cap nhat https://www.facebook.com/groups/4890: BLOCK DAN TRUYEN NO! THAT Block d&n truyén néi that hay block nhanh chi tinh trang réi joan dn truyén xung d6ng dién bén trong that théng qua mét hay nhiéu nhanh cia bé His. Block nhanh co thé la block mot nhanh, block hai nhanh hoac block ba nhanh. Nat nhi that cued Bé His 1 Bé nhénh trai =. zs 5 = a £ Phan nhanh trai sau a © = 2? Phannhanh tréitruéc = <0 c £ § £ Bo nhanh phai 5 = y i | Mang l6i Purkinje | Hinh 7.1, Cac dong dan truyén trong that® 1. BLOCK NHANH PHAI 1.1. Dac diém dién tam dd + O chuyén dao V1: phtrc bd QRS co dang M (rsr’, rsR’, SR’), hoac déi khi co dang séng R don pha hoac gR + O' chuyén dao DI, V6: song S réng = 0,04 gidy | + Thay di ST-T tht phat: ST chénh xuéng va/hoac T dao nguge & V1-3 * Block nhanh phai: * Hoan toan: QRS 2 0,12 giay » Khéng hoan toan: QRS < 0,12 gidy zalo nhom duy nhdt 0528112107 |"y khoa cap nhat https://www.facebook.com/groups/48902 72 || Sé tay dién tam dd Block nhanh phai [___Lead-1 || ow Il v6 ‘Séng S rong Hinh 7.2. Bac diém PTH cua block nhanh phai 1.2. Nguyén nhan + Sinh ly & ngwoi binh thong (15%) * Phi dai that phai/bénh tam phé ° Thuyén tac phéi * Bénh tim thiéu mau cyc bd * Bénh thap tim + Bénh tim bam sinh (thdng lién nhi, Ebstein, kénh chung nhi that,...) - Viém co tim ¢ Bénhco tim ; - , * Bénh Lenégre-Lev: thoai héa hé th6ng dan truyén nguyén phat Sy yp po ahah ad ta] shee a Bn A A yy pa es am Ll | Bd) eel ech Eh AME Saja | y il Hinh 7.3. DTD cla mét bénh nhan nam 67 tudi, tian cdn bénh tim thiéu mau cuc bd, ghi nhan block nhanh phai hoan toan zalo nhom duy nhat 0528112107ny khoa cap nhat https://www.facebook.com/groups/489022 Block d&n truyén ndi that || 73 2. BLOCK NHANH TRAI 2.1. Dac diém dién tam dd + O chuyén dao V5-6, DI, aVL: song R don pha c6 méc; QRS cé dang M (RsR’); khéng cé bat ky song Q nao + O' chuyén dao V1: QRS co dang QS hoac rS - VAT & V5-6 > 60 ms + Thay déi ST-T thte phat: ST chénh xudng va/hoadc song T dao nguorc & V5-6, DI, aVL ¢ Block nhanh trai: = Hoan toan: QRS 2 0,12 giay » Kh6ng hoan toan: QRS < 0,12 gidy _ a Block nhanh trai [__ Lead-1 I VI ll ve V4: dang Os e ene 2R5 14 song ea, Hinh 7.4. Dac diém DTD ctia block nhanh trai 2.2. Nguyén nhan ¢ Suy tim trai ° Hep van d6éng mach cht * Bénh mach vanh, nhdi mau co tim thanh trvéc * Tang huyét ap ¢ Bénh co tim gian no * Bénh Lenégre-Lev: thoai héa hé théng dn truyén nguyén phat * Tang kali mau * Ng6 déc digoxin zalo nhom duy nhat 0528112107uy khoa cap nhat https://www.facebook.com/groups/48902 74 || Sé tay dién tam ad Rims eapteare YTY ay nay aay 2 Nad amine Ye NL I By yy yyy NL | i ee ae a a Hinh 7.5. DTD cia mot bénh nhan n@& 70 tudi dug chan doan suy tim, ghi nhan block nhanh trai hoan toan 3. CHAM DAN TRUYEN NOI THAT 3.1, Dac diém dién tam dé * QRS gian réng > 0,11 giay « Khéng cé hinh anh dién hinh ctia block nhénh phai hay block nhanh trai 3.2. Nguyén nhan * Hau qua cudi cing cia nhiéu tién trinh bénh ly khac nhau hon la do nhéfng bénh ly tai hé théng dan truyén nhu trong trwong hop block nhanh trai/nhanh phai: nhdi mau co tim, bénh co tim voi xo’ héa co tim, gian budng tim... | er ptt ney pore eet a det tte on ye Hinh 7.6. DTD cham d&n truyén ndi that ctia mét bénh nhan nam 56 tudi cé tién cn nhdi mau co’ tim coi zalo nhom duy nhat 0528112107ny khoa cap nhat https://www.facebook.com/groups/4890 2M Block dan truyén néi that || 75 4, BLOCK PHAN NHANH TRAI TRU'O'C 4.1. Dac diém dién tam dd + Truc léch qua trai (-30° dén -90°) voi QRS 6: = O' chuyén dao DI, aVL: song duong dang qR -0 chuyén dao DIl, Dill, aVF: song 4m dang rS « VAT 0 aVF > 45 ms * Meo phan tich nhanh: truc \éch trai (DI duong va aVF am) kém DIl Am thi chac chan Ia truc léch qua trai. 4.2. Nguyén nhan + Tang huyét ap ¢ Bénh mach vanh * Bénhce tim gian ne + Bénh tim cau tric * Thoai hda hé théng d&n truyén e Viém co tim * Bién cheng cla TAVR, dét nhanh vach bang cén trong didu tri bénh co’ tim phi dai. PLL tere yp peyry | OT RL PT te | Bret yy ge Bee MY Tega Hinh 7.7. DTD block phan nhanh trai trvéc ctia mot bénh nhan nam 60 tudi, tian c&n tang huyét ap man tinh zalo nhom duy nhat 0528112107y khoa cap nhat https://www.facebook.com/groups/48902 76 || Sé tay dién tam 4d 5. BLOCK PHAN NHANH TRAI SAU 5.1. Dac diém dién tam dé + Truc léch qua phai (2 120°) véi QRS &: = Ochuyén dao DI, aVL: song 4m dang rS = Ochuyén dao Dil, Dill, aVF: song dvong dang gR ° VAT & aVF > 45 ms 5.2. Nguyén nhan Gidéng block phan nhanh trai true. Hinh 7.8. DTD block phan nhanh trai sau 6. BLOCK HAI NHANH 6.1. Dac diém dién tam dé DTD biéu hién mat trong hai dang sau: * Block nhanh phai kéem block phan nhanh trai truéc, biéu hién truc léch trai * Block nhanh phai kém block phan nhanh trai sau, biéu hién truc léch phai zalo nhom duy nhat 0528112107ry khoa cap nhat https://www.facebook.com/groups/489022 Block dan truyén ndi that || 77 6.2. Nguyén nhan ¢ Bénh tim thiéu mau cuc b6 (40 — 60%) * Bénh tim cau tric (50 — 80%) « Hep van d6éng mach cht + Nhdéi mau co tim thanh trdc (5 — 7%) * Bénh Lenégre-Lev ¢ Bénh tim bam sinh * Tang kali mau (hdi phuc voi diéu tri). $)—)—t Is, eee {I ayy pp! BO a Hinh 7.9. DTD block hai nhanh (block nhanh phai kém block phan nhanh trai truré'c) RY I FAA A IIL or tee he A ACCANEA LA A PA kk her Nem tenmb— ASD ANY ty + VI AAA AS, AAP AANA AAA A lL | Hinh 7.10. DTA block hai nhanh (block nhanh phai kém block phan nhénh trai sau) zalo nhom duy nhat 0528112107a y khoa cap nhat https://www.facebook.com/groups/489022 78 || Sé tay dién tam do 7. BLOCK BA NHANH 7.1. Dac diém dién tam dé DTD cé thé biéu hién mét trong cdc dang sau: +» Block ba nhanh khéng hoan toan * Block hai nhanh kém block nht that do | (thong gap nhat) * Block hai nhanh kém block nhi that d6 II * Block nhanh phai kém xen ké block phan nhanh trai trwéc/block phan nhanh trai sau + Block ba nhanh hoan toan = Block hai nhanh kéem block nht that 46 III 7.2. Nguyén nhan Tuong tw nhw cac nguyén nhan gay block hai nhanh. Ny ttt MI A Wy Me Raa yy aed me th RRA AAA AAA ALAA AMAA A Anh nh ean Hinh 7.41. DTD cla mét bénh nhan nam 60 tudi dén kham vi 6 nhéing con choang vang, chéng mat, tién can bénh tim thiéu mau cuc b6. DTD ghi nh&n block ba nhanh (block nhanh phai kém block phan nhanh trai truéc kém block nhi that do 1) zalo nhom duy nhat 0528112107ny khoa cap nhat https://www.facebook.com/groups/4890 2a Block dan truyén ngi that || 79 (ol ip yy pop oe ap eA Loy uv aS SS o5 Spe yyy Hinh 7.12. DTD cua mét bénh nhan nv 69 tudi c6 tién cAn tang huyét Ap, ghi nhan hinh anh block ba nhanh (block nhaénh phai kém block phan nhanh trai sau kém block nhi that d6 1) a tm | we Ar —l, Hinh 7.13. DTD cia mét bénh nhén nam 70 tudi nhap vién vi ngat, ghi nhan block ba nhanh (block nhanh phai kém block phan nhanh trai truéc kém block nhi that dd III) zalo nhom duy nhat 0528112107y khoa cap nhat https://www.facebook.com/groups/48902% HOI CHUNG KiCH THICH SOM H6i chteng kich thich sém la mét bat thuéng bam sinh, vi sv hién dién dung d&n truyén phu di vong khéng qua nut nhi that, ndi tat gifra tam nhi va tam that; hoac néi tat nut nhi that dén cac hé théng dan truyén chuyén biét khac. Xung déng dién d&n truyén qua duéng phy gay ra khtr cy tam that som hon so véi xung déng truyén binh thuong qua nut nhi that. Hdi chteng kich thich som bao gdm: * Hi chtrng Wolff-Parkinson-White (WPW) * Hi chteng Lown-Ganong-Levin (LGL) * Hi chteng kich thich sm do soi Mahaim. Cac dvéng dan truyén phy twong tng voi cdc hdi chteng bao gdm (Hinh 8.1 va Bang 8.1): Gi nut (INBT) Bo nhi nut (ANT) Cac vung cla nut nhi that ‘Ving chuyén tiép (transitional zone) Nut dae (compact node) S B6 xuyén (penetrating bundle) Hinh 8.1. So d6 cdc dueng phy dan truyén nhi that? g0 | zalonhom duy nhat 0528112107