Atlas of Electrocardiography 1 ( Tieng Viet )

Atlas of Eletrocardiography

Bs Nguyn Quang Ton

1

Phn 1

Cc o trnh: DI, DII, DIII, aVR, aVL. aVF

2

3V8: khoang LS V trn ng gia xng vai

V9: gia V8 v CSTL trn khoang LS V pha sau

Cc o trnh ngc phi:

V1R: LS IV cnh b c tri

V2R: LS IV cnh b c phi

V3R: im gia ng ni V2R v V4R

V4R: khoang LS V trn ng gia n phi

V5R: giao ng qua V4R vi ng nch trc

V6R: giao ng qua V5R vi ng nch gia

4

6Nhp xoang bnh thng

Nhp chm xoang

Nhp nhanh xoang

Lon nhp xoang: thng do h hp

- Nhp xoang, tn s lun bt(60-100), tn s tng khi ht vo, gim khi th ra c th < 60. S khc nhau gia RR ngn nht v RR di nht > 0,12s.

- Hnh dng sng P, thi gian PR, QRS bnh thng

7

8Ngng xoang

Ch nhp lu ng nh

9Nhp nhanh nh

Ngoi tm thu nh

10

Nhp nhanh nh (f: 150-250 l/p)

Nhp nhanh trn tht(f: 150-250, sng P ln vo QRST)

11

Nhp nhanh kch pht trn tht

Cung nh

Rung nh

12

Hc Wolf-Parkinson-White

13

Nhp b ni

Nhp b ni gia tc

14

Nhp b ni nhanh

Nhp thot b ni

15

Ngoi tm thu b ni

16

Nhp t tht

Nhp t tht gia tc

17

Ngoi tm thu tht

NTT tht 1 dng

NTT tht a dng

18

NTT tht nhp ba

NTT tht nhp i

NTT tht nhp bn

NTT tht 2 nhp lin tip

19

NTT tht R on T

NTT tht xen k(INTERPOLATED PVC)

Xon nh

20

Nhp nhanh tht 1 dng

Nhp nhanh tht nhiu dng

21

Rung tht

Phn ly in c(Hot ng in v mch)

Atrioventricular and

Bundle Branch Blocks

22

(Block nh tht v block nhnh)

23

Block AV I

Block AV III

Bl

24

Block AV II: Mobitz typ I hay chu k Lucian-Wenkebach

Block AV II: Mobitz typ II

25

Block nhnh phi hon ton Block nhnh tri hon ton

NHI MU C TIM

26

Nhi muc tim cpthnhtrc

28

29

NMCT cp thnh di

NMCT cp thnh di NMCT cp thnh bn

30

NMCT cp vng vch

ECG Case

31

Ri lon nhp xoang do h hp

32

001

Nhp nhanh xoang

33

002

Nhp xoang vi block AV II dn truyn 2:134

003

Nhp xoang vi block AV II 2:1

Block nhnh phi hon ton Block phn nhnh tri trc

C th dy nh tri; c th NMCT thnh di 35

004

Nhp b ni chm(25l/p)

C th l hi chng suy nt xoang36

005

Nhp xoang 64l/p; nhp tht 45l/p

Block nh tht III

C th c dy nh tri 37

006

Nhp xoang 90l/p, block AV III Nhp my to nhp 60l/p Vim tim trong bnh Lyme 38

007

Nhp nhanh nh a : P c nhiu dng, PP khc nhau; tng gnh nh tri vi P cao DII, DIII, aVF; sng R ngho nn cc chuyn o ngoi vi

ECG ca bnh nhn COPD 39

Nhp nhanh nh(f=200l/p); block AV 2:1; NTT tht tha; tng gnh tht tri 40

Nhp nhanh nh vi block AV 2:1;block nhnh phi khng hon ton; QT ko di

41

Nhp nhanh nh(f=180l/p); block AV 2:1(r trn V1); Dy tht tri, R ct ct t V1-V4(dng QS)=> NMCT c thnh trc vch

42

Nhp nhanh trn tht vng vo li nt nh tht(AVNRT)(f=150l/p)43

008

Cung nh 2:1(r trn DII, V1)

44

009

Cung nh(tn s nh 300l/p), t l dn truyn 2:1 v 3:1

45

010

Rung nh vi block nhnh tri hon ton

46

011

Cung nh dn truyn 2:1; block nhnh tri hon ton

Hot ha nh r DII(tn s 320l/p)47

012

Rung nh vi block tim hon ton v nhp thot b ni.

QRS rng cho thy c s ri lon dn truyn trong tht nh trc tri, tng gnh tht tri48

013

Rung nh; trc phi, tng gnh tht tri

ECG ny gi c tng gnh 2 tht bin chng ca hp 2 l v bnh van m ch49

014

HC W-P-W: PR ngn, QRS dn rng, sng delta

50

Sng delta

015

Rung nh; HC W-P-W

51

016

Nhp t tht gia tc

52

017

Hc QT di(0,6s)

53

018

Nhp nhanh tht n dng(f=170l/p): hnh dng ca block nhnh phi hon ton v t l R:S < 1 trn V6 gi nhp nhanh tht vi pht nhp mt tri tim gn y tim

54

019

Bn n 43t, th trng bo, kh th, nn v v m hi55

020

Phn tch:

- Nhp xoang

- NMCT cp thnh di: ST chnh ln DII, DIII, aVF

- NMCT tht phi: gi ST chnh ln DIII v V1

- in th thp

56

A

B CA- phn bit ST chnh trong ti cc sm(Ber) v trong NMCT cp (AMI)B-C: ST chnh trong khng NMCT cp v trong NMCT cp

Bn nam 46t, hi hp trng ngc ko di, kh th tng t

ECG:

Nhp xoang u 69l/p

Tng gnh tht tri

HC WPW tng cn

57

021

Bn n 46t, b nn v i ngoi 2 ngy nay

ECG: nhp xoang u 82l/p; QT ko di 58

022

Bn nam 58t b k di cn phi, hin c kh th, tm, tt HA(88/45)59

023

Phn tch:- Nhp xoang u tn s 97l/p, trc phi- Block nhnh phi khng hon ton- Sng T bt thng ph hp vi thiu mu c tim vng di v trc vch

60

Comment:- S o ngc sng T cc chuyn o trc tim gi tc nghn on gn LAD. Ngoi ra s o ngc song T cng c

th gi ti sng Wellen hay du hiu Wellen. Tuy nhin hin ti trn ECG ny vi trc phi, block nhnh phi v ng thi s o ngc song T vng thnh di v trc vch gi ti thuyn tc phi ln.

- Bn ny sau t vong, gii phu t thi cho thy c tc nhiu m phi trong c tc m phi vng yn nga

Bn n 75t, b nn v a chy 61

024

ECG:- Nhp nhanh xoang (f=115l/p)- NTT nh- Dy nh phi- Dng QS V1, V2: NMCT c trc vch- Sng T ti cc khng c hiu

62

Bn n 64t tnh trng sau ngt

ECG: Nhp xoang nhanh vi block AV cp II dn truyn 2:1, tn s tht 75l/p(sng P r /V2,V3, tn s 150l/p)

Dng QS V1, V2: NMCT c thnh trc vch 63

025

BN nam 29t, trng thi tm thn bin i v thay i hnh vi sau khi dung thuc qu liu(khng r thuc g)64

026

ECG:- Nhp xoang nhanh(f=128l/p)- Chm dn truyn trong tht khng c hiu

Comment:

ECG ny gi qu liu thuc chng trm cm 3 vng:

+ Nhp tim nhanh

+ Trc phi

+ Bin song P/aVR 3mm

+ QRS dn nh

+ Ngoi ra du hiu thng gp na l QT di

- Ng c thuc chng trm cm 3 vng l mt trong nhng chn on phn bit quan trng khi gp trc phi, QRS dn, QT di. Bn trong ca ny l do qu liu Amitriptyline

65

BN n 18t, ang c thai 26 tun, kh th, hi hp trng ngc, lo lng 66

027

ECG:- Nhp xoang u 79l/p- Block nhnh phi khng hon ton- Sng T m V1-V3: thiu mu c tim trc vch- Bt thng song T khng c hiu thnh di

Comment:

ECG ny gi 1 nhi mu phi. Block nhnh phi khng hon ton c th gi dn tht

phi. Sng T bt thng l du hiu thng thy ca nhi mu phi. Sng T o ngc

thnh di v trc vch l c hiu cao cho nhi mu phi. Tuy nhin sng T o ngc

ch c lp vng trc vch th c nhy cao hn. Ch rng bn ny khng c nhp

nhanh. Nhp nhanh xut hin t hn mt na cc trng hp nhi mu phi

67

68

028

* LS: Bn n 48t, b bnh c tim hn ch nng, kh th khi gng sc, tin ngt. * ECG:- Nhp xoang bt- NMCT cp trc vch

Sau vi gi ghi tip in tim...

69

70

029

ECG:

- Nhp xoang chm

- NMCT trc vch:ST chnh ln V1, V2

- Block nhnh phi hon ton: QRS >0,12s; Dng RsR/V1; S rng DI, aVL, V5, V6

- Block phn nhnh tri sau: trc phi t nht > 1200, dng qR/DII,DIII,aVF

Nh vy sau vi gi ghi li in tim thy c them block nhnh phi, hemiblock. y l hu qu ca nhi mu c tim trc vch

71

72

030

LS: BN nam 74t, kim tra tim mch trc PT thay khp gi. Bn c tin s ph hp vi bnh mv c pt bc cu ni ch-vnh cch 1 nm.

ECG:

- Nhp xoang bt

- Block AV I

- NMCT c trc vch

- Phn ly nh tht(atrioventricular dissociation)

73

74

031

LS: Bn nam 48t, b suy tim xung huyt, hin ti c bun nn, nn, kh th

ECG:

- Tn s nh 200l/p, u: nhp nhanh nh

- Tn s tht 70l/p

- Block AV III

in tim gi nhim c digoxin. nh lng nng digoxin mu l 4,4ng/ml(bt 0,5-2,2ng/ml)

75

76

032

LS: Bn n 40t, c kh th, au tc ngc. HA 85/50

ECG:

- Nhp xoang nhanh 130l/p

- in th thp

Comment:

- in th thp: khi bin QRS cc chuyn o chi

78

033

LS: Bn nam 37t, tnh trng sau ngt. Hin ti bnh thng

ECG

- Nhp xoang f=75

- Tng gnh tht tri

- Block nhnh phi khng hon ton

- ST chnh ln cc chuyn o trc ngc => Hc Brugada

79

Hi chng Brugada

1. nh ngha: HC Brugada l mt bnh l knh ion v in hc tin pht ca timc trng bi on ST chnh ln chuyn o trc tim bn phi, khng cbt thng cu trc tim. Bnh nhn thng c nhng cn ngt hoc t t donhp nhanh tht hoc rung tht.

2. PL ECG:

80

Cc typ hc brugada

81

82

HC Brugada typ 1

83

Hc Brugada typ 1

84

Hc Brugada typ 1

85

Hc Brugada typ 2

HC Brugada type 2

86

87

034

LS: Bn n 53t cm thy chng mt

ECG

- Nhp xoang

- Block nh tht cp II kiu Mobitz 1(chu k Lucian-wenkebach)

- NTT tht tha

88

* LS: Bn nam 50t, ang trong tnh trng au ngc d di ECG:

- Nhp xoang

- Ngoi tm thu tht

- Sng Q V3-V5

- ST chnh ln DI, aVL, V3-V6

- ST chnh xung DIII, aVF

KL: NMCT cp thnh trc bn; Ngoi tm thu tht

90

LS:BN nam 65t, tin s v hin ti khng c biu hin g bnh tim. ECG c ghi thng quy trc m.

ECG:

- Nhp xoang

- Trc bnh thng

- Block AV I(PR = 0,28s)

- Block nhnh phi hon ton

92

93

035

LS: Bn nam 50t vo cp cu v au ngc ko di 1h. Khm khng pht hin triu chng tim mch

ECG:

- Nhp xoang vi 1 nht ngoi tm thu nh

- Sng T o ngc trn aVL, V1-V6

KL: NMCT cp khng ST chnh thnh trc bn

94

95

036

LS: BN nam 50t vo cp cu v au vng gia ngc ko di 2h vi c im cn au ngc ca NMCT cp. Cch 6 thng ECG ca bn bnh thng

ECG:

- Nhp xoang

- Trc bnh thng

- NTT tht

- Block nhnh tri cc nhp xoang

96

Nhp xoang, block AV I

Block nhnh tri hon ton 97

037

98

H/c W-P-W

038

99

039

* LS: BN nam 40t, khng c triu chng g. Vo cp cu sau khi b ngt ECG:

- Nhp xoang, 70l/p

- Thi gian PR v QRS bnh thng

- Trc bnh thng

- Phc b QRS V1, V2 c dng RSR

- ST chnh ln i xung V1, V2

KL: HC Brugada

100

101

040

* LS: BN n 30t, iu tr trm cm nhiu nm. Bn vo cp cu sau khi t t bng ung nhiu aspirin

ECG:

- Sinus rhythm

- Normal axis

- Normal QRS complexes

- T wave inversion in leads I, VL, V4-V6(T o ngc DI, aVL, V4-V6)

KL: T o ngc thnh trc bn do dung lithium

102

103

041

* LS: ECG ca 1 cu b 15t, b ngt khi chi bng . Gia nh c b b cht t ngt ECG:

- Nhp xoang

- Khong PR bnh thng tr phc hp th 3 trn aVL, nht ny gi 1 tin kch thch

- Trc v QRS bnh thng

- QT di(khong 640ms)

- Cc sng U thy r trn cc chuyn o ngc

KL: Hi chng QT ko di

104

105

042

* LS: Bn nam 70t vo vin v kh th

ECG:

- Nhp xoang

- Sng P 2 pha, r V1, V2, cao gn 3mm DII

- Trc chuyn phi

- Ch s Sokolyon tht phi > 12mm

- Sng S su V6, khng c dng ca tng gnh tht tri

Kl: Dy nh phi

106

107

043

* LS: BN nam 25t, vo vin v au ngc

ECG:

- Nhp xoang

- Trc bnh thng

- ST chnh ln DI, DII, DIII, aVF, V4-V6

KL: Vim mng ngoi tim

108

109

044

* LS: Bn nam 65t vo vin v kh th, bn c cc biu hin ca suy tim mc va ECG:

- Nhp xoang

- Ngoi tm thu tht nhiu

- Block nhnh phi

- Sng Q cc nhp xoang trn DIII, aVF

KL:

- NTT tht nhiu

- Block nhnh phi

- C th l nhi mu c tim c thnh di

110

111

045

* LS: Bn nam 50t vo vin v au ngc vi c im ca thiu mu c tim, HA 150-80, khng c biu hin suy tim ECG:

- Nhp nhanh phc b rng, tn s 200l/p

- Khng c song P

- Trc phi

- Broad-complex tachycardia, rate 200/min

- Thi gian QRS khong 140ms

- QRS dng block nhnh phi

- QRS complex duration about 140 ms

Right bundle branch block pattern, with the R

peak taller than the R1

peak in lead V1

Non-concordant QRS complexes with negative

QS pattern in lead V6 (i.e. complexes are upwards

in lead Vl but downwards in lead V6)

112

113

046

Bn n 60t, b suy tim thi gian di, hin ti kh th, gim cn, n ung km

Rung nh(Atrial fibrillation)

Ngoi tm thu tht nhp i(Coupled ventricular extrasystoles)

Sng Q aVL( cc nhp trn tht)(Q waves in lead VL (in the supraventricul beats)

Cc song T dt v song U (thy r V3)(Flattened T waves and prominent U wave (best seen in lead V3)

ST chnh xung V6

KL:

- Rung nh vi nhp thot tht

- C th nhim c digoxin v h kali mu

114

115

047

Bn nam 40t, khng c biu hin g, ECG thc hin trong khm sc khe nh k Nhp xoang(Sinus rhythm)

Trc bnh thng(Normal axis)

Mt song R V3

ST chnh ln cao V4

Sng T o ngc DIII, aVF

KL:

- C th l ST chnh ln cao bnh thng

- C th l thiu mu c tim thnh di

- C th l nhi mu c tim c thnh trc

116

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Atlas of Electrocardiography 1 ( Tieng Viet )