atlas of electrocardiography 1 ( tieng viet )
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ecgTRANSCRIPT
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Atlas of Eletrocardiography
Bs Nguyn Quang Ton
1
Phn 1
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Cc o trnh: DI, DII, DIII, aVR, aVL. aVF
2
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3V8: khoang LS V trn ng gia xng vai
V9: gia V8 v CSTL trn khoang LS V pha sau
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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
-
5
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6Nhp xoang bnh thng
Nhp chm xoang
Nhp nhanh xoang
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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
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8Ngng xoang
Ch nhp lu ng nh
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9Nhp nhanh nh
Ngoi tm thu nh
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10
Nhp nhanh nh (f: 150-250 l/p)
Nhp nhanh trn tht(f: 150-250, sng P ln vo QRST)
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11
Nhp nhanh kch pht trn tht
Cung nh
Rung nh
-
12
Hc Wolf-Parkinson-White
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13
Nhp b ni
Nhp b ni gia tc
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14
Nhp b ni nhanh
Nhp thot b ni
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15
Ngoi tm thu b ni
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16
Nhp t tht
Nhp t tht gia tc
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17
Ngoi tm thu tht
NTT tht 1 dng
NTT tht a dng
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18
NTT tht nhp ba
NTT tht nhp i
NTT tht nhp bn
NTT tht 2 nhp lin tip
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19
NTT tht R on T
NTT tht xen k(INTERPOLATED PVC)
Xon nh
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20
Nhp nhanh tht 1 dng
Nhp nhanh tht nhiu dng
-
21
Rung tht
Phn ly in c(Hot ng in v mch)
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Atrioventricular and
Bundle Branch Blocks
22
(Block nh tht v block nhnh)
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23
Block AV I
Block AV III
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Bl
24
Block AV II: Mobitz typ I hay chu k Lucian-Wenkebach
Block AV II: Mobitz typ II
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25
Block nhnh phi hon ton Block nhnh tri hon ton
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NHI MU C TIM
26
-
27
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Nhi muc tim cpthnhtrc
28
-
29
NMCT cp thnh di
NMCT cp thnh di NMCT cp thnh bn
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30
NMCT cp vng vch
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ECG Case
31
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Ri lon nhp xoang do h hp
32
001
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Nhp nhanh xoang
33
002
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Nhp xoang vi block AV II dn truyn 2:134
003
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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
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Nhp b ni chm(25l/p)
C th l hi chng suy nt xoang36
005
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Nhp xoang 64l/p; nhp tht 45l/p
Block nh tht III
C th c dy nh tri 37
006
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Nhp xoang 90l/p, block AV III Nhp my to nhp 60l/p Vim tim trong bnh Lyme 38
007
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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
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Nhp nhanh nh(f=200l/p); block AV 2:1; NTT tht tha; tng gnh tht tri 40
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Nhp nhanh nh vi block AV 2:1;block nhnh phi khng hon ton; QT ko di
41
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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
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Nhp nhanh trn tht vng vo li nt nh tht(AVNRT)(f=150l/p)43
008
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Cung nh 2:1(r trn DII, V1)
44
009
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Cung nh(tn s nh 300l/p), t l dn truyn 2:1 v 3:1
45
010
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Rung nh vi block nhnh tri hon ton
46
011
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Cung nh dn truyn 2:1; block nhnh tri hon ton
Hot ha nh r DII(tn s 320l/p)47
012
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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
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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
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HC W-P-W: PR ngn, QRS dn rng, sng delta
50
Sng delta
015
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Rung nh; HC W-P-W
51
016
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Nhp t tht gia tc
52
017
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Hc QT di(0,6s)
53
018
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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
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Bn n 43t, th trng bo, kh th, nn v v m hi55
020
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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
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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
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Bn nam 58t b k di cn phi, hin c kh th, tm, tt HA(88/45)59
023
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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
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Bn n 75t, b nn v a chy 61
024
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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
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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
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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
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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
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BN n 18t, ang c thai 26 tun, kh th, hi hp trng ngc, lo lng 66
027
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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
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* 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
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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
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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
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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
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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
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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
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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
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HC Brugada type 2
86
-
87
034
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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
-
89
-
* 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
-
91
-
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
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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
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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
-
117
-
118
-
119
-
120