bài giảng tiếp cận nhanh ecg

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<small>Faculty of Traditional Medicine</small>

<b><small>University of Medicine and Pharmacy</small></b>

<b>Tiếp cận nhanh ECG </b>

ThS. Võ Thanh Phong

<small>1</small>

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<small>Faculty of Traditional Medicine</small>

<b>Hệ thống dẫn truyền</b>

<small>2</small>

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<small>Faculty of Traditional Medicine</small>

<b>Phức bộ sóng</b>

<small>3</small>

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<small>Faculty of Traditional Medicine</small>

<b>Vị trí điện cực</b>

<small>4</small>

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<small>Faculty of Traditional Medicine</small>

<b>Vị trí các điện cực</b>

<small>5</small>

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<small>Faculty of Traditional Medicine</small>

<b>Hình thành QRS</b>

<small>6</small>

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<small>Faculty of Traditional Medicine</small>

<b>Trục tim</b>

<small>7</small>

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<small>Faculty of Traditional Medicine</small>

<b>Tần số</b>

<small>8</small>

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<small>Faculty of Traditional Medicine</small>

<b>Tần số</b>

<small>9</small>

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<small>Faculty of Traditional Medicine</small>

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<small>Faculty of Traditional Medicine</small>

<b>Nhanh xoang</b>

<small>11</small>

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<small>Faculty of Traditional Medicine</small>

• _{Cường giáp}

• _{Tất cả các nguyên nhân gây kích thích giao cảm: lo lắng, đau,}

sợ, sốt, tập luyện

<small>12</small>

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<small>Faculty of Traditional Medicine</small>

<b>Rung nhĩ</b>

<small>13</small>

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<small>Faculty of Traditional Medicine</small>

<b>Rung nhĩ</b>

• _{Tăng huyết áp}• _{Thiếu máu cơ tim}• _{Bệnh van tim}

• Bệnh cơ tim

• _{Viêm cơ tim}

• Thơng liên nhĩ và bệnh tim bẩm sinh khác

• _{Cường giáp}• Rượu

• _{Thuyên tắc phổi}• _{Viêm phổi}

• _{Phẫu thuật tim mạch}

<small>14</small>

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<small>Faculty of Traditional Medicine</small>

<b>Đánh giá nguy cơ huyết khối</b>

<small>15</small>

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<small>Faculty of Traditional Medicine</small>

<b>Đánh giá nguy cơ xuất huyết</b>

<b><small>HAS-BLED score ≥3 indicates a ‘high risk’ for bleeding</small></b>

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<small>Faculty of Traditional Medicine</small>

<b>Đường dẫn truyền phụ</b>

<small>17</small>

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<small>Faculty of Traditional Medicine</small>

<small>18</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block AV</b>

<small>19</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block AV</b>

<small>20</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block AV</b>

<small>21</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block AV</b>

<small>22</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block AV</b>

<b>Nguyên nhân:</b>

• _{Bẩm sinh}• _{Mắc phải:}

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<small>Faculty of Traditional Medicine</small>

<b>Block nhánh P</b>

<small>24</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block nhánh P</b>

<small>25</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block nhánh P</b>

<small>26</small>

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<small>Faculty of Traditional Medicine</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block nhánh T</b>

<small>28</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block nhánh T</b>

<small>29</small>

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<small>Faculty of Traditional Medicine</small>

<b>Block nhánh T</b>

<small>30</small>

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<small>Faculty of Traditional Medicine</small>

• _{Xơ hóa hệ thống dẫn truyền}

<b>LBBB mới là luôn ln bệnh lý và có thể là một dấu hiệu của nhồi máu cơ tim</b>

<small>31</small>

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<small>Faculty of Traditional Medicine</small>

<b>Sóng Q</b>

<b>Sóng Q được gọi là bất thường khi:</b>

• _{Sâu >2 ơ nhỏ}• Rộng >1 ơ nhỏ

• _{Cao >1/4 sóng R liền kề}

<small>32</small>

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<small>Faculty of Traditional Medicine</small>

<b>Sóng Q</b>

<small>33</small>

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<small>Faculty of Traditional Medicine</small>

<b>Q bệnh lý</b>

<small>34</small>

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<small>Faculty of Traditional Medicine</small>

<b>Q bệnh lý</b>

<small>35</small>

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<small>Faculty of Traditional Medicine</small>

<b>Q bệnh lý</b>

<b>Nguyên nhân:</b>

• _{NMCT ST chênh lên}• _{Lớn thất trái}

• Block nhánh T

• _{HC Wolff-Parkinson-White}• Thuyên tắc phổi

<small>36</small>

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<small>Faculty of Traditional Medicine</small>

<b>Tiêu chuẩn SGARBOSSA</b>

<small>37</small>

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<small>Faculty of Traditional </small>

</div><span class="text_page_counter">Trang 39</span><div class="page_container" data-page="39">

<small>Faculty of Traditional Medicine</small>

<b>Động học ST trong NMCT</b>

<small>39</small>

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<small>Faculty of Traditional Medicine</small>

<b>Định khu NMCT</b>

<small>40</small>

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<small>Faculty of Traditional Medicine</small>

<small>41</small>

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<small>Faculty of Traditional Medicine</small>

<small>42</small>

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<small>Faculty of Traditional Medicine</small>

<small>43</small>

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<small>Faculty of Traditional Medicine</small>

<b>Phình thất trái</b>

<small>44</small>

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<small>Faculty of Traditional Medicine</small>

<b>Viêm màng ngoài tim</b>

<small>45</small>

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<small>Faculty of Traditional Medicine</small>

<b>ST chênh lên</b>

<b>Nguyên nhân:</b>

• _{NMCT ST chênh lên}• _{Phình thất trái}

• Tăng kali máu

• _{Tăng calci máu}• U xâm lấn thất trái

• _{Thuyên tắc phổi cấp}

<small>46</small>

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<small>Faculty of Traditional Medicine</small>

<b>Ngấm digoxin</b>

<small>47</small>

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<small>Faculty of Traditional Medicine</small>

<b>Lớn thất T kèm dãn</b>

<small>48</small>

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<small>Faculty of Traditional Medicine</small>

<small>49</small>

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<small>Faculty of Traditional Medicine</small>

<b>T cao</b>

<small>50</small>

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<small>Faculty of Traditional Medicine</small>

</div><span class="text_page_counter">Trang 52</span><div class="page_container" data-page="52">

<small>Faculty of Traditional Medicine</small>

• _{Viêm màng ngồi tim}• _{Tăng thơng khí}

• _{Sa van 2 lá}

• _{Thuyên tắc phổi}

• Xuất huyết dưới nhện

<small>52</small>

</div>