chẩn đoán nhồi máu cơ tim bằng điện tâm đồ

ChÈn ®o¸n nhåi m¸u c¬
ChÈn ®o¸n nhåi m¸u c¬
tim b»ng ®iÖn t©m ®å
tim b»ng ®iÖn t©m ®å
Thùc nghiÖm g©y t¾c ®éng m¹ch vµnh


 !"
#$%

&'()*

&'(+, %-)

&'(.%/
C¸c biÕn ®æi ®Æc trng trong NMCT

01-)chªnh lªn2"+, 

01-)chªnh xuèng234$5(, 6

&'(/78

-9":

-)":;
ST chªnh lªn
R
P
Q
ST


&<32(=>?)

&'234@
"A

-)B4#2CD
3CE,F@,F
Sãng Q s©u hay “Q bÖnh lý”
R
P
Q
T
ST

G+,H7I"J4
KL<>?)

?FMNO'7PQPR(

?;(STEUV(9
234
C¸c biÕn ®æi cña sãng T
R
P
Q
T
ST

&'


&<3M@
7-)

W,H'32;
34=@:
%5X6QYQ$KZ
C¸c biÕn ®æi ®Æc trng trong NMCT
>?)thµnh tríc >?)thµnh díi
?+trùc tiÕp%
/78Q-)chªnh
lªnQ)5X6
[DQCGQ34
,=
[EQ[\QC]Q34
#O(
^+soi g¬ng
-)chªnh xuèngQ)5_6
[EQ[\QC]34
#O(
[DQCGQ34
,=
C¸c biÕn ®æi d¹ng tiÕn triÓn cña nhåi m¸u c¬ tim
Tiªu chuÈn chÈn ®o¸n NMCT cÊp

)!(/TP`PR(

^(/TEUV(9
34


-)72?W@
AK$I(
, J2?W$

-)S(S$KZ2
?W7a"A
§Þnh khu vïng nhåi m¸u c¬ tim
12 chuyÓn ®¹o ®iÖn tim

Díi (Inferior) DII, III, aVF

V¸ch (Septal) V1 - V2

Tríc (Anterior) V3 - V4

Bªn (Lateral) V5 - V6

Bªn cao (High Lateral) DI, aVL
Khu tró c¸c vïng nhåi m¸u phèi hîp
aVR
V1
V4
I
II
III
Bên cao
Sau dưới
Vách
Trước
Bên

aVL
aVF
V2
V3
V5
V6
NMCT vïng tríc
Anterior infarction
I II III
aVR aVL aVF V1 V2 V3 V4 V5 V6
Left
coronary
artery
CDXC\%),=bCRXCc%),=bCDXCR%),=
NMCT vïng tríc v¸ch
NMCT vïng tríc réng
NMCT sau díi
Inferior infarction
I II III
aVR aVL aVF V1 V2 V3 V4 V5 V6
Right
coronary
artery
NMCT sau díi
NMCT thµnh bªn (Lateral infarction)
Lateral infarction
I II III
aVR aVL aVF V1 V2 V3 V4 V5 V6
Left
circumflex

coronary
artery
NMCT thµnh bªn cao
Tr×nh tù c¸c biÕn ®æi ®iÖn tim trong NMCT cÊp
1 min sau NMCT
1 h sau NMCT
Vµi h sau NMCT cÊp
> 1 ngµy sau NMCT
C¸c biÕn ®æi muén h¬n
Mét vµi th¸ng sau
Q
R
P
Q
ST
R
P
Q
ST
P
Q
T
ST
R
P
S
T
P
Q
T

ST
R
P
Q
T
TiÕn triÓn cña æ NMCT
TiÕn triÓn cña æ NMCT
NMCT cÊp (0h - 24h)

-)7

/dMe

)d:;Me

W-)fQE#59#7-)#((6
TiÕn triÓn cña æ NMCT
NMCT b¸n cÊp (24h – 1 tuÇn)

-)7OMe

/d7=

):;

W-)fO@,F
TiÕn triÓn cña æ NMCT
NMCT cò ( > 1 tuÇn)

-)Me


/d7=

):;dMe

W-)f
TiÕn triÓn cña æ NMCT

g?h@,F,=>

^+()%iMO,=:;7j!`?
4'3-)7

?7-)+()

&'(/78Q-)7OQ#k$(
):;5/TPQPR(TEUV9?W6

/78Q):;5.(B6

/78Q)$KZ5(B>6
Infarction Time Line
NMCT tríc réng cÊp (Acute Anterior Wall Infarction)
Infarction Time Line
NMCT sau díi cò (Old Inferior Wall Infarction)