Nhp nhanh vi QRS hep

Ths BS Nguyen Hu Khoa Nguyen

Bo mon Noi - HYD

He thong ien hoc trong tim

Nhp nhanh vi QRS hep (< 0.12s)

Nhp nhanh eu

Nhp nhanh
Nhp nhanh
Cuong nh
Nhp nhanh
that
Nhp nhanh
Nhp nhanh

xoang
nh (n o)

Nhp nhanh khong eu

vao lai nut nh

vao lai nh that

bo noi

Rung nh ap ng that
nhanh
Cuong nh vi dan truyen
nh that thay oi
Nhp nhanh nh a o

Nhp nhanh eu vi QRS hep

Nhp nhanh eu vi QRS hep

Song P va moi lien he vi QRS
(P i trc, lan vao hay i sau QRS) la
cha khoa e chan oan

Nhp nhanh xoang

C che: tang t ong tnh

P xoang (dng I, II, III, aVF; hai phases hoac am V1)
P i trc QRS (RP dai), vi PR bnh thng
Tan so: > 100 l/p, thng 100 -160, max: 220 tuoi,
Khi phat t t vi warmwarm-up, khong bi ngoai tam thu

Nhp nhanh xoang

Nhp nhanh nh n o

C che: tang t ong tnh,

vong vao lai hoac khi kch
Khi phat va ket thuc t t
Song P: khac vi P xoang
(nhon hn, thi gian ngan
hn), tuy v tr o phat nhp
P i trc QRS (RP dai)
PR > 0.12 s (khac vi nhp
nhanh bo noi)
Tan so nh: 150 250 l/p

Nhp nhanh nh n o
Hnh dang song P theo v tr o phat nhp

O phat nhp gan nut xoang: kho phan biet vi P xoang

Nhp nhanh nh n o

Nhp nhanh bo noi gia toc

t gap, c che: tang t ong tnh

Tan so that: 100 120
Co the song P dan truyen ngc len nh: P am II, III, aVF;
dng V1 va aVR
Song P dan truyen ngc co the i trc (PR < 0.12 s), lan
vao hoac i sau QRS

Nhp nhanh bo noi gia toc

Nhp nhanh vao lai nut nh that

AtrioVentricular Nodal Reentrant Tachycardia: AVNRT

Thng gap
Vong vao lai tai nut
nh that
P dan truyen ngc
len nh (am II, III,
aVF)
Lien he vi QRS tuy
theo hng dan truyen
qua vong vao lai

Khi phat ot ngot bi

ngoai tam thu nh
tan so: 150150-250 l/p

Nhp nhanh vao lai nh that

Atrioventricular reentrant tachycardia (AVRT)

Vong vao lai qua nut nh that va ng dan truyen phu

Khi phat ot ngot bi ngoai tam thu nh
P dan truyen ngc, i sau QRS vi RR-P > 80 ms
Tan so 150150-250 l/p

Kch thch sm qua ng dan truyen phu

Type A
Delta dng cac
chuyen ao V, vi R/S
>1

Type B
Delta am V1, V2

Kch thch sm
Song delta

Kch thch sm

Hoi chng WolfWolf-Parkinson

Parkinson--White

Ngoai cn nhp nhanh:

PR ngan, song delta, QRS rong

Cn nhp nhanh: nhp nhanh vao lai nh that

(AtrioVentricular Reentrant Tachycardia: AVRT)
Orthodromic AVRT: dan truyen xuong that qua nut AV va
dan truyen ngc len nh qua ng phu
nhp nhanh vi QRS hep
Antidromic AVRT: t gap hn, dan truyen xuong that qua
ng phu va dan truyen ngc len nh qua nut AV
nhp nhanh vi QRS rong

Nhp nhanh vao lai nh that

Nhp nhanh vao lai nh that vi QRS hep

Orthodromic AVRT

Nhp nhanh vao lai nh that vi QRS rong

Orthodromic AVRT

Cuong nh

Vong vao lai ln trong nh P

Nhp nh: 250250-350 l/p
Song F (Flutter) rang ca
(II, III, aVF, V1): sawsaw-tooth
baseline
Dan truyen nh that

2:1 tan so that 150 l/p

3:1, 4:1 (do dung thuoc)
1:1 roi loan huyet ong
Dan truyen nh that thay oi:
nhp that khong eu

Cuong nh

Cuong nh

Nhp nhanh khong eu vi

QRS hep

Rung nh ap ng that nhanh

La roi loan nhp nhanh vi QRS hep thng gap nhat

Cac vong vi vao lai tai nh
Khong P vi QRS hoan toan khong eu
Baseline: ang ien hoac co song rung nh (f) vi tan
so 350350-450 l/p

Rung nh ap ng that nhanh

Rung nh ap ng that nhanh

Cuong nh vi dan truyen nh that thay oi

Nhp nhanh nh a o

Song P co t nhat 3 dang khac nhau

Chan oan phan biet nhp nhanh

eu vi QRS hep

Chan oan phan biet nhp nhanh eu vi

QRS hep

Tan so:
100
100--140:

Nhanh xoang (max: 220 tuoi)

Nhp nhanh bo noi gia toc (100(100-120)

140140-160: cuong nh vi dan truyen 2:1

160
160--220: AVNRT, AVRT, nhanh nh

Chan oan phan biet nhp nhanh eu vi

QRS hep

Song P:
Khong P:

Nhanh bo noi gia toc (tan so 100 -140)

AVNRT (tan so 160160-200)

P trc QRS:

P xoang vi PR bnh thng: nhanh xoang

Nhp nhanh nh

P sau QRS:

Nhanh bo noi gia toc vi P dan truyen ngc (tan so 100100-140)

AVNRT (160(160-200 ./p)

P rang ca vi tan so 300 l/p: cuong nh

Chan oan phan biet nhp nhanh eu vi

QRS hep

ac iem
Nhanh xoang: P xoang (dng II, III, aVF; am hoac
2 phase V1), PR bnh thng
Cuong nh: song rang ca II, III, aVF
AVNRT: r gia V1 va s gia II
AVRT: P dan truyen ngc i sau QRS
Nhp nhanh nh: giong nhanh xoang nhng khong
phai P xoang

The End

Nhp nhanh bo noi o phat nhp ngoai v

(Junctional Ectopic Tachycardia: JET)

Nhp nhanh eu
vi QRS hep
Phan li nh that

Nhp nhanh vao lai nut xoang

Hiem gap
C che: vong vao lai tai nut xoang
ECG: tng t nhp nhanh xoang, tan so: 100 150
lan/phut
Khi phat (thng bi ngoai tam thu nh) va cham dt
ot ngot