TS. BS.

Phan nh Phong
Vin Tim mch Vit Nam
B mn Tim mch i hc Y H Ni
 Cn tim nhanh vi QRS
rng l khi:
Tn s cao hn 100 CK/ph
Phc b QRS rng hn 120 ms

Stewart RB. Ann Intern Med 1986

 Nu nhp u
(hoc tng i u):
Tim nhanh tht
Tim nhanh trn tht km theo:
Dn truyn lch hng (aberrancy)
Bloc nhnh t trc
Ri lon dn truyn trong tht
Cn tim nhanh vo li nh tht chiu
ngc (Antidromic AVRT)

Chous Electrocardiography in Clinical Practice 6th Edition

 Nu nhp khng u:
Rung-cung-nhanh nh c dn truyn lch
hng/ trn nn bloc nhnh t trc/
km theo hi chng WPW.
Tim nhanh tht a hnh thi
Xon nh

Chous Electrocardiography in Clinical Practice 6th Edition

Tim nhanh tht
Cung tht
 Tim nhanh trn tht km
theo bloc nhnh t trc (1)

Chous Electrocardiography in Clinical Practice 6th Edition

 Tim nhanh trn tht km
theo bloc nhnh t trc (2)

Chous Electrocardiography in Clinical Practice 6th Edition

Tim nhanh trn tht c
dn truyn lch hng
Antidromic AVRT

Chous Electrocardiography in Clinical Practice 6th Edition

Rung nh/ HC WPW
 Rung nh km theo
dn truyn lch hng

Chous Electrocardiography in Clinical Practice 6th Edition

Tim nhanh tht a hnh thi

Chous Electrocardiography in Clinical Practice 6th Edition

 Xon nh

Chous Electrocardiography in Clinical Practice 6th Edition

Chn on l TIM NHANH THT
ch da vo cn tim nhanh c
phc b QRS rng (> 120 ms):
Kh nng ng: >80%,
Kh nng sai: <20% .
Nhng nu hi: Ti sao cn tim
nhanh vi QRS rng khng
phi l TIM NHANH TRN THT ?
>80% khng bit gii thch.
<20% bit .
 Chn on phn bit
TIM NHANH THT
vs.
TIM NHANH TRN THT
c dn truyn lch hng
The ACC Algorithm

ACC guidelines. J Am Cardiol 2003

The Brugada Algorithm
The Brugada Algorithm

Brugada P. Ciculation 1991

Bc 1: Tm phc b RS t V1-V6,
nu KHNG C VT
Khng c phc b RS t V1-V6
Tim nhanh tht

Brugada P. Ciculation 1991

Bc 2: Nu c RS, o thi gian t
khi u sng R ti y sng S,
nu > 100 ms VT
 C dng RS V2 nhng khong
khi u sng R ti y sng S l
120 ms Tim nhanh tht
Bc 3: Nu < 100 ms, tm du hiu
phn ly tht-nh, nu C VT
Dng R/S V3 v RS < 100 ms nhng
c phn ly tht-nh D2
Tim nhanh tht
Bc 4: Nu khng thy du hiu
phn ly tht-nh, phn tch dng
QRS V1 v V6, tm QRS gi VT
Nu QRS c dng bloc nhnh tri

SVT VT
R wave > 40ms
small R wave notching of S wave

V1

fast downslope
of S wave > 70ms

Q wave
V6 no Q wave
Tim nhanh tht
Tim nhanh trn tht
Nu QRS c dng bloc nhnh phi
SVT VT
rSR configuration monophasic R wave qR (or Rs) complex

V1 or

R/S > 1 R/S ratio < 1 QS complex

V6 or
Tim nhanh tht
Tim nhanh trn tht
 Mt s tiu chun khc
Trc QRS v nh - Trc Ty-Bc

ng dng dng, ng dng m

Nht hn hp, nht bt c tht

Dn truyn tht nh 1:1

 Trc Ty-Bc

Tim nhanh tht

QRS ng hng dng/m

Tim nhanh tht

Nht hn hp/ bt c tht

Tim nhanh tht

 Dn truyn tht nh 1:1

Tim nhanh tht

 Li kt
1. in tm c th gip phn bit mt cn
tim nhanh vi QRS gin rng l Tim
nhanh tht hay Tim nhanh trn tht c
dn lch hng.

2. Trong trng hp kh phn bit, x tr

Tim nhanh trn tht nh l Tim nhanh
tht s an ton hn x tr Tim nhanh
tht nh l Tim nhanh trn tht.
Kt lun
t t tim VV c th do nhiu nguyn
nhn khc nhau v c th c pht hin,
d phng sm bng cc thm d khng
xm nhp.

Cn thn trong phn bit gia cc bin

i sinh l thch nghi ca tim trn VV vi
cc trng hp bnh l tim mch thc
s.