ien tam o can ban

TS. BS Trng Quang Bnh

nh ngha ien tam o

T la ng cong bieu dien hoat ong ien cua tim, c ghi lai bang cac ien cc be mat c the.

Cac khai niem c ban ve T

* Phan cc. * Kh cc va vect kh cc. * Hoi cc hay tai cc va vect hoi cc * ien cc va cac vect ien cc. * ien trng tim. * Cac nguyen ly tao thanh song ien c o. * Nh o. * That o. * Cac chuyen ao.

Trang thai phan cc

S kh cc
* Khi co kch thch th se bat au co kh cc. * Kh cc lam cho ien the ben ngoai khoi c am hn so vi ben trong khoi c. => Khi kh cc se lam xuat hien s khac biet ien the gia hai au khoi c. * S khac biet ien the gia hai au khoi c tao ra vect kh cc. * Vect kh cc hng t am sang dng cho nen chieu cua vect kh cc cung chieu vi chieu kh cc

S o kh cc

Vect kh cc

Cac lu y ve kh cc
* Vect kh cc ch xuat hien trong suot qua trnh kh cc. * Vect kh cc co chieu cung vi chieu kh cc khoi c. * Khi s kh cc hoan thanh th vect kh cc cung bien mat (v khong con s khac biet ve ien the gia 2 au khoi c).

Hoi cc

S tai cc
* Tai cc la s t phuc hoi lai trang thai phan cc t trang thai a c kh cc. * oi vi cac loai c thng th kh cc ni nao trc th ni o se tai cc trc. * Ni tai cc se lam cho ien the ngoai khoi c dng hn trong khoi c co s chenh lech ien the gia 2 au khoi c trong qua trnh hoi cc

Vect hoi cc

Cac iem lu y ve s hoi cc

* Vect hoi cc ch xuat hien trong suot qua trnh hoi cc. * Vect hoi cc co chieu ngc vi chieu hoi cc khoi c. * Khi s hoi cc hoan thanh th vect hoi cc cung bien mat (v khong con s khac biet ve ien the gia 2 au khoi c).

Tnh chat cua s kh cc va s tai cc

* Kh cc la qua trnh chu ong, xay ra rat nhanh va manh. * Hoi cc la qua trnh thu ong, xay ra cham, keo dai va yeu. * Hai tnh chat tren se giup giai thch s khac nhau gia song kh cc va song hoi cc

Vect tong hp

Khai niem ve ien cc va vect ien cc

* ien cc la dung cu e ghi lai ien the tai mot iem nao o tren be mat c the (trong trng hp ien cc n cc) hoac ghi lai chenh lech ien the gia hai iem (trong trng hp ien cc lng cc). * Co the bien ien cc lng cc thanh ien cc n cc bang cach bien ien the tai cho cua mot ien cc = 0. Trong trng hp nay ien cc kia se tr thanh ien cc tham do.

Vect ien cc
Vect ien cc se co hng t ni ien cc co ien the am hn sang ni ien cc co ien the dng hn. A (-) *

vect ien cc

B(+)

A co ien the am hn B

Vect ien cc
Khi ien the A = 0 th B tr thanh ien cc tham do va B tr thanh ien cc n cc. A=0 * B

vect ien cc

S tao thanh cac song ien c o

* Can biet nguyen ly tao thanh cac song ien c o * Can nh s kh cc, vect kh cc, vect ien cc ( va ca hoi cc)

Nguyen ly tao thanh song ien c o

* Khi vect kh cc hay vect hoi cc cung chieu vi vect ien cc th se tao thanh song dng va ngc lai. *Song dng la song ve tren ng ong ien va song am la song ve di ng ong ien

V du

vect ien cc
B+

A-

*
vect tong hp

Trnh t kh cc tim

He thong dan truyen va qua trnh kh cc, hoi cc c tim

Qua trnh kh cc va hoi cc c tim, s tao ra song ECG

Trnh t kh cc va hoi cc nh
* Kh cc nh khi phat t tren xuong di, t phai qua trai va t sau ra trc. S kh cc lan toa t nut xoang ra xung quanh. * S kh cc nh tao ra vect kh cc co chieu nh chieu cua kh cc. * Vect hoi cc co chieu ngc vi vect kh cc.

S tao thanh nh o

S tao thanh nh o
*
Tam nh

Vect ien cc

Song P DII

*
C nh mong cho nen lc kh cc yeu

S kh cc tam that
* au tien la kh cc vach lien that t ben trai sang phai va t tren hng xuong di. * Ke en la kh cc thanh t do tam that. S kh cc i t noi tam mac ra ngoai tam mac. That trai day va hoat ong ien manh hn that phai. * Cuoi cung la kh cc phan ay cua that, hng kh cc la t di len tren va t trai sang phai.

Vect kh cc that
* S kh cc that tao ra nhieu vect kh cc nhng tong hp lai chung ta co 3 vect chnh sau: * Vect kh cc vach lien that, hng t trai sang phai va t tren xuong (vect 1) * Vect kh cc thanh t do that, hng t tren xuong va t phai sang trai (vect 2) * Vect kh cc ay tim, hng t di len va t trai sang phai (vect 3)

S tao thanh that o

S tao thanh that o

S hoi cc cua tam that

* oi vi cac loai c thng, ni nao kh cc trc th se hoi cc trc. * C that th co s ngc lai: kh cc t noi tam mac ra ngoai tam mac nhng hoi cc lai t ngoai tam mac vao noi tam mac. vect hoi cc lai cung chieu vi vect kh cc. * Co vai gia thuyet giai thch s kien nay: sc cang thanh tim, he mach mau nuoi dng c tim.

Hnh anh ECG cua 1 chu chuyen tim

ien trng tim

Tim phat ra hoat ong ien trong suot qua trnh kh cc va hoi cc C the la mot moi trng dan truyen ien c. Dong ien phat ra t tim lan toa khap c the va tao nen ien trng cua tim.

ien trng tim

Cac tnh chat cua ien trng tim

* T v tr trung tam la tim, T lan toa ong eu ra xung quanh. * Cang gan tim th ien trng cang manh, cang xa th cang yeu. * Hoat ong tim bnh thng th cho ra ien trng bnh thng va ngc lai. * Hoat ong ien cua vung nao cua tim bat thng th se cho ra ien trng bat thng se vung o.

Cac chuyen ao
* Muc ch chnh cua cac chuyen ao tim la lam sao e co the thu nhan c ien trng cua tim moi goc o. * Bang cach dung cac chuyen ao lng cc e phat hien s chenh lech ien the gia 2 iem trong ien trng hoac dung chuyen ao n cc e tham do ien the tng iem trong ien trng ma cac chuyen ao co the ghi lai hoat ong ien cua tim tng bnh dien khac nhau.

+ +

Cach tao ra chuyen ao n cc

Cach mac chuyen ao n cc

Chuyen ao n cc tang them

OR = 3/2 OR

Tng t cho cac chuyen ao tang them khac

Cac vect ien cc cua C tang them

Cac chuyen ao trc ngc

Cac chuyen ao trc ngc

Cac chuyen ao trc ngc

Cac chuyen ao trc ngc

S thu nhan ien trng cua cac C

Cac C khac
V7, V8, V9 V3R, V4R, V5R Chuyen ao thc quan

Chuyen ao trong buong tim.

Mot ECG thng qui

Ket luan
e co the hieu c ECG va t oc them, i chuyen sau hn th can biet ro: - Hoat ong phan cc, kh cc, hoi cc cua tim. - ien trng cua tim - Cac C tim - S tao thanh cac song ECG cac C khac nhau