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  • Tìm hiểu hiện tượng block nhánh trái ở tim - Phòng khám Siêu âm Tim mạch BS Phạm Xuân Hậu

    Tìm hiểu hiện tượng block nhánh trái ở tim

    Block nhánh trái là tình trạng xung động không thể dẫn truyền xuống bó nhĩ thất trái, do đó xung động sẽ đi sang bó nhĩ thất phải để khử cực thất phải trước sau đó mới dẫn truyền sang trái để khử cực thất trái.

    1. Nhận biết dấu hiệu block nhánh trái

    Block nhánh là một danh từ để chỉ hình ảnh điện tâm đồ khi xuất hiện những rối loạn về dẫn truyền xung động trong một nhánh của bó His, còn được gọi là rối loạn dẫn truyền trong thất.

    Quan sát trên điện tâm đồ ta sẽ thấy block nhánh trái có các dấu hiệu:

    • Thời gian QRS rộng: >= 0,12 giây
    • QRS có dạng:
    • rS ở V1, V2
    • R đơn pha có thể có khía ở V5,V6.
    • Đoạn ST chênh xuống và T âm ở V5, V6, Dl, aVL

    2. Cơ chế hình thành block nhánh trái

    Hình ảnh block nhánh trái

    Do xung động đi quanh co từ bó nhĩ thất phải rồi mới dẫn truyền sang bó nhĩ thất trái (do block nhánh trái ) dẫn tới QRS rộng trên điện tâm đồ.

    Quy trình khử cực trong block nhánh trái:

    • Xung động dẫn truyền xuống bó nhĩ thất nhưng bị tắc nghẽn (do bị block) sẽ khiến xung động tạo ra một vector khử cực bên phải (hướng về V1, V2 tạo sóng R nhỏ)
    • Sau khi thất phải khử cực xong thì các xung động đi qua bên trái, tạo thành vector thứ hai hướng nhiều qua hướng bên trái (thành bên và đáy) khử cực bên trái (hướng về V5,V6 tạo thành sóng R dương), xuất hiện hiện tượng tăng điện thế.

    Quá trình tái cực trong block nhánh trái :

    • Bên phải tái cực trước, bên trái tái cực sau.
    • Điện thế tái cực bên trái cao hơn bên phải.
    • Vector tái cực hướng từ trái sang phải.
    • ST-T chênh xuống ở các chuyển đạo bên trái.
    • ST-T chênh lên ở các chuyển đạo bên phải.

    3. Nguyên nhân gây ra block nhánh trái

    Block nhánh trái (hoặc phải) có thể do nhánh đó bị cắt đứt, thoái hóa hay thương tổn, xung động từ nhĩ truyền xuống sẽ phải đi vào nhánh phía bên kia và tiến hành khử cực thất bên đó trước rồi mới chuyển sang khử cực thất bị block sau.

    Các nguyên nhân có thể gây ra block nhánh trái bao gồm:

    • Chứng hẹp động mạch chủ
    • Bệnh lý tim thiếu máu.
    • Suy tim giai đoạn cuối (giãn lớn thất trái gây mất đồng bộ 2 thất)
    • Tăng huyết áp
    • Bệnh lý cơ tim giãn

    Tăng kali máu có thể gây ra block nhánh trái

    • Nhồi máu cơ tim (tắc nhánh LAD)
    • MI thành trước.
    • Bệnh thoái hóa tiên phát hệ thống dẫn truyền (bệnh Lenegre).
    • Tăng kali máu
    • Nhiễm độc tính Digoxin.

    4. Tiêu chuẩn để chẩn đoán block nhánh trái

    Tiêu chuẩn block nhánh trái bao gồm quy trình bác sĩ sẽ kiểm tra và xác định bệnh nhân có các triệu chứng nhồi máu cơ tim cấp, suy tim trái hoặc thiếu máu cơ tim hay không.

    Đánh giá khả năng nhồi máu cơ tim cấp dựa trên:

    • Tình trạng đau ngực gần đây
    • Tiêu chuẩn Sgarbossa để xác định block nhánh trái mới xuất hiện hay đã từ lâu.
    • Xét nghiệm chỉ số men tim.

    Đánh giá khả năng suy tim trái dựa trên:

    • Tình trạng mệt, khó thở (nếu có).
    • Khám lâm sàng phát hiện dấu hiệu tim to.
    • Dấu hiệu rối loạn nhịp tim .
    • Kết quả chụp X-quang ngực thẳng, siêu âm tim để tìm dấu hiệu tim bất thường.

    Đánh giá khả năng thiếu máu cơ tim dựa trên:

    • Hỏi về tiền căn đau ngực.
    • Nguy cơ mắc bệnh mạch vành .

    Bài viết gợi ý

    Thông tin liên hệ

    Hotline - 0938 237 460
    336A Phan Văn Trị, Phường 11
    Bình Thạnh, TPHCM

    Giờ làm việc

    Thứ 2 - 7:
    Chiều: 16:30 - 19:30
    Chủ nhật, Ngày lễ nghỉ

    Phụ trách phòng khám: BSCK2 Phạm Xuân Hậu. GPHĐ: 06075/HCM-GPHĐ ngày 07/9/2018 do Sở y tế TP HCM cấp

    © 2024 Phòng khám Tim mạch OCA. Designed By Medcomis & JoomShaper
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