2. Nội dung trình bày
1. Tổng quan
2. Rối loạn nhịp chậm và xử trí
3. Rối loạn nhịp nhanh và xử trí
3. Vấn đề
RLNT thường gặp trong bệnh lý tim mạch
Nguyên nhân tử vong hàng đầu trong tim mạch
Phát hiện muộn cấp cứu muộn tăng tử vong tim mạch và biến
chứng kèm theo sau cấp cứu
Phát hiện sớm và điều trị kịp thời giúp giảm tử vong và biến chứng
4. Sudden Cardiac Death: unexpected death within 1 hour of symptoms
Final, common pathway: Vtach/fib 90%
300,000/yr in US
◦ Over 35 years
◦ 80% due to CAD
◦ 15% Cardiomyopathy
NEJM Huikuri et al. 345 (20): 1473, November 15, 2001
5. Sudden Cardiac Death: 1-35 yrs
Final, common pathway: Vtach/fib 90%
3,000/yr U.S.
70% have a structural abnormality
◦ Cardiomyopathies
◦ Coronary Anomalies
◦ Myocarditis
◦ Valvular Disorders
Primary arrhythmic syndromes
◦ Accessory pathways
◦ QT intervalopathies
◦ Ion channelopathies
0%
5%
10%
15%
20%
25%
30%
Identified Causes SCD 1-35 years
HCM
Coronary
Anomalies
Myocarditis
Valvulopathies
Primary arrhythmic
syndromes
ARVD
NEJM Huikuri et al. 345 (20): 1473, November 15, 2001
6. ECG findings in Sentinel Death Events
Cardiomyopathies: (flipped T waves plus…)
◦Hypertrophic Cardiomyopathy (LVH)
◦Dilated (LVH)
◦Restrictive cardiomyopathy (low voltage,a-fib, conduction
disturbances)
◦Arrhythmogenic Right Ventricular Dysplasia /Cardiomyopathy
(Epsilon waves, RBBB pattern)
7. ECG findings in Sentinel Death Events
Primary arrhythmic syndromes
◦Brugada coved/saddle deformity ST V1 &V2
◦WPW Delta waves, short PR interval, RBBB pattern
◦Prolonged/shortened QT
◦Not so-BER inferior-lateral j-point elevation
◦Catecholaminergic Polymorphic Ventricular Tachycardia:Normal RESTING
EKG/ECHO with recurrent syncope starting in childhood related to exertion/emotions.
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
8. ECG findings in Sentinel Death Events
Myocarditis (diffuse flipped T waves)
Congenital coronary-artery anomalies (large p waves)
Coronary artery disease: (Wellen’s Sign, Hyperacute T waves, Too tall T-waves)
Valvular disorders (AS: LVH; MVP: normal or flipped T waves inferiorly)
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
9. The Normal Adult ECG
Majority QRS complexes are positive (have tall R waves)
◦ Except AVR & V1-2; r-wave progression across the precordium
◦ T wave in V1 should be small, flat or flipped
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
10. Differential Dx of Tall R waves in V1
Posterior MI
RBBB
Right Strain
◦ PE
◦ COPD
◦ Cor Pulmonale
RBBB mimics
◦ PE
◦ Brugada
◦ ARVD
◦ WPW
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
11. Specific causes of non-specific flipped T-Waves
CAD/ischemia
Cardiomyopathies
Myocarditis, pericarditis
PE
Valvular disorders
CNS bleed
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
12. Differential Diagnosis: Tall t-waves
Hyperacute T-waves/ischemia
HyperKalemia
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
13. Low voltage: qrs <10mm precordial
Obese patient
Restrictive cardiomyopathy
Pericardial effusion
Hypothyroid
Hypothermia
Myocarditis
ECGs for the Emergency Physician by Mattu & Brady
Electrocardiography in Emergency Medicine by Amal Mattu
14. Bradycardia
300 patients ED with symptomatic bradycardia
Syncope, dizziness, collapse, angina, and dyspnea/heart failure.
Laying the patient flat eliminated symptoms in 40%
60% received ACLS intervention(s): atropine in 80%, epinephrine or dopamine in 50%,
and transcutaneous pacing in 30%.
Half of all patients ultimately required a permanent pacemaker, but the other half had a
reversible cause.
Sodeck GH, Domanovits H, Meron G, et al. Compromising bradycardia: management in the emergency department. Resuscitation 2007;73:96-102
21. Block AV
Mất liên hệ giữa sóng P và
phức bộ QRS
Thường nhịp thất đều
Phức bộ QRS càng dãn
rộng: nhịp tim càng chậm
do ổ tạo nhịp càng ở phần
dưới của hệ thống dẫn
truyền
36. Xử trí nhịp chậm
Dayal, N. B., & Burri, H. K.
(2018). Acute management of
bradycardia in the emergency
setting. Cardiovascular
Medicine, 21(04), 98-104.
37. Xử trí nhịp chậm
Dayal, N. B., & Burri, H. K.
(2018). Acute management of
bradycardia in the emergency
setting. Cardiovascular
Medicine, 21(04), 98-104.
38. Đặt máy tạo nhịp
Dayal, N. B., & Burri, H. K. (2018). Acute management of bradycardia in the emergency setting. Cardiovascular Medicine, 21(04), 98-104.
39. Drugs used to increase heart rate
Dayal, N. B., & Burri, H. K. (2018). Acute management of bradycardia in the emergency setting. Cardiovascular Medicine, 21(04), 98-104.
41. Take home points for approach to
bradycardia and BRADI mnemonic
The approach to bradycardia includes assessing stability, symptoms, ECG
localization, and reversible causes of
BRADI: BRASH/hyperkalemia, Reduced vitals (oxygen, glucose,
temp), Acute coronary occlusion, Drugs (eg beta-blockers, calcium blockers,
dig), and ICP/Infections (eg Lyme, endocarditis)
The ECG can localize the mechanism of bradycardia/blocks and identify two
important reversible causes prior to lab confirmation: hyperkalemia and acute
coronary occlusion
42. CÁC LOẠI RỐI LOẠN NHỊP THẤT
Các loại rối loạn nhịp thất:
Nhịp nhanh thất
Xoắn đỉnh (Torsades de pointes)
Cuồng thất
Rung thất
Circulation. 2018;138:e272–e391
43. NHỊP NHANH THẤT
Gồm > 3 phức bộ nguồn gốc từ thất, f > 100 lần/phút
Circulation. 2018;138:e272–e391
46. Phân loại nhịp nhanh thất
Kéo dài/Dai dẳng (Sustained): Nhịp nhanh thất kéo dài > 30 giây hoặc cần phải chuyển nhịp do
rối loạn huyết động (<30 giây)
Không kéo dài: ≥ 3 nhịp, tự kết thúc
Đơn dạng: Phức bộ QRS đồng dạng giữa các nhát bóp
Đa dạng: Thay đổi hình dạng phức bộ QRS giữa các nhát bóp
Hai chiều (Bidirectional): Hình dạng phức bộ QRS luân phiên giữa các nhát bóp ở các trục của
mặt phẳng trán, vd. Ngộ độc digoxin hoặc catecholaminergic polymorphic VT
47. Phân loại nhịp nhanh thất
Circulation. 2018;138:e272–e391
48. Cơ chế của rối loạn nhịp thất
Tăng tự động tính
Hoạt động lẫy cò
Vòng vào lại
49. Bệnh sử và thăm khám
COR LOE Recommendation for Syncope*
I B-NR
1. Patients presenting with syncope for which VA is documented, or
thought to be a likely cause, should be hospitalized for
evaluation, monitoring, and management.
*This section covers practices that are well accepted, and a new recommendation was determined to only
be warranted for syncope.
50. Các xét nghiệm
ĐIỆN TÂM ĐỒ 12 CHUYỂN ĐẠO VÀ NGHIỆM PHÁP GẮNG SỨC
COR LOE Recommendations for 12-lead ECG and Exercise Testing
I B-NR
1. In patients with sustained, hemodynamically stable, wide
complex tachycardia, a 12-lead ECG during tachycardia should
be obtained.
I B-NR
2. In patients with VA symptoms associated with exertion,
suspected ischemic heart disease, or catecholaminergic
polymorphic ventricular tachycardia, exercise treadmill testing
is useful to assess for exercise-induced VA.
I B-NR
3. In patients with suspected or documented VA, a 12-lead ECG
should be obtained in sinus rhythm to look for evidence of
heart disease.
51. Các xét nghiệm
HOLTER ĐIỆN TÂM ĐỒ
COR LOE Recommendation for Ambulatory Electrocardiography
I B-NR
1. Ambulatory ECG monitoring is useful to evaluate whether
symptoms, including palpitations, presyncope, or syncope, are
caused by VA.
THIẾT BỊ THEO DÕI CẤY GHÉP ĐƯỢC
COR LOE Recommendation for Implanted Cardiac Monitors
IIa B-NR
1. In patients with sporadic symptoms (including syncope)
suspected to be related to VA implanted cardiac monitors can
be useful.
52. Các xét nghiệm
HÌNH ẢNH HỌC KHÔNG XÂM LẤN
COR LOE Recommendations for Noninvasive Cardiac Imaging
I B-NR
1. In patients with known or suspected VA that may be associated
with underlying structural heart disease or a risk of SCA,
echocardiography is recommended for evaluation of cardiac
structure and function.
IIa C-EO
2. In patients presenting with VA who are suspected of having
structural heart disease, cardiac MRI or CT can be useful to
detect and characterize underlying structural heart disease.
53. Các xét nghiệm
CÁC CHỈ ĐIỂM SINH HỌC
COR LOE Recommendation for Biomarkers
IIa B-R
1. In patients with structural heart disease, measurement of
natriuretic peptides (BNP or N-terminal pro-BNP) can be useful
by adding prognostic information to standard risk factors for
predicting SCD or SCA.
COR LOE Recommendation for Genetic Counselling
I C-EO
1. In patients and family members in whom genetic testing for risk
stratification for SCA/SCD is recommended, genetic counseling is
beneficial.
XÉT NGHIỆM GEN
54. Các xét nghiệm
HÌNH ẢNH HỌC XÂM LẤN
COR LOE Recommendation for Invasive Imaging: Cardiac Catheterization
I C-EO
1. In patients who have recovered from unexplained SCA, CT or
invasive coronary angiography is useful to confirm the presence
or absence of ischemic heart disease and guide decisions for
myocardial revascularization.
55. Các xét nghiệm
KHẢO SÁT ĐIỆN SINH LÝ
COR LOE Recommendations for Electrophysiological Study
IIa B-R
1. In patients with ischemic cardiomyopathy, NICM, or adult
congenital heart disease who have syncope or other VA
symptoms and who do not meet indications for a primary
prevention ICD, an electrophysiological study can be useful for
assessing the risk of sustained VT.
III: No
Benefit
B-R
2. In patients who meet criteria for ICD implantation, an
electrophysiological study for the sole reason of inducing VA is
not indicated for risk stratification.
III: No
Benefit
B-NR
3. An electrophysiological study is not recommended for risk
stratification for VA in the setting of long QT syndrome,
catecholaminergic polymorphic ventricular tachycardia, short
QT syndrome, or early repolarization syndromes.
56. ĐIỀU TRỊ CẤP CỨU
COR LOE Recommendations for Management of Cardiac Arrest
I A
1. In patients in cardiac arrest, CPR should be performed
according to published Basic and Advanced Cardiac Life Support
algorithms.
I A
2. In patients with hemodynamically unstable VA that persist or
recur after a maximal energy shock, intravenous amiodarone
should be administered to attempt to achieve a stable rhythm
after further defibrillation.
I A
3. Patients presenting with VA with hemodynamic instability
should undergo direct current cardioversion.
I B-NR
4. In patients with polymorphic VT or VF with ST elevation MI,
angiography with emergent revascularization is recommended.
I C-EO
5. Patients with a wide-QRS tachycardia should be presumed to
have VT if the diagnosis is unclear.
57. ĐIỀU TRỊ CẤP CỨU
COR LOE Recommendations for Management of Cardiac Arrest
IIa A
6. In patients with hemodynamically stable VT, administration of
intravenous procainamide can be useful to attempt to terminate VT
.
IIa B-R
7. In patients with a witnessed cardiac arrest due to VF or
polymorphic VT that is unresponsive to CPR, defibrillation, and
vasopressor therapy, intravenous lidocaine can be beneficial.
IIa B-R
8. In patients with polymorphic VT due to myocardial ischemia,
intravenous beta blockers can be useful.
IIa B-NR
9. In patients with a recent MI who have VT/VF that repeatedly recurs
despite direct current cardioversion and antiarrhythmic
medications (VT/VF storm), an intravenous beta blocker can be
useful.
IIb A
10. In patients in cardiac arrest, administration of epinephrine (1 mg
every 3 to 5 minutes) during CPR may be reasonable.
58. ĐIỀU TRỊ CẤP CỨU
COR LOE Recommendations for Management of Cardiac Arrest
IIb B-R
11. In patients with hemodynamically stable VT administration of
intravenous amiodarone, or sotalol may be considered to attempt
to terminate VT.
III: No
Benefit
A
12. In patients with cardiac arrest, administration of high-dose
epinephrine (>1 mg boluses) compared to standard doses is not
beneficial.
III: No
Benefit
A
13. In patients with refractory VF not related to torsades de pointes,
administration of intravenous magnesium is not beneficial.
III:
Harm
B-R
14. In patients with suspected AMI, prophylactic administration of
lidocaine or high-dose amiodarone for the prevention of VT is
potentially harmful.
III:
Harm
C-LD
15. In patients with a wide QRS complex tachycardia of unknown
origin, calcium channel blockers (e.g., verapamil and diltiazem) are
potentially harmful.
59. ĐIỀU TRỊ NHỊP NHANH THẤT
ĐƠN DẠNG DAI DẲNG
Sustained
Monomorphic VT
Direct current
cardioversion &
ACLS
Unstable
Stable
Hemodynamic
stablility
12-lead ECG,
history & physical
Cardioversion
(Class I)
IV amiodarone or
sotalol
(Class IIb)
Therapy guided
by underlying
heart disease
IV procainamide
(Class IIa)
VT
termination
Catheter ablation
(Class I)
Consider disease
specific VTs
Structural
heart disease
Therapy to prevent
recurrence preferred
VT
termination
Verapamil sensitive VT* : verapamil
or
Outflow tract VT: beta blocker
for acute termination of VT
(Class IIa)
Cardioversion
(Class I)
Yes
Sedation/anesthesia,
reassess antiarrhythmic
therapeutic options,
repeat cardioversion
No
VT
termination
No
Yes No
No
Catheter ablation
(Class I)
Verapamil or
beta blocker
(Class IIa)
Typical ECG
morphology for
idiopathic VA
Cardioversion
(Class I)
Effective No
Yes
Yes
Yes
Colors correspond to Class of Recommendation in Table 1.
*Known history of Verapamil sensitive or classical ECG presentation.
ACLS indicates advanced cardiovascular life support; ECG, electrocardiogram; VA,
ventricular arrhythmia; and VT, ventricular tachycardia.
60. Nhịp nhanh thất vô căn
Nhịp nhanh thất từ buồng tống thất phải (Right Ventricular Outflow Tract VT)
Nhịp nhanh thất từ bó trái (Fascicular Left Ventricular Tachycardia)
Nhịp nhanh thất vòng vào lại bó nhánh (Bundle Branch Reentrant Tachycardia)
64. DỰ PHÒNG
Colors correspond to Class of Recommendation in Table 1.
*Exclude reversible causes.
†History consistent with an arrhythmic etiology for syncope.
║ICD candidacy as determined by functional status, life expectancy,
or patient preference.
EP indicates electrophysiological; GDMT, guideline-directed
management and therapy; ICD, implantable cardioverter-defibrillator;
IHD, ischemic heart disease; LVEF, left ventricular ejection fraction;
SCA, sudden cardiac arrest; SCD, sudden cardiac death; and VT,
ventricular tachycardia
DỰ PHÒNG NGUYÊN
PHÁT Ở BỆNH NHÂN
CÓ BỆNH TIM THIẾU
MÁU CỤC BỘ
MI <40 d
and/or
revascularization
<90 d
WCD
(Class IIb)
NYHA
class II or III
LVEF ≤35%
NYHA class I
LVEF ≤30%
ICD
(Class I)*
GDMT
(Class I)
NYHA
class IV candidate
for advanced HF
therapy†
ICD
(Class IIa)
Yes
ICD should not
be implanted
(Class III:
No Benefit)
No
Primary prevention in pts with IHD,
LVEF ≤40%
EP study
(especially in the
presence of
NSVT)
Yes
Yes
ICD
(Class I)
Inducible
sustained VT
Reassess LVEF
>40 d after MI
and/or >90 d after
revascularization
LVEF ≤40%,
NSVT, inducible
sustained VT on
EP study
ICD
(Class I)
Yes
GDMT
No
No
No
Yes*
65. DỰ PHÒNG
Colors correspond to Class of Recommendation in Table 1.
*Exclude reversible causes.
†History consistent with an arrhythmic etiology for syncope.
║ICD candidacy as determined by functional status, life expectancy, or patient
preference.
EP indicates electrophysiological; GDMT, guideline-directed management and
therapy; ICD, implantable cardioverter-defibrillator; IHD, ischemic heart disease;
LVEF, left ventricular ejection fraction; SCA, sudden cardiac arrest; SCD,
sudden cardiac death; and VT, ventricular tachycardia
Secondary prevention in
pts with IHD
Revascularize
& reassess
SCD risk
(Class I)
No
LVEF≤35%
Yes
EP study
(Class IIa)
No
Extended
monitoring
ICD
(Class I)
GDMT
(Class I)
Ischemia
warranting
revascularization
Yes
ICD candidate║
No
ICD
(Class I)
Yes
Inducible
VT
No
Yes
SCA survivor*
or sustained
spontaneous
monomorphic VT*
Cardiac syncope†
ICD
(Class I)
DỰ PHÒNG THỨ PHÁT
Ở BỆNH NHÂN CÓ
BỆNH TIM THIẾU MÁU
CỤC BỘ
66. Colors correspond to Class of Recommendation in Table 1.
*Exclude reversible causes.
†History consistent with an arrhythmic etiology for syncope.
║ICD candidacy as determined by functional status, life expectancy, or patient
preference.
EP indicates electrophysiological; GDMT, guideline-directed management and
therapy; ICD, implantable cardioverter-defibrillator; IHD, ischemic heart disease;
LVEF, left ventricular ejection fraction; SCA, sudden cardiac arrest; SCD,
sudden cardiac death; and VT, ventricular tachycardia
ĐIỀU TRỊ BỆNH NHÂN CÓ NHỊP
NHANH THẤT TÁI PHÁT
Polymorphic
VT/VF
Sustained
monomorphic VT
Identifiable
PVC triggers
Consider
reversible
causes
Amiodarone
(Class I)
Catheter
ablation
(Class I)
Autonomic
modulation
(Class IIb)
Yes No
Amiodarone or
sotalol
(Class I)
Catheter
ablation
(Class I)
ICD with VT/VF
recurrent arrhythmia*
Revascularize
(Class I)
Treat for QT prolongation,
discontinue offending
medication,
correct electrolytes
(Class I)
Drug, electrolyte induced Ischemia
Catheter ablation
as first-line therapy
(Class IIb)
Yes
Catheter
ablation
(Class IIa)
NICM
IHD with
frequent VT or
VT storm
No
Catheter
ablation
(Class IIa)
Beta blockers
or lidocaine
(Class IIa)
Arrhythmia
not controlled
Arrhythmia
not controlled
No reversible causes
67. DỰ PHÒNG
DỰ PHÒNG NGUYÊN PHÁT
VÀ THỨ PHÁT Ở BỆNH
NHÂN KHÔNG CÓ BỆNH
TIM THIẾU MÁU CỤC BỘ
SCA survivor/
sustained VT
(spontaneous/
inducible)
Yes
Arrythmogenic
syncope
suspected
ICD
(Class I)
Patients with NICM
NICM due to
LMNA mutation
and 2º risk
factors
Symptoms
concerning
for VA
Class II-III
HF and
LVEF ≤35%
ICD
candidate*
No
No
Yes
Yes Etiology uncertain
ICD
candidate*
ICD
(Class I)
No
WCD
(Class IIb)
ICD
candidate*
Yes
ICD
(Class IIa)
Yes
Yes
Yes
Yes
EP Study
(Class IIa)
ICD
(Class IIa)
Amiodarone
(Class IIb)
No
Reassess
LVEF ≥3mo
No, due to newly
diagnosed HF
(<3 mo GDMT)
or not on optimal
GDMT
If positive
If LVEF ≤35%
and
Class II-III
HF
Colors correspond to Class of Recommendation in Table 1.
*ICD candidacy as determined by functional status, life expectancy or patient
preference.
2° indicates secondary; EP, electrophysiological; GDMT, guideline-directed
management and therapy; HF, heart failure; ICD, implantable cardioverter-
defibrillator; LVEF, left ventricular ejection fraction; NICM, nonischemic
cardiomyopathy; SCA, sudden cardiac arrest; SCD, sudden cardiac death; VA,
ventricular arrhythmia; and WCD, wearable cardiac-defibrillator.
68. DỰ PHÒNG
DỰ PHÒNG Ở BỆNH
NHÂN BỊ
SARCOIDOSIS TIM
Patients with cardiac
sarcoidosis
SCA survivor/
sustained VT,
either spontaneous
or inducible
ICD
candidate*
ICD†
(Class I)
Immunosuppression
(Class IIa)
EP study
or ICD†
(Class IIa)
LVEF
≤35%
Syncope, and/or
extensive scar by
cardiac MRI or PET
and/or a candidate for
permanent pacemaker
ICD
candidate*
ICD
candidate*
ICD†
(Class I)
Recurrent
VA and
Inflammation
Yes
No No
Yes
Yes
Yes
Yes Yes
Yes
GDMT
(Class I)
GDMT
(Class I)
GDMT
(Class I)
No No
No
Colors correspond to Class of Recommendation in Table 1.
*ICD candidacy as determined by functional status, life expectancy, or
patient preference.
†For recurrent sustained monomorphic VT, refer to Figure Management
of Sustained Monomorphic VT.
CEP indicates electrophysiological; GDMT, guideline-directed
management and therapy; ICD, implantable cardiac-defibrillator; LVEF,
left ventricular ejection fraction; MRI, magnetic resonance imaging; PET,
positron emission tomography; SCA, sudden cardiac arrest; SCD,
sudden cardiac death; VA, ventricular arrhythmia; and VT, ventricular
tachycardia.
69. HỘI CHỨNG QT DÀI
QTc ≥450 ms ở nam và ≥460 ms ở nữ. QTc > 500ms gây gia tang nguy cơ đột tử
Đoạn QT dài nhất được dung để xác định nguy cơ
70.
71. Nguyên nhân
Di truyền: Hội chứng Jerwell và Lange-Nielsen, Hội chứng Romano-Ward, vô căn
Mắc phải:
Rối loạn chuyển hoá: Hạ kali, hạ magnie, hạ calci
Rối loạn nhịp chậm: Block nhĩ thất. Rối loạn chức năng nút xuoan
Do thuốc
78. Sử dụng
thuốc có
nguy cơ
kéo dài
đoạn QT
Guidance on Minimizing Risk of Drug-Induced Ventricular Arrhythmia During Treatment of COVID-19: A Statement from the
Canadian Heart Rhythm Society
79. CHẨN ĐOÁN HỘI CHỨNG
QT DÀI DI TRUYỀN
Tiêu chuẩn chẩn đoán
Schwartz score
80. Các phân loại HC QT
dài di truyền
Long-QT Syndrome, N Engl J Med 2008; 358:169-176
82. Colors correspond to Class of Recommendation in Table 1.
*ICD candidacy as determined by functional status, life
expectancy, or patient preference.
†High-risk patients with LQTS include those with QTc >500
ms, genotypes LQT2 and LQT3, females with genotype
LQT2, <40 years of age, onset of symptoms at <10 years of
age, and patients with recurrent syncope
ICD indicates implantable cardioverter-defibrillator; LQTS,
long-QT syndrome; VT, ventricular tachycardia.
Resuscitated
cardiac arrest
ICD
(Class I)
Beta blocker
(Class I)
LQTS
Asymptomatic and
QTc >500 ms
Persistent symptoms
and/or other high-risk
features†
QTc <470 ms QTc ≥470 ms and/
or symptomatic
Beta blocker
(Class IIa)
Beta blocker
(Class I)
QT prolonging drugs/
hypokalemia/
hypomagnesemia
(Class III: Harm)
Treatment intensification:
additional medications,
left cardiac sympathetic
denervation and/or an ICD
(Class I)
Treatment intensification:
additional medications,
left cardiac sympathetic
denervation and/or an ICD
(Class IIb)
Treatment intensification:
additional medications,
left cardiac sympathetic
denervation
(Class I)
ICD
candidate*
Recurrent ICD
shocks for VT
DỰ PHÒNG Ở BỆNH
NHÂN BỊ HỘI CHỨNG
QT DÀI
DỰ PHÒNG
83. HỘI CHỨNG BRUGADA
Được mô tả lần đầu tiên năm 1992
Là một bệnh kênh ion (đột biến kênh SCN5A) có tính di truyền làm tăng nguy
cơ rung thất và đột tử
Thường ở nam giới và ở vùng Đông Nam Á
Chẩn đoán thường thách thức bởi bệnh nhân thường không có triệu chứng và
ECG thay đổi và bị che dấu
Perm J. 2019; 23: 19.044
84. ĐIỆN TÂM ĐỒ
Điện tâm đồ dạng Brugada
https://doi.org/10.1016/j.joa.2013.01.001
85. ĐIỆN TÂM ĐỒ
Di chuyển điện cực V3 và V5 để tăng
độ nhạy phát hiện
86. CHẨN ĐOÁN
Điện tâm đồ Brugada type 1 và một trong những yếu tố sau:
Ghi nhận rung thất
Nhịp nhanh thất đa hình
Tiền căn gia đình có người đột tử < 45 tuổi
Kích hoạt được cơn rung thất khi kích thích thất theo chương trình
Ngất
Nocturnal agonal respiration.
https://doi.org/10.1161/CIRCEP.111.964577
87. Colors correspond to Class of Recommendation in
Table 1.
*ICD candidacy as determined by functional
status, life expectancy or patient preference.
1° indicates primary; ECG, electrocardiogram;
EP, electrophysiological; ICD implantable
cardioverter-defibrillator; SCD, sudden cardiac
death; VT, ventricular tachycardia; and VF,
ventricular fibrillation.
ICD
(Class I)
Genetic counselling for
mutation specific
genotyping of 1º relatives
(Class I)
Cardiac arrest,
recent unexplained
syncope
Quinidine or
catheter ablation
(Class I)
EP study for risk
stratification
(Class IIb)
Quinidine or
catheter ablation
(Class I)
Recurrent VT,
VF Storm
ICD
candidate*
Yes
Yes
No
Pharmacologic
challenge
(Class IIa)
Suspected Brugada syndrome
without Type I ECG
Genotyping
(Class IIb)
Positive
Spontaneous Type 1
Brugada ECG
Documented or
suspected Brugada
syndrome
Lifestyle changes:
1. Avoid Brugada
aggravating drugs
2. Treat fever
3. Avoid excessive
alcohol
4. Avoid cocaine
No
Observe
without therapy
Yes
DỰ PHÒNG Ở BỆNH
NHÂN BỊ HỘI CHỨNG
BRUGADA
DỰ PHÒNG
