{"id":31242,"date":"2023-05-04T14:41:50","date_gmt":"2023-05-04T07:41:50","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31242"},"modified":"2023-05-04T16:31:56","modified_gmt":"2023-05-04T09:31:56","slug":"roi-loan-nhip-cham-va-mot-so-nguyen-nhan-thuong-gap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/roi-loan-nhip-cham-va-mot-so-nguyen-nhan-thuong-gap\/","title":{"rendered":"R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm v\u00e0 m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p"},"content":{"rendered":"

R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi nh\u1ecbp tim l\u00fac ngh\u1ec9 <60 bpm. Ch\u00fang \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh hai lo\u1ea1i ch\u00ednh: r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00fat xoang v\u00e0 block nh\u0129 th\u1ea5t. Ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm d\u1ef1a v\u00e0o s\u1ef1 c\u00f3 m\u1eb7t ho\u1eb7c kh\u00f4ng c\u00f3 m\u1eb7t s\u00f3ng P, h\u00ecnh th\u00e1i s\u00f3ng P, m\u1ed1i quan h\u1ec7 gi\u1eefa P v\u00e0 ph\u1ee9c b\u1ed9 QRS.<\/strong><\/p>\n

1. Ch\u1eadm nh\u1ecbp n\u00fat xoang<\/h2>\n

Ch\u1eadm nh\u1ecbp n\u00fat xoang<\/a> li\u00ean quan \u0111\u1ebfn s\u1ef1 b\u1ea5t th\u01b0\u1eddng c\u1ee7a n\u00fat xoang ho\u1eb7c h\u1ec7 th\u1ed1ng d\u1eabn truy\u1ec1n nh\u0129.<\/p>\n

Ch\u1eadm nh\u1ecbp xoang<\/strong><\/p>\n

Ch\u1eadm nh\u1ecbp xoang \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 nh\u1ecbp xoang v\u1edbi nh\u1ecbp tim ch\u1eadm h\u01a1n 60 bpm. Nh\u1ecbp xoang \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 m\u1ed9t s\u00f3ng P ti\u1ebfp theo l\u00e0 m\u1ed9t ph\u1ee9c b\u1ed9 QRS r\u1ed9ng ch\u01b0a t\u1edbi 100 mili gi\u00e2y, v\u00e0 m\u1ed9t kho\u1ea3ng PR li\u00ean t\u1ee5c. M\u1ed9t nh\u1ecbp xoang h\u00e0m \u00fd r\u1eb1ng n\u00fat xoang ph\u00e1t xung \u0111\u1ec1u \u0111\u1eb7n. Ch\u1eadm nh\u1ecbp xoang l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng t\u01b0\u01a1ng \u0111\u1ed1i ph\u1ed5 bi\u1ebfn \u1edf c\u00e1c v\u1eadn \u0111\u1ed9ng vi\u00ean chuy\u00ean nghi\u1ec7p (v\u1eadn \u0111\u1ed9ng vi\u00ean marathon) v\u00e0 ng\u01b0\u1eddi gi\u00e0.
\nNguy\u00ean nh\u00e2n
\n\u2022 Thu\u1ed1c (thu\u1ed1c ch\u1eb9n b\u00eata, thu\u1ed1c ch\u1eb9n k\u00eanh calci), suy gi\u00e1p, t\u0103ng kali m\u00e1u, v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00fat xoang.
\n\u2022 <\/strong>Ch\u1eadm nh\u1ecbp xoang hi\u1ebfm khi g\u00e2y ra s\u1ef1 b\u1ea5t \u1ed5n huy\u1ebft \u0111\u1ed9ng \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u1ecfe m\u1ea1nh.
\nCh\u1ea9n \u0111o\u00e1n
\n<\/strong>\u2022 \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t ch\u1eadm nh\u1ecbp xoang v\u1edbi r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm. M\u1ed9t r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm s\u1ebd c\u00f3 m\u1ed9t nh\u1ecbp tim ch\u1eadm v\u00e0 s\u1ebd thi\u1ebfu m\u1ed9t nh\u1ecbp xoang. Ch\u1ea9n \u0111o\u00e1n qua ECG 12 chuy\u1ec3n \u0111\u1ea1o.
\n\u0110i\u1ec1u tr\u1ecb
\n<\/strong>\u2022 B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng: <\/strong>\u0110i\u1ec1u tr\u1ecb li\u00ean quan \u0111\u1ebfn vi\u1ec7c theo d\u00f5i th\u01b0\u1eddng xuy\u00ean v\u00e0 s\u1eeda ch\u1eefa b\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng n\u1ec1n.
\n\u2022 N\u1ebfu ch\u1eadm nh\u1ecbp xoang l\u00e0 tri\u1ec7u ch\u1ee9ng do t\u01b0\u1edbi m\u00e1u gi\u1ea3m (ng\u1ea5t, kh\u00f3 th\u1edf, ph\u00f9 n\u1ec1 \u1edf chi, …), n\u00f3 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng vi\u1ec7c c\u1ea5y gh\u00e9p m\u00e1y t\u1ea1o nh\u1ecbp th\u01b0\u1eddng tr\u1ef1c \u0111\u1ec3 kh\u00f4i ph\u1ee5c l\u1ea1i nh\u1ecbp tim th\u00edch h\u1ee3p.<\/p>\n

H\u1ed9i ch\u1ee9ng suy n\u00fat xoang (SSS)<\/strong>
\n<\/strong>SSS l\u00e0 ph\u00e2n lo\u1ea1i cho m\u1ed9t nh\u00f3m c\u00e1c \u0111i\u1ec1u ki\u1ec7n g\u00e2y ra b\u1edfi t\u1ed5n th\u01b0\u01a1ng n\u00fat xoang ho\u1eb7c h\u1ec7 th\u1ed1ng d\u1eabn
\n<\/strong>truy\u1ec1n nh\u0129. SSS l\u00e0 ph\u1ed5 bi\u1ebfn h\u01a1n \u1edf ng\u01b0\u1eddi gi\u00e0 v\u00e0 l\u00e0 m\u1ed9t di ch\u1ee9ng c\u1ee7a ph\u1eabu thu\u1eadt tim trong d\u00e2n s\u1ed1 tr\u1ebb em.
\nNguy\u00ean nh\u00e2n<\/strong>
\n<\/strong>\u2022 T\u00ecnh tr\u1ea1ng n\u00e0y \u0111\u01b0\u1ee3c nh\u00ecn th\u1ea5y trong h\u1ed9i ch\u1ee9ng tho\u00e1i h\u00f3a v\u00e0 c\u00e1c t\u00ecnh tr\u1ea1ng d\u1eabn \u0111\u1ebfn s\u1ef1 h\u00ecnh th\u00e0nh
\n<\/strong>s\u1eb9o trong tim nh\u01b0 amyloidosis, sarcoidosis, b\u1ec7nh \u1ee9 s\u1eaft, v\u00e0 b\u1ec7nh c\u01a1 tim.
\nCh\u1ea9n \u0111o\u00e1n<\/strong>
\n<\/strong>\u2022 SSS c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ch\u1eadm nh\u1ecbp xoang, r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm, nh\u1ecbp tim nhanh, ho\u1eb7c th\u1eadm ch\u00ed h\u1ed9i ch\u1ee9ng
\n<\/strong>nh\u1ecbp tim ch\u1eadm-nh\u1ecbp tim nhanh. Ch\u1ea9n \u0111o\u00e1n l\u00e0 kh\u00f3 kh\u0103n v\u00ec l\u00fd do n\u00e0y. Holter ECG c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng
\n<\/strong>\u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n SSS.
\nC\u00e1c tri\u1ec7u ch\u1ee9ng<\/strong>
\n<\/strong>\u2022 C\u00e1c tri\u1ec7u ch\u1ee9ng bao g\u1ed3m \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi v\u00e0 ch\u00f3ng m\u1eb7t.
\n\u0110i\u1ec1u tr\u1ecb<\/strong>
\n<\/strong>\u2022 \u0110i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 bao g\u1ed3m m\u1ed9t m\u00e1y t\u1ea1o nh\u1ecbp tim \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp tim ch\u1eadm, thu\u1ed1c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1ecbp tim
\n<\/strong>nhanh, ho\u1eb7c c\u1ea3 hai \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng nh\u1ecbp tim ch\u1eadm-nh\u1ecbp tim nhanh.
\nNg\u1eebng xoang v\u00e0 ngh\u1ec9 xoang<\/strong>
\n<\/strong>Ng\u1eebng xoang l\u00e0 n\u00fat xoang kh\u00f4ng th\u1ec3 ph\u00e1t xung kh\u1eed c\u1ef1c. Th\u00f4ng th\u01b0\u1eddng c\u00e1c n\u00fat nh\u0129 th\u1ea5t \u0111\u00f3ng vai tr\u00f2
\n<\/strong>nh\u01b0 m\u1ed9t m\u00e1y t\u1ea1o nh\u1ecbp v\u00e0 t\u1ea1o ra m\u1ed9t xung \u0111i\u1ec7n 40-60 l\u1ea7n m\u1ed7i ph\u00fat g\u1ecdi l\u00e0 nh\u1ecbp tho\u00e1t. Tuy nhi\u00ean, \u0111\u00e2y s\u1ebd l\u00e0 m\u1ed9t nh\u1ecbp \u0111i\u1ec7u b\u1ea5t th\u01b0\u1eddng v\u00ec n\u00f3 kh\u00f4ng c\u00f3 ngu\u1ed3n g\u1ed1c t\u1ea1i n\u00fat nh\u0129 th\u1ea5t
\nCh\u1ea9n \u0111o\u00e1n<\/strong>
\n<\/strong>\u2022 ECG s\u1ebd bi\u1ec3u th\u1ecb s\u1ef1 v\u1eafng m\u1eb7t ho\u1ea1t \u0111\u1ed9ng n\u00fat xoang k\u00e9o d\u00e0i (s\u00f3ng P v\u1eafng m\u1eb7t)> 3 gi\u00e2y trong ng\u1eebng
\n<\/strong>xoang v\u00e0 <3 gi\u00e2y trong ngh\u1ec9 xoang
\nTri\u1ec7u ch\u1ee9ng<\/strong>
\n<\/strong>\u2022 Ngh\u1ec9 xoang d\u01b0\u1edbi 3 gi\u00e2y th\u1ec9nh tho\u1ea3ng t\u00ecm th\u1ea5y \u1edf ng\u01b0\u1eddi l\u1edbn kh\u1ecfe m\u1ea1nh.
\n<\/strong>\u2022 Ngh\u1ec9 xoang h\u01a1n 3 gi\u00e2y c\u00f3 th\u1ec3 c\u1ea7n s\u1ef1 can thi\u1ec7p v\u00e0 h\u1ed3i sinh<\/p>\n

2. R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm do Block nh\u0129 th\u1ea5t<\/h2>\n

Block nh\u0129 th\u1ea5t m\u00f4 t\u1ea3 qu\u00e1 tr\u00ecnh d\u1eabn truy\u1ec1n t\u00edn hi\u1ec7u b\u1ecb ch\u1eadm ho\u1eb7c r\u1edbt ho\u00e0n to\u00e0n trong n\u0103ng l\u01b0\u1ee3ng xung \u0111i\u1ec7n khi n\u00f3 \u0111i t\u1eeb t\u00e2m nh\u0129 \u0111\u1ebfn t\u00e2m th\u1ea5t th\u00f4ng qua n\u00fat nh\u0129 th\u1ea5t.
\n2.1 Block nh\u0129 th\u1ea5t \u0111\u1ed9 1<\/strong>
\nM\u00f4 t\u1ea3 m\u1ed9t kho\u1ea3ng PR k\u00e9o d\u00e0i l\u1edbn h\u01a1n 200 ms tr\u00ean ECG. N\u00fat xoang t\u1ea1o ra m\u1ed9t xung \u0111i\u1ec7n \u0111i qua t\u00e2m nh\u0129 \u0111\u1ec1u \u0111\u1eb7n v\u00e0 v\u00e0o n\u00fat AV n\u01a1i n\u00f3 ng\u01b0ng l\u1ea1i. Block nh\u0129 th\u1ea5t \u0111\u1ed9 1 th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, v\u00e0 do t\u0103ng tr\u01b0\u01a1ng l\u1ef1c ph\u1ebf v\u1ecb, ho\u1eb7c c\u00e1c lo\u1ea1i thu\u1ed1c nh\u01b0 thu\u1ed1c ch\u1eb9n b\u00eata ho\u1eb7c CCB.<\/p>\n

2.2 Block nh\u0129 th\u1ea5t \u0111\u1ed9 2<\/strong>
\nC\u00f3 2 lo\u1ea1i block nh\u0129 th\u1ea5t \u0111\u1ed9 hai:
\n2.2.1. Mobitz 1 (Wenckebach)<\/strong><\/p>\n

    \n
  • Block nh\u0129 th\u1ea5t \u0111\u1ed9 2 Mobitz 1 l\u00e0 m\u1ed9t nh\u1ecbp b\u1ea5t th\u01b0\u1eddng v\u00ec kho\u1ea3ng PR t\u0103ng d\u1ea7n v\u1edbim\u1ed7i nh\u1ecbp tr\u00ean ECG cho \u0111\u1ebfn khi c\u00f3 m\u1ed9t “nh\u1ecbp r\u1edbt” (c\u00f3 ngh\u0129a r\u1eb1ng c\u00f3 s\u00f3ng Pkh\u00f4ng c\u00f3 ph\u1ee9c b\u1ed9 QRS t\u01b0\u01a1ng \u1ee9ng). Khi\u1ebfm khuy\u1ebft l\u00e0 t\u1ea1i n\u00fat AV v\u00e0 th\u01b0\u1eddng l\u00e0 k\u1ebftqu\u1ea3 c\u1ee7a t\u0103ng qu\u00e1 m\u1ee9c tr\u01b0\u01a1ng l\u1ef1c \u0111\u1ed1i giao c\u1ea3m tr\u00ean n\u00fat nh\u0129 th\u1ea5t. N\u00f3 th\u01b0\u1eddngkh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, kh\u00f4ng ti\u1ebfn tri\u1ec3n, v\u00e0 kh\u00f4ng c\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3.<\/li>\n
  • Block nh\u0129 th\u1ea5t \u0111\u1ed9 2 Mobitz 1 l\u00e0 m\u1ed9t nh\u1ecbp b\u1ea5t th\u01b0\u1eddng v\u00ec kho\u1ea3ng PR t\u0103ng d\u1ea7n v\u1edbim\u1ed7i nh\u1ecbp tr\u00ean ECG cho \u0111\u1ebfn khi c\u00f3 m\u1ed9t “nh\u1ecbp r\u1edbt” (c\u00f3 ngh\u0129a r\u1eb1ng c\u00f3 s\u00f3ng Pkh\u00f4ng c\u00f3 ph\u1ee9c b\u1ed9 QRS t\u01b0\u01a1ng \u1ee9ng). Khi\u1ebfm khuy\u1ebft l\u00e0 t\u1ea1i n\u00fat AV v\u00e0 th\u01b0\u1eddng l\u00e0 k\u1ebftqu\u1ea3 c\u1ee7a t\u0103ng qu\u00e1 m\u1ee9c tr\u01b0\u01a1ng l\u1ef1c \u0111\u1ed1i giao c\u1ea3m tr\u00ean n\u00fat nh\u0129 th\u1ea5t. N\u00f3 th\u01b0\u1eddngkh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, kh\u00f4ng ti\u1ebfn tri\u1ec3n, v\u00e0 kh\u00f4ng c\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3.<\/li>\n<\/ul>\n
    \"roi-loan-nhip-cham\"
    Block nh\u0129 th\u1ea5t \u0111\u1ed9 2 Mobitz 1<\/figcaption><\/figure>\n

    2.2.2. Mobitz 2<\/strong><\/p>\n

    Block nh\u0129 th\u1ea5t \u0111\u1ed9 2 Mobitz 2 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi “r\u1edbt nh\u1ecbp” kh\u00f4ng li\u00ean t\u1ee5c (s\u00f3ng P m\u00e0 kh\u00f4ng c\u00f3 ph\u1ee9c b\u1ed9 QRS v\u00e0 s\u00f3ng T theo sau) m\u00e0 kh\u00f4ng c\u1ea7n b\u1ea5t k\u1ef3 thay \u0111\u1ed5i n\u00e0o trong kho\u1ea3ng PR. Nh\u1ecbp \u1edf hai b\u00ean v\u1ecb tr\u00ed r\u1edbt nh\u1ecbp v\u1eabn b\u00ecnh th\u01b0\u1eddng. \u0110\u00f4i khi r\u1edbt nh\u1ecbp theo m\u1ed9t ki\u1ec3u, v\u00ed d\u1ee5: 3: 1 m\u00f4 t\u1ea3 m\u1ed9t nh\u1ecbp \u0111i\u1ec7u m\u00e0 ch\u1ec9 c\u00f3 m\u1ed7i s\u00f3ng P th\u1ee9 ba \u0111\u01b0\u1ee3c theo sau b\u1edfi m\u1ed9t ph\u1ee9c b\u1ed9 QRS v\u00e0 s\u00f3ng T. Block nh\u0129 th\u1ea5t \u0111\u1ed9 2 Mobitz 2 c\u00f3 th\u1ec3 ti\u1ebfn tri\u1ec3n th\u00e0nh block nh\u0129 th\u1ea5t \u0111\u1ed9 3 v\u00e0 \u0111\u00f2i h\u1ecfi theo d\u00f5i c\u1ea9n th\u1eadn v\u00e0 th\u01b0\u1eddng c\u1ea7n c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp.<\/p>\n

    2.3 Block nh\u0129 th\u1ea5t \u0111\u1ed9 3<\/strong><\/p>\n

    \u0110i\u1ec1u n\u00e0y c\u0169ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 block tim ho\u00e0n to\u00e0n, v\u00e0 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi ph\u00e2n ly nh\u0129 th\u1ea5t ho\u00e0n to\u00e0n. N\u00f3 c\u00f3 ngh\u0129a l\u00e0 kh\u00f4ng c\u00f3 m\u1ed1i quan h\u1ec7 n\u00e0o gi\u1eefa s\u00f3ng P v\u00e0 ph\u1ee9c b\u1ed9 QRS. Block nh\u0129 th\u1ea5t \u0111\u1ed9 3 l\u00e0 r\u1ea5t nguy hi\u1ec3m. Khi t\u1ed1c \u0111\u1ed9 th\u1ea5t n\u1ed9i t\u1ea1i l\u00e0 kho\u1ea3ng 30 bpm, nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng. C\u00e1c tri\u1ec7u ch\u1ee9ng bao g\u1ed3m c\u00e1c \u0111\u1ee3t ng\u1ea5t. S\u1ed1c tim c\u00f3 th\u1ec3 x\u1ea3y ra, \u0111\u00f2i h\u1ecfi ph\u1ea3i \u0111i\u1ec1u tr\u1ecb c\u1ea5p c\u1ee9u ngay l\u1eadp t\u1ee9c. \u0110i\u1ec1u tr\u1ecb l\u00e0 thay th\u1ebf b\u1eb1ng m\u00e1y t\u1ea1o nh\u1ecbp tim th\u01b0\u1eddng tr\u1ef1c.<\/p>\n

    T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong> B\u1ec7nh H\u1ecdc Tim M\u1ea1ch Lecturio<\/p>\n","protected":false},"excerpt":{"rendered":"

    R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi nh\u1ecbp tim l\u00fac ngh\u1ec9 <60 bpm. Ch\u00fang \u0111\u01b0\u1ee3c ph\u00e2n th\u00e0nh hai lo\u1ea1i ch\u00ednh: r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng n\u00fat xoang v\u00e0 block nh\u0129 th\u1ea5t. Ch\u1ea9n \u0111o\u00e1n \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm d\u1ef1a v\u00e0o s\u1ef1 c\u00f3 m\u1eb7t ho\u1eb7c kh\u00f4ng c\u00f3 m\u1eb7t s\u00f3ng P, h\u00ecnh th\u00e1i s\u00f3ng P, […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nR\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm v\u00e0 m\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p - Vinmec<\/title>\n<meta name=\"description\" content=\"R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi nh\u1ecbp tim l\u00fac ngh\u1ec9 <60 bpm. 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