{"id":20871,"date":"2023-04-14T20:53:41","date_gmt":"2023-04-14T13:53:41","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20871"},"modified":"2023-04-18T12:37:41","modified_gmt":"2023-04-18T05:37:41","slug":"can-lam-sang-chi-dinh-trong-suy-tim-man","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/can-lam-sang-chi-dinh-trong-suy-tim-man\/","title":{"rendered":"C\u1eadn l\u00e2m s\u00e0ng ch\u1ec9 \u0111\u1ecbnh trong suy tim m\u1ea1n"},"content":{"rendered":"<p><strong>Suy tim l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh h\u1ecdc \u0111a d\u1ea1ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng c\u1ee7a tim. K\u1ebft qu\u1ea3 l\u00e0 \u00e1p l\u1ef1c trong bu\u1ed3ng tim t\u0103ng cao, cung l\u01b0\u1ee3ng tim gi\u1ea3m. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tim l\u00e0 do s\u1ef1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 tim, bao g\u1ed3m t\u00e2m thu, t\u00e2m tr\u01b0\u01a1ng ho\u1eb7c c\u1ea3 hai. Tuy nhi\u00ean, s\u1ef1 b\u1ea5t th\u01b0\u1eddng t\u1ea1i van, m\u00e0ng ngo\u00e0i tim, n\u1ed9i m\u1ea1c tim v\u00e0 s\u1ef1 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n nh\u1ecbp c\u0169ng l\u00e0 nguy\u00ean nh\u00e2n \u0111\u00f3ng g\u00f3p cho s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a suy tim.<\/strong><\/p>\n<p>Suy tim m\u1ea1n l\u00e0 thu\u1eadt ng\u1eef \u0111\u1ec3 ch\u1ec9 nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111ang \u0111i\u1ec1u tr\u1ecb suy tim \u1ed5n \u0111\u1ecbnh ho\u1eb7c nh\u1eefng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 tri\u1ec7u ch\u1ee9ng suy tim kh\u1edfi ph\u00e1t t\u1eeb t\u1eeb.<\/p>\n<h1>1.Tri\u1ec7u ch\u1ee9ng<\/h1>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng \u0111i\u1ec3n h\u00ecnh hay g\u1eb7p tr\u00ean h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n:<\/p>\n<ul>\n<li>Kh\u00f3 th\u1edf v\u00e0 c\u01a1n kh\u00f3 th\u1edf k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam<\/li>\n<li>Gi\u1ea3m kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c, t\u0103ng th\u1eddi gian ngh\u1ec9 gi\u1eefa hai l\u1ea7n g\u1eafng s\u1ee9c<\/li>\n<li>M\u1ec7t mo\u0309i<\/li>\n<li>Ph\u00f9 m\u1eaft c\u00e1 ch\u00e2n<\/li>\n<\/ul>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, g\u1eb7p tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n:<\/p>\n<ul>\n<li>Ho v\u1ec1 \u0111\u00eam<\/li>\n<li>Th\u1edf r\u00edt<\/li>\n<li>C\u1ea3m gi\u00e1c ch\u01b0\u1edbng b\u1ee5ng<\/li>\n<li>M\u1ea5t c\u1ea3m gi\u00e1c ngon mi\u1ec7ng<\/li>\n<li>H\u1ed3i h\u1ed9p, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c<\/li>\n<li>Ch\u00f3ng m\u1eb7t<\/li>\n<li>Ng\u1ea5t<\/li>\n<li>C\u1ea3m gi\u00e1c kh\u00f3 th\u1edf khi c\u00fai ng\u01b0\u1eddi<\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"aligncenter\" src=\"https:\/\/suckhoedoisong.qltns.mediacdn.vn\/thumb_w\/640\/324455921873985536\/2022\/3\/31\/suy-tim-2-16487326546551542221732.jpg\" alt=\"suy tim m\u1ea1n \" width=\"435\" height=\"220\" \/><\/p>\n<p>Khi th\u0103m kh\u00e1m, b\u00e1c s\u1ef9 c\u00f3 th\u1ec3 th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1eb7c hi\u1ec7u c\u1ee7a suy tim m\u1ea1n nh\u01b0 sau:<\/p>\n<ul>\n<li>T\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i<\/li>\n<li>Ph\u1ea3n h\u1ed3i gan \u2013 t\u0129nh m\u1ea1ch c\u1ed5 d\u01b0\u01a1ng t\u00ednh<\/li>\n<li>Ti\u1ebfng ng\u1ef1a phi<\/li>\n<li>T\u0103ng di\u1ec7n \u0111\u1eadp c\u1ee7a mo\u0309m tim<\/li>\n<\/ul>\n<h2>2.C\u00e1c ph\u01b0\u01a1ng ph\u00e1p c\u1eadn l\u00e2m s\u00e0ng<\/h2>\n<h4>2.1.C\u00e1c peptide b\u00e0i ni\u1ec7u : BNP, NTpro-BNP<\/h4>\n<p>Ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb suy tim:<\/p>\n<ul>\n<li>B-type natriuretic peptide (BNP) &lt; 35 pg\/mL<\/li>\n<li>N-terminal pro-B-type natriuretic peptide (NTpro-BNP) &lt; 125 pg\/mL<\/li>\n<\/ul>\n<h4>2.2.\u0110i\u1ec7n tim 12 chuy\u1ec3n \u0111\u1ea1o<\/h4>\n<p>H\u00ecnh \u1ea3nh \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u00ecnh th\u01b0\u1eddng: \u00edt kh\u1ea3 n\u0103ng suy tim<\/p>\n<p>H\u00ecnh \u1ea3nh \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u1ea5t th\u01b0\u1eddng (rung nh\u0129, c\u00f3 s\u00f3ng Q b\u1ec7nh l\u00fd, t\u0103ng g\u00e1nh th\u1ea5t tr\u00e1i, ph\u1ee9c b\u1ed9 QRS gi\u00e3n r\u1ed9ng): t\u0103ng kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n suy tim<\/p>\n<h4>2.3.Si\u00eau \u00e2m tim<\/h4>\n<p>\u0110\u00e2y l\u00e0 bi\u1ec7n ph\u00e1p th\u0103m d\u00f2 ch\u00ednh kh\u1ea3o s\u00e1t ch\u1ee9c n\u0103ng tim, qua c\u00e1c th\u00f4ng tin v\u1ec1: ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i, k\u00edch th\u01b0\u1edbc c\u00e1c bu\u1ed3ng tim, v\u1eadn \u0111\u1ed9ng c\u00e1c th\u00e0nh tim, t\u00ednh ch\u1ea5t c\u00e1c van tim, ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng, ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i, \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng tim.<\/p>\n<h4>2.4.Ch\u1ee5p X-quang tim ph\u1ed5i<\/h4>\n<p>H\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n suy tim: d\u1ea5u hi\u1ec7u \u1ee9 huy\u1ebft ph\u1ed5i, b\u00f3ng tim to, cung \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i n\u1ed5i<\/p>\n<p>H\u1ed7 tr\u1ee3 ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb: b\u1ec7nh l\u00fd ph\u1ed5i, m\u00e0ng ph\u1ed5i<\/p>\n<h4>2.5.C\u00e1c x\u00e9t nghi\u1ec7m m\u00e1u th\u01b0\u1eddng quy<\/h4>\n<p>Gi\u00fap ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n, ch\u1ea9n \u0111o\u00e1n lo\u1ea1i tr\u1eeb, ti\u00ean l\u01b0\u1ee3ng v\u00e0 h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>c\u00f4ng th\u1ee9c m\u00e1u<\/p>\n<p>Ho\u00e1 sinh : ur\u00ea, creatinine, AST, ALT, c\u00e1c th\u00e0nh ph\u1ea7n lipid m\u00e1u, tuy\u1ebfn gi\u00e1p\u2026<\/p>\n<h4>2.6.<a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/dieu-gi-xay-ra-trong-suot-qua-trinh-lam-nghiem-phap-gang-suc\/\">Nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c<\/a> (thu\u1ed1c, th\u1ec3 l\u1ef1c)<\/h4>\n<p>Gi\u00fap ph\u00e1t hi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng c\u1ee7a suy tim trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng khai th\u00e1c \u0111\u01b0\u1ee3c r\u00f5 r\u00e0ng t\u1eeb ng\u01b0\u1eddi b\u1ec7nh v\u00e0 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u01a1 tim khi g\u1eafng s\u1ee9c \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0111ang c\u00e2n nh\u1eafc t\u00e1i t\u01b0\u1edbi m\u00e1u m\u1ea1ch v\u00e0nh.<\/p>\n<p>\u1ede b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF), b\u1ec7nh van tim ho\u1eb7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f3 th\u1edf kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c nguy\u00ean nh\u00e2n, si\u00eau \u00e2m tim g\u1eafng s\u1ee9c c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t.<\/p>\n<h4>2.7.C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/h4>\n<p>Trong ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim, h\u00ecnh \u1ea3nh thu \u0111\u01b0\u1ee3c trong pha mu\u1ed9n v\u1edbi gadolinium (LGE), th\u00ec T1 v\u00e0 s\u1ef1 ph\u00e2n b\u1ed1 th\u1ec3 t\u00edch d\u1ecbch ngo\u1ea1i b\u00e0o cho ph\u00e9p \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c m\u1ee9c \u0111\u1ed9 x\u01a1 h\u00f3a\/ s\u1eb9o c\u01a1 tim d\u01b0\u1edbi n\u1ed9i t\u00e2m m\u1ea1c, \u0111i\u1ec3n h\u00ecnh v\u1edbi tr\u01b0\u1eddng h\u1ee3p thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim tr\u00e1i ng\u01b0\u1ee3c v\u1edbi h\u00ecnh \u1ea3nh t\u1ed5n th\u01b0\u01a1ng s\u1eb9o \u1edf l\u1edbp gi\u1eefa th\u00e0nh tim trong b\u1ec7nh c\u01a1 tim d\u00e3n n\u1edf (gi\u00e3n).<\/p>\n<p>Ngo\u00e0i ra, c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim c\u00f2n cho ph\u00e9p ph\u00e2n bi\u1ec7t c\u00e1c t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim \u0111\u1eb7c tr\u01b0ng nh\u01b0 vi\u00eam c\u01a1 tim, b\u1ec7nh c\u01a1 tim th\u00e2m nhi\u1ec5m amyloid (amyloidosis), b\u1ec7nh Chagas, b\u1ec7nh Fabry, b\u1ec7nh c\u01a1 tim x\u1ed1p, b\u1ec7nh c\u01a1 tim do \u1ee9 \u0111\u1ecdng s\u1eaft v\u00e0 b\u1ec7nh lo\u1ea1n s\u1ea3n c\u01a1 tim g\u00e2y r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/p>\n<h4>2.8.Ch\u1ee5p x\u1ea1 h\u00ecnh SPECT (single-photon emission CT)<\/h4>\n<p>Ch\u1ee5p x\u1ea1 h\u00ecnh ch\u00f9m \u0111\u01a1n photon (SPECT) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u v\u00e0 s\u1ed1ng c\u00f2n c\u01a1 tim, t\u00ecnh tr\u1ea1ng vi\u00eam hay th\u00e2m nhi\u1ec5m c\u01a1 tim. Ch\u1ee5p x\u1ea1 h\u00ecnh v\u1edbi Technetium (Tc) c\u00f3 g\u1eafn bisphosphonate \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 ph\u01b0\u01a1ng ph\u00e1p c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u cao trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh c\u01a1 tim amyloid th\u1ec3 trans-thyretin.<\/p>\n<h4>2.9.Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da<\/h4>\n<p>Ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim c\u00f3 c\u01a1n \u0111au th\u1eaft ng\u1ef1c ho\u1eb7c \u0111au ng\u1ef1c \u201cki\u1ec3u m\u1ea1ch v\u00e0nh\u201d nh\u1eb1m ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n suy tim c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m c\u00f3 nguy c\u01a1 t\u1eeb trung b\u00ecnh \u0111\u1ebfn cao m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh v\u00e0 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng c\u1ea7n can thi\u1ec7p t\u00e1i t\u01b0\u1edbi m\u00e1u.<\/p>\n<h3>3. Ch\u1ea9n \u0111o\u00e1n suy tim m\u1ea1n<\/h3>\n<p>Ch\u1ea9n \u0111o\u00e1n <a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/suy-tim-co-may-cap-do-phan-biet-cac-cap-do-cua-suy-tim-nhu-nao\/\">suy tim<\/a> d\u1ef1a tr\u00ean s\u1ef1 k\u1ebft h\u1ee3p c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng, th\u1ef1c th\u1ec3 v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m, th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng. \u00a0Ph\u00e1c \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n suy tim c\u1ee7a B\u1ed9 y t\u1ebf: <img decoding=\"async\" loading=\"lazy\" class=\"aligncenter\" src=\"https:\/\/scontent.fhan3-2.fna.fbcdn.net\/v\/t1.15752-9\/340254677_976932776658024_4176600646817707896_n.png?_nc_cat=100&amp;ccb=1-7&amp;_nc_sid=ae9488&amp;_nc_ohc=5zOZMIvlxPYAX8MOTwB&amp;_nc_ht=scontent.fhan3-2.fna&amp;oh=03_AdTTRsfPSAbbjTCKy2WbymX_pqzJFeg_SGNfrJK5JncVcg&amp;oe=6460D6BA\" alt=\"suy tim m\u1ea1n \" width=\"530\" height=\"551\" \/><\/p>\n<h3><\/h3>\n<p>Ngu\u1ed3n: 1857\/Q\u0110-BYT<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Suy tim l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh h\u1ecdc \u0111a d\u1ea1ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng c\u1ee7a tim. K\u1ebft qu\u1ea3 l\u00e0 \u00e1p l\u1ef1c trong bu\u1ed3ng tim t\u0103ng cao, cung l\u01b0\u1ee3ng tim gi\u1ea3m. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tim l\u00e0 do s\u1ef1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 [&hellip;]<\/p>\n","protected":false},"author":36,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u1eadn l\u00e2m s\u00e0ng ch\u1ec9 \u0111\u1ecbnh trong suy tim m\u1ea1n - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy tim l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng c\u00f3 nguy\u00ean nh\u00e2n b\u1ec7nh h\u1ecdc \u0111a d\u1ea1ng, d\u1eabn \u0111\u1ebfn bi\u1ebfn \u0111\u1ed5i c\u1ea5u tr\u00fac, ch\u1ee9c n\u0103ng c\u1ee7a tim. K\u1ebft qu\u1ea3 l\u00e0 \u00e1p l\u1ef1c trong bu\u1ed3ng tim t\u0103ng cao, cung l\u01b0\u1ee3ng tim gi\u1ea3m. H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tim l\u00e0 do s\u1ef1 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u1ee7a c\u01a1 tim, bao g\u1ed3m t\u00e2m thu, t\u00e2m tr\u01b0\u01a1ng ho\u1eb7c c\u1ea3 hai. 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