{"id":24397,"date":"2023-04-18T22:17:24","date_gmt":"2023-04-18T15:17:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=24397"},"modified":"2023-04-19T16:04:54","modified_gmt":"2023-04-19T09:04:54","slug":"nhoi-mau-co-tim-cap-khong-co-ton-thuong-dong-mach-vanh","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/18\/nhoi-mau-co-tim-cap-khong-co-ton-thuong-dong-mach-vanh\/","title":{"rendered":"Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh"},"content":{"rendered":"

Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (Myocardial infarction with non-obstructive coronary arteries- MINOCA) \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong y v\u0103n t\u1eeb 80 n\u0103m tr\u01b0\u1edbc nh\u01b0ng m\u1edbi \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. M\u1ed9t s\u1ed1 kh\u00f4ng nh\u1ecf c\u00e1c b\u1ec7nh nh\u00e2n\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 timc\u1ea5p c\u00f3 th\u1ec3 coi l\u00e0 MINOCA. Tuy nhi\u00ean, nhi\u1ec1u th\u1ea7y thu\u1ed1c th\u01b0\u1eddng b\u1ecf qua v\u00e0 cho r\u1eb1ng kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh th\u00ec c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim.<\/a><\/strong><\/p>\n

\"nh\u1ed3i
nh\u1ed3i m\u00e1u c\u01a1 tim<\/figcaption><\/figure>\n

1. Gi\u1edbi thi\u1ec7u<\/h2>\n

C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y t\u1ef7 l\u1ec7 MINOCA trong qu\u1ea7n th\u1ec3 dao \u0111\u1ed9ng trong kho\u1ea3ng 3,5-15%. D\u00f9 \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a b\u1ec7nh nh\u00e2n v\u1edbi Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 t\u01b0\u01a1ng \u0111\u1ed1i kh\u00e1c bi\u1ec7t, t\u1ef7 l\u1ec7 t\u1eed vong t\u1ea1i th\u1eddi \u0111i\u1ec3m 1 th\u00e1ng v\u00e0 1 n\u0103m kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t. M\u1ed9t s\u1ed1 \u0111\u1eb7c \u0111i\u1ec3m c\u01a1 b\u1ea3n c\u1ee7a MINOCA:<\/p>\n

MINOCA kh\u00f4ng ph\u1ea3i l\u00e0 ch\u1ea9n \u0111o\u00e1n hi\u1ebfm g\u1eb7p <\/em>v\u1edbi b\u1ec7nh nh\u00e2n\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, g\u1eb7p nhi\u1ec1u h\u01a1n \u1edf ph\u1ee5 n\u1eef tr\u1ebb tu\u1ed5i kh\u00f4ng ph\u1ea3i ng\u01b0\u1eddi da tr\u1eafng, \u00edt c\u00f3 s\u1ef1 li\u00ean quan v\u1edbi c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 truy\u1ec1n th\u1ed1ng, th\u01b0\u1eddng g\u1eb7p \u1edf th\u1ec3\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ST kh\u1ea3 n\u0103ng \u1edf.<\/p>\n

B\u1ec7nh nh\u00e2n nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n MINOCA n\u00ean \u0111\u01b0\u1ee3c th\u0103m d\u00f2 k\u1ef9 l\u01b0\u1ee1ng c\u00e1c b\u1ec7nh l\u00fd k\u00e8m theo c\u00f3 th\u1ec3 g\u00e2y nh\u1ea7m l\u1eabn v\u00e0 nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh.<\/p>\n

MINOCA c\u00f3 ti\u00ean l\u01b0\u1ee3ng c\u0169ng n\u1eb7ng n\u1ec1 g\u1ea7n nh\u01b0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

2. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh theo H 2019 v\u00e0 \u0111\u1ecbnh ngh\u0129a to\u00e0n c\u1ea7u l\u1ea7n th\u1ee9 t\u01b0 v\u1ec1 Nh\u1ed3i m\u00e1u c\u01a1 tim 2018<\/h2>\n

Ch\u1ea9n \u0111o\u00e1n MINOCA sau khi c\u00f3 k\u1ebft qu\u1ea3 ch\u1ee5p \u0110MV \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 ch\u1ea9n \u0111o\u00e1n \u00a0NH\u1ed2I M\u00c1U C\u01a0 TIM:<\/p>\n

    \n
  • Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim.<\/li>\n
  • Kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh: \u0110\u1ed9ng m\u1ea1ch v\u00e0nh kh\u00f4ng c\u00f3 h\u1eb9p \u0111\u00e1ng k\u1ec3 (50% l\u00f2ng m\u1ea1ch) \u1edf m\u1ecdi nh\u00e1nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim bao g\u1ed3m c\u1ea3 \u0110MV b\u00ecnh th\u01b0\u1eddng (h\u1eb9p < 30%) ho\u1eb7c h\u1eb9p nh\u1eb9 \u0111\u1ebfn v\u1eeba (h\u1eb9p t\u1eeb 30 \u0111\u1ebfn 50%).<\/li>\n
  • Kh\u00f4ng c\u00f3 ch\u1ea9n \u0111o\u00e1n kh\u00e1c ph\u00e2n bi\u1ec7t nguy\u00ean nh\u00e2n\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p.<\/li>\n<\/ul>\n

    3. C\u0103n nguy\u00ean Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/h2>\n

    3.1. <\/em>C\u0103n nguy\u00ean do x\u01a1 v\u1eefa m\u1ea1ch v\u00e0nh<\/em><\/h3>\n

    Bao g\u1ed3m c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1ee9t v\u1ee1, x\u00f3i m\u00f2n m\u1ea3ng x\u01a1 v\u1eefa ho\u1eb7c n\u1ed1t v\u00f4i h\u00f3a g\u00e2y ra nh\u1ed3i m\u00e1u c\u01a1 tim type 1 theo \u0111\u1ecbnh ngh\u0129a to\u00e0n c\u1ea7u. C\u01a1 ch\u1ebf g\u00e2y MINOCA trong c\u00e1c b\u1ec7nh c\u1ea3nh n\u00e0y bao g\u1ed3m (1) n\u1ee9t v\u1ee1 m\u1ea3ng x\u01a1 v\u1eefa g\u00e2y co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, (2) h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i nh\u01b0ng t\u1ef1 ly gi\u1ea3i ho\u1eb7c b\u1eafn \u0111i g\u00e2y t\u1eafc c\u00e1c nh\u00e1nh t\u1eadn. Ch\u1ea9n \u0111o\u00e1n m\u1ea3ng x\u01a1 v\u1eefa kh\u00f4ng \u1ed5n \u0111\u1ecbnh d\u1ef1a v\u00e0o c\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh trong l\u00f2ng m\u1ea1ch v\u00e0nh nh\u01b0 si\u00eau \u00e2m trong l\u00f2ng m\u1ea1ch ho\u1eb7c ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh quang h\u1ecdc.<\/p>\n

    3.2. <\/em>C\u0103n nguy\u00ean kh\u00f4ng do x\u01a1 v\u1eefa m\u1ea1ch v\u00e0nh<\/em><\/h3>\n

    Co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh t\u1ea1i ngo\u1ea1i m\u1ea1c: <\/strong>L\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh t\u1ea1i ngo\u1ea1i m\u1ea1c co th\u1eaft tr\u00ean 90% \u0111\u01b0\u1eddng k\u00ednh l\u00e0m gi\u1ea3m t\u01b0\u1edbi m\u00e1u c\u01a1 tim. Co th\u1eaft \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 do thu\u1ed1c\/\u0111\u1ed9c ch\u1ea5t (v\u00ed d\u1ee5 cocaine, fluorouracil) ho\u1eb7c t\u1ef1 ph\u00e1t do r\u1ed1i lo\u1ea1n tr\u01b0\u01a1ng l\u1ef1c v\u1eadn m\u1ea1ch. Ch\u1ea9n \u0111o\u00e1n th\u01b0\u1eddng ph\u1ea3i d\u1ef1a v\u00e0o c\u00e1c nghi\u1ec7m ph\u00e1p k\u00edch th\u00edch m\u1ea1ch v\u00e0nh.<\/p>\n

    R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng vi m\u1ea1ch m\u1ea1ch v\u00e0nh: <\/strong>Vi tu\u1ea7n ho\u00e0n m\u1ea1ch v\u00e0nh bao g\u1ed3m c\u00e1c m\u1ea1ch m\u00e1u c\u00f3 \u0111\u01b0\u1eddng k\u00ednh d\u01b0\u1edbi 0,5 mm, kh\u00f4ng hi\u1ec7n h\u00ecnh r\u00f5 tr\u00ean ch\u1ee5p m\u1ea1ch v\u00e0nh. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng vi tu\u1ea7n ho\u00e0n m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 g\u00e2y thi\u1ebfu m\u00e1u c\u01a1 tim, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim do b\u1ea5t k\u00ec nguy\u00ean nh\u00e2n n\u00e0o.<\/p>\n

    Huy\u1ebft kh\u1ed1i\/thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh: <\/strong>Huy\u1ebft kh\u1ed1i ho\u1eb7c thuy\u00ean t\u1eafc \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 g\u00e2y ra b\u1ec7nh c\u1ea3nh MINOCA trong tr\u01b0\u1eddng h\u1ee3p huy\u1ebft kh\u1ed1i b\u1ecb ly gi\u1ea3i ho\u1eb7c g\u00e2y t\u1eafc \u1edf vi tu\u1ea7n ho\u00e0n m\u1ea1ch v\u00e0nh. C\u00f3 th\u1ec3 g\u1eb7p huy\u1ebft kh\u1ed1i ho\u1eb7c huy\u1ebft t\u1eafc m\u1ea1ch v\u00e0nh trong c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00f4ng ho\u1eb7c kh\u00f4ng.<\/p>\n

    T\u00e1ch th\u00e0nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ti\u00ean ph\u00e1t: <\/strong>Nguy\u00ean nh\u00e2n c\u1ee5 th\u1ec3 kh\u00f4ng r\u00f5, g\u00e2y thi\u1ebfu m\u00e1u c\u01a1 tim do t\u00e1ch l\u1edbp \u00e1o gi\u1eefa v\u00e0 \u00e1o ngo\u00e0i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh c\u1ea7n c\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh trong l\u00f2ng m\u1ea1ch<\/p>\n

    4. <\/em>Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng<\/h2>\n

    MINOCA l\u00e0 ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9, \u0111\u00f2i h\u1ecfi ng\u01b0\u1eddi th\u1ea7y thu\u1ed1c ti\u1ebfp t\u1ee5c l\u00e0m c\u00e1c th\u0103m d\u00f2 s\u00e2u h\u01a1n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1, ch\u1ea9n \u0111o\u00e1n c\u00e1c nguy\u00ean nh\u00e2n k\u00e8m theo. Ch\u1eb3ng h\u1ea1n trong l\u00fac ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u00f3 th\u1ec3 ch\u1ee5p bu\u1ed3ng tim, IVUS, OCT \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n. Th\u0103m d\u00f2 c\u00f3 gi\u00e1 tr\u1ecb nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n l\u00e0 MRI tim, c\u00f3 th\u1ec3 gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00f9ng t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim v\u00e0 ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u01a1 tim hay c\u00e1c h\u1ed9i ch\u1ee9ng kh\u00e1c li\u00ean quan. M\u1ed9t c\u1eadn l\u00e2m s\u00e0ng kh\u00e1c c\u0169ng c\u00f3 gi\u00e1 tr\u1ecb l\u00e0 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u0111\u1ec3 gi\u00fap l\u00e0m r\u00f5 h\u01a1n b\u1ea3n ch\u1ea5t c\u1ee7a c\u00e1c m\u1ea3ng x\u01a1 v\u1eefa n\u1ebfu c\u00f3 trong l\u00f2ng m\u1ea1ch (ngay c\u1ea3 khi b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee5p \u0110MV qua da).<\/p>\n

    5.\u0110i\u1ec1u tr\u1ecb<\/strong><\/h2>\n

    B\u1ec7nh nh\u00e2n MINOCA ph\u1ea7n l\u1edbn kh\u00f4ng c\u1ea7n can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da.<\/p>\n

    \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa hi\u1ec7n v\u1eabn ch\u01b0a c\u00f3 s\u1ef1 \u0111\u1ed3ng thu\u1eadn, ph\u1ea7n l\u1edbn v\u1eabn d\u1ef1a tr\u00ean \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa c\u01a1 b\u1ea3n c\u1ee7a\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p v\u00e0 tu\u1ef3 thu\u1ed9c v\u00e0o quan \u0111i\u1ec3m c\u1ee7a trung t\u00e2m\/b\u00e1c s\u0129 l\u00e2m s\u00e0ng: Thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p, thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, Statin; trong \u0111\u00f3 l\u1ee3i \u00edch l\u00e2u d\u00e0i trong 1 n\u0103m \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn v\u1edbi thu\u1ed1c ch\u1eb9n \u03b2 giao c\u1ea3m, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, Statin. Li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p c\u00f2n ch\u01b0a ghi nh\u1eadn \u0111\u01b0\u1ee3c l\u1ee3i \u00edch v\u1ec1 l\u00e2u d\u00e0i.<\/p>\n

    Ti\u00ean l\u01b0\u1ee3ng c\u1ee7a MINOCA trong 1 n\u0103m c\u0169ng g\u1ea7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim “th\u1ef1c s\u1ef1” khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tuy nhi\u00ean c\u0169ng c\u00f3 th\u1ec3 1 ph\u1ea7n do b\u1ec7nh sinh\/ \u0111i\u1ec1u tr\u1ecb c\u1ee7a MINOCA v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c l\u00e0m r\u00f5 v\u00e0 v\u1eabn c\u1ea7n th\u00eam nhi\u1ec1u nghi\u00ean c\u1ee9u trong th\u1eddi gian t\u1edbi \u0111\u00e2y<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (Myocardial infarction with non-obstructive coronary arteries- MINOCA) \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 trong y v\u0103n t\u1eeb 80 n\u0103m tr\u01b0\u1edbc nh\u01b0ng m\u1edbi \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y. M\u1ed9t s\u1ed1 kh\u00f4ng nh\u1ecf c\u00e1c b\u1ec7nh nh\u00e2n\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 timc\u1ea5p c\u00f3 th\u1ec3 […]<\/p>\n","protected":false},"author":25,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nNh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/title>\n<meta name=\"description\" content=\"Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p kh\u00f4ng t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u0169ng n\u1eb7ng n\u1ec1 t\u01b0\u01a1ng \u0111\u01b0\u1eddng nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u00e1ng k\u1ec3 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta 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