{"id":26526,"date":"2023-04-22T18:34:11","date_gmt":"2023-04-22T11:34:11","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26526"},"modified":"2023-04-22T18:34:11","modified_gmt":"2023-04-22T11:34:11","slug":"chi-dinh-dieu-tri-noi-ngoai-khoa-benh-van-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/chi-dinh-dieu-tri-noi-ngoai-khoa-benh-van-tim\/","title":{"rendered":"Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i ngo\u1ea1i khoa b\u1ec7nh van tim"},"content":{"rendered":"

B\u1ea5t k\u1ef3 b\u1ec7nh van tim n\u00e0o d\u00f9 b\u1ecb h\u1eb9p ho\u1eb7c h\u1edf (\u0111\u00f3ng kh\u00f4ng k\u00edn) \u0111\u1ec1u g\u00e2y ra bi\u1ebfn \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng trong th\u1eddi gian d\u00e0i tr\u01b0\u1edbc khi c\u00f3 tri\u1ec7u ch\u1ee9ng. H\u1eb9p van hay h\u1edf van th\u01b0\u1eddng x\u1ea3y ra \u0111\u01a1n l\u1ebb, nh\u01b0ng nhi\u1ec1u b\u1ec7nh l\u00fd van tim c\u00f3 th\u1ec3 c\u00f9ng t\u1ed3n t\u1ea1i v\u00e0 m\u1ed9t van c\u00f3 th\u1ec3 b\u1ecb c\u1ea3 h\u1eb9p v\u00e0 h\u1edf. \u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd van tim th\u01b0\u1eddng ch\u1ec9 \u0111\u00f2i h\u1ecfi theo d\u00f5i \u0111\u1ecbnh k\u1ef3, kh\u00f4ng c\u1ea7n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p can thi\u1ec7p t\u00edch c\u1ef1c trong nhi\u1ec1u n\u0103m.<\/strong><\/p>\n

C\u00e1c b\u1ea5t th\u01b0\u1eddng van tim th\u01b0\u1eddng g\u1eb7p<\/strong><\/p>\n

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a>: \u0110\u00f3ng kh\u00f4ng k\u00edn van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 g\u00e2y ch\u1ea3y ng\u01b0\u1ee3c d\u00f2ng m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u1ec1 th\u1ea5t tr\u00e1i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng<\/p>\n

H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a>: H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, c\u1ea3n tr\u1edf l\u01b0u l\u01b0\u1ee3ng m\u00e1u t\u1eeb th\u1ea5t tr\u00e1i \u0111\u1ebfn \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 trong th\u1eddi k\u1ef3 t\u00e2m thu<\/p>\n

H\u1edf van hai l\u00e1<\/a>: \u0110\u00f3ng kh\u00f4ng k\u00edn van hai l\u00e1 g\u00e2y d\u00f2ng m\u00e1u t\u1eeb th\u1ea5t tr\u00e1i (LV) v\u00e0o nh\u0129 tr\u00e1i trong th\u1eddi k\u1ef3 t\u00e2m thu.<\/p>\n

H\u1eb9p van hai l\u00e1<\/a>: H\u1eb9p van hai l\u00e1 ng\u0103n c\u1ea3n s\u1ef1 l\u01b0u th\u00f4ng m\u00e1u t\u1eeb nh\u0129 tr\u00e1i t\u1edbi th\u1ea5t tr\u00e1i<\/p>\n

Sa van 2 l\u00e1<\/a>: Sa c\u00e1c l\u00e1 van c\u1ee7a van hai l\u00e1 v\u00e0o t\u00e2m nh\u0129 tr\u00e1i trong th\u00ec t\u00e2m thu<\/p>\n

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/a>: \u0110\u00f3ng kh\u00f4ng k\u00edn van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i t\u1ea1o ra d\u00f2ng m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0o th\u1ea5t ph\u1ea3i trong su\u1ed1t t\u00e2m tr\u01b0\u01a1ng<\/p>\n

H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/a>: H\u1eb9p \u0111\u01b0\u1eddng ra \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i g\u00e2y c\u1ea3n tr\u1edf l\u01b0u l\u01b0\u1ee3ng m\u00e1u t\u1eeb th\u1ea5t ph\u1ea3i t\u1edbi \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i trong th\u1eddi k\u1ef3 t\u00e2m thu<\/p>\n

H\u1edf van ba la<\/a>: \u0110\u00f3ng kh\u00f4ng k\u00edn van ba l\u00e1 g\u00e2y ra d\u00f2ng m\u00e1u t\u1eeb th\u1ea5t ph\u1ea3i \u0111\u1ebfn nh\u0129 ph\u1ea3i trong th\u1eddi t\u00e2m thu<\/p>\n

H\u1eb9p van ba l\u00e1<\/a>: H\u1eb9p l\u1ed7 van ba l\u00e1 l\u00e0m t\u1eafc ngh\u1ebdn d\u00f2ng m\u00e1u t\u1eeb nh\u0129 ph\u1ea3i t\u1edbi th\u1ea5t ph\u1ea3i<\/p>\n

\"minh-hoa-benh-van-tim\"<\/p>\n

1. Nguy\u00ean t\u1eafc:<\/h2>\n

C\u1ea7n tr\u1ea3 l\u1eddi \u0111\u01b0\u1ee3c c\u00e1c c\u00e2u h\u1ecfi<\/p>\n

    \n
  • Giai \u0111o\u1ea1n n\u00e0o c\u1ee7a b\u1ec7nh n\u00ean \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/li>\n
  • Lo\u1ea1i thu\u1ed1c n\u00e0o th\u00edch h\u1ee3p t\u1eebng lo\u1ea1i b\u1ec7nh van tim?<\/li>\n
  • Th\u1eddi \u0111i\u1ec3m ph\u1eabu thu\u1eadt?<\/li>\n
  • Khi n\u00e0o kh\u00f4ng ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c?<\/li>\n
  • Ph\u1eabu thu\u1eadt c\u00f3 t\u0103ng s\u1ed1ng c\u00f2n cho b\u1ec7nh nh\u00e2n hay kh\u00f4ng?<\/li>\n<\/ul>\n

    2. Ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb m\u1ed9t s\u1ed1 b\u1ec7nh van tim<\/h2>\n

    2.1 H\u1eb9p van hai l\u00e1<\/strong><\/p>\n

    \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/strong><\/p>\n

      \n
    • Ph\u00f2ng th\u1ea5p \u2013 Ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng<\/li>\n
    • Gi\u1ea3i quy\u1ebft c\u00e1c y\u1ebfu t\u1ed1 l\u00e0m gi\u1ea3m th\u1eddi gian t\u00e2m tr\u01b0\u01a1ng (s\u1ed1t, thi\u1ebfu m\u00e1u, c\u01b0\u1eddng gi\u00e1p)<\/li>\n
    • L\u1ee3i ti\u1ec3u<\/li>\n
    • Nitrate<\/li>\n
    • Digitalis, Diltizem, Propranolol<\/li>\n
    • S\u1ed1c \u0111i\u1ec7n; Amiodarone; Quinidine<\/li>\n<\/ul>\n

      V\u1edbi b\u1ec7nh nh\u00e2n rung nh\u0129\/ H\u1eb9p van hai l\u00e1<\/strong><\/p>\n

        \n
      • Rung nh\u0129 trong v\u00f2ng 24-48 gi\u1edd:<\/li>\n
      • Heparin<\/li>\n
      • S\u1ed1c \u0111i\u1ec7n<\/li>\n
      • Kh\u00e1ng \u0111\u00f4ng u\u1ed1ng<\/li>\n
      • Rung nh\u0129 > 48 gi\u1edd:<\/li>\n
      • Kh\u00e1ng \u0111\u00f4ng u\u1ed1ng 4 tu\u1ea7n<\/li>\n
      • Heparine + SATQTQ<\/li>\n
      • Amiodarone li\u1ec1u th\u1ea5p : duy tr\u00ec nh\u1ecbp xoang (200- 300 mg\/ng\u00e0y)<\/li>\n<\/ul>\n

        Theo nghi\u00ean c\u1ee9u Olesen: H\u1eb9p 2 l\u00e1 c\u00f3 NYHA 3: \u0111i\u1ec1u tr\u1ecb n\u1ed9i => s\u1ed1ng c\u00f2n\u00a0 62% sau 5 n\u0103m, \u00a038% sau 10 n\u0103m<\/p>\n

        Theo nghi\u00ean c\u1ee9u Rapaport: 133 b\u1ec7nh nh\u00e2n h\u1eb9p 2 l\u00e1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i => s\u1ed1ng c\u00f2n 80% sau 5 n\u0103m, 60% sau 10 n\u0103m.<\/p>\n

          \n
        • NYHA:<\/li>\n<\/ul>\n

          NYHA I : Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u00f4ng th\u01b0\u1eddng kh\u00f4ng g\u00e2y m\u1ec7t m\u1ecfi, kh\u00f3 th\u1edf, ho\u1eb7c \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c.<\/p>\n

          NYHA II : Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c th\u00f4ng th\u01b0\u1eddng g\u00e2y m\u1ec7t m\u1ecfi, kh\u00f3 th\u1edf, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, ho\u1eb7c \u0111au th\u1eaft ng\u1ef1c.<\/p>\n

          NYHA III: Tho\u1ea3i m\u00e1i khi ngh\u1ec9 ng\u01a1i; ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c v\u1edbi m\u1ee9c \u0111\u1ed9 th\u1ea5p h\u01a1n b\u00ecnh th\u01b0\u1eddng g\u00e2y m\u1ec7t m\u1ecfi, kh\u00f3 th\u1edf, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, ho\u1eb7c \u0111au th\u1eaft ng\u1ef1c.<\/p>\n

          NYHA IV: C\u00e1c tri\u1ec7u ch\u1ee9ng x\u1ea3y ra khi ngh\u1ec9 ng\u01a1i; b\u1ea5t k\u1ef3 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c n\u00e0o c\u0169ng l\u00e0m t\u0103ng c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu.<\/p>\n

          Ch\u1ec9 \u0111\u1ecbnh nong van<\/strong><\/p>\n

            \n
          • H\u1eb9p kh\u00edt van 2 l\u00e1 (DT \u2264 1 cm2 ho\u1eb7c \u2264 0.6 cm2\/m2)<\/li>\n
          • H\u1eb9p n\u1eb7ng van 2 l\u00e1 m\u1edbi c\u00f3 bi\u1ebfn ch\u1ee9ng rung nh\u0129<\/li>\n
          • H\u1eb9p n\u1eb7ng van 2 l\u00e1 + NYHA \u2265 2 ho\u1eb7c kh\u00f3 \u0111\u00e1p \u1ee9ng sinh ho\u1ea1t h\u1eb1ng ng\u00e0y<\/li>\n
          • C\u00f3 c\u01a1n thuy\u00ean t\u1eafc<\/li>\n
          • H\u1eb9p 2 l\u00e1 k\u00e8m t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/li>\n<\/ul>\n

            Quy\u1ebft \u0111\u1ecbnh m\u1ed5 tim k\u00edn hay m\u1ed5 tim h\u1edf d\u1ef1a v\u00e0o:<\/strong><\/p>\n

              \n
            • T\u00ednh ch\u1ea5t l\u00e1 van (d\u1ea7y, s\u1ee3i ho\u00e1, v\u00f4i ho\u00e1)<\/li>\n
            • B\u1ed9 m\u00e1y d\u01b0\u1edbi van<\/li>\n
            • H\u1eb9p \u0111\u01a1n thu\u1ea7n hay c\u00f3 k\u00e8m h\u1edf van<\/li>\n
            • C\u00f3 c\u1ee5c m\u00e1u \u0111\u00f4ng hay kh\u00f4ng.<\/li>\n
            • T\u1ed5n th\u01b0\u01a1ng ph\u1ed1i h\u1ee3p c\u00e1c van kh\u00e1c<\/li>\n<\/ul>\n

              2.2 H\u1edf van 2 l\u00e1 m\u00e3n<\/strong><\/p>\n

              \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa:<\/strong><\/p>\n

                \n
              • H\u1ea1n ch\u1ebf g\u1eafng s\u1ee9c \u2013 Ph\u00f2ng ng\u1eeba vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng<\/li>\n
              • Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng : \u1ee9c ch\u1ebf men chuy\u1ec3n<\/li>\n
              • L\u1ee3i ti\u1ec3u: Digitalis<\/li>\n
              • Kh\u00e1ng \u0111\u00f4ng<\/li>\n<\/ul>\n

                Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt<\/strong><\/p>\n

                  \n
                • Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng: NYHA \u0111\u1ed9 3 d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u<\/li>\n
                • R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i [kh\u1ea3o s\u00e1t x\u00e2m nh\u1eadp hay kh\u00f4ng x\u00e2m nh\u1eadp (TD:si\u00eau \u00e2m) 2 l\u1ea7n li\u00ean ti\u1ebfp] c\u00f3:<\/li>\n
                • LVEDD > 7 cm ho\u1eb7c > 4 cm\/ m2 ; LVESD>5 cm ho\u1eb7c 2.6 cm\/ m2 ;<\/li>\n
                • Ph\u00e2n xu\u1ea5t co th\u1eaft< 30%; ESWSI> 195 mmHg; T\u1ef7 l\u1ec7 ESWSI\/ ESVI< 5-6 \u00b1 0.9<\/li>\n
                • LVEDD: \u0110\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng<\/li>\n
                • LVESD: \u0110\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu<\/li>\n
                • ESWSI: Ch\u1ec9 s\u1ed1 s\u1ee9c c\u0103ng th\u00e0nh cu\u1ed1i t\u00e2m thu<\/li>\n
                • ESVI :\u00a0 Ch\u1ec9 s\u1ed1 dung l\u01b0\u1ee3ng cu\u1ed1i t\u00e2m thu<\/li>\n<\/ul>\n

                  2.3 H\u1edf van \u0110\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/p>\n

                  \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/strong><\/p>\n

                    \n
                  • H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng \u2013 Ph\u00f2ng ng\u1eeba vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng<\/li>\n
                  • C\u1ea7n t\u00ecm v\u00e0 \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n hay y\u1ebfu t\u1ed1 l\u00e0m n\u1eb7ng nh\u01b0: VNTMNT, giang mai, b\u1ec7nh ch\u1ea5t keo<\/li>\n
                  • D\u00e3n m\u1ea1ch: n\u00ean d\u00f9ng \u1ee9c ch\u1ebf men chuy\u1ec3n<\/li>\n
                  • L\u1ee3i ti\u1ec3u: Digitalis<\/li>\n<\/ul>\n

                    Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 m\u00e3n<\/strong><\/p>\n

                      \n
                    • Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng : NYHA 3 d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u<\/li>\n
                    • R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i (kh\u1ea3o s\u00e1t x\u00e2m nh\u1eadp 1 l\u1ea7n hay kh\u00f4ng x\u00e2m nh\u1eadp 2 l\u1ea7n li\u00ean ti\u1ebfp) : ESD> 55mm; Ph\u00e2n xu\u1ea5t t\u1ed1ng m\u00e1u < 55%<\/li>\n<\/ul>\n

                      T\u00f3m t\u1eaft<\/strong><\/p>\n

                      H\u1edf van \u0110MC n\u1eb7ng (\u0111\u1ed9 3,4) + NYHA \u22653: \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i d\u00f9 ch\u01b0a c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng<\/p>\n

                      H\u1edf van \u0110MC n\u1eb7ng + Ph\u00e2n xu\u1ea5t t\u1ed1ng m\u00e1u < 55% ho\u1eb7c \u0111\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu > 50 mm: ph\u1eabu thu\u1eadt<\/p>\n

                      H\u1edf van \u0110MC n\u1eb7ng + R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i: ph\u1eabu thu\u1eadt<\/p>\n

                      3.3 H\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/strong><\/p>\n

                      \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/strong><\/p>\n

                        \n
                      • H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng<\/li>\n
                      • Ph\u00f2ng ng\u1eeba vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng<\/li>\n
                      • Kh\u00f4ng n\u00ean d\u00f9ng d\u00e3n m\u1ea1ch (c\u00f3 th\u1ec3 cho ng\u1eadm Nitroglycerine khi c\u00f3 c\u01a1n \u0111au th\u1eaft ng\u1ef1c)<\/li>\n
                      • Digitalis: khi d\u00e3n tim tr\u00e1i. Ph\u00e2n xu\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m<\/li>\n
                      • L\u1ee3i ti\u1ec3u: khi c\u00f3 ph\u00f9; li\u1ec1u th\u1ea5p<\/li>\n<\/ul>\n

                        Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt<\/strong><\/p>\n

                          \n
                        • H\u1eb9p van \u0110MC n\u1eb7ng (\u0111\u1ed9 ch\u00eanh \u00e1p l\u1ef1c gi\u1eefa th\u1ea5t tr\u00e1i v\u00e0 \u0110MC \u2265 70 mmHg) c\u00f3 k\u00e8m tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/li>\n
                        • C\u1ea7n can thi\u1ec7p ngo\u1ea1i khoa tr\u01b0\u1edbc khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 tim<\/li>\n<\/ul>\n

                          T\u00e0i li\u1ec7u tham kh\u1ea3o: PGS.TS. Ph\u1ea1m Nguy\u1ec5n Vinh –\u00a0 \u0110\u1ea1i H\u1ecdc Y Khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch – B\u1ec7nh Vi\u1ec7n Tim T\u00e2m \u0110\u1ee9c – Vi\u1ec7n Tim Tp.HCM<\/p>\n","protected":false},"excerpt":{"rendered":"

                          B\u1ea5t k\u1ef3 b\u1ec7nh van tim n\u00e0o d\u00f9 b\u1ecb h\u1eb9p ho\u1eb7c h\u1edf (\u0111\u00f3ng kh\u00f4ng k\u00edn) \u0111\u1ec1u g\u00e2y ra bi\u1ebfn \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng trong th\u1eddi gian d\u00e0i tr\u01b0\u1edbc khi c\u00f3 tri\u1ec7u ch\u1ee9ng. H\u1eb9p van hay h\u1edf van th\u01b0\u1eddng x\u1ea3y ra \u0111\u01a1n l\u1ebb, nh\u01b0ng nhi\u1ec1u b\u1ec7nh l\u00fd van tim c\u00f3 th\u1ec3 c\u00f9ng t\u1ed3n t\u1ea1i v\u00e0 m\u1ed9t van c\u00f3 […]<\/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":"\nCh\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i ngo\u1ea1i khoa b\u1ec7nh van tim - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ea5t k\u1ef3 b\u1ec7nh van tim n\u00e0o d\u00f9b\u1ecb h\u1eb9p ho\u1eb7c h\u1edf (\u0111\u00f3ng kh\u00f4ng k\u00edn), g\u00e2y ra bi\u1ebfn \u0111\u1ed5i huy\u1ebft \u0111\u1ed9ng trong th\u1eddi gian d\u00e0i tr\u01b0\u1edbc khi c\u00f3 tri\u1ec7u ch\u1ee9ng.\" \/>\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 property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb n\u1ed9i ngo\u1ea1i khoa b\u1ec7nh van tim - 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