{"id":27342,"date":"2023-04-23T21:36:21","date_gmt":"2023-04-23T14:36:21","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27342"},"modified":"2023-04-23T21:36:21","modified_gmt":"2023-04-23T14:36:21","slug":"suy-tim-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/suy-tim-cap\/","title":{"rendered":"Suy tim c\u1ea5p"},"content":{"rendered":"<p><strong>Suy tim c\u1ea5p l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng\/th\u1ef1c th\u1ec3 c\u1ee7a suy tim. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p.<\/strong><\/p>\n<h2>1.\u0110\u1ecbnh ngh\u0129a<\/h2>\n<p><strong>Suy tim c\u1ea5p <\/strong>l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng\/th\u1ef1c th\u1ec3 c\u1ee7a suy tim. Suy tim c\u1ea5p bao g\u1ed3m:<\/p>\n<ul>\n<li><strong>Suy tim m\u1ea5t b\u00f9 c\u1ea5p (Acutely Decompensated Heart failure &#8211; ADHF): L\u00e0 <\/strong>tr\u01b0\u1eddng h\u1ee3p hay g\u1eb7p nh\u1ea5t tr\u00ean l\u00e2m s\u00e0ng (70%), do c\u00e1c y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t t\u00e1c \u0111\u1ed9ng l\u00ean t\u00ecnh tr\u1ea1ng suy tim m\u1ea1n t\u00ednh.<\/li>\n<li><strong>Suy tim c\u1ea5p m\u1edbi xu\u1ea5t hi\u1ec7n (De novo acute HF<\/strong>): L\u00e0 c\u00e1c tr\u01b0\u1eddng h\u1ee3p suy tim \u0111\u1ed9t ng\u1ed9t tr\u00ean n\u1ec1n ch\u1ee9c n\u0103ng tim b\u00ecnh th\u01b0\u1eddng tr\u01b0\u1edbc \u0111\u00f3, chi\u1ebfm 25% tr\u01b0\u1eddng h\u1ee3p. V\u00ed d\u1ee5: Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p, vi\u00eam c\u01a1 tim c\u1ea5p, t\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u&#8230;<\/li>\n<li><strong>R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu <\/strong>n\u1eb7ng ti\u1ebfn tri\u1ec3n d\u1ea7n t\u1edbi m\u1ed9t ng\u01b0\u1ee1ng n\u00e0o \u0111\u00f3: Chi\u1ebfm kho\u1ea3ng 5% tr\u01b0\u1eddng h\u1ee3p.<\/li>\n<\/ul>\n<h2>2. C\u00e1c nguy\u00ean nh\u00e2n g\u00e2y suy tim c\u1ea5p\/suy tim m\u1ea5t b\u00f9 c\u1ea5p<\/h2>\n<ul>\n<li>C\u00f3 th\u1ec3 l\u00e0 c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch ho\u1eb7c kh\u00f4ng ph\u1ea3i tim m\u1ea1ch: H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p.<\/li>\n<li>R\u1ed1i lo\u1ea1n nh\u1ecbp (nh\u1ecbp nhanh\/nh\u1ecbp ch\u1eadm).<\/li>\n<li>T\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u.<\/li>\n<li>Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc c\u1ea5p: Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p c\u00f3 bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc, k\u1eb9t van tim c\u01a1 h\u1ecdc, ch\u1ea5n th\u01b0\u01a1ng ng\u1ef1c, bi\u1ebfn ch\u1ee9ng can thi\u1ec7p&#8230; Thu\u1ed1c\/\u0111\u1ed9c ch\u1ea5t: NSAIDs, r\u01b0\u1ee3u, thu\u1ed1c k\u00edch th\u00edch.<\/li>\n<li>Kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb: Kh\u00f4ng h\u1ea1n ch\u1ebf mu\u1ed1i\/n\u01b0\u1edbc, b\u1ecf thu\u1ed1c. R\u1ed1i lo\u1ea1n chuy\u1ec3n h\u00f3a: C\u01b0\u1eddng gi\u00e1p, toan ceton, c\u00f3 thai&#8230;<\/li>\n<li>B\u1ec7nh l\u00fd n\u1ed9i khoa c\u1ea5p: Nhi\u1ec5m khu\u1ea9n, \u0111\u1ee3t c\u1ea5p COPD, b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u n\u00e3o&#8230;<\/li>\n<\/ul>\n<h2>3. Ph\u00e2n lo\u1ea1i suy tim c\u1ea5p<\/h2>\n<p>D\u1ef1a v\u00e0o tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u1ec1 t\u00ecnh tr\u1ea1ng sung huy\u1ebft (\u201ckh\u00f4\u201d v\u00e0 \u201c\u01b0\u1edbt\u201d) v\u00e0 gi\u1ea3m t\u01b0\u1edbi m\u00e1u ngo\u1ea1i vi (\u201c\u1ea5m\u201d v\u00e0 \u201cl\u1ea1nh\u201d) c\u00f3 th\u1ec3 ph\u00e2n b\u1ec7nh nh\u00e2n l\u00e0m 4 nh\u00f3m gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb v\u00e0 ti\u00ean l\u01b0\u1ee3ng:<\/p>\n<p><strong><em>C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u1ec3 ph\u00e2n lo\u1ea1i bao g\u1ed3m:<\/em><\/strong><\/p>\n<ul>\n<li><strong>Tri\u1ec7u ch\u1ee9ng sung huy\u1ebft:<\/strong><\/li>\n<\/ul>\n<ol>\n<li>Sung huy\u1ebft ph\u1ed5i: Kh\u00f3 th\u1edf k\u1ecbch ph\u00e1t, kh\u00f3 th\u1edf li\u00ean quan g\u1eafng s\u1ee9c\/t\u01b0 th\u1ebf, ph\u00f9 ph\u1ed5i c\u1ea5p.<\/li>\n<li>Sung huy\u1ebft t\u0129nh m\u1ea1ch ngo\u1ea1i vi: Ph\u00f9, gan to, ph\u1ea3n h\u1ed3i gan-t\u0129nh m\u1ea1ch c\u1ea3nh, sung huy\u1ebft ru\u1ed9t, c\u1ed5 tr\u01b0\u1edbng.<\/li>\n<\/ol>\n<ul>\n<li><strong>Tri\u1ec7u ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u:<\/strong><\/li>\n<\/ul>\n<ol>\n<li>\u0110\u1ea7u chi l\u1ea1nh\/\u1ea9m.<\/li>\n<li>R\u1ed1i lo\u1ea1n tri gi\u00e1c (gi\u1ea3m t\u01b0\u1edbi m\u00e1u n\u00e3o). Thi\u1ec3u ni\u1ec7u\/v\u00f4 ni\u1ec7u.<\/li>\n<li>T\u1ee5t HA.<\/li>\n<li>HA k\u1eb9t (pulse pressure): Hi\u1ec7u s\u1ed1 huy\u1ebft \u00e1p t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng d\u01b0\u1edbi 25% gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p t\u00e2m thu. \u0110\u00e2y l\u00e0 d\u1ea5u hi\u1ec7u nh\u1ea1y v\u00e0 \u0111\u1eb7c hi\u1ec7u nh\u1ea5t cho gi\u1ea3m cung l\u01b0\u1ee3ng tim.<\/li>\n<\/ol>\n<p>Ph\u00e2n lo\u1ea1i suy tim c\u1ea5p:<\/p>\n<ul>\n<li><strong>\u1ea4m v\u00e0 \u1ea9m: <\/strong>L\u00e0 d\u1ea1ng ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean l\u00e2m s\u00e0ng (&gt; 70%), c\u00f3 th\u1ec3 chia ti\u1ebfp l\u00e0m 2 type:<\/li>\n<\/ul>\n<ol>\n<li>Type tim: Huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng, ch\u1ee7 y\u1ebfu sung huy\u1ebft ph\u1ed5i v\u00e0 tu\u1ea7n ho\u00e0n ngo\u1ea1i vi do qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch,<\/li>\n<li>type m\u1ea1ch: Huy\u1ebft \u00e1p cao, bi\u1ec3u hi\u1ec7n suy tim do t\u00e1i ph\u00e2n b\u1ed1 d\u1ecbch \u1edf ph\u1ed5i, sung huy\u1ebft \u1edf m\u00f4 ngo\u1ea1i vi \u00edt; ch\u1ee7 y\u1ebfu \u1edf ng\u01b0\u1eddi cao tu\u1ed5i, t\u0103ng huy\u1ebft \u00e1p v\u00e0 ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n.<\/li>\n<\/ol>\n<ul>\n<li><strong>L\u1ea1nh v\u00e0 \u1ea9m<\/strong>: G\u1eb7p &lt; 20% b\u1ec7nh nh\u00e2n suy tim c\u1ea5p tr\u00ean l\u00e2m s\u00e0ng, \u0111a ph\u1ea7n l\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n s\u1ed1c tim v\u00e0 suy tim cung l\u01b0\u1ee3ng th\u1ea5p. Nguy c\u01a1 t\u1eed vong cao h\u01a1n nh\u00f3m \u201c\u1ea5m v\u00e0 \u1ea9m\u201d.<\/li>\n<li><strong>L\u1ea1nh v\u00e0 kh\u00f4: <\/strong>Hi\u1ebfm g\u1eb7p (&lt; 5%), do gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n ho\u1eb7c ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i gi\u1ea3m nhi\u1ec1u d\u00f9 kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n b\u00ecnh th\u01b0\u1eddng; ti\u00ean l\u01b0\u1ee3ng x\u1ea5u.<\/li>\n<\/ul>\n<h2>4. Ch\u1ea9n \u0111o\u00e1n suy tim c\u1ea5p<\/h2>\n<h3><strong>4.1 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/strong><\/h3>\n<p>Ch\u1ea9n \u0111o\u00e1n suy tim c\u1ea5p l\u00e0 m\u1ed9t ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng, d\u1ef1a tr\u00ean h\u1ecfi ti\u1ec1n s\u1eed, tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng, th\u1ef1c th\u1ec3 v\u00e0 h\u1ed7 tr\u1ee3 b\u1edfi c\u00e1c th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng (x\u00e9t nghi\u1ec7m, X-quang ph\u1ed5i, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, si\u00eau \u00e2m tim).<\/p>\n<p>B\u1ec7nh nh\u00e2n nghi ng\u1edd tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 ph\u00e2n l\u00e0m 3 nh\u00f3m d\u1ef1a tr\u00ean nguy c\u01a1 m\u1eafc suy tim c\u1ea5p:<\/p>\n<p><strong>Nguy c\u01a1 suy tim c\u1ea5p cao: <\/strong>B\u1ec7nh nh\u00e2n c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed suy tim t\u1eeb tr\u01b0\u1edbc, c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00f3 th\u1edf v\u00e0 sung huy\u1ebft (t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ph\u00f9 ph\u1ed5i, ph\u00f9 ngo\u1ea1i vi&#8230;)<\/p>\n<p><strong>Nguy c\u01a1 trung b\u00ecnh: <\/strong>B\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n kh\u00f3 th\u1edf, c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch t\u1eeb tr\u01b0\u1edbc, nh\u01b0ng c\u00e1c d\u1ea5u hi\u1ec7u sung huy\u1ebft kh\u00f4ng r\u00f5 r\u00e0ng.<\/p>\n<p><strong>Nguy c\u01a1 th\u1ea5p: <\/strong>B\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf nh\u01b0ng kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u sung huy\u1ebft v\u00e0 kh\u00f3 th\u1edf c\u00f3 th\u1ec3 gi\u1ea3i th\u00edch b\u1eb1ng b\u1ec7nh l\u00fd kh\u00e1c ngo\u00e0i tim m\u1ea1ch.<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-27375 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/17069-congestive-heart-failure-illustration-240x300.webp\" alt=\"Suy tim c\u1ea5p\" width=\"240\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/17069-congestive-heart-failure-illustration-240x300.webp 240w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/17069-congestive-heart-failure-illustration-768x960.webp 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/17069-congestive-heart-failure-illustration.webp 800w\" sizes=\"(max-width: 240px) 100vw, 240px\" \/><\/p>\n<p style=\"text-align: center;\"><strong>Suy tim c\u1ea5p<\/strong><\/p>\n<h3>4.2 C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n<h4>4.2.1 X-quang ng\u1ef1c th\u1eb3ng:<\/h4>\n<ul>\n<li>C\u00e1c d\u1ea5u hi\u1ec7u b\u1ec7nh tim v\u00e0 sung huy\u1ebft t\u0129nh m\u1ea1ch ph\u1ed5i: \u0110\u01b0\u1eddng Kerley B, ph\u00f9 kho\u1ea3ng k\u1ebd, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, b\u00f3ng tim to.<\/li>\n<li>Lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y kh\u00f3 th\u1edf kh\u00e1c: Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, vi\u00eam ph\u1ed5i, COPD.<\/li>\n<\/ul>\n<h4>4.2.2 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3:<\/h4>\n<ul>\n<li>Gi\u00fap \u0111\u1ecbnh h\u01b0\u1edbng nguy\u00ean nh\u00e2n v\u00e0 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t suy tim c\u1ea5p (V\u00ed d\u1ee5 rung nh\u0129 nhanh). Hi\u1ebfm khi b\u00ecnh th\u01b0\u1eddng trong suy tim c\u1ea5p c\u00f3 gi\u00e1 tr\u1ecb ch\u1ea9n \u0111o\u00e1n \u00e2m t\u00ednh cao.<\/li>\n<\/ul>\n<h4>4.2.3 Si\u00eau \u00e2m tim:<\/h4>\n<ul>\n<li>C\u1ea7n l\u00e0m c\u1ea5p n\u1ebfu b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng; l\u00e0m s\u1edbm \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n suy tim c\u1ea5p m\u1edbi xu\u1ea5t hi\u1ec7n v\u00e0 kh\u00f4ng r\u00f5 ch\u1ee9c n\u0103ng tim. Gi\u00fap \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng tim v\u00e0 b\u1ec7nh l\u00fd tim m\u1ea1ch n\u1ec1n.<\/li>\n<li>Si\u00eau \u00e2m c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng (point-of-care echo): X\u00e1c \u0111\u1ecbnh th\u00eam c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a suy tim c\u1ea5p nh\u01b0 tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, \u0111\u01b0\u1eddng B-line.<\/li>\n<\/ul>\n<h4>4.2.4 X\u00e9t nghi\u1ec7m m\u00e1u:<\/h4>\n<ul>\n<li>C\u1ea7n l\u00e0m NT-proBNP ho\u1eb7c BNP \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n kh\u00f3 th\u1edf c\u1ea5p nghi ng\u1edd do suy tim, \u00edt ngh\u0129 \u0111\u1ebfn suy tim c\u1ea5p n\u1ebfu BNP &lt; 100 pg\/mL ho\u1eb7c NT-proBNP &lt; 300 pg\/mL.<\/li>\n<li>Ngo\u00e0i ra c\u1ea7n l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n (urea, creatinine, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3&#8230;) v\u00e0 c\u00e1c x\u00e9t nghi\u1ec7m t\u00ecm nguy\u00ean nh\u00e2n kh\u1edfi ph\u00e1t \u0111\u1ee3t c\u1ea5p t\u00f9y t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n (procalcitonin, TSH&#8230;).<\/li>\n<\/ul>\n<h3>4.3 Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n suy tim c\u1ea5p<\/h3>\n<p>Khi ti\u1ebfp c\u1eadn b\u1ec7nh nh\u00e2n nghi ng\u1edd suy tim c\u1ea5p, c\u1ea7n x\u00e1c \u0111\u1ecbnh ngay xem c\u00f3 t\u00ecnh tr\u1ea1ng s\u1ed1c tim v\u00e0 ph\u00f9 ph\u1ed5i c\u1ea5p. Sau khi \u0111\u00e3 \u1ed5n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n t\u1ea1i khoa h\u1ed3i s\u1ee9c, c\u1ea7n t\u00ecm v\u00e0 x\u1eed tr\u00ed c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y suy tim c\u1ea5p th\u01b0\u1eddng g\u1eb7p, bao g\u1ed3m:<\/p>\n<ul>\n<li><strong>C (acute C oronary syndrome): <\/strong>H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p<\/li>\n<li><strong>H ( H ypertension emergency): <\/strong>T\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u<\/li>\n<li><strong>A (A rrhythmia): <\/strong>R\u1ed1i lo\u1ea1n nh\u1ecbp<\/li>\n<li><strong>M (acute M echanical cause): <\/strong>Nguy\u00ean nh\u00e2n c\u01a1 h\u1ecdc (ch\u1ea5n th\u01b0\u01a1ng, can thi\u1ec7p tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim bi\u1ebfn ch\u1ee9ng v\u1ee1 th\u00e0nh t\u1ef1 do&#8230;)<\/li>\n<li><strong>P ( P ulmonary embolism): <\/strong>Thuy\u00ean t\u1eafc ph\u1ed5i<\/li>\n<\/ul>\n<h3>4.4\u00a0 X\u1eed tr\u00ed suy tim c\u1ea5p<\/h3>\n<h4><strong>4.4.1 Nguy\u00ean t\u1eafc x\u1eed tr\u00ed<\/strong><\/h4>\n<p>Suy tim c\u1ea5p l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa, h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n suy tim c\u1ea5p ph\u1ea3i v\u00e0o vi\u1ec7n theo d\u00f5i. Nh\u1eefng b\u1ec7nh nh\u00e2n sau c\u1ea7n ph\u1ea3i theo d\u00f5i t\u1ea1i khoa \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c:<\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n ho\u1eb7c \u0111\u00e3 \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n. C\u00f3 d\u1ea5u hi\u1ec7u\/tri\u1ec7u ch\u1ee9ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4<\/li>\n<li>SpO\u2082 &lt; 90% d\u00f9 \u0111\u00e3 th\u1edf oxy; ho\u1eb7c co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p ph\u1ee5, nh\u1ecbp th\u1edf &gt; 25 nh\u1ecbp\/ph\u00fat.<\/li>\n<li>Nh\u1ecbp tim &lt; 40 ho\u1eb7c &gt; 130 nh\u1ecbp\/ph\u00fat, huy\u1ebft \u00e1p t\u00e2m thu &lt; 90 mmHg.<\/li>\n<li>C\u1ea7n ti\u1ebfp c\u1eadn x\u1eed tr\u00ed b\u1ec7nh nh\u00e2n t\u00f9y theo ph\u00e2n lo\u1ea1i suy tim c\u1ea5p<\/li>\n<\/ul>\n<h4>4.4.2 Li\u1ec7u ph\u00e1p oxy v\u00e0 h\u1ed7 tr\u1ee3 h\u00f4 h\u1ea5p<\/h4>\n<ul>\n<li>Cho b\u1ec7nh nh\u00e2n th\u1edf oxy <strong>n\u1ebfu SpO\u2082 &lt; 90%, ho\u1eb7c PaO\u2082 &lt; 60 mmHg<\/strong>. Kh\u00f4ng th\u1edf oxy th\u01b0\u1eddng quy n\u1ebfu kh\u00f4ng h\u1ea1 oxy m\u00e1u do g\u00e2y co m\u1ea1ch v\u00e0 gi\u1ea3m cung l\u01b0\u1ee3ng tim.<\/li>\n<li>Th\u00f4ng kh\u00ed kh\u00f4ng x\u00e2m nh\u1eadp \u00e1p l\u1ef1c d\u01b0\u01a1ng (BiPAP, CPAP) s\u1edbm \u1edf b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p (SpO\u2082 &lt; 90%, th\u1edf &gt; 25 nh\u1ecbp\/ph\u00fat) gi\u00fap gi\u1ea3m ti\u1ec1n g\u00e1nh, gi\u1ea3m sung huy\u1ebft ph\u1ed5i v\u00e0 gi\u1ea3m nguy c\u01a1 \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n. Ch\u1ec9 th\u1edf kh\u00f4ng x\u00e2m nh\u1eadp \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng suy h\u00f4 h\u1ea5p qu\u00e1 n\u1eb7ng, pH &gt; 7,2 v\u00e0 b\u1ec7nh nh\u00e2n h\u1ee3p t\u00e1c th\u1edf. C\u1ea7n \u0111\u1eb7t \u1ed1ng ngay n\u1ebfu th\u1edf kh\u00f4ng x\u00e2m nh\u1eadp kh\u00f4ng hi\u1ec7u qu\u1ea3 trong v\u00f2ng 30 ph\u00fat.<\/li>\n<li>\u0110\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n \u1edf b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p n\u1eb7ng, kh\u00f4ng \u0111\u00e1p \u1ee9ng th\u1edf kh\u00f4ng x\u00e2m nh\u1eadp (PaO\u2082 &lt; 60 mmHg, PaCO\u2082 &gt; 50 mmHg, pH &lt; 7,35).<\/li>\n<li>C\u1ea7n theo d\u00f5i s\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o \u00e1p l\u1ef1c d\u01b0\u01a1ng v\u00ec c\u00f3 th\u1ec3 t\u1ee5t huy\u1ebft \u00e1p do gi\u1ea3m ti\u1ec1n g\u00e1nh v\u00e0 c\u00e1c thu\u1ed1c an th\u1ea7n d\u00f9ng khi \u0111\u1eb7t n\u1ed9i kh\u00ed qu\u1ea3n.<\/li>\n<\/ul>\n<h4>4.4.3 L\u1ee3i ti\u1ec3u<\/h4>\n<ul>\n<li>L\u1ee3i ti\u1ec3u quai l\u00e0 \u0111i\u1ec1u tr\u1ecb c\u0103n b\u1ea3n trong suy tim c\u1ea5p, gi\u00fap gi\u1ea3m t\u00ecnh tr\u1ea1ng sung huy\u1ebft. T\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch xu\u1ea5t hi\u1ec7n s\u1edbm sau 10 &#8211; 15 ph\u00fat, t\u00e1c d\u1ee5ng l\u1ee3i ti\u1ec3u xu\u1ea5t hi\u1ec7n sau 30 &#8211; 60 ph\u00fat v\u00e0 k\u00e9o d\u00e0i 4 &#8211; 6 gi\u1edd.<\/li>\n<li>C\u1ea7n d\u00f9ng l\u1ee3i ti\u1ec3u \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch do ph\u00f9 v\u00e0 gi\u1ea3m t\u01b0\u1edbi m\u00e1u ni\u00eam m\u1ea1c ru\u1ed9t l\u00e0m gi\u1ea3m sinh kh\u1ea3 d\u1ee5ng c\u1ee7a l\u1ee3i ti\u1ec3u \u0111\u01b0\u1eddng u\u1ed1ng. Ch\u1ee7 y\u1ebfu d\u00f9ng l\u1ee3i ti\u1ec3u quai m\u00e0 ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 furosemide. Th\u01b0\u1eddng bolus 40 &#8211; 80mg, c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u ti\u00eam t\u0129nh m\u1ea1ch 20mg \u1edf b\u1ec7nh nh\u00e2n ch\u01b0a d\u00f9ng l\u1ee3i ti\u1ec3u bao gi\u1edd ho\u1eb7c t\u0103ng li\u1ec1u t\u1edbi 200 mg \u1edf b\u1ec7nh nh\u00e2n suy th\u1eadn. Theo d\u00f5i \u0111\u00e1p \u1ee9ng sau 30 &#8211; 60 ph\u00fat, t\u0103ng g\u1ea5p \u0111\u00f4i li\u1ec1u n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng.<\/li>\n<li>N\u00ean d\u00f9ng l\u1ee3i ti\u1ec3u v\u1edbi li\u1ec1u \u0111\u00e1p \u1ee9ng nhi\u1ec1u l\u1ea7n trong ng\u00e0y thay v\u00ec m\u1ed9t li\u1ec1u cao \u0111\u1ec3 gi\u1ea3m t\u00e1i h\u1ea5p thu natri sau khi l\u1ee3i ti\u1ec3u c\u00f3 t\u00e1c d\u1ee5ng.<\/li>\n<li>\u1ede b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng l\u1ee3i ti\u1ec3u tr\u01b0\u1edbc \u0111\u00f3: B\u1eaft \u0111\u1ea7u li\u1ec1u ti\u00eam t\u0129nh m\u1ea1ch \u00edt nh\u1ea5t b\u1eb1ng li\u1ec1u \u0111\u01a1n b\u1ec7nh nh\u00e2n d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng, t\u1ed5ng li\u1ec1u h\u00e0ng ng\u00e0y <strong><em>\u00edt nh\u1ea5t 2,5 li\u1ec1u h\u00e0ng ng\u00e0y<\/em> <\/strong>c\u1ee7a b\u1ec7nh nh\u00e2n. V\u00ed d\u1ee5: B\u1ec7nh nh\u00e2n \u0111ang u\u1ed1ng Furosemide 80 mg x 2 l\u1ea7n\/24h khi nh\u1eadp vi\u1ec7n c\u1ea7n chuy\u1ec3n sang li\u1ec1u ti\u00eam 80 mg x 04 l\u1ea7n\/24h.<\/li>\n<li>M\u1ee5c ti\u00eau l\u1ee3i ti\u1ec3u: C\u00e2n b\u1eb1ng d\u1ecbch \u00e2m 2 &#8211; 3 L\/24h, m\u1ee5c ti\u00eau n\u00e0y th\u1ea5p h\u01a1n \u1edf c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ph\u00f9 ngo\u1ea1i vi v\u00e0 kh\u00f4ng gi\u00e3n th\u1ea5t tr\u00e1i. M\u1ee5c ti\u00eau l\u1ee3i ti\u1ec3u c\u0169ng th\u1ea5p h\u01a1n \u1edf b\u1ec7nh nh\u00e2n suy th\u1ea5t ph\u1ea3i \u0111\u01a1n thu\u1ea7n v\u00e0 bi\u1ec3u hi\u1ec7n ch\u1ee7 y\u1ebfu l\u00e0 c\u1ed5 tr\u01b0\u1edbng.<\/li>\n<\/ul>\n<p>B\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ee3i ti\u1ec3u:<\/p>\n<ul>\n<li>C\u00f3 th\u1ec3 do (1) Gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn do gi\u1ea3m cung l\u01b0\u1ee3ng tim ho\u1eb7c (2) T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p k\u00e8m theo; c\u1ea7n ph\u1ea3i d\u00f9ng th\u00eam thu\u1ed1c v\u1eadn m\u1ea1ch\/t\u0103ng co b\u00f3p ho\u1eb7c l\u1ecdc m\u00e1u.<\/li>\n<li>S\u1eed d\u1ee5ng th\u00eam l\u1ee3i ti\u1ec3u thiazid ho\u1eb7c kh\u00e1ng aldosterone c\u00f3 th\u1ec3 gi\u00fap t\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ee3i ti\u1ec3u quai; tuy nhi\u00ean kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng n\u1ebfu b\u1ec7nh nh\u00e2n v\u00f4 ni\u1ec7u ho\u00e0n to\u00e0n.<\/li>\n<\/ul>\n<h4>4.4.4 Thu\u1ed1c gi\u00e3n m\u1ea1ch<\/h4>\n<ul>\n<li><strong>T\u00e1c d\u1ee5ng: <\/strong>(1) Gi\u00e3n \u0110M l\u00e0m gi\u1ea3m h\u1eadu g\u00e1nh, c\u1ea3i thi\u1ec7n cung l\u01b0\u1ee3ng tim, (2) Gi\u00e3n TM l\u00e0m gi\u1ea3m ti\u1ec1n g\u00e1nh, c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng ph\u00f9 ph\u1ed5i v\u00e0 sung huy\u1ebft m\u1ea1ch th\u1eadn.<\/li>\n<li>Ch\u1ee7 y\u1ebfu d\u00f9ng trong suy tim c\u1ea5p th\u1ec3 \u201c\u1ea5m v\u00e0 \u1ea9m\u201d, ph\u1ea3i \u0111\u1ea3m b\u1ea3o huy\u1ebft \u00e1p t\u00e2m thu &gt; 110 mmHg khi s\u1eed d\u1ee5ng.<\/li>\n<li>C\u00e1c thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: D\u00f9ng trong giai \u0111o\u1ea1n c\u1ea5p, v\u00ed d\u1ee5 nitroglycerin (kh\u1edfi \u0111\u1ea7u 20 \u00b5g\/min, t\u0103ng 10 &#8211; 20 \u00b5g\/min m\u1ed7i 5 ph\u00fat, t\u1ed1i \u0111a 200 \u00b5g\/pli\u00fat). nitroprusside.<\/li>\n<li>Chuy\u1ec3n sang thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng u\u1ed1ng khi b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh: \u1ee8c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, hydralazine k\u1ebft h\u1ee3p nitrate.<\/li>\n<\/ul>\n<h4>4.4.5 Thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 t\u0103ng co b\u00f3p<\/h4>\n<ul>\n<li>C\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 t\u0103ng co b\u00f3p (inotrope) c\u00f3 th\u1ec3 l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n suy tim, do v\u1eady c\u1ea7n s\u1eed d\u1ee5ng c\u1ea9n tr\u1ecdng, b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p, t\u0103ng d\u1ea7n v\u00e0 theo d\u00f5i s\u00e1t. Ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 t\u0103ng co b\u00f3p trong suy tim c\u1ea5p: (1) Suy tim c\u1ea5p th\u1ec3 \u1ea9m v\u00e0 l\u1ea1nh v\u1edbi HA t\u00e2m thu &lt; 85 &#8211; 90 mmg ho\u1eb7c (2) Suy tim c\u1ea5p th\u1ec3 \u1ea9m v\u00e0 l\u1ea1nh kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi l\u1ee3i ti\u1ec3u.<\/li>\n<li>C\u00e1c thu\u1ed1c t\u0103ng co b\u00f3p c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch (Dobutamine v\u00e0 milrinone):<\/li>\n<li>Milrinone l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf phosphodiesterase-5 v\u00e0 l\u00e0m t\u0103ng cAMP n\u1ed9i b\u00e0o. Thu\u1ed1c th\u1ea3i tr\u1eeb qua th\u1eadn, c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch v\u00e0 k\u00e9o d\u00e0i h\u01a1n dobutamine. Do v\u1eady c\u1ea7n tr\u00e1nh d\u00f9ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 HA t\u00e2m thu &lt; 80 mmHg, tr\u00e1nh d\u00f9ng li\u1ec1u bolus m\u00e0 b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p (0.2 \u00b5g\/kg\/min) v\u00e0 t\u0103ng d\u1ea7n \u0111\u1ec3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 t\u00e1c d\u1ee5ng t\u0103ng co b\u00f3p. Vai tr\u00f2 ch\u1ee7 y\u1ebfu c\u1ee7a milrinone trong suy tim c\u1ea5p: (1) B\u1ec7nh nh\u00e2n t\u1ee5t \u00e1p do ch\u1eb9n beta, \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi dobutamine, (2) B\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng \u00e1p l\u1ef1c \u0110MP (milrinone c\u00f3 t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch ph\u1ed5i \u0111\u00e1ng k\u1ec3).<\/li>\n<li>Dobutamine t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu tr\u00ean receptor \u00df1 (tr\u00ean c\u01a1 tim). t\u00e1c d\u1ee5ng c\u01b0\u1eddng \u00df2 v\u00e0 \u03b11 (tr\u00ean th\u00e0nh m\u1ea1ch) \u00edt n\u00ean t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch kh\u00f4ng nhi\u1ec1u v\u00e0 huy\u1ebft \u00e1p th\u01b0\u1eddng c\u1ea3i thi\u1ec7n khi d\u00f9ng thu\u1ed1c. Th\u01b0\u1eddng c\u00f3 hi\u1ec7u qu\u1ea3 t\u1eeb li\u1ec1u th\u1ea5p (2 &#8211; 5 \u00b5g\/kg\/min). c\u1ea7n li\u1ec1u cao h\u01a1n n\u1ebfu b\u1ec7nh nh\u00e2n d\u00f9ng ch\u1eb9n beta tr\u01b0\u1edbc \u0111\u00f3 (tr\u00ean 10 \u00b5g\/kg\/min).<\/li>\n<li>R\u1ed1i lo\u1ea1n nh\u1ecbp th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u1edbi milrinone l\u00e0 rung nh\u0129, v\u1edbi dobutamine l\u00e0 nh\u1ecbp nhanh xoang. C\u1ea3 hai \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y ngo\u1ea1i t\u00e2m thu th\u1ea5t kh\u00f4ng tri\u1ec7u ch\u1ee9ng nh\u01b0ng hi\u1ebfm khi g\u00e2y nhanh th\u1ea5t.<\/li>\n<li>C\u00e1c thu\u1ed1c t\u0103ng co b\u00f3p c\u00f3 t\u00e1c d\u1ee5ng co m\u1ea1ch (Dopamine, noradrenalin, adrenaline)<\/li>\n<li>\u01afu ti\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n huy\u1ebft \u00e1p th\u1ea5p (Huy\u1ebft \u00e1p t\u00e2m thu &lt; 70 &#8211; 80 mmHg) V\u1edbi c\u00f9ng m\u1ee9c \u0111\u1ed9 t\u0103ng cung l\u01b0\u1ee3ng tim, dopamine l\u00e0 t\u0103ng nh\u1ecbp tim v\u00e0 t\u0103ng nguy c\u01a1 r\u1ed1i lo\u1ea1n nh\u1ecbp h\u01a1n dobutamine v\u00e0 noradrenaline.<\/li>\n<li>Adrenaline ch\u1ec9 n\u00ean d\u00f9ng trong c\u1ea5p c\u1ee9u ng\u1eebng tu\u1ea7n ho\u00e0n v\u00e0 khi kh\u00f4ng n\u00e2ng \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p d\u00f9 \u0111\u00e3 d\u00f9ng c\u00e1c v\u1eadn m\u1ea1ch kh\u00e1c.<\/li>\n<\/ul>\n<h4>4.4.6 C\u00e1c bi\u1ec7n ph\u00e1p c\u01a1 h\u1ecdc h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n<\/h4>\n<ul>\n<li>C\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc nh\u01b0 ECLS, ECMO c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong th\u1eddi gian ng\u1eafn trong l\u00fac ch\u1edd ch\u1ee9c n\u0103ng tim v\u00e0 c\u00e1c c\u01a1 quan kh\u00e1c h\u1ed3i ph\u1ee5c, ho\u1eb7c s\u1eed d\u1ee5ng nh\u01b0 c\u1ea7u n\u1ed1i \u0111\u1ebfn c\u00e1c li\u1ec7u ph\u00e1p v\u1ec1 sau nh\u01b0 gh\u00e9p tim hay c\u1ea5y thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 th\u1ea5t tr\u00e1i.<\/li>\n<li>C\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n \u0111\u1eb7t qua da nh\u01b0 IABP c\u00f3 th\u1ec3 tri\u1ec3n khai d\u1ec5 d\u00e0ng, gi\u00fap c\u1ea3i thi\u1ec7n huy\u1ebft \u0111\u1ed9ng nh\u01b0ng ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh c\u1ea3i thi\u1ec7n t\u1eed vong.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Suy tim c\u1ea5p l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng\/th\u1ef1c th\u1ec3 c\u1ee7a suy tim. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p. 1.\u0110\u1ecbnh ngh\u0129a Suy tim c\u1ea5p l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng\/th\u1ef1c th\u1ec3 c\u1ee7a suy tim. Suy tim [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Suy tim c\u1ea5p - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy tim c\u1ea5p l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng\/th\u1ef1c th\u1ec3 c\u1ee7a suy tim. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p.\" \/>\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=\"Suy tim c\u1ea5p - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Suy tim c\u1ea5p l\u00e0 s\u1ef1 xu\u1ea5t hi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng\/th\u1ef1c th\u1ec3 c\u1ee7a suy tim. \u0110\u00e2y l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/suy-tim-cap\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-23T14:36:21+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/17069-congestive-heart-failure-illustration-240x300.webp\" \/>\n<meta name=\"author\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"L\u01b0\u01a1ng Vi\u1ebft T\u00e0i\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/suy-tim-cap\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/suy-tim-cap\/\",\"name\":\"Suy tim c\u1ea5p - 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