{"id":27377,"date":"2023-04-23T21:35:48","date_gmt":"2023-04-23T14:35:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27377"},"modified":"2023-04-23T21:35:48","modified_gmt":"2023-04-23T14:35:48","slug":"cac-van-de-thuong-gap-trong-suy-tim-cap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/cac-van-de-thuong-gap-trong-suy-tim-cap\/","title":{"rendered":"Suy tim c\u1ea5p v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p"},"content":{"rendered":"

Suy tim c\u1ea5p<\/a> l\u00e0 c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p\u00a0 trong suy tim c\u1ea5p<\/strong><\/p>\n

1.Ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng<\/strong><\/h2>\n

1.1 \u0110\u1ecbnh ngh\u0129a<\/h3>\n
    \n
  • Ph\u00f9 ph\u1ed5i c\u1ea5p l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa, h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng t\u00edch t\u1ee5 n\u01b0\u1edbc v\u00e0 c\u00e1c th\u00e0nh ph\u1ea7n h\u1eefu h\u00ecnh c\u1ee7a huy\u1ebft t\u01b0\u01a1ng trong kho\u1ea3ng k\u1ebd g\u00e2y tho\u00e1t thanh d\u1ecbch v\u00e0o l\u00f2ng ph\u1ebf nang, d\u0201n \u0111\u1ebfn h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p tr\u00ean l\u00e2m s\u00e0ng.<\/li>\n
  • Ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng hay ph\u00f9 ph\u1ed5i c\u1ea5p do tim l\u00e0 do m\u1ea5t c\u00e2n b\u1eb1ng \u00e1p l\u1ef1c 2 ph\u00eda m\u00e0ng ph\u1ebf nang mao m\u1ea1ch do \u00e1p l\u1ef1c th\u1ee7y t\u0129nh trong l\u00f2ng mao m\u1ea1ch t\u0103ng. T\u00ecnh tr\u1ea1ng ph\u00f9 kho\u1ea3ng k\u1ebd xu\u1ea5t hi\u1ec7n khi \u00e1p l\u1ef1c nh\u0129 tr\u00e1i \u0111\u1ea1t 18 – 25 mmHg v\u00e0 ph\u00f9 ph\u1ed5i khi tr\u00ean 25 mmHg.<\/li>\n
  • Ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng c\u00f3 th\u1ec3 g\u1eb7p trong suy tim c\u1ea5p \u201c\u1ea9m v\u00e0 \u1ea5m\u201d ho\u1eb7c \u201c\u1ea9m v\u00e0 l\u1ea1nh\u201d, trong \u0111\u00f3 n\u1ed5i b\u1eadt l\u00e0 bi\u1ec3u hi\u1ec7n suy h\u00f4 h\u1ea5p do sung huy\u1ebft t\u1ea1i ph\u1ed5i. Ngo\u00e0i c\u00e1c c\u0103n nguy\u00ean g\u00e2y suy tim c\u1ea5p n\u00f3i chung, ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng c\u00f3 th\u1ec3 g\u1eb7p do: Thay \u0111\u1ed5i \u0111\u1ed9 cao, suy tu\u1ea7n ho\u00e0n b\u1ea1ch m\u1ea1ch, r\u00fat d\u1ecbch qu\u00e1 nhanh trong tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i nhi\u1ec1u …<\/li>\n<\/ul>\n

    \"C\u01a1<\/p>\n

    C\u01a1 ch\u1ebf ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng<\/strong><\/p>\n

    1.2 Ch\u1ea9n \u0111o\u00e1n ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng<\/h3>\n

    Ti\u1ec1n s\u1eed: <\/strong>G\u1ee3i \u00fd nguy\u00ean nh\u00e2n g\u00e2y suy tim c\u1ea5p, v\u00ed d\u1ee5: suy tim m\u1ea1n t\u00ednh, t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, b\u1ec7nh van tim…<\/p>\n

    1.2.1 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng:<\/h4>\n
      \n
    • Tri\u1ec7u ch\u1ee9ng suy h\u00f4 h\u1ea5p: Kh\u00f3 th\u1edf nhanh, d\u1eef d\u1ed9i, co k\u00e9o c\u01a1 h\u00f4 h\u1ea5p<\/li>\n
    • Tri\u1ec7u ch\u1ee9ng sung huy\u1ebft ph\u1ed5i: Rale \u1ea9m t\u0103ng nhanh t\u1eeb hai \u0111\u00e1y l\u00ean \u0111\u1ec9nh ph\u1ed5i, ho kh\u1ea1c b\u1ecdt h\u1ed3ng.<\/li>\n
    • Tri\u1ec7u ch\u1ee9ng g\u1ee3i \u00fd c\u0103n nguy\u00ean: \u0110au th\u1eaft ng\u1ef1c, huy\u1ebft \u00e1p cao, nghe tim c\u00f3 ti\u1ebfng th\u1ed5i, ti\u1ebfng ng\u1ef1a phi…<\/li>\n<\/ul>\n

      1.2.2 C\u1eadn l\u00e2m s\u00e0ng:<\/h4>\n
        \n
      • X-quang ng\u1ef1c: Tim to, m\u1edd h\u00ecnh c\u00e1nh b\u01b0\u1edbm, \u0111\u01b0\u1eddng Kerley B, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i,<\/li>\n
      • \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: Nh\u1ecbp nhanh xoang, c\u00e1c d\u1ea5u hi\u1ec7u g\u1ee3i \u00fd b\u1ec7nh nguy\u00ean (T\u0103ng g\u00e1nh th\u1ea5t tr\u00e1i, thay \u0111\u1ed5i ST\/T, rung nh\u0129 nhanh…)<\/li>\n
      • Si\u00eau \u00e2m tim: Nhi\u1ec1u \u0111\u01b0\u1eddng B-line 2 tr\u01b0\u1eddng ph\u1ed5i (d\u1ea5u hi\u1ec7u ph\u00f9 kho\u1ea3ng k\u1ebd), gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, b\u1ec7nh l\u00fd van tim…<\/li>\n
      • Kh\u00ed m\u00e1u \u0111\u1ed9ng m\u1ea1ch: Gi\u1ea3m oxy m\u00e1u, gi\u1ea3m CO\u2082 m\u00e1u do t\u0103ng th\u00f4ng kh\u00ed<\/li>\n
      • X\u00e9t nghi\u1ec7m m\u00e1u: T\u0103ng BNP, NT-proBNP; t\u0103ng men tim (cTn, CK, CK-MB); suy th\u1eadn…<\/li>\n<\/ul>\n

        \u0110i\u1ec1u tr\u1ecb ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng<\/p>\n

          \n
        • Nguy\u00ean t\u1eafc chung t\u01b0\u01a1ng t\u1ef1 \u0111i\u1ec1u tr\u1ecb suy tim c\u1ea5p: \u1ed4n \u0111\u1ecbnh h\u00f4 h\u1ea5p, tu\u1ea7n ho\u00e0n; gi\u1ea3m t\u00ecnh tr\u1ea1ng sung huy\u1ebft b\u1eb1ng l\u1ee3i ti\u1ec3u, thu\u1ed1c gi\u00e3n m\u1ea1ch ho\u1eb7c l\u1ecdc m\u00e1u; x\u1eed tr\u00ed c\u0103n nguy\u00ean g\u00e2y ph\u00f9 ph\u1ed5i.<\/li>\n
        • Cho b\u1ec7nh nh\u00e2n n\u1eb1m \u0111\u1ea7u cao, tr\u1eeb khi t\u1ee5t huy\u1ebft \u00e1p.<\/li>\n
        • \u0110\u1ea3m b\u1ea3o ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p (SpO\u2082 > 90%):<\/li>\n
        • B\u1ec7nh nh\u00e2n t\u1ec9nh, h\u1ee3p t\u00e1c t\u1ed1t: Th\u1edf oxy mask t\u00fai 6 – 10 L\/min, chuy\u1ec3n sang th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o kh\u00f4ng x\u00e2m nh\u1eadp (CPAP, BiPAP) n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng.<\/li>\n
        • B\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n \u00fd th\u1ee9c, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi th\u1edf kh\u00f4ng x\u00e2m nh\u1eadp: \u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n, th\u1edf m\u00e1y x\u00e2m nh\u1eadp v\u1edbi PEEP.<\/li>\n<\/ul>\n

          Gi\u1ea3m ti\u1ec1n g\u00e1nh:<\/p>\n

            \n
          • L\u1ee3i ti\u1ec3u quai \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: <\/em><\/strong>S\u1eed d\u1ee5ng nh\u01b0 trong suy tim c\u1ea5p n\u00f3i chung. C\u00f3 hi\u1ec7u qu\u1ea3 cao nh\u01b0ng t\u00e1c d\u1ee5ng ch\u1eadm (30 – 60 ph\u00fat sau ti\u00eam), do \u0111\u00f3 n\u00ean b\u1eaft \u0111\u1ea7u \u0111\u1ed3ng th\u1eddi c\u00f9ng thu\u1ed1c gi\u00e3n m\u1ea1ch n\u1ebfu c\u00f3 th\u1ec3.<\/li>\n
          • Thu\u1ed1c gi\u00e3n m\u1ea1ch \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch: <\/em><\/strong>Hay d\u00f9ng nitroglycerine do t\u00e1c d\u1ee5ng gi\u00e3n t\u0129nh m\u1ea1ch l\u00e0m gi\u1ea3m ti\u1ec1n g\u00e1nh m\u1ea1nh. Ch\u1ec9 d\u00f9ng tr\u00ean b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng \u1ed5n \u0111\u1ecbnh (Huy\u1ebft \u00e1p t\u00e2m thu \u2265 110 mmHg kh\u00f4ng c\u1ea7n v\u1eadn m\u1ea1ch).<\/li>\n
          • Morphine sulfate: <\/em><\/strong>T\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu l\u00e0 gi\u1ea3m k\u00edch th\u00edch, lo l\u1eafng, t\u00e1c d\u1ee5ng gi\u00e3n m\u1ea1ch nh\u1eb9. Th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng, \u0111\u1eb7c bi\u1ec7t n\u1ebfu kh\u00f4ng c\u00f3 th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o s\u1eb5n s\u00e0ng do thu\u1ed1c g\u00e2y \u1ee9c ch\u1ebf h\u00f4 h\u1ea5p.<\/li>\n
          • Th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o v\u1edbi PEEP cao <\/em><\/strong>(x\u00e2m nh\u1eadp ho\u1eb7c kh\u00f4ng x\u00e2m nh\u1eadp) l\u00e0 bi\u1ec7n ph\u00e1p hi\u1ec7u qu\u1ea3 gi\u00fap gi\u1ea3m ti\u1ec1n g\u00e1nh, nh\u01b0ng c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t \u00e1p (\u0111\u1eb7c bi\u1ec7t khi PEEP > 14 cmH\u2082O).<\/li>\n
          • Gi\u1ea3m h\u1eadu g\u00e1nh: <\/strong>Ch\u1ee7 y\u1ebfu s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch; ngo\u00e0i nitroglycerine ra c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc: nicardipine, nitroprusside (Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p v\u00e0 ph\u1ee5 n\u1eef c\u00f3 thai).<\/li>\n
          • Thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 t\u0103ng co b\u00f3p: <\/strong>S\u1eed d\u1ee5ng khi b\u1ec7nh nh\u00e2n t\u1ee5t huy\u1ebft \u00e1p, gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 (Suy tim c\u1ea5p \u1ea9m v\u00e0 l\u1ea1nh).<\/li>\n
          • T\u00ecm v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u0103n nguy\u00ean <\/strong>(H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, t\u0103ng huy\u1ebft \u00e1p c\u1ea5p c\u1ee9u, r\u1ed1i lo\u1ea1n nh\u1ecbp tim, nguy\u00ean nh\u00e2n c\u01a1 h\u1ecdc, t\u1eafc m\u1ea1ch ph\u1ed5i).<\/li>\n<\/ul>\n

            C\u00e1c bi\u1ec7n ph\u00e1p kh\u00e1c:<\/p>\n

              \n
            • H\u1ea1n ch\u1ebf d\u1ecbch v\u00e0o.<\/li>\n
            • Si\u00eau l\u1ecdc, th\u1eadn nh\u00e2n t\u1ea1o n\u1ebfu d\u00f9ng thu\u1ed1c kh\u00f4ng hi\u1ec7u qu\u1ea3.<\/li>\n
            • Chuy\u1ec3n sang c\u00e1c thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng (tr\u1ecb li\u1ec7u d\u1ef1a theo b\u1eb1ng ch\u1ee9ng) khi b\u1ec7nh nh\u00e2n sang giai \u0111o\u1ea1n \u1ed5n \u0111\u1ecbnh.<\/li>\n<\/ul>\n

              2.S\u1ed1c tim<\/h2>\n

              2.1 \u0110\u1ecbnh ngh\u0129a<\/h3>\n

              S\u1ed1c tim l\u00e0 t\u00ecnh tr\u1ea1ng gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 th\u1ecfa \u0111\u00e1ng do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim. \u0110\u1eb7c \u0111i\u1ec3m huy\u1ebft \u0111\u1ed9ng trong s\u1ed1c tim bao g\u1ed3m (1) T\u1ee5t huy\u1ebft \u00e1p dai d\u1eb3ng (huy\u1ebft \u00e1p trung b\u00ecnh < 65 mmHg ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m thu < 90 mmHg ho\u1eb7c t\u1ee5t tr\u00ean 30 mmHg so v\u1edbi n\u1ec1n tr\u00ean 30 ph\u00fat), (2) Suy gi\u1ea3m n\u1eb7ng ch\u1ee9c n\u0103ng tim (Ch\u1ec9 s\u1ed1 cung l\u01b0\u1ee3ng tim (CI) d\u01b0\u1edbi 1,8 L\/min\/m\u00b2 da kh\u00f4ng c\u00f3 h\u1ed7 tr\u1ee3 ho\u1eb7c d\u01b0\u1edbi 2,0 – 2,2 L\/min\/m\u00b2 da n\u1ebfu c\u00f3 h\u1ed7 tr\u1ee3) v\u00e0 (3) \u00c1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y t\u00e2m th\u1ea5t b\u00ecnh th\u01b0\u1eddng ho\u1eb7c t\u0103ng.<\/p>\n

              S\u1ed1c tim c\u00f3 th\u1ec3 do b\u1ea5t c\u1ee9 nguy\u00ean nh\u00e2n n\u00e0o g\u00e2y suy tim c\u1ea5p (th\u1ec3 \u201cl\u1ea1nh\u201d), tuy nhi\u00ean th\u01b0\u1eddng g\u1eb7p nh\u1ea5t do nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p.<\/p>\n

              2.2 L\u00e2m s\u00e0ng<\/h3>\n

              Ti\u1ec1n s\u1eed <\/strong>g\u1ee3i \u00fd nguy\u00ean nh\u00e2n tim m\u1ea1ch: \u0110au th\u1eaft ng\u1ef1c \u0111i\u1ec3n h\u00ecnh, suy tim m\u1ea1n t\u00ednh tr\u01b0\u1edbc \u0111\u00f3, b\u1ec7nh l\u00fd van tim, r\u1ed1i lo\u1ea1n nh\u1ecbp tim…<\/p>\n

              Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng chung c\u1ee7a suy tim c\u1ea5p <\/strong>nh\u01b0ng n\u1ed5i tr\u1ed9i l\u00e0 t\u1ee5t \u00e1p v\u00e0 gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 (suy tim c\u1ea5p \u201cl\u1ea1nh\u201d):<\/p>\n

                \n
              • Huy\u1ebft \u00e1p trung b\u00ecnh < 65 mmHg, ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m thu < 90 mmHg, ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m thu t\u1ee5t tr\u00ean 40 mmHg so v\u1edbi huy\u1ebft \u00e1p n\u1ec1n t\u1ea3ng.<\/li>\n
              • Chi l\u1ea1nh, \u1ea9m; thi\u1ec3u ni\u1ec7u (ti\u1ec3u d\u01b0\u1edbi 30 mL\/h), thay \u0111\u1ed5i tri gi\u00e1c…<\/li>\n
              • Bi\u1ec3u hi\u1ec7n sung huy\u1ebft: Rale \u1ea9m hai ph\u1ed5i, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, CVP t\u0103ng (> 12 mmHg). C\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 rale ph\u1ed5i n\u1ebfu s\u1ed1c do suy th\u1ea5t ph\u1ea3i l\u00e0 ch\u1ee7 y\u1ebfu (nh\u1ed3i m\u00e1u c\u01a1 tim th\u1ea5t ph\u1ea3i).<\/li>\n
              • D\u1ea5u hi\u1ec7u kh\u00e1m tim m\u1ea1ch: Ti\u1ebfng tim, m\u1edd (ch\u00e8n \u00e9p tim), ti\u1ebfng th\u1ed5i m\u1edbi xu\u1ea5t hi\u1ec7n (bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim, vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n…), ti\u1ebfng ng\u1ef1a phi…<\/li>\n<\/ul>\n

                2.3 C\u1eadn l\u00e2m s\u00e0ng<\/h3>\n

                2.3.1 Si\u00eau \u00e2m tim: <\/strong><\/h4>\n
                  \n
                • C\u1ea7n ti\u1ebfn h\u00e0nh si\u00eau \u00e2m tim c\u1ea5p c\u1ee9u trong tr\u01b0\u1eddng h\u1ee3p suy tim c\u1ea5p c\u00f3 s\u1ed1c tim. Kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i si\u00eau \u00e2m \u0111\u1ea7y \u0111\u1ee7 m\u00e0 c\u00f3 th\u1ec3 si\u00eau \u00e2m s\u01a1 b\u1ed9 (point-of-care ultrasound) n\u1eb1m \u0111\u00e1nh gi\u00e1:<\/li>\n
                • Gi\u1ea3m ch\u1ee9c n\u0103ng co b\u00f3p c\u01a1 tim, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng c\u01a1 tim.<\/li>\n
                • Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc: Tr\u00e0n d\u1ecbch m\u00e0ng tim, h\u1edf van tim c\u1ea5p, th\u00f4ng li\u00ean th\u1ea5t m\u1edbi xu\u1ea5t hi\u1ec7n, k\u1eb9t van tim c\u01a1 h\u1ecdc, huy\u1ebft kh\u1ed1i th\u00e2n \u0110MP…<\/li>\n
                • C\u00e1c d\u1ea5u hi\u1ec7u ngo\u00e0i tim: Tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, sung huy\u1ebft ph\u1ed5i (\u0111\u01b0\u1eddng B-line), t\u00ecnh tr\u1ea1ng t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/li>\n<\/ul>\n

                  2.3.2 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3:<\/h4>\n
                    \n
                  • \u0110a ph\u1ea7n l\u00e0 nh\u1ecbp nhanh xoang. Tr\u01b0\u1eddng h\u1ee3p nh\u1ecbp xoang t\u1ea7n s\u1ed1 \u201cb\u00ecnh th\u01b0\u1eddng\u201d (60 – 70 nh\u1ecbp\/ph\u00fat) ho\u1eb7c ch\u1eadm c\u00f3 th\u1ec3 do c\u01b0\u1eddng ph\u1ebf v\u1ecb, t\u1ee5t \u00e1p ho\u1eb7c oxy m\u00e1u k\u00e9o d\u00e0i v\u00e0 c\u00f3 ti\u00ean l\u01b0\u1ee3ng x\u1ea5u.<\/li>\n
                  • C\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh ho\u1eb7c ch\u1eadm l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y s\u1ed1c. Nh\u1ecbp nhanh tr\u00ean th\u1ea5t (v\u00ed d\u1ee5 rung nh\u0129 nhanh) th\u01b0\u1eddng ph\u1ea3i \u0111\u1ea1t t\u1ea7n s\u1ed1 > 150 nh\u1ecbp\/ph\u00fat m\u1edbi c\u00f3 th\u1ec3 g\u00e2y t\u1ee5t \u00e1p, \u1edf t\u1ea7n s\u1ed1 th\u1ea5p h\u01a1n th\u00ec nh\u1ecbp nhanh th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u1ee5t \u00e1p.<\/li>\n
                  • R\u1ea5t quan tr\u1ecdng trong ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim. S\u1ed1c tim th\u01b0\u1eddng g\u1eb7p trong nh\u1ed3i m\u00e1u tr\u01b0\u1edbc r\u1ed9ng; n\u1ebfu \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f3 d\u1ea5u hi\u1ec7u nh\u1ed3i m\u00e1u sau d\u01b0\u1edbi th\u00ec c\u1ea7n ngh\u0129 t\u1edbi:<\/li>\n<\/ul>\n
                      \n
                    • S\u1ed1c tim do suy th\u1ea5t ph\u1ea3i n\u1eb7ng, (2) Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc, (3) R\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm k\u00e8m theo (ch\u1eadm xoang ho\u1eb7c block nh\u0129 th\u1ea5t), (4) Suy tim ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim tr\u01b0\u1edbc \u0111\u00f3, (5) \u0110\u1ed9ng m\u1ea1ch v\u00e0nh ph\u1ea3i \u01b0u n\u0103ng, c\u1ea5p m\u00e1u cho c\u1ea3 v\u00f9ng m\u1ecfm l\u0201n v\u00f9ng sau, b\u00ean, (6) T\u00e1ch th\u00e0nh \u0110M ch\u1ee7 c\u1ea5p.<\/li>\n<\/ul>\n

                      C\u00e1c ph\u01b0\u01a1ng ti\u1ec7n th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng (PICCO, USCOM, Catheter \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i): Gi\u1ea3m cung l\u01b0\u1ee3ng tim v\u00e0 ch\u1ec9 s\u1ed1 cung l\u01b0\u1ee3ng tim (CI < 1,8 L\/min\/m\u00b2da n\u1ebfu kh\u00f4ng c\u00f3 h\u1ed7 tr\u1ee3 ho\u1eb7c < 2,2 L\/min\/m\u00b2da n\u1ebfu c\u00f3 h\u1ed7 tr\u1ee3, \u00e1p l\u1ef1c mao m\u1ea1ch ph\u1ed5i b\u00edt t\u0103ng (PCWP) > 15 mmHg, s\u1ee9c c\u1ea3n h\u1ec7 th\u1ed1ng (SVR) t\u0103ng.<\/p>\n

                      2.3.3 X\u00e9t nghi\u1ec7m m\u00e1u:<\/h4>\n
                        \n
                      • D\u1ea5u hi\u1ec7u gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4: Lactate > 2 mmol\/L, toan chuy\u1ec3n h\u00f3a t\u0103ng kho\u1ea3ng tr\u1ed1ng anion, ScvO\u2082(b\u00e3o h\u00f2a oxy m\u00e1u t\u0129nh m\u1ea1ch trung t\u00e2m) < 65%, t\u0103ng urea v\u00e0 creatinine m\u00e1u (gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u1eadn) BNP, NT-proBNP v\u00e0 troponin tim th\u01b0\u1eddng t\u0103ng trong s\u1ed1c tim, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p trong c\u00e1c nguy\u00ean nh\u00e2n s\u1ed1c kh\u00e1c do t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim ho\u1eb7c gi\u1ea3m t\u01b0\u1edbi m\u00e1u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n<\/ul>\n

                        2.3.4 X-quang ng\u1ef1c th\u1eb3ng: <\/strong><\/h4>\n

                        C\u00f3 th\u1ec3 ch\u1ee5p c\u1ea5p c\u1ee9u t\u1ea1i gi\u01b0\u1eddng, cho th\u1ea5y h\u00ecnh \u1ea3nh sung huy\u1ebft ph\u1ed5i, tim to, c\u00e1c t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i k\u00e8m theo…<\/p>\n

                        2.4 X\u1eed tr\u00ed s\u1ed1c tim<\/h3>\n

                        X\u1eed tr\u00ed s\u1ed1c tim v\u0201n tu\u00e2n theo nguy\u00ean t\u1eafc chung c\u1ee7a x\u1eed tr\u00ed suy tim c\u1ea5p n\u00f3i chung: (1) \u1ed4n \u0111\u1ecbnh h\u00f4 h\u1ea5p, (2) \u1ed4n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng v\u00e0 (3) X\u1eed tr\u00ed c\u0103n nguy\u00ean. C\u1ea7n nhanh ch\u00f3ng \u0111\u1ea3m b\u1ea3o \u0111\u01b0\u1eddng th\u1edf v\u00e0 \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch ngo\u1ea1i vi.<\/p>\n

                        2.4.1 \u1ed4n \u0111\u1ecbnh h\u00f4 h\u1ea5p:<\/h4>\n
                          \n
                        • C\u1ea7n nhanh ch\u00f3ng \u0111\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n v\u00e0 th\u00f4ng kh\u00ed nh\u00e2n t\u1ea1o ki\u1ec3m so\u00e1t ho\u00e0n to\u00e0n nh\u1eb1m gi\u1ea3m g\u00e1nh n\u1eb7ng cho c\u01a1 tim.<\/li>\n
                        • Th\u1edf m\u00e1y PEEP cao gi\u00fap gi\u1ea3m sung huy\u1ebft ph\u1ed5i nh\u01b0ng g\u00e2y t\u1ee5t huy\u1ebft \u00e1p, \u0111\u1eb7c bi\u1ec7t v\u1edbi PEEP \u2265 14 cmH\u2082O.<\/li>\n<\/ul>\n

                          2.4.2 \u1ed4n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng:<\/h4>\n
                            \n
                          • \u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng d\u1ecbch: <\/em><\/strong>T\u1ee5t huy\u1ebft \u00e1p trong s\u1ed1c tim c\u00f3 th\u1ec3 l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ea5t d\u1ecbch (do n\u00f4n, l\u1ee3i ti\u1ec3u qu\u00e1 m\u1ee9c) ho\u1eb7c gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t ph\u1ea3i (suy th\u1ea5t ph\u1ea3i c\u1ea5p). Do v\u1eady n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u sung huy\u1ebft ph\u1ed5i, suy ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i n\u1eb7ng c\u00f3 th\u1ec3 l\u00e0m test truy\u1ec1n d\u1ecbch v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng b\u1ec7nh nh\u00e2n.<\/li>\n
                          • S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch v\u00e0 t\u0103ng co b\u00f3p: <\/em><\/strong>N\u00ean s\u1eed d\u1ee5ng v\u1edbi s\u1ed1 l\u01b0\u1ee3ng v\u00e0 li\u1ec1u l\u01b0\u1ee3ng th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3. Th\u01b0\u1eddng b\u1eaft \u0111\u1ea7u b\u1eb1ng noradrenaline do nguy c\u01a1 g\u00e2y r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong th\u1ea5p nh\u1ea5t trong c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch\/t\u0103ng co b\u00f3p gi\u1ed1ng giao c\u1ea3m.<\/li>\n
                          • Ch\u01b0a c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o cho th\u1ea5y \u0111i\u1ec1u ch\u1ec9nh v\u00e0 l\u1ef1a ch\u1ecdn c\u00e1c thu\u1ed1c v\u1eadn m\u1ea1ch\/t\u0103ng co b\u00f3p d\u1ef1a theo c\u00e1c ch\u1ec9 s\u1ed1 th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng gi\u00fap c\u1ea3i thi\u1ec7n t\u1eed vong.<\/li>\n
                          • C\u00e1c thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng trong shock tim:<\/li>\n<\/ul>\n

                            B\u00f3ng \u0111\u1ed1i xung \u0110M ch\u1ee7 (IABP) <\/em>: <\/strong>L\u00e0 thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng c\u01a1 h\u1ecdc ph\u1ed5 bi\u1ebfn nh\u1ea5t, r\u1ebb ti\u1ec1n nh\u1ea5t, c\u00f3 th\u1ec3 \u0111\u1eb7t v\u00e0 s\u1eed d\u1ee5ng nhanh ch\u00f3ng. Nghi\u00ean c\u1ee9u IABP-SHOCK II cho th\u1ea5y IABP kh\u00f4ng c\u1ea3i thi\u1ec7n t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 shock tim. Tuy nhi\u00ean, \u0111\u1eb7c \u0111i\u1ec3m c\u00e1c b\u1ec7nh nh\u00e2n shock tim trong nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng thu\u1ea7n nh\u1ea5t, c\u00f3 c\u00e1c b\u1ec7nh nh\u00e2n shock kh\u00f4ng ch\u1ec9 do suy th\u1ea5t tr\u00e1i \u0111\u01a1n thu\u1ea7n, IABP \u0111\u01b0\u1ee3c \u0111\u1eb7t sau khi ti\u1ebfn h\u00e0nh PCI. \u1ede b\u1ec7nh nh\u00e2n shock tim do suy tim tr\u00e1i c\u1ea5p, v\u0201n c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111\u1eb7t IABP tr\u01b0\u1edbc khi can thi\u1ec7p \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n, gi\u1ea3m nhu c\u1ea7u oxy, gi\u1ea3m t\u1ed5n th\u01b0\u01a1ng t\u00e1i t\u01b0\u1edbi m\u00e1u \u0111\u1ec3 th\u1ef1c hi\u1ec7n PCI an to\u00e0n h\u01a1n.<\/p>\n

                            Thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 th\u1ea5t tr\u00e1i qua van \u0110M ch\u1ee7 (Impella) <\/em><\/strong>: C\u00f3 th\u1ec3 \u0111\u1eb7t ng\u01b0\u1ee3c d\u00f2ng qua \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i v\u00e0o th\u1ea5t tr\u00e1i, gi\u00fap b\u01a1m m\u00e1u t\u1eeb th\u1ea5t tr\u00e1i v\u00e0o \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 theo c\u01a1 ch\u1ebf b\u01a1m v\u00f2ng xo\u1eafn c\u1ee7a Archimedes. Impella gi\u1ea3m th\u1ec3 t\u00edch cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng(ti\u1ec1n g\u00e1nh), th\u1ec3 t\u00edch cu\u1ed1i t\u00e2m thu (h\u1eadu g\u00e1nh), gi\u1ea3m nhu c\u1ea7u oxy c\u01a1 tim. Nghi\u00ean c\u1ee9u ng\u0201u nhi\u00ean, \u0111a trung t\u00e2m PROTECT-II tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n nguy c\u01a1 cao can thi\u1ec7p kh\u00f4ng c\u1ea5p c\u1ee9u (LVEF <30%, b\u1ec7nh 3 th\u00e2n \u0110MV) cho th\u1ea5y b\u1ec7nh nh\u00e2n d\u00f9ng Impel\u00eda g\u1eb7p \u00edt bi\u1ebfn c\u1ed1 ch\u00ednh sau 90 ng\u00e0y h\u01a1n IABP. Kh\u00f4ng d\u00f9ng Impel\u00eda \u1edf b\u1ec7nh nh\u00e2n h\u1eb9p ho\u1eb7c h\u1edf ch\u1ee7 n\u1eb7ng, c\u00f3 huy\u1ebft kh\u1ed1i th\u1ea5t tr\u00e1i, kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi v\u1edbi IABP.<\/p>\n

                            Thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 nh\u0129 tr\u00e1i – \u0110M ch\u1ee7 (TandemHeart) <\/em>: <\/strong>G\u1ed3m catheter t\u0129nh m\u1ea1ch \u0111\u1eb7t xuy\u00ean qua v\u00e1ch li\u00ean nh\u0129 v\u00e0o nh\u0129 tr\u00e1i, m\u1ed9t cannula \u0111\u1ed9ng m\u1ea1ch \u0111\u1eb7t v\u00e0o \u0110M ch\u1eadu-\u0111\u00f9i, m\u00e1u \u0111\u01b0\u1ee3c b\u01a1m b\u1eb1ng b\u01a1m ly t\u00e2m t\u1eeb nh\u0129 tr\u00e1i v\u00e0o \u0110M \u0111\u00f9i. Do gi\u1ea3m t\u1ea3i th\u1ea5t tr\u00e1i gi\u00e1n ti\u1ebfp, hi\u1ec7u qu\u1ea3 gi\u1ea3m ti\u00eau th\u1ee5 oxy c\u01a1 tim c\u1ee7a TandemHeart th\u1ea5p h\u01a1n Impella, nh\u01b0ng h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n t\u1ed1t h\u01a1n. Impella ph\u00f9 h\u1ee3p v\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u c\u01a1 tim ho\u1eb7c PCI nguy c\u01a1 cao do gi\u00fap b\u1ea3o v\u1ec7 kh\u1ecfi thi\u1ebfu m\u00e1u c\u01a1 tim, c\u00f2n TandemHeart ph\u00f9 h\u1ee3p v\u1edbi shock tim do cung c\u1ea5p d\u00f2ng ch\u1ea3y l\u1edbn. Hi\u1ec7n nay, TandemHeart \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng h\u01a1n do Impella CP h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n t\u1ed1t h\u01a1n m\u00e0 v\u0201n gi\u1ea3m thi\u1ebfu m\u00e1u c\u01a1 tim.<\/p>\n

                            Trao \u0111\u1ed5i oxy qua m\u00e0ng ngo\u00e0i c\u01a1 th\u1ec3 (ECMO) <\/em><\/strong>: <\/strong>VA ECMO (venoarterial ECMO): G\u1ed3m m\u1ed9t cannula t\u0129nh m\u1ea1ch \u0111\u00f9i, m\u1ed9t cannula \u0111\u1ed9ng m\u1ea1ch \u0111\u00f9i, b\u01a1m v\u00e0 m\u00e0ng oxy h\u00f3a m\u00e1u. M\u00e1u t\u1eeb TM sau khi \u0111\u01b0\u1ee3c oxy h\u00f3a \u0111\u01b0\u1ee3c b\u01a1m ng\u01b0\u1ee3c d\u00f2ng l\u00ean ph\u1ea7n tr\u00ean c\u01a1 th\u1ec3, cung c\u1ea5p tu\u1ea7n ho\u00e0n m\u00e0 kh\u00f4ng c\u1ea7n co b\u00f3p t\u1eeb tim. Ch\u1ec9 \u0111\u1ecbnh VA ECMO g\u1ed3m: (1) B\u1ec7nh nh\u00e2n ng\u1eebng tu\u1ea7n ho\u00e0n \u0111\u01b0\u1ee3c ch\u1ee9ng ki\u1ebfn v\u00e0 c\u1ea5p c\u1ee9u ngay l\u1eadp t\u1ee9c nh\u01b0ng kh\u00f4ng c\u00f3 m\u1ea1ch tr\u1edf l\u1ea1i sau > 10 ph\u00fat, c\u00f3 th\u1ec3 \u0111\u1eb7t ECMO c\u1ea5p c\u1ee9u khi \u0111ang \u00e9p tim, (2) Shock tim n\u1eb7ng v\u00e0 suy c\u1ea3 hai th\u1ea5t do nh\u1ed3i m\u00e1u c\u01a1 tim, vi\u00eam c\u01a1 tim.<\/p>\n

                            VV ECMO (veno-venous ECMO): L\u1ea5y m\u00e1u t\u1eeb TM \u0111\u00f9i v\u00e0 b\u01a1m l\u1ea1i v\u00e0o TM c\u1ea3nh sau khi oxy h\u00f3a. S\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n suy h\u00f4 h\u1ea5p n\u1eb7ng nh\u01b0ng tim v\u0201n co b\u00f3p \u0111\u01b0\u1ee3c.<\/p>\n

                            2.4.3 \u0110i\u1ec1u tr\u1ecb c\u0103n nguy\u00ean:<\/strong><\/h4>\n
                              \n
                            • Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p: <\/strong>C\u1ea7n t\u00e1i t\u01b0\u1edbi m\u00e1u c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t, b\u1ea5t k\u1ec3 th\u1eddi gian kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng. \u01afu ti\u00ean can thi\u1ec7p nh\u00e1nh m\u1ea1ch v\u00e0nh th\u1ee7 ph\u1ea1m h\u01a1n l\u00e0 t\u1ea5t c\u1ea3 c\u00e1c nh\u00e1nh n\u1ebfu t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u nh\u00e1nh m\u1ea1ch v\u00e0nh (Gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 ch\u1ea1y th\u1eadn trong 30 ng\u00e0y \u0111\u1ea7u, nghi\u00ean c\u1ee9u CULPRIT-SHOCK).<\/li>\n
                            • T\u1ed5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc: <\/strong>Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim th\u01b0\u1eddng g\u1eb7p trong 14 ng\u00e0y \u0111\u1ea7u v\u1edbi 2 th\u1eddi \u0111i\u1ec3m ch\u00ednh l\u00e0 24 gi\u1edd \u0111\u1ea7u (v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c t\u00e1i t\u01b0\u1edbi m\u00e1u) v\u00e0 sau 3 – 5 ng\u00e0y (v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c t\u00e1i t\u01b0\u1edbi m\u00e1u). C\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u00e0y c\u1ea7n ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u k\u1ebft h\u1ee3p t\u00e1i t\u01b0\u1edbi m\u00e1u (t\u1ef7 l\u1ec7 t\u1eed vong gi\u1ea3m t\u1eeb 90 – 100% xu\u1ed1ng 20 – 50%). T\u01b0\u01a1ng t\u1ef1, s\u1ed1c tim do t\u1ed5n th\u01b0\u01a1ng van tim c\u1ea5p trong Osler, k\u1eb9t van tim c\u01a1 h\u1ecdc c\u0169ng c\u1ea7n ph\u0201u thu\u1eadt c\u1ea5p c\u1ee9u.<\/li>\n
                            • R\u1ed1i lo\u1ea1n nh\u1ecbp tim: <\/strong>S\u1ed1c \u0111i\u1ec7n v\u1edbi r\u1ed1i lo\u1ea1n nh\u1ecbp nhanh v\u00e0 t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi v\u1edbi nh\u1ecbp ch\u1eadm. Trong nh\u1ed3i m\u00e1u c\u01a1 tim th\u1ea5t ph\u1ea3i g\u00e2y s\u1ed1c tim, kh\u00f4i ph\u1ee5c \u0111\u1ed3ng b\u1ed9 nh\u0129 – th\u1ea5t r\u1ea5t quan tr\u1ecdng do co b\u00f3p t\u00e2m nh\u0129 g\u00f3p ph\u1ea7n \u0111\u00e1ng k\u1ec3 v\u00e0o \u0111\u1ed5 \u0111\u1ea7y t\u00e2m th\u1ea5t; c\u00f3 th\u1ec3 ph\u1ea3i s\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp rung nh\u0129 ho\u1eb7c t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi 2 bu\u1ed3ng tim n\u1ebfu block nh\u0129 – th\u1ea5t.<\/li>\n
                            • Nh\u1ed3i m\u00e1u ph\u1ed5i: <\/strong>C\u1ea7n t\u00e1i t\u01b0\u1edbi m\u00e1u b\u1eb1ng ti\u00eau s\u1ee3i huy\u1ebft, h\u00fat huy\u1ebft kh\u1ed1i qua da ho\u1eb7c ph\u0201u thu\u1eadt l\u1ea5y huy\u1ebft kh\u1ed1i trong tr\u01b0\u1eddng h\u1ee3p nh\u1ed3i m\u00e1u ph\u1ed5i c\u00f3 s\u1ed1c, t\u1ee5t \u00e1p.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

                              Suy tim c\u1ea5p l\u00e0 c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p\u00a0 trong suy tim c\u1ea5p 1.Ph\u00f9 ph\u1ed5i c\u1ea5p huy\u1ebft \u0111\u1ed9ng 1.1 \u0110\u1ecbnh ngh\u0129a Ph\u00f9 ph\u1ed5i c\u1ea5p l\u00e0 m\u1ed9t c\u1ea5p c\u1ee9u n\u1ed9i khoa, h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng t\u00edch t\u1ee5 n\u01b0\u1edbc v\u00e0 c\u00e1c […]<\/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":"\nSuy tim c\u1ea5p v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p<\/title>\n<meta name=\"description\" content=\"Suy tim c\u1ea5p l\u00e0 c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. B\u00e0i vi\u1ebft cung c\u1ea5p c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p\u00a0 trong suy tim c\u1ea5p\" \/>\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 v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 th\u01b0\u1eddng g\u1eb7p\" \/>\n<meta property=\"og:description\" content=\"Suy tim c\u1ea5p l\u00e0 c\u1ea5p c\u1ee9u n\u1ed9i khoa th\u01b0\u1eddng g\u1eb7p trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. 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