{"id":27633,"date":"2023-04-23T21:34:25","date_gmt":"2023-04-23T14:34:25","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=27633"},"modified":"2023-04-23T21:34:25","modified_gmt":"2023-04-23T14:34:25","slug":"viem-co-tim-va-dieu-tri-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/23\/viem-co-tim-va-dieu-tri-2\/","title":{"rendered":"Vi\u00eam c\u01a1 tim v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

Vi\u00eam c\u01a1 tim<\/a> l\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim b\u1ecb vi\u00eam do ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n ngo\u1ea1i lai nh\u01b0 virus, vi khu\u1ea9n, k\u00ed sinh tr\u00f9ng, thu\u1ed1c ho\u1eb7c c\u00e1c nguy\u00ean nh\u00e2n n\u1ed9i sinh nh\u01b0 trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n.<\/strong><\/p>\n

1.Kh\u00e1i ni\u1ec7m<\/h2>\n

L\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim b\u1ecb vi\u00eam do ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n ngo\u1ea1i lai nh\u01b0 virus, vi khu\u1ea9n, k\u00ed sinh tr\u00f9ng, thu\u1ed1c ho\u1eb7c c\u00e1c nguy\u00ean nh\u00e2n n\u1ed9i sinh nh\u01b0 trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n.<\/p>\n

1.1 Th\u1ec3 l\u00e2m s\u00e0ng <\/strong><\/h3>\n
    \n
  • Vi\u00eam c\u01a1 tim c\u1ea5p.<\/li>\n
  • Vi\u00eam c\u01a1 tim t\u1ed1i c\u1ea5p.<\/li>\n
  • Vi\u00eam c\u01a1 tim t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3.<\/li>\n
  • Vi\u00eam c\u01a1 tim m\u1ea1n t\u00ednh ti\u1ebfn tri\u1ec3n.<\/li>\n
  • B\u1ec7nh c\u01a1 tim sau \u0111\u1ebb.<\/li>\n<\/ul>\n

    \"Vi\u00eam<\/p>\n

    Vi\u00eam c\u01a1 tim<\/strong><\/p>\n

    1.2 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h3>\n
      \n
    • Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 kh\u00f3 th\u1edf, \u0111au ng\u1ef1c v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/li>\n
    • \u0110au ng\u1ef1c, \u0111au ki\u1ec3u m\u00e0ng v\u00e0 khu tr\u00fa n\u1ebfu c\u00f3 k\u00e8m theo vi\u00eam m\u00e0ng ngo\u00e0i tim. Nh\u1ecbp nhanh dai d\u1eb3ng ngay c\u1ea3 khi \u0111\u00e3 c\u1eaft s\u1ed1t.<\/li>\n
    • R\u1ed1i lo\u1ea1n nh\u1ecbp tim ch\u1eadm v\u00e0 block nh\u0129 th\u1ea5t m\u1edbi xu\u1ea5t hi\u1ec7n c\u00f3 th\u1ec3 g\u1eb7p trong c\u1ea3 b\u1ec7nh c\u1ea3nh nhi\u1ec5m tr\u00f9ng v\u00e0 vi\u00eam c\u01a1 tim th\u00f4ng qua trung gian mi\u1ec5n d\u1ecbch.<\/li>\n
    • Ti\u1ebfng T1 m\u1edd, ti\u1ebfng T3, T4 c\u00f3 th\u1ec3 g\u1eb7p trong tr\u01b0\u1eddng h\u1ee3p suy tim c\u1ea5p. Ti\u1ebfng c\u1ecd m\u00e0ng tim n\u1ebfu c\u00f3 vi\u00eam m\u00e0ng ngo\u00e0i tim k\u00e8m theo.<\/li>\n
    • C\u00f3 th\u1ec3 c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh c\u0103n nguy\u00ean.<\/li>\n<\/ul>\n

      M\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng n\u1eb7ng c\u1ea5p c\u1ee9u :<\/p>\n

        \n
      • Tri\u1ec7u ch\u1ee9ng c\u1ee7a suy tim sung huy\u1ebft: m\u1ec7t m\u1ecfi, kh\u00f3 th\u1edf, gi\u1ea3m kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c.<\/li>\n
      • B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n s\u1ed1c tim th\u1eadm ch\u00ed t\u1eed vong trong m\u1ed9t s\u1ed1 th\u1ec3 vi\u00eam c\u01a1 tim n\u1eb7ng v\u00e0 lan t\u1ecfa. M\u1ed9t s\u1ed1 bi\u1ec3u hi\u1ec7n g\u1ee3i \u00fd suy tim to\u00e0n b\u1ed9 nh\u01b0: T\u1ee5t huy\u1ebft \u00e1p, gan to, ph\u00f9 ngo\u1ea1i vi, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ti\u1ebfng T3, ph\u00f9 ph\u1ed5i.<\/li>\n
      • C\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nguy hi\u1ec3m:Ngo\u1ea1i t\u00e2m thu th\u1ea5t \u0111a d\u1ea1ng, c\u01a1n nh\u1ecbp nhanh th\u1ea5t,rung th\u1ea5t ho\u1eb7c c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp ch\u1eadm nguy hi\u1ec3m nh\u01b0 block nh\u0129 th\u1ea5t c\u1ea5p 3.<\/li>\n<\/ul>\n

        M\u1ed9t s\u1ed1 x\u00e9t nghi\u1ec7m \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng c\u1ea5p c\u1ee9u c\u1ee7a vi\u00eam c\u01a1 tim<\/p>\n

          \n
        • Troponin T ho\u1eb7c Troponin I, CK-MB t\u0103ng trong t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim. C\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc t\u0103ng cao li\u00ean t\u1ee5c g\u1ee3i \u00fd c\u01a1 tim b\u1ecb t\u1ed5n th\u01b0\u01a1ng k\u00e9o d\u00e0i.<\/li>\n
        • BNP v\u00e0 NT-pro BNP n\u00ean \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh.<\/li>\n<\/ul>\n

          C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh:<\/p>\n

            \n
          • \u0110i\u1ec7n t\u00e2m \u0111\u1ed3: <\/em><\/strong>C\u00f3 th\u1ec3 g\u1eb7p nh\u1ecbp nhanh xoang, s\u00f3ng ST-T bi\u1ebfn \u0111\u1ed5i kh\u00f4ng \u0111\u1eb7c hi\u1ec7u tr\u1eeb khi c\u00f3 k\u00e8m theo vi\u00eam m\u00e0ng ngo\u00e0i tim th\u01b0\u1eddng c\u00f3 nh\u1eefng bi\u1ebfn \u0111\u1ed5i kh\u00e1c \u0111\u1eb7c hi\u1ec7u h\u01a1n. C\u00f3 th\u1ec3 g\u1eb7p block nh\u00e1nh, block d\u0201n truy\u1ec1n nh\u0129 th\u1ea5t. B\u00ean c\u1ea1nh \u0111\u00f3 ph\u00e1t hi\u1ec7n c\u00e1c bi\u1ebfn ch\u1ee9ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim li\u00ean quan \u0111\u1ebfn vi\u00eam c\u01a1 tim nh\u01b0 ngo\u1ea1i t\u00e2m thu th\u1ea5t, c\u01a1n nh\u1ecbp nhanh th\u1ea5t.<\/li>\n
          • Si\u00eau \u00e2m tim: <\/em><\/strong>L\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n quan tr\u1ecdng. Si\u00eau \u00e2m tim gi\u00fap \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc v\u00e0 ch\u1ee9c n\u0103ng tim,v\u1eadn \u0111\u1ed9ng c\u00e1c th\u00e0nh tim, t\u00ecnh tr\u1ea1ng m\u00e0ng ngo\u00e0i tim.<\/li>\n
          • Ch\u1ee5p MRI tim: <\/em><\/strong>Bi\u1ec3u hi\u1ec7n t\u1ed5n th\u01b0\u01a1ng v\u00e0 ph\u00f9 n\u1ec1 c\u00e1c t\u1ebf b\u00e0o c\u01a1 tim. T\u0103ng m\u1eadt \u0111\u1ed9 t\u00edn hi\u1ec7u c\u1ee5c b\u1ed9 ho\u1eb7c to\u00e0n b\u1ed9 c\u01a1 tim gi\u00fap \u0111\u00e1nh gi\u00e1 t\u1ef7’ l\u1ec7 ph\u00f9 n\u1ec1 c\u01a1 tim. T\u00ecnh tr\u1ea1ng ph\u00f9 n\u1ec1 c\u01a1 tim m\u00e0 kh\u00f4ng c\u00f3 s\u1eb9o t\u1ed5n th\u01b0\u01a1ng ho\u1eb7c t\u00ecnh tr\u1ea1ng ho\u1ea1i t\u1eed c\u01a1 tim d\u1ef1 b\u00e1o kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c v\u00e0 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t h\u01a1n.<\/li>\n
          • Th\u00f4ng tim v\u00e0 ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh: <\/em><\/strong>Lo\u1ea1i tr\u1eeb h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p, k\u00e8m theo k\u1ebft h\u1ee3p th\u1ee7 thu\u1eadt sinh thi\u1ebft c\u01a1 tim n\u1ebfu c\u00f3 th\u1ec3.<\/li>\n<\/ul>\n

            2. \u0110i\u1ec1u tr\u1ecb<\/h2>\n
              \n
            • H\u1ea1n ch\u1ebf t\u1ed1i \u0111a g\u1eafng s\u1ee9c. Li\u1ec7u ph\u00e1p oxy<\/strong>.<\/li>\n
            • \u0110i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n <\/strong>vi\u00eam c\u01a1 tim c\u1ea5p (Kh\u00e1ng sinh trong tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m tr\u00f9ng…).<\/li>\n
            • \u0110i\u1ec1u tr\u1ecb suy tim sung huy\u1ebft ti\u00eau chu\u1ea9n <\/strong>v\u1edbi c\u00e1c nh\u00f3m thu\u1ed1c l\u1ee3i ti\u1ec3u, thu\u1ed1c \u01afCMC\/\u01afCTT, ‘h\u1ea1n ch\u1ebf mu\u1ed1i. Ch\u1eb9n beta giao c\u1ea3m c\u1ea7n th\u1eadn tr\u1ecdng v\u00e0 ch\u1ec9 n\u00ean b\u1eaft \u0111\u1ea7u khi t\u00ecnh tr\u1ea1ng suy tim \u0111\u00e3 \u1ed5n \u0111\u1ecbnh. Digoxin n\u00ean h\u1ea1n ch\u1ebf, n\u1ebfu c\u1ea7n s\u1eed d\u1ee5ng n\u00ean b\u1eaft \u0111\u1ea7u v\u1edbi li\u1ec1u th\u1ea5p v\u00e0 theo d\u00f5i ch\u1eb7t ch\u1ebd.<\/li>\n
            • Theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim<\/strong>. \u0110\u1ed1i v\u1edbi c\u00e1c ‘tr\u01b0\u1eddng h\u1ee3p r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t, c\u01a1n nh\u1ecbp nhanh th\u1ea5t c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng r\u1ed1i lo\u1ea1n nh\u1ecbp tim nh\u01b0 Amiodarone. C\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim ch\u1eadm nh\u01b0 block nh\u0129 th\u1ea5t ho\u00e0n to\u00e0n c\u1ea7n \u0111\u01b0\u1ee3c t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi. Th\u00f4ng th\u01b0\u1eddng block nh\u0129 th\u1ea5t c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i v\u1ec1 nh\u1ecbp xoang sau giai \u0111o\u1ea1n c\u1ea5p. Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p block nh\u0129 th\u1ea5t c\u00f3 th\u1ec3 tr\u1edf n\u00ean v\u0129nh vi\u1ec5n v\u00e0 kh\u00f4ng th\u1ec3 h\u1ed3i ph\u1ee5c, c\u1ea7n ch\u1ec9 \u0111\u1ecbnh c\u1ea5y m\u00e1y t\u1ea1o nh\u1ecbp tim thay th\u1ebf.<\/li>\n
            • Trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh c\u1ea3nh n\u1eb7ng n\u1ec1 <\/strong>nh\u01b0 s\u1ed1c tim, c\u00e1c thu\u1ed1c t\u0103ng co b\u00f3p c\u01a1 tim (Dobutamine,…) c\u1ea7n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh s\u1edbm. C\u00e2n nh\u1eafc h\u1ed7 tr\u1ee3 b\u1eb1ng c\u00e1c thi\u1ebft b\u1ecb c\u01a1 h\u1ecdc nh\u01b0 IABP , ECMO …<\/li>\n
            • Corticosteroide <\/strong>kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy v\u00e0 r\u1ed9ng r\u00e3i \u0111\u1ed1i v\u1edbi t\u1ea5t c\u1ea3 c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam c\u01a1 tim. C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc trong m\u1ed9t s\u1ed1 \u0111\u1ed1i t\u01b0\u1ee3ng ch\u1ecdn l\u1ecdc nh\u01b0 suy tim suy huy\u1ebft n\u1eb7ng kh\u00f4ng \u0111\u00e1p \u1ee9ng thu\u1ed1c, nhi\u1ec5m \u0111\u1ed9c h\u1ec7 th\u1ed1ng n\u1eb7ng, r\u1ed1i lo\u1ea1n nh\u1ecbp tim \u0111e d\u1ecda t\u00ednh m\u1ea1ng n\u1eb7ng n\u1ec1 v\u00e0 t\u00e1i ph\u00e1t nhi\u1ec1u l\u1ea7n.<\/li>\n
            • Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch <\/strong>kh\u00f4ng gi\u00fap c\u1ea3i thi\u1ec7n ti\u00ean l\u01b0\u1ee3ng v\u00e0 do \u0111\u00f3 kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy. Thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ch\u1ec9’ n\u00ean s\u1eed d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam c\u01a1 tim do b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n h\u1ec7 th\u1ed1ng nh\u01b0 lupus ban \u0111\u1ecf., b\u1ec7nh vi\u00eam c\u01a1 tim t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3, b\u1ec7nh sarcoidosis, vi\u00eam c\u01a1 tim do qu\u00e1 m\u0201n.<\/li>\n
            • Globulin mi\u1ec5n d\u1ecbch <\/strong>\u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u nh\u01b0ng cho \u0111\u1ebfn nay v\u0201n c\u00f2n thi\u1ebfu c\u00e1c b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng v\u1ec1 hi\u1ec7u qu\u1ea3.<\/li>\n<\/ul>\n

              3. K\u1ebft lu\u1eadn:<\/h2>\n

              L\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u00e0 c\u01a1 tim c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh b\u1ecb vi\u00eam nhi\u1ec5m v\u00e0 t\u1ed5n th\u01b0\u01a1ng. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh n\u00e0y bao g\u1ed3m \u0111au ng\u1ef1c, kh\u00f3 th\u1edf, m\u1ec7t m\u1ecfi v\u00e0 \u0111au \u0111\u1ea7u. Nguy\u00ean nh\u00e2n c\u1ee7a b\u1ec7nh vi\u00eam c\u01a1 tim c\u00f3 th\u1ec3 do nhi\u1ec5m tr\u00f9ng vi khu\u1ea9n ho\u1eb7c virus, ho\u1eb7c do c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nh\u01b0 vi\u00eam kh\u1edbp, ung th\u01b0 ho\u1eb7c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n

              \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n, th\u01b0\u1eddng s\u1eed d\u1ee5ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p nh\u01b0 si\u00eau \u00e2m tim, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 v\u00e0 x\u00e9t nghi\u1ec7m m\u00e1u. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u00e0y ph\u1ee5 thu\u1ed9c v\u00e0o nguy\u00ean nh\u00e2n g\u00e2y b\u1ec7nh v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng c\u1ee7a c\u01a1 tim. \u0110i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 bao g\u1ed3m thu\u1ed1c kh\u00e1ng sinh, thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u1ee7a t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n

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

              Vi\u00eam c\u01a1 tim l\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim b\u1ecb vi\u00eam do ph\u01a1i nhi\u1ec5m v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n ngo\u1ea1i lai nh\u01b0 virus, vi khu\u1ea9n, k\u00ed sinh tr\u00f9ng, thu\u1ed1c ho\u1eb7c c\u00e1c nguy\u00ean nh\u00e2n n\u1ed9i sinh nh\u01b0 trong m\u1ed9t s\u1ed1 b\u1ec7nh l\u00fd t\u1ef1 mi\u1ec5n. 1.Kh\u00e1i ni\u1ec7m L\u00e0 t\u00ecnh tr\u1ea1ng c\u01a1 tim b\u1ecb vi\u00eam do ph\u01a1i nhi\u1ec5m v\u1edbi 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":"\nVi\u00eam c\u01a1 tim v\u00e0 \u0111i\u1ec1u tr\u1ecb - Vinmec<\/title>\n<meta name=\"description\" content=\"Vi\u00eam c\u01a1 tim v\u00e0 \u0111i\u1ec1u tr\u1ecb l\u00e0 v\u1ea5n \u0111\u1ec1 \u0111\u01b0\u1ee3c quan t\u00e2m trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. 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