{"id":29095,"date":"2023-04-30T20:43:22","date_gmt":"2023-04-30T13:43:22","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29095"},"modified":"2023-04-30T20:43:22","modified_gmt":"2023-04-30T13:43:22","slug":"cong-huong-tu-trong-danh-gia-cac-benh-ly-co-tim","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/cong-huong-tu-trong-danh-gia-cac-benh-ly-co-tim\/","title":{"rendered":"Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim"},"content":{"rendered":"

Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb<\/a> trong \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim g\u1ed3m: b\u1ec7nh c\u01a1 tim gi\u00e3n, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, b\u1ec7nh vi\u00eam c\u01a1 tim. B\u00e0i vi\u1ebft cung c\u1ea5p th\u00f4ng tin v\u1ec1 vai tr\u00f2 c\u1ee7a c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim.<\/strong><\/p>\n

\"C\u1ed9ng<\/p>\n

Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/strong><\/p>\n

1.B\u1ec7nh c\u01a1 tim gi\u00e3n<\/h2>\n

B\u1ec7nh c\u01a1 tim gi\u00e3n l\u00e0 b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u01a1 tim \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng gi\u00e3n v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng t\u1ed1ng m\u00e1u c\u1ee7a th\u1ea5t tr\u00e1i v\u00e0 ho\u1eb7c th\u1ea5t ph\u1ea3i, m\u00e0 kh\u00f4ng do h\u1eb9p c\u00f3 \u00fd ngh\u0129a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Kh\u1ea3 n\u0103ng l\u01b0\u1ee3ng gi\u00e1 ch\u00ednh x\u00e1c th\u1ec3 t\u00edch hai bu\u1ed3ng th\u1ea5t c\u1ee7a c\u1ed9ng h\u01b0\u1edfng t\u1eeb (CHT) tim gi\u00fap ph\u00e1t hi\u1ec7n s\u1edbm gi\u00e3n bu\u1ed3ng tim, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i v\u00e0 c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh trong vi\u1ec7c theo d\u00f5i, \u0111\u00e1nh gi\u00e1 s\u1ef1 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb. CHT tim v\u1edbi h\u00ecnh \u1ea3nh ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang t\u1eeb th\u00ec mu\u1ed9n c\u00f3 th\u1ec3 cho ph\u00e9p x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n g\u00e2y thi\u1ebfu m\u00e1u c\u01a1 tim.<\/p>\n

Nh\u1eefng b\u1ec7nh nh\u00e2n v\u1edbi b\u1ec7nh c\u01a1 tim gi\u00e3n, kh\u00f4ng c\u00f3 h\u1eb9p \u0111\u00e1ng k\u1ec3 h\u1ec7 \u0111\u1ed9ng m\u1ea1ch v\u00e0nh s\u1ebd kh\u00f4ng c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang mu\u1ed9n (60%), ho\u1eb7c ng\u1ea5m thu\u1ed1c th\u00e0nh gi\u1eefa c\u01a1 tim t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi qu\u00e1 tr\u00ecnh x\u01a1 h\u00f3a gi\u1eefa th\u00e0nh tim trong b\u1ec7nh s\u1eed (30%).<\/p>\n

H\u01a1n 10% c\u00f3 b\u1eb1ng ch\u1ee9ng ng\u1ea5m thu\u1ed1c l\u1edbp d\u01b0\u1edbi n\u1ed9i m\u1ea1c trong ph\u00e2n ph\u1ed1i tu\u1ea7n ho\u00e0n v\u00e0nh. Bi\u1ec3u hi\u1ec7n c\u00f3 t\u1eafc ngh\u1ebdn, co th\u1eaft, huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u01b0\u1edbc \u0111\u00f3 nh\u01b0ng \u0111\u00e3 \u0111\u01b0\u1ee3c t\u00e1i th\u00f4ng t\u1ef1 nhi\u00ean.<\/p>\n

Tuy nhi\u00ean, nh\u1eefng b\u1ec7nh nh\u00e2n t\u1eafc ngh\u1ebdn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh s\u1ebd c\u00f3 d\u1ea5u hi\u1ec7u ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang t\u1eeb l\u1edbp d\u01b0\u1edbi n\u1ed9i m\u1ea1c th\u00ec mu\u1ed9n. Do \u0111\u00f3, CHT tim gi\u00fap gi\u1ea3m ch\u1ec9 \u0111\u1ecbnh ch\u1ee5p \u0110MV x\u00e2m l\u1ea5n tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n. V\u00e0 trong tr\u01b0\u1eddng h\u1ee3p ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh s\u1ebd gi\u00fap b\u00e1c s\u0129 c\u00f3 nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p ph\u00f2ng ng\u1eeba b\u1ec7nh l\u00fd th\u1ee9 ph\u00e1t th\u00edch h\u1ee3p.<\/p>\n

D\u1ea5u hi\u1ec7u ng\u1ea5m thu\u1ed1c th\u00ec mu\u1ed9n c\u1ee7a th\u00e0nh gi\u1eefa c\u00f3 \u00fd ngh\u0129a ti\u00ean l\u01b0\u1ee3ng \u0111\u1ed9c l\u1eadp v\u00e0 x\u00e1c \u0111\u1ecbnh m\u1ed9t nh\u00f3m b\u1ec7nh nh\u00e2n t\u0103ng nguy c\u01a1 t\u1eed vong v\u00e0 nh\u1eadp vi\u1ec7n kh\u00f4ng k\u1ebf ho\u1ea1ch.<\/p>\n

H\u00ecnh \u1ea3nh th\u00ec s\u1edbm sau khi ti\u00eam thu\u1ed1c \u0111\u1ed1i quang cho ph\u00e9p x\u00e1c \u0111\u1ecbnh huy\u1ebft kh\u1ed1i b\u00e1m th\u00e0nh, l\u00e0 bi\u1ebfn ch\u1ee9ng c\u00f3 th\u1ec3 g\u1eb7p trong t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i n\u1eb7ng.<\/p>\n

2.B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/h2>\n

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i l\u00e0 m\u1ed9t t\u00ecnh tr\u1ea1ng r\u1ed1i lo\u1ea1n c\u01a1 tim c\u00f3 t\u00ednh ch\u1ea5t di truy\u1ec1n, \u0111\u1eb7c tr\u01b0ng b\u1edfi h\u00ecnh \u1ea3nh ph\u00ec \u0111\u1ea1i c\u01a1 th\u1ea5t tr\u00e1i m\u00e0 kh\u00f4ng c\u00f3 s\u1ef1 t\u0103ng g\u00e1nh sinh l\u00fd ho\u1eb7c k\u00edch th\u00edch sinh b\u1ec7nh h\u1ecdc.<\/p>\n

Kh\u1ea3 n\u0103ng thu nh\u1eadn h\u00ecnh \u1ea3nh \u0111a chi\u1ec1u v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i kh\u00f4ng gian cao c\u1ee7a CHT \u0111em l\u1ea1i m\u1ed9t s\u1ed1 l\u1ee3i th\u1ebf so v\u1edbi si\u00eau \u00e2m tim. B\u1eb1ng c\u00e1ch tr\u00e1nh c\u00e1c m\u1eb7t c\u1eaft xi\u00ean, CHT tr\u00e1nh \u0111\u01b0\u1ee3c vi\u1ec7c \u01b0\u1edbc l\u01b0\u1ee3ng qu\u00e1 m\u1ee9c b\u1ec1 d\u00e0y th\u00e0nh c\u01a1 th\u1ea5t tr\u00e1i so v\u1edbi tr\u00ean si\u00eau \u00e2m tim. CHT tim c\u0169ng cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ph\u00ec \u0111\u1ea1i c\u01a1 th\u1ea5t tr\u00e1i v\u00f9ng m\u1ecfm v\u00e0 th\u00e0nh tr\u01b0\u1edbc b\u00ean, c\u00e1c v\u00f9ng n\u00e0y th\u01b0\u1eddng kh\u00f3 \u0111\u00e1nh gi\u00e1 h\u01a1n tr\u00ean si\u00eau \u00e2m.<\/p>\n

\u1ede v\u1ecb tr\u00ed v\u00f9ng \u0111\u00e1y tr\u01b0\u1edbc v\u00e1ch li\u00ean th\u1ea5t, v\u00f9ng th\u01b0\u1eddng g\u1eb7p ph\u00ec \u0111\u1ea1i trong b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, CHT cho ph\u00e9p ph\u00e2n bi\u1ec7t ch\u00ednh x\u00e1c gi\u1eefa v\u00e1ch li\u00ean th\u1ea5t v\u1edbi b\u00e8 c\u01a1 th\u1ea5t ph\u1ea3i. Do \u0111\u00f3 \u0111\u00e1nh gi\u00e1 kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 th\u1ea5t tr\u00e1i ch\u00ednh x\u00e1c h\u01a1n si\u00eau \u00e2m tim (tr\u00ean si\u00eau \u00e2m tim, th\u01b0\u1eddng \u0111\u00e1nh gi\u00e1 kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 cao h\u01a1n so v\u1edbi th\u1ef1c t\u1ebf).<\/p>\n

CHT tim c\u00f3 kh\u1ea3 n\u0103ng x\u00e1c \u0111\u1ecbnh t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i, s\u1ef1 v\u1eadn \u0111\u1ed9ng ra tr\u01b0\u1edbc c\u1ee7a l\u00e1 tr\u01b0\u1edbc van hai l\u00e1 trong th\u00ec t\u00e2m thu (SAM), v\u00e0 \u0111\u00e1nh gi\u00e1 li\u00ean quan h\u01b0\u1edbng d\u00f2ng h\u1edf hai l\u00e1 ph\u00eda sau. M\u1eb7c d\u00f9 v\u1edbi \u0111\u1ed9 ph\u00e2n gi\u1ea3i th\u1eddi gian cao h\u01a1n, si\u00eau \u00e2m tim c\u00f3 l\u1ee3i th\u1ebf trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh d\u1ea5u hi\u1ec7u SAM, \u0111\u1eb7c bi\u1ec7t v\u1edbi kh\u1ea3 n\u0103ng \u0111\u00e1nh gi\u00e1 s\u1ef1 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i khi ngh\u1ec9 ng\u01a1i ho\u1eb7c khi g\u1eafng s\u1ee9c.<\/p>\n

CHT c\u0169ng c\u00f3 cho th\u1ea5y s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a c\u00e1c c\u01a1 nh\u00fa v\u00e0 c\u00e1c c\u1ed9t c\u01a1 trong t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i. \u0110i\u1ec1u n\u00e0y \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng tr\u01b0\u1edbc khi c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb x\u00e2m l\u1ea5n.<\/p>\n

CHT c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh di\u1ec7n t\u00edch v\u00f9ng gi\u1ea3m co b\u00f3p do s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a ph\u00ec \u0111\u1ea1i v\u00f9ng. CHT c\u0169ng c\u00f3 th\u1ec3 d\u1ec5 d\u00e0ng x\u00e1c \u0111\u1ecbnh c\u00e1c b\u00e8 c\u01a1 v\u00f9ng m\u1ecfm tim cho ph\u00e9p ph\u00e2n bi\u1ec7t b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i ph\u1ea7n m\u1ecfm v\u1edbi b\u1ec7nh c\u01a1 tim x\u1ed1p ho\u1eb7c x\u01a1 h\u00f3a n\u1ed9i m\u1ea1c c\u01a1 tim, nh\u1eefng b\u1ec7nh c\u00f3 t\u00ednh ch\u1ea5t t\u01b0\u01a1ng t\u1ef1 tr\u00ean si\u00eau \u00e2m.<\/p>\n

M\u1eb7t kh\u00e1c, CHT v\u1edbi h\u00ecnh \u1ea3nh ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang mu\u1ed9n c\u0169ng g\u1ee3i \u00fd s\u1ef1 x\u01a1 h\u00f3a c\u01a1 tim. S\u1ef1 x\u01a1 h\u00f3a n\u00e0y \u0111i\u1ec3n h\u00ecnh s\u1ebd ph\u00e2n b\u1ed1 \u1edf th\u00e0nh gi\u1eefa nh\u1eefng v\u00f9ng c\u01a1 tim ph\u00ec \u0111\u1ea1i. D\u1ea5u hi\u1ec7u n\u00e0y c\u0169ng c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y \u1edf v\u00f9ng m\u1ecfm th\u1ea5t tr\u00e1i, t\u0103ng nguy c\u01a1 nh\u1ed3i m\u00e1u c\u01a1 tim v\u00f9ng m\u1ecfm v\u00e0 g\u00e2y ra ph\u00ecnh v\u00f9ng m\u1ecfm c\u00f3 k\u00e8m theo ho\u1eb7c kh\u00f4ng k\u00e8m theo huy\u1ebft kh\u1ed1i m\u1ecfm th\u1ea5t, kh\u00f4ng th\u1ec3 quan s\u00e1t th\u1ea5y tr\u00ean si\u00eau \u00e2m. CHT c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u00ednh x\u00e1c m\u1ee9c \u0111\u1ed9 v\u00e0 s\u1ef1 ph\u00e2n b\u1ed1 x\u01a1 h\u00f3a g\u00e2y ra b\u1edfi k\u1ef9 thu\u1eadt \u0111\u1ed1t c\u1ed3n v\u00f9ng v\u00e1ch, v\u00e0 do \u0111\u00f3 c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb.<\/p>\n

CHT tim g\u1eafng s\u1ee9c v\u1edbi thu\u1ed1c adenosine c\u00f3 th\u1ec3 x\u00e1c \u0111\u1ecbnh di\u1ec7n t\u00edch v\u00f9ng c\u01a1 tim gi\u1ea3m t\u01b0\u1edbi m\u00e1u t\u01b0\u01a1ng quan v\u1edbi m\u1ee9c t\u0103ng \u0111\u1ed9 d\u00e0y th\u00e0nh tim.<\/p>\n

CHT c\u0169ng gi\u00fap \u00edch trong ph\u00e2n bi\u1ec7t b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u1edbi c\u01a1 tim ph\u00ec \u0111\u1ea1i \u1edf v\u1eadn \u0111\u1ed9ng vi\u00ean v\u00e0 b\u1ec7nh c\u01a1 tim nhi\u1ec5m b\u1ed9t amyloid.<\/p>\n

B\u1ec7nh Anderson-Fabry l\u00e0 m\u1ed9t r\u1ed1i lo\u1ea1n do s\u1ef1 thi\u1ebfu h\u1ee5t ho\u1eb7c kh\u00f4ng c\u00f3 enzyme a- galactosidase-A. B\u1ec7nh n\u00e0y c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n ph\u00ec \u0111\u1ea1i c\u01a1 th\u1ea5t tr\u00e1i \u0111\u1ed3ng t\u00e2m nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 ph\u00ec \u0111\u1ea1i l\u1ec7ch t\u00e2m. Kho\u1ea3ng 50% tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang mu\u1ed9n \u1edf l\u1edbp gi\u1eefa \u0111\u1eb7c bi\u1ec7t g\u1eb7p \u1edf v\u00f9ng \u0111\u00e1y th\u00e0nh sau b\u00ean (chi\u1ebfm >90% tr\u01b0\u1eddng h\u1ee3p c\u00f3 bi\u1ec3u hi\u1ec7n tim), gi\u1ea3m t\u00edn hi\u1ec7u tr\u00ean Xung T1. \u0110i\u1ec1u n\u00e0y \u0111\u01b0\u1ee3c nh\u1ea5n m\u1ea1nh b\u1edfi th\u1ef1c t\u1ebf 4% b\u1ec7nh nh\u00e2n nghi ng\u1edd m\u1eafc b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i l\u1ea1i c\u00f3 b\u1ec7nh Anderson-Fabry v\u00e0 b\u1ec7nh n\u00e0y \u0111\u00e3 c\u00f3 li\u1ec7u ph\u00e1p enzyme thay th\u1ebf d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/p>\n

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng g\u00e2y \u0111\u1ed9t t\u1eed \u1edf ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i. \u0110\u1eb7c bi\u1ec7t, \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng v\u1eadn \u0111\u1ed9ng vi\u00ean s\u1ebd ph\u00e1t tri\u1ec3n ph\u00ec \u0111\u1ea1i sinh l\u00fd \u1edf m\u1ed9t m\u1ee9c \u0111\u1ed9 n\u00e0o \u0111\u00f3 v\u00e0 d\u0201n t\u1edbi th\u00e1ch th\u1ee9c cho vi\u1ec7c ch\u1ea9n \u0111o\u00e1n. Tuy nhi\u00ean th\u00e0nh th\u1ea5t tr\u00e1i hi\u1ebfm khi d\u00e0y qu\u00e1 15 mm . Th\u1ec3 t\u00edch th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng c\u00f3 xu h\u01b0\u1edbng t\u0103ng l\u00ean \u1edf nh\u1eefng v\u1eadn \u0111\u1ed9ng vi\u00ean g\u1eafng s\u1ee9c nhi\u1ec1u v\u00e0 s\u1ebd kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a s\u1ef1 ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang mu\u1ed9n. D\u1ea5u hi\u1ec7u kh\u00f4ng ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang mu\u1ed9n v\u00e0 m\u1ee9c \u0111\u1ed9 ph\u00ec \u0111\u1ea1i nh\u1eb9 (12 – 15mm) th\u01b0\u1eddng \u00edt g\u1eb7p, tuy nhi\u00ean kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u00e0 \u0111\u00f4i khi c\u1ea7n ch\u1ee5p l\u1ea1i CHT sau 3 th\u00e1ng .<\/p>\n

CHT c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t gi\u1eefa ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i do t\u0103ng huy\u1ebft \u00e1p v\u1edbi b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i. Ph\u00ec \u0111\u1ea1i > 15mm \u00edt g\u1eb7p trong ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i do t\u0103ng huy\u1ebft \u00e1p. \u1ede m\u1ee9c > 20 mm th\u00ec ngh\u0129 nhi\u1ec1u \u0111\u1ebfn b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i. M\u1eb7c d\u00f9, b\u1ec7nh c\u01a1 tim do t\u0103ng huy\u1ebft \u00e1p c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn t\u0103ng x\u01a1 h\u00f3a kho\u1ea3ng k\u1ebd th\u1ea5t tr\u00e1i, tuy nhi\u00ean kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang mu\u1ed9n c\u1ee7a l\u1edbp gi\u1eefa nh\u01b0 trong b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i.<\/p>\n

CHT do \u0111\u00f3 c\u00f3 \u00fd ngh\u0129a trong vi\u1ec7c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t, theo d\u00f5i, l\u00ean k\u1ebf ho\u1ea1ch \u0111i\u1ec1u tr\u1ecb x\u00e2m l\u1ea5n trong t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i v\u00e0 x\u00e1c \u0111\u1ecbnh c\u00e1c bi\u1ebfn ch\u1ee9ng. Trong t\u01b0\u01a1ng lai, l\u01b0\u1ee3ng gi\u00e1 m\u1ee9c \u0111\u1ed9 ng\u1ea5m thu\u1ed1c th\u00ec mu\u1ed9n c\u00f3 th\u1ec3 c\u00f3 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng.<\/p>\n

3.B\u1ec7nh vi\u00eam c\u01a1 tim<\/h2>\n

Vi\u00eam c\u01a1 tim c\u1ea5p l\u00e0 nguy\u00ean nh\u00e2n quan tr\u1ecdng trong suy tim c\u1ea5p v\u00e0 c\u00f3 t\u1ef7 l\u1ec7 l\u1edbn b\u1ec7nh nh\u00e2n di\u1ec5n ti\u1ebfn th\u00e0nh b\u1ec7nh c\u01a1 tim gi\u00e3n sau \u0111\u00f3 ho\u1eb7c \u0111\u1ed9t t\u1eed do nguy\u00ean nh\u00e2n tim m\u1ea1ch. Kinh \u0111i\u1ec3n ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u01a1 tim \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng sinh thi\u1ebft c\u01a1 tim. Tuy nhi\u00ean,<\/p>\n

th\u01b0\u1eddng th\u1ea5t b\u1ea1i do c\u00f3 th\u1ec3 sinh thi\u1ebft v\u00e0o v\u00f9ng c\u01a1 tim l\u00e0nh v\u00e0 v\u00ec v\u1eady ph\u01b0\u01a1ng ph\u00e1p n\u00e0y c\u00f3 \u0111\u1ed9 nh\u1ea1y th\u1ea5p v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng \u00e2m t\u00ednh th\u1ea5p.<\/p>\n

CHT tim cho ph\u00e9p x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u00f9ng c\u01a1 tim t\u1ed5n th\u01b0\u01a1ng v\u00e0 \u0111\u00e1nh gi\u00e1 h\u1eadu qu\u1ea3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t do vi\u00eam c\u01a1 tim g\u00e2y ra. CHT ph\u00e1t hi\u1ec7n thay \u0111\u1ed5i kh\u1ed1i l\u01b0\u1ee3ng c\u01a1 th\u1ea5t tr\u00e1i v\u00e0 th\u1ec3 t\u00edch th\u1ea5t tr\u00e1i c\u00f9ng v\u1edbi h\u00ecnh \u1ea3nh ph\u00f9 c\u01a1 tim. Qu\u00e1 tr\u00ecnh vi\u00eam ti\u1ebfn tri\u1ec3n bao g\u1ed3m vi\u00eam m\u00e0ng ngo\u00e0i tim g\u1eb7p \u1edf kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim. CHT ph\u00e1t hi\u1ec7n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim. Xung T2-weighted cho th\u1ea5y d\u1ea5u hi\u1ec7u ph\u00f9 c\u01a1 tim. Xung T2-STIR c\u0169ng cho th\u1ea5y h\u00ecnh \u1ea3nh ph\u00f9 c\u01a1 tim.<\/p>\n

Ph\u00f9 c\u01a1 tim v\u00e0 vi\u00eam l\u00e0 nguy\u00ean nh\u00e2n d\u0201n t\u1edbi gi\u00e3n r\u1ed9ng c\u00e1c kho\u1ea3ng gian b\u00e0o. Ph\u00e2n b\u1ed1 ng\u1ea5m Gadolinium nhanh ch\u00f3ng lan t\u1ecfa \u1edf v\u00f9ng t\u1ebf b\u00e0o c\u01a1 tim b\u1ecb t\u1ed5n th\u01b0\u01a1ng v\u00e0 vi\u00eam, d\u0201n \u0111\u1ebfn h\u00ecnh \u1ea3nh ng\u1ea5m thu\u1ed1c th\u00ec s\u1edbm cho th\u1ea5y s\u1ef1 khu\u1ebfch \u0111\u1ea1i nhanh c\u1ee7a thu\u1ed1c v\u00e0 tho\u00e1t thu\u1ed1c qua h\u1ec7 th\u1ed1ng mao m\u1ea1ch. H\u00ecnh \u1ea3nh ng\u1ea5m thu\u1ed1c mu\u1ed9n cho th\u1ea5y t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng ph\u1ee5c h\u1ed3i c\u1ee7a c\u01a1 tim \u0111\u01b0\u1ee3c bi\u1ec3u hi\u1ec7n v\u1edbi d\u1ea5u hi\u1ec7u x\u01a1 ho\u00e1 c\u01a1 tim v\u00e0 \u0111i\u1ec3n h\u00ecnh l\u00e0 d\u01b0\u1edbi n\u1ed9i t\u00e2m m\u1ea1c v\u00e0 th\u00e0nh gi\u1eefa c\u01a1 tim, kh\u00f4ng gi\u1ed1ng trong b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 vi\u00eam c\u01a1 tim th\u01b0\u1eddng t\u1ed5n th\u01b0\u01a1ng d\u01b0\u1edbi th\u01b0\u1ee3ng t\u00e2m m\u1ea1c.<\/p>\n

X\u00e1c \u0111\u1ecbnh t\u0103ng ng\u1ea5m thu\u1ed1c th\u00ec s\u1edbm, kh\u00f4ng c\u00f3 t\u0103ng ng\u1ea5m thu\u1ed1c th\u00ec mu\u1ed9n cho th\u1ea5y \u0111\u1eb7c tr\u01b0ng c\u1ee7a vi\u00eam v\u00e0 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i. C\u1ed9ng h\u01b0\u1edfng t\u1eeb c\u00f3 th\u1ec3 h\u01b0\u1edbng d\u0201n trong sinh thi\u1ebft c\u01a1 tim v\u00e0 t\u0103ng \u0111\u1ed9 ch\u00ednh x\u00e1c trong ch\u1ea9n \u0111o\u00e1n.<\/p>\n

K\u1ef9 thu\u1eadt ch\u1ee5p CHT ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u01b0\u01a1ng quan v\u1edbi m\u00f4 b\u1ec7nh h\u1ecdc. V\u00e0 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n tr\u00ean CHT (ti\u00eau chu\u1ea9n Lake Louise) d\u1ef1a tr\u00ean s\u1ef1 \u0111\u1ed3ng thu\u1eadn c\u1ee7a c\u00e1c chuy\u00ean gia v\u00e0 b\u1ed1i c\u1ea3nh l\u00e2m s\u00e0ng nghi ng\u1edd \u0111\u00f2i h\u1ecfi 2\/3 ti\u00eau chu\u1ea9n:<\/p>\n

    \n
  • T\u0103ng t\u00edn hi\u1ec7u T2-Weighted t\u1eebng v\u00f9ng ho\u1eb7c to\u00e0n b\u1ed9 c\u01a1 tim.<\/li>\n
  • T\u0103ng ng\u1ea5m thu\u1ed1c \u0111\u1ed1i quang Gadolinium th\u00ec s\u1edbm \u1edf to\u00e0n b\u1ed9 c\u01a1 tim \u1edf th\u00ec T1- weighted.<\/li>\n
  • C\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a 1 ho\u1eb7c h\u01a1n 1 v\u00f9ng t\u1ed5n th\u01b0\u01a1ng tr\u00ean h\u00ecnh \u1ea3nh ng\u1ea5m Gadolinium mu\u1ed9n tr\u00ean T1-weighted.<\/li>\n<\/ul>\n

    C\u00e1c ti\u00eau chu\u1ea9n tr\u00ean gi\u00fap ch\u1ea9n \u0111o\u00e1n ch\u00ednh x\u00e1c kho\u1ea3ng 78% tr\u01b0\u1eddng h\u1ee3p. Tuy nhi\u00ean, CHT c\u00f3 th\u1ec3 ch\u1ee5p l\u1ea1i sau 1 – 2 tu\u1ea7n trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p l\u00e2m s\u00e0ng nghi ng\u1edd cao \u0111\u1ed1i v\u1edbi b\u1ec7nh l\u00fd vi\u00eam c\u01a1 tim nh\u01b0ng kh\u00f4ng tho\u1ea3 m\u00e3n ti\u00eau chu\u1ea9n tr\u00ean. Ch\u1ee5p theo d\u00f5i sau 1 th\u00e1ng ho\u1eb7c h\u01a1n c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111\u1ec3 theo d\u00f5i di\u1ec5n ti\u1ebfn sau \u0111\u00f3.<\/p>\n

    4.\u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng nhi\u1ec5m s\u1eaft c\u01a1 tim<\/h2>\n

    Kh\u00f4ng c\u00f3 c\u01a1 ch\u1ebf sinh l\u00fd hi\u1ec7u qu\u1ea3 \u0111\u1ec3 th\u1ea3i tr\u1eeb s\u1eaft d\u01b0 th\u1eeba ra kh\u1ecfi c\u01a1 th\u1ec3. Nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh l\u00fd huy\u1ebft s\u1eafc t\u1ed1 nh\u01b0 0- Thalassemia th\u1ec3 n\u1eb7ng v\u00e0 b\u1ec7nh h\u1ed3ng c\u1ea7u li\u1ec1m c\u1ea7n \u0111\u01b0\u1ee3c truy\u1ec1n m\u00e1u \u0111\u1ecbnh k\u1ef3, do \u0111\u00f3 ti\u1ebfn tri\u1ec3n t\u1edbi t\u00ecnh tr\u1ea1ng qu\u00e1 t\u1ea3i s\u1eaft.<\/p>\n

    M\u1ee9c \u0111\u1ed9 \u1ee9 s\u1eaft trong c\u01a1 tim r\u1ea5t \u00edt t\u01b0\u01a1ng quan v\u1edbi c\u00e1c ch\u1ea5t ch\u1ec9 d\u1ea5u c\u1ee7a s\u1eaft trong huy\u1ebft thanh t\u01b0\u01a1ng t\u1ef1 nh\u01b0 t\u00ecnh tr\u1ea1ng \u1ee9 s\u1eaft t\u1ea1i gan c\u0169ng ch\u1ec9 x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c nh\u1edd sinh thi\u1ebft. Tr\u01b0\u1edbc khi c\u00f3 ch\u1ee5p CHT tim, b\u1ec7nh l\u00fd c\u01a1 tim do qu\u00e1 t\u1ea3i s\u1eaft l\u00e0 nguy\u00ean nh\u00e2n h\u00e0ng \u0111\u1ea7u d\u0201n t\u1edbi t\u1eed vong \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n thi\u1ebfu m\u00e1u ph\u1ee5 thu\u1ed9c truy\u1ec1n m\u00e1u. M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 c\u00e1c thu\u1ed1c th\u1ea3i s\u1eaft chelate h\u00f3a \u0111\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch v\u00e0 \u0111\u01b0\u1eddng u\u1ed1ng, tr\u01b0\u1edbc khi c\u00f3 CHT, kh\u00f4ng c\u00f3 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh x\u00e1c \u0111\u1ec3 ti\u00ean l\u01b0\u1ee3ng th\u1eddi \u0111i\u1ec3m c\u0169ng nh\u01b0 li\u1ec1u<\/p>\n

    l\u01b0\u1ee3ng c\u1ee7a c\u00e1c thu\u1ed1c th\u1ea3i s\u1eaft.<\/p>\n

    C\u00e1c tri\u1ec7u ch\u1ee9ng suy tim v\u00e0 gi\u1ea3m ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u ch\u1ec9 xu\u1ea5t hi\u1ec7n \u1edf giai \u0111o\u1ea1n r\u1ea5t mu\u1ed9n. Nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u1ea3i s\u1eaft b\u1eb1ng c\u00e1c thu\u1ed1c chelate h\u00f3a c\u00f3 hi\u1ec7u qu\u1ea3 r\u00f5 r\u00e0ng khi \u0111\u00e1nh gi\u00e1 b\u1eb1ng c\u00e1c ph\u01b0\u01a1ng ph\u00e1p truy\u1ec1n th\u1ed1ng c\u0169ng kh\u00f4ng tr\u00e1nh \u0111\u01b0\u1ee3c t\u1eed vong do b\u1ec7nh c\u01a1 tim qu\u00e1 t\u1ea3i s\u1eaft.<\/p>\n

    Do s\u1eaft l\u00e0 m\u1ed9t ch\u1ea5t thu\u1eadn t\u1eeb m\u1ea1nh [1] , s\u1ef1 l\u1eafng \u0111\u1ecdng c\u00e1c ph\u00e2n t\u1eed s\u1eaft vi th\u1ec3 (hemosiderin) trong ty th\u1ec3 c\u1ee7a t\u1ebf b\u00e0o c\u01a1 tim \u0111\u1eb7c bi\u1ec7t t\u1ea1o ra m\u1ed9t v\u00f9ng t\u1eeb tr\u01b0\u1eddng h\u1ed7n \u0111\u1ed9n khu tr\u00fa c\u00f9ng v\u1edbi t\u01b0\u01a1ng t\u00e1c tri\u1ec7t ti\u00eau spin-spin [2] d\u0201n t\u1edbi r\u00fat ng\u1eafn th\u1eddi gian T2*, m\u1ed9t th\u00f4ng s\u1ed1 h\u1ed3i gi\u00e3n hay h\u1eb1ng s\u1ed1 th\u1eddi gian \u0111\u1ea1i di\u1ec7n cho s\u1ef1 suy gi\u1ea3m t\u1eeb tr\u01b0\u1eddng ngang. T2* c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111o ch\u1ec9 trong 1 l\u1ea7n n\u00edn th\u1edf v\u00e0 d\u1ec5 d\u00e0ng \u0111o l\u1ea1i nhi\u1ec1u l\u1ea7n. Gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng c\u1ee7a T2* l\u00e0 37 \u00b1 5 ms, v\u1edbi gi\u00e1 tr\u1ecb > 20 ms nh\u00ecn chung c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb t\u00ecnh tr\u1ea1ng nhi\u1ec5m s\u1eaft c\u01a1 tim. Gi\u00e1 tr\u1ecb < 20 ms th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi t\u00ecnh tr\u1ea1ng \u1ee9 \u0111\u1ecdng s\u1eaft \u0111ang ti\u1ebfn tri\u1ec3n v\u00e0 d\u0201n t\u1edbi r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng co b\u00f3p.<\/p>\n

    Gi\u00e1 tr\u1ecb < 10 ms c\u00f3 \u0111\u1ed9 nh\u1ea1y 98% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u 86% \u0111\u1ec3 ti\u00ean l\u01b0\u1ee3ng s\u1ef1 ti\u1ebfn tri\u1ec3n t\u1edbi suy tim trong 1 n\u0103m; 47% b\u1ec7nh nh\u00e2n c\u00f3 th\u1eddi gian T2* < 6 ms ti\u1ebfn tri\u1ec3n th\u00e0nh suy tim trong 1 n\u0103m. K\u1ef9 thu\u1eadt t\u01b0\u01a1ng t\u1ef1 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 d\u1ef1 tr\u1eef s\u1eaft t\u1ea1i gan v\u00e0 x\u00e1c \u0111\u1ecbnh li\u1ec7u ph\u00e1p th\u1ea3i s\u1eaft b\u1eb1ng thu\u1ed1c chelate h\u00f3a gi\u00fap th\u1ea3i tr\u1eeb s\u1eaft t\u1ea1i gan nhanh h\u01a1n \u1edf tim.<\/p>\n

    K\u1ef9 thu\u1eadt n\u00e0y cho ph\u00e9p l\u1ef1a ch\u1ecdn lo\u1ea1i thu\u1ed1c, th\u1eddi gian v\u00e0 li\u1ec1u l\u01b0\u1ee3ng thu\u1ed1c chelate ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n, \u0111\u1ed3ng th\u1eddi l\u00e0 bi\u1ec7n ph\u00e1p theo d\u00f5i hi\u1ec7u qu\u1ea3, kh\u00f4ng x\u00e2m l\u1ea5n, c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n nhi\u1ec1u l\u1ea7n v\u00e0 g\u00f3p ph\u1ea7n l\u00e0m thay \u0111\u1ed5i tri\u1ec3n v\u1ecdng cho c\u00e1c b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh l\u00fd huy\u1ebft h\u1ecdc ph\u1ee5 thu\u1ed9c truy\u1ec1n m\u00e1u.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim g\u1ed3m: b\u1ec7nh c\u01a1 tim gi\u00e3n, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, b\u1ec7nh vi\u00eam c\u01a1 tim. B\u00e0i vi\u1ebft cung c\u1ea5p th\u00f4ng tin v\u1ec1 vai tr\u00f2 c\u1ee7a c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim. Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim 1.B\u1ec7nh c\u01a1 tim gi\u00e3n B\u1ec7nh […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[88,33],"tags":[],"yoast_head":"\nCh\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim g\u1ed3m: b\u1ec7nh c\u01a1 tim gi\u00e3n, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, b\u1ec7nh vi\u00eam c\u01a1 tim.\" \/>\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\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb trong \u0111\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd c\u01a1 tim - 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