{"id":29959,"date":"2023-05-07T00:42:01","date_gmt":"2023-05-06T17:42:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29959"},"modified":"2023-05-07T00:42:01","modified_gmt":"2023-05-06T17:42:01","slug":"chan-doan-hoi-chung-dong-mach-vanh-man-theo-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/chan-doan-hoi-chung-dong-mach-vanh-man-theo-bo-y-te\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (P1)"},"content":{"rendered":"<h2><strong>1. GI\u1edaI THI\u1ec6U<\/strong><\/h2>\n<h3><strong>1.1. \u0110\u1ecbnh ngh\u0129a, thu\u1eadt ng\u1eef H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n<\/strong><\/h3>\n<p><strong>H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n\u00a0<\/strong>(Chronic coronary syndrome) l\u00e0 thu\u1eadt ng\u1eef m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a ra t\u1ea1i H\u1ed9i Ngh\u1ecb Tim M\u1ea1ch Ch\u00e2u \u00c2u (ESC) 2019, thay cho t\u00ean g\u1ecdi tr\u01b0\u1edbc \u0111\u00e2y l\u00e0 \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh, b\u1ec7nh \u0110MV \u1ed5n \u0111\u1ecbnh, b\u1ec7nh c\u01a1 tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 m\u1ea1n t\u00ednh ho\u1eb7c suy v\u00e0nh.<\/p>\n<p>H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n l\u00e0 b\u1ec7nh l\u00fd li\u00ean quan \u0111\u1ebfn\u00a0<strong>s\u1ef1 \u1ed5n \u0111\u1ecbnh t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0nh,\u00a0<\/strong>khi kh\u00f4ng c\u00f3 s\u1ef1 n\u1ee9t v\u1ee1 \u0111\u1ed9t ng\u1ed9t ho\u1eb7c sau giai \u0111o\u1ea1n c\u1ea5p ho\u1eb7c sau khi \u0111\u00e3 \u0111\u01b0\u1ee3c can thi\u1ec7p\/ph\u1eabu thu\u1eadt. Khi m\u1ea3ng x\u01a1 v\u1eefa ti\u1ebfn tri\u1ec3n d\u1ea7n g\u00e2y h\u1eb9p l\u00f2ng \u0110MV m\u1ed9t c\u00e1ch \u0111\u00e1ng k\u1ec3 (th\u01b0\u1eddng l\u00e0 h\u1eb9p tr\u00ean 70% \u0111\u01b0\u1eddng k\u00ednh l\u00f2ng m\u1ea1ch) th\u00ec c\u00f3 th\u1ec3 g\u00e2y ra tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec3n h\u00ecnh nh\u1ea5t l\u00e0 \u0111au th\u1eaft ng\u1ef1c\/kh\u00f3 th\u1edf khi b\u1ec7nh nh\u00e2n g\u1eafng s\u1ee9c v\u00e0 \u0111\u1ee1 khi ngh\u1ec9.<\/p>\n<p>Trong qu\u00e1 tr\u00ecnh ph\u00e1t tri\u1ec3n c\u1ee7a m\u1ea3ng x\u01a1 v\u1eefa, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n nh\u1eefng bi\u1ebfn c\u1ed1 c\u1ea5p t\u00ednh do s\u1ef1 n\u1ee9t v\u1ee1 m\u1ea3ng x\u01a1 v\u1eefa, d\u1eabn t\u1edbi h\u00ecnh th\u00e0nh huy\u1ebft kh\u1ed1i g\u00e2y h\u1eb9p ho\u1eb7c t\u1eafc l\u00f2ng m\u1ea1ch m\u1ed9t c\u00e1ch nhanh ch\u00f3ng \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p (HCMVC).<\/p>\n<p>Do qu\u00e1 tr\u00ecnh di\u1ec5n ti\u1ebfn \u0111\u1ed9ng c\u1ee7a b\u1ec7nh l\u00fd m\u1ea1ch v\u00e0nh v\u00e0 c\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh kh\u00f4ng ch\u1ec9 l\u00e0 t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch v\u00e0nh th\u01b0\u1ee3ng t\u00e2m m\u1ea1c m\u00e0 c\u00f3 c\u1ea3 c\u01a1 ch\u1ebf t\u1ed5n th\u01b0\u01a1ng h\u1ec7 vi tu\u1ea7n ho\u00e0n v\u00e0nh, co th\u1eaft m\u1ea1ch&#8230; Do v\u1eady, hi\u1ec7n nay thu\u1eadt ng\u1eef \u201cH\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n\u201d \u0111\u01b0\u1ee3c ch\u00ednh th\u1ee9c c\u00f4ng b\u1ed1, vi\u1ebft t\u1eaft l\u00e0 HCMVM.<\/p>\n<h3><strong>1.2. C\u00e1c b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng c\u1ee7a H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n<\/strong><\/h3>\n<p>Theo ESC 2019, h\u1ed9i ch\u1ee9ng \u0110MV m\u1ea1n t\u00ednh c\u00f3\u00a0<strong><em>6 b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng<\/em><\/strong><em>:<\/em><\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n nghi ng\u1edd c\u00f3 b\u1ec7nh \u0110MV v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh v\u00e0\/ho\u1eb7c kh\u00f3 th\u1edf.<\/li>\n<li>B\u1ec7nh nh\u00e2n m\u1edbi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng suy tim\/gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i v\u00e0 nghi ng\u1edd c\u00f3 b\u1ec7nh l\u00fd b\u1ec7nh \u0110MV.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p ho\u1eb7c \u0111\u01b0\u1ee3c t\u00e1i th\u00f4ng \u0110MV trong v\u00f2ng 1 n\u0103m, c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/li>\n<li>B\u1ec7nh nh\u00e2n sau h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p ho\u1eb7c \u0111\u01b0\u1ee3c t\u00e1i th\u00f4ng \u0110MV tr\u00ean 1 n\u0103m.<\/li>\n<li>B\u1ec7nh nh\u00e2n \u0111au th\u1eaft ng\u1ef1c nghi ng\u1edd do b\u1ec7nh l\u00fd vi m\u1ea1ch ho\u1eb7c co th\u1eaft \u0110MV.<\/li>\n<li>B\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u ch\u1ee9ng, kh\u00e1m s\u00e0ng l\u1ecdc ph\u00e1t hi\u1ec7n ra b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/li>\n<\/ul>\n<h2><strong>2. L\u00c2M S\u00c0NG V\u00c0 C\u1eacN L\u00c2M S\u00c0NG<\/strong><\/h2>\n<h3><strong>2.1.\u00a0Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/strong><\/h3>\n<p>Trong ch\u1ea9n \u0111o\u00e1n <a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/benh-mach-vanh-bieu-hien-nguyen-nhan-va-cach-dieu-tri-o-vinmec\/\">b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/a>, c\u01a1n \u0111au th\u1eaft ng\u1ef1c l\u00e0 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng quan tr\u1ecdng nh\u1ea5t (x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c ki\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh). C\u1ea7n l\u01b0u \u00fd m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u1ea1i kh\u00f4ng c\u00f3 c\u01a1n \u0111au ng\u1ef1c (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh th\u1ea7m l\u1eb7ng).<\/p>\n<h4><strong>2.1.1.\u00a0C\u01a1n \u0111au th\u1eaft ng\u1ef1c<\/strong><\/h4>\n<p><strong>V\u1ecb tr\u00ed:<\/strong><\/p>\n<ul>\n<li>Th\u01b0\u1eddng \u1edf sau x\u01b0\u01a1ng \u1ee9c v\u00e0 l\u00e0 m\u1ed9t v\u00f9ng (ch\u1ee9 kh\u00f4ng ph\u1ea3i m\u1ed9t \u0111i\u1ec3m), \u0111au c\u00f3 th\u1ec3 lan l\u00ean c\u1ed5, vai, tay, h\u00e0m, th\u01b0\u1ee3ng v\u1ecb, sau l\u01b0ng.<\/li>\n<li>Hay g\u1eb7p h\u01a1n c\u1ea3 l\u00e0 h\u01b0\u1edbng lan l\u00ean vai tr\u00e1i r\u1ed3i lan xu\u1ed1ng m\u1eb7t trong tay tr\u00e1i, c\u00f3 khi xu\u1ed1ng t\u1eadn c\u00e1c ng\u00f3n tay 4, 5.<\/li>\n<\/ul>\n<p><strong>Ho\u00e0n c\u1ea3nh xu\u1ea5t hi\u1ec7n:<\/strong><\/p>\n<ul>\n<li>Th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n khi g\u1eafng s\u1ee9c, x\u00fac c\u1ea3m m\u1ea1nh, g\u1eb7p l\u1ea1nh, sau b\u1eefa \u0103n nhi\u1ec1u ho\u1eb7c h\u00fat thu\u1ed1c l\u00e1 v\u00e0 nhanh ch\u00f3ng gi\u1ea3m\/ bi\u1ebfn m\u1ea5t trong v\u00f2ng v\u00e0i ph\u00fat khi c\u00e1c y\u1ebfu t\u1ed1 tr\u00ean gi\u1ea3m.<\/li>\n<li>C\u01a1n \u0111au c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n t\u1ef1 nhi\u00ean. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u01a1n \u0111au th\u1eaft ng\u1ef1c c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n v\u1ec1 \u0111\u00eam, khi thay \u0111\u1ed5i t\u01b0 th\u1ebf, ho\u1eb7c khi k\u00e8m c\u01a1n nh\u1ecbp nhanh.<\/li>\n<\/ul>\n<p><strong>T\u00ednh ch\u1ea5t:<\/strong><\/p>\n<ul>\n<li>H\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n m\u00f4 t\u1ea3 c\u01a1n \u0111au th\u1eaft ng\u1ef1c nh\u01b0 th\u1eaft l\u1ea1i, b\u00f3 ngh\u1eb9t, ho\u1eb7c b\u1ecb \u0111\u00e8 n\u1eb7ng tr\u01b0\u1edbc ng\u1ef1c v\u00e0 \u0111\u00f4i khi c\u1ea3m gi\u00e1c bu\u1ed1t gi\u00e1, b\u1ecfng r\u00e1t.<\/li>\n<li>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 kh\u00f3 th\u1edf, m\u1ec7t l\u1ea3, \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n, v\u00e3 m\u1ed3 h\u00f4i&#8230;<\/li>\n<\/ul>\n<p><strong>Th\u1eddi gian:<\/strong><\/p>\n<ul>\n<li>Th\u01b0\u1eddng k\u00e9o d\u00e0i kho\u1ea3ng v\u00e0i ph\u00fat (3 &#8211; 5 ph\u00fat), c\u00f3 th\u1ec3 d\u00e0i h\u01a1n nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng qu\u00e1 20 ph\u00fat (n\u1ebfu \u0111au k\u00e9o d\u00e0i h\u01a1n v\u00e0 xu\u1ea5t hi\u1ec7n ngay c\u1ea3 khi ngh\u1ec9 th\u00ec c\u1ea7n ngh\u0129 \u0111\u1ebfn c\u01a1n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c nh\u1ed3i m\u00e1u c\u01a1 tim).<\/li>\n<li>Nh\u1eefng c\u01a1n \u0111au x\u1ea3y ra do x\u00fac c\u1ea3m th\u01b0\u1eddng k\u00e9o d\u00e0i h\u01a1n l\u00e0 \u0111au do g\u1eafng s\u1ee9c. Nh\u1eefng c\u01a1n \u0111au m\u00e0 ch\u1ec9 k\u00e9o d\u00e0i d\u01b0\u1edbi 1 ph\u00fat th\u00ec n\u00ean t\u00ecm nh\u1eefng nguy\u00ean nh\u00e2n kh\u00e1c ngo\u00e0i tim.<\/li>\n<\/ul>\n<h4><strong>2.1.2. m\u1ed9t\u00a0s\u1ed1 bi\u1ebfn th\u1ec3<\/strong><\/h4>\n<ul>\n<li>Kh\u00f3 th\u1edf: \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh cao, \u0111\u01b0\u1ee3c coi l\u00e0 ch\u1ec9 b\u00e1o quan tr\u1ecdng tr\u00ean l\u00e2m s\u00e0ng v\u00e0 \u0111\u01b0\u1ee3c ESC 2019 khuy\u1ebfn c\u00e1o b\u00ean c\u1ea1nh tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c.<\/li>\n<li>\u1ede m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng bi\u1ec3u hi\u1ec7n r\u00f5 c\u01a1n \u0111au m\u00e0 ch\u1ec9 c\u1ea3m gi\u00e1c t\u1ee9c n\u1eb7ng ng\u1ef1c, kh\u00f3 ch\u1ecbu \u1edf ng\u1ef1c, m\u1ed9t s\u1ed1 kh\u00e1c l\u1ea1i c\u1ea3m gi\u00e1c nh\u01b0 c\u1ee9ng h\u00e0m khi g\u1eafng s\u1ee9c&#8230;<\/li>\n<li>Ng\u01b0\u1ee3c l\u1ea1i, m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p l\u1ea1i c\u00f3 c\u01a1n \u0111au gi\u1ea3 th\u1eaft ng\u1ef1c (nh\u1ea5t l\u00e0 \u1edf n\u1eef gi\u1edbi).<\/li>\n<li>M\u1ed9t s\u1ed1 kh\u00e1c l\u1ea1i \u0111au ng\u1ef1c khi ho\u1ea1t \u0111\u1ed9ng g\u1eafng s\u1ee9c nh\u1eefng l\u1ea7n \u0111\u1ea7u, sau \u0111\u00f3, \u0111\u1ee1 \u0111au khi ho\u1ea1t \u0111\u1ed9ng l\u1eb7p l\u1ea1i v\u1edbi c\u01b0\u1eddng \u0111\u1ed9 t\u01b0\u01a1ng t\u1ef1 (hi\u1ec7n t\u01b0\u1ee3ng \u201ch\u00e2m n\u00f3ng\u201d &#8211; warming up).<\/li>\n<\/ul>\n<h4><strong>2.1.3.\u00a0Ph\u00e2n lo\u1ea1i \u0111au th\u1eaft ng\u1ef1c<\/strong><\/h4>\n<ul>\n<li>\u0110au th\u1eaft ng\u1ef1c \u0111i\u1ec3n h\u00ecnh ki\u1ec3u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh bao g\u1ed3m 3 y\u1ebfu t\u1ed1:<\/li>\n<li>\u0110au th\u1eaft ng\u1ef1c sau x\u01b0\u01a1ng \u1ee9c v\u1edbi t\u00ednh ch\u1ea5t v\u00e0 th\u1eddi gian \u0111i\u1ec3n h\u00ecnh.<\/li>\n<li>Xu\u1ea5t hi\u1ec7n\/t\u0103ng l\u00ean khi g\u1eafng s\u1ee9c ho\u1eb7c x\u00fac c\u1ea3m.<\/li>\n<li>\u0110\u1ee1 \u0111au khi ngh\u1ec9 ho\u1eb7c d\u00f9ng nitroglycerin nhanh x\u1ecbt\/ng\u1eadm d\u01b0\u1edbi l\u01b0\u1ee1i trong v\u00f2ng 5 ph\u00fat.<\/li>\n<li>\u0110au th\u1eaft ng\u1ef1c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh: Ch\u1ec9 g\u1ed3m 2 y\u1ebfu t\u1ed1 tr\u00ean.<\/li>\n<li>Kh\u00f4ng gi\u1ed1ng \u0111au th\u1eaft ng\u1ef1c: Ch\u1ec9 c\u00f3 m\u1ed9t ho\u1eb7c kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 n\u00e0o n\u00f3i tr\u00ean.<\/li>\n<\/ul>\n<p><strong><em>B\u1ea3ng 3.1. Ph\u00e2n lo\u1ea1i m\u1ee9c \u0111 \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh<\/em><\/strong><strong>:\u00a0<\/strong>theo H\u1ed9i Tim m\u1ea1ch Canada<\/p>\n<table style=\"height: 331px;\" width=\"822\">\n<tbody>\n<tr>\n<td width=\"7%\"><strong>\u0110\u1ed9<\/strong><\/td>\n<td width=\"22%\"><strong>\u0110\u1eb7c \u0111i\u1ec3m<\/strong><\/td>\n<td width=\"69%\"><strong>Ch\u00fa th\u00edch<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"7%\"><strong>I<\/strong><\/td>\n<td width=\"22%\">\u0110au th\u1eaft ng\u1ef1c x\u1ea3y ra khi l\u00e0m vi\u1ec7c n\u1eb7ng ho\u1eb7c g\u1eafng s\u1ee9c nhi\u1ec1u<\/td>\n<td width=\"69%\">\u0110au th\u1eaft ng\u1ef1c ch\u1ec9 xu\u1ea5t hi\u1ec7n khi ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c r\u1ea5t m\u1ea1nh, nhanh ho\u1eb7c c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c b\u00ecnh th\u01b0\u1eddng nh\u01b0ng th\u1eddi gian k\u00e9o d\u00e0i (\u0111i b\u1ed9, leo c\u1ea7u thang)<\/td>\n<\/tr>\n<tr>\n<td width=\"7%\"><strong>II<\/strong><\/td>\n<td width=\"22%\">\u0110au th\u1eaft ng\u1ef1c x\u1ea3y ra khi ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh<\/td>\n<td width=\"69%\">\u00cdt h\u1ea1n ch\u1ebf c\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u01b0\u1eddng ng\u00e0y khi ch\u00fang \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh nhanh, sau b\u1eefa \u0103n, trong tr\u1eddi l\u1ea1nh, trong gi\u00f3, trong tr\u1ea1ng th\u00e1i c\u0103ng th\u1eb3ng hay v\u00e0i gi\u1edd sau khi th\u1ee9c d\u1eady; nh\u01b0ng v\u1eabn th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c leo d\u1ed1c, leo cao \u0111\u01b0\u1ee3c h\u01a1n 1 t\u1ea7ng g\u00e1c v\u1edbi t\u1ed1c \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng v\u00e0 trong \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng.<\/td>\n<\/tr>\n<tr>\n<td width=\"7%\"><strong>III<\/strong><\/td>\n<td width=\"22%\">\u0110au th\u1eaft ng\u1ef1c x\u1ea3y ra khi ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9<\/td>\n<td width=\"69%\">Kh\u00f3 kh\u0103n khi \u0111i b\u1ed9 d\u00e0i t\u1eeb 1 &#8211; 2 d\u00e3y nh\u00e0 ho\u1eb7c leo cao 1 t\u1ea7ng g\u00e1c v\u1edbi t\u1ed1c \u0111\u1ed9 v\u00e0 \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng.<\/td>\n<\/tr>\n<tr>\n<td width=\"7%\"><strong>IV<\/strong><\/td>\n<td width=\"22%\">\u0110au th\u1eaft ng\u1ef1c x\u1ea3y ra khi ngh\u1ec9 ng\u01a1i<\/td>\n<td width=\"69%\">Kh\u00f4ng c\u1ea7n g\u1eafng s\u1ee9c \u0111\u1ec3 kh\u1edfi ph\u00e1t c\u01a1n \u0111au th\u1eaft ng\u1ef1c.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong>2.2.\u00a0Kh\u00e1m l\u00e2m s\u00e0ng<\/strong><\/h3>\n<p>Kh\u00e1m l\u00e2m s\u00e0ng trong h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (HCMVM) gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y b\u1ec7nh, c\u00e1c bi\u1ebfn ch\u1ee9ng, ph\u00e2n t\u1ea7ng nguy c\u01a1, c\u00e1c b\u1ec7nh \u0111\u1ed3ng m\u1eafc c\u0169ng nh\u01b0 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t. Kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u th\u1ef1c t\u1ed5n n\u00e0o \u0111\u1eb7c hi\u1ec7u trong HCMVM.<\/p>\n<p>&#8211;\u00a0<strong>\u0110\u1ebfm m\u1ea1ch\/nh\u1ecbp tim<\/strong><em>:\u00a0<\/em>N\u1ebfu thi\u1ebfu m\u00e1u c\u01a1 tim th\u00e0nh d\u01b0\u1edbi s\u1ebd l\u00e0m ch\u1eadm nh\u1ecbp tim do thi\u1ebfu m\u00e1u n\u00fat nh\u0129 th\u1ea5t. Nh\u1ecbp nhanh l\u00fac ngh\u1ec9: th\u01b0\u1eddng l\u00e0 do ho\u1ea1t ho\u00e1 h\u1ec7 th\u1ea7n kinh giao c\u1ea3m, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 l\u00e0 bi\u1ec3u hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp tim do thi\u1ebfu m\u00e1u.<\/p>\n<p>&#8211;\u00a0<strong>\u0110o huy\u1ebft \u00e1p<\/strong>: C\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n t\u0103ng huy\u1ebft \u00e1p, ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p (do suy tim ho\u1eb7c qu\u00e1 li\u1ec1u thu\u1ed1c).<\/p>\n<p>&#8211;\u00a0<strong>Kh\u00e1m tim<\/strong>: T\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, c\u01a1 tim gi\u00e3n, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng c\u1ee7a tim khi s\u1edd tim, nghe tim th\u1ea5y ti\u1ebfng th\u1ed5i khi thi\u1ebfu m\u00e1u c\u01a1 tim c\u1ea5p, h\u1eb9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, h\u1edf hai l\u00e1 (do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng c\u01a1 nh\u00fa), b\u1ea5t th\u01b0\u1eddng b\u1ea9m sinh c\u1ee7a tim\u2026<\/p>\n<p>&#8211;\u00a0<strong>T\u00ecm ki\u1ebfm c\u00e1c d\u1ea5u hi\u1ec7u suy tim<\/strong><em>:\u00a0<\/em>S\u1edd di\u1ec7n \u0111\u1eadp c\u1ee7a tim th\u1ea5y b\u00f3ng tim l\u1edbn, nh\u1ecbp tim nhanh l\u00fac th\u0103m kh\u00e1m, nghe ph\u1ed5i th\u1ea5y ran \u1ea9m t\u1ea1i hai ph\u1ebf tr\u01b0\u1eddng ph\u1ed5i, ho\u1eb7c d\u1ea5u hi\u1ec7u tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i khi th\u0103m kh\u00e1m. Ph\u00f9 \u0111\u1ec1u hai chi d\u01b0\u1edbi, gan to m\u1ec1m, \u1ea5n \u0111au, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i \u2026<\/p>\n<p>&#8211;\u00a0<strong>T\u00ecm ki\u1ebfm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch ngo\u1ea1i vi<\/strong>: S\u1edd t\u00ecm kh\u1ed1i ph\u00ecnh \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng, b\u1eaft m\u1ea1ch c\u1ea3nh v\u00e0 m\u1ea1ch chi, nghe m\u1ea1ch c\u1ea3nh, th\u1eadn, \u0111\u00f9i. \u0110\u00e1nh gi\u00e1 nu\u00f4i d\u01b0\u1ee1ng chi d\u01b0\u1edbi.<\/p>\n<p>&#8211;\u00a0<strong>T\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a t\u0103ng cholesterol<\/strong>: T\u00ecm c\u00e1c d\u1ea5u hi\u1ec7u t\u00edch t\u1ee5 cholesterol tr\u00ean da nh\u01b0 u xanthoma tr\u00ean mi m\u1eaft, tr\u00ean da, tr\u00ean g\u00e2n \u0111\u1eb7c bi\u1ec7t g\u00e2n Achilles, g\u1ee3i \u00fd t\u1edbi t\u0103ng cholesterol m\u00e1u t\u00ednh ch\u1ea5t gia \u0111\u00ecnh x\u1ea3y ra c\u1ea3 \u1edf ng\u01b0\u1eddi tr\u1ebb, l\u00e0m t\u0103ng nguy c\u01a1 b\u1ec7nh m\u1ea1ch v\u00e0nh, b\u1ec7nh l\u00fd x\u01a1 v\u1eefa m\u1ea1ch m\u00e1u\u2026.<\/p>\n<p>&#8211;\u00a0C\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t nh\u01b0: Ti\u1ebfng c\u1ecd trong vi\u00eam m\u00e0ng ngo\u00e0i tim, c\u00e1c d\u1ea5u hi\u1ec7u tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i, vi\u00eam kh\u1edbp \u1ee9c s\u01b0\u1eddn&#8230;<\/p>\n<p><strong>2.3.\u00a0C\u00e1c th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n<p>C\u00e1c x\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng \u0110MV m\u1ea1n t\u00ednh bao g\u1ed3m: C\u00e1c x\u00e9t nghi\u1ec7m sinh h\u00f3a c\u01a1 b\u1ea3n, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 khi ngh\u1ec9, c\u00f3 th\u1ec3 theo d\u00f5i Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, si\u00eau \u00e2m tim khi ngh\u1ec9, X-quang ng\u1ef1c th\u1eb3ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ph\u00f9 h\u1ee3p.<\/p>\n<p><strong>2.3.1.\u00a0X\u00e9t nghi\u1ec7m sinh h\u00f3a c\u01a1 b\u1ea3n<\/strong><\/p>\n<p>&#8211;\u00a0X\u00e9t nghi\u1ec7m hs Troponin \u0111\u1ec3 lo\u1ea1i tr\u1eeb h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p.<\/p>\n<p>&#8211;\u00a0C\u00e1c x\u00e9t nghi\u1ec7m m\u00e1u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n HCMVM:<\/p>\n<ul>\n<li>T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u, ch\u00fa \u00fd hemoglobin.<\/li>\n<li>X\u00e9t nghi\u1ec7m creatinin v\u00e0 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1eadn.<\/li>\n<li>Bilan lipid m\u00e1u (LDL-C, cholesterol to\u00e0n ph\u1ea7n, HDL-C; Triglycerid).<\/li>\n<\/ul>\n<p>&#8211;\u00a0S\u00e0ng l\u1ecdc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd ho\u1eb7c \u0111\u00e3 c\u00f3 HCMVM v\u1edbi HbA1c, \u0111\u01b0\u1eddng m\u00e1u l\u00fac \u0111\u00f3i. Nghi\u1ec7m ph\u00e1p dung n\u1ea1p \u0111\u01b0\u1eddng n\u1ebfu HbA1c v\u00e0 \u0111\u01b0\u1eddng m\u00e1u l\u00fac \u0111\u00f3i kh\u00f4ng k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c.<\/p>\n<p>&#8211;\u00a0\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p n\u1ebfu l\u00e2m s\u00e0ng nghi ng\u1edd b\u1ec7nh l\u00fd tuy\u1ebfn gi\u00e1p.<\/p>\n<p><strong>2.3.2.\u00a0\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 v\u00e0 Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3<\/strong><\/p>\n<p>&#8211;\u00a0\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 l\u00fac ngh\u1ec9: Ch\u1ec9 \u0111\u1ecbnh cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n HCMVM<\/p>\n<ul>\n<li>C\u00f3 t\u1edbi &gt; 60% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh c\u00f3 \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u00ecnh th\u01b0\u1eddng.<\/li>\n<li>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 s\u00f3ng Q (ch\u1ee9ng t\u1ecf c\u00f3 NMCT c\u0169).<\/li>\n<li>M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n kh\u00e1c c\u00f3 ST ch\u00eanh xu\u1ed1ng, c\u1ee9ng, th\u1eb3ng \u0111u\u1ed7n.<\/li>\n<li>\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 c\u00f2n gi\u00fap ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng kh\u00e1c nh\u01b0 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, block nh\u00e1nh, h\u1ed9i ch\u1ee9ng ti\u1ec1n k\u00edch th\u00edch, r\u1ed1i lo\u1ea1n nh\u1ecbp, r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n\u2026<\/li>\n<\/ul>\n<p>&#8211;\u00a0\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 trong c\u01a1n \u0111au: C\u00f3 th\u1ec3 th\u1ea5y s\u1ef1 thay \u0111\u1ed5i s\u00f3ng T v\u00e0 \u0111o\u1ea1n ST (ST ch\u00eanh xu\u1ed1ng, s\u00f3ng T \u00e2m). Tuy nhi\u00ean, n\u1ebfu \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 b\u00ecnh th\u01b0\u1eddng c\u0169ng kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n c\u00f3 b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9.<\/p>\n<p>&#8211;\u00a0Thay \u0111\u1ed5i \u0111o\u1ea1n ST trong c\u01a1n nh\u1ecbp nhanh tr\u00ean th\u1ea5t kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c xem nh\u01b0 b\u1eb1ng ch\u1ee9ng b\u1ec7nh l\u00fd \u0110MV.<\/p>\n<p>&#8211;\u00a0Khuy\u1ebfn c\u00e1o ESC 2019 v\u1ec1 theo d\u00f5i Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3:<\/p>\n<ul>\n<li>Khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c v\u00e0 nghi ng\u1edd r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/li>\n<li>N\u00ean xem x\u00e9t \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd co th\u1eaft \u0110MV.<\/li>\n<\/ul>\n<p>Kh\u00f4ng n\u00ean th\u1ef1c hi\u1ec7n nh\u01b0 th\u0103m d\u00f2 th\u01b0\u1eddng quy \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd h\u1ed9i ch\u1ee9ng \u0110MV m\u1ea1n<\/p>\n<figure id=\"attachment_30394\" aria-describedby=\"caption-attachment-30394\" style=\"width: 485px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-30394\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/dien-tam-do.jpg\" alt=\"\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n.\" width=\"485\" height=\"198\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/dien-tam-do.jpg 485w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/dien-tam-do-300x122.jpg 300w\" sizes=\"(max-width: 485px) 100vw, 485px\" \/><figcaption id=\"caption-attachment-30394\" class=\"wp-caption-text\"><strong>\u0110i\u1ec7n t\u00e2m \u0111\u1ed3 b\u1ec7nh nh\u00e2n h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n.<\/strong><\/figcaption><\/figure>\n<p>.<em>C\u00f3 ST d\u1eb9t, th\u1eb3ng \u0111u\u1ed7n t\u1ea1i c\u00e1c chuy\u1ec3n \u0111\u1ea1o DII, DIII, aVF v\u00e0 V4-V6.<\/em><\/p>\n<p><strong>2.3.3.\u00a0X-quang tim ph\u1ed5i th\u1eb3ng<\/strong><\/p>\n<p>&#8211;\u00a0X-quang gi\u00fap \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 gi\u00e3n c\u00e1c bu\u1ed3ng tim, \u1ee9 tr\u1ec7 tu\u1ea7n ho\u00e0n ph\u1ed5i ho\u1eb7c \u0111\u1ec3 ph\u00e2n bi\u1ec7t v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n<p>&#8211;\u00a0Khuy\u1ebfn c\u00e1o X-quang ng\u1ef1c cho b\u1ec7nh nh\u00e2n l\u00e2m s\u00e0ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh, c\u00f3 d\u1ea5u hi\u1ec7u\/tri\u1ec7u ch\u1ee9ng suy tim ho\u1eb7c nghi ng\u1edd b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p.<\/p>\n<p><strong>2.3.4.\u00a0Si\u00eau \u00e2m tim<\/strong><\/p>\n<p>&#8211;\u00a0Si\u00eau \u00e2m Doppler tim v\u00e0 2D qua th\u00e0nh ng\u1ef1c \u0111\u00e1nh gi\u00e1 c\u1ea5u tr\u00fac v\u00e0 ch\u1ee9c n\u0103ng tim, gi\u00fap ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t v\u1edbi m\u1ed9t s\u1ed1 b\u1ec7nh tim kh\u00e1c c\u0169ng c\u00f3 th\u1ec3 g\u00e2y \u0111au ng\u1ef1c (h\u1eb9p kh\u00edt van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i c\u00f3 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i, vi\u00eam m\u00e0ng ngo\u00e0i tim,&#8230;)<\/p>\n<p>&#8211;\u00a0\u0110\u00e1nh gi\u00e1 v\u00f9ng thi\u1ebfu m\u00e1u c\u01a1 tim (gi\u1ea3m v\u1eadn \u0111\u1ed9ng v\u00f9ng) khi si\u00eau \u00e2m tim, c\u00f3 th\u1ec3 ti\u1ebfn h\u00e0nh trong c\u01a1n \u0111au ng\u1ef1c ho\u1eb7c ngay sau c\u01a1n \u0111au ng\u1ef1c.<\/p>\n<p>&#8211;\u00a0Si\u00eau \u00e2m Doppler m\u00f4 v\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ee9c c\u0103ng c\u01a1 tim c\u0169ng c\u00f3 th\u1ec3 gi\u00fap ph\u00e1t hi\u1ec7n suy tim v\u1edbi EF b\u1ea3o t\u1ed3n, gi\u1ea3i th\u00edch cho nh\u1eefng tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn g\u1eafng s\u1ee9c c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n<p>&#8211;\u00a0Si\u00eau \u00e2m tim g\u1eafng s\u1ee9c v\u1edbi g\u1eafng s\u1ee9c th\u1ec3 l\u1ef1c (\u0111\u1ea1p xe, th\u1ea3m ch\u1ea1y) ho\u1eb7c d\u00f9ng thu\u1ed1c (dobutamine), gi\u00fap ch\u1ea9n \u0111o\u00e1n r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng thi\u1ebfu m\u00e1u c\u01a1 tim ho\u1eb7c kh\u1ea3 n\u0103ng ph\u1ee5c h\u1ed3i c\u01a1 tim. Hi\u1ec7n nay, v\u1edbi c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n m\u00e1y si\u00eau \u00e2m hi\u1ec7n \u0111\u1ea1i th\u1ebf h\u1ec7 m\u1edbi \u0111\u00e3 gi\u00fap ph\u01b0\u01a1ng ph\u00e1p si\u00eau \u00e2m tim g\u1eafng s\u1ee9c tr\u1edf th\u00e0nh m\u1ed9t th\u0103m d\u00f2 r\u1ea5t \u0111\u00e1ng tin c\u1eady trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0110MV.nh\u01b0 th\u0103m d\u00f2 th\u01b0\u1eddng quy \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd h\u1ed9i ch\u1ee9ng \u0110MV m\u1ea1n.<\/p>\n<p>&nbsp;<\/p>\n<p>Ngu\u1ed3n : B\u1ed9 Y t\u1ebf (2020) &#8211; Th\u1ef1c h\u00e0nh ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/p>\n","protected":false},"excerpt":{"rendered":"<p>1. GI\u1edaI THI\u1ec6U 1.1. \u0110\u1ecbnh ngh\u0129a, thu\u1eadt ng\u1eef H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n\u00a0(Chronic coronary syndrome) l\u00e0 thu\u1eadt ng\u1eef m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a ra t\u1ea1i H\u1ed9i Ngh\u1ecb Tim M\u1ea1ch Ch\u00e2u \u00c2u (ESC) 2019, thay cho t\u00ean g\u1ecdi tr\u01b0\u1edbc \u0111\u00e2y l\u00e0 \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh, b\u1ec7nh \u0110MV \u1ed5n \u0111\u1ecbnh, b\u1ec7nh [&hellip;]<\/p>\n","protected":false},"author":58,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,7,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Ch\u1ea9n \u0111o\u00e1n H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (P1) - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n\u00a0(Chronic coronary syndrome) l\u00e0 thu\u1eadt ng\u1eef m\u1edbi \u0111\u01b0\u1ee3c \u0111\u01b0a ra t\u1ea1i H\u1ed9i Ngh\u1ecb Tim M\u1ea1ch Ch\u00e2u \u00c2u (ESC) 2019,\" \/>\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\u1ea9n \u0111o\u00e1n H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (P1) - 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