{"id":30090,"date":"2023-05-01T22:54:27","date_gmt":"2023-05-01T15:54:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30090"},"modified":"2023-05-01T22:54:27","modified_gmt":"2023-05-01T15:54:27","slug":"benh-co-tim-phi-dai-va-chan-doan-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/benh-co-tim-phi-dai-va-chan-doan-lam-sang\/","title":{"rendered":"B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng"},"content":{"rendered":"

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/a> \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 t\u0103ng \u0111\u1ed9 d\u00e0y b\u1ea5t th\u01b0\u1eddng (ph\u00ec \u0111\u1ea1i) c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng g\u00e1nh huy\u1ebft \u0111\u1ed9ng, t\u1ef7 l\u1ec7 b\u1ec7nh l\u00e0 1:500 d\u00e2n. \u0110\u00e2y l\u00e0 lo\u1ea1i b\u1ec7nh l\u00fd c\u01a1 tim \u0111a d\u1ea1ng c\u1ea3 v\u1ec1 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, c\u1ea5u tr\u00fac tim v\u00e0 di\u1ec5n bi\u1ebfn t\u1ef1 nhi\u00ean.<\/strong><\/p>\n

1.\u0110\u1ecbnh ngh\u0129a<\/h2>\n

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 t\u0103ng \u0111\u1ed9 d\u00e0y b\u1ea5t th\u01b0\u1eddng (ph\u00ec \u0111\u1ea1i) c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i <\/strong>m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng g\u00e1nh huy\u1ebft \u0111\u1ed9ng, t\u1ef7 l\u1ec7 b\u1ec7nh l\u00e0 1:500 d\u00e2n. \u0110\u00e2y l\u00e0 lo\u1ea1i b\u1ec7nh l\u00fd c\u01a1 tim \u0111a d\u1ea1ng c\u1ea3 v\u1ec1 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, c\u1ea5u tr\u00fac tim v\u00e0 di\u1ec5n bi\u1ebfn t\u1ef1 nhi\u00ean. \u0110a s\u1ed1 ng\u01b0\u1eddi m\u1eafc c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n g\u1ea7n nh\u01b0 b\u00ecnh th\u01b0\u1eddng trong su\u1ed1t cu\u1ed9c \u0111\u1eddi, tuy nhi\u00ean b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i \u0111\u01b0\u1ee3c ghi nh\u1eadn l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ed9t t\u1eed do tim li\u00ean quan \u0111\u1ebfn g\u1eafng s\u1ee9c ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf ng\u01b0\u1eddi d\u01b0\u1edbi 35 tu\u1ed5i.<\/p>\n

2. Y\u1ebfu t\u1ed1 di truy\u1ec1n<\/h2>\n

B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i di truy\u1ec1n d\u1ecb h\u1ee3p t\u1eed <\/strong>alen ho\u1eb7c kh\u00f4ng alen, v\u1edbi nhi\u1ec1u \u0111\u1ed9t bi\u1ebfn tr\u00ean \u00edt nh\u1ea5t 12 gen m\u00e3 h\u00f3a cho c\u00e1c protein co c\u1ee7a \u0111\u01a1n v\u1ecb cO c\u01a1 (sarcomere). \u0110a s\u1ed1 c\u00e1c \u0111\u1ed9t bi\u1ebfn (> 70%) n\u1eb1m \u1edf gen m\u00e3 h\u00f3a chu\u1ed7i n\u1eb7ng P-myosin, troponin T v\u00e0 protein C g\u1eafn myosin.<\/p>\n

3. Sinh l\u00fd b\u1ec7nh<\/h2>\n

H\u00ecnh \u1ea3nh \u0111\u1eb7c tr\u01b0ng v\u1ec1 m\u1eb7t \u0111\u1ea1i th\u1ec3 c\u1ee7a b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i l\u00e0 ph\u00ec \u0111\u1ea1i kh\u1ed1i c\u01a1 th\u1ea5t tr\u00e1i<\/em>, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t \u1edf v\u00e1ch li\u00ean th\u1ea5t trong ki\u1ec3u ph\u00ec \u0111\u1ea1i l\u1ec7ch t\u00e2m, nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p \u1edf b\u1ea5t k\u1ef3 ki\u1ec3u h\u00ecnh n\u00e0o, bao g\u1ed3m ph\u00ec \u0111\u1ea1i c\u01a1 th\u1ea5t tr\u00e1i \u0111\u1ed3ng t\u00e2m t\u01b0\u01a1ng t\u1ef1 nh\u01b0 b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, ho\u1eb7c ph\u00ec \u0111\u1ea1i khu tr\u00fa \u1edf 1 – 2 v\u00f9ng c\u01a1 tim.<\/p>\n

M\u1ee9c \u0111\u1ed9 ph\u00ec \u0111\u1ea1i <\/strong>c\u0169ng r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 r\u1ea5t n\u1eb7ng (> 30 mm) ho\u1eb7c r\u1ea5t nh\u1eb9 (13 – 15 mm). C\u00e1c b\u1ea5t th\u01b0\u1eddng n\u00e0y khi ph\u1ed1i h\u1ee3p v\u1edbi nhau s\u1ebd bi\u1ec3u hi\u1ec7n th\u00e0nh:<\/p>\n

    \n
  • T\u0103ng co b\u00f3p tim th\u00ec t\u00e2m thu.<\/li>\n
  • T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i do s\u1ef1 v\u1eadn \u0111\u1ed9ng ra ph\u00eda tr\u01b0\u1edbc c\u1ee7a van hai l\u00e1 trong th\u00ec t\u00e2m thu (d\u1ea5u hi\u1ec7u SAM) xu\u1ea5t hi\u1ec7n \u1edf 25% c\u00e1c b\u1ec7nh nh\u00e2n khi ngh\u1ec9 nh\u01b0ng l\u00ean t\u1edbi 70% khi g\u1eafng s\u1ee9c.<\/li>\n
  • R\u1ed1i lo\u1ea1n qu\u00e1 tr\u00ecnh th\u01b0 gi\u00e3n c\u01a1 tim v\u00e0 t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y th\u1ea5t. Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim.<\/li>\n<\/ul>\n

    Nguy c\u01a1 \u0111\u1ed9t t\u1eed <\/strong>do nh\u1ecbp nhanh tr\u00ean th\u1ea5t nguy hi\u1ec3m ho\u1eb7c nh\u1ecbp nhanh th\u1ea5t\/rung th\u1ea5t.<\/p>\n

    4. Tri\u1ec7u ch\u1ee9ng<\/h2>\n

    C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i (m\u1ecfm tim \u0111\u1eadp m\u1ea1nh, \u0111\u1eadp l\u1ec7ch tr\u00e1i, ti\u1ebfng T4). T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n b\u1eb1ng ti\u1ebfng T2 t\u00e1ch \u0111\u00f4i \u1edf m\u1ecfm tim, ti\u1ebfng th\u1ed5i t\u00e2m thu b\u1eaft \u0111\u1ea7u t\u1eeb gi\u1eefa th\u00ec t\u00e2m thu v\u00e0 thay \u0111\u1ed5i khi l\u00e0m nghi\u1ec7m ph\u00e1p Valsalva ho\u1eb7c ng\u1ed3i x\u1ed5m. Ti\u1ebfng th\u1ed5i to\u00e0n t\u00e2m thu do h\u1edf van hai l\u00e1 (SAM).<\/p>\n

    5. Kh\u00e1m th\u1ef1c th\u1ec3<\/h2>\n

    C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i (m\u1ecfm tim \u0111\u1eadp m\u1ea1nh, \u0111\u1eadp l\u1ec7ch tr\u00e1i, ti\u1ebfng T4). T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n b\u1eb1ng ti\u1ebfng T2 t\u00e1ch \u0111\u00f4i \u1edf m\u1ecfm tim, ti\u1ebfng th\u1ed5i t\u00e2m thu b\u1eaft \u0111\u1ea7u t\u1eeb gi\u1eefa th\u00ec t\u00e2m thu v\u00e0 thay \u0111\u1ed5i khi l\u00e0m nghi\u1ec7m ph\u00e1p Valsalva ho\u1eb7c ng\u1ed3i x\u1ed5m. Ti\u1ebfng th\u1ed5i to\u00e0n t\u00e2m thu do h\u1edf van hai l\u00e1 (SAM).<\/p>\n

    6. C\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n<\/h2>\n

    6.1 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/h3>\n
      \n
    • B\u1ea5t th\u01b0\u1eddng tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 g\u1eb7p \u1edf > 95% s\u1ed1 ca b\u1ec7nh. Ti\u00eau chu\u1ea9n Sokolow-Lyon \u0111\u01a1n \u0111\u1ed9c ch\u1ec9 g\u1eb7p \u1edf 2% c\u00e1c ca. C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 bao g\u1ed3m: B\u1ea5t th\u01b0\u1eddng \u0111o\u1ea1n ST v\u00e0 s\u00f3ng T.<\/li>\n
    • Ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i v\u1edbi \u0111i\u1ec3m Romhilt – Estes > 5, ch\u1ec9 s\u1ed1 Sokolow > 50<\/li>\n
    • S\u00f3ng Q b\u1ec7nh l\u00fd t\u1ea1i c\u00e1c v\u00f9ng chuy\u1ec3n \u0111\u1ea1o d\u01b0\u1edbi v\u00e0 b\u00ean (do ph\u00ec \u0111\u1ea1i v\u00e1ch li\u00ean th\u1ea5t).<\/li>\n
    • S\u00f3ng T \u00e2m s\u00e2u (\u0111\u1eb7c bi\u1ec7t \u1edf c\u00e1c chuy\u1ec3n \u0111\u1ea1o v\u00f9ng tr\u01b0\u1edbc v\u00e0 d\u01b0\u1edbi trong b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u00f9ng m\u1ecfm).<\/li>\n
    • \u0110o\u1ea1n PR ng\u1eafn v\u00e0 h\u1ed9i ch\u1ee9ng Wolff – Parkinson – White (WPW).<\/li>\n
    • Block nh\u0129 th\u1ea5t Ngo\u1ea1i t\u00e2m thu th\u1ea5t. Rung nh\u0129.<\/li>\n<\/ul>\n

      6.2 Si\u00eau \u00e2m tim<\/h3>\n

      Si\u00eau \u00e2m tim v\u0201n l\u00e0 th\u0103m d\u00f2 ti\u00eau chu\u1ea9n v\u00e0ng do t\u00ednh ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i. Si\u00eau \u00e2m tim gi\u00fap x\u00e1c \u0111\u1ecbnh, \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 v\u00e0 v\u1ecb tr\u00ed v\u00f9ng th\u1ea5t tr\u00e1i ph\u00ec \u0111\u1ea1i c\u0169ng nh\u01b0 t\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i. C\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1eb7c tr\u01b0ng tr\u00ean si\u00eau \u00e2m tim bao g\u1ed3m:<\/p>\n

        \n
      • Ph\u00ec \u0111\u1ea1i l\u1ec7ch t\u00e2m \u1edf v\u00f9ng v\u00e1ch li\u00ean th\u1ea5t (> 15 mm): V\u00e1ch li\u00ean th\u1ea5t ph\u00ec \u0111\u1ea1i nhi\u1ec1u so v\u1edbi th\u00e0nh sau th\u1ea5t tr\u00e1i, gi\u1ea3m v\u1eadn \u0111\u1ed9ng v\u00e1ch li\u00ean th\u1ea5t. Tuy nhi\u00ean, b\u1ea5t k\u1ef3 ki\u1ec3u h\u00ecnh ph\u00ec \u0111\u1ea1i n\u00e0o c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p.<\/li>\n
      • Bu\u1ed3ng th\u1ea5t tr\u00e1i nh\u1ecf.<\/li>\n
      • D\u1ea5u hi\u1ec7u SAM (Systolic Anterior Motion): S\u1ef1 di chuy\u1ec3n ra tr\u01b0\u1edbc c\u1ee7a van hai l\u00e1 trong th\u00ec t\u00e2m thu.<\/li>\n
      • \u0110\u00f3ng van \u0110M ch\u1ee7 gi\u1eefa t\u00e2m thu v\u00e0 rung c\u00e1nh van \u0110M ch\u1ee7.<\/li>\n<\/ul>\n

        \"B\u1ec7nh<\/p>\n

        B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i<\/strong><\/p>\n

        T\u1eafc ngh\u1ebdn \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i: <\/strong>Ch\u00eanh \u00e1p qua \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i \u2265 30 mmHg l\u00fac ngh\u1ec9 ho\u1eb7c khi l\u00e0m c\u00e1c nghi\u1ec7m ph\u00e1p \u0111\u1ed9ng nh\u01b0 nghi\u1ec7m ph\u00e1p Valsalva. Ch\u00eanh \u00e1p<\/u> <\/em>\u2265 50 mmHg \u0111\u01b0\u1ee2c coi l\u00e0 ng\u01b0\u1ee1ng c\u00f3 \u00fd ngh\u0129a quan tr\u1ecdng v\u1ec1 m\u1eb7t huy\u1ebft \u0111\u1ed9ng. N\u1ebfu ch\u00eanh \u00e1p qua \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i < 50 mmHg k\u1ec3 c\u1ea3 khi l\u00e0m nghi\u1ec7m ph\u00e1p \u0111\u1ed9ng, c\u1ea7n ch\u1ec9 \u0111\u1ecbnh si\u00eau \u00e2m tim g\u1eafng s\u1ee9c.<\/p>\n

        Si\u00eau \u00e2m tim g\u1eafng s\u1ee9c<\/strong>: \u0110\u01b0\u1ee3c \u00e1p d\u1ee5ng trong tr\u01b0\u1eddng h\u1ee3p si\u00eau \u00e2m tim l\u00fac ngh\u1ec9 ng\u01a1i ho\u1eb7c khi l\u00e0m nghi\u1ec7m ph\u00e1p Valsalva c\u00f3 ch\u00eanh \u00e1p \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i < 50 mmHg nh\u01b0ng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u00ean l\u00e2m s\u00e0ng. N\u1ebfu ch\u00eanh \u00e1p \u0111\u01b0\u1eddng ra th\u1ea5t tr\u00e1i \u2265 50 mmHg <\/em>th\u00ec c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb l\u00e0m m\u1ecfng v\u00e1ch li\u00ean th\u1ea5t. (Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng dobutamine do g\u00e2y gi\u1ea3m k\u00edch th\u01b0\u1edbc th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu v\u00e0 t\u0103ng ch\u00eanh \u00e1p trong bu\u1ed3ng th\u1ea5t).<\/p>\n

        Si\u00eau \u00e2m tim c\u1ea3n \u00e2m <\/strong>v\u1edbi c\u00e1c ch\u1ea5t c\u1ea3n \u00e2m si\u00eau nh\u1ecf ti\u00eam t\u0129nh m\u1ea1ch: \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i khu tr\u00fa \u1edf v\u00f9ng m\u1ecfm ho\u1eb7c ph\u00ec \u0111\u1ea1i th\u00e0nh b\u00ean th\u1ea5t tr\u00e1i kh\u00f3 quan s\u00e1t tr\u00ean si\u00eau \u00e2m th\u01b0\u1eddng quy. \u1ede b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c can thi\u1ec7p l\u00e0m m\u1ecfng v\u00e1ch li\u00ean th\u1ea5t b\u1eb1ng c\u1ed3n, si\u00eau \u00e2m tim v\u1edbi b\u1ecdt c\u1ea3n \u00e2m ti\u00eam v\u00e0o m\u1ea1ch v\u00e0nh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u00ednh x\u00e1c v\u1ecb tr\u00ed ti\u00eam c\u1ed3n.<\/p>\n

        Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n<\/p>\n

        \u0110\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p si\u00eau \u00e2m tim th\u00e0nh ng\u1ef1c qu\u00e1 m\u1edd. L\u00e0 ph\u01b0\u01a1ng ti\u1ec7n thay th\u1ebf v\u00e0 b\u1ed5 tr\u1ee3 cho ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim.<\/p>\n

        Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n k\u1ebft h\u1ee3p ti\u00eam ch\u1ea5t c\u1ea3n \u00e2m v\u00e0o \u0111\u1ed9ng m\u1ea1ch v\u00e0nh \u0111\u1ec3 h\u01b0\u1edbng d\u0201n can thi\u1ec7p l\u00e0m m\u1ecfng v\u00e1ch li\u00ean th\u1ea5t b\u1eb1ng c\u1ed3n, trong tr\u01b0\u1eddng h\u1ee3p si\u00eau \u00e2m tim th\u00e0nh ng\u1ef1c qu\u00e1 m\u1edd \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh trong th\u1ee7 thu\u1eadt can thi\u1ec7p v\u00e1ch li\u00ean th\u1ea5t b\u1eb1ng c\u1ed3n.<\/p>\n

        6.3 Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/h3>\n

        Ch\u1ee5p CHT tim \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch \u0111\u1ec3 ph\u00e1t hi\u1ec7n b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i khu tr\u00fa v\u00f9ng m\u1ecfm, \u0111\u00e1nh gi\u00e1 th\u00e0nh t\u1ef1 do v\u00f9ng tr\u01b0\u1edbc b\u00ean c\u0169ng nh\u01b0 ph\u00e1t hi\u1ec7n s\u1eb9o c\u01a1 tim v\u00e0 x\u01a1 h\u00f3a c\u01a1 tim.<\/p>\n

        6.4 C\u00e1c th\u0103m d\u00f2 kh\u00e1c<\/h3>\n

        C\u00e1c th\u0103m d\u00f2 kh\u00e1c gi\u00fap ph\u00e2n t\u1ea7ng nguy c\u01a1 <\/em>cho b\u1ec7nh nh\u00e2n b\u1ecb b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i. Kh\u00f4ng c\u00f3 th\u0103m d\u00f2 \u0111\u01a1n l\u1ebb n\u00e0o gi\u00fap ti\u00ean l\u01b0\u1ee3ng ch\u00ednh x\u00e1c nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 \u0111\u1ed9t t\u1eed, c\u00e1c nghi\u1ec7m ph\u00e1p \u00e2m t\u00ednh c\u0169ng kh\u00f4ng cho ph\u00e9p lo\u1ea1i tr\u1eeb ho\u00e0n to\u00e0n nguy c\u01a1 \u0111\u1ed9t t\u1eed.<\/p>\n

        Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3: <\/strong>Ph\u00e1t hi\u1ec7n c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp nh\u01b0 nh\u1ecbp nhanh th\u1ea5t, rung nh\u0129. Nh\u1ecbp nhanh th\u1ea5t kh\u00f4ng b\u1ec1n b\u1ec9 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 \u0111\u1ed9t t\u1eed do tim.<\/p>\n

        Nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c <\/strong>(v\u1edbi thu\u1ed1c, th\u1ea3m ch\u1ea1y, xe \u0111\u1ea1p l\u1ef1c k\u1ebf): \u0110\u00e1nh gi\u00e1 kh\u1ea3 n\u0103ng g\u1eafng s\u1ee9c v\u00e0 \u0111\u00e1p \u1ee9ng huy\u1ebft \u00e1p v\u1edbi g\u1eafng s\u1ee9c. N\u1ebfu \u0111\u00e1p \u1ee9ng huy\u1ebft \u00e1p \u201cph\u1eb3ng\u201d (Huy\u1ebft \u00e1p t\u00e2m thu t\u0103ng < 25 mmHg t\u1eeb l\u00fac ngh\u1ec9 cho t\u1edbi \u0111\u1ec9nh g\u1eafng s\u1ee9c ho\u1eb7c c\u00f3 t\u1ee5t huy\u1ebft \u00e1p t\u00e2m thu ngh\u1ecbch th\u01b0\u1eddng trong khi g\u1eafng s\u1ee9c) l\u00e0 m\u1ed9t ch\u1ec9 d\u1ea5u c\u1ee7a \u0111\u1ed9t t\u1eed.<\/p>\n

        Th\u00f4ng tim <\/strong>kh\u00f4ng c\u00f3 vai tr\u00f2 trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i m\u1eb7c d\u00f9 c\u00f3 th\u1ec3 c\u1ea7n ch\u1ee5p \u0110MV ki\u1ec3m tra \u1edf b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi l\u1edbn nh\u1eb1m lo\u1ea1i tr\u1eeb b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m theo.<\/p>\n","protected":false},"excerpt":{"rendered":"

        B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 s\u1ef1 t\u0103ng \u0111\u1ed9 d\u00e0y b\u1ea5t th\u01b0\u1eddng (ph\u00ec \u0111\u1ea1i) c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng g\u00e1nh huy\u1ebft \u0111\u1ed9ng, t\u1ef7 l\u1ec7 b\u1ec7nh l\u00e0 1:500 d\u00e2n. \u0110\u00e2y l\u00e0 lo\u1ea1i b\u1ec7nh l\u00fd c\u01a1 tim \u0111a d\u1ea1ng c\u1ea3 v\u1ec1 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng, […]<\/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":"\nB\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i l\u00e0 s\u1ef1 t\u0103ng \u0111\u1ed9 d\u00e0y b\u1ea5t th\u01b0\u1eddng c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i m\u00e0 kh\u00f4ng gi\u1ea3i th\u00edch \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng t\u0103ng g\u00e1nh huy\u1ebft \u0111\u1ed9ng.\" \/>\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=\"B\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i v\u00e0 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng - 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