{"id":30943,"date":"2023-05-07T00:41:46","date_gmt":"2023-05-06T17:41:46","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=30943"},"modified":"2023-05-07T00:41:46","modified_gmt":"2023-05-06T17:41:46","slug":"chan-doan-hoi-chung-dong-mach-vanh-man-p2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/07\/chan-doan-hoi-chung-dong-mach-vanh-man-p2\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (P2)"},"content":{"rendered":"

Theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2019, chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c c\u00f3 nghi ng\u1edd b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u1ed3m 6 b\u01b0\u1edbc (thay cho 3 b\u01b0\u1edbc ti\u1ebfp c\u1eadn trong ESC 2013):<\/p>\n

\"B\u01b0\u1edbc
B\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (Theo ESC 2019)<\/figcaption><\/figure>\n

1. \u0110\u00e1nh gi\u00e1 tri\u1ec7u ch\u1ee9ng v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/strong><\/h3>\n

–\u00a0Khai th\u00e1c ti\u1ec1n s\u1eed b\u1ec7nh l\u00fd tim m\u1ea1ch v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1.<\/p>\n

–\u00a0\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u01a1n \u0111au th\u1eaft ng\u1ef1c: C\u00f3 ph\u1ea3i c\u01a1n \u0111au th\u1eaft ng\u1ef1c ki\u1ec3u m\u1ea1ch v\u00e0nh kh\u00f4ng, \u0111i\u1ec3n h\u00ecnh hay ko \u0111i\u1ec3n h\u00ecnh, \u1ed5n \u0111\u1ecbnh hay kh\u00f4ng \u1ed5n \u0111\u1ecbnh.<\/p>\n

–\u00a0Ph\u00e2n bi\u1ec7t \u0111au ng\u1ef1c do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c: Thi\u1ebfu m\u00e1u, huy\u1ebft \u00e1p cao, b\u1ec7nh l\u00fd van tim, b\u1ec7nh l\u00fd m\u00e0ng ngo\u00e0i tim, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, c\u00e1c r\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n

–\u00a0Ch\u00fa \u00fd ph\u00e2n bi\u1ec7t t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u do h\u1eb9p \u0110MV th\u01b0\u1ee3ng t\u00e2m m\u1ea1c v\u00e0 co th\u1eaft \u0110MV hay b\u1ec7nh vi m\u1ea1ch. Khi tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111i\u1ec3n h\u00ecnh th\u00ec c\u00f3 th\u1ec3 c\u1ea7n l\u00e0m th\u00eam nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u01a1 tim hay h\u00ecnh \u1ea3nh h\u1ecdc \u0110MV.<\/p>\n

N\u1ebfu \u0111\u00e1nh gi\u00e1 l\u00e0 c\u01a1n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh th\u00ec x\u1eed tr\u00ed nh\u01b0 v\u1edbi h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng v\u00e0nh c\u1ea5p. N\u1ebfu lo\u1ea1i tr\u1eeb ho\u1eb7c kh\u00f4ng ngh\u0129 \u0111\u1ebfn th\u00ec chuy\u1ec3n ti\u1ebfp qua b\u01b0\u1edbc 2<\/em>.<\/p>\n

2. \u0110\u00e1nh gi\u00e1 c\u00e1c b\u1ec7nh l\u00fd ph\u1ed1i h\u1ee3p v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng<\/strong><\/h3>\n

–\u00a0Tr\u01b0\u1edbc khi ti\u1ebfn h\u00e0nh b\u1ea5t k\u1ef3 th\u0103m d\u00f2 g\u00ec c\u1ea7n \u0111\u00e1nh gi\u00e1 t\u1ed5ng quan b\u1ec7nh nh\u00e2n v\u1ec1 t\u00ecnh h\u00ecnh s\u1ee9c kh\u1ecfe n\u00f3i chung, g\u00e1nh n\u1eb7ng b\u1ec7nh t\u1eadt k\u00e8m theo v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. N\u1ebfu kh\u1ea3 n\u0103ng ch\u1ee5p v\u00e0 t\u00e1i th\u00f4ng \u0110MV kh\u00f4ng \u0111em l\u1ea1i l\u1ee3i \u00edch th\u00ec n\u00ean h\u1ea1n ch\u1ebf c\u00e1c th\u0103m d\u00f2 s\u00e2u h\u01a1n v\u00e0 c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/p>\n

–\u00a0N\u1ebfu kh\u00f4ng ph\u1ea3i \u0111au th\u1eaft ng\u1ef1c do b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh th\u00ec c\u00f3 th\u1ec3 l\u00e0m th\u00eam c\u00e1c th\u0103m d\u00f2 \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0111au ng\u1ef1c do c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c nh\u01b0 d\u1ea1 d\u00e0y ru\u1ed9t, h\u00f4 h\u1ea5p, c\u01a1 x\u01b0\u01a1ng kh\u1edbp. Tuy nhi\u00ean, c\u00e1c b\u1ec7nh nh\u00e2n n\u00e0y v\u1eabn n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 nguy c\u01a1 tim m\u1ea1ch t\u1ed5ng th\u1ec3 (v\u00ed d\u1ee5 theo thang \u0111i\u1ec3m SCORE).<\/p>\n

3. Th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng<\/strong><\/h3>\n

C\u00e1c th\u0103m d\u00f2 c\u01a1 b\u1ea3n v\u1edbi b\u1ec7nh nh\u00e2n nghi ng\u1edd c\u00f3 b\u1ec7nh l\u00fd \u0111\u1ed9ng m\u1ea1ch v\u00e0nh bao g\u1ed3m: Sinh h\u00f3a m\u00e1u, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 l\u00fac ngh\u1ec9, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 24 gi\u1edd (n\u1ebfu c\u1ea7n), si\u00eau \u00e2m tim, X-quang ng\u1ef1c.<\/p>\n

4. \u0110\u00e1nh gi\u00e1 x\u00e1c su\u1ea5t ti\u1ec1n nghi\u1ec7m (PTP) v\u00e0 kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/strong><\/h3>\n

4.1. \u0110\u00e1nh gi\u00e1 x\u00e1c su\u1ea5t ti\u1ec1n nghi\u1ec7m (PTP)<\/strong><\/h4>\n

Tr\u01b0\u1edbc khi l\u00e0m th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng (test) ch\u1ea9n \u0111o\u00e1n b\u1ec7nh, c\u1ea7n d\u1ef1 b\u00e1o kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng nh\u01b0: T\u00ednh ch\u1ea5t \u0111au th\u1eaft ng\u1ef1c c\u00f3 \u0111i\u1ec3n h\u00ecnh hay kh\u00f4ng, gi\u1edbi, tu\u1ed5i v\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch \u0111i k\u00e8m<\/p>\n

\u0110\u00e1nh gi\u00e1 x\u00e1c su\u1ea5t ti\u1ec1n nghi\u1ec7m (PTP) \u1edf b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c (theo ESC 2019)<\/em><\/strong><\/p>\n\n\n\n\n\n\n\n\n\n
<\/td>\n\u0110au th\u1eaft ng\u1ef1c \u0111i\u1ec3n h\u00ecnh<\/strong><\/td>\n\u0110au th\u1eaft ng\u1ef1c kh\u00f4ng \u0111i\u1ec3n h\u00ecnh<\/strong><\/td>\nKh\u00f4ng ph\u1ea3i \u0111au th\u1eaft ng\u1ef1c<\/strong><\/td>\nKh\u00f3 th\u1edf<\/strong><\/td>\n<\/tr>\n
Tu\u1ed5i<\/strong><\/td>\nNam<\/td>\nN\u1eef<\/td>\nNam<\/td>\nN\u1eef<\/td>\nNam<\/td>\nN\u1eef<\/td>\nNam<\/td>\nN\u1eef<\/td>\n<\/tr>\n
30 \u2013 39<\/strong><\/td>\n3%<\/td>\n5%<\/td>\n4%<\/td>\n3%<\/td>\n1%<\/td>\n1%<\/td>\n0%<\/td>\n3%<\/td>\n<\/tr>\n
40 \u2013 49<\/strong><\/td>\n22%<\/td>\n10%<\/td>\n10%<\/td>\n6%<\/td>\n3%<\/td>\n2%<\/td>\n12%<\/td>\n3%<\/td>\n<\/tr>\n
50 \u2013 59<\/strong><\/td>\n32%<\/td>\n13%<\/td>\n17%<\/td>\n6%<\/td>\n11%<\/td>\n3%<\/td>\n20%<\/td>\n9%<\/td>\n<\/tr>\n
60 \u2013 69<\/strong><\/td>\n44%<\/td>\n16%<\/td>\n26%<\/td>\n11%<\/td>\n22%<\/td>\n6%<\/td>\n27%<\/td>\n14%<\/td>\n<\/tr>\n
70+<\/strong><\/td>\n52%<\/td>\n27%<\/td>\n34%<\/td>\n19%<\/td>\n24%<\/td>\n10%<\/td>\n32%<\/td>\n12%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*PTP: Pre-test probability (X\u00e1c su\u1ea5t ti\u1ec1n nghi\u1ec7m)<\/em><\/p>\n

    \n
  • Nh\u00f3m c\u00f3 PTP > 15%:\u00a0<\/strong>L\u1ef1a ch\u1ecdn c\u00e1c th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n ph\u00f9 h\u1ee3p nh\u1ea5t (s\u01a1 \u0111\u1ed3 11.6).<\/li>\n
  • Nh\u00f3m c\u00f3 PTP t\u1eeb 5 – 15%:\u00a0<\/strong>C\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n kh\u00f4ng x\u00e2m l\u1ea5n c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc sau khi x\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (xem th\u00eam \u1edf ph\u1ea7n sau).<\/li>\n
  • Nh\u00f3m c\u00f3 PTP < 5%:\u00a0<\/strong>D\u1ef1 b\u00e1o kh\u1ea3 n\u0103ng th\u1ea5p m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh, c\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n kh\u00f4ng x\u00e2m l\u1ea5n ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n khi c\u00f3 l\u00fd do kh\u00e1c b\u1eaft bu\u1ed9c (v\u00ed d\u1ee5 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt).<\/li>\n<\/ul>\n

    4.2. Kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh<\/strong><\/h4>\n

    X\u00e1c su\u1ea5t m\u1eafc \u0110MV t\u0103ng l\u00ean khi s\u1ef1 c\u00f3 m\u1eb7t c\u00e1c\u00a0y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch\u00a0<\/em><\/strong>(ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc b\u1ec7nh tim m\u1ea1ch, r\u1ed1i lo\u1ea1n lipid m\u00e1u, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, t\u0103ng huy\u1ebft \u00e1p, h\u00fat thu\u1ed1c v\u00e0 y\u1ebfu t\u1ed1 l\u1ed1i s\u1ed1ng kh\u00e1c).<\/p>\n

    D\u1ef1a tr\u00ean tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng k\u1ebft h\u1ee3p v\u1edbi: C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch, thay \u0111\u1ed5i \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 khi ngh\u1ec9, v\u00f4i h\u00f3a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00ean CLVT… gi\u00fap b\u1ed5 sung \u01b0\u1edbc \u0111o\u00e1n b\u1ec7nh \u0110MV ch\u00ednh x\u00e1c h\u01a1n khi so s\u00e1nh v\u1edbi PTP (tu\u1ed5i, gi\u1edbi v\u00e0 tri\u1ec7u ch\u1ee9ng) \u0111\u01a1n thu\u1ea7n.<\/p>\n

    \"X\u00e1c
    X\u00e1c \u0111\u1ecbnh kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (theo ESC 2019)<\/figcaption><\/figure>\n

    5. L\u1ef1a ch\u1ecdn th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n ph\u00f9 h\u1ee3p<\/strong><\/h3>\n
    \"L\u1ef1a
    L\u1ef1a ch\u1ecdn th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n nghi ng\u1edd m\u1eafc b\u1ec7nh \u0110MV<\/figcaption><\/figure>\n

    (T\u00f9y thu\u1ed9c v\u00e0o \u0111i\u1ec1u ki\u1ec7n t\u1ea1i khu v\u1ef1c, ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 b\u1eaft \u0111\u1ea7u t\u1eeb 1 trong 3 l\u1ef1a ch\u1ecdn: Th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n, ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0110MV ho\u1eb7c ch\u1ee5p \u0110MV x\u00e2m l\u1ea5n. Qua m\u1ed7i l\u1ef1a ch\u1ecdn, nh\u1eefng th\u00f4ng tin v\u1ec1 gi\u1ea3i ph\u1eabu v\u00e0 ch\u1ee9c n\u0103ng \u0111\u01b0\u1ee3c gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00e0 l\u1ef1a ch\u1ecdn chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb.)<\/em><\/p>\n

    L\u1ef1a ch\u1ecdn th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u d\u1ef1a tr\u00ean kh\u1ea3 n\u0103ng m\u1eafc b\u1ec7nh \u0110MV v\u00e0 \u0111\u1eb7c \u0111i\u1ec3m b\u1ec7nh nh\u00e2n, kinh nghi\u1ec7m trung t\u00e2m, t\u00ednh s\u1eb5n c\u00f3 c\u1ee7a th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng. Khuy\u1ebfn c\u00e1o ESC 2019 nh\u1ea5n m\u1ea1nh \u0111\u1ebfn vai tr\u00f2 quan tr\u1ecdng c\u1ee7a th\u0103m d\u00f2 h\u00ecnh \u1ea3nh kh\u00f4ng x\u00e2m l\u1ea5n, c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng ngay t\u1eeb \u0111\u1ea7u khi nghi ng\u1edd b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

    –\u00a0C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng th\u0103m d\u00f2 h\u00ecnh \u1ea3nh, ch\u1ee9c n\u0103ng kh\u00f4ng x\u00e2m l\u1ea5n (si\u00eau \u00e2m g\u1eafng s\u1ee9c, c\u1ed9ng h\u01b0\u1edfng t\u1eeb, PET-CT…) ho\u1eb7c ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh \u0110MV nh\u01b0 l\u00e0 th\u0103m d\u00f2 ban \u0111\u1ea7u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0110MV \u1edf b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng m\u00e0 kh\u00f4ng th\u1ec3 lo\u1ea1i tr\u1eeb b\u1ec7nh \u0110MV b\u1eb1ng \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng \u0111\u01a1n thu\u1ea7n.<\/strong><\/p>\n

    –\u00a0Ch\u1ee5p CLVT \u0110MV n\u00ean xem x\u00e9t nh\u01b0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u1ed5n th\u01b0\u01a1ng gi\u1ea3i ph\u1eabu \u0110MV, khi c\u00e1c bi\u1ec7n ph\u00e1p kh\u00f4ng x\u00e2m l\u1ea5n kh\u00e1c kh\u00f4ng ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c.<\/p>\n

    –\u00a0Ch\u1ee5p \u0110MV qua da: L\u00e0 bi\u1ec7n ph\u00e1p ch\u1ea9n \u0111o\u00e1n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng cao m\u1eafc b\u1ec7nh \u0110MV, tri\u1ec7u ch\u1ee9ng n\u1eb7ng kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c v\u1edbi \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa ho\u1eb7c \u0111au ng\u1ef1c \u0111i\u1ec3n h\u00ecnh khi g\u1eafng s\u1ee9c nh\u1eb9 v\u00e0 \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng cho th\u1ea5y nguy c\u01a1 bi\u1ebfn c\u1ed1 cao.<\/p>\n

    –\u00a0\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh x\u00e2m l\u1ea5n (v\u00ed d\u1ee5 nh\u01b0 FFR): C\u1ea7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 thi\u1ebfu m\u00e1u c\u01a1 tim tr\u01b0\u1edbc khi t\u00e1i th\u00f4ng \u0110MV, tr\u1eeb khi h\u1eb9p n\u1eb7ng (h\u1eb9p > 90% \u0111\u01b0\u1eddng k\u00ednh \u0110MV).<\/p>\n

    –\u00a0Tr\u01b0\u1eddng h\u1ee3p ch\u1ea9n \u0111o\u00e1n \u0110MV kh\u00f4ng ch\u1eafc ch\u1eafn v\u1edbi c\u00e1c th\u0103m d\u00f2 kh\u00f4ng x\u00e2m l\u1ea5n, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc ch\u1ee5p v\u00e0 \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng \u0110MV x\u00e2m l\u1ea5n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n.<\/p>\n

    –\u00a0Kh\u00f4ng khuy\u1ebfn c\u00e1o ch\u1ee5p CLVT \u0110MV khi: V\u00f4i h\u00f3a m\u1ea1ch v\u00e0nh lan t\u1ecfa, nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u, b\u00e9o ph\u00ec, kh\u00f4ng th\u1ec3 ph\u1ed1i h\u1ee3p n\u00edn th\u1edf ho\u1eb7c b\u1ea5t k\u1ef3 t\u00ecnh tr\u1ea1ng n\u00e0o \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng h\u00ecnh \u1ea3nh.<\/p>\n

    –\u00a0C\u1ea7n l\u01b0u \u00fd v\u00f4i h\u00f3a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ph\u00e1t hi\u1ec7n tr\u00ean c\u1eaft l\u1edbp vi t\u00ednh kh\u00f4ng \u0111\u1ed3ng ngh\u0129a b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

    \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 g\u1eafng s\u1ee9c:\u00a0<\/strong>Vai tr\u00f2 trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb gi\u1ea3m xu\u1ed1ng so v\u1edbi h\u01b0\u1edbng d\u1eabn ESC n\u0103m 2013, nh\u01b0ng l\u00e0 x\u00e9t nghi\u1ec7m quan tr\u1ecdng gi\u00fap \u0111\u00e1nh gi\u00e1 dung n\u1ea1p v\u1edbi g\u1eafng s\u1ee9c tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

    –\u00a0Gi\u00fap \u0111\u00e1nh gi\u00e1 dung n\u1ea1p g\u1eafng s\u1ee9c, tri\u1ec7u ch\u1ee9ng, r\u1ed1i lo\u1ea1n nh\u1ecbp, \u0111\u00e1p \u1ee9ng huy\u1ebft \u00e1p v\u00e0 nguy c\u01a1 bi\u1ebfn c\u1ed1 c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

    –\u00a0C\u00f3 th\u1ec3 xem x\u00e9t nh\u01b0 th\u0103m d\u00f2 thay th\u1ebf \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh\/lo\u1ea1i tr\u1eeb b\u1ec7nh \u0110MV khi kh\u00f4ng c\u00f3 s\u1eb5n c\u00e1c ph\u01b0\u01a1ng ph\u00e1p C\u0110HA kh\u00f4ng x\u00e2m l\u1ea5n.<\/p>\n

    –\u00a0Xem x\u00e9t \u1edf b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng v\u00e0 thi\u1ebfu m\u00e1u c\u01a1 tim.<\/p>\n

    –\u00a0Kh\u00f4ng khuy\u1ebfn c\u00e1o \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u1edf b\u1ec7nh nh\u00e2n v\u1edbi ST ch\u00eanh xu\u1ed1ng \u2265 0,1 mV tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 khi ngh\u1ec9 ho\u1eb7c khi \u0111ang \u0111i\u1ec1u tr\u1ecb Digitalis.<\/p>\n

    6. \u0110i\u1ec1u tr\u1ecb theo tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u00e2n t\u1ea7ng nguy c\u01a1<\/strong><\/h3>\n

    Ph\u00e2n t\u1ea7ng nguy c\u01a1 gi\u00fap \u0111\u01b0a ra th\u00e1i \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb th\u00edch h\u1ee3p v\u00e0 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh. Nh\u1eefng b\u1ec7nh nh\u00e2n thu\u1ed9c nh\u00f3m nguy c\u01a1 cao (t\u1ec9 l\u1ec7 t\u1eed vong tim m\u1ea1ch > 3%\/n\u0103m) l\u00e0 nh\u1eefng ng\u01b0\u1eddi s\u1ebd \u0111\u01b0\u1ee3c h\u01b0\u1edfng l\u1ee3i nhi\u1ec1u nh\u1ea5t khi ti\u1ebfn h\u00e0nh ch\u1ee5p v\u00e0 t\u00e1i th\u00f4ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

    \u0110\u1ecbnh ngh\u0129a nguy c\u01a1 cao \u0111\u1ed1i v\u1edbi c\u00e1c ph<\/strong>\u01b0<\/strong>\u01a1ng ph\u00e1p th\u0103m d\u00f2 b\u1ec7nh nh\u00e2n m<\/strong>\u1eaf<\/strong>c b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n<\/strong><\/p>\n\n\n\n\n\n\n\n\n
    \u0110T\u0110 g\u1eafng s\u1ee9c<\/strong><\/td>\nT\u1eed vong tim m\u1ea1ch > 3%\/n\u0103m theo thang \u0111i\u1ec3m Duke.<\/td>\n<\/tr>\n
    SPECT\/PET<\/strong><\/td>\nV\u00f9ng thi\u1ebfu m\u00e1u c\u01a1 tim > 10%.<\/td>\n<\/tr>\n
    Si\u00eau \u00e2m tim g\u1eafng s\u1ee9c<\/strong><\/td>\nGi\u1ea3m ho\u1eb7c kh\u00f4ng v\u1eadn \u0111\u1ed9ng \u2265 3\/16 v\u00f9ng c\u01a1 tim khi g\u1eafng s\u1ee9c.<\/td>\n<\/tr>\n
    CHT tim<\/strong><\/td>\nGi\u1ea3m t\u01b0\u1edbi m\u00e1u \u2265 2\/16 v\u00f9ng c\u01a1 tim khi g\u1eafng s\u1ee9c ho\u1eb7c \u22653 v\u00f9ng r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng khi d\u00f9ng dobutamine.<\/td>\n<\/tr>\n
    Ch\u1ee5p CLVT \u0110MV ho\u1eb7c ch\u1ee5p \u0110MV qua da<\/strong><\/td>\nB\u1ec7nh 3 th\u00e2n \u0110MV c\u00f3 h\u1eb9p \u0111o\u1ea1n g\u1ea7n, t\u1ed5n th\u01b0\u01a1ng LM ho\u1eb7c \u0111o\u1ea1n g\u1ea7n LAD.<\/td>\n<\/tr>\n
    Th\u0103m d\u00f2 ch\u1ee9c n\u0103ng x\u00e2m l\u1ea5n<\/strong><\/td>\nFFR < 0,8; iwFR < 0,89.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Ch\u00fa th\u00edch: \u0110T\u0110: \u0110i\u1ec7n t\u00e2m \u0111\u1ed3, CHT: C\u1ed9ng h\u01b0\u1edfng t\u1eeb,<\/em><\/p>\n

    CLVT: C\u1eaft l\u1edbp vi t\u00ednh, \u0110MV: \u0110\u1ed9ng m\u1ea1ch v\u00e0nh,<\/em><\/p>\n

    SPECT: Ch\u1ee5p c\u1eaft l\u1edbp b\u1eb1ng b\u1ee9c x\u1ea1 \u0111\u01a1n photon, PET: C\u1eaft l\u1edbp ph\u00e1t x\u1ea1 Positron,<\/em><\/p>\n

    FFR: Ph\u00e2n su\u1ea5t d\u1ef1 tr\u1eef l\u01b0u l\u01b0\u1ee3ng m\u1ea1ch v\u00e0nh, iwFR: Instantaneous wave-free ratio.<\/em><\/p>\n

     <\/p>\n

    Ngu\u1ed3n : B\u1ed9 Y t\u1ebf (2020) – 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":"

    Theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2019, chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c c\u00f3 nghi ng\u1edd b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u1ed3m 6 b\u01b0\u1edbc (thay cho 3 b\u01b0\u1edbc ti\u1ebfp c\u1eadn trong ESC 2013): 1. \u0110\u00e1nh gi\u00e1 tri\u1ec7u ch\u1ee9ng v\u00e0 th\u0103m kh\u00e1m l\u00e2m s\u00e0ng h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh –\u00a0Khai th\u00e1c ti\u1ec1n s\u1eed b\u1ec7nh […]<\/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":"\nCh\u1ea9n \u0111o\u00e1n H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n (P2) - Vinmec<\/title>\n<meta name=\"description\" content=\"Theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2019, chi\u1ebfn l\u01b0\u1ee3c ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c c\u00f3 nghi ng\u1edd b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u1ed3m 6 b\u01b0\u1edbc\" \/>\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 (P2) - 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