{"id":31675,"date":"2023-05-04T14:40:48","date_gmt":"2023-05-04T07:40:48","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31675"},"modified":"2023-05-04T16:32:50","modified_gmt":"2023-05-04T09:32:50","slug":"dac-diem-lam-sang-va-bien-chung-phinh-boc-tach-dong-mach-chu","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/dac-diem-lam-sang-va-bien-chung-phinh-boc-tach-dong-mach-chu\/","title":{"rendered":"\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 bi\u1ebfn ch\u1ee9ng ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7"},"content":{"rendered":"

Ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ea5p c\u1ee9u c\u00f3 \u0111\u1eb7c tr\u01b0ng l\u00e0 t\u00ecnh tr\u00e0ng r\u00e1ch l\u1edbp \u00e1o trong c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh n\u00ean m\u1ed9t l\u00f2ng m\u1ea1ch gi\u1ea3 – false channel. D\u01b0\u1edbi \u00e1p l\u1ef1c, m\u00e1u lu\u1ed3n v\u00e0o v\u1ebft r\u00e1ch v\u00e0 s\u1ebd b\u00f3c c\u00e1c l\u1edbp c\u1ee7a m\u1ea1ch m\u00e1u ra, t\u1ea1o n\u00ean c\u01a1n \u0111au d\u1eef d\u1ed9i, \u0111c b\u1ec7nh nh\u00e2n m\u00f4 t\u1ea3 l\u00e0 c\u01a1n \u0111au theo ki\u1ec3u x\u00e9 r\u00e1ch \u2013 tearing pain.<\/strong><\/p>\n

1. L\u00e2m s\u00e0ng<\/h2>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 d\u1ea5u hi\u1ec7u
\nB\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a \u0111au ng\u1ef1c. Tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c c\u00f3 th\u1ec3 c\u00f3 nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m sau:
\n\u2022 V\u1ecb tr\u00ed: c\u1ee7a tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c ph\u1ee5 thu\u1ed9c v\u00e0o v\u1ecb tr\u00ed c\u1ee7a b\u00f3c t\u00e1ch (c\u00f3 th\u1ec3 gi\u1ea3 tri\u1ec7u ch\u1ee9ng \u0111au c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim). C\u01a1n \u0111au n\u00e0y x\u1ea3y ra do s\u1ef1 gi\u00e1n \u0111o\u1ea1n c\u1ee7a d\u00f2ng m\u00e1u \u0111\u1ebfn c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u00e2y ra t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u (th\u01b0\u1eddng l\u00e0 khi cung ho\u1eb7c g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ecb \u1ea3nh h\u01b0\u1edfng) \u0110au th\u01b0\u1eddng kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t v\u00e0 n\u1eb7ng ngay khi kh\u1edfi ph\u00e1t khi so v\u1edbi tri\u1ec7u ch\u1ee9ng \u0111au trong nh\u1ed3i m\u00e1u c\u01a1 tim. B\u00f3c t\u00e1ch kh\u00f4ng \u0111au g\u1eb7p \u1edf 10% b\u1ec7nh nh\u00e2n.
\n\u2022 Kh\u1edfi ph\u00e1t: \u0111\u1ed9t ng\u1ed9t
\n\u2022 \u0110\u1eb7c \u0111i\u1ec3m: c\u01a1n \u0111au nh\u01b0 x\u00e9 (n\u1ebfu \u0111au nh\u01b0 x\u00e9 gi\u1eefa hai b\u1ea3 vai th\u00ec th\u01b0\u1eddng l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi).
\n\u2022 H\u01b0\u1edbng lan: lan ra sau l\u01b0ng v\u00e0\/ho\u1eb7c gi\u1eefa hai vai. C\u00f3 th\u1ec3 lan l\u00ean c\u1ed5 ho\u1eb7c c\u1eb1m (th\u01b0\u1eddng l\u00e0 khi b\u00f3c t\u00e1ch cung \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 r\u1ed3i lan ra c\u00e1c nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7)
\n\u2022 M\u1ee9c \u0111\u1ed9: th\u01b0\u1eddng l\u00e0 n\u1eb7ng ngay ban \u0111\u1ea7u (c\u00f3 th\u1ec3 nh\u1eb9 \u1edf m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p).<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh<\/strong> sau c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n (20 %):
\n\u2022 Ng\u1ea5t (do gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u, r\u1ed1i lo\u1ea1n nh\u1ecbp, t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a d\u00e2y ph\u1ebf v\u1ecb
\n\u2022 Thay \u0111\u1ed5i tr\u1ea1ng th\u00e1i nh\u1eadn th\u1ee9c
\n\u2022 \u0110\u1ed9t qu\u1ef5 (bi\u1ebfn c\u1ed1 tim m\u1ea1ch) \u2013 y\u1ebfu ho\u1eb7c li\u1ec7t n\u1eeda ng\u01b0\u1eddi k\u00e8m v\u1edbi d\u1ecb c\u1ea3m n\u1eeda ng\u01b0\u1eddi
\n\u2022 Thay \u0111\u1ed5i ch\u1ee9c n\u0103ng c\u1ea3m gi\u00e1c v\u00e0 ch\u1ee9c n\u0103ng v\u1eadn \u0111\u1ed9ng c\u00f3 th\u1ec3 x\u1ea3y ra n\u1ebfu nh\u01b0 c\u00e1c d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean b\u1ecb \u1ea3nh h\u01b0\u1edfng do thi\u1ebfu m\u00e1u
\n\u2022 Kh\u00e0n gi\u1ecdng c\u00f3 th\u1ec3 do ch\u00e8n \u00e9p v\u00e0o d\u00e2y th\u1ea7n kinh thanh qu\u1ea3n
\nNgo\u00e0i ra, c\u00e1c nh\u00f3m tri\u1ec7u ch\u1ee9ng kh\u00e1c c\u00f3 th\u1ec3 x\u1ea3y ra d\u1ecdc theo \u0111\u01b0\u1eddng b\u00f3c t\u00e1ch.<\/p>\n

C\u00e1c tri\u1ec7u ch\u1ee9ng tim m\u1ea1ch<\/strong>: C\u00f3 th\u1ec3 g\u00e2y ch\u00e8n \u00e9p van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p n\u1eb7ng d\u1eabn \u0111\u1ebfn suy tim sung huy\u1ebft th\u1ee9 ph\u00e1t. D\u1eabn \u0111\u1ebfn kh\u00f3 th\u1edf khi n\u1eb1m v\u00e0 kh\u00f3 th\u1edf.
\n\u2022 T\u0103ng huy\u1ebft \u00e1p: b\u1ec7nh n\u1ec1n l\u00e0 t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c gia t\u0103ng catecholamine trong tu\u1ea7n ho\u00e0n.
\n\u2022 Huy\u1ebft \u00e1p t\u1ee5t: l\u00e0 m\u1ed9t d\u1ea5u hi\u1ec7u ti\u00ean l\u01b0\u1ee3ng n\u1eb7ng c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a ch\u00e8n \u00e9p tim, gi\u1ea3m th\u1ec3 t\u00edch m\u00e1u ho\u1eb7c gia t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a th\u1ea7n kinh ph\u1ebf v\u1ecb.<\/p>\n

* C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a ch\u00e8n \u00e9p th\u1ef1c qu\u1ea3n<\/strong>: kh\u00f3 nu\u1ed1t.
\n\u2022 \u0110au b\u1ee5ng: khi x\u1ea3y ra \u1edf \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 b\u1ee5ng
\n\u2022 \u0110au v\u00f9ng m\u1ea1n s\u01b0\u1eddn: do b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch th\u1eadn.
\n\u2022 C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n: b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n c\u1ee7a b\u1ec7nh l\u00fd to\u00e0n th\u00e2n c\u00f3 li\u00ean quan \u0111\u1ebfn b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 c\u00f3 th\u1ec3 do \u0111\u00f3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ngo\u1ea1i bi\u00ean, nhi\u1ec5m tr\u00f9ng, h\u1ed9i ch\u1ee9ng Marfan, ho\u1eb7c h\u1ed9i ch\u1ee9ng Ehler-Danlos.<\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c<\/strong>\u1ee7a b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7:<\/p>\n

Huy\u1ebft \u00e1p kh\u00f4ng \u0111\u1ec1u \u1edf hai tay, th\u01b0\u1eddng ch\u00eanh >20mmHg gi\u1eefa tay ph\u1ea3i v\u00e0 tay tr\u00e1i do b\u00f3c t\u00e1ch g\u00e2y t\u1eafc ngh\u1ebdn c\u00e1c nh\u00e1nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n\u2022 H\u1edf ch\u1ee7 \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi bi\u1ec3u hi\u1ec7n m\u1ea1ch d\u1ed9i \u2013\u00a0 hi\u1ec7u \u00e1p r\u1ed9ng >50mmHg, ti\u1ebfng th\u1ed5i (th\u00ec t\u00e2m tr\u01b0\u01a1ng).
\n\u2022 C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a suy tim sung huy\u1ebft th\u1ee9 ph\u00e1t do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van ch\u1ee7 nghi\u00eam tr\u1ecdng, v\u1edbi bi\u1ec3u hi\u1ec7n c\u1ee7a kh\u00f3 th\u1edf khi n\u1eb1m, kh\u00f3 th\u1edf, t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ed5, ran hai \u0111\u00e1y ph\u1ed5i.
\n\u2022 C\u00f3 kh\u1ea3 n\u0103ng kh\u00f4ng c\u00f2n t\u1ec9nh t\u00e1o.
\n\u2022 Ch\u00e8n \u00e9p tim v\u1edbi c\u00e1c \u0111\u1eb7c tr\u01b0ng \u0111\u00f3 l\u00e0 t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, t\u1ee5t huy\u1ebft \u00e1p, m\u1ea1ch ngh\u1ecbch l\u00fd, d\u1ea5u Kussmaul.
\n\u2022 T\u1eafc ngh\u1ebdn t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean (hi\u1ebfm g\u1eb7p) c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn h\u1ed9i ch\u1ee9ng t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean.
\n\u2022 C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a \u0111\u1ed9t qu\u1ef5 – th\u00e2n m\u00ecnh \u0111\u1ed5 v\u1ec1 m\u1ed9t b\u00ean
\n\u2022 B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n shock: l\u1ea1nh, t\u00edm t\u00e1i, m\u1ea1ch nhanh v\u00e0 th\u1edf nhanh<\/p>\n

\u2022 H\u1ed9i ch\u1ee9ng Horner c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n do ch\u00e8n \u00e9p giao c\u1ea3m c\u1ed5<\/p>\n

C\u1ea3m gi\u00e1c t\u00ea v\u00e0 ki\u1ebfn b\u00f2 \u1edf chi tr\u00ean v\u00e0 chi d\u01b0\u1edbi do tthi\u1ebfu m\u00e1u ngo\u1ea1i vi.
\n\u2022 Ti\u1ebfng th\u1ed5i t\u00e2m tr\u01b0\u01a1ng m\u1edbi v\u00e0\/ho\u1eb7c m\u1ea1ch kh\u00f4ng \u0111\u1ed1i x\u1ee9ng.
\n\u2022 C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a tr\u00e0n m\u00e0u m\u00e0ng ph\u1ed5i n\u1ebfu nh\u01b0 v\u1ee1 m\u1ea1ch m\u00e1u ch\u1ea3y v\u00e0o khoang m\u00e0ng
\nph\u1ed5i, bi\u1ec3u hi\u1ec7n c\u1ee7a th\u1edf nhanh n\u00f4ng, \u0111au nh\u00f3 ki\u1ec3u m\u00e0ng ph\u1ed5i.
\n\u2022 Thi\u1ebfu m\u00e1u \u0111\u1ed9ng m\u1ea1ch c\u1ea5p \u1edf chi d\u01b0\u1edbi ho\u1eb7c \u1edf chi tr\u00ean, bi\u1ec3u hi\u1ec7n c\u1ee7a m\u1ea1ch y\u1ebfu, t\u00edm t\u00e1i, nhi\u1ec7t \u0111\u1ed9 c\u01a1 th\u1ec3 th\u1ea5p, gi\u1ea3m c\u1ea3m gi\u1eafc, d\u1ecb c\u1ea3m, m\u1ea5t c\u1ea3m gi\u00e1c.
\n\u2022 C\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a b\u1ec7nh l\u00fd m\u00f4 li\u00ean k\u1ebft nh\u01b0 c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a h\u1ed9i ch\u1ee9ng Marfan ho\u1eb7c h\u1ed9i<\/a>
\nch\u1ee9ng Ehler-Danlos.<\/p>\n

2. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/h2>\n

B\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u00f3 th\u1ec3 g\u00e2y ra c\u00e1c bi\u1ebfn ch\u1ee9ng sau:<\/p>\n

T\u1ee5t huy\u1ebft \u00e1p v\u00e0 shock (gi\u1ea3m th\u1ec3 t\u00edch) th\u1eadm ch\u00ed c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong do m\u1ea5t m\u00e1u
\n\u2022 T\u00e0n t\u1eadt v\u0129nh vi\u1ec5n do \u0111\u1ed9t qu\u1ef5
\n\u2022 H\u1edf ch\u1ee7 c\u1ea5p d\u1eabn \u0111\u1ebfn b\u00f3c t\u00e1ch \u0111o\u1ea1n g\u1ea7n lan \u0111\u1ebfn xoang Valsalva v\u00e0 g\u1ed1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.
\n\u2022 Ph\u00f9 ph\u1ed5i do h\u1edf ch\u1ee7 c\u1ea5p
\n\u2022 Ch\u00e8n \u00e9p tim do tr\u00e0n m\u00e1u v\u00e0o khang ngo\u00e0i m\u00e0ng tim.
\n\u2022 Thi\u1ebfu m\u00e1u c\u01a1 tim do gi\u1ea3m d\u00f2ng m\u00e1u \u0111\u1ebfn c\u00e1c \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.
\n\u2022 H\u1edf ch\u1ee7
\n\u2022 Nh\u1ed3i m\u00e1u c\u01a1 tim
\n\u2022 Thi\u1ebfu m\u00e1u to\u00e0n c\u01a1 th\u1ec3 v\u00ed d\u1ee5 m\u1ea1c treo ru\u1ed9t, th\u1eadn, t\u1ee7y s\u1ed1ng, thi\u1ebfu m\u00e1u\/nh\u1ed3i m\u00e1u t\u1ea1ng. Ch\u00e8n \u00e9p c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu bao g\u1ed3m c\u00f3 th\u1ef1c qu\u1ea3n, t\u0129nh m\u1ea1ch ch\u1ee7 tr\u00ean, h\u1ea1ch th\u1ea7n kinh (h\u1ed9i ch\u1ee9ng Horner do ch\u00e8n \u00e9p h\u1ea1ch giao c\u1ea3m), \u0111\u01b0\u1eddng th\u1edf, v\u00e0 th\u1ea7n kinh qu\u1eb7t ng\u01b0\u1ee3c thanh qu\u1ea3n tr\u00e1i (kh\u00e0n gi\u1ecdng v\u00e0 li\u1ec7t d\u00e2y thanh).
\n\u2022 Ph\u1ed3ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/p>\n

\"boc<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong> B\u1ec7nh H\u1ecdc Tim M\u1ea1ch Lecturio<\/p>\n","protected":false},"excerpt":{"rendered":"

Ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ea5p c\u1ee9u c\u00f3 \u0111\u1eb7c tr\u01b0ng l\u00e0 t\u00ecnh tr\u00e0ng r\u00e1ch l\u1edbp \u00e1o trong c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 d\u1eabn \u0111\u1ebfn h\u00ecnh th\u00e0nh n\u00ean m\u1ed9t l\u00f2ng m\u1ea1ch gi\u1ea3 – false channel. D\u01b0\u1edbi \u00e1p l\u1ef1c, m\u00e1u lu\u1ed3n v\u00e0o v\u1ebft r\u00e1ch v\u00e0 s\u1ebd b\u00f3c c\u00e1c l\u1edbp c\u1ee7a m\u1ea1ch m\u00e1u […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\n\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 bi\u1ebfn ch\u1ee9ng ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 - Vinmec<\/title>\n<meta name=\"description\" content=\"ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd c\u1ea5p c\u1ee9u c\u00f3 \u0111\u1eb7c tr\u01b0ng l\u00e0 t\u00ecnh tr\u00e0ng r\u00e1ch l\u1edbp \u00e1o trong c\u1ee7a \u0111\u1ed9ng m\u1ea1ch ch\u1ee7\" \/>\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=\"\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 bi\u1ebfn ch\u1ee9ng ph\u00ecnh b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 - 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