{"id":31865,"date":"2023-05-05T17:38:55","date_gmt":"2023-05-05T10:38:55","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31865"},"modified":"2023-05-05T17:38:55","modified_gmt":"2023-05-05T10:38:55","slug":"ho-van-dong-mach-chu-dac-diem-lam-sang-va-can-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/ho-van-dong-mach-chu-dac-diem-lam-sang-va-can-lam-sang\/","title":{"rendered":"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng"},"content":{"rendered":"

H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (hay h\u1edf ch\u1ee7), l\u00e0 b\u1ec7nh l\u00fd van tim \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng kh\u00f4ng ho\u00e0n to\u00e0n, d\u1eabn \u0111\u1ebfn th\u1ee5t ng\u01b0\u1ee3c d\u00f2ng m\u00e1u t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (\u0110MC) v\u1ec1 l\u1ea1i th\u1ea5t tr\u00e1i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng. C\u00f3 th\u1ec3 di\u1ec5n ra c\u1ea5p, d\u1eabn \u0111\u1ebfn suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i m\u1ea5t b\u00f9 c\u1ea5p nh\u01b0 trong tr\u01b0\u1eddng h\u1ee3p b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/a>, ho\u1eb7c m\u1ea1n t\u00ednh, c\u00f3 th\u1ec3 kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng trong m\u1ed9t th\u1eddi gian d\u00e0i.<\/strong><\/p>\n

1. L\u00e2m s\u00e0ng h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/h2>\n

1.1. C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p<\/strong>
\n– Kh\u00f3 th\u1edf n\u1eb7ng \u0111\u1ed9t ng\u1ed9t
\n– Suy tim tr\u00e1i m\u1ea5t b\u00f9 di\u1ec5n ra nhanh v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng ph\u00f9 ph\u1ed5i.<\/p>\n

1.2 C\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1edf ch\u1ee7 m\u1ea1n t\u00ednh<\/strong>
\n\u2022 C\u01a1 th\u1ec3 c\u00f3 th\u1ec3 \u201cdung n\u1ea1p\u201d v\u1edbi t\u00ecnh tr\u1ea1ng h\u1edf ch\u1ee7 m\u1ea1n trong v\u00e0i ch\u1ee5c n\u0103m v\u00e0 duy tr\u00ec t\u00ecnh tr\u1ea1ng kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng.
\n\u2022 C\u00e1c tri\u1ec7u ch\u1ee9ng ban \u0111\u1ea7u th\u01b0\u1eddng l\u00e0 c\u1ea3m gi\u00e1c h\u1ed3i h\u1ed9p
\n\u2022 V\u1edbi b\u1ec7nh l\u00fd ti\u1ebfn tri\u1ec3n, th\u1ec3 tr\u1ea1ng b\u1ec7nh nh\u00e2n gi\u1ea3m v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a suy th\u1ea5t tr\u00e1i bi\u1ec3u hi\u1ec7n:
\n\u2022 Kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c
\n\u2022 Kh\u00f3 th\u1edf khi n\u1eb1m
\n\u2022 R\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 ng\u1ea5t<\/p>\n

\u2022\u0110au th\u1eaft ng\u1ef1c do gi\u1ea3m t\u01b0\u1edbi m\u00e1u v\u00e0nh
\n\u2022 D\u1ec5 m\u1ec7t m\u1ecfi<\/p>\n

1.3 \u00a0Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/strong>
\n– H\u1edf van \u0110MC giai \u0111o\u1ea1n \u0111\u1ea7u kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, \u0111\u00f4i khi BN c\u00f3 h\u1ed3i h\u1ed9p, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c do tim t\u0103ng co b\u00f3p, hay do r\u1ed1i lo\u1ea1n nh\u1ecbp.
\n– Giai \u0111o\u1ea1n sau, khi th\u1ea5t tr\u00e1i gi\u00e3n n\u1edf nhi\u1ec1u v\u00e0 r\u1ed1i lo\u1ea1n co b\u00f3p s\u1ebd xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u00ecnh tr\u1ea1ng suy tim: kh\u00f3 th\u1edf \u0111i t\u1eeb nh\u1eb9 \u0111\u1ebfn n\u1eb7ng: kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, kh\u00f3 th\u1edf khi n\u1eb1m \u0111\u1ea7u th\u1ea5p, kh\u00f3 th\u1edf k\u1ecbch ph\u00e1t v\u1ec1 \u0111\u00eam, ph\u00f9 ph\u1ed5i c\u1ea5p.
\n– C\u00f3 th\u1ec3 do c\u01a1n \u0111au th\u1eaft ng\u1ef1c hay c\u01a1n \u0111au b\u1ee5ng c\u1ea5p do thi\u1ebfu m\u00e1u m\u1ea1c treo.
\n– Tri\u1ec7u ch\u1ee9ng ng\u1ea5t \u00edt khi x\u1ea3y ra.
\n1.4 . Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/strong>
\n* \u00a0\u00a0C\u00e1c d\u1ea5u hi\u1ec7u ngo\u1ea1i bi\u00ean
\n\u2022 Huy\u1ebft \u00e1p t\u1ed1i \u0111a tang v\u00e0 huy\u1ebft \u00e1p t\u1ed1i thi\u1ec3u gi\u1ea3m, l\u00e0m \u0111\u1ed9 c\u00e1ch bi\u1ec7t HA t\u0103ng g\u00e2y n\u00ean
\n\u2022 M\u1ea1ch Corrigan: m\u1ea1ch n\u1ea3y m\u1ea1nh, bi\u00ean \u0111\u1ed9 cao, ch\u00ecm nhanh.
\n\u2022 D\u1ea5u hi\u1ec7u Musset: \u0111\u1ea7u g\u1eadt g\u00f9 theo nh\u1ecbp \u0111\u1eadp c\u1ee7a tim.
\n\u2022 D\u1ea5u hi\u1ec7u m\u1ea1ch mao qu\u1ea3n Quinke \u1edf m\u00f3ng tay
\n\u2022 D\u1ea5u hi\u1ec7u Traube: nghe m\u1ea1ch \u0111\u1eadp m\u1ea1nh nh\u01b0 s\u00fang l\u1ee5c b\u1eafn \u1edf \u0110\u1ed9ng m\u1ea1ch \u0111\u00f9i.
\n\u2022 \u00c2m \u0111i\u1ec7u Duroziez: \u0111\u1ec3 \u1ed1ng nghe \u1edf \u0110\u1ed9ng m\u1ea1ch \u0111\u00f9i, \u1ea5n \u1edf tr\u00ean, nghe \u00e2m th\u1ed5i t\u00e2m thu, \u1ea5n \u1edf d\u01b0\u1edbi: nghe \u00e2m th\u1ed5i t\u00e2m tr\u01b0\u01a1ng.
\n\u2022 D\u1ea5u Hill: HAmax chi d\u01b0\u1edbi > HAmax chi tr\u00ean: tr\u00ean 60mmHg
\nC\u00e1c d\u1ea5u hi\u1ec7u ngo\u1ea1i bi\u00ean r\u00f5 trong tr\u01b0\u1eddng h\u1ee3p h\u1edf n\u1eb7ng v\u00e0 m\u00e3n.
\nTrong tr\u01b0\u1eddng h\u1ee3p h\u1edf van \u0110MC c\u1ea5p hay suy tim n\u1eb7ng c\u00f3 h\u1eb9p van \u0110MC \u0111i k\u00e8m: c\u00e1c d\u1ea5u hi\u1ec7u ngo\u1ea1i bi\u00ean kh\u00f4ng c\u00f3 hay kh\u00f4ng r\u00f5.
\n* \u00a0Kh\u00e1m tim
\n\u2022 Nh\u00ecn : M\u1ecfm tim l\u1ec7ch xu\u1ed1ng d\u01b0\u1edbi v\u00e0 sang tr\u00e1i.
\n\u2022 H\u00f5m tr\u00ean \u1ee9c v\u00e0 \u0110\u1ed9ng m\u1ea1ch c\u1ea3nh n\u1ea3y m\u1ea1nh.
\n\u2022 S\u1edd: m\u1ecfm tim n\u1ea3y m\u1ea1nh, bi\u00ean \u0111\u1ed9 cao, ch\u00ecm nhanh.
\n\u2022 Nghe: Nh\u1ecbp tim: \u0111\u1ec1u hay kh\u00f4ng \u0111\u1ec1u ( Ngo\u1ea1i t\u00e2m thu )<\/p>\n

T1: thay \u0111\u1ed5i .<\/strong>
\n– H\u1edf nh\u1eb9 : ch\u1ee9c n\u0103ng th\u1ea5t (T) c\u00f2n t\u1ed1t: T1 b\u00ecnh th\u01b0\u1eddng hay t\u0103ng l\u00ean do tim t\u0103ng \u0111\u1ed9ng.
\n– H\u1edf van \u0110MC n\u1eb7ng ho\u1eb7c suy tim \u1ee9 huy\u1ebft:<\/p>\n

T1 gi\u1ea3m c\u01b0\u1eddng \u0111\u1ed9
\nT2: h\u1edf n\u1eb7ng: A2 m\u1edd
\nP2: c\u00f3 th\u1ec3 t\u0103ng do t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i
\nT3 do t\u0103ng g\u00e1nh t\u00e2m tr\u01b0\u01a1ng ho\u1eb7c suy tim
\n\u0110\u00f4i khi c\u00f3 th\u1ec3 c\u00f3 T4
\n\u2022 Clic \u0111\u1ea7u t\u00e2m thu: do t\u0103ng l\u01b0\u1ee3ng m\u00e1u qua van \u0110MC l\u00e0m gi\u00e3n g\u1ed1c \u0110MC.
\n\u2022 \u00c2m th\u1ed5i:
\n– Th\u1eddi gian: \u0111\u1ea7u t\u00e2m tr\u01b0\u01a1ng, b\u1eaft \u0111\u1ea7u sau T2:
\n– V\u1ecb tr\u00ed:
\no T\u1ed5n th\u01b0\u01a1ng l\u00e1 van: nghe \u1edf li\u00ean s\u01b0\u1eddn III b\u1edd tr\u00e1i \u1ee9c
\no T\u1ed5n th\u01b0\u01a1ng g\u1ed1c van: nghe \u1edf li\u00ean s\u01b0\u1eddn II b\u1edd ph\u1ea3i \u1ee9c
\n– C\u01b0\u1eddng \u0111\u1ed9 2\/6 tr\u1edf l\u00ean
\n– \u00c2m s\u1eafc \u00eam d\u1ecbu.
\n– H\u01b0\u1edbng lan: lan d\u1ecdc b\u1edd (T) x.\u1ee9c xu\u1ed1ng m\u1ecfm.
\n– Nghi\u1ec7m ph\u00e1p:
\no Kh\u00f4ng c\u00f3 d\u1ea5u Carvallo
\no Ng\u1ed3i cu\u1ed1i ra tr\u01b0\u1edbc \u00e2m th\u1ed5i nghe r\u00f5 h\u01a1n
\no Nghi\u1ec7m ph\u00e1p Handgrip Exercise : \u00e2m th\u1ed5i nghe r\u00f5 h\u01a1n
\nTrong tr\u01b0\u1eddng h\u1ee3p Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m tr\u00f9ng l\u00e0m r\u00e1ch van hay van l\u1ed9n ng\u01b0\u1ee3c v\u00e0o trong: \u00e2m th\u1ed5i c\u00f3 t\u1ea7n s\u1ed1 cao, th\u00f4 r\u00e1p g\u1ecdi l\u00e0 \u00e2m th\u1ed5i \u00e2m nh\u1ea1c.
\n– Kh\u00f4ng d\u00f9ng c\u01b0\u1eddng \u0111\u1ed9 \u00e2m th\u1ed5i \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 m\u00e0 d\u00f9ng th\u1eddi gian
\no H\u1edf n\u1eb7ng: \u00e2m th\u1ed5i k\u00e9o d\u00e0i
\no H\u1edf c\u1ea5p t\u00ednh: \u00e2m th\u1ed5i ng\u1eafn
\n– Th\u01b0\u1eddng c\u00f3 \u00e2m th\u1ed5i t\u00e2m thu gi\u1eefa t\u00e2m thu \u0111i k\u00e8m do s\u1ef1 gia t\u0103ng l\u01b0\u1ee3ng m\u00e1u qua van \u0110MC: h\u1eb9p van \u0110MC c\u01a1 n\u0103ng, c\u01b0\u1eddng \u0111\u1ed9 thay \u0111\u1ed5i t\u1eeb 2\/6 \u0111\u1ebfn 4\/6.
\nDo d\u00f2ng ph\u1ee5t ng\u01b0\u1ee3c h\u1ea1n ch\u1ebf \u0111\u1ed9 m\u1edf r\u1ed9ng c\u1ee7a van 2 l\u00e1, m\u00e1u \u0111i qua l\u1ed7 van 2 l\u00e1 h\u1ea1n ch\u1ebf m\u1edf, c\u00f3 th\u1ec3 nghe \u0111\u01b0\u1ee3c ti\u1ebfng r\u00f9 t\u00e2m tr\u01b0\u01a1ng \u1edf m\u1ecfm: R\u00f9 Austin \u2013 Flint.<\/p>\n

2. C\u1eadn l\u00e2m s\u00e0ng<\/h2>\n

2.1. Xquang tim ph\u1ed5i th\u1eb3ng<\/strong>
\n– B\u00f3ng tim l\u1edbn
\n– Cung d\u01b0\u1edbi tr\u00e1i ph\u1ed3ng to do gi\u00e3n th\u1ea5t tr\u00e1i
\n– Quai \u0110MC gi\u00e3n r\u1ed9ng, c\u00f3 th\u1ec3 c\u00f3 v\u00f4i h\u00f3a quai \u0110MC.
\n– T\u0103ng tu\u1ea7n ho\u00e0n ph\u1ed5i do suy tim \u1ee9 huy\u1ebft.
\n2.2. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 ( ECG )<\/strong>
\n– D\u1ea5u hi\u1ec7u t\u0103ng g\u00e1nh t\u00e2m tr\u01b0\u01a1ng th\u1ea5t tr\u00e1i: S\u00f3ng q, R cao, T (+), ST ch\u00eanh l\u00ean l\u00f5m.
\n– N\u1ebfu c\u00f3 thi\u1ebfu m\u00e1u c\u01a1 tim \u0111i k\u00e8m: ST ch\u00eanh xu\u1ed1ng, T (-)
\n– Ph\u00e1t hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n.
\n2.3. Si\u00eau \u00e2m tim<\/strong><\/p>\n

\"ho-van-dong-mach-chu\"
\n2.3.1. Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c ( TTE )<\/strong>
\n– Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh h\u1edf van \u0110MC d\u1ef1a tr\u00ean d\u00f2ng ph\u1ee5t ng\u01b0\u1ee3c t\u1eeb \u0110MC v\u1ec1 th\u1ea5t tr\u00e1i.
\n– M\u00f4 t\u1ea3 sang th\u01b0\u01a1ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n.
\n– Ch\u1ea9n \u0111o\u00e1n m\u1ee9c \u0111\u1ed9 n\u1eb7ng nh\u1eb9 c\u1ee7a h\u1edf van \u0110MC d\u1ef1a tr\u00ean s\u1ef1 ph\u1ee5t ng\u01b0\u1ee3c c\u1ee7a d\u00f2ng h\u1edf:
\no \u0110\u1ed9 1: d\u00f2ng h\u1edf d\u01b0\u1edbi m\u00fat van 2 l\u00e1
\no \u0110\u1ed9 2: h\u1edf t\u1edbi m\u00fat van
\no \u0110\u1ed9 3: h\u1edf t\u1edbi nh\u00fa c\u01a1
\no \u0110\u1ed9 4: h\u1edf t\u1edbi m\u1ecfm tim
\n– \u0110\u00e1nh gi\u00e1 h\u00ecnh d\u1ea1ng, k\u00edch th\u01b0\u1edbc, ch\u1ee9c n\u0103ng c\u1ee7a c\u00e1c bu\u1ed3ng tim.<\/p>\n

2.3.2. Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n ( TEE )<\/strong>
\n– Khi h\u1edf van \u0110MC c\u1ea5p do b\u00f3c t\u00e1ch \u0110MC ng\u1ef1c.
\n– X\u00e1c \u0111\u1ecbnh r\u00f5 ng\u1ecf v\u00e0o b\u00f3c t\u00e1ch.
\n– B\u1ec7nh \u0110MC ng\u1ef1c k\u00e8m h\u1edf van \u0110MC: Ph\u00ecnh \u0110MC ng\u1ef1c, H\u1eb9p eo \u0110MC, B\u00f3c t\u00e1ch \u0110MC\u2026
\n2.4. Ch\u1ee5p c\u1eaft l\u1edbp ( CT Scan )<\/strong>
\nH\u1eefu \u00edch trong h\u1edf van \u0110MC do b\u00f3c t\u00e1ch: ch\u1ea9n \u0111o\u00e1n nhanh b\u00f3c t\u00e1ch v\u1edbi h\u00ecnh \u1ea3nh 2 l\u00f2ng c\u00f3 m\u1eadt \u0111\u1ed9 c\u1ea3n quang kh\u00e1c nhau, kh\u1ea3o s\u00e1t h\u1eb9p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m n\u1ebfu nghi ng\u1edd c\u00f3 B\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh k\u00e8m theo.
\n2.5 Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim ( CMR )<\/strong>
\nCh\u1ec9 \u0111\u1ecbnh trong tr\u01b0\u1eddng h\u1ee3p h\u00ecnh \u1ea3nh si\u00eau \u00e2m b\u1ecb h\u1ea1n ch\u1ebf kh\u00f4ng th\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c, l\u00fac \u0111\u00f3
\nCMR c\u00f3 th\u1ec3 kh\u1ea3o s\u00e1t k\u00edch th\u01b0\u1edbc v\u00e0 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i, \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 n\u0103ng h\u1edf ch\u1ee7.
\n2.6 Ch\u1ee5p m\u1ea1ch m\u00e1u ( DSA )<\/strong>
\nCh\u1ec9 \u0111\u1ecbnh khi c\u00e1c ph\u01b0\u01a1ng ti\u1ec7n kh\u00f4ng x\u00e2m l\u1ea5n kh\u00f4ng kh\u1eb3nh \u0111\u1ecbnh \u0111\u01b0\u1ee3c ch\u1ea9n do\u00e1n, ho\u1eb7c khi c\u1ea7n kh\u1ea3o s\u00e1t v\u00e0 can thi\u1ec7p m\u1ea1ch v\u00e0nh.<\/p>\n

T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong><\/p>\n

    \n
  • B\u1ec7nh H\u1ecdc Tim M\u1ea1ch Lecturio<\/li>\n
  • B\u00e0i gi\u1ea3ng N\u1ed9i Tim m\u1ea1ch \u2013 \u0110\u1ea1i h\u1ecdc Y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch – 2016<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

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C\u00f3 th\u1ec3 di\u1ec5n ra c\u1ea5p, d\u1eabn \u0111\u1ebfn suy […]<\/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":"\nH\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (hay h\u1edf ch\u1ee7), l\u00e0 b\u1ec7nh l\u00fd van tim \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi t\u00ecnh tr\u1ea1ng van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 \u0111\u00f3ng kh\u00f4ng ho\u00e0n to\u00e0n\" \/>\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=\"H\u1edf van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7: \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng - 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