{"id":31915,"date":"2023-05-05T20:21:49","date_gmt":"2023-05-05T13:21:49","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=31915"},"modified":"2023-05-05T20:21:49","modified_gmt":"2023-05-05T13:21:49","slug":"tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/","title":{"rendered":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean"},"content":{"rendered":"

Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t m\u1ea3nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb t\u1eafc ngh\u1ebdn ho\u00e0n to\u00e0n, d\u1eabn \u0111\u1ebfn vi\u1ec7c kh\u00f4ng c\u00f2n m\u00e1u v\u00e0 d\u01b0\u1ee1ng ch\u1ea5t \u0111\u01b0\u1ee3c cung c\u1ea5p cho m\u1ed9t ph\u1ea7n c\u1ee7a c\u01a1 tim. Khi \u0111\u00f3, c\u00e1c t\u1ebf b\u00e0o trong ph\u1ea7n c\u01a1 tim b\u1ecb \u1ea3nh h\u01b0\u1edfng b\u1edfi thi\u1ebfu m\u00e1u, g\u00e2y ra c\u01a1n \u0111au th\u1eaft ng\u1ef1c v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn suy tim ho\u1eb7c th\u1eadm ch\u00ed l\u00e0 t\u1eed vong.<\/strong><\/p>\n

1. T\u1ed5ng quan v\u1ec1 b\u1ec7nh m\u1ea1ch v\u00e0nh<\/strong><\/h2>\n

1.1 Thu\u1eadt ng\u1eef v\u1ec1 h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p<\/strong><\/h3>\n
\"Ngu\u1ed3n:
Ngu\u1ed3n: JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome<\/strong><\/figcaption><\/figure>\n

1.2 \u0110\u1ecbnh ngh\u0129a to\u00e0n c\u1ea7u n\u0103m 2018 v\u1ec1 nh\u1ed3i m\u00e1u c\u01a1 tim<\/strong><\/h3>\n

Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p l\u00e0 khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u1ea5p k\u00e8m theo b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1 tim, ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 t\u0103ng v\u00e0\/ho\u1eb7c gi\u1ea3m c\u1ee7a troponin v\u1edbi \u00edt nh\u1ea5t m\u1ed9t gi\u00e1 tr\u1ecb cao h\u01a1n b\u00e1ch ph\u00e2n v\u1ecb th\u1ee9 99 c\u1ee7a kho\u1ea3ng tham chi\u1ebfu tr\u00ean, k\u00e8m theo \u00edt nh\u1ea5t m\u1ed9t trong c\u00e1c d\u1ea5u hi\u1ec7u sau:<\/p>\n

\u2666 Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1 tim
\n\u2666 D\u1ea5u hi\u1ec7u thi\u1ebfu m\u00e1u m\u1edbi tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3
\n\u2666 Xu\u1ea5t hi\u1ec7n s\u00f3ng Q b\u1ec7nh l\u00fd
\n\u2666 B\u1eb1ng ch\u1ee9ng m\u1edbi v\u1ec1 m\u1ea5t s\u1ed1ng c\u00f2n c\u01a1 tim ho\u1eb7c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng ph\u00f9 h\u1ee3p v\u1edbi c\u0103n nguy\u00ean thi\u1ebfu m\u00e1u.
\n\u2666 Ph\u00e1t hi\u1ec7n huy\u1ebft kh\u1ed1i \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00ean ch\u1ee5p m\u1ea1ch ho\u1eb7c gi\u1ea3i ph\u1eabu t\u1eed thi.<\/p>\n

1.3 Ph\u00e2n lo\u1ea1i NMCT:<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
Ph\u00e2n lo\u1ea1i<\/strong><\/td>\nTi\u00eau ch\u00ed<\/strong><\/td>\n<\/tr>\n
\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Type 1<\/p>\n

(NMCT t\u1ef1 nhi\u00ean)<\/td>\n

NMCT li\u00ean quan \u0111\u1ebfn b\u1ec7nh m\u1ea1ch v\u00e0nh do x\u01a1 v\u1eefa, v\u00e0 th\u01b0\u1eddng do m\u1ea3ng x\u01a1 v\u1ee1 b\u1ecb n\u1ee9t hay x\u00f3i m\u00f2n.<\/td>\n<\/tr>\n
Type 2<\/td>\nNMCT do c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n \u0111\u1ed1i gi\u1eefa cung v\u00e0 c\u1ea7u c\u1ee7a c\u01a1 tim.<\/td>\n<\/tr>\n
Type 3<\/td>\nNMCT m\u00e0 b\u1ec7nh nh\u00e2n ch\u1ebft \u0111\u1ed9t t\u1eed tr\u01b0\u1edbc khi c\u00f3 m\u1eabu m\u00e1u x\u00e9t nghi\u1ec7m<\/td>\n<\/tr>\n
Type 4a<\/td>\nNMCT li\u00ean quan \u0111\u1ebfn th\u1ee7 thu\u1eadt can thi\u1ec7p PCI. Troponin t\u0103ng \u00edt nh\u1ea5t 5 l\u1ea7n m\u1ee9c tr\u00ean c\u1ee7a 99% b\u00e1ch ph\u00e2n v\u1ecb. (trong v\u00f2ng 48h \u0111\u1ea7u sau PCI)<\/td>\n<\/tr>\n
Type 4b<\/td>\nNMCT li\u00ean quan huy\u1ebft kh\u1ed1i trong \u0111\u1eb7t stent<\/td>\n<\/tr>\n
Type 4c<\/td>\nNMCT li\u00ean quan \u0111\u1ebfn t\u00e1i h\u1eb9p trong \u0111\u1eb7t stent<\/td>\n<\/tr>\n
Type 5<\/td>\nNMCT sau ph\u1eabu thu\u1eadt c\u1ea7u n\u1ed1i \u0110MV. Troponin t\u0103ng \u00edt nh\u1ea5t 10 l\u1ea7n m\u1ee9c tr\u00ean c\u1ee7a 99% b\u00e1ch ph\u00e2n v\u1ecb.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. Ti\u1ebfp c\u1eadn nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean (STEMI)<\/strong><\/h2>\n

2.1 Ti\u1ebfp c\u1eadn v\u1edbi c\u01a1n \u0111au th\u1eaft ng\u1ef1c<\/strong><\/p>\n

\u0110au ng\u1ef1c c\u1ea5p c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n b\u1edfi:<\/strong>
\n\u2022 B\u1ec7nh c\u1ea3nh \u0111\u1ed9t t\u1eed do tim
\n\u2022 Ng\u1eebng tu\u1ea7n ho\u00e0n ngo\u1ea1i vi\u1ec7n
\n\u2022 R\u1ed1i lo\u1ea1n nh\u1ecbp tim
\n\u2022 H\u1ed9i ch\u1ee9ng suy tim c\u1ea5p, shock tim
\n\u2022 M\u1ec7t gi\u1ea3m dung n\u1ea1p g\u1eafng s\u1ee9c<\/p>\n

Bi\u1ec3u hi\u1ec7n \u0111au ng\u1ef1c c\u1ea5p do c\u00e1c nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 \u0111e d\u1ecda \u0111\u1ebfn t\u00ednh m\u1ea1ng:<\/strong>
\no H\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p
\no H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 c\u1ea5p
\no Nh\u1ed3i m\u00e1u ph\u1ed5i
\no Tr\u00e0n kh\u00ed m\u00e0ng ph\u1ed5i c\u00f3 \u00e1p l\u1ef1c
\no Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim c\u00f3 ch\u00e8n \u00e9p
\no Th\u1ee7ng t\u1ea1ng r\u1ed7ng<\/p>\n

Th\u0103m d\u00f2 c\u1eadn khi \u0111au ng\u1ef1c c\u1ea5p:<\/strong>
\n\u2666 ECG
\n\u2666 Markers: Hs Troponin T,I , CK\/CKMB, NT-BNP, D-Dimer
\n\u2666 Xquang ng\u1ef1c th\u1eb3ng
\n\u2666 Si\u00eau \u00e2m tim
\n\u2666 CT scanner ng\u1ef1c b\u1ee5ng
\n\u2666 MRI \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 ng\u1ef1c b\u1ee5ng
\n\u2666 Ch\u1ee5p \u0110MV
\n\u2666 C\u00e1c x\u00e9t nghi\u1ec7m chuy\u00ean khoa kh\u00e1c<\/p>\n

 <\/p>\n\n\n\n\n\n\n\n
<\/td>\nKh\u1ea3 n\u0103ng ACS cao\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/td>\nKh\u1ea3 n\u0103ng ACS th\u1ea5p<\/strong><\/td>\n<\/tr>\n
D\u1ea5u hi\u1ec7u\u00a0\u00a0 sinh t\u1ed3n<\/td>\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ng\u1eebng tu\u1ea7n ho\u00e0n, th\u1ec9u\/ ng\u1ea5t, m\u1ea5t \u00fd th\u1ee9c, tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh khu tr\u00fa<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00f3 th\u1edf<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 N\u00f4n, bu\u1ed3n n\u00f4n<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 RL Nh\u1ecbp, nh\u1ecbp nhanh<\/td>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tri gi\u00e1c b\u00ecnh th\u01b0\u1eddng<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nh\u1ecbp\/ki\u1ec3u th\u1edf b\u00ecnh th\u01b0\u1eddng<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nh\u1ecbp tim b\u00ecnh th\u01b0\u1eddng<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Th\u00e2n nhi\u1ec7t cao<\/td>\n<\/tr>\n

B\u1ed1i c\u1ea3nh,\u00a0 y\u1ebfu t\u1ed1\u00a0 nguy c\u01a1<\/td>\n\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tu\u1ed5i > 40<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u1ec1n s\u1eed NMCT, TBMN<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 YTNC: h\u00fat thu\u1ed1c, THA, RL lipid, \u0110T\u0110<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u0110ang \u0111i\u1ec1u tr\u1ecb b\u1ec7nh TM<\/td>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tu\u1ed5i <40<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ko ti\u1ec1n s\u1eed b\u1ec7nh tim m\u1ea1ch<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ko c\u00f3 YTNC TM<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ko \u0111i\u1ec1u tr\u1ecb b\u1ec7nh TM m\u1ea1n t\u00ednh<\/td>\n<\/tr>\n

V\u1ecb tr\u00ed, ho\u00e0n c\u1ea3nh \u0111au<\/td>\n\u0110au gi\u1eefa ng\u1ef1c, m\u1ea1nh, k\u00e8m kh\u00f3 th\u1edf<\/td>\n\u0110au thay \u0111\u1ed5i theo t\u01b0 th\u1ebf, v\u1eadn \u0111\u1ed9ng, h\u1ed3i h\u1ed9p<\/p>\n

M\u1ee9c \u0111\u1ed9 \u0111au \u0111a d\u1ea1ng, \u0111au < 1 ph\u00fat<\/td>\n<\/tr>\n

T\u00ednh ch\u1ea5t \u0111au<\/td>\n\u0110au sau x\u01b0\u01a1ng \u1ee9c, b\u00f3p ngh\u1eb9n, lan l\u00ean\u00a0 c\u1eb1m\/c\u1ed5\/c\u00e1nh tay\/l\u01b0ng, xu\u1ea5t hi\u1ec7n t\u1ef1\u00a0 nhi\u00ean, d\u00e0i >20 ph\u00fat, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi\u00a0 nitroglycerid, k\u00e8m kh\u00f3 th\u1edf, v\u00e3 m\u1ed3 h\u00f4i,\u00a0 hoa m\u1eaft ch\u00f3ng m\u1eb7t, bu\u1ed3n n\u00f4n<\/td>\nLan sang h\u00f4ng, xu\u1ed1ng b\u1ee5ng, sau l\u01b0ng<\/p>\n

Kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u1ea7n kinh th\u1ef1c v\u1eadt<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u0110\u1eb7c bi\u1ec7t tr\u00ean b\u1ec7nh nh\u00e2n \u0110\u00e1i Th\u00e1o \u0110\u01b0\u1eddng, THA, v\u00e0 ng\u01b0\u1eddi cao tu\u1ed5i c\u00f3 th\u1ec3 kh\u00f4ng r\u00f5 c\u00e1c tri\u1ec7u ch\u1ee9ng<\/strong><\/p>\n

Th\u0103m kh\u00e1m c\u1ea9n th\u1eadn \u0111\u1ec3:<\/strong>
\n\u2022 \u0110\u00e1nh gi\u00e1 c\u00e1c bi\u1ebfn ch\u1ee9ng
\n\u2022 Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t
\n\u2022 C\u00e1c b\u1ec7nh l\u00fd \u0111i k\u00e8m
\n\u2022 Y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch…<\/p>\n\n\n\n\n\n\n\n
\u00a0\u00a0\u00a0\u00a0 \u0110\u1ed9<\/strong> Killip<\/strong><\/td>\n\u0110\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng<\/strong><\/td>\nT\u1ef7 l\u1ec7 t\u1eed vong<\/strong><\/p>\n

trong 30 ng\u00e0y<\/strong><\/td>\n<\/tr>\n

I<\/strong><\/td>\nKh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng suy tim tr\u00e1i<\/strong><\/td>\n5,1%<\/strong><\/td>\n<\/tr>\n
II<\/strong><\/td>\nC\u00f3 rale \u1ea9m < \u00bd ph\u1ed5i, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i,<\/strong><\/p>\n

ti\u1ebfng ng\u1ef1a phi T3<\/strong><\/td>\n

13,6%<\/strong><\/td>\n<\/tr>\n
III<\/strong><\/td>\nPh\u00f9 ph\u1ed5i c\u1ea5p<\/strong><\/td>\n32,2%<\/strong><\/td>\n<\/tr>\n
IV<\/strong><\/td>\nS\u1ed1c tim<\/strong><\/td>\n57,8%<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2.2 ECG:<\/strong>
\n– Thay \u0111\u1ed5i \u0111\u1ed9ng h\u1ecdc STEMI<\/p>\n

\"Ngu\u1ed3n:
Ngu\u1ed3n: ECGWaves. com<\/strong><\/figcaption><\/figure>\n

– \u0110\u1ecbnh khu nh\u1ed3i m\u00e1u c\u01a1 tim<\/strong><\/p>\n

+ Th\u00e0nh d\u01b0\u1edbi:<\/strong> DII, aVF, DIII<\/p>\n

\u0110m v\u00e0nh ph\u1ea3i\/ \u0110m m\u0169<\/p>\n

+ Th\u00e0nh b\u00ean:<\/strong> DI, aVL; V5, V6
\n\u0110m m\u0169\/ nh\u00e1nh ch\u00e9o \u0110m LTT<\/p>\n

+ Th\u00e0nh tr\u01b0\u1edbc:<\/strong> \u0110m li\u00ean th\u1ea5t tr\u01b0\u1edbc (LTT)
\n\u2666 V\u00f9ng v\u00e1ch: V1, V2
\n\u2666 V\u00f9ng tr\u01b0\u1edbc: V4, V5<\/p>\n

– Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n:<\/strong> C\u00f3 \u0111o\u1ea1n ST ch\u00eanh l\u00ean \u1edf \u0111i\u1ec3m J t\u1ea1i \u00edt nh\u1ea5t 2 chuy\u1ec3n \u0111\u1ea1o li\u00ean ti\u1ebfp: (kh\u00f4ng c\u00f3 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i ho\u1eb7c block nh\u00e1nh tr\u00e1i)
\n\u2022 \u1ede V2-V3:
\n\u2265 2.5\u2009mm khi < 40 tu\u1ed5i, \u2265 2\u2009mm khi \u2265 40 tu\u1ed5i \u1edf nam
\n\u2265 1,5mm \u1edf n\u1eef
\n\u2022 v\u00e0\/ho\u1eb7c \u1edf c\u00e1c chuy\u1ec3n \u0111\u1ea1o kh\u00e1c \u2265 1mm
\n\u2022 Khi ST ch\u00eanh xu\u1ed1ng \u1edf V1-V3, nh\u1ea5t l\u00e0 khi s\u00f3ng T d\u01b0\u01a1ng th\u00ec g\u1ee3i \u00fd nhi\u1ec1u t\u00ecnh tr\u1ea1ng NMCT th\u00e0nh sau, v\u00e0 \u0111\u01b0\u1ee3c kh\u1eb3ng \u0111\u1ecbnh v\u1edbi ST ch\u00eanh l\u00ean c\u00f9ng l\u00fac \u2265 0,5mm \u1edf V7-V9<\/p>\n

\u2666 Nh\u1ed3i m\u00e1u th\u1ea5t ph\u1ea3i: ST ch\u00eanh l\u00ean c\u00f9ng l\u00fac \u2265 0,5-1mm \u1edf c\u00e1c chuy\u1ec3n \u0111\u1ea1o b\u00ean ph\u1ea3i V3R-V5R, trong \u0111\u00f3 nh\u1ea1y nh\u1ea5t V4R<\/p>\n

S\u00f3ng Q b\u1ec7nh l\u00fd<\/strong>
\n\u2022 Khi kh\u00f4ng c\u00f3 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i v\u00e0 block nh\u00e1nh tr\u00e1i
\n\u2022 B\u1ea5t k\u1ef3 s\u00f3ng Q \u2265 0.02 s ho\u1eb7c d\u1ea1ng QS \u1edf V2 v\u00e0 V3
\n\u2022 S\u00f3ng Q \u2265 0.03 s v\u00e0 > 0.1 mV ho\u1eb7c d\u1ea1ng QS \u1edf b\u1ea5t k\u00ec 2 chuy\u1ec3n \u0111\u1ea1o k\u1ebf ti\u1ebfp n\u00e0o (I, aVL; V4\u2013V6; II, III, aVF)
\n\u2022 S\u00f3ng R > 0.04 s \u1edf V1\u2013V2 v\u00e0 R\/S \u2265 1 k\u00e8m s\u00f3ng T d\u01b0\u01a1ng c\u00f9ng chi\u1ec1u m\u00e0 kh\u00f4ng c\u00f3 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n
\nM\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p t\u01b0\u01a1ng \u0111\u01b0\u01a1ng c\u1ee7a STEMI:
\n\u2022 H\u1ed9i ch\u1ee9ng Wellens
\n\u2022 NMCT k\u00e8m block nh\u00e1nh tr\u00e1i
\n\u2022 H\u1ed9i ch\u1ee9ng De Winter
\n\u2022 S\u00f3ng T t\u1ed1i c\u1ea5p
\n\u2022 NMCT ST ch\u00eanh l\u00ean kh\u00f4ng theo gi\u1ea3i ph\u1eabu
\n\u2022 NMCT ST ch\u00eanh l\u00ean aVR v\u1edbi ST ch\u00eanh xu\u1ed1ng lan t\u1ecfa chuy\u1ec3n \u0111\u1ea1o kh\u00e1c<\/p>\n

2.3 C\u00e1c ch\u1ec9 \u0111i\u1ec3m sinh h\u1ecdc tim:<\/strong>
\nThay \u0111\u1ed5i c\u00f3 t\u00ednh \u0111\u1ed9ng h\u1ecdc<\/p>\n

\"Ngu\u1ed3n:
\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Ngu\u1ed3n: ScienceDirect Topics<\/strong><\/figcaption><\/figure>\n

2.3 C\u00e1c th\u0103m d\u00f2 kh\u00e1c:<\/strong><\/p>\n

\u2022 CTM, sinh h\u00f3a c\u01a1 b\u1ea3n (Bilan Lipid c\u1ea7n \u0111\u01b0\u1ee3c l\u00e0m s\u1edbm), kh\u00ed m\u00e1u (theo y\u00eau c\u1ea7u l\u00e2m s\u00e0ng)…
\n\u2022 Si\u00eau \u00e2m tim: \u0111\u00e1nh gi\u00e1 r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng
\n\u2022 Kh\u00f4ng ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy khi \u0111\u00e3 r\u00f5 C\u0110 (\u0110T\u0110, l\u00e2m s\u00e0ng \u0111\u00e3 r\u00f5)
\n\u2022 C\u1ea7n l\u00e0m khi c\u00f2n nghi ng\u1edd ch\u1ea9n \u0111o\u00e1n, ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t ho\u1eb7c c\u00f3 bi\u1ebfn ch\u1ee9ng
\n\u2022 C\u1ea7n l\u00e0m (sau \u0111\u00f3) trong th\u1eddi gian b\u1ec7nh nh\u00e2n n\u1eb1m vi\u1ec7n.
\n\u2022 C\u00e1c th\u0103m d\u00f2: MSCT, MRI, X\u1ea1 \u0111\u1ed3,… kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh trong giai \u0111o\u1ea1n c\u1ea5p<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o<\/strong>
\n1. JCS 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome
\n2. 2018 ESC\/ACC\/AHS\/WHF Fourth Universal Definition of MI
\n3. https:\/\/ecgwaves.com\/topic\/ecg-st-elevation-segment-ischemia-myocardial-infarction-stemi\/
\n4. www.escardio.org\/guidelines
\n5. Jeffrey L. Anderson et al. J Am Coll Cardiol 2007; 50:e1-e157.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t m\u1ea3nh c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh b\u1ecb t\u1eafc ngh\u1ebdn ho\u00e0n to\u00e0n, d\u1eabn \u0111\u1ebfn vi\u1ec7c kh\u00f4ng c\u00f2n m\u00e1u v\u00e0 d\u01b0\u1ee1ng ch\u1ea5t \u0111\u01b0\u1ee3c cung c\u1ea5p cho m\u1ed9t ph\u1ea7n […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nTi\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t\" \/>\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=\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-05T13:21:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/i.imgur.com\/Q5TOeb6.png\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/\",\"name\":\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-05-05T13:21:49+00:00\",\"dateModified\":\"2023-05-05T13:21:49+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6\"},\"description\":\"Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6\",\"name\":\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g\",\"caption\":\"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/phamvanhoa1612gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean - Vinmec","description":"Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean - Vinmec","og_description":"Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/","og_site_name":"Vinmec","article_published_time":"2023-05-05T13:21:49+00:00","og_image":[{"url":"https:\/\/i.imgur.com\/Q5TOeb6.png"}],"author":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/","name":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean - Vinmec","isPartOf":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-05-05T13:21:49+00:00","dateModified":"2023-05-05T13:21:49+00:00","author":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6"},"description":"Nh\u1ed3i m\u00e1u c\u01a1 tim ST ch\u00eanh l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh tim m\u1ea1ch nguy hi\u1ec3m nh\u1ea5t hi\u1ec7n nay. \u0110\u00e2y l\u00e0 m\u1ed9t lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim x\u1ea3y ra khi m\u1ed9t","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/05\/tiep-can-chan-doan-nhoi-mau-co-tim-co-st-chenh-len\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean"}]},{"@type":"WebSite","@id":"https:\/\/noithathoaphat.in\/ctv\/#website","url":"https:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/93244bcbae85b37711d0dde67f41b5f6","name":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/1b748902abde9a821c917fe33912a06a?s=96&d=mm&r=g","caption":"Nguy\u1ec5n H\u00f9ng Nh\u1eadt Duy"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/phamvanhoa1612gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31915"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=31915"}],"version-history":[{"count":3,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31915\/revisions"}],"predecessor-version":[{"id":32089,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/31915\/revisions\/32089"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=31915"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=31915"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=31915"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}