{"id":34708,"date":"2023-06-07T15:00:44","date_gmt":"2023-06-07T08:00:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34708"},"modified":"2023-06-07T15:01:23","modified_gmt":"2023-06-07T08:01:23","slug":"nhung-bien-chung-nguy-hiem-cua-nhoi-mau-co-tim-va-cach-xu-tri","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/07\/nhung-bien-chung-nguy-hiem-cua-nhoi-mau-co-tim-va-cach-xu-tri\/","title":{"rendered":"Nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 c\u00e1ch x\u1eed tr\u00ed"},"content":{"rendered":"<p><strong>Nh\u1ed3i m\u00e1u c\u01a1 tim (NMCT) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim, trong \u0111\u00f3 c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim ho\u1eb7c ho\u1ea1i t\u1eed. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ch\u1ec9 l\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh m\u00e0 c\u00f2n \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng x\u1ea3y ra trong v\u00e0 sau qu\u00e1 tr\u00ecnh b\u1ec7nh \u0111\u1ec3 n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng s\u1ed1ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-34710 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/c62b48a0-65eb-42d1-b7d8-87c6341d0710-1-300x300.jpg\" alt=\"bien-chung-nhoi-mau-co-tim\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/c62b48a0-65eb-42d1-b7d8-87c6341d0710-1-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/c62b48a0-65eb-42d1-b7d8-87c6341d0710-1-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/c62b48a0-65eb-42d1-b7d8-87c6341d0710-1-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/c62b48a0-65eb-42d1-b7d8-87c6341d0710-1.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2><strong>1. \u0110\u1ea1i c\u01b0\u01a1ng<\/strong><\/h2>\n<p>C\u00e1c vi\u1ec7c c\u1ea7n l\u00e0m khi nghi ng\u1edd BN NMCT:<\/p>\n<ul>\n<li>Ch\u1ea9n \u0111o\u00e1n b\u1eb1ng men tim v\u00e0 ECG<\/li>\n<li>Gi\u1ea3m \u0111au do t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u01a1 tim<\/li>\n<li>\u0110\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng v\u00e0 \u0111i\u1ec1u ch\u1ec9nh c\u00e1c b\u1ea5t th\u01b0\u1eddng kh\u00e1c<\/li>\n<li>B\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng huy\u1ebft kh\u1ed1i v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u n\u1ebfu \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh<\/li>\n<\/ul>\n<p>Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n nh\u1ed3i m\u00e1u c\u01a1 tim<\/p>\n<p>C\u00f3 b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng c\u1ee7a TMCT c\u1ea5p v\u00e0 s\u1ef1 t\u0103ng v\u00e0\/ho\u1eb7c gi\u1ea3m c\u1ee7a men tim (troponin) v\u1edbi \u00edt nh\u1ea5t 1 gi\u00e1 tr\u1ecb tr\u00ean b\u00e1ch ph\u00e2n v\u1ecb th\u1ee9 99%, k\u00e8m theo \u00edt nh\u1ea5t 1 trong c\u00e1c y\u1ebfu t\u1ed1:<\/p>\n<ul>\n<li>Tri\u1ec7u ch\u1ee9ng c\u1ee7a thi\u1ebfu m\u00e1u c\u01a1 tim<\/li>\n<li>Thay \u0111\u1ed5i \u0111i\u1ec7n tim (ST \u2013 T m\u1edbi, Block nh\u00e1nh tr\u00e1i m\u1edbi, s\u00f3ng Q m\u1edbi)<\/li>\n<li>Th\u0103m d\u00f2 h\u00ecnh \u1ea3nh h\u1ecdc c\u00f3 b\u1eb1ng ch\u1ee9ng thi\u1ebfu m\u00e1u c\u01a1 tim (r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng m\u1edbi)<\/li>\n<li>H\u00ecnh \u1ea3nh huy\u1ebft kh\u1ed1i trong \u0111\u1ed9ng m\u1ea1ch v\u00e0nh (ch\u1ee5p \u0110MV, m\u1ed5 t\u1eed thi)<\/li>\n<\/ul>\n<p>Ph\u00e2n lo\u1ea1i nh\u1ed3i m\u00e1u c\u01a1 tim<\/p>\n<ul>\n<li>Type 1: Nh\u1ed3i m\u00e1u c\u01a1 tim nguy\u00ean ph\u00e1t do s\u1ef1 m\u1ea5t \u1ed5n \u0111\u1ecbnh m\u1ea3ng x\u01a1 v\u1eefa<\/li>\n<li>Type 2: NMCT th\u1ee9 ph\u00e1t do m\u1ea5t c\u00e2n b\u1eb1ng cung c\u1ea7u oxy c\u01a1 tim<\/li>\n<li>Type 3: NMCT g\u00e2y \u0111\u1ed9t t\u1eed.<\/li>\n<li>Type 4a: NMCT sau PCI (troponin t\u0103ng &gt; 5 l\u1ea7n b\u00e1ch ph\u00e2n v\u1ecb 99%) \u2264 48h<\/li>\n<li>Type 4b: Huy\u1ebft kh\u1ed1i trong stent<\/li>\n<li>Type 4c: T\u00e1i h\u1eb9p trong stent (Restenosis associated with percutaneous coronary intervention)<\/li>\n<li>Type 5: NMCT li\u00ean quan t\u1edbi m\u1ed5 b\u1eafc c\u1ea7u (troponin t\u0103ng &gt; 10 l\u1ea7n b\u00e1ch ph\u00e2n v\u1ecb 99%) \u2264 48h<\/li>\n<\/ul>\n<h2><strong>2. C\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 c\u00e1ch x\u1eed tr\u00ed<\/strong><\/h2>\n<p><strong><br \/>\n2.1 R\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng<\/strong><\/p>\n<p><strong>B\u1ec7nh nh\u00e2n<\/strong> c\u00f3 th\u1ec3 th\u1ec3 hi\u1ec7n 1 trong 3 t\u00ecnh tr\u1ea1ng huy\u1ebft \u0111\u1ed9ng sau<br \/>\n\u00b7 B\u00ecnh th\u01b0\u1eddng: Huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng, nh\u1ecbp tim v\u00e0 nh\u1ecbp th\u1edf b\u00ecnh th\u01b0\u1eddng, tu\u1ea7n ho\u00e0n ngo\u1ea1i bi\u00ean t\u1ed1t<br \/>\n\u00b7 T\u0103ng \u0111\u1ed9ng: Nh\u1ecbp tim nhanh, ti\u1ebfng tim to, tu\u1ea7n ho\u00e0n ngo\u1ea1i bi\u00ean t\u1ed1t. Huy\u1ebft \u00e1p cao, m\u1ea1ch nhanh c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng \u1ee9c ch\u1ebf b\u00eata, \u1ee9c ch\u1ebf men chuy\u1ec3n.<br \/>\n\u00b7 T\u1ee5t huy\u1ebft \u00e1p:<strong><br \/>\n<\/strong>&#8211; Do nh\u1ecbp tim ch\u1eadm: nh\u1ecbp tim ch\u1eadm, d\u00e3n t\u0129nh m\u1ea1ch, \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh b\u00ecnh th\u01b0\u1eddng, gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4. Th\u01b0\u1eddng g\u1eb7p trong NMCT c\u1ea5p th\u00e0nh d\u01b0\u1edbi nh\u01b0ng c\u00f3 th\u1ec3 do t\u00e1c d\u1ee5ng phu c\u1ee7a morphine.<br \/>\n\u0110i\u1ec1u tr\u1ecb b\u1eb1ng atropin, \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp.<br \/>\n&#8211; NMCT th\u1ea5t ph\u1ea3i: t\u0103ng \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh, nh\u1ecbp tim ch\u1eadm, t\u1ee5t huy\u1ebft \u00e1p, gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 hay<br \/>\ncho\u00e1ng.<br \/>\n&#8211; Do gi\u1ea3m th\u1ec3 t\u00edch: co t\u0129nh m\u1ea1ch, gi\u1ea3m \u00e1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh, gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4. \u0110\u00e1p \u1ee9ng v\u1edbi truy\u1ec1n<br \/>\nd\u1ecbch.<br \/>\n<strong>2.2 \u00a0Bi\u1ebfn ch\u1ee9ng suy b\u01a1m:<\/strong><br \/>\n\u00b7 L\u00e2m s\u00e0ng (ph\u00e2n \u0111\u1ed9 theo Killip)<strong><br \/>\n<\/strong>&#8211; Xung huy\u1ebft ph\u1ed5i: nh\u1ecbp tim nhanh, th\u1edf nhanh, rale \u1edf \u0111\u00e1y ph\u1ed5i<br \/>\n&#8211; Ph\u00f9 ph\u1ed5i c\u1ea5p: nh\u1ecbp tim nhanh, th\u1edf nhanh, rale \u1edf &gt;50% ph\u1ebf tr\u01b0\u1eddng<br \/>\n&#8211; Cho\u00e1ng tim: d\u1ea5u hi\u1ec7u gi\u1ea3m t\u01b0\u1edbi m\u00e1u m\u00f4 (thi\u1ec3u ni\u1ec7u, r\u1ed1i lo\u1ea1n tri gi\u00e1c), t\u1ee5y huy\u1ebft \u00e1p, gi\u1ea3m hi\u1ec7u \u00e1p, nh\u1ecbp tim nhanh, ph\u00f9 ph\u1ed5i<br \/>\n\u00b7 \u0110i\u1ec1u tr\u1ecb:<strong><br \/>\n<\/strong>* \u00a0Suy tim nh\u1eb9 (KillipII):<strong><em><br \/>\n<\/em><\/strong>&#8211; Th\u1edf oxy<br \/>\n&#8211; L\u1ee3i ti\u1ec3u quai: furosemide 20-40mg t\u0129nh m\u1ea1ch ch\u00edch, l\u1eb7p l\u1ea1i m\u1ed7i 1-4gi\u1edd.<br \/>\n&#8211; Nitrate: n\u1ebfu kh\u00f4ng c\u00f3 t\u1ee5t huy\u1ebft \u00e1p<br \/>\n&#8211; \u00dac ch\u1ebf men chuy\u1ec3n: khi kh\u00f4ng c\u00f3 t\u1ee5t HA, gi\u1ea3m th\u1ec3 t\u00edch hay suy th\u1eadn<br \/>\n&#8211; Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 angiotensin II (valsartan): khi b\u1ec7nh nh\u00e2n kh\u00f4ng dung n\u1ea1p \u1ee9c ch\u1ebf men<br \/>\nchuy\u1ec3n<br \/>\n* \u00a0Suy tim n\u1eb7ng (Killip III):<strong><em><br \/>\n<\/em><\/strong>&#8211; Th\u1edf oxy<br \/>\n&#8211; Th\u00f4ng kh\u00ed h\u1ed7 tr\u1ee3 t\u00f9y theo k\u1ebft qu\u1ea3 kh\u00ed m\u00e1u<br \/>\n&#8211; L\u1ee3i ti\u1ec3u quai<br \/>\n&#8211; Nitrate<br \/>\n&#8211; Thu\u1ed1c t\u0103ng co: Dobutamine v\u00e0\/ho\u1eb7c dopamine.<br \/>\n&#8211; Th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng h\u1ecdc x\u00e2m l\u1ea5n (sonde Swan-ganz)<br \/>\n&#8211; Can thi\u1ec7p m\u1ea1ch v\u00e0nh s\u1edbm<br \/>\n* Cho\u00e1ng tim (Killip IV):<br \/>\n&#8211; Th\u1edf oxy<br \/>\n&#8211; Th\u00f4ng kh\u00ed h\u1ed7 tr\u1ee3 t\u00f9y theo k\u1ebft qu\u1ea3 kh\u00ed m\u00e1u<br \/>\n&#8211; Th\u0103m d\u00f2 huy\u1ebft \u0111\u1ed9ng h\u1ecdc x\u00e2m l\u1ea5n (sonde Swan-ganz).<br \/>\n&#8211; Thu\u1ed1c t\u0103ng co: Dobutamine v\u00e0\/ho\u1eb7c dopamine, noradrenaline<br \/>\n&#8211; B\u00f3ng d\u1ed9i ng\u01b0\u1ee3c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<br \/>\n&#8211; D\u1ee5ng c\u1ee5 h\u1ed7 tr\u1ee3 t\u00e2m th\u1ea5t<br \/>\n&#8211; Can thi\u1ec7p m\u1ea1ch v\u00e0nh s\u1edbm<br \/>\n<strong>2.3\u00a0 Bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc:<\/strong> G\u1ed3m h\u1edf van hai l\u00e1 c\u1ea5p, th\u1ee7ng v\u00e1ch li\u00ean th\u1ea5t, v\u1ee1 th\u00e0nh t\u1ef1 do th\u1ea5t.<br \/>\n&#8211; C\u1ea7n ch\u1ee5p m\u1ea1ch v\u00e0nh kh\u1ea9n, sau \u0111\u00f3 ph\u1eadu thu\u00e2t m\u1ed5 b\u1eafc c\u1ea7u v\u00e0 s\u1eeda lu\u00f4n c\u00e1c bi\u1ebfn ch\u1ee9ng c\u01a1 h\u1ecdc<br \/>\n&#8211; C\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u00edch c\u1ef1c \u0111\u1ec3 h\u1ed7 tr\u1ee3: Nitroprusside, v\u1eadn m\u1ea1ch, b\u00f3ng d\u1ed9i ng\u01b0\u1ee3c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<br \/>\n<strong>2.4\u00a0 Nh\u1ed3i m\u00e1u c\u01a1 tim th\u1ea5t ph\u1ea3i<\/strong>:<\/p>\n<p>G\u1ed3m 4 nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb: duy tr\u00ec ti\u1ec1n t\u1ea3i th\u1ea5t ph\u1ea3i, gi\u1ea3m h\u1eadu t\u1ea3i th\u1ea5t ph\u1ea3i, d\u00f9ng thu\u1ed1c t\u0103ng co b\u00f3p v\u00e0 t\u00e1i t\u01b0\u1edbi m\u00e1u s\u1edbm b\u1eb1ng thu\u1ed1c hay can thi\u1ec7p m\u1ea1ch v\u00e0nh.<br \/>\n\u00b7 Duy tr\u00ec ti\u1ec1n t\u1ea3i th\u00e2t ph\u1ea3i:<strong><br \/>\n<\/strong>&#8211; Tr\u00e1nh d\u00f9ng thu\u1ed1c nitrate, l\u1ee3i ti\u1ec3u.<br \/>\n&#8211; Truy\u1ec1n 0, 5-1L n\u01b0\u1edbc mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng \u0111\u1ec3 n\u00e2ng HA. N\u1ebfu HA kh\u00f4ng l\u00ean \u0111\u01b0\u1ee3c th\u00ec coi nh\u01b0 th\u1ea5t b\u1ea1i.<br \/>\n&#8211; Ch\u00fa \u00fd ph\u1ea3i duy tr\u00ec \u0111\u01b0\u1ee3c \u0111\u1ed3ng b\u1ed9 nh\u0129-th\u1ea5t th\u00ec m\u1edbi duy tr\u00ec \u0111\u01b0\u1ee3c ti\u1ec1n t\u1ea3i th\u1ea5t ph\u1ea3i: v\u00ec 50% NMCT th\u1ea5t ph\u1ea3i c\u00f3 bl\u1ed1c nh\u0129 th\u1ea5t v\u00e0 1\/3 c\u00f3 rung nh\u0129 k\u00e8m n\u00ean \u0111\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp 2 bu\u1ed3ng khi block nh\u0129 th\u1ea5t, s\u1ed1c \u0111i\u1ec7n khi rung nh\u0129 g\u00e2y r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng<br \/>\n\u00b7 Gi\u1ea3m h\u1eadu t\u1ea3i th\u1ea5t ph\u1ea3i:<strong><br \/>\n<\/strong>&#8211; Th\u01b0\u1eddng g\u1eb7p l\u00e0 c\u00f3 RLCN th\u1ea5t tr\u00e1i hay suy th\u1ea5t tr\u00e1i \u0111i k\u00e8m<br \/>\n&#8211; \u0110i\u1ec1u tr\u1ecb: thu\u1ed1c t\u0103ng co b\u00f3p, nitroprusside, \u0111\u1eb7t b\u00f3ng d\u1ed9i ng\u01b0\u1ee3c \u0110MC<br \/>\n\u00b7 D\u00f9ng thu\u1ed1c t\u0103ng co b\u00f3p: Sau truy\u1ec1n 0, 5-1l n\u01b0\u1edbc mu\u1ed1i \u0111\u1eb3ng tr\u01b0\u01a1ng \u0111\u1ec3 n\u00e2ng HA m\u00e0 Ha kh\u00f4ng l\u00ean \u0111\u01b0\u1ee3c th\u00ec coi nh\u01b0 th\u1ea5t b\u1ea1i\u00e0 d\u00f9ng thu\u1ed1c t\u0103ng co b\u00f3p: Dobutamin \u0111\u01b0\u1ee3c \u01b0a chu\u1ed9ng nh\u1ea5t.<br \/>\n\u00b7 T\u00e1i t\u01b0\u1edbi m\u00e1u s\u1edbm: L\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong t\u1eeb 30\/% c\u00f2n 7%. Trong \u0111\u00f3 can thi\u1ec7p m\u1ea1ch v\u00e0nh c\u00f3 hi\u1ec7u qu\u1ea3 nh\u1ea5t<br \/>\n<strong>2.5 \u0110i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u1ed3i m\u00e1u c\u01a1 tim v\u1ec1 \u0111i\u1ec7n h\u1ecdc:<\/strong><br \/>\n\u00b7 Nhanh th\u1ea5t k\u00e8m r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng hay rung th\u1ea5t: s\u1ed1c \u0111i\u1ec7n<br \/>\n\u00b7 Nhanh th\u1ea5t \u0111\u01a1n d\u1ea1ng, k\u00e9o d\u00e0i, kh\u00e1ng tr\u1ecb v\u1edbi s\u1ed1c \u0111i\u1ec7n, r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng:<strong><br \/>\n<\/strong>&#8211; Amiodarone t\u0129nh m\u1ea1ch<br \/>\n&#8211; Lidocaine, sotalol<br \/>\n&#8211; \u0110\u1eb7t m\u00e1y catheter t\u1ea1o nh\u1ecbp t\u0129nh m\u1ea1ch c\u1eaft c\u01a1n n\u1ebfu kh\u00e1ng tr\u1ecb v\u1edbi s\u1ed1c \u0111i\u1ec7n hay t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp<br \/>\n\u00b7 Chu\u1ed7i nhanh th\u1ea5t \u0111\u01a1n d\u1ea1ng kh\u00f4ng k\u00e9o d\u00e0i c\u00f3 tri\u1ec7u ch\u1ee9ng: Amiodarone t\u0129nh m\u1ea1ch, sotalol hay \u1ee9c ch\u1ebf b\u00eata<br \/>\n\u00b7 Nhanh th\u1ea5t \u0111a d\u1ea1ng:<strong><br \/>\n<\/strong>&#8211; QT b\u00ecnh th\u01b0\u1eddng: Ch\u00edch t\u0129nh m\u1ea1ch sotalol, \u1ee9c ch\u1ebf b\u00eata k\u00e1hc, amiodarone hay lidocaine<br \/>\n&#8211; QT k\u00e9o d\u00e0i: \u0110i\u1ec1u ch\u1ec9nh r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i, xem x\u00e9t magn\u00e9, t\u1ea1o nh\u1ecbp v\u01b0\u1ee3t t\u1ea7n s\u1ed1, isoproterenol hay lidocaine. N\u00ean xem x\u00e9t ch\u1ee5p v\u00e0 can thi\u1ec7p m\u1ea1ch v\u00e0nh kh\u1ea9n<br \/>\n\u00b7 Rung nh\u0129:<strong><br \/>\n<\/strong>&#8211; Ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t: Ch\u00edch t\u0129nh m\u1ea1ch \u1ee9c ch\u1ebf b\u00eata hay \u1ee9c ch\u1ebf canxi kh\u00f4ng dihydropyridine (diltiazem hay verapamil) khi kh\u00f4ng c\u00f3 suy tim, co th\u1eaft ph\u1ebf qu\u1ea3n (ri\u00eang cho \u1ee9c ch\u1ebf b\u00eata), v\u00e0 bl\u1ed1c nh\u0129 th\u1ea5t. Digitalis t\u0129nh m\u1ea1ch n\u1ebfu gi\u1ea3m ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i n\u1eb7ng hay suy tim.<br \/>\n&#8211; Chuy\u1ec3n nh\u1ecbp<strong><em><br \/>\n<\/em><\/strong>a. Amiodarone t\u0129nh m\u1ea1ch \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u1ea7n s\u1ed1 th\u1ea5t v\u00e0 chuy\u1ec3n nh\u1ecbp<br \/>\nb. S\u1ed1c \u0111i\u1ec7n chuy\u1ec3n nh\u1ecbp khi c\u00f3 r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng n\u1eb7ng hay thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 n\u1eb7ng hay t\u1ea7n s\u1ed1 th\u1ea5t kh\u00f4ng th\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c thu\u1ed1c.<br \/>\n&#8211; Kh\u00e1ng \u0111\u00f4ng trong rung nh\u0129: heparin chu\u1ea9n hay heparin tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed th\u1ea5p<br \/>\n\u00b7 Nh\u1ecbp xoang ch\u1eadm k\u00e8m t\u1ee5t huy\u1ebft \u00e1p:<strong><br \/>\n<\/strong>&#8211; Atropine t\u0129nh m\u1ea1ch<br \/>\n&#8211; \u0110\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi n\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi atropine<br \/>\n\u00b7 Bl\u1ed1c nh\u0129 th\u1ea5t \u0111\u1ed9 II (Mobitz II), bl\u1ed1c nh\u0129 th\u1ea5t \u0111\u1ed9 III:<strong><br \/>\n<\/strong>&#8211; Atropine t\u0129nh m\u1ea1ch<br \/>\n&#8211; \u0110\u1eb7t m\u00e1y t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi n\u1ebfu kh\u00f4ng\u0111\u00e1p \u1ee9ng v\u1edbi atropine<\/p>\n<p>Xem th\u00eam:<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/vi\/benh\/nhoi-mau-co-tim-cap-4866\/\"><strong>Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p: Nguy\u00ean nh\u00e2n, tri\u1ec7u ch\u1ee9ng, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/strong><\/a><\/p>\n<p><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<br \/>\n<\/strong>1. T\u00e0i li\u1ec7u l\u00e2m s\u00e0ng n\u1ed9i khoa \u2013 \u0110\u1ea1i h\u1ecdc y khoa Ph\u1ea1m Ng\u1ecdc Th\u1ea1ch<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nh\u1ed3i m\u00e1u c\u01a1 tim (NMCT) \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim, trong \u0111\u00f3 c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim ho\u1eb7c ho\u1ea1i t\u1eed. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ch\u1ec9 l\u00e0 \u0111i\u1ec1u tr\u1ecb t\u00e1i th\u00f4ng m\u1ea1ch v\u00e0nh m\u00e0 c\u00f2n \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn ch\u1ee9ng x\u1ea3y ra [&hellip;]<\/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":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 c\u00e1ch x\u1eed tr\u00ed - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1ed3i m\u00e1u c\u01a1 tim \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim, trong \u0111\u00f3 c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim ho\u1eb7c bi\u1ebfn ch\u1ee9ng ho\u1ea1i t\u1eed.\" \/>\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=\"Nh\u1eefng bi\u1ebfn ch\u1ee9ng nguy hi\u1ec3m c\u1ee7a nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 c\u00e1ch x\u1eed tr\u00ed - 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