{"id":34754,"date":"2023-06-08T17:49:27","date_gmt":"2023-06-08T10:49:27","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34754"},"modified":"2023-06-08T17:49:27","modified_gmt":"2023-06-08T10:49:27","slug":"benh-tim-thieu-mau-cuc-bo-cac-trieu-chung-va-phuong-phap-chan-doan-theo-icd10","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/08\/benh-tim-thieu-mau-cuc-bo-cac-trieu-chung-va-phuong-phap-chan-doan-theo-icd10\/","title":{"rendered":"B\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9: C\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n theo ICD10"},"content":{"rendered":"

Suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh d\u1eabn t\u1edbi b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9\u00a0 c\u00f3 th\u1ec3 l\u00e0 m\u1ea1n t\u00ednh (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n) hay suy c\u1ea5p t\u00ednh (suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p). Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a suy v\u00e0nh l\u00e0 c\u01a1n \u0111au th\u1eaft ng\u1ef1c. Tr\u00ean l\u00e2m s\u00e0ng, suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n b\u1edbi 1 trong 5 d\u1ea1ng sau: c\u01a1n \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh, c\u01a1n \u0111au th\u1eaft ng\u1ef1c Prinzmetal, thi\u1ebfu m\u00e1u c\u01a1 tim y\u00ean l\u1eb7ng, b\u1ec7nh c\u01a1 tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 h\u1edf van hai l\u00e1 do b\u1ec7nh m\u1ea1ch v\u00e0nh.<\/strong><\/p>\n

\"b\u1ec7nh<\/p>\n

1. Ph\u00e2n bi\u1ec7t b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh:<\/h2>\n

\uf02dThi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 l\u00e0 thu\u1eadt ng\u1eef mang t\u00ednh ch\u1ea5t sinh l\u00ed d\u00f9ng \u0111\u1ec3 ch\u1ec9 t\u00ecnh tr\u1ea1ng m\u1ea5t c\u00e2n b\u1eb1ng gi\u1eefa nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim v\u00e0 kh\u1ea3 n\u0103ng cung c\u1ea5p oxy c\u1ee7a m\u1ea1ch v\u00e0nh. Trong khi thu\u1eadt ng\u1eef b\u1ec7nh m\u1ea1ch v\u00e0nh d\u00f9ng \u0111\u1ec3 ch\u1ec9 m\u1ed9t t\u00ecnh tr\u1ea1ng m\u1ea5t ch\u1ee9c n\u0103ng t\u01b0\u1edbi m\u00e1u m\u1ed9t c\u00e1ch t\u1ed1i \u01b0u c\u1ee7a \u0111\u1ed9ng m\u1ea1ch v\u00e0nh do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau m\u00e0 th\u01b0\u1eddng th\u1ea5y nh\u1ea5t l\u00e0 do nguy\u00ean nh\u00e2n x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.
\n\uf02dDo \u0111\u00f3 kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim \u0111\u1ec1u l\u00e0 do b\u1ec7nh m\u1ea1ch v\u00e0nh, m\u00e0 c\u00f2n nhi\u1ec1u l\u00ed do kh\u00e1c n\u1eefa ch\u1eb3ng h\u1ea1n nh\u01b0 b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i (nhu c\u1ea7u gia t\u0103ng trong khi \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u1eabn c\u00f2n to\u00e0n v\u1eb9n). V\u00e0 kh\u00f4ng ph\u1ea3i t\u1ea5t c\u1ea3 b\u1ec7nh m\u1ea1ch v\u00e0nh \u0111\u1ec1u l\u00e0 do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch g\u00e2y ra m\u00e0 c\u00f2n do nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c n\u1eefa ch\u1eb3ng han nh\u01b0 vi\u00eam n\u00fat \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u0169ng g\u00e2y ra t\u00ecnh tr\u1ea1ng suy gi\u1ea3m t\u01b0\u1edbi m\u00e1u v\u00e0nh (suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh).
\nPh\u00e2n lo\u1ea1i b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9:
\nM\u1ea1n t\u00ednh
\n1. C\u01a1n \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh.
\n2. C\u01a1n \u0111au th\u1eaft ng\u1ef1c bi\u1ebfn th\u00e1i (Prinzmetal).
\n3. Thi\u1ebfu m\u00e1u c\u01a1 tim y\u00ean l\u1eb7ng.
\n4. B\u1ec7nh c\u01a1 tim do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9
\nC\u1ea5p t\u00ednh
\n1. Nh\u1ed3i m\u00e1u c\u01a1 tim c\u00f3 ST ch\u00eanh l\u00ean (STEMI).
\n2. Nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng ST ch\u00eanh l\u00ean (NSTEMI).
\n3. C\u01a1n \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh (UA).
\nXem ph\u00e2n lo\u1ea1i ch\u1ea9n \u0111o\u00e1n theo ICD-10<\/a>
\nB\u1ec7nh nguy\u00ean c\u1ee7a b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh:
\n– X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch.
\n– Di t\u1eadt b\u1ea9m sinh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.
\n– Ngh\u1ebdn \u0111\u1ed9ng m\u1ea1ch v\u00e0nh do thuy\u00ean t\u1eafc (th\u01b0\u1eddng g\u00e2y h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p).
\n– C\u1ea7u c\u01a1 tim.
\n– Vi\u00eam \u0111\u1ed9ng m\u1ea1ch v\u00e0nh trong b\u1ec7nh h\u1ec7 th\u1ed1ng (Lupus ban \u0111\u1ecf, b\u1ec7nh Kawasaki, b\u1ec7nh Takayasu,…)
\nC\u01a1n \u0111au th\u1eaft ng\u1ef1c l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a t\u00ecnh tr\u1ea1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u00f4 c\u01a1 tim, x\u1ea3y ra khi c\u00f3 s\u1ef1 m\u1ea5t c\u00e2n b\u1eb1ng trong cung – c\u1ea7u oxy cho c\u01a1 tim: t\u0103ng nhu c\u1ea7u oxy c\u01a1 tim ho\u1eb7c gi\u1ea3m t\u01b0\u1edbi m\u00e1u c\u01a1 tim do b\u1ec7nh m\u1ea1ch v\u00e0nh. S\u1ef1 gia t\u0103ng nhu c\u1ea7u v\u1ec1 oxy c\u1ee7a c\u01a1 tim x\u1ea3y ra trong 3 tr\u01b0\u1eddng h\u1ee3p sau: t\u0103ng t\u1ea7n s\u1ed1 tim – t\u0103ng s\u1ee9c c\u0103ng th\u00e0nh t\u00e2m th\u1ea5t tr\u00e1i – t\u0103ng co b\u00f3p c\u01a1 tim.
\na) C\u01a1n \u0111au th\u1eaft ng\u1ef1c do s\u1ef1 gia t\u0103ng nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim:
\n– Ba y\u1ebfu t\u1ed1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 gia t\u0103ng nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim nh\u01b0 \u0111\u00e3 n\u00f3i l\u00e0 t\u0103ng t\u1ea7n s\u1ed1 tim, t\u0103ng l\u1ef1c c\u0103ng th\u00e0nh t\u00e2m th\u1ea5t v\u00e0 t\u0103ng s\u1ee9c co b\u00f3p c\u01a1 tim, trong \u0111\u00f3 y\u1ebfu t\u1ed1 t\u0103ng t\u1ea7n s\u1ed1 tim l\u00e0 quan tr\u1ecdng nh\u1ea5t.
\n– C\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 g\u00e2y ra t\u0103ng nhu c\u1ea7u oxy c\u1ee7a c\u01a1 tim l\u00e0 c\u00e1c stress v\u1ec1 th\u1ec3 ch\u1ea5t l\u1eabn tinh th\u1ea7n, g\u1eafng s\u1ee9c, sau khi \u0103n no, s\u1ed1t, c\u01b0\u1eddng gi\u00e1p v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.
\na) C\u01a1n \u0111au ng\u1ef1c do gi\u1ea3m t\u1ea1m th\u1eddi cung c\u1ea5p oxy cho c\u01a1 tim:
\n– C\u01a1 ch\u1ebf b\u1ec7nh sinh n\u00e0y kh\u00f4ng ch\u1ec9 x\u1ea3y ra \u0111\u1ed1i v\u1edbi th\u1ec3 b\u1ec7nh \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh m\u00e0 c\u00f2n x\u1ea3y ra \u0111\u1ed1i v\u1edbi th\u1ec3 b\u1ec7nh m\u1ea1ch v\u00e0nh c\u1ea5p.
\n– T\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch l\u00e0m thay \u0111\u1ed5i ch\u1ee9c n\u0103ng c\u1ee7a n\u1ed9i m\u1ea1c m\u1ea1ch m\u00e1u, d\u1eabn t\u1edbi t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u00e1p \u1ee9ng co m\u1ea1ch khi c\u00f3 k\u00edch th\u00edch. Ti\u1ec3u c\u1ea7u v\u00e0 b\u1ea1ch c\u1ea7u ti\u1ebft ra ch\u1ea5t co m\u1ea1ch nh\u01b0 serotonin, thromboxan A2.
\n– Trong th\u1ec3 b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh c\u00f3 th\u1ec3 c\u00f3 ng\u01b0\u1ee1ng thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim thay \u0111\u1ed5i do s\u1ef1 thay \u0111\u1ed5i co m\u1ea1ch.<\/p>\n

2. Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n<\/h2>\n

– C\u01a1n \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh l\u00e0 m\u1ed9t h\u1ed9i ch\u1ee9ng l\u00e2m s\u00e0ng bi\u1ec3u hi\u1ec7n b\u1eb1ng t\u0103ng c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu \u1edf ng\u1ef1c, h\u00e0m d\u01b0\u1edbi, vai, l\u01b0ng ho\u1eb7c c\u00e1nh tay. Tri\u1ec7u ch\u1ee9ng n\u00e0y gia t\u0103ng khi g\u1eafng s\u1ee9c ho\u1eb7c stress t\u00ecnh c\u1ea3m, bi\u1ebfn m\u1ea5t khi ng\u00e2m nitroglycerin.
\n– M\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec \u0111au ng\u1ef1c, th\u0103m kh\u00e1m l\u00e2m s\u00e0ng bao g\u1ed3m: h\u1ecfi b\u1ec7nh s\u1eed, kh\u00e1m th\u1ef1c th\u1ec3, l\u01b0\u1ee3ng \u0111\u1ecbnh c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 b\u1eb1ng l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng. Sau c\u00f9ng l\u00e0 ch\u1ec9 \u0111\u1ecbnh l\u00e0m c\u00e1c test c\u1ea7n thi\u1ebft gi\u00fap ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n. Ti\u00eau chu\u1ea9n v\u00e0ng ch\u1ea9n \u0111o\u00e1n c\u01a1n \u0111au th\u1eaft ng\u1ef1c m\u1ea1n t\u00ednh l\u00e0 ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh. Tuy nhi\u00ean v\u1eabn c\u00f3 tr\u01b0\u1eddng h\u1ee3p ch\u1ee5p m\u1ea1ch v\u00e0nh nh\u01b0ng kh\u00f4ng ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c khi m\u00e0 \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh n\u00e0y l\u00e0 do t\u1ed5n th\u01b0\u01a1ng vi m\u1ea1ch g\u00e2y thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 c\u01a1 tim (c\u01a1n \u0111au th\u1eaft ng\u1ef1c vi m\u1ea1ch).
\nT\u00f3m t\u1eaft c\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n tr\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb.<\/strong>
\nB\u01b0\u1edbc 1: \u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng<\/strong> (ch\u01b0a c\u1ea7n ph\u1ea3i d\u00f9ng c\u1eadn l\u00e2m s\u00e0ng) \u0111\u1ed1i v\u1edbi m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec tri\u1ec7u ch\u1ee9ng \u0111au ng\u1ef1c. M\u1ee5c \u0111\u00edch cu\u1ed1i c\u00f9ng l\u00e0 ch\u1ea9n \u0111o\u00e1n s\u01a1 b\u1ed9 \u0111au l\u00e0 \u0111au th\u1eaft ng\u1ef1c (b\u1ec7nh m\u1ea1ch v\u00e0nh m\u1ea1n) v\u1edbi kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n d\u00fang l\u00e0 cao hay th\u1ea5p hay trung b\u00ecnh v\u00e0 ph\u00e2n \u0111\u1ed9 n\u0103ng c\u1ee7a \u0111au th\u1eaft ng\u1ef1c.
\n\u2756 B\u01b0\u1edbc 1 -1: xem x\u00e9t tinh ch\u1ea5t \u0111au ng\u1ef1c:
\n– H\u1ecfi b\u1ec7nh s\u1eed l\u00e0 ph\u1ea7n quan tr\u1ecdng nh\u1ea5t trong ch\u1ea9n \u0111o\u00e1n \u0111au th\u1eaft ng\u1ef1c.
\n– \u0110au th\u1eaft ng\u1ef1c \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u1ed5n \u0111\u1ecbnh khi c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u01a1n \u0111au (t\u1ea7n su\u1ea5t – \u0111\u1ed9 n\u1eb7ng – th\u1eddi gian \u0111au – gi\u1edd xu\u1ea5t hi\u1ec7n – y\u1ebfu t\u1ed1 l\u00e0m n\u1eb7ng) kh\u00f4ng thay \u0111\u1ed5i trong v\u00f2ng 60 ng\u00e0y tr\u01b0\u1edbc..
\n– M\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 kh\u00f4ng \u0111\u1ed3ng \u00fd v\u1edbi ch\u00fang ta khi s\u1eed d\u1ee5ng t\u1eeb \u0111au v\u00ec r\u1eb1ng theo h\u1ecd \u0111\u00f3 l\u00e0 m\u1ed9t c\u1ea3m gi\u00e1c kh\u00f3 ch\u1ecbu \u1edf ng\u1ef1c: \u0111\u00e8 n\u1eb7ng, b\u00f3p ngh\u1eb9t, n\u00f3ng b\u1ecfng, kh\u00f3 ti\u00eau, xi\u1ebft ch\u1eb7t, t\u1ee9c, \u0111\u1ea7y \u0111\u1ea7y,…
\n– C\u00e1c chi ti\u1ebft kh\u00e1c kh\u00f4ng th\u1ec3 b\u1ecf qua khi h\u1ecfi b\u1ec7nh s\u1eed l\u00e0 ho\u00e0n c\u1ea3nh kh\u1edfi ph\u00e1t c\u01a1n \u0111au, v\u1ecb tr\u00ed \u0111au, c\u00e1ch kh\u1edfi ph\u00e1t c\u01a1n, th\u1eddi gian \u0111au v\u00e0 c\u00e1ch h\u1ebft \u0111au, h\u01b0\u1edbng lan c\u1ee7a \u0111au.
\n1. Vi tr\u00ed, \u0111au sau x\u01b0\u01a1ng \u1ee9c.
\n2. Tinh ch\u1ea5t \u0111au th\u1eaft.
\n3. C\u01b0\u1eddng \u0111\u00f4 nh\u1eb9 ho\u1eb7c trung b\u00ecnh (t\u1eeb CCS 1 – 2)
\n4. H\u01b0\u1edbng lan: c\u1ed5, h\u00e0m d\u01b0\u1edbi, vai v\u00e0 c\u00e1nh tay tr\u00e1i.
\n5. Th\u1eddi gian \u0111au: th\u01b0\u1eddng d\u01b0\u1edbi 15 ph\u00fat.
\n6. Ho\u00e0n c\u1ea3nh kh\u1edfi ph\u00e1t c\u01a1n \u0111au: \u0111au xu\u1ea5t hi\u1ec7n trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 t\u0103ng nhu c\u1ea7u ti\u00eau th\u1ee5 oxy nh\u01b0 g\u1eafng s\u1ee9c, stress t\u00ecnh c\u1ea3m, sau khi \u0103n,…
\n7. Y\u1ebfu t\u1ed1 l\u00e0m gi\u1ea3m: ngh\u1ec9 ng\u01a1i, ng\u00e2m nitrate.
\n8. Tri\u1ec1u ch\u1ee9ng to\u00e0n th\u00e2n \u0111i k\u00e8m: th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng to\u00e0n th\u00e2n. M\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u00f3 th\u1ec3 c\u00f3 t\u00e1i m\u1eb7t, v\u00e3 m\u1ed3 h\u00f4i, thay \u0111\u1ed5i m\u1ea1ch v\u00e0 huy\u1ebft \u00e1p.
\n– Ch\u00fa \u00fd m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 thi\u1ebfu c\u01a1 tim c\u1ee5c b\u1ed9 nh\u01b0ng kh\u00f4ng c\u00f3 \u0111au ho\u1eb7c kh\u00f3 ch\u1ecbu \u1edf ng\u1ef1c nh\u01b0ng kh\u00f4ng ph\u1ea3i l\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 tri\u1ec7u ch\u1ee9ng t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi \u0111au th\u1eaft ng\u1ef1c. Bi\u1ec3u hi\u1ec7n n\u00e0y l\u00e0 do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu ho\u1eb7c ch\u1ee9c n\u0103ng t\u00e2m tr\u01b0\u01a1ng c\u1ee7a th\u1ea5t tr\u00e1i. C\u00e1c bi\u1ec3u hi\u1ec7n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi \u0111au th\u1eaft ng\u1ef1c bao g\u1ed3m: kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c v\u00e0 m\u1ec7t ho\u0103c c\u1ea3m gi\u00e1c ki\u1ec7t s\u1ee9c khi g\u1eafng s\u1ee9c (gi\u1ea3m m\u1ee9c \u0111\u00f4 g\u1eafng s\u1ee9c do m\u1ec7t ho\u0103c do kh\u00f3 th\u1edf).
\n\u2756 Khi \u0111\u00e3 h\u1ecfi v\u00e0 x\u00e1c \u0111\u1ecbnh \u0111\u00e2y r\u1ea5t c\u00f3 kh\u1ea3 n\u0103ng l\u00e0 \u0111au th\u1eaft ng\u1ef1c th\u00ec ph\u1ea3i ph\u00e2n \u0111\u1ed9 n\u1eb7ng c\u1ee7a c\u01a1n \u0111au theo CCS:
\n– \u0110\u1ed9 IV: \u0111au \u0111\u1ed1i v\u1edbi m\u1ecdi ho\u1ea1t \u0111\u1ed9ng, k\u1ec3 c\u1ea3 khi ngh\u1ec9.
\n– \u0110\u1ed9 III: H\u1ea1n ch\u1ebf ho\u1ea1t \u0111\u1ed9ng th\u00f4ng th\u01b0\u1eddng m\u1ee9c \u0111\u1ed9 n\u1eb7ng. \u0110au khi \u0111i b\u1ed9 1 – 2 khu nh\u00e0 ho\u1eb7c leo m\u1ed9t t\u1ea7ng l\u1ea7u v\u1edbi t\u1ed1c \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng v\u00e0 \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng.
\n– \u0110\u1ed9 II: H\u1ea1n ch\u1ebf ho\u1ea1t \u0111\u1ed9ng th\u00f4ng th\u01b0\u1eddng m\u1ee9c \u0111\u1ed9 nh\u1eb9. \u0110au x\u1ea3y ra khi \u0111i b\u1ed9 hay l\u00ean c\u1ea7u thang nhanh, l\u00ean d\u1ed1c, \u0111i b\u1ed9 ho\u1eb7c l\u00ean c\u1ea7u thang sau khi \u0103n, ho\u1eb7c trong gi\u00f3 l\u1ea1nh, tr\u1eddi l\u1ea1nh ho\u1eb7c ch\u1ec9 v\u00e0i gi\u1edd sau khi th\u1ee9c d\u1eady. Ho\u1eb7c \u0111au th\u1eaft ng\u1ef1c x\u1ea3y ra khi \u0111i b\u1ed9 h\u01a1n 2 khu nh\u00e0 ho\u1eb7c leo h\u01a1n 1 t\u1ea7ng l\u1ea7u v\u1edbi t\u1ed1c \u0111\u1ed9 b\u00ecnh th\u01b0\u1eddng v\u00e0 trong \u0111i\u1ec1u ki\u1ec7n b\u00ecnh th\u01b0\u1eddng.
\n– \u0110\u1ed9 I: C\u00e1c ho\u1ea1t \u0111\u1ed9ng th\u00f4ng th\u01b0\u1eddng (\u0111i b\u1ed9, l\u00ean c\u1ea7u thang) kh\u00f4ng l\u00e0m \u0111au th\u1eaft ng\u1ef1c. C\u01a1n \u0111au th\u1eaft ng\u1ef1c ch\u1ec9 x\u1ea3y ra khi g\u1eafng s\u1ee9c nhi\u1ec1u ho\u1eb7c nhanh.
\nB\u01b0\u1edbc 2: \u0110\u1ec1 ngh\u1ecb c\u00e1c x\u00e9t nghi\u1ec7m th\u01b0\u1eddng qui kh\u1ea3o s\u00e1t ban \u0111\u1ea7u \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec \u0111au th\u1eaft ng\u1ef1c.<\/strong>
\nC\u00e1c x\u00e9t nghi\u1ec7m ban \u0111\u1ea7u c\u1ea7n thi\u1ebft cho m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec \u0111au th\u1eaft ng\u1ef1c:
\n1. C\u00e1c x\u00e9t nghi\u1ec7m th\u01b0\u1eddng qui chung.
\n2. Bilan lipid.
\n3. \u0110\u01b0\u1eddng huy\u1ebft l\u00fac \u0111\u00f3i.
\n4. X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng tuy\u1ebfn gi\u00e1p.
\n5. \u0110i\u1ec7n t\u00e2m \u0111\u1ed3 l\u00fac ngh\u1ec9.
\n6. X – quang ng\u1ef1c.
\n7. Si\u00eau \u00e2m tim l\u00fac ngh\u1ec9.
\nB\u01b0\u1edbc 3: Xem x\u00e9t l\u1ea7n l\u01b0\u1ee3t b\u1ec7nh nh\u00e2n c\u00f3 c\u1ea7n l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m kh\u1ea3o s\u00e1t tim m\u1ea1ch kh\u00f4ng x\u00e2m l\u1ea5n hay kh\u00f4ng.<\/strong>
\nXem x\u00e9t ch\u1ec9 \u0111\u1ecbnh ECG g\u1eafng s\u1ee9c<\/strong>
\nTest g\u1eafng s\u1ee9c l\u00e0 m\u1ed9t c\u1eadn l\u00e2m s\u00e0ng quan trong gi\u00fap ch\u1ea9n \u0111o\u00e1n v\u00e0 l\u01b0\u1ee3ng gi\u00e1 kh\u1ea3 n\u0103ng t\u1eed vong cho b\u1ec7nh nh\u00e2n. N\u00f3 l\u00e0 c\u1eadn l\u00e2m s\u00e0ng ph\u1ea3i \u0111\u01b0\u1ee3c ngh\u0129 t\u1edbi \u0111\u1ea7u ti\u00ean \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n cho b\u1ec7nh nh\u00e2n. V\u1ea5n \u0111\u1ec1 \u0111\u1eb7t ra khi l\u00e0m test g\u1eafng s\u1ee9c l\u00e0 g\u1eafng s\u1ee9c th\u1ec3 l\u1ef1c hay g\u1eafng s\u1ee9c b\u1eb1ng thu\u1ed1c.
\nXem x\u00e9t ch\u1ec9 \u0111\u1ecbnh test s\u1eafng s\u1ee9c bans h\u00ecnh \u1ea3nh (si\u00eau \u00e2m v\u00e0 x\u1ea1 ki s\u1eafng s\u1ee9c).<\/strong>
\nXem x\u00e9t ch\u1ec9 \u0111\u1ecbnh Holter ECG.<\/strong>
\n\u2756 Ch\u1ec9 \u0111inh loaiI (r\u1ea5t n\u00ean l\u00e0m cho b\u00eanh nh\u00e2n’):
\n– Nghi ng\u1edd c\u00f3 lo\u1ea1n nh\u1ecbp tim tr\u00ean b\u1ec7nh nh\u00e2n \u0111au th\u1eaft ng\u1ef1c.
\n\u2756 Ch\u1ec9 \u0111inh lo\u1ea1i Ila (c\u00e2n nh\u1eafc nh\u01b0ng c\u00f3 xu h\u01b0\u1edbng s\u1ebd cho b\u00eanh nh\u00e2n th\u1ef1c hi\u00ean):
\n– Nghi \u0111au th\u1eaft ng\u1ef1c do co th\u1eaft m\u1ea1ch (\u0111au th\u1eaft ng\u1ef1c Prinzmetal).
\nXem x\u00e9t ch\u1ec9 \u0111\u1ecbnh MSCT
\nKh\u00f4ng n\u00ean l\u00e0m cho c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng sau (mu\u1ed1n l\u00e0m cho ai c\u0169ng \u0111\u01b0\u1ee3c tr\u1eeb nh\u1eefng ng\u01b0\u1eddi n\u00e0y v\u00ec l\u00e0m c\u0169ng kh\u00f4ng c\u00f3 l\u1ee3i nhi\u1ec1u nh\u01b0ng kh\u00f4ng c\u00f3 h\u1ea1i g\u00ec \u0111\u00e1ng k\u1ec3 cho b\u1ec7nh nh\u00e2n):
\n– B\u1ec7nh nh\u00e2n \u0111au ng\u1ef1c kh\u1ea3 n\u0103ng do b\u1ec7nh m\u1ea1ch v\u00e0nh th\u1ea5p k\u00e8m theo ECG g\u1eafng s\u1ee9c ho\u1eb7c tr\u1eafc nghi\u1ec7m stress h\u00ecnh \u1ea3nh kh\u00f4ng k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c (ch\u1ec9 \u0111\u1ecbnh lo\u1ea1i IIb)<\/p>\n

B\u01b0\u1edbc 4: X\u00e1c \u0111inh nguy c\u01a1 t\u1eed vong tim m\u1ea1ch tr\u00ean b\u1ec7nh nh\u00e2n \u0111\u1ebfn kh\u00e1m v\u00ec \u0111au th\u1eaft<\/strong>
\nng\u1ef1c:
\nC\u00f3 3 c\u00e1ch \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1:
\n– C\u00e1ch 1: ch\u1ec9 s\u1ed1 th\u1ea3m l\u0103n.
\n– C\u00e1ch 2: d\u1ef1a v\u00e0o c\u00e1c test kh\u00f4ng x\u00e2m nh\u1eadp kh- C\u00e1ch 3: ph\u00e2n t\u1ea7ng d\u1ef1a tr\u00ean ch\u1ee5p m\u1ea1ch v\u00e0nh (xem \u1edf b\u01b0\u1edbc 4)
\nB\u01b0\u1edbc 5: Xem x\u00e9t ch\u1ec9 \u0111inh ch\u1ee5p m\u1ea1ch v\u00e0nh cho b\u1ec7nh nh\u00e2n<\/strong>
\nCh\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh l\u00e0 ph\u01b0\u01a1ng ph\u00e1p th\u0103m d\u00f2 x\u00e2m nh\u1eadp, ch\u00ednh x\u00e1c nh\u1ea5t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n ngh\u1ebdn m\u1ea1ch v\u00e0nh do x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch ho\u1eb7c b\u1ec7nh m\u1ea1ch v\u00e0nh do co th\u1eaft m\u1ea1ch v\u00e0nh, b\u1ec7nh Kawasaki, b\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch v\u00e0nh v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh do x\u1ea1 tr\u1ecb.
\nCh\u1ee5p m\u1ea1ch v\u00e0nh \u0111\u01b0\u1ee3c xem l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng trong ch\u1ea9n \u0111o\u00e1n b\u1ec7nh m\u1ea1ch v\u00e0nh. Tri\u1ec7u ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c \u1ed5n \u0111\u1ecbnh c\u00f3 \u0111i\u1ec3n h\u00ecnh hay kh\u00f4ng, k\u1ebft h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m c\u00f3 kh\u1ea3 n\u0103ng b\u1ec7nh m\u1ea1ch v\u00e0nh cao s\u1ebd qui \u0111\u1ecbnh m\u1ee9c d\u01b0\u01a1ng nghi\u1ec7m c\u1ee7a ch\u1ee5p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh.<\/p>\n

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

Suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh d\u1eabn t\u1edbi b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9\u00a0 c\u00f3 th\u1ec3 l\u00e0 m\u1ea1n t\u00ednh (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n) hay suy c\u1ea5p t\u00ednh (suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p). Bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u1ee7a suy v\u00e0nh l\u00e0 c\u01a1n \u0111au th\u1eaft ng\u1ef1c. Tr\u00ean l\u00e2m s\u00e0ng, suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n c\u00f3 th\u1ec3 bi\u1ec3u hi\u1ec7n […]<\/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":"\nB\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9: C\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n theo ICD10 - Vinmec<\/title>\n<meta name=\"description\" content=\"Suy \u0111\u1ed9ng m\u1ea1ch v\u00e0nh d\u1eabn t\u1edbi b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9\u00a0 c\u00f3 th\u1ec3 l\u00e0 m\u1ea1n t\u00ednh (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n) hay suy c\u1ea5p t\u00ednh (b\u1ec7nh\u0111\u1ed9ng m\u1ea1ch v\u00e0nh c\u1ea5p).\" \/>\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=\"B\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9: C\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n theo ICD10 - 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