{"id":136980,"date":"2025-09-05T17:14:07","date_gmt":"2025-09-05T10:14:07","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=136980"},"modified":"2025-10-23T08:18:47","modified_gmt":"2025-10-23T01:18:47","slug":"khuyen-cao-esc-2025-ve-quan-ly-viem-co-tim-va-viem-mang-ngoai-tim","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/khuyen-cao-esc-2025-ve-quan-ly-viem-co-tim-va-viem-mang-ngoai-tim\/","title":{"rendered":"Khuy\u1ebfn c\u00e1o ESC 2025 v\u1ec1 qu\u1ea3n l\u00fd vi\u00eam c\u01a1 tim v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim"},"content":{"rendered":"

Xem v\u00e0 t\u1ea3i file PDF t\u1ea1i \u0111\u00e2y<\/a>.<\/p>\n

T\u00f3m l\u01b0\u1ee3c nh\u1eefng \u0111i\u1ec3m m\u1edbi trong khuy\u1ebfn c\u00e1o<\/h1>\n
Khung ti\u1ebfp c\u1eadn m\u1edbi: s\u1eed d\u1ee5ng thu\u1eadt ng\u1eef H\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim – m\u00e0ng ngo\u00e0i tim (IMPS), nh\u1ea5n m\u1ea1nh s\u1ef1 giao thoa b\u1ec7nh h\u1ecdc.<\/p>\n
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Ch\u1ea9n \u0111o\u00e1n<\/li>\n
Ch\u1ee5p c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim (CMR): l\u00e0 ph\u01b0\u01a1ng ph\u00e1p ch\u00ednh cho ch\u1ea9n \u0111o\u00e1n, theo d\u00f5i, \u00e1p d\u1ee5ng ti\u00eau chu\u1ea9n Lake Louise c\u1eadp nh\u1eadt.<\/li>\n
Sinh thi\u1ebft c\u01a1 tim: ch\u1ec9 \u0111\u1ecbnh ch\u1ecdn l\u1ecdc khi nguy c\u01a1 cao ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb, \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n v\u00e0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u.<\/li>\n
\u0110\u01b0a ra tri\u1ec7u ch\u1ee9ng c\u1ea3nh b\u00e1o, ti\u00eau chu\u1ea9n ph\u00e2n t\u1ea7ng nguy c\u01a1 r\u00f5 r\u00e0ng \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh nh\u1eadp vi\u1ec7n & \u0111i\u1ec1u tr\u1ecb.<\/li>\n<\/ul>\n
\u0110i\u1ec1u tr\u1ecb<\/p>\n
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\u0110\u01b0a ra ph\u00e1c \u0111\u1ed3 chung v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 cho t\u1eebng th\u1ec3 b\u1ec7nh theo nguy\u00ean nh\u00e2n v\u00e0 m\u00f4 b\u1ec7nh h\u1ecdc<\/li>\n
\u0110\u01b0a ra c\u00e1c thu\u1ed1c m\u1edbi kh\u00e1ng IL-1 cho vi\u00eam m\u00e0ng ngo\u00e0i tim.<\/li>\n<\/ul>\n
Theo d\u00f5i: nh\u1ea5n m\u1ea1nh t\u1ea7m quan tr\u1ecdng c\u1ee7a MRI tim (ch\u1ea9n \u0111o\u00e1n v\u00e0 theo d\u00f5i), \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 d\u00e0i h\u1ea1n, v\u00e0 ph\u00e2n t\u1ea7ng nguy c\u01a1 lo\u1ea1n nh\u1ecbp sau xu\u1ea5t vi\u1ec7n.<\/p>\n
$\"H\u00ecnh$
H\u00ecnh 1. Minh h\u1ecda trung t\u00e2m c\u1ee7a khuy\u1ebfn c\u00e1o ESC v\u1ec1 vi\u00eam c\u01a1 tim v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 2. S\u1ef1 thay \u0111\u1ed5i m\u00f4 h\u00ecnh trong ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng vi\u00eam c\u01a1 tim<\/figcaption><\/figure>\n
Thu\u1eadt ng\u1eef v\u00e0 giai \u0111o\u1ea1n<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Thu\u1eadt ng\u1eef<\/td>\n \u0110\u1ecbnh ngh\u0129a<\/td>\n<\/tr>\n
IMPS<\/td>\n Thu\u1eadt ng\u1eef chung cho c\u00e1c h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim – m\u00e0ng ngo\u00e0i tim.<\/td>\n<\/tr>\n
Myopericarditis<\/td>\n Ch\u1ee7 y\u1ebfu vi\u00eam m\u00e0ng ngo\u00e0i tim.<\/td>\n<\/tr>\n
Perimyocarditis<\/td>\n Ch\u1ee7 y\u1ebfu vi\u00eam c\u01a1 tim.<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim c\u1ea5p<\/td>\n Tri\u1ec7u ch\u1ee9ng \u2264 4 tu\u1ea7n.<\/p>\n
N\u1ebfu kh\u1edfi ph\u00e1t c\u1ea5p v\u00e0 b\u1ec7nh nh\u00e2n huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, c\u1ea7n thu\u1ed1c t\u0103ng co b\u00f3p ho\u1eb7c h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc g\u1ecdi l\u00e0 vi\u00eam c\u01a1 tim t\u1ed1i c\u1ea5p (fulminant).<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim bi\u1ebfn ch\u1ee9ng<\/td>\n C\u00f3 \u22651 trong c\u00e1c ti\u00eau chu\u1ea9n sau: LVEF <50% tr\u00ean si\u00eau \u00e2m tim Lo\u1ea1n nh\u1ecbp th\u1ea5t k\u00e9o d\u00e0i Block nh\u0129 th\u1ea5t n\u1eb7ng<\/p>\n
Suy tim<\/p>\n
S\u1ed1c tim<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p<\/td>\n Tri\u1ec7u ch\u1ee9ng \u2264 4 tu\u1ea7n.<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim b\u00e1n c\u1ea5p\/\u0111ang ti\u1ebfn tri\u1ec3n<\/td>\n Tri\u1ec7u ch\u1ee9ng >4 tu\u1ea7n – \u22643\u00a0th\u00e1ng.<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim b\u00e1n c\u1ea5p\/dai d\u1eb3ng<\/td>\n Tri\u1ec7u ch\u1ee9ng >4 tu\u1ea7n – \u22643 th\u00e1ng.<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim\/m\u00e0ng ngo\u00e0i tim m\u1ea1n t\u00ednh<\/td>\n Tri\u1ec7u ch\u1ee9ng >3 th\u00e1ng<\/td>\n<\/tr>\n
B\u1ec7nh c\u01a1 tim do vi\u00eam<\/td>\n Vi\u00eam c\u01a1 tim m\u1ea1n k\u00e8m r\u1ed1\u00ec lo\u1ea1n ch\u1ee9c n\u0103ng tim v\u00e0 t\u00e1i c\u1ea5u tr\u00fac th\u1ea5t, bi\u1ec3u hi\u1ec7n gi\u1ea3m v\u1eadn \u0111\u1ed9ng nh\u01b0 b\u1ec7nh c\u01a1 tim gi\u00e3n ho\u1eb7c kh\u00f4ng gi\u00e3n, k\u00e8m\/kh\u00f4ng k\u00e8m c\u01a1 ch\u1ea5t lo\u1ea1n nh\u1ecbp.<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim\/m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t<\/td>\n Xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng ho\u1eb7c ho\u1ea1t t\u00ednh b\u1ec7nh m\u1edbi sau giai \u0111o\u1ea1n lui b\u1ec7nh.<\/td>\n<\/tr>\n
Lui b\u1ec7nh kh\u00f4ng di ch\u1ee9ng<\/td>\n H\u1ebft tri\u1ec7u ch\u1ee9ng, ECG, marker sinh h\u1ecdc v\u00e0 h\u00ecnh \u1ea3nh (si\u00eau \u00e2m\/CMR) b\u00ecnh th\u01b0\u1eddng.<\/td>\n<\/tr>\n
Lui b\u1ec7nh c\u00f3 di ch\u1ee9ng<\/td>\n H\u1ebft tri\u1ec7u ch\u1ee9ng nh\u01b0ng c\u00f2n b\u1ea5t th\u01b0\u1eddng ECG, marker sinh h\u1ecdc ho\u1eb7c h\u00ecnh \u1ea3nh.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 3. C\u00e1c giai \u0111o\u1ea1n c\u1ee7a h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim – m\u00e0ng ngo\u00e0i tim<\/figcaption><\/figure>\n
Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim – m\u00e0ng ngo\u00e0i tim (IMPS)<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
IMPS<\/td>\n<\/tr>\n
N\u1ebfu th\u1ecfa m\u00e3n ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u01a1 tim v\u00e0\/ho\u1eb7c vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n<\/tr>\n
<\/td>\n Vi\u00eam c\u01a1 tim<\/td>\n Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n<\/tr>\n
X\u00e1c \u0111\u1ecbnh<\/td>\n Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng + x\u00e1c \u0111\u1ecbnh b\u1eb1ng CMR ho\u1eb7c sinh thi\u1ebft c\u01a1 tim (EMB)<\/td>\n Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng + 1 ti\u00eau ch\u00ed b\u1ed5 sung.<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3<\/td>\n Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng + \u22651 ti\u00eau ch\u00ed b\u1ed5 sung, CMR\/EMB kh\u00f4ng ch\u1eafc ch\u1eafn ho\u1eb7c kh\u00f4ng c\u00f3.<\/td>\n Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng + 1 ti\u00eau ch\u00ed b\u1ed5 sung<\/td>\n<\/tr>\n
Kh\u00f4ng gi\u1ed1ng\/ Lo\u1ea1i tr\u1eeb<\/td>\n Ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, kh\u00f4ng c\u00f3 ti\u00eau ch\u00ed b\u1ed5 sung.<\/td>\n Ch\u1ec9 c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, kh\u00f4ng c\u00f3 ti\u00eau ch\u00ed b\u1ed5 sung.<\/td>\n<\/tr>\n
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Ti\u00eau ch\u00ed b\u1ed5 sung<\/p>\n<\/td>\n<\/tr>\n
<\/td>\n Vi\u00eam c\u01a1 tim<\/td>\n Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n<\/tr>\n
L\u00e2m s\u00e0ng<\/td>\n Tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.<\/td>\n Ti\u1ebfng c\u1ecd m\u00e0ng tim<\/td>\n<\/tr>\n
ECG<\/td>\n Thay \u0111\u1ed5i ST-T<\/td>\n PR ch\u00eanh xu\u1ed1\u00edng, ST ch\u00eanh l\u00ean lan t\u1ecfa<\/td>\n<\/tr>\n
Biomarkers<\/td>\n T\u0103ng Troponin<\/td>\n CRP t\u0103ng<\/td>\n<\/tr>\n
H\u00ecnh \u1ea3nh<\/td>\n Gi\u1ea3m EF, r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng, thay \u0111\u1ed5i s\u1ee9c c\u0103ng. Ph\u00f9 n\u1ec1 c\u01a1 tim v\u00e0 \/ho\u1eb7c ng\u1ea5m thu\u1ed1\u00edc mu\u1ed9n (LGE) tr\u00ean MRI<\/td>\n Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim m\u1edbi ho\u1eb7c ti\u1ebfn tri\u1ec3n<\/p>\n
Ph\u00f9 n\u1ec1 m\u00e0ng ngo\u00e0i tim v\u00e0 \/ho\u1eb7c ng\u1ea5m thu\u1ed1\u00edc mu\u1ed9n (LGE) tr\u00ean MRI<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 4. Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u01a1 tim tr\u00ean CMR theo ti\u00eau chu\u1ea9n Lake Louise c\u1eadp nh\u1eadt<\/figcaption><\/figure>\n
Ti\u00eau chu\u1ea9n m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee7a vi\u00eam c\u01a1 tim<\/h1>\n\n\n\n\n\n\n\n\n\n
Thu\u1eadt ng\u1eef<\/td>\n T\u1ebf b\u00e0o vi\u00eam ch\u1ee7 y\u1ebfu<\/td>\n Ho\u1ea1i t\u1eed c\u01a1 tim<\/td>\n PCR d\u01b0\u01a1ng t\u00ednh (viruses, etc.)<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim lympho b\u00e0o ho\u1ea1t \u0111\u1ed9ng<\/td>\n CD3+ T lymphocytes >7\/mm^{2<\/sup>, CD68+ macrophages<\/td>\n} c\u00f3<\/td>\n c\u00f3\/kh\u00f4ng<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim lympho b\u00e0o t\u1ed3n t\u1ea1i<\/td>\n CD3+ T lymphocytes >7\/mm^{2<\/sup>, CD68+ macrophages<\/td>\n} c\u00f3<\/td>\n c\u00f3\/kh\u00f4ng<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim lympho b\u00e0o tho\u00e1i lui<\/td>\n –<\/td>\n kh\u00f4ng<\/td>\n c\u00f3\/kh\u00f4ng<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim \u00e1i toan (giai \u0111o\u1ea1n c\u1ea5p)<\/td>\n Eosinophils, CD3+T lymphocytes, CD68^{+<\/sup> macrophages<\/td>\n} c\u00f3<\/td>\n c\u00f3\/kh\u00f4ng<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 (giai \u0111o\u1ea1n c\u1ea5p)<\/td>\n Eosinophils, CD68+ giant cells, CD3+ T lymphocytes, CD68+ macrophages<\/td>\n c\u00f3<\/td>\n kh\u00f4ng<\/td>\n<\/tr>\n
Sarcoidosis<\/td>\n CD68+ giant cells, granuloma, CD3+ T lymphocytes, CD68^{+<\/sup> macrophages<\/td>\n} c\u00f3\/kh\u00f4ng<\/td>\n kh\u00f4ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Red flags (D\u1ea5u hi\u1ec7u c\u1ea3nh b\u00e1o) trong ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng vi\u00eam c\u01a1 tim & vi\u00eam m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n
Vi\u00eam c\u01a1 tim<\/td>\n Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ee9ng gi\u1ed1ng c\u00fam\/ti\u00eau h\u00f3a g\u1ea7n \u0111\u00e2y<\/p>\n
\u0110au ng\u1ef1c ki\u1ec3u nh\u1ed3i m\u00e1u<\/p>\n
\u0110\u00e1nh tr\u00f4ng ng\u1ef1c<\/p>\n
Tri\u1ec7u ch\u1ee9ng suy tim<\/p>\n
Thay \u0111\u1ed5i ECG, lo\u1ea1n nh\u1ecbp th\u1ea5t, ng\u1ea5t, t\u1ee5t huy\u1ebft \u0111\u1ed9ng Troponin, CK-MB t\u0103ng<\/p>\n
NT-proBNP t\u0103ng<\/p>\n
R\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng, d\u00e0y th\u00e0nh, gi\u1ea3m EF<\/p>\n
CMR: ph\u00f9 c\u01a1 tim v\u00e0 ho\u1eb7c ng\u1ea5m thu\u1ed1c mu\u1ed9n<\/td>\n
H\u1ed9i ch\u1ee9ng gi\u1ed1ng c\u00fam\/ti\u00eau h\u00f3a g\u1ea7n \u0111\u00e2y \u0110au ng\u1ef1c ki\u1ec3u m\u00e0ng ph\u1ed5i\/nh\u1ed3i m\u00e1u Tri\u1ec7u ch\u1ee9ng suy tim ph\u1ea3i, co th\u1eaft S\u1ed1t, ti\u1ebfng c\u1ecd m\u00e0ng tim, CRP t\u0103ng<\/p>\n
Tr\u00e0n d\u1ecbch m\u00e0ng tim, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, vi\u00eam \u0111a m\u00e0ng<\/p>\n
CMR: ph\u00f9 m\u00e0ng tim v\u00e0\/ho\u1eb7c ng\u1ea5m thu\u1ed1c mu\u1ed9n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u00e2n t\u1ea7ng nguy c\u01a1 l\u00e2m s\u00e0ng \u0111\u1ec3 \u0111\u1ecbnh h\u01b0\u1edbng ti\u1ebfp c\u1eadn<\/h1>\n\n\n\n\n\n\n\n
Nguy c\u01a1<\/td>\n Nguy c\u01a1 cao<\/td>\n Nguy c\u01a1 trung b\u00ecnh<\/td>\n Nguy c\u01a1 th\u1ea5p<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim<\/p>\n
<\/td>\n
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Suy tim c\u1ea5p\/s\u1ed1c tim<\/li>\n
Kh\u00f3 th\u1edf NYHA III-IV kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/li>\n
Ng\u1eebng tim\/ng\u1ea5t<\/li>\n
Rung th\u1ea5t\/nhanh th\u1ea5t b\u1ec1n b\u1ec9<\/li>\n
Block nh\u0129 th\u1ea5t \u0111\u1ed9 cao<\/li>\n<\/ul>\n<\/td>\n
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Kh\u00f3 th\u1edf ti\u1ebfn tri\u1ec3n\/ m\u1edbi xu\u1ea5t hi\u1ec7n<\/li>\n
Lo\u1ea1n nh\u1ecbp th\u1ea5t kh\u00f4ng b\u1ec1n b\u1ec9<\/li>\n
T\u0103ng troponin k\u00e9o d\u00e0i ho\u1eb7c t\u0103ng tr\u1edf l\u1ea1i<\/li>\n<\/ul>\n<\/td>\n
\u00cdt tri\u1ec7u ch\u1ee9ng\/ \u1ed5n \u0111\u1ecbnh<\/td>\n<\/tr>\n
Ti\u00eau chu\u1ea9n h\u00ecnh \u1ea3nh<\/p>\n
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LVEF gi\u1ea3m m\u1edbi xu\u1ea5t hi\u1ec7n (<40%)<\/li>\n
Ng\u1ea5m thu\u1ed1c mu\u1ed9n (LGE) lan r\u1ed9ng<\/li>\n<\/ul>\n<\/td>\n
Ti\u00eau chu\u1ea9n h\u00ecnh \u1ea3nh<\/p>\n
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Suy tim EF gi\u1ea3m nh\u1eb9 m\u1edbi xu\u1ea5t hi\u1ec7n(41%-49%) v\u00e0\/ho\u1eb7c r\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng v\u00f9ng<\/li>\n
LVEF b\u1ea3o t\u1ed3n (\u226550%) v\u00e0 c\u00f3 \u22652 v\u00f9ng ng\u1ea5m thu\u1ed1c mu\u1ed9n (LGE) tr\u00ean MRI tim<\/li>\n<\/ul>\n<\/td>\n
Ti\u00eau chu\u1ea9n h\u00ecnh \u1ea3nh<\/p>\n
LVEF (\u226550%) b\u1ea3o t\u1ed3n v\u00e0 kh\u00f4ng c\u00f3 ho\u1eb7c c\u00f3 \u00edt <2 v\u00f9ng ng\u1ea5m thu\u1ed1c mu\u1ed9n (LGE) tr\u00ean MRI tim<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/p>\n
<\/td>\n
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D\u1ea5u hi\u1ec7u\/ tri\u1ec7u ch\u1ee9ng ch\u00e8n \u00e9p tim c\u1ea5p<\/li>\n
S\u1ed1t (>38\u00b0C)<\/li>\n
Vi\u00eam co th\u1eaft-tr\u00e0n d\u1ecbch<\/li>\n
Th\u1ea5t b\u1ea1i v\u1edbi NSAID<\/li>\n
Vi\u00eam MNT dai d\u1eb3ng<\/li>\n<\/ul>\n<\/td>\n
D\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng suy tim ph\u1ea3i<\/td>\n \u0110\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb trong 1-2 tu\u1ea7n<\/td>\n<\/tr>\n
Ti\u00eau chu\u1ea9n h\u00ecnh \u1ea3nh<\/p>\n
\n
Tr\u00e0n d\u1ecbch nhi\u1ec1u(>20 mm cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng)<\/li>\n
Ch\u00e8n \u00e9p tim<\/li>\n
Ng\u1ea5m thu\u1ed1c mu\u1ed9n lan r\u1ed9ng MNT tr\u00ean MRI<\/li>\n<\/ul>\n<\/td>\n
Ti\u00eau chu\u1ea9n h\u00ecnh \u1ea3nh<\/p>\n
\n
Tr\u00e0n d\u1ecbch v\u1eeba-nhi\u1ec1u (10-20 mm cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng)<\/li>\n
R\u1ed1i lo\u1ea1n ki\u1ec3u co th\u1eaft b\u1ea5t k\u1ec3 m\u1ee9c \u0111\u1ed9 d\u1ecbch<\/li>\n<\/ul>\n<\/td>\n
Ti\u00eau chu\u1ea9n h\u00ecnh \u1ea3nh<\/p>\n
\n
Kh\u00f4ng c\u00f3\/ tr\u00e0n d\u1ecbch \u00edt<\/li>\n
Kh\u00f4ng c\u00f3 ng\u1ea5m thu\u1ed1c mu\u1ed9n tr\u00ean MRI tim<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 5. L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n & ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n n\u1ed9i tr\u00fa v\u1edbi vi\u00eam c\u01a1 tim<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 6. L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i b\u1ec7nh nh\u00e2n ngo\u1ea1i tr\u00fa v\u1edbi vi\u00eam c\u01a1 tim<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 7. L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n v\u00e0 ph\u00e2n lo\u1ea1i vi\u00eam m\u00e0ng ngo\u00e0i tim<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 8. Bi\u1ec3u hi\u1ec7n v\u00e0 ti\u00ean l\u01b0\u1ee3ng c\u1ee7a vi\u00eam c\u01a1 tim<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 9. L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n \u0111au ng\u1ef1c c\u1ea5p<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 10. L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n suy tim c\u1ea5p<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 11. L\u01b0u \u0111\u1ed3 ch\u1ea9n \u0111o\u00e1n b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp<\/figcaption><\/figure>\n
$\"H\u00ecnh$
H\u00ecnh 12. X\u1eed tr\u00ed ch\u00e8n \u00e9p tim<\/figcaption><\/figure>\n
Nguy\u00ean nh\u00e2n ch\u00e8n \u00e9p tim<\/h1>\n
Nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p (th\u1ee9 t\u1ef1 theo t\u1ea7n su\u1ea5t):<\/p>\n
\n
U\/ B\u1ec7nh l\u00fd \u00e1c t\u00ednh<\/li>\n
latrogenic\/ch\u1ea5n th\u01b0\u01a1ng<\/li>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/li>\n
Lao (th\u01b0\u1eddng g\u1eb7p \u1edf c\u00e1c n\u01b0\u1edbc \u0111ang ph\u00e1t tri\u1ec3n)<\/li>\n<\/ol>\n
Nguy\u00ean nh\u00e2n \u00edt g\u1eb7p (th\u1ee9 t\u1ef1 theo t\u1ea7n su\u1ea5t):<\/p>\n
\n
B\u1ec7nh collagen m\u1ea1ch m\u00e1u(lupus, vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p, x\u01a1 c\u1ee9ng b\u00ec)<\/li>\n
H\u1ed9i ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng m\u00e0ng tim<\/li>\n
Nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p<\/li>\n
L\u00f3c t\u00e1ch \u0111\u1ed9ng m\u1ea1ch ch\u1ee7<\/li>\n
T\u0103ng ure m\u00e1u<\/li>\n
Nhi\u1ec5m khu\u1ea9n<\/li>\n
Tr\u00e0n kh\u00ed m\u00e0ng tim<\/li>\n<\/ol>\n
$\"H\u00ecnh$
H\u00ecnh 13. X\u1eed tr\u00ed vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft<\/figcaption><\/figure>\n
\u0110\u00e1nh gi\u00e1 c\u01a1 b\u1ea3n v\u00e0 n\u00e2ng cao (1)<\/h1>\n
\u0110\u00e1nh gi\u00e1 c\u01a1 b\u1ea3n:<\/p>\n
\n
B\u1ec7nh s\u1eed: nguy\u00ean nh\u00e2n v\u00e0 y\u1ebfu t\u1ed1 kh\u1edfi ph\u00e1t (virus \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean ho\u1eb7c \u0111\u01b0\u1eddng ti\u00eau h\u00f3a, nhi\u1ec5m \u0111\u1ed9c, ma t\u00fay ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c), tri\u1ec7u ch\u1ee9ng t\u00e1i ph\u00e1t, ti\u1ec1n s\u1eed gia \u0111\u00ecnh c\u00f3 IMPS\/b\u1ec7nh c\u01a1 tim\/\u0111\u1ed9t t\u1eed, v\u00e0 b\u1ec7nh t\u1ef1 mi\u1ec5n\/ vi\u00eam h\u1ec7 th\u1ed1ng.<\/li>\n
Kh\u00e1m l\u00e2m s\u00e0ng: \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng, tri\u1ec7u ch\u1ee9ng (\u0111au ng\u1ef1c, suy tim, \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, ng\u1ea5t), cho\u00e1ng, m\u1ec7t, ti\u1ebfng c\u1ecd m\u00e0ng ngo\u00e0i tim v\u00e0 c\u00e1c d\u1ea5u hi\u1ec7u ch\u00e8n \u00e9p tm c\u1ea5p<\/li>\n
ECG: PR ch\u00eanh xu\u1ed1ng, thay \u0111\u1ed5i ST-T, block nh\u0129 th\u1ea5t, lo\u1ea1n nh\u1ecbp th\u1ea5t.<\/li>\n
X-quang ng\u1ef1c<\/li>\n
X\u00e9t nghi\u1ec7m c\u01a1 b\u1ea3n:<\/li>\n
T\u1ed5n th\u01b0\u01a1ng c\u01a1 tim(e.g. hs-TnT\/TnI)<\/li>\n
Vi\u00eam h\u1ec7 th\u1ed1ng (e.g. CRP, m\u00e1u l\u1eafng, b\u1ea1ch c\u1ea7u)<\/li>\n
Suy tim (e.g. NT-proBNP)<\/li>\n
T\u1ed5ng ph\u00e2n t\u00edch t\u1ebf b\u00e0o m\u00e1u (bao g\u1ed3m c\u1ea3 b\u1ea1ch c\u1ea7u \u00e1i toan)<\/li>\n
CN th\u1eadn v\u00e0 \u0111i\u1ec7n gi\u1ea3i(e.g. sodium, potassium, creatinine)<\/li>\n
CN tuy\u1ebfn gi\u00e1p(e.g. TSH)<\/li>\n
Ch\u1ee9c n\u0103ng gan v\u00e0 x\u00e9t nghi\u1ec7m kh\u00e1c (e.g. lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase)<\/li>\n
Si\u00eau \u00e2m tim bao g\u1ed3m c\u1ea3 \u0111\u00e1nh d\u1ea5u m\u00f4<\/li>\n<\/ul>\n
\u0110\u00e1nh gi\u00e1 c\u01a1 b\u1ea3n v\u00e0 n\u00e2ng cao (2)<\/h1>\n
\u0110\u00e1nh gi\u00e1 n\u00e2ng cao (sau nh\u1eadp vi\u1ec7n):<\/p>\n
\n
\u0110\u00e1nh gi\u00e1 gi\u1ea3i ph\u1eabu m\u1ea1ch v\u00e0nh (Ch\u1ee5p m\u1ea1ch v\u00e0nh x\u00e2m l\u1ea5n ho\u1eb7c CT m\u1ea1ch v\u00e0nh khi nghi ng\u1edd h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p)<\/li>\n
C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 vi\u00eam v\u00e0 ho\u1eb7c x\u01a1 h\u00f3a c\u01a1 tim v\u00e0 m\u00e0ng ngo\u00e0i tim<\/li>\n
S\u00e0ng l\u1ecdc r\u1ed1i lo\u1ea1n nh\u1ecbp t\u00f9y theo m\u1ee9c \u0111\u1ed9 nguy c\u01a1 (v\u00ed d\u1ee5 Holter \u0111i\u1ec7n t\u00e2m \u0111\u1ed3)<\/li>\n
X\u00e9t nghi\u1ec7m b\u1ed5 sung theo nghi ng\u1edd l\u00e2m s\u00e0ng. (v\u00ed d\u1ee5 n\u1ebfu c\u00f3 th\u1ec3 s\u1ebd gi\u00fap thay \u0111\u1ed5i ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb)<\/li>\n
X\u00e9t nghi\u1ec7m di truy\u1ec1n n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh<\/li>\n
CT \u0111\u00e1nh gi\u00e1 b\u1ec7nh ph\u1ed5i k\u00e8m theo<\/li>\n
Vi\u00eam c\u01a1 tim: Sinh thi\u1ebft c\u01a1 tim \u1edf nguy c\u01a1 cao ho\u1eb7c m\u1ed9t s\u1ed1 ca trung b\u00ecnh \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee5 th\u1ec3 v\u00e0 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n<\/li>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim: ch\u1ecdc d\u1ecbch m\u00e0ng tim \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh<\/li>\n<\/ul>\n
Khuy\u1ebfn c\u00e1o \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng vi\u00eam c\u01a1 tim v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim (1)<\/h1>\n\n\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Lo\u1ea1i<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
N\u00ean l\u00e0m \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng \u0111\u1ea7y \u0111\u1ee7 (khai th\u00e1c b\u1ec7nh s\u1eed, kh\u00e1m, X-quang ng\u1ef1c, d\u1ea5u \u1ea5n sinh h\u1ecdc, ECG, si\u00eau \u00e2m tim) \u1edf m\u1ecdi b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam c\u01a1 tim\/m\u00e0ng ngo\u00e0i tim.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam c\u01a1 tim(s\u1eed d\u1ee5ng ti\u00eau chu\u1ea9n LL c\u1eadp nh\u1eadt) v\u00e0\/ho\u1eb7c vi\u00eam m\u00e0ng ngo\u00e0i tim \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n kh\u00f4ng x\u00e2m l\u1ea5n ph\u1ea3n \u1ee9ng vi\u00eam.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Nh\u1eadp vi\u1ec7n n\u1ebfu vi\u00eam m\u00e0ng ngo\u00e0i tim nguy c\u01a1 cao \u0111\u1ec3 theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Nh\u1eadp vi\u1ec7n n\u1ebfu vi\u00eam c\u01a1 tim nguy c\u01a1 trung b\u00ecnh – cao \u0111\u1ec3 theo d\u00f5i v\u00e0 \u0111i\u1ec1u tr\u1ecb.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Sinh thi\u1ebft c\u01a1 tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n \u1edf b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim nguy c\u01a1 cao, v\u00e0\/ho\u1eb7c r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng v\u00e0\/ho\u1eb7c nguy c\u01a1 trung b\u00ecnh kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng quy \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ph\u00e2n lo\u1ea1i d\u01b0\u1edbi m\u00f4 b\u1ec7nh h\u1ecdc v\u00e0 x\u00e9t nghi\u1ec7m x\u00e1c \u0111\u1ecbnh virus cho \u0111i\u1ec1u tr\u1ecb.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng vi\u00eam c\u01a1 tim v\u00e0 vi\u00eam m\u00e0ng ngo\u00e0i tim (2)<\/h1>\n\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Lo\u1ea1i<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ch\u1ee5p m\u1ea1ch v\u00e0nh ho\u1eb7c CT m\u1ea1ch v\u00e0nh (t\u00f9y thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 nghi ng\u1edd) n\u1ebfu nghi ng\u1edd h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p \u0111\u1ec3 lo\u1ea1i tr\u1eeb h\u1eb9p m\u1ea1ch v\u00e0nh.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3 nh\u1eadp vi\u1ec7n b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim nguy c\u01a1 th\u1ea5p \u0111\u1ec3 theo d\u00f5i.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
Sinh thi\u1ebft m\u00e0ng ngo\u00e0i tim c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc trong tr\u00e0n d\u1ecbch t\u00e1i ph\u00e1t, khi kh\u00f4ng r\u00f5 ch\u1ea9n \u0111o\u00e1n b\u1eb1ng x\u00e9t nghi\u1ec7m v\u00e0 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh.<\/td>\n IIb<\/td>\n C<\/td>\n<\/tr>\n
Kh\u00f4ng n\u00ean l\u00e0m huy\u1ebft thanh h\u1ecdc virus th\u01b0\u1eddng quy, tr\u1eeb HIV, vi\u00eam gan C, Lyme<\/td>\n III<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 14. Di\u1ec5n ti\u1ebfn kh\u00e1c nhau c\u1ee7a h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim \u2013 m\u00e0ng ngo\u00e0i tim v\u00e0 m\u1ed1i li\u00ean h\u1ec7 gi\u1eefa y\u1ebfu t\u1ed1 di truy\u1ec1n, vi\u00eam, t\u1ef1 mi\u1ec5n v\u00e0 t\u00e1c nh\u00e2n nhi\u1ec5m tr\u00f9ng kh\u1edfi ph\u00e1t ban \u0111\u1ea7u<\/figcaption><\/figure>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 x\u00e9t nghi\u1ec7m di truy\u1ec1n<\/h1>\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o n\u00ean khai th\u00e1c ti\u1ec1n s\u1eed gia \u0111\u00ecnh, bao g\u1ed3m c\u1ea3 ph\u1ea3 h\u1ec7, trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim v\u00e0 m\u00e0ng ngo\u00e0i tim (IMPS) t\u00e1i ph\u00e1t \u0111\u1ec3 cung c\u1ea5p manh m\u1ed1i v\u1ec1 nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n, x\u00e1c \u0111\u1ecbnh ki\u1ec3u di truy\u1ec1n v\u00e0 nh\u1eadn di\u1ec7n nh\u1eefng ng\u01b0\u1eddi th\u00e2n c\u00f3 nguy c\u01a1.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc x\u00e9t nghi\u1ec7m di truy\u1ec1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh vi\u00eam c\u01a1 tim\/vi\u00eam m\u00e0ng ngo\u00e0i tim trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p:<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ti\u1ec1n s\u1eed gia \u0111\u00ecnh m\u1eafc IMPS, b\u1ec7nh c\u01a1 tim di truy\u1ec1n ho\u1eb7c nghi ng\u1edd di truy\u1ec1n<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 R\u1ed1\u00ec lo\u1ea1n nh\u1ecbp th\u1ea5t n\u1eb7ng<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ng\u1ea5m thu\u1ed1c mu\u1ed9n (LGE) \u0111\u00e1ng k\u1ec3 \u1edf th\u1ea5t tr\u00e1i\/ph\u1ea3i (v\u00ed d\u1ee5: d\u1ea1ng v\u00f2ng ho\u1eb7c \u1edf v\u00e1ch li\u00ean th\u1ea5t) ho\u1eb7c r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i (LVEF) dai d\u1eb3ng<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vi\u00eam c\u01a1 tim t\u00e1i ph\u00e1t ho\u1eb7c t\u0103ng troponin dai d\u1eb3ng<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vi\u00eam m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t v\u1edbi ki\u1ec3u h\u00ecnh vi\u00eam, kh\u00e1ng tr\u1ecb v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, nh\u1eb1m m\u1ee5c \u0111\u00edch ph\u00e1t hi\u1ec7n nguy\u00ean nh\u00e2n di truy\u1ec1n ti\u1ec1m \u1ea9n..<\/td>\n
Ila<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Ph\u00e2n lo\u1ea1i tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n\n\n
Kh\u1edfi ph\u00e1t<\/td>\n C\u1ea5p (\u2264 4 tu\u1ea7n)<\/p>\n
B\u00e1n c\u1ea5p (> 4 tu\u1ea7n \u0111\u1ebfn \u2264 3 th\u00e1ng)<\/p>\n
M\u1ea1n t\u00ednh (> 3 th\u00e1ng)<\/td>\n<\/tr>\n
K\u00edch th\u01b0\u1edbc<\/td>\n Nh\u1eb9 < 10 mm<\/p>\n
Trung b\u00ecnh 10-20 mm<\/p>\n
Nhi\u1ec1u > 20 mm<\/td>\n<\/tr>\n
Ph\u00e2n b\u1ed1<\/td>\n Lan t\u1ecfa \/ Khu tr\u00fa<\/td>\n<\/tr>\n
Th\u00e0nh ph\u1ea7n<\/td>\n D\u1ecbch th\u1ea5m \/ D\u1ecbch ti\u1ebft<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 vi\u1ec7c s\u1eed d\u1ee5ng c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim m\u1ea1ch (CMR)<\/h1>\n\n\n\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Vi\u00eam c\u01a1 tim<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng CMR \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam c\u01a1 tim \u0111\u1ec3 \u0111i \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 x\u00e1c \u0111\u1ecbnh nguy\u00ean nh\u00e2n t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim c\u1ea5p, bao g\u1ed3m \u0111\u00e1nh gi\u00e1 ph\u00f9 n\u1ec1, thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, v\u00e0 ho\u1ea1i t\u1eed\/x\u01a1 h\u00f3a\/s\u1eb9o.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng CMR \u0111\u1ec3 theo d\u00f5i, \u00edt nh\u1ea5t trong v\u00f2ng 6 th\u00e1ng \u0111\u1ea7u, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh qu\u00e1 tr\u00ecnh \u0111\u00e3 l\u00e0nh hay c\u00f2n ti\u1ebfp di\u1ec5n, \u0111\u1ec3 ph\u00e2n t\u1ea7ng nguy c\u01a1 v\u00e0 c\u00e1 th\u1ec3 h\u00f3a \u0111i\u1ec1u tr\u1ecb, v\u00e0 \u0111\u1ec3 cho ph\u00e9p quay tr\u1edf l\u1ea1i t\u1eadp luy\u1ec7n th\u1ec3 l\u1ef1c.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng CMR \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam m\u00e0ng ngo\u00e0i tim khi ch\u1ea9n \u0111o\u00e1n kh\u00f4ng th\u1ec3 th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c b\u1eb1ng c\u00e1c ti\u00eau chu\u1ea9n l\u00e2m s\u00e0ng, nh\u1eb1m \u0111\u00e1nh gi\u00e1 b\u1eb1ng ch\u1ee9ng d\u00e0y m\u00e0ng ngo\u00e0i tim, ph\u00f9 n\u1ec1, ng\u1ea5m thu\u1ed1c mu\u1ed9n (LGE), v\u00e0 \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a b\u1ec7nh trong qu\u00e1 tr\u00ecnh theo d\u00f5i \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u1ecdn l\u1ecdc.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 ch\u1ee5p c\u1eaft l\u1edbp vi t\u00ednh (CT)<\/h1>\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u0153c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng CT \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 \u0111\u1ed9 d\u00e0y m\u00e0ng ngo\u00e0i tim, v\u00f4i h\u00f3a, c\u00e1c kh\u1ed1i u, v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim khu tr\u00fa, c\u0169ng nh\u01b0 c\u00e1c b\u1ec7nh l\u00fd m\u00e0ng ph\u1ed5i-ph\u1ed5i v\u00e0 b\u1ea5t th\u01b0\u1eddng l\u1ed3ng ng\u1ef1c \u0111i k\u00e8m<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 y h\u1ecdc h\u1ea1t nh\u00e2n<\/h1>\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
PET 18F-FDG kh\u00f4ng d\u00f9ng carb ho\u1eb7c PET\/CT 18F-FDG n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t trong ch\u1ea9n \u0111o\u00e1n cho b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam c\u01a1 tim v\u00e0\/ho\u1eb7c vi\u00eam m\u00e0ng ngo\u00e0i tim khi si\u00eau \u00e2m tim v\u00e0 CMR kh\u00f4ng cho k\u1ebft lu\u1eadn r\u00f5 r\u00e0ng v\u1ec1 ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
C\u00e1c th\u00f4ng s\u1ed1 c\u1ea7n b\u00e1o c\u00e1o t\u1eeb sinh thi\u1ebft n\u1ed9i m\u1ea1c c\u01a1 tim (EMB)<\/h1>\n\n\n\n\n\n\n\n\n
Ti\u00eau ch\u00ed<\/td>\n C\u00e1c th\u00f4ng s\u1ed1 c\u1ea7n b\u00e1o c\u00e1o<\/td>\n<\/tr>\n
M\u00f4 b\u1ec7nh h\u1ecdc (m\u1eabu EMB \u0111\u01b0\u1ee3c \u0111\u00fac n\u1ebfn, \u00edt nh\u1ea5t 3 m\u1eabu)<\/td>\n S\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 ho\u1ea1i t\u1eed t\u1ebf b\u00e0o c\u01a1 tim, t\u00ecnh tr\u1ea1ng vi\u00eam, x\u01a1 h\u00f3a.<\/td>\n<\/tr>\n
H\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch (m\u1eabu EMB \u0111\u01b0\u1ee3c \u0111\u00fac n\u1ebfn, \u00edt nh\u1ea5t 3 m\u1eabu c\u01a1 tim)<\/td>\n S\u1ef1 hi\u1ec7n di\u1ec7n, m\u1ee9c \u0111\u1ed9, v\u1ecb tr\u00ed v\u00e0 lo\u1ea1i t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch trong c\u01a1 tim: Lympho T CD3+, \u0111\u1ea1i th\u1ef1c b\u00e0o CD68+ (\u226514 b\u1ea1ch c\u1ea7u\/mm^{2<\/sup> v\u1edbi lympho T \u22657 t\u1ebf b\u00e0o\/mm^{2<\/sup>), bi\u1ec3u hi\u1ec7n HLA-DR tr\u00ean t\u1ebf b\u00e0o mi\u1ec5n d\u1ecbch v\u00e0 t\u1ebf b\u00e0o n\u1ed9i m\u00f4.<\/td>\n<\/tr>\n}}
B\u1ec7nh h\u1ecdc ph\u00e2n t\u1eed [nhi\u1ec5m tr\u00f9ng]: RNAlater, m\u00f4 \u0111\u00f4ng l\u1ea1nh t\u1ee9c th\u00ec (1-2 m\u1eabu EMB), m\u1eabu EMB \u0111\u00fac n\u1ebfn<\/td>\n S\u1ef1 hi\u1ec7n di\u1ec7n, \u0111\u1ecbnh lo\u1ea1i v\u00e0 \u0111\u1ecbnh l\u01b0\u1ee3ng DNA\/RNA c\u1ee7a c\u00e1c t\u00e1c nh\u00e2n g\u00e2y nhi\u1ec5m b\u1eb1ng q(RT)-PCR. Virus: ch\u1ee7 y\u1ebfu l\u00e0 enterovirus, parvovirus B19, human herpesvirus 6, virus Epstein-Barr; Borrelia spp, Trypanosoma cruzi.<\/td>\n<\/tr>\n
M\u00e1u<\/td>\n q(RT)-PCR \u0111\u1ec3 ph\u00e1t hi\u1ec7n nhi\u1ec5m tr\u00f9ng h\u1ec7 th\u1ed1ng.<\/td>\n<\/tr>\n
B\u1ec7nh h\u1ecdc ph\u00e2n t\u1eed [di truy\u1ec1n]:<\/p>\n
RNAlater, m\u00f4 \u0111\u00f4ng l\u1ea1nh, m\u1eabu EMB \u0111\u00fac n\u1ebfn, m\u00e1u<\/td>\n
Gi\u1ea3i tr\u00ecnh t\u1ef1 gen th\u1ebf h\u1ec7 m\u1edbi (NGS) \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c bi\u1ebfn th\u1ec3 g\u00e2y b\u1ec7nh trong c\u00e1c gen tim, th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn c\u00e1c b\u1ec7nh c\u01a1 tim (\u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c gen desmosome v\u00e0 sarcomere\/b\u1ed9 x\u01b0\u01a1ng t\u1ebf b\u00e0o).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 sinh thi\u1ebft n\u1ed9i m\u1ea1c c\u01a1 tim (EMB)<\/h1>\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o th\u1ef1c hi\u1ec7n EMB \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim nguy c\u01a1 cao v\u00e0\/ho\u1eb7c c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh, v\u00e0\/ho\u1eb7c \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim nguy c\u01a1 trung b\u00ecnh kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng, nh\u1eb1m ph\u00e1t hi\u1ec7n m\u1ed9t d\u01b0\u1edbi nh\u00f3m m\u00f4 b\u1ec7nh h\u1ecdc c\u1ee5 th\u1ec3 v\u00e0 \u0111\u00e1nh gi\u00e1 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a b\u1ed9 gen virus \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
$\"H\u00ecnh$
H\u00ecnh 15. C\u00e1c ph\u00e1t hi\u1ec7n tr\u00ean m\u00f4 b\u1ec7nh h\u1ecdc trong vi\u00eam c\u01a1 tim<\/figcaption><\/figure>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 kh\u00e1m nghi\u1ec7m t\u1eed thi<\/h1>\n\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o th\u1ef1c hi\u1ec7n kh\u00e1m nghi\u1ec7m t\u1eed thi to\u00e0n di\u1ec7n \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n <50 tu\u1ed5i b\u1ecb \u0111\u1ed9t t\u1eed do tim (SCD) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a vi\u00eam c\u01a1 tim c\u1ea5p nh\u01b0 m\u1ed9t nguy\u00ean nh\u00e2n v\u00e0 \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c b\u1ec7nh tim di truy\u1ec1n ti\u1ec1m \u1ea9n.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o l\u01b0u gi\u1eef c\u00e1c m\u1eabu ph\u00f9 h\u1ee3p \u0111\u1ec3 t\u00e1ch chi\u1ebft DNA v\u00e0 tham v\u1ea5n m\u1ed9t b\u00e1c s\u0129 gi\u1ea3i ph\u1eabu b\u1ec7nh tim m\u1ea1ch trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p SCD, khi nghi ng\u1edd c\u00f3 nguy\u00ean nh\u00e2n di truy\u1ec1n, ho\u1eb7c khi nguy\u00ean nh\u00e2n t\u1eed vong v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 l\u1eadp b\u1ea3n \u0111\u1ed3 \u0111i\u1ec7n h\u1ecdc gi\u1ea3i ph\u1eabu<\/h1>\n\n\n\n\n
Khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc l\u1eadp b\u1ea3n \u0111\u1ed3 \u0111i\u1ec7n h\u1ecdc gi\u1ea3i ph\u1eabu trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nghi ng\u1edd vi\u00eam c\u01a1 tim (\u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh sarcoidosis tim) \u0111\u1ec3 h\u01b0\u1edbng d\u1eabn sinh thi\u1ebft n\u1ed9i m\u1ea1c c\u01a1 tim.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 vi\u00eam c\u01a1 tim \u0111\u1eb7c hi\u1ec7u (1)<\/h1>\n\n\n\n\n\n\n\n\n\n\n
Vi\u00eam c\u01a1 tim lympho b\u00e0o (\u00e2m t\u00ednh v\u1edbi virus)<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 1^{st<\/sup> line<\/td>\n} Kh\u00f4ng n\u1eb7ng: prednisone 1 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u.<\/p>\n
N\u1eb7ng: methylprednisolone 7-14 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch trong 3 ng\u00e0y, sau \u0111\u00f3 d\u00f9ng 1 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng.<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 2nd line<\/td>\n Corticosteroid \u0111\u01b0\u1eddng u\u1ed1ng + azathioprine^{a<\/sup> ho\u1eb7c mycophenolate mofetil^{b<\/sup>, cyclosporine^{c<\/sup>, methotrexate^{d<\/sup><\/td>\n<\/tr>\n}}}}
Li\u1ec7u ph\u00e1p 3rd line<\/td>\n IVIG^{e<\/sup> ho\u1eb7c thay huy\u1ebft t\u01b0\u01a1ng^{f<\/sup><\/td>\n<\/tr>\n}}
Vi\u00eam c\u01a1 tim do b\u1ea1ch c\u1ea7u Eosinophil<\/td>\n<\/tr>\n
1st line therapy<\/td>\n T\u01b0\u01a1ng t\u1ef1 vi\u00eam c\u01a1 tim lympho b\u00e0o + \u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd li\u00ean quan n\u1ebfu x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c.<\/td>\n<\/tr>\n
2nd line therapy<\/td>\n T\u01b0\u01a1ng t\u1ef1 vi\u00eam c\u01a1 tim lympho b\u00e0o + \u0110i\u1ec1u tr\u1ecb b\u1ec7nh l\u00fd li\u00ean quan n\u1ebfu x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c.<\/td>\n<\/tr>\n
3rd line therapy<\/td>\n –<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
\n
Azathioprine (thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, t\u01b0\u01a1ng t\u1ef1 purine): li\u1ec1u 1-2 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng (th\u01b0\u1eddng 100-150 mg\/ng\u00e0y, chia 1-2 l\u1ea7n). \u0110\u00edch t\u00e1c \u0111\u1ed9ng ch\u00ednh: t\u1ebf b\u00e0o lympho.<\/li>\n
Mycophenolate mofetil (thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, \u1ee9c ch\u1ebf enzym inosine monophosphate dehydrogenase, \u0111\u00edch t\u00e1c \u0111\u1ed9ng ch\u00ednh: t\u1ebf b\u00e0o lympho): li\u1ec1u 500-1000 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y (t\u1ed5ng li\u1ec1u 1-2 g\/ng\u00e0y).<\/li>\n
Cyclosporine (thu\u1ed1c \u1ee9c ch\u1ebf calcineurin, ng\u0103n ch\u1eb7n s\u1ef1 phi\u00ean m\u00e3 IL-2 \u1edf t\u1ebf b\u00e0o T ho\u1ea1t h\u00f3a): kho\u1ea3ng 3-5 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng (chia 2 l\u1ea7n), hi\u1ec7u ch\u1ec9nh theo n\u1ed3ng \u0111\u1ed9 \u0111\u00e1y m\u1ee5c ti\u00eau ~150-250 ng\/mL.<\/li>\n
Methotrexate (thu\u1ed1c ch\u1ed1ng chuy\u1ec3n h\u00f3a, \u1ee9c ch\u1ebf dihydrofolate reductase v\u00e0 c\u00e1c b\u01b0\u1edbc ph\u1ee5 thu\u1ed9c folate kh\u00e1c, l\u00e0m gi\u1ea3m t\u0103ng sinh t\u1ebf b\u00e0o lympho ho\u1ea1t h\u00f3a): li\u1ec1u 15-20 mg\/tu\u1ea7n \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c d\u01b0\u1edbi da (li\u1ec1u th\u1ea5p h\u1eb1ng tu\u1ea7n, c\u1ea7n b\u1ed5 sung acid folic).<\/li>\n
IVIG (tr\u1ecb li\u1ec7u \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch b\u1eb1ng c\u00e1ch cung c\u1ea5p kh\u00e1ng th\u1ec3 IgG g\u1ed9p): li\u1ec1u chu\u1ea9n ngo\u00e0i ch\u1ec9 \u0111\u1ecbnh 2 g\/kg t\u1ed5ng li\u1ec1u, th\u01b0\u1eddng truy\u1ec1n trong 1-2 ng\u00e0y; li\u1ec1u thay th\u1ebf: 0,4 g\/kg\/ng\u00e0y trong 5 ng\u00e0y li\u00ean ti\u1ebfp (\u00edt d\u00f9ng h\u01a1n trong vi\u00eam c\u01a1 tim, nh\u01b0ng \u0111\u00f4i khi \u00e1p d\u1ee5ng trong b\u1ed1i c\u1ea3nh t\u1ef1 mi\u1ec5n).<\/li>\n
L\u1ecdc huy\u1ebft t\u01b0\u01a1ng (plasmapheresis): ph\u01b0\u01a1ng ph\u00e1p thay huy\u1ebft t\u01b0\u01a1ng \u0111i\u1ec1u tr\u1ecb, lo\u1ea1i b\u1ecf t\u1ef1 kh\u00e1ng th\u1ec3 l\u01b0u h\u00e0nh, ph\u1ee9c h\u1ee3p mi\u1ec5n d\u1ecbch v\u00e0 c\u00e1c ch\u1ea5t trung gian vi\u00eam; th\u01b0\u1eddng th\u1ef1c hi\u1ec7n 3-5 phi\u00ean trong 5-10 ng\u00e0y.<\/li>\n<\/ol>\n
\u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 vi\u00eam c\u01a1 tim \u0111\u1eb7c hi\u1ec7u (2)<\/h1>\n\n\n\n\n\n\n
Vi\u00eam c\u01a1 tim t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 1st line<\/td>\n Kh\u00f4ng n\u1eb7ng: prednisolone 1 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u.<\/p>\n
N\u1eb7ng: methylprednisolone 7\u201314 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch trong 3 ng\u00e0y, sau \u0111\u00f3 d\u00f9ng 1 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng + thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch (azathioprine\u00aa ho\u1eb7c mycophenolate mofetil\u1d47, cyclosporine\u1d9c)<\/td>\n<\/tr>\n
\n
\n
Li\u1ec7u ph\u00e1p 2nd line<\/div>\n<\/div>\n<\/td>\n
Antithymocyte Globulin (ATG)^{g<\/sup> cyclophosphamide^{h<\/sup>, rituximab^{i\u00a0<\/sup><\/td>\n<\/tr>\n}}}
\n
\n
Li\u1ec7u ph\u00e1p 3rd line<\/div>\n<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
a. Azathioprine (thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, d\u1eabn ch\u1ea5t purine): li\u1ec1u 1\u20132 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng (th\u01b0\u1eddng 100\u2013150 mg\/ng\u00e0y, chia 1\u20132 l\u1ea7n). \u0110\u00edch t\u00e1c \u0111\u1ed9ng: lympho.<\/p>\n
b. Mycophenolate mofetil (\u1ee9c ch\u1ebf inosine monophosphate dehydrogenase, \u0111\u00edch t\u00e1c \u0111\u1ed9ng: lympho): li\u1ec1u 500\u20131000 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y (t\u1ed5ng 1\u20132 g\/ng\u00e0y).<\/p>\n
c. Cyclosporine (\u1ee9c ch\u1ebf calcineurin, ng\u0103n IL-2 phi\u00ean m\u00e3 \u1edf t\u1ebf b\u00e0o T ho\u1ea1t h\u00f3a): 3\u20135 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng (chia 2 l\u1ea7n), ch\u1ec9nh li\u1ec1u theo n\u1ed3ng \u0111\u1ed9 \u0111\u00e1y m\u1ee5c ti\u00eau ~150\u2013250 ng\/mL.<\/p>\n
g. Antithymocyte Globulin \u2013 ATG (kh\u00e1ng th\u1ec3 \u0111a d\u00f2ng ch\u1ed1ng t\u1ebf b\u00e0o T g\u00e2y suy gi\u1ea3m s\u00e2u T-cell): ~1 mg\/kg ti\u00eam t\u0129nh m\u1ea1ch, th\u01b0\u1eddng d\u00f9ng m\u1ed7i ng\u00e0y trong 3\u20135 ng\u00e0y.<\/p>\n
h. Cyclophosphamide (thu\u1ed1c g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o, g\u1eafn ch\u00e9o DNA \u1edf c\u00e1c t\u1ebf b\u00e0o ph\u00e2n chia nhanh, \u0111\u00edch ch\u00ednh: lympho): 600 mg\/m\u00b2 ti\u00eam t\u0129nh m\u1ea1ch bolus v\u00e0o c\u00e1c ng\u00e0y 1, 15, v\u00e0 30 (\u0111i\u1ec1u tr\u1ecb xung).<\/p>\n
i. Rituximab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ch\u1ed1ng CD20 tr\u00ean t\u1ebf b\u00e0o B): 375 mg\/m\u00b2 truy\u1ec1n t\u0129nh m\u1ea1ch, m\u1ed7i tu\u1ea7n 1 l\u1ea7n \u00d7 4 li\u1ec1u (1 th\u00e1ng).<\/p>\n
\u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 vi\u00eam c\u01a1 tim \u0111\u1eb7c hi\u1ec7u (3)<\/h1>\n\n\n\n\n\n\n
B\u1ec7nh sarcoidosis tim<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 1st line<\/td>\n Kh\u00f4ng n\u1eb7ng: prednisone 1 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng, gi\u1ea3m li\u1ec1u t\u1eeb 40-60 mg m\u1ed7i ng\u00e0y.<\/p>\n
N\u1eb7ng: methylprednisolone 7-14 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch trong 3 ng\u00e0y, sau \u0111\u00f3 d\u00f9ng 1 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 2nd line<\/td>\n Methotrexate^{d<\/sup> (l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay), ho\u1eb7c azathioprine^{a<\/sup>, mycophenolate mofetil^{b<\/sup>, cyclophosphamide^{h<\/sup>\u00a0|<\/td>\n<\/tr>\n}}}}
Li\u1ec7u ph\u00e1p 3rd line<\/td>\n Infliximab\u02b2 ho\u1eb7c adalimumab^{k<\/sup>, rituximab’<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\na. Azathioprine (thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, d\u1eabn ch\u1ea5t purine): li\u1ec1u 1\u20132 mg\/kg\/ng\u00e0y \u0111\u01b0\u1eddng u\u1ed1ng (th\u01b0\u1eddng 100\u2013150 mg\/ng\u00e0y, chia 1\u20132 l\u1ea7n). \u0110\u00edch t\u00e1c \u0111\u1ed9ng ch\u00ednh: t\u1ebf b\u00e0o lympho.<\/p>\n
b. Mycophenolate mofetil (\u1ee9c ch\u1ebf inosine monophosphate dehydrogenase, \u0111\u00edch ch\u00ednh: lympho): li\u1ec1u 500\u20131000 mg \u0111\u01b0\u1eddng u\u1ed1ng, ng\u00e0y 2 l\u1ea7n (t\u1ed5ng li\u1ec1u 1\u20132 g\/ng\u00e0y).<\/p>\n
d. Methotrexate (thu\u1ed1c ch\u1ed1ng chuy\u1ec3n h\u00f3a, \u1ee9c ch\u1ebf dihydrofolate reductase v\u00e0 c\u00e1c b\u01b0\u1edbc ph\u1ee5 thu\u1ed9c folate kh\u00e1c, l\u00e0m gi\u1ea3m t\u0103ng sinh lympho ho\u1ea1t h\u00f3a): li\u1ec1u 15\u201320 mg\/tu\u1ea7n, \u0111\u01b0\u1eddng u\u1ed1ng ho\u1eb7c d\u01b0\u1edbi da (d\u00f9ng li\u1ec1u th\u1ea5p h\u1eb1ng tu\u1ea7n, c\u00f3 b\u1ed5 sung acid folic).<\/p>\n
h. Cyclophosphamide (alkyl h\u00f3a, g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o, g\u1eafn ch\u00e9o DNA \u1edf t\u1ebf b\u00e0o ph\u00e2n chia nhanh, \u0111\u00edch ch\u00ednh: lympho): li\u1ec1u 600 mg\/m\u00b2 ti\u00eam t\u0129nh m\u1ea1ch bolus v\u00e0o ng\u00e0y 1, 15 v\u00e0 30 (\u0111i\u1ec1u tr\u1ecb xung).<\/p>\n
i. Rituximab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng kh\u00e1ng CD20 tr\u00ean t\u1ebf b\u00e0o B): li\u1ec1u 375 mg\/m\u00b2 truy\u1ec1n t\u0129nh m\u1ea1ch, m\u1ed7i tu\u1ea7n 1 l\u1ea7n \u00d7 4 tu\u1ea7n (1 th\u00e1ng).<\/p>\n
j. Infliximab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng kh\u00e1ng TNF-\u03b1): li\u1ec1u 5 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch \u1edf tu\u1ea7n 0, 2, 6, sau \u0111\u00f3 m\u1ed7i ~8 tu\u1ea7n (duy tr\u00ec).<\/p>\n
k. Adalimumab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ng\u01b0\u1eddi ho\u00e0n to\u00e0n kh\u00e1ng TNF-\u03b1): li\u1ec1u 40 mg ti\u00eam d\u01b0\u1edbi da m\u1ed7i tu\u1ea7n (ho\u1eb7c m\u1ed7i 2 tu\u1ea7n t\u00f9y \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng).<\/p>\n
\u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 vi\u00eam c\u01a1 tim \u0111\u1eb7c hi\u1ec7u (4)<\/h1>\n\n\n\n\n\n\n\n\n\n\nVi\u00eam c\u01a1 tim do b\u1ec7nh Lyme<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 1st line<\/td>\n (a) Kh\u00e1ng sinh \u0111\u01b0\u1eddng u\u1ed1ng (ca nh\u1eb9):<\/p>\n– Doxycycline 100 mg hai l\u1ea7n\/ng\u00e0y (14\u201321 ng\u00e0y)<\/p>\n
– Amoxicillin 500 mg ba l\u1ea7n\/ng\u00e0y (14\u201321 ng\u00e0y)<\/p>\n
– Cefuroxime axetil 500 mg hai l\u1ea7n\/ng\u00e0y (14\u201321 ng\u00e0y)<\/p>\n
(b) Kh\u00e1ng sinh ti\u00eam t\u0129nh m\u1ea1ch (ca n\u1eb7ng):<\/p>\n
– Ceftriaxone 2 g\/ng\u00e0y (14\u201321 ng\u00e0y)<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 2nd line<\/td>\n Kh\u00e1ng sinh ti\u00eam t\u0129nh m\u1ea1ch: Cefotaxime (2 g m\u1ed7i 8 gi\u1edd x 14\u201321 ng\u00e0y) ho\u1eb7c Penicillin G (18\u201324 tri\u1ec7u \u0111\u01a1n<\/p>\nv\u1ecb\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch m\u1ed7i 4 gi\u1edd x 14\u201321 ng\u00e0y)<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 3rd line<\/td>\n –<\/td>\n<\/tr>\n
B\u1ec7nh Chagas<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 1st line<\/td>\n Benznidazole 5\u20137 mg\/kg\/ng\u00e0y chia 2 li\u1ec1u trong 60 ng\u00e0y<\/p>\nNifurtimox 8\u201310 mg\/kg\/ng\u00e0y chia 3 li\u1ec1u trong 60\u201390 ng\u00e0y<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 2nd line<\/td>\n –<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 3rd line<\/td>\n –<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\u0110i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 vi\u00eam c\u01a1 tim \u0111\u1eb7c hi\u1ec7u (5)<\/h1>\n\n\n\n\n\n\nVi\u00eam c\u01a1 tim do thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch (ICI)<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 1st line<\/td>\n Ng\u1eebng ICI, \u0111\u00e1nh gi\u00e1 l\u1ea1i.<\/p>\nKh\u00f4ng n\u1eb7ng: methylprednisolone 500\u20131000 mg\/ng\u00e0y x 3 ng\u00e0y, sau \u0111\u00f3 gi\u1ea3m li\u1ec1u v\u1edbi prednisone<\/p>\n
\u0111\u01b0\u1eddng u\u1ed1ng.<\/p>\n
N\u1eb7ng: methylprednisolone 7\u201314 mg\/kg\/ng\u00e0y ti\u00eam t\u0129nh m\u1ea1ch x 3 ng\u00e0y, sau \u0111\u00f3 1 mg\/kg\/ng\u00e0y.<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 2nd line<\/td>\n N\u1ebfu kh\u00f4ng \u0111\u00e1p \u1ee9ng trong 24\u201348 gi\u1edd: mycophenolate mofetil, ATG, abatacept, alemtuzumab<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p 3rd line<\/td>\n Infliximab ho\u1eb7c adalimumab, rituximabi.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\nMycophenolate mofetil (\u1ee9c ch\u1ebf inosine monophosphate dehydrogenase, \u0111\u00edch t\u00e1c \u0111\u1ed9ng ch\u00ednh: lympho): li\u1ec1u 500\u20131000 mg \u0111\u01b0\u1eddng u\u1ed1ng, ng\u00e0y 2 l\u1ea7n (t\u1ed5ng li\u1ec1u 1\u20132 g\/ng\u00e0y).<\/li>\n
Antithymocyte Globulin \u2013 ATG (kh\u00e1ng th\u1ec3 \u0111a d\u00f2ng kh\u00e1ng t\u1ebf b\u00e0o T, g\u00e2y suy gi\u1ea3m m\u1ea1nh s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o T): ~1 mg\/kg ti\u00eam t\u0129nh m\u1ea1ch, th\u01b0\u1eddng d\u00f9ng m\u1ed7i ng\u00e0y trong 3\u20135 ng\u00e0y li\u00ean ti\u1ebfp.<\/li>\n
Rituximab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ch\u1ed1ng CD20 tr\u00ean t\u1ebf b\u00e0o B): 375 mg\/m2 truy\u1ec1n t\u0129nh m\u1ea1ch, m\u1ed7i tu\u1ea7n 1 l\u1ea7n \u00d7 4 tu\u1ea7n (1 th\u00e1ng).<\/li>\n
Infliximab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ch\u1ed1ng TNF-\u03b1): 5 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch \u1edf tu\u1ea7n 0, 2, 6, sau \u0111\u00f3 m\u1ed7i ~8 tu\u1ea7n (\u0111i\u1ec1u tr\u1ecb duy tr\u00ec).<\/li>\n
Adalimumab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ng\u01b0\u1eddi ho\u00e0n to\u00e0n ch\u1ed1ng TNF-\u03b1): 40 mg ti\u00eam d\u01b0\u1edbi da m\u1ed7i tu\u1ea7n (ho\u1eb7c m\u1ed7i 2 tu\u1ea7n t\u00f9y \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng).<\/li>\n
Abatacept (protein dung h\u1ee3p CTLA-4 Ig, g\u1eafn v\u1edbi CD80\/86 tr\u00ean t\u1ebf b\u00e0o tr\u00ecnh di\u1ec7n kh\u00e1ng nguy\u00ean, ch\u1eb7n t\u00edn hi\u1ec7u \u0111\u1ed3ng k\u00edch th\u00edch CD28 c\u1ea7n thi\u1ebft \u0111\u1ec3 ho\u1ea1t h\u00f3a ho\u00e0n to\u00e0n t\u1ebf b\u00e0o T): 500 mg truy\u1ec1n t\u0129nh m\u1ea1ch m\u1ed7i 2 tu\u1ea7n \u00d7 5 li\u1ec1u (kho\u1ea3ng 10 tu\u1ea7n).<\/li>\n
Alemtuzumab (kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng ch\u1ed1ng CD52 tr\u00ean lympho): 30 mg ti\u00eam t\u0129nh m\u1ea1ch 1 l\u1ea7n (ho\u1eb7c 15 mg t\u0129nh m\u1ea1ch m\u1ed7i ng\u00e0y trong 2 ng\u00e0y).<\/li>\n<\/ol>\nC\u00e1c c\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng ch\u00ednh<\/h1>\n– \u1ee8c ch\u1ebf t\u1ebf b\u00e0o T (v\u00ed d\u1ee5: corticosteroid, cyclosporine, abatacept)<\/p>\n
– Gi\u1ea3m s\u1ed1 l\u01b0\u1ee3ng t\u1ebf b\u00e0o B (rituximab)<\/p>\n
– \u1ee8c ch\u1ebf cytokine (ch\u1ea5t ch\u1eb9n TNF-\u03b1 nh\u01b0 infliximab, adalimumab)<\/p>\n
– \u1ee8c ch\u1ebf t\u1ed5ng h\u1ee3p DNA (azathioprine, mycophenolate, methotrexate)<\/p>\n
– Thay th\u1ebf\/\u0111i\u1ec1u h\u00f2a globulin mi\u1ec5n d\u1ecbch (IVIG)<\/p>\n
– L\u1ecdc huy\u1ebft t\u01b0\u01a1ng (thay huy\u1ebft t\u01b0\u01a1ng)<\/p>\n
Khuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa trong vi\u00eam c\u01a1 tim<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nKhuy\u1ebfn c\u00e1o Nh\u00f3m M\u1ee9c<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Qu\u1ea3n l\u00fd tri\u1ec7u ch\u1ee9ng<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc NSAID (c\u00f9ng v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng vi\u00eam m\u00e0ng ngo\u00e0i tim \u0111i k\u00e8m \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc Colchicine \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1-m\u00e0ng ngo\u00e0i tim \u0111\u1ec3 gi\u1ea3m t\u00e1i ph\u00e1t.<\/td>\n IIa<\/td>\n B<\/td>\n<\/tr>\n
Qu\u1ea3n l\u00fd suy tim<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o tu\u00e2n th\u1ee7 c\u00e1c h\u01b0\u1edbng d\u1eabn v\u1ec1 suy tim c\u1ee7a ESC trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam c\u01a1 tim c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m thu th\u1ea5t tr\u00e1i v\u00e0\/ho\u1eb7c suy tim \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 c\u1ea3i<\/p>\nthi\u1ec7n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb suy tim \u00edt nh\u1ea5t 6 th\u00e1ng sau khi ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i h\u1ed3i ph\u1ee5c ho\u00e0n<\/p>\nto\u00e0n \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
Qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n nh\u1ecbp<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc thu\u1ed1c ch\u1eb9n beta, duy tr\u00ec \u00edt nh\u1ea5t 6 th\u00e1ng, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u1ea5p, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u0103ng troponin, \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 ng\u0103n ng\u1eeba<\/p>\nr\u1ed1i lo\u1ea1n nh\u1ecbp.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng lo\u1ea1n nh\u1ecbp \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n sau vi\u00eam c\u01a1 tim c\u00f3 nh\u1ecbp nhanh th\u1ea5t (VT) t\u00e1i ph\u00e1t, c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ec3 gi\u1ea3m g\u00e1nh n\u1eb7ng r\u1ed1i lo\u1ea1n nh\u1ecbp.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc Corticosteroid \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim th\u1ec3 t\u1ed1i c\u1ea5p, kh\u00f4ng do nhi\u1ec5m tr\u00f9ng \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc Corticosteroid \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u1ea5p c\u00f3 gi\u1ea3m LVEF n\u1ebfu kh\u00e1ng tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p suy tim chu\u1ea9n \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n.<\/td>\n Iib<\/td>\n C<\/td>\n<\/tr>\n
Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng th\u01b0\u1eddng quy li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch trong vi\u00eam c\u01a1 tim c\u1ea5p c\u00f3 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i b\u1ea3o t\u1ed3n v\u00ec ch\u01b0a ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch v\u1ec1 k\u1ebft c\u1ee5c.<\/td>\n III<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nLi\u1ec1u kh\u1edfi \u0111\u1ea7u v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u cho vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p v\u00e0 t\u00e1i ph\u00e1t<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\n\nThu\u1ed1c<\/td>\n Li\u1ec1u<\/td>\n Th\u1eddi gian<\/td>\n Gi\u1ea3m li\u1ec1u<\/td>\n<\/tr>\n
Aspirin<\/td>\n 750\u20131000mg 3 l\u1ea7n\/ng\u00e0y<\/td>\n 1\u20132 tu\u1ea7n<\/td>\n Gi\u1ea3m 250mg m\u1ed7i 1-2 tu\u1ea7n<\/td>\n<\/tr>\n
Ibuprofen<\/td>\n 600\u2013800mg 3 l\u1ea7n\/ng\u00e0y<\/td>\n 1\u20132 tu\u1ea7n<\/td>\n Gi\u1ea3m 200mg m\u1ed7i 1-2 tu\u1ea7n<\/td>\n<\/tr>\n
Indomethacin<\/td>\n 25\u201350mg3l\u1ea7n\/ng\u00e0y<\/td>\n 1-2 tu\u1ea7n<\/td>\n Gi\u1ea3m 25 mg m\u1ed7i 1-2 tu\u1ea7n<\/td>\n<\/tr>\n
Colchicine<\/td>\n 0.5 mg 1 l\u1ea7n\/ng\u00e0y (<70 kg or siu gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn n\u1eb7ng) ho\u1eb7c 0.5mg 2 l\u1ea7n\/ng\u00e0y<\/td>\n 3-6 th\u00e1ng<\/td>\n Kh\u00f4ng c\u1ea7n<\/td>\n<\/tr>\n
Prednisone<\/td>\n 0.2-0.5 mg\/kg\/ng\u00e0y<\/td>\n 2-4 tu\u1ea7n<\/td>\n M\u1ed9t v\u00e0i th\u00e1ng<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb ch\u1ec9 cho tr\u01b0\u1eddng h\u1ee3p t\u00e1i ph\u00e1t<\/td>\n<\/tr>\n
Azathioprine<\/td>\n B\u1eaft \u0111\u1ea7u v\u1edbi 1 mg\/kg\/day sau \u0111\u00f3 t\u0103ng d\u1ea7n l\u00ean 2-3 mg\/kg\/day<\/td>\n Nhi\u1ec1u th\u00e1ng<\/td>\n Nhi\u1ec1u th\u00e1ng<\/td>\n<\/tr>\n
IVIG<\/td>\n 400-500 mg\/kg i.v. h\u00e0ng ng\u00e0y cho 5 ng\u00e0y<\/td>\n 5 ng\u00e0y<\/td>\n Kh\u00f4ng c\u1ea7n<\/td>\n<\/tr>\n
Anakinra<\/td>\n 1-2 mg\/kg\/day t\u1edbi 100 mg\/day \u1edf ng\u01b0\u1eddi l\u1edbn<\/td>\n T\u1ed1i thi\u1ec3u 6 th\u00e1ng<\/td>\n Khi c\u1ea7n (t\u1ed1i thi\u1ec3u 3-6 th\u00e1ng)<\/td>\n<\/tr>\n
Rilonacept<\/td>\n 320 mg m\u1ed9t l\u1ea7n\/ng\u00e0y sau \u0111\u00f3 160 mg m\u1ed7i tu\u1ea7n<\/td>\n >12 th\u00e1ng<\/td>\n Kh\u00f4ng c\u00f3 th\u00f4ng tin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nGi\u1ea3m li\u1ec1u corticosteroid<\/h1>\n\n\n\n\nLi\u1ec1u Prednisone<\/td>\n Li\u1ec1u kh\u1edfi \u0111\u1ea7u 0.20 to 0.50 mg\/kg\/ng\u00e0y<\/td>\n Gi\u1ea3m li\u1ec1u<\/td>\n<\/tr>\n
Li\u1ec1u Prednisone<\/p>\nh\u00e0ng ng\u00e0y<\/td>\n > 50 mg<\/p>\n50-25 mg<\/p>\n
25-15 mg<\/p>\n
< 15 mg<\/td>\n 10 mg\/ng\u00e0y m\u1ed7i 1 \u0111\u1ebfn 2 tu\u1ea7n<\/p>\n5-10 mg\/ng\u00e0y m\u1ed7i 1 \u0111\u1ebfn 2 tu\u1ea7n<\/p>\n
2.5 mg\/ng\u00e0y m\u1ed7i 2 \u0111\u1ebfn 4 tu\u1ea7n<\/p>\n
1.25 \u0111\u1ebfn 2.5 mg\/ng\u00e0y m\u1ed7i 2 \u0111\u1ebfn 6 tu\u1ea7n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
L\u01b0u \u0111\u1ed3 \u0111\u1ec1 xu\u1ea5t \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa cho vi\u00eam m\u00e0ng ngo\u00e0i tim \u1edf ng\u01b0\u1eddi l\u1edbn<\/figcaption><\/figure>\nKhuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa trong vi\u00eam m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng Colchicine nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p b\u1ed5 tr\u1ee3 cho aspirin\/NSAID ho\u1eb7c corticosteroid \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim \u0111\u1ec3 gi\u1ea3m t\u00e1i ph\u00e1t sau n\u00e0y.<\/td>\n I<\/td>\n A<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng IL-1 (anakinra ho\u1eb7c rilonacept) cho b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t sau khi th\u1ea5t b\u1ea1i v\u1edbi li\u1ec7u ph\u00e1p b\u01b0\u1edbc m\u1ed9t v\u00e0 corticosteroid, v\u00e0 c\u00f3 t\u0103ng n\u1ed3ng \u0111\u1ed9 CRP, \u0111\u1ec3 gi\u1ea3m t\u00e1i ph\u00e1t v\u00e0 cho ph\u00e9p ng\u1eebng corticosteroid.<\/td>\n I<\/td>\n A<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng aspirin ho\u1eb7c NSAID li\u1ec1u cao c\u00f9ng v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf b\u01a1m proton l\u00e0m li\u1ec7u ph\u00e1p b\u01b0\u1edbc m\u1ed9t \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m t\u00e1i ph\u00e1t.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng, m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng vi\u00eam \u0111\u1ea7y \u0111\u1ee7, v\u00e0 nh\u1ecbp tim l\u00fac ngh\u1ec9 >75 bpm \u0111\u1ec3 c\u1ea3i thi\u1ec7n ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc thu\u1ed1c kh\u00e1ng IL-1 \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam m\u00e0ng ngo\u00e0i tim dai d\u1eb3ng\/t\u00e1i ph\u00e1t c\u00f3 b\u1eb1ng ch\u1ee9ng vi\u00eam m\u00e0ng ngo\u00e0i tim tr\u00ean CMR sau khi th\u1ea5t b\u1ea1i,c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, v\u00e0 kh\u00f4ng dung n\u1ea1p v\u1edbi li\u1ec7u ph\u00e1p b\u01b0\u1edbc m\u1ed9t v\u00e0 corticosteroid, b\u1ea5t k\u1ec3 n\u1ed3ng \u0111\u1ed9 CRP, \u0111\u1ec3 gi\u1ea3m t\u00e1i ph\u00e1t v\u00e0 ch\u00f5 ph\u00e9p ng\u1eebng corticosteroid.<\/td>\n lla<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc corticosteroid li\u1ec1u th\u1ea5p \u0111\u1ebfn trung b\u00ecnh cho b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim ch\u1ec9 trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh\/th\u1ea5t b\u1ea1i v\u1edbi aspirin\/NSAID v\u00e0 colchicine, ho\u1eb7c khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3 \u0111\u1ec3 ki\u1ec3m so\u00e1t tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m t\u00e1i ph\u00e1t.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc Hydroxychloroquine \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t kh\u00e1ng tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p chu\u1ea9n (bao g\u1ed3m corticosteroid v\u00e0 thu\u1ed1c kh\u00e1ng IL-1) \u0111\u1ec3 k\u00e9o d\u00e0i th\u1eddi gian s\u1ed1ng kh\u1ed5ng t\u00e1i ph\u00e1t.<\/td>\n llb<\/td>\n B<\/td>\n<\/tr>\n
Kh\u00f4ng khuy\u1ebfn c\u00e1o corticosteroid l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay cho b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim khi kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh c\u1ee5 th\u1ec3.<\/td>\n Ill<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o v\u1ec1 c\u00e1c k\u1ef9 thu\u1eadt can thi\u1ec7p bao g\u1ed3m h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n trong vi\u00eam c\u01a1 tim<\/h1>\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o th\u1ea3o lu\u1eadn k\u1ecbp th\u1eddi v\u00e0 chuy\u00ean s\u00e2u b\u1edfi m\u1ed9t “\u0110\u1ed9i S\u1ed1c” (Shock Team) \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u1ecf r\u1ed1i lo\u1ea1n huy\u1ebft \u0111\u1ed9ng, \u0111\u1ec3 quy\u1ebft \u0111\u1ecbnh nhu c\u1ea7u n\u00e2ng b\u1eadc l\u00ean h\u1ed7 tr\u1ee3 tu\u1ea7n ho\u00e0n c\u01a1 h\u1ecdc (MCS) v\u00e0 x\u00e1c \u0111\u1ecbnh k\u1ebf ho\u1ea1ch qu\u1ea3n l\u00fd d\u00e0i h\u1ea1n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc MCS t\u1ea1m th\u1eddi \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim v\u00e0 s\u1ed1c tim ho\u1eb7c m\u1ea5t b\u00f9 c\u1ea5p trong vi\u00eam c\u01a1 tim m\u1ea1n t\u00ednh \u0111\u1ec3 \u1ed5n \u0111\u1ecbnh b\u1ec7nh nh\u00e2n.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o v\u1ec1 c\u00e1c k\u1ef9 thu\u1eadt can thi\u1ec7p trong vi\u00eam m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o d\u1eabn l\u01b0u d\u1ecbch m\u00e0ng ngo\u00e0i tim (d\u01b0\u1edbi h\u01b0\u1edbng d\u1eabn c\u1ee7a si\u00eau \u00e2m, CT ho\u1eb7c m\u00e0n t\u0103ng s\u00e1ng) trong tr\u01b0\u1eddng h\u1ee3p ch\u00e8n \u00e9p tim, nghi ng\u1edd vi\u00eam m\u00e0ng ngo\u00e0i tim do vi khu\u1ea9n ho\u1eb7c ung th\u01b0, ho\u1eb7c tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim l\u01b0\u1ee3ng trung b\u00ecnh \u0111\u1ebfn nhi\u1ec1u c\u00f3 tri\u1ec7u ch\u1ee9ng d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o d\u1eabn l\u01b0u m\u00e0ng ngo\u00e0i tim b\u1eb1ng ph\u1eabu thu\u1eadt \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim khi kh\u00f4ng th\u1ec3 ch\u1ecdc d\u1ecbch qua da ho\u1eb7c c\u00f3 tr\u00e0n m\u1ee7 m\u00e0ng ngo\u00e0i tim \u0111\u1ec3 cho ph\u00e9p d\u1eabn l\u01b0u ho\u00e0n to\u00e0n V\u00e0 ng\u0103n ng\u1eeba co th\u1eaft.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o ph\u1eabu thu\u1eadt t\u1ea1o c\u1eeda s\u1ed5 m\u00e0ng ph\u1ed5i – m\u00e0ng ngo\u00e0i tim \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim t\u00e1i ph\u00e1t d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o v\u1ec1 \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt<\/h1>\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf m\u00e0ng ngo\u00e0i tim \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft m\u1ea1n t\u00ednh ho\u1eb7c dai d\u1eb3ng d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa \u0111\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 s\u1ed1ng c\u00f2n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o s\u1eeda van ba l\u00e1 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft v\u00e0 h\u1edf van ba l\u00e1 n\u1eb7ng \u0111\u1ec3 c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng va s\u1ed1ng c\u00f2n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o v\u1ec1 qu\u1ea3n l\u00fd r\u1ed1i lo\u1ea1n nh\u1ecbp v\u00e0 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim trong vi\u00eam c\u01a1 tim<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
T\u1ea1o nh\u1ecbp trong vi\u00eam c\u01a1 tim<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc t\u1ea1o nh\u1ecbp t\u1ea1m th\u1eddi qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u1ea5p v\u00e0 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n \u0111\u1ed9 cao nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p b\u1eafc c\u1ea7u \u0111\u1ec3 h\u1ed3i ph\u1ee5c.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
M\u00e1y kh\u1eed rung tim \u0111eo b\u00ean ngo\u00e0i (WCD) trong vi\u00eam c\u01a1 tim<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng WCD trong 3-6 th\u00e1ng \u1edf b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t b\u1ec1n b\u1ec9 trong giai \u0111o\u1ea1n c\u1ea5p cua vi\u00eam c\u01a1 tim nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p b\u1eafc c\u1ea7u \u0111\u1ec3 h\u1ed3i ph\u1ee5c.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
Tri\u1ec7t \u0111\u1ed1t trong vi\u00eam c\u01a1 tim<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc tri\u1ec7t \u0111\u1ed1t qua catheter, th\u1ef1c hi\u1ec7n t\u1ea1i c\u00e1c trung t\u00e2m chuy\u00ean s\u00e2u, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n sau vi\u00eam c\u01a1 tim c\u00f3 nh\u1ecbp nhanh th\u1ea5t \u0111\u01a1n d\u1ea1ng b\u1ec1n b\u1ec9 (SMVT) t\u00e1i ph\u00e1t c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c s\u1ed1c ICD m\u00e0 thu\u1ed1c ch\u1ed1ng lo\u1ea1n nh\u1ecbp kh\u00f4ng hi\u1ec7u qu\u1ea3, kh\u00f4ng dung n\u1ea1p ho\u1eb7c kh\u00f4ng mong mu\u1ed1n.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
C\u1ea5y m\u00e1y kh\u1eed rung tim (ICD) trong vi\u00eam c\u01a1 tim<\/td>\n<\/tr>\n
D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o c\u1ea5y ICD \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng v\u00e0 c\u00f3 nh\u1ecbp nhanh th\u1ea5t (VT) b\u1ec1n b\u1ec9 kh\u00f4ng dung n\u1ea1p v\u1ec1 huy\u1ebft \u0111\u1ed9ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do tim (SCD).<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
D\u1ef1 ph\u00f2ng th\u1ee9 ph\u00e1t (Ti\u1ebfp theo)<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc c\u1ea5y ICD \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim kh\u00f4ng ho\u1ea1t \u0111\u1ed9ng v\u00e0 c\u00f3 VT b\u1ec1n b\u1ec9 dung n\u1ea1p v\u1ec1 huy\u1ebft \u0111\u1ed9ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba SCD.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc c\u1ea5y ICD \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u1ea5p v\u00e0 c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t (VA) b\u1ec1n b\u1ec9 (VT\/VF) trong giai \u0111o\u1ea1n c\u1ea5p \u0111\u1ec3 ph\u00f2ng ng\u1eeba SCD.<\/td>\n Ilb<\/td>\n C<\/td>\n<\/tr>\n
D\u1ef1 ph\u00f2ng ti\u00ean ph\u00e1t<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc c\u1ea5y ICD \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n sau giai \u0111o\u1ea1n c\u1ea5p c\u1ee7a vi\u00eam c\u01a1 tim (3-6 th\u00e1ng) v\u00e0 c\u00f3 c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 dai d\u0103ng c\u1ee7a r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t \u0111\u1ec3 ph\u00f2ng ng\u1eeba SCD.<\/td>\n Ilb<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nTheo d\u00f5i sau xu\u1ea5t vi\u1ec7n trong c\u00e1c h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim v\u00e0 m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\n\n<\/td>\n <\/td>\n Trong 1 th\u00e1ng<\/td>\n Trong 3-6 th\u00e1ng<\/td>\n 12 th\u00e1ng<\/td>\n >1 n\u0103m v\u00e0<\/p>\ntheo d\u00f5i d\u00e0i<\/p>\n
h\u1ea1n<\/td>\n<\/tr>\n
\u0110\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng v\u00e0 ECG<\/td>\n Vi\u00eam c\u01a1 tim<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n<\/tr>\n
D\u1ea5u \u1ea5n sinh h\u1ecdc (TnI, CRP)<\/td>\n Vi\u00eam c\u01a1 tim<\/td>\n x<\/td>\n x<\/td>\n (x)<\/td>\n (x)<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n x<\/td>\n x<\/td>\n (x)<\/td>\n (x)<\/td>\n<\/tr>\n
Nh\u1ecbp tim (g\u1eafng s\u1ee9c v\u00e0\/ho\u1eb7c Holter ECG)<\/td>\n Vi\u00eam c\u01a1 tim<\/td>\n –<\/td>\n x<\/td>\n (x)<\/td>\n (x)<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n –<\/td>\n –<\/td>\n –<\/td>\n –<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh -Vi\u00eam c\u01a1 tim<\/td>\n Si\u00eau \u00e2m tim<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n<\/tr>\n
C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh -Vi\u00eam m\u00e0ng ngo\u00e0i tim<\/td>\n Si\u00eau \u00e2m tim<\/td>\n x<\/td>\n x<\/td>\n x<\/td>\n<\/tr>\n
C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim<\/td>\n (x)<\/td>\n (x)<\/td>\n (x)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nTheo d\u00f5i v\u00e0 ph\u00e2n t\u1ea7ng nguy c\u01a1 sau vi\u00eam c\u01a1 tim c\u1ea5p c\u00f3 bi\u1ec3u hi\u1ec7n r\u1ed1i lo\u1ea1n nh\u1ecbp<\/figcaption><\/figure>\nKhuy\u1ebfn c\u00e1o v\u1ec1 ph\u00e2n t\u1ea7ng nguy c\u01a1, bi\u1ebfn ch\u1ee9ng v\u00e0 k\u1ebft c\u1ee5c c\u1ee7a c\u00e1c h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 tim v\u00e0 m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o theo d\u00f5i b\u1eb1ng \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, d\u1ea5u \u1ea5n sinh h\u1ecdc, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c, theo d\u00f5i Holter-ECG, si\u00eau \u00e2m tim v\u00e0 c\u1ed9ng h\u01b0\u1edfng t\u1eeb tim \u00edt nh\u1ea5t\u2019 trong v\u00f2ng 6 thang sau l\u1ea7n nh\u1eadp vi\u1ec7n ban \u0111\u1ea7u \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 ti\u1ebfn tri\u1ec3n ti\u1ec1m t\u00e0ng ho\u1eb7c c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 m\u1edbi.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o theo d\u00f5i d\u00e0i h\u1ea1n cho nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim c\u00f3 bi\u1ebfn ch\u1ee9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 ti\u1ebfn tri\u1ec3n ti\u1ec1m t\u00e0ng ho\u1eb7c c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1edbi.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Khuy\u1ebfn c\u00e1o theo d\u00f5i d\u00e0i h\u1ea1n cho nh\u1eefng b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng ngo\u00e0i tim dai d\u1eb3ng ho\u1eb7c t\u00e1i ph\u00e1t \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh s\u1ef1 ti\u1ebfn tri\u1ec3n ti\u1ec1m t\u00e0ng v\u00e0 c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1edbi.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nC\u00e1c y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh c\u0103n nguy\u00ean kh\u00f4ng do virus v\u00e0 bi\u1ebfn ch\u1ee9ng (d\u1ea5u nguy c\u01a1 cao ho\u1eb7c c\u1ea3nh b\u00e1o trong vi\u00eam m\u00e0ng ngo\u00e0i tim c\u1ea5p)<\/h1>\nTi\u00eau chu\u1ea9n ch\u00ednh<\/p>\n
\nS\u1ed1t >38\u00b0C (HR 3.56)<\/li>\n
Kh\u1edfi ph\u00e1t b\u00e1n c\u1ea5p (HR 3.97)<\/li>\n
Tr\u00e0n d\u1ecbch m\u00e0ng tim l\u1edbn (>20 mm tr\u00ean si\u00eau \u00e2m tim) (HR 2.15)<\/li>\n
Ch\u00e8n \u00e9p tim c\u1ea5p (HR 2.15)<\/li>\n
Kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi aspirin ho\u1eb7c NSAID sau \u00edt nh\u1ea5t 1 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb (HR 2.50)<\/li>\n<\/ul>\nTi\u00eau chu\u1ea9n ph\u1ee5<\/p>\n
\nVi\u00eam m\u00e0ng ngo\u00e0i tim k\u00e8m vi\u00eam c\u01a1 tim<\/li>\n
T\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch<\/li>\n
Ti\u1ec1n s\u1eed ch\u1ea5n th\u01b0\u01a1ng<\/li>\n
\u0110i\u1ec1u tr\u1ecb thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng<\/li>\n<\/ul>\nKhuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u01a1 tim t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3 (GCM)<\/h1>\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Sinh thi\u1ebft n\u1ed9i t\u00e2m m\u1ea1c (EMB) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd GCM do suy tim m\u1edbi kh\u1edfi ph\u00e1t kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n trong v\u00f2ng 2 tu\u1ea7n k\u00e8m th\u1ea5t tr\u00e1i b\u00ecnh th\u01b0\u1eddng ho\u1eb7c gi\u00e3n v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t m\u1edbi, block nh\u0129 th\u1ea5t \u0111\u1ed9 2-3, ho\u1eb7c kh\u00f4ng \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng trong 1-2 tu\u1ea7n nh\u1eb1m kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch ph\u1ed1i h\u1ee3p \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh GCM.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u01a1 tim trong b\u1ec7nh sarcoidosis<\/h1>\n\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n<\/td>\n<\/tr>\n
C\u1ed9ng h\u01b0\u1edfng t\u1eeb tim (CMR), s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt \u0111\u1eb7c t\u00ednh m\u00f4, \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd sarcoidosis tim (CS) \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng vi\u00eam c\u01a1 tim v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
18F-FDG-PET \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong quy tr\u00ecnh ch\u1ea9n \u0111o\u00e1n, bao g\u1ed3m ph\u00e1t hi\u1ec7n t\u00ecnh tr\u1ea1ng vi\u00eam, c\u0169ng nh\u01b0 theo d\u00f5i v\u00e0 \u0111\u00e1nh gi\u00e1 \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n sarcoidosis tim.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n
C\u1ea5y m\u00e1y ICD \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n CS v\u00e0 r\u1ed1i lo\u1ea1n nh\u1ecbp th\u1ea5t k\u00e9o d\u00e0i (VT\/VF) ho\u1eb7c ng\u1eebng tu\u1ea7n ho\u00e0n \u0111\u1ec3 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do c\u0103n nguy\u00ean tim (SCD).<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
C\u1ea5y m\u00e1y ICD \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n Sarcoidosis tim v\u00e0 ph\u00e2n su\u1ea5t r\u00f4ng m\u00e1u th\u1ea5t tr\u00e1i (LVEF) <35% \u0111\u1ec3 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do c\u0103n nguy\u00ean tim.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc c\u1ea5y m\u00e1y ICD \u1edf b\u1ec7nh nh\u00e2n Sarcoidosis tim v\u00e0 ph\u00e2n su\u1ea5t r\u00f4ng m\u00e1u th\u1ea5t tr\u00e1i >35% sau khi h\u1ebft giai \u0111o\u1ea1n c\u1ea5p t\u00ednh v\u1edbi t\u1ed5n th\u01b0\u01a1ng t\u0103ng t\u00edn hi\u1ec7u mu\u1ed9n (LGE) \u0111\u00e1ng k\u1ec3, ti\u1ec1n s\u1eed r\u1ed1i lo\u1ea1n nh\u1ecbp, ng\u1ea5t kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, lo\u1ea1n nh\u1ecbp th\u1ea5t (VA) k\u00e9o d\u00e0i c\u00f3 th\u1ec3 g\u00e2y ra t\u1ea1i nghi\u00ean c\u1ee9u \u0111i\u1ec7n sinh l\u00fd (PVS), ho\u1eb7c block nh\u0129 th\u1ea5t \u0111\u1ed9 cao dai d\u1eb3ng \u0111\u1ec3 ph\u00f2ng ng\u1eeba \u0111\u1ed9t t\u1eed do c\u0103n nguy\u00ean tim.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb vi\u00eam c\u01a1 tim li\u00ean quan \u0111\u1ebfn thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch<\/h1>\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ph\u00e2n lo\u1ea1i ch\u1ea9n \u0111o\u00e1n trong 24 gi\u1edd \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam c\u01a1 tim do ICI (thu\u1ed1c \u1ee9c ch\u1ebf \u0111i\u1ec3m ki\u1ec3m so\u00e1t mi\u1ec5n d\u1ecbch) g\u00e2y ra nh\u1eb1m kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Ng\u1eebng ngay l\u1eadp t\u1ee9c ICI v\u00e0 \u00e1p d\u1ee5ng corticosteroid li\u1ec1u cao \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim li\u00ean quan ICI nh\u1eb1m d\u1eebng ph\u1ea3n \u1ee9ng vi\u00eam v\u00e0 \u1ed5n \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch h\u00e0ng th\u1ee9 hai \u1edf b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim li\u00ean quan ICI kh\u00e1ng steroid.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
C\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch h\u00e0ng th\u1ee9 hai \u1edf b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim li\u00ean quan ICI th\u1ec3 fulminant\/n\u1eb7ng.<\/td>\n llb<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o \u0111i\u1ec1u b\u1ec7nh l\u00fd c\u01a1 tim vi\u00eam<\/h1>\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb suy tim theo h\u01b0\u1edbng d\u1eabn \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n b\u1ec7nh c\u01a1 tim vi\u00eam \u0111\u1ec3 c\u1ea3i thi\u1ec7n v\u00e0\/ho\u1eb7c \u1ed5n \u0111\u1ecbnh ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u cho b\u1ec7nh h\u1ec7 th\u1ed1ng ti\u1ec1m \u1ea9n (n\u1ebfu c\u00f3) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong b\u1ec7nh c\u01a1 tim vi\u00eam.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch, \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn b\u1edfi sinh thi\u1ebft n\u1ed9i t\u00e2m m\u1ea1c, \u1edf b\u1ec7nh c\u01a1 tim vi\u00eam \u00e2m t\u00ednh virus \u0111\u1ec3 \u1ee9c ch\u1ebf \u0111\u00e1p \u1ee9ng t\u1ef1 mi\u1ec5n.<\/td>\n Ila<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nC\u00e1c giai \u0111o\u1ea1n ti\u1ebfn tri\u1ec3n c\u1ee7a lao ngo\u00e0i m\u00e0ng tim<\/figcaption><\/figure>\nKhuy\u1ebfn c\u00e1o ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb lao ngo\u00e0i m\u00e0ng tim<\/h1>\n\n\n\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng ngo\u00e0i tim v\u00e0 tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim do lao<\/td>\n<\/tr>\n
Ch\u1ecdc d\u1ecbch m\u00e0ng tim \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nghi ng\u1edd lao m\u00e0ng tim khi ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c ch\u1ea9n t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh trong d\u1ecbch m\u00e0ng tim b\u1eb1ng x\u00e9t nghi\u1ec7m kh\u00f4ng x\u00e2m l\u1ea5n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng lao theo kinh nghi\u1ec7m \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n s\u1ed1ng t\u1ea1i v\u00f9ng l\u01b0u h\u00e0nh lao v\u1edbi tr\u00e0n d\u1ecbch m\u00e0ng tim xu\u1ea5t ti\u1ebft sau khi lo\u1ea1i tr\u1eeb c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p thu\u1ed1c kh\u00e1ng lao ti\u00eau chu\u1ea9n trong 6 th\u00e1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n lao ngo\u00e0i m\u00e0ng tim \u0111\u1ec3 ph\u00f2ng ng\u1eeba co th\u1eaft m\u00e0ng ngo\u00e0i tim.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
C\u1eaft m\u00e0ng tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n lao ngo\u00e0i m\u00e0ng tim n\u1ebfu t\u00ecnh tr\u1ea1ng kh\u00f4ng c\u1ea3i thi\u1ec7n ho\u1eb7c x\u1ea5u \u0111i sau 4-8 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng lao \u0111\u1ec3 thay \u0111\u1ed5i ti\u1ebfn tr\u00ecnh b\u1ec7nh.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb steroid b\u1ed5 tr\u1ee3 \u1edf c\u00e1c tr\u01b0\u1eddng h\u1ee3p HIV \u00e2m t\u00ednh \u0111\u1ec3 ph\u00f2ng ng\u1eeba ph\u00e1t tri\u1ec3n lao m\u00e0ng tim co th\u1eaft.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam ngo\u00e0i m\u00e0ng tim v\u00e0 tr\u00e0n d\u1ecbch ngo\u00e0i m\u00e0ng tim do lao (ti\u1ebfp)<\/td>\n<\/tr>\n
T\u1ea1i v\u00f9ng kh\u00f4ng l\u01b0u h\u00e0nh c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc sinh thi\u1ebft m\u00e0ng tim \u1edf b\u1ec7nh nh\u00e2n v\u1edbi b\u1ec7nh >3 tu\u1ea7n kh\u00f4ng c\u00f3 ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n.<\/td>\n Ilb<\/td>\n C<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m thu\u1ed1c kh\u00e1ng lao kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n s\u1ed1ng t\u1ea1i c\u00e1c v\u00f9ng kh\u00f4ng l\u01b0u h\u00e0nh b\u1ec7nh.<\/td>\n III<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o v\u1ec1 t\u1ed5n th\u01b0\u01a1ng m\u00e0ng tim do u \u00e1c t\u00ednh<\/h1>\n\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ch\u1ecdc d\u1ecbch m\u00e0ng tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n ch\u00e8n \u00e9p tim \u0111\u1ec3 gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n tr\u00e0n d\u1ecbch m\u00e0ng tim \u00e1c t\u00ednh.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
D\u1eabn l\u01b0u m\u00e0ng tim k\u00e9o d\u00e0i (3-6 ng\u00e0y) \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd ho\u1eb7c ch\u1eafc ch\u1eafn tr\u00e0n d\u1ecbch m\u00e0ng tim u \u00e1c t\u00ednh \u0111\u1ec3 ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t tr\u00e0n d\u1ecbch.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Ph\u00e2n t\u00edch t\u1ebf b\u00e0o h\u1ecdc d\u1ecbch m\u00e0ng tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng tim u \u00e1c t\u00ednh \u0111\u1ec3 x\u00e1c nh\u1eadn b\u1ec7nh m\u00e0ng tim \u00e1c t\u00ednh.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Thu\u1ed1c ch\u1ed1ng ung th\u01b0 to\u00e0n th\u00e2n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p x\u00e1c nh\u1eadn nguy\u00ean nh\u00e2n u \u00e1c t\u00ednh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ed5n th\u01b0\u01a1ng u \u00e1c t\u00ednh nguy\u00ean ph\u00e1t v\u00e0 th\u1ee9 ph\u00e1t di c\u0103n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc ch\u1ecdc d\u1ecbch m\u00e0ng tim \u1edf b\u1ec7nh nh\u00e2n tr\u00e0n d\u1ecbch m\u00e0ng tim m\u1ee9c \u0111\u1ed9 v\u1eeba \u0111\u1ebfn nhi\u1ec1u nh\u1eb1m x\u00e1c ch\u1ea9n tr\u00e0n d\u1ecbch m\u00e0ng tim \u00e1c t\u00ednh khi ch\u1ea9n \u0111o\u00e1n kh\u00f4ng th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c b\u1eb1ng h\u00ecnh \u1ea3nh \u0111a ph\u01b0\u01a1ng th\u1ee9c.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc sinh thi\u1ebft m\u00e0ng tim ho\u1eb7c th\u01b0\u1ee3ng t\u00e2m m\u1ea1c \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd b\u1ec7nh m\u00e0ng tim \u00e1c t\u00ednh khi ch\u01b0a ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c b\u1eb1ng h\u00ecnh \u1ea3nh \u0111a ph\u01b0\u01a1ng th\u1ee9c ho\u1eb7c ph\u00e2n t\u00edch t\u1ebf b\u00e0o h\u1ecdc.<\/td>\n Ilb<\/td>\n C<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb tr\u1ef1c ti\u1ebfp trong khoang m\u00e0ng tim c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc sau khi th\u1ed1ng nh\u1ea5t v\u1edbi b\u00e1c s\u0129 ung b\u01b0\u1edbu, trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb to\u00e0n th\u00e2n.<\/td>\n llb<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb h\u1ed9i ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng tim sau can thi\u1ec7p<\/h1>\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n c\u00f3 h\u1ed9i ch\u1ee9ng t\u1ed5n th\u01b0\u01a1ng tim sau can thi\u1ec7p (PCIS) \u0111\u1ec3 gi\u1ea3m nhanh tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m t\u00e1i ph\u00e1t.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Thu\u1ed1c \u0111\u1ed1\u00ec kh\u00e1ng IL-1 \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n PCIS kh\u00e1ng tr\u1ecb \u0111\u1ec3 ph\u00f2ng ng\u1eeba t\u00e1i ph\u00e1t v\u00e0 ti\u1ebfn tri\u1ec3n co th\u1eaft.<\/td>\n I<\/td>\n B<\/td>\n<\/tr>\n
Aspirin li\u1ec1u cao \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong kh\u00e1ng vi\u00eam cho vi\u00eam m\u00e0ng ngo\u00e0i tim sau nh\u1ed3i m\u00e1u c\u01a1 tim v\u00e0 \u1edf b\u1ec7nh nh\u00e2n \u0111ang d\u00f9ng thu\u1ed1c ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Colchicine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc b\u1eaft \u0111\u1ea7u 48-72 gi\u1edd tr\u01b0\u1edbc ph\u1eabu thu\u1eadt tim, trong 1 th\u00e1ng \u1edf b\u1ec7nh nh\u00e2n sau ph\u1eabu thu\u1eadt tim \u0111\u1ec3 ph\u00f2ng ng\u1eeba PCIS n\u1ebfu kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u00e0 \u0111\u01b0\u1ee3c dung n\u1ea1p.<\/td>\n Ila<\/td>\n A<\/td>\n<\/tr>\n
N\u00ean theo d\u00f5i c\u1ea9n th\u1eadn nh\u1eefng b\u1ec7nh nh\u00e2n PCIS \u0111\u1ec3 lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng ti\u1ebfn tri\u1ec3n th\u00e0nh vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft.<\/td>\n lla<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb v\u00e0 ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u1ee7 m\u00e0ng ngo\u00e0i tim<\/h1>\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ch\u1ecdc d\u1ecbch m\u00e0ng ngo\u00e0i tim c\u1ea5p c\u1ee9u v\u00e0\/ho\u1eb7c m\u1edf c\u1eeda s\u1ed5 ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam m\u00e0ng ngo\u00e0i tim m\u1ee7 nh\u1eb1m x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
C\u00e2n nh\u1eafc ti\u00eau s\u1ee3i huy\u1ebft trong m\u00e0ng tim \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u1ee7 m\u00e0ng m\u00e0ng tim \u0111\u1ec3 d\u1eabn l\u01b0u ho\u00e0n to\u00e0n d\u1ecbch m\u1ee7 v\u00e0 ph\u00f2ng ng\u1eeba co th\u1eaft.<\/td>\n Ila<\/td>\n B<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nPh\u00e2n lo\u1ea1i v\u00e0 x\u1eed tr\u00ed tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim<\/figcaption><\/figure>\nD\u1ea5u hi\u1ec7u si\u00eau \u00e2m tim c\u1ee7a ch\u00e8n \u00e9p tim<\/h1>\n\n\n\n\n\n\n\n\n\u0110\u1eb7c \u0111i\u1ec3m tr\u00ean si\u00eau \u00e2m tim<\/td>\n \u0110\u1ed9 nh\u1ea1y<\/td>\n \u0110\u1ed9 \u0111\u1eb7c hi\u1ec7u<\/td>\n<\/tr>\n
Tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim l\u01b0\u1ee3ng nhi\u1ec1u k\u00e8m h\u00ecnh \u1ea3nh tim \u201c\u0111ung \u0111\u01b0a\u201d<\/td>\n n.a.<\/td>\n n.a<\/td>\n<\/tr>\n
X\u1eb9p nh\u0129 ph\u1ea3i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng<\/td>\n 50%-100%<\/td>\n 33%-100%<\/td>\n<\/tr>\n
Th\u1eddi gian x\u1eb9p nh\u0129 ph\u1ea3i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng t\u00ednh theo t\u1ef7 l\u1ec7 chu k\u1ef3 tim > 0,34<\/td>\n >90%<\/td>\n 100%<\/td>\n<\/tr>\n
X\u1eb9p th\u1ea5t ph\u1ea3i trong th\u1eddi k\u1ef3 t\u00e2m tr\u01b0\u01a1ng<\/td>\n 48%-100%<\/td>\n 72%-100%<\/td>\n<\/tr>\n
Bi\u1ebfn thi\u00ean h\u00f4 h\u1ea5p c\u1ee7a v\u1eadn t\u1ed1c E van hai l\u00e1 >25%-30%, v\u1eadn t\u1ed1c E van ba l\u00e1 > 40%-60%<\/td>\n n.a.<\/td>\n n.a.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\u0110\u1ecbnh ngh\u0129a v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c th\u1ec3 co th\u1eaft m\u00e0ng ngo\u00e0i tim ch\u1ee7 y\u1ebfu<\/h1>\n\n\n\n\n\n\nTh\u1ec3 b\u1ec7nh<\/td>\n \u0110\u1ecbnh ngh\u0129a<\/td>\n \u0110i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n
Co th\u1eaft tho\u00e1ng qua (ph\u00e2n bi\u1ec7t v\u1edbi vi\u00eam m\u00e0ng tim co th\u1eaft v\u0129nh vi\u1ec5n, CMP – b\u1ec7nh c\u01a1 tim h\u1ea1n ch\u1ebf)<\/td>\n H\u00ecnh th\u00e1i co th\u1eaft c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c sau thuy\u00ean gi\u1ea3m t\u1ef1 nhi\u00ean ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam<\/td>\n Li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam theo kinh nghi\u1ec7m t\u1eeb 3 – 6 th\u00e1ng<\/td>\n<\/tr>\n
Vi\u00eam m\u00e0ng tim v\u1eeba tr\u00e0n d\u1ecbch v\u1eeba co th\u1eaft (ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t: ch\u00e8n \u00e9p tim, vi\u00eam m\u00e0ng tim co th\u1eaft)<\/td>\n \u00c1p l\u1ef1c t\u00e2m nh\u0129 ph\u1ea3i kh\u00f4ng gi\u1ea3m \u0111\u01b0\u1ee3c 50% ho\u1eb7c kh\u00f4ng xu\u1ed1ng d\u01b0\u1edbi 10 mmHg sau ch\u1ecdc d\u1ecbch m\u00e0ng tim. C\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n b\u1eb1ng h\u00ecnh \u1ea3nh h\u1ecdc kh\u00f4ng x\u00e2m l\u1ea5n<\/td>\n Ch\u1ecdc d\u1ecbch m\u00e0ng tim k\u1ebft h\u1ee3p \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa.<\/td>\n<\/tr>\n
Co th\u1eaft m\u00e3n t\u00ednh (ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t: co th\u1eaft t\u1ea1m th\u1eddi, b\u1ec7nh c\u01a1 tim h\u1ea1n ch\u1ebf)<\/td>\n Co th\u1eaft k\u00e9o d\u00e0i sau 3-6 th\u00e1ng<\/td>\n Ph\u1eabu thu\u1eadt trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p dai d\u1eb3ng<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb vi\u00eam m\u00e0ng ngo\u00e0i tim co th\u1eaft<\/h1>\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
Ch\u1ea9n \u0111o\u00e1n<\/td>\n<\/tr>\n
H\u00ecnh \u1ea3nh \u0111a ph\u01b0\u01a1ng th\u1ee9c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam m\u00e0ng tim co th\u1eaft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111\u00e1nh gi\u00e1 d\u00e0y m\u00e0ng tim, v\u00f4i h\u00f3a v\u00e0 vi\u00eam c\u1ea5p t\u00ednh.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc th\u00f4ng tim \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 huy\u1ebft \u0111\u1ed9ng h\u1ecdc \u1edf b\u1ec7nh nh\u00e2n nghi ng\u1edd vi\u00eam m\u00e0ng tim co th\u1eaft khi h\u00ecnh \u1ea3nh \u0111a ph\u01b0\u01a1ng th\u1ee9c kh\u00f4ng k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c.<\/td>\n Ila<\/td>\n C<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb<\/td>\n<\/tr>\n
\u0110i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n \u1ed5n \u0111\u1ecbnh huy\u1ebft \u0111\u1ed9ng h\u1ecdc v\u1edbi ch\u1ea9n \u0111o\u00e1n co th\u1eaft tho\u00e1ng qua ho\u1eb7c m\u1edbi v\u1edbi b\u1eb1ng ch\u1ee9ng \u0111\u1ed3ng th\u1eddi vi\u00eam m\u00e0ng tim \u0111\u1ec3 ph\u00f2ng ng\u1eeba ti\u1ebfn tri\u1ec3n co th\u1eaft v\u00e0 tr\u00e1nh ph\u1eabu thu\u1eadt c\u1eaft m\u00e0ng tim.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
Ph\u1eabu thu\u1eadt c\u1eaft m\u00e0ng tim \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n co th\u1eaft v\u0129nh vi\u1ec5n n\u1ebfu kh\u00f4ng c\u00f3 vi\u00eam c\u1ea5p t\u00ednh ho\u1eb7c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng vi\u00eam kh\u00f4ng th\u00e0nh c\u00f4ng sau 3-6 th\u00e1ng.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o li\u00ean quan \u0111\u1ebfn thai k\u1ef3, cho con b\u00fa v\u00e0 c\u00e1c v\u1ea5n \u0111\u1ec1 sinh s\u1ea3n<\/h1>\n\n\n\n\n\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
T\u01b0 v\u1ea5n tr\u01b0\u1edbc th\u1ee5 thai \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf ph\u1ee5 n\u1eef c\u00f3 ti\u1ec1n s\u1eed vi\u00eam m\u00e0ng tim t\u00e1i ph\u00e1t ho\u1eb7c vi\u00eam c\u01a1 tim \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a b\u1ec7nh v\u00e0 xem x\u00e9t ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n
NSAIDs (thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid) n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf thai ph\u1ee5 vi\u00eam m\u00e0ng ngo\u00e0i tim \u0111\u1ebfn tu\u1ea7n thai th\u1ee9 20 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb c\u00e1c \u0111\u1ee3t k\u00e9o d\u00e0i\/t\u00e1i ph\u00e1t.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
N\u00ean c\u00e2n nh\u1eafc c\u00e1c li\u1ec7u ph\u00e1p ch\u1ed1ng vi\u00eam \u1edf s\u1ea3n ph\u1ee5 c\u00f3 vi\u00eam m\u00e0ng tim trong th\u1eddi k\u1ef3 nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng vi\u00eam m\u00e0ng tim, v\u1edbi th\u1eddi \u0111i\u1ec3m s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh nh\u1eb1m gi\u1ea3m thi\u1ec3u ph\u01a1i nhi\u1ec5m thu\u1ed1c \u1edf tr\u1ebb b\u00fa m\u1eb9.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
Trong thai k\u1ef3 v\u00e0 th\u1eddi k\u1ef3 cho con b\u00fa, corticosteroid \u1edf li\u1ec1u hi\u1ec7u qu\u1ea3 t\u1ed1i thi\u1ec3u (t\u1ed1i \u01b0u kh\u00f4ng qu\u00e1 20 mg prednisolone\/ng\u00e0y) n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n vi\u00eam m\u00e0ng tim ti\u1ebfn tri\u1ec3n, ngo\u00e0i NSAIDs (n\u1ebfu th\u00edch h\u1ee3p), \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c \u0111\u1ee3t k\u00e9o d\u00e0i\/t\u00e1i ph\u00e1t.<\/td>\n IIa<\/td>\n C<\/td>\n<\/tr>\n
Colchicine c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf thai ph\u1ee5 vi\u00eam m\u00e0ng tim, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111ang s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y \u0111\u1ec3 d\u1ef1 ph\u00f2ng t\u00e1i ph\u00e1t.<\/td>\n IIb<\/td>\n C<\/td>\n<\/tr>\n
Anakinra c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc su\u1ed1t thai k\u1ef3 v\u00e0 th\u1eddi k\u1ef3 cho con b\u00fa \u1edf thai ph\u1ee5 vi\u00eam m\u00e0ng tim t\u00e1i ph\u00e1t kh\u00f4ng th\u1ec3 s\u1eed d\u1ee5ng c\u00e1c li\u1ec7u ph\u00e1p thay th\u1ebf kh\u00e1c \u0111\u1ec3 ng\u0103n ng\u1eeba c\u00e1c \u0111\u1ee3t k\u00e9o d\u00e0i\/t\u00e1i ph\u00e1t.<\/td>\n IIb<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o v\u1ec1 ho\u1ea1t \u0111\u1ed9ng th\u1ec3 l\u1ef1c trong vi\u00eam c\u01a1 tim\/vi\u00eam m\u00e0ng tim<\/h1>\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
H\u1ea1n ch\u1ebf luy\u1ec7n t\u1eadp th\u1ec3 thao cho \u0111\u1ebfn khi b\u1ec7nh thuy\u00ean gi\u1ea3m, t\u1ed1i thi\u1ec3u 1 th\u00e1ng, \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf c\u1ea3 v\u1eadn \u0111\u1ed9ng vi\u00ean v\u00e0 ng\u01b0\u1eddi kh\u00f4ng chuy\u00ean th\u1ec3 thao sau IMPS (h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 m\u00e0ng tim) theo ph\u01b0\u01a1ng ph\u00e1p c\u00e1 th\u1ec3 h\u00f3a \u0111\u1ec3 th\u00fac \u0111\u1ea9y qu\u00e1 tr\u00ecnh h\u1ed3i ph\u1ee5c<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\nKhuy\u1ebfn c\u00e1o nh\u00f3m chuy\u00ean m\u00f4n li\u00ean ng\u00e0nh trong h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 m\u00e0ng tim<\/h1>\n\n\n\n\nC\u00e1c khuy\u1ebfn c\u00e1o<\/td>\n Nh\u00f3m<\/td>\n M\u1ee9c<\/td>\n<\/tr>\n
H\u1ed9i ch\u1ea9n li\u00ean chuy\u00ean khoa t\u1ea1i trung t\u00e2m tuy\u1ebfn cu\u1ed1i \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf b\u1ec7nh nh\u00e2n IMPS (h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 m\u00e0ng tim) nguy c\u01a1 cao\/ph\u1ee9c t\u1ea1p \u0111\u1ec3 \u0111\u01b0a ra ph\u01b0\u01a1ng \u00e1n \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3.<\/td>\n I<\/td>\n C<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\u0110\u1ed9i ng\u0169 li\u00ean chuy\u00ean khoa cho h\u1ed9i ch\u1ee9ng vi\u00eam c\u01a1 m\u00e0ng tim<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"Xem v\u00e0 t\u1ea3i file PDF t\u1ea1i \u0111\u00e2y. Bi\u00ean d\u1ecbch: Khoa N\u1ed9i tim m\u1ea1ch – Vi\u1ec7n Tim m\u1ea1ch – B\u1ec7nh vi\u1ec7n Trung \u01b0\u01a1ng Qu\u00e2n \u0111\u1ed9i 108 BSNT L\u00e2m Man Nhu, Ho\u00e0ng Ph\u00fa Qu\u00fd – \u0110\u1ea1i h\u1ecdc VinUni BS Nguy\u1ec5n V\u0103n Hinh – B\u1ec7nh vi\u1ec7n T\u01afQ\u0110 108 TS. Ph\u1ea1m Tr\u01b0\u1eddng S\u01a1n – B\u1ec7nh vi\u1ec7n T\u01afQ\u0110 108 T\u00f3m […]\n","protected":false},"author":1,"featured_media":137535,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-136980","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/136980","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=136980"}],"version-history":[{"count":13,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/136980\/revisions"}],"predecessor-version":[{"id":145895,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/136980\/revisions\/145895"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/137535"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=136980"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=136980"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=136980"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}}