{"id":35282,"date":"2023-03-10T15:18:10","date_gmt":"2023-03-10T08:18:10","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=35282"},"modified":"2023-03-10T15:18:45","modified_gmt":"2023-03-10T08:18:45","slug":"viem-co-tim","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/viem-co-tim\/","title":{"rendered":"Vi\u00eam c\u01a1 tim: D\u1ecbch t\u00ea, sinh l\u00fd b\u1ec7nh, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

B\u00e0i vi\u1ebft Vi\u00eam c\u01a1 tim: D\u1ecbch t\u00ea, sinh l\u00fd b\u1ec7nh, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb<\/a> – T\u1ea3i file PDF T\u1ea1i \u0111\u00e2y<\/a>.<\/strong><\/p>\n

M\u00d4 T\u1ea2\u00a0<\/span><\/h2>\n
Vi\u00eam c\u01a1 tim l\u00e0 b\u1ec7nh l\u00fd ti\u1ec1m \u1ea9n nguy c\u01a1 \u0111e d\u1ecda t\u00ednh m\u1ea1ng\u00a0\u00a0<\/span><\/p>\n
Ph\u1ed5 b\u1ec7nh t\u1eeb kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ebfn suy tim sung huy\u1ebft (CHF)\u00a0<\/span><\/p>\n
Vi\u00eam c\u01a1 tim t\u1ed1i c\u1ea5p \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 khi c\u1ea7n h\u1ed7 tr\u1ee3 huy\u1ebft \u0111\u1ed9ng v\u00ec di\u1ec5n ti\u1ebfn x\u1ea5u\u00a0 nhanh ch\u00f3ng (<14 ng\u00e0y) sau nhi\u1ec5m virus ti\u1ec1n tri\u1ec7u v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t r\u00f5\u00a0 r\u1ec7t\u00a0\u00a0<\/span><\/p>\n
D\u1ecaCH T\u1ec4 H\u1eccC\u00a0<\/span><\/h2>\n
T\u1ef7 l\u1ec7 m\u1eafc\u00a0<\/span><\/i><\/p>\n
T\u1ef7 l\u1ec7 m\u1eafc m\u1edbi th\u1eadt th\u00ec kh\u00f4ng r\u00f5\u00a0\u00a0<\/span><\/p>\n
Trong s\u1ed1 tr\u1ebb \u0111\u01b0\u1ee3c kh\u00e1m nghi\u1ec7m t\u1eed thi, kho\u1ea3ng 10% cho th\u1ea5y b\u1eb1ng ch\u1ee9ng m\u00f4\u00a0 b\u1ec7nh h\u1ecdc c\u1ee7a vi\u00eam c\u01a1 tim (<\/span>1<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>50% c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf tr\u1ebb < 1 tu\u1ed5i (2% tr\u01b0\u1eddng h\u1ee3p t\u1eed vong \u1edf tr\u1ebb nh\u0169\u00a0 nhi) (<\/span>1<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>Chi\u1ebfm kho\u1ea3ng 5% s\u1ed1 ca t\u1eed vong \u1edf tr\u1ebb > 5 tu\u1ed5i (<\/span>1<\/span>)\u00a0<\/span><\/p>\n
T\u1ef6 L\u1ec6 L\u01afU H\u00c0NH\u00a0<\/span><\/i><\/h2>\n
T\u1ef7 l\u1ec7 l\u01b0u h\u00e0nh th\u1ea5p, nh\u01b0ng l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y suy tim sung\u00a0 huy\u1ebft v\u00e0 b\u1ec7nh c\u01a1 tim gi\u00e3n n\u1edf (30% c\u00e1c tr\u01b0\u1eddng h\u1ee3p); chi\u1ebfm > 80% trong t\u1ed5ng s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p gh\u00e9p tim kh\u00f4ng do tim b\u1ea9m sinh \u1edf tr\u1ebb em (<\/span>1<\/span>)\u00a0<\/span><\/p>\n
Hai \u0111\u1ec9nh tu\u1ed5i bi\u1ec3u hi\u1ec7n b\u1ec7nh: Trong n\u0103m \u0111\u1ea7u \u0111\u1eddi v\u00e0 tu\u1ed5i v\u1ecb th\u00e0nh ni\u00ean (<\/span>2<\/span>) <\/span>\u2013 <\/span>Ch\u1ec9 kho\u1ea3ng 15% bi\u1ec3u hi\u1ec7n trong kho\u1ea3ng tu\u1ed5i 2-12 tu\u1ed5i (<\/span>2<\/span>)\u00a0<\/span><\/p>\n
C\u00c1C Y\u1ebeU T\u1ed0 NGUY C\u01a0\u00a0<\/span><\/h2>\n
Kh\u00f4ng c\u00f3 y\u1ebfu t\u1ed1 nguy c\u01a1 n\u00e0o \u0111\u01b0\u1ee3c bi\u1ebft \u0111\u1ebfn \u0111\u1ed1i v\u1edbi vi\u00eam c\u01a1 tim\u00a0\u00a0<\/span><\/p>\n
SINH L\u00dd B\u1ec6NH\u00a0<\/span><\/h2>\n
B\u1ec7nh l\u00fd vi\u00eam c\u01a1 tim \u0111\u1eb7c tr\u01b0ng v\u1edbi s\u1ef1 th\u00e2m nhi\u1ec5m t\u1ebf b\u00e0o b\u1ea1ch c\u1ea7u di\u1ec5n ti\u1ebfn x\u01a1 h\u00f3a\u00a0 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 ho\u1ea1i t\u1eed. Vi\u00eam c\u01a1 tim c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c chia th\u00e0nh c\u1ea5p, b\u00e1n c\u1ea5p v\u00e0\u00a0 m\u1ea1n\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>C\u1ea5p: Giai \u0111o\u1ea1n \u0111\u1ea7u, c\u00e1c t\u1ebf b\u00e0o vi\u00eam x\u00e2m l\u1ea5n v\u00e0o c\u01a1 tim g\u00e2y ho\u1ea1i t\u1eed d\u1eabn \u0111\u1ebfn\u00a0 k\u00edch ho\u1ea1t mi\u1ec5n d\u1ecbch c\u1ee7a v\u1eadt ch\u1ee7\u00a0<\/span><\/p>\n
\u2013 <\/span>B\u00e1n c\u1ea5p: R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a mi\u1ec5n d\u1ecbch g\u00e2y ph\u00e1 h\u1ee7y t\u1ebf b\u00e0o c\u01a1 tim trong pha c\u1ea5p\u00a0<\/span><\/p>\n
\u2013 <\/span>M\u1ea1n: Giai \u0111o\u1ea1n l\u00e0nh b\u1ec7nh \u0111\u1eb7c tr\u01b0ng v\u1edbi ph\u1ea3n \u1ee9ng vi\u00eam li\u00ean t\u1ee5c, nhi\u1ec5m virus dai\u00a0 d\u1eb3ng v\u00e0 x\u01a1 h\u00f3a t\u1ebf b\u00e0o c\u01a1 tim ch\u1ecbu \u1ea3nh h\u01b0\u1edfng g\u00e2y gi\u00e3n v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng\u00a0 t\u00e2m th\u1ea5t; b\u1ee9c tranh l\u00e2m s\u00e0ng \u0111i\u1ec3n h\u00ecnh c\u1ee7a b\u1ec7nh c\u01a1 tim gi\u00e3n n\u1edf (<\/span>3<\/span>)\u00a0<\/span><\/p>\n
NGUY\u00caN NH\u00c2N\u00a0<\/span><\/h2>\n
Thu\u1ed1c v\u00e0 vaccin\u00a0<\/span><\/p>\n
\u2013 <\/span>Kh\u00e1ng sinh (i.e., penicillin, ampicillin, sulfonamides, tetracyclines) <\/span>\u2013 <\/span>Kh\u00e1ng vi\u00eam (i.e., mesalamine)\u00a0<\/span><\/p>\n
\u2013 <\/span>Ch\u1ed1ng lo\u1ea1n th\u1ea7n (i.e., clozapine, benzodiazepines)\u00a0<\/span><\/p>\n
\u2013 <\/span>L\u1ee3i ti\u1ec3u quai v\u00e0 thiazides\u00a0<\/span><\/p>\n
\u2013 <\/span>Methyldopa\u00a0<\/span><\/p>\n
\u2013 <\/span>Vaccin \u0111\u1eadu m\u00f9a\u00a0<\/span><\/p>\n
\u2013 <\/span>\u0110\u1ed9c t\u1ed1 u\u1ed1n v\u00e1n\u00a0<\/span><\/p>\n
\u2013 <\/span>Thu\u1ed1c ch\u1ed1ng tr\u1ea7m c\u1ea3m ba v\u00f2ng\u00a0\u00a0<\/span><\/p>\n
Vi\u00eam\u00a0<\/span><\/p>\n
\u2013 <\/span>Cardiac sarcoidosis\u00a0<\/span><\/p>\n
\u2013 <\/span>H\u1ed9i ch\u1ee9ng Churg\u2013Strauss\u00a0<\/span><\/p>\n
\u2013 <\/span>Vi\u00eam c\u01a1 tim t\u1ebf b\u00e0o kh\u1ed5ng l\u1ed3\u00a0<\/span><\/p>\n
\u2013 <\/span>B\u1ec7nh l\u00fd vi\u00eam ru\u1ed9t (Crohn\u2019s v\u00e0 UC)\u00a0<\/span><\/p>\n
\u2013 <\/span>Kawasaki disease\u00a0<\/span><\/p>\n
\u2013 <\/span>Loeffler disease (h\u1ed9i ch\u1ee9ng t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan)\u00a0<\/span><\/p>\n
\u2013 <\/span>Vi\u00eam kh\u1edbp d\u1ea1ng th\u1ea5p\u00a0<\/span><\/p>\n
\u2013 <\/span>Lupus ban \u0111\u1ecf h\u1ec7 th\u1ed1ng\u00a0\u00a0<\/span><\/p>\n
Nhi\u1ec5m khu\u1ea9n\u00a0<\/span><\/p>\n
\u2013 <\/span>Vi khu\u1ea9n (i.e., chlamydia<\/span>, Corynebacterium diphtheriae, <\/span><\/i>legionella, mycobacteria<\/span>, <\/span><\/i>mycoplasma<\/span>, <\/span><\/i>staphylococci<\/span>, Streptococcus pneumoniae<\/span><\/i>)\u00a0<\/span><\/p>\n
\u2013 <\/span>N\u1ea5m (i.e., actinomyces, aspergilli, candida, cryptococci)\u00a0<\/span><\/p>\n
\u2013 <\/span>Giun s\u00e1n (i.e., echinococci<\/span>, Trichinella<\/span><\/i>)\u00a0<\/span><\/p>\n
\u2013 <\/span>KST (i.e. <\/span>Toxoplasma gondii, Trypanosoma cruzi<\/span><\/i>)\u00a0<\/span><\/p>\n
\u2013 <\/span>Xo\u1eafn khu\u1ea9n (i.e., leptospira, <\/span>Treponema pallidum<\/span><\/i>)\u00a0\u00a0<\/span><\/p>\n
Nhi\u1ec5m virus v\u00e0 ph\u1ea3n \u1ee9ng mi\u1ec5n d\u1ecbch sau nhi\u1ec5m virus\u00a0<\/span><\/p>\n
\u2013 <\/span>Adenoviruses\u00a0<\/span><\/p>\n
\u2013 <\/span>Coxsackieviruses\u00a0<\/span><\/p>\n
\u2013 <\/span>Vi\u00eam gan C\u00a0<\/span><\/p>\n
\u2013 <\/span>Herpes viruses (cytomegalovirus, Epstein\u2013Barr virus, and human herpes virus 6) <\/span>\u2013 <\/span>HIV\u00a0<\/span><\/p>\n
\u2013 <\/span>C\u00fam A\u00a0<\/span><\/p>\n
\u2013 <\/span>Parvovirus B19\u00a0<\/span><\/p>\n
\u2013 <\/span>Rhinovirus<\/span><\/p>\n
CH\u1ea8N \u0110O\u00c1N\u00a0<\/span><\/h2>\n
B\u1ec6NH S\u1eec\u00a0<\/span><\/h3>\n
Tri\u1ec7u ch\u1ee9ng tim m\u1ea1ch xu\u1ea5t hi\u1ec7n trong v\u00f2ng 7-14 ng\u00e0y sau kh\u1edfi ph\u00e1t ti\u1ec1n tri\u1ec7u (<\/span>4<\/span>) <\/span>\u2013 <\/span>Kh\u00f3 th\u1edf (kho\u1ea3ng 70%), \u0111\u00e1nh tr\u1ed1ng ng\u1ef1c, ng\u1ea5t, y\u1ebfu\u00a0\u00a0<\/span><\/p>\n
\u0110au ng\u1ef1c (kho\u1ea3ng 30%) (<\/span>4<\/span>)\u00a0<\/span><\/p>\n
Kh\u00f4ng dung n\u1ea1p g\u1eafng s\u1ee9c\u00a0<\/span><\/p>\n
M\u1ec7t m\u1ecfi\u00a0\u00a0<\/span><\/p>\n
\u0110au c\u01a1\/\u0111au kh\u1edbp\u00a0<\/span><\/p>\n
Tri\u1ec7u ch\u1ee9ng ti\u1ec1n tri\u1ec7u c\u00f3 th\u1ec3 bao g\u1ed3m:\u00a0<\/span><\/p>\n
\u0110au b\u1ee5ng, ch\u00e1n \u0103n, n\u00f4n \u00f3i\u00a0<\/span><\/p>\n
\u2013 <\/span>S\u1ed1t, l\u01a1 m\u01a1 (40%)\u00a0<\/span><\/p>\n
\u2013 <\/span>Co gi\u1eadt\u00a0<\/span><\/p>\n
\u2013 <\/span>Tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean: Ho, ch\u1ea3y m\u0169i, ngh\u1eb9t m\u0169i\u00a0<\/span><\/p>\n
KH\u00c1M L\u00c2M S\u00c0NG\u00a0<\/span><\/h3>\n
Tim (<\/span>5<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>R\u1ed1i lo\u1ea1n nh\u1ecbp (kho\u1ea3ng 30%): Nh\u1ecbp nhanh th\u1ea5t\/rung th\u1ea5t, block nh\u0129 th\u1ea5t <\/span>\u2013 <\/span>Ti\u1ebfng th\u1ed5i m\u1edbi ho\u1eb7c ti\u1ebfng ng\u1ef1a phi (kho\u1ea3ng 30%)\u00a0<\/span><\/p>\n
\u2013 <\/span>Tim nhanh (kho\u1ea3ng 60%) (<\/span>6<\/span>)\u00a0\u00a0<\/span><\/p>\n
S\u1ed1t (30%)\u00a0<\/span><\/p>\n
Gan to\u00a0\u00a0<\/span><\/p>\n
T\u1ee5t huy\u1ebft \u00e1p\u00a0<\/span><\/p>\n
Ph\u00f9 ngo\u1ea1i bi\u00ean <\/span>(<\/span>\u223c<\/span>15%)\u00a0<\/span><\/p>\n
H\u00f4 h\u1ea5p (70%): Th\u1edf r\u00ean, thi\u1ebfu oxy m\u00e1u (10%), r\u00fat l\u00f5m\/co k\u00e9o, th\u1edf nhanh, rales\/kh\u00f2\u00a0 kh\u00e8 (<\/span>5<\/span>)\u00a0<\/span><\/p>\n
X\u00c9T NGHI\u1ec6M CH\u1ea8N \u0110O\u00c1N\u00a0<\/span><\/h3>\n
X\u00e9t nghi\u1ec7m ban \u0111\u1ea7u\u00a0<\/span><\/i><\/p>\n
Beta natriuretic peptide (BNP)\u00a0<\/span><\/p>\n
Markers vi\u00eam \u2013 gi\u00e1 tr\u1ecb b\u00ecnh th\u01b0\u1eddng kh\u00f4ng lo\u1ea1i tr\u1eeb vi\u00eam c\u01a1 tim c\u1ea5p <\/span>\u2013 <\/span>C-reactive protein (CRP)\u00a0<\/span><\/p>\n
\u2013 <\/span>WBC\u00a0<\/span><\/p>\n
\u2013 <\/span>ESR (T\u1ed1c \u0111\u1ed9 m\u00e1u l\u1eafng)\u00a0<\/span><\/p>\n
Troponin T \u2013 marker ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u01a1 tim \u1edf tr\u1ebb em\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>N\u1ebfu <0.01 ng\/mL, c\u00f3 th\u1ec3 lo\u1ea1i tr\u1eeb vi\u00eam c\u01a1 tim (<\/span>5<\/span>)\u00a0\u00a0<\/span><\/p>\n
X\u00e9t nghi\u1ec7m virus \u0111\u1eb7c hi\u1ec7u trong huy\u1ebft thanh n\u1ebfu nghi ng\u1edd t\u00e1c nh\u00e2n virus\u00a0 <\/span>H\u00ecnh \u1ea3nh h\u1ecdc<\/span><\/i><\/p>\n
X-quang ng\u1ef1c\u00a0<\/span><\/p>\n
\u2013 <\/span>B\u1ea5t th\u01b0\u1eddng tr\u00ean phim x-quang ng\u1ef1c \u0111\u01b0\u1ee3c mong \u0111\u1ee3i trong vi\u00eam c\u01a1 tim\u00a0<\/span><\/p>\n
\u2013 <\/span>B\u00f3ng tim to v\u00e0 ph\u00f9 ph\u1ed5i bi\u1ec3u hi\u1ec7n r\u00f5 \u1edf kho\u1ea3ng 80% b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim (<\/span>5<\/span>) Si\u00eau \u00e2m tim\u00a0<\/span><\/p>\n
\u2013 <\/span>\u0110\u1ed9 nh\u1ea1y kho\u1ea3ng 85% ph\u1ea3n \u00e1nh gi\u00e3n th\u1ea5t tr\u00e1i v\u00e0 gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u l\u00e0 bi\u1ec3u\u00a0 hi\u1ec7n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t li\u00ean quan \u0111\u1ebfn vi\u00eam c\u01a1 tim (<\/span>7<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y CHF nh\u01b0 b\u1ec7nh l\u00fd van tim, tr\u00e0n d\u1ecbch m\u00e0ng ngo\u00e0i tim,\u00a0 ho\u1eb7c b\u1ec7nh l\u00fd c\u01a1 tim kh\u00e1c ph\u1ea3i \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb (<\/span>7<\/span>)\u00a0<\/span><\/p>\n
MRI tim (cMRI)\u00a0<\/span><\/p>\n
\u2013 <\/span>Kh\u1ea3o s\u00e1t ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i, d\u1ef1 \u0111o\u00e1n k\u1ebft c\u1ee5c\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>Ti\u1ebfp c\u1eadn ch\u1ea9n \u0111o\u00e1n v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c 80% (<\/span>8<\/span>)\u00a0<\/span><\/p>\n
Th\u1ee7 thu\u1eadt ch\u1ea9n \u0111o\u00e1n\/kh\u00e1c\u00a0<\/span><\/i><\/p>\n
ECG\u00a0<\/span><\/p>\n
\u2013 <\/span>\u0110\u1ed9 nh\u1ea1y th\u1ea5p <50% trong vi\u00eam c\u01a1 tim (<\/span>4<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>Bi\u1ec3u hi\u1ec7n \u0111a d\u1ea1ng (<\/span>3<\/span>):\u00a0<\/span><\/p>\n
S\u00f3ng T v\u00e0 \u0111o\u1ea1n ST thay \u0111\u1ed5i kh\u00f4ng \u0111\u1eb7c hi\u1ec7u (30\u201360%)\u00a0<\/span><\/p>\n
Nh\u1ecbp nhanh xoang l\u00e0 b\u1ea5t th\u01b0\u1eddng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t (kho\u1ea3ng 45%), c\u00f3 ho\u1eb7c\u00a0 kh\u00f4ng c\u00f3 thay \u0111\u1ed5i s\u00f3ng T ho\u1eb7c ST\u00a0\u00a0<\/span><\/p>\n
ST ch\u00eanh l\u00ean\u00a0<\/span><\/p>\n
Ph\u00ec \u0111\u1ea1i t\u00e2m th\u1ea5t (kho\u1ea3ng 45%)\u00a0<\/span><\/p>\n
R\u1ed1i lo\u1ea1n nh\u1ecbp nhanh \u1edf 10%, trong \u0111\u00f3 80% l\u00e0 \u1edf th\u1ea5t\u00a0<\/span><\/p>\n
S\u00f3ng Q ho\u1eb7c block nh\u00e1nh b\u00f3 tr\u00e1i m\u1edbi xu\u1ea5t hi\u1ec7n li\u00ean quan \u0111\u1ebfn t\u1ec9 l\u1ec7 t\u1eed vong do tim\u00a0 ho\u1eb7c c\u1ea7n gh\u00e9p tim cao h\u01a1n\u00a0\u00a0<\/span><\/p>\n
\u0110\u1eb7c \u0111i\u1ec3m m\u00f4 b\u1ec7nh h\u1ecdc\u00a0<\/span><\/i><\/p>\n
Sinh thi\u1ebft n\u1ed9i t\u00e2m m\u1ea1c\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>Ti\u00eau chu\u1ea9n v\u00e0ng trong ch\u1ea9n \u0111o\u00e1n vi\u00eam c\u01a1 tim, m\u1eb7c d\u00f9 n\u00f3 kh\u00f4ng c\u1ea7n thi\u1ebft \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n (<\/span>4<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>Th\u00e2m nhi\u1ec5m t\u1ebf b\u00e0o lympho li\u00ean quan \u0111\u1ebfn m\u00f4 c\u01a1 tim ho\u1ea1i t\u1eed\u00a0<\/span><\/p>\n
\u2013 <\/span>Kho\u1ea3ng 30% \u0111\u1ed9 nh\u1ea1y trong vi\u1ec7c x\u00e1c \u0111\u1ecbnh t\u00e1c nh\u00e2n g\u00e2y vi\u00eam c\u01a1 tim (<\/span>8<\/span>) <\/span>\u2013 <\/span>H\u00f3a m\u00f4 mi\u1ec5n d\u1ecbch cho \u0111\u1ed9 nh\u1ea1y cao h\u01a1n (<\/span>4<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>PCR virus\u00a0\u00a0<\/span><\/p>\n
Cho ph\u00e9p x\u00e1c \u0111\u1ecbnh c\u00e1c lo\u1ea1i t\u1ebf b\u00e0o b\u00ean trong c\u01a1 tim\u00a0\u00a0<\/span><\/p>\n
CH\u1ea8N \u0110O\u00c1N PH\u00c2N BI\u1ec6T\u00a0<\/span><\/h3>\n
B\u1ec7nh l\u00fd c\u01a1 tim \u2013 ph\u00ec \u0111\u1ea1i ho\u1eb7c h\u1ea1n ch\u1ebf\u00a0\u00a0<\/span><\/p>\n
Kawasaki disease\u00a0<\/span><\/p>\n
Nh\u1ed3i m\u00e1u c\u01a1 tim\u00a0\u00a0<\/span><\/p>\n
H\u00f4 h\u1ea5p\u00a0<\/span><\/p>\n
\u2013 <\/span>Hen\u00a0<\/span><\/p>\n
\u2013 <\/span>Vi\u00eam ti\u1ec3u ph\u1ebf qu\u1ea3n\u00a0<\/span><\/p>\n
\u2013 <\/span>Vi\u00eam ph\u1ed5i<\/span><\/p>\n
Septic ho\u1eb7c shock gi\u1ea3m th\u1ec3 t\u00edch\u00a0<\/span><\/p>\n
B\u1ec7nh l\u00fd van tim\u00a0<\/span><\/p>\n
\u0110I\u1ec0U TR\u1eca\u00a0<\/span><\/h2>\n
\u0110I\u1ec0U TR\u1eca BAN \u0110\u1ea6U\u00a0<\/span><\/h3>\n
\u0110\u00e1nh gi\u00e1 nhanh ch\u00f3ng, h\u1ed7 tr\u1ee3 th\u00f4ng kh\u00ed v\u00e0 tu\u1ea7n ho\u00e0n\u00a0\u00a0<\/span><\/p>\n
V\u1edbi t\u1ec9 l\u1ec7 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i cao, x\u1eed tr\u00ed ban \u0111\u1ea7u nh\u1eb1m \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ec3u hi\u1ec7n\u00a0 c\u1ee7a CHF (<\/span>4<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>Gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed5 \u0111\u1ea7y t\u00e2m th\u1ea5t\u00a0<\/span><\/p>\n
\u2013 <\/span>Gi\u1ea3m kh\u00e1ng tr\u1edf m\u1ea1ch m\u00e1u h\u1ec7 th\u1ed1ng\u00a0<\/span><\/p>\n
\u2013 <\/span>T\u1ed1i \u0111a h\u00f3a vi\u1ec7c cung c\u1ea5p oxy\u00a0<\/span><\/p>\n
THU\u1ed0C\u00a0<\/span><\/h3>\n
\u0110\u1ea7u tay\u00a0<\/span><\/i><\/p>\n
Furosemide: Tr\u1ebb nh\u0169 nhi, tr\u1ebb em, tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean: PO, IM, IV: 0.5\u20132 mg\/kg\/li\u1ec1u (t\u1ed1i\u00a0 \u0111a 40 mg\/li\u1ec1u)\u00a0<\/span><\/p>\n
Captopril: Tr\u1ebb nh\u0169 nhi: PO: Kh\u1edfi \u0111\u1ea7u: 0.1\u20130.3 mg\/kg\/li\u1ec1u m\u1ed7i 6-24 gi\u1edd (t\u1ed1i \u0111a 6 mg\/kg\/ng\u00e0y); Tr\u1ebb nh\u1ecf, tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean: PO: Kh\u1edfi \u0111\u1ea7u: 0.3\u20130.5 mg\/kg\/li\u1ec1u m\u1ed7i 8-12\u00a0 gi\u1edd (t\u1ed1i \u0111a 6.25mg\/li\u1ec1u; max 6 mg\/kg\/ng\u00e0y); gi\u1ea3m h\u1eadu t\u1ea3i\u00a0<\/span><\/p>\n
Dopamine: T\u00e1c d\u1ee5ng l\u00ean huy\u1ebft \u0111\u1ed9ng ph\u1ee5 thu\u1ed9c li\u1ec1u. Truy\u1ec1n TM li\u00ean t\u1ee5c: Kh\u1edfi \u0111\u1ea7u: 5\u201310 mcg\/kg\/ph\u00fat, chu\u1ea9n \u0111\u1ed9 d\u1ea7n d\u1ea7n 5\u201310 mcg\/kg\/ph\u00fat cho \u0111\u1ebfn khi \u0111\u1ea1t \u0111\u01b0\u1ee3c \u0111\u00e1p\u00a0 \u1ee9ng mong mu\u1ed1n\u00a0<\/span><\/p>\n
\u2013 <\/span>D\u00f9ng trong CHF m\u1ea5t b\u00f9\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>\u201c\u0110i\u1ec1u tr\u1ecb c\u1ea7u n\u1ed1i\u201d \u2013 d\u00f9ng cho nh\u1eefng tr\u1ebb ch\u1edd ph\u1ee5c h\u1ed3i ho\u1eb7c gh\u00e9p tim\u00a0 <\/span>Second Line\u00a0<\/span><\/i><\/p>\n
Immunoglobulin c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i\u00a0\u00a0<\/span><\/p>\n
Hi\u1ec7u qu\u1ea3 c\u1ee7a corticosteroid v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh\u00a0<\/span><\/p>\n
C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n t\u1ef1 mi\u1ec5n g\u00e2y\u00a0 vi\u00eam c\u01a1 tim\u00a0\u00a0<\/span><\/p>\n
\u0110i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1ng virus\u00a0<\/span><\/p>\n
\u2013 <\/span>Ch\u1ec9 h\u1eefu \u00edch trong m\u1ed9t s\u1ed1 ca ch\u1ecdn l\u1ecdc (e.g., oseltamivir \u0111\u1ed1i v\u1edbi virus c\u00fam) <\/span>PH\u1eaaU THU\u1eacT\/C\u00c1C TH\u1ee6 THU\u1eacT KH\u00c1C\u00a0<\/span><\/p>\n
ECMO\u00a0<\/span><\/p>\n
\u2013 <\/span>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n shock tim m\u1ea5t b\u00f9 do vi\u00eam c\u01a1 tim t\u1ed1i c\u1ea5p m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>Ti\u00ean l\u01b0\u1ee3ng t\u1ed1t v\u1edbi >60\u201380% ng\u01b0\u1eddi s\u1ed1ng s\u00f3t (<\/span>9<\/span>)<\/span><\/p>\n
\u2013 <\/span>T\u1ec9 l\u1ec7 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i cao\u00a0\u00a0<\/span><\/p>\n
M\u00e1y t\u1ea1o nh\u1ecbp v\u00e0 c\u1ea5y m\u00e1y kh\u1eed rung tim\u00a0\u00a0<\/span><\/p>\n
Thi\u1ebft b\u1ecb h\u1ed7 tr\u1ee3 th\u1ea5t\u00a0<\/span><\/p>\n
\u2013 <\/span>Trong nhi khoa th\u01b0\u1eddng l\u00e0 h\u1ed7 tr\u1ee3 th\u1ea5t tr\u00e1i h\u01a1n l\u00e0 hai th\u1ea5t\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>H\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng \u1edf tr\u1ebb l\u1edbn v\u00e0 tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>\u1ee8ng d\u1ee5ng ch\u00ednh trong nhi khoa l\u00e0 c\u1ea7u n\u1ed1i \u0111\u1ec3 gh\u00e9p tim\u00a0\u00a0<\/span><\/p>\n
B\u1ed0 TR\u00cd\u00a0<\/span><\/h2>\n
Ti\u00eau chu\u1ea9n nh\u1eadp vi\u1ec7n\u00a0<\/span><\/i><\/p>\n
H\u1ea7u h\u1ebft t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n \u0111\u1ec1u c\u1ea7n nh\u1eadp vi\u1ec7n; nh\u1eefng\u00a0 ng\u01b0\u1eddi c\u00f3 huy\u1ebft \u0111\u1ed9ng kh\u00f4ng \u1ed5n \u0111\u1ecbnh ho\u1eb7c c\u00f3 r\u1ed1i lo\u1ea1n nh\u1ecbp n\u00ean \u0111\u01b0\u1ee3c nh\u1eadp khoa PICU\u00a0\u00a0<\/span><\/p>\n
C\u00e1c v\u1ea5n \u0111\u1ec1 chuy\u1ec3n khoa\u00a0<\/span><\/i><\/p>\n
T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n vi\u00eam c\u01a1 tim m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n n\u00ean \u0111\u01b0\u1ee3c b\u00e1c s\u0129 nhi tim m\u1ea1ch\u00a0 \u0111\u00e1nh gi\u00e1\u00a0\u00a0<\/span><\/p>\n
THEO D\u00d5I\u00a0<\/span><\/h2>\n
V\u1edbi b\u00e1c s\u0129 nhi khoa tim m\u1ea1ch\u00a0<\/span><\/p>\n
N\u00ean tr\u00e1nh ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t; g\u1eafng s\u1ee9c li\u00ean t\u1ee5c c\u00f3 th\u1ec3 g\u00e2y t\u0103ng t\u1ec9 l\u1ec7 t\u1eed vong v\u00e0 l\u00e0\u00a0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n g\u00e2y \u0111\u1ed9t t\u1eed \u1edf v\u1eadn \u0111\u1ed9ng vi\u00ean tr\u1ebb tu\u1ed5i\u00a0\u00a0<\/span><\/p>\n
TI\u00caN L\u01af\u1ee2NG\u00a0<\/span><\/h2>\n
T\u1ef7 l\u1ec7 s\u1ed1ng s\u00f3t thay \u0111\u1ed5i theo \u0111\u1ed9 tu\u1ed5i v\u00e0 b\u1ec7nh l\u00fd n\u1ec1n (<\/span>1<\/span>)\u00a0<\/span><\/p>\n
\u0110\u1ed1i v\u1edbi tr\u1ebb nh\u1eadp vi\u1ec7n v\u00ec vi\u00eam c\u01a1 tim, t\u1ec9 l\u1ec7 b\u1ec7nh t\u1eadt v\u00e0 t\u1eed vong cao (<\/span>10<\/span>) <\/span>\u2013 <\/span>L\u00ean \u0111\u1ebfn 33% tr\u1ebb c\u1ea7n h\u1ed7 tr\u1ee3 c\u01a1 h\u1ecdc\u00a0\u00a0<\/span><\/p>\n
\u2013 <\/span>L\u00ean \u0111\u1ebfn 15% tr\u1ebb c\u1ea7n gh\u00e9p tim\u00a0<\/span><\/p>\n
\u2013 <\/span>L\u00ean \u0111\u1ebfn 15% tr\u1ebb t\u1eed vong\u00a0<\/span><\/p>\n
75% t\u1ec9 l\u1ec7 t\u1eed vong \u1edf tr\u1ebb s\u01a1 sinh v\u00e0 nh\u0169 nhi trong n\u0103m \u0111\u1ea7u \u0111\u1eddi\u00a0\u00a0<\/span><\/p>\n
C\u00e1c y\u1ebfu t\u1ed1 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng x\u1ea5u\u00a0<\/span><\/p>\n
\u2013 <\/span>N\u1eef gi\u1edbi (<\/span>11<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>CHF\u00a0<\/span><\/p>\n
\u2013 <\/span>Tr\u00e0o ng\u01b0\u1ee3c van hai l\u00e1 m\u1ee9c \u0111\u1ed9 TB-n\u1eb7ng (<\/span>3<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>T\u01b0\u1edbi m\u00e1u k\u00e9m v\u1edbi gi\u1ea3m ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t tr\u00ean si\u00eau \u00e2m tim (<\/span>12<\/span>) <\/span>\u2013 <\/span>R\u1ed1i lo\u1ea1n nh\u1ecbp nhanh (<\/span>10<\/span>)\u00a0<\/span><\/p>\n
\u2013 <\/span>Tr\u1ebb nh\u1ecf (<\/span>12<\/span>)\u00a0<\/span><\/p>\n
BI\u1ebeN CH\u1ee8NG\u00a0<\/span><\/h2>\n
CHF<\/span><\/p>\n
B\u1ec7nh c\u01a1 tim gi\u00e3n n\u1edf\u00a0\u00a0<\/span><\/p>\n
R\u1ed1i lo\u1ea1n nh\u1ecbp\u00a0<\/span><\/p>\n
T\u1ed5n th\u01b0\u01a1ng c\u01a1 quan \u0111\u00edch\u00a0<\/span><\/p>\n
REFERENCES\u00a0<\/span><\/h2>\n
\n
Kuhl U, Schultheiss HP. Myocarditis in children. <\/span>Heart Fail Clin<\/span><\/i>. 2010;6(4):483\u2013 496.\u00a0<\/span><\/li>\n
Butts RJ, Boyle GJ, Deshpande SR, et al. Characteristics of clinically diagnosed pediatric myocarditis in a contemporary multi-center cohort. <\/span>Pediatr Cardiol<\/span><\/i>. 2017;38(6):1175\u20131182.\u00a0<\/span><\/li>\n
Levine MC, Klugman D, Teach SJ. Update on myocarditis in children. <\/span>Curr Opin Pediatr<\/span><\/i>. 2010;22(3):278\u2013283.\u00a0<\/span><\/li>\n
Cooper LT. Myocarditis. <\/span>N Engl J Med<\/span><\/i>. 2009;360(15):1526\u20131538. <\/span>5. <\/span>Pettit MA, Koyfman A, Fonan M. Myocarditis. <\/span>Pediatr Emerg Care<\/span><\/i>. 2014;30(11):832\u2013835; quiz 836\u2013838.\u00a0<\/span><\/li>\n
Durani Y, Egan M, Baffa J, et al. Pediatric myocarditis: Presenting clinical characteristics. <\/span>Am J Emerg Med<\/span><\/i>. 2009;27(8):942\u2013947.\u00a0<\/span><\/li>\n
Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. <\/span>Circulation<\/span><\/i>. 2014;129:115\u2013128.\u00a0<\/span><\/li>\n
Mavrogeni S, Bratis K, Georgakopoulos D, et al. Evaluation of myocarditis in a pediatric population using cardiovascular magnetic resonance and endomyocardial biopsy. <\/span>Int J Cardiol<\/span><\/i>. 2012;160(3):192\u2013195.\u00a0<\/span><\/li>\n
Ghelani SJ, Spaeder MC, Pastor W, et al. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006\u20132011. <\/span>Circ Cardiovasc Qual Outcomes<\/span><\/i>. 2012;5(5):622\u2013627.\u00a0<\/span><\/li>\n
Anderson BR, Silver ES, Richmond ME, et al. Usefulness of arrhythmias as predictors of death and resource utilization in children with myocarditis. <\/span>Am J Cardiol<\/span><\/i>. 2014;114(9):1400\u20131405.\u00a0<\/span><\/li>\n
Wu HP, Lin MJ, Yang WC, et al. Predictors of extracorporeal membrane oxygen support for children with acute myocarditis. <\/span>BioMed Res Int<\/span><\/i>. 2017;article ID 2510695; 1\u20138.\u00a0<\/span><\/li>\n
Messroghli DR, Pickardt T, Fischer M, et al. Toward evidence-based diagnosis of myocarditis in children and adolescents: Rationale, design, and first baseline data of MYKKE, a multicenter registry and study platform. <\/span>Am Heart J<\/span><\/i>. 2017;187:133\u2013144.\u00a0<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
B\u00e0i vi\u1ebft Vi\u00eam c\u01a1 tim: D\u1ecbch t\u00ea, sinh l\u00fd b\u1ec7nh, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb – T\u1ea3i file PDF T\u1ea1i \u0111\u00e2y. M\u00d4 T\u1ea2\u00a0 Vi\u00eam c\u01a1 tim l\u00e0 b\u1ec7nh l\u00fd ti\u1ec1m \u1ea9n nguy c\u01a1 \u0111e d\u1ecda t\u00ednh m\u1ea1ng\u00a0\u00a0 Ph\u1ed5 b\u1ec7nh t\u1eeb kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1ebfn suy tim sung huy\u1ebft (CHF)\u00a0 Vi\u00eam c\u01a1 tim t\u1ed1i c\u1ea5p […]\n","protected":false},"author":1,"featured_media":35284,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-35282","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\/35282","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=35282"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/35282\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/35284"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=35282"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=35282"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=35282"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}