B\u1ec7nh nh\u00e2n n\u1eef, 72 tu\u1ed5i, ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, \u0111\u1ebfn kh\u00e1m theo d\u00f5i sau l\u1ea7n nh\u1eadp vi\u1ec7n tr\u01b0\u1edbc \u0111\u00f3 do qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch v\u00e0 kh\u00f3 th\u1edf. B\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y kh\u00e1 h\u01a1n nhi\u1ec1u sau khi ra vi\u1ec7n, kh\u00f4ng c\u00f2n bi\u1ec3u hi\u1ec7n r\u1ed1i lo\u1ea1n khi g\u1eafng s\u1ee9c. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m metformin 1000 mg 2 l\u1ea7n\/ng\u00e0y, lisinopril 20 mg\/ng\u00e0y v\u00e0 furosemide 20 mg\/ng\u00e0y.<\/p>\n
Kh\u00e1m th\u1ea5y: th\u00e2n nhi\u1ec7t 37 \u0111\u1ed9 C, huy\u1ebft \u00e1p 115\/70 mmHg, nh\u1ecbp tim 70 l\u1ea7n\/ph\u00fat, nh\u1ecbp th\u1edf 12 l\u1ea7n\/ph\u00fat. Nghe ph\u1ed5i r\u00f5. Kh\u00e1m tim m\u1ea1ch th\u1ea5y \u0111i\u1ec3m tim \u0111\u1eadp m\u1ea1nh nh\u1ea5t l\u1ec7ch ra ph\u00eda ngo\u00e0i, k\u00e8m ti\u1ebfng th\u1ed5i t\u00e2m thu 2\/6 \u1edf m\u1ecfm. \u00c1p l\u1ef1c t\u0129nh m\u1ea1ch c\u1ea3nh \u0111o \u0111\u01b0\u1ee3c l\u00e0 6 cm n\u01b0\u1edbc khi b\u1ec7nh nh\u00e2n n\u1eb1m \u1edf t\u01b0 th\u1ebf 45 \u0111\u1ed9. Ph\u1ea3n h\u1ed3i gan t\u0129nh m\u1ea1ch c\u1ed5 \u00e2m t\u00ednh. Ph\u00f9 nh\u1eb9 \u1ea5n l\u00f5m hai b\u00ean.<\/p>\n
Si\u00eau \u00e2m l\u00e0m trong th\u1eddi gian b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n cho th\u1ea5y ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u th\u1ea5t tr\u00e1i l\u00e0 34%, gi\u1ea3m co b\u00f3p to\u00e0n b\u1ed9 c\u01a1 tim v\u00e0 h\u1edf van hai l\u00e1 trung t\u00e2m m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn v\u1eeba.<\/p>\n
A. Th\u00eam carvedilol
\nB. T\u0103ng li\u1ec1u furosemide
\nC. Th\u00eam spironolactone
\nD. Th\u00eam hydralazine v\u00e0 isosorbide dinitrate
\nE. Gi\u1eef nguy\u00ean ph\u00e1c \u0111\u1ed3 hi\u1ec7n t\u1ea1i.<\/p>\n
\u0110i\u1ec3m then ch\u1ed1t: \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n m\u1edbi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n suy tim c\u00f3 gi\u1ea3m ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u hi\u1ec7n kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch, \u0111\u00e3 d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf enzyme chuy\u1ec3n angiotensin, b\u01b0\u1edbc d\u00f9ng thu\u1ed1c ti\u1ebfp theo l\u00e0 th\u00eam m\u1ed9t trong s\u1ed1 c\u00e1c thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m sau \u0111\u00e2y: bisoprolol, carvedilol ho\u1eb7c metoprolol t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/p>\n
Khi b\u1ec7nh nh\u00e2n suy tim gi\u1ea3m ph\u00e2n s\u1ed1 t\u1ed1ng m\u00e1u (EF) c\u00f3 t\u00ecnh tr\u1ea1ng \u1ed5n \u0111\u1ecbnh v\u00e0 \u0111ang d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf enzyme chuy\u1ec3n angiotensin, ch\u1eb9n beta giao c\u1ea3m l\u00e0 thu\u1ed1c ph\u00f9 h\u1ee3p nh\u1ea5t c\u1ea7n th\u00eam v\u00e0o ph\u00e1c \u0111\u1ed3. Ba thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m sau \u0111\u00e2y cho th\u1ea5y c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong d\u00e0i h\u1ea1n \u1edf b\u1ec7nh nh\u00e2n suy tim gi\u1ea3m EF: bisoprolol, carvedilol ho\u1eb7c metoprolol t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i.<\/p>\n
Do b\u1ec7nh nh\u00e2n hi\u1ec7n kh\u00f4ng bi\u1ec3u hi\u1ec7n tri\u1ec7u ch\u1ee9ng v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng th\u1ea5y kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch (\u0111\u1eb3ng th\u1ec3 t\u00edch – euvolemia), th\u00eam thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 t\u0103ng li\u1ec1u furosemide l\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft.<\/p>\n
M\u1eb7c d\u00f9 spironolactone v\u00e0 ph\u1ed1i h\u1ee3p hydralazine v\u00e0 isosorbide dinitrate cho th\u1ea5y c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong \u1edf m\u1ed9t s\u1ed1 qu\u1ea7n th\u1ec3 suy tim gi\u1ea3m EF, k\u1ebft qu\u1ea3 l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong m\u1edbi ch\u1ec9 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e3 d\u00f9ng thu\u1ed1c ch\u1eb9n beta. Nh\u01b0 v\u1eady, tr\u01b0\u1edbc ti\u00ean n\u00ean b\u1eaft \u0111\u1ea7u d\u00f9ng ch\u1eb9n beta \u1edf b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n
R\u00f5 r\u00e0ng vi\u1ec7c gi\u1eef nguy\u00ean ph\u00e1c \u0111\u1ed3 hi\u1ec7n t\u1ea1i c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 kh\u00f4ng th\u00edch h\u1ee3p n\u1ebfu b\u1ec7nh nh\u00e2n dung n\u1ea1p \u0111\u01b0\u1ee3c thu\u1ed1c ch\u1eb9n beta, do \u0111\u00e3 x\u00e1c \u0111\u1ecbnh r\u00f5 l\u1ee3i \u00edch v\u1ec1 t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t trong b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng n\u00e0y.<\/p>\n
Writing Committee Members. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. Circulation 2013 Oct 15; 128:e240.<\/p>\n
Jessup M and Brozena S. Heart failure. N Engl J Med 2003 May 15; 348:2007.<\/p>\n