Chn on v iu tr suy timB MN TIM MCHTRNG I HC Y H NIPHAN NH PHONGphong.vtm@gmail.com

Mc tiu hc tpTriu chng suy tim triTriu chng suy tim phiCc nhm thuc chnh iu tr suy tim

nh nghaSuy tim l tnh trng bnh l trong cung lng tim khng p ng nhu cu ca c th v mt xy trong mi tnh hung sinh hot ca bnh nhn

Suy tim s lm mt dn cc hot ng hng ngy ca bnh nhn

nh ngha Suy tim l mt hi chng lm sng, l hu qu ca s ri lon chc nng y v tng mu ca tm tht. Suy tim l hu qu ca tt c cc bnh l thc tn v chc nng nh hng n hot ng ca tim. Chn on suy tim ch yu da vo khai thc tin s bnh v khm lm sng. ACCF/AHA Heart Failure Guideline 2013

Dch t hc suy tim(t l mc % qua 34 nm theo di nghin cu framingham - usa)

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T l mc suy tim theo tui v gii(Hoa K: 1988-94)Sources: NHANES III (1988-94), CDC/NCHS and the American Heart Association

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- 5,1 triu ngi ang b suy tim (330 triu dn).- Mi nm c thm 650.000 ca mi mc suy tim.- i vi mt ngi M trn 40 tui, nguy c mc suy tim trong thi gian cn li ca cuc i l 20%.ACCF/AHA Heart Failure Guideline 2013 Dch t hc suy tim (tI HOA K hin nay)

Sinh l bnhCc yu t nh hng n cung lng timTin gnh c nh gi bng V/P cui TTr ca tht Ph thuc: lng mu TM v tht, gin ca thtSc co bp ca tim (lut Starling) P/V cui TTr trong tm thtco bp c tim, V nht bp .Nhng khi suy tim ti mt mc no , th d P/V cui TTr ca tht tip tc nhng V nht bp s khng tng ng, thm ch cn

Sinh l bnhHu gnhHG l sc cn ca cc M i vi s co bp ca tim. Sc cn cao th sc co bp ca tm tht phi ln. Sc cn tng cao lm tng cng v tiu th oxy ca tim dn dn lm gim sc co bp ca c tim v gim lu lng tim.Tn s tim Trong suy tim, lc u TS tim tng b vo tnh trng gim V nht bp, qua duy tr cung lng tim. Nhng nu TS tim tng qu nhiu th nhu cu oxy ca tim tng, cng ca tim tng lm tim suy nhanh.

Cc yu t nh hng n cung lng tim

Sinh l bnhCc c ch b tr trong suy timC ch b tr ti tim Gin tm tht: thch ng vi p lc cui TTr ca tht -> ko di cc si c tim -> sc co bp ca cc si c tim nu d tr co c vn cn (Starling) Ph i tm tht: hu gnh -> V tng mu -> b dy thnh tim (Laplace)

Sinh l bnhCc c ch b tr trong suy timC ch b tr ngoi tim H TK giao cm b k.thch, Catecholamin -> co bp c tim v TS tim; co mch ngoi vi da, thn, c, cc tng trong bng... H Renin-Angiotensin-Aldosterol: Do cng giao cm v gim ti mu thn (do co mch) Renin Angiotensin II H Arginin-Vasopressin: giai on stim mun hn, vng di i tuyn yn b kthch s tit ra Arginin-Vasopressin t/d comch, v ti hp thu nc ng thn.Bradikinin, Prostaglandin (PGI2, PGE2) v yu t tng thi natri ngun gc tm nh (ANP) cng c huy ng song hiu qu thng khng nhiu.

Sinh l bnhHu qu ca suy timGim cung lng tim Gim vn chuyn oxy trong mu, gim cung cp oxy cho t chc. Lu lng mu gim da, c, thn v 1 s tng khc u tin mu cho no v ng mch vnh.Cung lng tim thp lu lng lc ca thn thpTng p lc tnh mch ngoi vi Suy tim phi: Tng P cui TTr tht phi nh phi P cc TM ngoi viTM c ni, gan to, ph, tm ti... Suy tim tri: Tng P cui TTr tht tri nh triP TM phi v mao mch phi. Mu phi th tch kh cc ph nang, trao i oxy phi kh th, ph phi.

Phn loiTheo nh khu: ST phi, ST tri, ST ton bTnh trng tin trin: ST cp, ST mnLu lng tim: ST gim lu lng, ST tng lu lngSuy tim tm thu v suy tim tm trng

Triu chng suy tim

Triu chng suy tim triPHING MCH

Triu chng suy tim triTriu chng c nngKh th: kh th khi gng sc kh th thng xuyn, phi ngi th, c cn hen tim hay ph phi cpHo khan/ c m ln t mu, ho v m hoc khi BN gng sc

Triu chng suy tim triTriu chng thc th ngoi binRan m ri rc hai y phi. Hen tim: ran rt, ran ngy. Ph phi: ran m to v nh ht dng nhanh t hai y phi ln khp 2 ph trng nh nc thu triu dngHA ti a , HA ti thiu nn HA chnh.Mch nhanh nh, ngoi tm thu nhp iTrn dch mng phi

Triu chng suy tim triTriu chng thc th ti timMm tim lch sang tri. Tim nhanh, nga phi tri.Thi tm thu nh mm do HoHL c nng (gin tht tri).Bnh tim gy ST tri.

Triu chng suy tim triXquang: tim to, cung di tri phng to v ko di do tht tri gin. Hai phi m nht l vng rn phi, ng Kerley do ph cc khong k ca h thng bch huyt phi, hnh nh cnh bm 2 rn phi khi c ph phi. T: Trc tri, dy nh tri, dy tht tri. Siu m tim: Nh tri v tht tri gin, co bp ca cc thnh tim , chc nng tm thu tht tri . Siu m tim cho bit nguyn nhn stim tri.Thm d huyt ng: Ch s tim gim (BT: 2-3,5l/ph/m2), p lc cui TTrTT tng. nh gi mc HoHL, HoC...

Triu chng suy tim triX quang: cung di tri gin

Triu chng suy tim tri T: ph i tht tri

Triu chng suy tim triSiu m tim: tht tri gin, EF gim

Triu chng suy tim phiPHITNH MCH,GAN

Triu chng suy tim phiTriu chng c nng Kh th: ngy mt dn khng c cn kch pht nh suy tim tri. au tc h sn phi do gan to v au.

Triu chng suy tim phiTriu chng thc th: Cc du hiu ngoi bin Gan to, n xp. TM c ni, phn hi gan-TM c (+). p lc TM trung tm v ngoi bin tng.Tm da v nim mcPh mm 2 chi di ph ton thn; trn dch cc mng.i t, nc tiu sm mu (200-300 ml/ngy).Phi: trn dch mng phi.

Triu chng suy tim phiTriu chng thc th: Cc du hiu ti tim Du hiu Hartzer: tht phi to, p vng mi c.Tim nhanh, nga phi phi.T2 mnh, thi tm trng do gin van MPThi tm thu nh trong mm do HoBL c nng. HA ti a BT, HA ti thiu tng.

Triu chng suy tim phiXquang: Cung di phi (nh phi) gin. Mm tim nng cao do tht phi gin. Cung MP gin. Tht phi to lm hp khong sng sau xng cT: trc phi, dy nh phi, dy tht phi.Siu m tim: Tht phi to, cc du hiu tng p MP, h van ba l.Thm d huyt ng: p lc cui TTrTP (>12 mmHg), p lc MP.

Triu chng suy tim phi X quang: mm tim chch ln

Triu chng suy tim phi T: tng gnh tht phi

Triu chng suy tim phi Siu m tim: tht phi gin

Triu chng suy tim ton bKh th thng xuyn, ngi cng kh thTM c ni to. p lc TM tng rt caoMch nhanh yuPh ton thn v ni tngGan to nhiuTrn dch mng tim, mng phi, c chngHa ti a h, HA ti thiu tng HA ktXquang: tim to ton bT: dy hai tht.

nh gi mc suy tim (theo NYHA)NYHA I: Bnh nhn c bnh tim nhng khng c triu chng c nng, sinh hot v hot ng th lc gn nh bnh thngNYHA II: Cc triu chng c nng ch xut hin khi gng sc nhiu, gim nh cc hot ng th lc.NYHA III: Cc triu chng c nng x/hin k c khi gng sc rt t lm hn ch nhiu cc hot ng th lc.NYHA IV: Cc triu chng c nng tn ti thng xuyn k c khi ngh.

NYHA I

NYHA II

NYHA III

NYHA IV

Giai on A: Bnh nhn c nguy c cao b suy tim trong thi gian ti, nhng cha c ri lon c nng hoc thc tn ca tim.Giai on B: C thc tn tim, nhng cha c biu hin c nng ca suy tim.Giai on C: C thc tn tim, v trong tin s hoc hin ti c triu chng c nng ca suy tim, v iu tr ni khoa c kt qu tt.Giai on D: Bnh tim tin trin nng, i hi phi iu tr ti bnh vin, hoc ni khoa tch cc hoc thay tim.Theo ACC/AHA 2001: 4 giai on suy tim:

Phn suy tim

Giai on suy tim theo ACCF/AHANYHAABnh nhn c nguy c cao b suy tim trong thi gian ti, nhng cha c ri lon c nng hoc thc tn ca tim.0BC bnh thc tn tim, nhng cha c biu hin c nng ca suy tim.IBnh nhn c bnh tim nhng khng c triu chng c nng, sinh hot v hot ng th lc gn nh bnh thngCC thc tn tim, v trong tin s hoc hin ti c triu chng c nng ca suy tim, v iu tr ni khoa c kt qu tt.IIICc triu chng c nng ch xut hin khi gng sc nhiu, gim nh cc hot ng th lc.

IIICc triu chng c nng x/hin k c khi gng sc rt t lm hn ch nhiu cc hot ng th lc.

DBnh tim tin trin nng, i hi phi iu tr ti bnh vin, hoc ni khoa tch cc hoc thay tim.IVCc triu chng c nng tn ti thng xuyn k c khi ngh.

Nguyn nhn suy timNguyn nhn suy tim triTHABnh van tim: HoHC (n thun hoc phi hp), HoHLCc tn thng c tim: NMCT; vim c tim do thp, nhim c, nhim khun; cc bnh c tim.Mt s ri lon nhp timMt s bnh tim bm sinh: hp eo MC; cn ng M...Ch : HHL biu hin triu chng nh suy tim tri nhng bn cht li gy suy tim phi.

Nguyn nhn suy timNguyn nhn suy tim phiSuy tim tri Cc bnh phi, d dng lng ngc-ct sngCc nguyn nhn tim mch: HHL l nguyn nhn thng gp nht Bnh van ba l v van MP Bnh tim bm sinh (hp phi, tam chng Fallot); cc bnh tim bm sinh c o lung shunt; u nhy nh tri, v ti phnh xoang Valsava vo cc bung tim phi...Ch : TDMT; Vim MNT co tht

Nguyn nhn suy timNguyn nhn suy tim ton bThng gp nht l ST tri tin trin thnh ST ton b.Bnh c tim gin; Vim tim ton b do thp tim, vim c tim.Suy tim ton b c tng cung lng: cng gip, thiu vitamin B1, thiu mu nng, d M-TM

iu tr suy timThay i li sng.iu tr ni khoa.Thit b h tr chc nng tim: bng i xung ng mch ch, thit b h tr tht triMy to nhp ti ng b tim CRT.Ghp tim

Thay i li sngDuy tr cn nng hp l, gim cn nng nu tha cn.Hn ch mui, ncNgng ht thuc l.Hn ch ru v cc cht gy c cho timTp luyn th lc va sc.

iu tr ni khoaiu tr tt THA, ri lon lipid mu, i tho ng, cc ri lon nhp tim (rung nh), bnh ng mch vnhCc thuc chng suy tim: thuc li tiu, thuc c ch men chuyn, thuc chn beta giao cm, nitrates, digoxinThuc chng ng d phng tc mch.

Thit b h tr tht tri (LVAD)

Bng i xung ng mch ch(IABP)

My to nhp ti ng b tim(CRT)

Ghp tim(Cardiac transplant)

Xin cm n s ch !

Welcome to INTRODUCTION TO RADIOFREQUENCY ABLATION THERAPY. This module contains an introduction to radiofrequency (RF) ablation therapy, reviews the current indications for RF ablation therapy, and discusses developing indications for RF ablation therapy.

This chart shows that males have a higher incidence of developing HF compared to females until age 65. At that time, females essentially equal males in the incidence of developing HF. Stroke volume is affected by preload, afterload, and contractility. Preload is the amount myocardial stretch at the end of diastole. Afterload is the resistance that needs to be overcome for the heart to eject the blood. There is an inverse relationship between afterload and ventricular function. As the resistance to contraction increases, the force of contraction decreases which results in a decreased stroke volume. Also, as an increase in resistance occurs, there is an increase in myocardial oxygen demand. Contractility is the inotropic state of the heart independent of the preload and the afterload. Synergistic LV contraction, wall integrity, and the competence of the valves also affect cardiac output.

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