Noi Khoa Flashcards
Muc tieu dieu tri hep 2 la
Ngua thap khop cap tai phat
Ngua va dieu tri bien chung
Theo doi tien trien
Phong ngua thap khop cap tai phat
Giu ve sinh hau hong
Nn hau thap:
-it nhat 10 nam sau dot thap khop cuoi cung va it nhat den 40 ys/ suot doi neu ncc viem hong
- peni g 1 200 000dv im /3-4ws; v 250mg*2 lan po/d
Sulfadiazine 0,5 g/d po if (27kg; 1g/d po if)27kg
Êrythromycine 250mg * 2 po/d
Bien chung hep 2 la
viem NTMNT
Tang ap dm phoi + suy tim p
Thuyen tac
Rung nhi
Ngua vntmnt/ hep 2 la
Ko khuyen cao
Co nhiem trung => xem xet cay mau va dieu tri tich cuc
Dieu tri bc tang ap dm phoi va suy tim phai
Han che muoi + hoat dong the luc nhe nhang + nam thang dung
Loi tieu
B-blocker/non DHP (nhip xoang nhanh)
Nong van/ thay van
Dien tien tu nhien cua hep 2 la co trieu chung
Olesen: ti le song 5 nam
Nyha 3: 62%
Nyha 4: 15 %
Chi dinh dung khang dong/ hep 2 la
Chi dịnh:
- tien can thuyen tac phoi/ tac mach he thong
- huyet khoi nhi T
- rung nhi
- hep nang + nhip xoan + d nhi T > 55mm/ sieu am tuong phan tu phat
Thuõc + chi dinh + muc tieu + theo doi khi dung dong trong hep 2 la
Rung nhi: heparin va duy tri bang ừaarin suot doi
Others: wafarin it nhat 1 nam
Muc tieu inr 2-3 / 2,5-3,5 trong van tim nhan tao
Nguyen tac dieu tri rung nhi
Kiem soat tan so
Phong ngua huyet khoi
Phuc hoi nhip xoang
Kiem soat tan so / rung nhi
On dinh huyet dong:
- 1st: non-DHP/ beta-blocker
- 2nd: digoxin / amiodarone
Huyet dong ko on dinh: chuyen nhip bang shock
Digoxin don thuan va lau dai: rung nhi + rlchuc nang that T
Phong ngua huyet khoi/ rung nhi
Heparin
Lau dai: wafarine
Phuc hoi nhip xoang/ rung nhi / hep 2 la
Chi dinj:
- tc du kiem soat f that
- chua du nang de nong van/ thay van
Yeu cau:
- khang dong thanh cong it nhat 3 tuan va sau chuyen nhip it nhat 4 tuan
- sieu am tim qua tq : nhi t ko huyet khoi
Thuoc: ibutilid
Duy tri nhip xoang
Note: cang som cang tot vi hq thuoc chuyen nhip khi rung nhi keo dai )7ds
Dieu tri can thiep trong hep van 2 la
Hinh chup Lam sang: tc (nyha 2-4) ; nguy co cao phau thuat, rung nhi moi xuat hien Sieu am tim: - S la van ( 1,5-1) - pap nghi )50 , van dong )60 - hinh thai la van - ho van 2 la (2+ ; huyet khoi nhi - nguy co phau thuat
Chi dinh thay van/ hep 2 la
Ho 2 la )2+
Voi hoa mep van lan toa/ xo hoa nang/ dinh dc duoi van
Da nong truoc day
Nen phau khi: nyha 3 + hep nang ( do bc lau dai + tltv 6-8%
Vntm nhiem trung :
- dn
- phan loai
O sui nhiem trung tu noi mac tim/ dong mach - lan tran
Phan loai:
- cap: 10%- S.aureus_khang peni| khong ton thuong van truox do
- ban cap: 90%- streptococcus_nhay peni/ ton thuong van truoc do
Nhom HACEK
Haemophillus Actino bacillus Cardiobacterium eikenella Kingella Hau hong- kho nuoi cay
Chung VK/ sang thuong/ vntmnt
Da: tu cau
Hau hong- rhm: lien cau
Nieu- sinh dux: enterococcus
Tieu hoa ( mat, ong tieu hoa) bovis
Tac nhan gay VNTMNT
Lien cau:
-viridans- 1/2 cap thuong gap nhat- hau hong
- nhom d:
+ enterococcus: nieu sinh duc- khang peni
+ non-enterococcus: he tieu hoa/ sau phau thuat ung thu dai trang
- nhom B: cap tinh/ cat tc va suc de khang kem ( maglinancy₫
Nhom tu cau :
- vang : sang thuog da+ sonde bv+tiem chich ma tuy_ khang peni- cap tinh
- other: ban cap/ van nhan tao
Cac nhom Khac: nam, noi bao, gram - (hacek)
Benh tim de gay VNTMNt
Vi tri mang sui trong tung benh
Hau qua su hien dien mang sui
- tlt( sui o that P), og dm
- ho/hep chu ( ho: sui o that T, mat that van chu, van 2 la)
- ho 2 la ( mat nhi van 2 la)
Tim:Pha huy (van, co nhu, day chang, vach lien that), bit lo van
Ngoai tim:
- thuyen tac
- phinh mach–) vo
- phuc hop kn-kt( viem mm, viem cau than cap)
Vntm ban cap ( osler )
Bang chung xam nhap vk: da( tu cau), hau hong-rhm ( lien cau ), nieu sinh duc ( enterococcus ), tieu hoa ( bovis ), tiem chich ma tuy/ thu thuat y te
Hc nhiem trung: sot (
Cls/ vntmnt
Ctm/vs/ cay mau Tptnt + can addis Mien dich: yeu to thap, giam bo the , tang ig G va M X quang nguc, ecg Sieu am tim Soi day mat!
2 tieu chuan chinh cua Duke ( co dien va cai tien)
Cay mau va sieu am
- cay mau
@ viridans, bovis, aureus / enterococcus cong dong va ko o nheim trung nguyen phat
@ vk phu hop 2 mau cach 12 h
@ 1 loai vk/ 3 mau cay cach nhau 30 phut
Sieu am: sui di dog/ apxe / ho van moi phat hien
Tieu chuan phu cua duke
- benh tim de gay vntm nt/ tiem chich ma tuy
- sot >= 38
- thuyen tac mm lon, thuyen tac phoi nhiem trung, phinh mach, xuat huyet niem mac, xuat huyet noi so, sang thuong janeway
- viem cau than cap , roth, osler, yeu to thap
- cay mau/ bo the: phu hop nhung ko phai tieu chua. Chinh
- sieu am phu hop nhung ko phai tieu chuan xhinh
Ddoc tieu chuan duke
Chac chan: 2 chinh, 1 c 3p, 5p Nghi ngo: 1c 1p, 3 p Loai tru: - dx khac - tc mat di sau dieu tri khang sinh
Yeu to quan trong/ chan doan ho van dmc
Am thoi tam truong cua ho van dm chu:
- khg gs 3 ben T, lan den mom tim, doc bo t xuong uc
- decrescendo
- tang khi tho ra va nin tho, nghieng ra truoc
-
So/ ho van dm chu
Lon that T ( mom tim lech xuong duoi va ra ngoai trung don )
Day that T ( mom tim nay manh va keo dai )
Rung mieu tam tr: doc bo trai uc
Rung mieu tam thu: hom uc va lan len dm canh
Nghe/ ho van dm chu
T1 nhe, t2 thay doi T3, +\- T4 Attt; rung tam truong austin flint ( mom , giua va cuoi tam thu, pb hep 2 la) (=Hep chu) click phun mau tam thu, attt ( ngan, tram, day tim lan doc dm canh) Ngoai bien: - musset, corrigan , quincke - traube, duroziez - hieu ap rong --) suy tim: hieu ap hep - hill: ha tam thu khoeo-tay >60
Chan doan hep van dmc
1/3: dau nguc, ngat, suy tim
Am thoi tam thu dien hinh :
- kgs 2 p, lan doc dm canh +_ mom ( cd pb ho 2 la- ht gallavardin)
- hinh tram
- am tho, 3/6
- tang cuong do khi ngoi xom, giam khi dung
So trong hep van dm chu
Mom tim nay manh va keo dai ( day that T)
Rung mieu tam thu , day tim, lan hom uc va doc dm canh, tang khi ngoi nghieng ra truoc va tho ra het suc
Suy tim P: hieu ung bernheim
Ngoai bien:
- mach nho , cham va keo dai
- ha bt, hieu ap bt den hep
Nghe / hep van dm chu
T1 bt/ nhe T2 1 tieg/tach doi nghich
T3, T4
Click phun mau dau tam thu vung van dmc / van ko voi hoa, attt *
Att truong ( ho chu ) nhe
Chan doan ho 2 la
T2 tach doi rong, t3 o mom
Att thu tai mom:
- am sac cao, cuong co dinh
- toan tam thu ( dau: ho 2 la cap, cuoi: sa van 2 la )
- mom, lan ra nach t va sau lubg ( la truoc ), vung uc va trog dmc ( la sau )
- tang vao thi tho ra, nam nghiem trai
So tron ho 2 la
Mom tim lech khoi duong trung dong va xuong duoi
Tang dong bo t xuog uc ( pb nhi t va that p)
+_ rung miu tam thu o mom
+_ tieng dog van dmp/ tang ap dmp
Nghe / ho 2 la
T1 bt, t2 tach doi rong *
T3, +_ t4
Attthu o mom, ru tam truong sau t3
Click phun mau dmp, ho ba la co nang
Dau hieu xay ra khi tang ap dm phoi co nang
T2 tach doi hep–) 1 tieng
Click phun mau van dm phoi, giam khi hit vao
Att truong (graham steel) : tang khi hit vao
Att thu ho van 3 la co nang: tang khi hit vao va giam khi tho ra gang suc
T3 t4 that p
Hep 2 la/ dau hieu chinh
T1 danh
Att truog (rung tam truog)+_ nhan manh tien tam thu
- sau clack mo van (mom lan bo t uc den day tim, tang vao thi tho ra)
- lan ra nach/ bo t xuog uc
- decrescendo
- nge ro o mom , tang: nghieng t va tho ra
