Noi Khoa Flashcards by ping ping

Muc tieu dieu tri hep 2 la

Ngua thap khop cap tai phat
Ngua va dieu tri bien chung
Theo doi tien trien

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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

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Bien chung hep 2 la

viem NTMNT
Tang ap dm phoi + suy tim p
Thuyen tac
Rung nhi

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Ngua vntmnt/ hep 2 la

Ko khuyen cao

Co nhiem trung => xem xet cay mau va dieu tri tich cuc

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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

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Dien tien tu nhien cua hep 2 la co trieu chung

Olesen: ti le song 5 nam
Nyha 3: 62%
Nyha 4: 15 %

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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

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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

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Nguyen tac dieu tri rung nhi

Kiem soat tan so
Phong ngua huyet khoi
Phuc hoi nhip xoang

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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

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Phong ngua huyet khoi/ rung nhi

Heparin

Lau dai: wafarine

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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

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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

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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%

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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

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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