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THA Flashcards

1
Q

Can xac dinh cac yeu to nao

A

Nguyen nha
Yeu to nguy co tim mach
Ton thuog co quab dich/ bieu hien tim mach tren lam sang

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2
Q

Yeu to nguy co benh tim mach

A

Nam >45, nu >55

Nam 1

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3
Q

Ton thuòn co quan dich~ bieu hien benh tim mach tren lam sang

A 
Day that trai
Suy tim
Dau that ngũc/ nhoi mau co tim cu
Can thieu mach vanh
Tbmmn, con thieu mau nao thoang qua
Sa sut tri tue
Vong mac do ThA
Than do tha
Bly dmnb
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4
Q

Phan nhom nguy co A B C

A

a : tha ko ytnc ko ton thuing co quan dĩch/bh tim mach tren lam sang
B: tha co it nhat mot ytnc khong phai DTD, ko ton thuong co quan dich/ b tim mah tren lam sang
C: tha kem dtd hoac ton thuong co quan dich/ benh tim mach trb lam sang

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5
Q

Dieu tri tha khong dung thuõc

A 
Giam can neu thua can
Han che ruou
Bo sung day du canxi, mg, kali
Giam stress
Tang van dog the luc
Ngung hit thiox la
Giam man
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6
Q

Giam can neu thua can

A

Muc tieu: 18,5-22,9
Tang can lam tan suat mac THA va dtd
Deu dan: van dong the luc, thux an nang luong thap va theo doi can nang
Tha va beo phi gidm Ha tam thu du giam can rat it
Thux an: giam beo bao hoa( thi mo dong vat, dau dua, dau co), beonbao hoa

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7
Q

Han che ruou

A

Nguyen tac:

-

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8
Q

Stress

A

Tha va tang nhip tom

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9
Q

Tang hoat dong the luc

A

Tang hoat dong the luc: da dang cac hoat dong, phu hop voi trang thai suc khoe bn
Chua co thoi quen: 10 phut-30 phut
Giam nguy co mac 28-35
Muc tieu: ha, duong, choles, mau tou nao va co quan ngoai vi

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10
Q

Ngung thuoc la

A

Tu tu va thay the san pham nicotin khac: gian, gum, hit, xit
Tang van dong the luc va giam thux an giau anng luog: tang can sau bo thuox
Bien conmah vanh, sor quy, mm ngoai bien

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11
Q

Giam an man

A
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12
Q

Loi tieu

A

Thiazide
Quai
Khang aldosterol

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13
Q

Ngh cuu Allhay

A

Bien co tim mach/ ti le tu vong khong khac biet o nhom dung loi tieu chlorthalidon, ucmc lisinopril, chen kenh canxi amplodipin

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14
Q

Theo doi| loi tieu

A

Chuc nang than

Roi loan dien giai

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15
Q

Loi tieu thiazide

A

Uc tai hap thu Na ong luon xa ( 10% nen loi tieu yeu )

Gfr

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16
Q

Loi tieu quai|tha

A

Chi dinh: suy than, tha khang tri, con tha nang
- sulfamide: di ung, doc tai
Roi loan dien giai
- loi tieu quai (25 % natri nen tac dung lointieu manh) hieu qua trog suy than

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17
Q

Loi tieu khang aldosterol|tha

A

Khag lai hoat tinh aldos: tai hap thu na va kenh K/H ong xa
Spironi khang hoat tinh aldos; trian va amiloride khog phu thuoc vao nong do aldos
- chindijh: cuog aldos
- ccd: suy than, tang kali
Phu: nu hoa tuyen vu, thieu nang sinh dux, roi laon tieu hao

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18
Q

Beta-blockers, tac dung

A

Giam nhip tim , giam co bop, giam co
Giam renin/ mau, giam tiet renin,
Hoat tinh tk ngoai bien, gian tiep qua truf uong

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19
Q

Ca yeu to de chon lua thuoc beta

A

Isa
Tan trog nuoc/ mo–) gan/ than
Dac hieu /khong dac hieu

20
Q

Mot so vibdu cua beta

  • gan , than
  • isa
  • khong dac hieu
  • phoi hop beta va alpha
A 
- proprn, carve, meto
Biso: gan va than, aten, nadolol:than
- acebutalol
- propran a timolol
- carve va labe
21
Q

Ccd beta

A

Nhip tim cham block nhi that nang suy tim ko on dinh, prinzmetal, ttrang CO thap, suc can ngoai bien, hen, hoi luu tinh mach
Tuong doi:
- verapamil, dil, amiodarone
- than trong voi diigoxin

22
Q

Tac dung phu beta

A 
Nhip tim cham
Block nhi that
Giam co bop co tim
Dau ngux khi ngung thuoc dot ngot
Hc reynauld, conthat phe quan
Tang ldl, giam hdl
Pud
23
Q

Thuox chen kenh canxi

- phan nhom

A

Dhp : amlo, nife, nicar –) gian mach ngoai bien
Non-DHp: : nut xoang va nut nhi that
- benzothiazepin ( diltiazem)
- diphenyl akylamin (verapamin)

24
Q

Ccd uc canxi

A

Suy tim : db nhom non DHP (dhp nhu amlo, felo dung duoc)
Nhip cham
Block nhi that

25
Tac dung phu cua uc canxi
Ngan: do bung mat, hoi hop, u tai Dai: phu mat ca chan ( uc men chuyen de giam tac dung nay₫
26
Muc tieu dieu tri
Nguyen nhan | Ng nhan ko giái quyet duoc| tha nguyen phat: kiem soat ha + giam cac ytnc tim mach
27
Co che tac dung uc che men chuyen /ThA
Uc che two ATii- gian mach Uc hinhbthanh aldos : giam u muoi nuoc Giam thoai bien brady: gian mach
28
Ccd ucmc
Hep dong mach than 2 ben Hep dm than/ than duy nhat Tang kali mau Mang thai va cho con bu
29
Tac dung phu ucmc
Ho khan Tang kali mau, suy than Phu mach, giam bc trung tinh, noi ban Thoingian tac dubg 5-7ds
30
Chia nhom ucmc
Hoa hoc/ sh, cacboxyl, phosphoryle Chuyen hoa: ko chuyen hai, gan, loai tan trong nuoc Tg tac dung: nagn (capto), dai
31
Thuoc uc che thu the
``` Thu the AT1 - at2: gian mach - aldos: giam muoi va nuoc - phu thanh mach va giam tiet endotheline, giam hoat hoa hiao cam Ko tac dong len brady--) ko ho ```
32
Loi diem cua uc che thu the
Uc canxi: khong phu mat a chan Bb: ko met mou, roi loan xuing; bang chung chonrang co cai thien chuc nang tinh duc a tt cuog Ucmc: ko ho
33
Ccd UCTT
Phu nu mang thai va cho con bu
34
Phoi hop thuoc:
Ha >160 (do ii theo jnc 7) | Yeu tonnguy contim machcao
35
Chindinh bat buoc cho tung loai thuoc
Hinh
36
Yeu to nguy co benh THA
``` Yeu to di truyen Gioi tinh (nam, nu man kinh) Tuoi (>60₫ Dtd Rl lipid mau Beo phi Hut thuoc la Ruou bia Che do sinh hoat An uong man it kali va canxi Doi song kinh te va ap luc tam ly ```
37
Chuan bi bn truoc do
Nghi ngoi 5 phut Khong cafe 1g truoc do Khong thiox la 15ph truoc do Khong dug thuoc cuong giao cam
38
Dung cu
2/3 chieu dai canh tay Bao chu vi canh tay Tren nep khuyu 3 cm
39
Ky thuat do
Bn nam / ngoi: quan trong la bang quan ngang muc tim Mat tieng mach: bom 20-30mmHg Xa van toc:3mmHg/s Co tieng mach dau tien: HAT Thu; mat mah (K V ) HA tam truog Nghe khing ro, de nghi bn dua tay cao len, nam mo ban tay nhieu lan sau do do lai! Mot lan kham do it nhat 2 lan; neu giua 2 lan tri so do khog henh qua la duoc; lay so tot hon Doi tuing: - tre: 2 tay, Ha chan. Su chenh lech, lay Ha tay cao hon - >65ys, dtd, tha: do 2 tu the ( nam va dung)
40
Cac chu y ve phan tih chi so HA:
Ha tam thu va truong cao: lay phan do cao nhat HA tam thu don thuan: tam thu >|=140 va tam truig135/85 - 24h : 125/80 Tha ai chiang trang: - cao o phong kham nhu Ha taj bha va 24h bunh thuog!
41
Trieu chung THA
Dien tien cham, nen thuong lo tr chung 3 nhom tc: 1) tang ha: nhuc dau vung cham vao buoi sang sau khi thux day, hay het sau khu vai gio chong mat, hoinhop, mau met moi 2) mach mau: nhin loa do ton thuong vong mac, chay mau lui, dau nguc do boc tach dm chu nguc, chong mat tu the! 3) can ban : (u tuy t3) nhuc dau tung con, do bung mat, kem hoi hop danh trong nguc, yeu liet co do ha kali mau
42
Hoi tienn can THa
Tien su gd ve THA Tri so HA bn co khi nao tang khong Benh tim mach som dtd benh thhan roi loan lipid. Ban than: - yeu to nc: ruou bia, thuoc la, cach sinh hoat... -bly: dtd, benh than, cac loai thuoc da va dang dung ( ngua thai, giam dau , steroid) - kho thi, dau nguc , phu truoc day - thoi gian phat jien tha, muc do ha( ha cao nhat, tri so ha lam bn sinh hoat de chiu) - thuix dieu tri ha, su tuan thu thuoc
43
Tham kham nguoi benh
``` Can nag, chieu cao, bmi,vong eo Mat tron beo ma ung hong, gay co buou mo Da day, cham chap, ve mat it linh hoat trong suy giap Mat can doi cac chi: hep ep dmc To cac dau chi Mach: - 2 ben va so sanh; mach chi treb va chi duoi - dau xo cug mm - dm nghe at: canh, chu, than (at quanh ron, canh duong giua ron benP hay T) tim: - mom tim, - nhip tim - a2 thuong manh - +_ t4, -t3 hay rale no goi y suy tim - am thoi tam thu, tam truong di kem Kham toan dien ``` -
44
Xet nghiem thuog quy trong tha
``` Ctm, hct Ion do Duong huyet doi Bilan lipid, acid uric Bun, crea, Tptnt Ecg Soi day mat, x quanh nguc thang Sieu am tim doppler ```
45
Bien chung tha
Tim: - day that trai: 85 la dong tam, 15 la lech tim--) nmct gap 3 lan, suy tim 4 la, dot qy 6 lan -suy tim: luc dau la suy tim tam truong, sau do anh huong tam thu - mach vanh: co tim thieu mau cuc bo/ nmct Than kinh: - dot quy - thieu mau nao thoang qua Than: - than do tha la nn hang dau gay stm giai doan cuoi Ton thuong cau than, mm than Mat: -phan loai keith-waegner-bakerr: @ 1; dm co nho, ngoan nghoeo ( bt d -2/3 tm) @ 2: bat cheo dm-tm @ 3: do 2 + xuat huyet, phu ne, xuat tiet @ 4: do 3 + phu gai thi Mach mau: - xo vua - dm chi duoi - phinh boc tach dm chu ngux! Mach mau
46
THA va thai ky
Truox khi co thai: truox tuan le 20 thai ky Trong thai ky: sau tuan le 20, ha thuog ve bt sau sanh, nhung lan co thai sau ko phai luon luon co tHA Tha: 24 h sau sanh: thoang qua Tha trong hai ky: - tam thu >/=140 hay t truong >|= 90 - > 25 tam thu/>15 tam truong voi ha trong 3 thanh dau thai ky
47
Cac nn khac
``` Tha va thai ky Benh tao keo: quanh nut d'm, takayasu, lupus Phong Da honh cau: tang kl mau va do quanh mau Nao Sau phai thuat long nguc ```

On Thi Noi Tru (5 decks)

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