THA Flashcards
Can xac dinh cac yeu to nao
Nguyen nha
Yeu to nguy co tim mach
Ton thuog co quab dich/ bieu hien tim mach tren lam sang
Yeu to nguy co benh tim mach
Nam >45, nu >55
Nam 1
Ton thuòn co quan dich~ bieu hien benh tim mach tren lam sang
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
Phan nhom nguy co A B C
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
Dieu tri tha khong dung thuõc
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
Giam can neu thua can
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
Han che ruou
Nguyen tac:
-
Stress
Tha va tang nhip tom
Tang hoat dong the luc
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
Ngung thuoc la
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
Giam an man
Loi tieu
Thiazide
Quai
Khang aldosterol
Ngh cuu Allhay
Bien co tim mach/ ti le tu vong khong khac biet o nhom dung loi tieu chlorthalidon, ucmc lisinopril, chen kenh canxi amplodipin
Theo doi| loi tieu
Chuc nang than
Roi loan dien giai
Loi tieu thiazide
Uc tai hap thu Na ong luon xa ( 10% nen loi tieu yeu )
Gfr
Loi tieu quai|tha
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
Loi tieu khang aldosterol|tha
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
Beta-blockers, tac dung
Giam nhip tim , giam co bop, giam co
Giam renin/ mau, giam tiet renin,
Hoat tinh tk ngoai bien, gian tiep qua truf uong
Ca yeu to de chon lua thuoc beta
Isa
Tan trog nuoc/ mo–) gan/ than
Dac hieu /khong dac hieu
Mot so vibdu cua beta
- gan , than
- isa
- khong dac hieu
- phoi hop beta va alpha
- proprn, carve, meto Biso: gan va than, aten, nadolol:than - acebutalol - propran a timolol - carve va labe
Ccd beta
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
Tac dung phu beta
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
Thuox chen kenh canxi
- phan nhom
Dhp : amlo, nife, nicar –) gian mach ngoai bien
Non-DHp: : nut xoang va nut nhi that
- benzothiazepin ( diltiazem)
- diphenyl akylamin (verapamin)
Ccd uc canxi
Suy tim : db nhom non DHP (dhp nhu amlo, felo dung duoc)
Nhip cham
Block nhi that
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₫
Muc tieu dieu tri
Nguyen nhan
Ng nhan ko giái quyet duoc| tha nguyen phat: kiem soat ha + giam cac ytnc tim mach
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
Ccd ucmc
Hep dong mach than 2 ben
Hep dm than/ than duy nhat
Tang kali mau
Mang thai va cho con bu
Tac dung phu ucmc
Ho khan
Tang kali mau, suy than
Phu mach, giam bc trung tinh, noi ban
Thoingian tac dubg 5-7ds
Chia nhom ucmc
Hoa hoc/ sh, cacboxyl, phosphoryle
Chuyen hoa: ko chuyen hai, gan, loai tan trong nuoc
Tg tac dung: nagn (capto), dai
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
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
Ccd UCTT
Phu nu mang thai va cho con bu
Phoi hop thuoc:
Ha >160 (do ii theo jnc 7)
Yeu tonnguy contim machcao
Chindinh bat buoc cho tung loai thuoc
Hinh
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
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
Dung cu
2/3 chieu dai canh tay
Bao chu vi canh tay
Tren nep khuyu 3 cm
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)
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!
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
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
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
-
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
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
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
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
