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TRIEU CHNG C NANG

BENH TIM MACH


BS Vo My Phng
TS BS Trng Quang
Bnh
Bo mon Noi
TRIEU CHNG C
NANG
* TCCN = symptoms: TC ma BN nhan
biet c va than phien vi BS, BS
dung mieng hoi ra c TCCN. Tat
ca ieu nay c thc hien trong
phan benh s (history) cua benh
an
* TCTT = signs: TC do BS kham va phat
hien ra c, thc hien trong phan
kham (examination) cua benh an.
* 1 TC co the va la TCCN va la
TCTT
VAI TRO CUA TCCN
* Y khoa: d phong va y khoa ieu tr
* Y khoa ieu tr: chan oan va ieu tr.
Co chan oan roi mi ieu tr.

* Chan oan da vao: TC lam sang + TC


can lam sang (xet nghiem).
* TC lam sang = TCCN + TCTT.

=> TCCN la thanh phan khong the


thieu c trong qui trnh thiet lap
chan oan
CAC TCCN BENH TIM
MACH
* au ngc (chest pain)
* Kho th (dyspnea)
* Ho, Ho ra mau (cough,
hemoptysis)
* Ngat (syncope)
* anh trong ngc (palpitation)
* Phu (edema)
* Xanh tm (cyanosis)
AU NGC
* Chest pain: au ngc chung chung

* Angina pectoris: au that ngc, am


ch au ngc do thieu mau c tim

* Typical angina: au that ngc ien hnh


do thieu mau c tim

* Atypical angina: au that ngc khong


ien hnh
AU THAT NGC IEN HNH
DO THIEU MAU C TIM CUC
BO
* Khi phat luc gang sc
* Ngay sau x. c, co khuynh hng ve
ben T.
* au nhoi nh dao am, xiet chat,
nghien nat
* Lan len vai T, ham T, canh tay T, mat
trong cang tay T, ngon ut ban tay T.
* Thi gian: 20 giay 20 phut.
* Giam i khi ngh tnh hoac ngam
di li thuoc nitrate tac dung
nhanh.
* Co the co cac trieu chng i kem
nh va mo hoi, buon non.
Angina pectoris
NGUYEN NHAN GAY
AU THAT NGC
au that ngc trong hoi chng
vanh cap (Acute Coronary
Syndrome)
* Khi phat luc
Angina Pectoris ngh tnh
* au d doi
Unstable Angina * Keo dai tren
30 phut

Acute Myocardial * Kem TC nang


ne
Infarction
* Khong giam
khi ngh tnh
hoac dung
thuoc Nitrate
tac dung nhanh
Cac NN tim mach gay au
ngc
* NMCT cap
* TMCT
* Viem mang ngoai tim
* Boc tach M chu
* Thuyen tac, nhoi mau phoi
* Phnh M chu
* Tang ap M phoi
NN TIEU HOA GAY AU
NGC
* V thc quan
* Viem thc quan, viem da day
* Loet da day
* Viem tuy
* Chng da day

NN PHOI GAY AU
NGC
Tran kh mang phoi, Viem
mang phoi
Nhoi mau phoi, U phoi
NN Than kinh c - xng
* au do khp c b x hoa
* Viem than kinh
* Benh tuy song
* Viem hoac co that c xng
* Viem sun sn
* Herpes zoster
KHO TH (Dyspnea)
* N: cam giac hi th ngan,
nhan thc c th khong
thoai mai (uncomfortable
awareness of breathing).

* Bn thng than phien: thieu


hi th, khong u hi e
th, ht vao khong u, ngop,
met, nang ngc.
CAC KIEU KHO TH
* Kho th khi gang sc
(exertional dyspnea): cam giac
kho th xuat hien khi gang
sc mc o va (chay bo
hoac len oi).

NN thng gap nhat cua kho


th khi gang sc la suy tim
trai. Bn benh phoi hoac the lc
kem cung co the co TC nay
KHO TH KCH PHAT
VE EM
(Paroxysmal Noctural
Dyspnea)
* em,BN nam ngu

* 2-3 gi sau, kho th ap en thc giac.

* BN ngoi day, thong chan xuong ging, co


the i lai quanh ging, gan ca so vai phut
sau th de th lai

* Bn nam ngu lai kho th lai ap en ngoi


day giam kho th nam ngu lai kho
th lai ap en

* BN khong dam ngu nam ngu ngoi, guc vao


au ging suot phan con lai cua em dai.
KHO TH THEO T THE
(ORTHOPNEA)
* C nam xuong la kho th
ap en.
* BN phai nam au cao hoac
ngoi tren ghe e ngu.
* La bieu hien cua suy tim
hoac phoi nang ne.
* T the ngoi giup ha thap c
hoanh va phan phoi dch ve
chi di giam TC kho th.
KHO TH TRONG PHU
PHOI CAP
* Xung huyet phoi ot ngot, nang
ne dch t mao mach phoi tran
vao phe nang kho th d doi.

* BN lo lang, kch ong, tai xanh, va


mo hoi t am, theu thao noi
khong thanh tieng, hi th tho rap
on ao lam ngi ng ben cung
nghe thay, co gang dung tat ca cac
c ho hap e th, ha hoc mieng
e p lay khong kh.

* Co the co bot hong trao ra mieng,


mui
PHU PHOI CAP
NN GAY KHO TH
* Benh tim: xung huyet phoi (suy tim
trai, tang ap M phoi)

* Phoi: tac nghen ng th (d


vat, u, viem, hen PQ, viem PQ man,
dan PQ, kh phe thung,benh nhu mo
phoi lan toa

* Benh thanh ngc va c ho hap

* Cac N N khac: tang thong kh, co


thai, thieu mau nang, toan huyet
PHU
N: l tnh trng tch t dch qu mc
khong gian bo.

C ch chnh: tng p thy tnh, gim


p keo, ri lon tnh thm mao mch

C 2 loi ph theo v tr: ton th hoc


khu tr.
NGUYN NHN PH
Ph tan th: suy tim sung huyt, tng p
phi, suy thn, x gan, mt protein qua
ng rut, suy gip, truyn dch qu
nhiu, suy dinh dng.

Ph khu tr: Thuyn tc tnh mch, $


chng chn p TM ch trn, tc TM ch
di, vim bch mch, d ng
Tip cn chn on ph
Da vo bnh s, khm v cc XN.
Bnh s: xc nh ph v cc tnh cht ca
n tm NN gy ph.
Cc TC gi ph: tng cn, nhn eo b
cht, giy cht, dy nt phi ni thm, nng
mt .
Khm: xc nh tnh trng ph: n lm
ca ph: lan rng, tc din tin,
cc TC i km.
NGAT (SYNCOPE)

N: mt thc.
Phan biet: me (mat y thc
keo dai), xu (khong b mat tri
giac).
C ch: gim ti mu no, ng kinh
cn nh.
NGUYN NHN NGAT
Vasovagal syncope: gim HA gim ti mu
no.
Postmicturation syncope:
Posttussive: bnh phi mn
Syncope do carotid sinus hypertensive
Postural syncope: antihypertensive medications,
hypovolumic
Arrhythmias: Adams Stokes
Hep van M chu kht
XANH TM (CYANOSIS)
* N: da b xanh tm khi lng Hb
kh tang (>5g%) hoac co Hb
bat thng (methemoglobine)

* Phan loai:
Xanh tm trung tam
Xanh tm ngoai bien
CYANOSIS TRUNG TAM
* Xanh tm trung tam : giam o bao
hoa oxy M do shunt phai trai hoac
do chc nang cua phoi kem.
* Shunt phai trai: benh tim bam
sinh co luong thong t tim phai qua
tim trai, mau en cha c oxy hoa
i vao ai tuan hoan tm.
* Chc nang phoi kem: khong oxy
hoa mau en tot tm. Cac benh
phoi man.
He tuan hoan

Shunt T P: mau en qua ai tuan


hoan tm
CAC BENH TIM BAM SINH
TM
* T chng fallot
* Thong lien that ; thong lien
nh, con ong ong mach a b
ao shunt.
* Chuyen v ai ong mach
XANH TM NGOAI BIEN

* Hau het la do co mach di da


trong tnh trang cung lng tim thap
hoac tiep xuc vi lanh.

* Neu cyanosis ch khu tru 1 chi th


phai ngh en tac nghen M hoac
TM.
HOI HOP ANH
TRONG NGC
N: cam giac tim ap nhanh hoac
manh, cam giac khong de chu.

BN mo ta: tim nhay trong long


ngc, tim chay ua (racing), tim ap
khong eu, cam giac doi co.
NGUYEN NHAN
Cac roi loan ve tan so hoac
ve nhp tim gay anh trong
ngc:
nhp tim nhanh,
ngoai tam thu,
khoang ngh bu,
tang cung lng tim,
tim tang ong,
nhp cham
HO
* Ho la mot phan xa e tong, lam
msach dch tiet hoac d vat ra khoi
he thong kh - phe quan.

* Cac bat thng cua he thong kh


- phe quan va nhu mo phoi eu
gay ho..

* Cac roi loan ve tim mach cung co


the gay ra ho
HO DO TIM MACH
* Tang ap TM phoi, phu mo ke
hoac phe nang phoi: suy tim
trai, hep van hai la.
* Nhoi mau phoi: ho, ho ra mau,
au ngc.
* Chen ep cay kh phe quan
(do phnh M chu).
* Tnh chat cua am giup chan
oan nguyen nhan gay ho.
HO RA MAU
* N: ho ra toan mau, ho ra am co
vng mau.
* NN:
Thoat HC vao phe nang do mach mau
sung huyet (benh tim mach).
V cac mach mau cua phe quan
(benh tim mach).
Hoai t va xuat huyet t nhu mo
phoi.
Loet niem mac PQ.
Xam lan mach mau phoi (K).
KET LUAN
* TCCN benh tim mach giup chan oan
c cac benh tim mach.
* Moi trieu chng co nhieu tnh chat
khac nhau the hien mot benh ly goc
khac nhau.
* Khai thac c ay u TCCN va cac tnh
chat cua chung mot cach chi tiet the
hien ban lnh va trnh o cua thay
thuoc.
* Can thc tap cach khai thac cac TCCN
benh tim mach mot cach thanh thuc,
nhanh chong va chnh xac.
THE END

TRIEU CHNG C
NANG
BENH TIM MACH
Chuc cac ban khai khac c cac TCCN cua
benh tim mach

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