TIP CN BNH NHN

KH TH
ThS.BS. Phan Tun t
Vin Tim mch Bnh vin Bch Mai
B mn Tim mch Trng i hc Y H Ni
 NH NGHA
Kh th l mt cm gic ch
quan ca ngi bnh biu hin
s khng thoi mi trong h hp
vi nhiu mc khc nhau, bt
ngun t s tng tc ca nhiu
yu t nh sinh l, tm l, x hi
v mi trng, c th gy ra cc
phn ng sinh l v hnh vi th
pht.
Am J Respir Crit Care Med. 2012;185(4):435
 NGUYN NHN
1. Kh th lin quan n tim mch:
Cc nguyn nhn dn n suy tim (gim chc
nng tm thu, gim chc nng tm trng): bnh
c tim, bnh van tim, hi chng mch vnh cp

Ri lon nhp tim

Ph phi cp

Trn dch mng tim

 NGUYN NHN
2. Kh th lin quan n h hp:
Tc nghn ng h hp trn.
Bnh phi tc nghn: Hen, COPD,...
Bnh l nhu m: vim phi, bnh phi k,...
Bnh l mng phi: TDMP, TKMP
Bnh mch mu phi.
3. Bnh l thn kinh c
 NGUYN NHN
4. Nguyn nhn khc

Thiu mu nng: nh hng ln c tim mch

v h hp

Tm l: hi chng tng thng kh

TIP CN TH NO ?
 HI BNH
1. Nhng iu cn ch :
Hon cnh xut hin: t nhin, sau gng sc, khi
thay i thi tit, khi tip xc vi d nguyn
Thi gian xut hin: t ngt mi xut hin hay
c nhiu thng, nhiu nm
c im: tng cn hay lin tc tng dn
Mc kh th
Cc du hiu i km
 HI BNH
2. Hi tin s:
Bn thn:
Cc yu t nguy c
Cc bnh l ni khoa mc
Cc bnh l ngoi khoa, chn thng, can thip
th thut c thc hin
Gia nh
 MC KH TH
Phn kh th (theo mMRC):
0: ch kh th khi lm vic nng
1: kh th khi i vi hay ln dc thng
2: i chm hn ngi cng tui v kh th hoc ang
i phi dng li th
3: kh th sau khi i c khong 100m hoc sau
vi pht trn ng bng phng
4: kh th khi thay qun o hoc khng th ra khi
nh v kh th
 KHM LM SNG
Nhng iu cn ch :
nh gi thc.
m nhp th, xc nh kiu th
Pht hin cc du hiu ca suy h hp: tm,
co ko cc c h hp ph
Khm t m pht hin cc du hiu thc th
v tim mch, h hp, thn kinh,...
 THM D CN LM SNG
1. Xt nghim thng quy:

XQ ngc thng- nghing

Kh mu ng mch

in tm

Cng thc mu, sinh ha mu c bn.

 THM D CN LM SNG
2. Xt nghim chuyn bit:
Chn on hnh nh: siu m ngc-bng,
siu m tim, CLVT lng ngc

Chc nng thng kh phi

Xt nghim: BNP/pro BNP, CK, CK-MB,

Troponin
 X quang tim phi thng

Trn kh mng phi Vim phi COPD

Vai tr ca BNP trong suy tim cp
Ngng chn on
NT-proBNP >300 pg/mL
v BNP > 100 pg/mL.
nh lng BNP di
ngng cho php loi tr
chn on suy tim.
Nguyn nhn tng BNP d
lm sng khng c suy tim:
Suy thn
Hi chng vnh cp
Hp van ng mch ch
H van hai l
Bnh c tim ph i
Eur Heart J 2012;33:17871847.
NH HNG
 THI GIAN XUT HIN
Cp tnh: t ngt mi xut hin hoc din bin trong
vng vi pht, bao gm:
Tc ng mch phi cp
NMCT cp, ph phi cp
Chn p tim cp
Trn kh mng phi
Phn v (ph Quincks)
D vt ph qun
JAMA. 2007;297:1810-1818
 THI GIAN XUT HIN
Bn cp: din bin trong vng
vi gi n vi ngy, bao gm:
Hen ph qun, t cp
COPD, vim phi
Ph phi, vim c tim, chn
p TM ch trn, vim mng
ngoi tim
JAMA. 2007;297:1810-1818
 THI GIAN XUT HIN
Mn tnh: din bin trong vng vi ngy n vi tun,
bao gm:
Suy tim
Bnh c tim
Vim mng ngoi tim
COPD, x phi, bnh mch mu phi, vim phi,
Bnh thn kinh - c (lon dng c, vim ct sng dnh
khp, x ha ct bn,...)
JAMA. 2000;283:1853-1857
 MC KH TH
Kh th d di:
Cn hen ph qun c tnh
TKMP p lc
Tc nghn ng h hp trn cp tnh (ph
Quincks, d vt)
Tc ng mch phi cp

Am J Respir Crit Care Med. 2012;185:435-452

 TRIU CHNG I KM
1. au ngc:
au ngc trung tm thng gi bnh
mch vnh, tc M phi, TKMP, trn kh
trung tht, hoc d vt ph qun.
au ngc kiu mng phi: vim phi, vim
mng phi, tc M phi, TKMP.

Ann Thorac Surg. 2008;86:962-966.

Eur J Cardiothorac Surg. 2001;19:185-189.
 TRIU CHNG I KM
2. St: thng gi bnh mt bnh cnh
nhim trng (vim phi, vim ph qun,...)
cn ch cc du hiu vim long h hp (hi
chng cm). XQ ngc l cn thit xc
nh.

Clin Infect Dis. 2000;31:942-946.

 TRIU CHNG I KM
3. Ting kh kh, c c: gi tnh trng cht
hp ng dn kh (hen ph qun, COPD,
ph phi, vim tiu ph qun hay d vt PQ)

4. Khc m mn tnh: gi COPD, gin ph

qun, x ha kn, ung th tiu ph qun ph
nang
Semin Respir Crit Care Med. 2002;23:127-134.
J Thorac Oncol. 2006;1:344-359.
 TRIU CHNG I KM
5. Ho mu: gi tnh trng tn thng mch
mu (tc M phi, chy mu ph nang, vim
phi hoi t, K phi, nm phi, lao phi)

Chest. 2008;133:1476-1478.
Fam Pract. 2004;21:605-611.
 TRIU CHNG I KM
6. Yu c, au c: gi cc bnh l thn kinh-
c (lon dng c, x ha ct bn teo c,
hi chng Guillain-Barre, nhim virus,
Leptospirosis)

Curr Opin Pulm Med. 1999;5:355-362

Braz J Infect Dis. 2002;6:135-139
Arch Neurol. 2003;60:947-948
 TRIU CHNG I KM
7. Du hiu sinh tn:

Mch nhanh, HA h, th nhanh: gi tnh trng

suy tim cp (do NMCT, bnh l MC, chn p
tim), tc M phi cp, nhim trng nng/sc.

HA cao gi ph phi huyt ng, hi chng

cng gip hoc pheochromocytoma
Eur J Cardiothorac Surg. 2008;34:1265-1267
Minn Med. 2008;91:38-40
 TRIU CHNG I KM

8. Lo lng qu mc: gi kh th do cn
nguyn tm l (trm cm, hi chng tng
thng kh)

J Gen Intern Med. 2008;23:1904-1908

 MT S KHUYN CO
1. Cn xc nh din bin ca kh th l cp tnh
hay mn tnh.
2. Cn xc nh kh th lin quan n tim mch hay
h hp.
3. Vic hi bnh chi tit v khm lm sng t m cho
php phn on khong 2/3 cc nguyn nhn gy
kh th.
 MT S KHUYN CO
4. XQ ngc l cn thit cho mi trng hp kh
th.

5. BNP/proBNP hu ch trong nh hng cc

nguyn nhn kh th do tim mch

6. Kh mu ng mch gip nh gi mc v
phn loi suy h hp