triệu chứng học bệnh lý tim mạch

8/6/2019 Triu chng hc bnh l tim mch

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TRIU CHNG C NNG

BNH L TIM MCH


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MC TIU

1. Nm c cc triu chng c nng ca bnh l

tim mch

2. Nu c cc c tnh cn khai thc ca au

ngc, kh th, ho ra mu

3. Vn dng c kin thc hc trong chm sc

bnh nhn tim mch


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I. I CNG- Bnh tim mch l mt vn sc khe cng ng

quan trng vi t l mc bnh v t vong cao

- Bnh tim mch gm nhiu bnh khc nhau nhng c

nhng bnh chnh sau y: Tng huyt p; Ri lon

m mu; X va ng mch; Bnh tim thiu mu cc

b; Tai bin mch mu no; Bnh van tim hu thp;Suy tim (thng l hu qu ca tng huyt p, bnh

ng mch vnh, bnh van tim hu thp)


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I. I CNG

- Triu chng ca bnh l tim mch c chia lm 2 loi: Triuchng c nng v triu chng thc th

- Triu chng c nng (ch quan) l nhng triu chng do ngi

bnh cm nhn v than phin vi bc s. Ngi iu dngcn phi ht sc kho lo hi bnh v khai thc c ht

cc triu chng c nng ca bnh nhn, t gip ch cho

chn on v lp k hoch chm sc bnh nhn c tt hn

- Triu chng thc th (khch quan) l nhng biu hin do thy

thuc pht hin ra khi khm bnh.


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I. I CNG

- Mt triu chng c th va l c nng va l thc th:VD: Kh th c th l than phin chnh ca BN (c nng)

nhng cng c th l triu chng c thy thuc pht

hin qua thm khm thc th (th nhanh, nng, co ko

c h hp ph)

- Triu chng c nng v thc th l nn tng trong chnon bnh


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I. I CNG

- Mun pht hin cc triu chng thc th thng cnphi c k nng v do bc s m nhim.

- Bi ny ch trnh by cc triu chng c nng tim

mch thng gp


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II. TRIU CHNG C NNG

Cc triu chng c nng tim mch thng gp l:1. au ngc:

- Thng gp trong bnh l tim mch.

- C th l biu hin ca mt tnh trng bnh khng quan trng ,

khng nguy him nhng cng c th l biu hin ca mt tnh

trng bnh rt cp tnh, trm trng, nguy him n tnh mng

nh nhi mu c tim cp, thuyn tc phi din rng, bc tch

ng mch ch

- Cc bnh tim hay gy au ngc gm: BTTMCB (Thiu mu c

tim; Nhi mu c tim cp); Hp, h van MC; VMNT


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II. TRIU CHNG C NNG

1. au ngc:

- Tuy nhin, au ngc cn gp trong cc bnh l khc nh bnh

phi, mng phi, c ngc, sn sn, thn kinh lin sn v

cn do yu t tm l

- Bnh l cc c quan trong bng cng c th gy au ngc nh

vim d dy, vim ti mt cp, vim ty cp

- Nguyn nhn ca au ngc trong cc bnh tim ch yu l do gim

hoc tc nghn dng mu ti c tim. Cn au s ht khi dng

mu n c tim c ci thin


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II. TRIU CHNG C NNG

THNH NGC

PHI

BNH L D DYTHC QUN

TI MT

TY


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II. TRIU CHNG C NNG- Khi nhn nh v au ngc, ngi iu dng cn phi khai thc

t m, cn thn (trnh b st au ngc do nhi mu c tim) vcc c im sau:

* Cch khi pht au: t ngt hay t t:

au t ngt thng do cc bnh cp tnh nh NMCT cp, bctch ng mch ch.

au t t thng do cc bnh t cp tnh hn nh ung th phi,vim mng ngoi tim

* V tr au:

au nng hoc su. Nu au khu tr da hoc t chc nng, tngln khi p th au ngc ny c ngun gc t thnh ngc

Khi BN ch r im au c th th thng khng do tim


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II. TRIU CHNG C NNG* Hng lan ca cn au:

Nu au ngc lan n vng di v tri hoc phn thp

bn phi thng khng phi do tim m c th do vim

khp xng, d dy y hi

Nu au lan n c, hm (T) th ngh n do bnh tim

thiu mu cc b, ri lon ct sng c

Nu au lan n vai tri, cnh tay (T) c th do bnh timthiu mu cc b, vim mng ngoi tim

Nu au sau lng lan dc xung bng phi ngh n do

bc tch MC


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II. TRIU CHNG C NNG* Thi gian au ko di bao lu?

au ngc c khi ch thong qua vi giy nhng cng ckhi ko di n vi ngy

Nu au ngc xy ra rt ngn (di 20 giy) th chc chn

khng phi l cn au tht ngc trong bnh tim m cth do c, xng ca thnh ngc

au ngc do thiu mu cc b c tim thng ko di 8-10

phtau ko di vi gi phi ngh n do NMCT cp, vim

mng ngoi tim, phnh MC, do c xng ca thnhngc, Zona thnh ngc


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II. TRIU CHNG C NNG* Yu t no lm gim au, lm tng au:

Trong VMNT cp, au ngc gim khi ngi chi ngi ra

trc.

Trong au ngc do vim mng phi hay au ngc c

ngun gc t thnh ngc: gim khi BN nn th, bt

ng thnh ngc

au khi gng sc hoc sau 1 ba n no hoc sau khi gp

lnh thng l do BTTMCB.

* Nu cn au ti pht th sau bao lu, cn au sau c

ging cn au trc khng?


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II. TRIU CHNG C NNG

* Cc triu chng km theo au ngc nh kh th , v mhi, bun nn, nn:

au ngc km v m hi thng l do NMCT cp

au ngc km kh th, th nng thng gp trongTKMP, thuyn tc phi

au t ngt km khc ra mu thng l do thuyn tc

phiau km st thng gp trong vim phi, vim mng phi,

vim mng ngoi tim


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II. TRIU CHNG C NNG

2. Kh th:- Th l 1 hot ng t nhin. Bnh thng, chng ta

khng ch n hi th

- Khi phi ch n hi th ca mnh th c kh th- Kh th c m t l ht hi, hi th ngn

- Gp trong giai on mun ca cc bnh tim nh THA,

bnh ng mch vnh, bnh c tim lm suy tim- C th gp trong cc bnh l ca phi (vim phi), ng

dn kh (d vt), mng phi (trn kh, trn dch mng

phi), chn thng thnh ngc


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II. TRIU CHNG C NNG

2. Kh th:- Kh th trong bnh tim c mt vi loi nh sau:

* Kh th khi gng sc: xy ra cng vi cc hot ng

gng sc, gp giai on u ca suy timKh th khi ln dc, ln cu thang, khi i nhanh hoc

lm vic nng

Khi ngh ngi th khng kh th naNhng dn dn s dn ti giai on kh th thng

xuyn.


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II. TRIU CHNG C NNGTM C NI


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II. TRIU CHNG C NNG

* Kh th thng xuyn: Xy ra sau mt thi gian bkh th khi gng sc.

giai on ny, ngi bnh khng lm vic nng,

nm cng kh th (kh th do t th) cho nn

ngi bnh thng mt ng hoc phi ngi ng

lng m ng. Kh th thng xuyn chng t tim

b suy nng.


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II. TRIU CHNG C NNG2. Kh th:

*Kh th xut hin tng cn: Gp trong cc trnghp:

- Ph phi cp: c th xut hin mt ngi c bnh

tim ri by gi b suy tim t ngt, cng c th lmt tai bin xy ra tc thi mt ngi trc bbnh tim nhng khng th hin ra cc ri lon chc

nng g, hoc cng c th xy ra mt ngi honton khng c bnh tim. V d: ng c bi hi c,tai bin khi dng adrenalin tim mch, tai bintrong bnh vim thn, bnh thn kinh, v.v


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II. TRIU CHNG C NNG2. Kh th:*Kh th xut hin tng cn:

- Kh th cp trong nhi mu phi: y l mt bin chngtc ng mch phi xy ra do cc mu ng ti ch

hoc cc mu ni khc do dng mu chy ti lm tcng mch phi.

Thng gp: nhng ngi b vim tnh mch, ngiva mi b sy thai, hoc sau khi m tun u.

- Cn KT kch pht v m: xy ra vo ban m, khingi bnh ng c 3-4 gi, lm ngi bnh t ngttnh gic, phi ngi dy cho n khi ht kh th ,thng sau khong 20-30 pht, cn kh th mi bt.


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II. TRIU CHNG C NNG2. Cc tnh cht ca kh th:

* Cch khi pht:

- t ngt: Ph phi cp, thuyn tc phi, d vt ng

th- T t: suy tim mn, TDMNT, TDMP

* Th kh th:

Hp/ tc nghn ng h hp trn: ch yu th ht voHp/ tc nghn ng h hp di: ch yu th th ra

Kh th 2 th: suy tim, ph phi cp


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II. TRIU CHNG C NNG2. Cc tnh cht ca kh th:*Lin quan n gng sc:

Kh th do tim mch thng tng khi gng sc.

Khi ngh c cm gic kh th v gng sc khng kh th

thng l do ri lon chc nng*Lin quan n t th:

Ngi hoc ng d th hn nm: suy tim T

* Cc yu t lm gim kh th:Ngh ngi, li tiu, tr tim: lm gim kh th trong

bnh tim

Gin ph qun: gim kh th trong hen, BPTNMT


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III. TRIU CHNG C NNG3. Ho ra mu:

* Khi BN c triu chng ho ra mu, phi phn bit:- Ho mu: mu t ng h hp di

- Khc mu: mu t ng h hp trn

- i mu: mu t ng tiu ha, c ln thc n

* Cc tnh cht cn lu :

- t ngt hay t t

- Lng

- Dch tit km theo: khng m, m trng

- Triu chng km theo


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III. TRIU CHNG C NNG3. Ho ra mu:

* Trong bnh tim, ho ra mu thng xy ra trong batrng hp:

- Hp van hai l: thng gp nht.

- Tc ng mch phi gy nhi mu phi.- Suy tim tri (ph phi cp).

Trong trng hp ph phi cp, ngi bnh si ra bthng l chnh nn d phn bit.

Cn trong hp van 2 l v nhi mu phi th mu rathng t, ln vi m; mun phn nh xem ho ramu thuc nguyn nhn bnh tim hay bnh phi ta

cn kt hp thm khm tim phi ngi bnh


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III. TRIU CHNG THC TH4. Xanh tm:

* Mu sc da v nim mc ngi bnh b tm c th mc :

- Tm t: ch tm mi, mng tay, mng chn, c khich xut hin khi ngi bnh lm vic nng km vikh th hoc khi em b khc.

- Tm nhiu: D pht hin: thy thuc, ngi nh

ngi bnh v bn thn ngi bnh cng thy.Thng l tm mi, li, u ngn tay, ngnchn.


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Xanh tm xut hin khi lng Hemoglobin kh trongmu mao mch trn 5g trong 100ml mu.

Xanh tm bnh tim mch xy ra trong cc trng

hp sau:* Cc bnh tim bm sinh c lung mu thng t tim

phi sang tim tri nn mu tnh mch qua trn vomu ng mch.

* Khi suy tim do tun hon b cn tr

* Mt s trng hp tm khu tr do cc bnh camch mu.


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* Cc tnh cht cn khai thc:

- V tr xanh tm: ton thn

hay khu tr- Tui xut hin: s sinh

hay thiu nin

- Yu t thc y: khc, b,

kh th, gng sc

- Triu chng i km ca bnh tim, phi, no


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II. TRIU CHNG C NNG5. Mt:

- L du hiu gp trong bnh tim, song cng gp trong

nhiu bnh khc

- Ngi bnh mau thy mt v cn mt thi gian luhn bnh thng hon thnh mt cng vic no

m trc y khng thy mt

- Trong bnh tim, mt thng do gim ti mu cquan, t chc, do mt ng v tiu m, v kh th

khi gng sc hoc kh th kch pht v m


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II. TRIU CHNG C NNG- Mt xy ra sau mt hot ng va phi hoc sau mt

gng sc do cung lng tim khng , ngi bnh

cn c qung ngh ngn khi hot ng


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II. TRIU CHNG C NNG6. Hi hp-trng ngc:

- L cm gic c hot ng ca tri tim: mt nhp,

tim nn thnh thch, tim ang nhy, tim p nhanh,

tim p mnh, tim p chm, tim khng u- Thng gp trong cc ri lon nhp tim nh nhp

nhanh xoang, ngoi tm thu, nhp nhanh kch pht

trn tht- Cng c th xy ra sau mt hot ng th lc cng

thng, ko di nh bi, chy


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II. TRIU CHNG C NNG


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II. TRIU CHNG C NNG6. Hi hp-trng ngc:

- Mt vi yu t khng phi bnh tim cng gy ra hi

hp nh lo s, mt, mt ng, dng mt s cht kch

thch nh c ph, thuc l, ru- Cch khi pht v kt thc:

Cc RLNN kch pht thng khi pht v kt thc t

ngtRLNN do lo lng hoc thiu mu mn th khi pht v

kt thc t t


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II. TRIU CHNG C NNG7. Ngt:

- L s mt thc tm thi trong mt thi gian ngn

- Do gim t ngt dng mu ti no. Bt k bnh nolm gim cung lng tim, gim mu n no u c

th gy ngt- Trong bnh l tim mch, ngt thng gp trong: ri

lon nhp tht, cn nhp tim nhanh/chm, cc bnhvan tim gy gim cung lng tim nh hp vanMC, hp van 2 l

- Ngoi ra, ngi ln tui ngt cn c th do tngnhy cm vi nhng kch thch vng xoang ng

mch cnh


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II. TRIU CHNG C NNG


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II. TRIU CHNG C NNG8. Tng cn t ngt v ph:

- Do tch ly qu nhiu dch trong khoang gian bo, gi

l ph

- Cn BN mi ngy gip pht hin du hiu tng cn

- Tng cn v ph ngoi vi l 2 du hiu ch im ca

suy tim phi

- Tng cn v ph cn do gi mui v nc do ccnguyn nhn ton th khc hoc do tc nghn tnh

mch gy ph khu tr vng tnh mch b tc

nghn


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II. TRIU CHNG C NNG


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III. TRIU CHNG THC TH8. Tng cn t ngt v ph:

* Tnh cht ph trong bnh tim:- Lc u khu tr chi di, dn dn v sau xut hin

bng, ngc, v ton thn hoc trong cc mng

bng, mng phi.- C km theo cc triu chng ca suy tim nh kh

th, gan to, tnh mch c ni

- Nu ph mi hnh thnh th c th iu tr cho htph nhng nu din bin lu hoc khng c iutr cho y , bnh cnh suy tim s dn theo hintng tng cht andosteron trong mu, v th Na+

li b gi trong c th,


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II. TRIU CHNG C NNG9. au chi:

- au chi trong bnh tim mch gp trong 2 bnh: thiu

mu cc b chi do XVM hoc suy TM

- au do thiu mu cc b chi thng c ngi

bnh k li l au xut hin khi i li v vn ng,

mt i khi ngh ngi, khng hot ng, khng i li

(cn gi l cn au cch hi)

- au 2 chn do ng hoc ngi qu lu thng l do

suy tnh mch, suy van tnh mch hoc tc nghn

tnh mch


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II. TRIU CHNG C NNG


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II. TRIU CHNG C NNG10. Thay i v mch:

- Bnh thng ngi trng thnh c mch ny r,u, tn s t 60 n 100 ln/pht

- Cc thay i v mch gm: mch yu, khng u,mch nhanh hay chm

- Cc nguyn nhn gy thay i mch:

* Cc trng thi sinh l nh lo u, cng thng, c thmt nhc do gng sc

* Dng cc cht kch thch nh nicotin, cafein, ru,thuc.


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II. TRIU CHNG C NNG

10. Thay i v mch:- Do bnh l nh bnh tim, cc trng thi sc, ri lon

nc-in gii, mt s bnh ni tit, nhim khun,

nhim c , thiu oxy, thiu mu, cc th thut timmch


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II. TRIU CHNG C NNG11. Thay i v huyt p:

- Bnh thng, ngi trng thnh, HA tm thu t90-140mmHg; huyt p tm trng t 50 n 90mmHg

- Cc thay i v HA gm: HA tng gy tng gnhnng cho tim tri, HA gim gy gim ti mu tchc

- Cc nn gy THA: THA nguyn pht, cc tnh trngbnh l gy THA th pht gm bnh thn, bnh nitit, tim mch

-Cc nn gy gim HA: sc, mt nc-in gii, suy

kit, dng thuc lm gim HA


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CM N.


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III. T LNG GI1. Triu chng au ngc ch gp trong bnh l tim

mch:

A. ng

B. B. Sai2. Triu chng c nng l do bc s pht hin khi khm

bnh, cn triu chng thc th do ngi bnh cm

nhn v than phin vi bc sA. ng

B. Sai


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III. T LNG GI3. Cc triu chng sau rt thng gp bnh tim

mch ngoi tr:

A. au ngc

B. Ho ra muC. i ra mu

D. Xanh tm

E. Tng cn v ph


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III. T LNG GI4. Cc triu chng thng gp bnh tim mch l:

A. Kh th

B. Hi hp, nh trng ngc

C. NgtD. Tt c u ng

E. Tt c u sai


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III. T LNG GI7. Ngt l do tng t ngt dng mu n no:

A. ng

B. Sai

8. Tng cn v ph ngoi vi l 2 du hiu ch im casuy tim phi:

A. ng

B. Sai


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III. T LNG GI9. Cc tnh cht no sau y cn phi m t bnh

nhn au ngc:

A. V tr au

B. Hon cnh xut hin cn auC. Hng lan ca cn au

D. Thi gian ko di ca cn au

E. Tt c u ng


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III. T LNG GI10. Lin h c im bnh thng v mch ct B vi

cc tiu ch ct A:

MCH BNH THNG

BIN NY U

NHP 60 100 LN/PHT

TN S R

G G


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III. T LNG GI11. Cc nguyn nhn gy tng HA l:

A. Bnh thn

B. Bnh l ni tit

C. X va ng mchD. Tt c u ng

E. Tt c u sai

III T LNG GI


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III. T LNG GI12. Cc nguyn nhn gy gim HA l:

A. Sc

B. Mt nc, in gii

C. Dng thuc lm h huyt pD. Tt c u ng

E. Tt c u sai

III T LNG GI


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III. T LNG GI13. Hi hp l triu chng ch gp trong bnh tim:

A. ng

B. Sai

14. Mt l triu chng ch gp trong bnh tim:A. ng

B. Sai

III T LNG GI


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III. T LNG GI15. Tn s tim bnh thng l:

A. 60 80

B. 60 -100

C. 80 100D. Tt c u ng

E. Tt c u sai

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