Su nguy hiem cua thieu mau co tim tham lang

Thứ sáu, 20 Tháng bảy 2012, 08:41 GMT+7

Dau that nguc (DTN) la mot bieu hien cua thieu mau co tim va la hau qua cua su mat can bang giua nhu cau oxy cua co tim va su cung cap oxy cho co tim qua dong mau duoc dua den boi he thong dong mach vanh. DTN la mot canh bao rat huu hieu, tuy nhien co truong hop benh khong bieu hien khien NB dieu tri kip thoi.

Vi sao xay ra thieu mau co tim khong dau?

Cac con thieu mau co tim co trieu chung dau that nguc thuong keo dai hon mot chut va tan suat co doan ST chenh xuong nhieu hon nhung con thieu mau co tim tham lang. Mot nguyen nhan khac lam con dau khong xuat hien khi thieu mau co tim la do he than kinh. Benh than kinh lam anh huong den than kinh cam giac huong tam thuong gap o mot so benh, dac biet la benh nhan dai thao duong. Cac yeu to tam ly hay van hoa co the anh huong den su nhan thuc dau.

Benh nhan co cac con thieu mau co tim tham lang duong nhu co nguong gay dau cao hon va dung nap voi kich thich dau tot hon nhung nguoi co trieu chung dau that nguc. Do vay, viec dan truyen cua cac tin hieu dau trong he thong than kinh trung uong gop phan vao su thay doi nguong dau hay lam trieu chung dau that nguc khong xuat hien.

Thieu mau gay ra boi tang nhu cau oxy do gang suc thuong la tham lang. Ghi dien tam do luu dong da cho ta su hieu biet sau sac cac co che co nhieu tiem nang cua rat nhieu con thieu mau co tim tham lang hay co trieu chung trong qua trinh sinh hoat hang ngay. Tan so tim khi co con thieu mau duoc phat hien bang ghi dien tim luu dong thuong thap hon so voi tan so tim trong luc lam nghiem phap gang suc de gay thieu mau. Dieu nay goi y rang, co that dong mach vanh da dong gop vao rat nhieu con thieu mau co tim tham lang.

images/vn888/hot/v2012/20120720-084122-1-dientimu2.jpeg

Dien tim de phat hien thieu mau co tim tham lang (hinh minh hoa)

Ai de mac thieu mau co tim tham lang?

Nhung benh nhan dai thao duong co mot ti le kha cao bi nhoi mau co tim tham lang va nhung con thieu mau co tim tham lang da duoc chung minh bang nghiem phap gang suc va ghi dien tim luu dong. Cac con thieu mau co tim khong trieu chung co the xuat hien o cac benh nhan bi bat ky mot hoi chung thieu mau co tim nao va co the quan sat thay o cac benh nhan hoan toan khong co trieu chung hay o nguoi co kho chiu o nguc voi mot so con thieu mau.

Ti le mac benh thieu mau co tim tham lang thuc su rat kho xac dinh nhung co su phu thuoc vao tuoi va muc do tram trong cua benh dong mach vanh. Nguoi mac benh dong mach vanh thuong gap nhung con thieu mau co tim tham lang hon la nhung con thieu mau co bieu hien dau that nguc.

Cac goi y lam sang cua thieu mau co tim tham lang

Thieu mau co tim khong trieu chung la mot thanh phan chung cua ca hoi chung dong mach vanh cap tinh va man tinh. Do vay no co the co cung mot muc do lam sang quan trong nhu thieu mau co tim co trieu chung. Nhung chi diem quan trong cua nguy co la do rong va muc do tram trong cua thieu mau, khong phu thuoc vao viec no bieu hien nhu the nao va lam the nao de phat hien ra va benh on dinh hay khong on dinh. Khi theo doi dien tim phat hien thieu mau co tim tham lang, thay doi dieu tri de lam giam va loai tru tu vong.

Dieu tri thieu mau va nhoi mau co tim tham lang

Hau het cac thuoc va chien luoc can thiep lam giam trieu chung thieu mau se lam giam thieu mau co tim khong trieu chung. Cac so lieu san co tu cac nghien cuu lam sang ban dau dieu tri thieu mau co tim tham lang trong dau that nguc on dinh da duoc tong ket gan day. Nitroglycerin co hieu qua cao, thuoc chen beta giao cam doi khi cho thay co hieu qua hon thuoc chen kenh canxi. Thuoc chen kenh canxi co the co hieu qua cao nhat trong phong ngua thieu mau xuat hien voi tan so tim thap hon, boi co that dong mach vanh co the la yeu to noi troi trong tinh huong nay. Voi benh nhan bi thieu mau co tim do benh dong mach vanh, ganh nang thieu mau toan bo va khong chi cac trieu chung co the la muc tieu dieu tri phu hop hon. Thieu mau co tim nang va keo dai cho du da duoc dieu tri noi khoa toi uu can phai xem xet den kha nang tai tao mach cho co tim (nong, dat stent dong mach vanh).

Nhoi mau co tim la hau qua cua tac mach gay ra thieu mau cuc bo keo dai tren mot dien co tim. Khoang 20% benh nhan bi nhoi mau co tim cap khong co trieu chung hoac co trieu chung khong dien hinh nen khong chan doan ra benh luc ban dau. Nhoi mau co tim khong dau thuong xuat hien o nguoi lon tuoi, nu gioi, dai thao duong va benh nhan sau phau thuat. Cac benh nhan nay thuong co bieu hien kho tho hoac suy tim u huyet nhu la trieu chung ban dau. Viec dieu tri tuong tu nhu dieu tri benh nhan co nguy co cao cho du co dau hay khong.   

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