Tip cn chn oỏn v x trớ Hi Chng ng Mch Vnh Cp PGS.TS Phm Mnh Hựng B Mụn Tim Mch i Hc Y H Ni Vin Tim mch Bnh Vin Bch Mai H thng MV nuụi qu tim v hu qu b tc nghn Tiến triển mảng xơ vữa Foam Cells Fatty Streak Intermediate Atheroma Lesion Fibrous Complicated Plaque Lesion/Rupture Endothelial Dysfunction From first decade From third decade Growth mainly by lipid accumulation From fourth decade Smooth muscle and collagen Thrombosis, hematoma Adapted from Stary HC et al Circulation 1995;92:1355-1374 Hi chng MV cp cú on ST chờnh lờn CK- MB or Troponin Hi chng MV cp khụng cú on ST chờnh lờn Troponin elevated or not Adapted from Michael Davies Hội chứng mạch vành cấp Không ST chênh lên ST chênh lên NMCT không ST chênh lên NMCT có Q TNKÔ NMCT không Q au ngc kiu MV HCMV cp Khai thỏc Tr/Ch XN chn oỏn ECG Khụng ST chờnh Cardiac Biomarker Non-ST ACS TNKễ NSTEMI Chn oỏn cui NKễ ST chờnh lờn NMCT cp Cú Q Khụng Q Libby P Circulation 2001;104:365, Hamm CW, Bertrand M, Braunwald E, Lancet 2001; 358:1533-1538; Davies MJ Heart 2000; 83:361366 Anderson JL, et al J Am Coll Cardiol 2007;50:e1-e157, Figure Reprinted with permission TRIU CHNG GI í ACS Khụng phi tim TN ễ iu tr theo nguyờn nhõn Theo khuyn cỏo ca HTMVN 08 Khng nh ACS Cú th ACS Khụng ST chờnh ST chờnh ST v/ hoc T thay i T khụng rừ au ngc tng Men tim bỡnh thng Men tim tng Bin i huyt ng Theo dừi 12 h k t triu chng bt u Khụng au ngc tỏi phỏt : Chin lc tỏi ti mỏu MV au ngc tỏi phỏt hoc cỏc theo dừi dng tớnh theo dừi õm tớnh Chn oỏn xỏc nh ACS NFGS ỏnh giỏ thiu mỏu c tim Khun cỏo NMCT cp ỏnh giỏ chc nng tht trỏi m tớnh Dng tớnh Nhp vin õu ngc nguyờn nhõn khỏc, ACS nguy c thp Khng nh ACS Theo phỏc K hoch theo dừi bnh nhõn Cú th ACS Algorithm for evaluation and management of patients suspected of having ACS Anderson JL, et al J Am Coll Cardiol 2007;50:e1e157, Figure Tip cn NMCT cp nh ngha NMCT cp (Universal 2012) NMCT l tỡnh trng hoi t t bo c tim tỡnh trng thiu mỏu nuụi dng kộo di Tiờu chun chn oỏn NMCT cp Cú s tng v/hoc gim marker sinh hc c tim (Troponin) trờn ớt nht 99% bỏch phõn v, kốm theo ớt nht yu t sau: Triu chng au ngc kiu MV Thay i T (ST; bloc nhỏnh trỏi mi; súng Q bnh lý) Thm dũ hỡnh nh hc cú bng chng thiu mỏu c tim (RLV vựng) Hỡnh nh huyt MV (chp MV; m t thi) Cỏc Phng thc iu tr c bn hin H/C MVC khụng cú ST chờnh lờn Beta-blocker Chng au tht ngc Nitroglycerin Diltiazem H Lipid v n nh x va Statins Aspirin Clopidogrel Chng ngng tiu cu Prasugrel Ticagrelor Heparin Enoxaparin Chng ụng Fondaparinux Bivalirudin Can thip nu cú ch nh Chp MV Can thip MV Chin lc iu tr Túm tt cỏc bc iu tr HCMV cp khụng ST chờnh lờn Bc 1: ỏnh giỏ ban u Bc 2: phõn tng nguy c Bc 3: Xỏc nh chin lc iu tr can thip Bc 4: Cỏc bin phỏp iu tr can thip Bc 5: chm súc nm vin v sau vin