3 guideline điều trị suy tim theo VNHA 2022

KHUYẾN CÁO CỦA HỘI TIM MẠCH QUỐC GIA VỀ CHẨN ĐOÁN VÀ ĐIỀU TRỊ SUY TIM CẤP VÀ SUY TIM MẠN (2022) Trưởng ban: PGS TS Phạm Nguyễn Vinh Đồng trưởng ban: PGS TS Phạm Mạnh Hùng THAM GIA BIÊN SOẠN: GS.TS Đặng Vạn Phước; GS.TS Nguyễn Lân Việt; GS.TS Huỳnh Văn Minh; GS.TS Trương Quang Bình; GS.TS Đỗ Doãn Lợi; PGS.TS Châu Ngọc Hoa; PGS.TS Nguyễn Ngọc Quang; PGS.TS Đỗ Quang Hn; PGS.TS Hồng Quốc Hịa; PGS.TS Hồ Thượng Dũng; PGS.TS Trần Văn Huy; TS.BS Trần Vũ Minh Thư; TS.BS Hồng Văn Sỹ; TS.BS Phan Đình Phong; TS.BS Phan Tuấn Đạt; TS.BS Đinh Đức Huy; TS.BS Nguyễn Thị Thu Hoài; BS.CK2 Nguyễn Thanh Hiền; BS.CK2 Lê Thị Đẹp; BS.CK1 Phạm Thục Minh Thủy; ThS.BS Huỳnh Thanh Kiều; ThS.BS Đỗ Thúy Cẩn; ThS.BS Lê Võ Kiên; ThS.BS Phạm Nhật Minh; ThS.BS Nguyễn Phương Anh; ThS BS Trần Tuấn Việt M CL C N: C L C C CÁC T T T T C HÌNH NH 10 C CÁC B NG 11 u: ch t i 13 13 y tim 14 D ch t nt 14 15 15 3.1 16 Ch 4.1 n 18 18 c ch u 4.3 h nv tt m ng thu c 5.1 ng c 36 Suy tim v 6.1 Ch tt mv m nh 45 tt m nh 45 tt tt 6.3 7.1 m nh 45 m nh 45 tt o t n 49 Gi i thi u 49 49 tt 7.3 7.4 7.5 Ch tt tt o t n 49 o t n 50 o t n 55 Suy tim nặng - Giai đoạn D 56 ng 56 8.1 D ch t 59 Suy tim cấp 69 Dịch tễ học 69 9.2 Sinh lý bệnh suy tim cấp .70 9.3 Chẩn đoán 70 9.4 Biểu lâm sàng 72 9.5 Điều trị 78 10 9.1 Các bệnh tim mạch đồng mắc 83 10.1 Loạn nhịp rối loạn dẫn truyền 83 10.2 Hội chứng mạch vành mạn 88 10.3 Bệnh van tim 91 10.4 Tăng huyết áp 96 10.5 Đột quỵ 97 11 Bệnh đồng mắc không tim mạch 98 11.1 Đái tháo đường (tiểu đường) 98 11.2 Rối loạn chức tuyến giáp 98 11.3 Béo phì 99 11.4 Cơ thể suy nhược (fraily), suy kiệt (cachexia) giảm thiểu vân (sarcopenia) 99 11.5 Thiếu sắt thiếu máu .100 11.6 Rối loạn chức thận 100 11.7 Rối loạn điện giải: Kali máu thấp, kali máu cao, natri máu thấp, natri máu cao 100 11.8 Bệnh phổi mạn bệnh hô hấp liên quan đến giấc ngủ .101 11.9 Gút viêm khớp 102 11.10 Rối loạn cương dương .102 11.11 Trầm cảm 102 11.12 Ung thư 102 11.13 Nhiễm trùng .105 12 Các tình trạng đặc biệt 105 12.1 Thai kỳ .105 12.2 Các bệnh tim 107 12.3 Bệnh tim bẩm sinh người lớn .131 13 Quản lý suy tim mạn đa chuyên khoa (QLSTĐCK) 135 13.1 Phòng ngừa suy tim 135 13.2 Các mơ hình chăm sóc .135 13.3 Nguyên tắc thành phần Chương trình quản lý suy tim 135 13.4 Giáo dục sức khoẻ, tự chăm sóc thay đổi lối sống 136 13.5 Tập luyện phục hồi chức 137 13.6 Theo dõi bệnh nhân suy tim mạn tính 137 13.7 Theo dõi từ xa (TDTX) .138 TÀI LIỆU THAM KHẢO 139 DANH M C CÁC T T vi t t t Ti ng Anh 5- 5- VI T T T Ti ng vi t ACC H i Tim m ch h ACE- c ch - ACHD B n AF AHA Hi p h ANA - ANCA ARB Ch n th th - c ch - - ARVC BCT - B BCTDN - B BCTKLC Non-compaction cardyomyopathy Bệnh tim không lèn chặt - B BCTSLN - B BNP B- - i n nh p BTB C un it ic un i BTC C un it BTD C u n i t i quy BTR C u n i t i h i ph c BTT C un u nh c y ghép B nh tim thi - BUN - C CABG -A - c c u ch - CARE-HF Thi - - CHS CHT CK - C ng t - -HF HF B nh ph i m n t c ngh n CPAP - CR CRT tim CRT-D Li tim v kh CRT-P Li tim v t o nh p tim CSA CT Ch p c - DAPA-HF u DAPA-HF ECG Tu EF tt c c u th EHRA H i Nh p h c Châu Âu châu Âu - - ESC Hi p h i Tim m ch châu Âu FAC FHS u ph i h p FHS HFA-ESC H i tim m ch châu Âu - ) Suy tim v gi m nh Suy tim v o t n) tt o t n Suy tim v gi m) tt tt gi m cho h D - K tu c ut nh Không LGE nv LVAD Thi LVEF h th tt -CRT -CRT H tu c -FR -FR th - Nh NP i ni u N- NT- -B- - NYHA t c ngh n ng -HF u PEP-CHF RAAS c u PEP-CHF - tt - tt - - H th - RAFT RASi - u RAFT - c ch h - RATE-AF u RATE-AF REVERSE u REVERSE SAVR ng ph u thu t - S8 -HF - Ch t c ch nc ng v n chuy - SPECT single-photon emission CT Chụp xạ hình chùm đơn photon STC - Suy tim cấp STMMBC - Suy tim mạn bù cấp STPSTM - Suy tim với phân suất tống máu STS-PROM Society of Thoracic Surgeons Predicted Risk of Mortality Điểm STS-PROM TAPSE Tricuspid annular plane systolic excursion Vận động vịng van ba tâm thu TAVI Transcatheter aortic valve implantation Thay van ĐMC qua da Tc technetium Chụp xạ hình với technetium ƯCMC - Ức chế men chuyển ƯCTT - Ức chế thụ thể VEGF Vascular endothelial growth factor Yếu tố tăng trưởng nội mô mạch máu VNTMNT - Viêm nội tâm mạc nhiễm trùng VPB Ventricular premature beat Ngoại tâm thu thất WCD Wearable Cardioverter-Defibrillator Áo phá rung chuyển nhịp XL Extended release Phóng thích kéo dài DANH MỤC HÌNH ẢNH Hình Định nghĩa tồn cầu suy tim Hình Nồng độ peptide niệu trợ giúp chẩn đoán suy tim Hình Qui trình chẩn đốn suy tim Hình Qui trình điều trị suy tim phân suất tống máu giảm Hình Điều trị suy tim phân suất tống máu giảm dựa kiểu hình bệnh Hình Chẩn đoán STPSTM bảo tồn dựa vào tháng điểm HFA-PEFF Hình Bước (F): Trắc nghiệm chức trường hợp chẩn đốn khơng chắn Hình Qui trình điều trị suy tim nặng Hình Phân loại bệnh nhân suy tim nặng xác định thời gian chuyển tuyến Hình 10 Sơ đồ sinh lý bệnh suy tim cấp Hình 11 Sơ đồ chẩn đốn suy tim cấp khởi phát Hình 12 Xử trí suy tim bù cấp Hình 13 Xử trí bệnh nhân phù phổi Hình 14 Xử trí bệnh nhân suy thất phải đơn độc Hình 15 Xử trí bệnh nhân sốc tim Hình 16 Tiếp cận ban đầu suy tim cấp Hình 17 Điều trị lợi tiểu (furosemide) suy tim cấp Hình 18 Điều trị rung nhĩ bệnh nhân suy tim Hình 19 Điều trị nội khoa hội chứng mạch vành mạn bệnh nhân STPSTM giảm Hình 20 Xử trí bệnh nhận hẹp van ĐMC nặng kèm lưu lượng thấp độ chênh áp thấp Hình 21 Xử trí hở van hai thứ phát bệnh nhân suy tim giảm phân suất tống máu Hình 22 Xử trí bệnh nhân ung thư suy tim Hình 23 Xử trí bệnh nhân suy tim trước có thai Hình 24 Các giai đoạn bệnh tâm nhĩ Hình 25 MRI 4D giúp khảo sát dịng máu nhĩ bệnh nhân có rung nhĩ Hình 26 Lưu đồ quản lý suy tim nghi viêm tim Hình 27 Chẩn đốn điều trị suy tim bệnh amyloidosis Hình 28 Bệnh tim bẩm sinh bệnh mạn tính cần theo dõi điều trị suốt đời 10 28 van Veldhuisen DJ, Cohen-Solal A, Bohm M, Anker SD et al Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: data from SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) J Am Coll Cardiol 2009;53:2150-2158 29 Solomon SD, Claggett B, Lewis EF et al TOPCAT Investigators Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction Eur Heart J 2016;37:455-462 30 Solomon SD, McMurray JJV, Anand IS et al PARAGON-HF Investigators and Committees Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction N Engl J Med 2019;381:1609-1620 31 Solomon SD, Vaduganathan M, Claggett BL et al Sacubitril/valsartan across the spectrum of ejection fraction in heart failure Circulation 2020;141:352-361 32 Anker SD, Butler J, Filippatos G et al Empagliflozin in Heart Failure with a Preserved Ejection Fraction the EMPEROR-Preserved Trial n engl j med DOI: 10.1056/NEJMoa2107038 33 Cleland JGF, Bunting KV, Flather MD et al Beta-blockers for heart failure with reduced, midrange, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials Eur Heart J 2018;39:26-35 34 Shah SJ, Feldman T, Ricciardi MJ et al One year safety and clinical outcomes of a transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction in the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure (REDUCE LAP-HF I) Trial: a randomized clinical trial JAMA Cardiol 2018;3:968-977 35 Borlaug BA: Treatment and prognosis of heart failure with mid-range ejection fraction Uptodate 2021 36 Adelstein E, Saba SM Cardiac resynchronization therapy in heart failure: Indications Uptodate 2021 37 Borlaug BA Evaluation and management of heart failure with preserved ejection fraction Nat Rev Cardiol 2020;17:559-573 38 Kini V, Soufi MK, Deo R, et al Appropriateness of primary prevention implantable cardioverterdefibrillators at the time of generator replacement: are indications still met? 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