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Bài giảng Điều trị nội khoa sau can thiệp ĐMV: các biện pháp giúp điều trị tối ưu và toàn diện - PGS. TS. Phạm Nguyễn Vinh

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Bài giảng Điều trị nội khoa sau can thiệp ĐMV: các biện pháp giúp điều trị tối ưu và toàn diện do PGS. TS. Phạm Nguyễn Vinh biên soạn trình bày các nội dung chính sau: Chăm sóc lâu dài sau tái lưu thông ĐMV; Điều trị bằng thuốc lâu dài sau tái tưới máu cơ tim;... Mời các bạn cùng tham khảo để nắm nội dung chi tiết.

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Nội dung Text: Bài giảng Điều trị nội khoa sau can thiệp ĐMV: các biện pháp giúp điều trị tối ưu và toàn diện - PGS. TS. Phạm Nguyễn Vinh

  1. Điều trị nội khoa sau can thiệp ĐMV: các biện pháp giúp điều trị tối ưu và toàn diện PGS. TS Phạm Nguyễn Vinh Bv tim Tâm Đức Viện Tim TP.HCM ĐH Y Khoa Phạm Ngọc Thạch ĐH Y Khoa Tân Tạo 1
  2. Đt nội khoa sau can thiệp ĐMV 2018 TL: Thygesen K et al. Fourth universal definition of myocardial infarction 2018. European Heart Journal (2018) 00, 1–33. doi:10.1093/eurheartj/ehy462 2
  3. Đt nội khoa sau can thiệp ĐMV 2018 TL: Thygesen K et al. Fourth universal definition of myocardial infarction 2018. European Heart Journal (2018) 00, 1–33. doi:10.1093/eurheartj/ehy462 3
  4. Đt nội khoa sau can thiệp ĐMV 2018 Type 2 MI: Clinical context and pathophysiological mechanisms TL: Thygesen K et al. Fourth universal definition of myocardial infarction 2018. 4 European Heart Journal (2018) 00, 1–33. doi:10.1093/eurheartj/ehy462
  5. Đt nội khoa sau can thiệp ĐMV 2018 Diagnostic test flow chart in MINOCA. (MINOCA = Myocardial Infarction with Non-Obstructed Coronary Arteries) 1 • Provocative testing for coronary artery spasm might be considered in selected patients with a recent AMI with suspected vasospastic angina. Provocative manoeuvres have to be always performed by operators with experience and not necessarily in the acute phase of STEMI. 2 • Clinically suspected myocarditis by ESC Task Force criteria = No angiographic stenosis ≥50% plus non ischemic pattern on CMR. Definite myocarditis by ESC Task Force criteria = No angiographic stenosis ≥50% plus endomyocardial biopsy confirmation (histology, immunohistology, polymerase- chain reaction based techniques to search for genome of infectious agents, mainly viruses). OCT = Optical Coherence Tomography; IVUS = IntraVascular UltraSound TL: Ibanez B et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST- segment elevation. eurheartj/ehx393. Sept 16, 2017 5
  6. Đt nội khoa sau can thiệp ĐMV 2018 Diagnostic test flow chart in MINOCA (1) TL: Ibanez B et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. eurheartj/ehx393. Sept 16, 2017 6
  7. Đt nội khoa sau can thiệp ĐMV 2018 Diagnostic test flow chart in MINOCA (2) TL: Ibanez B et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. eurheartj/ehx393. Sept 16, 2017 7
  8. Đt nội khoa sau can thiệp ĐMV 2018 Diagnostic test flow chart in MINOCA (3) TL: Ibanez B et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. eurheartj/ehx393. Sept 16, 2017 8
  9. Đt nội khoa sau can thiệp ĐMV 2018 9
  10. Đt nội khoa sau can thiệp ĐMV 2018 Syntax score 6 months Các điểm Radial access NOAC DES mới của Systemic re-evaluation Stabilised NSTE-ACS khuyến cáo radial artery grafts Pre- and post-hydration Dabigatran 150-mg 2018 LVEF ≤35% CABG preferred TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 10
  11. Đt nội khoa sau can thiệp ĐMV 2018 Indications for revascularization in patients with stable angina or silent ischaemia FFR = fractional flow reserve; iwFR = instantaneous wave-free ratio. (a) Class of recommendation; (b) Level of evidence; (c) With documented ischaemia or a haemodynamically relevant lesion defined by FFR
  12. Đt nội khoa sau can thiệp ĐMV 2018 Decision-making between PCI and CABG among patients with stable multivessel and/or left main CAD DAPT = dual antiplatelet therapy; LIMA = left internal mammary artery; RIMA = right internal mammary artery; MVD = multivessel coronary artery disease; RA = radial artery; SYNTAX = Synergy between Percutaneous Coronary Intervention with TAXUS and SYNTAX score ≥23 SYNTAX score 0-22 Cardiac Surgery; (a) Consider no-touch off-pump CABG in case of porcelain aorta. TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 12
  13. Đt nội khoa sau can thiệp ĐMV 2018 Selection of non-ST-elevation acute coronary syndrome treatment strategy and timing according to initial risks tratification Cardiogenic shock GRACE score >140 TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. 13 European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394
  14. Đt nội khoa sau can thiệp ĐMV 2018 Modes of patient’s medical contact, components of ischaemia time, and flow chart for reperfusion strategy selection. TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 14
  15. Đt nội khoa sau can thiệp ĐMV 2018 Primary PCI for myocardial reperfusion in STEMI: procedural aspects (strategy and technique) TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 15
  16. Đt nội khoa sau can thiệp ĐMV 2018 Algorithm for the management of patients with cardiogenic shock TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 16
  17. Đt nội khoa sau can thiệp ĐMV 2018 Intracoronary imaging for the assessment of stent failure TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 17
  18. Đt nội khoa sau can thiệp ĐMV 2018 Recommendations for the prevention of ventricular arrhythmias by revascularization TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 18
  19. Đt nội khoa sau can thiệp ĐMV 2018 Recommendations for the prevention and treatment of AF in the setting of myocardial revascularization TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 19
  20. Đt nội khoa sau can thiệp ĐMV 2018 Technical aspects of CABG BIMA = bilateral internal mammary artery; CABG = coronary artery bypass grafting; IMA = internal mammary artery; LAD= TL: Neumann FJ at al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal left anterior descending (2018) 00, 1–96. doi:10.1093/eurheartj/ehy394 coronary artery 20
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