1. Coronary artery disease (CAD), also known as ischemic heart disease, is caused by the narrowing of the coronary arteries due to atherosclerosis. Risk factors include smoking, hypertension, diabetes, and high cholesterol. 2. Symptoms of CAD include chest pain and shortness of breath. Left untreated, CAD can lead to damage of the heart muscle, arrhythmias, heart attack, or heart failure. 3. Diagnosis of chronic CAD involves medical history, physical exam, electrocardiogram, stress tests, coronary angiography, CT angiography, and cardiac MRI to evaluate the heart and blood flow in the coronary arteries.

1. BEÄNH ÑM VAØNH
PGS. TS. BS Tröông Quang Bình
Phoù CN boä moân Noäi Toång Quaùt
Tröôûng khoa tim maïch BV ÑHYD

2. Ñònh nghóa
• Tình traïng thieáu maùu cô tim do heïp loøng
ñoäng maïch vaønh do xô vöõa ÑM.
• Caùc teân goïi khaùc: Thieáu maùu cô tim cuïc boä,
thieåu naêng vaønh, suy ñoäng maïch vaønh.

3. Giaûi phaåu ÑM vaønh tim

4. Giaûi phaãu ÑM vaønh tim

5. Intimal thickening
Extralipid pool
Fibrous scar
Nguyeân nhaân sinh beänh: XVÑM

6. Intimal thickening
Lipid core
Fibrous cap
Maõng xô vöõa gaây heïp loøng ñoäng maïch vaønh

7. Plaque rupture
Occlusive
thrombus
Vôõ maõng xô vöõa:
gaây taéc ngheõn loøng ñoäng maïch vaønh

10. 10 naêm ñaàu Töø 30 naêm Töø 40 naêm Töø 50 naêm
NMCT Beänh maïch
ngoaïi bieân Ñoät quò
Roái loaïn chöùc naêng noäi maïc
Phoøng ngöøa
tieân phaùt
Phoøng ngöøa
thöù phaùt
Kieåm soaùt caùc yeáu toá nguy cô
Caùc teá
baøo boït
Veät môõ
Toån
thöông
trung gian
Maûng xô
vöõa
Toån thöông gaây bieán
chöùng
Pepine CJ. Am J Cardiol. 1998;82(suppl 10A):23S-27S.

11. NGUYEÂN NHAÂN
• * Chuû yeáu laø do xô vöõa ñoäng maïch gaây ra.
• * Caùc yeáu toá nguy cô cuûa beänh ÑM vaønh:
- Taùc ñoäng ñöôïc: huùt thuoác laù, taêng HA, roái
loaïn môõ maùu, ñaùi thaùo ñöôøng, beùo phì
- Khoâng taùc ñoäng ñöôïc: phaùi nam, tuoåi cao,
tieàn söû gia ñình …

12. Toång quan veà yeáu toá nguy cô
beänh ÑM vaønh
Bieåu hieän laâm saøng:
Beänh ñoäng maïch vaønh
Beänh maïch maùu naõo
Beänh ñoäng maïch ngoïai
bieân
YTNC khoâng thay ñoåi
ñöôïc
Tuoåi
Giôùi nam
Chuûng toäc
Tieàn caên gia ñình coù
BMV/Ñoät quò
YTNC thay ñoåi ñöôïc
Huùt thuoác laù
Cheá ñoä aên
Loái soáng
Nghieän röôïu
Beùo phì
Beänh ÑM caûnh
Rung nhó
THA
ÑTÑ
RL lipid maùu
Goldstein LB et al. Stroke. 2001;32:280-299.
Vöõa xô
ñoäng maïch

13.  Unmodifiable risk factors for stroke include advancing age,
male sex, Black and Hispanic race–ethnic background, and
family history of stroke.1
 Modifiable risk factors for stroke include lifestyle modification,
such as smoking cessation, improved diet, moderate physical
exercise, reducing excessive alcohol intake, and cessation of
drug abuse. Weight reduction may also be recommended.1
 Patients’ risk of stroke may be modified by pharmacologic
therapies targeting risk factors. These therapies may include
antiplatelet agents, anticoagulants, antihypertensive therapies,
antidiabetic medications, or lipid-lowering (statins), as
appropriate.1
 In some patients, carotid endarterectomy may be
recommended.1

14. Sinh lyù beänh TMCB:
Coronary equation
Heart rate
SBP
LVEDV
Wall
thickness
Contractility
Blood flow
O2 content

15. Sinh lyù beänh:
Ischemia and stenosis
PlaqueIschemic zone

16. Haäu quaû
cuûa thieáu maùu cô tim cuïc boä
 Ñau ngöïc
 Giaûm chöùc naêng co boùp cuûa tim
 Roái loïan nhòp nguy hieåm
 Cô tim chuaån bò tröôùc (preconditioning)
 Cô tim choùang vaùng (stunning)
 Cô tim nguû ñoâng (hibernating)
 NMCT

17. NMCT caáp: ñau ngöïc döõ doäi

18. Giaûi phaãu beänh NMCT caáp

19. NMCT thaønh sau

20. NMCT cuõ thaønh sau vaø NMCT caáp
thaønh tröôùc

21. NMCT thaønh beân

22. THEÅ LAÂM SAØNG
• * Beänh ÑM vaønh maïn tính
• * Thieáu maùu cô tim yeân laëng
• * Hoäi chöùng X
• * Ñau thaét ngöïc bieán thaùi
• * Hoäi chöùng maïch vaønh caáp

23. Chaån ñoaùn beänh ÑM vaønh maïn tính.
* TC laâm saøng
* Ñieän taâm ñoà
* Sieâu aâm tim
* ECG gaéng söùc
* SAÂT gaéng söùc
* Xaï hình tim
* CT ña lôùp caét
* Chuïp coäng höôûng töø
* Chuïp ÑM vaønh caûn quang

24. TC laâm saøng: ñau thaét ngöïc

25. Khaùm tim

26. Ño ñieän tim

27. Exercise
Stress
Test
ECG
gaéng söùc

28. Treadmill protocol

29. Nghieäm phaùp gaéng söùc

30. NPGS döông tính

32. Sieâu aâm tim

33. Stress
echocardiography

34. Stress echocardiography

35. Non invasive test for CAD

36. Nuclear cardiology

43. Regional contractility
Visual qualitative assessment

47. Base
5 µg
10 µg
Recovery

48. Visual analysis
Slope of curve/segment
MRI
Flow/segment
TEP
Time/signal curves
Perfusion imaging
quantitative analysis

49. CoroIRM
Left main and
LCX stenoses
RCA stenosis

50. Angiogram MRI reconstruction

51. Coronary artery MRI

52. MRI
• MRI is the only imaging method providing
– Precise quantification of left and right ventricular dimensions
– Evaluation of global and regional left and right ventricular
function
– Detection of myocardial ischemia and viability
– Visualization of coronary arteries and bypass grafts
– Exclude severe coronary disease

53. Chuïp ÑM vaønh

54. Chuïp ÑM vaønh

55. Chuïp ÑM vaønh

67. Keát luaän
• * Beänh ÑM vaønh: phoå bieán, traàm troïng.
* YTNC beänh ÑM vaønh, nguyeân nhaân.
* Sinh lyù beänh: caùn caân cung – caàu.
* Theå laâm saøng beänh ÑM vaønh.
* Laâm saøng beänh ÑM vaønh
* Caùc phöông tieän chaån ñoùan beänh ÑM
vaønh.

68. Chaân thaønh caùm ôn söï theo doõi cuûa quyù vò