Pre- ventricular contractions/ palpitations /Trigeminy are common to occur in pregnancy. Pregnancy is a hyprevolemic state.

It puts a new stress on the heart that may bring out a tendency for rapid heart action that was not manifest prior to pregnancy. The stroke volume of heart increases which is the cause. Also under the influence of progesterone the heart can beat irregularly occasionally. So it is a normal thing in pregnancy which can be ignored. But if the palpitations are accompanied with dizziness or shortness of breath or any past history of cardiac problem, It needs to be addressed immediately. It is better to avoid coffee, tea, alcohol and cigarettes.This can also can also bring on palpitations.

Ngoi tm thu tht l mt trong nhng ri lon nhp hay gp ph n mang thai. Khi mang thai, c th ph n c nhiu thay i v ni tit, tun hon... lm tng gnh nng ln tim v h tun hon. Hormon progesteron lm tim p nhanh hn bnh thng. NTT ph n mang thai thng l lnh tnh v khng cn iu tr. Trn EKG ca bnh nhn ny c NTT tht tha, ting thi nh mm c th l tng lu lng khi mang thai v c th c thiu mu, Xt nghim: - XN c bn - Siu m tim=> pht hin tn thng thc th - Holter in tim 24h(khng bit c cn khng???) Nn khuyn bnh nhn trnh xa c ph, thuc l v ru ,tp th dc u n hn ch c s xut hin ca ngoi tm thu. Ngoi tm thu cn iu tr khi c cc du hiu cnh bo nh - Triu chng c nng dn dp: nh trng ngc,chng mt,kh th, au ngc,. - Bnh nhn c tin s bnh tim

- NTT dy, nhp i,nhp ba,tng chm, a Th nht, em cn bit mt khi nim gi l hi chng vnh cp (Acute coronary syndrome - ACS). Cu hi l: 1. Mt bnh nhn c du hiu g th c chn on ACS? 2. ACS c chia lm nhng nhm no? Khi nim v tng vn . nh hng lm sng. Trong cc nhm ca ACS, em s gp tng i nhiu bnh nhn nhm nhi mu c tim ST chnh ln (STEMI). Cu hi l: 3. Nhng hnh nh tn thng gp trong nhi mu c tim. Hnh nh no xut hin sm, hnh nh no xut hin mun hn. 4. Tiu chun chn on STEMI trn in tm . Th hai, v chn on nh khu, n da vo ti mu ca tun hon vnh cho cc vng c tim. Cu hi l: 5. n tp li ti mu ca tun hon vnh. 6. 12 chuyn o trn in tm quan st c nhng vng no ca ca qu tim. T suy ra cch nh khu. Tm li, cch lm vic trn lm sng ch c 1 vi bc: 1. BN ny ti c ngh ti NMCT khng? 2. Nu ngh ti NMCT ti s cho lm g tip theo? 3. Khi c kt qu, ti nh gi bnh nhn ny c nguy c thp hay cao l mc NMCT? 4. Thi x tr tip theo ca ti?
HI CHNG NG MCH VNH CP I. NH NGHA V SINH L BNH HC

Va x ng mch l mt bnh mn tnh vi nhng t tin trin cp tnh m khi , c th c nhng biu hin lm sng, in hc v sinh ha khc nhau (cn au tht ngc khng n nh, nhi mu c tim (NMCT) cp vi sng Q xuyn thnh, NMCT cp khng c sng Q hay NMCT di ni tm mc). Nhng biu hin ny hin nay c gi di mt tn chung l Hi Chng ng Mch Vnh Cp (HCMVC) v chng u c chung mt c s sinh l bnh hc: s nt hoc v ca cc mng va x trn thnh MV (MV), gy hp hoc tc lng mch v s hnh thnh cc mu ng lm hp, tc lng mch nhiu hn na. HCMVC c chia thnh 2 nhm: HCMVC vi ST khng chnh v HCMVC vi ST chnh ln trn in tm . II. PHN LOI 1. HI CHNG NG MCH VNH CP VI ST KHNG CHNH LN C 2 th: A. au tht ngc khng n nh - Cn gi: cn au tht ngc din bin mi (angor de novo), au tht ngc gia tng (angor de crescendo), au tht ngc t pht, khng c iu kin thun li thc y, khi pht cn au (angor spontan), hi chng e da - in tm lc ngh c th khng thay i. - Men CK-MB, troponin T, Ic khng tng (c tim khng hoi t). B. Nhi mu c tim cp vi ST khng chnh ln - Lm sng: au tht ngc hoc au ngc khng gii thch c nguyn nhn, nn, bun nn, kh th, mt mi, xu hoc ngt - in tm (T): ST chnh xung hoc sng T m - Tng troponin Ic hoc T, tng CK ton phn trn 2 ln so vi bnh thng v CK-MB tng trn 6%. 2. HI CHNG NG MCH VNH CP VI ST CHNH LN Do tc nghn hon ton mt nhnh chnh ca MV. Can thip ti ti mu c tim (bng thuc tiu si huyt hoc nong v t stent MV) nn tin hnh cng sm cng tt. Chn on xc nh da trn 3 du hiu: - au tht ngc ko di >20 pht - ST chnh ln t nht 2 chuyn o k tip nhau trn T (> 1 mm cc chuyn o ngoi bin v > 2 mm cc chuyn o trc tim) - Cn au v ST khng thay i hoc ch thay i rt t khi dng nitroglycerin. Nu khng iu tr, sau 4-6 gi, c tim s hoi t v cc men troponin Ic hoc T, CK-MB s tng v sng Q xut hin trn T (NMCT xuyn thnh). Nu cn au tht ngc khng n nh ko di kt hp vi blc nhnh tri trn T th cng nn coi y l mt HCMVC vi ST chnh ln. TS. T Mnh Cng