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Hẹp 2 lá (tt) (INDICATIONS FOR INTERVENTION (Tổng quan: https…

- - - - Trước khi có anticoagulant therapy & surgical treatment, 30% BN MS bị thuyên tắc
      - combined therapy (dùng thêm antiplatelet) ko có ý nghĩa thống kê so với dùng đơn thuần anticoagulation
      - Uptodate recommends use of warfarin or heparin in adults with MS when anticoagulation is needed because patients with significant mitral valve disease were excluded from the trials of these newer agents (dabigatran)
  - - - limited.
        
        cải thiện triệu chứng, huyết động prior to intervention, for persistent symptoms after intervention, and for management of symptoms precipitated by an intercurrent illness or during pregnancy
    - - thích hợp khi có các TC sung huyết phổi: khó thở gắng sức, khó thở khi nằm, khó thở kịch phát về đêm; các TC suy tim: sung huyết gan, phù ngoại biên
        
        Loop diuretics acutely improve such manifestations of the congestive state
    - - heart rate control (in patients in atrial fibrillation or sinus rhythm) and to improve dyspnea, (though their effect on exercise tolerance is uncertain)
      - significantly decrease heart rate and cardiac output at rest, causing a decrease in the transmitral gradient,
        pulmonary venous pressure, and mean pulmonary artery pressure in patients with MS
      - can blunt the heart rate and cardiac output responses to exercise, while attenuating the rise in transmitral gradient that normally occurs
    - - limited since most patients have preserved ventricular systolic function
      - may be helpful in selected patients who have symptomatic left and/or right ventricular systolic dysfunction as in patients with other causes of systolic heart failure
        may also be helpful in controlling a rapid ventricular rate
        during AF, although it should not be considered a first-line drug for this indication
- - - - Nếu dấu hiệu SÂ & LS chỏi nhau -> Làm SÂ gắng sức để đánh giá gradient 2 lá & áp lực ĐMP