Bnh nhn n 57 tui, cch nhp vin 3 nm, pht hin cng gip, tng huyt p (cao nht l

150/80 mmHg) Bv Nguyn Tri, iu tr thuc (Concor, Thyrozole, Lexomil) lin tc 26

thng, triu chng ci thin, bnh nhn t b thuc 8 thng, Cch nhp vin 2 thng, bnh nhn
thy hi hp, nh trng ngc khi ngh ngi,leo cu thang ( 12 bc) th thy kh th 2 th phi
ngi ngh, b run u ngn tay bin nh, mi gi khi i b 100m, m hi nhiu, cm thy
nng nc, n ung bnh thng, i cu 2 ln / ngy phn vng st (trc khi khi bnh i cu 1
ln/ngy).
Cch nhp vin 3 tun, triu chng khng gim, bnh nhn chn n, ch ung sa, st cn 3kg,
mt ng-> Nhp vin Nguyn Tri.
Tnh trng lc nhp vin: (12/10)
M: 108l/ pht, Nhp th: 18 ln/pht, HA: 160/80mmHg, T: 37oC.
Cn nng: 46kg
Bnh nhn tnh, tip xc tt.
Da nim nht
Tim u nhanh
Phi trong, bng mm
ECG: nhp nhanh xoang 100 ln/ pht
- Chn on : Cng gip, tng huyt p, suy nhc c th
- iu tr
1/Dorocardyn (Propanolol) 40mg 1/2v (u)
2/Magdivix (Magnesi lactat dihdrat 470mg, Pyridoxin hydroclorid 5mg) 1v x2 (u) (C-T)
3/Bar 2v x2 (C-T)
4/Neopeptin(Alpha amylase) 1 v x2 (C-T
Calsid 1250mg 1v x2 (C-S)
Din tin t lc nhp vin n lc khm:
Gim mt, hi hp gim, n ung c
13/10 K+= 2,73 -> Kaleoride 0.6g 2v x2 (S-C)
14/10 mt ng Diazepam 5mg 1/2v (u) (T) Ngng Magdivix.
Thm Thyrozole(Thiamazole) 10mg 1v x3
Hin ti:
M: 100 l/p, HA: 120/80 mmHg, NT: 20l/p, T:37C
Nim hng nht
Da m, nng
Tuyn gip to II, lan ta , khng m thi, trn lng, mm, khng au, khng rung miu
Tim u r T1,T2, khng m thi
Run u chi bin nh, tn s cao
Du gh u (+)

Teo c thi dng

Phn x gn xng (+++)
nh mt long lanh, nhn chm ch, t chp mt.
Du Von Graefe(+)
Cn lm sng:
ECG : Nhp nhanh xoang tn s 110 ln/pht , trc trung gian 60
Sinh ha 13/10:
Glucose 5,18 mmol/l
Ure 4,3 mmol/l
Creatinin 45,5 umol/l
AST 32,3 U/l
ALT 22 U/l
Na 145,2 mmlol/l
K 2,73 mmol/l
Ca 2,39 mmol/l
Cl 106,6 mmol/l

FT3 > 30pg/ml (1,71-3,71)

FT4>6,18ng/dl (0,7-1,48)
TSH 0,01 mIU/ml (0,35-4,94)
1/ Cng thc mu:
WBC 6.09 k/ul
Neu: 2.4k/ul
Lym: 2.47k/ul
RBC: 4.05 M/ul
Hb: 10.9 g/dl Hct 33.7%
PLT: 291 k/ul
MCV 83.3 fl MCH :27pg MCHC 32.4g/dl
2/ 14/10 Siu m tim: chc nng tm thu tht tri bo tn
Siu m Tuyn gip 2 bn to, mt echo dy, km ng nht, tng sinh mch mu, khng tn
thng khu tr,
XQ (14/10) : quai c ch rng ,bong tikm to, 2 phi sang u
Chn on: Basedow gy tn thng mt 1 theo werner