HỘI CHỨNG TIM THẬN THIẾU máu

20. JoAnn E Manson, Matthew A. Alllison, Jacques E.Rosouw (2007). Estrogen therapy and
coronary artery calcification. The New England Journal of medicine. 356(25): 2591-
2602.
HI CHNG TIM THN THIU MÁU

Nguyễn Hùng, Nguyễn Thị Phòng
Đặng Anh Đào, Nguyễn Thị Thủy


SUMMARY
CARDIO RENAL ANEMIA SYNDROME
The interactione between chronic heart failure, chronic kidney insufficiency and anemia,
form a vicious cycle, term as the cardio renal anemia syndrome. The interaction between these
three conditions causes deterioration of the cardiac and renal function and increases anemia.
Each of three can cause or be caused by the others.
Many patients with congestive heart failure (CHF) fail to respond to maximal CHF therapy
and progress to end stage CHF with many hospitalizations, poor quality of life, progressive
chronic kidney disease (CKD) which can lead to end stage kidney disease (ESKD), or die of
cardiovascular complications within a short time. One factor that has generally been ignored in
many of these people is the fact that they are often anemic. The anemia in CHF is due mainly to
the frequently-associated CKD but also to the inhibitory effects of cytokines on erythropoietin
production and on bone marrow activity. Anemia itself may further worsen cardiac and renal
function and make the patients resistant to standard CHF therapy. Anemia in CHF has been
associated with increased severity of CHF, increased hospitalization, worse cardiac function and
functional class, the need for higher doses of diuretics, progressive worsening of renal function
and reduced QoL. Correction of the anemia with has been associated with improvement in many
cardiac and renal parameters and an increased QoL. Anemia, CHF and CKD interact as a vicious
circle so as to cause or worsen each other- the so-called cardio renal anemia syndrome. Only
adequate treatment of all three conditions can prevent the CHF and CKD from progressing.

I. 









             Renal Anemia








-


máu  


SUY TIM
SUY THẬN
TỦY XƯƠNG THIẾU MÁU
Co mạch
Giảm sản xuất hồng cầu
Giảm tưới máu
Hoạt hóa hệ RAAS

Tăng trương lực giao cảm
Điều trị ức chế men chuyển
Tăng TNF α
Giảm tưới máu
Suy dinh dưỡng
Đề kháng EPO
Thiếu máu cục bộ
Apoptosis
Phì đại thất trái
Tăng trương lực giao cảm
Pha loãng máu
Giảm tương đối EPO
TNF: yếu tố hoại tử u
EPO: erythropoietin
RAAS: renin angiotensin aldosterone system







Thiếu máu
Tổn thương thận
Tăng hoạt hệ RAA
Giảm oxy tổ chức
Giãn mạch ngoại biên
Giảm huyết áp
Tăng hoạt hệ giao cảm
Giảm lưu lượng máu thận

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
 -Angiotensine-Aldosterone và

  
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
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 
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


Trên n
                


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 
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
 Phosphate - PTH



-
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
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
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

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


             

 

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 
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





tr

            



                
-
         

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

                




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