U-Angina Ngezingqimba ZaseCoronary Normal
I-Cardiac Syndrome X, noma i-angina ezincane ezincane, itholakala uma umuntu e- angina , enobufakazi be- ischemia yenhliziyo ekuhlolweni kokucindezeleka , kodwa nge- aronic corneary-artery in the heart of catheterization . Ezikhathini eziningi, i-angina encane ye-microvascular ibangelwa ukukhubazeka kwamagatsha amancane emithanjeni ye-coronary lapho lezi zitsha ezincane zingaphumeleli khona ngokujwayelekile, ngaleyo ndlela zikhiqize ukungabi khona kwegazi ukugeleza kwenhliziyo.
Njengoba le nkinga manje icatshangwa ukuthi iyindawo yangasese emithanjeni encane, igama elidala le-X syndrome syndrome X liye laxhaswa ngegama elichazayo, i-angina ezincane. Kodwa-ke, ngokuphawulekayo, abanye ochwepheshe bakholelwa ukuthi abantu abanalo mkhuba bangase babe nokuzwela okungavamile ebuhlungu besisu senhliziyo.
Ama-angina ezincane ezincane zivame kakhulu kubantu besifazane (ngokuvamile, abesifazane base-postmenopausal) kunamadoda. Kunezimbangela eziningana ezibangelwa ukukhubazeka komthamo omncane okucatshangwa ukuthi ukhona nge-angina ezincane, okufaka ukungavumi kwe-insulin , ukuvuvukala, ukwanda komsebenzi we-adrenalin, ukuntuleka kwe-estrogen, ne- dysautonomia . Kungenzeka ukuthi iziguli ezahlukene ezine-angina ezincane zingase zibe nezimbangela ezihlukile.
Ngenkathi abantu abaningi abane-angina ezincane ezinomzimba ezincane behlaselwa kahle - ngokuthi ingozi ye -coronary syndrome eyingozi ebangelwa i-angina ezincane ezincane kakhulu - akuyona into engavamile ukuba ubuhlungu besifuba obuvezwa yile mkhuba kube yinto ebalulekile, futhi ekhubaza ngezinye izikhathi.
Ukwelapha i-Angina Microvascular
Noma nini lapho ubona uhlu olude lwezokwelapha okungenzeka kunesinye isimo sezokwelapha, kuyisibonakaliso sokuthi ukwelapha leso simo kungase kube nzima. (Cishe, yingakho ukwelashwa okuningi sekuye kwahlolwa kuqala.) Kunjalo nangama-angina ezincane.
Imithi eminingi itholakale ilusizo okungenani iziguli ezithile ezine-angina ezincane.
Kodwa-ke, ekutholeni ukwelashwa okungcono kakhulu kunoma yimuphi umuntu onikeziwe, indlela yokuvivinya nephutha idingeka njalo. Lokhu kusho ukuthi bobabili abanenkinga ye-angina ye-microvascular kanye nodokotela kungadingeka ukuba babe nesineke futhi bephikelela ukuze bathole ukwelashwa okulungile.
Nasi uhlu lwezokwelapha ezivame ukusetshenziselwa ukwelapha ama-angina ezincane ezincane:
Izidakamizwa ze-Angina zendabuko -
- Abavimbela i-Beta - ikakhulukazi i-atenolol
- Abavimbela isiteshi se-Calcium
- I-Nitrate - i-nitroglycerin engamabhalana ngokuvamile ikhulula i-angina enamandla ngama-angina ezincane, kodwa ama-nitrate asebenza isikhathi eside awazange aboniswe njengenzuzo
Izidakamizwa ezingekho zendabuko ze-Angina -
- I-Ranolazine - iphumelele kakhulu ezinkulweni ezincane zemitholampilo
- ACE inhibitors - ikakhulukazi ezigulini ezinegazi eliphakeme
- I-Ivabradine - iphinde iphumelele ezinkulweni ezincane zemitholampilo
- Izitatimende - ikakhulukazi ezigulini ezinezinga eliphezulu le-cholesterol
- Estrogens - emadodeni ase-post-menopausal
- I-imipramine - hhayi i-angina izidakamizwa, kodwa ingaba ngempumelelo ngokulawula ubuhlungu
- l-arginine - kungasiza ekubuyiseni ukuvuthwa okujwayelekile kwemithwalo yegazi encane
- I-Sildenafil (i-Viagra) - engafundanga kahle nge-angina encane, kepha ingase iphumelele kwabanye abantu
- I-Metformin - ukwesekwa kwalesi sidakamizwa ekunakekeleni i-angina ezincane ezincane kuyisimo se-anecdotal, futhi akuqinisekisiwe ngemininingwane yomtholampilo.
Ukwelapha Okungeyona Imithi -
- I-EECP - iboniswe esifundweni esisodwa esincane ukuze sisebenze nge-angina encane
- Ukuvuselela intambo yomgogodla - kuboniswe ukuthi kuyasiza kwezinye iziguli lapho ukwelashwa kwezidakamizwa kwehlulekile.
- Ukuqeqeshwa kokuzivocavoca bekuye kwaba usizo kakhulu, ikakhulukazi ezigulini ezithandwayo.
Indlela Ejwayelekile Yokunakekelwa Kwe-Microvascular Angina
Njengoba kunikezwe zonke lezi zindlela, izazi zezinhliziyo eziningi zizozama ukwandisa ukwelashwa kwama-angina ezincane ngokusebenzisa indlela ehlakaniphile. Uma ukulawula okwanele kwezimpawu kungatholakali nganoma yisiphi isinyathelo esinikeziwe, udokotela nesiguli sizoqhubeka nesinyathelo esilandelayo.
- Isinyathelo soku-1 sivame ukusebenzisa i-nitroglycerin engezansi ukuze kunqunywe izimpawu lapho kwenzeka khona. Uhlelo lokuqeqeshwa ngokomzimba luvame ukuphakanyiswa kakhulu njengengxenye yesinyathelo sokuqala. Uma lesi sinyathelo singanikezi ukuphumula okwanele:
- Isinyathelo sesibili sivame ukwengeza ibhukhakhi ye-beta.
- Isinyathelo sesi-3 sivame ukumisa ukuvimba kwe-beta bese ufaka indawo yokuvimba isiteshi se-calcium.
- Isinyathelo sesi-4 sivame ukuzama i-ranolazine, noma yedwa noma ne-beta blocker noma i-calcium blocker.
- Isinyathelo sesi-5 ukucabangela ezinye izidakamizwa noma ukwengeza ukwelashwa okungewona okwelapha izidakamizwa, ngokugqugquzela umgogodla noma i-EECP.
Ngaphezu kokuthatha izinyathelo ezinjengalezi, i-ACE inhibitor nayo kufanele icatshangwe ngokuqinile uma i-hypertension ikhona, kanti nesimiso kufanele sithathwe ngokucophelela uma kunezici ezingozini zezokwelapha ze- coronary artery nazo ezikhona. Kulabo besifazane abasandula ukuhlinzwa kwegazi, isrogen yokwelashwa kungase kudingeke ukucabange kanjalo.
Ngesineke-mhlawumbe ukubekezela okuhle - ukulawulwa okwanele kwezimpawu ekugcineni kungatholakala kubantu abaningi abanengculaza encane. Futhi ngenkathi uthuthuka ngokusebenzisa lezi zinyathelo, abantu abane-angina ezincane ezincane kufanele bahlale bekhumbula ukuthi ukuguqulwa kwabo isikhathi eside kulungile kakhulu.
> Imithombo:
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> Eriksson BE, uTyni-Lennè R, uSvedenhag J, et al. Ukuqeqeshwa Kwemvelo E-Syndrome X: Ukuqeqesha Ngokwenyama Ukunciphisa Ukunciphisa Nokubuhlungu Ku-Syndrome X. J Am Coll Cardiol 2000; 36: 1619.
> Kaski JC. I-Pathophysiology and Management of Iziguli ezine-Chest Pain ne-Normal Coronary Arteriograms (I-Cardiac Syndrome X). Ukujikeleza kuka-2004; 109: 568.
> Mehta PK, Goykhman P, Thomson LE, et al. I-Ranolazine Ithuthukisa i-Angina yabesifazane ngokufakazela ukuthi i-Myocardial ischemia kodwa ayikho isidingo sokuvimbela izifo ze-coronary artery. I-JACC Cardiovasc Imaging 2011; 4: 514.
> Amalungu e-Task Force, i-Montalescot G, iSechtem U, et al. Imihlahlandlela ye-ESC ka-2013 ekuphathweni kwe-Stable Coronary Artery Disease: i-Task Force ku-Management of Stable Coronary Artery Disease ye-European Society of Cardiology. I-Eur Heart J 2013; 34: 2949.