Izinhlobo ezintathu eziphuthumayo ze-aron coronary
Uma wena noma othandekayo enesifo se- coronary artery (CAD) , kungenzeka ukuthi uzwile igama elithi "acon coronary syndrome," elibizwa nangokuthi i-ACS. I-ACS yigama elisha elisha elisetshenziselwa izazi ze-cardiologists, futhi kungaba ukudideka okuncane. Noma kunjalo, ngoba limelela indlela entsha yokucabanga nge-CAD , kungaba usizo ukuthatha imizuzu embalwa ukuyiqonda.
I-coronary syndrome enhle kakhulu kunalokho okuzwakalayo.
Yisimo esiphuthumayo esithinta imishanguzo ye-coronary; okuphuthumayo. Kubonisa ukuthi i-CAD yomuntu ivele ingahlali kungazelelwe, futhi umonakalo ohlala unomphela we-cardiac kungenzeka okwamanje noma kungenzeka kwenzeke nganoma yisiphi isikhathi.
Kuyini i-ACS?
I-ASC iyenzeka uma i-clot yegazi idala ngokungazelelwe ngaphakathi komshini we-coronary , ngokuvamile ngenxa yokuphuka okuphawulekayo kwesikhala se- atherosclerotic . Ukuphuka kwe-plaque kungenzeka nganoma yisiphi isikhathi, kaningi ngokugcwele ngaphandle kwesixwayiso. I-clot yegazi ingabangela ukuvinjelwa okuncane noma okuphelele kwe-artery, noma ngabe iyiphi indlela yokubeka imisipha yenhliziyo ehlinzekwa yilo mshini ngesikhathi esengozini.
Noma yikuphi ukubekwa kunoma iyiphi i-artery coronary kungase kuphele, ngisho nezinsika ezincane ngokuvamile ezinganakwa yizinhliziyo ze-cardiacists ngesikhathi se- catheterizations zenhliziyo . Yingakho uzovame ukuzwa ngabantu abane- infarction ye-myocardial (MI, noma ukuhlasela kwenhliziyo), kungekudala ngemuva kokutshelwa i-CAD yabo "engabalulekile."
Izimpawu ze-ACS
Izimpawu ze-ACS zifana nezama-angina azinzile kepha ngokuvamile zivame kakhulu, zivame njalo ziphikelela. Ukungajabuli esifubeni ku-ACS kuvame ukuhambisana nezinye izimpawu eziphazamisayo ezifana nokujuluka, isizungu, isicashu, ukukhathazeka ngokweqile, nokuthi yini evame ukuchazwa ngokuthi "umuzwa wokulahlwa okuzayo". Ubuhlungu besifuba angeke buhlolwe yi- nitroglycerin (okuvame ukukhulula ama-angina azinzile).
Ngakolunye uhlangothi, abanye abantu abane-ACS bayoba nezibonakaliso ezimbalwa kuphela, bangase bahluleke ukuphawula noma yiziphi izimpawu - okungenani kuqala.
Ngeshwa, ukulimala kwenhliziyo okungapheli okuvame ukuphumela ku-ACS kuyokwenza, ngokushesha noma kamuva, ukuveza izimpawu.
Izinhlobo ze-ACS
I-cardiologists ihlukanisa i-ACS emaphethini omtholampilo amathathu. Amabili azo amele izinhlobo ezahlukene ze-MI, kanti enye imelela uhlobo olunzima kakhulu lwe-angina, okuthiwa "angina engazinzile." Yonke emithathu ibangelwa ama-blood clots ajwayelekile emithanjeni ye-coronary.
Uma i-clot yegazi inkulu ngokwanele futhi iphikelela okungaphezu kwamaminithi ambalwa nje, amanye amaseli e-muscle yehliziyo aqala ukufa. Ukufa kwemisipha yenhliziyo yilokho okuchaza i-MI. Izinhlobo ezimbili ze-MI ezingakhiwa yi-ACS.
- I-ST-Elevation infyoction infarction (STEMI) , okuthiwa ngenxa yokuthi "isigaba se-ST" ku- ECG ivela "ephakanyisiwe," kwenzeka lapho umthambo we-coronary uvinjelwe ngokuphelele ukuze ingxenye enkulu yensizwa yenhliziyo ihlinzekwe yilo mshini uqala ukufa I- STEMI ifomu elibi kakhulu le-ACS.
- Ukungena kwe-ST-Elevation infarction (NSTEMI) , lapho i-"ST segment" engeke iphakanyiswe khona, kwenzeka lapho ukuvinjelwa emgodini we-coronary "kuphela" okuyingxenye. Ukuvinjelwa okwanele kwenzeke ukulimaza ezinye zezingqamuzana zezinhliziyo zenhliziyo ezinikezwe umshini obulalayo, kodwa umonakalo uvame ukungabi mkhulu kune-STEMI. Enye inkinga nge- NSTEMI , noma kunjalo, yilokho ukwelashwa okunganele ukuvinjelwa cishe kuphelele, futhi i-NSTEMI iyoba i-STEMI.
- Ngezinye izikhathi i-ACS ikhiqiza i-clot yegazi engakabi ngokwanele ngokwanele. noma akaphiki isikhathi eside, ukukhiqiza noma yimuphi umonakalo wenhliziyo engapheli. (Izindlela zokuzivikela zomzimba zama ukuchitha ama-blood clots ezakhela ngaphakathi kwemithwalo yegazi.) Uma i-ACS ikhiqiza izimpawu ngaphandle kokwenza ukuba imisipha yenhliziyo ife, ibizwa ngokuthi i- angina engaqiniseki . Abantu abane-angina engazinzile banengozi enkulu yokuqhubekela phambili ku-NSTEMI noma i-STEMI.
Kokubili i-NSTEMI ne-angina engaqiniseki ingabhekwa njengokuhlaselwa kwenhliziyo "engaphelele." Lezi zindlela ezimbili ze-ACS zidinga ukuphathwa okwelapha okufanayo, ukuze kuncishiswe amathuba okuthi bazothuthukela ku-STEMI - yiziphi izazi ze-cardiologists ezivama ukubiza ngokuthi "zigcwalisiwe" MI.
Ukwenza Ukuxilongwa Okulungile ku-ACS
Ukufingqa, uma i-clot yegazi ifometha emthonjeni we-coronary, uma umonakalo omkhulu wezinhlanzi zenhliziyo usuvele usuvele unesifo se-STEMI. Uma "umonakalo" we-muscle umonakalo kwenzeka, i-NSTEMI itholakele. Uma kungekho ukulimala kwemisipha yenhliziyo elinganiswayo, i-angina engaqiniseki iyatholakala.
Uma unesimo se-ACS, ngokuvamile izibonakaliso zakho, ukuhlolwa ngokomzimba, umlando wezokwelapha kanye nezimo ezingozini zomzimba zizokwenza ngokushesha udokotela ukuba asolise ngokuqinile ukuthi uyatholakala yini. Kusukela ngaleso sikhathi, uzohlola ngokushesha i-ECG yakho futhi ahlole izinyimba zakho zenhliziyo. Ama-enzyme e-cardiac akhishwa egazini ngenxa yokufa kwamangqamuzana enhliziyo, ngakho-ke ukuphakama kwamanzyme enhliziyo kusho ukuthi ukulimala kwamangqamuzana enhliziyo kwenzeka.
Ngakho-ke: Ukubonakala kwe-ECG (okungukuthi, ukuba khona noma ukungabikho "kokuphakama" kumagceke we-ST) kuzohlukanisa phakathi kwe-STEMI ne-NSTEMI. Futhi ukutholakala noma ukungabikho kwamakhemikhali enhliziyo ephakeme kuzohlukanisa phakathi kwe-NSTEMI ne-angina engaqiniseki.
Ukubaluleka kwe-ACS
Lezi zinhlobo ezintathu ze-ACS zimelela umthamo wezimo zomtholampilo ezingase zenzeke lapho i-plaque ihlukana ngaphakathi komthambo we-coronary. Eqinisweni, empeleni akukho umugqa ocacile ohlukanisa ngokweqile i-STEMI, i-NSSTEMI, ne-angina engaqiniseki. Lapho izazi ze-cardiologists zidweba umugqa phakathi kwe-STEMI ne-NSTEMI, noma phakathi kwe-NSTEMI ne-angina engaqiniseki, isinqumo esithandanayo. Ngempela, izincazelo zalezi zinhlobo ezintathu ze-ACS ziye zashintsha kakhulu eminyakeni, njengoba ulwazi lwethu - ikakhulukazi ikhono lethu lokuhumusha ama-ECG nokuthola ukulimala kwamangqamuzana enhliziyo ngezivivinyo ze-enzyme - zithuthukisiwe.
Iphuzu elibalulekile ukuthi zonke izigameko ze-ACS (kungakhathaliseki ukuthi zihlelwe kanjani) ziphuthumayo zezokwelapha, futhi zidinga ukunakekelwa okusheshayo kwezokwelapha ukuzama ukufeza izinto ezimbili: 1) ukunciphisa umonakalo wemisipha yenhliziyo okwenziwa ngokucacile nge-clot yegazi ngaphakathi i-artery coronary, kanye no-2) ukunciphisa ukuthi kungenzeka ukuthi i-plaque - manje esezibonakalise ingazinzile futhi ijwayele ukuphuka - izophinda iphinde iphuke.
> Imithombo
> Amsterdam EA, Wenger NK, Brindis RG, et al. Umhlahlandlela we-AHA / ACC we-Management of Patients With Non-St-Elevation Acute Coronary Syndromes: Isifinyezo Esiphezulu: Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice. Ukujikeleza 2014; 130: 2354.
> I-Pollack CV Jr, ama-Diercks DB, i-Roe MT; Peterson ED. I-American American College of Cardiology / American Heart Association Imihlahlandlela yokuphathwa kweziguli ezine-st-elevation Myocardial Infarction: Impikiswano yokuSebenza koMnyango ophuthumayo. Ann Emerg Med 2005 Apr; 45 (4): 363-76.