I-Atrioventricular reentrant tachycardia (AVNRT) iyindlela ejwayelekile yokuzivocavoca yomzimba eqala ngokuzumayo futhi ngaphandle kwesixwayiso, futhi iyeka ngokuzumayo. Ngokuvamile kuthinta abadala abasebasha. Isilinganiso seminyaka lapho i-AVNRT iqala khona yi-32, futhi abantu abaningi abanalesi sigamu bazoba nesiqephu sabo sokuqala ngeminyaka engu-40. Uma kwenzeka kuqala, kufinyelela kuba yinkinga ephindaphindiwe.
Yini i-AVNRT?
U-AVNRT wuhlobo oluvame kakhulu lwe -tachycardia engaphezulu (i-SVT) , elinganiselwa ku-60% yazo zonke i-SVTs.
I-AVNRT ingenye ye-tentycardias enama-reentrant. ("I-Tachycardia" isho ukuthi isilinganiso senhliziyo esisheshayo esheshayo.) Ngayo yonke i-tachycardia esebenzayo, kunokuxhumeka okungavamile kagesi endaweni ethile enhliziyweni, eyenza isifunda esingaba khona sogesi. Uma enye yezimfutho zikagesi ezitholakala enhliziyweni ingena kwisifunda esingahle sibe ngaphansi kwezimo ezifanele, ingaba "ithunjulwe" ngaphakathi kwesifunda - okusho ukuthi iqala ukuzungeza nxazonke futhi isezungeze isifunda. Njalo uma ihambahamba nxazonke isisombane kagesi senza ukushaya kwenhliziyo entsha, kanye nemiphumela ye-tachycardia.
Njengoba kunjalo ngama-SVTs amaningi angenawo, iziguli ezine-AVNRT zizalwa ngokuxhumeka kagesi okwengeziwe enhliziyweni. Ku-AVNRT, uxhumano olwedlulele - nayo yonke isifunda esivela kabusha esakhiqiza i-arrhythmia - itholakala ngaphakathi noma eduze kakhulu node encane ye- atrioventricular (i-AV node) .
Ngakho igama - i-AV nodal reentrant tachycardia.
Izimpawu
Izimpawu ze-AVNRT zifanekisela i-SVT, futhi ngokuvamile zibandakanya ukuqala ngokuzumayo kwamaphutha , ikhanda elikhanyayo, kanye / noma isizungu. Ukuphefumula kufana nokujwayelekile kule mithetho.
Isibonakaliso esisodwa esivame ukubonwa ku-AVNRT esenzeka kaningi kangako nezinye izinhlobo ze-SVT kuyisimo sokugaya entanyeni.
Lesi sibonakaliso senziwa ngoba, ngezikhathi ze-AVNRT, i-atria kanye ne-ventricles ibetha ngesikhathi esifanayo. Ngenxa yokuthi i-atria ayikwazi ukulahla igazi layo ema-ventricles, igazi liqhutshwa phezulu phezulu emithanjeni yentamo - nemiphumela yokuzwa kwemizwa.
Iziqephu ze-AVNRT ziqala futhi zimise ngokuzumayo, futhi zivame ukugcina kusukela emaminithini ambalwa kuya emahoreni amaningana.
Ukuqala Nokumisa i-AVNRT.
I-node ye-AV ibucayi kakhulu ekushintsheni ohlelweni lwezinzwa ezizimele , ingxenye yesimiso sezinzwa ezilawula imithwalo yegazi nezitho zangaphakathi. Ngakho izinguquko kunoma yiliphi ithoni yokukhathazeka (impendulo yokucindezeleka) noma ithoni ye- vagus nerve (ithoni ye-parasympathetic, noma impendulo yokuphumula) ingaba nethonya elikhulu ku-node ye-AV.
Ngenxa yokuthi isifunda esikhulu se-AVNRT sitholakala ngaphakathi kwe-AV node, ukushintshwa kwethembo elizimele kungaba nomthelela ojulile ku-arrhythmia.
Ngenkathi i-AVNRT ivame ukuqala ngaphandle kwemiphumela ebonakalayo, kwabanye abantu ingaqala ngokuzivocavoca noma izikhathi zokucindezeleka ngokomzwelo noma ezinye izimo ezandisa ithoni yokuzwelana. Kwamanye, ingaqala ngesikhathi sokulala okujulile, ngokuqhekeka, noma uma ngokuzumayo uguqa phambili - izimo ezandisa ithoni ye-vagal.
Iziguli ezine-AVNRT zivame ukumisa iziqephu zazo ze-tachycardia ngokwenza izinto ngokungazelelwe zandise ithoni le-vagus nererve. Ukwenza umsebenzi we- Valsalva kuvame ukusebenza, nakuba izinyathelo ezinkulu (njengokungena ngobuso emanzini e-ice imizuzwana embalwa) ngezinye izikhathi kungadingeka.
Ukwelashwa Kwe-AVNRT
Odokotela bangaphatha iziqephu ezinzima ze-AVNRT ngokushesha futhi kalula. Ngokuvamile baqondisa isiguli ngokusebenzisa imizamo embalwa yokwandisa ithoni yabo ye-vagal. Uma lokho kwehluleka ukumisa isimiso se-arrhythmia, umjovo we-adenosine noma u-verapamil (i-calcium blocker) uzosebenza ngokushesha futhi ngokuthembekile.
Umbuzo obaluleke kakhudlwana wezokwelapha ubheka ukwelapha isikhathi eside ku-AVNRT.
Ngenxa yokuthi i-arrhythmia ayisongeli ukuphila, kodwa "ukuphazamiseka kokuphila", ukuhlukunyezwa kokwelashwa kufanele kubonise indlela okuphazamisa ngayo isiguli isiguli. Uma iziqephu zivame kakhulu, zibekezelele kahle, futhi zingaqedwa kahle ngokuzethemba ngamagagasi, cishe akukho okunye okumelwe kwenziwe.
Kodwa-ke, uma iziqephu ze-AVNRT ziphazamisa empilweni yesiguli (okuyinto evame ukubhekana nayo), khona-ke ukwelashwa kufanele kucatshangwe ngokujulile. Ukwelashwa nge- beta blockers noma abavimbela isiteshi se-calcium kusebenza ngokuphumelelayo ekunciphiseni imvamisa ye-AVNRT, futhi ezigulini eziningi, eyodwa noma zombili lezi zinhlobo zezidakamizwa zibekezeleleke kahle. Uma i-arrhythmia ingalawulwa ngokwanele, enye yezidakamizwa ezithathelwanayo ingase ivivinywe. Kodwa-ke, lezi zidakamizwa ziba nemiphumela emibi, futhi ngokuvamile ziphumelela ngokuphumelelayo ekuphatheni i-AVNRT.
Izindlela eziphumelela kakhulu zokwelapha i-AVNRT namuhla ukusebenzisa i- ablation therapy , inqubo yokwelashwa . Ngomuthi wokwelashwa, ukuxhumeka okungavamile kagesi noma eduze kwe-AV node kuhlolwe ngokucophelela bese kuhoxiswa, ngokuvamile nge-radiofrequency energy. I-AVNRT ingaphiliswa ngokuphelele nge-ablation therapy ngamacala angaphezu kwama-95%. Ngakho-ke ukubhekwa kufanele kubhekwe ngokuqinile yilowo nalowo i-AVNRT kuyinkinga enkulu, ikakhulukazi uma ingalawulwa ngokusebenzisa i-beta-blockers noma i-calcium blockers.
Umthombo:
UDenes P, Wu D, uDhingra R, et al. Imigudu emibili ye-atrioventricular nodal. Impendulo evamile ye-electrophysiological. I-Br Heart J 1975; 37: 1069.
Ikhasi RL, Joglar JA, Caldwell MA, et al. Umhlahlandlela we-ACC / AHA / HRS we-Management of Patients Adult With Tachycardia Supraventricular: Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice Guidelines kanye ne-Heart Rhythm Society. Ukujikeleza kuka-2015.