I-Sarcoidosis yisifo esibangela ama- granulomas- izibalo zamangqamuzana angavamile afana nezicubu ezinzima-cishe noma iyiphi isitho emzimbeni. Lezi granulomas zingaphazamisa ukusebenza okujwayelekile kwezitho lapho zivela khona, futhi ngaleyo ndlela zingabonakalisa izimpawu eziningi zezinkinga nezinkinga zezokwelapha. Ngenxa yokuthi i-granulomas ye-sarcoidosis ingenzeka ezinhlotsheni eziningi kangaka, abantu abanezimo bangakwazi ukuthola izimpawu ezibandakanya amaphaphu, amehlo, isikhumba, isimiso sezinzwa, uhlelo lwamathumbu, izigulane ze-endocrine-nenhliziyo.
I-cardiac sarcoidosis ingaba nzima ukuyihlolisisa. Nakuba kungase kube isimo esibucayi, ngezinye izikhathi i-sarcoidosis yengqondo ingabangela izinkinga ezinkulu zemitholampilo, kuhlanganise nokuhluleka kwenhliziyo noma ukufa okungazelelwe . Kulezi zimo, ukwenza i-sarcoidosis yesifo senhliziyo, nokubeka ukwelashwa, kubalulekile.
Kuyini iSarcoidosis?
Abacwaningi bakholelwa ukuthi i-sarcoidosis iqala lapho isimiso somzimba samasosha omzimba siphendula ngokungajwayelekile emthonjeni othile ongaziwa (mhlawumbe into ephikisiwe), okuholela ekwakheni ama-granulomas. Abesifazane bathinteka kaningi kunamadoda, futhi abantu abamnyama banamathuba amaningi okuthuthukisa i-sarcoidosis kunabantu abamhlophe. I-propensity ye-sarcoidosis nayo ingasebenza emindenini.
Izimpawu ze-sarcoidosis zihlukahlukene kakhulu. Abanye abantu bathuthukisa isimo esifana nesifo somkhuhlane ngokukhathala, umkhuhlane kanye nokulahlekelwa kwesisindo. Abanye bazoba nezimpawu eziningi ze-pulmonary ezifana nokukhwehlela, i- dyspnea , noma i-wheyzing.
Izinkinga zeso zingabandakanya ububomvu, ubuhlungu, umbono obonakalayo, nokuzwela kokukhanya. Izilonda zesikhumba zingase zihlanganise ukuqubuka okubuhlungu, izilonda ebusweni, ukushintsha kwesikhumba, kanye nama-nodules.
Noma iyiphi inhlanganisela yalezi zimpawu kungenzeka. Abanye abantu abane-sarcoidosis abangekho izimpawu, futhi isimo sibonakala senzeke lapho i-X-ray esifubeni isenzelwe esinye isizathu.
Kuyini I-Cardiac Sarcoidosis?
I-cardiac sarcoidosis ivela lapho ama-granulomas asardidi akha enhliziyweni. Njengoba kunjalo nge-sarcoidosis ngokujwayelekile, ukubonakaliswa kwe-cardiac sarcoidosis kuyahlukahluka kusuka komuntu kuya komuntu. Kwezinye abantu i-sarcoidosis yesifo singabangeli izinkinga; kwabanye, kungaba yingozi.
Ubukhulu be-sarcoidosis enhliziyo buxhomeke ekutheni isakhi se-granuloma enhliziyweni, futhi lapho enhliziyweni khona lezi zingu-granulomas zivela khona. Ngokuvamile, amaphesenti angaphansi kuka-10 abantu abane-sarcoidosis atholakala enesifo senhliziyo ngesikhathi sokuphila kwabo
Kodwa ezimfundweni ze-autopsy, abaningi abangamaphesenti angu-70 abantu abane-sarcoidosis baqala ukuba nama-granulomas enhliziyo. Lokhu kusikisela ukuthi iningi lesikhathi, i-sarcoidosis yenhliziyo ayikhiqizi izinkinga ezibonakalayo zomtholampilo.
Uma i-sarcoidosis iveza izinkinga zenhliziyo, noma kunjalo, lezo zinkinga zingaba nzima.
Izimpawu Nezimpawu Ze-Cardiac Sarcoidosis
Izinkinga ezikhiqizwa yi-sarcoidosis yenhliziyo zixhomeke ekutheni i-granulomas ivelaphi enhliziyweni. Ukubonakaliswa okuvame kakhulu kwe-sarcoidosis yenhliziyo kufaka:
- I-Heart Block . Ukuqeda i-heart block, okhiqiza i- bradycardia eqinile (ukunciphisa izinga lokushaya kwenhliziyo), kungenzeka uma i-granulomas ikhiwa ngaphakathi kwezicubu ezikhethekile zokwenza inhliziyo. ( Funda mayelana nenqubo yokuziphatha komzimba. ) Izimpawu zebhokisi lezinhliziyo zingabandakanya ubuhlungu obukhulu noma i- syncope (ukulahlekelwa isikhathi esithile), ngisho nokufa okungazelelwe.
- I-arrhythmias ye-cardiac . Izakhiwo ze- ventricular zangaphambi kwesikhathi (PVCs) noma i -tachycardia ye-ventricular ijwayelekile kwi-sarcoidosis yenhliziyo. Ama-arrhythmias ase-atrial, kuhlanganise nokufabulisa kwe-atrial , nakho kungenzeka. Lawa ma-arrhythmias athuthuka ngenxa ye-granulomas efomula emzimbeni wenhliziyo.
- Ukufa okungazelelwe . Ngenxa yokuthi i-heart block noma i-tachycardia ye-ventricular, ukufa okungazelelwe kuyinto evame ukuphazamiseka kwe-cardiac sarcoidosis, futhi ilandisa ngamaphesenti angaba ngu-50 okufa okubangelwa lesi simo.
- Ukungaphumeleli Inhliziyo . Ukuhluleka kwenhliziyo kungathuthuka enhliziyweni ye-sarcoidosis lapho i-granuloma eklanyelwe ngaphakathi kwe-muscle yenhliziyo iba mkhulu.
- Isifo se-Pericardial . I-Pericarditis noma i- pericardial effusions ingenzeka ngenxa ye-granulomas emgqeni we-pericardial wenhliziyo.
- Isifo senhliziyo se-valvular . I-granulomas ethinta amagagasi enhliziyo angabangela ukuphindaphinda kwe-mitral noma ukuphindaphindiwe , noma, ngokungajwayelekile, ukubuyela emuva kwe-aortic .
- Ukuhlaselwa kwenhliziyo . I-granulomas ye-Sarcoid ingathinta i- coronary arteries , eyenza ukufa kwezingxenye ze-heart attack-heart attack.
- Ukuhluleka kwenhliziyo kwesokunxele . I-sarcoidosis ekhululekile ye-pulmonary ingabangela ukucindezeleka kwe-pulmonary , okuholela ekuhlulekeni kwenhliziyo efanele.
Ukubona I-Cardiac Sarcoidosis
Ukwenza ukuxilongwa kwe-sarcoidosis yenhliziyo kuvame ukukhohlisa. Ukuhlolwa okucacile kakhulu yi-biopsy enhle yomzimba. Kodwa-ke, akuyona kuphela inqubo ye-biopsy, kodwa futhi (ngoba ama-granulomas e-sarcoid ahanjiswa ngezikhathi ezithile) i-biopsy ingabuya "njengejwayelekile" ngisho nalapho i-cardiac sarcoidosis ikhona ngempela.
Lokho kusho ukuthi, ngokuvamile, ukuxilongwa kwe-cardiac sarcoidosis kwenziwa ngokulinganisa ubufakazi obuvela ezinhlobonhlobo ezahlukene zokuxilonga.
Okokuqala, kubalulekile ukuthi odokotela bazi ukuthi kufanele bafune yini i-sarcoidosis yenhliziyo. Ukufuna i-sarcoidosis yenhliziyo kubalulekile kubantu abaziwa ukuthi bane-sarcoidosis ethinta ezinye izitho zomzimba. Futhi, i-sarcoidosis yenhliziyo kufanele icatshangelwe kunoma yimuphi umuntu osemncane (oneminyaka engaphansi kwengu-55) ovula i-heart block, i-ventricular arrhythmias, noma ukuhluleka kwenhliziyo ngezizathu ezingachaziwe.
Uma i-cardiac sarcoidosis ixilongwa okumelwe icatshangelwe, ukwenza i- echocardiogram ngokuvamile kuyisivivinyo sokuqala esingenasidingo esenziwa. Lokhu kuvivinye kuvame ukuveza izici ezibalulekile uma i-cardiac sarcoidosis ikhona, kufaka phakathi kwezinye izimo izibonakaliso ze-echo ezikhiqizwa yi-granulomas ngaphakathi kwesisu senhliziyo.
Kodwa-ke, isisindo se- MRI senhliziyo sinamathuba amaningi okubonisa ubufakazi be-granulomas sarcoid ngaphakathi kwenhliziyo, futhi ngokuvamile kuyisivivinyo esingenasidingo sokuzikhethela. Ukuhlola kwe- PET yenhliziyo nakho kunomthelela kakhulu ekutholeni i-cardiac sarcoid granulomas, kodwa ukukala kwe-PET akutholakali kalula kunokuba kutholakale i-MRI.
I-standard yegolide yokuhlola i-sarcoidosis yesifo senhliziyo i-biopsy ye-muscle ye-heart, engenziwa ngenkathi i-catheterization yenhliziyo. Nokho, njengoba sekuphawuliwe, ukuthola ama-granulomas ngale ndlela, ngisho nalapho bekhona, kufezwa ngempumelelo ngaphansi kwengxenye yesikhathi.
Ezikhathini eziningi, ngokusekelwe kokuhlanganiswa kwezibonakaliso nezimpawu zomtholampilo, ukuhlola okungahambi kahle, nokuhlola okungavamile, ukucacisa ukuba khona noma ukungabikho kwe-cardiac sarcoidosis kungenziwa ngezinga eliphakeme lokuzethemba.
I-Cardiac Sarcoidosis Injani?
Uma i-sarcoidosis ye-cardiac ikhona, ukwelashwa kuhloswe kokubili ukunciphisa noma ukuyeka ukuqhubeka kwe-sarcoidosis ngokwayo, nokuvimbela noma ukwelapha imiphumela ebuhlungu kakhulu yecala lesi sifo.
Ukwelapha i-sarcoidosis ngokwayo
Ukwelashwa okuhloswe ukuba i-sarcoidosis ngokwayo ihlose ukuvimbela ukusabela kwamagciwane okubangela ukubunjwa kwe-granulomas. E-sarcoidosis, ngokuvamile lokhu kwenziwa nge-glucocorticoid (steroid) therapy, ngokuvamile ebizwa nge-prednisone. Ngokuvamile, ukulinganisa okuphezulu kunqunywe ekuqaleni (40-60 mg / ngosuku). Ngaphezulu konyaka wokuqala, leli dose liyehliswa kancane kancane ku-10-15 mg / ngosuku, futhi liqhubeka okungenani elilodwa noma emibili iminyaka.
Uma ukuhlaziywa kabusha kubonisa ukuthi i-sarcoidosis isimeme (okungukuthi, akukho bufakazi obengeziwe bokubunjwa kwe-granuloma noma kuphi emzimbeni, nokuxazulula noma yiziphi izimpawu ezibangelwa i-sarcoidosis), kungenzeka ukuthi ekugcineni uyeke ukwelashwa kwe-steroid.
Kubantu abangabonakali ukuthi baphendule ukwelashwa kwe-steroid, amanye ama-immunosuppressants angadingeka, njenge-chloroquine, i-cyclosporine, noma i-methotrexate.
Ukuphatha ukubonakaliswa komzimba kwe-sarcoidosis
Umphumela wesabekayo kakhulu we-sarcoidosis womzimba ukufa okungazelelwe, okubangelwa yi-heart block noma i-tricycardia ye-ventricular. I- pacemaker engapheli kufanele isetshenziswe kunoma ubani one-sarcoidosis yenhliziyo okubonakaliswa kuyo izimpawu zokuthuthukisa i-heart block kwi- electrocardiogram .
I-cardioverter-defibrillators (i-ICDs) engasetshenziselwa ukusetshenziselwa ukuvimbela ukufa okungazelelwe kusuka ezigungwini ze-ventricular. Imiphakathi yobuchwepheshe ayikwazanga ukuthuthukisa iziqondiso ezicacile mayelana nokuthi abantu abane-cardiac sarcoidosis kufanele bathole i-ICDs. Kodwa-ke, ochwepheshe abaningi bancomeka kubantu abane-sarcoidosis abaye banciphisa kakhulu izingxenyana ze-ventricular ejection ezisekhohlo, noma abaye basinda ezinkampanini ze-tachycardia ezinomsoco ezinomsoco noma i- fibrication ye-ventricular .
Ngaphezu kwalokho, ukwenza ucwaningo lwe- electrophysiology kungasiza ekunqumeni ukuthi yiziphi abantu abane-cardiac sarcoidosis ezingengozini enkulu yokufa ngokuzumayo kusuka ezigodini ze-ventricular, ngakho-ke okufanele abe ne-ICD.
Uma isifo senhliziyo se-valvular esibangelwa i-cardiac sarcoidosis sitholakale, ukuhlinzekwa kufanele kubhekwe njengendlela efanelwe yimuphi umuntu onenkinga ye-valve yenhliziyo.
Uma ukwehluleka kwenhliziyo kwenzeka, abantu abane-cardiac sarcoidosis kufanele bathole ukwelashwa okufanayo okunonya okusetshenziselwa ukuhluleka kwenhliziyo okusetshenziselwa noma ubani onalesi simo. Uma inhliziyo yabo ihluleka kakhulu futhi ingaphenduli ukwelapha okwelapha, abantu abane-sarcoidosis kufanele bathole ukucabangela okufanayo ukufakelwa kwenhliziyo okunikezwa kunoma ubani omunye onokwehluleka kwenhliziyo. Eqinisweni, imiphumela yabo emva kokufakelwa kwe-cardiac kubonakala sengathi ingcono kunemiphumela ebikwe abantu abane-transplantation kwezinye izimbangela eziyinhloko.
Izwi elivela
Njengoba kunjalo nge-sarcoidosis ngokujwayelekile, i-sarcoidosis ethinta inhliziyo ingaba nemibono eminingi, evela ekuziphatheleni ngokuphelele. Uma kunesizathu sokusola i-sarcoidosis yomzimba, kubalulekile ukwenza ukuhlolwa okudingekayo ukwenza noma ukukhipha ukuxilongwa. Kumuntu one-sarcoidosis ye-cardiac, ukwelashwa kokuqala nolaka (kokubili i-sarcoidosis ngokwayo kanye nokubonakaliswa kwayo kwenhliziyo) kungathuthukisa kakhulu umphumela.
> Imithombo:
> Birnie DH, Sauer WH, Bogun F, et al. Ukwaziswa kwe-HRS Isitatimende Sokubambisana Ku-Diagnosis Nokuphathwa Kwe-Arrhythmias Ehlobene Ne-Cardiac Sarcoidosis. I-Heart Rhythm 2014; 11: 1305.
> Kim JS, Judson MA, Donnino R, et al. I-Cardiac Sarcoidosis. Am Heart J 2009; 157: 9.
> Perkel D, Czer LS, Morrissey RP, et al. Ukufakelwa Kwentliziyo Ukuhluleka Kwezinhliziyo Zokuphela Kwezinhliziyo Ngenxa Yenhliziyo Ka-Sarcoidosis. Ukufakelwa kwe-Proc 2013; 45: 2384.
> Soejima K, Yada H. Ukusebenza Nokuphathwa Kwabagulayo Ababonakalayo Noma Abathandekayo I-Cardiac Sarcoidosis: Ngokugcizelelwa Nge-Heart Associated Rhythm Rhythm. J Cardiovasc Electrophysiol 2009; 20: 578.