Ukubaluleka Kwe-Myocardium Eyingozi
Q. Umyeni wami unesifo senhliziyo ngenxa yesifo sakhe somzimba we-coronary artery. Udokotela wokuqala esiwubonile wamtshela ukuthi ukuhlinzwa okungahambi kahle kuzokwenza okuhle ngoba umcibisholo ovinjiwe uhlinzeka isisu senhliziyo esivele sefile. Kodwa udokotela wesibili uthi kungenzeka ukuthi imisipha yenhliziyo ayilimazi unomphela, kodwa nje "ukugubha." Uthi ukuhlinzeka ngokweqile kungavumela isisulu ukuba 'siphakamise,' futhi inhliziyo yakhe ihluleke ukuthuthukisa. Yini ongangitshela yona mayelana nokucwiliswa kwezinsizi zenhliziyo, futhi ucabanga ukuthi i-cardiologist yesibili ingahle ilungile?
Impendulo:
Umqondo obalulekile we-"hibernating myocardium" (i-myocardium isho imisipha yenhliziyo) kubonakala sengathi ingumqondo wangaphandle kwabanye odokotela, kodwa izazi ze-cardiologists ziyazi kahle. Kwamanye abantu abane- coronary artery disease (i-CAD) , izingxenye zenhliziyo ebonakala sengathi yonakaliswe kakhulu futhi engasebenziyo empeleni iyasebenza, futhi ingavuselelwa "uma kutholakala igazi.
Kulinganiselwa ukuthi phakathi kwabantu abangu-20 kuya ku-50% abanokuhluleka kwenhliziyo okubangelwa i-CAD banenani elikhulu le-myocardium, futhi ngenxa yalokho, banokukwazi ukuthola ukuthuthukiswa okunenjongo uma ukugeleza kwegazi kungabuyiselwa emzimbeni wabo wezinhliziyo.
Indlela "Yokudala" Yokucabanga Ngokwemisipha Yenhliziyo Yomzimba
Umcabango wezokwelapha wendabuko awuzange ushiye indawo enjengokubheka i-carbohydrium yokuqasha.
Imisipha yenhliziyo isebenza ngendlela evamile uma nje kukhona ukugeleza kwegazi okwanele. Uma ukugeleza kwegazi kungeneli ukuhlangabezana nezidingo zesisipha senhliziyo (isibonelo, uma umuntu one-CAD eqala ukuzivocavoca), imisipha iphenduka ischemic ngokweqile (elambile oksijini), futhi i- angina ingenzeka.
Ischemic muscle muscle akusebenzi ngendlela evamile. Eqinisweni, ukwenza i- echocardiogram ngesikhathi sokuzivocavoca kuyindlela eyodwa yokuhlola i-ischemia, ngoba ukuhlolwa kwe-echo kungabonakala ngeso lengqondo izingxenyana zenhliziyo ehluleka ukuzibopha ngokujwayelekile lapho zithathwa oksijini okwanele.
Indlela odokotela abavame ukucabanga ngayo nge-CAD, noma ngabe i-ischemia izosheshe ihambe (ngoba, isibonelo, umuntu ophethe i-CAD wayezoyeka ukusebenzisa uma i-angina ibonakala), noma i-ischemia izoqhubeka kuze kube yilapho kuhlaselwa yinhliziyo (ukushaywa kwe-myocardial infarction, noma ukufa kwenhliziyo imisipha) yenzeka.
Ngakho-ke, ngokwemvelo, i-myocardium ehlinzekwa ngombono wegazi okhubazekile ingase ikhona kwelinye lamazwe amathathu: okuvamile, ischemic, noma okufile.
Kodwa kuvela ukuthi leyo misipha yenhliziyo ingase iphinde iqhubekele esimweni sesine, umbuso obizwa ngokuthi ubusika.
Iyini I-Myocardium Eyingozi?
I-carbohydrate enezinto ezikhungetheyo yilokho okuzwakalayo. Njengobhere obuqhwaba phakathi nobusika, naphezu kokubonakala konke ukupheka kwenhliziyo okungafihli, kodwa kunalokho sekuvele kuthatha isimo "sokulala". Akusekho imisebenzi evamile - ayihambisani nenhliziyo ngayinye, futhi ayinakusiza emsebenzini wenhliziyo.
Kodwa futhi akufile. Kuvele esimweni sokungasebenzi okuzivikela. Ivale yonke imisebenzi yayo engeyona into ebalulekile ekuhlale iphila.
Imisipha yezinhliziyo ingangena esimweni se-hibernation lapho i-CAD inzima ngokwanele ukukhiqiza ischemia engavamile futhi ehlala njalo, kunokuba yi-ischemia ejwayelekile kakhulu ezayo futhi iya ngokuya njalo (okuyiyona iningi kubantu abaningi abane-angina). Ngakho-ke, ngokuyisisekelo, imisipha yenhliziyo ayitholi ngempela ukugeleza kwegazi okwanele ukuze isebenze ngendlela evamile, kodwa - kungekudala - ukuthola ukugeleza kwegazi okwanele ukuze uhlale uphila.
Kungani I-Myocardium Eyingozi Ibalulekile?
Inhlanzi yezinhliziyo ezithinta inhliziyo ingumqondo obalulekile ngoba imisipha isengakwazi ukusebenza, futhi ukushona kwe-hibernation kungashintshwa.
Uma ukutholakala kwegazi kwemisipha kungabuyiselwa - ngokusebenzisa ukuhlinzwa ngokweqile noma ukugcoba - kunethuba elihle kakhulu le-myocardidi yokugubha imoto lingakwazi "ukuvuka," bese uqala futhi ukufaka isandla emzimbeni. Kumuntu onokwehluleka kwenhliziyo , lokhu kukhula komsebenzi womzimba kungenza umehluko.
Endabeni yomyeni wakho Kuzwakala sengathi udokotela wesibili wabona ubufakazi bokuthi umyeni wakho angase abe ne-carbohydrate yokuziqhenya, futhi lokho okuvula umthamo owodwa noma ngaphezulu we- coronary arteries okuhlinzekwa yi-bypass kungavumela okungenani ingxenye yenhliziyo yakhe ukuba iqale ukusebenza futhi.
Kukhona izivivinyo ezikhethekile ukuthi izazi ze-cardiologists zenza ukusiza ukuhlukanisa imotocardium ehamba ngezinyawo ezivela emzimbeni wenhliziyo okungenakusebenza (okungukuthi, okufile), kufaka phakathi izifundo ze-MRI , nokuhlolwa okukhethekile kwe-echocardiographic.
Okubalulekile
Njengoba lolu hlobo lokuhlolwa lungenasidalwa futhi aluyikungena engozini, ukuphishekela ukuthi kungenzeka ukuthi i-myocardium ingabhekwa njengento enengqondo ingabonakala inengqondo ngokuphelele endabeni yomyeni wakho.
Uma lokhu kuhlola kwembula ukuthi kungenzeka ukuthi ube ne-carbohydrate eyingozi kakhulu, bese "ukuvusa" ukuthi ingxenye yesisu senhliziyo ingase ithuthukise kakhulu ukuhluleka kwenhliziyo yakhe. Ngakho-ke kungenza kube nomqondo omkhulu ukucabangela ngokuqinile ukuhlinzwa kwe-bypass i-cardiologist incoma uma ukuhlolwa kusekela ukutholakala kwe-myocardium yokuqasha.
> Imithombo:
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> Kim SJ, uPeppas A, Hong SK, et al. Ukukhishwa Okumangalisa Okumangalisayo Ukuzibamba Nokuvikelwa Kwama-Myocardial: Ukugeleza / ukusebenza kanye nezinqubo zamathambo. I-Circ Res 2003; 92: 1233.
> I-Parasher PS, i-Daher IN. Ukuvuselelwa kweMyocardial emva kwe-Hypoxia: Ukubuyisela Okumangalisa. I-Echocardiography 2008; 25: 1011.
> Rahimtoola SH, La Canna G, Ferrari R. I-Myocardium Eyibambezelayo: Enye ingxenye yePuzzles iyaqhuma endaweni. J Am Coll Cardiol 2006; 47: 978.
> Yancy CW, Jessup M, Bozkurt B, et al. Umhlahlandlela we-ACCF / AHA ka-2013 Wokulawulwa Kwenhliziyo: Ukubika kwe-American College of Cardiology Foundation / i-American Heart Association Task Force on Guidelines Practice. J Am Coll Cardiol 2013; 62: e147.