I-IST - Ukungaqondakali kwe-Cardiac Arrhythmia
I-sinus tachycardia engafanele (IST) yisimo lapho inhliziyo yomuntu ishaywa khona, lapho iphumula futhi ngesikhathi sokuzikhandla, iphakanyisiwe ngokungavamile ngenxa yesizathu esicacile. Abantu abane-IST bavame ukuphumula amazinga wezinhliziyo ezingaphezu kwezingu-100 ngomzuzu, futhi ngezinga elincane kakhulu izinga lokushaya kwenhliziyo livame ukuphakama emazingeni aphakeme kakhulu. Lezi zindleko zenhliziyo ezingalungile zivame ukuhambisana nezimpawu zokugulisa, ukukhathala nokuzibekezela.
Ngenxa yokuthi isigqi senhliziyo ku-IST sakhiwe yi- node yesusus (isakhiwo senhliziyo esilawula isigqi senhliziyo evamile), i-IST ayihlotshaniswa nephethini elingavamile kagesi ku- ECG .
Sibutsetelo
Nakuba i-IST ingenzeka kunoma ubani, ivame kakhulu kubantu abadala abasha futhi kuthinta abesifazane kaningi kunamadoda. I-"average" ye-IST isifo sesifazane wesifazane oneminyaka engu-20 noma eminyakeni engama-30 ubudala oye waba nezimpawu izinyanga ezinyaka. Ngaphandle kwezibonakaliso ezivelele kakhulu zokuphazamiseka, ukukhathala nokuzibophezela ngokweqile, i-IST ivamise futhi ihlotshaniswa nezinye izimpawu ezifana ne-orthostatic hypotension (ukwehla komfutho wegazi lapho umile), umbono obonakalayo, ugozi , ukulinganisa, i- dyspnea ukuphefumula), nokujuluka.
Nge-IST, isilinganiso senhliziyo sokuphumula ngokuvamile sikhulu kunamaphesenti angu-100 ngomzuzu, kodwa ngesikhathi sokulala okujulile, kungase kwehlele ku-80 noma 90 beats ngomzuzu, noma ngisho ephansi. Ngisho nokuzikhandla okuncane ukushaya kwenhliziyo ngokushesha kuphuthumayo kuze kube ngaphezu kwezingu 140 noma 150 ngomzuzu.
Amapulpitations ayimpawu evelele noma ngabe (njengoba kunjalo njalo) azikho "okungavamile" ukushaya kwenhliziyo okwenzekayo. (Okungukuthi, ukushaya kwenhliziyo ngayinye kuvela kwi-node ye-sinus, njengenhliziyo evamile yesigqi senhliziyo.) Izimpawu ezitholwa ngabagulayo be-IST zingakwazi ukukhubaza futhi ukukhiqiza ukukhathazeka.
I-IST yaqashelwa njenge-syndrome kuphela nje ngo-1979 futhi iye yamukelwa njengenhlangano yezokwelapha yangempela kuphela kusukela ngasekupheleni kwawo-1980. Ngisho nanamuhla, kuyilapho i-IST ibhekwa ngokugcwele njengesimo sangempela sezokwelapha yizo zonke izikhungo zokwelapha zaseyunivesithi, iningi labahlengikazi abaqeqeshwayo abangazange balizwe noma balibhale njengenkinga yengqondo (okungukuthi, "ukukhathazeka").
Izimbangela
Umbuzo oyinhloko ubonakala ukuthi i-IST imele yini isifo esiyisisekelo se-node ye-sinus, noma ukuthi, esikhundleni salokho, imelela ukuhlekwa okuvamile kwesimiso sezinzwa ezizimele-isimo esibizwa ngokuthi i- dysautonomia . (I-system ye-neon autonomic ilawula "imisebenzi engasebenzi" engokomzimba, njengokugaya, ukuphefumula, nesilinganiso senhliziyo.)
Abantu abane-IST baxhumene ne-adrenaline; kancane kancane kwe-adrenaline (njengokungathi ukuzama kancane) kubangela ukuphakama okukhulu kwenhliziyo. Ngenkathi kukhona ubufakazi bokuthi kunezinguquko zesakhiwo esimisweni se-sinus ku-IST, obunye ubufakazi obuningi bubonisa ukuthi ukugula okuvamile okuphazamisa isimiso sezinzwa esizimele kubonakala kulezi ziguli eziningi. (I-dysautonomia ejwayelekile ngokujwayelekile ingachaza ukuthi kungani izimpawu nge-IST ngokuvamile zibonakala zingafani nokwanda kwenhliziyo.) Umqondo wokuthi i-sinus node ngokwayo ingavamile ngokweqile eyenziwe ukuthi i-electrophysiologists isebenzise ekuqedeni i-node yesusus njenge ukwelashwa kwe-IST (okungaphezulu ngalokhu ngezansi).
Ukuxilongwa
Ezinye izinkinga ezithile zokwelashwa eziphathekayo nezilaphayo zingahle zidideke ne-IST, futhi kumuntu owethulayo nge-sinus tachycardia engavamile, lezi ezinye izimbangela kudingeka zikhishwe ngaphandle. Lezi zinkinga zihlanganisa i- anemia , fever, izifo, i- hyperthyroidism , i- pheochromocytoma , i-dysautonomia, kanye nokusetshenziswa kabi kwezidakamizwa. Lezi zimo ngokuvamile zingahle zikhishwe ngokuhlolwa kwezokwelapha jikelele, nokuhlolwa kwegazi kanye nomchamo.
Ngaphezu kwalokho, amanye ama- arrhythmias enhliziyo- ngokuvamile, izinhlobo ezithile ze -tachycardia ezingaphezulu (nge-SVT) -ngesinye isikhathi zidideka nge-IST. Ngokuvamile akunzima kudokotela ukutshela umehluko phakathi kwe-SVT ne-IST ngokuhlola ngokucophelela i-ECG nokuthatha umlando wezokwelapha ngokuphelele.
Ukwenza lokhu kuhlukaniswa kubaluleke kakhulu ngoba ukwelashwa kwe-SVT ngokuvamile kuvamile.
Ukwelapha
Ukwelashwa Kwezidakamizwa
Eziguli eziningi ezine-IST, ukwelapha izidakamizwa kungasebenza ngokuphumelelayo. Kodwa ukufeza imiphumela emihle ngokuvamile kudinga imizamo yokulinga-nephutha ngemithi eminingana, i-singly noma inhlanganisela.
Ama-beta-blockers avimbela umphumela we-adrenaline kwi-node yesusus, futhi njengoba abantu abane-IST bephendula ngokunyanyisa ku-adrenaline, ukusebenzisa i-beta blockers kunengqondo. Lezi zidakamizwa zivame ukusiza kancane ekunciphiseni izimpawu ze-IST.
Ama-blockers e-calcium anganciphisa ngokuqondile isenzo se-node yesinus kodwa abe esebenzayo kuphela ekuphatheni i-IST.
Isidakamizwa ivabradine sisetshenziswe ngempumelelo ekuphatheni abantu abane-IST. I-Ivabradine ithinta ngokuqondile "izinga lokudubula" le-node yesusus, futhi ngaleyo ndlela kunciphisa izinga lenhliziyo. I-Ivabradine ivunywe e-US njengokwelashwa kwe-angina kanye nokuhluleka kwenhliziyo ezigulini ezingenakubekezelela abavimba be-beta, kodwa hhayi nge-IST. Kodwa-ke, okungenani iphumelela njengenye imithi, futhi ochwepheshe abaningi batusa i-ivabradine njengokwelashwa okuwusizo kwalesi simo. Ngaphezu kwalokho, izinhlangano eziningana zobuchwepheshe manje nazo zisekela ukusetshenziswa kwayo kwe-IST.
Abaningi be-cardiologists bavame ukungabhalisi "ekusebenziseni okuzimele okuzenzakalelayo" kwe-IST, ngakho-ke abazange bazame ukubeka izidakamizwa eziye zasiza ezigulini ezinamanye ama-dysautonomia. Kodwa-ke, njengoba ngokuvamile kuvame ukungena phakathi kwe-IST namanye ama-syndrome (i- POTS kanye ne- vasovagal syncope ), izidakamizwa eziphumelelayo ekwelapheni lezi zimo zingasiza ngezikhathi ezithile ekuphatheni iziguli ezine-IST. Lezi zidakamizwa zingabandakanya:
- Florinef , okuyinto umuthi obangela ukugcinwa kwe-sodium. Amanye ama-syndromes e-dysautonomic, ikakhulukazi i-POTS kanye ne-syncope ye-vasovagal, aboniswe ukuthi ahlobene nokuncipha kwevolumu yegazi, futhi isidakamizwa sokugcina i-sodium singakhuphula ivolumu yegazi ngokujwayelekile, futhi sinciphise izimpawu.
- I-Midodrine , umuthi odala ukwanda kwethambo lamathambo , okusiza ukuvimbela ukucindezeleka kwegazi eliphansi.
- I-serotonin-reuptake inhibitors (umndeni wakwaProzac wezidakamizwa) isetshenziselwa ngokuyinhloko ukuphatha ukucindezeleka nokukhathazeka, kodwa futhi kuqinisekiswe ukuthi iyasiza ekuphatheni izinkinga eziningi ze-dysautonomia syndromes.
Ngokuvamile, izimpawu ze-IST zingalawulwa ngezinga elifanele ngokusebenzisa inhlanganisela yezidakamizwa. Ngokuvamile, i-beta blockers izama kuqala, futhi i-ivabradine ingeziwe (noma ishintshwe) uma i-bloa ye-beta ingalawuli izimpawu ngokwanele. Kodwa-ke, ukwelashwa okusebenzayo kwezidakamizwa ngokuvamile kudinga ukuphikelela, ukusebenza ngesisekelo sokulinga nesiphambeko. Inani elithile lokubekezela, ukuqonda nokuthembela phakathi kukadokotela nesiguli kuyadingeka. Lokhu kunzima ukufeza uma udokotela ecabanga ukuthi isiguli singumuthi kuphela. Ukuze baphathwe ngempumelelo, abantu abane-IST (namanye ama-dysautonomias) kumele bavame ukwenza inani elifanele lokuthenga ngodokotela.
Ukwelapha Okungeyona Imithi
Ukwandisa usawoti. Lokhu kufanele kwenziwe ngokuvunywa kukadokotela wakho, ngenxa yobandlululo lwethu lwamanje ngokudla okudla okuphansi kwe-sodium. Kodwa usawoti ukwandisa ivolumu yegazi, kanti izinga lokuthi igazi elincishisiwe linciphisa izimpawu, ukwandisa uketshezi kasawoti kungasiza ekunciphiseni izimpawu ze-IST.
Isaphulelo se-sinus node. Abaningi be-cardiologists, ikakhulukazi i-electrophysiologists, baye baxoshwa kakhulu yi-data ebonisa ukuthi i-IST ngokuyinhloko isifo se-sinus node (ngokungafani nesifo esijwayelekile ngokwengeziwe sesistimu yezinzwa ezizimele). Le nkolelo yenze umdlandla othile wokusebenzisa i- ablation therapy (inqubo lapho ingxenye yegesi yomshuwalense wenhliziyo iqhutshwa khona nge-catheter) ukuguqula umsebenzi, noma ngisho nokubhubhisa, i-node yesusus.
Isaphulelo se-sinus node sesifinyelele ekuphumeleleni okulinganiselwe kuphela. Ngenkathi le nqubo ingasusa i-IST kubantu abangaba ngu-80% ngokushesha ngemuva kwenqubo, i-IST ibuyela ezinyangeni ezimbalwa kuningi lalabo bantu.
Ilinde. Enye indlela engeyona ye-pharmacologic yokuphatha i-IST akukwenzi lutho. Ngenkathi umlando wemvelo walesi sifo ungabhalwanga ngokomthetho, kubonakala sengathi i-IST ijwayele ukuthuthukisa ngokuhamba kwesikhathi kubantu abaningi. "Ukungenzi lutho" kungenzeka ukuthi akuyona inketho kubantu abanesifo esibucayi, kodwa abantu abaningi abane-IST emincane kuphela abakwazi ukubekezelela izimpawu zabo uma beqinisekiswa ukuthi abanenkinga yokuphila komphefumulo futhi nokuthi inkinga ingase ithuthukise ekugcineni.
Okubalulekile
Uma i-IST itholakale, futhi kunqunywa ukuthi ukumane nje "kulinde" ngeke kube yindlela eyanele, ochwepheshe abaningi namuhla batusa ukuqala nge-drug treatment. Ngokuvamile, i-beta blocker izozama kuqala, ilandelwe isilingo se-ivabradine (noma yedwa noma ihambisana ne-beta blocker). Uma lezi zilingo zihluleka ukulawula izimpawu, ezinye izidakamizwa eziningana kanye nokuhlanganiswa kwezidakamizwa zingahlolwa. Ochwepheshe abaningi manje bancoma ukwelashwa kwe-ablation kuphela uma okungenani izivivinyo ezimbili zezidakamizwa zehlulekile.
> Imithombo:
> 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 2016; 133: e506.
> Schulze, V, Steiner, S, Hennersdorf, M, Strauer, BE. I-Ivabradine njengelinye ilanga lezokwelapha zokwelashwa okungeyona efanelekile yeSinus Tachycardia: Umbiko Wezehlakalo. I-cardiology 2008; 110: 206.
> Sheldon RS, Grubb BP 2, Olshansky B, et al. 2015 I-Heart Rhythm Society Isazi Isitatimende Sokuvumelana Sokuthola Ukuhlonza Nokunakekelwa kwe-Postural Tachycardia Syndrome, i-Inappropriate Sinus Tachycardia, ne-Vasovagal Syncope. I-Heart Rhythm 2015; 12: e41.