Uhlobo Olunzima Kokuhlasela Kwenhliziyo
I-ST-I-ST-segment elevation infyoction (STEMI) yi-term cardiologists esebenzisa ukuchaza ukuhlaselwa kwenhliziyo. Uhlobo olulodwa lwe- infarction ye-myocardial lapho ingxenye ye-muscular heart (i-myocardium) ifile ngenxa yokuvinjelwa kwegazi endaweni.
Ingxenye ye-ST ibhekisela kwisigaba esicacile sokufunda kwe- electrocardiogram (ECG) futhi imelela isikhala phakathi kwezinhliziyo ezinzima.
Uma umuntu enesifo senhliziyo, le ngxenye ngeke isaba flat kodwa izovela ngokungavamile ephakanyisiwe.
Izinhlobo nobunzima be-STEMI
I-STEMI ingenye yezinhlobo ezintathu ze- acon coronary syndrome (ACS) . I-ACS ivela lapho i-plaque iphuka ngaphakathi kwe-artery coronary, okwenza kube nokuvinjelwa okuyingxenye noma okuphelele kwalowo mshini. Ukuvimbela ngokwayo kubangelwa lapho ama-clots egazi enza ifomu nxazonke.
Uma ivinjelwe, ingxenye yesisindo senhliziyo esetshenziswa yilo mshini izoba ngokushesha ngenxa yokuntuleka kwe-oksijeni, okuthiwa yi- ischemia . Izinhlungu zesifuba ( angina ) ngokuvamile ziyizibonakaliso zokuqala zalokhu. Uma ukuvinjelwa kubanzi ngokwanele, ezinye zezinhlanzi zenhliziyo zizoqala ukufa, okuholele ekutheni i-myocardial infarction.
Sihlukanisa i-ACS ngezinga lokuvimbela kanye nokulimala okubangelwa imisipha yenhliziyo:
- Uma ukuvimbela okuphelele kwe-aron coronary kwenzeka, okuholela ekufeni kwezinhlanzi zenhliziyo, sikhuluma ngokuthi njenge-STEMI, uhlobo olubi kakhulu lwe-ACS.
- Kodwa-ke, kwezinye izimo, ama-clots azokwakha, ahlakaze, futhi aphinde enze kabusha phakathi nesikhathi samahora noma izinsuku ngaphandle kokubangela ukuvinjelwa okungaguquki. Uma lokhu kwenzeka, lo muntu angase aphinde aphinde aphinde aphinde angina ngisho nalapho ephumula. Lolu hlobo lwe-ACS lubizwa ngokuthi i- angina engaqiniseki .
- Phakathi kwe-STEMI ne-angina engazinzile yisimo abanye abhekisela kuzo ngokuthi "ukuhlasela kwenhliziyo okuyingxenye." Lokhu kwenzeka lapho ukuvinjelwa akuvimbeli ngokuphelele ukugeleza kwegazi. Ngenkathi isifo esithile sezitho zizokwenzeka, ezinye izingxenye zomzimba zizosinda. Ithimba lezokwelashwa lale yi-non-ST-segment infotction elevation ye-myocardial ( NSTEMI ).
Kungakhathaliseki ukuthi umcimbi we-ACS uhlukaniswa kanjani, usabhekwa njengesiziphuthumayo sezokwelapha kusukela angina engaqinisekisiwe kanye ne-NSTEMI ngokuvamile izibonakaliso zokuxwayisa zenhliziyo enkulu.
Izimpawu ze-STEMI
I-STEMI izovame ukuphumela ebuhlungu obukhulu noma ngokucindezela ngaphakathi noma ezungeze esifubeni, ngokuvamile ekhanyisa entanyeni, emhlathini, ehlombe noma engalo. Ukuthuthumela okukhulu, ukuphefumula, kanye nomqondo ojulile wokubhujiswa okuzayo nakho kuyavamile. Ngezinye izikhathi, izimpawu zingase zingabonakali kakhulu, zibonakaliswe ngezimpawu ezingenasici noma ezijwayelekile ezifana nalokhu:
- Ubuhlungu obuzungeze amahlombe ehlombe, ingalo, isifuba, umhlathi, ingalo yesokunxele, noma isisu esisenhla
- Ukuzwa okubuhlungu okuchazwe njengokuthi "kunesibindi esiboshiwe esifubeni"
- Ukunganaki noma ukuqina entanyeni noma engalweni
- Ukuzithoba noma ukushaya inhliziyo
- I-nausea nokuhlanza
- Ukukhathala noma ukuphelelwa amandla okungazelelwe
- Ukuphelelwa umoya
- Ukuzivocavoca noma ubukhulu obunzima
- Ukwenyuka kwenhliziyo noma okungavamile
- Isikhumba se-Clammy
Njengomthetho ojwayelekile wesithupha, noma ubani osengozini enkulu yokuhlaselwa yinhliziyo kufanele akhokhe ngokucophelela noma yiluphi uphawu olungavamile olusuka ngenhla okhalweni.
Ukuxilongwa kwe-STEMI
Ezimweni eziningi, ukuxilongwa kwe-STEMI kungenziwa ngokushesha uma umuntu ephathwa ngaphansi kwezempilo. Ukubuyekezwa kwezimpawu, okuhambisana nokuhlolwa kwesigaba se-ST ku-ECG, kuvame ukuba nodokotela ukuba aqale ukwelashwa.
Ukubuyekezwa kwama- enzyme enhliziyo kungasiza kepha kuvame ukufika kahle ngemuva kokwelashwa okunzima.
Kubalulekile ukumisa umuntu ngokushesha ngangokunokwenzeka. Ngaphezu kokubuhlungu nokucindezeleka, i-STEMI ingabangela ukufa okungazelelwe ngenxa ye-fibrillation ye-ventricular (ukuphazamiseka okukhulu kwenhliziyo) noma ukuhluleka kwenhliziyo (lapho inhliziyo ingakwazi ukupompa igazi elanele ukuze linikeze umzimba ngendlela efanele).
Ngemuva kokuhlasela kwenhliziyo kuqhubekile, imisipha ngokwayo ingase ishiye umonakalo omkhulu unomphela. Ukuhluleka kwenhliziyo okungapheli kuyisimo esivamile salokhu, njengengozi eyanda kakhulu ye-arrhythmias ye-cardiac eyingozi (izinhliziyo ezingavamile).
Ukwelashwa kwe-STEMI
Ukwelapha kufanele kuqalwe ngesikhathi umgudu we-STEMI utholakala. Ngaphandle kokwenza izidakamizwa ukuze kuqiniswe imisipha yenhliziyo (kufaka phakathi i-morphine, i- beta blockers , nemithi ye-statin ), kuzokwenza imizamo yokuvula kabusha umthamo ovinjiwe ngokushesha.
Lokhu kudinga isivinini. Ngaphandle kokuba i-artery ivulwe kungakapheli amahora amathathu okuvimba, okungenani umonakalo ongunaphakade ungalindelwa. Ngokuvamile, umonakalo omkhulu unganciphisa uma umcibisholo uvaliwe phakathi kwamahora ayisithupha okuqala okuhlaselwa. Kuze kube amahora angu-12, omunye umonakalo ungasuswa. Ngemuva kwalokho, kuthatha isikhathi eside ukuvulela umshini, umonakalo omkhulu uzoba khona.
Kunezindlela eziningana zokuvula isithiyo sokuvimbela:
- Ukwelashwa kwe-thrombolytic kuhilela ukusetshenziswa kwezidakamizwa ezihamba phambili.
- I-Angioplasty yigama lezokwelapha lokulungisa / ukuvulwa kokuhlinzwa kwe-artery.
- Ukugxila kuhilela ukufaka ithubhu elimathini ukuvula kabusha umthamo.
Uma isigaba sokwelapha esiyinkimbinkimbi sesiphelile futhi umcibisholo ovinjiwe uvuliwe, kusekhona okuningi okumelwe kwenziwe ukuze kuqiniswe inhliziyo, nokunciphisa izinkinga zesifo senhliziyo.
Lokhu kuvame ukubandakanya isikhathi eside sokuphulukisa, kuhlanganise nohlelo lokuvuselela ukuvivinya umzimba, izinguquko zokudla, nokusetshenziswa kwe-anticoagulants (igazi elincane) kanye nemithi yokulawula i-lipid.
> Umthombo:
> O'Gara, uP .; Kushner, F .; I-Ascheim, D .; et al. "Isiqondiso se-ACCF / AHA sika-2013 sokuphathwa kwe-ST-elevation Myocardial Infarction: Ukufingqwa koMbiko: Umbiko we-American College of Cardiology Foundation / American Heart Association Task Force on Guidelines Practice." Umagazini we-American College of Cardiology. 2013; 61 (4): DOI: 10.1016 / j.jacc.2012.11.018.