Kungani ngisho nokuhlaselwa "kwenhliziyo" kungaba yinto enkulu
I-infinction ye-non-ST ye-elevation ye-myocardial infarction (NSTEMI) nesifo se-ST-segment elevation of cardiovascular infarction (STEMI) bobabili baziwa ngokuthi ukuhlasela kwenhliziyo. I-NSTEMI iyinto engavamile kakhulu kulababili, ibhalwa ngamaphesenti angaba ngu-30 azo zonke izinhlanzi zenhliziyo.
I-NSTEMI, STEMI, nesimo sesithathu okuthiwa i-angina engaqiniseki yizo zonke izinhlobo ze- acon coronary syndrome (ACS) .
Ngokwengxenye yayo, i-ACS ichazwa njenganoma yisiphi isimo esilethwa ngokunciphisa ngokungazelelwe noma ukuvinjelwa kokugeleza kwegazi enhliziyweni.
Ukuqonda Acute Coronary Syndrome
Zonke izinhlobo ze-ACS zivame ukubangelwa ukuqubuka kwe- plaque emgodini we- coronary , okuholela ekunqandeni noma ekuqedeni isitsha. Ngokuya ngobukhulu bokuvimbela, i-ACS ingahlukaniswa ibe izinhlobo ezintathu ezihlukene:
- I-angina engaqiniseki i-artery breaks of artery eyenza izinhlungu zesifuba. Ngokungafani no-angina ozinzile (okwenzeka lapho uzikhandla), i-angina engaqiniseki ingenzeka nganoma yisiphi isikhathi futhi ibhekwa njengento engathà sina. Naphezu kwezibonakaliso, i-angina engazinzile ayibangeli ukulimala okungapheli enhliziyweni.
- I-STEMI ibhekwa njenge-"classic" yokuhlasela kwenhliziyo lapho i-plaque ephukile ngokuphelele ivimba umthambo omkhulu we-coronary, okwenza kube nomonakalo omkhulu wenhliziyo.
- I-NSTEMI ibhekwa njengefomu "eliphakathi" le-ACS lapho ukuvinjelwa kubonakala khona emgodini omncane we-coronary noma kubangela ukuvinjelwa okuyingxenye umthambo omkhulu we-coronary. Ngenkathi izimpawu zingafana ne-STEMI, umonakalo wenhliziyo uzoba mkhulu kakhulu.
I-NSTEMI ne-angina engazinzile ngokuvamile zizoqhubeka nokuhlaselwa kwenhliziyo "ephelele" ngaphakathi kwesikhala samahora ambalwa noma izinyanga ezimbalwa. Ngenxa yalokho, ngayinye ingabhekwa njengabaqaphi be-STEMI kanye nesignali sokuxwayisa zakudala ukuthi kuyadingeka ukwelashwa okunonya okudinga usizo.
Ihlukanisa i-NSTEMI kusuka ku-STEMI
Ukuxilongwa kwe-NSTEMI kwenziwa ngokujwayelekile uma umuntu enezibonakaliso ze-angina engazinzile.
Singakwazi ukwahlukanisa i-STEMI kusuka ku-NSTEMI ngokufundwa kwi- electrocardiogram (ECG) kule okuthiwa "isigaba se-ST." Ngaphansi kwezimo ezivamile, isigaba se-ST yindawo esicacile esiyibona ku-ECG phakathi kwezinhliziyo. Phakathi nokuhlaselwa kwenhliziyo, isigaba se-ST sikhuliswa. Ngenxa yalokho, i-NSTEMI ibizwa igama ngoba ayikho ubufakazi bokuphakama kwesigaba se-ST.
Ngenxa yokuthi i-NSTEMI ibangela ukulimala kwenhliziyo, odokotela bazoqhubeka bethatha ukuhlaselwa yinhliziyo (abanye bangase bathi "ukuhlaselwa kwenhliziyo"). Ngalokho kuthiwa, i-NSTEMI inokufana kakhulu ne-angina engazinzile futhi, njengoba kunjalo, ngokuvamile, inemiphumela engcono.
Ukwelashwa Okuphuthumayo kwe-NSTEMI
Ukwelashwa kwe-NSTEMI kufana nalokho kokungena okungazinzile. Uma umuntu ebonakala enezimpawu zomzimba (ukuqina kwesifuba, ukukhanya kwekhanda, izinhlungu zokudubula esandleni sokunxele, njll.), Udokotela uzoqala ukwelashwa okunamandla ukuqinisa inhliziyo nokuvimbela umonakalo owengeziwe.
Ukuqiniswa kuzogxila ezintweni ezimbili:
- Ukuqeda i-ischemia enzima , isimo lapho inhliziyo ingatholi okwanele okwanele, okubangela ukufa kwe-cell. Lokhu kwenziwa, ngokwengxenye, ngokuhlinzeka nge- beta blockers ukuvimbela umonakalo obangelwa ukukhiqizwa ngokweqile kwe-adrenaline kanye nezitezi eziphezulu kakhulu ukuze kuqinisekiswe ukuqubuka kwesibhamu futhi kuncishiswe ukuvuvukala kwesifo. Ukusetshenziswa kwezidakamizwa ngokuvamile kuzokwehlisa ischemia yenhliziyo emaminithini. I-oksijeni ne-morphine izovame ukuhlinzeka ukusiza ukuphefumula nokunciphisa ubuhlungu.
- Ukumisa i-blood clot formation kuhilela ukusetshenziswa kwe-aspirin, i-Plavix, neminye imithi yokwehlisa igazi nokuvimbela ukuqoqwa kwamaplatelets. Kuhlanganisa nokugwema "ama-clot busters," ngokuvamile asetshenziswe ku-STEMI, okungenza izinto zibe zimbi nakakhulu.
Kwenzekani Uma Isimo Sizinzile
Lapho isiguli sigxilile, udokotela uzohlola ukuthi kungadingeka yini ukungenelela okwengeziwe. Abaningi be-cardiologists bazosebenzisa i-TIMI (thrombosis ku-myocardial infarction) score ukuthola ukuthi kungenzeka yini umphumela kumuntu ngamunye.
Ithimba le-TIMI lihlola ukuthi ngabe lowo muntu unezizathu ezilandelayo eziyingozi:
- Uneminyaka engu-65 noma ngaphezulu
- Ukuba khona okungenani izinto ezintathu ezingozini zokugula kwesifo senhliziyo
- Ukuvinjelwa kwamaphesenti okuqala kwamaphesenti angaphezu kwangu-50
- Ukuphambuka kwesigaba se-ST ku-ECG yokungena
- Okungenani ama-angina episodes amahora angu-24 adlule
- I-enzyme ye-cardiac ephakeme
- Ukusetshenziswa kwe-aspirin ezinsukwini eziyisikhombisa ezedlule
Uma lowo muntu enezinkinga ezimbili noma ezimbalwa (i-TIMI score 0-2), isidingo sokungenelela okunye kungavinjelwa. Uma amaphuzu ephakeme, i-cardiologist ingase ifune ukwenza i- catheterization ye-cardiac nge- angioplasty ne- stenting .
Kubantu abayeka ukwelashwa okungahambi kahle, ukuhlolwa kokucindezeleka kuzokwenziwa ngokuvamile ngaphambi kokukhipha. Uma kukhona izibonakaliso ze-ischemia yenhliziyo eqhubekayo, ukwelashwa okungajwayelekile kuyokwaziswa kakhulu.
> Umthombo
- > Amsterdam, E .; UWenger, uN .; Brindis, R .; et al. "Umhlahlandlela we-AHA / ACC we-2014 wokuphatha iziguli ezine-syndromes ezinamandla ezingezona eze-ST: isishwankathelo esiphezulu: umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice." Ukujikeleza. 2014; 130: 2354.