Ukuhlolwa kokucindezeleka kwe-cardia, okubizwa nangokuthi ukuvivinya umzimba, kungasiza ekuboneni ukuvinjelwa okuyingxenye emithanjeni yakho ye-coronary.
Izikhathi eziningi, ukutholakala kwezifo ze- coronary artery (CAD) kubhekene kalula uma umuntu ephumula, ngoba ekuphumuleni kungase kube khona uphawu lwenkinga noma ekuhloleni ngokomzimba noma ku- ECG . Kulezi zimo, ukukhubazeka kwenhliziyo kungase kubonakale kuphela uma inhliziyo ibuzwa ukuba yenze umsebenzi owandayo.
Isivivinyo sokucindezeleka sisetshenziselwa ukuhlola inhliziyo nenqubo ye-vascular ngesikhathi sokuzivocavoca. Kuyasiza ukuphendula imibuzo emibili ejwayelekile: 1) Ingabe ikhona i-CAD ebonakalayo kuphela lapho inhliziyo igcizelelwa umsebenzi? 2) Uma kukhona isifo senhliziyo esiyinkimbinkimbi, kungenzeka ukuthi kunzima kangakanani?
Isivivinyo Sokucindezeleka Senziwa Kanjani?
Okokuqala, uzobe uhola (izintambo) kumshini we- ECG onamathele esifubeni sakho, futhi i-cuff pressure yegazi igxilwe engalweni yakho. Inzwa efana ne-dressspin ingafakwa emunwe wakho ukukala inani le-oksijini egazini lakho. Ngemva kokuthola i-ECG eyisisekelo, uzocelwa ukuba uqale ukwenza izinga eliphansi lokuzivocavoca, kungaba ngokuhamba ngesiteji sokuhamba noma ukuhamba ngebhayisekili. Ukuvivinya umzimba "kubanjwe" - okungukuthi, njalo imizuzu emithathu, izinga lokuzivocavoca landa. Esikhathini ngasinye "isigaba" sokuzivocavoca, ukushayela kwakho, ukucindezelwa kwegazi kanye ne-ECG kubhaliwe, kanye nanoma yiziphi izimpawu ongase uzizwe.
Ngokuhlolwa kokucindezeleka , "izinga lokuzivocavoca liye landa kancane kuze kube yilapho ungeke ukwazi ukuqhubeka uphelele ngenxa yokukhathala, noma kuze kube yilapho ubona izibonakaliso ( ubuhlungu besifuba , ukuphefumula , noma ukukhanya) okuvimbela ukuqhutshwa okuqhubekayo, noma kuze kufike izinguquko ku-ECG yakho ikhombisa inkinga yenhliziyo.
Ukuhlolwa kokucindezeleka okuphezulu kufanele kwenziwe uma umgomo ukubuka noma yibuphi ubufakazi be-CAD.
Ngesicingo sokucindezeleka "esincane" , uzosebenzisa kuze kube yilapho izinga lokuzivocavoca lingakafiki. Izivivinyo ze-Submaximal zisetshenziselwa iziguli ezine-CAD eyaziwayo, ukuze zilinganise ukuthi izinga elithile lokuzivocavoca lingenziwa ngokuphepha. Lolu hlobo lokuhlola luwusizo kudokotela ekunconyeni ukuthi umuntu ophethe i-CAD angenza kahle kangakanani.
Ngemuva kokuhlolwa, uzobe uhlolwe kuze kube yiziphi izimpawu ezidlulayo, futhi kuze kube yilapho uphawula, ukucindezelwa kwegazi kanye ne-ECG ubuyela emuva.
Yiziphi izinhlobo zezifo zengqondo Ungakwazi Ukuhlola Ukucindezeleka Usizo Ukuhlola?
Ukuhlolwa kokucindezeleka kusetshenziselwa ukuxilongwa kwe-CAD okukhiqiza i-blockages emithanjeni ye-coronary , i-arteries ehlinzeka ngegazi emzimbeni wenhliziyo. Uma ukuvinjelwa okuyingxenye kukhona, imisipha yenhliziyo ehlinzekwa yilokhu kuvinjelwe okuyingxenye ingase ithole lonke igazi elilidingayo esimweni sokuphumula. Kodwa uma umuntu onokuzivocavoca okuyingqayizivele, umthambo kungenzeka ukuthi awukwazi ukunikeza lonke igazi isisindo senhliziyo esidinga ukuyenza ezingeni eliphakeme manje elidingekayo.
Uma ingxenye yesisu senhliziyo ngokungazelelwe ingayitholi ukugeleza kwegazi okwanele, iba yiksijini-elambile, noma ischemic .
Isisu senhliziyo yesisu ngokuvamile idala ukungahambi kahle kwesifuba (isifo esibizwa ngokuthi " angina ") kanye nezinguquko zesimo se-ECG. Ukuzivocavoca kungabangela nezinguquko enhliziyweni yomculo, noma ekucindezelweni kwegazi. Ngokucindezela "inhliziyo ngokuzivocavoca, ukuhlolwa kokucindezeleka kungabangela ukungalingani okubangelwa ukuvinjelwa okuyingxenye emithanjeni ye-coronary - okungavamile okungeke kwenzeke ngokuphelele ekuphumuleni.
Kubalulekile ukuthi uqaphele ukuthi ukuhlolwa kokucindezeleka kungasiza ekutholeni i-CAD eveza ukuvinjelwa okuyingxenye - okuthiwa i-CAD obstructive. I-CAD ivame ukukhiqiza ama- plaque emithanjeni engabangela ukuvimbela, futhi lezi zingqimba ezingenqamuki zingenza (futhi zenze), zidale ukwakheka kwegazi, okudala ukuvimbela okukhulu komthambo, okuvame ukuholela ekutheni i- myocardial infarction (ukuhlasela kwenhliziyo ).
Ngakho-ke ngokuqinisekile kungenzeka ukuba ube nokuhlolwa kokucindezeleka "okuvamile" ngenkathi usenayo i-CAD.
Ngenxa yokuthi ukuvivinya umzimba kuphakamisa amazinga e-adrenaline, ukuhlolwa kokucindezeleka kungasiza futhi ekuhloleni izinqubo ezithile zezinhliziyo ezivame ukuvela ngezikhathi lapho amazinga e-adrenaline enyuka.
Izivivinyo zokucindezeleka nazo ziyasiza ekulingeni "amandla okusebenza" weziguli ezinesifo senhliziyo. Uma isiguli sinesifo se-CAD, isibonelo, ukuhlolwa kokucindezeleka kungasiza ekuhloleni ukubaluleka kokuvinjelwa okuyingxenye. Uma izimpawu ze-ischemia zenzeka ezingeni eliphansi lokuzivocavoca, i-blockages kungenzeka ibe yinto ebaluleke kakhulu. Kodwa uma ischemia ingenzeki, noma uma kwenzeka kumazinga aphezulu kakhulu okuvivinya umzimba, ama-blockages cishe angabaluleki kakhulu.
Ukwenza ukuhlolwa kokucindezeleka ngezikhathi ezithile kungabuye kube yindlela ewusizo yokuqapha ukuqhubeka kweziguli ezinqenqemeni ze-heart congestive . Uma izinga eliphakeme lokuzivocavoca elifinyelelekayo liye landa kakhulu ngokuhamba kwesikhathi, noma isifo senhliziyo esiyingozi singase sibe sibi kakhulu, noma ukwelashwa kwezokwelapha kungase kudingeke kulungiswe kabusha.
Izinguquko Ezisetshenziswa Ngemizamo Yokucindezeleka
Ukunemba kokuhlolwa kokucindezeleka ekuhloleni i-CAD kwanda kakhulu ngokwenza ucwaningo lwe- nuclear nyukliya ngokuhambisana nokuhlolwa kokucindezeleka. Into e-radioactive ebizwa ngokuthi i-thallium (noma into efanayo ebizwa ngokuthi i-sestamibi noma i-Cardiolite) ifakwe ku-vein ngesikhathi sokuvivinya umzimba. I-thallium iqoqa ezingxenyeni zenhliziyo ezinegazi elihle. Izithombe zenhliziyo zithathwe ngekhamera ekhethekile engayifaka isithombe se-radioactivity ye-thallium. Kusukela kulezi zithombe, izingxenye zenhliziyo ezingatholi ukugeleza kwegazi okuhle (ngenxa yokuvimba emithanjeni ye-coronary) zingabonakala. Ucwaningo lwe-thallium luyandisa kakhulu ukunemba kwesifundo sokuzivocavoca ekutholeni i-CAD. Isibalo sesiguli esivela ku-thallium singaphansi kwalokhu kusuka e-x-ray yesifuba.
Ngezinye izikhathi ama- Echocardiograms asetshenziselwa ngokuhambisana nokuhlolwa kokucindezeleka. Isivivinyo se-echo senziwa ekuphumuleni, bese sisebenza ngokuzivocavoca, sifuna izinguquko ekusebenziseni imisipha yenhliziyo ngesikhathi sokuvivinya umzimba. Ukuwohloka kwemisipha ngesikhathi sokuzivocavoca kungabonisa isifo se-artery coronary .
Ngezinye izikhathi iziguli azikwazi ukwenza umsebenzi ngenxa yokulinganiselwa ngokomzimba. Imithi ye-Persantine ne-dobutamine ingasetshenziswa kulezi zimo ukulingisa imiphumela yokuzivocavoca enhliziyweni.
Ukulinganiselwa
Kwezinye iziguli, izinguquko ze-ECG ezibonisa ukuthi i-ischemia ingenzeka ngisho nangaphandle kwe-CAD. (Ngamanye amazwi, izivivinyo zokucindezeleka azikho into engavamile.) Kwezinye iziguli, akukho izinguquko eziphawulekayo ze-ECG ezibonakalayo ngisho nangaphambi kwe-CAD. (Ngakho-ke ukuhlolwa kokucindezeleka okungabonakali "okungamanga" kungabonakala.) Izifundo ezingamanga nezamanga ezingalungile zingaba nomthelela omkhulu ekuhloleni ukuhlolwa kokucindezeleka ezigulini eziningi. Ngokufaka ucwaningo lwe-nuclear nyukliya ekuvivinyweni kokucindezeleka, lokhu kunciphisa kuncishisiwe, futhi amandla okuhlonza ukuhlolwa kokucindezeleka athuthukiswa kakhulu.
Izingozi
Ukuhlolwa kokucindezeleka kuboniswe ukuthi kuphephile ngokuphawulekayo. Ibeka ezingeni elifanayo leengozi njengokuthatha ukuhamba okusheshayo noma ukuhamba phezulu entabeni. Nakuba kungenzeka ukuthi i-ischemia ecindezelwe ukucindezeleka okunjalo ingabangela ukungena kwe-myocardial noma ukuphazamiseka kwengqondo okukhulu kakhulu, ngokwenza lo mcimbi awuvamile. Ngaphezu kwalokho, lapho lezi zenzakalo ezimbi zenzeka ngesikhathi sokuhlolwa kokucindezeleka, zenzeka phambi kosizo lwezokwelapha eziqeqeshiwe ezingakwazi ukubhekana nazo ngokushesha.
> Imithombo:
> Gibbons, RJ, Abrams, J, Chatterjee, K, et al. ACC / AHA 2002 isibuyekezo sokuqondisa ukuphathwa kweziguli ezine-angina ezingapheli.