Ukuhluleka kwenhliziyo kwesimo esilungile yisimo lapho ohlangothini olungakwesokudla senhliziyo engakwazi ukupompa igazi emaphashini ngendlela efanele.
Ukungakwazi kwenhliziyo ukupompa igazi ngendlela efanele emaphashini kubangela ukuthi igazi libuyele esimweni esibucayi, futhi likhawulelise ukukhishwa kwenhliziyo (inani eliphelele legazi inhliziyo ingashaya ngomzuzu ngamunye). Izimpawu ezivela ekuhlulekeni kwenhliziyo kwangempela kungaba nzima kakhulu, futhi lesi simo singanciphisa kakhulu ukulindela impilo uma kungenakulinganiswa ngendlela efanele.
Ukuhluleka kwenhliziyo kwangakwesokunene kubangelwa ngokuhambisana nokuhluleka kwenhliziyo kwesokunxele, ngakho-ke igama elivamile elithi " ukwehluleka kwenhliziyo " kuhlanganisa okungenani ukungasebenzi kwamacala omabili enhliziyo.
Kodwa ngesinye isikhathi, ukwehluleka kwenhliziyo kwangakwesokunene kungenzeka ngokwayo, kanti umsebenzi ohlangothini lwesobunxele wenhliziyo uhlala ujwayelekile (noma cishe uvamile). Kubalulekile ukuqaphela ukuhluleka kwenhliziyo efanele uma kukhona, ngoba izimbangela zayo, izimpawu ezikhiqizayo, kanye nokwelashwa okudinga, ngokuvamile zihluke kakhulu ezinhlobonhlobo ezijwayelekile kakhulu, ezinhlobonhlobo ezinhlangothini ezisekhohlo kwenhliziyo.
I-Side Right Side Side vs. Side Side
Uma kuqhathaniswa nehlangothini lwesobunxele senhliziyo , inhliziyo enhle ingcono kakhulu. Umsebenzi we-ventricle wesokunxele ukupompa igazi ngaphandle kwenhliziyo, ngokumelene nengcindezi ephakeme kakhulu, kuzo zonke izitho zomzimba (ngaphandle kwamaphaphu). Ukwenza lo msebenzi ngokucophelela kudinga izindonga ze-muscular ze-ventricle kwesokunxele zibe zikhulu futhi ziqinile.
Ngokuphambene nalokho, umsebenzi we-ventricle ofanele ukupompa "isetshenziswe," igazi elingenayo i-deoxygenated ukuya emaphashini nge-arteriary artery, ngakho-ke ingagcwaliswa nge-oxygen. Ngenxa yokuthi umthambo we-pulmonary isistimu encane yokucindezela, i-ventricle efanele akudingeki ukuthi idale ukucindezelwa kwegazi okuningi ukuze yenze umsebenzi wayo.
Ngenxa yalesi sizathu, ngenkathi i-ventricle efanele kufanele iphepule igazi eliningi ngenhliziyo ngayinye ishaya njenge-ventricle engakwesobunxele, inani lomsebenzi okumele lisebenze ngokwenza kanjalo kungamaphesenti angama-25 omsebenzi okwenziwa yi-ventricle kwesokunxele. Ngenxa yokuthi i-ventricle efanele isebenze endaweni ephansi kakhulu yokucindezela, ephansi ukusebenza, isakhiwo esincane kakhulu, futhi sinesisindo esincane kakhulu senhliziyo ngaphandle kwe-ventricle kwesokunxele.
Uhlangothi lwesokudla lwenhliziyo lusebenza ngokuphumelelayo ekupombaneni imifula enkulu yegazi (njengezikhathi lapho senza ukukhishwa okukhulu). Kodwa i-ventricle yangakwesokunene engamabhande ayinamandla kakhulu ekusebenzeni ngaphansi kwezimo zokucindezela okukhulu. Ngakho-ke uma i-ventricle efanele ithola ukuthi kufanele isebenze isikhathi esithile eside ngokumelene nezingcindezi eziphakeme emthini we-pulmonary, iqala ukuhluleka.
Ngakho-ke, ukwehluleka kwenhliziyo kwesigameko kwenzeka ngokuvamile ngaphansi kwezimo ezibangelwa ukucindezelwa okuphakeme emthini we-pulmonary-okungukuthi, uma umfutho wegazi ophezulu we-pulmonary ukhona. Uma i-ventricle efanele ithola ukuthi kufanele iqhume ngokumelene nokucindezela okukhulu, imane nje ayikwazi ukusebenza kahle, futhi ngaphandle kokuba ingcindezi ephakeme ikhululiwe, ukuhluleka kwenhliziyo kwesokudla kuyaqhubeka.
Izimbangela Zokuhluleka Kwezinhliziyo Ezingakwesokudla
Uhlu lwezimiso ezibangelwa ukuhluleka kwenhliziyo ngokuqondile ngokuhlukile kuhlukile ezimweni ezikhiqiza "okuvamile," ikakhulukazi ukuhluleka kwenhliziyo kwesokunxele.
Ngenxa yokuthi i-ventricle engakwesobunxele iqukethe ingxenye yengonyama yesisu senhliziyo, izinqubo zezinkinga ezithinta imisipha yenhliziyo zivame ukuthinta kakhulu i-ventricle engakwesokunxele. Ngakho-ke, ukuhluleka kwenhliziyo okubangelwa ukuhlaselwa kwenhliziyo, ukuphelelwa yisifo senhliziyo , i- hypertrophic cardiomyopathy , nezinhlobo eziningi ze- valvular isifo senhliziyo , cishe kuhlale kunesimo senhliziyo esingakwesokunxele.
Ngokuphambene nalokho, izimo ezikhiqiza ukuhluleka kwenhliziyo kwangempela zivame ukungena ezigabeni ezintathu ezijwayelekile: izimo ezikhiqiza umfutho wegazi ophezulu we-pulmonary, izifo ezithile ze-valvular heart, kanye nokuhlasela kwenhliziyo kwangempela.
Ukucindezeleka komfutho wegazi
Ukuhluleka kwenhliziyo kwesokunxele ngokuvamile kuvame ngenxa yesifo somfutho wegazi. Uhlu olude lwezimo lungabangela ukushisa komfutho we-pulmonary , futhi konke kungabangela ukuhluleka kwenhliziyo efanele. Izimbangela ezivame kakhulu zomshuwalense we-pulmonary eziholela ekuhlulekeni kwenhliziyo kwesokudla zihlanganisa:
- Ukuhluleka kwenhliziyo kwesokunxele: Ukuhluleka kwenhliziyo ikakhulukazi kuthinta ohlangothini lwesobunxele senhliziyo (okungukuthi, "ukukhubazeka kwenhliziyo"), kwandisa ingcindezi ngaphakathi kwe-pulmonary vascular system, futhi ukucindezela kwamapulmonary okuphakeme ngokuvamile kuholela ekugcineni, kwesokudla ukuhluleka kwenhliziyo. Eqinisweni, kulungile ukusho ukuthi ukwehluleka kwenhliziyo kwangasese kungumphumela ovamile futhi wemvelo wokuhluleka kwenhliziyo engakwesokunxele noma ephatheka kabi.
- I-pulmonary embolus: I- pulmonary big embolus ingakhuphula umthambo we-pulmonary ukucindezela emazingeni aphakeme kakhulu, futhi ngaleyo ndlela ingabangela ukwehluleka kwenhliziyo ehlanzekile. Okuncane kakhulu, okuvame ukuvuthwa kwe-pulmonary emboli kunganciphisa kancane kancane umthamo we-arterium, futhi ngaleyo ndlela kungabangela ukuqala kokungaqondakali kwenhliziyo efanele.
- Isifo samaphaphu angapheli : Izinhlobo ezingapheli zezifo zamaphaphu, ikakhulukazi isifo esingenasifo sokuphefumula (COPD) noma ukuphazamiseka kokuphefumula kokulala , kungagcina kugcwalise umfutho wegazi wegazi kanye nokuhluleka kwenhliziyo efanele.
- Isifo esibuhlungu sokucindezeleka (ARDS) : Lokhu ingaveza uhlobo oluyingozi lwe-pulmonary hypertension kanye nokuhluleka kwenhliziyo efanele.
- Isifo senhliziyo esibangelwa yi-congenital: Inhlamba ye-septal ye-atrial ikakhulukazi ne-septric defect defect, lokhu kungagcina kuveza ukucindezeleka kwe-pulmonary kanye nokuhluleka kwenhliziyo.
- Ezinye izimbangela ze-hypertension ye-pulmonary: Lokhu kufaka phakathi ukucindezeleka okukhulu kwe-pulmonary, scleroderma , sarcoidosis , noma izinhlobo ezahlukene ze- vasculitis ezithinta amaphaphu.
Kulolu hlu, kubonakala ukuthi ukuhluleka kwenhliziyo ehlanzekile-okuwukuthi, ukuhluleka kwenhliziyo okungekho emthethweni okungabangelwa isifo senhliziyo eshiya uhlangothi lwesobunxele senhliziyo-cishe njalo ngenxa yesimo sengqondo se-lung okukhiqiza umfutho wegazi ophezulu we-pulmonary. Ukuhluleka kwenhliziyo kwesokunxele okubhekene nesimo se-pulmonary kubizwa ngokuthi i- cor pulmonale . Ngenxa yokuthi ukwehluleka kwenhliziyo kwangasese kubangelwa njalo ngesimo sephaphu, odokotela abaningi basebenzisa i- "cor pulmonale" njengendlela efana nayo yokuhluleka kwenhliziyo.
Noma kunjalo, ukuhluleka kwenhliziyo kwangasese kungabangela ezinye izimbangela, ngakho-ke le migomo ayiyona ingqinamba yangempela.
I-Valvular Heart Heart
Noma yiluphi uhlobo lwesifo se-valvular senhliziyo eyinhloko ukukhulisa ukucindezela ngaphakathi kwesokudla senhliziyo, noma ukuvimbela ukugeleza kwegazi ngakwesokunene senhliziyo, kungenza ukuhluleka kwenhliziyo kwangempela.
Ngenkathi izifo zamagundane ezinhliziyo zangasese-i-valve ye-tricuspid kanye ne-valve ye-pulmonary-ingabangela ukuhluleka kwenhliziyo kwangakwesokudla, lokhu kubonakala kuyimbangela engavamile. Ukubuyisela emuva (ukuvuza) kwalezi zivini ezimbili ngokuvamile kungumphumela (futhi hhayi imbangela) yegazi lomfutho wegazi. I-stenosis (encane) yalezi valve ivame ukubangelwa isifo senhliziyo esiswini noma esiyinkimbinkimbi esithinta ezinye izingxenye zenhliziyo ngezinga elikhulu. Ngakho-ke isifo se-valve noma isifo se-valve, ngokwalo, yisisusa esiyingozi kakhulu sokuhluleka kwenhliziyo efanele.
Ngakolunye uhlangothi, i- stenosis ye-mitral valve-i -valve ephakathi kwe-atrium kwesokunxele ne-left ventricle-ngokuvamile idala ukuhluleka kwenhliziyo efanele. Igazi elibuyela e-atrium lesokunxele lisuka emaphashini livame ukuba "liphume" uma i-mitral stenosis ikhona, okuholela ekwenyuseni ukucindezela kwamasiphaphu emaphashini, okugcina ekukhiqizeni umfutho wegazi ophezulu we-pulmonary kanye nokuhluleka kwenhliziyo efanele.
Infarth ye-Ventricular Myocardial Infarction
Abantu abanokuhlukunyezwa kwe-myocardial (ukuhlaselwa yinhliziyo) okubangelwa ukuvinjelwa emgodini we- coronary efanele kungabhekana nomonakalo kumisipha ye-ventricular efanele, okhiqiza ukwehluleka kwenhliziyo kwangempela. Ukwelapha isifo senhliziyo senhliziyo efanele ngokuvamile kufana nokuphatha noma yikuphi i- STEMI , kufaka phakathi ngokushesha ukuvula isitsha segazi esivinjelwe "ngezidakamizwa ze-clot-busting" noma i- stent .
Kodwa-ke, ngoba ukuhluleka kwenhliziyo kwangakwesokudla kunganciphisa inani legazi elifinyelela ohlangothini lwesobunxele lwenhliziyo, izidakamizwa ezihloswe ngokuyinhloko ekwelapheni ubuthakathaka bokungena kwesokunxele (njengezitrate, i- beta blockers , ne- block calcium channel ). ngokuqapha okukhulu ekuhlaselweni kwenhliziyo kwangempela.
Izimpawu Zokuhluleka Kwezinhliziyo Ezinhlangene
Izimpawu ezibangelwa ukuhluleka kwenhliziyo kwangaphakathi zingafana nezibonakaliso zabantu abanesimo "esivamile," esiningi senhliziyo ehlulekayo. Lokhu kufaka phakathi i- dyspnea (ukuphefumula), ubuthakathaka, ukululazeka kalula, kanye ne-edema (ukuvuvukala).
Ngokwehluleka kwenhliziyo kwesokunxele, noma kunjalo, ezinye zalezo zimpawu zingaba nzima kakhulu. I-Dyspnea ngokuzikhandla okuncane kakhulu, ukukhathala okwedlulele, ngisho nokweqile kungenzeka. I-edema ebhekene nabantu abanokuhluleka kwenhliziyo ehle kakhulu ivame kakhulu kunokuba "nje" i-edema yamagqabha kanye nemigqa ephansi. Bangaba ne-edema yamathanga, isisu, ngisho nesifuba.
Futhi, izikhumba zazo zingaba nokuvuvukala futhi zibuhlungu, futhi zingakwazi ukuthuthukisa ama- ascites (oketshezi emgodini wesisu). I-Anorexia (ukulahlekelwa okukhulu kwesidlo) ingaba uphawu oluvelele. Bangakwazi futhi ukuvumelanisa i-syncope (ukulahlekelwa kwengqondo), ngoba abakwazi ukwandisa umkhiqizo wabo wenhliziyo uma beyisebenzisa.
Ukuhlonza Ukuhluleka Kwezinhliziyo Ezingakwesokudla
Ukuhlolwa ngokucophelela komtholampilo kumele unikeze odokotela ulwazi oluqinile mayelana nokuba khona kwenhliziyo ehlulekile. Umlingiswa kanye nekhwalithi yezimpawu (okuchazwe nje) kubaluleke kakhulu ekwenzeni ukuxilongwa, njenganoma imuphi umlando wezokwelapha wezinkinga zamaphalenda, ukucindezeleka okujulile kwegazi noma i-pulmonary embolus.
I-Electrocardiogram (ECG ) kanye nokuhlola kwe- echocardiogram kuvame ukuveza ukucindezelwa komthambo ophakeme kakhulu, futhi noma yisiphi isifo senhliziyo senhliziyo noma izifo ezithinta isisu senhliziyo. Lezi zivivinyo zivame ukwelapha ukuxilongwa kwesokunxele senhliziyo.
Ukuhlolwa okungeziwe kuyadingeka ukusiza ukuphoqa imbangela yokuhluleka kwenhliziyo kwesokudla. Isibonelo, ukuhlolwa komsebenzi wephalenda kungabonisa ukuthi ubukhona nobukhulu be-COPD, futhi ukulala ukuhlolwa kungasiza ukwenza ukutholakala kwe-apnea yokulala. Ukuhlolwa kwe-CT , ukuhlolwa kwe-MRI , kanye / noma ukuphazamiseka kwengqondo kungase kudingeke, kuye ngokuthi yiluphi uhlobo lwesibangela esicasulayo.
Kubalulekile ukuphawula phansi imbangela ebalulekile, ngoba ukwelashwa kuxhomeke kulo.
Ukwelashwa Kokuhluleka Kwezinhliziyo Ezingakwesokudla
Ukwelashwa okwanele kokuhluleka kwenhliziyo efanelekile kuncike ngokuphelele ekuboneni nasekuphatheni imbangela eyimbangela. Ake sibheke izimbangela ezingase zibe khona:
- Uma imbangela isifo senhliziyo ye-valvular (ngokuvamile ngokuvamile, i-mitral stenosis), ukulungiswa okuhlinzekwayo noma ukuguqula i-valve egulayo kuyadingeka.
- Uma i-infricction ye-ventricular myocardial isisusa, ukwelashwa okunamandla nokushesha ukuvula umthambo we-coronary efanelekile ovinjiwe kuyadingeka.
- Uma imbangela ebangela ukuhluleka kwenhliziyo kwesokunxele, ukwelashwa okwanele kolunye uhlangothi lwenhliziyo kudinga ukwandisa ukwelashwa kokuhluleka kwenhliziyo kwesokunxele .
- Uma imbangela yokuhluleka kwenhliziyo efanelekile yinkinga ye-pulmonary (okungukuthi, uma i-cor pulmonale ikhona), khona-ke ukwelashwa kuxhomeke ekwenzeni ukwandisa ukwelashwa kwenkinga yamaphaphu angaphansi.
Ngenkathi inqubo yesifo esiyinkimbinkimbi ibonakala, futhi ukwelashwa kwayo kulungiselelwe, izidakamizwa zingase zisetshenziselwe ukunciphisa i-edema ngokweqile (nakuba lezi zidakamizwa zidinga ukusetshenziselwa ngokuhlakanipha ngokuhluleka kwenhliziyo). Ukunakekelwa kufanele kuthathwe ukuze kugweme izimo ezandisa ukwanda kwengcindezi yomthambo we-pulmonary, njengezinga eliphansi le-oksijeni yegazi, ne- acidosis . Izidakamizwa ezinganciphisa ukucindezelwa komthambo we-pulmonary nazo zingasiza.
Kodwa okusemqoka, futhi, ukuthi ukuphatha kahle ukuhluleka kwenhliziyo kwangempela kusho ukuphatha ngobuhlungu imbangela eyimbangela.
Izwi elivela
Ukuhluleka kwenhliziyo kwangempela kuyisimo esibi kakhulu esivame ukudala izimpawu ezinzima, futhi kungabangela ukufa ngaphambi kwesikhathi. Kubalulekile ukuthi noma ubani onesi simo athole ukuhlolwa okuphelele kwezokwelapha ukuze abone ngokucacile isizathu esiyimbangela, bese uthola ukwelashwa okunamandla ukuguqula noma ukuvuselela lokho okubangela.
> Imithombo:
> UBruce CJ, u-Connolly HM. Izifo Zama-Valve Ehlangene Zifanele Ukuhlonishwa Okuncane. Ukujikeleza. 2009; 119: 2726.
> Falk JA, Kadiev S, Criner GJ, et al. Izifo Zezinhliziyo Ezikhungweni Eziphephile Zokuvimbela Izifo. I-Proc Am Thorac Soc 2008; 5: 543.
> Galiè N, Humbert M, Vachiery JL, et al. Imikhombandlela ye-ESC / ERS ka-2015 yokuHlola nokuPhathwa kwe-Hypertension ye-Pulmonary: I-Joint Task Force for the Discover and Treatment of Pulmonary Hypertension ye-European Society of Cardiology (ESC) kanye ne-European Respiratory Society (ERS): Kuvunyelwe yi: Association of European I-Pediatric and Cardiology Congenital (AEPC), International Society for Heart and Lung Transplantation (ISHLT). I-Eur Heart J 2016; 37:67.