Imishanguzo ye-coronary yiyona imithwalo yegazi ehlinzeka igazi kwi-myocardium (imisipha yenhliziyo). Ngoba kufanele isebenze ngokuqhubekayo (ngokungafani neminye imizimba yomzimba, evame ukuphumula), isisu senhliziyo sinesidingo esikhulu kakhulu se-oksijeni nezakhi futhi ngakho-ke sidinga ukunikezwa kwegazi okuthembekile kakhulu. I-coronary arteries yenzelwe ukuletha ukuhlinzeka kwegazi okuqhubekayo okudingekayo ukuba inhliziyo isebenze kahle.
Uma igazi ligeleza emithanjeni ye-coronary livinjelwe kancane, imisipha yenhliziyo ingaba ischemic (oksijeni-ilambile), isimo esivame ukukhiqiza i-angina kanye nokudonswa kwemisipha emsebenzini (kuboniswa ubuthakathaka kanye ne- dyspnea ). Uma ukugeleza kwegazi kuvinjelwe ngokuphelele, imisipha yenhliziyo ehlinzekwa umthamo ovinjiwe ingabhekana ne-infarction noma i-cell death. Lokhu kubizwa ngokuthi i- infarction ye-myocardial, noma ukuhlasela kwenhliziyo .
I-Anatomy ye-Coronary Arteries
Imishanguzo emibili ye-coronary, i-coronary artery (RC) ne-articular main (LM) yombono we-coronary, ovela e-aorta (umthambo omkhulu womzimba) ngaphesheya kwe-valve ye-aortic yenhliziyo.
Umcibisholo we-LM ngokushesha usuka emagqumeni amabili amakhulu - i-artery ye-anterior ehla (LAD) kanye nomthambo we-circumflex (Cx). Ngakho-ke, imisipha yezinhliziyo ihlinzekwa ngenye yalezi zimbangela ezinkulu ezintathu ze-coronary: i-LAD, i-Cx, ne-RC. Isithombe (ngenhla) sibonisa i-RC nemithambo ye-LAD.
(Umthamo we-Cx uboniswa ngethunzi elifana nomoya ngemuva kwenhliziyo.)
Umshini we-RC uboniswa ngakwesobunxele besibalo, uhamba ngasemaphethelweni enhliziyo. Ingxenyana ende ye-RC ukuthi, kulesisithombe, iya encekwini enkulu yenhliziyo (i-pepe) ibizwa ngokuthi i-posterior descending artery (PDA).
Kubantu abaningi (abangaba ngu-75%) i-PDA iphuma ku-RC, njengalesi sithombe. Lokhu kubizwa ngokuthi "okulungile kakhulu." Nokho, ngo-25% i-PDA ivela emthonjeni we-Cx, obizwa ngokuthi "ngakwesokunxele kakhulu". Lokhu kwahluleka kubalulekile, ngoba (isibonelo) ukuhlaselwa kwenhliziyo okuvela ekuvinjweni ku-RC. inhliziyo enhle kakhulu iyokwenza umonakalo omkhulu kunokuba ingase inhliziyo ephezulu kwesokunxele.
Umthambo we-RC namagatsha awo unikeza igazi eningi le-atrium elungile, i-ventricle efanele, i- sinus node , futhi (kubantu abaningi) i- AV node .
Ukubuyela esithombeni, i-LAD namagatsha ayo amaningi aboniswa ehlehlela phansi ephezulu ukusuka enhliziyweni. I-LAD inikeza i-atrium engakwesokunxele nezinxenye ezinkulu ze-ventricle kwesokunxele-ikamelo elikhulu lokuphambanisa inhliziyo. Ngakho ukuhlaselwa kwenhliziyo okuvela ekuvinjeni ku-LAD cishe kudala umonakalo omkhulu. Amapayipi e-coronary e-LAD avame ukubhekwa yizinhliziyo ze-cardiologists ngokuthi "abenzi bomfelokazi."
Ukubaluleka kokulimala okwenziwe emisipha yenhliziyo ngesikhathi sokuhlaselwa kwenhliziyo akuxhomeki nje kuphela ukuthi yisiphi isithinteli esithintekayo kodwa futhi endaweni yokuvimba ngaphakathi komshini. Ukuvinjelwa eduze kokuqedwa komshini cishe kuyokwenza umonakalo omkhulu kakhulu kunokuvimbela okuqhubekayo phansi komthamo, noma kwenye yamagatsha awo amancane.
Uma ukuhlasela kwenhliziyo kwenzeka, umonakalo unomphela ungavinjelwa ngokuthola ukunakekelwa okusheshayo, njengoba amasu amaningana atholakalayo ukuvula ngokushesha umthambo we-coronary ovinjiwe.
Imithombo:
Farooq V, van Klaveren D, Steyerberg EW, et al. Izici zesimo esidalwa yi-anatomical and clinical ukuqondisa ukwenziwa kwezinqumo phakathi kokuhlinzwa kwe-artery coronary and intervention interonary coronary for iziguli ngabanye: ukuthuthukiswa nokuqinisekiswa kwe-SYNTAX score II. Lancet 2013; 381: 639.
Abalobi / Amalungu e-Task Force, i-Windecker S, i-Kolh P, et al. Iziqondiso zakwa-ESC / EACTS ka-2014 nge-revascularization ye-myocardial: I-Task Force kwi-Myocardial Revascularization ye-European Society of Cardiology (ESC) kanye ne-European Association ye-Cardio-Thoracic Surgery (EACTS) Yakhelwa ngegalelo elikhethekile le-European Association of Percutaneous Cardiovascular Interventions ( EAPCI). I-Eur Heart J 2014; 35: 2541.