Kungani i-LBBB ibalulekile?
Isigxobo segatsha lesobunxele esingaphansi kwesimiso sibonakala esingavamile esibonakala ku- electrocardiogram (ECG) , esibonisa ukuthi umfutho wegazi kagesi awuhambiswanga kuwo wonke ama -ventricles yenhliziyo ngendlela evamile.
Yini Ebangelwa Isibopho Esihlangothini Segatsha?
Amagatsha ezinqwaba angacatshangwa njengengxenye ye "wiring" yenhliziyo. Ziyizindlela zikagesi ezenzelwe ukusabalalisa umfutho wenhliziyo kagesi ngokulinganayo ngokusebenzisa ama-ventricles.
Lokhu kuqinisekisa ukuthi ukukhishwa kwama-ventricle amabili kuhlanganiswa.
Ngesikhwama segatsha lesobunxele kwesokunxele, igatsha lezinqwaba elihambisa umfutho kagesi ku-ventricle kwesokunxele livinjelwe noma livinjelwe ngokuphelele. Lokhu kuvinjelwa kwehlisa ukusebenziswa kagesi kwe-ventricle kwesokunxele. Ngenxa yalokho, i-ventricle efanele ivuliwe, futhi iqala ukwenza isivumelwano, ngaphambi kokuba i-ventricle engakwesokunxele icushiwe.
Ukuze inhliziyo ishaye ngokuphumelelayo ngangokunokwenzeka, zombili izitshalo zezimoto kufanele zivumelane ngesikhathi esisodwa. Ngakho-ke isakhiwo segatsha lesishiyagalombili singasinciphisa ukusebenza kahle kwenhliziyo. Lokhu kuncishiswa kokusebenza komzimba kungaba okuncane kumuntu onenhliziyo engavamile, kodwa kungaba nomthelela omkhulu kubantu abanezinhlobo ezithile zesifo senhliziyo-ikakhulukazi ukwehluleka kwenhliziyo .
Ukubona Isibopho Sokungakwesokunxele Igatsha Lokuvimba
Isigatshana segatsha lesobunxele senza izinguquko zesici ku-ECG, ngakho odokotela bayakwazi ukuhlonza lesi simo ngokuhlola i-ECG kuphela.
Ingxenye ye-ECG ebizwa ngokuthi inkimbinkimbi ye-QRS imelela ukugxila kagesi okusabalaliswa kuwo wonke ama-ventricles. Ngokuvamile, ngoba kokubili ama-ventricle akhuthazwa ngesikhathi esifanayo, isakhiwo se-QRS sincane kakhulu-ngokuvamile, phakathi kwamaminithi angu-0.08 no-0.1 esikhathini eside. Ngenqolobane yegatsha lesobunxele, isakhiwo se-QRS siningi kakhulu, ngokuvamile sikhulu kunemizuzwana engu-0.12.
Ngaphezu kwalokho, ukurekhoda okujwayelekile kwe-ECG kubonisa "imibono" ehlukene engu-12 (ebizwa ngokuthi "imikhombandlela") yomsebenzi kagesi wenhliziyo, nodokotela bangahlola lokhu okuholela ekutholeni umbono wezinkinga ezihlukahlukene zenhliziyo. Ngesikhwama segatsha lesobunxele kwesokunxele, isakhiwo esikhulu se-QRS sibonakala siqondile ekuholeni okuthile, futhi phansi kwezinye. Ngokuhlola kokubili ubude benkimbinkimbi ye-QRS, kanye nephethini yayo emithonjeni ehlukahlukene ye-ECG, ngokuvamile kulula kakhulu ukuxilonga isikhwama segatsha lesokunxele lapho kukhona khona.
Kungani Isigatshana Sokungakwesokunxele Sigxile Kubalulekile?
Isibhamu segatsha lesobunxele sitholakala ngokubalulekile ngezizathu ezimbili ezahlukene.
Okokuqala, isikhwama segatsha lesishiyagalolunye esishiya ngokuvamile sinzeka ngenxa yenkinga ethile yenhliziyo engaphansi. Ngakho uma itholakala, cishe kungenzeka ukuthi isimo esithile esibalulekile sokwemvelo sisekhona.
Okwesibili, njengoba kuphawuliwe ekuqaleni, igatsha lesigatshana lesokunxele ngokwayo lingabangela inhliziyo ukuba isebenze kangcono kubantu abanezinhlobo ezithile zesifo senhliziyo.
Isibopho Sobunxele Esigatsheni Segatsha Nezifo Zengqondo Eziphansi
Ibhande legatsha lesobunxele elithinta kakhulu lithinta kakhulu abadala asebekhulile. Itholakala engaphansi kwamaphesenti angu-1 abantu abangaphansi kweminyaka engu-50; Ngokuphambene nalokho, cishe amaphesenti angu-6 aneminyaka engu-80 ubudala asele igatsha legatsha.
Iningi labantu abanegatsha legatsha lesokunxele linesimo sengqondo senhliziyo. Esifundweni seFramingham, izihloko ezakhiwe esakhiweni segatsha lesishiyagalombili zinezigaba ezineminyaka engama-62 ubudala, futhi zinezifo eziphakeme kakhulu zengozi yomshuwalense , i-cardiomyopathy egxilile noma i- coronary artery disease (CAD) . Eqinisweni, phakathi nocwaningo lukaFramingham, amaphesenti angama-89 abantu abaye baqala ukuphuma kwesigatshana segatsha kamuva babhekwa ukuthi banesifo esithile senhliziyo ephawulekayo.
Lokho kusho ukuthi noma ubani, noma yimuphi ubudala, otholakala ukuthi uye washiya isikhwama segatsha lesigungu kufanele abe nokuhlolwa kwenhliziyo ukuze afune isifo senhliziyo esingaphansi.
Lokho kuhlola kufanele kufaka phakathi okungenani i- echocardiogram , futhi uma kukhona izinto ezibeka ingozi ku-CAD, isifundo sokucindezeleka / thallium kufanele sicatshangwe ngokujulile. Izinkinga ezivame kakhulu zenhliziyo ezitholakala esimweni se-LBBB zihlanganisa ukucindezeleka, i-CAD, ukwehluleka kwenhliziyo, ukuphefumula kwe-hypertrophic , noma isifo senhliziyo se-valvular .
Uma kungekho isifo senhliziyo esitholakala ngemuva kokuhlolwa kwenhliziyo ephelele kumuntu onesihluthulelo segatsha lesokunxele, ikakhulukazi kubantu abangaphansi kweminyaka engu-50, ukubikezela ukuthi kulungile kakhulu. Kulezi zimo, ibhokisi legatsha lesokunxele libhekwa ngokucatshangelwa njengokutholakala kwe-ECG enobungozi, engafanele.
Isibopho Segatsha Esesobunxele Ukuvimbela Nokusebenza Kwe-Heartbeat
E-block block yesigcawu esesobunxele, izinhliziyo ezimbili ze-ventricle ziyashukumiswa yi-cardiac electrical impulse ngokulandelana, esikhundleni esisodwa. Okusho ukuthi i-ventricle yesokunxele ivuselelwa kuphela emva kokuba i-ventricle efanele ivuselelwe. Ngakho-ke, isikhwama segatsha lesishiyagalolunye lesishiyagalolunye sibangela ukulahlekelwa kokusebenzisana okuvamile phakathi kwama-ventricles amabili, okunciphisa ukusebenza kahle kwenhliziyo. Inhliziyo kufanele isebenze kanzima ukuze ikwazi ukufeza amandla ajwayelekile okumpompa.
Kubantu abancane, abanempilo enesibalo segatsha lesokunxele, ngisho nakubantu asebekhulile abanesihluthulelo segatsha esingakwesobunxele abangase babe nesifo senhliziyo esincane, ukwehliswa kokusebenza komzimba kubonakala kuncane kakhulu, kanti ubufakazi bamanje bubonisa ukuthi isakhiwo segatsha lesokunxele esisele ngokwabo akuyona inkinga kulaba bantu.
Kodwa-ke, kubantu abanokuhluleka kwenhliziyo kanye nengxenyana ye- ventricular ejection engxenyeni yesokunxele eyancipha ibe ngamaphesenti angaba ngu-35, ukuvimba kwesigcawu segatsha kwesokunxele kungaveza ukuyeka okukhulu ekusebenzeni kwenhliziyo. Lokhu kufinyelela kahle kunganciphisa ukuwohloka kwenhliziyo ukuhluleka, futhi ukwenza izimpawu zibi nakakhulu.
Ukusetshenziswa kwekhambi lokuvuselela inhliziyo (CRT) ukucubungula kabusha kwe-cardiac (CRT) kufanele kucatshangelwe ngokuqinile kubantu abanjengalokhu. I-CRT wuhlobo lwe-pacemaker oluqondisa kabusha ukukhishwa kwama-ventricles, futhi lungathuthukisa kakhulu ukusebenza kahle kwenhliziyo kubantu abanesivinini segatsha lesobunxele nokuhluleka kwenhliziyo.
Ukwelapha okuqhubekayo kwe-Pacemaker ne-Left Bundle Branch Block
I- pacemaker ehlala njalo ishukumisa inhliziyo esuka ekuholeni okuhamba phambili e-ventricle efanele. Ngenxa yokuthi ukugesi kagesi (okuyinto kulokhu okuvela ku-pacemaker) kuvuselela i-ventricle efanele ngaphambi kwe-ventricle engakwesobunxele, abantu abanezimoto zomshoshaphansi ezihlala njalo banezigceme zamagatsha ezisekhohlo ezenziwe nge-pacemaker.
Eminyakeni yamuva nje, ubufakazi obunye buphakanyisile ukuthi abantu abanezicucu ze-ventricular ejection ezisekhohlo ezisekhohlo, abanamaphimikhali e-ventricular asebenzayo okuhlala unomphela okwamanje, angase abe nengozi eyengeziwe yokwehluleka kwenhliziyo ngenxa yesokunxele esenziwe nge-pacemaker isikhwama segatsha lesigxobo. Ngenxa yalesi sizathu, abanye ochwepheshe manje basebenzisa i-CRT pacemakers (okugwema ukuvimba igatsha lesigungu lesokunxele lesigxathu) lapho abantu abanezicucu ezincishisiwe ezixhomeke ngokuphelele kunama-pacemaker angunaphakade.
Ingabe Isigatshana Sokushiya Isigcawu Segatsha Sidinga I-Pacemaker Yomphela?
Ngaphandle kokuba kube nesizathu sokufaka i-CRT pacemaker ukuze iqondise kabusha umsebenzi wezingqalasizinda, iningi labantu elinesihluthulelo segatsha lesokunxele akudingi ukuba i-pacemaker.
Kodwa-ke, kwezinye izimo ukutholakala kwesigcawu segatsha lesobunxele kubonisa ukukhathazeka okuvamile kwesistimu yokusebenza kagesi yomzimba. Kubantu abanjalo, isibonakaliso sogesi senhliziyo singaphazamiseka ngezindlela eziningana, futhi i-bradycardia ephawulekayo (izinga lentliziyo elincane) lingagcina likhula, futhi kungenzeka ukuthi i-pacemaker engapheli ingadingeka. Ngenxa yalesi sizathu sodwa, abantu abanesihluthulelo segatsha lesokunxele kumele baqiniseke ukuthi bahlolwa njalo ngezokwelapha.
Izwi elivela
Isikhumulo segatsha lesobunxele kwesigxobo yisifo esiyinkinga yokuqhutshwa kagesi kagesi. Noma ubani otholwe ngesibalo segatsha lesobunxele kufanele abe nokuhlolwa kwenhliziyo ukuze afune isifo senhliziyo esiyinkinga esidinga ukwelashwa. Futhi kwezinye izimo-ikakhulukazi kubantu abanokuhluleka kwenhliziyo ngaphezu kwesibalo segatsha lesokunxele-i-block block yesiqu ngokwayo ingadinga ukwelashwa nge-CRT pacemaker.
Kodwa-ke, uma ukuhlolwa kwenhliziyo okuphelele kungabonisi isifo senhliziyo, isakhi segatsha lesobunxele esingasese singabhekwa njengesimo esibucayi.
> Imithombo:
> Badheka AO, Singh V, Patel NJ, et al. Isikhathi se-QRS ku-Electrocardiography nokufa Kwezinhliziyo (kusukela ku-National Health and Nutrition Examination Survey-III). Am J Cardiol 2013; 112: 671.
> Curtis AB, Worley SJ, Adamson PB, et al. I-Biventricular Pacing ye-Atrioventricular Block kanye ne-Systolic Dysfunction. N Engl J Med 2013; 368: 1585.
> Imanishi R, Seto S, Ichimaru S, et al. Ukubaluleka kokubikezelwa kwesigameko Isigxobo esiphezulu sokungena kwesigatshana Igatsha Ukuvinjelwa Kuqaphele Isikhathi Esiyiminyaka Engama-40. Am J Cardiol 2006; 98: 644.
> Schneider JF, Thomas HE Jr, uKreger BE, et al. Isibopho esisha esitholakalayo esisha-Igatsha lokuvimba: isifundo seFramingham. U-Ann Intern Med 1979; 90: 303.