Uma umuntu enesifo sokushaya isisu, ukwelashwa okungcono kakhulu (kokubili ukwelashwa okunamandla, kanye nokwelashwa ukuvimbela enye isifo) kuncike kulokho okwakhiqiza lesi sifo . Ngakho kubaluleke kakhulu ukuthi odokotela bakwazi ukwehlisa imbangela eyinhloko yimuphi uhlangothi.
Ngeshwa, amaphesenti angaba ngu-40 aseMelika aphethwe yisifo sokushaya isifo aqeda ukuhlukaniswa kwesifo sokushaya i-cryptogenic , okusho ukuthi ngisho nangemva kokuhlolwa okuphelele kwezokwelapha imbangela yesifo sabo isaziwa.
Ngaphandle kokwazi imbangela, ukuphathwa kahle kwesifo sabo kungenziwa ngokusekelwe ekuqedeni.
Sekuyiminyaka eminingana abacwaningi bebelokhu bezama ukuqonda ukuthi yiziphi izimo zezokwelapha ezingase zidale imivimbo ngaphandle kokushiya umthamo ocacile, okungukuthi, yiziphi izimo zezokwelapha ezingase zikhiqize imivimbo ye-cryptogenic. La macala amabili asondelene kakhulu yi- patent foramen ovale (PFO) kanye ne- friction fibrillation . Ukunquma ukuthi i-PFO kungenzeka ukuthi iyimbangela yesifo sokushaya i-cryptogenic isiqinisekisile kunzima futhi kuphikisana.
Ingxabano encane ingozi evezwa yi-fibrification ye-atrial. Ukushaywa yisisu, inkinga ebhekene nokwesaba kakhulu ye-fibrillation ye-atrial, njalo njalo ezigulini ezine-arrhythmia. Futhi manje kubonakala sengathi i-fibrillation ye-atrial ingase ibe imbangela evamile kakhulu yesifo sohlangothi lwe-cryptogenic kunalokho esasiqaphela ngaphambili.
Ukuphefumula Kwe-Atrial & Stroke Cryptogenic
Nakuba ngokuvamile kubangela izimpawu ezibalulekile (njenge-palpitations nobukhulu bokukhanya), iziqephu ze-fibrillation ye-atrial zingase zenzeke ngaphandle kokuveza noma yiziphi izimpawu. Kulezi zimo, noma isiguli noma udokotela angase abe nomqondo wokuthi ukucubungula kwe-atrial kwenzeka. Manje sekuya ngokucacile ukuthi iziqephu ezinjalo ze-"subclinical" (okungukuthi, ezingaziwa) i-fibrillation ye-atrial iyimbangela ebalulekile yokushaywa kwe-cryptogenic.
Ucwaningo lwe-CRYSTAL-AF, oluzama ukukala ukuthi kaningi kangakanani ukucwiliswa kwe-atrial fibrillation okungenzeka kube nomthwalo wemivimbo ye-cryptogenic, kubheke abantu abangu-414 ababethelwa ngaphambilini nge-cryptogenic. Abaphenyi bafaka isimiso esincane senhliziyo-i-Device Reveal (Medtronic, Inc.) - kubo abangakwazi ukuqapha isigqi senhliziyo yomuntu kuze kube yiminyaka emithathu.
Ekupheleni kwesifundo, amaphesenti angu-30 weziguli ezinama-cardiac ahlolwe ayenayo iziqephu ze-fibrillation yangaphambili ye-atrial engalindelekile. Ngokuphambene nalokho, eqenjini elilawulayo leziguli ezingu-220 ezahlukunyezwa yi-cryptogenic ngaphandle kokuqapha kwenkathi yesikhathi eside, iziqephu ze-fibrillation ye-atrial zabonakala ngaphansi kwamaphesenti angaphansi kwamabili.
Lokhu kusikisela izinto ezimbili ezintsha mayelana nokuphefumula kwe-atrial kanye nesifo sokushaya i-cryptogenic. Okokuqala, ukucwiliswa kwe-atrial subrial nge-atrial mhlawumbe kubangelwa amacala amaningi kakhulu we-stroke ye-cryptogenic kunalokho esasiyazi ngaphambili. Futhi okwesibili, ukuqapha kwenhliziyo yesikhathi eside kungadingeka ukukhomba iziguli ezinenkinga. (Isikhathi esilinganisiwe sokuqapha okufakwe ngaphakathi kulesi sifundo ngaphambi kokuba kufakwe i-fibrillation ye-atrial kwakuyizinsuku ezingu-84.)
Lesi sifundo ngokuqinisekile asifakazi ukuthi ukubhebhetheka kwe-atrial kwakungenxa yemivimbo ye-cryptogenic kuzo zonke lezi ziguli, futhi akubonakali ukuthi ukusebenzisa izidakamizwa zokuvimbela kuzokwenza ngcono imiphumela yabo.
Ukuhlolwa komphumela wesikhathi eside kuzodingeka ukuthi kuboniswe ngokucacile lezi zinto. Kodwa siyazi ukuthi abantu abane-stroke ye-cryptogenic banengozi enkulu yokushaywa yisifo esivamile, ukuthi i-fibrillation ye-atrial iyandisa kakhulu ingozi yokushaywa yisisu, futhi leyo thinta yokuvimbela i-anti-clotting inciphisa kakhulu ingozi yokushaywa yisifo senhliziyo. Ngalo mqondo engqondweni, amaphesenti angu-97 eziguli ezicwaningweni ze-CRYSTAL-AF ezaziwa ngokuthi zinezinyosi ezincane ezingaphansi kwe-atrial fibrillation zafakwa kwizidakamizwa zokuvimbela izidakamizwa odokotela bazo.
Ukuqapha Inhliziyo Yesikhathi Eside
Ngokusekelwe kulokho esikwaziyo namuhla, ukuqapha kwezinhliziyo zesikhathi eside kufanele kubhekwe okungenani ezigulini eziye zabhekana nokushaya kanzima, ikakhulukazi uma odokotela bezoshintsha izincomo zabo zokwelashwa ngokusekelwe emphumela wokuqapha okunjalo.
Ukuqapha kwenhliziyo yesikhathi eside kunokwenzeka kakhulu ekusebenzeni komtholampilo. Abaqapheli bezinhliziyo ezibuhlungu manje bangasetshenziswa izinsuku ezingaba ngu-30, isikhathi sokuqapha esiye saboniswa ukuze sibone inani elikhulu leziguli ezine-fibrillation e-atrial sublilin. Futhi abaqapheli bezinhliziyo ezihlala isikhathi eside-abangasetshenziswa ekutadisheni kwe-CRYSTAL-AF kanye namamodeli amancane kakhulu "esizukulwane esilandelayo" atholakala ekusetshenzisweni kwemitholampilo.
Uma wena noma othandekayo ube nesifo sokushaya i-cryptogenic, futhi uma udokotela wakho engashintsha ukwelashwa kwakho kuye ngokuthi ngabe yini noma kungabonakali i-fibrillation ye-atrial, kufanele ukhulume nodokotela mayelana nokuqapha kwengqondo yesikhathi eside.
Imithombo:
Imiphumela ye-CRYSTAL-AF Trial. I-International Stroke Conference (ISC) 2014. Abstract LB11. Ihanjiswe ngo-February 14, 2014.
Liao J, Khalid Z, Scallan C, et al. Ukuqapha kwenhliziyo okungapheli kokuthola i-paroxysmal fibrillation ye-atrial noma i-flutter ngemuva kokushaya kabuhlungu kwe-ischemic: ukubuyekezwa okuhlelekile. Isibhamu 2007; 38: 2935.
Hylek EM, Hamba AS, Chang Y, et al. Umphumela wokuqina kwe-anticoagulation ngomlomo ngokuqina okukhulu kokufa kanye nokufa kwe-fibrillation ye-atrial. N Engl J Med 2003; 349: 1019.