Lapho i-Spasm e-Artery Coronary iholela ekuhluphekeni kwesifuba
I-Prinzmetal angina , ebizwa nangokuthi i-vasospastic angina noma i-angina ehlukile, iyimbangela evamile kakhulu yezihlungu zesifuba. Kuyenzeka uma i-spasm ishaywa komunye wemibhobho ye- coronary - i-arteries eyenza igazi enhliziyweni yakho. I-spasm ibangela ingxenye ye-muscle yenhliziyo ukuba ilahlekelwe igazi layo, futhi i-angina ivela. Ngenkathi i-Prinzmetal angina ingaba nemiphumela ebalulekile, kuhlanganise nokuhlaselwa kwenhliziyo nokuqapha kwe-cardiac arrhythmias , kungaba njalo ukuphathwa ngempumelelo uma kutholakala kahle.
Akuyona Inhlanzi Yezinhliziyo, Kodwa Kungase Kuzizwe Ngayo
Ubuhlungu besifuba abantu ababhekana nakho ne-Prinzmetal angina abukwazi ukungafani nobuntu bokuqala, i-angina ejwayelekile ebangelwa ukuqina kwesifo sofuba . Njenge-angina ejwayelekile, abantu abane-Prinzmetal angina bavame ukuchaza ingxube yezimpawu, kufaka phakathi isifuba, ukucindezela, ukucindezela, ukugcwala, isisindo noma ifindo esifubeni, ukukhala noma ukuzwa okuvuthayo. "Ukungathokozi" kwesifuba kungase kuhambisane ne- dyspnea , i-nausea, noma i-sweating, kanye / noma i- palpitations . Lezi zimpawu ngokuvamile ziqhubeka imizuzu engu-15 noma ngaphezulu. Futhi ngokungafani ne-angina ejwayelekile, evame ukuvela ngesikhathi sokuzama noma ukucindezeleka, i-Prinzmetal angina ngokuvamile ivela ngenkathi ephumula. Eqinisweni, abantu bavame ukuzwa i-prinzmetal angina ngesikhathi esithulile sosuku-phakathi kwamabili nobusuku.
Lokhu kuhlanganiswa kwezimpawu ngezinye izikhathi kubangela abantu abane-Prinzmetal angina ukuba bakholelwe ukuthi banesifo senhliziyo.
Ngandlela-thile, lokhu kungase kungabi into embi, ngoba abantu abacabanga ukuthi banesifo senhliziyo banamathuba amaningi okufuna usizo lwezokwelapha. Futhi ngokushesha i-Prinzmetal angina itholakele, ngokushesha izolashwa ngempumelelo.
Izimbangela
Noma ubani angathuthukisa lesi simo, kodwa kuvamile kakhulu kwabesifazane. Abantu abahlakulela i-Prinzmetal angina bavame ukuba bancane, bephilile kakhulu futhi banesibalo esincane kakhulu sezinkinga zesifo senhliziyo - ngaphandle kokubhema.
Ukubhema ngokuvamile kuyisici esiyinhloko ekwenzeni i-angina kule nkinga ngoba imikhiqizo kagwayi ingabangela ukungabi namagciwane.
Ngaphandle kokubhema, ukusebenzisa i-cocaine noma i-amphetamines nakho kungabangela i-Prinzmetal angina. Abahlukumezi bezinto ezinamandla nge-Prinzmetal angina banamathuba amaningi okulimala (noma okubulala) ngenhliziyo kunokulimala okungewona umuthi.
Kwezinye izimo, i-Prinzmetal angina kucatshangwa ukuthi ibangelwa " ukungasebenzi kokuphela kwesikhathi ," isimo lapho i-lining yangaphakathi (okungukuthi, i-endothelium) ye-arteries ingasebenzi ngendlela evamile. Ukukhubazeka kokuphela kwesifo kubuye kuhlotshaniswe ne- syndrome ye-x , isimo sikaRaynaud, kanye nekhanda le-migraine . Ngempela, abantu abanama-angina ka-Prinzmetal kaningi nabo banesifo se-migraine.
Indlela i-Prinzmetal Angina Eyaziwa ngayo
I-Prinzmetal angina yenzeka uma indawo engaphansi komunye wemithi emikhulu ye-coronary ivele ibe yi-spasm, ivala okwesikhashana ukugeleza kwegazi kuze kube semisipha yenhliziyo ehlinzekwa yilo mshini. Phakathi nalezi ziqephu, i- electrocardigram (ECG) ibonisa ukuphakama okukhulu kwesigaba "se- ST " - izinguquko ezifanayo ze-ECG zivame ukubonakala ngokuhlaselwa kwenhliziyo. I-nitrate ngokuvamile ikhulula isikhala ngokushesha, ibuyisela umthambo we-coronary back to normal.
Ngakho-ke, izinto odokotela abafuna ukuzitholela i-Prinzmetal angina yizo:
- okuvamile "ubuhlungu besifuba" se-anginal "
- ihambisane nezinguquko ezinkulu kwi-ECG,
- okukhululwa yi-nitrate ukuphathwa,
- nge "izifo" ezivamile ze-coronary ezibonakaliswe ekuguleni komzimba .
Ezimweni eziningi, udokotela ngeke abe khona ngesikhathi sesiqephu sangempela se-angina. Okokuthi, umuntu ophethe i-Prinzmetal angina uzofika ukuze ahlolwe ngemuva kokuba i-angina ihambe. Kulezi zimo, ukuhlolwa kokuxilonga kungafaka phakathi ukuqapha kwe-ECG okwesikhashana kwamasonto ambalwa (ukufuna iziqephu zengxenyana zengculazi ezihambisana nezinguquko ze-ECG), noma ukuhlolwa kokucindezeleka . (Ngenkathi i-Prinzmetal angina ivame ukuphumula, abantu abangaba ngu-20% abanalo nalesi simo bangase babe no-angina wabo ngesikhathi sokuvivinya umzimba.)
Ngezinye izikhathi, noma kunjalo, i-catheterization yomzimba "yokuhlolwa okuvusa amadlingozi" kuyadingeka ukuze kutholakale ukuthi kutholakala yini. Ngenxa yokuthi i-Prinzmetal angina ibangelwa i-coronary artery spasm kunokuba ivinjelwe ngokuqinile emthini, ukugcoba ngokuvamile kubonisa imishanguzo ye-coronary "evamile". Ngaphezu kwalokho, ngoba i-Prinzmetal angina ayiyona yodwa uhlobo lwe-angina engabonakala nge-coronary arteries ejwayelekile , okwenza ukuxilongwa okulungile kungadinga ukuboniswa ukuthi ukugcoba komthambo we-coronary kungacasulwa.
Izinhlobo ezimbili "zokucasula" zivame ukusetshenziselwa ukuzama ukudala isikhala se-aron coronary - hyperventilation, nokuhlolwa kwezidakamizwa nge-acetylcholine noma i-ergonovine.
Ukuhlolwa kwe-Hyperventilation kuyilingo elingavumelekile. ngokuvamile kwenziwa ekuseni kakhulu, lapho i-spasm ingenzeka kakhulu. Ngokuhlolwa kwe-hyperventilation, isiguli siyalwa ukuba siphefumule ngokujulile futhi sisheshe imizuzu eyisithupha egcwele - okuyinto enzima kakhulu kunokuba ingase izwakale-kuyilapho i-ECG ibhalwe ngokuqhubekayo, futhi i- echocardiography yenziwe ukuhlola izibonakaliso ze-astronomy artery spasm . Lokhu kuhlolwa kuyasiza kakhulu kubantu abaneziqephu ezivamile ze-angina ye-Prinzmetal. Akulindeleki ukuthi kusetshenziswe njengabawusizo kulabo iziqephu zabo ezincane noma ezingavamile.
Ukuhlolwa nge- acetylcholine noma i-ergonovine kwenziwa ngesikhathi sokuhlushwa inhliziyo. Lolu hlobo lokuhlola lunikeza ukuxilongwa okulungile ngokuthembekile kunokuhlolwa kwe-hyperventilation. Kulesi sivivinyo, enye yalezi zidakamizwa ijojowe nge-intravenously (ergonovine) noma ngqo emgodini we-coronary (acetylcholine). Kubantu abane-Prinzmental angina, lokhu kuvame ukuvusa ukusabalalisa kwe-artery coronary yendawo efanayo ebangela izimpawu zabo. Le spasm yangasese ingabonwa ngesikhathi senqubo yokucwaninga. Njengamanje, ukuhlolwa nge-acetylcholine kubhekwa njengokuphephile kunokuba kuhlolwa nge-ergonovine futhi kuyisimo esithandwayo esicindezelayo esiphuthumayo.
Outlook kanye nemiphumela
Nakuba ngokuvamile umbono weziguli ezine-Prinzmental angina kuhle kakhulu, lesi simo singabangela izinkinga ezinkulu. Kungabangela ama-arrhythmias enhliziyo ayingozi futhi angase abulale, ikakhulukazi i-fibrillation ye-ventricular. Futhi nakuba ukuhlaselwa kwenhliziyo kuvamile nge-Prinzmetal angina, kungenzeka ngempela kwenzeke, ukukhiqiza umonakalo unomphela emzimbeni wenhliziyo. Ukwelashwa okwanele kwe-Prinzmental angina kunciphisa kakhulu ingozi yezimo ezinjalo. Eqinisweni, kanye kuphela ekwelapheni okuphumelelayo, abantu abanalesi simo bangalindela ukuhola impilo egcwele, enempilo.
Ukwelapha
Uma une-Prinzmetal angina, kuyobaluleka kuwe (njengoba kunabantu bonke) ukulawula zonke izici zengozi yomzimba wakho. Kodwa kuwe, kubaluleke kakhulu ukugwema imikhiqizo kagwayi, okuyizinto ezinamandla zokuvuselela umshini we-coronary artery spasm.
Kungenzeka ukuthi wena nodokotela wakho bazokwazi ukuthola ukulawula okuhle kakhulu ngeziqephu zakho ze-angina ne- nitrates kanye / noma i- calcium channel blockers . Futhi, ungase uxoxe nodokotela wakho ukusetshenziswa kwesimiso - isigaba semithi engeyona nje ehlisa i-cholesterol kodwa iphinde ithuthukise umsebenzi wokugcina - njengoba idatha yakamuva ibonisa ukuthi izitembu zingasiza ekuvimbeleni i-coronary artery spasm.
Izidakamizwa ezingabangela ukungena kwe-artery coronary futhi okumele uyenqabe ukugwema kufaka phakathi abaningi be-beta blockers kanye nezinye izidakamizwa ze-migraine - ikakhulukazi i- Imitrex (sumatriptan).
> Imithombo:
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> Kusama Y, Kodani E, Nakagomi A, et al. Ukuhlukahluka kwe-Angina ne-Coronary Artery Spasm: i-Spectrum Clinic, i-Pathophysiology, ne-Management. UJ Nippon Med Sch 2011; 78: 4.
> Ong P, Athanasiadis A, uBorgulya G, et al. Ukusetshenziswa Kwemitholampilo, Izinhlamvu Zezingelosi, Nokuhlola Ukuphepha Kwe-Intracoronary Acetylcholine Ukuxoshwa TYestest Among 921 Iziguli White Elandelanayo Ngemizimba Ezingavamile Corneary Arteries. Ukujikeleza 2014; 129: 1723.
> Stern S, Bayes de Luna A. I-Coronary Artery Spasm: Ukubuyekezwa kuka-2009. Ukujikeleza ngo-2009; 119: 2531.