Ukwelashwa okumangalisa, noma okungenasidalwa, ukwelashwa?
Yini Angina Enamandla Angina?
"I- angina eqinile " yigama odokotela abasebenzisa ukuchaza izimpawu ze- coronary artery disease (CAD) ezikhiqizwa yi- plaque esesimweni esingaqinile. Ngenxa yokuthi i-plaque ayishintshi (noma iyashintsha kancane kancane), izimpawu ezikhiqizayo (ngokuvamile, ukuhlukumeza kwesifuba) zivame ukuba khona ngendlela ephindaphindiwe, ngendlela engalindelekile.
Le iphethini ibizwa ngokuthi i-angina eqinile.
Izinhloso Zokuphatha Angina Enamandla
Uma udokotela ephakamisa ukwelashwa komuntu onomuntu ozinzile, kunezinhloso ezintathu ezihlukene ezidingekayo zombili zombili:
- Ukuqeda noma ukunciphisa kakhulu izimpawu ze-angina.
- Ukunciphisa ukuqhubeka kwe-atherosclerotic isifo esenza ama-plaque.
- Ukuvimbela ukuqala kwezinkinga ezinkulu zenhliziyo, kuhlanganise ne- acon coronary syndrome (ACS) , ukwehluleka kwenhliziyo , nokufa.
Noma yiluphi uhlobo lwezokwelapha oluqunyiwe - ukwelapha okungahambi noma ukwelashwa kwezokwelapha - ukwelashwa kufanele kulungise amathuba okufeza zonke lezi zinhloso ezintathu.
Ukwelashwa Okungavamile Okungavamile
Indlela engavamile yokwenza ama-angina azinzile ukukhulula ukuvimbela okuphawulekayo emithanjeni ye-coronary noma ukuhlinzeka ngokweqile, noma i- angioplasty ne- stenting .
Nakuba kungase kubonakale kucacile uma ucabanga ukuthi ukukhulula ukuvinjelwa kufanele kube nemiphumela engcono kakhulu, amashumi eminyaka wezifundo zemitholampilo abonise ukuthi ezimweni eziningi lokhu akukona okwenzekayo. Ngokuvamile, ukuphathwa kokwelashwa yedwa kuholela emiphumeleni yomtholampilo enhle noma engcono kunemiphumela etholakalayo ngokuhlinzwa noma ukugcoba.
Iningi labachwepheshe batusa manje ukuqala ngendlela engavumelekile, indlela yokwelashwa kubantu abaningi abane-angina esinezinzile. Le ndlela "yokwelashwa kokuqala" iveza indlela entsha yokucabanga nge-CAD .
Kodwa-ke, kunezimo ezimbili lapho ukwelashwa okungahambi kahle kufanele kucatshangwe ngokujulile. Ukwelashwa okumangalisa kungaba ngcono:
- Abantu abakwa-angina abakwazi ukulawulwa ngokwanele ngelashwa lwezokwelapha.
- Abantu abanezinkinga ezithile ze-coronary arteries, lapho umphumela wokwelapha okwelashwa wedwa ukhonjiswe ukuthi ubi kakhulu kunokwelapha okungahambi kahle.
Lesi sigaba sokugcina sihlanganisa abantu abanezicabha e-artery coronary eyinhloko, noma abanezifo ezintathu, noma abanesifo esingaphansi kwe-artery ehlangene nesifo okungenani esinye iseri somzimba.
Kwabaningi abantu abane-angina ezinzile, noma kunjalo, ukwelashwa ukhetho olukhethwa.
Ukwelashwa Kwe-Stable Angina
Ukuze ukwelashwa kuphumelele ekunciphiseni izimpawu, ukuvimbela i-ACS, nokuthuthukisa ukusinda kubantu abane-angina esinezinzile, izinyathelo eziningana zokwelapha ziyadingeka. Lokhu kufaka kokubili ukwelashwa kwezidakamizwa nokuphila kokusebenza kahle.
(Ukucaca, ukulungiswa kokuphila kuyadingeka ngisho noma indlela ephikisayo yokwelashwa ikhethiwe.)
Ukwelapha Ukwelashwa Ukuqeda u-Angina
Izinhlobo ezine zezidakamizwa zivame ukusetshenziswa namuhla ukukhulula izimpawu ze-angina ezinzile. Iningi labantu abanezimo zizothola imithi emibili noma ngaphezulu yalezi zidakamizwa:
Abavimbela i-Beta: Abavimbeli be- Beta banciphisa umphumela we-adrenaline emisipha yehliziyo, okunciphisa izinga lokushaya kwenhliziyo namandla e-muscle contraction, ngaleyo ndlela ukunciphisa ukufunwa kwe-oxygen yenhliziyo. Lezi zidakamizwa nazo zithuthukisa ukusinda kwezinye iziguli ezine-CAD. Kufanele zisetshenziswe kunoma ubani onamandla angina.
Funda nge-blocka blockers ekwelapheni i-angina .
Abavimbela i-calcium: Abavimbela i- calcium bancishisa ukukhuphuka kwe-calcium ensikeni yesifo senhliziyo, futhi ku-muscle ebushelelezi yemithwalo yegazi. Lokhu kubangela ukuguqulwa kwesigazi segazi, ukwehlisa kwenhliziyo, nokunciphisa amandla okushaya kwenhliziyo - konke okunciphisa ukufunwa kwe-oxygen yenhliziyo. Funda mayelana nabavimbela i-calcium ekwelapheni i-angina .
I-Nitrate: I- nitrate ibangela ukuxiliswa kweminye yegazi, okunciphisa ukucindezeleka emzimbeni wenhliziyo, ngaleyo ndlela kuncishiswe isidingo senhliziyo sokuphefumula oksijini. Funda nge-nitrate ekwelapheni i-angina .
I-Ranexa (ranolazine): I- Ranexa iyinhlobo entsha ye-anti-angina izidakamizwa ezibonakala zisebenza ngokuvimbela lokho okubizwa ngokuthi "isiteshi se-sodium sekwephuzile" ezinqenjini zenhliziyo ezibhekene ne-ischemia. Ukuvimba lesi siteshi se-sodium kuthuthukisa imetabolism amangqamuzana ehliziyo ischemic, ukunciphisa umonakalo emzimbeni wenhliziyo, futhi nokunciphisa izimpawu ze-angina. Funda kabanzi ngoRanexa ekwelapheni i-angina .
Zonke lezi zidakamizwa zisetshenziswa kanjani? Noma ubani onokuthula angina kufanele afakwe ku-bloa ye-beta. I-nitrolycerin (enye ye-nitrate) kufanele inikezwe ukuze isetshenziswe ngokuqinile lapho kunesidingo ukuphatha noma yiziphi iziqephu ze-angina. Uma izitshalo ze-beta zodwa aziqedi ama-angina, noma ngabe ifomu elidala le-nitrate therapy noma i-calcium channel blocker (noma kokubili) ingeziwe ngokujwayelekile. U-Ranexa, namanje ungumuthi omusha kakhulu, uvame ukunikezwa njengesidakamizwa sesithathu noma sesine uma kudingeka - kodwa ezinye izazi ze-cardiologists zithole ukuthi ziyasiza uma zengeziwe ngaphambili.
Ukwelapha Ukuvimbela Ukuqhuma Kwe-CAD
I-antiplatelet therapy: Ukunciphisa ubungozi be-ACS, noma ubani onama-angina kufanele abe ukwelashwa ukunciphisa ukuvala igazi. Kubantu abaningi lokhu kusho ukwelapha nsuku zonke lwe- aspirin (75 kuya ku-325 mg / ngosuku). I-Plavix (clopidogrel) ingasetshenziselwa abantu abaphikisana ne-aspirin.
Ukuguqulwa Kwezinto Eziyingozi: Ukunciphisa ukuqhubekela phambili kwe-atherosclerosis kubalulekile. Lokhu kusho ukulawula umfutho wegazi ophakeme , ukubhema, ukulawula isisindo, ukwelashwa nesimiso, ukulawula isifo sikashukela, nokuzivocavoca.
Ukuzivocavoca: Ngaphezu kokunciphisa ukuqhubekela phambili kwe-atherosclerosis, ukuvivinya umzimba njalo kungase kube yindlela yokwelapha efanelekayo yama-angina. Ukuzivocavoca umzimba okungapheli, okuncane kakhulu (isibonelo, ukuhamba noma ukuhamba ngebhayisikili) "uqeqesha" uhlelo lwezinhliziyo nemisipha yamathambo ukuze iphumelele ngokwengeziwe. Lokhu kusho ukuthi amazinga aphezulu okuzivocavoca angatholakala ngaphandle kokubangela i-angina. Abantu abane-angina abazinzile kumele bacele udokotela wabo ukuba bahanjiswe ohlelweni lokuvuselela inhliziyo ukuwasiza ukuba bafinyelele ohlelweni lokuzivocavoca okuvamile, okuphephile.
Okunye Ukucabangela Ukwelapha I-Angina Eqinile
Ukucindezeleka okungapheliyo: Ukukhathazeka okungalungile kungaba yingozi kunoma ubani onesi-CAD, futhi uhlelo lokunciphisa ukucindezeleka lungasiza.
- Funda ngokucindezeleka nenhliziyo.
- Funda ngokuphathwa kokucindezeleka.
Ukuyeka ukubhema: Ukuyeka ukubhema kukhonjisiwe ekuqaleni, kodwa lokhu kubaluleke kakhulu kudinga ukubizwa futhi. Ukubhema okuqhubekayo kungaba, futhi kuvame ukuthi, kuyingozi kumuntu one-CAD. Ukuyeka ukubhema kuyadingeka.
Ukunciphisa kwangaphandle okuthuthukisiwe (EECP): I- EECP yindlela yokwelapha eyingqayizivele ye-angina enesimo esingahle iphumelele kwezinye iziguli, kodwa yiziphi izidakamizwa eziningi ezikungazinaki.
Uma kusetshenziswe ngokuhlukumezeka nangokufanele, le ndlela engavumelekile yokuphatha i-angina esinezinkinga iveza imiphumela okungenani ilinganisiwe, uma ingcono, kunemiphumela etholakala nge-invasive therapy. Kodwa-ke, noma yikuphi ukufinyeleleka kokusombululayo, khumbula ukuthi i-CAD isifo esingelapheki esivame ukuqhubeka. Kuzodingeka usebenze eduze ne-cardiologist yakho ukuqapha futhi uphinde uhlole isimo sakho njengoba isikhathi sihamba, futhi uqiniseke ukuthi ukwelashwa kwakho kuvuselelwa njalo futhi kuhlelwe.
Imithombo:
Fihn SD, Gardin JM, Abrams J, et al. Isikhathi se-ACCF / AHA / ACP / ATS / PCA / SCA / SCA / SCS / ukuhlolwa kwe-STAI / STS yokuxilongwa nokuphathwa kweziguli ezinesifo senhliziyo esisimeme: umbiko we-American College of Cardiology Foundation / i-American Heart Association emisebenzini yokuqondisa, kanye ne-American I-College of Physicians, i-American Association ye-Thoracic Surgery, i-Preventive Cardiovascular Association Association, Society for Cardiovascular Angiography and Interventions, kanye neNhlangano Yezifo Ezihlinzayo Zezintambo. Ukujikeleza ngo-2012; 126: e354.
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC / AHA / AATS / PCNA / SCAI / STS ukugxilwa okugxilwe kokuqondiswa kokuxilongwa nokuphathwa kweziguli ezinesifo senhliziyo esisimeme: umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice, kanye I-American Association ye-Thoracic Surgery, i-Preventive Cardiovascular Association Association, Society for Cardiovascular Angiography and Interventions, kanye neNhlangano Yezifo Ezihlinza NgamaTriracic. J Am Coll Cardiol 2014; 64: 1929.