Ka maikaʻi ʻole o ka naʻau: nā kumu, nā ʻōuli, nā hoʻāʻo no ka hōʻoia ʻana a me ka mālama ʻana

By Cristiano Antonino On Aug 5, 2021

ʻO ka puʻuwai puʻuwai kekahi o nā cardiopathies maʻamau i nā makahiki 65. Hoʻohālikelike ʻia e ka hiki ʻole o ka puʻuwai ke hana i kāna hana pauma, i ka hopena o ka lawa ʻole o ke koko i ke koena o ke kino a me ka "stagnation" o ke koko i uka o nā keʻena puʻuwai maikaʻi ʻole, e alakaʻi ai i ka "huikau" o nā mea i hoʻopilikia ʻia. Kuhi ʻia kēia me ke kīnā ʻole o ka puʻuwai

He aha ka puʻuwai puʻuwai? He aha ia ona?

ʻO ka puʻuwai puʻuwai kahi kūlana hoʻomau nona ka pinepine ma Italia ma kahi o 2%, akā e lilo i ka holomua i ka pinepine a me ka makahiki a me ka wahine wahine, e piʻi ana i 15% i nā kāne ʻelua ma mua o 85s.

Ma muli o ka ʻelemakule maʻamau o ka heluna kanaka, ʻo ia ka maʻi maʻi maʻi maʻi i kēia manawa me ka nui o nā hanana (1-5 mau hihia hou no nā 1000 kumuhana / makahiki) a me ka prevalence (ma luna o 100 mau hihia no 1000 mau kumuhana ma kahi o 65 mau makahiki) a me ke kumu nui o ka haukapila. i nā kānaka ma luna o 65 mau makahiki.

Hoʻoiho Systolic a me ka hoʻohaʻahaʻa diastolic

Loaʻa i ka puʻuwai ke koko koko mai ka periphery (ma o ka atrium ʻākau a me ka ventricle), paipai i ka oxygenation ma ka hoʻolauna ʻana iā ia i loko o ke kahe o ka pulmonary, a laila, ma o ka atrium hema a me ka ventricle, pahu i ke koko oxygenated i loko o ka aorta a laila i nā aʻa no halihali i nā ʻōpala a me nā ʻaʻa o ke kino.

No laila hiki ke hoʻokaʻawale mua i waena o:

Hoʻololi Systolic, i ke alo o kahi hoʻemi hoʻemi o ka ventricle hema e excrete koko;
Hoʻololi Diastolic, i ke alo o ka hoʻopiha hema hema ventricular.

Ma muli o ka loiloi pinepine ʻia o ka hana hema ventricular e ka hapa i kapa ʻia he ejection (pākēneka o ke koko e hoʻōkele ʻia i loko o ke aorta ma kēlā me kēia contraction (systole) o ka ventricle hema), maʻa mau ʻia e echocardiogram, kahi ʻokoʻa hou aʻe ma waena o:

Mālama ʻia ka puʻukū kuhi (a i ʻole diastolic) decompensation, kahi i ʻoi aku ai ka hapa nui o ka eject ma mua o 50%.
Hoʻemi ʻia ka hakina ʻume (a systolic) decompensation, kahi i emi ai ka hakina hoʻolei ma mua o 40%.
Hoʻemi iki i ka decaction uku hakina, a ma waena o 40 a 49%.

He mea nui kēia hoʻohālikelike no ka hoʻomohala ʻana i nā therapies i hoʻonui pinepine ʻia (e like me kā mākou e ʻike ai, aia wale nō i kēia manawa nā therapies i hōʻoia ʻia no ka hoʻēmi ʻia ʻana o ka decompensional fraction etion).

Hoka puʻuwai: He aha nā kumu?

ʻO ke kumu o ka hōʻino ʻole o ka puʻuwai ka hōʻino pinepine i ka myocardium, ka puʻuwai puʻuwai, i hiki ke kumu ʻia, e laʻa me ka puʻuwai puʻuwai a i ʻole ke kaumaha nui i hoʻokumu ʻia e ka hypertension a me ka maʻi kīnā ʻole valve.

Hiki i ka electrocardiogram o nā mea maʻi decompensated ke hōʻike i kahi āpana lālā bundle hema (BBS), kahi hoʻololi i ka hoʻolaha ʻana o ka impulse uila e hiki ai ke hoʻololi i nā mīkini o ka puʻuwai, e hana ana i kahi dissynchrony o ke kuʻina a, no laila, e hoʻonāukiuki ana i ka hana a ka puʻuwai cardiac.

Hōʻino puʻuwai: nā mea weliweli

Ma nā kikoʻī kikoʻī, ʻo nā mea aʻe o ka hopena no ka decompensation me ka hapa liʻiliʻi o ka eject

maʻi maʻi ischemic (i kahi infarction myocardial mua)
maʻi puʻuwai valvular
hypertension

Ma ka ʻaoʻao ʻē aʻe, nā mea pilikia no ka decompensment me nā ʻāpana e kīnai e mālama ʻia

diabetes
metabolic syndrome
obesity
ke hoʻopunipuniʻana i keʻano o ka hana
hypertension
moekolohe wahine.

He aha nā hōʻailona o ka puʻuwai puʻuwai?

I nā wā mua o ka holo pono ʻole o ka puʻuwai, hiki ke hele a maʻa paha nā ʻōuli (e like me ka hanu ʻole ma hope o ka hoʻoikaika ikaika).

ʻO ka maikaʻi ʻole o ka puʻuwai, kahi kūlana holomua, kahi e lilo ai i mau ʻōuli i mea nui e ʻike ʻia, e alakaʻi ana i ka pono e ʻimi i ka lāʻau lapaʻau a i ʻole i kekahi manawa e pono ai ka haukapila.

Nā ʻōuli, kahi hopena o ka hōʻemi ʻia ʻana o ke koko i nā ʻokena a me nā aʻa a me ka 'stagnation' o ke koko i luna o nā keena puʻuwai me ka 'congest' o nā mea i hoʻopilikia ʻia, e hoʻopili pū ʻia paha:

ʻO Dyspnoea, ʻo ia hoʻi ka hanu ʻana o ka hanu, i hoʻokumu ʻia e ka hōʻiliʻili o ka wai i loko o nā akemāmā: hoʻomaka mua ia ma hope o ka ikaika o ka hana, akā nō hoʻi ma hope o ka hoʻoikaika ʻana, hoʻomaha iki a moe moe i ka wā hiamoe (decubitus dyspnoea) e koi ana i kekahi e noho i luna.
ʻO Edema (ka pehu) i nā lālā o lalo (nā wāwae, nā kuʻekuʻe wāwae, nā wāwae), i hoʻokumu ʻia e kahi kūkulu o ka wai.
ʻO ka puhū o ka ʻōpū a me / a ʻeha paha, hoʻokumu hou ʻia e ka hoʻoulu wai, i kēia hihia i ka viscera.
Asthenia (luhi), hoʻokumu ʻia e ka hoʻoliʻiliʻi o ke koko i nā mākala.
Mākō maloʻo, ma muli o ka hōʻiliʻili o ka wai i nā akemāmā.
Loaʻa ka ʻai ʻole.
ʻO ka paʻakikī ka noʻonoʻo ʻana, hoʻokumu ʻia e ka hoʻoliʻiliʻi o ke koko i ka lolo, a, i nā hihia koʻikoʻi, huikau.

Hewa ka puʻuwai: nā pae o ke koʻikoʻi

Ma muli o nā ʻōuli a ka hoʻoikaika kino e hoʻoulu ai a, no laila, ke kekelē i kaupalena ʻia ai, ua wehewehe ka New York Heart Association i ʻehā mau papa o ka hoʻonui ʻana i ke koʻikoʻi (mai I a i IV) o ka puʻuwai puʻuwai.

ʻO ka mea hoʻomanawanui asymptomat: ʻo ka hana maʻamau i ke kino ʻaʻole ia e kumu i ka luhi a i ʻole ka dispnoea.
Hewa puʻuwai puʻuwai: Ma hope o ka hoʻoikaika kino ʻana (e laʻa me ka piʻi ʻana i ʻelua mau alapiʻi a i ʻole he mau ʻanuʻu wale nō me ke kaupaona), ʻike ʻia ka dyspnoea a me ka luhi.
Kūpono i ka puʻuwai puʻuwai koʻikoʻi: hiki i ka dyspnoea a me ka luhi ma hope o ka hoʻoikaika kino ʻana, e like me ka hele ʻana ma lalo o 100 m ma ka pae honua i kahi wikiwiki a piʻi paha i kahi alapiʻi.
Hewa ka puʻuwai koʻikoʻi: astenia, hanu a me ka luhi i ka wā hoʻomaha, noho a moe paha i lalo.

Kānāwai: kahi hoʻokolohua naʻau

ʻO ka loaʻa ʻana o kahi hōʻailona mua o ka puʻuwai puʻuwai he mea nui e hoʻokele maikaʻi i kēia kūlana maʻi, e hoʻolohi i kāna holomua a pēlā e kōkua ai i ka hoʻomaikaʻi ʻana i ke ola o ka mea maʻi.

Eia naʻe, ʻaʻole maʻalahi ka ʻike ʻana i ka puʻuwai puʻuwai.

Eia kekahi, e like me kā mākou i ʻike ai, he mau hōʻailona kikoʻī ʻole kēia, nā mea maʻi, ʻo ia hoʻi nā mea ʻelemākule a me nā mea e hakakā nei me nā maʻi ʻē aʻe, e hoʻowahāwahā a i ʻole ke kumu i nā kumu ʻē aʻe.

Ma ka ʻaoʻao ʻē aʻe, ke kū ʻana o ka dyspnoea a me / a i ʻole ka edema i loko o kēlā me kēia kanaka me nā kumu pilikia no ka holo pono ʻole o ka puʻuwai.

He aha nā hoʻokolohua e pono ai e ʻike i ka hōʻino ʻana o ka puʻuwai?

ʻO ka hoʻokolohua diagnostical no ka hōʻino puʻuwai me kahi moʻolelo (ie ʻohiʻohi i ka ʻike e pili ana i ka mōʻaukala a me nā ʻōuli o ka mea maʻi) a me kahi hoʻokolohua kino mua. E noi paha ka loea no kekahi mau noiʻi hou (nā hale hana a me nā hoʻokolohua instrumental), e like me

ka electrocardiogram
echocardiogram
kiʻi resonance ʻume mākenēki o ka puʻuwai me ka waena waena
nā kōkō o nā peptides natriuretic (nā molekiola i hana nui ʻia e ka ventricle hema; nā kūlana koko maʻamau e kāpae i ka decompensation).

ʻO nā hoʻokolohua hoʻouka hou aku, e like me ka catheterisation puʻuwai a me ka coronarography, e koi ʻia paha.

Pehea e mālama ʻia ai ka maikaʻi ʻole o ka puʻuwai?

ʻO ke kīnā ʻole o ka puʻuwai kahi kūlana hoʻomau e koi ai i kahi ala multidisciplinary i mea e hōʻemi ai i nā hōʻailona, hoʻolohi i ka holomua o ka maʻi, hoʻemi i ke komo ʻana i ka haukapila, hoʻonui i ke ola hoʻomanawanui a hoʻomaikaʻi i ka maikaʻi o ke ola.

Ma waho aʻe o ka ʻike mua ʻana, he mea nui ka hana a ka mea hoʻomanawanui a me ka hana pū ʻana ma waena o ka hui multidisciplinary a me ke kauka ʻohana.

ʻO nā koho lapaʻau nui nā:

Hoʻololi ka nohona, i hoʻopili ʻia:
Hoʻoemi i ka ʻai paʻakai;
ʻO ka hana hoʻoikaika kino aerobic maʻamau o ke ʻano kaulike (e laʻa: 30 mau minuke o ka hele wāwae ma kahi o 5 mau lā o ka pule);
Ka palena ʻana i ka lawe ʻana o ka wai;
ʻO ka nānā ʻana iā ʻoe iho, ʻo ia hoʻi ka nānā ʻana i kēlā me kēia lā o ke kino, kaomi koko, ka helu o ka puʻuwai, hiki ke loaʻa i ka edema.
Hoʻomaʻamaʻa lāʻau, me nā lāʻau i hui pū ʻia me:
Nā lāʻau e ālai ana i ka ʻōnaehana renin-angiotensin-aldolone (nā mea kāohi ACE, sartans a me nā lāʻau antialdosteronic);
Nā lāʻau e antagonize i ka ʻōnaehana hopohopo sympathetic (beta-blockers, e like me carvedilol, bisoprolol, nebivolol a me metoprolol);
Neprilysin mea kāohi lāʻau lapaʻau (e like me sacubitril);
Nā mea kūpale ʻo Sodium-glucose cotransporter.
Hoʻomaʻamaʻa Cardiac resynchronisation therapy (me ka lāʻau lapaʻau, inā aia kekahi maʻi o ka uila impulse conduction, e like me ka hema o ka lālā o nā ʻāpana uila): pono i ka implantation o nā pono uila (pacemakers a i ʻole defivedrive biventricular), e hoʻoponopono hou i ka puʻuwai puʻuwai. Me nā lāʻau lapaʻau, hiki i nā hāmeʻa ke hoʻolohi i ka holomua o ka maʻi a i kekahi manawa e alakaʻi i ka normalization o ka fraction eject ventricular hema.
Nā hana ʻoki lāʻau (e like me ka hoʻoponopono ʻana a me ka percutaneus o ka maʻi valve, kaukoki a i ʻole percutaneus myocardial revascularisation, a hiki i ka implantation o ka 'puʻuwai puʻuwai' a me ka lawe ʻana o ka naʻau).

Kuhi ʻia e like me nā lāʻau i ʻōlelo ʻia ma luna aʻe a me ka resynchronisation therapy i hōʻoia maikaʻi wale ʻia i ka decompensation systolic a i ʻole ka hapa ʻemi e hoʻoliʻiliʻi. Ma nā kikoʻī, ʻo nā papa mua ʻelua o nā lāʻau i ʻōlelo ʻia ma luna, ʻo ia hoʻi nā blockers ʻōnaehana renin-angiotensin-aldosterone (nā mea kāohi ACE, sartans a me nā lāʻau anti-aldosteronic) a me nā mea e antagonize i ka ʻōnaehana hopohopo (beta-blockers), ʻo ia nō ka mua laina line therapy no kēia ʻano.

Hōʻike ʻia kēia mau mea e hoʻololi i ka mōʻaukala o ka maʻi, hoʻemi i ka make a me ka maʻi maʻi ma o ka hana ʻana i nā pilina maikaʻi ʻole ma waena o ka hyper-activation o ka sympathetic nerve system a me ka renin-angiotensin-ald testosterone ʻōnaehana a me ka holomua o ka maʻi ventricular.

I nā makahiki i hala iho nei, ua loaʻa ka hoʻopukapuka i ka noiʻi ʻana i nā mole mole hou i hiki ke hana hou me ka antagonizing i nā neo neurohormonal e pili ana i ka holomua o ka puʻuwai.

ʻO ka hui pū ʻana o ka sacubitril lāʻau (kahi e kāohi ai i ka neprilysin a pēlā e hoʻonui ai i nā pae o nā peptides natriuretic, kahi e pale ai) a me kahi sartan, valsartan, i ʻike ʻia.

ʻO kēia hui ʻana i hiki ai ke hoʻolohi i ka holomua o ka maʻi ʻoi aku ka nui ma mua o ka hiki ke loaʻa i kahi lāʻau e pili ana i nā mea kāohi ACE.

He papa hou kēia o nā lāʻau antidiabetic (SGLT2-i a me SGLT1 & 2-i) i hōʻike ʻia e hoʻoliʻiliʻi nui i ka make a me ka maʻi o nā mea maʻi me ka liʻiliʻi o ka puʻuwai puʻuwai liʻiliʻi e loaʻa ana i ka lāʻau me nā mea kāohi ACE / sartans / sacubitril-valsartan, anti-aldosteronics a me beta-blockers.

Aia kekahi hōʻike mua e loaʻa paha kēia hopena o nā lāʻau i kahi hopena prognostic maikaʻi i nā mea maʻi me kahi ʻāpana eject> 40%.

Hiki ke pale ʻia ka hōʻeha puʻuwai?

I ka wā e pili ana i nā maʻi maʻi cardiovascular, me ka ʻole o ka puʻuwai, he mea nui ka pale ʻana, e hana ana i nā mea e hiki ai ke hoʻololi ʻia i ka maʻi maʻi, e like me hypertension, kolesterol kiʻekiʻe, puhipaka, sedentariness a me ka momona.

No laila he mea pono e nānā pono i ka nohona o kekahi, hoʻopau i ka puhihihi, lawe ʻana i ka hoʻoikaika kino maʻamau, ka mālama ʻana i nā pae kolesterol a me ke kaupaona ma lalo o ka kaohi.

ʻO nā kānaka i ka makaʻu ʻole no ka puʻuwai puʻuwai e pono hoʻi e nānā i nā lāʻau lapaʻau pale no ka hōʻoia mua, ʻoiai i ka loaʻa ʻole o nā ʻōuli (e like me ke ʻano o ka hana ʻole ventricular hema hema asymptomat), a hana koke i nā hana e like me ia.