Kulephera kwa mtima ndichimodzi mwazofala kwambiri za mtima zapakati pa 65s. Amadziwika ndi kulephera kwa mtima kuchita ntchito yake ya pampu, zomwe zimapangitsa magazi kupezeka mokwanira mthupi lonse komanso "kufooka" kwa magazi kumtunda kwa zipinda zosagwira mtima, zomwe zimabweretsa "kuchulukana" kwa ziwalo zomwe zakhudzidwa. Izi zimatchulidwanso kuti kulephera kwa mtima

Kodi kulephera mtima ndi chiyani? Kodi zimakhala ndi chiyani?

Kulephera kwa mtima ndichikhalidwe chomwe mafupipafupi ku Italy amakhala pafupifupi 2%, koma chimachulukirachulukira ndi msinkhu komanso mwa akazi, kufikira 15% mwa amuna ndi akazi pazaka zopitilira 85.

Chifukwa cha ukalamba wa anthu, pakadali pano ndi matenda amtima omwe amapezeka kwambiri (1-5 milandu yatsopano pamitu ya 1000 / chaka) komanso kufalikira (milandu yopitilira 100 pamitu 1000 pazaka 65) komanso chifukwa chachikulu chogona kuchipatala mwa anthu azaka zopitilira 65.

Systolic decompensation ndi diastolic decompensation

Mtima umalandira magazi am'mapapo kuchokera kumtunda (kudzera pa atrium yoyenera ndi ventricle), amalimbikitsa oxygenation poyiyambitsa mu pulmonary circulation, kenako, kudzera pa atrium kumanzere ndi ventricle, imakankhira magazi omwe ali ndi mpweya mu aorta kenako m'mitsempha ya kunyamula kupita ku ziwalo zonse ndi ziwalo za thupi.

Kusiyana koyambirira kumatha kupangidwa pakati pa:

• Systolic decompensation, pamaso pa kuchepa kwamphamvu kwa ventricle wakumanzere kuti atulutse magazi;
• Kusokonekera kwa Diastolic, pamaso pa kudzaza kwamitsempha yamavuto kumanzere.

Popeza ntchito yamitsempha yamanzere imayesedwa kawirikawiri ndi gawo lomwe limatchedwa ejection kachigawo (kuchuluka kwa magazi oponyedwa mu aorta pachimake chilichonse)

• Gawo lotulutsira losungidwa (kapena diastolic) decompensation, momwe gawo la ejection limaposa 50%.
• Kuchepetsa kachigawo kakang'ono ka ejection (kapena systolic) decompensation, momwe kachigawo kakang'ono kotulutsira kamakhala kosakwana 40%.
• Kuchepetsa pang'ono kutaya kwa ejection, komwe kachigawo kakang'ono ka ejection kakhala pakati pa 40 ndi 49%.

Izi ndizofunikira pakukhazikitsa njira zochiritsira zowonjezereka (monga tionere, pakadali pano pali njira zochiritsira zotsimikizika zochepetsera kutaya kwa gawo).

Kulephera kwamtima: Zimayambitsa ndi chiyani?

Zomwe zimayambitsa kulephera kwa mtima nthawi zambiri zimawononga myocardiamu, minofu ya mtima, yomwe imatha kuyambitsidwa, mwachitsanzo, ndi matenda amtima kapena kupsinjika kopitilira muyeso komwe kumachitika chifukwa cha kupsyinjika kwa magazi kapena kupindika kwa valavu.

Electrococardiogram ya odwala ambiri omwe amatha kuwonongedwa amatha kuwonetsa gawo lamanzere (BBS), zosintha pakufalikira kwamphamvu yamagetsi yomwe imatha kusintha makina amtima, ndikupangitsa kuti pakhale vuto lochepa ndipo, chifukwa chake, kuwonjezeka kwa ntchito yamitsempha yamtima.

Kulephera kwa mtima: zoopsa

Mwatsatanetsatane, zotsatirazi ndi zifukwa zoopsa za decompensation ndi kuchepetsedwa ejection kagawo

• ischemic matenda amtima (makamaka infarction yam'mimba yam'mbuyo)
• matenda a mtima ovomerezeka
• matenda oopsa.

Kumbali inayi, zomwe zimayambitsa chiwopsezo chololedwa ndi kachigawo kakang'ono ka ejection ndi

• shuga
• syndrome kagayidwe kachakudya
• kunenepa
• matenda opweteka
• oopsa
• kugonana kwa akazi.

Kodi zizindikiro zakulephera kwa mtima ndi ziti?

Kumayambiriro kwa mtima kulephera, zizindikilo zimatha kupezeka kapena zochepa (monga kupuma pambuyo pochita masewera olimbitsa thupi).

Kulephera kwa mtima, komabe, kumakhala patsogolo, komwe zizindikilo zimayamba kuwonekera pang'onopang'ono, zomwe zimapangitsa kuti pakufunika kupita kuchipatala kapena nthawi zina kumafunikira kuchipatala.

Zizindikiro, zotsatira zakuchepetsa magazi m'ziwalo ndi minofu ndi 'kuchepa' kwa magazi kumtunda kwa zipinda zamtima zosagwira ndi 'kuchulukana' kwa ziwalo zomwe zakhudzidwa, zingaphatikizepo izi:

• Dyspnoea, kutanthauza kupuma pang'ono, komwe kumayambitsidwa ndi kudzikundikira kwa madzi m'mapapo: koyambirira kumawonekera pambuyo poyeserera kwambiri, koma pang'onopang'ono komanso pambuyo poyeserera pang'ono, kupumula komanso kugona tulo tofa nato tulo (decubitus dyspnoea), kusokoneza nthawi yopuma usiku ndi kukakamiza wina kuti akhale tsonga.
• Edema (kutupa) m'miyendo m'munsi (mapazi, akakolo, miyendo), imayambitsanso chifukwa chakumangirira kwamadzimadzi.
• Kutupa m'mimba ndi / kapena kupweteka, komwe kumayambitsanso ndi kudzikundikira kwamadzimadzi, mu nkhani iyi mu viscera.
• Asthenia (kutopa), yoyambitsidwa ndi kuchepa kwa magazi kumatenda.
• Chifuwa chowuma, chifukwa chodzikundikira madzimadzi m'mapapu.
• Kutaya njala.
• Zovuta kuzilingalira, zimayambitsa kuchepa kwa magazi kuubongo, ndipo, pamavuto akulu, chisokonezo.

Kulephera kwa mtima: milingo yovuta

Kutengera ndi zomwe zimachitika chifukwa chakulimbitsa thupi, chifukwa chake, malire ake, New York Heart Association yatanthauzira magawo anayi owopsa (kuyambira I mpaka IV) a mtima kulephera:

• Asymptomatic wodwala: kuchita masewera olimbitsa thupi sikuyambitsa kutopa kapena dyspnoea.
• Kulephera mtima mtima: Mukachita masewera olimbitsa thupi (monga kukwera masitepe angapo kapena masitepe ochepa polemera), dyspnoea ndi kutopa zimachitika.
• Kulephera kwapakati pamtima: dyspnoea ndi kutopa zimachitika ngakhale mutachita masewera olimbitsa thupi, monga kuyenda pansi pa 100 m pamtunda pamalo othamanga kapena kukwera masitepe.
• Kulephera kwamtima: asthenia, kupuma komanso kutopa kumachitika ngakhale atapuma, kukhala pansi kapena kugona pansi.

Kuzindikira: kuwunika kwamtima

Kuzindikira koyambirira kwa kulephera kwa mtima ndikofunikira kuti athane ndi vutoli, muchepetse kukula kwake ndikuthandizira kukonza moyo wa wodwalayo.

Komabe, kuzindikira kulephera kwa mtima sikophweka nthawi zonse: zizindikilo nthawi zambiri zimasinthasintha, zimasiyanasiyana mwamphamvu masiku akamadutsa.

Kuphatikiza apo, monga tawonera, izi sizizindikiro zenizeni, zomwe odwala, makamaka okalamba komanso omwe akuvutika ndi matenda ena, amakonda kunyalanyaza kapena kunena kuti zimayambitsa zina.

Kumbali inayi, kupezeka kwa dyspnoea ndi / kapena edema mwa anthu omwe ali pachiwopsezo cha kulephera kwa mtima kuyenera kuyambitsa katswiri wazowunika zamtima.

Ndi mayeso ati omwe akuyenera kuchitidwa kuti apeze kulephera kwa mtima?

Kupimidwa koyesa kwa kulephera kwa mtima kumaphatikizaponso mbiri (mwachitsanzo, kusonkhanitsa zambiri za mbiri ya wodwalayo komanso zomwe adachita) ndikuwunika koyambirira. Katswiriyo atha kufunsa kuti afufuze zina (zoyeserera ndi labotale), kuphatikiza

• electrocardiogram
• kutuloji
• kulingalira kwa maginito kwamtima kwamkati mosiyanasiyana
• Mlingo wamagazi wama peptide natriuretic (mamolekyulu omwe amapangidwa makamaka ndi ventricle yakumanzere; milingo yamagazi yabwinobwino imalamulira kuwonongeka).

Kuyesanso kowopsa, monga catheterisation yamtima ndi coronarography, kungafunikirenso.

Kodi kulephera kwa mtima kumathandizidwa bwanji?

Kulephera kwa mtima ndichikhalidwe chosafunikira chomwe chimafunikira njira zingapo kuti muchepetse zizindikilo, kuchepetsa kukula kwa matendawa, kuchepetsa kulandilidwa kuchipatala, kuwonjezera kupulumuka kwa wodwala komanso kukhala ndi moyo wabwino.

Kuphatikiza pa kuzindikira msanga, gawo logwira ntchito la wodwala komanso mgwirizano pakati pa gulu la akatswiri osiyanasiyana ndi dokotala wabanja ndizofunikira.

Njira zazikulu zothandizira ndi monga:

• Kusintha kwa moyo, monga:
• Kuchepetsa kumwa mchere;
• Kuchita masewera olimbitsa thupi pafupipafupi mwamphamvu (mwachitsanzo, kuyenda kwa mphindi 30 osachepera masiku asanu pasabata);
• Kuchepetsa kudya kwamadzimadzi;
• Kudziyang'anira, mwachitsanzo, kuyang'anira kulemera kwa tsiku ndi tsiku, kuthamanga kwa magazi, kuthamanga kwa mtima, kupezeka kwa edema.
• Mankhwala othandizira mankhwala, omwe ali ndi mankhwala angapo kuphatikiza:
• Mankhwala oletsa renin-angiotensin-aldosterone system (ACE inhibitors, sartans ndi mankhwala a antialdosteronic);
• Mankhwala omwe amatsutsana ndi dongosolo lamanjenje (beta-blockers, monga carvedilol, bisoprolol, nebivolol ndi metoprolol);
• Mankhwala osokoneza bongo a Neprilysin (monga sacubitril);
• Sodium-glucose cotransporter inhibitors.
• Mankhwala opatsirana pogonana (kuphatikiza mankhwala, ngati pali vuto lamagetsi oyendetsa, monga gawo lamanzere la nthambi): kumafuna kuyikika kwa zida zamagetsi (zopangira ma pacemaker kapena biventricular defibrillators), kuti ayambitsenso kupindika kwamtima. Pamodzi ndi mankhwala, zida zimatha kuchepetsa kukula kwa matendawa ndipo nthawi zina zimabweretsa kufalikira kwa kachigawo kakang'ono kotulutsira kwamitsempha yamagetsi.
• Njira zopangira maopareshoni (monga kukonza kapena kupangika kwa matenda a valavu, opareshoni kapena opatsirana a myocardial revascularisation, mpaka kukhazikika kwa 'mitima yokumba' ndikuyika mtima).

Tiyenera kudziwa kuti mankhwala omwe atchulidwa pamwambapa ndi mphamvu yakukhazikitsanso mphamvu zatsimikizira kuti ndizothandiza mu systolic decompensation kapena kuchepetsedwa kwa gawo la ejection. Makamaka, magulu awiri oyamba a mankhwala omwe atchulidwa pamwambapa, mwachitsanzo renin-angiotensin-aldosterone system blockers (ACE inhibitors, sartans ndi anti-aldosteronic mankhwala) ndi omwe amatsutsana ndi dongosolo lamanjenje lomvera (beta-blockers), akadali oyamba- chithandizo chamankhwala pamtunduwu.

Izi zawonetsedwa kuti zasintha mbiri yamatendawa, kuchepetsa kufa ndi kuwonongeka chifukwa chogwiritsa ntchito kulumikizana koipa pakati pa hyper-activation ya dongosolo lamanjenje lomvera ndi dongosolo la renin-angiotensin-aldosterone komanso kupitilira kwa kuwonongeka kwa ma ventricular.

M'zaka zaposachedwa kwakhala kukugwiritsidwa ntchito pofufuza mamolekyulu atsopano omwe amatha kuthana kwambiri ndi njira zama neurohormonal zomwe zimayambitsa kukula kwa mtima.

Kuphatikiza kwa mankhwala a sacubitril (omwe amaletsa neprilysin ndikuwonjezera kuchuluka kwa ma peptide natriuretic, omwe amateteza) komanso sartan, valsartan, amadziwika.

Kuphatikizana kumeneku kunapangitsa kuti muchepetse kukula kwa matendawa kuposa momwe zimakhalira kale ndi chithandizo chothandizidwa ndi ACE inhibitors.

Awa ndi gulu latsopanoli la mankhwala antidiabetic (SGLT2-i ndi SGLT1 & 2-i) omwe awonetsedwa kuti amachepetsa kwambiri kufa ndi matenda kwa odwala omwe ali ndi vuto lochepa kwambiri la mtima omwe akulandila kale ACE inhibitors / sartans / sacubitril-valsartan, anti-aldosteronics ndi beta-blockers.

Pali umboni woyambirira woti gulu la mankhwalawa litha kukhalanso ndi chiyembekezo kwa odwala omwe ali ndi gawo lotulutsa> 40%.

Kodi kulephera mtima kungapewedwe?

Pankhani yamatenda amtima, kuphatikiza kulephera kwa mtima, kupewa ndikofunikira kwambiri, kuchitapo kanthu pazomwe zingasokoneze mtima, monga matenda oopsa, cholesterol, kusuta, kugona pansi ndi kunenepa kwambiri.

Ndikofunikira kudziwa momwe munthu amakhalira, kusiya kusuta, kuchita masewera olimbitsa thupi, kusunga mafuta m'thupi komanso kulemera kwake.

Anthu omwe ali pachiwopsezo cha kulephera kwa mtima ayeneranso kupita kukayezetsa kuchipatala kuti adziwe ngati ali ndi vuto, ngakhale atakhala kuti alibe zizindikiro (monga momwe zimakhalira ndi vuto lakumapeto kwa ma ventricular), ndikuchitapo kanthu mwachangu.

Werengani Ndiponso:

AHA Scientific - Kulephera Kwamtima Kwamtenda Yobadwa Ndi Matenda a Mtima

Kuchepetsa Kulephera Kwa Mtima Kuchipatala Kuchipatala Ku Italy Munthawi Ya Matenda A Coronavirus Mliri Wa Mliri

Tchuthi Ku Italy Ndi Chitetezo, IRC: "Zowonjezera Zambiri Pamagombe Ndi Misasa. Tikufuna Mapu Owonetsera AED "

Source:

Dr. Daniela Pini - Anthu