Ukusilela kwentliziyo: oonobangela, iimpawu, iimvavanyo zokufumanisa isifo kunye nonyango

By UCristiano Antonino On Aug 5, 2021

Ukusilela kwentliziyo yenye yezona zinto zixhaphake kakhulu kwi-cardiopathies kwii-65s. Ibonakaliswa kukungakwazi kwentliziyo ukwenza umsebenzi wayo wokumpompa, okukhokelela ekunikezelweni kwegazi eloneleyo kuwo wonke umzimba kunye "nokuma" kwegazi ukunyuka kwamagumbi entliziyo angasebenzi kakuhle, ekhokelela "kwingxinano" yamalungu achaphazelekayo. Oku kukwabizwa ngokuba kukusilela kwentliziyo

Yintoni ukusilela kwentliziyo? Iquka ntoni?

Ukungaphumeleli kwentliziyo yimeko engapheliyo yokuhamba rhoqo e-Itali malunga neepesenti ezi-2, kodwa iya iqhubeka ngokuthe ngcembe kunye nobudala nakwisini sabasetyhini, ukufikelela kwi-15% kuzo zombini izini kwisithuba esingaphezulu kwama-85s.

Ngenxa yokuguga ngokubanzi kwabemi, okwangoku sisifo sentliziyo esineziganeko eziphezulu (1-5 amatyala amatsha kwizifundo ezili-1000 / ngonyaka) kunye nokuxhaphaka (ngaphezulu kwe-100 yamatyala kwizifundo ezili-1000 ngaphezulu kweminyaka engama-65) kunye nesona sizathu siphambili sokulaliswa esibhedlele kubantu abangaphezu kweminyaka engama-65 ubudala.

Ukuchithwa kwempahla kunye ne-diastolic decompensation

Intliziyo ifumana igazi elinemithambo yegazi (ngokusebenzisa i-atrium elungileyo kunye ne-ventricle), ikhuthaza i-oxygenation ngokungenisa ekujikelezeni kwepulmonary, emva koko, nge-atrium yasekhohlo kunye ne-ventricle, ityhale igazi elingena-oxygen kwi-aorta kwaye emva koko iye kwimithambo ukuthuthwa kuwo onke amalungu kunye nezicubu zomzimba.

Umahluko wokuqala unokwenziwa phakathi:

Ukubola kweSystolic, kubukho bomthamo ocothayo we-ventricle yasekhohlo yokukhupha igazi;
Ukuchithwa kwediastolic, phambi kokukhubazeka kokugcwalisa i-ventricular.

Kuba umsebenzi wasekhohlo we-ventricular uvavanywa ngokwesiqhelo ngento ebizwa ngokuba yi-ejection fraction (ipesenti yegazi efakwe kwi-aorta kwisivumelwano ngasinye (systole) se-ventricle yasekhohlo), ihlala ibalwa yi-echocardiogram, umahluko ochanekileyo phakathi:

Iqhezu lokukhutshwa eligciniweyo (okanye i-diastolic) yokubola, apho iqhezu lokukhutshwa lingaphezulu kwama-50%.
Ukunciphisa iqhekeza lokukhutshwa (okanye i-systolic) ukubola, apho iqhezu lokukhutshwa lingaphantsi kwama-40%.
Kuncitshiswe kancinci ukubuya kweqhezu lokukhutshwa, apho iqhezu lokukhutshwa liphakathi kwama-40 nama-49%.

Olu luhlu lubalulekile kuphuhliso lwezonyango ekujolise kuzo (njengoko siza kubona, okwangoku kukho unyango kuphela oluqinisekisiweyo lokunciphisa ukubola kweqhezu).

Ukusilela kwentliziyo: Zintoni izizathu?

Unobangela wokungaphumeleli kwentliziyo uhlala ukonakalisa i-myocardium, imisipha yentliziyo, enokubangelwa, umzekelo, sisifo sentliziyo okanye uxinzelelo olugqithisileyo olubangelwa kukungalawuleki koxinzelelo lwegazi okanye ukungasebenzi kwevalve.

I-electrocardiogram yezigulana ezininzi ezisembindini zingabonisa ibhloko yesebe lasekhohlo (i-BBS), utshintsho kulwandiso lwefuthe lombane elinokuthi litshintshe ubucukubhede bentliziyo, lubangele idyssynchrony yothintelo kwaye, ngenxa yoko, isiba mandundu imisebenzi yesivumelwano sentliziyo.

Ukusilela kwentliziyo: umngcipheko

Ngolwazi oluthe kratya, oku kulandelayo yimiba yomngcipheko wokubuyiselwa kwembuyekezo ngecandelo lokuncitshiswa kokuncitshiswa

Ischemic isifo sentliziyo (ngakumbi isifo sephepha esingabalulekanga kwangaphambili)
isifo sentliziyo valvular
uxinzelelo lwegazi.

Kwelinye icala, iimeko zomngcipheko wokubola kunye neqhekeza lokukhutshwa eligciniweyo

iswekile
syndrome
ukunyanya
i-fibrillation ye-atrial
xi nzelelo
isini sabasetyhini.

Ziintoni iimpawu zokusilela kwentliziyo?

Kumanqanaba okuqala okusilela kwentliziyo, iimpawu zisenokungabikho okanye zithambe (njengokuphefumla emva kokuzilolonga).

Ukungaphumeleli kwentliziyo, nangona kunjalo, yimeko eqhubela phambili, apho iimpawu ziye zibonakale ngokuthe ngcembe, zikhokelela kwisidingo sokufuna unyango okanye ngamanye amaxesha kufuneke ukuba ulaliswe esibhedlele.

Iimpawu, iziphumo zokuncitshiswa kwegazi kumalungu nakwizicubu kunye 'nokuma' kwegazi ukunyuka kwamagumbi entliziyo angasebenziyo 'nokudibana' kwamalungu achaphazelekayo, anokubandakanya:

I-Dyspnoea, okt ukuphefumla kancinci, okubangelwa kukufumba kolwelo emiphungeni: ekuqaleni kubonakala emva kokusebenza ngamandla, kodwa ngokuthe ngcembe nasemva kokuzilolonga kancinci, ukuphumla kunye nokulala ulala ngexesha lokulala (i-decubitus dyspnoea), ukuphazamisa ixesha lokuphumla ebusuku kunye Ukunyanzela umntu ukuba ahlale phantsi.
I-Edema (ukudumba) kwimilenze esezantsi (iinyawo, amaqatha, imilenze), ikwabangelwa kukwakhiwa kolwelo.
Ukudumba kwesisu kunye / okanye nentlungu, iphinda ibangelwe kukuqokelelana kolwelo, kule meko kwi-viscera.
I-Asthenia (ukudinwa), okubangelwa kukuncitshiswa kwegazi kwezihlunu.
Ukukhwehlela owomileyo, ngenxa yokuqokelelwa kolwelo emiphungeni.
Ukuphelelwa ngumdla wokutya.
Kunzima ukugxila, kubangelwa kukuncitshiswa kwegazi kwingqondo, kwaye, kwiimeko ezinzima, ukudideka.

Ukusilela kwentliziyo: amanqanaba obukrakra

Ngokusekwe kwiimpawu ezenziwa ngumzimba kwaye, ke, inqanaba ekuthintelwe kulo, iNew York Heart Association ichaze iiklasi ezine zokuqina kobukrakra (ukusuka ku-I kuye ku-IV) kwentliziyo ukusilela:

Isigulana esingafakwanga emzimbeni: Ukuziqhelanisa nokwenza umthambo akubangeli ukudinwa okanye idyspnoea.
Ukusilela kwentliziyo emnene: Emva kokuzilolonga ngokomzimba (umzekelo, ukunyuka izinyuko ezimbalwa okanye nje amanyathelo ambalwa ngesisindo), idyspnoea kunye nokudinwa kunamava.
Ukumodareyitha ukusilela kwentliziyo okumandla: idyspnoea kunye nokudinwa kwenzeka nasemva kokusebenza komzimba, njengokuhamba ngaphantsi kwe-100 yeemitha kumgangatho othe ngqo okanye ukunyuka kwizinyuko.
Ukungaphumeleli kwentliziyo: i-asthenia, ukungaphefumli kunye nokudinwa kwenzeka nokuba uphumle, uhleli okanye ulele phantsi.

Ukuchongwa: uvavanyo lweentliziyo

Ukufumana ukuxilongwa kwangoko kokusilela kwentliziyo kubalulekile ukuze ulawule ngcono le meko ingapheliyo, unciphise ukuqhubela phambili kwaye uncede ukuphucula umgangatho wobomi besigulana.

Nangona kunjalo, ukuxilonga ukungaphumeleli kwentliziyo akusoloko kulula: iimpawu zihlala ziguquka, zihluka ngamandla njengoko iintsuku zihamba.

Ngapha koko, njengoko sele sibonile, ezi ziimpawu ezingangqalanga, ethi izigulana, ngakumbi abagulayo kunye nabo sele besokola nezinye izifo, bathande ukujongela phantsi okanye babangelwe zezinye izizathu.

Kwelinye icala, ubukho be-dyspnoea kunye / okanye i-edema kubantu abanomngcipheko wokungaphumeleli kwentliziyo kufuneka kukhuthaze uvavanyo lweengcali zentliziyo.

Zeziphi iimvavanyo ekufuneka zenziwe ukufumanisa ukusilela kwentliziyo?

Uvavanyo lokuchonga ukusilela kwentliziyo lubandakanya imbali (okt ukuqokelela ulwazi malunga nembali yesigulana kunye neempawu zalo) kunye novavanyo lokuqala lomzimba. Ingcali inokucela olunye uphando olongezelelweyo (elebhu kunye novavanyo lwezixhobo), kubandakanya

electrocardiogram
qeebloyi
Ukujonga ngemagneti yentliziyo ngentlukwano ephakathi
idosi yegazi yee-peptides ze-natriuretic (iimolekyuli eziveliswa ikakhulu yi-ventricle yasekhohlo;

Olunye uvavanyo olungenelelayo, olufana ne-catheterisation yentliziyo kunye ne-coronarography, kunokufuneka.

Iphathwa njani ukusilela kwentliziyo?

Ukungaphumeleli kwentliziyo yimeko engapheliyo efuna iindlela ngeendlela zokunciphisa iimpawu, ukucothisa ukuqhubela phambili kwesi sifo, ukunciphisa ukwamkelwa esibhedlele, ukwandisa ukusinda kwesigulana kunye nokuphucula umgangatho wobomi.

Ukongeza kokuchongwa kwangoko, kubalulekile indima yesigulana kunye nentsebenziswano phakathi kweqela lezemfundo kunye nogqirha wosapho.

Olona nyango luphambili lubandakanya:

Utshintsho kwindlela yokuphila, ebandakanya:
Ukunciphisa ukusetyenziswa kwetyuwa;
Umsebenzi oqhelekileyo womzimba we-aerobic ngamandla aphakathi (umz. Imizuzu engama-30 yokuhamba ubuncinci iintsuku ezintlanu ngeveki);
Ukunciphisa ukutya okungafunekiyo;
Ukuzibek 'esweni, okt ukubeka esweni imihla ngemihla ubunzima bomzimba, uxinzelelo lwegazi, ukubetha kwentliziyo, ubukho be-edema.
Unyango lwe-Pharmacological, kunye namachiza aliqela ngokudibeneyo kubandakanya:
Iziyobisi ezivimba inkqubo ye-renin-angiotensin-aldosterone system (i-ACE inhibitors, i-sartans kunye ne-antialdosteronic drug);
Iziyobisi ezichasene nenkqubo yemfesane yovelwano (i-beta-blockers, enje nge-carvedilol, bisoprolol, nebivolol kunye ne-metoprolol);
Iziyobisi zeNeprilysin inhibitor (njenge sacubitril);
Isodium-glucose cotransporter inhibitors.
Unyango lwe-Cardiac resynchronisation (ngokudibanisa namayeza, ukuba kukho ukungahambi kakuhle kombane, njengebhloko yesebe lasekhohlo): kufuna ukufakelwa kwezixhobo zombane (ii-pacemaker okanye i-biventricular defibrillators), ukuphinda wenze isivumelwano sentliziyo. Kunye neziyobisi, izixhobo zinokucothisa ukuqhubela phambili kwesi sifo kwaye ngamanye amaxesha zikhokelele kwimeko yesiqhelo seqhekeza lasekhohlo le-ventricular ejection.
Ungenelelo lotyando (njengokuhlinzwa okanye ukulungiswa kwesifo sevalvu, ukuqhaqha okanye ukunyusa i-myocardial revascularisation, ukuya kufakelwa 'iintliziyo ezingezizo' kunye nokufakelwa kwentliziyo).

Kuya kufuneka ukuba kuboniswe ukuba la machiza sele ekhankanyiwe kunye nonyango lokuphinda ubuye kwakhona kungqineke kusebenza kuphela ekunciphiseni amandla e-systolic okanye kunciphise iqhezu lokukhutshwa. Ngokukodwa, iindidi ezimbini zokuqala zamachiza ezikhankanywe apha ngasentla, okt renin-angiotensin-aldosterone system blockers (ACE inhibitors, sartans kunye ne-anti-aldosteronic drug) kunye nezo zichasene nenkqubo yemfesane yovelwano (beta-blockers), iseyeyokuqala- unyango lomgca kule meko.

Oku kubonisiwe ukutshintsha imbali yesi sifo, ukunciphisa ukusweleka kunye nokugula ngokusebenza kunxibelelwano olubi phakathi kokusebenza kwenkqubo yeemvakalelo enovelwano kunye nenkqubo ye-renin-angiotensin-aldosterone kunye nokuqhubela phambili kokungasebenzi kakuhle kwentliziyo.

Kwiminyaka yakutshanje kuye kwakho utyalomali kuphando kwiimolekyuli ezintsha ezinokusebenza ngokuchaseneyo ngakumbi neendlela ze-neurohormonal ezisisiseko sokuqhubela phambili kwentliziyo.

Indibaniselwano yesakramitril yeziyobisi (ethintela i-neprilysin kwaye inyuse amanqanaba eepeptides ze-natriuretic, ezidlala indima yokhuselo) kunye ne-sartan, i-valsartan, ichongiwe.

Olu dibana lwenze ukuba kube lula ukuthothisa ukuqhubela phambili kwesi sifo nangaphezulu kunokuba bekunokwenzeka ngonyango olusekwe kwi-ACE inhibitors.

Olu ludidi olutsha lwamachiza antidiabetic (SGLT2-i kunye ne-SGLT1 & 2-i) eziye zaboniswa ukunciphisa ukubhubha kunye nokugula kwabaguli abane-low ejection fraction ukusilela kwentliziyo esele befumana unyango nge-ACE inhibitors / sartans / sacubitril-valsartan, anti-aldosteronics kunye ne-beta-blockers.

Kukho ubungqina bokuqala bokuba eli klasi leziyobisi linokuba nefuthe elihle lokuxela kwizigulana ezinenxalenye yokukhutshwa> 40%.

Ngaba ukuthintelwa kwentliziyo kunokuthintelwa?

Xa kuziwa kwizifo zentliziyo, kubandakanya ukusilela kwentliziyo, uthintelo lubaluleke kakhulu, lisebenza kwizinto ezinobungozi ezinokubangela ingozi, ezinje ngexinzelelo lwegazi, icholesterol ephezulu, ukutshaya, ukuhlala phantsi kunye nokutyeba kakhulu.

Kuyimfuneko ke ukuba unike ingqwalaselo efanelekileyo kubomi bomntu, ukuphelisa ukutshaya, ukwenza umthambo rhoqo, ukugcina amanqanaba e-cholesterol kunye nobunzima phantsi kolawulo.

Abantu abasemngciphekweni wokungaphumeleli kwentliziyo kufuneka babe nokuvavanywa kukhuseleko kuthintelo lokufumanisa isifo kwangoko, nokuba azikho iimpawu (njengakwimeko yokungasebenzi kakuhle kwekhohlo kwentliziyo), kwaye bathathe amanyathelo ngokukhawuleza.