Acute Coronary Syndrome - ACS

Zochitika zapadera za mitundu itatu yokha ya mitsempha yamakono

Ngati inu kapena wokondedwa wanu muli ndi matenda amtundu wa matenda (CAD) , mwina munamva mawu akuti "aconic syndrome," omwe amatchedwanso ACS. ACS ndi mawu atsopano ogwiritsidwa ntchito ndi akatswiri a cardiologists, ndipo zingakhale zosokoneza kwambiri. Komabe, chifukwa zimayimira njira yatsopano yoganizira za CAD , zingakhale zothandiza kutenga maminiti pang'ono kuti mumvetsetse.

Matenda a coronary ndi abwino kwambiri.

Ndicho chidziwitso chofulumira chomwe chimakhudza mitsempha yamakono; zovuta. Zimasonyeza kuti CAD ya munthu yakhala yosasunthika mwadzidzidzi, ndipo kuwonongeka kwa mtima kosatha kumachitika pakali pano kapena kungakhale kochitika nthawi iliyonse.

Kodi ACS Ndi Chiyani?

ASC imachitika pamene magazi amawombera mwadzidzidzi mu mitsempha yamakono , kawirikawiri chifukwa cha kuphulika kwakukulu kwa chikwangwani cha atherosclerotic . Kuphulika kwapadera kungathe kuchitika nthawi iliyonse, nthawi zambiri popanda chenjezo. Mphuno yamagazi ikhoza kutsegula pang'ono kapena kutsekemera kwathunthu kwa mitsempha, mwina njira yoyika minofu ya mtima yomwe imaperekedwa ndi mitsempha yomweyo pangozi.

Chipilala chirichonse mu mitsempha iliyonse yamakono imatha kupasuka, ngakhale zidutswa zing'onozing'ono zomwe nthawi zambiri zimanyalanyazidwa ndi cardiologists pa catheterizations ya mtima . Ichi ndichifukwa chake nthawi zambiri mumamva za anthu omwe ali ndi matenda a myocardial (MI, kapena matenda a mtima), posachedwa atauzidwa kuti CAD yawo ndi "yopanda phindu."

Zizindikiro za ACS

Zizindikiro za ACS zili zofanana ndi za angina zokhazikika koma nthawi zambiri zimakhala zolimba , zosavuta komanso zosavuta. Chifuwa chosasunthika ku ACS kawirikawiri chimaphatikizapo zizindikiro zina zosokoneza monga kutukuta, chizungulire, kunyoza, nkhaŵa yaikulu, ndi zomwe nthawi zambiri zimafotokozedwa ngati "kumverera kwa chiwonongeko." Kupweteka kwa chifuwa sikungatheke ndi nitroglycerin (yomwe nthawi zambiri imathandizira angina).

Komabe, anthu ena omwe ali ndi ACS adzakhala ndi zizindikiro zochepa chabe, akhoza kulephera ngakhale kuzindikira zizindikiro zilizonse - poyamba.

Mwamwayi, kuwonongeka kwa mtima kosatha kumene kumabweretsa kuchokera ku ACS, posachedwa kapena pambuyo pake, kudzabala zizindikiro.

Mitundu ya ACS

Akatswiri a matenda a mtima amagawaniza ACS kukhala njira zitatu zosiyana siyana. Awiri mwa iwo amaimira mitundu yosiyanasiyana ya MI, ndipo imodzi imayimira mtundu waukulu wa angina, wotchedwa "angina wosakhazikika." Zonse zitatuzi zimayambitsidwa ndi magazi ambiri m'mitsempha yamakono.

Ngati khungu la magazi liri lalikulu mokwanira ndipo limapitiriza kwa zoposa maminiti ochepa, maselo ena ammimba amayamba kufa. Imfa ya minofu ya mtima ndiyo yomwe imatanthawuza MI. Mitundu iwiri ya MI yomwe ingapangidwe ndi ACS.

1. ST-Elevation myocardial infarction (STEMI) , yomwe imatchulidwa chifukwa "gawo la ST" pa ECG likuwoneka "okwezeka," amapezeka pamene mitsempha yotsekemera imatsekedwa kwathunthu kotero kuti chiwerengero chachikulu cha minofu ya mtima ikuperekedwa ndi mitsemphayo imayamba kufa STEMI ndi mtundu woopsa kwambiri wa ACS.
2. Nthenda ya ST-Elevation myocardial infarction (NSTEMI) , imene "ST segment" silingakwezeke, imachitika pamene kutsekedwa mu mitsempha yamakono ndi "yokha". Kutsekeka kokwanira kumachitika kuti kuwononge ena mwa maselo a mtima wamtundu omwe amaperekedwa ndi matenda odwala, koma kuwonongeka kumawoneka kochepa kwambiri kuposa STEMI. Vuto lina ndi NSTEMI , ndilo kuti mankhwala osakwanira amatha kukwanira, ndipo NSTEMI idzakhala STEMI.

1. Nthawi zina ACS imatulutsa magazi omwe sali aakulu mokwanira. kapena sichipitirira nthawi yaitali, kuti chiwonongeke minofu ya mtima yosatha. (Njira zotetezera thupi zimayesa kuthetsa magazi omwe amapanga m'mitsempha ya mitsempha.) Pamene ACS ikuonetsa zizindikiro popanda kuchititsa minofu ya mtima kufa, imatchedwa angina wosakhazikika . Anthu omwe ali ndi angina osakhazikika amakhala ndi chiopsezo chachikulu chopita patsogolo ku NSTEMI kapena STEMI.

NSTEMI ndi angina osakhazikika zikhoza kuonedwa ngati "zosakwanira" m'mitima ya mtima. Mitundu iwiriyi ya ACS imafuna chithandizo chofanana ndi chankhanza cha mankhwala kuti athe kuchepetsa mwayi woti apite ku STEMI - omwe ali ndi matenda a mtima nthawi zambiri amatcha "MI".

Kupanga Chidziwitso Choyenera ku ACS

Kuti afotokozere mwachidule, kamodzi kokha magazi atapangidwa mu mitsempha yamakono, ngati kutayika kwa mitsempha yambiri yachitika kale, STEMI imapezeka. Ngati "kuchepa" kwa mtima kumatayika, NSTEMI imapezeka. Ngati palibe minofu yowonongeka ya mtima imachitika, angina wosakhazikika amapezeka.

Ngati muli ndi ACS, kawirikawiri zizindikiro zanu, kuyezetsa thupi, mbiri yachipatala ndi zinthu zoopsa za thupi zimayambitsa dokotala nthawi yomweyo kuti aganize kuti akudwala. Kuchokera nthawi imeneyo, iye adzafulumira kuyesa ECG yanu ndi kuyeza michere yanu ya mtima. Mavitamini a mtima amamasulidwa m'magazi mwa maselo a mtima wamtundu wakufa, choncho kukwera kwa mapuloteni a mtima kumatanthawuza kuti kuwonongeka kwa maselo a mtima kukuchitika.

Choncho: maonekedwe a ECG (mwachitsanzo, kupezeka kapena kupezeka kwa "kukwera" m'magulu a ST) adzasiyanitsa pakati pa STEMI ndi NSTEMI. Ndipo kukhalapo kapena kupezeka kwa mapuloteni a mtima wamtunduwu kumasiyanitsa pakati pa NSTEMI ndi angina osakhazikika.

Kufunika kwa ACS

Mitundu itatu ya ACS imaimira zochitika zosiyanasiyana za matenda omwe angathe kuchitika pamene chikwangwani chimaphulika pamtunda. Ndipotu, palibe mzere woonekera bwino umene umagawanitsa STEMI, NSSTEMI, ndi angina osakhazikika. Kumene akatswiri a mtima akugwirizanitsa pakati pa STEMI ndi NSTEMI, kapena pakati pa NSTEMI ndi angina osakhazikika, ndi chisankho chosasinthika. Zoonadi, tanthauzo la mitundu itatu ya ACS lasintha kwambiri pazaka, monga momwe chidziwitso chathu - makamaka kuthekera kwathu kutanthauzira ma ECG ndikuzindikira kuwonongeka kwa maselo a mtima ndi mayesero a enzyme - zakula.

Mfundo yofunika ndi yakuti, vuto lililonse la ACS (ziribe kanthu kuti ndiloledwa bwanji) ndizochitika mwadzidzidzi, ndipo zimafuna chithandizo chamankhwala mwamsanga kuti akwaniritse zinthu ziwiri: 1) kuchepetsa kuwonongeka kwa minofu ya mtima kukuchitidwa mwachangu ndi magazi a mkati mitsempha yowonongeka, ndi 2) kuchepetsa kuthekera kuti chipika - chomwe tsopano chikuwoneka kuti chosakhazikika ndi chizoloŵezi chotha - chidzaphulika kachiwiri.

> Zosowa

> Amsterdam EA, Wenger NK, Brindis RG, ndi al. 2014 AHA / ACC Chitsogozo cha Ulamuliro wa Odwala Osakhala ndi St-Elevation Ambiri A Coronomes Atsogoleredwe: Chidule Chachidule: Lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130: 2354.

> Pollack CV Jr, Dercks DB, Roe MT; Peterson ED. 2004 American College of Cardiology / American Heart Association Malangizo Othandiza Otsogolera Odwala Omwe Akudwala Myocardial Infarction: Zopweteka pa Ntchito Yopangitsira Bwino. Ann Emerg Med 2005 Apr; 45 (4): 363-76.