Atrioventricular nodal reentrant tachycardia (AVNRT) ndi chizoloŵezi chokhazikika, chokhazikika cha mtima chomwe chimayamba mwadzidzidzi popanda chenjezo, ndipo chimangoima mwadzidzidzi. Ambiri amakhudza achinyamata akuluakulu. Avereji ya zaka zomwe AVNRT amapezeka poyamba ndi 32, ndipo anthu ambiri omwe ali ndi arrhythmia adzakhala ndi chiyambi chawo choyamba ndi zaka 40. Akayamba kuchitika, zimakhala vuto lalikulu.
Kodi AVNRT ndi chiyani?
AVNRT ndi mtundu wofala kwambiri wa tachycardia (SVT) , wowerengera pafupifupi 60% mwa SVTs onse.
AVNRT ndi imodzi mwa reentrant tachycardias . ("Tachycardia" kumangotanthauza kuthamanga kwa mtima mofulumira.) Ndi mtundu wina uliwonse wa tachycardia, pali kugwirizana kosagwirizana kwa magetsi kwinakwake pamtima, komwe kumapanga magetsi oyendetsa magetsi. Pamene mtima umodzi wa magetsi umalowa mu dera loyendetsa bwino pokhapokha ngati zili bwino, akhoza "kutengedwa" mkati mwa dera - zomwe zikutanthauza kuti zimayambira kuzungulira kuzungulira dera lonselo. Nthawi iliyonse pamene amayenda kuzungulira dera, magetsi amachititsa mtima watsopano, ndipo zotsatira za tachycardia.
Monga momwe ziliri ndi ma SVTs ochuluka, odwala omwe ali ndi AVNRT amabadwa ndi kugwirizana kwa magetsi pamtima. Mu AVNRT, mgwirizano wowonjezera - ndizowonongeka zonse zomwe zimapanga arrhythmia - zili mkati kapena pafupi kwambiri ndi chidziwitso cha atrioventricular (AV node) .
Choncho dzina - AV nodal reentrant tachycardia.
Zizindikiro
Zizindikiro za AVNRT zimakhala zofanana ndi za SVT, ndipo nthawi zambiri zimaphatikizapo kutulukira kwadzidzidzi, kumutu, ndi chizungulire. Kupuma pang'ono kumakhalanso kofala mu dongosololi.
Chizindikiro chimodzi chimene kawirikawiri chikuwoneka mu AVNRT chomwe chimapezeka mobwerezabwereza ndi mitundu ina ya SVT ndikumverera kothamangira m'khosi.
Chizindikiro ichi chimapezeka chifukwa, panthawi ya AVNRT, atria ndi zinyama zimagunda pa nthawi yomweyo. Chifukwa ma atria sangathe kuchotsa magazi awo m'matumbo, magazi amawombera m'mwamba m'mitsempha ya m'khosi - komanso zotsatira zowonongeka.
Mipukutu ya AVNRT imayambira ndipo imasiya mwadzidzidzi, ndipo nthawi zambiri imatha kuchokera kwa mphindi zingapo mpaka maola angapo.
Kuyambira ndi Kuyimitsa AVNRT.
Nkhungu ya AV imakhala yovuta kwambiri pa kusintha kwa kayendedwe ka mantha , gawo la mitsempha ya mitsempha yomwe imalamulira mitsempha ya mthupi ndi ziwalo za thupi. Choncho kusintha kwa mawu achisoni (maganizo a maganizo) kapena mau a vagus nerve (mau a parasympathetic, kapena mpumulo wachisangalalo) amatha kukhala ndi mphamvu yaikulu pa vesi la AV.
Chifukwa chakuti zambiri zamtundu wa reentrant woyendayenda mu AVNRT zili m'kati mwa kachilombo ka AV, kusintha kwa mawu ovomerezeka kungakhudze kwambiri pa arrhythmia.
Ngakhale kuti AVNRT imayamba nthawi zambiri popanda zooneka ngati zovuta, anthu ena akhoza kuyamba ndi masewera olimbitsa thupi kapena nthawi zovuta maganizo kapena zochitika zina zomwe zimawonjezera mawu omvera. Kwa ena, ikhoza kuyambira pa tulo tofa nato, ndi kugwedeza, kapena pang'onopang'ono kutsogolo - mikhalidwe yomwe imayambitsa vagal tone.
Odwala omwe ali ndi AVNRT amatha kuimitsa masewera awo a tachycardia pochita zinthu mwadzidzidzi kuwonjezera mphamvu ya vagus nerve. Kupanga kayendetsedwe ka Valsalva kawirikawiri kumagwira ntchito, ngakhale kuti pali zovuta zambiri (monga kumiza nkhope zawo m'madzi a ayezi kwa masekondi angapo) nthawi zina zingakhale zofunikira.
Chithandizo chachipatala cha AVNRT
Madokotala akhoza kuchiza ma episodes a AVNRT mofulumira komanso mosavuta. Poyamba amatsogolera wodwalayo kudzera m'mayesero ochepa poonjezera chikhalidwe chawo cha vagal. Ngati izo sizilephera kuyimitsa arrhythmia, jekeseni yamatenda ya adenosine kapena verapamil (calcium blocker) idzagwira ntchito mwamsanga ndi moyenera.
Funso lovuta kwambiri lachipatala limakhudza mankhwala a nthawi yayitali kwa AVNRT.
Chifukwa arrhythmia siika moyo pachiswe, koma "kungokhala" kusokoneza moyo, kupweteka kwa mankhwala ayenera kusonyeza momwe kusokonekera kwa wodwalayo kumasokonezera. Ngati ma episodes ali ochepa, amalekerera bwino, ndipo akhoza kuthetseratu zokongola ndi ma vagal, choncho palibe chofunika kuti chichitike.
Komabe, ngati magulu a AVNRT akusokoneza moyo wa wodwalayo (zomwe nthawi zambiri zimakhala choncho), ndiye kuti mankhwala ayenera kuganiziridwa mozama. Chithandizo ndi beta blockers kapena calcium channel blockers zimathandiza kwambiri kuchepetsa mafupipafupi a AVNRT, ndipo ambiri mwa odwala, imodzi kapena mitundu yonse ya mankhwalawa imalekerera. Ngati arrhythmia siiliyendetsedwa mokwanira, ndiye kuti mankhwala ena oyambitsa matenda angayesedwe. Komabe, mankhwalawa amakhala ndi zotsatirapo zambiri, ndipo nthawi zambiri amatha kuchitapo kanthu pochiza AVNRT.
Njira zothandiza kwambiri zothandizira anthu masiku ano ndi kugwiritsa ntchito njira yopatsira ablation , njira yothandizira anthu. Ndi mankhwala opatsirana, kugwirizana kwa magetsi kosaneneka kapena pafupi ndi kachilombo ka AV kumayang'anitsitsa mosamalitsa ndipo kenaka imayambitsidwa, nthawi zambiri ndi mphamvu yamagetsi. AVNRT ikhoza kuchiritsidwa kwathunthu ndi mankhwala opatsirana pogwiritsa ntchito mankhwala opitirira 95%. Choncho kubwezeretsa kuyenera kuyang'aniridwa kwambiri ndi aliyense amene AVNRT ndi vuto lalikulu, makamaka ngati sanagwiritsidwe ntchito pogwiritsa ntchito beta-blockers kapena calcium blockers.
Chitsime:
Denes P, Wu D, Dhingra R, et al. Njira ziwiri zamtundu wa anrioventricular nodal. Njira yowonjezera ya electrophysiological. Br Heart J 1975; 37: 1069.
Tsamba RL, Joglar JA, Caldwell MA, et al. Msonkhano wa 2015 ACC / AHA / HRS kwa Otsogolera Odwala Achikulire Omwe Ali ndi Suprasventry Tachycardia: Lipoti la American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines ndi Heart Rhythm Society. Kuthamangitsidwa 2015.