Bradycardia

Kodi Pang'onopang'ono Mtima Wopambana Ndi Vuto Liti, ndipo Ndi Liti Pamene Tiyenera Kuchitidwa?

Bradycardia ndilo lingaliro la zachipatala chifukwa cha mpweya wa mtima womwe umakhala wocheperapo kuposa wamba. M'mabuku azachipatala, bradycardia nthawi zambiri imatchulidwa ngati mpweya wamtima wopumula womwe umakhala pansi pa 60 kugunda pa mphindi. Komabe, ambiri (mwina ambiri) a thanzi labwino amakhala ndi kupuma kwa mtima pansi pa 60. Choncho kukhala ndi bradycardia sikuti ndi chinthu choipa, kapena chinthu cholakwika.

Nthawi zambiri ndi chizindikiro cha thanzi labwino.

Kumbali ina, bradycardia ikhoza kukhala vuto lalikulu ngati vuto la mtima limakhala lochedwa kwambiri moti mtima sungathe kupopera magazi okwanira kuti apereke zosowa za thupi. Ndi mtundu wodabwitsa wa bradycardia umene umakhala udandaulo wa zachipatala, ndipo umafuna kusamala mosamala ndi chithandizo.

Zizindikiro za Kusalongosoka kwa Bradycardia

Ngati chiŵerengero cha mtima chimakhala chocheperachepera, ziwalo zingapo za thupi sizingagwire ntchito bwino, ndipo zizindikiro zosiyanasiyana zingayambitse. Kawirikawiri, zizindikiro za bradycardia zosazoloŵereka zimayamba kuwonjezereka ndi kuyesayesa (chifukwa zofunikira za thupi zimakhala zazikulu mukamachita khama), koma zizindikiro zingakhalepo panthawi yopumula ngati bradycardia ndi yovuta.

Zizindikiro zomwe zingabwere chifukwa cha bradycardia ndizo:

• Lightheadedness kapena chizungulire (makamaka pakuyesera)
• Zosavuta
• Syncope (kutaya) kapena pafupi-syncope
• Dyspnea (kupuma pang'ono)

• Kupweteka pamtima kapena kupweteka
• Kusokonezeka

Ngati bradycardia ikugwirizanitsidwa ndi zizindikiro izi, chifukwa cha bradycardia chiyenera kutsimikiziridwa, ndipo chithandizo chiyenera kuperekedwa kuti kubwezeretsa mtima kwachibadwa.

Mitundu ya Bradycardia: Sinus Bradycardia

Pa mitundu iŵiri ya mtundu wa bradycardia, sinus bradycardia ndi yofala kwambiri.

Kotero kodi sinus bradycardia ndi chiyani?

Kugunda kwa mtima kumapangidwira ndikugwirizanitsidwa ndi magetsi a mtima, ndipo magetsi amachokera mu nthenda ya sinus, chisa chaching'ono cha maselo omwe ali pamwamba pa atrium yoyenera. Pamene nthenda ya sinus ikupanga malingaliro awa a magetsi pamtunda wochepa, mtima wa mtima umakhala wochepa, ndipo sinus bradycardia imakhalapo.

Werengani zambiri za magetsi a mtima .

Zowonongeka vs. Zovuta Zachibadwa za Bradycardia. Pa mpumulo, node ya sinus imapanga magetsi pamtunda wa pakati pa 50-60 ndi 100 pa mphindi. Kotero mpweya wamtima wopumula mkati mwake umatchedwa " yachibadwa sinus rhythm ." Pamene chiwerengero cha sinus chifulumira katatu pa mphindi, chimatchedwa tachycardia sinus . Ndipo chiwerengero cha sinus pang'onopang'ono ka 60 pa mphindi chimatchedwa sinus bradycardia.

Sinus bradycardia nthawi zambiri imakhala yachilendo. Thupi labwino ndi lothandiza kwambiri pakuletsa kuthamanga kwa mtima kukhala chirichonse chomwe chiyenera kukhala kuti zithandizire ntchito za thupi. Ndipo kawirikawiri, kuthamanga kwa mtima kumeneku kumakhala kosiyana ndi zomwe madokotala "amavomereza" amadziwika monga sinus bradycardia.

Choncho, achinyamata omwe ali ndi thanzi labwino, ngakhale achikulire pamene ali ndi thanzi labwino, nthawi zambiri amakhala ndi miyeso ya mtima m'masiku 40 kapena 50.

Zimakhalanso zachilendo (ndi zachizolowezi) kwa anthu ambiri kuti azikhala ndi mtima wautali pamtundu umenewu pamene akugona. Ngakhale izi zimapanga sinus bradycardia, ndi "physiologic" ya sinus bradycardia - zomwe zikutanthawuza kutentha kwa mtima ndikofunikira kwa thupi, ndipo motero, sinus bradycardia ndi yachibadwa.

Sinus bradycardia imaonedwa ngati vuto ngati chiwombankhanga cha mtima sichichedwa kukwaniritsa zosowa za thupi. Ngati chiwombankhanga cha mtima chimakhala chocheperapo kuti magazi osakwanira akuponyedwa ndi mtima, zizindikiro zimatha. Ngati sinus bradycardia ikuonetsa zizindikiro, si zachilendo ndipo amafunika kuchiritsidwa.

Kodi Chimachititsa Bwanji Zachilengedwe Zosasintha? Pamene sinus bradycardia ikuwonetsa zizindikiro, nthawi zonse imalingaliridwa kuti ndi yachilendo.

Nthenda yosachiritsika sinus bradycardia ikhoza kukhala yopitirira, kapena yopitirira.

Sinus bradycardia yamtunduwu nthawi zambiri imayambitsidwa ndi mowonjezereka mu mitsempha ya vagus . Kulimbikitsidwa kwa mitsempha ya vagus kumachepetsanso nthenda ya sinus, kuchititsa kuchepa kwa mtima. Kutsekemera kwa mitsempha kumatulutsa mavuto osiyanasiyana a m'mimba (makamaka kunyoza kapena kusanza), kapena chifukwa cha ululu waukulu kapena kupsinjika maganizo.

Sinus bradycardia yomwe imayambitsidwa ndi chisokonezo cha vagus imatengedwa kuti ndi "thupi" (mosiyana ndi matenda), chifukwa ndiyomwe imayankha, ndipo imatha posakhalitsa pamene vutalimu yapamwamba imatha.

Nthenda yosachiritsika ya bradycardia yomwe ikupitirira nthawi zambiri imayambitsidwa ndi matenda oyambitsa matenda a uchimo - matenda mkati mwa nthenda yokhayokha. Kawirikawiri, matenda amtundu wa sinus amayamba chifukwa cha mtundu wina wa fibrosis (scarring) mkati mwa nthenda ya sinus, yomwe imawonetsa kawirikawiri ukalamba. Choncho matenda amtundu wa uchimo amayamba kuwoneka mwa anthu omwe ali ndi zaka 70 kapena kuposerapo.

Kwa anthu omwe ali ndi matenda amtundu wa sinus, mtima wamakono nthawi zambiri umakhala wotsika kwambiri panthawi yonse, komanso pochita khama. Anthu omwe ali ndi matenda osokoneza bongo amachititsa kuti akhale ndi " matenda a sinus syndrome ".

Kuphatikiza pa matenda a uchimo, matenda ena angapangitse sinus bradycardia. (Izi zidzatchulidwa posachedwa.) Koma ziribe kanthu chifukwa chake, pamene sinus bradycardia ikhoza kubweretsa zizindikiro zazikulu, chiopsezo chofa ndicho chochepa.

Mitundu ya Bradycardia: Mtima Wopewera

Mtundu wachiŵiri wa mtundu wa bradycardia ndi mtima wamkati. Mosiyana ndi sinus bradycardia, yomwe mwa anthu ambiri ndi yachilendo, chipika cha mtima nthawi zonse chimakhala chachilendo.

Mphepo yamtima imapezeka pamene mtima wa magetsi uli pang'ono kapena wotsekedwa pamene akuyenda kuchokera ku atria ya mtima kupita ku zinyama. Chifukwa chakuti zovuta zonse zamagetsi sizifika pamakinawa, mtima umakhala wochepa kuposa momwe umayenera kukhalira. Werengani zambiri zokhudzana ndi mtima .

Monga momwe zilili ndi sinus bongo bradycardias, mtima wamkati ukhoza kukhala wamphongo kapena wopitilirapo.

Chokhazikika pamtima chikhoza kuchitika (monga ndi sinus bradycardia) yomwe ili ndi zizindikiro za vagal tone. Mtundu wa mtima wamtundu umenewu umapezeka kawirikawiri ndi anthu achichepere, omwe ali ndi thanzi labwino lomwe limakwera chifukwa cha kunyozedwa, kupweteka mwadzidzidzi, kapena kupsinjika maganizo. Bwalo la mtima limeneli limaonedwa kuti ndi lopweteka, ndipo pafupifupi silikusowa chithandizo choposa kuchiza (kapena kupeŵa) zochitika zomwe zinayambitsa vagal okwera.

Kukanikiza mtima pamtima ndizovuta kwambiri chifukwa zimakhala zoipira (ndipo zingakhale zoopsa) pamene nthawi ikupita. Komabe, ndi chiwalo cha mtima, ngakhale pamene vutoli likupitirirabe, bradycardia yokha ingakhale yapakatikati. Izi zikutanthauza kuti nthawi zina, zingakhale ngakhale nthawi yochulukirapo, mpweya wotsalira wa mtima uli m'kati mwake; koma kuthamanga kwa mtima kungawonongeke pang'onopang'ono kuzipanga zozizwitsa popanda chifukwa chilichonse chowoneka kapena choyambitsa (chifukwa vutoli likupitirira). Izi zimapangitsa kuti mtima ukhale wovuta kwambiri kuti uzindikire kuposa uchimo bradycardia. Kaya bradycardia imakhala nthawi zonse kapena ili pakati, komabe, kupitiliza mtima kutseka pafupifupi nthawi zonse kumafuna chithandizo.

Zifukwa za Bradycardia

Monga tawonera, sinus bradycardia yodalirika ndi mtima wamkati wamkati nthawi zambiri zimayambitsidwa ndi kuwonjezeka kwadzidzidzi kwa vagal. Kamodzi kamene kamatulutsa kachilombo kameneka, kachilombo ka mtima kamabwereranso kwachibadwa - kotero palibe chithandizo chokhazikika cha bradycardia.

Komabe, kulimbika koopsa kwa bradycardia kungayambitse matenda osiyanasiyana. Izi zikuphatikizapo:

• Matenda a mitsempha ya Coronary
• Pericarditis
• Myocarditis
• Matenda a mtima chifukwa chavulala kapena opaleshoni ya mtima
• Amyloidosis
• Hypothyroidism
• Dysautonomia
• Mitundu yosiyanasiyana ya matenda, kuphatikizapo matenda a Lyme, matenda a Chagas , ndi matenda a Rocky Mountain
• Matenda a ubongo, makamaka omwe amagwirizanitsidwa ndi kuwonjezeka kwa mankhwala osokoneza bongo kapena kupwetekedwa
• Hypoxia (m'munsi mwa magazi ochepa), nthawi zambiri zimachitika ndi matenda obisala ogona
• Mankhwala osiyanasiyana, kuphatikizapo beta blockers , calcium channel blockers , antiarrhythmic mankhwala , opioids , lithiamu, ndi mankhwala osiyanasiyana a chemotherapy

Kodi Bradycardia Iyenera Kuyesedwa Motani?

Kuwunika kwa bradycardia nthawi zambiri kumakhala kosavuta. Choyamba, dokotala ayenera kuyesa electrocardiogram (ECG) pamene bradycardia alipo, kuti adziwe ngati ndi chifukwa cha sinus bradycardia kapena mtima block.

Ndiye, dokotala ayenera kudziwa ngati bradycardia iyenera kukhala yolimbikira, kapena mmalo mwake ngati chiri chochitika cham'tsogolo chifukwa cha kuwonjezeka kwa vagal. Izi zikhoza kukhala nthawizonse zikwaniritsidwe mwa kungotenga mbiri yachipatala mosamala.

Mayesero otha kupanikizika angakhale othandiza pochotsa matenda amtundu wa sinus kapena mapiritsi a mtima omwe amawonekera pokhapokha atagwira ntchito. Kuwunika kwa ECG kwa nthawi yaitali kungathandizenso kuti muzindikire ma barocardias omwe amapezeka pokhapokha. Phunziro la electrophysiology lingakhale losatsimikizirika pozindikira matenda onse a nthenda komanso mtima wamkati, koma sizowona kuti ndizofunika kuti tichite zimenezi.

Kodi Bradycardia Iyenera Kuchitidwa Motani?

Chithandizo cha bradycardia chimadalira ngati ndi sinus bradycardia kapena mtima block, ndipo ngati ikusinthika kapena ayi.

Bradycardias yowonongeka ikhoza kukhala chifukwa cha kukwera kwachidziwitso mu njira ya vagal yomwe takambirana kale. Zikatero, mankhwala amapewa kupeŵa mtundu wa zikhalidwe zomwe zimachititsa kuti vagalimu akhale okwera.

Kulimba mtima kwa bradycardia kungathenso kusinthika ngati kuyambitsidwa ndi mankhwala, matenda opatsirana, pericarditis, myocarditis kapena hypothyroidism. Pazochitikazi, kuthetsa vutoli mofulumira nthawi zambiri kumasamalira kuchepa kwa mtima.

Ngati sinus bradycardia imasinthidwa, kapena siimatulutsa zizindikiro, nthawi zambiri imatha kuyang'aniridwa ndi kufufuza nthawi zonse. Komabe, nthawi zina anthu okalamba matenda a sinus amakhala ndi zizindikiro panthawi yomwe akuyesera, pamene kuthamanga kwa mtima sikukulirakulira ngati kumafunika kuchita masewera olimbitsa thupi. Choncho mayesero angakhale othandiza pakuzindikira ngati matenda a sinus amachititsa zizindikiro kapena ayi.

Sinus bradycardia yomwe siidasinthika ndipo ikupereka zizindikiro ziyenera kuperekedwa ndi pacemaker yosatha .

Chiwalo cha mtima ndizovuta kwambiri, chifukwa chokhala ndi mtima wamtima chimakhala chopita patsogolo, ndipo chimatha kupha imfa. Choncho, pokhapokha ngati mtima wamtunduwu umayambitsidwa ndi chidziwitso mosavuta, chithandizo ndi pacemaker yosatha nthawi zonse amafunika.

Mawu Ochokera

Bradycardia kawirikawiri ndi chinthu chachilendo chomwe sichifuna kuyeza kafukufuku wamankhwala, kapena mankhwala enaake.

Koma ngati muli ndi sinus bradycardia yomwe ikuonetsa zizindikiro, kapena ngati mtima ulipo ngati pali zizindikiro kapena ayi, muyenera kugwira ntchito ndi dokotala wanu kuti mudziwe chifukwa chake muli nacho, ndi kusankha ngati pacemaker angafunike.

> Zotsatira:

> Epstein AE, DiMarco JP, Ellenbogen KA, ndi al. 2012 ACCF / AHA / HRS Kukonzekera Kwambiri Kuphatikizidwa mu ACCF / AHA / HRS 2008 Malangizo Othandiza Kugwiritsa Ntchito Chipangizo cha Cardiac Rhythm Zolakwika: Lipoti la American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines ndi Mtima Rhythm Society. J ndi Coll Cardiol 2013; 61: e6.

> Fogoros RN, Mandrola JM. Phunziro la Electrophysiology mu Kufufuza kwa Bradycardia: SA Node, AV Node, ndi Wake-Purkinje System. Mu: Fogoros 'Electrophysiologic Testing, Edition Yachisanu ndi chimodzi. Wiley Blackwell, 2017.