Njira ina yomwe amai akhoza kukhala ndi kupweteka pachifuwa ndi mitsempha ya "corneary"
Ngakhale kuti matenda amtundu wamakono (CAD) ndi ofunika kwambiri kwa amayi monga momwe amachitira amuna, zifukwa zingapo zingapangitse CAD kukhala kovuta kwambiri kuti azindikire amayi. Chimodzi mwa izi ndi "CATE-model" CAD. M'machitidwe a akazi a CAD, coronary angiography - "ndondomeko ya golidi" kuti apeze CAD - nthawi zambiri amatanthauziridwa kuti ndi yachibadwa.
- Khalidwe lachikazi CAD ndi chimodzi mwa zinthu zingapo zomwe zingapangitse CAD ndi mitsempha yodalirika. Werengani apa za ena.
Pakati pa matendawa omwe amatchedwa atherosclerosis , mitsempha yamatope imakhala yolimba, yowuma, ndi yotupa ndi mitundu yonse ya "grunge" - kuphatikizapo ndalama za calcium, mafuta, ndi maselo osapsa. Matenda a atherosclerosis nthawi zambiri amakhala ndi malo omwe amawunikira . Miphika imeneyi, yomwe ingaganizidwe ngati "ziphuphu" zazikulu zomwe zimayendetsedwa mumtsinje wa mitsempha, nthawi zambiri zimapangitsa kuti ziwonongeko zowonongeka zikhale mkati mwake. (Chikhalidwe chawo ndi chimene chimapangitsa kuti azitha kuchiritsidwa ndi angioplasty , poizoni kapena opaleshoni .) Odwala omwe ali ndi CAD akhoza kukhala ndi zipilala chimodzi kapena ziwiri, kapena angakhale nawo ambirimbiri omwe amagawira mitsempha yawo yonse.
Kwa amayi omwe ali ndi CAD ya akazi , matenda a satana sagwiritsa ntchito miyala yodabwitsa, kotero kuti malo omwe amakhalapo alibe. M'malo mwake, zipilala mwa akaziwa zimakhala zofala kwambiri, zomwe zimakhudza mbali yonse ya mitsempha, kotero kuti chotsekeka cha mitsempha chimakhala cholimba.
Ngakhale kuti palibe malo osadziwika a blockage, mkatikatikati mwa mitsempha imakhala yochepa kwambiri. Pa catheterization ya mtima, mitsempha yamakono imakhala yosalala komanso yodabwitsa (ngakhale kuti nthawi zambiri imawoneka "yaying'ono" m'mimba mwake).
Kuvomereza kwa amayi omwe ali ndi kachitidwe ka CAD yachikazi kumaganiziridwa kukhala bwino kusiyana ndi CAD yeniyeni, koma izi sizowonongeka .
Kugonjetsedwa kwa mtima ndi imfa zimachitika.
Mwapadera, chiwerengero cha amayi cha CAD chingayambitse matenda aakulu a coronary syndrome (ACS) . ACS imachitika chifukwa mapulaneti omwe amatha kufalikira amatha kuphulika ndi kutha (monga miyala yowonongeka yomwe imapanga mu CAD yowonjezera), kuchititsa kuti magazi alowe mkati mwa mitsempha ndikupanga kutseka kwadzidzidzi. Ngati phokosoli lidzasungunuka ndi mankhwala osokoneza bongo, zotsatira zokhudzana ndi mtima wamba zimasonyeza kuti mitsempha yowoneka ngati yachibadwa, yomwe imakhala yofanana ndi ya CAD yazimayi, imasokoneza katswiri wa zamoyo.
Kodi kachitidwe kazimayi ka CAD kanapezeka bwanji?
Kutengera kwa machitidwe azimayi a CAD angapangidwe motsimikizika ndi njira yatsopano yomwe imatchulidwa kuti intravascular ultrasound (IVUS). IVUS (yomwe siimapangidwa nthawi zonse panthawi ya catheterization, ndipo yomwe sichipezeka ngakhale muzipatala zambiri) imafuna kuika catheter yapadera mu mitsempha yotchedwa ultrasound (ie, zojambula zojambula zithunzi ) kuti tiwone ngati khoma la mitsempha mkati mwake. Mipangidwe yosiyanasiyana ya machitidwe a amayi a CAD angadziwike motere. Mu kafukufuku waposachedwapa, oposa hafu ya akazi omwe ali ndi zizindikiro za angina ndi mitsempha ya "corneary" yamakono anali ndi zizindikiro zozindikiritsa kugwiritsa ntchito IVUS.
Kukhalapo kwa kachitidwe ka akazi kwa CAD kungatheke poyerekeza ndi kuthekera kwa mitsempha yowonjezereka yomwe ingayambe kuchepetsedwa poyankha mankhwala otchedwa acetylcholine. Mitsempha yowopsya yomwe yawonetsedwa mu kachitidwe ka akazi CAD imalephera kuwonjezereka kawirikawiri.
Mchitidwe wamayi wa CAD ayenera kuyerekezedwa ndi mkazi aliyense yemwe ali ndi angina kapena ACS, koma yemwe ali ndi "mitsempha" yowonongeka yokhudzana ndi chithandizo cha mtima.
Kodi chikhalidwe chachikazi cha CAD chinasankhidwa bwanji?
Chifukwa chakuti mitsempha yowonongeka yomwe imakhala yofanana ndi ya CAD imawonekera, njira zothandizira kuthetsa zolepheretsa malo - monga angioplasty, stents, ndi opaleshoni yopitirira - sizimagwira ntchito.
Mmalo mwake, mankhwala ayenera kukhala achipatala. Njira yabwino kwambiri yothetsera vutoli silingathe kufotokozedwa, koma njira yowonongeka yambiri imakhala yabwino kwambiri pakali pano, ndipo iyenera kuphatikizapo chiopsezo choopsa cha kusintha kwa mankhwala, chithandizo chochepetsera chiopsezo cha aspirin, ndi mankhwala kuti ateteze minofu ya mtima (beta blockers ndi mwina ACE inhibitors). Ochita kafukufuku tsopano akuika maganizo awo pazithunzi za akazi, ndipo kumvetsetsa bwino matendawa ndi chithandizo chake makamaka m'tsogolomu.
Padakali pano, ngati ndinu mkazi yemwe akudwala kupweteka kwa mfupa, koma kuphunzira kwanu kwa mtima kumasonyeza mitsempha yodalirika, inu ndi dokotala muyenera kuzindikira kuti ntchito yanu isanafike. Pachikhalidwe ichi, kuphunzira "mwachibadwa" kumapangidwe ka angiography sikutulutsa vuto la mtima. Mmalo mwake, zikutanthauza kuti kufufuzidwe kwina kuli kofunika kuti mupeze chifukwa cha zizindikiro zanu.
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von Mering GO, Arant CB, Wessel TR, et al. Kugonjetsedwa kwapadera kwapadera monga chisonyezero cha zochitika za mtima m'mayi: zotsatira za National Heart, Lung, ndi Blood Institute inathandizidwa ndi Women's Ischemia Syndrome Evaluation (WISE). Circulation 2004; 109: 722-5.
CJ yapafupi, matenda a mtima Ischemic kwa akazi: mfundo ndi malingaliro okhumba. J Am Coll Cardiol Pepine 43 (10): 1727.