Matenda Omwe Amakhala Amtundu Wachibadwa
Matenda a hypertrophic cardiomyopathy (HCM) ndi ofanana kwambiri ndi matenda amtundu wa mtima (omwe amachititsa anthu pafupifupi 1 mwa anthu 500), omwe amachititsa mavuto angapo, kuphatikizapo mtima wosalimba ndi kufa mwadzidzidzi. Komabe, kuuma kwa HCM kumakhala kosiyana kuchokera kwa munthu wina, ndipo anthu ambiri omwe ali ndi HCM amatha kukhala ndi moyo wabwino.
Zimayambitsa
HCM imayambitsidwa ndi umodzi kapena mzake mwa kusintha kwa mitundu ya majini yomwe imabweretsa matenda mu kukula kwa mtima wa minofu.
HCM imaperekedwa ngati khalidwe la "autosomal", lomwe limatanthauza kuti ngati jini losadziwika lochokera kwa kholo limodzi, mwanayo adzakhala ndi matendawa.
Komabe, pafupifupi theka la odwala omwe ali ndi HCM, matenda a chibadwa sakhala obadwa nawo, koma amapezeka ngati kusintha kwa gene mutation - pa nthawiyi, makolo ndi abale a wodwalayo sadzakhala ndi chiopsezo chachikulu kwa HCM. Komabe, kusintha "kotere" kumeneku kungaperekedwe kwa mbadwo wotsatira.
Zotsatira za Cardiac
Mu HCM, makoma ovuta a ventricles (zipinda zam'munsi za mtima) amakhala ochepa kwambiri - chikhalidwe chotchedwa "hypertrophy." Kuphulika uku kumapangitsa mtima wa minofu kugwira ntchito mopanda malire, ngakhale pang'ono. Ngati zovuta, hypertrophy ikhoza kuchititsa mtima kulephera ndi mtima arrhythmias .
Kuonjezera apo, ngati zowonjezereka matenda a hypertrophy angayambitse kupotoka kwa mpweya, zomwe zingasokoneze ntchito ya valve aortic ndi valve ya mitral, kusokoneza kutuluka kwa magazi kudzera mu mtima.
HCM ingayambitse mitundu iwiri ya mavuto aakulu mtima:
1) HCM ikhoza kuyambitsa matenda osokoneza bongo. "Kusokonezeka kwa diastolic" kumatanthauza "kuuma" kosazolowereka kwa mitsempha ya ventricular, zomwe zimapangitsa kuti zikhale zovuta kuti zinyama zikhale ndi magazi pakati pa kumenya mtima kulikonse.
Mu HCM, hypertrophy palokha imabweretsa zovuta zina za diastolic. Ngati chokwanira, vutoli la diastolic lingayambitse mtima wa diastolic, komanso zizindikiro zoopsa za dyspnea (kupuma pang'ono) ndi kutopa. Ngakhale kufooka kwa diastolic wofatsa kumapangitsa kuti odwala ali ndi HCM azivutika kwambiri ndi matenda a mtima, makamaka kufooka kwa magazi .
2) HCM ikhoza kuyambitsa "kuchoka kwa ventricular outflow kudziletsa. (LVOT). " Mu LVOT, pali njira yothetsa pang'onopang'ono kuti zikhale zovuta kuti ventricle yakumanzere ichotse magazi ake ndi kumenya mtima kulikonse. Vutoli limakhalanso ndi stenosis ya aortic valve , yomwe valve ya aortic imakula ndipo imalephera kutsegulidwa mwachizolowezi. Komabe, pamene aortic stenosis imayamba chifukwa cha matenda mumtima wa valve wokha, LVOT ndi HCM imayambitsidwa ndi kuphulika kwa minofu ya mtima pansi pa valve ya aortic. Matendawa amatchedwa "subvalvular stenosis." Mofanana ndi aortic stenosis, LVOT yomwe imayambitsidwa ndi HCM ingapangitse mtima kulephera.
3) HCM ikhoza kubwezeretsa mitral. Mu mitral regurgitation , valve mitral imatha kutseka nthawi zonse pamene kumapeto kwa ventricle kumagunda, kumalola kuti magazi abwere kutsogolo ("regurgitate") kumalo othamanga.
Mitral regurgitation yowoneka ndi HCM sichimayambitsa vuto la mtima wa valve, koma zimapangidwa ndi kusokonezeka monga momwe mgwirizano wa ventricle umayambira, chifukwa cha kuphulika kwa mitsempha ya ventricular. Kubwerera kwa Mitral ndi njira ina yomwe anthu omwe ali ndi HCM angathe kukhala ndi mtima wolephera.
4) HCM ikhoza kuyambitsa ischemia ya minofu ya mtima. Ischemia - mpweya wokhala ndi mpweya wabwino - umakhala wochuluka kwambiri kwa odwala omwe ali ndi matenda a mitsempha (CAD) . Ndi HCM, minofu ya mtima ikhoza kulemera kwambiri moti mbali zina za minofu sizingalandire magazi okwanira, ngakhale pamene mitsempha yamakono imakhala yachilendo.
Izi zikachitika, angina ikhoza kuchitika (makamaka ndi kuyesayesa), ndipo matenda a myocardial (imfa ya minofu ya mtima) ndi yotheka.
5) HCM ikhoza kupha imfa mwadzidzidzi. Imfa yosayembekezereka mwa HCM imakhala chifukwa cha tachycardia kapena ventricular fibrillation , ndipo nthawi zambiri imayenderana ndi kuchita mwamphamvu. Zikutheka kuti ischemia ya minofu ya mtima imabweretsa zambiri ngati sizinthu zambiri zomwe zimayambitsa imfa mwadzidzidzi kwa odwala omwe ali ndi HCM. Pa chifukwa chimenechi, odwala ambiri omwe ali ndi HCM amafunika kuchita zolimbitsa thupi.
Zizindikiro
Zizindikiro zomwe anthu omwe ali ndi HCM zimakhala zosiyana. Ndizochilendo kwa odwala omwe ali ndi matenda ochepa kuti asakhale ndi zizindikiro zilizonse. Komabe, ngati mavuto ena amtunduwu adatchulidwa alipo, zizindikiro zina zingakhalepo. Zizindikiro zomwe zimachitika ndi odwala omwe ali ndi HCM ndi dyspnea ochita masewera olimbitsa thupi, orthopnea , dyspnea , maulendo, mapepala am'mutu , kupweteka pachifuwa, kutopa kapena kutupa kwa mitsempha. Syncope (kutayika kwa chidziwitso) kwa aliyense yemwe ali ndi HCM, makamaka ngati akugwiritsidwa ntchito, ndizovuta kwambiri, ndipo angasonyeze kuti ali ndi chiopsezo chachikulu chakufa mwadzidzidzi. Chochitika chilichonse cha syncope chiyenera kuyesedwa nthawi yomweyo ndi dokotala.
Kudziwa
Kawirikawiri, echocardiogram ndiyo njira yabwino yodziwira HCM. Echocardiogram imalola kuyenerera molondola kwa makulidwe a makoma a ventricular, ndipo amatha kuzindikira LVOT ndi mitration kubwezeretsanso.
Electrocardiogram (ECG) ikhoza kusonyeza zowonjezera zowonjezera zowopsa, ndipo zakhala zikugwiritsidwa ntchito ngati chida choyang'ana pofuna kuyang'ana HCM achinyamata othamanga.
Zonse za ECG ndi echocardiogram ziyenera kuchitidwa ndi achibale apamtima a aliyense amene ali ndi HCM, ndipo ma echocardiogram ayenera kuchitidwa mwa munthu aliyense amene ECG kapena kuyezetsa thupi kumaphatikizapo hypertrophy ventricular.
Chithandizo
HCM sangathe kuchiritsidwa, koma nthawi zambiri chithandizo chamankhwala chingathetsere zizindikiro ndi kusintha zotsatira zachipatala. Komabe, kasamalidwe ka HCM akhoza kukhala ovuta, ndipo aliyense amene ali ndi zizindikiro chifukwa cha HCM ayenera kutsatiridwa ndi katswiri wa zamoyo.
Olemba Beta ndi calcium blockers angathandize kuchepetsa "kuuma" mu mitsempha ya mtima wokhuthala. Kupewa kutaya madzi m'thupi n'kofunika kwa odwala omwe ali ndi HCM pochepetsa zizindikiro zokhudzana ndi LVOT. Mu opaleshoni ena ochotsa odwala kuchotsa mbali zina za minofu ya mtima yowonjezereka ndi kofunikira kuti athetse LVOT.
Matenda a atrial, ngati amapezeka, nthawi zambiri amachititsa zizindikiro zoopsa ndipo amayenera kulamuliridwa mwamphamvu kwa odwala omwe ali ndi HCM kusiyana ndi anthu ambiri.
Kupewa Imfa Yodzidzimutsa
HCM ndilo vuto lalikulu la imfa mwadzidzidzi m'maseĊµera achinyamata Pamene imfa yadzidzidzi imakhala yovuta kwambiri, makamaka makamaka ikachitika achinyamata. Pachifukwa ichi, kuyesetsa mwamphamvu ndi kupikisana kumafunika kokha kwa odwala omwe ali ndi HCM.
Njira zambiri zayesedwa pofuna kuchepetsa kufala kwadzidzidzi kwa odwala omwe ali ndi HCM - kuphatikizapo kugwiritsa ntchito beta blockers ndi calcium blockers, ndi mankhwala osokoneza bongo . Komabe, njirazi sizinawonetseke mokwanira. Tsopano zikuwoneka bwino kuti, kwa odwala omwe ali ndi HCM omwe ali ndi chiopsezo cha imfa mwadzidzidzi, mkulu wowonongeka ayenera kuganiziridwa mozama.
Zotsatira:
Massie, BM "Mtima Wolephera" mwa: Goldman L ndi Ausiello D (Eds). Cecil Textbook of Medicine, WB Saunders, 2003.
Nishimura RA, Holmes DR Jr. Kupita kuchipatala. Hypertrophic obstructive cardiomyopathy. N Engl J Med 2004; 350: 1320.
Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF / AHA chitsogozo cha chithandizo ndi chithandizo cha hypertrophic cardiomyopathy: chidule chachidule: lipoti la American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. Kuyendayenda kwa 2011; 124: 2761.