Kaya munthu wokhala ndi vuto la mtima amafunikira pacemaker kumadalira zifukwa zingapo
"Chikondi cha mtima" ndi vuto lomwe limakhudza magetsi a mtima. Cholinga cha mtima - chomwe chimatchedwanso otrioventricular block, kapena AV block-ndi chimodzi mwa zifukwa zazikuluzikulu za bradycardia (kuchepa kwa mtima).
Mwachidule
Mukatikati mwa mtima, maganizo a magetsi amatsitsimula pang'ono kapena atatsekeredwa pamene akuyesa kuyenda kuchokera m'chipinda cham'kati mwa mtima kupita ku zipinda zam'mimba.
Chifukwa chakuti zida zamagetsizi zimapangitsa mtima kudziwa pamene ziyenera kumenyedwa, ngati mtima wautali uli wolimba kwambiri ndipo ukhoza kuchepetsa mtima waumtima ku zovuta.
Ngati muli ndi mtima wamtima, apa pali zifukwa zazikulu zomwe zidzatsimikizire ngati mukufunikira pacemaker:
- Ngati chipika chanu cha mtima chimawonjezeka chifukwa cha kuwonjezereka kochepa kwa vagal, kutentha kwa mtima sikukusowa.
- Ngati muli ndi digitala yoyamba yamtima, chopanga pacemaker sikofunikira pokhapokha ngati bwalo likusiyana.
- Ngati muli ndi kachilombo ka mtima kakang'ono kamene kamakhala ndi zizindikiro kapena ndizosiyana, chofunika kwambiri. Cholinga chachiwiri cha digito chimene sichimachititsa kuti zizindikilo zikhale zovuta ndipo nthawi zambiri sichifuna pacemaker.
- Ngati muli ndi digitala ya mtima wachitatu, ndiye kuti pokhapokha ngati chitachitika chifukwa cha kuwonjezereka kwa vagal, chiwombankhanga chimakhala chofunika nthawi zonse.
Zimayambitsa
Zizindikiro zochepa za mtima sizingakhale zoopsa kapena zosazolowereka. Chokhazikika pamtima chimapezeka nthawi zambiri achinyamata omwe ali ndi thanzi labwino omwe amatha kuwonjezeka mwadzidzidzi kuti amamva bwanji.
Izi zowonjezera mawu a vagal nthawi zambiri zimachitika ndi kunyoza, kusanza, kapena poyankha kupweteka, mantha, kapena kusokonezeka mwadzidzidzi. Mpangidwe uwu wa mtima wamkati siwuwopsyeza moyo ndipo sukutanthauza chilichonse chomwe chimayambitsa vuto la magetsi. Icho chimatha mwamsanga pomwe chinthu chowopsya chachepa ndipo sizingafunikire kuikapo pacemaker.
Komabe, chiwalo cha mtima chikhoza kuchitika ndi matenda osiyanasiyana a mtima, makamaka matenda a mitsempha ya mitsempha, matenda a mtima , kapena myocarditis . Palinso mitundu yosiyanasiyana ya mtima wamkati.
Kawirikawiri, pamene chiwalo cha mtima chimapangidwa ndi matenda a mtima, zimatanthauza kuti pali matenda osatha a magetsi. Mitundu yamtundu uwu imakhala yoipa kwambiri pakapita nthawi, choncho nthawi zambiri zimakhala zowawa.
Zizindikiro
Malinga ndi kuuma kwake, mtima wamkati ukhoza kukhala ndi zizindikiro zosiyanasiyana, kuyambira palibe ngakhale chizungulire , syncope (kutaya chidziwitso), kapena imfa. Chiwalo cha mtima chomwe chili chokwanira kuti chikhale ndi zizindikiro, kapena chomwe chimawopsyeza kuti chikhale choopsa, chikhoza kuchiritsidwa bwino ndi pacemaker . Kotero ngati muli ndi mtima wamtima, vuto lalikulu kwa inu ndi dokotala lanu lidzakhala ngati mudzi wanu wamtima uli wokwanira kuti mukhale ndi pacemaker.
Chiwalo cha mtima chomwe sichizindikiro chilichonse nthawi zambiri safuna pacemaker, pokhapokha ngati ali ndi digiri yachitatu mtima kapena distal mtima block. Ngati bwalo lamtima likuonetsa zizindikiro-makamaka chizungulire kapena syncope-ndiye kuchiza ndi pacemaker nthawi zambiri amafunika. Chokhachokha ndi pamene mtima wamkati umadziwika kuti uli wanthawi yayitali-mwachitsanzo, chifukwa cha kuwonjezereka kwa vagal.
Degree
Chipinda cha mtima chimagawidwa ndi madokotala kukhala chimodzi mwa "madigiri" atatu. Dokotala wanu akhoza kudziwa kukula kwa mtima wanu wamkati ndi electrocardiogram (ECG) .
- Mbali yoyamba ya digiri imatanthauza kuti mtima uliwonse wa mtima umapanga kuchokera ku atria kupita ku zinyama, koma kuyendetsa ganizo kumachepa.
- Bwalo lachiwiri la digiri limatanthauza kuti zina mwazimenezo zimayendetsedwa bwino ku zinyama, koma ena sali.
- Cholinga chachitatu chimatanthawuza kuti zofuna zonse zatsekedwa. Bwalo lachitatu la mtima limatchedwanso "chiwalo chokwanira mtima."
Mu munthu yemwe ali ndi digiri ya mtima wachitatu, kupulumuka kumadalira kukhalapo kwa maselo othandizira odwala pachipatala pansi pa tsamba la malo.
Izi ndizo, maselo omwe amapanga zofuna zawo zamagetsi zomwe zimalola mtima kupitirizabe kumenya.
Mtima wamtima womwe umatulutsidwa ndi maselo ochepa a pacemaker amatchedwa "nyimbo yopulumukira." Kaŵirikaŵiri, nyimbo zothamangazi ndizosavomerezeka zokhazikika komanso zosalimba. Nthawi zina kukhalapo kwa nyimbo yopulumuka kumaonedwa kuti ndizochitika mwamsanga.
Kawirikawiri, kupitirira mlingo wa mtima wamkati, ndikofunika kwambiri kuti mukhale ndi pacemaker. Omwe amapanga pulasitiki nthawi zonse amafunidwa ndi digiti yachitatu digiti, nthawi zambiri ndi digiti yachiwiri, koma kawirikawiri ndi digiri yoyamba.
Malo
Panthawi ya mtima wamtima, mtima wa magetsi umayenera kudutsa pakati pa atria ndi ventricles (AV junction). Mgwirizano wa AV umenewu uli ndi zigawo ziwiri:
- Vuto la AV
- Mtolo Wake (kuganiza kuti ndi "makina" ofiira omwe amachititsa magetsi kuchokera ku nthenda ya AV kupita ku zinyama)
Pozindikira kukula kwa mtima wamkati, ndikofunikira kudziŵa kuti mu jokesani la AV likuchitika. Ndiko, kodi chilolezo chiri mu vesi la AV kapena chiri mu mtolo Wake (kapena nthambi za mtolo zomwe zimachokera ku mtolo Wake)?
Nthaŵi zambiri, dokotala amatha kudziwa komwe kuli mtima wamtima mwa kungoyang'ana ECG. Komabe, nthawi zina, kuphunzira kwa electrophysiology ndikofunikira.
Chipangizo chamtima chomwe chimapezeka mkati mwa kachilombo ka AV ("kovuta" mtima) nthawi zambiri amakhala woipa ndipo nthawi zambiri safuna pacemaker. Izi zili choncho chifukwa pamene chipika chikuchitika mkati mwa kachilombo ka AV, maselo othandizira odwala pachipangizo cha AV pamtundu wa AV pafupi ndi malo omwe amakhalapo nthawi zambiri amatenga chiyero cha mtima. Chomwe chimatchedwa "chiwonetsero chothamanga" chimakhala chokhazikika ndipo sichisokoneza moyo.
Kumbali ina, ndi "distal" block block, yomwe chipikacho chimapezeka kapena pansi pa mtolo wake, maselo aliwonse othandizira otha kupweteketsa mtima amatha kukhala mumtunda wokhoma kapena m'matumbo. Zotsatira za mtima wamtima zimatchedwa "ventricular kuthawa rhythm." Chifukwa chakuti maselo othandizira a pacemaker ameneŵa amadziwika kuti ndi odalirika ndipo amatha kuimitsa mwadzidzidzi, nyimbo yamagetsi yothamanga ikuwoneka ngati yoopsa.
Chikondi cha mtima chapafupi chimakhala choipa kwambiri pakapita nthawi. Kotero ngakhale pamene pakalipano pangopangika kokha koyamba kapena yachiwiri digiti, mtima wa distal umaonedwa kuti ndi wowopsa ndipo nthawi zonse umafuna chithandizo ndi pacemaker.
Mawu Ochokera
Ngati mwauzidwa kuti muli ndi block mtima kapena AV block, inu ndi adokotala muyenera kulingalira zinthu zonsezi kuti mudziwe ngati mukufunikira pacemaker. Mwamwayi, kusonkhanitsa mfundo zofunikira nthawi zambiri kumakhala kofulumira komanso kosavuta ndipo nthawi zina kumafuna kuphunzira kwa electrophysiology.
> Chitsime:
> Epstein AE, DiMarco JP, Ellenbogen KA, ndi al. Mauthenga a ACC / AHA / HRS 2008 Malangizo Othandiza Kugwiritsa Ntchito Chipangizo cha Cardiac Rhythm Zolakwika: Lipoti la American College of Cardiology / American Heart Association Ntchito Yogwiritsa Ntchito Malangizo Othandizira (Komiti Yolemba Kubwereza Bungwe la ACC / AHA / NASPE 2002 Lotsogoleredwe Loyamba Kukhazikitsa ya Cardiac Pacemakers ndi Antiarrhythmia Devices): inakhazikitsidwa mogwirizana ndi American Association for Thoracic Surgery ndi Society of Thoracic Surgeons. Kuyendayenda kwa 2008; 117: e350.