Pamene Spasm mu Mitsempha ya Coronary imatsogolera ku Chifuwa
Prinzmetal angina , yomwe imatchedwanso vasospastic angina kapena yosiyana angina, ndi chifukwa chosavuta kwambiri cha kupweteka pachifuwa. Zimapezeka pamene mvula imayambira mumodzi mwa mitsempha yamakono - mitsempha yomwe imapereka magazi kwa mtima wanu. Mphunoyi imayambitsa mbali ya minofu ya mtima kuti isalowe magazi, ndipo angina imapezeka. Ngakhale Prinzmetal angina ikhoza kukhala ndi zotsatira zofunikira, kuphatikizapo kupweteka kwa mtima ndi kuopsa kwa moyo wa mtima , zimakhala zosalekeza nthawi zonse zikadziwika bwino.
Osati Kugonjetsa Mtima, Koma Momwe Mungayesere
Kupweteka kwa chifuwa chimene anthu amachiwona ndi Prinzmetal angina sichikudziwikiratu kuchokera pachikale, chomwe chimayambitsa matenda a atherosclerosis . Monga momwe angina amachitira, anthu omwe ali ndi Prinzmetal angina nthawi zambiri amafotokoza zizindikiro zosakaniza, kuphatikizapo chifuwa chimamatira, kufinya, kupanikiza, kukhuta, kulemera kapena mfundo mu chifuwa, kupweteka, kapena kutentha. Chifuwa "chovuta" chikhoza kukhala ndi dyspnea , khunyu, kapena thukuta, ndi / kapena palpitations . Zizindikiro izi zimapitilira kwa mphindi khumi kapena kuposerapo. Ndipo mosiyana ndi angina, omwe kawirikawiri amapezeka pamene akuyesedwa kapena kupanikizika, Prinzmetal angina zambiri amawonekera pamene akupuma. Ndipotu, nthawi zambiri anthu amakhala ndi angina ya Prinzmetal nthawi yovuta kwambiri pakati pa usiku ndi m'mawa.
Nthawi zina zizindikirozi zimayambitsa anthu ndi Prinzmetal angina kukhulupirira kuti akudwala matenda a mtima.
Mwanjira ina, izi sizingakhale zovuta, chifukwa anthu omwe amaganiza kuti ali ndi vuto la mtima amatha kupeza thandizo lachipatala. Ndipo posachedwa Prinzmetal angina amapezeka, mwamsanga ingathe kuchiritsidwa bwino.
Zimayambitsa
Aliyense akhoza kukhala ndi vutoli, koma ndilofala kwambiri kwa amayi. Anthu omwe amapanga angmani ya Prinzmetal nthawi zambiri amakhala aang'ono, amathanzi, ndipo kawirikawiri amakhala ndi ziwopsezo zochepa za matenda a mtima - kupatula kusuta.
Kusuta makamaka ndi chinthu chachikulu chomwe chimapangitsa angina kupweteka chifukwa cha fodya zingayambitse matendawa.
Kuwonjezera pa kusuta, kugwiritsa ntchito cocaine kapena amphetamines kungapangitsenso Prinzmetal angina. Anthu ogwiritsira ntchito mankhwala ndi Prinzmetal angina amatha kuwonongeka kwambiri (kapena kufa) kwa mtima kusiyana ndi osagwiritsira ntchito mankhwala osokoneza bongo.
Nthawi zina, Prinzmetal angina amaganiza kuti imayambitsidwa ndi " endothelial disfectiction ", yomwe imakhala mkati mwake (ie, endothelium) ya mitsempha sikugwira bwino. Endothelial kusemphana maganizo kumagwirizananso ndi matenda a mtima x , zochitika za Raynaud, ndi mutu wa mutu wa migraine . Inde, anthu omwe ali ndi angina a Prinzmetal nthawi zambiri amakhalanso ndi vuto la migraine.
Angina wa Prinzmetal Amadziwika Bwanji
Prinzmetal angina umachitika pamene malo amodzi mwa mitsempha yambiri yamakono imalowa mwadzidzidzi, kutseka kwa magazi kwa kanthaŵi kochepa kupita ku mtima wamtundu umene umaperekedwa ndi matabwawo. Pazigawo izi, electrocardigram (ECG) imasonyeza kuti " ST segment " ikukwera kwambiri - ECG yomweyo imasintha kwambiri ndi matenda a mtima. Nitrates nthawi zambiri amachepetsa msanga mofulumira, kubwezeretsanso mitsempha yowonongeka.
Choncho, zinthu zomwe madokotala amafuna kuti azindikire kuti Prinzmetal angina ndizo:
- Kawirikawiri ululu wamapiko "angin"
- limodzi ndi kusintha kwakukulu kwa ECG,
- zomwe zimamasulidwa ndi nitrate administration,
- ndi "zizolowezi" zamakono zomwenso zimawonetseratu zapatheti .
Nthaŵi zambiri, dokotala sadzakhalapo panthawi yeniyeni ya angina. Izi zikutanthauza kuti munthu yemwe ali ndi angina a Prinzmetal angalowemo kuti ayesedwe pambuyo poti angina achoka. Muzochitikazi, kuyezetsa magazi kungaphatikizepo kuyang'anitsitsa kwa ECG kwa nthawi ya masabata angapo (kufunafuna zochitika zokha za angina pamodzi ndi kusintha kwa ECG), kapena kuyezetsa kupanikizika . (Ngakhale kuti ang'anga ya Prinzmetal imapezeka pamapumulo, pafupifupi 20% mwa anthu omwe ali ndi vutoli angakhale ndi angina awo atayesedwa panthawi ya kuyesa.)
Nthawi zina, catheterization ya mtima ndi "kuyesa kosautsa" ndikofunika kuti mudziwe. Chifukwa Prinzmetal angina imayamba chifukwa cha mitsempha yamatenda m'malo mwake chifukwa chokhala ndi mitsempha yotsekemera, nthawi zambiri zimakhala ndi mitsempha yodalirika. Komanso, chifukwa Prinzmetal angina siyo yokha ya angina yomwe ingathe kuwonedwa ndi mitsempha yowonongeka , kuti chidziwitso choyenera chikhoze kuwonetsa kuti chiwonongeko cha mitsempha chikhoza kupsa mtima.
Mitundu iwiri ya "kupsa mtima" imagwiritsidwa ntchito kuyesa kupangitsa kuti mitsempha yamakina amatha kusokoneza - hyperventilation, ndi kuyezetsa mankhwala ndi acetylcholine kapena ergonovine.
Kuyeza kwa Hyperventilation ndi mayeso osagonjetsa. Kawirikawiri imachitidwa m'mawa kwambiri, pamene malowa amatha kupezeka. Ndi mayeso a hyperventilation, wodwalayo akuuzidwa kuti apume mofulumira komanso mofulumira kwa mphindi zisanu ndi chimodzi - zomwe zimakhala zovuta kwambiri kuposa zomwe zingamveke - pamene ECG ikuwerengedwanso, ndipo kujambula zithunzi kumapangidwira kuti ziwone zizindikiro za mitsempha yamatope . Mayesowa ndi othandiza makamaka kwa anthu omwe nthawi zambiri amakhala ndi Angina a Prinzmetal. Izo sizikuwoneka ngati zothandiza kwa iwo omwe ma episodes awo amakhala osasintha kapena osasintha.
Kuyesedwa ndi acetylcholine kapena ergonovine kumachitika nthawi ya catheterization ya mtima. Kuyesedwa kwa mtundu umenewu kumapereka chithandizo cholondola kwambiri mofanana ndi mayeso a hyperventilation. Pachiyeso ichi, imodzi mwa mankhwalawa imayikidwa mkati mwazitsulo (ergonovine) kapena mwachindunji mumatope (acetylcholine). Kwa anthu omwe ali ndi Prinzmental angina, nthawi zambiri amachititsa kuti mitsempha yamakono imayambitsa matenda awo. Malo osungira malowa akhoza kuwonetsedwa panthawi yothandizira. Pakalipano, kuyezetsa ndi acetylcholine kumawoneka otetezeka kusiyana ndi kuyesedwa ndi ergonovine ndipo ndiyeso yowonongeka yopondereza.
Maonekedwe ndi Zotsatira
Ngakhale kuti maganizo a odwala omwe ali ndi Prinzmental angina ndi abwino, vutoli lingayambitse mavuto aakulu. Zingayambitse matenda oopsa a mtima, makamaka ventricular fibrillation. Ndipo ngakhale kupweteka kwa mtima sikukudziwika ndi Prinzmetal angina, iwo amatha kuchitika, kutulutsa kuwonongeka kosatha kwa minofu ya mtima. Kuchiza mokwanira Prinzmental angina kumachepetsa kwambiri chiopsezo chotere. Ndipotu, kamodzi pa chithandizo chamankhwala, anthu omwe ali ndi vutoli akhoza kuyembekezera kukhala ndi moyo wathanzi, wathanzi.
Chithandizo
Ngati muli ndi Prinzmetal angina, zidzakhala zofunikira kwa inu (monga momwe zilili ndi aliyense) kuti muzitha kuyambitsa matenda anu onse. Koma kwa inu, ndizofunika kwambiri kuti musagwiritse ntchito fodya, zomwe zimayambitsa mphamvu zamakono.
N'zotheka kuti iwe ndi dokotala wanu mudzatha kupeza bwino kwambiri pazigawo zanu za angina ndi nitrates ndi / kapena calcium channel blockers . Komanso mungathe kukambirana ndi dokotala kugwiritsa ntchito mankhwala osokoneza bongo omwe sikuti amachepetsa cholesterol koma amathandizanso kuti ntchito yomaliza ikhale yotsiriza.
Mankhwala osokoneza bongo omwe angapangitse mitsempha ya mitsempha yamtunduwu ndipo zomwe muyenera kuzipewa muyenera kuphatikizapo mankhwala ambiri a beta komanso mankhwala osokoneza bongo - makamaka Imitrex (sumatriptan).
> Zotsatira:
> Beltrame JF, Crea F, Kaski JC, et al. Kukhazikitsidwa Kwachidziwitso kwa Zosowa Zowononga kwa Vasospastic Angina. Eur Mtima J 2015.
> Kusama Y, Kodani E, Nakagomi A, et al. Kusiyana kwa Angina ndi Coronary Artery Spasm: Clinical Spectrum, Pathophysiology, ndi Management. J Nippon Med Sch 2011; 78: 4.
> Ong P, Athanasiadis A, Borgulya G, ndi al. Kugwiritsa ntchito kachipatala, zizindikiro za Angiographic, ndi Kuwonetsetsa Mwachidziwitso cha Intracoronary Acetylcholine Kukwiyitsa TYestest Of 921 Odwala White Otsatira ndi Mitsempha Yachikhalire Coronary Mitsempha. Circulation 2014; 129: 1723.
> Stern S, Bayes de Luna A. Coronary Madzimadzi: Kupanga kwa 2009. Circulation 2009; 119: 2531.