Zachidule za Matenda a Magulu a Mtima
Cholinga cha magetsi anayi (tricuspid, pulmonary, mitral, ndi aortic valves) ndikoonetsetsa kuti mtima ukagunda, magazi amayenda momasuka. Ngati imodzi kapena miyendo yambiri ya mtima imakhala ndi matenda, ngakhale kutuluka mwazi kwaulere pamtima kumatetezedwa (stenosis), kapena magazi amatha kubwerera kumbuyo ku valavu yowonongeka. Vuto lamtundu uliwonse, ngati osayang'aniridwa nthawi zonse ndi kuchiritsidwa bwino, lingayambe kukhumudwitsa mtima , komanso mavuto ena a mtima.
Zotsatira za matenda a valve pamtima zimadalira kuti ma valve amathandizira, kaya vuto lalikulu ndi stenosis kapena kubwezeretsanso, komanso kuwonongeka kwa valvular. Ngati muli ndi matenda a mtima wa valvular, muyenera kugwirizana kwambiri ndi katswiri wanu wa cardiologist kuti muonetsetse kuti vuto lanu la valvular matenda, ndi kufunika kwa chithandizo, liwerengedwenso nthawi zonse.
Mavuni Anayi Amtima ndi Zimene Amachita
> Onetsetsani magetsi anayi a mtima.
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Zimene Muyenera Kudziwa Zokhudza Aortic Stenosis
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Kodi N'chiyani Chimayambitsa ndi Chithandizo cha Mitral Stenosis?
Mtima uli ndi zipinda zinayi-ma atria abwino komanso omanzere, ndi ventricle yolondola ndi yakumzere. Mphulo iliyonse imakhala pakatseguka pakati pa zipinda ziwiri ndikuphatikizira kutseguka ndi mphete yowonjezera, yotchedwa annulus. Zomwe zimagwiritsidwa ntchito pamalopo zimakhala ndi timapepala awiri kapena atatu (nthawi zina amatchedwa cusps) omwe amagwira ntchito ngati "ziphuphu." Mphalapala wa mitral uli ndi timapepala awiri; ma valve ena onse ali ndi timapepala atatu.
Pamene mtima ukugunda, timapepala timatseguka ndi kutseka. Pamene timapepala timatseguka, magazi akhoza kuyenda kudutsa pa valve. Pamene timapepala timatsekedwa, magazi akuthamanga pa valavu imasiya.
Vulricric yolondola imayang'aniridwa ndi valve tricuspid ndi pulmonary valves . Vivus valve imakhala pakati pa atrium yoyenera ndi ventricle yoyenera. Pamene mgwirizano wa pa atrium woyenera, viveti yotsegulira imatsegula ndipo imalola kuti magazi alowe mu ventricle yoyenera. Kenaka, pamene chitsimikizo chovomerezeka chikugwiritsidwa ntchito, valavu yamkati imatseka (kuteteza magazi kuti asabwererenso ku atrium yoyenera), ndipo valve yamapuluni imatsegulira kuti magazi alowe pambali ndi ventricle yolondola kuti ayenderere mu mitsempha ya pulmonary ndi kwa mapapo.
Mpweya wam'mzere wakumzere umasungidwa ndi valve ya mitral ndi valve aortic . Mitsempha yotchedwa mitral, yomwe ili pakati pa atrium kumanzere ndi kuchoka ku ventricle, imatsegulira pamene maselo otchedwa atrium amalola kuti magazi alowe mu ventricle kumanzere. Pamene ventricle ya kumanzere imagunda, valve ya mitral imatseka ndipo valve ya aortic imatsegulira kutsogolera magazi opopedwa mu aorta ndi kunja kwa matupi a thupi.
Kodi Mitundu Yabwino Yotani Imakhudza Mitima ya Valavu?
Kubwereza, magetsi amachititsa zinthu ziwiri zofunika: Amatsimikizira kuti mtima ukagunda, magazi amayenda mumtima mwaulere ndipo amayenda m'njira yoyenera.
Choncho n'zomveka kuti ngati valve yamtima imakhala matenda, mitundu iwiri ya mavuto imakhalapo.
Choyamba, vuto la valve la mtima lingapangitse kuti valve ipeputsedwe pang'ono, kuti magazi asatulukire momasuka. Matendawa amatchedwa valvular stenosis . Pamene valve yamtima imakhala stenotic, chipinda chamoyo chomwe chiyenera kukankhira magazi kudutsa pa valavu yochepetsetsa iyenera kugwira ntchito zovuta kuti ikankhire magazi kunja. Izi zimachititsa kuti chipindachi chiwonjezeke, chomwe chimapangitsa mtima kukhala minofu (kukhala "hypertrophic"), ndipo pamapeto pake zingayambitse minofuyo.
Chachiwiri, matenda a valve a mtima amachititsa kuti valve isakhale yopanda nzeru; ndiko kuti, valve imalephera kutseka kwathunthu ndipo magazi amatha kuthamangira kumbuyo kwa valavu pamene imayenera kutsekedwa. Matendawa amatchedwa valvular regurgitation . Kubwezeretsa kumayambitsa chiwombankhanga chomwe chimakhudzidwa kuti chikhomere magazi ochulukirapo kuposa achizolowezi, chomwe chingayambitse kupatula zipinda za mtima, kufooketsa minofu ya mtima, ndipo potsiriza, mtima wosalimba.
Choncho, mphamvu za valvular stenosis komanso kugwiritsidwa ntchito kwa valvular zingayambitse mtima. Kuwonjezera pamenepo, matenda a valve a mtima amakhudzidwa kwambiri ndi chiopsezo cha mtima wamagayimia , makamaka mafinya odwala .
Mmodzi mwa mavavini a mtima anayi akhoza kukhala stenotic kapena regurgitant, ndipo magalasi ena amtima amatha kusonyeza mavuto onsewa panthawi yomweyo. Matenda a mtima wa valve amadalira kuchuluka kwa stenosis kapena kubwezeretsedwa kumene kukupangidwa. Ndi mitundu yambiri ya matenda a mtima wa valvular, kuuma kwa chikhalidwe-ndi zotsatira zake pa ntchito ya mtima-kungapite patsogolo kwambiri pamene nthawi ikupita. Ngakhale "mtima wofatsa" matenda a valve ayenera kunyalanyazidwa mozama ndikutsatiridwa nthawi ndi nthawi ndi dokotala wodziwa bwino.
Kodi Ndizifukwa Ziti Zimayambitsa Matenda a Mtima Wodalirika?
Matenda a mtima wa Valvular amatha chifukwa cha matenda osiyanasiyana. Zomwe zimayambitsa matenda a mtima wa valve ndi awa:
- Kulemba kwa Valvular: Ma deposit a calcium angapangidwe pamagetsi pamtima, popanda chifukwa chomveka, pokhudzana ndi ukalamba. Valvular calcification amatha kukhala makamaka ndi mitral valve ndipo, pang'onopang'ono, ndi valve aortic. Nthawi zambiri, kugwiritsira ntchito valvular sikumayambitsa kusintha kwakukulu pa ntchito ya valve. Koma ikhoza kubweretsa stenosis kapena kubwezeretsanso, kotero aliyense amene ali ndi valvular calcification ayenera kutsatiridwa nthawi zonse kuti ayambirenso mkhalidwewo.
- Kupweteka kwa mtima: Ngati chipinda cha mtima chimayamba kuchepetsedwa, chimatha kuchititsa kuti mapaipi a mtima asakanike, omwe angathe kuteteza timapepala timeneti kuti tisatseke kwathunthu. Valvular kubwezeretsedwa kungabweretse. Kusungunuka kwa mtima kumachitika ndi mitundu yambiri ya matenda a mtima. Kawirikawiri, kupweteka kumene kumachitika pambuyo pa kupweteka kwa mtima , kapena kupweteka kwa mtima , kumaphatikizapo kutambasula mitral valve kapena valve valve, zomwe zimapangitsa mitral kapena kuthamanga mofulumira.
- Matenda a mtima wodwalayo: Mitundu yambiri ya matenda opatsirana m'mimba imayanjanitsidwa ndi ziphuphu zamtunduwu zomwe zimatha kupanga stenosis kapena kubwezeretsanso. Mitundu yowonjezereka ya mavuto a valve omwe amawoneka ndi mtima wamtima wobadwa ndi matenda a pulmonary stenosis, matenda a bicuspid aortic valve (momwe a valtic valve ili ndi zifukwa ziwiri zokha, zomwe zingayambitse aortic stenosis), ndi proral valve prolapse.
- Matenda opatsirana opatsirana : Matenda opatsirana pogonana, matenda a chigoba cha mtima komanso makamaka magetsi a mtima, amachititsa kuti vhubu liwonongeke mtima, nthawi zambiri limapangidwanso. Matenda a valvular omwe amayamba chifukwa cha matenda opatsirana amatha kupitilira pang'onopang'ono, koma ichi ndi chikhalidwe chimodzi chomwe nthawi zambiri chimabweretsa zovuta, ndipo mwinamwake choopsa, mtima wa valve watsopano.
- Matenda a mtima wa Rheumatic Heart: Rheumatic heart disease ndi mawonekedwe a mtima wa valve omwe nthawi zina amawoneka munthu atakhala ndi rheumatic fever . Ngakhale kuti matenda a mtima wa rheumatic ndi ochuluka kwambiri m'mayiko a kumadzulo omwe anali zaka 50 zapitazo, adakali ndi nkhawa kwambiri m'madera ambiri padziko lapansi. Kupewa chimfine cha nthendayi pogwiritsa ntchito mchitidwe wa mitsempha mwamphamvu kumakhalabe kofunika kwambiri.
- Zochitika Zochiritsira Zina: Matenda a mtima wa valve amatha chifukwa cha matenda ena ambiri, kuphatikizapo syphilis , matenda opatsirana (monga lupus ), zotupa zosiyanasiyana, aortic aneurysm , carcinoid , ndi mankhwala othandizira kuchipatala.
Zizindikiro za Matenda a Mtima Wa Valve
Kawirikawiri, matenda a valve a mtima samakhala ndi zizindikiro konse mpaka minofu ya mtima iwonongeke kuti ayambe kulephera. Pamene zizindikiro zimachitika, zimakhala zofanana ndi zizindikiro za mtima wosalimba . Izi zimaphatikizapo dyspnea (kupuma pang'ono); zofooka; umutu ; kapena edema (kutupa) m'makumbo, mapazi kapena mimba.
Arrhythmias angakhalenso ndi matenda a mtima wa valve; monga taonera, chiopsezo cha kupha tizilombo toyambitsa matenda chimakula makamaka. Zisonyezero za mtima wamaganizo zimaphatikizapo zizindikiro za kugwedezeka, kufooka, kufooka, kapena kuchita masewera olimbitsa thupi.
Kwa anthu ambiri, zizindikiro za matenda a mtima wa valvular kawirikawiri zimawonetsa kuti matendawa amatha. Momwemo, munthu yemwe ali ndi matenda a valve mtima adzakhala ataphunzira bwino bwino asanatuluke zizindikiro, kotero kuti chithandizocho chikhoza kukhazikitsidwa musanayambe kuwonongeka kwa mitsempha ya mtima.
Nthawi zina, matenda a valve pamtima angakhale vuto lalikulu komanso osati pang'onopang'ono. Matenda a mtima a valvular amatha kuchitika, mwachitsanzo, chifukwa cha minofu ya mtima yowonongeka ndi matenda a mtima, kapena kuchoka kwa mtima wamagetsi kuchokera ku matenda opatsirana pogonana kapena rheumatic heart disease.
Koma mobwerezabwereza, matenda a valve a mtima ndi matenda osapitirira, omwe amatha kupezeka bwino asanakhale zizindikiro. Choyamba, matendawa, ndifungulo.
Kuzindikira Matenda a Mtima wa Valvular
Matenda oyambirira a matenda a mtima wa valve ndi ofunika kwambiri kuti awatsogolere bwino. Momwemo, mankhwala amayambika musanayambe kugunda minofu ya mtima ndikulephera kuwonongeka kwa mtima. Koma kuti tichite zimenezi, nthawi zambiri n'kofunika kudziŵa kuti matenda a valve alipo kale asanakhalepo zizindikiro.
Matenda oyambirira a mtima wa valve ndi imodzi mwa mavuto omwe amawagwiritsira ntchito pa zamankhwala omwe nthawi zambiri amatha kuwonekera poyambirira ndi kafukufuku wamankhwala wamba-ndipo ndi chimodzi mwa zifukwa zomwe ife tonse timalimbikitsidwa kuti tikhale ndi machitidwe omwewo.
Chizindikiro choyamba cha vuto la valve la mtima nthawi zambiri ndilo kuzindikira kuti mtima ukudandaula panthawi yofufuza. Vuto la valvular stenosis kapena valvular regurgitation limapangitsa kuchuluka kwa chisokonezo cha magazi mkati mwa mtima. Izi zimapangitsa kuti dokotala amve ndi stethoscope (mtima ukudandaula). Sikuti kudandaula mtima konse kumasonyeza vuto la mtima, ngakhale; ambiri amatchedwa "osalakwa" kung'ung'udza, ndiko kuti, amayambitsidwa ndi chivomezi pang'ono chimene chingakhale pamtima pafupifupi.
Ngati dokotala wanu atulukira zowona zomwe zingasonyeze matenda a mtima wa valvular, kachipangizo kameneka kamakhala bwino kwambiri kusiyanitsa pakati pa vuto la valve la mtima ndi kung'ung'udza kosalakwa. Ndi kachipangizo kameneka, chitsimikizo chotsimikizika chingapangidwe pafupifupi mtundu uliwonse wa vuto la valve la mtima.
Ngati matenda a valvular alipo, echocardiogram imatha kudziwa bwinobwino kukula kwa vutoli. Zitsanzo zingapo zingapangidwe ndi kayendedwe ka magazi ndi kukula kwa chipinda cha mtima, ndipo miyesoyi ikhoza kufanikizidwa ndi ena omwe amayesedwa kuti ayambe kuyesedwa pofuna kudziwa momwe vutolo likuwonjezereka (ngati kulibe).
Mavuto a Valve a Mtima Wathu Ndi Matenda Awo
Mitral Stenosis: Mu mitral stenosis , kutsekedwa kwa mitral valve kumachepetsa kutuluka kwa magazi kuchokera kumanzere kumanzere kupita kumanzere kwa ventricle. Pakapita nthawi, kupanikizika kumawombera kumanzere, ndipo pamapeto pake kumayambitsa mitsempha yothamanga kwambiri komanso mtima wosagwirizana makamaka pambali ya mtima. Chithandizo ndi kukonza opaleshoni kapena kusintha kwa valve mitral, ndipo nthawi ya opaleshoni ndi yofunika kwambiri. Pomwe pakufunika kuchitidwa opaleshoni, opaleshoni ya mitral stenosis yabwino imayenera kudziwika kwa munthu aliyense.
Mitral Kudzudzula: Mitration regurgitation , yomwe imachititsa kuti magazi abwerere kumbuyo kwa ventricle kupita kumanzere kumbali ya kumanzere, ndiyo mtundu wambiri wa matenda a mtima wa valve chifukwa uli ndi zifukwa zambiri. Mwachitsanzo, tanthauzo lalikulu la mitral valve prolapse (MVP) ndiloti nthawi zina zimatha kubwezeretsa mitral. Kubwezeretsa kwa Mitral kungayambitse kuwonjezeka kwachangu m'kati mwa maulendo a kumanzere ndi kuchoka ku ventricle, ndipo ngati kupatsidwa chithandizo kungapangitse kusokonezeka kwa mtima kosasinthika. Nthawi yoyenera yothandizira opaleshoni imadalira gawo la kubwezeretsedwa . Njira zambiri zochititsira opaleshoni zilipo zothandizira kubwezeretsa mitral.
Aortic Stenosis: Mu aortic stenosis , valve ya aortic imalepheretsedwa pang'ono, zomwe zimapangitsa kuti zikhale zovuta kwa ventricle kumanzere kuchotsa magazi ku matupi a thupi. Zimatsogolera ku hypertrophy ya minofu ya ventricle kumanzere, ndipo pamapeto pake pamtima kulephera. Kuwonjezera pamenepo, ngati kuchuluka kwa magazi komwe mtima ukupopera kumachepa kwambiri chifukwa cha kulepheretsedwa, syncope kapena imfa yadzidzidzi ikhoza kuchitika. Ndipotu, syncope chifukwa cha aortic stenosis iyenera kuchitidwa ngati chithandizo chachipatala, chifukwa imasonyeza kuti valve ya aortic imakhala yochepa kwambiri. Mofanana ndi mtundu uliwonse wa matenda a mtima wa valvular, aortic stenosis yofatsa imafunika kuyang'anitsitsa mosapita nthawi. Ngati vutoli likukhala lofunika kwambiri, opaleshoni ya valve ya aortic idzafunika.
Aortic Kubwezeretsa: Ndi kutembenuka kwa aortic, valve ya aortic imakhala yotayika kotero kuti magazi amatsuka kumbuyo kuchokera ku aorta kupita kumalo otsekemera. Kutuluka kwa magazi kumbuyoku kumawonjezera ntchito ya ventricle ya kumanzere. Ngati kubwezeretsa kumakhala kofunika, ululu wamakono umakula kwambiri ndipo mtima umatha. Chithandizo cha kubwezeretsa kwakukulu kwa aortic kumafuna kudzoza opaleshoni ya valve aortic.
Matenda otchedwa Stricy Stenosis: Kutsekemera kwa stenosis, kutsekemera kwapadera kwa valve yamagetsi, ndizovuta kwambiri pa matenda akuluakulu a valvular. Kawirikawiri amawoneka mwa anthu omwe ali ndi matenda a mtima wambiri ndipo nthawi zambiri amaphatikizidwa ndi matenda m'magetsi ena a mtima. Ngati kuli kofunika, tricuspid stenosis imapangitsa kuti zinthu zikhale zosavuta komanso zowonongeka. Komabe, zizindikiro zomwe zimayambitsidwa ndi matenda m'magetsi ena nthawi zambiri zimachitika bwino tricuspid stenosis itayamba kuonetsa zizindikiro. Chifukwa chake, chithandizo cha opaleshoni cha tricuspid stenosis (chomwe chiri ndi kukonzanso kwa valvular m'malo molowera m'malo) nthawi zambiri zimachitika ngati "kuwonjezerapo" njira, pamene opaleshoni ndi yofunikira kuti muzitha kugwira ntchito yotsegula mtima kwambiri.
Kukonzekera mobwerezabwereza: Mwachidziwitso mofulumira , magazi akuthamanga pamagetsi a tricuspid kuchokera ku ventricle yolondola mpaka ku atrium yoyenera. Kuchulukitsanso kawirikawiri kumayambitsidwa chifukwa chotsitsa tricuspid annulus yomwe imapezeka chifukwa cha mitsempha yapamwamba yowopsa kwambiri, mtima wosalimba, kapena kupuma kwa pulmonary . Kuwongolera nthawi yomweyo kumakhala kofatsa ndipo kawirikawiri sikutanthauza chithandizo cha opaleshoni. Kufufuza mosamalitsa kuti muwone vuto lalikulu lachipatala ndilofunika, popeza kuthana ndi vutoli nthawi zambiri kumapangitsa kuti kusintha kwakukulu kuwonjezeke.
Pulmonary Stenosis: Kupweteka kwa mpweya, kutsekereza kwa mpweya wa pulmonary, kawirikawiri ndi matenda osokonezeka omwe nthawi zambiri amagwirizanitsidwa ndi tetralogy ya Fallot, Matenda a Noonan (matenda a chibadwa ndi zovuta za mtima, nthawi yayifupi, chifuwa cha chifuwa, ndi mavuto ophunzirira), kapena congenital rubella. Stenosis yapamwamba imapezeka nthawi yoberedwa kapena posakhalitsa pambuyo pake. Ngati ndizowopsa, zingathe kulepheretsa mbali yeniyeni ya mtima. Mphuno yochepa yotchedwa pulmonary stenosis ingakhale yodalirika kwambiri yomwe imasowa mankhwala. Ngati matendawa ndi ovuta kwambiri, nthawi zambiri amatha kuchizidwa ndi valloloplasty yavuni, njira yowonongeka yochepa.
Kukonzekera Mwamwayi: Mu mitsempha yowonongeka, magazi akuthamanga pamphuno yotsekemera ya pulmonary valve kuchokera mu mitsempha ya pulmonary kupita mu ventricle yoyenera. Chinthu chofala kwambiri cha pulmonary regurgitation ndi mapulaneti amtundu waumphazi wambiri, umene ungapangitse kutulutsa mpweya wotchedwa valvular annulus mpaka kuti mpweya wa pulmonary sungathe kutseka kwathunthu. Ngati zovuta, kupuma kwa pulmonary kungachititse mtima wabwino kuti ukhale wosasunthika, ndipo mtima ungathe kuchitapo kanthu. Kawirikawiri, chithandizo cha pulmonary regurgitation ndikutenga njira zothandizira kupopera mankhwala am'mimba . Nthawi zambiri opaleshoni amafunika.
Kodi Pali Njira Yopanda Opaleshoni Yopewera Matenda a Valve?
Matenda a mtima wamagetsi ndi vuto lalikulu. Pofuna kuthana ndi chifukwa chake, opaleshoni nthawi zambiri ndi njira yokhayo.
Komabe, nthawi zambiri chithandizo chamankhwala chikhoza kupezeka chomwe chingathandize. Nthawi zina, mankhwala amathandiza kuchepetsa mtima ndi kuchepetsa kukula kwa matenda a valve. Izi zimakhala choncho ndi mitundu yosiyanasiyana ya valvular regurgitation, yomwe vuto la valve limayambitsidwa ndi chipinda cha mtima. Chithandizo chamankhwala chopweteka chomwe chimaperekedwa pochiza matenda oopsa kwambiri kapena kuchepa kwa mtima , kapena kuteteza ventricular kukonzanso pambuyo pa matenda a mtima, kapena ngakhale kuchepetsa kutentha kwa mtima m'thupi , mwachitsanzo, kungachepetse mpata wokhala ndi mitral kapena kuthamanga kwambiri.
Pachifukwachi, ndibwino kuti anthu omwe ali ndi matenda a mtima wa valvular aziwonekera nthawi zonse ndi katswiri wa zamoyo, amene angathe kuthana ndi mavuto omwe ali nawo pamtima.
Kukhala ndi Matenda a Magetsi a Mtima
Ngati muli ndi matenda a valve mtima, palinso zinthu zina zomwe muyenera kuchita kuti mukhale ndi moyo wathanzi komanso wathanzi. Muyenera kuphunzira zonse zomwe mungathe pa mtundu wa matenda a valvular omwe muli nawo, komanso vuto lanu la valavu. Ngati muli ndi mankhwala othandizira mtima wanu kugwira bwino ntchito, muyenera kuwatenga nthawi zonse ndikuwafotokozera dokotala.
Pa chifukwa chimenechi, muyenera kusunga maadiresi anu ndi dokotala wanu nthawi zonse. Ngakhale izi zili zofunika kwa aliyense, ndizofunika kwambiri kwa munthu amene ali ndi vuto la valve la mtima, chifukwa matenda a mtima wa valvular amapitirira nthawi. Muyenera kuyankhula ndi dokotala wanu ngati mukufuna kutenga antibiotic prophylaxis ya endocarditis .
Pomalizira, popeza muli ndi vuto la mtima, muyenera kuchita zonse zomwe mungathe kuti muchepetse matenda ena a mtima: Musasute; Pitirizani kudya chakudya chabwino komanso kulemera kwabwino; khalani ndi masewera olimbitsa thupi; ndipo, ngati muli ndi matenda oopsa kapena shuga , onetsetsani kuti muli ndi zifukwa izi muzitha kuyendetsa bwino.
Mawu Ochokera
Matenda a mtima wa Valvular akhoza kukhala vuto lalikulu. Koma pozindikira mwamsanga, kulandira chithandizo chamankhwala nthawi zonse, komanso kupezeka kwa chisamaliro chamakono ndi chithandizo cha opaleshoni masiku ano, anthu ambiri omwe ali ndi matenda a valve amatha kuyembekezera kukhala ndi moyo wautali ndi wathanzi.
Zotsatira:
> Gulu Loyamba la Ntchito pa Utsogoleri wa Valvular Heart Disease wa European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Malangizo otsogolera matenda a mtima wa valvular (2012). Mtima; 33: 2451.
Nishimura RA, Otto CM, Bonow RO, ndi al. 2014 AHA / ACC chitsogozo cha odwala odwala matenda a valvular: lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57.