Angina Ndi Mitsempha Yachikhalire ya Coronary
Cardiac Syndrome X, kapena microvascular angina, imapezeka ngati munthu ali ndi angina , omwe ali ndi umboni wa mtima wamachimake pamayesero , koma ndi mitsempha yowonongeka yowonongeka kwa mtima . Kawirikawiri, microvascular angina imayambitsidwa ndi matenda a nthambi zing'onozing'ono za mitsempha yamakono yomwe mitsuko ing'onoing'ono imalephera kuchepetsedwa bwino, motero kumapangitsa kuti magazi asapitike mpaka kumtima.
Popeza vutoli tsopano limaganiziridwa kuti limakhala ndi mitsempha yaing'onoting'ono, dzina lachilendo la matenda a mtima wa X lakhala likuphatikizidwa ndi nthawi yowonjezereka, angina ya microvascular. Komabe, komabe akatswiri ena amakhulupirira kuti anthu omwe ali ndi vutoli akhoza kukhala ndi vuto lachidziwitso cha kupweteka kwa minofu ya mtima.
Amayi a microvascular amavomerezeka kwambiri mwa amayi (makamaka, amayi a postmenopausal) kuposa amuna. Pali zifukwa zingapo zomwe zimayambitsa matenda ochepa omwe amaganiza kuti amakhalapo mu microvascular angina, kuphatikizapo insulini kukana , kutupa, kuwonjezeka kwa adrenalin, kusowa kwa estrogen, ndi dysautonomia . N'kutheka kuti odwala osiyana ndi angina a microvascular angakhale ndi zifukwa zosiyana.
Ngakhale kuti anthu ambiri okhala ndi microvascular angina ali ndi vuto labwino - chifukwa chakuti chiopsezo cha matenda oopsa omwe amayamba chifukwa cha microvascular angina ndi otsika kwambiri - si zachilendo kuti chifuwa cha chifuwachi chikhale chofunikira, ndipo nthawi zina chimakhala chovuta, komanso vuto.
Kuchiza Angachipatala Angina
Nthawi iliyonse mukawona mndandanda wautali wa mankhwala ochiritsira matenda ena, ndi chizindikiro chakuti kuchiza vutoli kungakhale kovuta. (N'zosakayikitsa kuti ndichifukwa chake mankhwala ambiri ayesedwa poyamba.) Ndi mmenenso zilili ndi microvascular angina.
Mankhwala ambiri apezeka athandiza kwa odwala ena omwe ali ndi microvascular angina.
Komabe, pakupeza chithandizo "chabwino" kwa munthu aliyense, njira yoyesera ndi yolakwika nthawi zambiri imafunika. Izi zikutanthauza kuti onse odwala matenda a microvascular angina ndi dokotala angafunike kukhala oleza mtima ndi olimbikira kuti athe kupeza chithandizo chabwino kwambiri.
Pano pali mndandanda wa mankhwala omwe nthawi zambiri amagwiritsidwa ntchito pochiza angina ya microvascular:
Mankhwala a Angina Achikhalidwe -
- Ophwanya Beta - makamaka atenolol
- Makanema a calcium
- Nitrates - zilembo zenizeni nitroglycerin nthawi zambiri zimathandiza kwambiri angina mu microvascular angina, koma nthawi yaitali akuchita nitrates sizinapindule
Mankhwala Osakhala Achikhalidwe Ambiri -
- Ranolazine - yothandiza kwambiri m'mayesero aang'ono a chipatala
- ACE inhibitors - makamaka odwala omwe ali ndi matenda oopsa
- Ivabradine - imathandizanso m'mayesero aang'ono a chipatala
- Statins - makamaka odwala omwe ali ndi mitsempha yapamwamba ya cholesterol
- Estrogens - m'mayi am'mbuyo azimayi
- Imipramine - osati mankhwala a angina, koma ikhoza kukhala yothandiza ndi kupweteka kwa ululu
- l-arginine - ingathandize kubwezeretsanso mitsempha yaing'ono yambiri
- Sildenafil (Viagra) - osaphunzira bwino kwa microvascular angina, koma akhoza kukhala othandiza kwambiri kwa anthu ena
- Metformin - chithandizo cha mankhwalawa pochiza angina ya microvascular ndiyodabwitsa, ndipo sichikutsimikiziridwa ndi deta yachipatala.
Mankhwala Osagwiritsa Ntchito Mankhwala -
- EECP - ikuwonetsedwa mu phunziro limodzi laling'ono kuti likhale lothandiza kwa microvascular angina
- Kusakanikirana kwa msana - kukuwonetseratu kukhala kothandiza kwa odwala ena amene mankhwala osokoneza bongo alephera.
- Kuchita masewera olimbitsa thupi kwakhala kopindulitsa kwambiri, makamaka kwa odwala omwe ali ovomerezeka.
Njira Yambiri Yopangira Chithandizo cha Microvascular Angina
Chifukwa cha zonsezi, akatswiri a mtima wa mtima adzayesera kupititsa patsogolo chithandizo cha microvascular angina pogwiritsa ntchito njira yothetsera nzeru. Ngati mphamvu zowonongeka sizingapezeke ndi sitepe iliyonse, dokotala ndi wodwalayo adzapitirira kuntchito yotsatira.
- Khwerero 1 kawirikawiri amagwiritsira ntchito sublingual nitroglycerin kuti athetse zizindikiro nthawi zonse zikachitika. Pulogalamu yophunzitsa thupi nthawi zambiri imalimbikitsidwa ngati gawo limodzi. Ngati sitepe iyi sipereka chithandizo chokwanira:
- Khwerero 2 kawiri kawirikawiri ndi kuwonjezera beta blocker.
- Khwerero 3 nthawi zambiri amasiya beta blocker ndi m'malo m'malo calcium blocker.
- Khwerero 4 nthawi zambiri amayesa ranolazine, kaya yokha kapena ndi beta blocker kapena calcium blocker.
- Gawo lachisanu ndilo kuganizira mankhwala ena kapena kuwonjezera mankhwala osagwiritsa ntchito mankhwala, ndi zokopa zamtsempha kapena EECP.
Kuphatikizapo kutenga njira ngati izi, aCE inhibitor nayenso ayenera kuganiziridwa mozama ngati matendawa ali pomwepo, ndipo chiwerengero chiyenera kuganiziridwa mozama ngati zifukwa zoopsya za matenda a mitsempha yamakono amapezeka. Azimayi amene posachedwapa amachititsa minofu, mankhwala a estrogen angakhale ofunika kuganiziranso.
Ndi chipiriro - mwinamwake kuleza mtima kwakukulu - kulamulira koyenera kwa zizindikiro kumapeto kumatha kupezeka kwa anthu ambiri omwe ali ndi angina ya microvascular. Ndipo pamene akupitiliza kudutsa pamayendedwe awa, anthu omwe ali ndi angina a microvascular akuyenera kukumbukira kuti nthawi zambiri matendawa amakhala abwino kwambiri.
> Zotsatira:
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> Eriksson BE, Tyni-Lennè R, Svedenhag J, et al. Maphunziro aumunthu mu Syndrome X: Physical Training Kuletsa Kugonjetsa ndi Kupweteka mu Syndrome X. J Am Coll Cardiol 2000; 36: 1619.
> Kaski JC. Matenda a Pathophysiology ndi Utsogoleri wa Odwala ndi Chifuwa Chofufumitsa ndi Zachilendo za Coronary Arteriograms (Cardiac Syndrome X). Chizungulire 2004; 109: 568.
> Mehta PK, Goykhman P, Thomson LE, et al. Ranolazine Amapangitsa Angina Akazi Kuti Azikhala ndi Umboni wa Myocardial Ischemia koma Palibe Choletsa Kachilombo ka Mitsempha ya Coronary. JACC Cardiovasc Imaging 2011; 4: 514.
> Anthu a Task Force, Montalescot G, Sechtem U, ndi al. Malangizo a ESC a 2013: Utsogoleri wa Stable Coronary Artery Disease: Task Force on Management of Stable Coronary Artery Disease of the European Society of Cardiology. Mtima; 34: 2949.