Kulephera kumtima kwa mtima ndi mkhalidwe umene mbali yeniyeni ya mtima sungakhoze kupopera magazi m'mapapo monga mwabwino.
Kulephera kwa mtima kupopera mwazi mwabwino m'mapapu kumapangitsa kuti magazi abwererenso ku chiwopsezo cha mitsempha, ndipo amalepheretsa kuchuluka kwa mtima (mphamvu yonse ya magazi yomwe mtima ukhoza kupopera pa mphindi imodzi). Zizindikiro zomwe zimapangitsa kuti mtima ukhale wolephera zingakhale zovuta kwambiri, ndipo matendawa akhoza kuchepetsa chiyembekezo cha moyo ngati sichikhoza kuchiritsidwa mokwanira.
Kulephera kumtima kwa mtima nthawi zambiri kumachitika mogwirizana ndi kulephera kwa mtima pamtima, kotero mawu akuti " mtima kulephera " amachitiranso zovuta za mbali zonse ziwiri za mtima.
Koma nthawi zina, kuperewera kwa mtima kumakhala kokha, pomwe ntchito ya kumanzere ya mtima imakhala yachibadwa (kapena yachibadwa). Ndikofunika kuzindikira kufooka mtima kwa mtima pamene kulipo, chifukwa zimayambitsa, zizindikiro zomwe zimabweretsa, komanso chithandizo chomwe chimafuna, nthawi zambiri zimasiyana ndi zomwe zimakhala zosiyana kwambiri, makamaka m'magulu a mtima wosalimba.
Mtima Wawo Kumanzere Kumanzere Kuchokera Kumanzere
Poyerekeza ndi mbali ya kumanzere ya mtima , mtima woyenera ndi wosasangalatsa. Ntchito ya kumapeto kwa ventricle ndiyo kupopera magazi kuchokera mumtima, motsutsana ndi kuthamanga kwakukulu, kwa ziwalo zonse za thupi (kupatula mapapo). Kuchita ntchitoyi moyenera kumafuna makoma ozungulira a ventricle kumanzere kuti akhale ochepa komanso amphamvu.
Mosiyana ndi ntchitoyi, ntchito yamagulu yoyenera ndiyo kupopera "ntchito," magazi ochotsedwa kuchokera m'mapapo kudzera m'mitsempha ya pulmonary, kotero amatha kudzaza ndi mpweya. Chifukwa chakuti mitsempha ya pulmonary ndi yotsika kwambiri, njira yoyenera yoyenera kutulutsa sikuti imayambitsa mphamvu yambiri ya magazi kuti ikwaniritse ntchito yake.
Pachifukwa ichi, pamene ventricle yoyenera iyenera kupopera magazi ochulukirapo ndi mtima uliwonse kumenyedwa monga ventricle yakum'manzere, kuchuluka kwa ntchito yomwe ayenera kuyigwiritsa ntchito pochita izi ndi pafupifupi 25 peresenti ya ntchito yomwe ventricle ya kumanzere ikuyenera kugwira. Chifukwa chakuti ventricle yoyenera imagwira ntchito yochepa kwambiri, imakhala yokhala ndi mipanda yokhala ndi mpanda wochepa kwambiri, ndipo imakhala ndi minofu yambiri ya mtima kuposa ya ventricle yotsala.
Mbali yowongoka ya mtima imapindula kwambiri pakupopera ngakhale miyandamiyanda yambiri ya magazi (monga nthawi zina pamene tikuchita zozizwitsa). Koma ma ventricle omwe ali ndi mipanda yolimba kwambiri sagwira ntchito movutikira. Kotero ngati ventricle yoyenera ikupeza kuti ikuyenera kugwira ntchito kwa nthawi yayitali motsutsana ndi zovuta zapamwamba mu mitsempha ya pulmonary, imayamba kulephera.
Motero, kulephera kumtima kwa mtima kumachitika nthawi zambiri pazifukwa zomwe zimayambitsa mavuto aakulu mu mitsempha ya pulmonary-ndiko kuti, pamene mpweya wamagazi ulipo. Pamene ventricle yoyenera ikupeza kuti ikuyenera kuthamanga motsutsana ndi kuthamanga kwapamwamba, sizingathe kugwira bwino ntchito, ndipo pokhapokha ngati kuthamanga kwakukulu kumasulidwa, kukanika kwa mtima kumakhala kovuta.
Zifukwa za Mtima Wosunjika Mtima Walephera
Mndandanda wa zinthu zomwe zimapangitsa kuti mtima ukhale wolephera ndi wosiyana ndi zikhalidwe zomwe zimabweretsa "zojambulajambula," makamaka kumbuyo kwa mtima kulephera.
Chifukwa chowombera chakumanzere chimakhala ndi gawo la mkango wa minofu ya mtima, matenda omwe amachititsa kuti mitsempha ya mtima imakhudzidwe makamaka ku ventricle ya kumanzere. Choncho, kuperewera kwa mtima komwe kumabwera chifukwa cha matenda a mtima, kuchepa kwa mtima , hypertrophic cardiomyopathy , ndi mitundu yambiri ya matenda a mtima wa valvular , nthawi zambiri nthawi zambiri imachoka pamtima.
Mosiyana ndi zimenezi, zinthu zomwe zimapangitsa kuti mtima ukhale wolephera, zimakhala zovuta zitatu: zikhalidwe zomwe zimabweretsa matenda a mtima, matenda ena a mtima wa valvular, komanso kudwala mtima kwa ventricular.
Kuthamanga kwa magazi
Kulephera kwa mtima kumtima kawirikawiri kumapezeka chifukwa cha kuthamanga kwa magazi. Mndandanda wautali wa zinthu zingabweretse mchere wamagazi , ndipo zonsezi zingapangitse kulephera kwa mtima. Zomwe zimayambitsa matenda oopsa a pulmonary omwe amatsogolera kumbuyo kwa mtima kumaphatikizapo:
- Kulephera kumtima kwa mtima: Kulephera kwa mtima kumakhudza kwambiri kumanzere kwa mtima (ndiko kuti, "mtima" wosalimba), kumawonjezera kupsyinjika mkati mwa pulmonary vascular system, ndipo kuthamanga kwapopysikumeneku kumapangitsa kuti, pamapeto pake, kumanja mtima kulephera. Ndipotu, ndizomveka kunena kuti kulephera mtima kwa mtima kumakhala kosavuta komanso zotsatira za chikhalidwe cha mtima wautali kapena wodwalayo.
- Kuphatikizana: Kuphatikizana kwakukulu kwa pulmonary kumathandiza kwambiri kukweza mitsempha ya pulmonary kuti ikhale yapamwamba kwambiri, ndipo ikhoza kuchititsa kulephera mtima kwa mtima. Zing'onozing'ono, zomwe zimapezeka m'mapiritsi zowonjezereka zingapangitse kuti mitsempha yamatenda ikhale yovuta, ndipo izi zingayambitse kusokonezeka kwa mtima.
- Matenda a m'mapapo: Matenda a mapapu omwe amatha kupweteka kwambiri (COPD) kapena matenda osokoneza bongo omwe amachititsa kuti munthu asagone , amatha kutulutsa mthempha ya m'magazi komanso kutaya mtima.
- Pachifuwa chopweteka matenda (ARDS) : Izi Zingathe kupanga mtundu wamapiritsi oopsa kwambiri komanso kuperewera kwa mtima.
- Matenda a mtima: Matenda osokoneza bongo la septal ndi sevaloli, amatha kutulutsa mthempha yapamwamba komanso mtima wabwino.
- Zina zomwe zimayambitsa matenda a m'magazi: Izi zimaphatikizapo kupopera kwapopysipeni, scleroderma , sarcoidosis , kapena mitundu yosiyanasiyana ya vasulitis yokhudza mapapu.
Kuchokera mndandandawu, zikuwoneka kuti "zoyera" zowongoka mtima pamtima-ndiko kuti, kulakwitsa kwa mtima kusagwidwe ndi matenda a mtima kumbali ya kumanzere ya mtima-nthawi zonse chifukwa cha matenda a m'mapapo zomwe zimapanga mpweya wamagazi. Kulephera kumtima kwa mtima komwe kumakhala koyambira kwa pulmonary imatchedwa cor pulmonale . Chifukwa chakuti kulephera kwa mtima kumayendedwe kawirikawiri chifukwa cha matenda a m'mapapo, madokotala ambiri amagwiritsa ntchito "cor pulmonale" monga momwe amachitira zolakwika pamtima.
Komabe, kulephera kumtima kwa mtima kumatha kukhala ndi zifukwa zina, kotero mawu awa sali ofanana kwenikweni.
Matenda a Mtima wa Valvular
Mtundu uliwonse wa matenda a mtima wa valvular womwe umakhala ndi mphamvu yaikulu ndiyo kuwonjezera kupanikizika kumbali yowongoka kwa mtima, kapena kuti kulepheretsa kutaya kwa magazi kupyola kumbali yowongoka kwa mtima, kukhoza kutulutsa mtima wolephera.
Ngakhale kuti matenda a m'magetsi a mtima wokhazikika-vivuspid valve ndi pulvary valve-angayambitse vuto la mtima lolephera, izi zimakhala chifukwa chosazolowereka. Kubwezeretsa (kuthamanga) kwa ma valve awiriwa ndi zotsatira (osati chifukwa) cha mfupa ya magazi. Matendawa amayamba chifukwa cha matenda a mtima kapena amthempha omwe amakhudza mbali zina za mtima kwambiri. Choncho mwina matenda a valve kapena pulmonary valve, mwaokha, ndi chifukwa chosavuta kwambiri cha kufooka kwa mtima.
Komabe, stenosis ya valve mitral -vini yomwe ili pakati pa atrium kumanzere ndi kuchoka ku ventricle-kawirikawiri imayambitsa vuto la mtima lolephera. Magazi kubwerera ku mapiritsi a kumanzere amachititsa kuti "kuimirira" pamene mitral stenosis ilipo, zomwe zimapangitsa kuwonjezeka kwa mitsempha m'mapapu, zomwe pamapeto pake zimapangitsa kuti thupi lizizira kwambiri komanso likhale lolephera.
Kumeneko Kwambiri Myocardial Infarction
Anthu omwe ali ndi matenda opatsirana ndi minocardial (matenda a mtima) omwe amachitidwa ndi kutsekeka kwa mitsempha yoyenerera amatha kuwonongeka ndi mitsempha yoyenera ya ventricular, yopanga mtima wolephera. Kupereka mankhwala ozunguza mtima a ventricular kawirikawiri amafanana ndi kuchiza STEMI iliyonse, kuphatikizapo kutsegula mwamsanga mitsuko yamagazi yotsekedwa ndi mankhwala osokoneza bongo kapena stent .
Komabe, chifukwa cholephera kulapa mtima kumachepetsa kuchuluka kwa magazi omwe amafikira kumanzere kwa mtima, mankhwala osokoneza bongo omwe amagwiritsidwa ntchito makamaka pochiza zofooka zam'mimba (monga nitrates , beta blockers , ndi calcium channel blockers ) ziyenera kugwiritsidwa ntchito Muchenjezo kwambiri pamayendedwe a mtima owopsa.
Zizindikiro za Mtima Woongoka Mtima Kulephera
Zizindikiro zomwe zimayambitsidwa ndi mtima wolephera kumakhala zofanana kwambiri ndi zizindikiro zomwe anthu omwe ali nazo "amodzi," omwe amachoka pamtima. Izi zimaphatikizapo dyspnea (kupuma pang'ono), zofooka, zosavuta, komanso edema (kutupa).
Komabe, ali ndi vuto la mtima lolephera, zizindikiro zina zingakhale zovuta kwambiri. Dyspnea pa kuyesayesa kochepa kwambiri, kutopa kwakukulu, ngakhalenso kutaya mtima kumachitika. Edema yomwe anthu omwe ali ndi mtima wolephereka mtima amakhala nawo nthawi zambiri amakhala ovuta kwambiri kuposa "edema" ya m'maso ndi m'munsi mwake. Iwo akhoza kukhala ndi edema wa ntchafu, mimba, ngakhalenso chifuwa.
Ndiponso, ziwindi zawo zimatha kutupa ndi kupweteka, ndipo zimatha kukhala ndi ascites (madzimadzi m'mimba m'mimba). Anorexia (imfa yaikulu ya chilakolako) ikhoza kukhala chizindikiro chodziwika. Angathe kukhala ndi syncope (kuperewera kwa chidziwitso), chifukwa sangathe kuwonjezera mtima wawo pamene akuchita.
Kuzindikira Kusowa Mtima Kumtima
Kuyezetsa kachipatala mosamalitsa kuyenera kupereka madokotala ndi chitsimikizo champhamvu chokhudza kukhalapo kwa mtima wosalimba mtima. Chikhalidwe ndi khalidwe la zizindikiro (zongotchulidwa) ndizofunikira kwambiri pakupanga matenda, monga momwe ziliri mbiri yachipatala ya mavuto a pulmonary, kupweteka kwamtundu wa mpweya kapena pulmonary embolus.
Ma electrocardiogram (ECG ) ndi kafukufuku wa echocardiogram nthawi zambiri amasonyeza mitsempha yamapiritsi yowonjezereka, ndi matenda aliwonse a mtima wa valvular kapena matenda okhudza minofu ya mtima. Mayeserowa nthawi zambiri amachititsa kuti munthu adziwe kuti ali ndi mtima wolephera.
Kuyesera kwowonjezereka nthawi zambiri n'kofunika kuti tithandizire kusokoneza chifukwa cha kulakwitsa mtima kwa mtima. Mwachitsanzo, kuyezetsa ntchito yamapiritsi kungatsimikizire kupezeka ndi kuuma kwa COPD, ndipo kugona kukayezetsa kungathandize kuti munthu adwale matenda obisala. Kufufuza kwa CT , MRI akuyang'ana , ndi / kapena catheterization ya mtima ingathenso, malinga ndi mtundu wanji wa chifukwa chomwe chikugwiriridwa.
Ndikofunika kufooketsa chifukwa chomwe chithandizo chimadalira.
Kuchiza kwa Mtima Woongoka Mtima Kulephera
Kuchiza koyenera kwa kulephera mtima kwa mtima kumadalira kwathunthu pozindikira ndi kuchiza chifukwa choyambitsa. Tiyeni tiwone zomwe zingayambitse:
- Ngati chifukwa chake ndi matenda a mtima wa valvular (ambiri, mitral stenosis), kukonza opaleshoni kapena kusintha kwa valve wodwala n'kofunika.
- Pamene ventricular myocardial infarction ndi chifukwa chake, chithandizo chaukali komanso chofulumira kutsegula mitsempha yoyenera yolumikizidwa bwino.
- Ngati chifukwa chomwe chimayambitsa kuperewera kwa mtima, kupatsirana kokwanira kumbali yoyenera ya mtima kumafuna kupititsa patsogolo mankhwala osokoneza mtima .
- Cholinga cha kufooka kwa mtima ndi matenda a pulmonary (ndiko kuti, ngati cor pulmonale alipo), ndiye mankhwalawa akudalira kukulitsa chithandizo cha vuto la mapapu.
Ngakhale kuti njira yowonongeka ya matenda ikudziwikiratu, ndipo mankhwala ochiritsira, amatha kugwiritsidwa ntchito kuti athetse vuto la edema (ngakhale mankhwalawa ayenera kugwiritsidwa ntchito mwanzeru pamtima wabwino). Chisamaliro chiyenera kutengedwa kuti tipewe zochitika zomwe zingapangitse kuti mitsempha ya pulmonary imveke, monga magazi otsika kwambiri, ndi acidosis . Mankhwala omwe angachepetse mitsempha ya pulmonary imathandizanso.
Koma chofunikira, kachiwiri, ndiko kuti kuchiza kulakwitsa pamtima kumatanthauza kuthetsa mofulumira chifukwa chomwe chimayambitsa.
Mawu Ochokera
Kulephera kumtima kwa mtima ndi vuto lalikulu lomwe nthawi zambiri limayambitsa zizindikiro zoopsa, ndipo zimayambitsa kufa msanga. Ndikofunika kwambiri kuti aliyense amene ali ndi matendawa adzalandire bwino kuti adziwe chifukwa chake, ndiyeno adzalandira chithandizo chamankhwala kuti asinthe kapena kuti athetse chifukwa chake.
> Zotsatira:
> Bruce CJ, HM Connolly. Matenda Oyenera a Valve Akuyenera Kulemekezedwa Kwambiri. Kudutsa. 2009; 119: 2726.
> Falk JA, Kadiev S, Criner GJ, et al. Matenda a Mtima Wopanda Matenda M'njira Zolepheretsa Matenda Opatsirana. Proc Am Thorac Soc 2008; 5: 543.
> Galiè N, Humbert M, Vachiery JL, et al. Maphunziro a ESC / ERS a Gulu la Edzi / Kupeza Chithandizo cha Kuchulukanso kwa Mthupi: Gulu Loyamba la Gulu la Kuzindikira ndi Kuchiza Kachilombo Kachilombo ka European Society of Cardiology (ESC) ndi European Respiratory Society (ERS): Kuvomerezedwa ndi: Association of European Matenda ndi Matenda a Khungu (AEPC), International Society for Heart ndi Lung Transplantation (ISHLT). Mtima; 37:67.