Sarcoidosis ndi matenda omwe amachititsa granulomas- zigawo za maselo osadziwika ofanana ndi ziphuphu-pafupifupi pafupifupi lirilonse la thupi. Granulomas izi zingathe kulepheretsa kugwira ntchito kwa ziwalo zomwe zikuwonekera, ndipo motero zingabweretse zizindikiro zozizwitsa ndi mavuto azachipatala. Chifukwa granulomas ya sarcoidosis ikhoza kuchitika m'ziwalo zambiri, anthu omwe ali ndi vutoli akhoza kuona zizindikiro za mapapo, maso, khungu, dongosolo la mitsempha, masewera a m'mimba, matenda a endocrine-ndi mtima.
Khungu la sarcoidosis lingakhale lovuta kudziwitsa. Ngakhale zikhoza kukhala zovuta kwambiri, nthawi zina sarcoidosis ya mtima ikhoza kubweretsa mavuto aakulu, kuphatikizapo mtima wosagonjetsa kapena imfa yadzidzidzi . Pazochitikazi, kupanga matenda a mtima wa sarcoidosis, ndi kukhazikitsa mankhwala, n'kofunika kwambiri.
Kodi Sarcoidosis Ndi Chiyani?
Ochita kafukufuku amakhulupirira kuti sarcoidosis imachitika pamene chitetezo cha mthupi chimayankhula mwachilendo kwa chinthu chosadziwika (mwina mankhwala osakanikirana), zomwe zimapanga mapangidwe a granulomas. Azimayi amakhudzidwa mobwerezabwereza kuposa amuna, ndipo anthu akuda amatha kukhala ndi sarcoidosis kuposa anthu oyera. Kuwopsa kwa sarcoidosis kungathenso kumabanja.
Zizindikiro za sarcoidosis ndizosiyana kwambiri. Anthu ena amakhala ndi vuto la chimfine ndi kutopa, malungo, ndi kutaya thupi. Zina zimakhala ndi zizindikiro zowonjezera m'mapapo monga chifuwa, dyspnea , kapena kuyenda.
Mavuto a maso angaphatikizepo kufiira, kupweteka, kuona masomphenya, ndi kuzindikiritsa kuwala. Zilonda zakhungu zimaphatikizapo kupweteka kowawa, zilonda pamaso, kusintha kwa khungu, ndi mitsempha.
Kuphatikizidwa kulikonse kwa zizindikirozi kungachitike. Anthu ena omwe ali ndi sarcoidosis sakhala ndi zizindikiro zilizonse, ndipo matendawa amapezeka mwadzidzidzi pamene chifuwa cha X-ray chachitika chifukwa china.
Kodi Cardiac Sarcoidosis N'chiyani?
Sarcoidosis ya cardiac imapezeka pamene granulomas yamchere imapangidwa mu mtima. Monga momwe zilili ndi sarcoidosis ambiri, mawonetseredwe a mtima wa sarcoidosis amakhala osiyana kuchokera kwa munthu ndi munthu. Mu anthu ena sarcoidosis ya mtima imabweretsa mavuto; mwa ena, zikhoza kupha.
Kulemera kwa mtima wa sarcoidosis kumadalira kukula kwa granuloma kupangidwira mumtima, ndipo mkati mwa mtima izi granulomas zimawonekera. Kawirikawiri, osachepera 10 peresenti ya anthu omwe ali ndi sarcoidosis amapezeka kuti ali ndi mtima wokhudzana ndi mtima wawo wonse
Koma m'maphunziro a autopsy, anthu ambiri mwa anthu 70 aliwonse omwe ali ndi sarcoidosis amakhala ndi mtima umodzi wa granulomas. Izi zikusonyeza kuti nthawi zambiri, sarcoidosis ya mtima siimabweretsa mavuto omwe amadziwika nawo.
Pamene sarcoidosis imabweretsa mavuto a mtima, komabe mavutowa akhoza kukhala ovuta.
Zizindikiro ndi zizindikiro za mtima wa Sarcoidosis
Matenda opangidwa ndi mtima wa sarcoidosis amadalira kumene mtima uli ndi granulomas. Zowonekera kwambiri za sarcoidosis ya mtima ndi izi:
- Mtima Wopinga . Mitsempha yonse ya mtima, yomwe imapanga bradycardia yoopsa (kuchepa kwa mtima), ikhoza kuchitika pamene granulomas imapangidwira mkati mwa mapangidwe apadera a mtima. ( Werengani za kayendedwe kabwino ka mtima. ) Zizindikiro za katemera wa mtima zimaphatikizapo kupweteka kwambiri kapena syncope (kuperewera kwadzidzidzi), kapena imfa yadzidzidzi.
- Cardiac arrhythmias . Maofesi am'mimba otentha (PVC) kapena ventricular tachycardia amapezeka m'thupi la sarcoidosis. Mankhwala a atrial, kuphatikizapo kupha tizilombo toyambitsa matenda , angathenso kupezeka. Mitunduyi imayamba chifukwa cha granulomas yomwe imapanga mu minofu ya mtima.
- Imfa yadzidzidzi . Chifukwa cha matenda a mtima kapena ventricular tachycardia, imfa mwadzidzidzi imakhala yofala kwambiri mu sarcoidosis ya mtima, ndipo imakhala pafupifupi 50 peresenti ya imfa zomwe zimayambitsa matendawa.
- Kulephera kwa Mtima . Kulephera kwa mtima kungayambe mu mtima wa sarcoidosis pamene granuloma imapanga mkati mwa minofu ya mtima imakhala yaikulu.
- Matenda a Pericardial . Ma pericarditis kapena maonekedwe owonetsetsa amatha kuchitika chifukwa cha granulomas mu chovala chamtima cha pericardial.
- Valvular matenda a mtima . Magalamu omwe amakhudza mtima wamagetsi angayambitsenso mitral kapena kuthamanga mofulumira , kapena, kawirikawiri, aortic kubwerera .
- Kuwononga mtima . Mbalame zamchere za mchere zimakhudza mitsempha yamakono , ndipo imapha imfa ya ziwalo za mtima wa mtima.
- Kulephera kwa mtima pamtima . Kuwopsa kwa pulonary sarcoidosis kungayambitse kupweteka kwapachipatala , kumatsogolera ku mtima wolephera kulephera.
Kusanthula Magulu a Cardiac Sarcoidosis
Kupanga matenda a mtima wa sarcoidosis nthawi zambiri kumakhala kovuta. Chiyeso chotsimikizirika kwambiri ndi chikhalidwe chabwino cha mtima. Komabe, si biopsy yokhayo yomwe imakhala yovuta, komanso (chifukwa mafuta a granulomas amafalitsidwa mobwerezabwereza) chiwombankhanga chimabwereranso ngati "chachibadwa" ngakhale pamene sarcoidosis ya mtima ilipo.
Izi zikutanthawuza kuti, kawirikawiri, matenda a mtima wa sarcoidosis amapangidwa ndi kuyeza umboni kuchokera ku njira zosiyana zowunikira.
Choyamba, ndikofunikira kuti madokotala adziwe nthawi yoyenera kuyang'ana sarcoidosis. Kuyang'ana mtima wa sarcoidosis ndi wofunikira kwa anthu omwe amadziwika kuti ali ndi sarcoidosis yokhudza ziwalo zina za thupi. Komanso, sarcoidosis ya mtima imayenera kuganiziridwa ndi munthu aliyense (yemwe ali ndi zaka zoposa 55) amene amachititsa kuti mtima wake ukhale wolimba, ventricular arrhythmias, kapena mtima kulephera chifukwa chosadziwika.
Ngati matenda a mtima wa sarcoidosis ndi omwe akuyenera kuganiziridwa, kuchita nawo echocardiogram ndizoyeso yoyamba yopanda kuvuta. Kawirikawiri mayesowa amavumbula mfundo zofunika ngati mtima wa sarcoidosis ulipo, kuphatikizapo nthawi zina zizindikiro zomwe zimapangidwa ndi granulomas mkati mwa minofu ya mtima.
Komabe, matenda a MRI a mtima kwambiri amatha kusonyeza umboni wa granulomas mu mtima, ndipo kawirikawiri sizomwe zimakhala zovuta. Kufufuza kwa PET kwa mtima kumakhalanso kovuta kwambiri kuti muzindikire mapuloteni a mtima, koma PET silingapezeke mosavuta kuposa MRI.
Miyezo ya golide ya matenda a mtima wa sarcoidosis ndi chiwopsezo cha minofu ya mtima, yomwe ingakhoze kuchitidwa panthawi ya catheterization ya mtima. Komabe, monga taonera kale, kuyesa granulomas mwa njira iyi, ngakhale pamene ilipo, ikukwaniritsidwa bwino kuposa theka la nthawi.
Nthawi zambiri, pogwiritsa ntchito zizindikiro za kuchipatala, kuyezetsa magazi, ndi kuyesa kosavuta, kuwonetsa kukhalapo kapena kusapezeka kwa mtima wa sarcoidosis kumatha kukhala ndi chidaliro chokwanira.
Kodi Cardiac Sarcoidosis Imachitika Motani?
Ngati mtima wa sarcoidosis ulipo, chithandizochi chimapangitsa kuti pang'onopang'ono kapena kuchepetsa kukula kwa sarcoidosis palokha, komanso poletsa kapena kuchiza zotsatira zoopsa kwambiri za matendawa.
Kuchiza sarcoidosis palokha
Mankhwalawa amachititsa kuti sarcoidosis ikhale yovuta kuthetsa chitetezo cha mthupi chomwe chimayambitsa mapangidwe a granulomas. Mu sarcoidosis, izi zimachitidwa ndi glucocorticoid (steroid) mankhwala, omwe amapezeka ndi prednisone. Kawirikawiri, mlingo waukulu umayikidwa (40-60 mg / tsiku). Pa chaka choyamba, mlingo umenewu umachepetsedwa mpaka 10-15 mg / tsiku, ndipo umapitilira kwa zaka chimodzi kapena ziwiri.
Ngati kuyambiranso kuwonetsa kuti sarcoidosis yakhazikika (ndiko kuti, palibe umboni wina wa granuloma wopanga paliponse m'thupi, ndi kuthetsa zizindikiro zirizonse zomwe zimayambitsa sarcoidosis), zingakhale zotheka kumaliza steroid therapy.
Kwa anthu omwe samawoneka ngati atayankha mankhwala a steroid, ma immunosuppressants ena angafunike, monga chloroquine, cyclosporine, kapena methotrexate.
Kuchiza mawonetseredwe a mtima wa sarcoidosis
Zotsatira zoopsa kwambiri za mtima wa sarcoidosis ndi imfa yadzidzidzi, yomwe imapangidwira ndi mtima wamkati kapena tricycardia. Pulogalamu ya pacemaker yodalirika iyenera kuikidwa mwa aliyense yemwe ali ndi mtima wa sarcoidosis yemwe amasonyeza kuti mtima wake umakhala wotetezeka pamtundu wa electrocardiogram .
Mankhwala opangira ma cardiverter-defibrillators (ICDs) angagwiritsidwe ntchito pofuna kupewa kufa mwadzidzidzi kuchokera ku ventricular arrhythmias. Mabungwe azalephereka kuti athe kupeza njira zowonongeka zomwe anthu omwe ali ndi mtima wa sarcoidosis ayenera kulandira ICD. Komabe, akatswiri ambiri amalimbikitsa iwo kuti akhale ndi anthu omwe ali ndi sarcoidosis omwe adachepetseratu timagulu ting'onoting'ono tomwe timakhala tizilombo toyambitsa matenda , kapena amene apulumuka ku zigawo za tachycardia kapena ventricular fibrillation .
Kuphatikiza apo, kupanga phunziro la electrophysiology kungathandize pakuzindikira kuti ndi anthu ati omwe ali ndi mtima wa sarcoidosis omwe ali pangozi yaikulu ya kufa mwadzidzidzi kuchokera ku ventricular arrhythmias, motero amene ayenera kukhala ndi ICD.
Ngati matenda a mtima wa valvular amayamba chifukwa cha sarcoidosis ya mtima, opaleshoni iyenera kuganiziridwa pogwiritsa ntchito njira zomwe zimagwiritsidwa ntchito kwa wina aliyense amene ali ndi vuto la mpweya wa mtima.
Ngati vuto la mtima likupezeka, anthu omwe ali ndi mtima wa sarcoidosis ayenera kulandira chithandizo chomwechi chachisokonezo cha mtima wosagwiritsidwa ntchito kwa aliyense amene ali ndi vutoli. Ngati mtima wawo ukulephereka ndipo sungayankhidwe kuchipatala, anthu omwe ali ndi sarcoidosis ayenera kulingalira mofananamo ndi kusintha kwa mtima woperekedwa kwa wina aliyense amene ali ndi vuto la mtima. Ndipotu, zotsatira zawo pambuyo poti thupi limapangika likuwoneka bwino kuposa zotsatira zomwe zimaperekedwa kwa anthu omwe ali ndi zifukwa zina.
Mawu Ochokera
Monga momwe zilili ndi sarcoidosis kawirikawiri, sarcoidosis yomwe imakhudza mtima ikhoza kukhala ndi mawonetseredwe osiyanasiyana, kuchokera ku chiwonongeko choopsa. Ngati pali chifukwa chodandaulira mtima wa sarcoidosis, ndikofunikira kuchita mayesero oyenerera kupanga kapena kutulukira matenda. Kwa munthu yemwe ali ndi sarcoidosis ya mtima, mankhwala oyambirira ndi achiwawa (onse a sarcoidosis omwe ndi mawonetseredwe ake a mtima) akhoza kusintha kwambiri zotsatira zake.
> Zotsatira:
> Birnie DH, Sauer WH, Bogun F, et al. Malangizo a HRS Ovomerezeka pa Kuzindikira ndi Kulamulira Kwa Arrhythmias Yogwirizana ndi Mtima wa Sarcoidosis. Mtima; 11: 1305.
> Kim JS, Judson MA, Donnino R, et al. Cardiac Sarcoidosis. Amtima J 2009; 157: 9.
> Perkel D, Czer LS, Morrissey RP, et al. Kutsekemera kwa Mtima Kwa Mtima Wotsiriza Kulephera Chifukwa cha Mtima wa Sarcoidosis. Kusindikiza Proc 2013; 45: 2384.
> Soejima K, Yada H. Ntchito Yothandizira ndi Utsogoleri Wa Odwala Odziwika Ndi Ogwiritsira Ntchito Magulu a Mtima Wosakaniza Sarcoidosis: Ndi Kulimbikitsana Pa Mgwirizano wa Mtima Wachikondi Rhythm Abnormalities. J Cardiovasc Electrophysiol 2009; 20: 578.