IST - Kusamvetsetsana Kanyama Kanyama ka Arrhythmia
Sinus tachycardia (IST) yosavomerezeka ndi chikhalidwe chimene mtima wa munthu umakhala, kupumula ndi panthawi yomwe akuyesera, imakwera mosalekeza popanda chifukwa chomveka. Anthu omwe ali ndi IST kawirikawiri amakhala ndi chiwerengero cha mtima pamtima kupitirira 100 kugunda pa mphindi, ndipo ngakhale ngakhale kuyesa kochepa mtima umakhala wotsika kwambiri. Mitima yapamwambayi yapamwamba imakhala pamodzi ndi zizindikiro za kugwedeza , kutopa, ndi kulekerera.
Chifukwa chakuti mtima wa mu IST umapangidwa ndi node ya sinus (chikhalidwe cha mtima chomwe chimayendetsa chizoloŵezi cha mtima wamba), IST sichikugwirizana ndi kachitidwe ka magetsi kosadziwika pa ECG .
Mwachidule
Ngakhale kuti IST ikhoza kuchitika mwa aliyense, zimakhala zofala kwambiri kwa achinyamata akuluakulu ndipo zimakhudza amayi nthawi zambiri kuposa amuna. "Odwala" omwe ali ndi matenda a IST ndi amayi omwe ali ndi zaka za m'ma 20 kapena 30 zapitazo omwe akhala ndi zizindikiro kwa miyezi ndi zaka. Kuwonjezera pa zizindikiro zowonjezereka za katapu, kutopa ndi kusasalana, IST nthawi zambiri imagwirizananso ndi zizindikiro zina zomwe zimaphatikizapo zizindikiro za hypotension (kugwedezeka kwa kupsyinjika kwa magazi paimidwe), kusokonekera kwa masomphenya, chizungulire , kutsekemera, dyspnea (kuchepa kwa mpweya), ndi thukuta.
Pogwiritsa ntchito IST, kupuma kwa mtima kumakhala koposa 100 kugunda kwa mphindi, koma pamene wagona tulo tambiri, timatha kugunda mpaka 80 kapena 90 pamphindi, kapena pansi. Ngakhale kulimbika mtima mtima kumathamanga mofulumira mpaka kufika 140 kapena 150 kugunda kwa mphindi.
Palpitations ndi chizindikiro chodziwika ngakhale kuti (monga momwe ziliri nthawi zambiri) palibe "zachilendo" zomwe zimagwera mtima. (Ndiko kuti, mtima uliwonse umachokera ku nthenda ya sinus, monga momwe zimakhalira ndi mtima wamba.) Zizindikiro zomwe odwala a IST amamva zimakhala zolepheretsa kwambiri komanso zochititsa mantha.
IST inazindikiridwa ngati matenda kokha posachedwapa monga 1979 ndipo yakhala ikuvomerezedwa kukhala gulu lenileni lachipatala kuyambira kumapeto kwa zaka za m'ma 1980. Ndipo ngakhale lero, pamene IST imadziwika bwino ngati matenda enieni a chipatala aliyense wa zamankhwala, madokotala ochuluka mwina samvapo kapena kulemba ngati vuto la maganizo (kutanthauza "nkhawa").
Zimayambitsa
Funso lofunikira likuwoneka ngati IST imayimira vuto lalikulu la nthenda ya sinus, kapena kuti, m'malo mwake, likuyimira chitetezo chodziwika kwambiri cha kayendedwe kabwino ka mitsempha-chikhalidwe chotchedwa dysautonomia . (Mankhwalawa amachititsa "ntchito" za thupi, monga kuperewera, kupuma, ndi kuthamanga kwa mtima.)
Anthu omwe ali ndi IST amadzipangitsa kukhala adrenaline; pang'ono pokha adrenaline (ngati kupitilira pang'ono) amachititsa kukula kwa mtima wamtima. Ngakhale pali zowona kuti pali kusintha kwa kayendedwe kameneka mu IST, umboni wina wambiri umasonyeza kuti vuto lalikulu lomwe likukhudzana ndi kayendedwe ka mantha kamene kalipo ambiri mwa odwalawa. (Dysautonomia yowonjezereka ikufotokozera chifukwa chake zizindikiro za IST kawirikawiri zimawoneka zosagwirizana ndi kuwonjezeka kwa mtima wamkokomo.) Ndi lingaliro lakuti chidolechi chimadziwika chokha ndichachilendo chomwe chachititsa kuti electrophysiologists agwiritse ntchito kuperekera kwa nthenda ya sinus monga chithandizo cha IST (zambiri pa izi pansipa).
Kudziwa
Matenda ena ochiritsira ndi ochiritsira omwe angachiritsidwe akhoza kusokonezeka ndi IST, ndipo mwa munthu yemwe akupereka ndi tastycardia yosadziwika, zifukwa zinazi ziyenera kutulutsidwa kunja. Matendawa akuphatikizapo kuchepa kwa magazi , malungo, matenda, hyperthyroidism , pheochromocytoma , matenda a shuga-omwe amachititsa dysautonomia, ndi kugwiritsa ntchito mankhwala osokoneza bongo. Zomwezi zimachitika kawirikawiri zimatha kuyesedwa ndi kafukufuku wamkulu wa zachipatala, komanso kuyesa magazi ndi mkodzo.
Kuphatikizanso apo, ziwalo zina za mtima zamkati-makamaka nthawi zambiri, mitundu ina yapamwamba ya tachycardia (SVT) -yina nthawi zina imasokonezeka ndi IST. Nthawi zambiri sizivuta kuti dokotala amene kusiyana pakati pa SVT ndi IST mwa kufufuza mosamala ECG ndi kutenga mbiri yachipatala.
Kusiyanitsa izi ndikofunikira chifukwa chithandizo cha SVT nthawi zambiri chimakhala chosavuta.
Kuchiza
Mankhwala Osokoneza Bongo
Odwala ambiri omwe ali ndi IST, mankhwala osokoneza bongo angakhale othandiza. Koma kukwaniritsa zotsatira zabwino nthawi zambiri kumafuna kuyesera-ndi-kulakwitsa kuyesera ndi mankhwala angapo, singly kapena kuphatikiza.
Mabeta-blockers amalepheretsa zotsatira za adrenaline pa nthenda ya sinus, ndipo popeza anthu omwe ali ndi IST ali ndi zowonongeka ku adrenaline, pogwiritsa ntchito beta blockers ndi zomveka. Mankhwalawa nthawi zambiri amathandiza kuchepetsa zizindikiro za IST.
Olemba kalisium akhoza kuchepetsa mwachindunji ntchito ya nthenda ya sinus koma akhala ochepa pokhapokha pochiza IST.
Mankhwala ivabradine akhala akugwiritsidwa ntchito bwino pakuchiritsa anthu okhala ndi IST. Ivabradine mwachindunji imakhudza "chiwerengero cha kuwombera" kwa nthenda ya sinus, ndipo motero amachepetsa kuchuluka kwa mtima. Ivabradine imavomerezedwa ku US ngati chithandizo cha angina komanso chifukwa cha kulephera kwa mtima kwa odwala omwe sangathe kulekerera beta blockers, koma osati IST. Komabe, ndizothandiza kwambiri monga mankhwala ena, ndipo akatswiri ambiri amalimbikitsa ivabradine ngati mankhwala othandiza pa vutoli. Kuwonjezera apo, mabungwe angapo ogwira ntchito tsopano akuthandizira kugwiritsa ntchito kwa IST.
Akatswiri ambiri a zamoyo samakonda kugwirizana ndi "zosavomerezeka zomwe zimachitika pokhapokha" za IST, choncho sadayese kupereka mankhwala omwe akhala othandiza kwa odwala omwe ali ndi dysautonomia. Komabe, popeza nthawi zambiri zimakhala zovuta pakati pa IST ndi zina zotchedwa dysautonomia syndromes (makamaka POTS ndi vasovagal syncope ), mankhwala omwe ali othandiza kuthetsa zinthuzi nthawi zina amathandiza kwambiri kuchiza odwala omwe ali ndi IST. Mankhwalawa angaphatikizepo:
- Florinef , yomwe ndi mankhwala omwe amachititsa sodium kusungidwa. Ma syndromes ena a dysautonomic, makamaka POTS ndi vasovagal syncope, awonetsedwa kuti akugwirizana ndi kuchepa kwa magazi, ndipo mankhwala osungirako sodium akhoza kuwonjezera mphamvu ya magazi yowoneka bwino, ndi kuchepetsa zizindikiro.
- Midodrine , mankhwala omwe amachititsa kuwonjezeka kwa mitsempha, kuteteza kutsika kwa magazi.
- Serotonin-reuptake inhibitors (Banja la Prozac la mankhwala osokoneza bongo) amagwiritsidwa ntchito makamaka pofuna kuthetsa kuvutika maganizo ndi nkhawa, komanso zatsimikiziridwa zothandiza pochiza matenda ambiri a dysautonomia.
Kawirikawiri, zizindikiro za IST zimatha kuyendetsedwa moyenera mwa kugwiritsa ntchito mankhwala osokoneza bongo. Kawirikawiri, beta blockers amayesedwa poyamba, ndipo ivabradine yawonjezeredwa (kapena kulowetsedwa) ngati beta blocker sichilamulira mphamvu mokwanira. Komabe, mankhwala othandiza ogwiritsira ntchito mankhwala nthawi zambiri amayenera kupitiriza, kugwira ntchito pazoyeso ndi zolakwika. Kuleza mtima, kumvetsetsa, ndi kudalirika pakati pa dokotala ndi wodwala ndizofunikira. Izi n'zovuta kukwaniritsa ngati dokotala akuganiza kuti wodwalayo ndi mtedza chabe. Kuti athe kuchiritsidwa bwino, anthu omwe ali ndi IST (ndi ma dysautonomias ena) ayenera kuchita zambiri pochita dokotala.
Mankhwala Osagwiritsa Ntchito Mankhwala
Kuwonjezera mchere. Izi ziyenera kuchitidwa ndi kuvomerezedwa kwa dokotala wanu, chifukwa cha tsankho lathu tsopano chifukwa cha zakudya zochepa za sodium. Koma mchere umawonjezera mphamvu ya magazi, ndipo mpaka momwe magazi ochepetsera amachepetsera amathandizira zizindikiro, kuwonjezeka kwa mchere kungathandize kuchepetsa zizindikiro za IST.
Sinus abode ablation. Ambiri a cardiologists, makamaka electrophysiologists, akhala akutsutsana ndi chidziwitso chakuti IST kwenikweni ndi matenda a nthenda ya sinus (mosiyana ndi matenda ambiri omwe amachititsa kuti magetsi azitsatira). Chikhulupiliro chimenechi chachititsa chidwi kwambiri pogwiritsira ntchito ablation therapy (njira yomwe magetsi amagwiritsira ntchito makatitala) kuti asinthe ntchito, kapena kuwononga, node ya sinus.
Kuperekera kwa mphamvu ya sinus kwafika pokhapokha kupambana. Ngakhale njirayi ikhoza kuthetsa IST pakati pa anthu 80 pokhapokha mutatha njirayi, i-IST ikhoza kubwerera mkati mwa miyezi ingapo mwa ambiri mwa anthuwa.
Kudikira. Njira yodalirika yosagwiritsira ntchito mankhwala ku SIT isachite kanthu. Ngakhale mbiri yakale ya matendawa siinalembedwe, zikuoneka kuti IST imawoneka bwino pakapita nthawi mu anthu ambiri. "Kuchita kanthu" sikungakhale kovuta kwa anthu omwe ali ndi zizindikiro zoopsa, koma anthu ambiri omwe ali ndi kachilombo kochepa kokha amatha kulekerera zizindikiro zawo atatsimikiziridwa kuti alibe matenda a mtima wa moyo komanso kuti vutoli likhoza kusintha pamapeto pake.
Mfundo Yofunika Kwambiri
Pomwe IST ikupezeka, ndipo zatsimikiziridwa kuti "kungoyembekezera" sikungakhale njira yokwanira, akatswiri ambiri lero amalimbikitsa kuyamba ndi mankhwala. Kawirikawiri, beta idzayesa kuyesedwa yoyamba, ndikutsatiridwa ndi mayesero a ivabradine (mwina yekha kapena kuphatikizapo beta blocker). Ngati mayeserowa samaletsa zizindikiro, mankhwala ena ambiri ndi mankhwala osokoneza bongo angathe kuyesedwa. Akatswiri ambiri tsopano amalimbikitsa mankhwala opatsirana pokhapokha ngati mayesero awiri osokoneza bongo alephera.
> Zotsatira:
> Tsamba RL, Joglar JA, Caldwell MA, et al. Msonkhano wa 2015 ACC / AHA / HRS kwa Otsogolera Odwala Achikulire Omwe Ali ndi Suprasventry Tachycardia: Lipoti la American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines ndi Heart Rhythm Society. Kuthamanga 2016; 133: e506.
> Schulze, V, Steiner, S, Hennersdorf, M, Strauer, BE. Ivabradine monga Mchitidwe Wachiritsira Wachilendo M'magwiridwe a Zachimo Zosayenera Tachycardia: Nkhani Yokhudza Nkhani. Zojambulajambula 2008; 110: 206.
> Sheldon RS, Grubb BP 2, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement pa Kuzindikira ndi Chithandizo cha Postural Tachycardia Syndrome, Sinas Inappropriate Tachycardia, ndi Vasovagal Syncope. Mtima; 12: e41.