Nchifukwa chiyani LBBB ndi yofunika?
Gulu la nthambi lamanzere ndi lachilendo lomwe likuwonetsedwa pa electrocardiogram (ECG) , lomwe limasonyeza kuti mphamvu ya magetsi ya mtima sikumagawidwa pamtunda wa mtima mwa njira yachibadwa.
Kodi N'chiyani Chimayambitsa Mtolo Wotsalira?
Nthambi za mtolo zingaganizedwe ngati gawo la "wiring" wamagetsi. Ndiwo njira zamagetsi zomwe zimapangitsa kufalitsa mphamvu ya magetsi mofanana mwazitsulo.
Izi zimatsimikizira kuti kuvomereza kwazitsulo ziwirizi zikugwirizana.
Ndi nthambi yamanzere yothandizira, nthambi yowonjezera yomwe imagawira magetsi kumagulu a kumanzere amachotsedwa pang'ono kapena kwathunthu. Kuzimitsa uku kumachedwetsa kuyatsa kwa magetsi kumalo otsekemera. Chotsatira chake, chithunzithunzi cholondola chikuyambitsidwa, ndipo chimayamba kugwira ntchito, isanayambe kuchoka kwa ventricle.
Kuti mtima ugwire bwino kwambiri momwe zingathere, zitsulo zonsezi ziyenera kugwirizana chimodzimodzi. Kotero kuchoka kwa mtolo wa nthambi kumachepetsa ubwino wa kugunda kwa mtima. Kuchepetsa kuchepa kwa mtima kumakhala kochepa kwambiri kwa munthu yemwe mtima wake si wamba, koma umatha kukhala ndi mphamvu yaikulu kwa anthu omwe ali ndi matenda a mtima - makamaka mtima wosalimba .
Kusanthula Gulu Lotsalira la Nthambi
Gulu la nthambi lamanzere limapanga kusintha kwa makhalidwe ku ECG, kotero madotolo amatha kudziwa matendawa pokhapokha atafufuza ECG.
Gawo la ECG limatanthawuza kuti QRS yovuta imagwiritsa ntchito magetsi pogawanika pamtunda. Kawirikawiri, chifukwa zonsezi zimalimbikitsa panthawi imodzimodzi, QRS ndizochepa kwambiri, pakati pa 0.08 ndi 0.1 seconds. Ndi malo ogulitsira katundu, nthambi ya QRS imakhala yochulukirapo, nthawi zambiri yaikulu kuposa masekondi 0.12.
Kuwonjezera apo, zolemba zofanana za ECG zikuwonetsera "mawonedwe" 12 (otchedwa "kutsogolera") a magetsi a mtima, ndipo madokotala akhoza kuyang'ana mosiyana siyana amatsogolera kupeza malingaliro a malo a mavuto osiyanasiyana a mtima. Ndi malo otchinga a mtolo wamanzere, mawonekedwe aakulu a QRS amawoneka owongoka kumalo ena, ndi pansi mkati mwa ena. Poganizira nthawi yonse ya QRS, ndi chitsanzo chake pa njira zosiyanasiyana za ECG, kawirikawiri zimakhala zosavuta kupeza kachilombo kachitsulo kamene kalipo.
Nchifukwa Chiyani Gulu Lotsalira la Nthambi Ndilofunika Kwambiri?
Gulu la nthambi lamanzere ndilofunika kupeza zifukwa ziwiri.
Choyamba, malo osungiramo nthambi omwe amachoka nthawi zambiri amapezeka chifukwa cha vuto lina la mtima. Kotero, pamene izo zapezeka, ndizowona kuti vuto lina lachikhalidwe la mtima likupezekapo.
Chachiwiri, monga tanenera poyamba, chipinda chachitsulo chotsalira chachinsinsi chomwe chimapangitsa mtima kukhala wogwira ntchito mochepa mwa anthu omwe ali ndi matenda ena amtima.
Gulu lamanzere la Nthambi ndi Matenda Ovutika Mtima
Nthambi ya kumanzere yachitsamba imakhudza kwambiri akuluakulu. Amapezeka muchepera 1 peresenti ya anthu osakwana zaka 50; Mosiyana ndi zimenezi, pafupifupi 6 peresenti ya ana azaka 80 anasiya nthambi.
Anthu ambiri omwe ali ndi nthambi yachitsamba yamanzere ali ndi mtundu wina wa matenda a mtima. Mu phunziro la Framingham, anthu omwe anakhazikitsa nthambi yotsala yachitsulo anali ndi zaka makumi asanu ndi awiri ndi makumi asanu ndi awiri (62), ndipo anali ndi chiwerengero chachikulu cha matenda a hypertension , kuchepa kwa mtima , kapena matenda amtundu wa matenda (CAD) . Ndipotu, panthawi ya phunziro la Framingham, anthu 89 peresenti ya anthu omwe anasiya ntchito yothandizira nthambi yowonjezera anapeza kuti ali ndi mtundu wina wa matenda a mtima.
Izi zikutanthawuza kuti aliyense, wa msinkhu uliwonse, amene apezeka kuti wasiya nthambi ya nthambi, ayenera kukhala ndi mtima wofufuza kuti ayang'ane matenda a mtima.
Kufufuza kumeneku kuyenera kuphatikizapo ochocardiogram , ndipo ngati pali zifukwa zowonjezera ku CAD, kuphunzira / nkhawa ya thallium iyeneranso kuganiziridwa mozama. Matenda a mtima kwambiri omwe amapezeka pa malo a LBBB amawopsa kwambiri, CAD, mtima wolephera, hypertrophic cardiomyopathy , kapena matenda a mtima wa valvular .
Ngati palibe matenda a mtima amapezeka pambuyo pofufuza mtima mwa munthu yemwe ali ndi nthambi yotsalira, makamaka kwa anthu oposa 50, zizindikirozo zimakhala zabwino kwambiri. M'mayesero amenewa, bwalo la nthambi lamanzere limaganiziridwa bwino ngati kupeza kosavuta, kupeza mwa ECG.
Gulu Lotsalira la Nthambi ndi Kuchita Kwambiri kwa Mtima
Muchitetezo chachitsulo cha kumanzere, mtima wamakono awiri amachititsa chidwi ndi magetsi pamagetsi, m'malo mofanana. Izi zikutanthauza kuti, ventricle ya kumanzere imalimbikitsidwa kokha pambuyo poti ventricle yoyenera ikulimbikitsidwa. Momwemonso, nthambi yachitsulo yotsalira imachotsa kuwonongeka kwabwino pakati pa zitsulo ziwiri, zomwe zimachepetsa kupambana kwa mtima. Mtima uyenera kugwira ntchito mwakhama kuti ufike pamtunda.
Achinyamata, anthu wathanzi omwe ali ndi nthambi yotsalira, ndipo ngakhale anthu achikulire omwe ali ndi nthambi yachitsulo yotsalira omwe angakhale ndi matenda a mtima wochepa, kugwidwa mu mtima wabwino kumaoneka ngati kosavuta, ndipo umboni wamakono umasonyeza kuti nthambi yotsala ya nthambi palokha silimakhala vuto mwa anthu awa.
Komabe, kwa anthu omwe ali ndi mtima wosalimba komanso gawo lamanzere lochepa lomwe limakhala locheperachepera 35 peresenti, kuchoka pamtundu wa nthambi kumatha kuchotsa kwambiri ntchito ya mtima. Izi zimachepa bwino zimatha kuchepetsa kuperewera kwamtima, ndipo zimakhala zovuta kwambiri.
Kugwiritsiridwa ntchito kwa mankhwala a resynchronization therapy (CRT) ayenera kuganiziridwa mozama mwa anthu onga awa. CRT ndi mtundu wa pacemaker womwe umagwirizanitsa kusinthasintha kwa zinyama, ndipo amatha kusintha kwambiri mphamvu ya mtima kwa anthu omwe ali ndi nthambi yachitsulo yachitsulo ndi kulephera kwa mtima.
Thandizo la Pakememaker Lopala ndi Mtolo Wotsalira
Chimake chokhazikika chotetezera mtima chimapangitsa mtima kukhala wopita kutsogolo. Chifukwa chakuti kugwiritsira ntchito magetsi (komwe kumachokera ku pacemaker) kumalimbikitsa chithunzithunzi choyenera kusanayambe kumalo otsekemera, anthu omwe ali ndi zida zowononga okhazikika amakhala ndi kampu yachitetezo chochitidwa ndi pacemaker.
Zaka zaposachedwapa, umboni wina wanena kuti anthu omwe ali ndi magawo ochepa omwe amatsitsika, omwe ali ndi zolinga zowonongeka za ventricular zomwe zakhala zikuyenda nthawi zonse kapena nthawi zambiri, akhoza kukhala ndi chiopsezo chowonjezeka cha mtima chifukwa cha kusakanikirana kwa pacemaker thumba la nthambi. Pachifukwa ichi, akatswiri ena tsopano amagwiritsira ntchito CRT pacemakers (yomwe imapewa chipangizo chachitetezo chotsalira pachipatala) anthu omwe ali ndi tizigawo ting'onoting'ono ta ejection omwe amadalira kwathunthu pacemakers.
Kodi Ndalama Yosiyidwa Yofesi ya Nthambi Imapempha Kuti Pemaker Wamuyaya Azikhala Wosatha?
Pokhapokha pali chifukwa choyika CRT pacemaker kuti agwirizanitsenso ntchito ya ventricles, anthu ambiri omwe ali ndi bolodi lachitsulo cha kumanzere sakufuna pacemaker.
Komabe, nthawi zina kukhalapo kwachitsulo cha nthambi kumanzere kumasonyeza chisokonezo chachikulu cha kayendedwe kamagetsi ka magetsi. Mwa anthu oterowo, chizindikiro cha magetsi cha mtima chimatha kusokonezeka m'njira zambiri, ndipo bradycardia yowonjezereka (yothamanga mtima) ingathe kukhalapo, ndipo phokoso la pacemaker lingakhale lofunika. Pa chifukwa ichi chokha, anthu omwe ali ndi nthambi yachitsamba cha kumanzere ayenera kuonetsetsa kuti akufufuza nthawi zonse zachipatala.
Mawu Ochokera
Nthambi ya kumanzere ndi nthambi ya magetsi. Aliyense amene amapezeka ndi bwalo lachitsulo lachitetezo ayenera kukhala ndi mtima wofufuza kuti ayang'ane matenda a mtima omwe amafunikira chithandizo. Ndipo nthawi zina makamaka anthu omwe ali ndi vuto la mtima kuwonjezera pa nthambi yachitsulo yachitsulo-bwalo la nthambi likhoza kufuna chithandizo ndi CRT pacemaker.
Komabe, ngati kufufuza kwathunthu kwa mtima kumasonyeza kuti palibe matenda a mtima, bwalo lamanzere la nthambi lamanzere lingathe kuonedwa ngati lachilendo.
> Zotsatira:
> Badheka AO, Singh V, Patel NJ, et al. Nthawi ya QRS pa Electrocardiography ndi Cardiovascular Mortality (Kuchokera pa National Health and Nutrition Research Survey-III). Am J Cardiol 2013; 112: 671.
> Curtis AB, Worley SJ, Adamson PB, et al. Biventricular Pacing ya Blocked Atrioventricular ndi Systolic Disysction. N Engl J Med 2013; 368: 1585.
> Imanishi R, Seto S, Ichimaru S, et al. Zochitika Zowonongeka Zomwe Zachitika Chikwama Chokwanira Chotsalira Chokwanira Nthambi Yoyang'aniridwa Pakati pa Zaka 40. Am J Cardiol 2006; 98: 644.
> Schneider JF, Thomas HE Jr, Kreger BE, et al. Chotsalira Chotsalira Chotsalira Chotsalira-Nthambi ya Nthambi: phunziro la Framingham. Ann Intern Med 1979; 90: 303.