Matenda a Brugada ndi achilendo, osayenerera kamene kamayambitsa magetsi kamene kangabweretse kuntchito ya ventricular ndi kufa kwadzidzidzi mwa achinyamata omwe ali ndi thanzi labwino. Mosiyana ndi zovuta zina zomwe zimayambitsa imfa mwadzidzidzi kwa achinyamata, arrhythmias yotulutsidwa ndi matenda a Brugada kawirikawiri imachitika pogona, osati pa nthawi yochita masewera olimbitsa thupi.
Zochitika
Anthu ambiri omwe amapezeka kuti ali ndi matenda a Brugada ali achichepere kwa okalamba omwe ali ndi zaka zapakati, omwe ali ndi zaka zapakati pa nthawi yochidziwitso ndi 41. Matenda a Brugada amawonekera nthawi zambiri mwa amuna kusiyana ndi akazi-m'maphunziro ena, kufalikira kwa amuna nthawi zisanu ndi zitatu kuposa akazi. Ku United States, matenda a Brugada akuganiza kuti amapezeka pafupifupi mmodzi mwa anthu 10,000. Komabe, ndilofala kwambiri-mwinamwake wapamwamba kuposa mmodzi mwa anthu 100-mwa anthu ochokera kumwera cha Kumwera kwa Asia. Chosaoneka chokha cha mtima ndi magetsi; Mitima ya anthu omwe ali ndi matenda a Brugada mwachibadwa.
Zizindikiro
Vuto lalikulu lomwe limayambitsa matenda a Brugada ndi imfa mwadzidzidzi pogona. Komabe, anthu omwe ali ndi matenda a Brugada akhoza kukhala ndi mitu yambiri, chizungulire , kapena syncope (kuperewera kwa chidziwitso) chisanafike chiwonongekocho. Ngati izi sizingatheke kuzibweretsa kwa dokotala, matendawa angapangidwe ndipo mankhwala amayikidwa kuti asamwalire mwadzidzidzi imfa.
Matenda a Brugada azindikiritsidwa kuti ndi chifukwa chodabwitsa "mwadzidzidzi" matenda osokoneza bongo imfa, "kapena SUNDS. Mipingo inayamba kufotokozedwa zaka zambiri zapitazo ngati chikhalidwe chokhudza anyamata ku Southeast Asia. Zakhala zikuzindikiridwa kuti anyamata achimuna awa a ku Asia ali ndi matenda a Brugada, omwe ali ochuluka kwambiri ku gawo limenelo ladziko kusiyana ndi malo ena ambiri.
Zimayambitsa
Matenda a Brugada akuwonekera chifukwa cha chimodzi kapena zambiri zosabadwa zomwe zimakhudza maselo a mtima, makamaka m'magulu omwe amayendetsa sodium channel. Icho ndi cholowa chokhala ngati khalidwe lodziwika bwino , koma sikuti aliyense amene ali ndi jini kapena majini osasinthika amakhudzidwa mofanana.
Chizindikiro cha magetsi chomwe chimayang'anira mtima wamtunduwu chimapangidwa ndi njira m'magulu a mtima wamtima, omwe amalola kuti ma particles (otchedwa ions) aziyenda mobwerezabwereza kudutsa pamphana. Kuthamanga kwa ions kupyolera mu njira izi kumapangitsa chizindikiro cha magetsi cha mtima. Imodzi mwa njira zofunika kwambiri ndi njira yotchedwa sodium, yomwe imalola kuti sodium ipange maselo a mtima. Mu matenda a Brugada, njira ya sodium imatsekeredwa pang'ono, kotero kuti chizindikiro cha magetsi chimene chimapangidwa ndi mtima chimasintha. Kusintha kumeneku kumayambitsa kusakhazikika kwa magetsi komwe, mwa zina, kungapangitse tizilombo toyambitsa matenda.
Kuphatikizanso apo, anthu omwe ali ndi matenda a Brugada akhoza kukhala ndi mtundu wa dysautonomia - kusalinganizana pakati pa mawu achifundo ndi omvera . Zimatchulidwa kuti kuwonjezeka kwachidziwitso kwa mawu omwe amapezeka pa nthawi ya tulo kungakopedwe kwa anthu omwe ali ndi matenda a Brugada, komanso kuti mawu ofanana ndi a parasympathtic amachititsa kuti njira zosayenerera zisasunthike, ndipo zimabala imfa mwadzidzidzi.
Zifukwa zina zomwe zingayambitse matenda oopsa a anthu omwe ali ndi matenda a Brugada akuphatikizapo malungo, kugwiritsa ntchito mankhwala a cocaine, komanso kugwiritsa ntchito mankhwala osiyanasiyana, makamaka mankhwala osokoneza bongo.
Kudziwa
Kusokonezeka kwa magetsi komwe kunayambitsidwa ndi matenda a Brugada kungapangitse chitsanzo cha ECG , chitsanzo chotchedwa Brugada. Pulogalamu imeneyi imakhala ndi malo osungirako zida zowonongeka , kuphatikizapo zigawo za ST zomwe zikutsogolera V1 ndi V2.
Sikuti onse omwe ali ndi matenda a Brugada ali ndi "chitsanzo" cha Brugada pa ECG yawo, ngakhale kuti iwo angakhale ndi kusintha kwina kosayenera.
Choncho, ngati matenda a Brugada akudandaula (chifukwa, mwachitsanzo, syncope yachitika kapena wachibale wafa mwadzidzidzi atagona), zovuta zonse za ECG ziyenera kutumizidwa kwa katswiri wa electrophysiology, kuti aone ngati chitsanzo cha Brugada chikhoza kukhala panopa.
Ngati munthu wa ECG akuwonetsa mafilimu a Brugada, ndipo ngati ali ndi zizindikiro za chizungulire kapena syncope, sadapulumuka mtima , kapena ali ndi mbiri ya banja la imfa yadzidzidzi yomwe ili pansi pa zaka 45, ndi okwera. Komabe, ngati chitsanzo cha Brugada chiripo ndipo palibe zina mwazifukwazi zomwe zachitika, chiopsezo cha imfa mwadzidzidzi chimawonekera kwambiri.
Anthu omwe ali ndi matenda a Brugada omwe ali ndi chiopsezo chachikulu chofa mwadzidzidzi ayenera kuchitidwa nkhanza. Koma kwa iwo omwe ali ndi chitsanzo cha Brudada pa ECG yawo koma palibe zoopsa zina, kusankha kuti kukwiya kukhala kosakhala kosavuta.
Kuyeza kwa electrophysiologic kwagwiritsidwa ntchito kuthandizira ndi chisankho chovuta kwambiri chachipatala, pofotokozera chiopsezo cha munthu pa imfa yadzidzidzi. Kukhoza kwa kuyesa kwa electrophysiologic kuti azindikire molondola kuti chiopsezocho ndi chochepera kwambiri kuposa changwiro. Komabe, magulu akuluakulu a zamalonda panopa akuthandiza kuchita chiyeso ichi kwa anthu omwe ali ndi chitsanzo cha Brugada pa ECGs popanda zifukwa zina zoopsa.
Kuyeza kwa majeremusi kungathandize kutsimikizira kuti matenda a Brugada akupezeka, koma nthawi zambiri sichithandiza kulingalira kuti chiopsezo cha wodwalayo chikhoza kufa. Kuwonjezera apo, kuyesa kwa majeremusi ku matenda a Brugada ndi kovuta kwambiri, ndipo nthawi zambiri samapereka mayankho omveka bwino. Kotero akatswiri ambiri samapereka chizoloŵezi choyesera zamatenda mwa anthu omwe ali ndi vutoli.
Chifukwa chakuti matenda a Brugada ndi matenda omwe amayamba kulandira, malingaliro amakono akuyesa kufufuza achibale onse oyambirira a aliyense yemwe akupezeka kuti ali ndi vutoli. Kuwunika kumafunika kukhala ndikuyang'anitsitsa ECG, ndikuyang'ana mbiri yachipatala yowonongeka pofuna kuyang'ana zochitika za syncope kapena mutu wowala.
Chithandizo
Njira yokhayo yotsimikiziridwa kuti yothetsa imfa mwadzidzidzi mu matenda a Brugada ikuika munthu wowonongeka . Kawirikawiri, mankhwala oletsa antiarrhythmic ayenera kupeŵa. Chifukwa cha momwe mankhwalawa amagwiritsira ntchito pazitsulo zamagulu a mtima, amalephera kuchepetsa chiopsezo cha ventricular fibrillation ku syndrome ya Brugada, komanso akhoza kuwonjezera chiopsezo chimenecho.
Ngati munthu wina ali ndi matenda a Brugada ayenera kulandira mankhwala osokoneza bongo amatha kudziŵa ngati chiopsezo cha imfa mwadzidzidzi ndikumveka kuti ndi chapamwamba kapena chochepa. Ngati chiopsezo chiri chapamwamba (chokhazikitsidwa ndi zizindikiro kapena kuyesayesa kwa electrophysiologic), wogwiritsira ntchito mankhwalawa ayenera kupatsirizidwa. Koma opayika mankhwalawa ndi okwera mtengo ndipo amakhala ndi mavuto awo , kotero ngati chiopsezo cha imfa yodzidzimutsa chimaweruzidwa kukhala chochepa, zipangizo izi sizinakonzedwe pakalipano.
Malangizo Ogwira Ntchito
Nthawi iliyonse munthu wamng'ono atapezeka kuti ali ndi matenda a mtima omwe angabweretse modzidzimutsa imfa, funso loti ndilobwino kuchita masewera olimbitsa thupi ayenera kufunsidwa. Izi zili choncho chifukwa ambiri amachititsa imfa mwadzidzidzi achinyamata.
Mu matenda a Brugada, mosiyana, ma arrhythmi omwe amafa amatha kuchitika nthawi ya tulo kusiyana ndi nthawi yochita maseŵera olimbitsa thupi. Komabe, zikuganiziridwa (ndi umboni wochepa chabe kapena wopanda cholinga) kuti kuyesayesa mwamphamvu kungapangitse chiopsezo chapamwamba kuposa chikhalidwe kwa anthu omwe ali ndi vutoli. Pa chifukwa chimenechi, matenda a Brugada akuphatikizidwa mu ndondomeko zoyendetsera ntchito zomwe zimapangidwa ndi akatswiri omwe amapanga machitidwe omwe amalimbikitsa ochita maseŵera omwe ali ndi matenda.
Poyamba, malangizo okhudzana ndi zolimbitsa thupi ndi matenda a Brugada anali oletsedwa. Msonkhano wa Bethesda wa 2004 wa 2004 pa Zolingalira Zomwe Ochita Masewera Othamanga ndi Odwala Matenda Okhudza Mtima Amalimbikitsa kuti anthu omwe ali ndi matenda a Brugada asapewe kuchita masewera olimbitsa thupi.
Komabe, lamuloli lokhazikitsidwa mwamtheradi lakhala likudziwika kuti ndi loopsa kwambiri. Poganizira kuti arrhythmias akuwona ndi matenda a Brugada kawirikawiri samachitika nthawi ya masewero olimbitsa thupi, malangizowo anamasulidwa mu 2015 motsogoleredwa ndi American Heart Association ndi American College of Cardiology.
Malinga ndi zomwe zatchulidwa posachedwa, 2015, ngati othamanga achinyamata omwe ali ndi matenda a Brugada alibe zizindikilo zochita masewera olimbitsa thupi, ndizomveka kuti atenge nawo masewera olimbirana ngati:
- Iwo, madokotala awo, makolo awo kapena othandizira amadziwa zoopsa zomwe zingachitike, ndipo avomereza kutenga zofunikira zoyenera.
- Chokhachokha chochotsa kunja (AED) ndi gawo labwino la zipangizo zawo zamasewero.
- Akuluakulu a gulu ndi okhoza komanso okonzeka kugwiritsa ntchito AED ndikuchita CPR ngati kuli kofunikira.
Chidule
Matenda a Brugada ndi achibadwa ambiri omwe amachititsa kuti anthu azifa mwadzidzidzi, nthawi zambiri pa nthawi ya tulo, ngati achinyamata athanzi. Chinyengo ndikutulukira chikhalidwe ichi musanachitike chochitika chosasinthika. Izi zimafuna kuti madokotala akhale ochenjera-makamaka kwa aliyense amene ali ndi syncope kapena zosazindikiritsa zochitika za mutu wautali-ku zovuta zogwirizana za ECG zomwe zikuwoneka mu matenda a Brugada.
Anthu amene amapezeka ndi matenda a Brugada nthawi zonse amatha kupewa zotsatira zoopsa ndi mankhwala oyenera, ndipo amatha kuyembekezera kukhala moyo wathanzi.
> Zotsatira:
> Brugada P, Bungwe la Nthambi ya Brugada J., Malo Otsatira Okhazikika ST Kukula ndi Mliri Wachimwimitsa Mwadzidzidzi: Matenda osokonekera a Clinical and Electrocardiographic Syndrome. Nkhani Yowonjezereka. J Am Coll Cardiol 1992; 20: 1391.
> Maron BJ, Zipes DP, Kovacs RJ, et al. Malingaliro Ovomerezeka ndi Oletsedwa Othandiza Othandiza Achinyamata Kulimbana ndi Mavuto Okhudza Mtima. Circulation 2015; DOI: 10.1161 / CIR.0000000000000236.
> Priori SG, Wilde AA, Horie M, et al. HRS / EHRA / APHRS Wogwirizanitsa Chidziwitso Chokhudza Kuzindikira ndi Kulamulira kwa Odwala Amene Ali Nawo Pachiyambi Pakati pa Arrhythmia Syndromes: Chilolezo Chovomerezedwa ndi HRS, EHRA, ndi APHRS mu May 2013 ndi ACCF, AHA, PACES, ndi AEPC mu June 2013. Heart Rhythm 2013 ; 10: 1932.
> Ziphika, DP, Ackerman, MJ, Estes NA, 3, et al. Task Force 7: Arrhythmias. J Am Coll Cardiol 2005; 45: 1354.