I-atherossteotic cardiossteosis (amanye amagama alesi sifo - i-myocardiossteosis, isifo senhliziyo) ukusabalalisa okuthe xaxa kwezicubu ezithintekayo ku-myocardium ngenxa yokufakwa kwe-cholesterol emikhunjini ye-coronary. Uphawu oluphambili lwalesi sifo yisifo se-artery esisebenza ngokuqhubekayo, esiboniswa ukwehluleka kwenhliziyo, i-arrhythmia, ukwehluleka kwe-conduction kanye nobuhlungu benhliziyo.
Ukuxilongwa kwe-pathology kufaka izindlela ezahlukahlukene - i-electrocardiography, i-echocardiography, i-ergometry yamabhayisekili, i-cholesterol, i-lipoproteins kanye nokuhlolwa kwemithi.
Ukuxilongwa okuthembekile okusheshayo kwenziwa, kulapho isiguli kufanele simise ushintsho lwe-pathological emikhunjini ye-coronary. Ukwelashwa kuhloselwe ukujikeleza kwegazi okujwayelekile emithanjeni yama-coronary, i-conduction kanye nesigqi, ukuqeda izinhlungu futhi kunciphise ukugcwala kwe-cholesterol.
Izimbangela kanye pathogenesis yalesi sifo
Kwi-cardiology, kukholelwa ukuthi i-atherosulinotic cardiossteosis iyisibonakaliso se-IHD. Lesi sifo sibeka esikhundleni sokugxila noma sokudluliselwa kwesakhiwo semisipha yamathambo.
Isizathu esikhulu sokuthuthuka kwenqubo ye-pathological ukufakwa kwamakhemikhali e-cholesterol emikhunjini yama-coronary eyenzeka ngaphezulu kweminyaka engama-50.
Ukufakwa okunjalo kungumphumela wokuphazamiseka kwe-lipid metabolism, lapho okuqukethwe kwegazi kwama-low density lipoproteins (LDL) kukhuphuka - amakhompiyutha akhethekile ahambisa i-cholesterol kumaseli. Azincibilikisi egazini, ngakho-ke lapho kukhona okuthe xaxa ezindongeni zemithambo yegazi, i-precipitate iqala ukwenza uhlobo lwama-cholesterol plaques.
Kulokhu, kukhona ukwehla kwezinga eliphakeme lokuxineka kwezomzimba (HDL), okungewona ama-atherogenic. Amazinga abo aphezulu egazi awuphawu lwe-lipid metabolism ejwayelekile. Amaprotheni la ahlangana ancibilike kahle egazini futhi avimbele ukwakheka kwama-plaque.
I-Lipid metabolism disorder ivela futhi kubantu abanganamatheli empilweni enempilo. Izici ezikhulisa ubungozi be-myocardiossteosis zifaka:
- ukuntuleka kokuzivocavoca nokukhuluphala;
- ukusetshenziswa ngokweqile kokudla nge-cholesterol ephezulu;
- ukuba khona kwesifo sikashukela i-mellitus (uhlobo 1 noma 2);
- ukusetshenziswa kwemithi yokuvimbela inzalo yama-hormonal;
- imikhuba emibi - ukubhema kanye notshwala.
Iqembu lengcuphe lifaka amadoda amadala kuneminyaka engama-45, abanesifo sikashukela, abantu asebekhulile futhi abanokuthambekela kokuthola ifa lokuthuthukisa le nkinga. Kumele kuqashelwe ukuthi ukuba khona kwesifo senhliziyo nesifo sikashukela kukhuphuka ngamaphesenti angama-80 amathuba okuba ne-atherosclerotic cardiossteosis.
Ukufa kwemisipha ye-myocardium kuthatha isikhathi eside. Ngenxa yokufa kwama-receptors, ukuzwela kwengqimba yezicubu kufinyelela komoya-mpilo kuyancipha, okubuye kukhuphule izinga lokukhula kwe-IHD.
Izinhlobo nezinhlobo ze-myocardiossteosis
Lesi sifo sizibonakalisa ngezindlela ezimbili - susa okugxile okuncane nokugxilwe okukhulu. Umehluko omkhulu phakathi kwezinhlobo ezimbili zalesi sifo indawo yendawo ethintekile.
Ukuxilongwa "i-myocardiossteosis encane" kusho ukuthi lesi sifo asithintanga ezindaweni ezingekho ngaphezu kwe-2 mm ububanzi. Ngokufanelekile, ngefomu elibheke kakhulu, amasayithi atshintshwe izicubu ezithintekayo anobukhulu obungaphezulu kuka-2 mm.
Kukhona ukwahlukaniswa kwe-myocardiossteosis, kucatshangelwa izindlela ezisetshenziswa njenge-pathogenetic. Ngokwalo mkhomba, izinhlobo ezintathu ze-cardiossteosis zingahlukaniswa:
- I-Ischemic. I-pathology yathuthuka isikhathi eside, futhi ithinta imisipha yenhliziyo ngokungafani. Lolu hlobo lwesifo lukhula ngenxa yokugeleza kwegazi okunganele kanye nendlala ye-oxygen.
- I-Postinfarction (elinye igama - i-post-necrotic). Kubonakaliswa ukwakheka kwezibazi ezindaweni ezinama-necrotic e-myocardium. Ziza ngobukhulu obuhlukahlukene, ngokuhlaselwa yinhliziyo okulandelayo zingazihlanganisa nezibazi zakudala, zenze amanxeba amakhulu. Ngenxa yokwanda kwendawo yesibazi, isiguli sinokuhlaselwa umfutho wegazi ophakeme.
- Okwesikhashana (okuxubekile). Hlanganisa lezi zinhlobo ezimbili ezingenhla ze-pathology. Kwi-cardiossteosis exubekile, ukwanda kancane kancane kwezicubu ze-fibrous kuba nesici, lapho i-necrotic foci ngezikhathi ezithile ivela khona ngemuva kokuhlaselwa yinhliziyo okuphindaphindiwe.
Imvamisa, i-myocardiossteosis ihambisana nezifo ezihlangana nazo. Lokhu kufaka i-ischemia, i-myocardial dystrophy, ukucekelwa phansi kwesakhiwo semisipha nokuphazamiseka kwe-metabolic enhliziyweni.
Izimpawu nezimpawu zesifo
I-Coronarocardiossteosis yisifo esikhula isikhathi eside, ngakho-ke ezigabeni zokuqala umuntu angazizwa anazo izimpawu. Imvamisa, izinguquko zokuqala ze-pathological ziyaqaphela ngokuhamba kwe-electrocardiogram (ECG).
Kunamaqembu amathathu wezimpawu, kuya ngokuqhubeka kwesifo. Bangasho ukwephulwa komsebenzi wesivumelwano senhliziyo, isigqi kanye nokwenza, kanye nokungapheleli kwe-coronary.
Uma ekuqaleni kwentuthuko yokwelashwa kwe-atherosulinotic cardiossteosis isiguli asizizwa sibhekene nobunzima, khona-ke ngokuhamba kwesikhathi angakhalaza ngobuhlungu ku-sternum radiating kwingalo yangakwesobunxele, i-scapula noma esifundeni se-epigastric. Kukhona ubungozi bokuphindaphindeka ukuhlaselwa yinhliziyo.
Lapho izicubu ezixakile zisakazeka kuyi-myocardium, isiguli sinezimpawu ezilandelayo:
- ukuncipha kokusebenza;
- ukuphefumula komoya (okokuqala - ngokukhathala, bese - lapho uhamba);
- ukuhlaselwa kwesifuba somoya;
- i-pulmonary edema.
Lapho i-myocardiossteosis ihambisana nokuhluleka kwenhliziyo, kuvela izinqubo ezilandelayo ze-pathological:
- Uketshezi oluqinile emaphashini.
- Ukuzikhukhumeza ngokweqile.
- Ukwanda ngosayizi wesibindi (hepatomegaly).
- Ukuthuthukiswa kwama-pleurisy nama-ascites.
Isigqi senhliziyo kanye ne-conduction disorder ngokuhambisana ne-myocardiossteosis kubangela imiphumela engaphezu kweyodwa. Ngenxa yalokhu, i-extrasystole ingenzeka - ukuvela okungafani kwezingxenye ngazinye noma inhliziyo yonke; i-fibrillation ye-atrial - izinkontileka ze-atonic eziyisiphazamiso nokuqina kwamaqembu athile wemisipha ye-atrial; i-atrioventricular kanye ne-intraventricular blockade.
Uma ekuqaleni izimpawu ziqashelwa ngezikhathi ezithile, lapho ngokugula ziba yisigameko esivamile.
Lapho kuhlanganiswa i-myocardiosclerosis ne-atherosulinosis ye-aorta, imithambo emikhulu yengozi kanye ne-cerebral artery (macroangiopathy), isiguli sikhononda ngezimpawu ezinjengokwenza umsebenzi wobuchopho obhebhetheka, isiyezi, i-lameness, njll.
Ingozi yalesi sifo ukuthi ngemuva kokuqina kwesimo, ukuthuthukiswa okufushane kungenzeka.
Ukuthuthuka okuhlobene nokuphila kahle kungahlala iminyaka emithathu, kepha bese kuba nokuphazamiseka okuthe xaxa ekuhlinzekweni kwegazi, okudala izimpawu ezibucayi ze-myocardiossteosis.
Imiphumela yokwelashwa engasebenzi
Ngokukhula kwenhliziyo, kubalulekile ukuyikhomba ngesikhathi futhi uqale ukwelashwa okusebenzayo. Ngaphandle kwalokho, ubungozi bokuqhamuka nezinkinga ezinkulu kungenzeka.
Ukuqhubeka okuqhubekayo kwe-pathology kubangela ukuphazamiseka okuningi. Ngenxa yokuthi inhliziyo ayikwazi ukuxosha ngokuphelele igazi, izikhalazo zesiguli zingahlotshaniswa nokufushane komoya, ukufoka, ukuvuvukala kwemikhawulo, i-pallor yesikhumba, izinhlungu emilenzeni nokuvuvukala kwemithambo yesibeletho.
Ukuhlanganiswa kwezinguquko ze-myocardial ne-stenosis of the coronary artery (> 70%) kufaka izingqinamba eziningi. Phakathi kwazo, kubalulekile ukugqamisa:
- ukwehluleka kwenhliziyo okukhanyayo, okubonakaliswa yinhliziyo ye-pulmonary acute, ukushaqeka kwe-cardiogenic kanye ne-edema yamaphaphu
- ukufinyelwa kwemikhondo yenhliziyo, i.e. ukukhuphuka kwenani lamakamelo alo;
- i-thromboembolism (ukuqedwa komkhumbi yi-thrombus) ne-thrombosis;
- ukuqhuma kwe-aorta ne-aneurysm (vasodilation);
- i-fibrillation ye-atrial;
- i-pulmonary edema;
- ukwephulwa kokusungulwa nesigqi;
- paroxysmal tachycardia.
Izibalo ezedumazayo zibonisa ukuthi e-85% yamacala emiphumela ye-myocardiossteosis, kwenzeka umphumela obulalayo.
Ngakho-ke, isiguli nodokotela banomsebenzi onzima - ukulandela yonke imithetho yokwelashwa ngezidakamizwa, ukudla nokuvimbela imiphumela ye-atherosclerotic cardiossteosis.
Izimiso zokuxilongwa kwe-pathology
Ukuxilongwa kusenesikhathi noma yisiphi isifo sekuyingxenye yokwelashwa okuphumelelayo. Kulokhu, i-cardiossteosis iyabonakala ngesikhathi sezifundo zokuxilonga ezijwayelekile isikhathi eside akazenzi azizwe.
Udokotela uxilonga isiguli ngokusekelwe emlandweni nasezimpawu zokuthi zilingane. Lapho uqoqa i-anamnesis, uchwepheshe unquma ukuthi isiguli sinesifo se-coronary artery isifo, ukuphazamiseka kwesigqi, isifo samathambo, ukushaya kwenhliziyo, njll.
Ukuqinisekisa noma ukuphika ukutholwa, udokotela uyalela ukuthi kwenziwe izifundo zokuxilonga ezahlukahlukene. Kuyadingeka: Ukuhlolwa kwegazi kwe-biochemical (LHC). Lapho kukhona i-myocarodiosclerosis, kubhekwa izinga eliphezulu le-cholesterol ne-beta-lipoprotein; i-electrocardiogram (ECG). Lolu cwaningo lukhombisa izimpawu zokuhluleka kwenhliziyo, isigqi senhliziyo kanye nokwehluleka kwendle, i-hypertrophy esezingeni eliphakathi kwesobunxele, kanye nokuba khona kwezibazi zangemva kokulimazeka.
I-Echocardiography (EchoCG) ne-ergometry yamabhayidi nayo iyadingeka (kusetshenziswa le ndlela yokuxilonga, kungenzeka ukucacisa izinga lokungasebenzi kahle).
Izindlela ezingeziwe zokutholwa kwe-cardiossteosis zibandakanya:
- i-rcycociiography - ocwaningweni lwenhliziyo;
- i-polycardiography - ukuhlola umsebenzi wesivumelwano;
- ukuqoshwa kwesikhathi eside kwe-ECG, okubonisa umsebenzi wenhliziyo amahora angama-24;
- i-coronography - ukuthola indawo nobungako bokunciphisa imithambo ye-coronary artery;
- i-ventriculografikhi - ukuhlola umsebenzi wesivumelwano wezinkonzo ezingena ngaphakathi;
- izivivinyo zamakhemikhali;
- Inhliziyo MRI;
- I-Ultrasound ye-patural ne-esiswini yesisu;
Ngaphezu kwalokho, i-radiograph ye-sternal ingahle isetshenziswe.
Ukwelapha kwe-atherosclerotic cardiossteosis
Izinguquko ze-Cardiossteotic ziyinqubo engenakuphikwa, ngakho-ke selashwa kanzima. I-coronary artery stenosis kanye nama-cholesterol plaque aqedwa, ngokushesha ungamisa ukuqhubeka kwalesi sifo.
Ngokuvamile, ukwelashwa kwe-myocardiossteosis kuhloswe ngakho ukulwa nezimpawu zokuhluleka kwenhliziyo, ukumisa inqubo ye-atherosclerotic, kanye nokuqeda izici zobungozi njengokubhema, ukukhuluphala ngokweqile nesifo sikashukela.
Ukwelashwa kwalesi sifo kubandakanya izindlela zokwelashwa nezokuhlinzwa.
Kunezidakamizwa eziningi ezilwa nezimpawu zesifo senhliziyo. Udokotela anganikeza isiguli lesi sidakamizwa elandelayo:
- izidakamizwa ze-nitro - ze-vasodilatation, ukukhulisa ukuzimela kwe-myocardial kanye ne-microcirculation;
- i-glycosides ye-cardiac - ukulungisa ukushaya kwenhliziyo, ukuhamba kwegazi, umfutho wegazi nokwenza ngcono ukuhamba kwegazi;
- ama-calcium antagonists - ukunciphisa imvamisa yezinkontileka kanye nokwanda kwemithambo yegazi;
- ama-vasodilators - ukuqinisa nokukhulisa ukugqama kwezindonga zemithambo yegazi;
- izishoshovu zeziteshi ze-calcium - ukwandisa i-elasticity nokwanda kwemithambo yegazi, ukunciphisa umfutho wegazi;
- i-beta-blockers - ukwehlisa amandla nezinga lokushaya kwenhliziyo, yenza isigqi senhliziyo kube ngokwejwayelekile nokwandisa isikhathi sokuphumula;
- ama-statins - ukwenza ngokwejwayelekile i-lipid metabolism, anciphise i-cholesterol ye-LDL futhi avimbele ukwakheka kwama-cholesterol plaque;
- ama-antithrombotic agents - ukuvikela ukunamathela kwe-platelet kanye nokuqhekeka kwegazi;
- ama-cytoprotectors nezidakamizwa ezithuthukisa i-metabolism - ukusheshisa izinqubo ze-metabolic, ukubuyisela ukusebenza kwe-cardiomyocyte kanye ne-myocardial contractility.
Ezimweni lapho ukwelashwa ngezidakamizwa kungalethi umphumela owufunayo, ukuhlinzwa kuyenziwa.
Kunezinhlobo eziningi zokuhlinzwa ezihlose ukuqeda indlala yomoya-mpilo wenhliziyo: i-coronary artery bypass grafting, emisa ukuhanjiswa kwegazi enhliziyweni; ukumunca, ukuqeda i-vasen stenosis kanye nokugeleza kokujwayelekile kwegazi; i-angioplasty evaliwe yemithambo yegazi, ukuvimbela i-vasoconstriction.
Ngaphezu kwalokho, ukususwa kwe-auric aneurysm kwenziwa, lokhu kungenelela kususa izithiyo ekujikelezweni kwegazi okujwayelekile.
Ungakuvimbela kanjani ukukhula kwesifo?
Izinyathelo zokuvimbela ukugula zibandakanya ukulungisa isisindo somzimba nokudla, ukuyeka imikhuba emibi nokudlala imidlalo.
Indlela ehlanganisiwe yokwelashwa nokuvimbela engaqinisa uhlelo lwezinhliziyo futhi ivikele ukuthuthukiswa kwezifo ezinzima.
Indima ekhethekile inikezwa ekudleni, ngoba ama-atherosulinotic amana ahambisana ngqo nokulimala kwe-lipid metabolism. Umgomo oyinhloko wokudla okhethekile ukunciphisa ukushiswa kwe-cholesterol.
Izincomo zokulandela ekudleni okuphansi kwe-cholesterol ye-cardiossteosis:
- Ukuze unciphise ukuthathwa kwemikhiqizo yezilwane - izikhupha zamaqanda, i-offal (ubuchopho, isibindi), isinqe, imajarini, ibhotela, ushizi. Le mikhiqizo ekhulisa i-cholesterol idinga ukulahlwa unomphela.
- Kuyadingeka ukucebisa ekudleni ngezinhlobo ezinamafutha amancane enyama, inhlanzi, imikhiqizo yobisi enamaphesenti aphansi wokuqukethwe kwamafutha, imifino eluhlaza nezithelo, nokudla okuphezulu kufayibha yemvelo.
- Yehlisa ukungena kwenosawoti ku-5 amagremu ngosuku. Esikhundleni salokho, ungangeza i-horseradish, i-ginger, i-garlic. Lokhu kuzosiza ukwehlisa inani lamanzi amaningi ngokweqile emzimbeni.
- Khipha kumasemisebeni wokudla, amasoseji, ukudla okusheshayo, imikhiqizo eseqediwe, ikhofi eqinile netiye, i-confectionery, amalulwane, ukudla okusemathinini, okuthosiwe, okubunjiwe nokudla okunamafutha.
- Kuyadingeka ukunciphisa ukungena kokudla okuqukethe ama-carbohydrate amaningi. Lokhu kufaka amakhekhe, u-ayisikhilimu, amaswidi, ushokoledi, amagilebhisi, i-pasta, isinkwa esimhlophe, amanzi amnandi e-carbonated.
- Okuthandwayo kufanele kunikezwe okusanhlamvu okuhlukahlukene - i-oatmeal, i-buckwheat, amabele, ngoba Zinothile ngefayibha yokudla, ezisiza ngokwejwayelekile indlela yokugaya ukudla futhi zilwe namakhilogremu angeziwe.
- Ukudla kuthathwa ngezingxenye ezincane izikhathi ezingama-5-6 ngosuku. Ukudla kokugcina kufanele kube okungenani amahora ama-2 ngaphambi kokuphumula kobusuku.
Enye into ebalulekile yokuvinjezelwa kwama-pathologies wezinhliziyo kuyinto yomzimba. Zonke izinsuku kunconywa ukuhamba emoyeni omusha okungenani imizuzu engama-40. Awukwazi ukwenqaba ukuzilibazisa okusebenzayo - ezemidlalo, ukubhukuda, njll.
Kodwa-ke, ngezimpawu ezinzima zokuntuleka kwe-coronary, ukondleka, irejimusi yokuphuza, ukusebenza komzimba kanye nokusebenza kwansuku zonke kunqunywa ngudokotela oyi-cardiologist.
I-Cardiossteosis ichazwa kuvidiyo kule ndatshana.
