I-Cardiossteosis inguquko ye-pathological ekwakhiweni kwemisipha yenhliziyo kanye nokufakwa kwayo izicubu ezithintekayo, kwenzeka ngemuva kwezifo ezithathelwanayo - i-myocarditis, i-endocarditis ethelelekayo, ngemuva kokumiliselwa kwe-myocardial. I-Atherossteosis ibuye iholele ekuthatheni kwenhliziyo, izinguquko ze-pathological zenzeka ngenxa ye-ischemia yezicubu kanye nokugeleza kwegazi okungahambi kahle. Lesi simo senzeka kaningi kubantu abadala noma asebekhulile, ngezifo ezibangelwa i-angina pectoris kanye ne-hypertension.
I-atherosclerotic cardiossteosis iba ngenxa yokuhlanganiswa kwezinto eziningana, njengokuphazamiseka ekudleni - ukubaluleka kokudla okugcwele emafutheni kanye ne-cholesterol kanye nokwehla kokudla kwezithelo nemifino, ukuncipha komzimba nomsebenzi wokuhlala phansi, ukubhema nokusebenzisa kabi utshwala, ukucindezela njalo, ukuthambekela komndeni kwezifo zenhliziyo. uhlelo.
Amadoda kungenzeka ukuba athuthukise i-atherossteosis, njengama-hormone ocansi abesifazane, anjenge-estrogen, anethonya lokuvikela ezindongeni zemithambo yegazi futhi avimbele ukwakheka kwama-plaque. Abesifazane banezifo zenhliziyo ezi-coronary kanye ne-hyperlipidemia, kodwa ngemuva kweminyaka engama-45 - 50 ngemuva kokunqamuka kokuya esikhathini. Lezi zinto ziholela ekuxineni nasekunciphiseni i-lumen yemikhumbi ye-coronary, ischemia ne-hypoxia yama-myocyte, ukukhubazeka kwabo kanye ne-atrophy.
Ngokuphikisana nesizinda sokuntuleka komoya-mpilo, ama-fibroblasts ayasebenza, akha ama-collagen kanye nemicu ye-elastic esikhundleni samaseli abhubhisiwe wemisipha yenhliziyo. Amaseli emisipha ashintshiwe kancane kancane athathelwa indawo yizicubu ezithintekayo, ezingasebenzi imisebenzi yokuvimbela inzalo neye-conduction. Lapho lesi sifo siqhubeka, imithambo yemisipha eminingi i-atrophy ne-deform iholela ekuthuthukisweni kwe-hypertrophy yesinxephezelo sobunxele, ukusongela kwempilo esisongela impilo, njengokuqina kwemizwa, ukwehluleka kwenhliziyo nokuhluleka kokujikeleza kwegazi.
Ukuhlukaniswa kwe-atherosclerosis kanye nesifo senhliziyo esisebenza ngokuhambisana ne-ICD 10
I-atherosclerotic cardiosclerosis ku-ICD 10 akuyona i-nosology ezimele, kepha ingenye yezindlela zesifo senhliziyo esisebenza ngokuqinile.
Ukwenza lula ukuxilongwa kufomathi yamazwe omhlaba, kungokwesiko ukubheka zonke izifo ngokuya nge-ICD ngezigaba 10.
Yakhelwe njengomhlahlandlela onesigaba se-alphanumeric, lapho iqembu ngalinye lesifo linikezwa ikhodi yalo eyingqayizivele.
Ukugula kwesistimu yenhliziyo kuboniswa ngamakhodi I00 nge-I90.
Isifo senhliziyo esingelapheki, ngokwe-ICD 10, sinezindlela ezilandelayo:
- I125.1 - Isifo i-atherosclerotic of the coronary artery.
- I125.2 - I-infraction ye-myocardial edlule etholwe yizimpawu zomtholampilo kanye nezifundo ezengeziwe - ama-enzyme (ALT, AST, LDH), ukuhlolwa kwe-troponin, i-ECG.
- I125.3 - I-Aneurysm yenhliziyo noma i-aorta - i-ventricular noma udonga.
- I125.4 - I-Arneurysm ye-coronary artery and stratation yayo, ithole coronary arteriovenous fistula.
- I125.5 - Ischemic cardiomyopathy.
- I125.6 - Asymptomatic myocardial ischemia.
- I125.8 - Ezinye izindlela zesifo senhliziyo ezi-coronary.
- I125.9 - Isifo senhliziyo esingama-ischemic esingachazwanga.
Isifo sokuqina kwenhliziyo siyabonakala futhi ngenxa yendlela okwenzeka ngayo lendawo kanye nokwanda kwenqubo - izicubu ezithintekayo zitholakala ngokulinganayo ku-myocardium, kanti isikhafu noma esigxile - izindawo ezi-sclerotic zinobukhulu obukhulu futhi zitholakala ezindaweni ezinkulu.
Uhlobo lokuqala lwenzeka ngemuva kwezinqubo zokutheleleka noma ngenxa ye-ischemia engapheli, esesibili - ngemuva kokufakelwa kwe-myocardial endaweni ye-necrosis yamaseli emisipha yenhliziyo.
Zombili lezi zinhlobo zomonakalo zingenzeka ngasikhathi sinye.
Ukubonakaliswa kwezifo zesifo
Izimpawu zesifo zivele kuphela ngokuqhekeka okukhulu kwe-lumen yemikhumbi kanye ne-ischemia ye-myocardial, ngokuya ngokusakazeka nokwenziwa kwasendaweni kwenqubo ye-pathological.
Ukubonakaliswa kokuqala kwalesi sifo kubuhlungu obufushane ngemuva kwe-sternum noma umuzwa wokungakhululeki kule ndawo ngemuva kokuxineka ngokomzimba noma ngokomzwelo, i-hypothermia. Ubuhlungu buxakile emvelweni, ukuqaqamba noma ukugoba, kuhambisana nobuthakathaka obujwayelekile, isiyezi, nokujuluka okubandayo kungabonakala.
Kwesinye isikhathi isiguli sinikeza izinhlungu kwezinye izindawo - ekhweni elingakwesobunxele noma engalweni, ehlombe. Isikhathi sobuhlungu besifo senhliziyo esivela ku-2 kuya ku-3 imizuzu ukuya kwesigamu sehora, siyancipha noma siyeke ngemuva kokuphumula, sithatha iNitroglycerin.
Ngokuqhubeka kwesifo, kufakelwa izimpawu zokuhluleka kwenhliziyo - ukufupheka komoya, ukuvuvukala komlenze, isikhumba se-cyanosis, ukukhwehlela kuhluleki kwe-ventricular yokwehluleka, ukukhuphula kwesibindi nokwanda, i-tachycardia noma i-bradycardia.
Ukuphefumula kancane kwenzeka kakhulu ngemuva kokuxineka ngokomzimba nangokomzwelo, endaweni ephakeme, kunciphisa ukuphumula, kuhleli. Ngokukhula kokwehluleka okubabazekayo kwe-ventricular acute, ukufupheka kuyanda, ukukhwehlela okuomile, okubuhlungu kuyakujoyina.
I-Edema iyisibonakaliso sokudonswa kwemali ukwehluleka kwenhliziyo, kwenzeka lapho imithambo ye-venous yemilenze igcwele igazi futhi umsebenzi wokumpompa kwenhliziyo uncipha. Ekuqaleni kwalesi sifo, i-edema yezinyawo nezinyawo kuphela ibhekwa, ngokuthuthuka kusakazeka ngaphezulu, futhi kungenziwa kwasendaweni nasebusweni nase esifubeni, i-pericardial, cavity esiswini.
Izimpawu ze-ischemia ne-hypoxia yobuchopho nazo ziyaqashelwa - ikhanda, isiyezi, i-tinnitus, ukuqhuma. Ngokufakelwa okuphambili kwama-myocyte wesistimu yokuqalisa kwenhliziyo ngezicubu ezixhumananayo, ukuphazamiseka kwendlela yokwenza - ukuvimbela, ama-arrhythmias, kungenzeka.
Ngokucashile, i-arrhythmias ingabonakala ngemizwa yokuphazamiseka emsebenzini wenhliziyo, izinkontileka zayo ngaphambi kwesikhathi noma ze-belated, umuzwa we-palpitations. Ngokuphikisana nesizinda se-cardiosclerosis, izimo ezifana ne-tachycardia noma i-bradycardia, i-blockade, i-atrasystrica, i-extrasystoles ye-atrial noma i-ventricularizationization, i-fibrillation ye-ventricular kungenzeka.
I-Cardiosulinosis yemvelaphi ye-atherosulinotic yisifo esenzeka kancane kancane esingavela ngokuxhamazela nokwesulwa.
Izindlela zokutholwa kwe-cardiossteosis
Ukuxilongwa kwalesi sifo kuqukethe imininingwane ye-anamnestic - isikhathi sokuqala kwesifo, izimpawu zokuqala, isimo sazo, ubude besikhathi, ukuxilongwa kanye nokwelashwa. Futhi, ukuthola ukuxilongwa, kubalulekile ukuthola umlando wesiguli wokuphila - ukugula kwangaphambilini, ukusebenza kanye nokulimala, ukuthambekela komndeni ezifweni, ukuba khona kwemikhuba emibi, indlela yokuphila, izici zobungcweti.
Izimpawu zemitholampilo yizo ezihamba phambili ekuxilongweni kwe-atherosulinotic cardiossteosis, kubalulekile ukucacisa izimpawu ezikhona, izimo zokuvela kwazo, amandla ashukumisayo kusifo sonke lesi. Faka imininingwane ngolwazi ngezindlela zaselebhu kanye nezinsizakalo zocwaningo.
Sebenzisa izindlela ezingeziwe:
- Ukuhlaziywa okujwayelekile kwegazi nomchamo - ngokugula okuncane, lezi zivivinyo ngeke zishintshwe. Kwi-hypoxia engamahlalakhona, ukwehla kwe-hemoglobin ne-erythrocyte kanye nokwanda kwe-SOE kubhekwa lapho kuhlolwa igazi.
- Ukuhlolwa kwegazi kwe-glucose, ukuhlolwa kokubekezelelwa kwe-glucose - ukuphambuka kukhona kuphela nge-mellitus yesifo sikashukela kanye nokubekezelelwa kwe-glucose ephazamisekile.
- Ukuhlolwa kwegazi kwe-biochemical - nquma iphrofayili ye-lipid, nge-atherossteosis, i-cholesterol ephelele izophakanyiswa, lipoprotein ephansi nephansi kakhulu, i-triglycerides, i-lipoproteins ephansi iyancishiswa.
Kulesi sivivinyo, kubuye kuhlolwe nokuhlolwa kwe-hepatic kanye ne-renal, okungakhombisa ukulimala kulezi zitho zomzimba ngesikhathi sokuqina kwe-ischemia.
Izindlela zensimbi ezingeziwe
I-X-ray yezitho zesifuba - yenza ukuthi kunqume i-cardiomegaly, deflectic aortic, i-aneurysm yenhliziyo nemithambo yegazi, ukugcwala emaphashini, i-edema yabo. I-Angiography yindlela yokuhlasela, eyenziwe ngokwazisa kwe-ejenti ye-intravenous agent, ikuvumela ukuthi unqume izinga kanye nokutholakala kokuwohloka kwemithambo yegazi, ukuhanjiswa kwegazi ezindaweni ngazinye, ukuthuthukiswa kokubumbana. I-Dopplerography yemithambo yegazi noma ukuskena kwe-triplex, okwenziwa kusetshenziswa amaza e-ultrasonic, ikuvumela ukuthi unqume uhlobo lokuhamba kwegazi kanye nezinga lokuvinjwa.
Kufanele kwenziwe i-electrocardiography - inquma ukuba khona kwe-arrhythmias, i-hypertrophy yesinxele noma kwesokudla ye-ventricular, ukugcwala ngokweqile kwenhliziyo, ukuqala kwe-myocardial infarction. Ushintsho lwe-Ischemic lubonwa ku-electrocardiogram ngokuncipha kwamandla kagesi (usayizi) wawo wonke amazinyo, ukucindezelwa (ukuncipha) kwengxenye ye-ST ngaphansi kwe-contour, igagasi le-T elibi.
I-ECG inezelwa ucwaningo lwe-echocardiographic, noma i-ultrasound yenhliziyo - inquma ngosayizi nokwakheka, ukuzimela kwe-myocardial, ukuba khona kwezindawo ezingagudluki, ukubalwa, ukusebenza kohlelo lwe-valve, ukuguquka kokuvuvukala noma kwe-metabolic.
Indlela efundisa kunazo zonke yokuxilongwa kwanoma yiziphi izinqubo ze-pathological is scintigraphy - isithombe esibonisa ukuqongelela kokuqhathanisa noma isotopes esibhalwe ile Myocardium. Imvamisa, ukusatshalaliswa kwento kuyinto efanayo, ngaphandle kwezindawo ezandayo noma ezincishisiwe kwabantu. Izicubu ezixhumekile zinamandla anciphisiwe okubamba umehluko, futhi ama-sclerosis patches awabonwa esithombeni.
Ekuhlolweni kwezilonda zamaseli zanoma iyiphi indawo, i-magnetic resonance scanning, i-multispiral computer tomography ihlala iyindlela yokuzikhethela. Inzuzo yabo ibaluleke kakhulu emtholampilo, amandla okubonisa ukwenziwa kwasekhaya okuqondile kokuvinjezelwa.
Kwezinye izimo, ukuthola isifo esinembile ngokwengeziwe, kwenziwa ama-hormone, ngokwesibonelo, ukuthola i-hypothyroidism noma isifo i-Itsenko-Cushing's.
Ukwelashwa kwesifo senhliziyo nesifo senhliziyo
Ukwelashwa nokuvimbela izifo zenhliziyo ezi-coronary kuqala ngokushintsha kwendlela yokuphila - ukunamathela ekudleni okunekhalori ephansi, ukuyeka imikhuba emibi, imfundo yezomzimba noma ukwelashwa kokuzivocavoca.
Ukudla kwe-atherossteosis kususelwa ekudleni kobisi nemifino, ngokwenqatshelwa ngokuphelele kokudla okusheshayo, okunamafutha nokudla okuthosiwe, ukudla okusetshenzisiwe, inyama enamafutha nenhlanzi, i-confectionery, ushokoledi.
Ukudla kudliwa ikakhulukazi - imithombo yefayibha (imifino nezithelo, okusanhlamvu nemidumba), amafutha angenampilo anempilo (uwoyela wemifino, inhlanzi, amantongomane), izindlela zokupheka - ukupheka, ukubhaka, ukuhambisa amandla.
Izidakamizwa ezisetshenziselwa i-cholesterol ephakeme nesifo senhliziyo i-nitrate yokunciphisa ukuhlaselwa kwe-angina (i-Nitroglycerin, i-Nitro-ende), ama-antiplatelet agents ekuvimbeleni i-thrombosis (Aspirin, Thrombo Ass), ama-anticoagulants phambi kwe-hypercoagulation (Heparin, Enoxyparin, Hypindia, kanye ne-inhibitors) , URamipril), ama-diuretics (Furosemide, Veroshpiron) - ukunciphisa ukudumba.
Ama-Statins (Atorvastatin, Lovastatin) noma i-fibrate, i-nicotinic acid nayo isetshenziselwa ukuvikela i-hypercholesterolemia kanye nokuqhubeka kwesifo.
Ama-arrhythmias, izidakamizwa ze-antiarimic (Verapamil, Amiodarone), i-beta-blockers (Metoprolol, Atenolol) ziyabekelwa, bese kusetshenziswa i-cardiac glycosides (Digoxin) ekwelapheni ukwehluleka kwenhliziyo okungamahlalakhona.
I-Cardiossteosis ichazwa kuvidiyo kule ndatshana.
