Matenda a Mtima mwa Agalu ndi Amphaka

"Galu wanga ali ndi chinachake pamtima pake" ndi zomwe mumamva nthawi zambiri, makamaka nyamayo ikakula. Koma kodi zonsezi ndi chiyani? dokotala wa zinyama dr Sebastian Goßmann-Jonigkeit amapereka chidziwitso cha zizindikiro za matenda a mtima mwa agalu ndi amphaka ndikuwonetsa njira zochiritsira zomwe zingatheke.

Matenda a Mtima… Kodi Izi Zikutanthauza Chiyani Kwenikweni?

Pano pali ulendo wopita ku cardiology - sayansi ya mtima.
Mtima umagwira ntchito yofanana mu nyama zonse: umapopa magazi kudzera m'thupi. Izi zimatsimikizira kuti mpweya wopita ku maselo ofiira a magazi umapezeka ku selo iliyonse ya thupi mokwanira. Zofunikira zimatha kusiyana kuchokera kumunsi kupita kumtunda panthawi yochita zolimbitsa thupi popuma - kubwezera izi kumagweranso mkati mwa gawo la mtima laudindo.

Mapangidwe a Mtima

Kupatulapo pang'ono pazanyama, mtima umakhala wofanana kwambiri ndi chiwalo chopanda kanthu. Kumbali zonse pali ventricle yayikulu pansi pa atrium yaing'ono, yosiyanitsidwa bwino ndi mzake ndi valve yamtima yomwe imagwira ntchito ngati valavu ya njira imodzi kotero kuti magazi amangoyenda mbali imodzi. Magazi amasungidwa mosalekeza panthawi ya kupopera ndi dongosolo lapamwamba la kugwedezeka kwa minofu ndi kayendedwe ka valve.
Mpweya wochepa wa okosijeni umalowa mkati mwa chiwalocho kudzera pa afferent posterior vena cava. Imalowa mu ventricle yoyenera kuchokera ku atrium yoyenera kupyolera mu chotchedwa tricuspid valve. Kuchokera pamenepo kudzera mu mtsempha wa m'mapapo kupita m'mitsempha ya m'mapapo, kumene maselo ofiira amadzaza ndi mpweya watsopano. The m`mapapo mwanga mtsempha amatsogolera magazi kumanzere atrium, mwa otchedwa bicuspid valavu kumanzere ventricle, ndi kutulutsidwa kuchokera kumeneko kudzera msempha mu zokhudza zonse kufalitsidwa, wolemera mu mpweya.

The Stimulation Line

Kuti magazi agwire ntchito chimodzimodzi monga chonchi, kugunda kwa minofu ya mtima kuyenera kuyendetsedwa bwino. Zomwe zimatchedwa sinus node zimayendetsa izi - zimatumiza mphamvu yamagetsi yomwe imafika m'maselo a minofu ya mtima moyenerera kuti agwirizane ndendende ndi ntchito yopopera. Kutulutsa kwamagetsi kumeneku kumatha kuwonetsedwa pogwiritsa ntchito electrocardiogram (ECG) ndikuwonetsa kuwongolera kolimbikitsa mu minofu yamtima. Amagwiritsidwa ntchito kuti azindikire ma arrhythmias (mwachitsanzo, nthawi yolakwika kapena kuwongolera kolakwika) komwe, mosazindikirika, kungayambitse magazi osakwanira. Ichi ndichifukwa chake kuyang'anira mtima pa nthawi ya anesthesia n'kofunika kwambiri.

Zizindikiro za Matenda a Mtima mwa Agalu ndi Amphaka

Zizindikiro zonse za kulephera kwa mtima zimatha kufotokozedwa ndi kusagwira bwino ntchito kwa mtima. Chimodzi mwa zifukwa zazikulu zopangira nthawi yochezerana ndi kutsika kwakukulu kwa ntchito - izi nthawi zambiri zimawonekera pamene kutentha kwa kunja kumakhala kokwera kumayambiriro kwa chilimwe. Popeza mtima wokhala ndi vuto la valavu chifukwa cha ukalamba nthawi zambiri umangophimba zomwe mpweya umafunikira pa chamoyo, wodwalayo nthawi zambiri amayenda mopanda chidwi kapena pang'onopang'ono kuposa masiku onse. Ndi kuwonjezeka kwa kutentha kwa kunja, dongosolo la mtima limatsindika kwambiri, popeza mbali yaikulu ya mphamvu ya thupi imayenda mu kayendetsedwe ka kutentha ndi mpweya wochepa wa mpweya m'zigawo zonse (makamaka zofunika mu ubongo) sizikutsimikiziridwa nthawi zonse. Izi zimabweretsa kukomoka kwa wodwala wamtima wosadziwika kapena wosachiritsika bwino masiku otentha achilimwe.

Chizindikiro china chingakhale bluish (cyanotic) disccolored mucous nembanemba (monga conjunctiva m'diso kapena unpigmented m`kamwa), amene amayamba chifukwa cha kusowa kwa mpweya m'magazi.
Pakupita patsogolo, chomwe chimatchedwa 'chifuwa chamtima' nthawi zambiri chimachitika - uku ndi edema ya m'mapapo, yomwe wodwalayo amayesa kukhosomola kapena kutsamwitsidwa koma koma koma osalephera. Izi zimachitika pamene magazi ochokera kumanzere kwa atrium abwerera m'mapapo ndipo madzi omwe ali m'magazi amatuluka kuchokera m'mitsempha kupita m'mipata yapakati pa bronchi - ngati sanalandire chithandizo, nyama zimatha 'kumira' kapena 'kufota'.

Matendawa

Pali njira zingapo zounika mtima. Chosavuta ndikumvetsera ndi stethoscope - zomwe zimatchedwa auscultation. M'kati mwake, phokoso lachiwiri la mtima (kufuula, kugwedeza, ndi zina zotero) likhoza kuzindikiridwa ndi ma valve opanda vuto. Panthawi imodzimodziyo, munthu akhoza kuwerengera kugunda kwa mtima ndipo mwina kumva arrhythmia.

Pankhani ya mtima wa X-ray (kawirikawiri zotheka popanda sedation), miyeso yopingasa ndi yowongoka ya chiwalo imayikidwa molingana ndi kukula kwa thoracic vertebrae kuti awone ngati ikukulirakulira. Ngati imayeza kuchuluka kwa matupi amtundu wa 10.5 mu galu, izi zimatchedwa kukulitsa mtima komwe kumafuna chithandizo - njira yowerengera iyi imatchedwa VHS X-rays (Vertebral Heart Score).

Kuti athe kuwunika magwiridwe antchito a mavavu popanda kukayikira kulikonse, Doppler ultrasound yadzitsimikizira yokha. Kuphatikiza pa miyeso ya ma valve a mtima, kutuluka kulikonse kwa magazi chifukwa cha zolakwika kumatha kuwonetsedwa mumtundu.

DCM vs HCM

Pamene kulephera kwa mtima kumachitika muukalamba, zamoyo za agalu ndi amphaka nthawi zambiri zimachita mosiyana kwambiri. Popeza kuti kutuluka kwa magazi kumasokonekera ndi ma valve osokonekera a mtima ndipo amatha kuchepetsedwa m'madera ena, mtima monga malo opopera apakati ayenera kumangidwanso ndi kusinthidwa moyenera.

Agalu nthawi zambiri amakhala ndi zomwe zimadziwika kuti dilated cardiomyopathy (DCM). Uku ndikukulitsa chiwalo chomwe chimatha kuwonedwa mosavuta pa X-ray. Kuchuluka kwa zipinda ziwirizi kumawoneka kuti kukuchulukirachulukira kotero kuti magazi ochulukirapo amatha kusuntha pa kugunda kwa mtima. Vuto la kusinthika uku ndikuti minofu yamtima imakhala yopapatiza kwambiri m'dera la zipinda - ilibe mphamvu zothandizira chiwalo chokulitsa bwino.

Amphaka, Komano, amakhala ndi hypertrophic cardiomyopathy (HCM) pafupifupi mu ukalamba kokha ngati pali zolakwika zofanana ndi ma valve. Ndi mtundu uwu wa chipukuta misozi, minofu ya mtima imakhala yolimba kwambiri ndi kuchepa kwakukulu kwa zipinda za mtima. Choncho, magazi ochepa okha ndi omwe amatha kupopa pa kugunda kwa mtima ndipo mtima umayenera kugunda pafupipafupi kuti athe kunyamula magazi ochepa.

Therapy

Posachedwapa pamene zizindikiro za matenda a mtima zomwe zafotokozedwa pamwambapa zikuwonekera mwa agalu ndi amphaka, dokotala wa zinyama ayenera kufunsidwa mwamsanga kuti apime mtima.

Popeza ma valve amtima amachepa pang'onopang'ono ndi ukalamba, agalu ndi amphaka ambiri posakhalitsa amayamba kukhala ndi zizindikiro zofanana ndipo amafuna chithandizo. Pofuna kubwezera kulephera kwa mtima, mankhwala amakono a Chowona Zanyama amagwiritsa ntchito zipilala zinayi za mtima (mankhwala a mtima):

1. Kuchepetsa katundu ndi ACE inhibitors (pokulitsa mitsempha yamagazi, zimakhala zosavuta kuti mtima upope motsutsana ndi kuthamanga kwa magazi komwe kulipo)
2. Kuchedwetsa kapena kusinthira kukonzanso komwe kumachitika mu dilated kapena hypertrophic cardiomyopathy
3. Kulimbitsa mphamvu ya minofu ya mtima kudzera mu chogwiritsira ntchito 'pimobendan' mwa agalu.
4. Kukhetsa m'mapapo mwa kuyambitsa ntchito ya impso ndi zinthu zomwe zimagwira "Furosemide" kapena "Torasemide" pamaso pa pulmonary edema.

Kuphatikiza apo, mankhwala olimbikitsa kufalikira kwa magazi monga propentofylline angagwiritsidwe ntchito m'dera la njira zodutsa.

Ndi mankhwala ati omwe amagwiritsidwa ntchito omwe wodwala ayenera kusankhidwa potengera zomwe apeza komanso zizindikiro. A generalization sizingatheke.

Kutsiliza

Zaka zingapo zapitazo, matenda a mtima agalu ndi amphaka, makamaka okhudzana ndi ukalamba, ankaonedwa kuti ndi ovuta kwambiri. Kumbali imodzi, chifukwa zosankha zamankhwala zinali zochepa kwambiri ndipo, kumbali ina, mankhwala omwe anali ovuta kumwa (mwachitsanzo, poizoni wa foxglove wofiira) analipo.

Makamaka, kulimbikitsa zotsatira za pimobendan wabweretsa patsogolo kwambiri pa chithandizo cha agalu ndi matenda a mtima m'zaka zaposachedwapa.
Masiku ano, nthawi ya moyo wa wodwala wamtima wokonzedwa bwino ndi kuyang'aniridwa bwino ikhoza kukhala yofanana ndi ya wodwala wathanzi - ngati achitapo kanthu mwamsanga.