Atrioventricular nodal reentrant tachycardia (AVNRT) inokurumidza, yenguva dzose chirongwa chemwoyo chinotanga kamwe kamwe uye pasina kunyeverwa, uye chinomira kamwe kamwe. Iko inowanzokonzera vanhu vakuru vaduku. Ivhareji yemakore iyo AVNRT inotanga kuitika iri 32, uye vanhu vakawanda vane urongwa hwemagariro aya vachava nechikamu chavo chekutanga nezera remakore makumi mana. Kana rokutanga raitika, rinowanzova dambudziko rinowanzoitika.
Chii icho AVNRT?
AVNRT ndiyo iyo inowanzozivikanwa yepamusoro- soro tachycardia (SVT) , inofungidzirwa inenge 60% yeSVTs yose.
AVNRT ndeimwe yezvezvekare tachycardias . ("Tachycardia" zvinongoreva kukurumidza kwemoyo wemwoyo.) Nezvose zvinogadziriswa tachycardia, pane kushandiswa kwemagetsi kusinganzwisisiki kune imwe nzvimbo mumoyo, iyo inoumba magetsi emugetsi. Apo imwe yemafungiro emagetsi emwoyo inopinda munharaunda iyi inogona kunge iri pasi pemamiriro ezvinhu akanaka, inogona "kutorwa" mukati memutunhu - zvinoreva kuti inotanga kupoteredza nekupoteredza dunhu. Nguva imwe neimwe iyo inofamba-famba nechepakati yedunhu mafungiro emagetsi anounza hutsva hwemwoyo, uye tachycardia mhinduro.
Sezvakangoita neSVTs dzakawanda zvakare, varwere vane AVNRT vanoberekwa vane humwe humwe hutano hwemagetsi mumoyo. MuAVNRT, humwe hutano hunobudiswa - uye iyo yose inotenderedzera inotakura iyo inogadzirisa arrhythmia - iri mukati kana pedyo zvikuru nediki duku reriotico (AV node) .
Nokudaro zita - AV nodal reentrant tachycardia.
Zviratidzo
Zviratidzo zveAVNRT zvinowanzoenderana neSVT, uye zvinowanzobatanidza kamwe kamwe kamwe kwekunyekwa , kuchena kwemavara, uye / kana chirwere. Kupfupika kwefema kunowanikwawo zvakanyanya mune iyi arrhythmia.
Chimwe chiratidzo chinowanzoonekwa muAVNRT icho chinowanzoitika kashoma kazhinji nemamwe marudzi eSVT inonzwa kusuruvara mumutsipa.
Ichi chiratidzo chinoitika nokuti, panguva dzezvikamu zveAVNRT, maatria uye mhepo dzinofamba dziri kurova panguva imwe chete. Nemhaka yekuti atria haikwanise kubudisa ropa rayo mumhepo, ropa rinomanikidzwa kumusoro kumitsipa yemutsipa - uye zvinokonzera kushungurudzika.
Zvikamu zveAVNRT zvinotanga uye zvinomira pakarepo, uye dzinowanzotora kubva kumaminitsi mashomanana kusvika maawa akawanda.
Kutanga Nokumisa AVNRT.
Iyo nhamba yeAV inonyanya kunetseka kuchinjwa muhurongwa hwehutongi hwezvimirira , chikamu chehurongwa hwemagetsi hunodzora midzi yeropa uye nhengo dzomukati. Saka kuchinja kune kunzwira tsitsi kunzwika (kushungurudzika) kana kuti inzwi revirus nerve (parasympathetic tone, kana kupindura kwekuzorora) kunogona kuva nemigumisiro yakakura paNode yeAV.
Nemhaka yekuti zvakawanda zvekare zvekudzoka muAVNRT zvinowanikwa mukati memusana weAV, kuchinja mumutauro wekuzvidzivirira kunogona kuva nehukuita hukuru pane arrhythmia.
Kunyange zvazvo AVNRT inowanzotanga pasina mamiriro ezvinhu anooneka, kune vamwe vanhu inogona kutanga nekurovedza muviri kana nguva dzekunetseka mupfungwa kana mamwe mamiriro ezvinhu anowedzera mutsa une tsitsi. Mune vamwe, inogona kutanga panguva yokurara zvakadzika, nekuputika, kana pakarepo nekukotamira mberi - mamiriro ezvinhu anowedzera vagal tone.
Varwere neAVNRT vanogona kumira zvikamu zve tachycardia nekuita zvinhu nokukurumidza kuwedzera inzwi reve vagus nerve. Kuita mufambiro weValsalva kunowanzoshanda, kunyange mamwe matanho makuru (zvakadai sokuzadza chiso chavo mumvura yechando kwemaminitsi mashomanana) dzimwe nguva ingada.
Kurapwa kweAVNRT
Vanachiremba vanogona kurapa zvikamu zvakanyanya zveAVNRT zvakakurumidza uye nyore. Ivo vanotanga kutungamirira murwere kuburikidza nekuedza zvishomanana pakuwedzera maitiro avo evhu. Kana izvozvo zvisingakwanisi kumisa arrhythmia, injectedous injection ye adenosine kana verapamil (calcium blocker) ichashanda nekukurumidza.
Mubvunzo unonyanya kukosha wezvechiremba unobata kwenguva refu kwenguva refu yerapi yeAVNRT.
Nemhaka yokuti arrmthmia haisi kutyisa upenyu, asi "kungoita" -kuvhiringidza hupenyu, kushungurudzwa kwehutano kunofanirwa kuratidzira kukanganisa kwokuti chirongwa chacho ndechei murwere. Kana zvikamu zvisinganyanyi kuitika, zvinonzwisisika zvakanaka, uye zvinogona kugumiswa zvakanaka zvakajeka kuburikidza nekugadzirisa vagal, saka zvichida hapana chimwezve chinofanira kuitwa.
Zvisinei, kana zvikamu zveAVNRT zvikavhiringidza hupenyu hwemurwere (izvo zvinowanzoitika), ipapo kurapwa kunofanira kunyatsoongororwa. Kurapa ne beta blockers kana calcium channel blockers kunonyatsobudirira mukuderedza kuwandisa kweAVNRT, uye kune varwere vazhinji, rimwe kana kuti zvose izvi zvemarudzi aya zvinorambidzwa zvakanaka. Kana iyo arrhythmia isingakwanisi kudzora, imwe yemishonga inorwisa maitiro inogona kuedzwa. Zvisinei, mishonga iyi inowanzova nemigumisiro, uye inongowanzoita zvishoma nezvishoma mukurapa AVNRT.
Nzira dzakanakisisa dzekurapa AVNRT nhasi ndedze kushandisa ablation therapy , chirongwa checatheterization. Neine chirongwa chekuwedzera, kushandiswa kwemagetsi kusinganzwisisiki mukati kana pedyo neNode yeAV kunonyatsorongedzwa uye zvakanyatsorongedzwa, kazhinji nehuwandu hwemhepo. AVNRT inogona kupodzwa zvakakwana nehutachiona huripo muhuwandu hunopfuura 95% yematambudziko. Saka kubatanidzwa kunofanira kunyatsoongororwa nemunhu wese anonzi AVNRT dambudziko guru, kunyanya kana risina kutungamirirwa nekushandisa beta-blockers kana calcium blockers.
Kunobva:
Denes P, Wu D, Dhingra R, et al. Dual atrioventricular nodal pathways. A common electrophysiological response. Br Heart J 1975; 37: 1069.
Peji RL, Joglar JA, Caldwell MA, uye al. 2015 ACC / AHA / HRS Nhungamiro yekutungamirirwa kwevarwere vakwegura ne Supraventricular Tachycardia: Mharidzo yeAmerican College of Cardiology / American Heart Association Task Force pamitemo yeChipiki Practice uye Heart Rhythm Society. Circulation 2015.