A Common Genetic Heart Disorder
Hypertrophic cardiomyopathy (HCM) inowanzojairika maitiro emoyo (anobata anenge 1 muvanhu 500), izvo zvinogona kukonzera matambudziko akawanda, kusanganisira mwoyo kusakatika uye kamwe kamwe kufa. Zvisinei, kuoma kweHCM kunowanzosiyana kubva kumunhu kusvika kune mumwe munhu, uye vanhu vazhinji vane HCM vanogona kutungamirira hupenyu hwehupenyu hwose.
Zvinokonzera
HCM inokonzerwa nechimwe kana chimwe chezvizvarwa zvakasiyana-siyana zvinoshandura zvirwere zvinokonzera chirwere mukukura kwemwoyo yemasikironi.
HCM inopedzerwa se "autosomal", iyo inoreva kuti kana gwesi risina kuwanikwa rakagara nhaka kubva kune mubereki mumwe chete, mwana achava nehosha.
Zvisinei, inenge hafu yevarwere vane HCM, chirwere che genetic hachina nhaka zvachose, asi chinowanzoita sechinhu chinokanganisa gene mutation - mumamiriro ezvinhu akadaro, vabereki nevanin'ina vemurwere havazove vari pangozi yeHCM. Zvisinei, iyi "itsva" inochinja inogona kupfuudzwa kune chizvarwa chinotevera.
Migumisiro yeCardiac
MuHCM, masvingo emasumbu emakumbo emagetsi (makamuri ekumusoro emwoyo) anoita seasina kuwandisa - chiitiko chinonzi "hypertrophy." Kuwedzera uku kunokonzera musimba wemwoyo kuita zvisina kufanira, kusvika pamwero. Kana zvakanyanya, iyo hypertrophy inogona kutungamirira kukundikana kwemoyo uye chimiro chechimiro .
Mukuwedzera, kana ikava yakanyanyisa iyo hypertrophy inogona kukonzera kusvibisa mumhepo, iyo inogona kupindira nebasa reaortic valve uye mitral valve, kuparadza kubuda kweropa kuburikidza nemwoyo.
HCM inogona kukonzera mashoma marudzi mashanu ematambudziko akakomba emwoyo:
1) HCM inogona kuita kuti diastolic isakanganise. "Diastolic kusagadzikana" kunoreva "kusagadzikana" kusingaoneki kwemuviri wemhepo, izvo zvinoita kuti zvive zvakaoma kuti mhepo dzive nemhepo dzizere neropa pakati pemoyo mumwe.
MuHCM, iyo hypertrophy inobereka zvimwe zvinosvibisa diastolic. Kana zvakakomba zvakakwana, uku kusvibiswa kwe diastolic kunogona kutungamirira ku diastolic mwoyo kusakundikana, uye zviratidzo zvakakomba zve dyspnea (kupfupika kwemhepo) uye kuneta. Kunyange kunyoroka kwechirwere che diastolic kunoita kuti zvive zvakaoma kune varwere vane HCM kuti vashandise pfungwa dzomwoyo, kunyanya kushaya firati .
2) HCM inogona kukonzera "kusasiya ventricular outflow kudzivisa. (LVOT). " MuLVOT, pane kuvhiringidza zvishoma kuita kuti zvive zvakaoma kuruboshwe rweseri kurambidza ropa raro nekurova kwemwoyo. Dambudziko iri rinoitikawo ne aortic valve stenosis , umo inonzi aortic valve inooma uye inokundikana kuzarura kazhinji. Zvisinei, apo aortic stenosis inokonzerwa nechirwere mumoyo wevhavha pachayo, iVVOT neHCM inokonzerwa nekuwedzera kwemutsipa wemwoyo kunenge pasi peaortic valve. Izvi zvinonzi "subvalvular stenosis." Kungofanana ne aortic stenosis, iVVOT inokonzerwa neHCM inogona kukonzera kukundikana kwemoyo.
3) HCM inogona kukonzera mitral kudzokera zvakare. Mu mitral regurgitation , mitral valve inokundikana kuvhara kazhinji kana kuruboshwe rwemhepo inobhururuka, zvichiita kuti ropa riyerere kumashure ("regurgitate") kuruboshwe rwenyamu.
Iyo mitral regurgitation inowanikwa neHCM haina kukonzerwa nenharo yemwoyo yevhavha yemwoyo, asi, inobudiswa nekusavhiringidza nenzira iyo mabvumirano emhepo, anokonzerwa nekudzika kwehutachiona hwemhepo. Mitral kudzokerazve imwe nzira iyo vanhu vane HCM vanogona kukudziridza kukanganisa kwemwoyo.
4) HCM inogona kukonzera ischemia yemutsipa wemwoyo. Ischemia - oxygen kubviswa - ndiyo inonyanya kuonekwa kune varwere vane chirwere chinonzi coronary artery (CAD) , umo kuvhara mumarita ekugadzirisa kunoita ropa kunopfuurira kune chikamu chemuviri wemwoyo. NeHCM, mutsara wemwoyo unogona kuwedzera zvokuti zvimwe zvikamu zvemuviri hazvigoni kuwana ropa rakakwana, kunyange apo maronary coronary pachawo akazara.
Kana izvi zvikaitika, angina inogona kuitika (zvikurukuru nekushanda), uye myocardial infarction (kufa kwemwoyo mususu) inogona kuitika.
5) HCM inogona kukonzera kufa kamwe kamwe. Kungoerekana kwafa muHCM kazhinji kunokonzerwa ne ventricular tachycardia kana ventricular fibrillation , uye inowanzoenderana nekushingaira kwakanyanya. Zvichida kuti ischemia yemutsipa wemwoyo inobereka akawanda kana isiri iyo yakawanda yemarimthmias iyo inotungamirira kukurumidza kufa kune varwere vane HCM. Nokuda kwechikonzero ichi, vazhinji varwere vane HCM vanofanira kuvhara maitiro avo.
Zviratidzo
Zviratidzo zvinowanikwa nevanhu vane HCM zvakasiyana chaizvo. Zvinowanzoitirwa varwere vane zvirwere zvishoma kuti varege kuva nezviratidzo zvachose. Zvisinei, kana imwe yematambudziko emwoyo achangobva kutaurwa aripo, zvimwe zviratidzo zvingangodaro. Zviratidzo zvinowanzoonekwa nevarwere vane HCM ndeye dyspnea ane maitiro, orthopnea , paroxysmal nocturnal dyspnea , palpitations , zvikamu zvehutema , marwadzo emapfupa, kuneta kana kuputika kwezvikwama. Syncope (kurasikirwa kwekuziva) kune umwe munhu ane HCM, kunyanya kana yakabatanidzwa nekurovedza muviri, inhau yakakomba, uye inogona kuratidza dambudziko rakakura rekufa kamwe kamwe. Chero chikamu che syncope chinofanira kuongororwa pakarepo nachiremba.
Kuziva
Muzhinji, echocardiogram ndiyo nzira yakanakisisa yekuona HCM. Echocardiogram inobvumira kuenzana kwakakwana kwehupamhi hwemhepo yakasimba, uye inogona kuona LVOT uye mitral kudzoka zvakare.
I electrocardiogram (ECG) inogona kuratidza kusara ventricular hypertrophy, uye yakashandiswa senhumbi yekuongorora kuti iongorore HCM mumatambi vechidiki.
Zvose EECG uye echocardiogram inofanira kuitwa munzvimbo dzepedyo dzehama chero ipi zvayo inotarirwa neHCM, uye echocardiogram inofanira kuitwa kune munhu chero upi zvake mune iyo ECG kana kuongorora kwepanyama kunoratidza ventricular hypertrophy.
Kurapa
HCM haikwanisi kurapwa, asi kazhinji zvirwere zvinogona kurapa zviratidzo uye kuvandudza zvibereko zvekurapwa. Zvisinei, vatungamiri veHCM vanogona kunge vakaoma, uye ani naani ane zviratidzo zveHCM inofanira kuteverwa ne cardiologist.
Beta blockers uye calcium blockers inogona kubatsira kuderedza "kusuruvara" mukati memwoyo wakaoma musumbu. Kudzivisa kupera mvura kunokosha kune varwere vane HCM mukuderedza zviratidzo zvine chokuita neLVOT. Mune vamwe varwere vanovhiya kubvisa zvikamu zvehutano hwemwoyo musungo inodiwa kuti isunungure LVOT.
Atrial fibrillation, kana ikaitika, kazhinji inokonzera zviratidzo zvakakomba uye zvinoda kutarisirwa zvakanyanya kune varwere vane HCM kupfuura kune vanhu vakawanda.
Kudzivirirwa Kwekufa Kwekufa
HCM ndiyo inonyanya kukonzera rufu rwechimbichimbi muvatambi vaduku Apo rufu rwe kamwe kamwe rwuri dambudziko rinoparadza, kunyanya kana richiitika kune vechidiki. Nokuda kwechikonzero ichi, kushingaira kwakanyanya uye kukwikwidzana kunoitwa kunofanira kuvharirwa kune varwere vane HCM.
Nzira dzakawanda dzave dzakaedzwa kuti dziwedzere ngozi yekufa kamwe kamwe kune varwere vane HCM - kusanganisira kushandisa beta blockers uye calcium blockers, uye antiarrhythmic zvinodhaka . Zvisinei, nzira idzi hadzina kuonekwa zvakakwana. Iko zvino inoratidzika zvakajeka kuti, kune varwere vane HCM vane ngozi yekufa kamwe kamwe-kamwe inowanikwa yakakwirira, iyo inogadziriswa inogadziriswa inofanira kuve yakanyatsofungidzirwa.
Sources:
Massie, BM "Heart Failure" mu: Goldman L naAusiello D (Eds). Cecil Textbook of Medicine, WB Saunders, 2003.
Nishimura RA, Holmes DR Jr. Chipatara chekuita. Hypertrophic obstructive cardiomyopathy. N Engl J Med 2004; 350: 1320.
Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF / AHA murayiridzo wekuongororwa uye kurapwa kwe hypertrophic cardiomyopathy: nhepfenyuro huru: mushumo weAmerican College yeCardiology Foundation / American Heart Association Task Force pamusoro pekushandisa mazano. Kurwisana 2011; 124: 2761.