Nei LBBB inokosha?
Kubva kuruboshwe bbazi rebazi ndiyo nzira isingaenzaniswi yakaonekwa pa electrocardiogram (ECG) , iyo inoratidza kuti mafungiro emagetsi emagetsi haasi kugoverwa mukati memhepo yepfungwa mumoyo nenzira yakajairika.
Chii Chinokonzera Kusara Bundle Rekuvhara Bato?
Matavi ehomwe anogona kufungidzirwa senhengo yemagetsi emwoyo "wiring." Iyo ndiyo nzira dzemagetsi dzakagadzirirwa kuparadzira moyo wemagetsi emhepo pamwe chete kuburikidza nemhepo inotenderera.
Izvi zvinovimbisa kuti kupindirana kwemashure maviri aya kunoenderana.
Nebhokisi rakasara rebazi, bundle bazi iro rinoparidzira kushandiswa kwemagetsi kumhepo yakasara iri kumativi ose kana zvakadziviswa zvachose. Izvi zvinotadzisa kushandiswa kwemagetsi kwechishanu chinonzi ventricle. Somugumisiro, ventricle yakarurama inoshandiswa, uye inotanga kubvumirana, musati mhepo inobhururuka isati yavhurwa.
Kuti mwoyo urove zvakajeka sezvinobvira, zvose zvinyorwa zvinofanira kubvumirana panguva imwe chete. Saka chikasara chikamu chebazi chinogona kuderedza kunaka kwekushaya moyo. Izvi zvinoderedza kushanda kwepfungwa zvingasava zvishoma kune mumwe munhu ane mwoyo wakafanana, asi unogona kuva nemigumisiro inokosha kune vanhu vane mamwe marudzi ehutano hwemoyo-kunyanya mwoyo kusagadzikana .
Kuongororwa Bundle Bundle Branch Block
Kubva kuruboshwe bbazi rebazi rinounza kuchinja kwemaitiro paEECG, saka vanachiremba vanogona kuongorora chirwere ichi nekungoongorora ECG.
Chikamu cheEEC chinonzi QRS yakaoma chinomirira kushandiswa kwemagetsi kugoverwa pamhepo. Kazhinji, nokuti zvose zvinyorwa zvinokurudzirwa panguva imwechete, chidimbu cheQRS chakanyanya kunyanyisa-kazhinji, pakati pe 0.08 ne1 seconds pamusana. Nebhokisi rakasara rebazi rebazi, tsvina yeQRS yakawanda kwazvo, kazhinji inopfuura masikati 0.12.
Uyezve, iyo yekutarisa ECG inoratidzira 12 "maonero" akasiyana-siyana (anonzi "vatungamiri") emabasa emagetsi emwoyo, uye vanachiremba vanogona kuongorora izvi zvakasiyana zvinotungamirira kuwana pfungwa yehutano hwezvinetso zvemwoyo zvakasiyana. Nebhokisi rakasara rebazi, ruzivo rwakakura rweQRS rwunooneka rwakarurama mune dzimwe nzira, uye pasi kune vamwe. Nokuongorora nguva mbiri ye QRS yakaoma, uye muenzaniso wayo pamitemo yakasiyana-siyana yeEGG, inowanzo nyore nyore kuongorora shanduko rebazi rebazi iro kana riripo.
Chikonzero Nei Kuruboshwe Bundle Bhuku Rinovhara Kunokosha?
Kuruboshwe bundlebazi rebazi ndiro rinokosha kuwana zvikonzero zviviri zvakasiyana.
Chokutanga, kusiya bundle branch block kanowanzoitika semugumisiro weimwe dambudziko remwoyo. Saka kana yawanikwa, zvinenge zvichida kuti chimwe chinhu chinokosha chechimiro chemoyo chinowanikwawo.
Chechipiri, sezvakambotaurwa kare, bhomba rakasara rebazi iro pachako rinogona kukonzera mwoyo kushanda zvishoma nezvishoma kune vanhu vane mamwe marudzi ezvirwere zvemoyo.
Kuruboshwe Bundle Rebazi Kuvhara uye Mwoyo Wakakomba Mwoyo
Kubva kuruboshwe bbazi rebazi rinonyanya kubata vanhu vakuru. Inowanikwa muzasi pe1% yevanhu vari pasi pemakore makumi mashanu; Kusiyana neizvi, inenge 6 muzana yevana vane makore makumi mapfumbamwe nemasere vakasiya bundle branch block.
Vanhu vakawanda vane bhokisi rekumashure rebazi rine chimwe chimiro chepfungwa yepfungwa iri pasi. Muchidzidzo cheFramingham, vateeresi vakagadzira shanduko rebazi rebazi rakange rine mavhareji ava nemakore makumi matanhatu nematanhatu, uye vane huwandu hwekuwedzera kwehuwandu hwehutachiona , hutachiona hwechirwere , kana hutachiona hwechirwere (CAD) . Kutaura zvazviri, munguva yekudzidza kwaFramingham, 89 muzana yevanhu vakagadzika kusara bundle branch block vakazoonekwa kuti vane rumwe rudzi rwehutano hwehutano hwehutano.
Izvi zvinorevei kuti ani zvake, wezera ripi neripi, uyo anowanikwa kuti akasiyira bundle branch block anofanira kuva nekuongorora kwemoyo kutsvaka chirwere chepfungwa chepfungwa.
Iko kuongorora kunofanira kusanganisira zvishoma echocardiogram , uye kana zvipingamupinyi zviripo kune CAD, kushungurudzika / thallium kudzidza inofanirawo kunyatsofungidzirwa. Dambudziko rezvepfungwa dzomumwoyo rinowanikwa munharaunda yeLBBB dzinosanganisira kuwedzera kwehutano, CAD, mwoyo kusagadzikana, hypertrophic cardiomyopathy , kana chirwere chemwoyo chinonzi valvular .
Kana pasina chirwere chemwoyo chinowanikwa mushure mekuongorora kwepfungwa mukati memunhu ane chikamu chekusimuka kwebazi, kunyanya kuvanhu vari pasi pe50, kufungidzira kunoratidza kuti kwakanaka chaizvo. Muzviitiko izvi, bhomba rakasara rebazi rebazi rinofungidzirwa zvakanakisisa sechirwere, chinokonzerwa nekuwana ECG.
Kuruboshwe Bundle Branch Kuvhara uye Kubudirira kweMwoyo
Muchikwata chechipiri chebazi, mapiro maviri emhepo ari kukurudzirwa nemhepo yemagetsi inokonzera kuenzanisa, panzvimbo imwe chete. Iko ndiko kuti, kuruboshwe kuruboshwe hunosimudzirwa chete mushure mokunge ventricle yakarurama inokurudzirwa. Nokudaro, chikamu chinosara chebazi chinokonzera kurasikirwa kwemaitiro akaenzana pakati pemhepo mbiri, iyo inoderedza kushanda kwepfungwa yemoyo. Mwoyo unoshanda kushanda nesimba kuti uwane purogiramu yako yakakwana yekupemha.
Muvanhu vaduku, vane hutano vane ruboshwe rweseri rebazi, uye kunyange kune vanhu vakwegura vane ruboshwe rweseri rebazi iro ringangodaro rakave nechirwere chepfungwa, kudonha muhutano hwemwoyo kunoratidzika kunge kwakanaka kwazvo, uye uchapupu huripo hunoratidza kuti yakasara bundle branch block iyo pachayo haiiti chinetso muvanhu ava.
Zvisinei, kune vanhu vane mwoyo wekukundikana uye chikamu chekunze chinonzi ventricular ejection chikamu chinoderera kusvika pasi pe35 muzana, chikasara bundle branch block chinogona kubvisa kudarika kukuru kwekushanda kwemwoyo. Izvi zvishoma nezvishoma zvinogona kukurumidza kuora kwekushaya mwoyo, uye kuita zviratidzo zvakanyanya kuipa.
Kushandiswa kwechimiro resynchronization therapy (CRT) kunofanira kunyatsoongororwa kuvanhu vakadai. CRT rudzi rwe pacemaker iyo inogadzirisa zvakare kushandiswa kwemhepo, uye inogona kuwedzera kunyatsogadzirisa mwoyo mukati mevanhu vane chikamu chesimbe chebazi uye mwoyo kusakundikana.
Chronic Pacemaker Therapy uye Chikamu Chechipiri Chechivharo
Iko inowanzogara pacemaker inoita kuti mwoyo unobva kune chinotungamira chinotungamirirwa nekodzero yakarurama. Nemhaka yokuti kushanda kwemagetsi (iyo ino munyaya ino inobva pacemaker) kunosimudzira ventricle yakarurama pamberi pevasikiriri yakasara, vanhu vane magadzirirwo emagetsi anogara varipo vane pacemaker-induced left bundle branch block.
Mumakore achangobva kupfuura, humwe uchapupu hwakaratidza kuti vanhu vane zvishoma zvakasara zve ventricular ejection fractions, avo vane kodzero yekugara zvakanaka ye ventricular pacemakers iyo iri kunyatsofamba nguva yose kana nguva yakawanda, inogona kuva nehuwandu hwekukuvadza kukanganisa kwemwoyo nekuda kwekushivirira kwe pacemaker bundle branch block. Nokuda kwechikonzero ichi, dzimwe nyanzvi iye zvino dzinoshandisa CRT pacemakers (iyo inodzivisa pacemaker-induced left bundle branch block) kune vanhu vane zvikamu zviduku zvinokonzerwa nemajekiti anonyanya kuvimba nehupenyu husingaperi pacemakers.
Rinosara Bundle Rekuvhara Bato Rinoda Kuti Pemaker Inogara Iripo Here?
Kunze kwekunge pane chikonzero chekuisa CRT pacemaker kuti agadzirise zvakare basa revashandi, vanhu vakawanda vane bundle rebazi rebazi rega rega havatsvaki pacemaker.
Zvisinei, mune dzimwe nguva kuvepo kwebato rakasara bhokisi rinoratidza humwe hutano hukuru hwehupenyu hwemagetsi hunogadzirisa hurongwa. Muvanhu vakadaro, chiratidzo chemagetsi chemwoyo chinogona kuvhiringidzwa munzira dzakawanda, uye bradycardia inokosha (inononoka yemutengo wemwoyo) inogona kukurumidza kuitika, uye inogara pacemaker inogona kudiwa. Nokuda kwechikonzero ichi bedzi, vanhu vane chikamu chekupedzisira chebazi rinofanira kuva nechokwadi chokuti vane nguva dzose yekuongororwa kwechiremba.
Shoko Rinobva
Kuruboshwe bundle bazi ndiro chirwere chemhepo chekuita magetsi. Munhu wose anowanikwa nechebhoshwe bundle branch block anofanira kuva nekuongorora kwemoyo kutsvaka chirwere chemwoyo chinoda kurapwa. Uye mune zvimwe zviitiko-kunyanya kune vanhu vane mwoyo wekukundikana kuwedzera kune yakasara bundle branch block-bundle bazi rega pacharo rinogona kurapa kurapwa neCRT pacemaker.
Zvisinei, kana chirwere chepfungwa chakakwana chinoratidza kuti hapana chirwere chepfungwa chinenge chiri pasi, bhokisi rekupedzisira rebazi rinogona kuonekwa sebenign condition.
> Sources:
> Badheka AO, Singh V, Patel NJ, et al. QRS Nguva yakatarwa neElectrocardiography uye Kufa Kwemwoyo (kubva kuNational Health uye Nutrition Examination Survey-III). Am J Cardiol 2013; 112: 671.
> Curtis AB, Worley SJ, Adamson PB, et al. Biventricular Pacing yeAntrioventricular Block uye Dysfunction Dysfunction. N Engl J Med 2013; 368: 1585.
> Imanishi R, Seto S, Ichimaru S, et al. Chirevo chekufananidzira kwechiitiko Chiitiko Chizere Chebhendi Chebato Chivharo Chekuchengetedzwa Kwemakore Anopfuura makumi mana. Am J Cardiol 2006; 98: 644.
> Schneider JF, Thomas HE Jr, Kreger BE, et al. Nzvimbo Ichangobva Kuwanikwa Yakasara Yakasara-Davi Rebazi: kudzidza kweFramingham. Ann Intern Med 1979; 90: 303.