IST - A Kusanzwisiswa Nechirwere Arrhythmia
Sinat inappropriate tachycardia (IST) ndiyo mamiriro ayo mwoyo wevanhu, pakuzorora uye panguva yekuedza, inowanzosimudzwa pasina chikonzero chakaoneka. Vanhu vane IST vanowanzova nemafungiro ekuzorora mapiro makuru kudarika 100 kurova paminiti, uye nekutowedzera kushingaira kwomwoyo kunowanzosvika kune yakakwirira kwazvo. Izvi zvinoremekedzwa mwoyo yemitengo zvinowanzoenda pamwe nezviratidzo zvepilpitations , kuneta, uye kusagadzikana kwepabonde.
Nemhaka yokuti mwoyo rhythm muIt inoumbwa nesode ye sinus (chimiro chemwoyo chinodzora chimiro chemwoyo chaiwo), IST haisi kuwirirana neyemagetsi yemagetsi pane ECG .
Overview
Kunyange zvazvo IST inogona kuitika kune ani zvake, inonyanya kuwanzana kune vechidiki vaduku uye inokanganisa vakadzi kakawanda kupfuura varume. Iyo "muvhareji" IST chirwere ndeye mukadzi ari mumakore makumi maviri kana makumi matatu ekutanga uye ave ane zviratidzo zvemwedzi kusvika kumakore. Mukuwedzera kune zvakakurumbira zviratidzo zvepilpitations, kuneta uye kusagadzikana kwebasa, IST inowanzobatanidzwawo nehuwandu hwezviratidzo zvinosanganisira orthostatic hypotension (kudonha mumubhadha weropa pamire pamire), kusvibiswa kwemaonero, chizivi , kubata, dyspnea (kupfupika kwe kufema), uye kutuka.
NeyoIt, kusara kwemoyo wemwoyo kunowanzowedzera kupfuura 100 kurohwa paminiti, asi panguva yehope huru, inogona kudonha kusvika ku 80 kana 90 kurohwa paminiti, kana kunyange pasi. Kunyangwe kunyange kushanda nesimba mwoyo inokurumidza kukurumidza kusvika kune yakakwirira se 140 kana 150 kurohwa paminiti.
Phipamende ndiyo chiratidzo chakakurumbira kunyange zvazvo (sezvazvakawanzo zvakadaro) hapana "zvisina kujairika" moyo unobaya unowanikwa. (Ndiko kuti, kukanganisa kwemwoyo mumwe kunokonzerwa nechirwere chechivi, sezvinoenderana nemwoyo wose.) Zviratidzo zvinowanikwa nevarwere veIt zvinogona kunge zvisingagoni kuvhiringidza uye kuzvidya mwoyo.
IST yaizivikanwa sechirwere chete munguva pfupi yapfuura muna 1979 uye yave ichigamuchirwa sechinhu chechokwadi chezvechiremba kubva kubva kuma1980. Uye kunyange nhasi, nepo IST ichizivikanwa zvizere sehutano hwehutano hwehutano hwehupi hwehutano hwehutano hwehuyunivhesiti, vakawanda vanochiremba vanachiremba havana kunge vakambonzwa nezvazvo kana kuti vakanyora icho sechinetso chepfungwa (kureva, "kuzvidya mwoyo").
Zvinokonzera
Mubvunzo mukuru unoratidzika kuva wekuti IST inomiririra chirwere chekutanga chechivi chechi sinus, kana kuti, pane kudaro, inomiririra kukanganisa kwakawanda kwehutongi hwehutongi hwekuzvidzivirira-chiitiko chinonzi dysautonomia . (Izwi rinotyisa remhepo rinotungamirira "mabasa asingazivi" emumuviri, akadai sokuchera, kufema, uye kushaya mwoyo.)
Vanhu vane IST vane hypersensitive kune adrenaline; zvishoma zvishoma adrenaline (sechinguva chiduku chekuedza) zvinokonzera kukura kwechimiro chemoyo. Nepo pane uchapupu hwekuti pane kuchinja kwemuitiro munharaunda ye sinus muIt, humwe humwe humwe uchapupu hunoti humwe hutano hukuru hwehutachiona huripo huri mune vazhinji vevarwere ava. (Chimwe chinowanzoitwa dysautonomia chinotsanangura chikonzero nei zviratidzo neIt kazhinji dzichiita sezviri kuenzana nekuwedzera kwepfungwa yemwoyo.) Ndiyo pfungwa yokuti sinus iyo inofanirwa pachayo inenge isinganzwisisiki iyo yakaita kuti electrophysiologists ishandise kuenderera mberi kwekodhi ye sinus kurapwa kweIt (kunyanya pane iri pasi apa).
Kuziva
Zvimwe zvirwere zvakasiyana uye zvinorapwa zvinorapa zvinogona kuvhiringidzwa neIt, uye mumunhu anouya nechivi chisina kujairika tachycardia, izvi zvimwe zvikonzero zvinofanira kubudiswa kunze. Matambudziko aya anosanganisira anemia , fever, zvirwere, hyperthyroidism , pheochromocytoma , chirwere cheshuga-chinokonzerwa nedysautonomia, nekushandisa zvinodhaka. Izvi zvinowanzogadziriswa kunze kwehuwandu hwehutano hwekuongorora, uye kuongorora ropa uye urini.
Mukuwedzera, mamwe maitiro e- cardiac arrhythmias -kunyanya kakawanda, mamwe marudzi e- supraventricular tachycardia (SVT) -dzimwe nguva inogona kuvhiringidzwa neIt. Zvinowanzova zvakaoma kuti chiremba ataure musiyano pakati peSVT neIt kuburikidza nekuongorora nokungwarira ECG uye kutora nhoroondo yezvechiremba.
Kuita izvi zvakakosha zvakakosha nokuti kurapwa kweSVT kunowanzomiririra.
Mishonga
Mishonga yekurapa
Mune varwere vakawanda vane IST, kurapa kwezvinodhaka kunogona kuve kwakanaka. Asi kubudirira kubudirira kunowanzodikanwa kuedza-uye-kukanganisa kuedza nemishonga yakawanda, zvinyorwa kana pamwe.
Beta-blockers inodzivisa kuitika kweAdrenaline pane node ye sinus, uye sezvo vanhu vane IST vane mhirizhonga yekupindura kudrenaline, kushandisa beta blockers kunonzwisisika. Iyi mishonga inowanzobatsira chaizvo kuderedza zviratidzo zveIt.
Calcium blockers inogona kuderedza zvakananga chiito chechivi chechi sinus asi chave chichigadzirisa zvishoma pakurapa IST.
Iyo drug ivabradine yakashandiswa kubudirira mukurapa vanhu vane IST. Ivabradine zvakananga kunokanganisa "kupisa firati" yenhamba ye sinus, uye nokudaro kunoderedza kushaya kwemwoyo. Ivabradine inogamuchirwa muUnited States sekurapwa kwemainina uye nekushaya simba kwemoyo kune varwere vasingagoni kubvumira beta blockers, asi kwete IST. Zvisinei, iyo inoshanda seyakashanda semamwe madhiragi, uye nyanzvi dzakawanda dzinokurudzira ivabradine sechirwere chinoshanda chechiitiko ichi. Uyezve, masangano akawanda emasangano iye zvino anotsigira kushandiswa kwayo kweIt.
Nyanzvi dzakawanda dzechirwere dzinotadza kusazvinyora kune "generalized autonomic dysfunction" dzidziso yeIt, saka hauna kuedza kuronga zvinodhaka zvakave zvichibatsira kune varwere vane mamwe maitiro eDysautonomia. Zvisinei, sezvo pane kazhinji kuwirirana pakati peIt uye mamwe maitiro eDysautonomia syndromes (kunyanya POTS uye vasovagal syncope ), zvinodhaka zvinoshanda mukurapa maitiro aya zvinogona kubatsira pane dzimwe nguva mukurapa varwere vane IST. Iyi mishonga inogona kusanganisira:
- Florinef , iyo mishonga inokonzera sodium kuchengetedza. Zvimwe zvirwere zve dysautonomic, kunyanya POTS uye vasovagal syncope, zvakaratidzwa kuti zvakabatana nekuderera muropa rehuwandu, uye dhiyabhorosi-kuchengetedza zvinodhaka zvinogona kuwedzera ropa redu kune zvisizvo, uye kuderedza zviratidzo.
- Midodrine , chirwere chinokonzera kuwedzera mumutauro wevascular, zvichibatsira kudzivirira kuderera kweropa.
- Serotonin-reuptake inhibitors (iyo Prozac yemhuri yemishonga) inoshandiswa kunyanya kurapa kuora mwoyo uye kuzvidya mwoyo, asi zvakare yakaratidza kuti inobatsira mukurapa maverengeka eyyyututomia syndromes.
Kakawanda, zviratidzo zveIt zvinogona kudzorwa kusvika pachiyero chakanaka nekushandisa kusanganiswa kwemishonga. Pakati pese, beta blockers vanoedza kutanga, uye ivabradine inowedzerwa (kana kuti inotsiviwa) kana beta blocker isingatauri zviratidzo zvakakwana. Zvisinei, kushandiswa kwemishonga inobatsira kunowanzodikanwa kushivirira, kushanda pachiyero-uye-kukanganisa. Chimwe chekushivirira, kunzwisisa, uye kuvimba pakati pechiremba uye murwere zvinotarisirwa. Izvi zvakaoma kubudirira kana chiremba achifunga kuti murwere ndeye mutsara chete. Kuti vave nekubudirira kurapwa, vanhu vane IST (nezvimwewo dysautonomias) vanofanira kugara vachiita zviyero zvakakwana zvezvitoro zvezvitoro.
Non-Mishonga Therapy
Wedzerai munyu kudya. Izvi zvinofanira kuitika kuburikidza nekugamuchirwa kwachiremba wako, nekuda kwekusarura kwedu kwezvino nekuda kwezvokudya zvepasi zvakanyanya. Asi munyu unoita kuti ropa riwedzere, uye kusvika pakaderedzwa ropa ropa rinokonzera zviratidzo, kuwedzerwa kunwa kwaunyu kunogona kubatsira kuderedza zviratidzo zveIt.
Sinus node ablation. Nyanzvi dzakawanda dzechirwere, uye kunyanya electrophysiologists, dzakawanda dzakashungurudzwa nedzimwe tsananguro inoratidza kuti IST inonyanya kuora mwoyo kwechirwere chechi sinus (kusiyana nehuwandu hwezvemagetsi ehutachiona hwehurumende). Kutenda uku kwakagadzira chimwe chido chekushingaira kwekushandisa ablation therapy (imwe nzira iyo chikamu chemagetsi emagetsi chinokonzerwa nekatheta) kuchinja basa, kana kuparadza, node ye sinus.
Sinus node ablation yakasvika pakubudirira zvishoma chete. Kunyange zvazvo iyi nzira inogona kubvisa IST kusvika kusvika ku80% yevanhu pakarepo mushure mekugadziriswa, IST inodzokera mukati memwedzi mishomanana muhuwandu hwevanhu ava.
Kumirira. Chimwe chinonzwisisika chisina-pharmacologic nzira yekugadzirisa IST ndechekuita chinhu. Kunyange zvazvo nhoroondo yezvisikwa zvechirwere ichi chisina kunyorwa zvakanyorwa, zvinoratidzika kuti IST inowanzovandudza nekufamba kwenguva munguva yevanhu vakawanda. "Kuita chinhu" hazvirevi kuva mukana kune vanhu vane zvirwere zvakanyanya, asi vanhu vakawanda vane IST ine unyoro chete vanogona kubvumira zviratidzo zvavo kana vaine chokwadi chokuti havana chirwere chinotyisa chemoyo uye kuti chinetso chinogona kuvandudza pachayo pachake.
The Bottom Line
Kamwe IST inowanikwa, uye yakatarwa kuti kungo "kumirira" hakuzovi nzira yakakwana, nyanzvi dzakawanda nhasi dzinokurudzira kutanga nemishonga inorapwa. Kazhinji, beta blocker ichaedzwa kutanga, inoteverwa nedhiyabhorosi ye ivabradine (ingave yoga kana inosangana ne beta blocker). Kana miedzo iyi isingakwanisi kudzora zviratidzo, dzimwe mishonga yakawanda uye kusanganiswa kwezvinodhaka zvinogona kuedzwa. Nenyanzvi dzakawanda zvino dzinokurudzira kubhadharwa kwepabonde chete kana kana zvisungo zviviri zvemishonga zvisakundikana.
> Sources:
> 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. Kurwisana 2016; 133: e506.
> Schulze, V, Steiner, S, Hennersdorf, M, Strauer, BE. Ivabradine senzira yekurapa kwakasiyana-siyana muTrans of Sinakodzera Sinus Tachycardia: A Case Report. Cardiology 2008; 110: 206.
> Sheldon RS, Grubb BP 2, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement pamusoro pekuziva nekurapa kwe Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, uye Vasovagal Syncope. Heart Rhythm 2015; 12: e41.