Kurapa kwechirwere che cardiomyopathy (DCM) - iyo inonyanya kufanana nemoyo wekukundikana - yakagadzirisa zvinoshamisa pamakore mashoma akapfuura.
Zvinosuruvarisa, zvidzidzo zvinoratidza kuti varwere vakawanda vane DCM havasi kugamuchira kurapwa kwavanofanira kugamuchira. Nokuda kwechikonzero ichi, zvakakosha kuti iwe uzive nezvemishonga inokurudzirwa kuDMM - kana iwe chete kuti uone kuti chiremba wako anofukidza zvigaro zvose.
Tora Chinokonzera Chikonzero
Murairo wekutanga mukurapa DCM ndekutsvaga uye kubata chikonzero chinokonzera. Kurapa chinokonzera chinokonzera kunogona kuchinonoka, kumira, kana kutomisa kufambira mberi kweDDCM. Iwe unogona kuverenga pano pamusoro pezvikonzero zvakawanda zve DCM .
Kurapa Kwemishonga yeMDCM
Beta blockers. Beta blockers inoderedza kusanyanya kudzvinyirira pamwoyo wakakundikana, uye yakaratidza kuti inonyatsovandudza mwoyo wose basa, zviratidzo, uye kupona kwevarwere vane DCM. Beta blockers iko zvino inonzi inofambisa zvikuru mukurapa DCM. Coreg (carvedilol), Toprol (metoprolol), uye Ziac (bisoprolol), ndiwo mabheji anonzi beta anowanzoshandiswa muDDCM, asi mamwe akawanda anowanikwawo.
Diuretics. Diuretics , kana kuti "mapiritsi emvura," ndiwo maitiro ekurapa kwevanhu vane mwoyo kusakundikana. Iyi mishonga inowedzera kuchenesa mvura kuburikidza neitsvo uye kuderedza kushandiswa kwemvura uye edema inowanzoitika muDDCM. Inowanzoshandiswa pakurapa inosanganisira Lasix (furosemide) uye Bumex (bumetanide).
Nzira yavo huru yakakonzerwa ndeyokuti inogona kukonzera pasi pasiziyamu mazinga, izvo zvinogona kutungamirira kumaridythmias .
ACE inhibitors. ACE inhibitors (zvinodhaka zvinodzivisa angiotensin kuchinja enzyme ) zvakaratidzwa kuva yakabudirira zvikuru mukuvandudza zvose zviratidzo uye kupona kune varwere vane mwoyo usina kukwana. Izvo zvinokonzerwa nemakwenzi zvinokonzera kana kuderedza ropa , asi vanhu vazhinji vane DCM vanovhiringidza ACE inhibitors zvakanaka.
Inowanzoshandiswa ACE inhibitors inosanganisira Vasotec (enalapril), Altace (ramipril), Accupril (quinapril), Lotensin (benazepril) uye Prinivil (lisinopril).
Angiotensin II receptor blockers (ARBS). ARBS imishonga inoshanda zvakafanana kune ACE inhibitors. Inogona kushandiswa kune vanhu vane DCM vasingagoni kutora ACE inhibitors. ARBS iyo yakagamuchirwa pamwoyo kukanganisa inosanganisira Atacand (candesartan) uye Diovan (valsartan).
Aldosterone antagonists. Aldactone (spironolactone) uye Inspra (eplerenone) vane anldosterone vanopikisa, rimwe boka remishonga rinonyatsoratidza kuratidza kuponesa mune vamwe vanhu vane mwoyo kusakundikana. Pazvinogona kushandiswa zvakachengeteka, imwe yemishonga iyi inowanzorudzirwa, kunze kweACE inhibitors (kana murairo weArb) uye beta blocker, kune vanhu vane DCM. Zvisinei, kana murwere akachera mafungiro epfungwa, zvinodhaka izvi zvinogona kukonzera zvikuru hyperkalemia (high potassium levels). Aldosterone vanopikisa vanoda kushandiswa nekuchenjerera kukuru, kana zvachose, kana basa rehvo risati rakanaka.
Hydralazine uye nitrates. Kune vanhu vane DCM vane zviratidzo zvinoramba zvichiramba pasinei ne beta-blockers, ACE inhibitors, uye diuretics, kusanganisa hydralazine pamwe ne nitrate yomuromo (yakadai se isosorbide) inogona kuchinja zvakanyanya migumisiro.
Neprilysin inhibitor. Yokutanga ye neprilysin inhibitors (boka idzva remishonga), rakagamuchirwa kuti rishandise mwoyo kusakundikana kweDAA muna 2015. Ichi chirwere, Entresto , chaicho chiri kusanganiswa kweA ARB (valsartan) ine neprilysin inhibitor (sacubitril) . Zvidzidzo zvepakutanga ne Ent Ento zvave zvichinyatsovimbisa, uye dzimwe nyanzvi dzinofunga kuti dzinofanira kushandiswa panzvimbo yeACE inhibitor kana ARB. Zvisinei, ruzivo nemishonga inoramba iripo uye nguva yakareba migumisiro inoramba iri mubvunzo . Uyewo, mushonga wacho unodhura zvikuru. Saizvozvowo kushandiswa kwayo kwemazuva ano kunyanya kune varwere vasingagoni kushivirira kana kukundikana kupindura zvakakwana kune ACE inhibitors kana ARB.
Sezvo humwe ruzivo rweEntresto rwakawedzerwa, kushandiswa kwaro kuchaita kuti kuwedzere.
Ivabradine . Ivabradine mishonga inoshandiswa kuderedza mwoyo wekutengesa. Inoshandiswa mumamiriro ezvinhu seasina kukodzera tachycardia , uko kutara kwomwoyo kusina kukwidziridzwa. Vanhu vane DCM vanogonawo kuva nokuzorora kwemitengo yepamusoro iyo yakakosha zvikuru kudarika inofungidzirwa yakanaka, uye pane uchapupu hwekuderedza iyo yakakosha yepamwoyo yemoyo ne ivabradine inogona kuvandudza migumisiro. Nyanzvi dzakawanda dzezvemapurisa dzinofunga kushandisa ivabradine kune vanhu vanowedzera kurapwa nemamwe madhiragi (kusanganisira beta blocker) uye avo vachiri nekunzwa kwepfungwa yepamwoyo pamusoro pemakore makumi manomwe neminomwe paminiti.
Digoxin. Kunyange mumakumi makumi emakore apfuura digoxin yaifungidzirwa sechinhu chikuru pakurapa mwoyo kusakundikana, iyo inobatsira chaizvo mukurapa DCM zvino inoratidzika kunge iri pfupi. Vanachiremba vazhinji vanongorayira chete kana mishonga inoshanda yakanyanya isingaoneki yakakwana.
Inotropic zvinodhaka. Inotropic zvinodhaka zvirwere zvinotapira zvinokonzera mwoyo musumbu kuti ushande zvakaoma, uye saizvozvo kupompa ropa rakawanda. Makore apfuura kwaive nekushingaira kukuru kwemishonga iyi, sezvo ivo vanenge vachiita nguva dzose vachigadzirisa kuwedzerwa kwekushanda kwemwoyo. Inotropic mbiri madhiragi kunyanya (milrinone uye dobutamine) yakashandiswa zvakakwana pakugadzirisa vanhu vane kukanganisa kwemwoyo kwakanyanya, uye yakashandiswa zvakare mune remishonga kwenguva refu yevamwe vanhu vane mwoyo wakaoma kusakundikana. Zvisinei, zvidzidzo zvinotevera zvakaratidza kuti vanhu vaibata neinotropic zvinodhaka-pasinei nekuvandudzwa kwezviratidzo izvo zvaiwanzoitika - zvakanyanya kuwedzera kufa. Iyi mishonga ikozvino inoshandiswa zvikuru kwazvo, uye chete kune vanhu vane mwoyo yakaoma kukundikana avo vakundikana kupindura kune dzimwe nzira dzakawanda dzokurapwa.
Cardiac Resynchronization Therapy
Cardiac resynchronization therapy (CRT) inoratidzira mafungiro emwoyo anokonzera zvose zvinonzi ventricles (kurudyi uye kuruboshwe) pamwe chete. (Vashandi vanogadzirisa zvinokonzera mhepo vanosimudzira chete ventricle yakakodzera.) Chinangwa che CRT ndechekugadzirisa kushandiswa kwemhepo, kuitira kuvandudza kushanda kwemoyo. Zvidzidzo neRCT zvinoratidza kuti kurapwa uku, mumakirini akasarudzwa zvakagadziriswa, kunoguma nekuvandudzika kwemaitiro emwoyo uye zviratidzo, kunoderedza hospital, uye kunowedzera hupenyu. Chero chero murwere ane DCM uye nebato rakakura rebazi rinofanirwa kuonekwa seRCT.
Implantable Defibrillator Therapy
Zvinosuruvarisa, vanhu vane ruregerero kusvika kune yakakomba DCM vane ngozi yakawedzerwa yekufa kwechirwere chemhepo kubva ku ventricular arrhythmias . Iko inonzi cardioverter defibrillator (ICD) inogadziriswa inoratidzwa kuti inoderedza zvakanyanya kufa kune vamwe vanhu vane DCM avo vakanyanyisa kuderedza ventricular ejection fractions . Kana iwe une DCM, unofanirwa kukurukura nachiremba wako kana ICD chimwe chinhu chinofanira kufungwa iwe.
Cardiac Transplantation
Kubudirira nehupenyu hwekutsvaga kwemuviri kwakavandudzika pamusoro pemakore makumi emakore apfuura. Zvisinei, nekuda kwechirwere chekurapa, uye kune chokwadi chokuti mitsva yemwoyo iri muhope shoma, kushandiswa kwemwoyo kunosungirirwa kune avo vanorwara zvikuru vane mwoyo kusakundikana. Zvakakosha, zvisinei, kuti mwoyo yakawanda yekuisa zvipatara yakawana kuti varwere vakawanda vanotaura kwavari ne "kuguma-gadziriro yemoyo kusakundikana" havana kumbobvira vakagamuchira kushungurudzika kwemoyo kusagadzikana kwavanoda - uye apo chirwere chinotyisa chinotangwa vanovandudza zvikuru uye hapana kwenguva refu inoda kuti mwoyo upinde.
Experimental Therapy
Tsvakurudzo yakawanda iri kuitwa kuitira kuziva kana chirwere chemajini kana stem cell therapy inogona kubatsira kune vanhu vane DCM. Kunyange zvazvo zvose zvekurapa uku kuenzanisira kuratidza chivimbiso, ivo vari kutangisa pakuongorora, uye havawanzowanika kune varwere vane DCM.
Shoko Rinobva
Zvidzidzo zvinoramba zvichiratidza kuti ruzhinji rwevanhu vane mwoyo wekukundikana nemhaka yeDDCM havasi kugamuchira kurapa kwose kwavanofanira kugamuchira. Nokuda kwechikonzero ichi, kana iwe kana munhu waunoda ane chimiro ichi iwe unofanira kuve nechokwadi kuti unoziva nezvose zvinorapwa, uye kuti unozvitaurirana nachiremba wako.
> Sources:
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> Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF / AHA Nhungamiro yekutungamira kweMwoyo kusakundikana: Executive Summary: Bhuku reAmerican College of Cardiology Foundation / American Heart Association Task Force pamitemo yekuita. Circulation 2013; 128: 1810.