Atrial flutter chironga chemwoyo chinobatanidza nenzira dzakasiyana-siyana kumagetsi eropafri . Itaurwa neAtrial inoratidzirwa nemafungiro emagetsi anotsvaga anokonzerwa neAria, zvichiita kuti mwoyo wose uwedzere kazhinji unowanzoita hafu yehuwandu hwepanyika. Mumvura inoputika, inoratidziro yepagree inowanzotarisana nemakumbo mazana matatu paminiti, uye inotenderera yakawanda inenge yakapoteredza 150 kurohwa paminiti.
Nokuti iyi arrhythmia inotanga muAria, inoonekwa sechimiro chepamusoro che tachycardia .
Overview
Atrial flutter rudzi rwekudzokorora arrhythmia ; zvinowanzoitika kana simba remagetsi "richibatwa" mudunhu mukati memwoyo, uye rinotanga kupoteredza nekupoteredza dunhu iroro. Nechipfuva chetrial, reentrant yeruzhinji inokosha zvikuru iyo inowanzova mukati meanori yakakodzera, uye iyo inowanzotora nzira inoratidza.
Izvi zvinowanzoita kuti pave nehutachiona hwemvura inonyanya kukodzera kubhadhara chirwere . Nokugadzirisa kuvharwa mune imwe nzvimbo mukati meyo nzira inofanirwa, iyo reterrant circuit inogona kuvhiringidzika, uye ruzha rwegungwa rusingachagoni kuitika.
Zviratidzo
Iko kunomhanya kwepfungwa yenguva dzose kunowanzobudiswa neairusti flutter kakawanda kunotungamirira pane zvinonzi palpitations , chirwere , kuneta, uye dyspnea (kufema).
Sezvakawanda zvekare zvekugadzirisa zvirythmias, zvikamu zvehutachiona hwepanyika zvinowanzouya nekuenda zvakangoerekana zvisingatarisirwi.
Kana murwere ane ruzivo rwemagetsi ane chirwere chetachiona, chirwere chepfungwa chinokurumidza chinogona kukonzera kushushikana kwakakwana pamusana wemwoyo kunokonzera angina . Kudengenyeka kwepanyika kunogonawo kuunza kukurumidza kuwedzera kwezviratidzo kune vanhu vane mwoyo kusakundikana .
Pertinence
Nemhaka yokuti zviratidzo zvinowedzera zvinogona kusinganzwisisiki, kuputika kwepanyika kunenge kuchida kukuruka kunyange dai zvose zvaiita zvakakonzera kupindira, chirwere uye dyspnea.
Asi dambudziko guru rakabatana neyemvura inoputika ndeyekuti, sezvakangoita neyetrial fibrillation, iyi arrhythmia inowanzoita kuti thrombus kuumbwa (blood clots) muAria. Aya mabhanhire eropa anokwanisa kusunungura ( embolize ) uye anoita kuti varohwe . Saka vanhu vane ruzha rwemagetsi, sevaya vane hutachiona hwetrial, vane dambudziko rakawandisa rekurohwa.
Uyezve, kuputika kwemvura kunowanzowanzova "bhiriji arrhythmia" kune inrial fibrillation. Izvozvo zvinoreva kuti vanhu vane ruzivo rwemagetsi vanowanzoenderera mberi kuti vave nehuwandu hwehutachiona hwehutachiona.
Risk Factors
Kunyange zvazvo chero munhu angakwanisa kukura mumagetsi, haisi chirongwa chinowanzoitwa arrhythmia. Izvo zvishoma kudarika nguva dzose, somuenzaniso, pane kushaya mafiriya.
Vanhu vanowanzova nehutachiona hwemagetsi ndevamwe chete vanogonawo kukura mafirimia fibrillation. Izvi zvinosanganisira vanhu vanorema, kana vane vane chirwere chemapapu (kusanganisira mapurumari embolus ), kurara kwepabonde , chirwere chinorwara sinus , pericarditis , kana hyperthyroidism . Inyanzvi yeAtrial inowanikwawo kune vanhu vakave nekuvhiyiwa kwemoyo munguva pfupi.
Kuziva
Kuongorora ruzivo rwemagetsi kunonyatsojeka. Zvinongoda kutora magaramusi kune ECG , uye kutarisa izvo zvinonzi "flutter mazai." Mafungu eFutter ndiwo zviratidzo zvinowanikwa paEECG iyo inomiririra kushandiswa kwemagetsi kunofamba-famba kumativi ose uye kwakakomberedza rerial reentrant circuit.
Kurapa
Nechimwe chinhu chikuru, kurapwa kwemvura inoputika kwakafanana neyomutambo wechirungu. Izvo zvakasiyana ndezvokuti, kana zvichienzaniswa nefriday fibrillation, kushandisa chirongwa chekubvumira kupedza kubhururuka kwepanyika kuri nyore nyore kuita.
Acute Episodes
Mune varwere vari kuve nechiitiko chakakomba, gomba rinenge risina kumira rinogona kumiswa nyore nyore nemagetsi emhepo , kana kuti nekunyatsorisa antiarrhythmic zvinodhaka (kazhinji, ibutilide kana dofetilide).
Kana zviratidzo zvikaoma panguva yechirwere chakaoma, kunonoka kutora mwoyo kunogona kudikanwa paunenge uchigadzirira garadioversion. Izvi zvingawanzoitika nokukurumidza kuburikidza nekupa maitiro emagetsi e calcium blockers diltiazem kana verapamil, kana kukurumidza-kuita intravenous beta blocker esmolol. Iyi mishonga inofanirwa kushandiswa nekuchenjerera, zvakadaro, kune varwere vane mwoyo yekukundikana.
Long-term Treatment
Pane imwe nguva chikamu chakaoma chave chichitaridzirwa, danho rinotevera nderokuedza kubvisa mamwe mapepa epamusoro-soro. Panyaya iyi zvakakosha kutarisa, uye kubata, chero chinokonzera chinokonzera chikonzero, chakadai se hyperthyroidism, kupererwa kwepnea, kana kuneta. Hyperthyroidism inogona kutongerwa zvakakwana mukati memazuva mashomanana, uye kurara kwepabonde kunowanzorapa mukati menguva yakafanira. Kunyangwe kuderera kunokonzera kukonzera kusarudzwa kwemvura inoputika, nenzira inobatsira iyo inowanzoregererwa zvakakwana kana kuti nokukurumidza zvakakwana kuti ibatsire kurapwa kwechirongwa ichi - saka dzimwe nzira dzokudzidzira dzinofanira kushandiswa.
Kana pasina chikonzero chinongoramba chichidzokorora chinowanika, chirwere chisingaperi chisingarapiki chinodiwa. Iko kusingagumi kurapwa kwemvura kunowanzosanganisira yekuderedza chirongwa chemishonga, kana kushandisa chirongwa chekubvisa.
Antiarrhythmic madhiragi ane urombo hwakanaka hwekubudirira nehuwandu hwemvura - asi 20% kusvika ku30% yevarwere vanorapwa nemishonga vanogadziriswa kubudirira mushure memakore ekurapa. Nokuda kwechikonzero ichi, uye nekuda kwezvinhu zvakawanda zvinokonzerwa ne antiarrhythmic drugs therapy, chirongwa cheblation chinonyanya kushandiswa kwekusarudzwa kwetrial flutter.
Nenzira yakanaka, sezvakambotaurwa, kubviswa kweputika yemvura kunowanzova nzira yakananga, nenzira ine huwandu hwakanaka hwekubudirira - zvinopfuura 90%. Muzhinji rwevarwere vane chirongwa ichi, kublation kunofanira kunyatsoongororwa.
Sezvo kubvumira kunoshanda zvakanaka, kushandiswa kune "chirongwa-chengeteredzwa" (inowanzoshandiswa kwepriyri fibrillation) inongowanzodikanwa kuyanzvirwa kwetrial. A rate control zano rinoreva kubvumira urongwa hwemagiramu kuti huvepo, uye kutarisa kutsva kwe mwoyo, kuti kuderedza zviratidzo.
Kudzora muchero wemwoyo mumhepo inoputika kune zvakanyanya kuoma kudarika iyo ne-atrial fibrillation, uye kazhinji inoda kushandiswa kwekubatanidzwa kwe beta blockers uye calcium blockers. Pane dzimwe nguva, kuti mwoyo uwedzere kutungamirirwa zvakakosha kubvisa mwoyo wekugadzirisa unhu hunoita kuti hugadzire mwoyo , ipapo isai pacemaker kuti ugadzire mwoyo wakadzikama. Zviri pachena kuti kubvisa kubhururuka kwepanyika zvakakwana pamwe nekugadzirisa nzira inowanzova ndiyo nzira yakanakisisa yekuita.
Mumamiriro ezvinhu apo chirongwa-chengetedza chirongwa chinoshandiswa, zvisinei, chisingarapiki anticoagulation therapy inokurudzirwa kudzivirira kushungurudzika, sezvinongoita neutrial fibrillation.
Sources:
Wellens HJ. Nhasi kutungamirirwa kwegungwa rinoputika. Circulation 2002; 106: 649.
Granada J, Uribe W, Chyou PH, et al. Nharaunda uye kufungidzira kwemhepo inoputika muhuwandu hwevanhu. J Am Coll Cardiol 2000; 36: 2242.