Muna 2010, vanotsvakurudza kubva kuYunivhesiti yeTexas Southwestern Medical Centre vakabudisa nyaya pamusoro pemhosva ye postural orthostatic tachycardia syndrome (POTS) . Nyaya yacho yakakonzera kukakavadzana kukuru uye kutsamwa pakati pevakaremara vePOTS, nekuda kwekududzirwa kwezvibereko zvayo, uye nokuda kwezita idzva vanyori vakagadzirirwa chirwere ichi - Grinch Syndrome.
Kuchema, chokwadi, kwaive kwakakura kwazvo zvokuti mukuru wezvinyorwa izvi, akanyora kudaro POTS muongorori Dr. Benjamin Levine, akabvuma chikumbiro chomunyori uyu kuti ataure pamusoro pehurukuro pachena. Mhinduro yake inowanikwa pasi apa.
Pamusoro pePOTS
POTS ndiyo mamiriro ezvinhu umo mwoyo womunhu unowedzera kumazinga akakwirira paanomira. Inowanzoperekedzwa nehutema hwakasimba, palpitations , uye dzimwe nguva nes syncope . POTS, iyo inogona kuvhiringidza zvikuru, ine zvakawanda zvakafanana nedysautonomias dzakasiyana-siyana. Inowanzowanzoonekwa muvechidiki, zvisinei kuti vanhu vane utano hwakakwana, uye mumadzimai kakawanda kupfuura varume.
Chidzidzo
Dhiyabhorosi reLineine vakadzidza vanhu 27 vakataura kuSouthwest nePOTS. Zvinyorwa zvitsva zvaive: 1) Hapana chimwe chezvidzidzo chakanga chisinganzwisisiki muhutano hwavo hwekutonga. 2) Vakawanda (inenge 70%) vaiva nemoyo mishoma uye pasi rekuyera ropa, zvakagadziriswa zvinoenderana nekududzirwa.
Uye 3) Pakati pevadzidzi, vateereri vakagamuchira zvakanaka zvikuru purogiramu yakawedzerwa, yakarongedzwa yekurovedza maitiro.
Vanyori vakapedzisa kuti POTS "pane imwechete" mamiriro ezvinhu anokonzerwa nekududzirwa. Nemhaka yemiduku miduku yavakaona mune vazhinji vevanhu vavo, vanyori vakarongedza (zvichida vane nendimi mumatama) vachitsanangurira POTS kuGrouch Syndrome (nokuti kugunun'una, maererano nemashoko akajeka, vane mwoyo muduku).
Mhinduro yevarwere vePOTS
Mapepanhau enyika dzakaputika pamusoro pechinyorwa ichi apo yakabudiswa, kuisa pamatanho maviri: iyo inofadza zita idzva Grinch Syndrome, uye pfungwa yokuti POTS inotungamirirwa nekutungamira hupenyu huripo. Izvi zvakapararira zvakashata zvekudzidza zvakakonzera kushamiswa kunoshamisa kubva kune vane chirwere chePOTS munyika yose.
Vanhu vanotarisana nePOTS vakatora huwandu hwemagariro evanhu mumitemo yakawanda kuti vanyunyuke pamusoro pekudzidza uku. Mukuwedzera kune chido chakajeka chekusada kutumidzwa sezvipfeko, vakatsigira kuti kupa mitezo yese yePOTS yekudzivisa haisi kungoipa chete asi inogona kukuvadza kune vane chirwere chePOTS.
Hazvina mubvunzo kuti ihwohwo huwandu kana vanhu vese vasina POTS yakakosha zvakasarudzwa. Iwe unenge uchitemwa zvakare kana iwe usingakwanisi kumira kunze kwekuti uine mutsara wakajeka kana kupfuura. Uye chidzidzo chaicho chakasimbisa kuti iyi ndiyo mhaka.
Asi chokwadi chokuti varwere vane POTS vangave vakaratidzwa kuti vane deconditioning hairatidzi (uye chaizvoizvo, haina kana kuratidza zvakasimba) kuti kudonongodza ndiko kukonzera kwePOTS, panzvimbo pekupedzisira.
Vanhu vanoongororwa kuti vane POTS vakatova nenguva yakaoma zvikuru kuti vawane vanachiremba nemhuri kuti vatore zvirwere zvavo zvakakomba.
Vanowanzopfuura nhamo yakareba yekutaurirwa nevanachiremba vanoverengeka kuti vane dambudziko kana kuora mwoyo kana zvimwe rudzi rwekutendeuka unopindura panzvimbo yechokwadi, physiologic mamiriro ezvinhu. Inowanzove mavhiki kana mwedzi, uye pane dzimwe nguva makore, musati mumwe chiremba achizopedzisira aona kuongorora kwechokwadi.
Uye ikozvino, kunyange mushure mokunge chirwere chinoratidzika chinogadzirwa, vanotarisana netariro yekuonekwa seve kuunza mamiriro avo pachavo, nekuda kwe "deconditioning," iyo inowanzotaura hurukuro yezvechiremba nekuda kwekugara kwenguva refu, kusava nehanya, uye kusviba. Uye kana mhuri yavo ichitaurirwa kuti dambudziko racho rinongobatsira, kuburikidza nemichina ye sloth, uye inoudzwa izvi nechiremba zvisati zvishoma, muwandu wekutsigirwa POTS vane chirwere vanogona kugamuchira kubva kune vadiwa, panguva chaiyo ivo kurwisana kuti vadzoke uye vari kunyanya kuidya, ichafanotaurira kupera.
Saka hue uye kuchema kubva kune vane chirwere chePOTS apo nyaya ino yakabudiswa i nyore nyore kutsanangura.
Dr. Levine Anopindura
Dhiabhorosi Levine akafadzwa kuti apindure pamatambudziko anotsanangurwa nevarwere vakawanda vePOTS mushure mekunge chidzidzo chake chibudiswa. Mukuita saizvozvo akaita nhatu huru huru.
" 1) Kukurudzira kwekutsvaga tsvakurudzo. Chokutanga pane zvose, regai ndikuratidzei kuti handina kumbo "kusimbisa" basa redu mune chero zvinyorwa zvemashizha, uye hapana mumwe munhu ari munharaunda yangu. Kutaura chokwadi, ini handiri mukuru mukuru wekubudisa nhau yezvesayenzi data, uye kunyange ini ndichataura nevanyori venhau kana vachidana kana ndikagona kupa chero humwe unyanzvi hwakasiyana, ini handitsvaki. Sezvandinoziva iwe unoziva, hatina simba pamusoro pevanyori venhau vanotaura nezvebasa redu. Vateereri vedu pamapepa edu ndevamwe vanachiremba uye masayendisiti, avo vanofanira kushandura dhesi yacho zvichienderana neruzivo rwavo uye kuverenga kwemabhuku. Ini ndinorayira varwere vose vanofanira kuwana ruzivo rwavo kubva kune vhidhiyo kuti varege kudarika-kududzira zvavanenge vaverenga mumagazini kana kuona paTV.
2) POTS haisi kukonzerwa ne "usimbe." Vazhinji vevarwere vandinoona vaishanda zvikuru (semashambadziro edu, avo vatakagadzirira POTS chirongwa chekudzidzisa) zvisati zvaitika kune chimwe chinhu - kune vamwe utachiona hwehutachiona; vamwe kukuvara kana zvimwe zvirwere; vamwe ndiko kutora mimba kana zvinetso zvekupa mwana. Ichi "chiitiko chetinel" chinokonzera chinhu chimwe chete chinoitika - chinoisa vanhu kurara.
Zvakakosha kusimbisa kuti kunyange maawa makumi maviri ekuzorora pamubhedha anogona kukonzera kurasikirwa kweplasma yepamusoro, kusina simba baroreflex basa, uye hutsika hunoita mutema mukati mevanhu vakawanda. Pashure pevhiki mbiri bedzi yemubhedha kana nzvimbo yepakati, inenge 2/3 yevanhu haigoni kumirira kwemaminitsi gumi!
Izvi zvakakoshawo kuziva kuti zvidzidzo zvepakutanga kubva panzvimbo yedu yakaratidza kuti ndiyo yaiva mitambo yakanakisisa yevamwe vanga vainge vasina kukwanisika kunyange kunyange nguva shoma (masvondo matatu) zororo zororo, uye kwenguva refu yekudzikinura nguva. Zvechokwadi, vazvipiri vakanga vasati vakodzera vasati vaenda kunorara, vakachimbidzika zvakakurumidza mukupindura kudzidziswa kwakapedzeredzwa, kazhinji mukati memavhiki maviri. Kune rumwe rutivi, ivo vanozvipira zvikuru kumitambo, mushure memavhiki matatu ekuzorora pamubhedha uye mwedzi miviri yekudzidziswa kwakasimba, vakanga vasati vadzokera kuhutano hwavo hwepakutanga. Zvinoshamisa, takadzidza zvidzidzo zvakafanana makore makumi matatu mushure mekudzidza kwepakutanga uye takaona kuti, zvinoshamisa, hakuna munhu mumwe chete akanga ari mumamiriro akaipisisa makore makumi matatu gare gare, kupfuura ivo mushure memavhiki matatu ekurara mumakore avo makumi maviri.
Mune mamwe mazwi, masvondo matatu ekurara aiva akaipa kune simba remuviri wekunyama muviri kunopfuura makore makumi matatu ekukwegura. (ona McGuire et al Circulation 2001).
Pasinei nokuti chii chakakonzera chiitiko chekutanga, panguva iyo chirwere (kana chero chii chakaitika) chakamhanya, varwere vakasara vane hurema hwakakomba (mumwe murwere mukudzidza kwedu akanga asingakwanisi kugara wakarurama kwemakore anopfuura 2 ) iyo inoratidzika kuva nani zviri nani nepurogiramu yedu yakatsaurirwa, yakananga, zvishoma nezvishoma kutanga muchikamu chechimiro chekugadzirisa. Izvozvo zvinoshandiswa zvinogona kunge zvakakosha mutsva kubwinya kwatakaunza patafura pakuchengeta varwere vePOTS.
Vazhinji POTS havagoni kushivirira kumira kwakanaka kuti kutanga kugara pasi kana kunyange kurara kumashure kunokosha pakubudirira kwavo. Uye zvakaoma! Varwere vakawanda vanotambudzika kuti vapedzise mavhiki mashomanana epurogiramu yekudzidzisa, iyo inotanga nenzira inotanga nemaminitsi makumi matatu pazuva, mazuva matatu pavhiki. Asi kana vakadzvinyirira kuburikidza nekunetseka kwekutanga, vanowanzozviwana ivo zvishoma nezvishoma vachinzwa zviri nani uye vakasimba.
Izvi zvinosimbisa pfungwa inokosha - Hatina kumbofunga kuti imwe POTS mumwe murwere akanga ane usimbe kana asina hanya - kana zvaive nyore kuratidzira POTS nekurovedza muviri, munhu wose aizoita !! Zvisinei kana tikashandisa purogiramu chaiyo yekudzidzisa yakatarira pakuita kuti mwoyo uwedzere, huwandu hwevarwere huri kunzwa huri nani uye vazhinji "vanoporesa", zvinoreva chete kuti havasati vasangana nemirairo yePOTS. Ndinofanira kusimbisa kunyange zvazvo kuchengetedza utano ndicho chinangwa cheupenyu hurefu chevarwere vedu vePOTS uye tinovakurudzira kuti vaone kurovedza muviri sechikamu chehutsanana hwavo. Kune avo varwere vakandinzwa ndichitaura, voga kune avo sevarwere, kana kuti pachena pamisangano, vanoziva kuti NDINOSIMBISA kuti "mwoyo yevasimba deconditioning" inzira chaiye uye inotsanangurwa isina chinhu chero chipi zvacho chinoita neuchenjeri.
Rega ndidzokerezve pfungwa iyi: CARDIOVASCULAR DECONDITIONING HAIYE YAKATAURWA "KUZIVA KUNYARA" !!!!! Chero ani anotsanangura deta yedu nenzira iyo kusanzwisisa zvitsva zvedu uye kurapa kwedu. Ndine tsitsi huru kuvarwere vedu vazhinji avo vanowanzovhiringidzika, uye ndakashungurudzika nokuda kwehuwandu hwebasa rangu ndichiedza kuwana mishonga inobata nguva dzose.
3) Nezve "Grinch Syndrome." Pakupedzisira, rega ndipedze nemashoko mashomanana pamusoro peGrish. Iro huwandu hwevarwere vedu vanonzwa izwi rokuti "The Grinch Syndrome" kuseka uye kunyaradzwa mumweya umo inoratidzwa. Kune rumwe rutivi, ndinonzwisisa kuti vamwe varwere vasingandizivi, uye vane hanya nekunyorwa nezita iro rinosanganiswa nekuve rine simba, rinoshandiswa kushandiswa kwezwi rokuti Grinch Syndrome, uye ndinoremekedza izvo zvinonetsa. Kutaura chokwadi, dai ndaifanira kuzviita zvakare, zvimwe ndingadai ndakanga ndisingachadi kushandisa izwi racho, uye ndinoda kuti varwere vose vePOTS vazive kuti isu tinovaudza kuti hapana chakaipa. Hapana "mukurumbira uye hupfumi" hunosanganiswa nezita iri uye ini handiwani rubatsiro rwomunhu kubva pakushandisa izwi iri. Zvisinei, ndakaona kuti inoshanda zvakadini pakushevedza kune izvo zvatakaona sepakutanga pathophysiology inobatanidza nekunyanyisa kwakanyanya kwevarwere. Sezvo ini ndinowanzoudza varwere vangu, izwi rokuti "POTS" rinongoratidzira mutsara pokuti mwoyo wemurwere unorova nokukurumidza pavanomira. I "Grinch Syndrome" inotarisa kumucheto, pane CHIMWE chimiro chemwoyo chakamira zvakanyanya-kureva kuti moyo "mashoma maviri akawandisa."
Kubva pahuwandu hwehuwandu huwandu hwevanhu, 2.5% yevakadzi vose vari munyika vachave nemwoyo unopfuura maitiro maviri ezvisikwa pasi pezvinoreva - tsanangudzo ye "yakasununguka" mukurapa. Tinotenda kuti vakadzi ava vari pangozi yekuwana zviratidzo zvePOTS zvinogona kukonzerwa zvinoshamisa nokukurumidza kunyange nguva pfupi yekuvata.
Pakupedzisira, zvakadaro, ndinoda kusimbisa kuti kuseka chinhu chine simba chekuporesa, kwete chete kune varwere vane POTS, asi chinenge chinenge chirwere chipi zvacho. Tinobata varwere vedu vose neruremekedzo rwakadzama uye vanoziva zvakajeka zvavari, izvo zvatinotora zvakanyanya. Mark Twain akamboti "Kuzvininipisa ndiko chikomborero chikuru chevanhu"; tinotenda kuti chikamu chinokosha chekuporesa uye tariro yokuti varwere vedu vose vanoyemwerera pavanofunga nezveThe Grinch, uye voenda kunoshanda!
- Dr. Benjamin D. Levine "
Shoko Rinobva
Dr. Levine mutsvakurudzi akazvitsaurira uye akangwarira, uye muviri wake webasa paPOTS yakasimudzira ruzivo rwedu pamusoro pechiitiko ichi zvikuru, uye somugumisiro, zviuru zvevanhu vane chirwere ichi vari kubatsirwa.
Zvinosuruvarisa kuti vanhu vazhinji - mukati kwete kwete chete nhau asi mukati mebasa rezvokurapa - vakatungamirirwa kuti vatsanangurire chidzidzo chake sechiratidza kuti POTS nenzira imwe neimwe chirwere chinokonzerwa nemunhu. Dhiabhorosi Levine pamusoro pechinhu ichocho anoratidza zvakajeka kuti yakanga isati yambova nechinangwa chokuratidza kuti POTS inofungidzira. Pane kudaro, zvaakawana zvinoratidza kuti nguva pfupi yenguva yekuzorora yemubhedha, zvimwe kunyanya mune vamwe vanhu vane simba (kazhinji vakadzi), zvingava zvakakwana kuti vauye pachiitiko ichi.
Chero mamiriro ezvinhu, vanhu vane POTS avo vanoda kugutsikana navanachiremba nemhuri yavo kuti mamiriro avo haasi chimwe chinhu chavakaunza pamusoro pavo iye zvino vane chirevo kubva pamuromo wemabhiza ichiratidza kuti POTS chinhu chinongoitika kuvanhu.
> Sources:
> Freeman R, Wieling W, Axelrod FB, et al. Kubvumirana Nhoroondo pamusoro peDonstatic Hypotension, Neurally Mediated Syncope uye Postural Tachycardia Syndrome. Auton Neurosci 2011; 161: 46.
> Fu Q, VanGundy TB, Galbreath M, et al. Nhengo dzeCardiac Of The Postural Orthostatic Tachycardia Syndrome. JACC 2010; 55: 2858-68.
> Kimpinski K, Figueroa JJ, Singer W, et al. Anotarisira, 1-Kuongorora-Kudzidza kwe Postural Tachycardia Syndrome. Mayo Clin Proc 2012; 87: 746.