Kururama kwepfungwa kunokonzerwa nemamiriro ezvinhu umo rutivi rworudyi rwemwoyo harukwanisi kuputira ropa kumapapu sezvakanaka sezvakajairika.
Kuvhiringidza kwemoyo kupompa ropa zvakakwana kumapapu kunokonzera ropa kuti ridzokere muchirwere chemhepo, uye inogadzirisa kubuda kwemwoyo (iyo yose inopa ropa mwoyo unogona kupomba paminiti). Zviratidzo zvinokonzerwa nekunonoka kwepfungwa kusagadzikana zvinogona kuva zvakanyanya, uye ichi chiitiko chinogona kuderedza zvakanyanya mararamiro ehupenyu kana asingakwanise kutarisirwa zvakakwana.
Kusava nemwoyo kunokwanisika kunowanzobatana pamwe chete necheboshwe pamwoyo kusakundikana, saka izwi rechirevo rokuti " moyo kusagadzikana " rinowanzosanganisira zvimwe zvisingabatsiri zvemativi ose emwoyo.
Asi pane imwe nguva, kukanganisa kwemwoyo kunokwanisika kunogona kuitika pachako, asi basa reruboshwe rwomwoyo rinoramba ruchigere (kana rinenge rukuru). Zvakakosha kuziva kukanganisa kwemwoyo kunokonzerwa nemoyo kana uripo, nokuti zvinokonzera, zviratidzo zvinowedzera, uye kurapwa kwaunoda, zvinowanzosiyana nezvinoyevedza, zvinowanzosiyiwa-maitiro emoyo kusakatika.
Mwoyo Wekona Kumativi vs. Kuruboshwe Kuruboshwe
Kuenzaniswa nerutivi rworuboshwe rwemoyo, mwoyo wakarurama pane zvisingashamisi. Basa reruboshwe rworuboshwe nderopa ropa kubva mumoyo, rinopesana nekumanikidzika kukuru, kune nhengo dzose dzomuviri (kunze kwemapapu). Kuita basa iri zvakakwana kunoda kuti masvingo emasvingo echokumabvazuva ave nesimba uye akasimba.
Kusiyana neizvi, basa rakanaka rokubvumira mhepo nderokuputira "kushandiswa," demoxygenated ropa kusvika pamapapu kuburikidza nemishonga yemapurmonary, saka inogona kuzadzikiswa nemhepo. Nemhaka yokuti mishonga yepermonary is low-pressure system, ventricle yakarurama haifaniri kuwedzera yakawanda yeropa kuitira kuti iite basa rayo.
Nokuda kwechikonzero ichi, nepo ventricle yakarurama inofanira kuputira ropa rakawandisa nemwoyo mumwechete kurohwa sechisimba chekusiya, muwandu webasa rinofanira kushandiswa pakuita izvi zvinongoda 25 muzana yebasa rakasara re ventricle rinofanira kuita. Nemhaka yekuti ventricle yakarurama inoshanda munzvimbo yakaderera-yakamanikana, yakadzika-kushanda, iyo yakagadzikana yakasimba-yakagadziriswa, uye ine muto mutsvuku wemwoyo kupfuura yevasikiriri yakasara.
Rutivi rworudyi rwemwoyo runoshanda zvikuru mukuputika kunyange mazana akawanda eropa (zvakadai panguva dzatinenge tichiita zvakanyanya). Asi mhepo yakasimba-yakagadzirirwa yakasimba yakanyanyisa haisi kushanda zvakanaka mukushanda mumamiriro ezvinhu ekudzvinyirirwa. Nokudaro kana ventricle yakarurama ichizviwana ichishanda kwenguva yakareba yakatarisana nezvinetso zvakakwirira mumapirmita arteri, inotanga kukanganisa.
Nokudaro, kukanganisa kwemwoyo kwakasununguka kunowanzoitika mumamiriro ezvinhu anokonzera kukwidziridzwa kwepamusoro mumapirmita arteri-ndiko kuti, kana kupemha kwepenemenha iripo. Apo iyo ventricle yakarurama inozviwana iine kuputira nekumanikidzika kukuru, inongogona kushanda zvakanaka, uye kunze kwekuti kukwirira kwakanyanya kusunungurwa, kururamisa kwemoyo kunokonzera kusagadzikana.
Zvinokonzera Kurudyi-Akabatanidzwa Mwoyo Kukundikana
Nyaya yemamiriro ezvinhu anokonzera zvakakosha pamwoyo kukanganisa yakasiyana nemamiriro ezvinhu anounza "zvekare," kunyanya kusiyiwa-mwoyo mwoyo kusakundikana.
Nemhaka yekuti ventricle yakasara ine chikamu chechirwere chemuviri wemwoyo, zvirwere zvehutano zvinokanganisa moyo wemisumbu zvinowanzokonzera zvikurukuru kuruboshwe rwe ventricle. Nokudaro, kukanganisa kwemwoyo kunokonzerwa nekurwadziwa kwemoyo, kupera kwepfungwa, chirwere chemoyo , uye marudzi mazhinji ehutano hwemwoyo , rinowanzowanzosiyiwa-mwoyo kusakundikana kwemoyo.
Kusiyana neizvi, mamiriro ezvinhu anokonzera kukanganisa kwemwoyo kunokanganisa kunowanzowira mumapoka matatu akaenzana: mamiriro ezvinhu anounza mishonga yeupemenia yehutachiona, zvimwe zvirwere zvehutano hwemwoyo ye valvular, uye zvakanaka ventricular mwoyo kurwisa.
Pulmonary Hypertension
Kururamisa kwepfungwa kwakakosha kakawanda kunowanzoitika nekuda kwepemonta yeupemha. Rwendo rurefu rwemamiriro ezvinhu rinogona kubudisa mishonga yeupemenia , uye ose awo anogona kutungamirira kukakundikana kwemoyo. Zvinonyanya kukonzerwa nepermonary hypertension inotungamirira kumakumbo ekururama kwemoyo zvinosanganisira:
- Kuruboshwe-pamwoyo kukanganisa kwemwoyo: Moyo kukanganisa kunonyanya kuisa rutivi rworuboshwe rwemoyo (ndiko kuti, "chimiro" chemoyo kusakundikana), kunowedzera kushungurudzika mukati me pulmonary vascular system, uye iyi yakakwirira yemapemmonia inowanzoendesa, pakupedzisira, kurudyi mwoyo kukanganisa. Muzvokwadi, zvakarurama kutaura kuti kukanganisa kwemwoyo kunokonzerwa nemoyo yakakosha uye zvinokonzerwa nehupenyu hwekureba kana kusabatwa zvakasara kumwoyo kusakundikana kwemoyo.
- Kugadzirwa kwepulmonary: Kukura kukuru kwemapurmoni kunogona kukwidziridza mishonga yemapurmoni kunetseka kusvika kune yakakwirira kwazvo, uye zvinogona kuita kuti munhu akwanise kushaya mwoyo. Zviduku, zvinowanzoitika zvepermon emboli zvishoma nezvishoma zvinowedzera mishonga yemapiritsi inoshandiswa, uye zvingadaro zvinokonzera kutanga kwekunyengera kwekushaya kwemoyo kwakarurama.
- Chirwere chemapapu chirwere: Mazuva ose mapfupa epamapapu, kunyanya chirwere chisingaperi chinokonzera chirwere chepinimoni (COPD) kana kuti kubvumira kubatwa nehope dzomukati , kunogona kuguma kubudisa mishonga yeupemenia uye kukanganisika kwemoyo.
- Acute respiratory distress syndrome (ARDS) : Ichi inogona kubudisa maitiro akaoma epammonary hypertension uye kukanganisa mwoyo kusarurama.
- Congenital chirwere chepfungwa: Kunyanya atrial septal chirema uye ventricular septal kasina, izvi zvinogona kuguma kubudisa mishonga yepamusoro uye kushaya mwoyo kwakakwana.
- Zvimwe zvinokonzera kusuruvara kwepermonta: Izvi zvinosanganisira primary pulmonary hypertension, scleroderma , sarcoidosis , kana kuti maitiro akasiyana-siyana evasculitis anokanganisa mapapu.
Kubva pane urongwa uhwu, zvinoratidzika kuti "yakachena" yakarurama-yakagadzikana mwoyo kusakundikana-kureva, kururamisa-kushaya mwoyo kusakundikana kusina kukonzerwa nechirwere chepfungwa chinosanganisira rutivi rworuboshwe rwemoyo-rinenge nguva dzose nekuda kweimwe nzira yepapu disorder iyo inobereka pulmonary hypertension. Kururama kwepfungwa kunokonzerwa nechepamusoro pemapurmonary chinonzi cor pulmonale . Nokuti kukanganisa kwemwoyo kwakagadzikana kunowanzokonzerwa nemamiriro emapapu, vanachiremba vakawanda vanoshandisa "cor pulmonale" sechinhu chinonyanya kufanana nechepamusoro-soro kusakundikana kwemoyo.
Zvisinei, kukanganiswa kwemwoyo kwakagadzikana kunogona kuva nezvimwe zvinokonzera zvakare, naizvozvo aya mazwi haasi echokwadi chaiwo.
Valvular Heart Disease
Chero chero rudzi rwechirwere chepfungwa chinonzi valvular chinonyanya kukosha ndechekuwedzera kukonzera mukati mekodzero yemwoyo, kana kuti kudzivisa kuputika kweropa kuburikidza nekodzero yemwoyo, kunogona kuita kuti mwoyo wakakundikana usina kukwana.
Kunyange zvazvo zvirwere zvemaoko emakumbo emagetsi-cheviguspid valve uye valve yeplmmary-inogona kukonzera kukanganisa kwemwoyo kusakundikana, izvi zvinoita kuti zvive chikonzero chisingawanzoiti. Kudzorera (kubvaruka) kwezvivharo zviviri izvi zvinowanzoguma (uye kwete chikonzero) chemapupa eupinha. Stenosis (narrowing) yemapapu aya inowanzokonzerwa nehutano hwepenital or rheumatic heart iyo inokanganisa zvimwe zvikamu zvemoyo kusvika pamwero mukuru. Saka kana chirwere chinonzi tricuspid kana pulmonary valve, pacharo, ndicho chikonzero chinonyanya kukanganisa chekusarurama kwemoyo kusakundikana.
Ukuwo rumwe rutivi, stenosis ye mitral valve -vhavhavha iyo iri pakati pekupedzisira ye-atrium uye yakasiya ventricle-kazhinji inokonzera zvakanaka-heart heart failure. Ropa kudzokera kuruboshwe kuruboshwe kubva kumapapu rinowanzoita "dam up" apo mitral stenosis iripo, zvichiita kuti kuwedzerwa kwemishonga mumakapu, izvo zvinoguma zvichibudisa hutachiona hwehutachiona uye kukanganisika kwemoyo.
Right Ventricular Myocardial Infarction
Vanhu vane myocardial infarctions (kurwadziwa kwemoyo) kunokonzerwa nekuvhara mukati memaawa ekutendeseka kunogona kutambura nekukuvadza kune kodzero ye ventricular musumbu, zvichiita kukanganisa mwoyo kusina kukwana. Kurapa kodzero ye ventricular yekurwisa mwoyo inowanzofanana nekurapa chero STEMI , kusanganisira kuzarura mhepo yakadziviswa yakavhara nemishonga inonzi "clot-busting" kana stent .
Zvisinei, nokuti kukanganiswa kwemwoyo kwakakosha kunogona kuderedza kuwanda kweropa rinosvika kuruboshwe rwomwoyo, zvinodhaka zvinowanzoshandiswa mukurapa kuseri-sided ventricular kusimba (zvakadai se nitrate , beta blockers , uye calcium channel blockers ) inofanira kushandiswa nekunyevera kwakasimba muzvakarurama zvekurwa kwemoyo yemwoyo.
Zviratidzo zveKakarurama-Mwoyo Wakakundikana
Zviratidzo zvinokonzerwa nekunonoka kwemwoyo zvakakundikana zvinogona kufanana zvikuru nezviratidzo zvinowanikwa nevanhu vane "zvakajeka," kunyanya kusiyiwa-mwoyo kusakundikana kwemoyo. Izvi zvinosanganisira dyspnea (kukurumidza kufema), kushaya simba, nyore kuneta, uye edema (kuzvimba).
Nekunetseka kwemwoyo kwakagadzikana, zvisinei, zvimwe zvezviratidzo izvi zvinogona kunyanya kuoma. Dyspnea pamusana pekushingaira kwakanyanya, kuneta zvakanyanya, uye kunyange kunetseka kunogona kuitika. IEdhiema inowanikwa nevanhu vane kururamisa kunetseka kwemoyo inowanzoipisisa kupfuura "kungo" edema yemakumbo uye kumucheto. Vanogona kuva neodema yemakumbo, mimba, uye kunyange bhokisi.
Uyewo, zviputi zvavo zvinogona kuvhiringidzika uye zvinorwadza, uye zvinogona kukura ascites (mvura inowedzera mumimba yepamuviri). Anorexia (kurasikirwa kukuru kwechido) inogona kukura kuva chiratidzo chakakurumbira. Vanogonawo kunge vane exertional syncope (kurasikirwa kwekuziva), nokuti havagoni kuwedzera chibereko chemoyo yavo pavanoshandisa.
Kuongororwa Kwekakarurama-Mwoyo Wakakundikana
Kuchengetedza kwekliniki yekuchenjerera kunofanirwa kupa vanachiremba vane chivimbo chakasimba pamusoro pekuvapo kwekakarurama kwepfungwa kusakundikana. Unhu uye hutano hwezviratidzo (zvinongorondedzerwa) zvakakosha pakuita kuti uongororwe, sezvinongoita nhoroondo yezvokurapa yezvinetso zveplmnary, zvakadzama zvinokonzerwa nehupenzi kana kuti mapurmoni.
Electrocardiogram (ECG ) uye zvidzidzo zve echocardiogram zvinowanzobudisa mishonga yakakwirira yemapirmaria, uye chero chirwere chemwoyo chinonzi valvular kana zvirwere zvinokonzera mutsara wemwoyo. Aya maedzo anowanzotarisa kuongororwa kwekakarurama kwemoyo kusakundikana.
Kuwedzerwa kuongororwa kunowanzodiwa kuti ubatsire kubvisa chinokonzera kukanganisa kwemwoyo. Semuenzaniso, mapurmonary work test vanogona kusimbisa kuvepo nekuoma kweCOPD, uye kuedza kurara kunogona kubatsira kuita kuti chirwere chepnea chinorara. CT inoongorora , MRI inoongorora , uye / kana catheterization yemwoyo inogonawo kudiwa, zvichienderana neiipi iyo inokonzera chikonzero ichifungidzirwa.
Zvakakosha kuderedza chinokonzera chinokonzera, nokuti kurapwa kunobva pazviri.
Kurapa Kwakarurama-Akabatanidzwa Mwoyo Kukundikana
Kurapa kwakakwana kwekusagadzikana kwemoyo kwakarurama kunotsamira pakuziva nekurapa chinokonzera chinokonzera. Ngatitorei zvingaita zvinokonzera:
- Kana chikonzero chacho chiri chirwere chemwoyo chinonzi valvular (kazhinji kazhinji, mitral stenosis), kugadzira chironga kana kugadziriswa kwevhavha yakakosha kunokosha.
- Apo kodzero ye ventricular myocardial infarction ndiyo chikonzero, kushungurudza uye kukurumidza kuratidza kuvhudzirwa kwakarurama kwekoniyoni yerari inodiwa.
- Kana chinokonzera chinokonzera kukanganisa kwemwoyo, kukwanisa kwakakwana kwerutivi rworudyi rwemoyo kunoda kugadzirisa kurapa kwekusara kwemoyo kusakundikana .
- Apo chinokonzera kukanganisa kwemwoyo kunokonzerwa nepfungwa inonzi pulmonary disorder (kureva, kana cor pulmonale iripo), zvino kurapa kunobva pakuvandudza kurapwa kwechinetso chepapu chinowanikwa.
Kunyange zvazvo chirwere chepachirwere ichi chiri kuonekwa, uye kurapwa kwayo kwakagadziridzwa, diuretics inogona kushandiswa kugadzirisa zvakanyanya edema (kunyange zvazvo mishonga iyi inofanirwa kushandiswa zvine musoro mumoyo wakakundikana). Kuchengetedza kunofanira kutorwa kuti usapinda mamiriro ezvinhu anowedzera kuwedzera mishonga yemapiritsi yakamanikidzwa, yakadai sechepasi yeropaji mazinga, uye acidosis . Zvinodhaka zvinogona kuderedza mishonga yemagetsi zvinogonawo kubatsira.
Asi icho chinokosha, zvakare, ndechekuti kunyatsoporesa kukanganisa kwemwoyo kunoreva kushungurudza nechisimba chikonzero chinokonzera.
Shoko Rinobva
Kurara kwakakwana pamwoyo chinhu chakakomba zvikuru chinowanzokonzera zviratidzo zvakakomba, uye zvinogona kukonzera kufa nguva isati yakwana. Zvinonyanya kukosha kuti ani naani ane chirwere ichi awane kuongororwa kwakakwana kwechiremba kuti aone zvakajeka chinokonzera chikonzero, uye obva agamuchira kurapwa kwechisimba kuchinja kana kujekesa icho chinokonzera.
> Sources:
> Bruce CJ, Connolly HM. Zvirwere-Zvakagadzirirwa Zvirwere zveValve Zvinotarisirwa Zvishoma Nokuremekedza. Circulation. 2009; 119: 2726.
> Falk JA, Kadiev S, Criner GJ, et al. Denda reCardiac muHisiporese Zvisingagadziriswi Pulmonary Disease. Proc Am Thorac Soc 2008; 5: 543.
> Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC / ERS Nhungamiro yeKutsvaga uye Kurapwa kwePulmonary Hypertension: The Joint Task Force yekuziva uye Kurapa kwePulmonary Hypertension yeEuropean Society of Cardiology (ESC) uye European Respiratory Society (ERS): Yakagamuchirwa ne: Association of European Chirwere uye Congenital Cardiology (AEPC), International Society for Heart uye Lung Transplantation (ISHLT). Eur Moyo J 2016; 37:67.