Kushandisa enzyme (Angieotensin-converting enzyme) (ACE) inhibitor zvinodhaka chikamu chinokosha chokurapa mwoyo kusakundikana . Mune vanhu vane kukanganisa kwemwoyo, ACE inhibitors vakaratidzwa kuderedza kudiwa kwekuchengetwa mumba, kuvandudza zviratidzo, uye kunyange kutora nguva refu. Kana wakamboonekwa kuti une congestive heart failure , iwe unofanirwa kurapwa neACE inhibitor kunze kwekuti chiremba wako ane chikonzero chakanaka chekuita.
Chii Chinonzi ACE Inhibitor Do?
ACE inhibitor inokonzera enzyme inokosha mu renin-angiotensin-aldostrone system (RAAS) . IRAAS inoputika yemakemikari anoshanda pamwe chete kuti atungamirire kuwedzera kweropa, uye kuwanda kwe sodium muropa.
Kana ropa richiyerera kusvika kune itsvo zvakaderedzwa, enzyme inonzi renin inosunungurwa muropa. Renin anokonzera imwe enzyme, angiotensin I, kuwedzera. Angiotensin Ini ndinoshandurwa neACE mune angiotensin II. Angiotensin II inowedzera kuwedzera kweropa, uye (kuburikidza nekusimudzira kusunungurwa kwehomoni aldosterone kubva kune zvinonzi adrenal glands) kunoita kuti muviri uchengetedze sodium.
RaAS inotanga kushanda nguva yakawanda kuvanhu vane mwoyo kusakundikana, izvo zvinowedzera sodium kuchengetedza uye kuwedzerwa kweropa, uye zvinokonzera mwoyo kushanda zvakaoma kudarika.
ACE inhibitors inoshanda nekudzivisa kuumbwa kwei angiotensin II. Mune vanhu vane kukanganisa kwemoyo izvi zvinoderedza kushanda kweropa uye kunoderedza kuchengetedza kwe sodium.
Nenzira iyi, ACE inhibitor inoderedza kushungurudzika pamwoyo uye inobvumira kuora mwoyo kwemisumbu kukura zvakanyanya.
ACE inhibitors inobatsirawo mukurapa kwehuwandu hwehutachiona , uye dzakaratidzwa kugadzirisa zviitiko kune vanhu vakave nekurwadziwa kwemwoyo . Mukuwedzera, vanogona kubatsira kudzivirira kuora kwepvo muvanhu vane chirwere cheshuga .
ACE Inhibitors inoshaya Mwoyo
Mamiriyoni makuru emakiriniki akaedza kutarisa kushandiswa kweACE inhibitors kune vanhu vane mwoyo kusakatika. Vose zvavo vakaratidza zvakakosha kubatsirwa. Meta-kuongorora mishanu miedzo yakadaro yaisanganisira vanhu vane 12 000 vane mwoyo yakakundikana yakaratidza kuti ACE inhibitors yakaderedza zvakanyanya kudikanwa kwekuchengetwa, kugadzirisa kuponesa, uye kuderedza dambudziko rekurwadziwa kwemoyo. Zviratidzo zvekushaya simba kwemoyo zvakadai seDyspnea (kukurumidza kufema) uye kuneta zvakasimudzirwa zvakare.
Nhasi mazano anobva kuAmerican College of Cardiology uye American Heart Association anonyatsokurudzira kuti ACE inhibitors ipiwe kune munhu ane mwoyo usina kukundikana, uyezve, kune ani zvake ane zvishoma zvakasara ventricular ejection fraction (pasi pe 0.4) kana vasina aiva nemoyo chaiwo wekukundikana.
Akawanda ACE inhibitors ari pamusika, uye kazhinji inofungidzirwa kuti inobatsira zvakaenzana mukurapa mwoyo kusakundikana. Inowanzoshandiswa ACE inhibitors inosanganisira captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril), ramipril (Altace), uye trandolarpril (Mavik).
Paunotanga kunyorwa, ACE inhibitors inowanzotanga pamwero wakaderera, uye kuyerwa kunowedzera zvishoma nezvishoma kusvika kumazinga akakwirira anoshandiswa mumakiriniki.
Zvishoma nezvishoma kuwedzera kuyerwa kunobatsira kudzivirira zvinetso zvakaipa. Kana iyo yakatarwa yakareba yepamusoro isingashiviriri zvakanaka, kurapwa kunowanzoenderera kune imwe yakaderera, inoregererwa. Nyanzvi nyanzvi dzinofunga kuti maitiro maduku eACE inhibitor anowanzoita seanobudirira semadhora akakwirira, asi iyo mizinga yakakwirira inoshandiswa nokuti yakanyatsoongororwa muzvidzidzo zvechiremba.
ACE inhibitors uye rudzi. Zvimwe zvidzidzo zvinoratidza kuti ACE inhibitor inogona kunge isinganyanyi kushanda kune vanhu vema-black kupfuura vatsvene, asi uchapupu hunopesana. Nhasi mirayiridzo inokurudzira kushandisa ACE inhibitors munhu wese ane mwoyo kusakundikana, pasinei nedzinza.
ACE inhibitors uye zvepabonde. Zvidzidzo zvekliniki hazvina kuratidza kufanana kwakafanana kwekubatsira neACE inhibitors kuvakadzi sekuratidzwa kwevarume. Zvisinei, kupererwa kwehuchapupu huchiri kushandisa kushandisa ACE inhibitors mune vakadzi vose vane mwoyo kusakatika.
Zvakaipa Zvakaipa zveACE Inhibitors
Kunyange zvazvo ACE inhibitors inowanzoremeswa zvakanaka, zvimwe zvikamu zvinogona kuitika.
ACE inhibitor inogona kuderedza kuwedzera kweropa zvakanyanya, kuunza zviratidzo zvekushaya simba, chirungu , kana syncope . Dambudziko iri rinowanzodzivirirwa nekutanga nehana shoma uye zvishoma nezvishoma kusimba kusvika kumazinga akawanda.
Kunyanya muvanhu vane zvirwere zvepfungwa, kushandiswa kweACE inhibitors kunogona kuderedza kupora kwepfungwa. Nokuda kwechikonzero ichi, kushanda kwepvo (kuongorora ropa) kunofanira kuongororwa kuvanhu vane zvirwere zvepfungwa uye vari kutanga ACE inhibitors.
ACE inhibitors inogona kuwedzera ropa yepamusoro potassium. Kunyange zvazvo izvi zvinowanzogadzikana zvikuru uye kwete kunyanya kukosha. Zvisinei, mune vamwe vanhu (anenge 3%) mazinga e potassium anogona kuva akakwirira zvikuru.
Mhedzisiro yakakosha yega yeACE inhibitors ndeyekuoma, kukwakuka, kunogona kuonekwa kusvika kusvika 20% yevanhu vakapa mishonga iyi. Kunyange zvazvo isiri dambudziko rine ngozi, iyi yechipfuva inogona kunge yakanyanya kuvhiringidza uye kazhinji inoda kubviswa kwechirwere.
Kazhinji kazhinji, vanhu vanotora ACE inhibitor vanogona kuona angioedema -a zvakanyanya kushaya simba-kufanana nekuita kunogona kuva nengozi.
ARBs seMutevedzeri weACE Inhibitors
Angiotensin II receptor blockers (ARB zvinodhaka) zvakafanana neACE inhibitors pakuti vanovhiringidza rusununguko rweRAS uye kuderedza kusviba kwe enzyme angiotensin II. Nemhaka yokuti ARB chete inokonzera kukonzera uye angioedema, dzimwe nguva inoshandiswa sechinotsiva kune vanhu vakave nemigumisiro iyi yakaipa neACE inhibitors.
ARBs dzakaratidzwa kuti dzinoshanda mukurapa mwoyo kusakundikana, kunyange kusvika pamwero muduku kudarika ACE inhibitors. Mukuwedzera, ARBs inenge yakaita seyakashanda seACE inhibitors mukurapa kwehuwandu hwehutachiona. Inowanzoshandiswa mishonga yeArabhu inosanganisira candesartan (Atacand), lasartan (Cozaar), uye valsartan (Diovan). Mimwe mishonga yakawanda yeArab inowanikwawo zvakare.
The Bottom Line
Kana iwe uine kukanganisa kwemwoyo, kuderedza zviratidzo zvako uye kugadzirisa zvawakaguma, iwe unofanirwa kurongerwa ACE inhibitor kunze kwekunge pane chikonzero chakanaka kwete.
> Sources:
> Flather MD, Yusuf S, Køber L, et al. Nguva Yakareba ACE-inhibitor Kurapa Muvarwere Nemwoyo Kusakundikana kana Kusara-Ventricular Kusagadzikana: IChirongwa cheKushandiswa kweDhiyabhorosi Kubva kuMunhu Mumwe Nomumwe. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000; 355: 1575.
> McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Zvinyorwa Zvokuziva uye Kurapwa kweApute uye Chronic Chronic Heart Failure 2012: Basa reKushandiswa kweKutsvaga uye Kurapwa kweApute uye Chronic Chronic Heart Fail 2012 yeEuropean Society of Cardiology. Yakagadzirirwa nekubatana ne Heart Failure Association (HFA) ye ESC. Eur Heart J 2012; 33: 1787.
> Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF / AHA Fuideline yekutungamirirwa kweMwoyo Kusakwanisa: Nyaya yeAmerican College yeCardiology Foundation / American Heart Association Task Force pamusoro pekushandisa mazano. J Am Coll Cardiol 2013; 62: e147.