I-Sarcoidosis isifo esivelisa i- granulomas -ziqhelo zeeseli ezingaqhelekanga ezifana nezicubu ezinqabileyo-phantse nayiphi na into emzimbeni. Ezi granulomas ziyakwazi ukuphazamisana nokusebenza ngokuqhelekileyo kwamalungu apho zibonakala khona, ngoko ke kunokuvelisa iimpawu zeengxaki kunye neengxaki zonyango. Ngenxa yokuba i-granulomas ye-sarcoidosis inokuvela kwizitho ezininzi ezahlukeneyo, abantu abanalo meko banokubona iimpawu ezibandakanya imiphunga, amehlo, isikhumba, inkqubo ye-nervous, isimiso sesisu, i-endocrine-and heart.
I-cardiac sarcoidosis ingaba nzima ukuyifumanisa. Nangona iimeko ezinobungozi, ngamanye amaxesha i-cardiac sarcoidosis inokubangela iingxaki ezinzulu zempilo, kuquka ukukhubazeka kwentliziyo okanye ukufa ngokukhawuleza . Kule meko, ukwenza ukuxilongwa kwe-cardiac sarcoidosis, kunye nokumiselwa unyango, kubaluleke kakhulu.
Yintoni i-Sarcoidosis?
Abaphandi bakholelwa ukuba i-sarcoidosis iqala xa isistim somzimba siphendula ngokungaqhelekanga kwinto ethile engaziwayo (mhlawumbi i-substance inhaled), okubangele ukubunjwa kwama-granulomas. Abasetyhini bachaphazeleka ngokuphindaphindiweyo kunamadoda, kwaye abantu abamnyama banakho amathuba okuphuhlisa i-sarcoidosis kunabantu abamhlophe. I-proparity ye-sarcoidosis inokuphinda isebenze kwiintsapho.
Iimpawu ze-sarcoidosis zihluke kakhulu. Abanye abantu bahlakulela imeko efana nomkhuhlane kunye nokukhathala, umkhuhlane kunye nokulahleka kwesisindo. Abanye baya kuba neempawu zamapulmoni ezinjengokukhwehlela, i- dyspnea , okanye i-wheezing.
Iingxaki zamehlo zinokubandakanya ubomvu, intlungu, umbono obonakalayo, kunye nobuthakathaka bokukhanya. Izilonda zesikhumba zingabandakanya ukugqithwa okubuhlungu, izilonda ebusweni, utshintsho kumbala wesikhumba, kunye neengqungquthela.
Naliphina inhlanganisela yale mpawu ingenzeka. Abanye abantu abane-sarcoidosis abazibonakalisi nantoni na, kwaye imeko iyafunyanwa ngengozi xa i-X-ray isifuba senziwa esinye isizathu.
Yintoni iCardiac Sarcoidosis?
I-cardiac sarcoidosis iyenzeka xa i-granulomas i-sarcoid yenziwa kwintliziyo. Njengoko kunjalo nge-sarcoidosis ngokubanzi, ukubonakaliswa kwe-cardiac sarcoidosis kuyahlukahluka kumntu kumntu. Kwezinye abantu i-cardiac sarcoidosis ibangela ukuba kungabikho iingxaki; kwabanye, ingaba yingozi.
Ubunzima be-cardiac sarcoidosis buxhomekeke kumlinganiselo we-granuloma eyenziwe entliziyweni, kwaye apho intliziyo ivela khona i-granulomas. Ngokuqhelekileyo, ngaphantsi kweepesenti ezili-10 zabantu abane-sarcoidosis bafumaneka ukuba bathathe inxaxheba kwimizimba ngexesha lokuphila kwabo
Kodwa kwizifundo ze-autopsy, abaninzi abangama-70 ekhulwini abantu abane-sarcoidosis bafumana ubuncinci be-granulomas. Oku kubonisa ukuba ininzi yexesha, i-cardiac sarcoidosis ayivelisi iingxaki zekliniki ezichongiweyo.
Xa i-sarcoidosis ivelisa iingxaki zengqondo, kunjalo, ezo ngxaki zinokuba nzima.
Iimpawu kunye neempawu zeCardiac Sarcoidosis
Iingxaki eziveliswa yi-cardiac sarcoidosis zixhomekeke kwindawo apho i-granulomas ivela entliziyweni. Imbonakalo eqhelekileyo ye-cardiac sarcoidosis ibandakanya:
- I-Heart Block . Gcwalisa iibhloko ze-heart, ukuvelisa i- bradycardia enamandla (ukuphuculwa kwentlawulo yenhliziyo), inokwenzeka xa i-granulomas yenziwa ngaphakathi kwezinto ezikhethekileyo zokuqhuba intliziyo. ( Funda malunga nenkqubo yokuziphatha komzimba. ) Iimpawu zebhloko yeentliziyo zingabandakanya ukukhanya okukhawulezayo okanye syncope (ukulahlekelwa kwexesha elide), okanye nokufa ngokukhawuleza.
- Iinqununu zomzimba . Izakhiwo ze-ventricular zangaphambili (PVCs) okanye i- tachycardia ye-ventricular iqhelekile kwi-cardiac sarcoidosis. Iimpawu ze-acrial, ezibandakanya i-fibrillation ye-atrial , nazo ziya kwenzeka. Ezi i-arrhythmias ziphuhliswa njengesiphumo se-granulomas ezenza ifom yehliziyo.
- Ukufa ngokukhawuleza . Ngenxa yokuba i-heart block okanye i-tachycardia ye-ventricular, ukufa ngokukhawuleza kudla ngokuphazamiseka kwi-cardiac sarcoidosis, kwaye i-akhawunti engama-50 ekhulwini yokufa okubangelwa yilo meko.
- Ukungaphumeleli Kwintliziyo . Ukuhluleka kwentliziyo kunokuhlakulela kwi-cardiac sarcoidosis xa i-granuloma eyenziwa ngaphakathi kwintliziyo ye-muscle iba enkulu.
- Izifo zePericardial . I-Pericarditis okanye i- pericardial effusions iyenzeka ngenxa ye-granulomas kwimbali ye-pericardial yentliziyo.
- Izifo zentliziyo yeValvular . I-Granulomas ezithinta iipilves zentliziyo zingabangela ukubuyiswa kwe-mitral okanye ukulungiswa kwe-tricus , okanye, ngokungaqhelekanga, ukubuyiswa kwe-aortic .
- Ukuhlasela kwentliziyo . I-granulomas ye-Sarcoid iyakuchukumisa iirriyari ze- coronary , ivelise ukufa kweenxalenye zesifo senhliziyo-ukuhlaselwa kwentliziyo.
- Ukungaphumeleli kwintliziyo yangasese . I-pulmary pulmonary sarcoidosis inokubangela ukuba ingozi yomshukela we-pulmonary , ekhokelela ekuphelelweni kwentliziyo ekunene.
Ukuchonga iCardiac Sarcoidosis
Ukwenza ukuxilongwa kwe-cardiac sarcoidosis kudla ngokukhohlisa. Uvavanyo oluchanekileyo luyi-biopsy enesifo esihle. Nangona kunjalo, kungekhona nje kuphela inkqubo ye-biopsy intshabalalayo, kodwa kwakhona (kuba i-marcoid granulomas ihanjiswe ngokukhawuleza) i-biopsy inokubuya "njengesiqhelo" nangona i-cardiac sarcoidosis ikhona.
Oko oku kuthetha ukuba, ngokuqhelekileyo, ukuxilongwa kwe-cardiac sarcoidosis kwenziwa ngokulinganisa ubungqina kwiindlela ezahlukeneyo zokuxilonga.
Okokuqala, kubalulekile ukuba oogqirha bazi ukuba bafanele bajonge i-cardiac sarcoidosis. Ukujonga i-cardiac sarcoidosis kubalulekile kubantu abaziwa ngokuba ne-sarcoidosis echaphazela ezinye izitho zomzimba. Kwakhona, i-cardiac sarcoidosis kufuneka icingelwe kuyo nayiphi na umntu osemtsha (ongaphantsi kweminyaka engama-55) owenza i-block block, i-ventricular arrhythmias, okanye ukungaphumeleli kwintliziyo ngenxa yezizathu ezingachazwanga.
Ukuba i-cardiac sarcoidosis isifo sokuxilongwa esifanele sicatshangelwe, ukwenza i- echocardiogram ngokuqhelekileyo luvavanyo lokuqala olungenangeniso olwenziwa. Olu vavanyo luvame ukutyhila impawu ezibalulekileyo ukuba i-cardiac sarcoidosis ikhona, kubandakanyeka kwezinye iimeko izibonakaliso ze-echo eziveliswa yi-granulomas ngaphakathi kwesifo senhliziyo.
Nangona kunjalo, i- scan ye-MRI isicatshulwa kakhulu ukuba ibonise ubungqina be-granulomas ngaphakathi kwintliziyo, kwaye ngokuqhelekileyo luvavanyo olungenakuvakala. I-PET ifunyenwe kwintliziyo nayo iyanqwenela ukufumanisa i-cardiac sarcoid granulomas, kodwa i-PET i-scans ayifumaneki ngokulula kunokuba i-MRI ihlole.
Umgangatho wegolide wokufumanisa i-cardiac sarcoidosis yi-biopsy ye-muscle ye-heart, enokuthi yenziwe ngexesha lokunyanyiswa komzimba. Nangona kunjalo, njengoko sele kuphawuliwe, ukufumanisa i-granulomas ngale ndlela, nangona xa bekhona, kuphunyezwa ngempumelelo ngaphantsi kwesigama sexesha.
Kwiimeko ezininzi, ngokusekelwe kwimiqondiso yeempawu kunye neempawu zekliniki, ukuvavanya okungabonakaliyo, kunye nokuvavanya okungenayo, ukucacisa ukuba khona okanye ukungabikho kwe-cardiac sarcoidosis kungafezwa ngezinga eliphezulu lokuzithemba.
I-Cardiac Sarcoidosis ithathwa njani?
Ukuba i-cardiac sarcoidosis ikhoyo, unyango lujoliswe ekunciphiseni okanye ukuyeka ukuqhubela phambili kwe-sarcoidosis ngokwalo, kwaye ekukhuseleni okanye ekunyangeni iziphumo ezinzima kakhulu zesifo.
Ukuphatha i-sarcoidosis ngokwayo
Ulwaphulo olujoliswe kwi-sarcoidosis ngokwayo uzama ukukhusela ukuphendula kwamagciwane okubangela ukubunjwa kwama-granulomas. Kwi-sarcoidosis, oku kufuthi kwenziwa nge-glucocorticoid (steroid) unyango, ngokuqhelekileyo kunye ne-prednisone. Ngokuqhelekileyo, amanani aphakamileyo amiselwe ekuqaleni (40-60 mg / ngosuku). Ngaphezulu konyaka wokuqala, le dosi yanciphisa kancane ukuya kwi-10-15 mg / ngosuku, kwaye iqhutyelwa ubuncinane kwiminyaka emibini okanye emibini.
Ukuba ukuhlaziywa kwakhona kubonisa ukuba i-sarcoidosis iye yazinza (okokuthi, akukho bubungqina obuninzi bokuveliswa kwegranuloma naphi na emzimbeni, kunye nesisombululo sempawu ezibangelwa yi-sarcoidosis), kunokwenzeka ukuba ekugqibeleni unqande unyango lwe-steroid.
Kubantu abangabonakaliyo ukuba baphendule kwiyeza le-steroid, ezinye i-immunosuppressants ingafuneka, njenge-chloroquine, i-cyclosporine, okanye i-methotrexate.
Ukunyamekela ukubonakaliswa kwemizimba ye-sarcoidosis
Isiphumo esisongelayo se-cardiac sarcoidosis kukufa ngokukhawuleza, okubangelwa yi-block block okanye i-tachycardia ye-ventricular. I- pacemaker esisigxina kufuneka ifakwe kunoma ubani onomdla we-cardiac sarcoidosis ekubonakaliswe kuyo iimpawu zokuvelisa i-heart block kubonakala kwi- electrocardiogram .
I-cardioverter-defibrillators (ii-ICDs) ezingasetyenziswayo zingasetyenziselwa ukuthintela ukufa ngokukhawuleza kwi-arrhythmias ye-ventricular. Iintlalo zengcali ziye zahluleka ukuphuhlisa izikhokelo ezicacileyo malunga nokuba abantu abane-cardiac sarcoidosis kufuneka bafumane ii-ICD. Nangona kunjalo, uninzi lweengcali zincoma abantu abane-sarcoidosis abaye banciphisa kakhulu amaqhezu e-ecrycycle ejection , okanye abaye basinda kwiziqwenga ze-tachycardia okanye i- fibrillation ye-ventricular .
Ukongezelela, ukuqhuba isifundo se- electrophysiology kunokunceda ekuqaliseni ukuba ngabaphi abane-cardiac sarcoidosis basengozini enkulu yokufa ngokukhawuleza kwi-arrhythmias ye-ventricular, kwaye ngoko ke ngubani omele abe ne-ICD.
Ukuba i-valvular isifo senhliziyo esabangelwa yi-cardiac sarcoidosis ikhona, utyando kufuneka kuthathelwe ingqalelo ukusetyenziswa kweendlela ezifanayo eziqeshwe nakubani na umntu onengxaki ze-valves.
Ukuba kukho ukungaphumeleli kwentliziyo, abantu abane-cardiac sarcoidosis kufuneka bafumane unyango olufanayo lokunyanzelisa intliziyo esetyenziselwa nawuphi na le meko. Ukuba intliziyo yabo iswelekile kwaye ayiphenduleli unyango lwezokwelapha, abantu abane-sarcoidosis kufuneka bafumane ingqalelo efanayo kwi-heart transplantation enikezelwa nakubani na umntu onokukhubazeka kwentliziyo. Enyanisweni, iziphumo zabo emva kokutshintshwa kwemizimba kubonakala zibhetele kuneziphumo ezibikwe ngabantu abafakelwa ukufakelwa kwezityalo kwezinye izizathu ezingundoqo.
ILizwi
Njengoko kunjalo nge-sarcoidosis ngokubanzi, i-sarcoidosis echaphazela intliziyo inokuba nolunye udidi lweembonakalo, oluvela kumntu obulalayo ngokupheleleyo. Ukuba kukho isizathu sokusola i-cardiac sarcoidosis, kubalulekile ukwenza uvavanyo oluyimfuneko ukwenza okanye ukulawula ukuxilongwa. Ukuba umntu one-cararac sarcoidosis, unyango kunye nolwaphulo olunamandla (zombini i-sarcoidosis ngokwayo kunye nokubonakaliswa kwentliziyo yakhe) lunokuphucula kakhulu umphumo.
> Imithombo:
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> Kim JS, Judson MA, Donnino R, et al. Cardiac Sarcoidosis. Inhliziyo J 2009; 157: 9.
> Perkel D, Czer LS, Morrissey RP, et al. Ukufakelwa Kwentliziyo Ukuphelelwa Kwintliziyo Yokugqibela Ukuphelelwa Kwelinye I-Cardiac Sarcoidosis. Ukutshintshwa kweNkqubo ka-2013; 45: 2384.
> Soejima K, Yada H. Umsebenzi-up kunye noLawulo lwezilwelisi ezinezixhobo ezibonakalayo okanye izicathulo zeCardiacosis: Ukugxininisa kwi-Heart Associated Rhythm. J Cardiovasc Electrophysiol 2009; 20: 578.