IST - I-Cardiac Arrhythmia
I-sinus tachycardia engafanelekanga (IST) yimeko apho izinga lentliziyo yomntu, ukuphumla kunye nexesha lokuzikhandla, liphakanyiswa ngokungavumelekanga ngenxa yesizathu esicacileyo. Abantu abane-IST kaninzi banokuphumla kweentliziyo ezingaphezu kwama-100 beats ngomzuzu, kwaye kunye nokunyanzeliswa kwezinga lentliziyo kaninzi kuphakama kumazinga aphakamileyo. Ezi ntliziyo zeenhliziyo ezingenakudla ngokuqhelekileyo zihamba kunye neempawu zentlongo , ukukhathala, nokunyamezela.
Ngenxa yokuba intliziyo yesisu kwi-IST iveliswa yiphonasi yesinus (isakhiwo senhliziyo esilawula isigqi sesisimo senhliziyo), i-IST ayinxulumene nomzekelo ongaqhelekanga kagesi kwi- ECG .
Sibanzi
Ngelixa i-IST inokuthi yenzeke kunoma ubani, ininzi kakhulu kubantu abadala kwaye ichaphazela abafazi ngokuphindaphindiweyo kunamadoda. "Umyinge" wesifo se-IST ngumfazi osema-20s okanye kwi-30 yama-30 ubudala oye wafumana iimpawu kwiinyanga ukuya kwiminyaka. Ukongeza kwiimpawu ezibalaseleyo zezibilini, ukukhathala nokunyamezela, i-IST iphinda idibaniswe kunye neminye impawu equka i-hypotension ye-orthostatic (i-drop in blood pressure), imbonakalo ephazamisayo, ukuxakeka , ukuzula, i- dyspnea (ukufutshane ukuphefumla), nokukhupha.
Nge-IST, izinga lokuphumla kwentliziyo lisoloko likhulu kunama-100 beats ngomzuzu, kodwa ngexesha lobuthongo obunzima, lingahlahlela ukuya kuma-80 okanye kwi-90 beats ngomzuzu, okanye nangaphantsi. Ngaphandle kokusebenza okuncinci intlawulo yesantya ngokukhawuleza ikhawuleza iphakame ukuya phezulu njengama-140 okanye ama-150 ukushaya ngomzuzu.
Iipilpitations zibonakaliso ezibalaseleyo nangona kunjalo (njengokuba kunjalo njalo) akukho "ukungaqhelekanga" kwentliziyo eyenzekayo. (Oko kukuthi, intliziyo nganye ivela kwi-node ye-sinus, njengokwenza isigqithiso senhliziyo esivamile.) Izimpawu ezibangelwa ngabagulayo be-IST zingaba zikhubaza kwaye zivelise ukukhathazeka.
I-IST yaqatshelwa njenge-syndrome kuphela nje ngo-1979 kwaye iyakwamkelwa ngokubanzi njengento yonyango yonyango kuphela ukususela ekupheleni kwee-1980. Kwaye nanamhlanje, ngelixa i-IST ibonakala ngokugqithiseleyo njengemeko yonyango yonyango yiziko lezonyango zonke zeyunivesithi, abaninzi abagqirha abangazange bakuve okanye babhale njengengxaki yengqondo (oko kukuthi, "uxhalaba").
Izizathu
Umbuzo oyintloko ubonakala ukuba i-IST imele i-disorder oyintloko ye-node yesusus, okanye nokuba, endaweni yoko, ibonisa ukunyanzeliswa ngokubanzi kwesimiso se-nerve-autonomic-imeko ebizwa ngokuthi i- dysautonomia . (I-system ye-nerveous autonomic ilawula imisebenzi "engaziwayo" yomzimba, njengokuguga, ukuphefumula kunye nentliziyo yezinga.)
Abantu abane-IST baxhomekeke kwi-adrenaline; i-adrenaline encinci (njengento encinci yokunyusa) ibangela ukuphakama okuphawulekayo kwintliziyo. Nangona kunenobungqina bokuba kukho utshintsho olusesikweni kwi-ISOD ye-sinus, ubuninzi bobubungqina obuninzi bubonisa ukuba inkathazo ebanzi echaphazela inkqubo ye-nervous autonomic ikhona ezininzi kwezi gulane. (I-dysautonomia ngokubanzi iya kuchaza ukuba kutheni iimpawu nge-IST zidla ngokungafaniyo nokunyuka kwenani lentliziyo.) Yona ngcamango yokuba i-sinus node ngokwayo ayifanelekanga eyenza ukuba i-electrophysiologists iphendulele ekugqibeleni i-node ye sinus unyango lwe-IST (ngaphezulu kule ngezantsi).
Ukuxilongwa
Ezinye izifo zonyango ezonyango kunye nezokwelapha zingadityaniswa ne-IST, kwaye kumntu obonisa isasus tachycardia engavamile, ezi zizathu zifuna ukukhutshwa ngaphandle. Ezi ngxaki ziquka i- anemia , umkhuhlane, izifo, i- hyperthyroidism , ipheochromocytoma , i-dysautonomia, kunye nokusetyenziswa kakubi kweziyobisi. Le miqathango ngokubanzi ingalawulwa ngaphandle kovavanyo oluqhelekileyo lwezonyango, kunye nokuhlolwa kwegazi kunye nomchamo.
Ukongezelela, ezinye i- arrhythmias ze-cardiac- ngokuqhelekileyo, iindidi ezithile ze -tachycardia (SVT) esezantsi-ngamanye amaxesha zidideka kunye ne-IST. Ngokuqhelekileyo kunzima ugqirha ukuxelela umahluko phakathi kwe-SVT ne-IST ngokuqwalasela ngokucophelela i-ECG kunye nokuthatha imbali yonyango.
Ukwenza oku kwahluke kubaluleke kakhulu kuba unyango lwe-SVT ludla ngokuthe ngqo.
Unyango
Unyango lweziyobisi
Kwizigulane ezininzi ezine-IST, unyango lweziyobisi lunokusebenza ngokufanelekileyo. Kodwa ukufumana iziphumo ezifanelekileyo kufuna ukuba iilingo kunye nephutha lizama ngamachiza amaninzi, ingoma okanye idibeneyo.
I-Beta-blockers ivimba umphumo we-adrenaline kwi-node yesusus, kwaye ekubeni abantu abane-IST banempendulo yokunyaniseka kwi-adrenaline, ukusebenzisa i-beta blockers kunengqiqo. Ezi ziyobisi zihlala zikunceda kakhulu ekunciphiseni iimpawu ze-IST.
I-blockers ye-calcium inganciphisa ngokukhawuleza inyathelo le-node ye-sinus kodwa iphumelele ngokukhawuleza ekuphatheni i-IST.
Isiyobisi i- ivabradine sisetyenziswe ngempumelelo ekuphatheni abantu abane-IST. I-Ivabradine ichaphazela ngokuthe ngqo "inqanaba lokukhwela" kwinqanaba le-sinus, kwaye ngaloo ndlela linciphisa izinga lentliziyo. I-Ivabradine ivunyiwe e-US njengonyango lwe-angina kunye nokungaphumeleli kwentliziyo kwizigulane ezingenako ukunyamezela i-block blockers, kodwa kungekhona i-IST. Nangona kunjalo, ubuncinci bunezinye iziyobisi, kwaye iingcali ezininzi zincoma i-ivabradine njengonyango oluluncedo kule meko. Ukongezelela, imibutho emininzi yolwazi ngoku ixhasa ngokusetyenziswa kwayo kwe-IST.
Uninzi lwezifo ze-cardiologists azivumelani ukuba zibhalise "kwi-autonomic disayomic disycle function" ye-IST, ngoko ke azange azame ukucacisa iziyobisi eziye zanceda kwizigulane ezinezinye iindiza ze-dysautonomia. Nangona kunjalo, kuba kudla ngokuphindaphindiweyo okukhulu phakathi kwe-IST kunye namanye ama-syndrome (i- POTS kunye ne- vasovagal syncope ), iziyobisi ezisebenzayo ekuphatheni le miqathango zinokuthi ziba luncedo ekuphuleni izigulane nge-IST. Ezi zi yobisi zingabandakanya:
- Florinef , esiyilwayo esibangela ukugcinwa kwe-sodium. Amanye ama-syndromes e-dysautonom, ngokukodwa i-POTS kunye ne-vasovagal syncope, aboniswe ukuba inxulumene nokunciphisa kwimiqulu yegazi, kwaye isicatshulwa sokugcina i-sodium sinokunyusa umthamo wegazi ngokuqhelekileyo, kwaye unciphise iimpawu.
- I-Midodrine , isilwanyana esibangela ukwanda kwithoni ye-vascular, ekuncedeni ukuthintela uxinzelelo lwegazi oluphantsi.
- I-Serotonin-reuptake inhibitors (intsapho yeProzac yeziyobisi) isetyenziselwa ngokuyinhloko ukuphatha uxinzelelo kunye nokuxhalaba, kodwa nayo ibonakaliswe iluncedo ekuphatheni amanani amaninzi e-dysautonomia syndromes.
Ngokuqhelekileyo, iimpawu ze-IST zinokulawulwa kwinqanaba elifanelekileyo ngokusebenzisa ukudibanisa iziyobisi. Ngokubanzi, i-beta blockers izama okokuqala, kwaye i-ivabradine yongezwa (okanye ifakwe endaweni) ukuba i-bloa ibhacker ayigcineli impawu ngokwaneleyo. Nangona kunjalo, unyango oluchanekileyo lwezonyango lufuna ukuphikelela, ukusebenza kwi-trial-and-error basis. Inani elithile lomonde, ukuqonda kunye nokholo phakathi kogqirha nesigulane kuyadingeka. Oku kunzima ukufezekisa ukuba ugqirha acinga ukuba isigulane simantla nje. Ukuze baphathwe ngempumelelo, abantu abane-IST (kunye nezinye i-dysautonomias) maxa wambi bafanele benze inani elifanelekileyo lokuthengwa kwegqirha.
Unyango Lonyango
Ukwandisa ityuwa. Oku kufanele kwenziwe ngokuvunyelwa ngugqirha wakho, ngenxa yobandlululo olukhoyo ngokusesikweni kokutya okuphantsi kwe-sodium. Kodwa ityuwa ikwandisa umthamo wegazi, kwaye kwindlela umlinganiselo wegazi owencitshisiwe uncedisa ngayo iimpawu, ukwandisa ukondla ityuwa kunokuncedisa ukunciphisa iimpawu kwi-IST.
I-sinus yokubhubhisa. Uninzi lwezifo ze-cardiologist, kunye ne-electrophysiologists, ziye zatshintshiswa ngedata ebonisa ukuba i-IST ngokuyinhloko i-disorder ye-sinus node (ngokuchasene ne-disorder's system of system autonomic system). Le nkolelo yenzele inzondelelo ethile yokusebenzisa unyango lwe-ablation (inqubo apho inxalenye yenkqubo yombane yomzimba ifakwa kwi-catheter) ukuguqula umsebenzi, okanye ukutshabalalisa, i-node ye-sinus.
Isaphulelo sokususa i-Sinus siphumelele ngokuphumelelayo kuphela impumelelo. Nangona le nkqubo inokuphelisa i-IST kuma-80% abantu emva kwenkqubo, i-IST ibuyeka emva kweenyanga ezimbalwa kuninzi lwabantu.
Ukulinda. Enye indlela engeyiyo ye-pharmacologic yokulawula i-IST akuyi kwenza nto. Nangona imbali yendalo yesi sifo ayizange ibhalwe ngokusemthethweni, kubonakala sengathi i-IST ijwayele ukuphucula ixesha elidlulileyo kubantu abaninzi. "Ukungenzi nto" akunako ukukhetha kubantu abanobuhlungu obukhulu, kodwa abantu abaninzi abane-IST emnene bayakwazi ukunyamezela iimpawu zabo xa beqinisekiswa ukuba abanalo isifo sengqondo esisongela ubomi kunye nokuba ingxaki inokuphucula ekugqibeleni.
Ngaphantsi
Emva kokuba i-IST ifunyaniswa, kwaye kunqunywe ukuba "nje ukulinda" ayiyi kuba yindlela eyaneleyo, ezininzi iingcali namhlanje zincoma ukuba ziqale ngonyango lweziyobisi. Ngokuqhelekileyo, i-beta blocker izakuzama ukuqala, ilandelwe yilingo le-ivabradine (nokuba yedwa okanye inxulumene ne-beta blocker). Ukuba ezi zilingo zahluleka ukulawula iimpawu, ezinye iziyobisi kunye nokudibanisa iziyobisi zingalingwa. Uninzi lweengcali ngoku zicebisa unyango lwe-inflation kuphela xa ubuncinane ubunzima bezilwanyana zamachiza behlulekile.
> Imithombo:
> Ikhasi RL, Joglar JA, Caldwell MA, et al. Isikhokelo se-ACC / i-AHA / HRS yoLawulo lwabadala abane-Supermarket Tachycardia: Ingxelo ye-American College of Cardiology / American Heart Association Task Force kwi-Clinical Practice Guidelines kunye ne-Heart Rhythm Society. Uhambo 2016; 133: e506.
> Schulze, V, Steiner, S, Hennersdorf, M, Strauer, BE. I-Ivabradine njengeNyathelo elongezelelweyo loPhepha loPhando kwiNyango engafanelekanga yeSasus Tachycardia: ingxelo yeNgxelo. Cardiology 2008; 110: 206.
> I-Sheldon RS, i-Grubb BP yesibili, i-Olshansky B, et al. 2015 I-Heart Rhythm Society Ingcali Ingxelo yokuBoniswa kweNgcaciso kunye nokuPhathwa kwe-Postural Tachycardia Syndrome, iSinappropriate Sinus Tachycardia, kunye neVasovagal Syncope. I-Heart Rhythm 2015; 12: e41.