Uhlobo Olona lukhulu lwe-Attack Heart
I-ST-segment elevation myocardial infarction (STEMI) igama elithi cardiologists lisetyenziselwa ukuchaza i-classic attack attack. Luhlobo olulodwa lwe- myocardial infarction apho inxalenye yesifo senhliziyo (i-myocardium) ifile ngenxa yokuphazamiseka kwegazi kwindawo leyo.
Icandelo le-ST libhekisela kwisigaba esicacileyo sokufunda kwe- electrocardiogram (ECG) kwaye imele ikhefu phakathi kweentliziyo zentliziyo.
Xa umntu enesifo senhliziyo, le nxalenye ayiyi kuphinda ibe yindlwana kodwa iya kubonakala ingaqhelekanga.
Iintlobo kunye nobunzima be-STEMI
I-STEMI yenye yeentlobo ezintathu ze -coronary syndrome (ACS) . I-ACS ivela xa i-plaque iphuka ngaphakathi kwintsimbi ye-coronary, eyenza ukukhutshwa okukodwa okanye okuphelelweyo kwaloo mzobo. Ukuthintela ngokwayo kubangelwa xa i-clots clots ifom ejikeleze indawo yokuphuka.
Xa isithintelo, isahlulo senhliziyo esisetyenziswa yilo mzobo siza kuba nexakeka ngokusweleka kwe-oxygen, ebizwa ngokuba yi- ischemia . Iintlungu zesifuba ( angina ) zihlala zibonakalisa okokuqala. Ukuba isithintelo sininzi ngokwaneleyo, ezinye zeentliziyo zenyama ziya kuqala ukufa, okubangele ukutshatyalaliswa kwe-myocardial infarction.
Sizahlula i-ACS ngezinga lokukhutshwa kunye nomonakalo obangela umfutho wentliziyo:
- Ukuba umqobo opheleleyo we-coronary artery kwenzeka, okuphumela ekufeni kweesisu zomzimba, sibhekisela kwi-STEMI, uhlobo olubi kakhulu lwe-ACS.
- Nangona kunjalo, kwezinye iimeko, amaqhosha aya kubumba, aphelise, kwaye aphinde enze kwifom ngexesha leeyure okanye iintsuku ngaphandle kokubangela ukuphazamiseka. Xa oku kwenzeka, umntu unokufumana kwakhona-kwakhona-off-kwakhona kwakhona angina nangokuphumla. Olu hlobo lwe-ACS lubizwa ngokuba yi- angina engaqinisekanga .
- Phakathi kwe-STEMI kunye ne-angina engaqinisekanga yimeko ethile ebhekiselwa kuyo ngokuthi "ukuhlaselwa kwentliziyo." Oku kwenzeka xa ukuvinjelwa kungavumi ngokupheleleyo ukuhamba kwegazi. Ngoxa i-cell cell death will occur, ezinye iinxalenye zesisipha ziya kuphila. Ixesha lesigqirha sale nxalenye ye-ST-segment-up myocardial infarction ( NSTEMI ).
Kungakhathaliseki ukuba umcimbi we-ACS uhlelwe njani, usabonwa njengongxamiseko lwezonyango ukususela kwi-angina engaqinisekanga kunye ne-NSTEMI ngokuqhelekileyo izibonakaliso zokuqala zesohlwayo senhliziyo.
Iimpawu ze-STEMI
I-STEMI iya kubangela intlungu ebuhlungu okanye uxinzelelo okanye kufuphi nasesifuba, ngokukhawuleza kukhanyela entanyeni, emhlathini, emagxeni okanye nangengalo. Ukufufumla, ukuphefumla, kunye nesimo esiqingqileyo sokutshabalalisa okuqhelekileyo kuyafana. Ngamanye amaxesha, imiqondiso ingabonakali kakhulu, ibonakalisa ngeempawu ezingenanto okanye eziqhelekileyo ezifana ne:
- Ubuhlungu obujikelezileyo emacaleni emagxa, ingalo, isifuba, umhlathi, ingalo ekhohlo, okanye isisu esiswini
- Uvakalelo olubuhlungu oluchazwe ngokuba "lukholo olufakwe kwisifuba"
- Ukuphazamiseka okanye ukuqina entanyeni okanye ngengalo
- Ukunyanzelisa okanye ukuguquka
- Isihlunu kunye nokuhlanza
- Ukukhathala okanye ukhathala ngokukhawuleza
- Ukuqhawukelwa ngumphefumlo
- Utywala okanye ukukhanya
- Ukukhula kwentliziyo okanye ukungavumelekanga
- Isikhumba seClammy
Njengomgaqo jikelele wesohlwayo, nabani na abasengozini enkulu yokuhlaselwa intliziyo kufuneka bahlawule ngokugqithiseleyo nasiphi na uphawu olungavamile oluvela phezulu kunqeni.
Ukuxilongwa kwe-STEMI
Kwiimeko ezininzi, ukuxilongwa kwe-STEMI kungenziwa ngokukhawuleza xa umntu engaphantsi kwonyango. Ukuhlaziywa kweempawu, ezihambisane nokuhlolwa kwecandelo le-ST kwi-ECG, kudla ngokwaneleyo ukuba ugqirha uqale unyango.
Ukuhlaziywa kwee- enzyme zenhliziyo kunokuncedisa kodwa ngokuqhelekileyo kufika emva kokuba unyango olunzima luqalisiwe.
Kubalulekile ukuzinzisa umntu ngokukhawuleza. Ukongeza kwintlungu kunye noxinzelelo, i-STEMI ingabangela ukufa ngokukhawuleza ngenxa yefayili ye-ventricular (ukuphazamiseka okukhulu kwesantya senhliziyo) okanye ukuhluleka kwentliziyo (xa intliziyo ayikwazi ukupompa igazi elaneleyo ukubonelela ngokufanelekileyo umzimba).
Emva kokuhlaselwa kwentliziyo, i-muscle ngokwayo ishiywe ngumonakalo omkhulu. Ukungaphumeleli kwintliziyo engapheliyo kuyisiphumo esiqhelekileyo sale nto, njengokuba ubungozi obunobungozi be-cardiac arrhythmias (iintliziyo ezingapheliyo).
Unyango lwe-STEMI
Unyango kufuneka uqalwe ngexesha le-STEMI ifunyenwe. Ukongezelela ekuphatheni iziyobisi ukuzinzisa imisipha yenhliziyo (kuquka i-morphine, i- beta blockers , kunye nemithi ye-statin ), kuya kwenziwa imizamo yokuphinda ivule ngokukhawuleza umthamo ovalwe.
Oku kufuna isivinini. Ngaphandle kokuba i-artery ivuliwe zingakapheli iiyure ezintathu zokuvalwa, ubuncinane umonakalo olungapheliyo kulindeleke. Ngokuqhelekileyo, umonakalo omkhulu unokuncitshiswa ukuba umriba ungavaliwe kwiiyure zokuqala zokuhlaselwa. Ukufikelela kwiiyure ezili-12, umonakalo othile ungasuswa. Emva koko, kuthatha ixesha elide ukuvulela umthamo, umonakalo omkhulu uya kuba khona.
Kukho iindlela ezininzi zokuvusa kwakhona umqobo wokhuselo:
- Ulwaphulo lwe-Thrombolytic luquka ukusetyenziswa kwezidakamizwa ezigqithisayo.
- I-Angioplasty yigama lonyango lokulungisa / ukuvulwa kwakhona komthambo.
- Ukugxotha kubandakanya ukungenisa ityhubhu ye-mesh ukuvula kwakhona umzobo.
Xa isiqendu esiphezulu sonyango siphelile kwaye i-artery evinjiweyo iyavulwa kwakhona, kusekho nto enokufuneka yenziwe ukuze kuzinze intliziyo, nokunciphisa iimeko zokuhlasela kwentliziyo.
Oku kudla ngokuquka ixesha elide lokubuyiselwa, kuquka inkqubo yokuvuselela izixhobo, ukuguqulwa kokutya, kunye nokusetyenziswa kwe-anticoagulants (abagcini begazi) kunye neyeza zokulawula iiliti.
> Umthombo:
> O'Gara, P .; Kushner, F .; Ascheim, D .; okqhubekayo. "Isikhokelo se-ACCF / AHA Isikhokelo soLawulo lwe-ST-elevation Myocardial Infarction: Isishwankathelo seSigqeba: Ingxelo ye-American College of Cardiology Foundation / i-American Heart Association Task Force kwi-Practice Guidelines." Umbhalo we-American College of Cardiology. 2013; 61 (4): INGXELO: 10.1016 / j.jacc.2012.11.018.