Umothuko weCardiogenic

Umothuko weCardiogenic wenzeka xa intliziyo yonakele kangangokuba ingakwazi ukubonelela ngegazi elaneleyo kumalungu omzimba.

Oonobangela abaqhelekileyo ziimeko ezinzulu zentliziyo. Zininzi zezi zinto zenzeka ngexesha okanye emva kokuhlaselwa kwentliziyo (i-myocardial infarction). Ezi ngxaki zibandakanya:

• Icandelo elikhulu lemisipha yentliziyo engasasebenzi kakuhle okanye engashukumi kwaphela
• Ukuqhekeka (ukuqhekeka) kwezihlunu zentliziyo ngenxa yomonakalo osuka ekuhlaselweni yintliziyo
• Iingqungquthela zentliziyo ezinobungozi, ezifana ne-tachycardia ye-ventricular, i-fibrication ye-ventricular, okanye i-tachycardia engaphezulu
• Uxinzelelo entliziyweni ngenxa yokwakheka kolwelo olujikelezileyo (pericardial tamponade)
• Ukulila okanye ukugqabhuka kwezihlunu okanye imisipha exhasa izithinteli zentliziyo, ngakumbi ivelufa yemitral
• Ukulila okanye ukuqhekeka kodonga (septum) phakathi kwe-ventricles yasekhohlo nasekunene (amagumbi entliziyo asezantsi)
• Isantya sentliziyo esicothayo (bradycardia) okanye ingxaki kwinkqubo yombane yentliziyo (ibhloko yentliziyo)

Ukutshatyalaliswa kweCardiogenic kwenzeka xa intliziyo ingakwazi ukupompa igazi elininzi njengoko umzimba ufuna. Inokwenzeka nokuba khange kubekho hlaselo lwentliziyo ukuba enye yezi ngxaki iyenzeka kwaye umsebenzi wentliziyo yakho wehla ngesiquphe.

Iimpawu zibandakanya:

• Intlungu yesifuba okanye uxinzelelo
• Coma
• Ukunciphisa ukuchama
• Ukuphefumla ngokukhawuleza
• Ukubetha ngokukhawuleza
• Ukubila okunzima, ulusu olumanzi
• Ubumhlophe
• Ukuphulukana nokulumka kunye nokukwazi ukugxila
• Ukuphumla, ukuphazamiseka, ukudideka
• Ukuqhawukelwa ngumphefumlo
• Ulusu oluziva lupholile xa uchukumisa
• Umbala wesikhumba onombala okanye ulusu olucekeceke
• Ukubetha okungathathi ntweni

Uviwo luya kubonisa:

• Uxinzelelo lwegazi olusezantsi (ubukhulu becala ngaphantsi kwe-90 systolic)
• Uxinzelelo lwegazi olwehla ngaphezulu kwamanqaku ali-10 xa uphakama emva kokulala (orthostatic hypotension)
• Ukubetha okungathathi ntweni
• Isikhumba esibandayo nesibumbayo

Ukuchonga ukothuka kwe-cardiogenic, i-catheter (ityhubhu) inokubekwa kwimithambo yemiphunga (ekunene catheterization yentliziyo). Uvavanyo lunokubonisa ukuba igazi liyabuyela emiphungeni kwaye intliziyo ayimpompi kakuhle.

Uvavanyo lubandakanya:

• Ukucinywa kwentliziyo
• I-x-ray yesifuba
• I-Coronary angiography
• Echocardiogram
• Electrocardiogram
• Ukuskena kwenyukliya kwentliziyo

Olunye uphononongo lunokwenziwa ukufumana ukuba kutheni intliziyo ingasebenzi kakuhle.

Uvavanyo lweLebhu lubandakanya:

• Irhasi yegazi ejikelezayo
• I-chemistry yegazi (i-chem-7, i-chem-20, i-electrolyte)
• Ii-enzymes zentliziyo (troponin, CKMB)
• Gcwalisa ubalo lwegazi (CBC)
• Idlala lengqula elikhuthaza amadlala (TSH)

Ukutshitshiswa kweCardiogenic ngxamisekileyo kwezonyango. Uya kudinga ukuhlala esibhedlele, amaxesha amaninzi kwiCandelo loKhathalelo oluKhulu (ICU). Injongo yonyango kukufumana kunye nokunyanga unobangela wothuselo ukugcina ubomi bakho.

Unokufuna amayeza ukunyusa uxinzelelo lwegazi kunye nokuphucula ukusebenza kwentliziyo, kubandakanya:

• Dobutamine
• Dopamine
• Epinephrine
• Levosimendan
• IMilrinone
• Inorepinephrin
• IVasopressin

La mayeza anokunceda kwixesha elifutshane. Azisoloko zisetyenziswa ixesha elide.

Xa ukuphazamiseka kwesingqisho senhliziyo (i-dysrhythmia) kubi, kunokufuneka unyango olukhawulezileyo ukubuyisela isingqi sentliziyo esiqhelekileyo. Oku kunokubandakanya:

• Unyango lombane "lothuka" (ukusasaza isisu okanye ukuphefumla komzimba)
• Ukufakela i-pacemaker yethutyana
• Amayeza anikwe ngomthambo (IV)

Unokufumana:

• Iyeza leentlungu
• Ioksijini
• Ulwelo, igazi, kunye neemveliso zegazi ngomthambo (IV)

Olunye unyango lokothuka lunokubandakanya:

• I-catheterization yentliziyo kunye ne-coronary angioplasty kunye ne-stenting
• Ukubeka iliso kwintliziyo ukukhokela unyango
• Utyando lwentliziyo (utyando lwe-coronary arttery bypass, ukutshintshwa kwentliziyo yevalve, isixhobo esincedisa i-ventricular assist)
• Intra-aortic balloon counterpulsation (IABP) yokunceda intliziyo isebenze ngcono
• Umenzi wePacemaker
• Isixhobo Ventricular ukunceda okanye enye inkxaso ngoomatshini

Kwixesha elidlulileyo, inqanaba lokusweleka ngenxa yokothuka kwe-Cardiogenic ukusuka kwi-80% ukuya kwi-90%. Kwizifundo zamva nje, eli zinga lehle laya kwi-50% ukuya kwi-75%.

Xa ukothuka kwe-Cardiogenic kunganyangwa, umbono awukho kakuhle.

Iingxaki zinokubandakanya:

• Umonakalo wobuchopho
• Umonakalo wezintso
• Umonakalo wesibindi

Yiya kwigumbi likaxakeka okanye fowunela inombolo yongxamiseko yendawo (enje nge-911) ukuba uneempawu zokothuka kwe-cardiogenic. Ukutshitshiswa kweCardiogenic ngxamisekileyo kwezonyango.

Unokuwunciphisa umngcipheko wokuhlaselwa kukothuka ngo:

• Ukunyanga ngokukhawuleza unobangela (njengokuhlaselwa sisifo sentliziyo okanye ingxaki yevalvu yentliziyo)
• Ukuthintela nokunyanga umngcipheko wesifo sentliziyo, njengesifo seswekile, uxinzelelo lwegazi oluphezulu, icholesterol ephezulu kunye ne-triglycerides, okanye ukusebenzisa icuba

Umothuko - weentliziyo

• Icandelo lentliziyo phakathi embindini

UFelker GM, iTeerlink JR. Ukuchongwa kunye nolawulo lokungaphumeleli kwentliziyo. Ku: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, ii-eds. Isifo sentliziyo seBraunwald: Incwadi yesifundo seMpilo yeNtliziyo. Ngomhla we-11. IPhiladelphia, PA: Elsevier; I-2019: isahluko 24.

IHollenberg SM. Umothuko weCardiogenic. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Ngomhla wama-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 99.