Cov kab mob plawv tau txuas mus tas li thiab maj mam ua rau ib leeg hnyav. Yog li, atherosclerosis ua rau muaj kab mob coronary, thiab kub siab - qhov nce ntawm sab laug ventricle ntawm lub plawv. Cov xwm txheej no ib txhij ua kom lub plawv tsis ua haujlwm, ua rau muaj kev pheej hmoo ntawm kev tsim myocardial infarction lossis angina pectoris.
Qee qhov xwm txheej tsis zoo uas ua rau mob plawv tuaj yeem pom tau thaum muaj hnub nyoog thaum lawv tuaj yeem kho kom raug. Yog li ntawd, yuav tsum tau saib xyuas tshwj xeeb rau cov ntsiab lus xws li sab laug ventricular hypertrophy (LVH) thiab dilatation, nrog rau kev kawm cov kab mob uas lawv tshwm sim, sim tsim cov kev ntsuas thiab cov tswv yim rau lawv kho.
Lub tswvyim ntawm hypertrophy thiab dilation
Hypertrophy thiab dilatation yog cov morphological phenomena uas ua rau kom loj hlob ntawm lub plawv, feem ntau yog vim sab laug ventricle thiabatrium, tsawg zaus vim txoj cai ventricle ntawm lub plawv. Hypertrophy yog nce nyob rau hauv sab laug ventricle ntawm lub plawv, thickening ntawm myocardium, feem ntau cov interventricular septum thiab posterior phab ntsa, tshwm sim los ntawm lub cev kev cob qhia los yog cov kab mob uas cuam tshuam intracardiac hemodynamics (malformations thiab hypertrophic cardiomyopathy) thiab afterload (hypertension). LVH yog nrog los ntawm kev nce hauv qhov ntim ntawm cov hlab ntsha thiab qhov nrawm ntawm kev cog lus, tso cai rau cov ntshav ntau ntxiv rau hauv cov hlab ntsha uas tau txais qhov siab dua.
Dilatation - stretching thiab thinning ntawm cov phab ntsa ntawm myocardium, tshwm sim los ntawm kev tsis zoo ntawm cov khoom noj khoom haus ntawm lub plawv cov leeg thiab lawv tsis muaj peev xwm tiv taus cov ntshav siab hauv cov kab noj hniav, uas yog nrog los ntawm kev nce hauv LV filling. thiab qhov txo qis hauv nws qhov ejection feem. Cov txheej txheem no inevitably ua raws li hypertrophy loj heev vim nws decompensation los yog tshwm sim los ntawm kev loj hlob ntawm dilated cardiomyopathy.
Ntseeg LV o
Kev loj hlob ntawm sab laug ventricle ntawm lub plawv, cov laj thawj uas yuav tau qhia hauv qab no, tuaj yeem txiav txim siab los ntawm kev kuaj xyuas yooj yim ntawm tus neeg mob, thaum lub sij hawm echocardiography, ECG lossis x-ray diagnostics. Feem ntau qhov no dhau los ua qhov kev kuaj pom asymptomatic thaum tus neeg mob tau kuaj xyuas rau lwm yam laj thawj.
Cov tsos mob ntawm hypertrophy yuav yog qhov nce ntawm percussion ciam teb ntawm lub plawv, kev hloov ntawm apex ntaus rau sab laug thiab nthuav dav ntawm nws thaj chaw, uas tuaj yeem txiav txim siab thaum kuaj mob. Nrog dilatation, percussion ciam teb kujdilated, tab sis lub apex yeej yog diffuse thiab tsis muaj zog, tej zaum yuav tsis pom nyob rau hauv tag nrho cov neeg mob rog rog. Yog li koj tuaj yeem xav tias qhov nce ntawm sab laug ventricle ntawm lub plawv (nws yog dab tsi los ntawm qhov pom ntawm cov tshuaj - nyeem hauv qab no).
Electro- thiab echocardiography
Thaum ECG ua tiav los ntawm tus kws kho mob ua haujlwm, qhov kev txiav txim siab feem ntau ua rau hypertrophy raws li kev suav cov qauv ntsuas raws li ntsuas qhov voltage ntawm R thiab S nthwv dej hauv lub hauv siab ua. Dilatation ntawm cov kab noj hniav siv ECG yog txiav txim ncaj qha los ntawm lub hauv paus ntawm systolic overload, uas tsis tuaj yeem ntseeg tau tias qhov nce ntawm sab laug ventricle ntawm lub plawv. Kev kho mob tsuas yog raws li ECG nyob rau hauv cov ntaub ntawv no tsis tuaj yeem raug sau tseg yog tias nws tsis yog hais txog kev sib koom ua ke ntawm arrhythmias.
ECG thaum kuaj pom cov txheej txheem pathologies ntawm lub plawv tsuas yog ib qho ntawm cov laj thawj uas yuav tsum tau txhaj tshuaj ultrasound ntawm lub plawv, uas yuav ua rau nws tuaj yeem ntsuas qhov loj ntawm cov kab noj hniav thiab txiav txim siab qhov tuab ntawm myocardium. Nyob rau hauv dilatation, lub plawv yog dilated nrog rau ib tug txo nyob rau hauv phab ntsa thickness, thiab nyob rau hauv hypertrophy, lub myocardium thickens, feem ntau ua rau ib tug txo nyob rau hauv lub ventricular kab noj hniav.
X-ray diagnostics
Hypertrophy lossis dilatation, tshwj xeeb tshaj yog hais, tuaj yeem txiav txim siab los ntawm X-ray. Fluorography lossis radiography tso cai rau koj kom pom cov kev teeb tsa ntawm lub plawv. Nyob rau hauv hypertrophy vim muaj kab mob aortic valve, muaj qhov sib txuam nrog kev nthuav dav ntawm sab laug ventricle thiab qhov loj ntawm lub atrium.
Thaum tus kab mob mitral valve raug cuam tshuam, kev teeb tsa sib txawv heev: nws qhia txog kev nthuav davatria nrog ib txwm lossis tsuas yog me ntsis loj LV. Hypertrophic cardiomyopathy tuaj yeem raug cim los ntawm kev teeb tsa tshwj xeeb, uas, vim nws qhov loj me, hu ua "bull's heart." Nyob rau hauv dilated cardiomyopathy, x-rays qhia cov tsos mob ntawm aortic thiab mitral configuration, feem ntau txuam nrog expansion ntawm txoj cai ciam teb ntawm lub plawv.
Lub luag haujlwm ntawm LVH thiab nthuav dav hauv kev txhim kho CHF
Kev sib raug zoo ntawm hypertrophy, dilatation, mob coronary syndrome thiab congestive plawv tsis ua hauj lwm yog ncaj qha thiab yooj yim ua raws. Raws li qhov tshwm sim ntawm kev kub siab mus ntev lossis muaj qhov tsis raug kho, qhov qub myocardium hypertrophies thiab them nyiaj rau kev cuam tshuam ntawm cov kab mob no ntev. Nrog rau kev nce ntxiv ntawm sab laug ventricle ntawm lub plawv thiab atria, thawj qhov kev hloov pauv thiab tom qab ntawd mus tas li ischemia tsim, uas maj mam ua rau kev tuag ntawm cov hlwb myocardial. Qhov tshwm sim yog qhov ua kom tsis muaj zog ntawm cov phab ntsa ntawm lub plawv, uas yog feem ntau hais nyob rau sab laug ventricle, ua rau pulmonary hypertension thiab thawj sab laug ventricular thiab tom qab ntawd tag nrho lub plawv tsis ua hauj lwm nrog congestion nyob rau hauv txoj kev.
Cas LVH thiab dilatation
Txhua yam ua rau muaj kev nce ntxiv ntawm sab laug ventricle ntawm lub plawv yuav tsum tau qhia meej meej raws li qhov tseem ceeb hauv kev loj hlob ntawm hypertrophy lossis dilatation. Cov kev hloov morphological no nyob rau hauv cov qauv ntawm lub plawv cov leeg muaj lub hauv paus chiv keeb, tab sis tib yam tshwm sim, uas nyob ntawm qhov degree.myocardial kev hloov pauv. Ntawm cov laj thawj ntawm sab laug ventricular hypertrophy yuav tsum tau qhia:
- lub cev muaj zog thiab qoj ib ce, qoj ib ce;
- hlab ntshav siab;
- hypertrophic cardiomyopathy;
- them nyiaj aortic stenosis lossis aortic insufficiency;
- pab tau lub plawv tsis xws luag.
Ua rau lub plawv dhia ntau tsawg, thiab lawv yuav tsum muab faib ua thawj thiab theem nrab. Cov thawj uas muaj xws li hereditary dilated cardiomyopathy, ib tug kab mob txuam nrog ib tug tsis xws luag nyob rau hauv lub structural proteins ntawm cov leeg hlwb. Vim li no, cov phab ntsa myocardial tsis tuaj yeem tiv taus cov ntshav siab hauv cov kab noj hniav ntawm lub plawv, uas yog vim li cas nws maj mam ncab thiab ua thinner. Qhov thib ob ua rau dilatation muaj xws li decompensation ntawm congenital thiab kis tsis xws luag, kis tau dilated cardiomyopathy (cawv, tshuaj lom lossis hluav taws xob).
Degrees of hypertrophy
Saum toj no yog ib qho kev piav qhia ntawm lub tswv yim ntawm qhov kev nce ntawm sab laug ventricle ntawm lub plawv txhais tau li cas, txawm li cas los xij, yuav tsum txhais li cas yuav tsum tau nkag siab ntau ntxiv. Yog hais tias nrog dilatation qhov kev cia siab rau kev loj hlob ntawm lub plawv tsis ua hauj lwm nrog ib tug poob nyob rau hauv ejection feem yog inevitable, ces nrog LVH qhov no yuav zam tau nyob rau hauv feem ntau lub sij hawm. Yog li ntawd, los tsim ib qho kev tshwm sim, nws tau thov kom ntsuas qhov ntsuas ntawm hypertrophy raws li cov txheej txheem echocardiographic.
LV phab ntsa tuab hauv cov poj niam yog 0.6 - 0.9 cm, thiabNyob rau hauv cov txiv neej, 0.6 - 1.0 cm nyob rau hauv lub cheeb tsam ntawm lub interventricular septum (IVS) thiab lub posterior phab ntsa ntawm sab laug ventricle (PLV).
Nrog rau qib me me ntawm hypertrophy hauv cov poj niam, muaj qhov tuab ntawm LVL thiab IVS txog li 1.0 - 1.2 cm, nrog qhov nruab nrab ntawm hypertrophy - 1.3 - 1.5 cm, thiab nrog qhov hnyav - ntau dua. 1.5 cm.
Hauv cov txiv neej, qhov ntsuas me me ntawm LVH tau pom thaum lub thickness ntawm IVS thiab ZSLZh nyob rau hauv 1.1 - 1.3 cm, qhov nruab nrab degree yog 1.4 - 1.6 cm, thiab hnyav - 1.7 los yog ntau tshaj.
Physiological hypertrophy
Nyob rau hauv lub moj khaum ntawm kev ua kis las tshuaj, muaj xws li physiological functional hypertrophy tshwm sim los ntawm intensive kev cob qhia ntawm lub cev, myocardium thiab skeletal leeg. Cov txheej txheem no tso cai rau lub plawv sib cog lus ntau zog thiab thawb ntau cov ntshav mus rau hauv cov hlab ntsha uas tau txais, uas ua kom cov leeg ntawm lub cev tau txais kev noj qab haus huv ntau dua li ntawm tus neeg mob uas tsis tau kawm.
Physiological hypertrophy yog qhov tshaj tawm, qhov nyuaj ntawm kev ua kis las, thiab ntau qhov dynamic lossis static loads nws xav tau. Txawm li cas los xij, qhov txawv ntawm nws los ntawm pathological hypertrophy yog tias nws ua rau muaj kev nce ntxiv ntawm ejection feem ntawm sab laug ventricle ntawm lub plawv. Ntawd yog, ib feem ntawm cov ntshav uas tau nkag mus rau sab laug ventricular kab noj hniav raug thawb tawm ntau dua li ntawm tus neeg mob tsis tau txais kev cob qhia, nrawm dua thiab muaj zog dua. Yog tias tus neeg noj qab haus huv muaj feem cuam tshuam txog 65-70%, ces rau tus neeg ncaws pob nws tuaj yeem yog 80-85% lossis siab dua.
Qhov no yog qhov txiav txim siab lub peev xwm ntawm lub siab kom kov yeej kev tawm dag zog lub cev. Txawm li cas los xij, physiological LVH tsis tshua muajmus dhau ntawm tus ciam teb ntawm ib tug me me degree raws li echocardiography, thiab kuj yog tus yam ntxwv los ntawm ib tug nplua nuj network ntawm collaterals nyob rau hauv lub myocardium. Vim li no, txoj kev pheej hmoo ntawm kev tsim lub plawv tsis ua haujlwm thaum tsis muaj lwm yam tseem ceeb, xws li ntshav siab, yog qhov tsawg heev. Nyob rau hauv cov ntaub ntawv no, hypertrophy yuav tsum tau ua kom cov feem ntawm sab laug ventricle ntawm lub plawv, thiab tsis txhob kov yeej tag nrho peripheral vascular kuj, xws li nyob rau hauv cov ntaub ntawv ntawm hypertensive hypertrophy.
sib xyaw hypertrophy
Yog tias tus neeg ncaws pob muaj ntshav siab, kev cob qhia kev tshaj lij yuav tsum raug tso tseg, vim tias LVH yuav ua rau tus cwj pwm tsis yog lub luag haujlwm them nyiaj, tab sis ib qho kab mob. Tsuas yog vim li cas muaj nyob rau hauv qhov nce ntawm sab laug ventricular ejection feem ntawm lub plawv tam sim no yuav ua hauj lwm tiv thaiv qhov nce ntawm kev ua siab ntev. Yuav muaj qhov nce hauv myocardial ntim, tom qab ntawd cov chaw subepicardial yuav pib muaj kev mob ischemia tas li. Qhov no yuav ua rau muaj qhov tshwm sim ntawm angina, yuav ua rau muaj kev pheej hmoo ntawm kev loj hlob ntxov ntawm myocardial infarction.
LV o kho
Nyob rau hauv nqe lus nug uas yuav tsum tau kho qhov mob sab laug ntawm lub plawv, yuav tsis sai sai no yuav muaj cov lus teb tsis txaus ntseeg vim tias tus mob no tsis suav tias yog kab mob, tshwj tsis yog mob plawv thiab dilatation. Hauv kev kub siab, cov tshuaj tseem ceeb uas txo cov ntshav siab tuaj yeem tiv thaiv kev txhim kho LVH. Txhua ACE inhibitors (Enalapril, Lisinopril, Quinapril, Ramipril), angiotensin receptor blockers (Candesartan,"Losartan", "Valsartan"), diuretics ("Indapofon", "Hydrochlorothiazide", "Furosemide", "Torasemide")
Kev Tiv Thaiv LVH
Tus kws kho mob, muab cov tshuaj sib xyaw ua ke rau kev kho mob ntshav siab lossis lub plawv tsis ua haujlwm, yog li ua rau qeeb ntawm kev loj hlob ntawm hypertrophy thiab dilatation. Qhov no txhais tau hais tias kev tiv thaiv ntawm hypertrophy tau ua tiav thaum lub sijhawm kho tshuaj kho mob ntshav siab, malformations, mob coronary syndromes thiab tom qab angina pectoris.
Hauv cov xwm txheej uas muaj qee yam mob plawv tau raug txheeb xyuas hauv tus neeg mob, nws yog qhov tsim nyog tsis txhob tos lub sijhawm decompensation, thaum hypertrophy hloov mus rau hauv dilatation, tab sis kho tus kab mob phais. Nyob rau hauv cov ntaub ntawv ntawm decompensation ntawm hypertrophic (tshwj xeeb tshaj yog concentric los yog obstructive) los yog dilated cardiomyopathy, cov tub ntxhais hluas cov neeg mob muaj rau hloov lub plawv los yog ib ntus implantation ntawm sab laug ventricular prostheses.
