IHD yog dab tsi, peb yuav xav txog hauv kab lus no.
kab mob Ischemic yog tus cwj pwm los ntawm cov kab mob organic thiab ua haujlwm ntawm myocardium, uas yog tshwm sim los ntawm qhov tsis muaj lossis ua tiav cov ntshav txaus rau cov leeg nqaij (ischemia). IHD manifests nws tus kheej li mob (lub plawv nres, myocardial infarction) thiab mob ntev (post-infarction cardiosclerosis, angina pectoris, plawv tsis ua hauj lwm). Cov tsos mob ntawm tus kab mob no yog txiav txim los ntawm nws daim ntawv tshwj xeeb. IHD yog feem ntau ua rau tuag sai sai, suav nrog cov neeg hnub nyoog ua haujlwm.
Cov tsos mob thiab kev kho mob rau cov kab mob plawv muaj nyob hauv qab no.
Kev piav qhia ntawm pathology
kab mob ischemic yog ib qho teeb meem loj heev nyob rau hauv niaj hnub cardiology thiab kev kho mob science feem ntau. Nyob rau theem tam sim no, kwv yees li 600 txhiab tus neeg tuag tau sau tseg hauv peb lub tebchaws, uas tshwm sim los ntawm ntau hom kab mob plawv (ICD 10 I24.9 - mob hnyav, I25.9 - mob ntev) txhua xyoo, thiab kev tuag thoob ntiaj teb los ntawm qhov no.kab mob yog li ntawm 75%. Cov kab mob no feem ntau tshwm sim hauv cov txiv neej hnub nyoog 50 txog 70 xyoo thiab tuaj yeem ua rau muaj kev tsis taus thiab tuag sai.
IHD yog dab tsi nthuav rau ntau.
Lub hauv paus ntawm kev tsim yog dab tsi?
Kev tsim tus kab mob yog ua raws li qhov tsis txaus ntseeg ntawm qhov xav tau cov ntshav mus rau cov nqaij mos ntawm lub plawv thiab cov ntshav coronary. Qhov tshwm sim no tuaj yeem txhim kho vim qhov xav tau ntawm myocardial oxygen siab thiab cov khoom tsis txaus, lossis nrog kev xav tau ib txwm, tab sis txo qis hauv cov ntshav coronary.
Kev tsis txaus ntawm cov ntshav mus rau cov hlwb ntawm cov leeg hauv lub plawv yog qhov tshwj xeeb tshaj yog thaum muaj kev txo qis hauv cov ntshav coronary, thiab qhov xav tau ntawm cov ntshav myocardial nce ntxiv. Tsis muaj ntshav txaus rau cov ntaub so ntswg ntawm lub plawv, lawv cov hypoxia yog tshwm sim los ntawm ntau hom kab mob plawv.
Pab pawg ntawm cov kab mob zoo sib xws suav nrog cov xwm txheej ntawm myocardial ischemia hauv cov mob hnyav thiab mob ntev, uas tau nrog nws cov kev hloov pauv tom ntej: necrosis, dystrophy, sclerosis. Zoo sib xws pathologies ntawm tus mob yog xam nyob rau hauv cardiology, raws li zoo raws li nosological ywj siab units.
Vim li cas IHD thiab angina tshwm sim?
Cas thiab yam tshwm sim
Nyob rau hauv feem coob (96%) ntawm kev kho mob, qhov tshwm sim ntawm tus kab mob no yog vim atherosclerotic hloov nyob rau hauv lub coronary hlab ntsha ntawm txawv qhov hnyav: los ntawm ib qho insignificant nqaim ntawm cov hlab ntsha lumen los ntawm atherosclerotic plaque kom meej. vascular occlusion. Ntawm 80% ntawm coronary stenosis, cov ntaub so ntswg ntawm lub plawv cov leeg pib teb rau qhov tsis muaj oxygen, thiab cov neeg mob tsim qhov hu ua exertional angina.
Lwm yam ua ntej
Lwm yam xwm txheej uas tuaj yeem ua rau muaj kev cuam tshuam ntawm cov tsos mob ntawm cov kab mob plawv hauv tib neeg yog spasm lossis thromboembolism ntawm cov hlab ntsha coronary, uas feem ntau tshwm sim tawm tsam keeb kwm yav dhau los ntawm cov kab mob atherosclerotic ntawm cov hlab ntsha. Cardiospasm ua rau muaj kev cuam tshuam hauv cov hlab ntsha thiab ua rau cov tsos mob tseem ceeb ntawm tus kab mob coronary.
Txhob Cia Siab
Yam tseem ceeb uas, ntxiv rau vascular atherosclerosis, ua rau muaj qhov tshwm sim ntawm cov hlab ntsha muaj xws li:
- Hyperlipidemia, uas ua rau muaj kev hloov pauv ntawm atherosclerotic thiab ua rau muaj kev pheej hmoo ntawm kev tsim kab mob plawv ntau zaus. Qhov txaus ntshai tshaj plaws ntawm kev pheej hmoo yog hyperlipidemia hom II, III, IV, thiab txo qis hauv cov ntsiab lus ntawm alpha-lipoproteins.
- Arterial hypertension, uas ua rau muaj kev pheej hmoo ntawm cov kab mob plawv los ntawm 6 npaug. Hauv cov neeg uas muaj systolic siab ntawm 180 mm Hg. Art. thiab saum toj no, xws li pathology tshwm sim txog li 9 zaug ntau dua li cov neeg uas muaj ntshav siab lossis ntshav siab.
- Kev haus luam yeeb. Raws li kev txheeb cais, kev haus luam yeeb ua rau muaj qhov tshwm sim ntawm cov kab mob no los ntawm 4 zaug. Kev tuag los ntawm tus kab mob coronary ntawm cov neeg haus luam yeeb hnub nyoog 30-55 uas haus luam yeeb 20-30 luam yeeb ib hnub yog ob zaug siab dua li cov neeg tsis haus luam yeeb ntawm tib lub hnub nyoog. Dab tsi ntxiv ua rau muaj kev pheej hmoo ntawm CHD?
- Kev rog thiab lub cev tsis ua haujlwm. Cov neeg uas lub cev tsis muaj zog yog qhov txaus ntshaituag los ntawm lub plawv ischemia 3 zaug ntau dua li cov neeg uas ua lub neej nquag. Nrog rau kev rog dhau, cov kev pheej hmoo no nce ntxiv.
- Impaired carbohydrate kam rau.
- Thaum muaj ntshav qab zib mellitus, suav nrog hauv daim ntawv latent, kev pheej hmoo ntawm kev mob ntshav qab zib nce ntxiv li 3 zaug.
Cov yam ntxwv uas ua rau muaj kev hem thawj rau kev tsim cov kab mob no yuav tsum muaj xws li kev hloov pauv hloov pauv, hnub nyoog dhau los thiab poj niam txiv neej ntawm cov neeg mob. Yog hais tias muaj ntau yam predisposing ib zaug, qhov tshwm sim yuav tshwm sim.
Qhov nrawm thiab ua rau ischemia, nrog rau nws qhov hnyav, lub sijhawm thiab lub sijhawm pib ntawm tib neeg lub plawv thiab cov hlab ntsha txiav txim siab qhov tshwm sim ntawm ib lossis lwm hom kab mob coronary.
IHD yog dab tsi tam sim no meej. Xav txog qhov kev faib tawm ntawm tus kab mob ntxiv.
YKev faib tawm ntawm pathology
Hauv kev kho mob plawv, cov hauv qab no systematization ntawm cov ntaub ntawv ntawm ischemic pathology tau txais:
1. Thawj lub plawv nres (kab mob tuag tes tuag taw) yog ib qho mob loj hlob sai, uas yog suav tias yog raws li hluav taws xob tsis muaj zog ntawm myocardium. Sudden coronary tuag yog suav hais tias tshwm sim tsis pub dhau 6 teev tom qab pib mob plawv lossis tuag tam sim ntawd. Muaj ib qho kev tuag tam sim ntawd nrog rau qhov zoo resuscitation thiab ib qho uas xaus rau hauv kev tuag.
2. Angina nrog tus kab mob coronary artery, uas yog subdivided, tig, mus rau hauv:
- stable(cov chav kawm ua haujlwm I, II, III lossis IV);
- tsis ruaj khov: qhov pib tshiab, tom qab ua haujlwm ntxov, kev loj hlob, lossis postinfarction;
- spontaneous - Prinzmetal's angina, vasospastic.
3. Cov ntaub ntawv tsis mob ntawm ischemic myocardial disorders.
4. Myocardial infarction:
- Q-infarction, transmural (loj focal);
- tsis yog Q-infarction (small focal).
5. Postinfarction cardiosclerosis.
6. Rhythm thiab cardiac conduction disorders.
7. Lub plawv tsis ua hauj lwm.
Hauv kev xyaum cardiology, muaj ib lo lus "mob coronary syndrome", uas sib txuas ntau hom kab mob: myocardial infarction, tsis ruaj khov angina, thiab lwm yam. Qee zaum pawg no suav nrog kev tuag sai sai los ntawm cov kab mob plawv.
Exertion Angina FC
Cov txheej txheem pathological no muaj ntau theem.
thawj chav kawm ua haujlwm, thaum muaj kev tawm tsam nrog kev ua kom lub cev muaj zog.
Qhov kev ua haujlwm thib ob, uas yog lub xeev uas tshwm sim hauv keeb kwm yav dhau los ntawm qhov nruab nrab load.
Cov chav kawm ua haujlwm thib peb, qhov chaw kho mob tshwm sim uas tshwm sim raws li cov lus teb rau kev ua haujlwm me, piv txwv li, nyob rau hauv daim ntawv ntawm kev taug kev lossis thaum muaj kev ntxhov siab ntxhov siab.
Cov chav ua haujlwm plaub, uas yog tus yam ntxwv ntawm qhov kev tawm tsam cuam tshuam rau tus neeg mob txawm tias so.
Symptoms of disease
Cov tsos mob ntawm IHD(ICD-10 code I20-I25) feem ntau yog txiav txim los ntawm daim ntawv ntawm tus kab mob. Feem ntau, xws li ib tug pathology muaj ib tug undulating chav kawm: tus neeg mob lub stably ib txwm lub xeev ntawm kev noj qab haus huv hloov nrog lub sij hawm ntawm exacerbation ntawm ischemia. Kwv yees li ib feem peb ntawm tag nrho cov neeg mob tsis xav tias lawv muaj kab mob coronary, qhov kev loj hlob tuaj yeem loj hlob qeeb, qee zaum txawm tias ntau xyoo lawm, thiab tsis tsuas yog cov qauv ntawm cov txheej txheem pathological, tab sis kuj cov tsos mob ntawm cov kab mob plawv tuaj yeem hloov pauv..
Cov cim qhia dav dav ntawm ischemia
Cov cim qhia ntawm ischemia muaj xws li mob hauv lub sternum, uas cuam tshuam nrog kev tawm dag zog lub cev lossis kev ntxhov siab hnyav, mob nraub qaum, caj npab, sab puab tsaig, ua tsis taus pa, nce plawv dhia lossis kev xav ntawm kev cuam tshuam hauv lub suab. ntawm lub plawv, qaug zog, xeev siab, clouding ntawm tsis nco qab thiab lwm yam. Feem ntau, cov kab mob coronary yog kuaj pom twb nyob rau ntawm lub sij hawm ntawm lub plawv tsis ua hauj lwm nrog cov tsos ntawm edema ntawm lub qis extremities, ua tsis taus pa luv, uas feem ntau yuam tus neeg mob mus ntsib ib tug kws kho mob..
Cov tsos mob saum toj no ntawm cov kab mob plawv (ICD code I20-I25) feem ntau tsis tshwm sim ib txhij, thiab nrog rau ib hom kab mob tshwj xeeb, muaj qhov tseem ceeb ntawm qee qhov tshwm sim ntawm ischemia.
Harbiners
Harbiners ntawm thawj daim ntawv ntawm lub plawv nres thaum lub plawv ischemia tej zaum yuav yog ib qho kev xav ntawm paroxysmal ntawm qhov tsis xis nyob tom qab lub sternum, ceeb ntshai, ntshai kev tuag, nrog rau kev puas siab puas ntsws instability. Nrog rau daim ntawv ntawm kev tuag sai sai, tus neeg mob tsis nco qab, nws muaj lub ntsws ua pa, tsis muaj lub plawv dhia. Cov hlab ntsha loj (carotid thiab femoral), lub plawv suab tsis hnov, cov menyuam kawm ntawv dilate, daim tawv nqaij ua daj ntseg. Cov xwm txheej ntawm cov kab mob no muaj txog li 63% ntawm cov neeg tuag hauv cov kab mob plawv (ICD code: I20–I25), feem ntau txawm tias ua ntej tus neeg mob mus pw hauv tsev kho mob.
Diagnosis
Kev kuaj tus kab mob no yog ua nyob rau hauv tsev kho mob lossis lub tsev kho mob uas siv cov cuab yeej tshwj xeeb. Cov kev tshawb fawb hauv chav kuaj feem ntau qhia tias muaj cov enzymes tshwj xeeb uas nce thaum lub plawv nres thiab angina pectoris (creatine phosphokinase, troponin-I, troponin-T, myoglobin aminotransferase, thiab lwm yam). yog txiav txim. triglycerides, nrog rau cov cim cytolysis.
Cov tsos mob thiab kev kho mob ntawm cov hlab ntsha ntawm cov hlab ntsha yog sib cuam tshuam.
ECG, echocardiography, ultrasound ntawm lub plawv, kev ntxhov siab echocardiography, thiab lwm yam yog txoj hauv kev tseem ceeb rau kev kuaj mob xws li kab mob plawv.
ECG Holter saib xyuas yog lwm txoj kev kuaj mob uas suav nrog kev kaw ECG hauv 24 teev.
Transesophageal electrocardiography - cov txheej txheem uas tso cai rau koj los ntsuas qhov kev coj ua, hluav taws xob excitability ntawm myocardium.
Kev ua kom pom cov kab mob plawv hauv kev txiav txim siab kab mob plawv tso cai rau koj pom cov hlab ntsha ntawm cov leeg plawv los ntawm kev qhia tus neeg sawv cev sib txawv rau hauv cov ntshav thiab txiav txim siab ua txhaum ntawm lawv cov patency, muaj stenosis lossis occlusion. Keeb kwm ntawm CAD tej zaumsib txawv ntawm tus kheej.
IHD kev kho mob
Cov tswv yim ntawm kev kho qee yam ntawm cov kab mob no muaj qee qhov tshwj xeeb. Txawm li cas los xij, muaj cov lus qhia tseem ceeb uas siv los kho ischemia. Cov no suav nrog:
- Drug therapy.
- Kev phais kho lub plawv cov leeg (coronary bypass grafting).
- Siv cov tswv yim endovascular (coronary angioplasty).
Kev kho tsis yog tshuaj muaj xws li kev ntsuas kev noj haus thiab kev ua neej. Hauv ntau hom ischemia, kev txwv ntawm kev ua haujlwm tau qhia, txij li thaum lub sijhawm ua haujlwm ntawm myocardial oxygen xav tau nce, qhov tsis txaus siab uas ua rau pom cov kab mob coronary artery. Yog li ntawd, nyob rau hauv txhua hom kab mob coronary artery, tus neeg mob hom kev ua si yog txwv.
Tshuaj
Tshuaj kho rau cov kab mob plawv (ICD-10 code I20-I25) suav nrog kev siv cov tshuaj hauv qab no:
- tshuaj tiv thaiv kab mob;
- tshuaj tiv thaiv kab mob siab;
- β-blockers
- Ydiuretics,
- tshuaj tiv thaiv kab mob.
Thaum tsis muaj kev cuam tshuam hauv kev siv tshuaj thiab lwm yam kev kho mob rau cov kab mob pathology, siv ntau txoj hauv kev ntawm kev phais mob.
Peb saib dab tsi yog CHD.
Huab cua thiab tiv thaiv
Kev kuaj mob rau tus kab mob coronary artery nyob ntawm ntau yam. Yog li, kev sib xyaw ua ke ntawm cov kab mob plawv thiabarterial hypertension, mob hnyav ntawm lipid metabolism thiab ntshav qab zib mellitus. Kev ntsuas kev kho tsuas tuaj yeem ua rau qeeb zuj zus ntawm cov kab mob coronary artery, tab sis tsis tso tseg kiag li.
Kev tiv thaiv zoo tshaj plaws ntawm cov kab mob plawv yog txo qis cov xwm txheej: koj yuav tsum tsis suav nrog cawv thiab haus luam yeeb, kev puas siab puas ntsws ntau dhau, tswj lub cev kom zoo, qoj ib ce, tswj ntshav siab, noj kom raug.
