Kev kho mob plawv pathologies yuav tsum tau mus cuag lub luag haujlwm, vim lawv muaj kev phom sij rau tib neeg lub neej. Piv txwv li, muaj ntau yam kev mob angina xws li Prinzmetal's angina, uas tuaj yeem ua rau lub plawv nres thiab tuag tam sim ntawd. Lub xeev no tuaj yeem tiv thaiv yog tias tsuas yog ib tus npaj rau qhov tshwm sim.
Specific pathology
Prinzmetal's angina yog ib hom mob angina uas tshwm sim nrog coronary angiospasm. Tus kab mob tau txais nws lub npe nyob rau hauv kev hwm ntawm M. Prinzmetal, kws kho plawv uas yog thawj tus piav txog daim ntawv no xyoo 1959. Hauv kev faib tawm thoob ntiaj teb ntawm cov kab mob, nws tau teev nyob rau hauv tus lej I20.
Cov kab mob no tseem hu ua tus kheej, hloov pauv thiab tsis ruaj khov vasospasm. Tus kab mob no tsis tshua muaj, vim nws tshwm sim li ntawm peb feem pua ntawm cov neeg mob. Feem ntau nws yog ib yam rau cov txiv neej los ntawm peb caug mus rau tsib caug xyoo. Qee zaum nws yuavyuav tsum tau soj ntsuam nrog rau exertional angina.
Lub ntsiab feature ntawm variant angina yog qhov txawv ntawm qhov mob ntev thiab mob hnyav uas tuaj yeem tshwm sim thaum so.
Kev tshwm sim
M. Prinzmetal yog thawj zaug qhia tias cov hlab ntsha ntawm cov hlab ntsha yog qhov ua rau muaj qhov sib txawv ntawm angina, uas tau lees paub hauv kev tshawb fawb ntxiv. Cov tsos mob ntawm spasm ntawm cov hlab ntsha coronary yog pom tau nrog coronary angiography. Spasms tshwm sim vim qhov chaw endothelial dysfunction nrog nce rhiab heev rau vasoconstrictor hom teebmeem. Nyob nruab nrab ntawm 70 thiab 90% ntawm cov neeg mob uas muaj mob angina yog cov txiv neej. Nws kuj tau sau tseg tias muaj coob tus neeg haus luam yeeb ntawm cov neeg muaj tus kab mob no.
Spontaneous variant angina yog tus cwj pwm los ntawm cov hlab ntsha hauv plawv, mob anginal mob hnyav thiab qhov nce siab ntawm RS-T ntu ntawm ECG.
Cov kev tshawb fawb hauv qab no tau pom tias cov neeg mob "ntshiab" (kib cais) angina tsis tshua muaj, tsawg dua 5% ntawm tag nrho cov neeg mob angina. Feem ntau hauv kev kho mob, cov neeg mob uas muaj hom mob angina pectoris no yuav tsis ntsib txawm tias tau kaum xyoo. Qhov ntau zaus ntawm kev hloov pauv angina tau sau tseg hauv Nyij Pooj nkaus xwb - txog 20-30%. Tab sis tam sim no tus nqi tau poob qis hauv Nyiv ib yam nkaus, nyob ib ncig ntawm 9% ntawm tag nrho cov mob angina.
Cov kab mob xws li exertional angina ("mixed angina") muaj ntau zaus - los ntawm 50 mus rau 75 feem puaCov neeg mob, nrog rau kev mob plawv, kwv yees li 75% ntawm cov neeg mob muaj cov hemodynamic stenoses ntawm cov hlab ntsha coronary nyob qhov twg hauv ib centimeter los ntawm qhov chaw ntawm spasm.
Txawm tias cov neeg mob muaj cov hlab ntsha tsis hloov pauv thaum lub sij hawm coronary angiography, ces tsis yog stenosing atherosclerosis yog kuaj los ntawm kev siv intracoronary ultrasound ntawm qhov chaw ntawm spasm.
Cov neeg mob feem ntau muaj qhov nqaim ntawm qhov tsawg kawg yog ib qho hlab ntsha loj. Qhov spasm feem ntau tshwm sim nyob rau hauv ib centimeter ntawm qhov chaw aggravated thiab feem ntau nrog ventricular arrhythmias.
Symptoms
Cov tsos mob ntawm qhov txawv txav angina yog qhov mob ntawm qhov mob. Lawv feem ntau tshwm sim thaum sawv ntxov thiab tsaus ntuj, lawv tuaj yeem tshwm sim txawm tias tsis muaj laj thawj zoo. Xws li mob los ntawm thaj tsam ntawm lub plawv, yog qhov txawv los ntawm kev txiav thiab nias lub cim, thiab tseem muaj peev xwm tawg mus rau lwm qhov ntawm lub cev. Kev tawm tsam nws tus kheej tuaj yeem piav qhia los ntawm kev suav nws cov yam ntxwv:
- tachycardia;
- tawm hws ntau yam;
- hypotension;
- fainting;
- mob taub hau;
- tawv pallor.
Qee zaum, cov tsos mob ntawm variant angina tuaj yeem ua tau xws li cov leeg mob plawv tsis ua haujlwm, ventricular fibrillation thiab atrioventricular blockade.
Feem ntau, qaug dab peg tsis pub dhau kaum tsib feeb. Tsis tshua muaj, qhov mob tuaj yeem ntev txog peb caug feeb, nws nyuaj heev rau zam. Tawm tsam qhov backdrop ntawm kev tawm tsammyocardial infarction tuaj yeem txhim kho, thiab yog li ntawd, nrog kev kho mob ntev, koj yuav tsum hu rau lub tsheb thauj neeg mob tam sim.
Cov cim dab tsi tsis zoo rau kev sib txawv ntawm angina? Qhov tseeb tias kev ua lub cev ua haujlwm tsis zoo yog qhov tsawg kawg nkaus.
Diagnosis
Ua ntej pib tag nrho cov txheej txheem kuaj mob, tus kws kho mob tshwj xeeb yuav sau cov anamnesis ntawm lub neej thiab tsev neeg. Tom qab ntawd, auscultation yog ua, qhov twg suab nrov tau hnov, thiab kuaj lub cev. Cov kev hloov pauv no yuav tsum tau ua rau kev kuaj mob sib txawv ntawm qhov txawv ntawm angina pectoris, nrog rau kev txiav txim siab thawj zaug.
Tom qab ntawd tus neeg mob raug tso tawm:
- kuaj ntshav thiab zis kom pom muaj kab mob sib kis;
- kuaj ntshav biochemical los ntsuas qhov concentration ntawm cov protein, cov roj cholesterol thiab lwm yam khoom uas pab txiav txim seb qhov ua rau tus kabmob;
- ECG, uas txiav txim siab lub ntsiab lus qhia ntawm variant angina - qhov nce ntawm ST-segment;
- Holter ECG saib xyuas, kuaj pom cov ischemia hloov pauv;
- kev sim ua rau muaj kev cuam tshuam los ntawm kev ua pa rau kev ua pa angiospasm induction;
- kev kuaj mob khaub thuas thiab ischemic;
- coronary angiography, uas kuaj pom stenosis li ntawm ib nrab ntawm cov neeg mob;
- veloergometry, uas txiav txim siab tus neeg mob qib kev ua haujlwm siab ntev.
Ntxiv rau, MRI tuaj yeem raug sau rau tus neeg mob yog tias muaj cov cuab yeej siv niaj hnub tsim nyog hauv cheeb tsam.
Kev kho mob
Kev kho mobPrinzmetal's variant angina yog qhov ua tau zoo hauv tsev kho mob, vim qhov no tso cai rau koj los tswj cov kev hloov pauv ntawm tus kab mob. Kev kho mob yog ua los ntawm kev sib xyaw ua ke ntawm kev kho mob thiab kev kho mob. Tsis tshua muaj neeg mob yuav tsum tau phais.
Nws tsis pom zoo kom pib kho cov kab mob coronary artery variant, vasospastic angina pectoris nrog cov tshuaj pej xeem.
txoj kev kho mob
Ntawm lub plawv ntawm cov txheej txheem kho mob ntawm qhov sib txawv ntawm angina yog qhov kev hloov kho tshiab ntawm tag nrho cov hauv paus ntsiab lus ntawm lub neej ntawm tus neeg. Tus neeg mob yuav tsum tso nws tus cwj pwm phem, tsis txhob haus cawv thiab haus luam yeeb. Tsis tas li ntawd, nws yog ib qho tseem ceeb heev uas yuav tau hloov kho cov zaub mov:
- txwv tsis pub noj cov tsiaj rog (hauv tag nrho calories - txog li 30%);
- txwv ntsev kom tsawg;
- txo qis kev siv cov txuj lom thiab txuj lom;
- dej multivitamin;
- them nyiaj tshwj xeeb rau zaub thiab cov khoom noj muaj protein ntau.
Tus neeg mob, nrog rau cov lus qhia no, yuav tsum tau ua kev kho mob, uas suav nrog kev ua haujlwm cardio.
Tshuaj kho mob
Nyob rau hauv daim ntawv ntawm kev kho mob mus sij hawm ntev rau variant angina, cov neeg mob raug sau tseg:
- Raws li kev kho tshuaj mus ntev, cov neeg mob tau muab tshuaj: alpha-blockers; calcium antagonists; nitrates.
- Txhawm rau tiv thaiv angina, tus neeg mob yuav tsum noj nitroglycerin hauv qab tus nplaig, nrog rau Nifedipine.
Surgery
Kev ua haujlwm tsuas yog qhia thaum muaj kev mob hnyav ntawm cov hlab ntsha thiab hauv cov xwm txheej uas qhov kev loj hlob ntawm angina pectoris tshwm sim hauv cheeb tsam ntawm lub plawv. Cov nram qab no manipulations yog siv:
- angioplasty, uas qhov nthuav dav ntawm lub nkoj yog nqa los ntawm lub zais pa thiab tsau hauv lub xeev no nrog lub laj kab hlau;
- coronary bypass grafting, uas txhais tau hais tias suturing ib lossis lwm lub nkoj ntawm tus neeg mob mus rau cov hlab ntsha kom pib ntshav hla qhov chaw nqaim.
Tsis tshua muaj, kab mob tuaj yeem cuam tshuam lub plawv zoo li nws tsis tuaj yeem ua haujlwm ntawm nws tus kheej. Hauv qhov no, nws tau pom tias muaj kev cuam tshuam ntawm tus kws phais.
ntsuas kev tiv thaiv
Kev tiv thaiv kev tiv thaiv kab mob angina los ntawm ntau cov lus pom zoo:
- noj tsawg ntsev thiab tsiaj rog, siab hauv nplej thiab zaub;
- tsis suav haus luam yeeb thiab cawv;
- ua raws li cov hauv paus ntsiab lus ntawm qhov piv ntawm so thiab ua haujlwm;
- yim teev pw tsaug zog;
- zam kev ntxhov siab.
Tsis tas li ntawd, cov neeg uas muaj kev pheej hmoo raug qhia kom tawm dag zog tsis tu ncua. Ib zaug txhua rau lub hlis, txhua tus yuav tsum tau mus ntsib kws kho plawv kom kuaj tus neeg mob rau kev tiv thaiv kab mob.
Kev nyuaj siab
Qhov teeb meem feem ntau ntawm daim ntawv no ntawm angina pectoris yog myocardial infarction, vim muaj ntau lub plawv mob hlwb tuag. Tsuas yogTsis tas li ntawd, yog tias tsis muaj peev xwm kho tau, tus kab mob tuaj yeem ua rau:
- mob hnyav tachycardia;
- arrhythmias;
- CHS;
- Qhov teeb meem txaus ntshai tshaj plaws ntawm pathology yog kev tuag ntawm lub plawv sai sai, uas tuaj yeem thim rov qab nrog kev pabcuam raws sijhawm.
Huab cua
Nws yog qhov nyuaj rau kev kwv yees cov chav kawm ntawm angina pectoris, txij li tus mob tau txiav txim siab los ntawm kev cuam tshuam ntawm ntau yam: hnub nyoog ntawm tus neeg mob, qhov hnyav ntawm kev tawm tsam, thiab lwm yam.
Nrog mob plawv mob me, qhov ua rau tuag tsawg heev: kwv yees li 0.5% ib xyoos.
Yog lub plawv mob hnyav, kev tuag tshwm sim hauv 25% ntawm tus neeg mob.
