kab mob plawv ischemic yog ib yam kab mob uas tshwm sim los ntawm kev tsis muaj zaub mov ntawm cov leeg nqaij vim qhov nqaim ntawm lumen ntawm cov hlab ntsha los yog lawv cov spasm. Nws ua ke ntau yam kev kuaj mob, xws li angina pectoris, myocardial infarction, cardiosclerosis, sudden coronary tuag thiab lwm yam.
Hnub no, nws yog tus kab mob ntau tshaj plaws hauv nws pawg hauv ntiaj teb thiab yog tus thib ib ua rau tuag thiab tsis taus nyob hauv txhua lub tebchaws tsim.
Predisposing factors
Tam sim no, cov txheej txheem tau tsim los uas nws muaj peev xwm kwv yees kev loj hlob ntawm ib tus kab mob. Kab mob plawv ischemic tsis muaj qhov zam. Tsis yog ib daim ntawv teev npe xwb, tab sis kev faib tawm ntawm cov xwm txheej txaus ntshai, pab pawg raws li qee qhov tshwj xeeb, uas tuaj yeem ua rau muaj qhov tshwm sim ntawm tus kab mob no.
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Biological:
- hnub nyoog tshaj 50 xyoo;
- poj niam txiv neej - txiv neej mob ntau zaus;- caj cespredisposition rau dysmetabolic kab mob.
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Kev Ntsuas:
- ntshav siab;
- rog;- muaj ntshav qab zib.
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Lifestyle:
- kev ua txhaum cai;
- haus luam yeeb;
- lub cev tsis ua haujlwm lossis tawm dag zog ntau dhau;- haus cawv.
Kev txhim kho kab mob
Pathogenetic ua rau kev loj hlob ntawm tus kab mob tuaj yeem yog ob qho teeb meem ntxiv- thiab intravascular, xws li nqaim ntawm lumen ntawm cov hlab ntsha vim atherosclerosis, thrombosis lossis spasm, lossis hnyav tachycardia nrog kub siab. Tab sis tseem, atherosclerosis yog thawj qhov chaw rau cov laj thawj rau kev loj hlob ntawm lub plawv nres. Thaum xub thawj, ib tug neeg tsim cov kab mob metabolic, uas tau nthuav tawm hauv cov ntshav lipids tsis tu ncua.
kauj ruam tom ntej yog kho cov lipid complexes nyob rau hauv cov phab ntsa ntawm cov hlab ntsha thiab lawv hws nyob rau hauv lub endothelial hlwb. Atherosclerotic plaques tsim. Lawv rhuav tshem cov phab ntsa ntawm cov hlab ntsha, ua rau nws yooj yim dua. Tus mob no tuaj yeem muaj ob qhov tshwm sim - yog cov ntshav txhaws tawm ntawm cov quav hniav thiab txhaws cov hlab ntsha ntawm cov ntshav, lossis txoj kab uas hla ntawm cov hlab ntsha ua rau me me uas cov ntshav tsis tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem tuaj yeem ua rau ob qho kev tshwm sim - yog cov ntshav txhaws tawm ntawm cov quav hniav thiab txhaws cov hlab ntsha ntawm cov hlab ntsha ntawm cov ntshav, los yog txoj kab uas hla ntawm cov hlab ntsha ua rau me me uas cov ntshav tsis tuaj yeem tawm mus tau dawb thiab noj ib qho chaw. Hauv qhov no, lub hom phiaj ntawm ischemia yog tsim, thiab tom qab ntawd necrosis. Yog tias tag nrho cov txheej txheem no tshwm sim hauv lub plawv, ces tus kab mob yuav hu ua kab mob coronary artery.
Muaj ntau daim ntawv kho mob thiab lawv cov kev kho mob sib xws rau cov kab mob plawv. Cov tshuaj raug xaiv raws li cov kab mob pathophysiological.
Sudden coronary death
Lwm yam hu ua mob plawv. Nws tuaj yeem muaj ob qhov txiaj ntsig: tus neeg tuag lossis xaus rau hauv kev saib xyuas hnyav. Nws cuam tshuam nrog kev tsis txaus siab ntawm myocardial instability. Qhov kev kuaj mob no yog qhov tshwj xeeb thaum tsis muaj laj thawj xav tias lwm hom kab mob coronary artery. Kev kho mob, tshuaj ntawm kev xaiv rau cov neeg ua haujlwm kho mob tseem zoo ib yam li hauv resuscitation. Lwm qhov xwm txheej yog tias kev tuag yuav tsum tshwm sim tam sim ntawd thiab nrog cov neeg tim khawv los yog tsis pub dhau rau teev tom qab pib mob plawv. Txwv tsis pub, nws twb poob rau hauv lwm qhov kev faib tawm.
Angina
Qhov no yog ib qho ntawm cov kab mob coronary artery. Nws kuj muaj nws tus kheej ntxiv kev faib tawm. So:
- Stable exertional angina.
- YVasospastic angina.
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Tsis ruaj khov angina, uas, dhau los, muab faib ua:
- nce qib;
- thawj zaug;
- Prinzmetal angina.
thawj hom yog feem ntau. Lub koom haum ntawm Cardiologists tau ntev tsim kho cov kab mob coronary artery rau angina pectoris. Cov tshuaj yuav tsum tau noj tsis tu ncua thiab ntev, qee zaum rau lub neej. Yog tias koj ua raws li cov lus pom zoo, koj tuaj yeem ncua kev noj qab haus huv tsis zoo rau ib ntus.
mob plawv mob plawv
Nws yog teem rau hauv tus account cov ntaub ntawv ntawm lub electrocardiogram, kuaj thiab anamnestic ntsuas. Feem ntauQhov nce ntawm cov enzymes xws li LDH (lactate dehydrogenase), ALAT (alanine aminotransferase) thiab ACaT (aspartate aminotransferase) yog suav tias yog cov ntaub ntawv, uas ib txwm nyob hauv lub cell thiab tshwm sim hauv cov ntshav tsuas yog thaum nws raug rhuav tshem.
Ib lub plawv nres yog ib qho ntawm qhov kawg tshwm sim ntawm kev tswj tsis tau cov kab mob plawv. Kev kho mob, tshuaj, kev pab - tag nrho cov no tuaj yeem lig, vim hais tias nyob rau hauv ib qho mob hnyav muaj sij hawm tsawg heev los thim qhov kev puas tsuaj.
Diagnosis
Ib txwm, txhua qhov kev tshawb fawb pib nrog kev soj ntsuam thiab tshuaj xyuas. Sau cov ntaub ntawv keeb kwm. Tus kws kho mob txaus siab rau cov kev tsis txaus siab xws li mob hauv siab tom qab qoj ib ce, ua tsis taus pa, qaug zog, tsis muaj zog, palpitations. Nws yuav yog ib qho tseem ceeb kom nco ntsoov thaum yav tsaus ntuj o, sov so rau qhov kov. Thiab tseem yuav ua li cas kho cov kab mob coronary artery. Cov tshuaj tuaj yeem qhia ntau rau tus kws kho mob. Piv txwv li, "Nitroglycerin". Yog tias nws pab daws qhov kev tawm tsam, qhov no yuav luag ib txwm hais lus pom zoo ntawm angina pectoris.
Kev kuaj lub cev muaj xws li ntsuas qhov siab, qhov ua pa ntawm lub ntsws thiab lub plawv dhia thiab auscultation ntawm lub plawv thiab lub ntsws. Tus kws kho mob sim hnov cov kab mob tsis zoo, ua kom lub plawv dhia, nrog rau hawb pob thiab hlwv hauv lub ntsws, uas yuav qhia txog cov txheej txheem congestive.
Tom ntej no, tus kws kho mob xa tus neeg mob mus kuaj thiab kuaj lub cev. Peb twb tau tham txog cov kev ntsuam xyuas, thiab los ntawm cov kev tshawb fawb, feem ntau yog ECG, EchoCG thiab ultrasound ntawm lub plawv.
Kev kho mob
Yog li peb mus rau qhov yooj yim tshaj plaws. Peb txaus siab rau kev kho mob ntawm IHD. Cov tshuaj ua lub luag haujlwm tseem ceeb hauv nws, tab sis tsis yog lawv tsuas yog pab txhim kho kev noj qab haus huv. Ua ntej tshaj plaws, tus neeg mob yuav tsum tau piav qhia tias nws yuav tsum tau hloov tag nrho nws txoj kev ua neej. Tshem tawm kev tawm dag zog ntau dhau, ua kom pw tsaug zog thiab so, thiab noj kom zoo. Kev noj zaub mov yuav tsum tau saib xyuas tshwj xeeb. Nws yuav tsum muaj cov poov tshuaj, calcium thiab sodium uas tsim nyog rau lub plawv, tab sis tib lub sij hawm txwv tsis pub noj ntsev, dej, cov khoom noj uas muaj ntau cov tsiaj rog thiab carbohydrates. Yog ib tug neeg rog dhau lawm ces yuav tsum kho.
Tab sis dhau li ntawm qhov no, cov txheej txheem tau tsim los rau kev tshem tawm cov teeb meem xws li kab mob plawv. Kev kho mob - tshuaj nyob rau hauv daim ntawv ntawm cov ntsiav tshuaj, tsiav tshuaj, hmoov thiab daws. Nrog kev xaiv kom raug thiab siv tsis tu ncua, koj tuaj yeem ua tiav cov txiaj ntsig zoo.
Cov tshuaj tiv thaiv kab mob
Cov tshuaj rau kev kho mob ntawm cov hlab ntsha ntawm cov hlab ntsha tau muab faib ua ob peb pawg, tab sis feem ntau - raws li cov txheej txheem ntawm kev ua. Peb yuav siv nws. Cov tshuaj antiplatelet txhim kho cov ntshav khiav. Lawv ua rau cov coagulation thiab anticoagulation systems, me ntsis uncoupling lawv, thiab yog li ua tiav liquefaction. Cov no suav nrog Aspirin, Clopidogrel, Warfarin thiab lwm yam. Thaum muab tshuaj rau lawv, nws yog ib txwm tsim nyog los tswj INR (kev sib raug zoo thoob ntiaj teb) txhawm rau tiv thaiv tus neeg los ntshav.
Betablockers
Muaj kev cuam tshuam rau receptors nyob rau hauv cov phab ntsa ntawm cov hlab ntsha, ua rau lub plawv dhia qeeb. Yog li ntawd, nws siv cov pa oxygen tsawg dua thiab xav tau cov ntshav tsawg, uas yog qhov tseem ceeb heev rau cov hlab ntsha hauv lub plawv. Qhov no yog ib qho ntawm feem ntau cov tshuaj rau cov kab mob coronary artery. Kev kho mob, tshuaj ntawm kev xaiv, thiab koob tshuaj nyob ntawm seb muaj kev cuam tshuam li cas. Muaj cov xaiv thiab tsis xaiv cov beta-blockers. Qee tus ntawm lawv ua ntau maj mam, lwm tus - me ntsis nyuaj, tab sis qhov tseeb contraindication yog tus neeg mob keeb kwm ntawm bronchial hawb pob lossis lwm yam kab mob pulmonary obstructive. Ntawm cov tshuaj feem ntau yog Biprolol, Visken, Carvedilol.
Nyob zoo Statins
Cov kws kho mob siv zog ntau heev rau kev kho tus kab mob coronary artery. Cov tshuaj tau raug txhim kho, txoj hauv kev tshiab tau tsim, thiab kev tshawb fawb tau ua tiav ntawm qhov ua rau muaj tus kabmob. Ib qho ntawm cov kev tshaj lij no yog los cuam tshuam rau cov dej nag, uas yog dyslipidemia lossis tsis txaus ntawm cov ntshav rog. Nws tau raug pov thawj tias kev txo qis cov roj cholesterol ua rau qeeb ntawm kev tsim cov atherosclerosis. Thiab qhov no yog qhov laj thawj tseem ceeb ntawm IBS. Cov cim qhia, kev kho mob, tshuaj - tag nrho cov no twb tau txheeb xyuas thiab tsim, koj tsuas yog yuav tsum muaj peev xwm siv cov ntaub ntawv muaj rau cov txiaj ntsig ntawm tus neeg mob. Piv txwv ntawm kev kho tau zoo yog Lovastatin, Atorvastatin, Simvastatin thiab lwm yam.
Nitrates Nitrates
Kev ua haujlwm ntawm cov tshuaj no yog ib qho kev kuaj mob uas pab taupaub meej tias muaj tus kab mob. Tab sis lawv kuj tseem xav tau los ua ib feem ntawm cov kev pab cuam uas suav nrog hauv kev kho mob ntawm cov hlab ntsha. Cov tshuaj thiab kev npaj tau ua tib zoo xaiv, cov koob tshuaj thiab zaus ntawm kev tswj hwm raug kho. Lawv cuam tshuam rau cov leeg du hauv cov phab ntsa ntawm cov hlab ntsha. So kom txaus, cov leeg no nce txoj kab uas hla ntawm lumen, yog li ua kom cov ntshav nkag. Qhov no pab txo qis ischemia thiab mob tawm tsam. Tab sis, hmoov tsis, nitrates tsis tuaj yeem tiv thaiv kev loj hlob ntawm lub plawv nres hauv lub ntiaj teb kev nkag siab ntawm lo lus, thiab tsis ua kom lub neej expectancy, yog li ntawd, nws raug nquahu kom noj cov tshuaj no tsuas yog thaum muaj kev tawm tsam (Dinisorb, Isoket), thiab xaiv ib yam dab tsi. Lwm yam ntawm kev ruaj ntseg.
Anticoagulants
Yog hais tias, ntxiv rau angina pectoris, tus neeg mob muaj kev hem thawj ntawm thrombosis, ces cov tshuaj no rau cov kab mob plawv yog muab rau nws. Cov tsos mob thiab kev kho mob, tshuaj nyob ntawm seb ntau npaum li cas qhov no los yog qhov txuas ntawm cov txheej txheem pathological yeej. Ib qho ntawm cov npe nrov tshaj plaws ntawm cov koob no yog Heparin. Nws yog siv nyob rau hauv ib koob loj ib zaug nyob rau hauv mob myocardial infarction, thiab tom qab ntawd rau ob peb hnub cov qib hauv cov ntshav plasma yog tswj. Lub sij hawm clotting yuav tsum tau ua tib zoo saib xyuas.
YDiuretics
Tshuaj rau kev kho mob ntawm IHD tsis yog tsuas yog pathogenetic, tab sis kuj muaj cov tsos mob. Lawv cuam tshuam rau qhov txuas xws li ntshav siab. Yog tias koj ua kom cov kua dej ntau ntxiv uas lub cev yuav poob, ces koj tuaj yeem ua rau txo qis rau cov lej qub thiab tshem tawm qhov kev hem thawj ntawm lub plawv nres thib ob. Tab sis tsis txhob ua sai dhauprovoke ib tug vau. Muaj ntau ntau hom tshuaj no, nyob ntawm seb ib feem ntawm lub voj voog ntawm Henle (section ntawm nephron) lawv cuam tshuam. Ib tus kws kho mob uas muaj peev xwm yuav xaiv cov tshuaj uas tsim nyog hauv qhov xwm txheej no. Ib qho uas tsis ua rau tus neeg mob hnyav dua. Noj qab nyob zoo!
