Intraventricular blockade yog ib yam kab mob uas tshwm sim los ntawm kev cuam tshuam ntawm kev xa hluav taws xob los ntawm lub ventricles ntawm lub plawv, vim muaj kev cuam tshuam ntawm ntau yam ntawm lub plawv, tab sis cov xwm txheej no yuav tsis muaj nyob. Qhov no pathology tuaj yeem txhim kho hauv cov neeg mob ntawm cov hnub nyoog sib txawv. Feem ntau, tus kab mob no tau kuaj pom thaum muaj hnub nyoog laus. Blockades kuj tuaj yeem tshwm sim hauv cov menyuam yaus, kwv yees li 5 ntawm 100,000.
Tus yam ntxwv ntawm tus kab mob
Yuav kom nkag siab tias yuav ua li cas thiab vim li cas cov kab mob intraventricular blockade tsim, nws yog ib qho tseem ceeb kom nkag siab tias nyob rau hauv myocardial system, uas muab cov hluav taws xob zoo sib xws, nruam thiab nrawm nrawm ntawm txhua lub plawv cov qauv, muaj cov leeg nqaij sib cais hu ua Purkinje fibers thiab Nws bundles.
Kev kawm thawj zaug nthuav tawmcardiomyocytes, uas yog tus cwj pwm los ntawm kev nce hluav taws xob excitability, thaum nyob rau hauv lub ventricles. Cov ceg sab laug thiab sab xis yog hu ua ob txhais ceg, qhov kawg ntawm cov ceg uas muaj cov ceg tom qab thiab sab hauv. Txo hauv txoj kab uas hla, lawv zoo li tawg mus rau hauv ntau cov ceg me me, uas yog Purkinje fibers.
Vim txhua yam ntawm cov organic lossis kev hloov pauv hauv lub siab, cov teeb meem tshwm sim hauv txoj hauv kev ntawm cov teeb liab hluav taws xob. Nyob rau hauv cov ntaub ntawv no, lub impulse tsis dhau mus ntxiv raws lub ventricles ntawm lub plawv (nyob rau hauv ib tug tej yam teeb meem). Cov cheeb tsam nyob hauv qab no, vim qhov no, tsis tuaj yeem cog lus thiab zoo siab. Qhov no yuav pom ntawm daim cardiogram.
Qhov chaw tshwm sim
Intraventricular blockade tuaj yeem tshwm sim nyob qhov twg hauv ventricles. Yog li ntawd, qhov tshwm sim ua txhaum cai tau muab faib ua tsis yog tshwj xeeb thiab thaiv cov pob khoom ntawm Nws. Txhua yam ntawm cov subtypes muaj nws tus kheej ECG cov qauv.
Nws yog ib qho tseem ceeb uas intraventricular blockade tuaj yeem txhim kho txawm tias tus neeg noj qab nyob zoo, tsis muaj kev cuam tshuam rau nws txoj kev noj qab haus huv. Tab sis nws tseem suav hais tias yog kev cuam tshuam kev cuam tshuam ntawm txoj cai ceg. Thaum sau npe rau sab laug hemiblock, nrog rau nrog ob lossis peb-khoom thaiv ntawm cov ceg dav hlau, nws tau txiav txim siab tias muaj qee yam mob plawv.
Yog vim li cas
Ua rau muaj kev cuam tshuam ntawm intraventricular conduction, raws li txoj cai, tshwm sim nyob rau hauv thaum yau. Cov kab mob vim qhov teeb meem no tshwm sim tuaj yeem ua tausab xis thiab sab laug hemiblock. Tsis tas li ntawd, kev thaiv ntawm cov ceg ntoo tuaj yeem cuam tshuam.
Cov kab mob no suav nrog: cardiomyopathy, myocarditis, ua txhaum ntawm architectonics ntawm lub plawv vim yog kis los yog congenital defects, cardiosclerosis, mob plawv. Tab sis koj yuav tsum tsis txhob ntshai ua ntej, ib yam li cov menyuam yaus thiab cov tub ntxhais hluas, kev ua tsis tiav thiab ua tiav kev thaiv ntawm sab xis yog suav tias yog ib qho xwm txheej, feem ntau tshwm sim tawm tsam lub nraub qaum ntawm lub plawv noj qab haus huv.
Nyob rau hauv cov neeg laus thiab cov hnub nyoog laus, intraventricular lub plawv blocks tsim vim txawv kiag li. Yuav luag ib nrab ntawm tag nrho cov mob yog txuam nrog atherosclerotic lesions ntawm cov hlab ntsha uas pub lub myocardium nyob rau hauv lub cheeb tsam ntawm lub conducting nras. Qhov no ua rau myocardial ischemia. Ntxiv nrog rau kev mob ischemia, mob myocardial infarction ua rau qhov teeb meem no.
Kwv yees li ib feem peb ntawm tag nrho cov mob yog vim mob ntshav siab. Tsis tas li ntawd, congenital lub plawv tsis xws luag thiab rheumatism tuaj yeem ua rau muaj kev cuam tshuam ntawm intraventricular blockade.
Txawm hais tias muaj hnub nyoog li cas, cov blockades provoked los ntawm cawv lom los yog nws surrogates, hyperkalemia, raws li txoj cai, nyob rau hauv lub raum tsis ua hauj lwm, mob hauv siab, siv ntau yam tshuaj. Piv txwv li, intraventricular blockade tshwm sim nyob rau hauv rooj plaub ntawm kev lom nrog cov poov tshuaj thiab qee cov tshuaj psychotropic.
Symptoms
Ntau zaus, tus kab mob no yog asymptomatic. Yog hais tias muaj tej yam tshwm sim ntawm intraventricular blockade, ces lawv yog vim lub hauv paus pathology uas coj mus rau qhov blockade. Piv txwv li, hauv myocardial ischemiamob taub hau tshwm, feem ntau nyob rau sab nraub qaum ntawm lub taub hau, mob retrosternal. Myocarditis yog tshwm sim los ntawm kev ua pa luv thiab tsis xis nyob hauv siab.
Yog tias tus neeg mob muaj qhov thaiv kab mob hauv lub plawv ntawm ECG, uas yog nrog los ntawm qee qhov kev tsis txaus siab tsis txaus ntseeg, ces tus neeg mob yuav tsum tau tshuaj xyuas sai sai rau kev mob plawv.
Attention at full blockade
Kev saib xyuas tshwj xeeb yuav tsum tau them rau qhov kev thaiv tag nrho yog tias nws tshwm sim thawj zaug, thiab tseem nrog mob nyob rau sab laug ntawm lub hauv siab lossis lub sternum. Qhov tseeb yog tias nws yuav luag tsis tuaj yeem paub txog qhov ua tiav sab laug ntawm lub cardiogram. Vim li no, yog tias muaj kev thaiv sab laug tag nrho tshwm sim, uas yog nrog los ntawm kev kub hnyiab lossis nias qhov mob hauv siab, tus neeg mob yuav tsum tau kuaj xyuas tus mob myocardial infarction, mus pw hauv tsev kho mob sai li sai tau hauv tsev kho mob plawv.
Tsis yog tshwj xeeb intraventricular block, raws li txoj cai, kuj tsis ua rau tsis xis nyob rau tus neeg mob, tab sis feem ntau yog nrog cov tsos mob uas tuaj yeem ua rau tus kab mob ua rau mob.
Diagnosis
Feem ntau, nws tuaj yeem kuaj xyuas qhov kev thaiv no tsuas yog ua daim cardiogram. Lub cim ntawm txoj cai intraventricular blockade ntawm ECG yog qhov nthuav dav thiab hloov kho M-shaped complex. Nyob rau tib lub sij hawm, ib tug jagged thiab sib sib zog nqus hniav yog pom raws li sab laug ceg. Ua kom tiav blockade txawv ntawm qhov tsis tiav blockade nyob rau hauv lub sij hawm ntawm lub complex. Thaum puvblockade, lub complex yuav ntau tshaj 0.12 s, thiab yog hais tias nws yog tsis tiav, nws yuav nyob rau hauv qab no qhia.
Ib qho cim ntawm sab laug intraventricular blockade ntawm ECG hauv tus neeg laus yuav yog qhov deformed thiab dilated ventricular complex raws sab laug hauv siab ua. Ntawm sab xis, pom ib tug jagged prong.
Local blockade of terminal ceg
Local terminal branch block, tseem hu ua local intraventricular block, kuj tseem tuaj yeem txhim kho. Hom no feem ntau yog tshwm sim los ntawm mob infarction. Focal intraventricular block yog tus cwj pwm los ntawm qhov mob "kev puas tsuaj", uas yog sawv cev los ntawm necrotic cardiomyocytes. Lawv tshwm sim thaum muaj teeb meem nyob rau hauv txoj kev ntawm hluav taws xob impulses, tsis muaj kev loj hlob ntawm R yoj mus rau lub thib plaub thoracic ceg.
Intra-infarction hauv zos intraventricular blockade yog tsim nyob rau hauv thaj tsam ntawm myocardial necrosis, manifested los ntawm kev sib cais ntawm pathological Q yoj. Thaum kawg, peri-infarction hauv zos intraventricular blockade ntawm ECG hauv cov neeg laus tuaj yeem txheeb xyuas tau los ntawm kev ua kom pom tseeb ntawm necrosis ntawm cardiomyocytes. Nws zoo nkaus li tus hniav jagged thiab deformed.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias nrog rau hauv zos intraventricular blockade ntawm ECG nws tsis tuaj yeem pom Q yoj.
xeem ntxiv
Thaum kuaj mobblockade, tus neeg mob, raws li txoj cai, yuav tsum tau kuaj ntxiv. Rau kev kuaj mob kom raug thiab raug, cov kws kho plawv tau qhia kom siv ib lossis tag nrho ntawm peb txoj kev no.
Ultrasound ntawm lub plawv lossis echocardioscopy. Cov txheej txheem no raug sau tseg yog tias muaj kev tsis txaus siab ntawm myocarditis, kab mob plawv, myocardial infarction. Yog tias tus neeg mob tsis lees paub qhov tseeb ntawm kev kho mob hauv tsev kho mob, Echo-CS yog qhov yuav tsum tau ua, vim tias lwm tus neeg mob tuaj yeem mob plawv nres ntawm nws ob txhais ceg, uas yuav ua rau tuag taus rau nws txoj kev noj qab haus huv.
Lwm txoj hauv kev yog coronary angiography. Nws yog ua tiav los soj ntsuam kom meej qhov patency ntawm cov hlab ntsha coronary, nrog rau kev txiav txim siab seb puas xav tau kev hla lossis stenting.
Thaum kawg, 24-teev Holter ECG saib xyuas feem ntau tau sau tseg. Nws yog qhov tshwj xeeb tshaj yog muaj txiaj ntsig rau kev thaiv tsis tu ncua. Qhov no tej zaum yuav yog vim tachy-dependent blockade, uas yog, tachycardia, uas manifests nws tus kheej thiab aggravates thaum lub cev exertion.
Kuv puas yuav tsum kho qhov thaiv?
Vim tias tus kab mob no feem ntau asymptomatic thiab tsis ib txwm qhia txog kev mob plawv, ntau tus xav paub seb puas tsim nyog kho txhua.
Raws li cov kws kho mob pom zoo, kev kho mob ntawm cov blockades ntawm hom no tsuas yog thaum tus neeg mob tiag tiag muaj pathology ntawm cov hlab plawv, uas ua rau muaj qhov teeb meem no.
Piv txwv li, nyob rau hauv mob myocardial infarction, kev phais lossis kev kho mob nrog cov kev saib xyuas tau pom zoo. Nyob rau hauv rooj plaub tom kawg, analogues raug muabnitroglycerin, analgesia nrog narcotic analgesics, loj heev antiplatelet thiab anticoagulant kho. Yog tias myocarditis raug tsim, kev kho tshuaj tiv thaiv yog ua tiav, thiab nyob rau hauv cov ntaub ntawv ntawm cardiosclerosis, cardiac glycosides thiab diuretics raug sau tseg, tshwj xeeb tshaj yog tias tus kab mob no tshwm sim tawm tsam keeb kwm ntawm lub plawv tsis ua hauj lwm.
Thaum lub plawv tsis xws luag yog qhov ua rau muaj qhov thaiv, yuav tsum tau kho phais kho.
Kev phom sij ntawm kev thaiv
Nws yuav tsum nkag siab tias tsis yog txhua qhov thaiv kab mob intraventricular yog qhov txaus ntshai tiag tiag. Piv txwv li, yog tias nws tsis tiav thiab ib leeg-nqaj, ces koj yuav tsum tsis txhob mloog nws kiag li, tshwj xeeb tshaj yog tias nws tsis provoked los ntawm ib co kab mob.
Ob-nqaj thaiv feem ntau yog hloov mus rau hauv peb-nqaj thaiv. Qhov kawg ua rau ua kom tiav kev thaiv kev sib txuas ntawm lub ventricles thiab atria. Hauv qhov no, qaug dab peg, tsis nco qab yog ua tau. Hauv qhov xwm txheej no, lub neej ntawm tus neeg mob yog nyob rau hauv qhov txaus ntshai. Muaj peev xwm ntawm lub plawv nres thiab tuag.
Kev tuag
Yog li ntawd, qhov yuav tsum ntshai tshaj plaws yog ob-nqaj Nws thaiv, uas ua ke nrog cov tsos mob ntawm tus kab mob plawv loj. Hauv qhov no, yuav tsum tau saib xyuas tus neeg mob tus mob kom zoo, vim tias muaj feem yuav tuag.
Thaum cov cim ntawm qhov thib ob- lossis thib peb-degree AV thaiv tshwm rau ntawm daim cardiogram, tus kws kho mob txiav txim siab los teeb tsa lub pacemaker. Nws yog ib qho tseem ceeb uas nws yuavimplanted txawm nyob rau hauv cov neeg mob uas tsis muaj mob heev qaug dab peg, raws li kev hem thawj rau lawv lub neej tseem nyob.
Nws yuav tsum tau muab sau tseg tias, ntxiv rau AV thaiv, cov teeb meem intraventricular ntawm cov cuab yeej no ua rau ventricular fibrillation, ventricular tachycardia, uas tuaj yeem ua rau tuag taus.
Kev Tiv Thaiv
Hauv qhov no, txoj hauv kev tiv thaiv kev tuag sai sai los ntawm kab mob plawv vim kev cuam tshuam ntawm kev sib dhos yog nquag xyaum.
Qhov tseeb, hom kev tiv thaiv no muaj nyob rau hauv ib txwm mus ntsib kws kho plawv, electrocardiogram, nrog rau kev txiav txim siab raws sijhawm thiab sai ntawm kev cog cov pacemaker, yog tias tsim nyog.
Raws li kev tiv thaiv tus kab mob no, nrog rau feem ntau txo qis qhov tshwm sim ntawm cov hlab plawv pathologies, nws raug nquahu kom tsis txhob muaj kev ntxhov siab tsis zoo hauv lub neej, tsis txhob haus cawv thiab haus luam yeeb, siv zog ua kom noj qab haus huv. kev ua neej nyob, kev tawm dag zog kev kawm lub cev thiab kev ua kis las.
Nco ntsoov noj tshuaj, tab sis tsis muaj kev kho tus kheej, ua raws li koj tus kws kho mob cov lus pom zoo hauv txhua yam.
Tus Kws Kho Mob
Tom qab muaj mob plawv lossis lwm yam mob plawv mob hnyav, nws yuav tsum tau mus ntsib kws kho plawv tsis tu ncua, tsawg kawg hauv thawj rau lub hlis. Qhov no yuav kho koj tus mob, txheeb xyuas qhov teeb meem, yog tias muaj, thiab tshem tawm sai sai.
Nws tsim nyog sau cia nyias tias ib yam ntawm cov kev txwv no ntawm thawj zaugtheem xav tau kev saib xyuas ntxiv, yuav tsum tau sab laj nrog koj tus kws kho mob.
Ua ntej tshaj plaws, koj yuav tsum mus ntsib kws kho mob lossis kws kho mob plawv uas yuav tuaj yeem qhia koj tias koj yuav tsum ntshai tus kab mob no tiag tiag, kev kuaj mob dab tsi, yuav ua li cas txhawm rau txhim kho koj txoj kev kho. Tom qab tag nrho, raws li peb twb tau sau tseg rau hauv tsab xov xwm no, tus kab mob no tuaj yeem ua rau muaj kev phom sij tag nrho thiab ua rau koj lub neej thiab kev noj qab haus huv. Thaum kawg, yuav tsum tau kho tus neeg mob hauv tsev kho mob, tej zaum yuav phais.
