Kodi 'kulandira' kwa mtima wanu kuli bwanji? Tiyeni tikambirane za 'Coronary Flow Reserve (CFR)'!

Kodi munayamba mwadzifunsapo ngati mtima wanu ukulandira magazi owonjezera omwe umafunikira ukakhala ndi nkhawa, monga mukamachita masewera olimbitsa thupi? Mtima wathu ndi chiwalo chodabwitsa. Umafunikira magazi abwino kuti ugwire bwino ntchito. Ndicho chimene tikambirana lero, ndipo chimanena zambiri za thanzi la mtima wanu: `Coronary Flow Reserve` kapena `CFR`. Musadandaule, mawu awa angamveke ovuta pang'ono, koma tiyeni tisunge mosavuta.

Kodi 'Coronary Flow Reserve (CFR)' ndi chiyani? Mwachidule...

Ganizirani mtima wanu ngati injini ya galimoto. Ikayenda bwino, injini imafunika mafuta enaake. Koma mukakwera phiri, kapena mukuyenda mofulumira, injini imafunika mafuta ambiri, eti? Umu ndi momwe mtima wathu ulili. Tikapuma, mtima umafunika magazi enaake. Koma tikamachita masewera olimbitsa thupi, kuthamanga, kulumpha, kunyamula zolemera, kapena kupsinjika maganizo, mtima umafunika mpweya ndi zakudya zambiri . Kuti tikwaniritse kufunikira kumeneku, magazi opita ku mtima ayenera kuwonjezeka.

Mitsempha ikuluikulu ya magazi yomwe imanyamula magazi kupita kumtima imatchedwa mitsempha ya mtima . Kusunga Mayendedwe a Mitsempha ya ...

Izi zimatchedwanso `Myocardial blood flow reserve`. Chifukwa magazi amatuluka kuchokera m'mitsempha ya mtima kupita ku minofu ya mtima wanu, kutanthauza kuti, kupita ku minofu ya mtima `(Myocardium)` . Chifukwa chake kudzera mu CFR iyi, madokotala amatha kuwona ngati minofu ya mtima wanu ikupeza magazi okwanira ikafunika.

Kodi mtengo wa CFR uwu umawerengedwa bwanji?

Kuwerengera kumeneku ndi kosavuta kwambiri. Koma kumafuna mayeso apadera kuti tichite izi. Mwachidule, CFR ndiye kuchuluka kwa magazi komwe kungayende kudzera m'mitsempha yanu ya mtima , yogawidwa ndi kuyenda kwa magazi kwabwinobwino komwe kumadutsa mwa inu mukapuma, popanda kuchita khama lililonse .

Mwachitsanzo, mukakhala mukupuma, mtima wanu umapopa ma mililita X a magazi pamphindi. Mukakhala ndi mphamvu zambiri (kapena vuto limenelo likachitika mwangozi), mtima wanu umapopa ma mililita Y a magazi. Kenako CFR = Y / X.

Umu ndi momwe mtima wanu ungapompe magazi ambiri kuposa masiku onse.

Kodi mayeso a CFR amachitidwa nthawi ziti?

Pali zifukwa zingapo zomwe dokotala angakulangizeni mayeso a CFR:

• Dziwani ngati muli ndi matenda a mitsempha ya mtima (CAD): Nthawi zina kupweteka pachifuwa (angina), kuvutika kupumaZizindikiro ngati izi zikachitika, mayesowa amathandiza kutsimikizira ngati chifukwa chake ndi kutsekeka kwa mitsempha ya mtima.
• Unikani kuopsa kwa CAD: Izi ndizofunikira kuti mumvetse kuchuluka kwa mitsempha yamagazi yomwe yakhudzidwa komanso kuchuluka kwa magazi omwe atsekedwa mwa munthu amene ali kale ndi CAD.
• Loserani za chiopsezo cha matenda a mtima mtsogolo: Pamene kuchuluka kwa CFR kukuchepa, chiopsezo cha matenda a mtima kapena matenda ena a mtima mtsogolo chikhoza kuwonjezeka.
• Yesani kupambana kwa chithandizo: Mayesowa angagwiritsidwenso ntchito kuti muwone ngati magazi opita kumtima abwerera m'mbuyo pambuyo pa chithandizo china (monga angioplasty, opaleshoni ya bypass).

Kodi mtengo wapakati wa CFR ndi wotani?

CFR ya munthu wathanzi nthawi zambiri imakhala pakati pa 2.0 ndi 2.5 kapena kupitirira apo . Izi zikutanthauza kuti mukamagwira ntchito molimbika, mtima wanu umalandira magazi ochulukirapo kawiri kuposa momwe mukupumula. Munthu wathanzi akhoza kukhala ndi mtengo wokwera kufika pa 3. Izi zikutanthauza kuti ali ndi mphamvu zowonjezera magazi awo katatu.

Kafukufuku wina adapeza kuti anthu omwe ali ndi CFR yoposa 2 adachira bwino kwa miyezi isanu ndi umodzi atatha kudwala matenda a mtima. CFR yochepera 2 imasonyeza chiopsezo chachikulu cha matenda a mtima.

Koma ndikofunikira kumvetsetsa kuti "zabwinobwino" izi zimatha kusintha ndi zaka. Wachinyamata wathanzi akhoza kukhala ndi CFR ya zaka 5 kapena 6. Koma ngakhale munthu wathanzi wazaka 80 akhoza kukhala ndi CFR yosakwana 2. Komanso, mwana amene adachitidwa opaleshoni ya vuto la mtima wobadwa nalo akhoza kukhala ndi CFR yotsika. Chifukwa chake, dokotala wanu adzasankha ngati CFR yanu ndi yabwinobwino kapena ayi, kutengera thanzi lanu lonse ndi zina.

Kodi mungatani kuti muyesedwe mayeso a CFR? Kodi mungakonzekere bwanji?

Pali njira ziwiri zazikulu zoyezera CFR. Njira imodzi ndi yolowerera , yomwe imaphatikizapo kulowetsa chinthu m'thupi. Izi zimaphatikizapo chinthu chotchedwa `Cardiac Catheterization`. Njira ina ndi yosalowerera , yomwe imaphatikizapo kugwiritsa ntchito `Nuclear Stress Test` yapadera, yomwe ndi `Rubidium-82 Positron Emission Tomography (PET) scan`. Nthawi zina, `Magnetic Resonance Imaging (MRI) scan` ingagwiritsidwenso ntchito pachifukwa ichi.

Tsopano tiyeni tiwone momwe tingakonzekerere mayeso awa ndi zomwe zimachitika patsiku la mayeso.

Zinthu zomwe muyenera kudziwa musanayese mayeso

• Uzani dokotala wanu za mankhwala omwe mukumwa: kuphatikizapo mankhwala olembedwa ndi dokotala, mankhwala ogulitsidwa kunja kwa chipatala, ndi mavitamini.Muyeneranso kuuza dokotala wanu za mankhwala aliwonse azitsamba omwe mukumwa, chifukwa mankhwala ena amatha kusokoneza kayendedwe ka magazi.
• Tiuzeni za ziwengo zanu: Ngati muli ndi ziwengo zilizonse za mankhwala, utoto wosiyanitsa womwe umagwiritsidwa ntchito poyesa, kapena latex, tidziwitseni pasadakhale.
• Malangizo a Chakudya ndi Chakumwa: Ngati mukuchitidwa opaleshoni ya mtima kapena PET scan, funsani dokotala wanu maola angati musanayesedwe kuti musiye kudya kapena kumwa. Kawirikawiri, simuloledwa kudya kapena kumwa chilichonse kwa maola 6 mpaka 8 musanayesedwe.

Kodi mungayembekezere chiyani pa tsiku la mayeso?

• Pa MRI scan: Simuyenera kukhala ndi zinthu zachitsulo (monga zodzikongoletsera kapena zolembera tsitsi) m'thupi lanu. Zipangizo zina zachipatala (monga pacemakers) sizingagwirizane ndi MRI. Choncho ngati muli ndi chipangizo choterocho, funsani dokotala wanu pasadakhale kuti atsimikizire kuti ndi chotetezeka pa MRI.
• Kukonza Mitsempha ya Mtima: Mu njira imeneyi, chubu choonda kwambiri (catheter) chimalowetsedwa kudzera m'mitsempha yamagazi m'khosi, m'mimba, kapena m'dzanja mu mitsempha ya mtima. Mudzapatsidwa mankhwala ochepetsa ululu kuti musamve bwino.
• Mzere wa IV: Mosasamala kanthu za njira yoyesera, ``Mzere wa Intravenous (IV)`` udzalumikizidwa ku mtsempha womwe uli m'dzanja lanu. IV iyi ndi komwe mankhwala (vasodilator) amaperekedwa kuti magazi aziyenda bwino kupita kumtima ndipo nthawi zina ``Utoto wosiyana`` kuti mitsempha ya mtima iwonekere bwino. Ngati mukuchitidwa ``PET scan``, mankhwala owopsa ``Radiotracer`` amaperekedwanso kudzera mu IV iyi.

Ndiloleni ndifotokoze pang'ono za momwe CFR imayezedwera...

Dokotala wanu adzagwiritsa ntchito njira zosiyanasiyana zojambulira zithunzi kuti ayeze kuyenda kwa magazi m'mitsempha yanu ya mtima mukupuma komanso mukuchita masewera olimbitsa thupi kwambiri. Njira zazikulu ndi izi:

• `PET scan`: Mu izi, pamene `Radiotracer` yoperekedwa kudzera mu IV ifika pamtima, zizindikiro zomwe zimatulutsidwa nazo zimajambulidwa ndi kamera yapadera, ndipo mothandizidwa ndi kompyuta, zithunzi zomveka bwino za kayendedwe ka magazi mumtima zimapezeka.
• ` MRI ya Mtima` : Iyi ndi njira yojambulira zithunzi. Komabe, imagwiritsidwa ntchito pang'ono poyeza CFR.

Ndikofunikira kwambiri kuti mukhale chete panthawi yojambula zithunzi, apo ayi zithunzi zomwe mwapeza sizingakhale zomveka bwino.

Njira ya `Cardiac Catheterization` ndi yosiyana pang'ono. Ikuphatikizapo:

1. Pambuyo poti catheter yalowetsedwa mu mitsempha ya mtima, waya wapadera umadutsamo. Pamapeto pa waya uwu pali `Ultrasound transducer` (chipangizo chaching'ono chomwe chimatulutsa ndikulandira mafunde a ultrasound). Izi zimatha kuyeza liwiro la magazi kuyenda mkati mwa mitsempha ya mtima.

2. Pa nthawi imeneyi, mankhwala otchedwa `Heparin` amaperekedwa kudzera mu IV kuti magazi asaundane.

3. Pali mitundu ina ya mawaya omwe amayesa kuyenda kwa magazi pogwiritsa ntchito masensa awiri oyezera kutentha ndi jakisoni wa saline.

Kodi n’chiyani kwenikweni chimachitika panthawi ya mayeso?

Pa nthawi yoyezetsa, gulu lachipatala lidzachita izi:

1. Choyamba, kuyenda kwa magazi m'mitsempha yanu ya mtima kumayesedwa pamene mukupuma .

2. Kenako, mankhwala amtundu wa `Vasodilator` (monga `Adenosine (Adenocard® kapena Adenoscan®)`) amaperekedwa kudzera mu IV yanu, zomwe zimawonjezera kugunda kwa mtima ndi kuyenda kwa magazi. Mankhwalawa amawonjezera kuyenda kwa magazi ndi nthawi zinayi mpaka zisanu poyerekeza ndi pamene mukupuma. Zimatenga nthawi yochepa, pafupifupi mphindi ziwiri kapena zitatu, kuti mankhwalawa agwire ntchito. Izi zimatchedwa `Cardiac Catheterization`, ndipo nthawi zina mankhwalawa amatha kuperekedwa kudzera mu catheter m'malo mwa IV.

3. Mankhwalawa akaperekedwa, magazi omwe ali m'mitsempha ya mtima amayesedwanso. Uwu ndiye kuchuluka kwa magazi omwe amatuluka.

4. Pomaliza, mtengo wanu wa `Coronary Flow Reserve (CFR)` umawerengedwa poyerekeza kuchuluka kwa magazi komwe kumayendera ndi kuchuluka kwa magazi komwe mumapuma .

Kodi chimachitika ndi chiyani pambuyo pa mayeso?

• Ngati mwaikamo katheta (makamaka m'chifuwa kapena m'dzanja), muyenera kusunga malo odulidwawo ali choyimirira kwa ola limodzi kapena kuposerapo kuti musatuluke magazi.
• Dokotala wanu angakuuzeni kuti mumwe madzi ambiri kuti akuthandizeni kuchotsa utoto wosiyana m'thupi lanu.
• Ngati mwapatsidwa mankhwala ochepetsa ululu, simudzatha kuyendetsa galimoto tsiku limenelo. Chifukwa chake, muyenera kubweretsa munthu wina kuti akutengereni kunyumba .

Kodi zoopsa ndi zotsatirapo zake za mayeso a CFR ndi ziti?

Kuyesa kwa CFR nthawi zambiri kumakhala kotetezeka, koma monga njira ina iliyonse yachipatala, pali zoopsa zina zazing'ono.

• Popeza ma catheter ndi mawaya amaikidwa mu mitsempha ya mtima, nthawi zambiri magazi amaundana, kugwedezeka kwa mitsempha, kapena kutuluka magazi kumachitika.
• Pali chiopsezo chochepa kwambiri cha kuwonongeka kwa mitsempha yamagazi. Ngati izi zitachitika, opaleshoni ingafunike kuti ikonzedwe , koma kawirikawiri.

Anthu ena akapatsidwa mankhwala a `Adenosine`, akhoza kukhala ndi zotsatirapo zotsatirazi, zomwe zimatenga masekondi ochepa okha:

• Kugunda kwa mtima kosazolowereka
• Kuthamanga kwa magazi pang'ono (Hypotension)
• Kupuma movutikira
• Kusasangalala pachifuwa

Chofunika: Mankhwala a `Adenosine` awa saperekedwa kwa anthu omwe ali ndi mphumu. Chifukwa angayambitse bronchospasms. Pazochitika zotere, dokotala angagwiritse ntchito mankhwala ena a IV monga `Dobutamine`.

Kodi zotsatira zake zimakhala bwanji? Kodi zikutiuza chiyani?

Mayeso anu a CFR amakupatsirani nambala. Nambala iyi imakuuzani kuchuluka kwa mitsempha yanu ya mtima yomwe ingawonjezere kuyenda kwa magazi mukamachita masewera olimbitsa thupi.

Monga tafotokozera kale, kuchuluka kumeneku kumatha kuchepa ndi ukalamba. Wachinyamata wathanzi akhoza kukhala ndi CFR ya 5 kapena 6. Koma munthu wamkulu wathanzi akhoza kukhala ndi CFR yochepera 2.

Kuchepa kwa magazi (monga chiopsezo) kungachitike pa CFR iliyonse pakati pa 1.6 ndi 3.3. Chomwe chili chachibadwa kwa munthu mmodzi sichingakhale chachibadwa kwa wina. Chifukwa chake, dokotala wanu yekha ndi amene angatanthauzire bwino zotsatira zanu. Iye adzaganizira zinthu zambiri, monga zaka zanu, thanzi lanu, ndi zizindikiro zanu, kuti atsimikizire.

Zimatenga nthawi yayitali bwanji kuti mudziwe zotsatira zake?

Zingatenge masiku angapo kuti dokotala wanu afufuze zotsatira za mayeso anu a CFR ndikukudziwitsani. Ngati zotsatira zanu zili zovuta, dokotala wanu angafune kukambirana ndi madokotala ena. Ngati zotsatira zanu zikusonyeza chiopsezo cha matenda a mtima, dokotala wanu adzakulankhulaninso za dongosolo lochepetsera chiopsezo chanu.

Ndiyenera kulankhula ndi dokotala liti?

Ngati muli ndi mafunso musanayese mayeso a CFR, funsani dokotala wanu. Komanso, ngati mukukumana ndi zizindikiro zachilendo, zotsatirapo zake, kapena kusasangalala mutatha mayeso , dziwitsani dokotala wanu nthawi yomweyo.

Uthenga Wopita Nawo Kunyumba

Mayeso a `Coronary Flow Reserve (CFR)` ndi mayeso omwe amapereka chidziwitso chofunikira chokhudza thanzi la mitsempha ya mtima yomwe imapereka magazi kumtima wanu. Angayang'ane ngati mtima wanu ukupeza magazi owonjezera omwe ukufunikira pamene ukugwira ntchito molimbika.

Kutsika kwa CFR kungakhale chizindikiro cha matenda a mitsempha ya mtima. Kungakupatseninso chithunzi cha chiopsezo chanu cha matenda a mtima mtsogolo.

Ngati pali chilichonse chomwe simukumvetsa chokhudza mayesowa, musaope kufunsa dokotala wanu. Adzakufotokozerani zonse ndikukuthandizani kuti mayesowo akhale omasuka momwe mungathere. Kumbukirani, kusamalira mtima wanu ndikofunikira kwambiri!

'Matenda a mtima, mitsempha ya mtima, kupereka magazi, mayeso a CFR, matenda a mtima, thanzi la mtima, mayeso azachipatala