Fibrillation - chii ichi? paroxysmal atrial fibrillation

Wakambonzwa vane nguva apo mwoyo akatanga kurova chaotically? Kana, pamusoro Zvakatosimbisa seiyi? Chinokonzera kunzwa kutya uye kuzvidya mwoyo, anoita kuti tifunge pamusoro kwidza kuchipatara. Doctors vane tsanangudzo upi mamiriro, kusanganisira kuti chinangwa ichi. Fibrillation - chiri muchimiro cardiac arrhythmias. In cardiology tsika Muzviitiko zvakadaro zviri zvakajairika, saka zviri pamusoro pavo tichataura nhasi.

Definition uye kupararira

Pane masayendisiti tsanangudzo maitiro akadaro kwomwoyo. Fibrillation - nayo tachyarrhythmia, icho pamwe chete runobva nemagetsi zvinodiwa atrial basa. maitikiro yavo isvike anorova mazana manomwe paminiti, uye pamwero chikwata rutapudzo zvisisakwanisiki.

Atrial fibrillation ndechimwe chezvinhu kwakapararira siyana arrhythmias. Yakavimbika inogona tsunga bedzi migumisiro electrocardiography. Kune mamirire zviratidzo: hapana sinus mutinhimira, pakaita add-wave (atrial flutter). Abbreviations maitikiro inotsamira ehupfumi ari atrioventricular raiva pedyo nebundu, uye basa autonomic tsinga akabatana zvinodhaka.

Nyanzvi vanoti chirwere kuti makemikari maronda mwoyo tsandanyama. Ita mhirizhonga sunga mwoyo zvinotungamirira kweropa matambudziko uye ngozi panowanikwa emboli. Fani iyi chokuita yakakwirira hunofa chirwere chacho.

kupatsanura

Pane zvinotevera siyana atrial fibrillation:

1. First kwakaratidza. chirwere akadaro unoitwa, kana murwere asina kare kutsvaka rubatsiro kuti atrial fibrillation.
2. Paroxysmal. Attack flutter rinovapo haana kupfuura pavhiki (kazhinji mazuva maviri) uye rinomhanya yakazvimiririra.
3. Kuramba. Kurwisa kwemazuva anopfuura manomwe.
4. Long kuramba. The Kurwisa rinovapo gumi - gumi mwedzi, asi vanachiremba akasarudza kudzorera mutinhimira.
5. Permanent. Atrial fibrillation kunoitika nguva dzose, asi mutinhimira yokudzorera pakutanga mumatanho isina kuitwa, uye ipapo vakadzokera isashande.

Maererano kwokuomerwa atrial fibrillation zviratidzo zviri rakakamurwa makirasi mana:

1. Asymptomatic.
2. Munyoro kusanzwa pasina kukanganisa basa.
3. Zvakakomba zviratidzo chokuita mhenyu nyaradzo.
4. Disability. Panyaya iyi, murwere anogona tikasakushandirai ave.

Zvichienderana kakawanda kurova kwemwoyo vanachiremba tisiyanise tachy, uye normo bradisistolicheskuyu chimiro chirwere.

zvinokonzera njodzi

mwoyo fibrillation anooneka varwere vane kubatwa nawo. Iye anogona pakurukurwa siyana matambudziko cardiac:

- neBP;
- mwoyo kutadza;
- vakatodzidza mitral vharafu;
- vachiberekwa malformations ose etiologies siyana.

An rinokosha iri reDare dilated cardiomyopathy, coronary tsinga chirwere, chisingaperi anogumbura zvirwere zvomwoyo membranes, uyewo namamota. Paroxysmal atrial fibrillation mune vanhu pasi makore makumi mana zvingaitika mune voga nezvimwe zvirwere.

Uyezve, pane mazita pathologies, izvo zvakaenzana kukanganisa panowanikwa atrial fibrillation, asi havana chokuita basa kumwoyo:

- kufutisa;
- cheshuga;
- chisingaperi obstructive pulmonary chirwere;
- vakawedzera basa thyroid shwanu.

Kana murwere kudzimika nhoroondo yemhuri, kureva, pakati dzepedyo, mune vanhu vane atrial fibrillation, mikana kuti chirwere achaonekwa ari proband, vakawedzera matatu muzana.

pathogenesis

Fibrillation - zviri runobva twitching tsandanyama, muchiitiko ichi mumwoyo. Organic chirwere pave STRUCTURAL zvachinja anatomi mwoyo uye kuti kutyora conduction ose magetsi nomunhu. Izvi imhaka kuwedzera uwandu connective zvinyama kwaizotevera fibrosis. Izvi mberi, Chinowedzera dissociation tsinga fibers saka fibrillation zvikaramba.

Doctors funga hypotheses dzakawanda sei pane paroxysmal chimiro chirwere ichi. Zvinonyanyozivikanwa Dzidziso foci uye vakawanda nemafungu. Mamwe masayendisiti vanosarudza chokubatanidza vose shanduro, sezvo hazvibviri kusiyanisa kuguma oga chikonzero chacho.

Maererano rokutanga pfungwa (zvatichiri) ari myocardium kunoitika muzvizhinji kuti foci kuti magetsi basa, izvo riri pedyo huru midziyo uye atrial musana rusvingo. Nokufamba kwenguva, anoshanda kune nzvimbo yose atria. Chechipiri dzidziso postulates kuti fibrillation ndiwo mugumisiro runobva kwatangwa uye vakawanda vashoma chinozunguzirwa excitation.

Zviratidzo uye zvinozouya

Paroxysmal atrial fibrillation kungava asymptomatic kana hemodynamic vachivavhiringidza ndanyarara hangu zvakakwana. Kazhinji, varwere vanotsutsumwa pamusoro kunzwa kakawanda palpitations, chipfuva kurwadziwa kana kusagadzikana munharaunda.

Against kumashure ichi, mberi mwoyo kukundikana, iyo akaora akaratidza dzungu, kufenda uye kupfupika mweya. Dzimwe nguva, apo pane kurwisa pavarwere zvakawedzera kakawanda weti. Nyanzvi vanoti izvi kuwedzera kwenhamba natriydiureticheskogo mapuroteni.

Chinangwa, pangava kupomba dhefisiti, kana uwandu kwemwoyo akapfuudza uwandu kupomba mafungu izvo kuparadzira kusvika arikunze. Kana asymptomatic muchimiro fibrillation wokutanga "bhero" rinogona kuva nesitiroko.

ichiyerera Long atrial fibrillation kuoma ne mwoyo nokukundikana, thrombosis makuru uye duku nemidziyo mwoyo kana uropi.

Diagnostics

Atrial fibrillation - a kakawanda kusingasaruri rutapudzo pamusoro cardiomyocytes. Pakutanga, chiremba anounganidza nhoroondo chirwere uye upenyu, anowana kubva musi kurwisa rokutanga, kuvapo zvinokonzera njodzi, uyewo kudzidza pamusoro mishonga kuti murwere anotora panguva. Varwere regai kunyunyuta, saka kuratidza zvokurwara ichi uchishandisa paku nzira. Izvi zvinosanganisira Ultrasound, Holter ECG uye kuongorora daily. Fibrillation kunoratidzwa zvinotevera chaicho zvinhu:

- pasina P chinozunguzirwa (hapana sinus mutinhimira);
- chitarisiko add-mafungu atrial fibrillation;
- dzisakarurama zvikamu pakati pameno R.

Chete nzira inogona kuona cardiac comorbidities :. Myocardial infarction, arrhythmia, etc. Ultrassom tikaongorora rinoitwa kuziva uye kusimbisa makemikari mwoyo chirwere, uye myocardial rusvingo ukobvu kuyerwa, bhuku racho atria uye ventricles. Mukuwedzera, chidzitiro zvakanaka zvinoonekwa parietal thrombi uye uswa pamusoro mavharuvhu.

Uyezve, pashure pechiitiko pamusoro atrial fibrillation chiremba wokutanga prescribes muedzo kuti thyroid mahomoni kuti asava wake wokusagadzikana.

anticoagulation

Panguva iyi muverengi ane pfungwa chii uye sei pane atrial fibrillation. Treatment akataurirwa kubviswa kwayo, kana etiological zvikonzero, kana nokuputsa zviratidzo.

Anticoagulants, kureva ropa rive dete mishonga, inoratidzwa kuti kudzivirira ropa clots uye somugumisiro nokurova uye mwoyo kurwiswa. Rakajairika pakati piritsi fomu - ndiye "Warfarin" uye "asipurini". In kugadzwa boka iri mishonga chiremba anofunga murwere propensity kuti thrombosis, ngozi ischemia munguva yemberi iri pedyo, uye kana murwere contraindications iyi mhando yokurapa.

Zvakakosha kurangarira kuti pane kushandiswa anticoagulants zvakafanira kuramba kuongorora INR (International normalized reshiyo). Izvi zvinobvumira nguva yakakwana kumisa zvinodhaka uye yekuzvidzivirira ropa.

mutinhimira kuzvidzora

Fibrillation mumwoyo kakawanda mamiriro iri reversible. Kana kubvira pakutanga kurwiswa akatora zvishoma nguva, chiremba anogona kudzorera chakaipa sinus mutinhimira. Izvi zvinogona kuitwa pamwe chete achitaura okuyerera dzemagetsi zvinodhaka kuitika kana antiarrhythmic.

Pakutanga, mwoyo mwero ipfupi kana vakarerwa zana anorova paminiti. Zvino unofanira kufungawo ngozi thromboembolism, saka kwevhiki nhatu asati nzira, uye mwedzi pashure murwere anogamuchira anticoagulant kurapa. Asi ichi zvose zviri chete kwakakodzera ari chiitiko kuti kurwisa atrial fibrillation rinovapo mazuva anopfuura maviri kana nguva inogona haangasimbiswi. Kana zvinozivikanwa kuti kubva pakutanga kunyongana kwaiva kumaruwa sunga nomwoyo maawa asingasviki-mana namasere zvakawanda, kana murwere zvakakomba hemodynamic kusagadzikana, mwero rutapudzo rinoitwa zvikurusa, dzakabatwa pasi samolecular uremu heparin.

1. Electrical cardioversion. Iri panzvimbo kunorwadza nzira chinoda mumvura iri hope murwere zvokurapa. In defibrillators ano tiite synchronous pamwe R-wave pamusoro ECG. Izvi haambotauri netsaona ventricular fibrillation. Tanga Kazhinji mumwe zana joules, uye kana zvakakodzera mumwe unozotevera buditsa akamutswa kuti mashanu Joules. Izvi zviviri-danho womuenzaniso. Single-danho buditsa pakarepo akaita joules mazana maviri, ari kumusoro dhigiri mana.
2. Drug cardioversion. For zvinodhaka kuti anogona kukanganisa mwoyo mutinhimira, zvinosanganisira "Procainamide", "Amiodarone", "Nibentan" uye "Propafenone".

Kudzivisa idzokororo yokurwiswa atrial fibrillation pashure cardioversion akagadzwa antiarrhythmic zvinodhaka, izvo murwere unofanira kutora mwedzi, kunyange kana makore.

kufamba kweropa kuzvidzora

All anozivikanwa siyana atrial fibrillation inosanganisira kutyora kwemwoyo. Naizvozvo, vanachiremba vakanga vakafunga kurapa kubvisa chiratidzo. Inoshandisa zvinodhaka kuti anogona kuderedza kwemwoyo. Idzi dzinosanganisira:

- beta-blockers;
- karusiyamu mugero blockers.

Tiine ineffectiveness mishonga izvi raitongwa mapoka "Amiodarone" kana "Dronedarone". kurapa kwakadaro kunogona kuderedza zviratidzo arrhythmia, asi bvisa zvachose harisi kukwanisa.

Kana marapirwo iri basa, vanachiremba dzimwe nguva kuita anobudisa mushonga zvishoma nezvishoma ablation. Kuti tirambe sinus mutinhimira, zvose nzvimbo kufara zvinofanira kugadziriswa. With radiofrequency vachiongorora cardiac chiremba rukungiso munda oga kubva mumwe, kudzivisa kupararira dzemagetsi nemafungu.

Pane imwe nzira umo kuparadza ganglion pakati atrium uye ventricle. Izvi zvinoita kwekanguva transverse mwoyo nechigumbuso. Zvadaro murwere uyu akasima chakagadzirwa introducer kuti mutinhimira, iyo anodzora uwandu heartbeats. Zvakaita upenyu murwere akavandudzika, asi kureba hwake haina kukanganiswa.

Atrial fibrillation pashure cardiac kuvhiyiwa

Paroxysm kuti atrial fibrillation sezvinobvira pashure pokuvhiyiwa pamwoyo. Ichi chimwe chezvinhu kakawanda matambudziko vasangana pashure kwacho. The pathophysiology iri ezvinhu akasiyana ruzivo varwere zvakajairika pamwe atrial fibrillation.

Kuwedzera kwakajairika zvinokonzera njodzi, murwere ndiye Ionic dissociation, zvinoti vasanyanye potassium yomuropa, ungaderedza vhoriyamu ropa, zvokuimba kukuvara mwoyo rinenge uye kuzvimba atria. izvi zvose chinokurwadzai kuti activation pakati kutapata ari chimiro mukwanisi Pazvinoitika hurongwa zvavaifunga. Inouya kusunungurwa anogumbura nevamiririri, kweiyi aimunzwira tsitsi tsinga, uyewo chisimba oxidation kuita. Zvose izvi ndizvo chikungiso raivapo pakatanga atrial fibrillation.

Naizvozvo, mabatiro post-kushanda zvakaoma kunzwisisa kutange rakasungwa dzose pamusoro matambudziko. Nokuti chinangwa ichi, Beta-blockers, "Amiodarone", steroids uye vasiri steroidal Anti-anogumbura zvinodhaka.

Kushurudzira uye kurumbidza

Munhu anogona kudzivisa chirwere chakadaro nengozi, sezvo "atrial fibrillation". Zvinotarisirwa pavadzidzisi dziri nyore chaizvo uye yakajeka. Zvakakodzera kutungamirira kuva nemararamiro ane utano, zvokudya, kudzivisa chirwere cheBP pamusoro rimwe namakumi mana. Izvi zviito nyore kwete chete kudzivisa panowanikwa atrial fibrillation, asiwo kubatsira kudzivirira vamwe zvirwere mwoyo.

Chokwadi, tinoratidza kurega kusvuta uye kuderedza doro. Kuti asimbise pangagara, cardiologists akakumbira kugamuchira zvakakwana mari Mishonga zvinokosha mafuta acids, kana kutora capsules mafuta hove.

Treatment kwemabhakitiriya uye kutapukirwa noutachiona ndiko kutevera kuburikidza, kunyange kana imi subjectively kunzwa zvakanaka.

Ngozi sitiroko mune vanhu vane atrial fibrillation kunowedzera kusvika makore makumi mashanu kubva muzana, uye makumi masere - maviri. Mumwe nhanhatu yakashuma sitiroko panyika iri kuchengetwa varwere nechirwere "atrial fibrillation".