I-Endocarditis

I-Endocarditis, isimo esibucayi esithinta ulwelwesi lwangaphakathi lwamagumbi enhliziyo namavalvu, ngokuvamile iqala ngokuthile okulula njengokungahlanzeki kwamazinyo. Lokhu kutheleleka kungaholela ekulimaleni okukhulu enhliziyweni uma kungelashwa, okwenza kube semqoka ukuqonda izimpawu zayo, izizathu, kanye nezindlela zokwelashwa.

Lesi sihloko sihlose ukuhlinzeka ngolwazi olubalulekile mayelana ne-endocarditis, ehlanganisa izinhlobo zayo ezihlukahlukene, izimpawu nezimpawu, kanye nezimbangela ezingase zibe khona. Sizohlola izici eziyingozi ezenza abanye abantu babe sengozini enkulu yalesi simo futhi sixoxe ngezinkinga ezingase ziphakame uma zingabhekwanga ngokushesha. 

Iyini i-Endocarditis?

I-Endocarditis ukuvuvukala okungathi sína futhi okungase kube yingozi empilweni kolwelwesi lwangaphakathi lwamagumbi enhliziyo (i-atria nama-ventricles) nama-valve, okwaziwa nge-endocardium. Lesi simo ngokuvamile senzeka lapho amagciwane (okungavamile ukukhunta) engena egazini futhi enamathela ezindaweni ezilimele enhliziyweni. Ukutheleleka kungathinta imisipha yenhliziyo, ama-valve, noma ulwelwesi, okuholela ezinkingeni ezinzima uma kungelashwa.

Kunezinhlobo ezintathu eziyinhloko ze-endocarditis: 

• I-Endocarditis eyingozi: Lesi simo esibucayi siqala ngokuzumayo futhi silimaza ngokushesha izakhiwo zenhliziyo futhi singaba yingozi empilweni phakathi nezinsuku. 
• I-Subacute Endocarditis: Le endocarditis iqhubeka kancane emavikini noma izinyanga. I-Subacute endocarditis iqala eqenjini elithile lamagciwane e-streptococci ngokuvamile akhona emlonyeni wakho futhi emphinjeni.
• I-Prosthetic Valvular Endocarditis: Lolu hlobo lwe-endocarditis luthinta abantu abaye baba nayo ukuhlinzwa esikhundleni se-valve yenhliziyo phakathi nonyaka odlule.

Izinkinga ze-Endocarditis

Ukutheleleka kwamagciwane ngokuyinhloko kubangela i-endocarditis, nakuba isikhunta singase sibe nesibopho ezimeni ezingavamile. Ukutheleleka kwenzeka lapho ama-microorganisms ayingozi engena ekugelezeni kwegazi futhi anamathele ezindaweni ezilimele zenhliziyo, ikakhulukazi ama-valve. Imisebenzi evamile engaholela ekutheni amagciwane angene egazini ahlanganisa izinqubo zamazinyo, ukudla, ukuxubha amazinyo, ngisho nokusebenzisa indlu yangasese. 

Ngesikhathi sokutheleleka, i-endocardium, ama-clumps amabhaktheriya noma isikhunta, nezinye izakhi ziyakhiwa, ezaziwa ngokuthi izimila. Lezi zitshalo zingahlukana ne-endocardium futhi zisakaze kwezinye izingxenye zomzimba, okuholela ezimweni ezihlukahlukene zenhliziyo.

Izimpawu ze-endocarditis

Izimpawu ze-endocarditis zingahluka kumuntu nomuntu futhi zingakhula kancane noma ngokuzumayo, kuye ngohlobo lwamagciwane abangela ukutheleleka kanye nezinkinga zenhliziyo ezikhona. Izimpawu ezijwayelekile ze-endocarditis nezimpawu zihlanganisa:

• Ukushisa ngaphezu kuka-38.4°C
• Izithukuthuku ebusuku
• Ukukhathala
• Ukushaya kwenhliziyo okusheshayo okumaphakathi
• ubuhlungu besifuba lapho uphefumula
• Ukuphelelwa umoya
• Inhliziyo entsha noma eshintshile ikhononda 
• Amalunga abuhlungu nemisipha
• Ukuvuvukala ezinyaweni, emilenzeni, noma isisu

Izimpawu ezingavamile zihlanganisa: 

• Ukulahlekelwa kwesisindo esingachaziwe
• Igazi emchameni
• Ubumnene ngaphansi kwekheji lezimbambo kwesokunxele
• Amabala abomvu, onsomi, noma ansundu ematheni ezinyawo noma ezintendeni zezandla (okubizwa ngokuthi izilonda zaseJaneway)

Uma uhlangabezana nanoma iyiphi yalezi zimpawu ze-endocarditis, ikakhulukazi uma unomlando wezinkinga zenhliziyo, kubalulekile ukubonana nodokotela ngokushesha ukuze ahlolwe kahle futhi axilongwe.

Izingozi Zezingozi

Kunezici eziningana ezandisa amathuba okuthuthukisa i-endocarditis, okuhlanganisa: 

• Abantu abadala, ikakhulukazi labo abangaphezu kweminyaka engama-60, basengozini enkulu. 
• Abantu abanamavalvu enhliziyo yokwenziwa noma amavalvu enhliziyo alimele ngenxa yezimo ezifana ne-rheumatic fever basengozini yokungenwa kalula yilesi sifo. 
• Ukukhubazeka kwenhliziyo ozalwa nakho kanye nemishini yenhliziyo etshaliwe nakho kuphakamisa ingozi. 
• Ukusetshenziswa kwezidakamizwa ngokujova ngezinaliti ezingcolile kuyinto ekhathaza kakhulu. 
• Impilo ebuthakathaka yamazinyo ingavumela amagciwane ukuthi angene egazini ngokusikeka kwezinsini. 
• Ukusetshenziswa kwe-catheter isikhathi eside kwandisa ingozi futhi. 
• Abesilisa banamathuba aphindwe kabili okuba ne-endocarditis uma kuqhathaniswa nabesifazane. 
• Ezinye izici eziyingozi ze-endocarditis zihlanganisa umlando we-endocarditis, amasosha omzimba acindezelwe, nezimo ezithile zenhliziyo njenge-hypertrophic cardiomyopathy. 

Kubalulekile ukuqaphela ukuthi i-endocarditis ayivamile ukwenzeka kubantu abanezinhliziyo ezinempilo.

Izinkinga ze-Endocarditis

I-Endocarditis ingaholela ezinkingeni ezinzima ezithinta izitho ezihlukahlukene, njenge: 

• Ukuhluleka kwenhliziyo kuyindaba evamile, ngokuvamile ebangelwa ukulimala kwe-valve. Imifino ingagqashuka, ibangele izinkinga kwezinye izitho zomzimba. Lokhu kungaholela ekushayweni kohlangothi, ukulimala kwezinso, noma amathumba emaphashini. 
• Amahlule egazi angakheka, okungenzeka abangele i-pulmonary embolism. 
• Kwezinye izimo, amaphakethe obomvu (amathumba) angase akhule enhliziyweni, ebuchosheni, noma kwezinye izitho. 
• Izinkinga ze-neurological, njenge-ischemic stroke noma i-intracranial hemorrhage, zithinta u-15% kuya ku-30% wamacala. 
• Ukwehluleka kwe-renal acute kanye ne-splenic infarcts nakho kungenzeka.

Lezi zinkinga zingenzeka ngesikhathi esisodwa, okwenza i-endocarditis ibe yisimo esisongela ukuphila esidinga ukunakwa ngokushesha.

Ukuxilongwa kwe-Endocarditis

Ukuxilongwa kwe-endocarditis kuhilela indlela ebanzi: 

• Umlando Wezokwelapha: Odokotela bazobuza ngezimpawu zakho, ukuthi ziqale kanjani, izinqubo zakamuva zamazinyo noma zokuhlinza, ukusetshenziswa kwezidakamizwa ngokufakwa emthanjeni, nokuthi unazo yini izici eziyingozi ze-endocarditis.
• Ukuhlolwa Komzimba: Odokotela bazolalela inhliziyo yakho uma befuna imisindo engavamile (inhliziyo ebubula) futhi bahlole ezinye izimpawu zokutheleleka, njengamachashaza amancane abomvu esikhumbeni kanye nokuvuvukala ezinyaweni noma emaqakaleni.
• Amasiko Egazi: Lezi zivivinyo zibalulekile ekuhlonzeni i-causative microorganism kanye nokwelashwa okuyisiqondiso. 
• Isibalo Segazi Esiphelele (CBC): Ukuhlola isibalo samangqamuzana amhlophe egazi aphakeme, okubonisa ukutheleleka.
• I-Erythrocyte Sedimentation Rate (ESR) kanye ne-C-reactive Protein (CRP) Ukuhlola: Ukubona ukuvuvukala emzimbeni.
• I-Echocardiography: I-Echocardiography idlala indima ebalulekile ekuxilongweni, lapho i-transoesophageal echocardiography (TEE) izwela kakhulu kune-transthoracic echocardiography (TTE) ukuze kutholwe ukukhula kwezitshalo nokunye okungahambi kahle kwenhliziyo okuhambisana ne-endocarditis. 
• I-Electrocardiogram (ECG): I-ECG iqapha ukusebenza kukagesi wenhliziyo futhi ithola noma yikuphi ukungahambi kahle okubangelwa i-endocarditis.

Ezimeni ze-culture-negative endocarditis, odokotela bangase benze izivivinyo ezikhethekile ze-serological noma izindlela zamangqamuzana ukuhlonza izinto eziphilayo ezisheshayo.

Ukwelashwa kwe-Endocarditis 

Ukwelashwa kwe-endocarditis ngokuvamile kuhilela: 

• Nemithi Elwa Namagciwane: Iziguli ngokuvamile zithola ama-antibiotics emithanjeni amasonto ambalwa, kodwa ngemva kokuqeda inkambo yokwelashwa kwe-IV, kungase kudingeke ukuthi ziphuze ama-antibiotics ngomlomo. Ama-antibiotics ngokuvamile anikezwa amasonto amabili kuya kwayisithupha ukuze kuqedwe ukutheleleka ngokuphelele. Ukukhethwa kwama-antibiotic ngokuvamile kuncike kumabhaktheriya athile abangela ukutheleleka. Nge-prosthetic valve endocarditis, ukwelashwa kuvame ukuba yinkimbinkimbi futhi kungadinga inkambo ende yama-antibiotics.
• Imithi ye-Antifungal: Odokotela banikeza imithi ye-antifungal yokwelapha i-endocarditis ebangelwa ukutheleleka kwefungal.
• Ukuhlinzwa: Kwezinye izimo, odokotela bangase bahlinze ukuze balungise noma babuyisele ama-valve enhliziyo alimele. 

Uzoyibona Nini Udokotela

Uma uhlangabezana nezimpawu ze-endocarditis, kubalulekile ukufuna isiqondiso sezokwelapha ngokushesha, ikakhulukazi uma unomlando wezimo zenhliziyo. Ungalindi ukuthi izimpawu zibe zimbi kakhulu ngaphambi kokubonana nodokotela. Ngisho noma ungaqiniseki ukuthi izimpawu zakho zibonisa i-endocarditis, kungcono ukwenza iphutha ohlangothini lokuqapha. Xhumana nodokotela wakho uma unezimpawu nezimpawu zokutheleleka, njengemfiva, ukugodola, noma ubuhlungu bamalunga. Kubalulekile ukuqaphela ukuthi nakuba imikhuhlane nomkhuhlane ingabangeli i-endocarditis, ingaba nezimpawu ezifanayo. 

Uma kutholwe ukuthi une-endocarditis futhi ubona izimpawu eziba zimbi njengokuphelelwa umoya noma izinhlungu zekhanda, yazisa udokotela wakho ngokushesha. Shayela abezimo eziphuthumayo ngaphandle kokulibala uma kuba nezimpawu ezingazelelwe, ezinzima ezingase zibonise isifo sohlangothi.

Ukuvimbela

Ukuvimbela i-endocarditis kuhilela izinyathelo ezimbalwa ezibalulekile:

• Ukugcina inhlanzeko yomlomo ibalulekile. Geza amazinyo kabili nsuku zonke, uwahlanze njalo, futhi uhlolwe amazinyo njalo ezinyangeni eziyisithupha. 
• Uma usengozini enkulu ye-endocarditis, yazisa udokotela wakho wamazinyo nodokotela. Bangase batuse ama-antibiotics ngaphambi kwezinqubo ezithile zamazinyo. 
• Gwema ukusetshenziswa kwezidakamizwa ezingekho emthethweni, ikakhulukazi izidakamizwa ezifakwa emthanjeni, njengoba zandisa kakhulu ingozi. 
• Yazi izimpawu nezimpawu ze-endocarditis futhi ufune ukungenelela kwezokwelapha ngokushesha uma uthola noma yikuphi. 
• Kulabo abanokukhubazeka kwenhliziyo yokuzalwa, landela iseluleko sikadokotela wakho mayelana nezinyathelo zokuvimbela.

Isiphetho

I-Endocarditis isifo senhliziyo esiyingozi esingaba nemiphumela emibi uma singelashwa ngokushesha. Ukuqonda izimpawu nezimpawu zayo kanye nokwazi ukuthi ungalufuna nini usizo lwezokwelapha kungaba nomthelela omkhulu umphumela walesi simo esingase sibe yingozi empilweni. Ukugcina inhlanzeko yomlomo omuhle nokulandela iseluleko sikadokotela wakho kuyizinyathelo ezibalulekile zokuvimbela i-endocarditis, ikakhulukazi ezigulini ezisengozini enkulu. Khumbula, nakuba lokhu kutheleleka kuyivelakancane ezinhliziyweni ezinempilo, kubalulekile ukuqaphela ubungozi futhi uthathe izinyathelo zokuphepha ezifanele. Ngokuhlala unolwazi futhi uqaphile, ungavikela impilo yenhliziyo yakho futhi uqinisekise ukusabela okusheshayo uma kuphakama noma yiziphi izimpawu.

FAQ sika

1. Ungalulama ku-endocarditis?

Ukululama ku-endocarditis kungenzeka ngokwelashwa okusheshayo nokufanelekile. Iziguli eziningi ziyalulama ngempumelelo ngokwelashwa ngama-antibiotic, okungase kuthathe amasonto ambalwa. Kodwa-ke, inqubo yokutakula ingaba yinde, futhi ukunakekelwa kokulandelela isikhathi eside kuvame ukudingeka ukuze kuvinjelwe ukuphindeka.

2. Yiziphi izimpawu eziyisixwayiso ze-endocarditis?

Izimpawu eziyisixwayiso ze-endocarditis zihlanganisa imfiva, ukugodola, ukujuluka ebusuku, ukukhathala, nokuncipha kwesisindo ngendlela engaqondakali. Ezinye izimpawu zingase zihilele ubuhlungu besifuba, ukuphefumula, kanye nokububula kwenhliziyo okusha noma okushintshile. Ezinye iziguli zingase zibe nokuqaqamba kwamalunga nemisipha, ukuvuvukala ezinyaweni noma emilenzeni, futhi isikhumba sishintshe njengamachashaza abomvu noma ansomi ezintendeni zezandla noma ematheni.

3. Yiziphi izigaba ezintathu ze-endocarditis?

I-Endocarditis ikhula ngezigaba ezintathu:
I-Bacteremia: Ama-microorganisms angena egazini.
Ukunamathela: Ama-microorganisms anamathela ezindaweni ezilimele zolwelwesi lwangaphakathi lwenhliziyo.
I-Colonisation: Izinto eziphilayo ziyanda, zenze uhlaza futhi zibangele ukuvuvukala.

4. Ubani osengozini ye-bacterial endocarditis?

Abantu abasengozini enkulu ye-endocarditis yebhaktheriya bahlanganisa labo abanamavalvu enhliziyo okwenziwa, ama-valve enhliziyo alimele, noma abanezinkinga zenhliziyo zokuzalwa. Ezinye izici eziyingozi zihlanganisa umlando we-endocarditis, ukusetshenziswa kwezidakamizwa ngokufakwa emthanjeni, ukungahlanzeki kwamazinyo, ukuba nama-catheter esikhathi eside nokuba namandla amasosha omzimba.

5. Ingabe i-endocarditis ingunaphakade?

I-Endocarditis ngokwayo ayihlali unomphela uma iphathwa ngokushesha nangempumelelo. Kodwa-ke, kungabangela ukulimala okungapheli kuma-valve enhliziyo noma ezinye izinkinga uma kungelashwa noma uma ukwelashwa kubambezeleka. Ezinye iziguli zingase zibe nemiphumela yesikhathi eside noma zidinga ukunakekelwa kwezokwelapha okuqhubekayo, ikakhulukazi uma zinezimo zenhliziyo ezivele zikhona noma ukutheleleka kubangele umonakalo omkhulu.

6. Ingabe i-endocarditis iyelapheka?

I-Endocarditis iyelapheka, ikakhulukazi ngemithamo ephezulu yemithi elwa namagciwane. Ukwelashwa ngokuvamile kuthatha amasonto ambalwa futhi kungase kudinge ukulaliswa esibhedlela ekuqaleni. Kwezinye izimo, imishanguzo ye-antifungal isetshenziswa uma isikhunta sibangela ukutheleleka. Odokotela bangase bahlinze ukuze balungise noma babuyisele ama-valve enhliziyo alimele noma bakhiphe izicubu ezinesifo.

UDkt. Chanakya Kishore Kammaripalli

MBBS, MD, DM (Cardiology) (AIIMS), FACC, FSCAI
CARE Medical Center, Tolichowki, Hyderabad, CARE Hospitals, HITEC City, Hyderabad

Ukuze Ubhukhe Isikhathi, shayela:

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