I-Bradycardia

Abantu abaningi bayazi ukuthi izinga lokushaya kwenhliziyo elijwayelekile lisukela phakathi kokushaya okungu-60 no-100 ngomzuzu, kodwa i-bradycardia yenzeka lapho inhliziyo ishaya izikhathi ezingaphansi kwezingu-60 ngomzuzu. Lo mhlahlandlela ophelele uhlola ukuthi iyini i-bradycardia, izimpawu zayo ezivamile, izimbangela, nezindlela zokwelapha. 

Iyini i-Bradycardia?

Inhliziyo yomuntu isebenza ngohlelo lukagesi oluyinkimbinkimbi, i-sinus node esebenza njenge-pacemaker yemvelo. Leli qembu lamangqamuzana akhethekile litholakala engxenyeni yenhliziyo engenhla kwesokudla, lakha izimpawu zikagesi eziqala ukushaya kwenhliziyo ngakunye.

I-Bradycardia yenzeka lapho lezi zimpawu zikagesi zehla noma zivimbekile, okuholela ekushayeni kwenhliziyo okungaphansi kwamabhithi angama-60 ngomzuzu. Nakuba lesi simo singathinta noma iyiphi iminyaka, sivame kakhulu kubantu abadala abangaphezu kweminyaka engama-65.

Ukusebenza okuvamile kwenhliziyo kuncike emagumbini amane asebenza ngokuzwana:

• Amakamelo amabili aphezulu (atria)
• Amakamelo amabili aphansi (ama-ventricles)

Akuwona wonke amacala e-bradycardia ayimbangela yokukhathazeka. Ukushaya kwenhliziyo okunensayo kungaba yinto evamile kubantu nabasubathi abakhuthele ngokomzimba. Nokho, i-bradycardia iba inkinga yezokwelapha lapho inhliziyo ingakwazi ukumpompa igazi elanele elinomoya-mpilo ukuze lihlangabezane nezidingo zomzimba.

Izimpawu ze-Bradycardia

Lapho i-bradycardia ithinta ukutholakala komoyampilo emzimbeni, ingabonakala ngezimpawu ezihlukahlukene ezithinta kokubili ukusebenza ngokomzimba nangokomqondo. 
Kubantu abakhuthele ngokomzimba, ikakhulukazi abasubathi, ukushaya kwenhliziyo okuphansi kungase kungazibangeli izimpawu njengoba izinhliziyo zabo zisebenza kahle ngokwemvelo. 

Okulandelayo yizimpawu ezijwayelekile zomzimba nezimpawu ze-bradycardia:

• Ukuphefumula, ikakhulukazi ngesikhathi sokusebenza ngokomzimba
• Ubuhlungu besifuba (angina)
• Ukukhathala nobuthakathaka obukhulu
• I-palpitations yenhliziyo
• Isiyezi noma ikhanda elikhanyayo
• Iziqephu zokuquleka noma eduze nokuquleka

Ubuchopho buthola phakathi kuka-15% no-20% wegazi eligeleza lisuka enhliziyweni, okwenza buzwele kakhulu ezinguqukweni zokushaya kwenhliziyo. Lokhu kuchaza ukuthi kungani abantu abane-bradycardia bevame ukuba nezimpawu zokucabanga njengokudideka, izinkinga zenkumbulo nobunzima bokugxilisa ingqondo.

Izinkinga ze-Bradycardia

I-Bradycardia ingakhula ezimweni ezihlukahlukene ezithinta isimiso sikagesi senhliziyo. Ukuqonda lezi zimbangela kusiza odokotela banqume indlela yokwelapha ephumelela kakhulu.

Nazi izizathu ezimbalwa ze-bradycardia: 

• Izinkinga nge-Sinoatrial (SA) Node: Lesi yisizathu esivame kakhulu se-sinus bradycardia. I-Node yemvelo ye-pacemaker yenhliziyo ingaphazamisa isigqi senhliziyo esivamile. Lokhu kuphazamiseka kuvame ukwenzeka ngenxa yesimo esibizwa ngokuthi i-sinus sinus syndrome, esivama kakhulu njengoba abantu bekhula.
• Izimo Zezokwelapha: Izifo eziningi ezibangela i-bradycardia yizi:
  • Ukulimala kwezicubu zenhliziyo ngenxa yokuguga noma Isifo senhliziyo
  • Izimo zokuvuvukala njenge-myocarditis
  • Ukungalingani kwe-Electrolyte okuthinta amazinga e-calcium noma e-potassium
  • I-Hypothyroidism (i-thyroid engasebenzi)
  • I-apnea yokulala yokuvimbela
  • I-Rheumatic fever, i-lupus noma ezinye izifo ezivuthayo
  • Ukutheleleka okufana nesifo se-Lyme nesifo se-Chagas

Izingozi Zezingozi

Iminyaka yobudala idlala indima ebalulekile ekuthuthukiseni i-bradycardia, futhi isimo sivame kakhulu kubantu abadala abangaphezu kweminyaka engama-65. Nakuba abantu abasha bengase babe ne-bradycardia, abantu abadala asebekhulile babhekene nengozi enkulu ngenxa yezinqubo zokuguga zemvelo ezithinta izicubu zenhliziyo.

Izingozi Ezibalulekile zihlanganisa:

• Umfutho wegazi ophezulu
• Izinkinga zokuhlinzwa kwenhliziyo, ukwelashwa kwemisebe imiphumela, kanye ne-hypothermia enzima
• Ukucindezeleka nokukhathazeka njalo
• Ukuphuza kakhulu utshwala
• Ukubhema
• Ukusetshenziswa kwezidakamizwa ezingekho emthethweni
• Imithi ethile, ikakhulukazi imithi yenhliziyo (i-Beta-blockers, i-calcium channel blockers, nezinye izidakamizwa ezilwa nesifo sokuqina kwemithambo yegazi)
• Ukushoda kwe-Electrolyte

Izinkinga zeBradycardia

Uma ingelashwa, i-bradycardia ingaholela ezinkingeni zempilo ezingase zibe nomthelela omkhulu eqophelweni lempilo yomuntu. Izinkinga ezinkulu zeBradycardia:

• Ukuquleka njalo (syncope)
• Ukuhluleka kwenhliziyo
• Ukuboshwa kwenhliziyo okungazelelwe
• Ezimweni ezimbi kakhulu, ukufa ngokuzumayo kwenhliziyo

Sifo

Ngesikhathi sokubonisana kokuqala, odokotela balalela inhliziyo nge-stethoscope futhi baxoxe ngezimpawu zesiguli nokuthi ziqale nini.

• I-Electrocardiogram (ECG): Ithuluzi eliyinhloko lokuxilonga i-Electrocardiogram (ECG), ekala umsebenzi kagesi wenhliziyo ngezinzwa ezibekwe esifubeni. Lokhu kuhlolwa kunikeza ulwazi olusheshayo mayelana nesigqi senhliziyo kanye nesilinganiso sokushaya kwenhliziyo, kusize odokotela babone noma yikuphi ukungahambi kahle.
• Ezimweni lapho i-bradycardia yenzeka ngezikhathi ezithile, izazi zenhliziyo zingancoma amadivaysi ahlukahlukene okuqapha:
  • I-Holter Monitor: I-ECG ephathekayo egqokwa izinsuku ezingu-1-7 erekhoda ngokuqhubekayo umsebenzi wenhliziyo
  • Isirekhoda Somcimbi: Idivayisi egqokekayo esetshenziswa izinsuku ezingafika kwezingu-30, isebenze uma kuvela izimpawu
  • I-Implantable Monitor: Ithuluzi elincane elibekwe ngaphansi kwesikhumba ukuze liqashwe isikhathi eside
• Ukuhlolwa kwegazi: Uphenyo lwegazi ludlala indima ebalulekile ekuxilongeni ngokuhlola izimo ezingaphansi. Lezi zivivinyo zihlola amazinga e-electrolyte, ukusebenza kwe-thyroid, kanye nezifo ezingase zibe khona. 
• Ukuhlolwa Okukhethekile: 
  • Tshekisa ukuhlolwa kwetafula ukuze ubone ukuthi inhliziyo isabela kanjani ekushintsheni kwesimo 
  • Zivivinye ukuhlolwa kokucindezeleka ukuze uhlole isigqi senhliziyo phakathi nomsebenzi womzimba
  • I-echocardiogram isiza ukuhlola ikhono lokumpompa kwenhliziyo kanye nokwakheka kwayo yonke. 

Ukwelashwa kwe-Bradycardia

Kubantu abangenazo izimpawu, odokotela bangase batuse ukuqapha isimo ngaphandle kokungenelela ngokushesha.

Lapho ukwelashwa kudingekile, odokotela ngokuvamile balandela indlela enyathelwe:

• Ukuguqulwa kwendlela yokuphila kanye nokwelashwa kwesimo esiwumsuka
• Ukulungiswa noma ukuyekwa kwemithi okubangela ukushaya kwenhliziyo kancane
• Ukulungiswa kokungalingani kwe-electrolyte
• Ukwenziwa kwamadivayisi ahambayo esikhashana noma unomphela
• Ezimweni eziphuthumayo lapho i-bradycardia ibangela izimpawu eziyingozi, odokotela bangase banikeze imishanguzo ye-intravenous. I-Atropine imithi eyinhloko, ngokuvamile inikezwa ngemithamo ye-0.5-1.0 mg ngezikhathi zemizuzu engu-3-5.

Ukuqaliswa kwePacemaker: Intuthuko enkulu ekwelashweni kwe-bradycardia ukusebenzisa ama-pacemaker. Lezi zinsimbi ezincane zifakwe ngaphansi kwesikhumba eduze kwe-collarbone futhi zisize ukulawula isigqi senhliziyo. Izinketho zesimanje zihlanganisa ama-pacemakers ahlala njalo kanye nezinguqulo ezintsha ezingenamthofu, ezingangosayizi wephilisi elikhulu lamavithamini futhi ezingatshalwa ngenqubo esekelwe kwi-catheter.

Uzoyibona Nini Udokotela

Funa ukunakekelwa ngokushesha uma uhlangabezana:

• Ubuhlungu besifuba obuhlala ngaphezu kwemizuzu embalwa
• Ukuphefumula kanzima noma ubunzima bokuphefumula
• Isiyezi, ikhanda elilula, noma ukuquleka
• Izimpawu ezikhula ngokushesha noma ngokuzumayo ziba zimbi kakhulu

Prevention

I-American Heart Association incoma izinguquko ezimbalwa ezibalulekile zendlela yokuphila ukusiza ukuvimbela izimo ezihlobene nenhliziyo, kuhlanganise ne-bradycardia. Lawa maqhinga asekelwe ebufakazini agxile ekugcineni impilo yonke yenhliziyo nemithambo yegazi:

• Zibandakanye nokuvivinya umzimba okuvamile, njengokuhamba kwansuku zonke kwemizuzu engama-30
• Idla ukudla okunomsoco okunothe ngezithelo, imifino, nokusanhlamvu
• Gcina umfutho wegazi kanye namazinga e-cholesterol esezingeni
• Finyelela futhi ulondoloze isisindo esinempilo
• Thola ukulala okwanele (amahora angu-7-9 nsuku zonke)
• Lawula ukucindezeleka ngokusebenzisa amasu okuphumula
• Hlala unamanzi ngendlela efanele
• Nciphisa noma gwema ukuphuza utshwala

Isiphetho

I-Bradycardia ithinta abantu abaningi ngendlela ehlukile, kusukela kubasubathi abagcina izinga lokushaya kwenhliziyo eliphansi ngokwemvelo ukuya kubantu abadinga usizo lwezokwelapha ngokushesha. Abantu abane-bradycardia bangaphila impilo evamile, enempilo ngokunakekelwa okufanele kwezokwelapha kanye nokulungiswa kwendlela yokuphila. Ukuhlolwa okuvamile, ukudla okulungele inhliziyo, nokuzivocavoca umzimba njalo kusiza ukuphatha lesi simo ngempumelelo. Isihluthulelo sisekuhlaleni uqaphile izimpawu eziyisixwayiso kanye nokufuna usizo lwezokwelapha lapho izimpawu zivela.

Odokotela manje banikeza izindlela zokwelapha ezihlukahlukene, kusukela ekulungisweni kwemithi kuya kubuchwepheshe besimanje be-pacemaker. Lokhu kuthuthuka, kuhlanganiswe nezinyathelo zokuvimbela njengokulawula ingcindezi nokulala okufanele, kunikeza iziguli ukulawula okungcono impilo yazo yenhliziyo.

Imibuzo Evame Ukubuzwa

1. Kuthinta bani?

I-Bradycardia ithinta kakhulu abantu abadala abaneminyaka engaphezu kwengama-65 ubudala, cishe oyedwa kwabangama-600 kuleli qembu leminyaka onezimpawu. Nakuba lesi simo singathinta noma ubani, sivame kakhulu emaqenjini amabili ahlukene: abadala abadala nabasubathi. Abantu abadala abancane, abanempilo enhle nabasubathi abaqeqeshiwe bavame ukuba nezinga lenhliziyo eliphansi ngokwemvelo ngaphandle kwemiphumela emibi.

2. Sivame kangakanani lesi simo?

Ukusabalala kwe-bradycardia kuyehluka emhlabeni wonke, kuthinta phakathi kuka-0.5% kuya ku-2.0% wabantu abaningi. Ucwaningo lubonisa ukuthi i-sinus bradycardia engachazwanga yenzeka cishe kubantu abangama-400 kubantu abayi-100,000 emhlabeni jikelele. Kuyathakazelisa ukuthi lesi simo sithinta amadoda nabesifazane ngokulinganayo.

3. Lesi simo siwuthinta kanjani umzimba wami?

Lapho i-bradycardia yenzeka, izinga lokushaya kwenhliziyo elihamba kancane lingathinta izinhlelo ezihlukahlukene zomzimba. Imiphumela eyinhloko ihlanganisa:

• Ukwehliswa kokulethwa komoyampilo ezithweni ezibalulekile
• Ukuncipha kokugeleza kwegazi ukuya ebuchosheni
• Ukusebenza ngokomzimba okukhubazekile
• Imiphumela engase ibe khona engqondweni

4. Nini ukukhathazeka nge-bradycardia?

Ukukhathazeka kuyafaneleka lapho i-bradycardia ivimbela inhliziyo ekumpompeni igazi elinomoya-mpilo ukuze lihlangabezane nezidingo zomzimba. Lesi simo ngokuvamile sibonakala ngezimpawu ezifana nesiyezi, ukukhathala okukhulu, noma ukuquleka. Abasubathi nabantu abadala abasebasha abanezinga lokushaya kwenhliziyo eliphansi ngokwemvelo akudingeki bakhathazeke ngaphandle uma behlangabezana nalezi zimpawu.

5. Ingabe ukubanda kungabanga i-bradycardia?

Yebo, ukuchayeka emakhazeni kungabangela i-bradycardia. Ucwaningo luveza ukuthi isimo sezulu esibandayo sidala ukuthi imithambo yegazi ibe mincane, okwenza inhliziyo isebenze kanzima ukumpompa igazi. Ngesikhathi sokuchayeka okubandayo, umzimba ungase uphendule ngendlela yokuzivikela ebizwa ngokuthi i-cold-induced bradycardia, ebonakala ikakhulukazi phakathi nokulala noma ukuchayeka isikhathi eside emazingeni okushisa abandayo.

UDkt. Nitin Modi

MBBS, MD, DNB, DM
Izibhedlela ze-CARE CHL, e-Indore

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