Ukushaqeka Kwe-Cardiogenic

Ukushaqeka kwe-Cardiogenic kuyisimo esiphuthumayo esisongela ukuphila esidinga ukunakekelwa kwezokwelapha ngokushesha. Ukushaqeka kwe-Cardiogenic kuvame ukuvela ngenxa yokuhlaselwa yinhliziyo, kodwa okunye izinkinga zenhliziyo kungabuye kubangele. Lesi sihloko sizohlola izizathu, izimpawu nezimpawu zokushaqeka kwe-cardiogenic, kanye nezinkinga ezingaba khona zokushaqeka kwe-cardiogenic. Sizophinde sixoxe ngokuthi odokotela basixilonga futhi basiphathe kanjani lesi simo, kanye nokuthi ungalufuna nini usizo lwezokwelapha. 

Kuyini I-Cardiogenic Shock?

I-Cardiogenic shock yisimo esisongela ukuphila esenzeka lapho inhliziyo ngokungazelele ihluleka ukumpompa igazi elanele ukuhlangabezana nezidingo zomzimba. 

Incazelo yomtholampilo yokushaqeka kwe-cardiogenic ihlanganisa ukuncipha kokuphuma kwenhliziyo kanye nezimpawu ze-thishu hypoxia, ngisho nalapho kunomthamo owanele we-intravascular. 

Ukushaqeka kwe-Cardiogenic kunemibandela ethile yomtholampilo neye-haemodynamic: 

• I-hypotension eqhubekayo, ene-systolic BP engu-90 mm Hg noma ngaphansi imizuzu engu-30 noma ngaphezulu, noma edinga ukwesekwa ukuze kugcinwe lo mfutho wegazi. 
• I-Urine okukhiphayo kungase kwehle kube ngu-30 mL/hr noma ngaphansi, futhi amaphethelo angase azizwe ebanda. 
• Inkomba yenhliziyo ecindezelekile (amalitha angu-2.2 ngomzuzu imitha yesikwele ngayinye yendawo yomzimba noma ngaphansi) kanye nomfutho ophakeme we-pulmonary-capillary wedge omkhulu kuno-15 mm Hg.

Izimbangela Nezingozi Zokushaqeka Kwenhliziyo

Isizathu esivame kakhulu sokushaqeka kwe-cardiogenic ukuhlasela kwenhliziyo okubi kakhulu. Lapho ukuhlaselwa yinhliziyo kwenzeka, kungalimaza imisipha yenhliziyo, okuholela ekwehleni ngokushesha kwekhono layo lokupompa igazi ngokuphumelelayo.

Kodwa-ke, ezinye izinkinga zenhliziyo nazo zingabangela ukushaqeka kwe-cardiogenic. Lokhu kubandakanya: 

• Ukuhluleka kwenhliziyo, lapho inhliziyo ingakwazi ukumpompa igazi elanele ukuze ihlangabezane nezidingo zomzimba
• I-arrhythmias noma isigqi senhliziyo esingavamile esingaphazamisa ukugeleza kwegazi okufanele
• Ukuvuvukala kwemisipha yenhliziyo (myocarditis) 
• Ukutheleleka kolwelwesi lwenhliziyo olungaphakathi namavalvu (endocarditis) 
• Ukulimala kwesifuba okulimaza inhliziyo futhi kuphazamise umsebenzi wayo wokupompa
• Amahlule egazi emaphashini (i-pulmonary embolism)
• Imithi ethile ingase ibangele ukushaqeka kwe-cardiogenic uma iphuzwe ngemithamo eyeqile 

Kunezici eziningana ezandisa ingozi yokuthuthukisa ukushaqeka kwe-cardiogenic. Lokhu kubandakanya: 

• Ubudala: Abantu abaneminyaka engu-75 noma ngaphezulu basengozini enkulu
• Isizinda sobuhlanga noma sobuzwe: Abantu base-Asia baseMelika kanye nabaseziqhingini zase-Pacific, isibonelo, basengozini enkulu uma kuqhathaniswa namanye amaqembu.
• Izinkinga Zenhliziyo Nemithambo Yegazi Esezivele Zikhona: I-Coronary Isifo senhliziyo futhi umfutho wegazi ophezulu ukhuphula ingozi
• Ezinye Izinto: Lezi zihlanganisa sikashukela, ukukhuluphala, kanye nomlando wokuxhunyelelwa komthambo we-coronary bypass.

Izimpawu ze-Cardiogenic Shock

Ukushaqeka kwe-Cardiogenic kunomthelela omkhulu emzimbeni, okubangela uhla lwezimpawu zokushaqeka okukhulu kwe-cardiogenic. Lokhu kubandakanya:

• Ubuhlungu besifuba: Uphawu oluvame kakhulu lokushaqeka kwe-cardiogenic ubuhlungu besifuba obuhlala ngaphezu kwamaminithi ambalwa noma ukuza nokuhamba. Lobu buhlungu bungase buzizwe bunzima, buqinile, noma bunjengomuzwa ocindezelayo, ovame ukuchazwa njengokufana nesilungulela.
• Ubuhlungu Ngaphandle Kobuhlungu Besifuba: Ubuhlungu noma ukungaphatheki kahle engxenyeni engenhla yomzimba, engalweni yangakwesokunxele, engenhla kwesisu, emphinjeni, noma emhlathini. 
• Ubunzima Bokuphefumula: Abantu ababhekene nokushaqeka kwe-cardiogenic bangase babe nenkinga yokuphefumula, okuhambisana nokuphefumula kanzima nokuphefumula ngokushesha.
• Ama-Cold Sweats: Ukujuluka, ikakhulukazi "ukujuluka okubandayo," kungenye isibonakaliso esivamile. Iziguli zivame ukubika ukuthi zizizwa zibuthakathaka kakhulu, zinekhanda elilula, futhi zikhathazekile. 
• Ukushaya Kwenhliziyo Okungavamile: Ukushaya kwenhliziyo okusheshayo noma okungajwayelekile (i-tachycardia), njengokushaya kwenhliziyo ebuthakathaka, kuvamile. 
• Umfutho Wegazi Ophansi: I-Hypotension iyinkomba eyinhloko yokushaqeka kwe-cardiogenic.
• Ezinye Izimpawu: Lezi zihlanganisa ukudideka noma ukungaqapheli, ukuquleka, isikhumba esiphaphatheka, ukuchama kancane, izandla nezinyawo ezipholile, ukuvuvukala kwesisu nemilenze nokungathandi ukudla.

Izinkinga

Ukushaqeka kwe-Cardiogenic kunomthelela omkhulu emzimbeni futhi kungaholela ezinkingeni ezinzima uma kungelashwanga ngokushesha. Lesi simo sinesimo esibi sokubikezela, cishe ku-80% weziguli ezifayo naphezu kokwelashwa kokushaqeka kwenhliziyo. Yimbangela ehamba phambili yokufa ezigulini ezine-acute myocardial infarction.

Izinkinga ezinkulu ze-cardiogenic shock zifaka: 

• Ukulimala kwezinso okukhulu 
• Ukulimala kwesibindi 
• I-Cardiointestinal syndrome (ethinta amathumbu) 
• Ukungasebenzi kahle kobuchopho nokulimala, okufana ne-cerebral infarction, ukopha, nokulimala kobuchopho okunoshukela
• Ukuboshwa kwe-cardiac
• Stroke
• Isigqi senhliziyo esingajwayelekile

Sifo

Inqubo yokuxilongwa ihlanganisa: 

• Umlando wezokwelapha ophelele, ohlanganisa noma yiziphi izimpawu zakamuva zokuhlaselwa yinhliziyo noma imithi yamanje.
• Ukuhlolwa ngokomzimba, okuhlanganisa ukuhlola izandla nezinyawo ezibandayo, ukuvuvukala, ukushaya kwenhliziyo nenhliziyo nemisindo yamaphaphu.
• Izilinganiso zomfutho wegazi 
• I-electrocardiogram (ECG) 
• Ama-X-ray esifubeni 
• Ukuhlolwa kwegazi ukuhlola ukulimala kwesitho, ukutheleleka, izimpawu zokuhlasela kwenhliziyo kanye nokulinganisa amazinga omoya-mpilo kanye ne-carbon dioxide
• I-echocardiogram ukuze ubone ukuthi inhliziyo impompa kanjani igazi futhi ikhombe noma yimuphi umonakalo ovela ekuhlaselweni kwenhliziyo.
• I-catheterization yenhliziyo ihilela ukufaka i-catheter emthanjeni ukuze kuhlolwe ukugeleza kwegazi nomfutho wenhliziyo, okusiza ekuboneni imithambo evalekile noma emincane.

Ukwelashwa Kwe-Cardiogenic Shock

Ukwelashwa kokushaqeka kwenhliziyo kugxile 'emithethweni ye-VIP': ukugcinwa komoya omncane, ukuthola i-euvolemia (umthamo ovamile wegazi noketshezi), kanye nokuphatha ama-vasopressor noma ama-inotropes.

• Ukwelashwa komoya-mpilo kunikezwa ngokushesha ukuze kwandiswe ukulethwa komoyampilo. 
• Ukuvuselela uketshezi kulawulwa ngokucophelela ukuze kuzuzwe isimo esilungile sokulayisha kuqala. 
• Ama-Vasopressors nama-inotropes (i-Norepinephrine, i-epinephrine, i-dobutamine) adlala indima ebalulekile ekulawuleni ukushaqeka kwenhliziyo.
• Imithi efana nemithi enciphisa igazi kanye nezidakamizwa ze-antiplatelet isiza ukuncibilikisa amahlule futhi ithuthukise ukugeleza kwegazi. 
• I-Percutaneous coronary intervention (PCI) iyinqubo engahlinzeki evula imithambo evalekile kusetshenziswa i-catheter kanye ne-stent. 
• Ukufakwa kwe-coronary artery bypass grafting (CABG) kungenziwa ezimeni ezinzima ukudala izindlela ezintsha zokugeleza kwegazi.
• Imishini yokusekela imishini ihlanganisa: 
  • Amaphampu e-Intra-aortic balloon (IABP), asiza inhliziyo iphampe igazi ngendlela ephumelela kakhudlwana
  • Imishini ye-Extracorporeal membrane oxygenation (ECMO) ithatha indawo yenhliziyo namaphaphu okwesikhashana. 

Uzoyibona Nini Udokotela

Ukushaqeka kwe-Cardiogenic kuyisimo esiphuthumayo esisongela ukuphila esidinga ukunakekelwa kwezokwelapha ngokushesha. Xhumana nodokotela wakho uma uhlangabezana: 

• Noma yiziphi izimpawu zokuhlaselwa yinhliziyo, njengobuhlungu besifuba obuhlala isikhathi esingaphezu kwamaminithi ambalwa noma obufika budlule
• Ukuphefumula, ukudideka, ukujuluka, nokuphefumula ngokushesha
• Ubuthakathaka, ikhanda elilula, noma ukuquleka

Prevention

Ukuvimbela ukushaqeka kwe-cardiogenic ngokuyinhloko kubandakanya ukugcina inhliziyo enempilo nokulawula izici eziyingozi zenhliziyo. 

• Yeka ukubhema noma gwema intuthu engenzi lutho
• Ukugcina isisindo esinempilo njengokukhuluphala ngokweqile kunomthelela kwezinye izici eziyingozi njengomfutho wegazi ophakeme, isifo senhliziyo nemithambo yegazi, nesifo sikashukela.
• Yehlisa ukusetshenziswa kwamafutha agcwele kanye nemikhiqizo ye-trans fat. 
• Nciphisa ukusetshenziswa kukasawoti ukusiza ukuvimbela ukunqwabelana koketshezi emzimbeni, okungase kucindezele inhliziyo. 
• Yehlisa ushukela ukuze ugcine isisindo esinempilo futhi uthuthukise impilo yonke yenhliziyo.
• Khomba okungenani imizuzu engu-150 yomsebenzi we-aerobic omaphakathi noma imizuzu engu-75 yomsebenzi onamandla we-aerobic ngesonto. 

Isiphetho

Ukunakekela inhliziyo yakho kuyindlela engcono kakhulu yokugwema ukushaqeka kwe-cardiogenic. Lokhu kusho ukudla kahle, ukuhlala umatasa, nokulawula izindaba zempilo ezifana nomfutho wegazi ophakeme. Uma unezinkinga zenhliziyo, sebenzisana eduze nodokotela wakho ukuze uzigcine zilawulwa. Uma kwenzeka uzwa izimpawu ezinjengobuhlungu besifuba noma ukuphefumula kanzima, ungalindi – thola usizo lwezokwelapha ngokushesha. Isenzo esisheshayo singasindisa izimpilo uma kuziwa ezimweni eziphuthumayo zenhliziyo.

Imibuzo Evame Ukubuzwa

1. Ingabe umuntu angalulama ekushaqekeni kwenhliziyo?

Isihluthulelo sokusinda ukuvuselelwa okusheshayo kanye nokuvuselelwa kwe-coronary artery. Ngisho nokunakekelwa okungcono kakhulu kanye nokwelashwa kwakamuva, isimo sisenamazinga aphezulu okufa.

2. Yiziphi izinhlobo ezine zokushaqeka kwenhliziyo?

Ukushaqeka kwe-Cardiogenic kungabangelwa izinhlobo ezahlukene zokungasebenzi kahle kwenhliziyo:

• Ukungasebenzi kahle kwe-Systolic
• Ukungasebenzi kwe-Diastolic
• Ukungasebenzi kahle kwe-valvular
• Ama-arrhythmias enhliziyo

3. Yiziphi izigaba zokushaqeka kwe-cardiogenic?

Ukushaqeka kwe-Cardiogenic kuqhubeka ngezigaba ezinhlanu:

• Engcupheni (A): Isifo senhliziyo sikhona, kodwa azikho izimpawu zokushaqeka kwenhliziyo
• Ukuqala (B): Izinga lokushaya kwenhliziyo eliphansi noma umfutho wegazi
• Okwakudala (C): Isidingo sokungenelela kwezokwelapha noma izinsiza zokusiza igazi ligeleze ezithweni
• Ukuwohloka (D): Ukungaphenduli ekwelashweni nokuba kubi kakhulu
• I-Extremis (E): Ukuboshwa kwenhliziyo okudinga i-CPR, i-ventilator, ne-defibrillator

4. Kuthatha isikhathi esingakanani ukululama kulokhu kwelashwa?

Isikhathi sokululama sincike kubukhulu bokushaqeka kanye nokwelashwa okutholiwe. Ngemva kwe-angioplasty, abantu ngokuvamile bazizwa bekhathele izinsuku ezimbalwa. Kodwa-ke, labo abane-angioplasty ngesikhathi noma ngemva kokuhlaselwa yinhliziyo bangadinga amasonto ayisithupha ukuze balulame ngokugcwele. Ukuthola kabusha isikhathi eside kuvame ukubandakanya ukuvuselelwa kwenhliziyo kanye nokulawula izimo zenhliziyo ezingaphansi ukuvimbela iziqephu zesikhathi esizayo.

UDkt. Arvind Singh Raghuwanshi

I-MBBS, i-MD-Medicine, i-DM-Cardiology
Izibhedlela ze-CARE CHL, e-Indore

Ukuze Ubhukhe Isikhathi, shayela:

+91 406 810 6585