Kontent qismiga oʻtish

Ishemik kardiomiopatiya

Vikipediya, erkin ensiklopediya
Ishemik kardiomiopatiya
Belgilari Tez charchash
Mutaxassislik Kardiologiya
Sabablari Ateroskleroz, Vazospazm[1]
Tashxis usullari MRT[2]

Ishemik kardiomiopatiya yurakni qon bilan taʼminlaydigan koronar arteriyalarning torayishi tufayli kelib chiqadigan kardiomiopatiyaning bir turi[3]. Koʻpincha ishemik kardiomiopatiyali bemorlarning kasallik tarixida miokard infarkti qayd etiladi[4], baʼzan kasallik tarixida miokard infarkti qayd etilmagan, lekin koronar arteriya kasalligi boʻlgan bemorlarda ham rivojlanadi. Ushbu kardiomiopatiya esa toʻsatdan yurak toʻxtashiga olib keladi[5]. Ishemiya – qon taʼminotining mexanik toʻsilishi natijasida yuzaga keladigan mahalliy anemiya bilan bogʻliq yoki unga xos boʻlgan xususiyatlarni anglatadi[6].

Ishemik kardiomiopatiyaning belgilariga tez charchash, nafas qisishi, bosh aylanishi va yurak urishining tezlashuvi kiradi[manba kerak].

Dunyo boʻylab surunkali yurak yetishmovchiligining 60% ishemik kardiomiopatiya tufayli kelib chiqadi[5][7]. Koʻkrak qafasi radiografiyasi koronar arteriyalarning kalsifikatsiyalanishi ishemik kardiomiopatiyaning ehtimolli koʻrsatkichi ekanligini koʻrsatadi[8]. Quyidagilar ushbu kasallikning sabablari hisoblanadi[1]:

Patofiziologiyasi

[tahrir | manbasini tahrirlash]

Ishemik kardiomiopatiya qon oqimining kamayishi tufayli yuzaga keladi, shuning uchun miokardga keladigan kislorod hajmi kamayib ketadi, bu esa oʻz navbatida yurak toj tomirlarining torayishi tufayli hujayralar oʻlimiga olib keladi. Bu toʻqimalarning turli darajadagi, shuningdek, yirik va mayda arteriyalarga birdek shikastlanishiga olib keladi[9][10][11].

Ishemik kardiomiopatiya magnetik rezonans tomografiya (MRT) orqali tashxislanadi, bunda umumiy va mahalliy oʻzgarishlarni koʻrish mumkin. Shuningdek, Luk Locker texnikasidan fibrozlarni aniqlash uchun foydalaniladi, bu usul ishemik chandiqlarni aniqlash uchun muhim hisoblanadi[2]. Miokardda odatda chap qorincha dilatatsiya (kengayish)si, qorinchalar disfunksiya (jiddiy buzilish)si va koʻplab infarkt belgilari kuzatiladi[12]. Belgilari surunkali yurak yetishmovchiligi, angina, shish, tez vazn yigʻish, hushdan ketish kabilarni oʻz ichiga oladi[5][13].

Yurakning oʻzak hujayralari
Koronar shuntlash operatsiyasi

Yurak yetishmovchiligi va koronar arteriya kasalligi bor bemorlarning yurak mushagiga yetarli qon oqimini tiklash ularning umr koʻrish davomiyligini sezilarli darajada uzaytirishi aniqlangan. Baʼzi tadqiqotlar natijalariga koʻra, bunday bemorlarning 5 yil ichida yashab qolish darajasi 75 foizgacha koʻtarilishi mumkin[14][15]. Yurak oʻzak hujayralari boʻyicha oʻtkazilgan tadqiqot shuni koʻrsatdiki, inson yuragini qayta tiklash uchun autolog yurak oʻzak hujayralaridan foydalanish (yurak xurujidan soʻng) yaxshi samaraga ega[16].

Amerika Yurak Assotsiatsiyasining amaliyot koʻrsatmalariga koʻra, Nyu-York Yurak Assotsiatsiyasi funksional sinfi I boʻlgan ishemik kardiomiopatiyali bemorlarga (miokard infarktidan 40 kun oʻtgach) implantatsiya qilinadigan kardiodefibilyatorlar qoʻllash tavsiya etiladi. Chap qorincha otish fraktsiyasi (CHQOF) oʻlchovi 30% dan yuqori boʻlsa (kardiologlar orasida oddiy CHQOF deb yuritiladi), bu koʻpincha birlamchi kardiomiopatiyani ishemik kardiomiopatiyadan farqlash va prognozni baholash uchun ishlatiladi[17][18].

2004-yilda oʻtkazilgan tadqiqot shuni koʻrsatdiki, koronar arteriyalarni shuntlash bilan birga qorinchalarning tiklanishi ushbu tadqiqotdagi bemorlarda operatsiyadan keyingi CHQOF faqat oxirgi operatsiyaga qaraganda kattaroq boʻlgan[19]. Ogʻir holatlarda yurak transplantatsiyasi bilan davolanadi[20].

Ishemik kardiomiopatiyani kardiomiopatiyaning boshqa shakllaridan farqlovchi eng muhim xususiyatlardan biri bunday bemorlarda umumiy ahvoli og`irroq va o`lim tezroq kuzatiladi. Bir nechta tadqiqotlarga ko‘ra, koronar arteriyalarni shuntlash operatsiyasi ishemik kardiomiopatiyani davolashda samara bergan[10][21][22][23].

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