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Ciwon zuciya mai tsanani

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Ciwon zuciya mai tsanani
Description (en) Fassara
Iri Cutar jijiyoyin Zuciya
coronary syndrome (en) Fassara
Field of study (en) Fassara cardiology (en) Fassara
Medical treatment (en) Fassara
Magani bisoprolol / hydrochlorothiazide (en) Fassara, ticagrelor (en) Fassara, clopidogrel (en) Fassara, aspirin (en) Fassara, prasugrel (en) Fassara da ezetimibe / simvastatin (en) Fassara
Identifier (en) Fassara
ICD-10 I20.0
MedlinePlus 007639
eMedicine 007639
MeSH D054058

Ciwon zuciya mai tsanani (ACS) ciwon cuta ne saboda raguwar jini a cikin jijiyoyin zuciya kamar yadda wani ɓangare na tsokoki na zuciya ba zai iya aiki yadda ya kamata ba ko ya mutu.[1] Alamar da aka fi sani da ita ita ce ciwon kirji mai kama da matsin lamba, sau da yawa yana haskakawa zuwa kafada ta hagu ko kusurwar jaw, kuma yana da alaƙa da ƙishirwa da gumi.[2] Mutane da yawa da ke fama da cututtukan zuciya masu tsanani suna nuna alamun da ba su da ciwon kirji, musamman mata, tsofaffi, da mutanen da ke fama le Ciwon sukari.[3]

Ana rarraba ciwon zuciya mai tsanani a cikin yanayi uku dangane da kasancewar canje-canje na electrocardiogram (ECG) da sakamakon gwajin jini (canji a cikin alamun zuciya kamar matakan troponin): [1] ST hauhawar myocardial infarction (STEMI), wanda ba ST hauhawa myocardial infarction (NSTEMI), ko angina mara daidaituwa. [2] STEMI ana nuna shi ta hanyar cikakkiyar toshewar jijiyar zuciya wanda ke haifar da necrosis na wani ɓangare na tsokoki na zuciya wanda aka nuna ta hanyar ST tsawo akan ECG, NSTEMI ana bayyana shi da wani ɓangaren jijiyar zuciya da ke haifar da neurosis na wani ɓangare da tsokoki wanda canje-canje na ECG zasu iya nunawa, kuma angina mara daidaituwa ana nuna shi da ischemia na tsokokin zuciya wanda ba ya haifar da rauni ko necrosis.[3][4]

Ya kamata a rarrabe ACS daga angina mai ɗorewa, wanda ke tasowa yayin aiki na jiki ko damuwa kuma yana ƙuduri a hutawa. Ya bambanta da angina mai ɗorewa, angina mara ɗorewa yana faruwa ba zato ba tsammani, sau da yawa a hutawa ko tare da ƙarancin ƙoƙari, ko a ƙananan matakan ƙoƙari fiye da angina na baya ("crescendo angina"). An kuma dauki sabon angina a matsayin angina mara daidaituwa, tunda yana nuna sabon matsala a cikin jijiyar zuciya.[5]

Alamomi da alamomi

[gyara sashe | gyara masomin]

Alamomin cututtukan zuciya masu tsanani suna kama da juna.[1] Babban alama na raguwar jini zuwa zuciya shine ciwon kirji, wanda aka samu kamar tsananin, matsin lamba, ko konewa.[2] Location ya fi yawa a kusa ko a kan kirji kuma yana iya haskakawa ko kasancewa a hannun, kafada, wuyansa, baya, ciki na sama, ko jaw.[2] Wannan na iya haɗawa da gumi, ƙishirwa, ko gajeren numfashi.[1][2] A baya, an yi amfani da kalmar "atypical" don bayyana ciwon kirji wanda ba ya da alaƙa da zuciya, duk da haka, ba a ba da shawarar wannan kalmar kuma an maye gurbin ta da "marasa ciwon kirki" don bayyana Ciwon kirji da ke nuna ƙarancin yiwuwar ciwon zuciya.[2]

A cikin angina mara daidaituwa, alamun na iya bayyana a kan hutawa ko a kan ƙaramin aiki.[3] Alamomin na iya zama na dogon lokaci fiye da waɗanda ke cikin angina mai ɗorewa, na iya zama masu tsayayya da hutawa ko magani, kuma na iya zama mafi muni a tsawon lokaci.[5][6]

Kodayake ACS yawanci ana danganta shi da coronary thrombosis, ana iya danganta shi le amfani da ƙasa-linkid="78" href="./Cocaine" id="mwcw" rel="mw:WikiLink" title="Cocaine">cocaine.[7] Ciwon kirji tare da siffofi na asalin zuciya (angina) kuma ana iya haifar da shi ta hanyar ƙarancin jini, Brady- ko tachycardia (mai saurin gaske ko saurin zuciya), ƙananan ko hawan jini, tsananin aortic valve stenosis (ƙuntata bawul a farkon aorta), Hawan jini na huhu da sauran yanayi da yawa.[8]

Ilimin jiki

[gyara sashe | gyara masomin]

A cikin waɗanda ke da ACS, fashewar atheroma galibi ana samun kashi 60% idan aka kwatanta da rushewar ateroma (30%), don haka yana haifar da samar da thrombus wanda ke toshe jijiyoyin zuciya. Rushewar plaque yana da alhakin kashi 60% a cikin ciwon zuciya mai girma na ST (STEMI) yayin da rushewar plaques ke da alhaken kashi 30% na STEMI kuma akasin haka ga ciwon zuciya na Non ST (NSTEMI). A cikin fashewar plaque, abubuwan da ke cikin plaque suna da wadataccen lipid, collagen matalauta, tare da kumburi mai yawa wanda shine macrophage mafi rinjaye, kuma an rufe shi da ƙanƙara mai laushi. A halin yanzu, a cikin lalacewar plaque, plaque yana da wadata tare da matrix na extracellular, proteoglycan, glycoaminoglycan. Bayan an buɗe jijiyoyin zuciya, akwai haɗarin raunin sakewa fasalin saboda yaduwar matsakanci a cikin jiki. Har yanzu ana gudanar da bincike kan rawar da cyclophilin D ke takawa wajen rage raunin sake fashewa.[1]

Sauran, wadanda ba a saba gani ba, abubuwan da ke haifar da ciwon zuciya mai tsanani sun hada da cututtukan jijiyoyin zuciya, [9] ischemia ba tare da cututsin jijiyoyin zuciya ba (INOCA), da kuma ciwon zuciya ba tare da cutar jijiyoyin zuciya (MINOCA). [10]

Binciken ganewa

[gyara sashe | gyara masomin]
Rarraba cututtukan zuciya masu tsanani.[11]

Electrocardiogram

[gyara sashe | gyara masomin]

A cikin saitin ciwon kirji mai tsanani, electrocardiogram (ECG ko EKG) shine binciken da ya fi dacewa ya bambanta tsakanin dalilai daban-daban.[12] Ya kamata a yi ECG da wuri kamar yadda zai yiwu, gami da a cikin motar asibiti idan ya yiwu.[13] Canje-canje na ECG da ke nuna mummunar lalacewar zuciya sun haɗa da: ST tsawo, sabon ɓangaren reshe na hagu da ST depression da sauransu. Rashin canje-canjen ECG ba ya rarrabe tsakanin angina da NSTEMI.[3]

Gwajin jini

[gyara sashe | gyara masomin]

Canji a cikin matakan alamun zuciya, kamar troponin I da troponin T, suna nuna Ciwon zuciya na myocardial ciki har da STEMI da NSTEMI, duk da haka matakan su ba su da tasiri a cikin angina mara daidaituwa.[3]

Sakamakon tsinkaya

[gyara sashe | gyara masomin]

Haɗin alamun Zuciya da ƙididdigar haɗari, kamar ƙimar HEART da ƙimar TIMI, na iya taimakawa wajen tantance yiwuwar ciwon zuciya a cikin yanayin gaggawa.[14][15]

Rigakafi

[gyara sashe | gyara masomin]

Ciwon zuciya mai tsanani sau da yawa yana nuna wani mataki na lalacewa ga coronaries ta hanyar atherosclerosis. Rigakafin farko na atherosclerosis yana sarrafa abubuwan haɗari: cin abinci mai kyau, motsa jiki, magani don hauhawar jini da Ciwon sukari, guje wa shan sigari da sarrafa matakan cholesterol; a cikin marasa lafiya tare da mahimman abubuwan haɗari, an nuna aspirin don rage haɗarin abubuwan da suka faru na zuciya. Ana tattauna rigakafin sakandare a cikin ciwon zuciya.[1]

Bayan an gabatar da haramtacciyar shan sigari a duk wuraren jama'a da aka rufe a Scotland a watan Maris na shekara ta 2006, an samu raguwar kashi 17% a cikin shigar da mutane a asibiti don ciwon zuciya mai tsanani. Kashi 67% na raguwar ya faru ne a cikin wadanda ba masu shan sigari ba.[16]

Manazarta

[gyara sashe | gyara masomin]
  1. ↑ Grech ED, Ramsdale DR (June 2003). "Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction". BMJ. 326 (7401): 1259–61. doi:10.1136/bmj.326.7401.1259. PMC 1126130. PMID 12791748.
  2. ↑ Torres M, Moayedi S (May 2007). "Evaluation of the acutely dyspneic elderly patient". Clin. Geriatr. Med. 23 (2): 307–25, vi. doi:10.1016/j.cger.2007.01.007. PMID 17462519.
  3. 1 2 3 4 Collet, Jean-Philippe; Thiele, Holger; Barbato, Emanuele; Barthélémy, Olivier; Bauersachs, Johann; et al. (2021-04-07). "2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation". European Heart Journal. 42 (14): 1289–1367. doi:10.1093/eurheartj/ehaa575. ISSN 1522-9645. PMID 32860058. Unstable angina is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. [...] Compared with NSTEMI patients, individuals with unstable angina do not experience acute cardiomyocyte injury/necrosis. |hdl-access= requires |hdl= (help) Cite error: Invalid <ref> tag; name "ESC2020" defined multiple times with different content.
  4. ↑ Barthélémy, Olivier; Jobs, Alexander; Meliga, Emanuele; et al. (2021-04-07). "Questions and answers on workup diagnosis and risk stratification: a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation". European Heart Journal. 42 (14): 1379–1386. doi:10.1093/eurheartj/ehaa602. ISSN 1522-9645. PMC 8026278 Check |pmc= value (help). PMID 32860030. NSTEMI is characterized by ischaemic symptoms associated with acute cardiomyocyte injury (=rise and/or fall in cardiac troponin T/I), while ischaemic symptoms at rest (or minimal effort) in the absence of acute cardiomyocyte injury define unstable angina. This translates into an increased risk of death in NSTEMI patients, while unstable angina patients are at relatively low short-term risk of death.
  5. 1 2 "Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) - Heart and Blood Vessel Disorders". MSD Manual Consumer Version (in Turanci). Retrieved 2023-02-12. Cite error: Invalid <ref> tag; name "MSD_ACS" defined multiple times with different content.
  6. ↑ "Unstable Angina". American Heart Association. Archived from the original on 13 February 2023. Retrieved 12 February 2023.
  7. ↑ Achar SA, Kundu S, Norcross WA (2005). "Diagnosis of acute coronary syndrome". Am Fam Physician. 72 (1): 119–26. PMID 16035692. Archived from the original on 2007-10-09.
  8. ↑ "Chest Pain in the Emergency Department: Differential Diagnosis". The Cardiology Advisor (in Turanci). 2019-01-20. Retrieved 2019-07-25.
  9. ↑ Franke, Kyle B; Wong, Dennis TL; Baumann, Angus; Nicholls, Stephen J; Gulati, Rajiv; Psaltis, Peter J (April 4, 2019). "Current state-of-play in spontaneous coronary artery dissection". Cardiovascular Diagnosis and Therapy. 9 (3): 281–298. doi:10.21037/cdt.2019.04.03. PMC 6603494. PMID 31275818.
  10. ↑ Tamis-Holland, JE (March 27, 2019). "Diagnosis and Management of MINOCA Patients". Circulation. 139 (18): 891–908. doi:10.1161/CIR.0000000000000670. PMID 30913893.
  11. ↑ Alpert JS, Thygesen K, Antman E, Bassand JP (2000). "Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction". J Am Coll Cardiol. 36 (3): 959–69. doi:10.1016/S0735-1097(00)00804-4. PMID 10987628.
  12. ↑ Chun AA, McGee SR (2004). "Bedside diagnosis of coronary artery disease: a systematic review". Am. J. Med. 117 (5): 334–43. doi:10.1016/j.amjmed.2004.03.021. PMID 15336583.
  13. ↑ Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, Kleinman ME, Kronick SL, Lavonas EJ, Link MS, Mancini ME, Morrison LJ, O'Connor RE, Samson RA, Schexnayder SM, Singletary EM, Sinz EH, Travers AH, Wyckoff MH, Hazinski MF (3 November 2015). "Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S315–67. doi:10.1161/cir.0000000000000252. PMID 26472989.
  14. ↑ Fanaroff, Alexander C.; Rymer, Jennifer A.; Goldstein, Sarah A.; Simel, David L.; Newby, L. Kristin (2015-11-10). "Does This Patient With Chest Pain Have Acute Coronary Syndrome?: The Rational Clinical Examination Systematic Review". JAMA. 314 (18): 1955–1965. doi:10.1001/jama.2015.12735. ISSN 1538-3598. PMID 26547467.
  15. ↑ Eisen, Alon; Giugliano, Robert P; Braunwald, Eugene (20 July 2016). "Updates on acute coronary syndrome: A review". JAMA Cardiology. 1 (16): 718–730. doi:10.1001/jamacardio.2016.2049. PMID 27438381.
  16. ↑ Pell JP, Haw S, Cobbe S, et al. (2008). "Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome" (PDF). New England Journal of Medicine. 359 (5): 482–91. doi:10.1056/NEJMsa0706740. PMID 18669427. |hdl-access= requires |hdl= (help)
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