Myocardial cardiosclerosis - nkọwa nke pathology

Myocardial cardiosclerosis - nkọwa nke pathology

Ọdịnaya

  • Kedu otu na gịnị kpatara ọrịa ahụ ji eme?
  • Nchọpụta Ọdịiche
  • Kedu ihe na-eme akwara obi?
  • Kedu ihe onye ọrịa na-eche?
  • Gịnị ka dọkịta ahụ na-ahụ?
  • Ụkpụrụ nke ọgwụgwọ na prognosis
  • Kedu ihe dị gị

Myocardial cardiosclerosis abụghị ọrịa mbụ. N'ọnọdụ niile, ọ na-eme megide ndabere nke myocarditis, i.e. mkpali ọnya nke obi obi.

Kedu otu na gịnị kpatara ọrịa ahụ ji eme?

Myocarditis na-akpata myocardial dystrophy. Mgbanwe Dystrophic na-akpalite uto nke anụ ahụ njikọ, ọdịdị nke mgbanwe sclerotic.

Na myocardial cardiosclerosis, isi ihe kpatara ọrịa ahụ bụ myocarditis gara aga nke ọdịdị ọ bụla (bacteria, fungal, viral). Myocardiosclerosis na-agbasa ma na-agbasa.

Nchọpụta Ọdịiche

Ekwesịrị icheta myocardial cardiosclerosis na:

  • Myocarditis na-adịghị ala ala;
  • Myocarditis na-adịte aka;
  • Atherosclerotic cardiosclerosis;
  • Cardiomyopathy.

Kedu ihe na-eme akwara obi?

Anụ ahụ akwara obi dị mma na-agbanwe ma nwee nkwekọrịta dị mma. Site na myocardial cardiosclerosis, a na-eji anụ ahụ fibrous dochie anụ ahụ obi, nke dị na nhazi ya yiri eriri siri ike. Ọnụnọ nke mpaghara fibrous na myocardium na-eduga n'ịda mbà nke ọrụ nkwekọrịta, yana ọgba aghara na ntụgharị eletrik nke obi. Ọ bụ mpaghara fibrosis na-akpalite ndakpọ obi na ụdị dị iche iche nke obi arrhythmias.

Mkpesa na ihe mgbaàmà na myocardial cardiosclerosis na-ejikọta ya na nkụda obi nke ogo dị iche iche, ma ọ bụ mmebi nke obi. Ihe na-emekarị bụ myocardial cardiosclerosis nke nwere ọgba aghara n'afọ. Mgbasa mmebi myocardial na-eduga na arrhythmias. Ọ bụrụ na anyị na-ekwu banyere mgbaàmà nke nkụda obi obi, mgbe ahụ, ha na-etolite dị ka ụdị ventricular ziri ezi.

Kedu ihe onye ọrịa na-eche?

Ọtụtụ mgbe, na ọrịa a, ndị ọrịa na-enwe nchegbu banyere mgbaàmà ndị a:

  • Dyspnea;
  • Ịkpagide ma ọ bụ ịpị mgbu na mpaghara obi;
  • Cardiopalmus.

Myocardial cardiosclerosis nke nwere ọgba aghara n'afọ na-amanye ndị ọrịa ileba anya n'ọkpụkpụ ha. Onye ọrịa ahụ na-eme mkpesa nke mbelata ma ọ bụ mmụba na ọnụọgụ pulse, dizziness, adịghị ike, ike ọgwụgwụ.

Gịnị ka dọkịta ahụ na-ahụ?

Na nyocha, dọkịta na-ekwu na mmụba nke akwara obi, ọrịa obi na-agbasasị na-ahụ anya na electrocardiogram. A na-emetụtakarị ventricle aka nri.

Nyocha auscultatory na-enye gị ohere ịnụ nkụda mmụọ nke ụda obi, mgbe ụfọdụ enwere "gallop rhythm", ntamu systolic n'elu obi na n'ogo nke valvụ tricuspid, arrhythmic phenomena.

Ụkpụrụ nke ọgwụgwọ na prognosis

Ọgwụgwọ nke pathology a, dị ka ọrịa obi ọ bụla ọzọ, bụ usoro dị ogologo na nke siri ike.
Edepụtara ụkpụrụ ọgwụgwọ bụ isi n'okpuru.

Ịdị ọcha nke ọma nke foci nke ọrịa

Gịnị mere ihe a chọrọ? Nke mbụ, iji gbochie myocarditis ugboro ugboro. Ịdị ọcha nke foci nke ọrịa gụnyere ọgwụgwọ caries, iwepụ sọlfọ plọg, ọgwụgwọ cholecystitis, sinusitis, sinusitis frontal, wdg. Ọbụlagodi na foci ndị a adịghị eme onwe ha mmetụta, ha nwere ike, n'okpuru ọnọdụ ụfọdụ, kpasuo mmepe nke myocarditis ugboro ugboro.

Nhọrọ nke ọgwụ antiarrhythmic

kwesiriA na-ahọrọ ọgwụ antiarrhythmic n'otu n'otu n'otu n'otu. A na-ejikarị Propanorm, etatsizin, amiodarone eme ihe na ọgwụ ụlọ. Ọgwụ ndị a nwere ọtụtụ contraindications, yabụ a na-eme nnabata ahụ n'okpuru nlekọta nke onye na-ahụ maka ọrịa obi.

Ọgwụgwọ ọdịda obi

Iji kpochapụ ma gbochie mmepe nke nkụchi obi, a na-eji otu ọgwụ ndị a:

  • glycosides obi (digoxin),
  • nkwadebe nke nitroglycerin (kardiket, nitroglycerin),
  • Ndị na-egbochi ACE (perindopril, ramilong),
  • mkpụrụ osisi (losartan),
  • diuretics (pamid, furosemide),
  • B-blockers (metoprolol, betalok).

Onye ọrịa kwesịrị ịma na a ga-ewere ọgwụ maka ọgwụgwọ nke nkụda mmụọ, yana ọgwụ antiarrhythmic maka ndụ, na-agbanweghị usoro onunu na ịkagbughị oriri na-enweghị ndenye ọgwụ. Nsonaazụ nke "creativity" n'ịṅụ ọgwụ ndị dị otú ahụ nwere ike bụrụ ihe jọgburu onwe ya, nkụda mmụọ obi nwere ike iduga nkwarụ na ọnwụ. Ugboro abụọ n'afọ, a na-anara ndị ọrịa dị otú ahụ n'ụlọ ọgwụ n'ụlọ ọgwụ obi.

Amụma ọgwụgwọ dabere na njupụta nke usoro a. Ọ bụrụ na a na-emetụta obere akụkụ nke anụ ahụ obi, ka oge na-aga, a na-akwụghachi usoro ahụ, ma, ọ dị mwute, ọ gaghị ekwe omume ịhapụ ọgwụ ahụ kpamkpam. N'ụzọ dị mwute, ọ gaghị ekwe omume iwepụ obi mgbawa ruo mgbe ebighị ebi.

Kedu ihe dị gị

Emechibidoro mmega ahụ maka ndị ọrịa nwere myocardial cardiosclerosis, ise siga na ị drinkingụ mmanya na-aba n'anya amachibidoro. Nri nnu na pickled, anụ ndị a na-ese anwụrụ, ihe ndị na-esi ísì ụtọ, ime achịcha, ngwa nri kwesịrị ịwepụ na nri. Rie ihe oriri ndị nwere ọtụtụ ihe ndị na-achọpụta ihe na vitamin. Akwara obi na-arịa ọrịa chọrọ oxygen n'ezie - ịgagharị n'ikuku dị ọhụrụ bụ iwu. A na-egosipụta ọgwụgwọ Sanatorium na ebe ntụrụndụ. Na nleba anya nke onye dibia bekee!

Ederede nnukwu myocarditis 100 100

Fadeev NP

Okwu ndị dị mkpa: arrhythmias na-abụghị coronarogenic ventricular , obi arrhythmogenic dysplasia, sclerosis obi nke metụtara myocarditis, myocarditis latent.

3) nchọpụta ihe ịrịba ama nke intercellular edema na myocardium (mmụba na ike nke MR mgbaàmà n'oge MRI na cine mode);

12. Shimoike E., Ohba Y., Yanagi N. et al. Igwe ikuku redio ugboro ugboro ablation nke traktị ventricular outflow nke aka ekpe tachycardia: Akụkọ nke ikpe abụọ // J. Cardivasc. Electrophysiol. - 1998. - Vol. 9. - P. 196-202.

Mgbasawanye oghere nke obi, gụnyere. Ọnụahịa kasị elu nke 6574

ECG: GU U2>120 ms + —

Leukocyte infiltration (biopsy, scintigraphy) + +

Mgbe anyị nyochachara atụmatụ nhazi nke myocardium ventricular na ADS na ISS dị ka MRI na ventriculography (VG) nke ventricle aka nri, anyị nwetara nsonaazụ e gosipụtara na Tebụl 6.

Nyocha nke ọnọdụ arrhythmic dị ka data nlekota ECG Holter si kwuo gosiri na ndị ọrịa nwere MCS na-achịkwa ya site na ụdị monomorphic ventricular tachycardia na-adịghị agbanwe agbanwe, monotopic ventricular allorhythmia. Stable VT paroxysms na-eme n'ihe na-erughị 35% nke ikpe, nke na-ejikọta na mgbaàmà ụlọ ọgwụ. Ọ dịkwa mma ịmara na ogologo oge okirikiri tachycardia ventricular na ndị ọrịa nwere ISS bụ na nkezi 110 ms karịa na dysplasia obi arrhythmogenic, yana 445± 48.4 ms. N'ihe karịrị 60% nke ikpe, ọrụ ectopic ventricular adịghị ibelata n'abalị, na 40% nke ikpe, a na-ebelata ya n'oge ule mmega ahụ, nke na-egosi n'ụzọ na-apụtaghị ìhè megide usoro nlọghachi nke arrhythmia.

Caforio ALP, Bauce B., Nava A. et al. Arrhythmogenic right ventricular cardiomyopathy: Enwere ihe akaebe maka pathogenesis nke autoimmune? Mgbakọ Mba Nile Mbụ na Arrhythmogenic Right Ventricular Dysplasia: Cardiomyopathy. Akwụkwọ nke Abstracts, Paris, 1996:6/10 .

10) nkewa nke mpempe akwụkwọ pericardial n'ime 3-5 mm, n'ihi ọnụnọ nke mmiri (dị ka echocardiography na myocardial MRI).

Ọ bụkwa ihe na-adọrọ mmasị na dị ka nsonaazụ nke maapụ endocardial na MCS si dị, a na-eme ka arrhythmias ziri ezi na-emekarị na septum nke RVOT, na ADS, na mgbidi ihu nke RVOT (Fig 4). N'ihi ya, septal localization nke ventricular arrhythmia na RVCA nwere ike ịbụ ihe ọzọ na-apụtaghị ìhè akara na-akwado nchoputa nke myocardial cardiosclerosis.

M.V. Noskova, S.A. Aleksandrova, A. Sh. Revishvili

Consilium medicum. - 2002. - Vol. 3. - P. 117-124. iri na ise

ọrịa prognosis.

Otú ọ dị, ventricular arrhythmias (VA) na-eme na ndị na-eto eto na-enweghị ọrịa obi na-ejikọta ya na nnukwu ihe ize ndụ nke ọnwụ obi obi mberede.

na profaịlụ cardiology dị ka echiche na-arụ ọrụ.

ndị ọrịa nwere tachycardia ventricular aka nri.

Septum nke pancreas n'akụkụ PG2

VPZh, Septemba 15

Mgbasawanye nke VLE (MRI, VG) + +

2) nchọpụta nke kpọmkwem ọgwụ mgbochi myocardial (M> 1: 10) na titer dị ịrịba ama;

- P. 885-894.

Osikapa. Fig. 3. Ebe nke arrhythmia foci na ventricles nke obi n'oge ISS (Josephson map).

15. Varma N., Josephson ME Therapy of "idiopathic" ventricular tachycardia // J. Cardiovasc. Electrophysiol.

Ntinye abụba na myocardium 2b 0 0.01b*

1) ndabere oge nke ihe omume arrhythmia na ọrịa na-efe efe na-ebufe;

Nchikota nke atrial na ventricular arrhythmias 63 98

Nsogbu nke ọnwụ arrhythmic mberede bụ otu n'ime ihe kachasị ngwa ngwa na ọrịa obi. Tachycardia ventricular na 90% nke ikpe na-etolite megide ndabere nke ọrịa akwara obi gbagwojuru anya site na postinfarction cardiosclerosis nke ịdị arọ dị iche iche.

Rịba ama. AAT - ọgwụgwọ antiarrhythmic.

Tinyegharịa RFA

ECG data

Mpaghara

Paleev N.R. Myocarditis // Ọrịa nke obi na arịa ọbara / Ed. E. I. Chazova. - M .: Ọgwụ, 1992. -S. 178-198.

Polytopic ventricular extrasystole 49 67

Myocardial MRI data

zology agaghị aga n'ihu dịka ụdị arrhythmic siri dị, mana data niile ewepụtara n'isiokwu a adabereghị na mkpokọta ndị ọrịa 8.

Mpaghara nke arrhythmia na mpaghara nke septum nke RVOT ++

Mmetụta RFA,

N'ime ndị ọrịa nwere ISS, egosipụtara usoro reentry nke arrhythmia n'oge EPS na 18% nke ikpe, na reentry tachycardia mere naanị na mpaghara septal nke traktị ahụ na-apụ apụ nke pancreas, yana arrhythmias niile aka ekpe megide ndabere nke ISS bụ "akpaka. ". Achọpụtara ike ventricular ikpeazụ na 10% nke pa-

E gosipụtara onyonyo resonance magnetik nke myocardium nke onye ọrịa nwere ISS na fig. otu.

%

Ihe ngosi nke sinus bradycardia (na-enweghị AAT) 82 90

iri abụọ

Ihe ịrịba ama nke ADS ISS

Usoro nke idioventricular 32 81

Mgbe a na-enyocha ihe mgbaàmà ụlọ ọgwụ kpatara ventricular arrhythmia nke mere megide ndabere nke ISS, ọ bịara bụrụ na ndị na-eduga bụ

gbasara

Mmụba trabecularity nke oke pancreatic 1b 2 0.023*

9) mmụba dị ịrịba ama na ụda nke ọmịiko NS na nyocha nke mgbanwe mgbanwe obi, gụnyere n'abalị;

McKenna WJ, Thiene G., Nava A. Nchọpụta nke arrhyth-mologenic right ventricular dysplasia / cardiomyopathy // Brit. Obi J. - 1994. - Vol. 71. - P. 215-218.

Osikapa. Fig. 2. Mpaghara nke myocardial myocardial ventricular aka ekpe na ezumike na onye ọrịa nwere PMCS.

Ebe kachasị dị mfe maka ihe omume arrhythmia bụ akụkụ mmepụta nke aka nri

Ngụkọta… 35

usoro nke usoro mkpali na-adịghị ala ala subclinical na-adịghị ala ala 5 na myocardium, njirimara nke na-arụ ọrụ dị mkpa n'ịhọrọ ọgwụgwọ etiotropic ziri ezi maka onye ọrịa ma na-ekpebi ogologo oge 6.

Ụgha ectopic 58 92

AAT p/o (ọnụọgụ ndị ọrịa)

Na-agbasa ma ọ bụ kpọsasịa mpaghara nke mgbidi RV/LV 98 34

Osikapa. Fig. 4. Nkesa nke foci nke arrhythmia na traktị na-apụ apụ nke ventricle ziri ezi na ADS na ISS.

ọnọdụ, myocardial MRI. N'ime ikpe ise, a chọpụtara na myocarditis latent na-achọpụtakwa nje bacteria. N'iji usoro mmeghachi omume polymerase na enzyme immunoassay (ELISA), ahụrụ ọnụnọ n'ime ọbara nke ndị ọrịa atọ nke ọgwụ mgbochi (na diagnostically titers) na Staphylococcus aureus, na abụọ - na oyi baa Mycoplasma. Ọ dị mkpa iburu n'obi na n'ọnọdụ niile n'oge nyocha ahụ, ndị ọrịa nwere mbelata nke ukwuu na LV EF (50-55%) na enwere tonsillogenic foci nke ọrịa na-adịghị ala ala, na-ewepụ ngwa ngwa ya na mgbochi mkpali zuru oke. ọgwụgwọ ọgwụ nje maka ọnwa 3 mere ka a na-ahazi paramịkọ ụlọ nyocha. yana ịba ụba ọrụ systolic LV A na-egosipụtakwa mmetụta dị mma na ọnọdụ ndị ọrịa na mwepu nke mkpesa nke adịghị ike,

ike ọgwụgwụ, mkpụmkpụ nke ume n'oge mgbatị anụ ahụ na mgbu na ọkara ekpe nke obi nke ọdịdị na-abụghị nke a kapịrị ọnụ. Ndị ọrịa niile kwuru na mbelata mmetụta nke nkwụsịtụ n'ọrụ obi, agbanyeghị, nlọghachi azụ zuru oke nke arrhythmia ventricular emeghị, nke, n'ụzọ doro anya, a kọwara ya site na ọnụnọ nke mpaghara etolitebu nke cardiosclerosis. Nleba anya 24-hour Holter ECG ugboro ugboro mgbe ọgwụgwọ ahụ gosipụtara mkpochapụ nke polytopic ventricular arrhythmias na arụ ọrụ ectopic nke dịbu adị, n'ihi nke RFA nwere ike ime, ebe ọ bụ na naanị arrhythmogenic elekwasị anya nọgidere na-arụ ọrụ.

Ihe kacha mkpa na-adakarị omume, nke na-ekpebi n'ihu N'ezie nke na-akpata ọrịa nke ìgwè ndị ọrịa, bụ nchọpụta nke latent myocarditis megide ndabere nke mbụ foci nke cardiosclerosis. Maka ebumnuche nke nchoputa dị iche iche, na mgbakwunye na nyocha nyocha, nyocha zuru ezu nke paramita dị egwu, immunological

14. Tsuboi N., Ito T., Yamada T. et al. Idiopathic ventricular tachycardia sitere na sinus aka ekpe nke Valsalva: Mmetụta maka ablation rediofrequency catheter ablation (Abstract) // PACE. - 1997. - Vol. 20. - P. 1089.

Isiokwu b ventriculography na myocardial MRI data na arrhythmogenic obi dysplasia na postmyocarditis cardiosclerosis

Ala

ISS na-enweghị mbufụt nke akwara obi ugbu a, o doro anya, enweghị uru ụlọ ọgwụ nwere onwe ya ma a bịa n'obere agwaetiti nke cardiosclerosis na myocardium atrial na ventricular, nke na-edugaghị na mbelata nke nkwekọrịta na ọnọdụ nke arrhythmias nke ụlọ ọgwụ. Otú ọ dị, ahụmahụ bara uru na-egosi na ọbụna obere akụkụ nke cardiosclerosis nwere ike ime ka ọ na-adịgide adịgide, na-eguzogide ọgwụ, na n'ọnọdụ ụfọdụ na-eyi ndụ egwu obi arrhythmias. Foto a na-ahụ maka ahụike nke myocarditis latent dị nnọọ iche, nke dị ntakịrị, a na-ekpebikwa site na oke na ịdị njọ nke mkpali foci na myocardium, mmetụta ha na ọrụ systolic ventricular aka ekpe, na concomitant obi arrhythmias [3, 4, 6, 8, 14]. doro anya,

Ya mere, ihe ịrịba ama ụlọ ọgwụ na-egosi, ngụkọta nke na-eme ka o kwe omume na-enyo enyo usoro mkpali dị umengwụ na myocardium, dị ka data anyị si dị:

Ya mere, ọ bụrụhaala na echiche banyere ISS dị ka ihe etiological nke ventricular arrhythmias nke elu gradations dị ka Lomin ziri ezi, na subgroup nke idiopathic VA na structural pathology nke myocardium, ụdị abụọ nke diagnostic njirisi na-pụrụ iche, nke e gosiri na Table 3. Dị ka data ndekọ ọnụ ọgụgụ enwetara si kwuo, anyị kwuru akara

tent myocarditis na-eso 4

© Otu ndị ode akwụkwọ, 2005

Anyị kwenyere na nchikota na-esonụ nke akara ngosi dị mkpa maka nchọpụta nke arrhythmogenic variant nke ISS: 3 nnukwu; 2 nnukwu na 2 obere; 1 isi na 4 obere njirisi nyocha.

VOLZH, subepicardial 6

®MKS & ADS

iri na otu%

Mbugharị nke onye na-eme ngwa ngwa site na atria 81 97

Ya mere, n'ime ihe ọmụmụ ngwá ọrụ, nke kasị baa uru maka nchọpụta nke ISS bụ myocardial MRI na data anamnesis na ọrịa gara aga na ọnụnọ nke ebe nchekwa nchekwa kpọmkwem nke mbufụt gara aga na myocardium (ọgwụ mgbochi antimyocardial nke klas IgG na nchọpụta diagnostically). titer).

Mmekọrịta dị n'etiti mpụta mbụ VA na ọrịa na-efe efe +++

100

89.5

- 1983. - Vol. 47. - P. 1077-1083.

Mkpokọta na ndim nke mpempe akwụkwọ nke pericardium 78 93

Transient AV ngọngọ II st. 79 46

Mpaghara nke arrhythmia na mpaghara nke mgbidi ihu nke RVOT + -

Basso C., Thiene G., Corrado D. et al. Arrhythmogenic ziri ezi ventricular cardiomyopathy: dysplasia, dystrophy ma ọ bụ myocarditis? // Mgbasa. - 1996. - Vol. 94.

E nwekwara ihe akaebe na akwụkwọ ndị na-esi na myocarditis nwere ike morphologically "simulate" arrhythmogenic obi dysplasia (ADS) na-egosipụta onwe ha na ndị ọrịa nwere VA dị ka mgbasa nke outflow tract nke aka nri ma ọ bụ aka ekpe - hypokinesia mpaghara na thinning nke ventricle. mgbidi na ebe fibrous ma ọ bụ sclerotic anụ ahụ [iri na anọ]. Ihe ịrịba ama dị mkpa dị iche iche bụ enweghị abụba infiltration na aneurysms nke mgbidi ventricular na ndị ọrịa nwere ISS [15].

Holter data

Hypersympathicotonia n'abalị 96 42

Isiokwu 2 Data nke nyocha ụlọ ọgwụ na ngwá ọrụ nke ndị ọrịa

Ihe isi ike n'ịchọpụta MCS jikọtara ya na enweghị njirisi nyocha anabatara nke achọpụtara n'oge ọmụmụ ụlọ ọgwụ dị. Ya mere, ọ bụrụ na a na-enyo enyo myocarditis latent, mmadụ nwere ike ịdabere na nyocha ụlọ nyocha (nnukwu akụkụ akụkụ, mgbochi nke mbugharị lymphocyte na antigen obi, basophil degranulation test [5], antimyocardial ^ M titer, wdg), mgbe ahụ maka nyocha nke MCS. Ọ dị mkpa iji chọpụta ebe nchekwa immunological ogologo oge (antimyocardial Ig G na titer diagnostically pụtara) yana nkwenye nke mpaghara fibrosis. N'okwu a, ọbụlagodi biopsy endomyocardial anaghị ekwe nkwa nchoputa nke ọma, ebe ọ bụ na n'ihe gbasara usoro nlegharị anya, enwere ohere dị ukwuu nke ịlele mkpụrụ ndụ myocardial na-agbanweghị agbanwe ma nweta nsonaazụ na-adịghị mma. Ahụmahụ nke ọtụtụ ndị edemede na-egosi na biopsy endomyocardial na-akwado nchoputa ụlọ ọgwụ nke myocarditis na ISS naanị na 17-37% nke ikpe [2, 11, 13, 15]. N'ime afọ ndị na-adịbeghị anya, e mepụtala usoro nyocha nke redioisotope dị mgbagwoju anya ma webata ya n'ime usoro ọgwụgwọ, nke na-enye ohere iji anya nke uche na-ahụ anya n'ọhịa nke infiltration neutrophilic na myocardium, ịdị arọ ha na oke ha, na-enyocha perfusion myocardial na ikpe ikpe siri ike nke cardiosclerosis foci [1, 2, Nkeji 7, 8]. N'ime ọmụmụ ihe ugbu a, anyị, ọ dị mwute ikwu, enweghị ohere iji usoro a, n'ihi ya, anyị na-eji usoro nke mkpokọta obi anyị nwere: MRI na scintigraphy myocardial na technetium. na-enye ohere iji anya nke uche na-ahụ n'ubi nke neutrophilic infiltration na myocardium, ịdị arọ ha na oke ha, nyochaa myocardial perfusion ma kpebie ịdị njọ nke cardiosclerosis foci [1, 2, 7, 8]. N'ime ọmụmụ ihe ugbu a, anyị, ọ dị mwute ikwu, enweghị ohere iji usoro a, n'ihi ya, anyị na-eji usoro nke mkpokọta obi anyị nwere: MRI na scintigraphy myocardial na technetium. na-enye ohere iji anya nke uche na-ahụ n'ubi nke neutrophilic infiltration na myocardium, ịdị arọ ha na oke ha, nyochaa myocardial perfusion ma kpebie ịdị njọ nke cardiosclerosis foci [1, 2, 7, 8]. N'ime ọmụmụ ihe ugbu a, anyị, ọ dị mwute ikwu, enweghị ohere iji usoro a, n'ihi ya, anyị na-eji usoro nke mkpokọta obi anyị nwere: MRI na scintigraphy myocardial na technetium.

Ọ bụghị ihe nzuzo na nchoputa nke "ISS" n'ọtụtụ n'ime ikpe ka a na-eme n'ụzọ pụrụ iche, na-enweghị morphological visualization nke mkpụrụ, nke, n'ezie, na-ezighị ezi.

Ihe na ụzọ

- P. 983-991.

- 1997. - Vol. 8. - P. 104-116.

4 (11%)

Ụlọ ọrụ sayensị maka ịwa ahụ obi. A. N. Bakuleva (Dir. - Academician nke Russian Academy of Medical Sciences L. A. Bokeria) RAMS, Moscow

- 1999. - Vol. 116. - P. 340-346.

Akpịrị akpịrị ugboro ugboro (ọrịa ndị ọzọ na-efe efe) 100 72

Ọnụnọ mpaghara nke anụ ahụ fibrous na myocardium nke ventricles na-enweghị akara nke abụba, 96 100 infiltration.

Ịba ụba na ntinye nke akwa pericardial 82 98

UDC 616.124-008.318.616.12-004.6

Ọdịdị nke mkpụmkpụ ume megide ndabere nke ọrịa na-efe efe 32 68

N'oge myocardial scintigraphy na izu ike, a na-achọpụta mpaghara nke ọbara na-adịghị mma nke ịdị njọ dị iche iche na 74% nke ndị ọrịa, nke na-egosi na ọnụnọ fibrosis na LV myocardium (focal cardiosclerosis). Chocoronary angiography na-egosi na ọ nweghị ihe ịrịba ama nke ọnya atherosclerotic nke akwara akwara na nke ọ bụla. Njirimara maka postmyocarditis cardiosclerosis (PMCS) na usoro nyocha anyị bụ otu ogo nke oke mpaghara hypoperfusion n'oge mmega ahụ na n'ezu ike (Fig 2).

Ya mere, mgbasawanye nke RVF, mpaghara anụ ahụ fibrous, na ọgba aghara mpaghara na kinetics nke myocardium ventricular ziri ezi na-eme n'otu oge na nosologies abụọ, na ntinye abụba, aneurysms nke pancreas, na ụbara trabecularity nke apex nke pancreas. akọwapụtara nke ọma maka ADS yana enweghị nkọwa maka ISS.

2. Boitsov S.A., Deryugin M. V., Sukhov V. Yu. // Cardiology. - 2001.- Nke 11.- S. 48-52.

Ọnụnọ nke mmiri n'ime oghere pericardial 57 100

Ogologo oge nke "enweghị mkpali" ọnọdụ subfebrile 52 87

N'ime ìgwè ndị ọrịa na-arịa ọrịa arrhythmias na-adịghị ala ala (Table 1).

29.3± 6.8 afọ

Achọpụtara mmetụta uche na nkọwapụta maka ihe ngosi ọ bụla.

Afọ

Njirimara Clinical nke ndị ọrịa nwere ISS

E gosipụtara data nke nyocha ụlọ ọgwụ na akụrụngwa nke ndị ọrịa na tebụl 2,

O doro anya na dọkịta na-ekwu okwu no- 7.

Nhazi nke obi ụwa nke ụwa na nkwekọrịta nkwekọrịta na histo- na immunohistopathology nke myocarditis. — Marburg, Eprel 28-29, 1997.

Ebe aka nri ventricle aka ekpe

Ihe kachasị dị ịrịba ama maka nchoputa, n'echiche anyị, bụ ule nyocha nke ọma na-ejikọta ya na nsonaazụ magnetik resonance imaging, nke na-ekpughe ihe ịrịba ama nke edema intercellular na myocardium, ya mere, nchikota nke ihe ịrịba ama anọ mbụ na nke abụọ na-esote dị mkpa. maka nchoputa nke latent myocarditis.

5) mmụba n'ogo nke protein ndị na-edozi ahụ n'oge nyocha nke immunological, ezigbo ule nke RTML na TBD;

Fowles R., Mason J. // Ann. Int. Med. - 1982. - Vol. 97.

MYOCARDICIC CARDIOSCLEROSIS nke ETIOLOGY na-adịghị akwụsị akwụsị dị ka ụdị ihu igwe n'ọdịdị nke ARRHYTHMIAS na-abụghị ọrịa akwara.

VOP, mgbidi ihu 1

Na ngalaba ọgwụgwọ ịwa ahụ nke tachyarrhythmias nke Sayensị Center for Cardiovascular Surgery aha ya bụ A.I. OTU Bakulev RAMS sitere na 1996 ruo 2004 wara n'ahụ ndị ọrịa 145 nwere tachycardia na-abụghị coronary ventricular tachycardia (VT). N'ime ndị ọrịa 35, ihe kpatara mmepe nke arrhythmias na-eyi ndụ egwu bụ myocarditis na nhazi nke foci nke fibrosis na myocardium nke ventricles aka nri na aka ekpe. Nnyocha nke foto ụlọ ọgwụ na data sitere na nchọpụta ngwá ọrụ na-ekpughe ọtụtụ ihe nchọpụta diagnostically pụtara nke na-eme ka o kwe omume ịmata ọdịiche dị na myocardium nke etiology na-egbuke egbuke site na ọrịa ndị ọzọ na-abụghị ischemic nke obi obi.

Mpaghara arrhythmogenic nke myocardium ventricular na ịdị irè nke RFA na postmyocarditis cardiosclerosis

Regurgitation nke subclinical valvular (rue ogbo 2) 92 51

- M., 1999.

Ọgba aghara mpaghara nke myocardial kinetics 28 19 0.25

8 (23%)

Mbelata dị obere na LV EF 82 60

na myocarditis na ISS, ma naanị na ọmụmụ nke ndị ọrịa na-na-eguzogide ọgwụ na-eguzogide ventricular arrhythmias, nke a kọwara kpọmkwem nke ngalaba na, ma eleghị anya, dịtụ agbagọ pụta nke ọmụmụ. The n'elu diagnostic algọridim, N'ezie, mkpa n'ihu mma, ma, n'echiche anyị, ha bụ nnọọ adabara ojiji na n'ozuzu ọgwụgwọ ngalaba.

Akụkọ a na-etinye aka na nyocha nke MCS na subclinical variants nke myocarditis dị ka ihe na-akpata mmepe nke ventricular arrhythmias na-eyi ndụ egwu, yana ohere nke ọgwụgwọ ntinye aka ha.

VOPZh, ihu septum. mpaghara 7

Mgbakwunye mgbaàmà nke arrhythmia megide ndabere nke ọrịa na-efe efe 61 90

xxxxxxxx: xxx xxx xxxxxxx: xxx xxxxxxx: xxx xxx: xxx xxxxxx: xxx:-:xx: xxx xxxxxx:

Mgbasa ventricular na-agafeghị oke 87 94

mkpesa nke mkpụmkpụ ume, mbelata na mmegide mmega ahụ, mmetụta nke nkwụsịtụ na ọrụ obi na obere oge nke nkụchi obi ngwa ngwa. Syncope na usoro nyocha anyị mere naanị na 26% nke ndị ọrịa, ebe arrhythmogenic cardiac dysplasia syncope megide ndabere nke paroxysms nke tachycardia nwere ihe karịrị 90% nke ndị ọrịa.

4) njirimara nke onye na-akpata ọrịa (diagnostically pụtara titer nke klaasị IgM antigens nke nje bacteria na nje);

Polytopic ventricular arrhythmias 35 74

Nchọpụta dị iche iche nke dysplasia obi arrhythmogenic (ADS)

Isi ihe nke myirịta na ọdịiche dị n'etiti ADS na PMKS, na-eburu n'uche data a tụlere n'elu, ka ewepụtara na Tebụl 4.

Ahụ ọkụ na-adị obere ogologo oge mgbe ọrịa na-efe efe 43 91

Isiokwu 3 Nchọpụta nchọpụta maka ISS na ndị ọrịa nwere arrhythmias ventricular

Ọrịa pancreatic aneurysms 29 1 0.011*

Valgma K. Myocarditis na-efe efe. Tallinn: Valgus, 1990.

na nkọwa dị elu, na obere - nwere mmetụta dị elu.

Mgbatị nke ERW 32 20 0.11

Mgbasa nke atrial na-agafeghị oke 65 96

Akara nke ADS (n=32) PMCS (n=35) P

71

Ihe mgbochi intraventricular na-agafe agafe 79 90

Adịghị ike nke oghere sinus 66 89

iri na ise'

81%

- P. 1339-1345.

1. Boitsov S.A., Deryugin M. V. ohere nke oge a

AKWỤKWỌ 13

Akụkọ ezinụlọ gbagwojuru anya + -

Akụkọ gbasara ARRHYTHMOLOGY, Nke 1, 2005

M. - 21, f. - iri na anọ

iri

Echocardiography data

ventricle, 66% nke arrhythmias niile mere megide ndabere nke ISS ka nọ na mpaghara a. Ọnụ ọgụgụ ka ukwuu nke arrhythmogenic foci na ADS bụkwa mpaghara ebe a. Eziokwu a na-eme ka ọ dị mkpa ime nchọpụta dị iche n'etiti ọrịa ndị a.

Na-eme nhazi nke ndị ọrịa nwere tachycardia na-abụghị coronary ventricular tachycardia dị ka njikọ nosological si dị, anyị maara na a naghị eme ọmụmụ ihe biopsy n'ime ọmụmụ anyị, ya mere, na nyocha nke ndị ọrịa na-arịa ọrịa ventricular arrhythmias, na mgbakwunye na nyocha. Ihe ọmụmụ ihe akọwara n'elu (myocardial MRI, myocardial scintigraphy na izu ike) na nyocha nyocha maka oke akụkụ akụkụ, gụnyere ọmụmụ nke ọnọdụ immunological na mkpebi nke titer nke kpọmkwem ọgwụ mgbochi myocardial (antimyocardial antibodies nke Ig M na Ig G). klas) na titer nke ọgwụ mgbochi ọrịa na-ahụkarị pathogens nke myocarditis nke nje na viral etiology.

A maara na usoro mkpali na myocardium na-esonyere edema nke oghere interstitial n'ihi mmụba nke capillary permeability [4, 7, 14]. N'oge MRI, anyị nwetara nkwenye na-apụtaghị ìhè nke ọrịa ume ume n'ụdị edema intercellular n'akụkụ nke ike nke mgbaàmà MR na cine mode, nke, na mkpokọta data ụlọ ọgwụ na ụlọ nyocha dị n'okpuru ebe a, nyere anyị ohere iche na onye ọrịa ahụ nwere myocarditis latent. MCS tomogram nke obi na-ekpughe akụkụ nke induration mpaghara, thinning, na hypokinesis, ebe myocardial scintigraphy na technetium gosipụtara mosaic akụkụ nke hypoperfusion na akwara akwara na-adịghị emebi emebi, na ogo nke mgbagwoju anya na ha na ezumike na n'oge mgbatị ahụ agbanweghị, na Iberibe mkpochapụ LV n'oge mmega ahụ mụbara.

Ngosipụta mmetụta, % Nkọwapụta, %

RFA arụmọrụ

8) ọchịchọ nke sinus tachycardia;

nchọpụta ọrịa nke na-abụghị rheumatic myocarditis //

Aneurysms nke RV (MRI, VG) + -

Rịba ama. * Ndịiche dị n'ìgwè dị ịrịba ama.

Akụkụ akụkụ nke pancreas (mpaghara anụ ahụ fibrous) 30 21 0.23

Ọnụọgụ nke ndị ọrịa

Na mgbakwunye, ọ ga-abụ na ISS na la-3

Ihe mgbochi intraventricular na-agafe agafe 75 96

Mbugharị nke onye na-eme ngwa ngwa site na atria 70 84

Vasilenko V. Kh., Feldman S. B., Kitrov N.K. Myocardial dystrophy. — M.: Ọgwụ, 1989.

Fadeev N.P., Sukhov V. Yu., Shevchenko Yu.L. // Nleba anya na ụlọ ọgwụ. - 1998. - Nke 13. - S. 9-13.

Anyị chọpụtara ISS dị ka ihe kpatara ventricular arrhythmia na ndị ọrịa 35 n'ime 145 nyochara n'ime oge site na 1996 ruo 2004.

Mpaghara anụ ahụ fibrous, hypokinesis mpaghara (MRI, VG) + +

Usoro electrophysiological kachasị nke arrhythmia bụ reentry automatism

6) ihe ngosi nke ọkụ ọkụ na-adịghị akpali akpali nke na-eme n'ime oge na-egbu oge mgbe ọrịa ahụ gasịrị ma jikọta ya na mmụba nke mgbaàmà ụlọ ọgwụ nke arrhythmia;

Syncope

AV ngọngọ I ogbo. 85 54

na postmyocarditis cardiosclerosis (MCS)

7) extrasystoles ventricular polytopic, jikọtara ya na ọrụ ectopic atrial (dị ka data nlekota ECG Holter si kwuo);

Na mgbakwunye, data anamnesis na ọmụmụ ihe eji eme ihe (EchoCG, ECG, Holter Monitoring), nke jikọtara ya na njirimara morphological bụ isi nke nosology a tụlere, enwere ike iji nyochaa MCS, nwere ike bụrụ ihe na-apụtachaghị ìhè, mana ezigbo ihe ịrịba ama nke usoro mkpali na myocardium.

A na-eme nchọpụta electrophysiological (EPS) na rediofrequency ablation (RFA) naanị n'ọnọdụ ebe enweghị ihe ịrịba ama nke mbufụt ugbu a na myocardium. Site n'enyemaka nke EPS, mpaghara mpaghara 6 arrhythmogenic dị na mpaghara, nke malitere na ventricles megide ndabere nke ISS. Edepụtara oke nkesa ha na ohere itinye aka na mkpụrụ osisi arrhythmia na tebụl 5 na eserese 3.

. m k:-::xx: . xxxxxx :xxxxxx: . kxxxxxx xxx x:, kxxxxxx:xxxxxx:. kxxxxxx:xxxxxx:, kxxxxxx:xxxxxx:. kxxxxxx:-:xx: , kxxxxxx ::-::-:xxxx: . kxxxxxx:-:xx: . xxxxxx :xxxxxx: . kxxxxxx:-:xx: . kxxxxx

Data akụkọ ihe mere eme

All clinical, instrumental na laabu ịrịba ama nke MCS na latent myocarditis ewepụtara na isiokwu bụ nke nta kpọmkwem, ma e wezụga nke myocardial ọgwụ mgbochi ọrịa, ma a keukwu ntule nke ndị a mgbaàmà, na-ewere n'ime akaụntụ a na-adakarị ọnọdụ, na-eme ka o kwe omume ikpe ikpe. nchoputa nke nwere oke ọnụ ọgụgụ dị elu.

11. Markowitz. SM, Litvak BL, Ramirez EA et al. Adenosine-sensitive ventricular tachycardia: Ọdịiche ụgbọ ala ziri ezi gosipụtara site na imaging resonance magnetik // okirikiri. - 1997. - Vol. 96. - P. 1192-1200.

ịwa ahụ maka mgbazi radical ha, yana ndị ọrịa nwere dysplasia obi arrhythmogenic n'oge ngosipụta nke ọrịa ahụ, mgbe akpọpụtara mgbanwe anatomical na ventricle aka nri na-ahapụ enweghị obi abụọ banyere nchoputa ahụ. Okwu ndị ọzọ niile, yana ọtụtụ n'ime ha, ka a na-akpọkarị "idiopathic". Otú ọ dị, site na nyocha zuru ezu, ọ ga-ekwe omume ịmata ụfọdụ ihe kpatara mmepe nke tachycardia ventricular. Dị ka data anyị si kwuo, ọtụtụ mgbe ihe ndị a bụ mmalite mmalite nke arrhythmogenic cardiac dysplasia (ADS) ma ọ bụ myocarditis na-ebufe n'ụdị subclinical, nke mere ka e nwee foci nke cardiosclerosis na ventricles. Ihe nchọpụta dị iche n'etiti ọnọdụ abụọ a anaghị apụta ìhè mgbe niile, na iji chọpụta n'ụzọ ziri ezi na nosology na nke a, ọ dị mkpa iji usoro nyocha nke W J. McKenna et al.

Subclinical (ruo ogbo II) valvụ regurgitation 96 42

Keywords: arrhythmias na-abụghị akwara, arrhythmogenic obi dysplasia, myocardial cardiosclerosis, myocarditis latent.

N'akụkụ a, anyị emepụtala algorithm dị iche iche nchoputa (Table 4), ojiji nke na-eme ka o kwe omume ime nchọpụta dị iche n'etiti mpụta mbụ nkebi nke ADS na post-inflammatory mgbanwe na myocardium nke ventricles nke obi, nke mere ka e guzobe arrhythmogenic foci kwụsiri ike.

VOLZH, endocardial 4

13. Stellbrink C., Diem B., Schauerte P. et al. transcoronary venous rediofrequency catheter ablation nke ventricular tachycardia // Ibid. - 1997. - Vol. 8. - P. 916-921.

Mbelata pere mpe na LVEF (ihe na-erughị 60%) 80 74

vc

AV conduction igbu oge 45 78

Njikọ oge oge nke mmalite nke arrhythmia na ọrịa na-efe efe 97 61

mgbidi nkebi. obere obodo

Nkewa kacha nta nke mpempe akwụkwọ pericardial 91 100

16. Yeh SJ, Wen MS, Wang CC et al. Adenosine-sensitive ventricular tachycardia sitere na ventricle ekpe anterobasal // J.Amer. Kọl. cardiol. - 1997. - Vol. iri atọ.

N'ịchịkọta ihe ndị a dị n'elu, anyị na-ahụta na ọ dị mkpa iji mesie ike na usoro KUHN maka ọrịa myocarditis na-abụghị rheumatic bụ ọkwa mbụ na nyocha nke ọrịa myocardial na-adịghị na-adịghị ala ala, nke na-emetụta ihe fọrọ nke nta ka ọ bụrụ naanị maka nnukwu, na-egosipụta ụdị nke pathology a. Iji chọpụta myocarditis latent, a chọrọ nkwenye nke immunological (ọnụnọ nke ọgwụ nje na myocardium, mgbochi dị mma nke mbugharị lymphocyte na antigen obi, basophil degranulation test) yana nhụta nke mpaghara mbufụt na myocardium (nyocha histological, radioisotope zuru oke). ọmụmụ nke obi na nyocha nke ịdị njọ nke usoro mkpali na myocardium na nchọpụta ebe nke cardiosclerosis [4, 13], nchọpụta nke intercellular edema na myocardium).

N'ihu

26%

Tinyegharịa. RFA (ọnụọgụ ndị ọrịa)

N'ime ụdị ndị ọrịa a, ọ bụ naanị obere akụkụ bụ ndị ọrịa bụ ndị ihe kpatara e ji guzobe mkpụrụ osisi arrhythmogenic na myocardium nke ventricles nke obi enweghị obi abụọ na dọkịta. Ndị a bụ ndị ọrịa nwere cardiomyopathies (hypertrophic na dilated), nkwarụ obi nke ọmụmụ, gụnyere ndị megoro.

Mravyan S.R. mkpa nke endomyocardial biopsy na nchoputa nke ụfọdụ ọrịa myocardial na-abụghị nke akwara ozi: Abstract of thesis. dis. … kandụl. mmanụ aṅụ. Sayensị. -M., 1998.

N'afọ 1996 - 2004, a na-arụ ndị ọrịa 145 nwere tachycardia na-abụghị coronarogenic ventricular tachycardia na Ngalaba Ịwa Ahụhụ nke Tachyarrhythmias. Ihe kpatara mmepe nke ventricular arrhythmias na-adịghị mma na mmadụ 35 n'ime ndị ọrịa ahụ bụ akụkọ ihe mere eme nke myocarditis sitere na mpaghara fibrosis na myocardium ventricular aka nri na aka ekpe. Dabere na nyocha nke ọnọdụ ụlọ ọgwụ na nsonaazụ nyocha anyị achọpụtala ọtụtụ njirisi diagnostically pụtara, nke kwere ka ọdịiche myocardial myocardial na-afụ ụfụ site na ọrịa obi ndị ọzọ na-abụghị nke ischemic.

ya mere nwere nnukwu ụlọ ọgwụ na mmekọrịta mmadụ na ibe ya.

Morita H., Kitaura Y., Deguchi et al. // Jap. okirikiri. J.

Nakagawa M., Sato A., Okagawa H. et al. // Igbe.

Ntinye abụba (MRI) ++ -


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