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Ishemik kardiomiopatiya

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

Belgilari

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

Sabablari

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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

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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].

Tashxisi

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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].

Davolash

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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].

Prognozi

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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].

Manbalar

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  1. ↑ 1,0 1,1 Bisognano, John D.; Baker, Marc L.; Earley, Mary Beth. Manual of Heart Failure Management. Springer Science & Business Media, 2009-04-09 — 50-bet. ISBN 9781848821859. 
  2. ↑ 2,0 2,1 Hodler, Jurg. Diseases of the Chest and Heart: Diagnostic Imaging and Interventional. Springer, 2015 — 146-bet. ISBN 978-88-470-5751-7. Qaraldi: 2015-yil 10-sentyabr. 
  3. ↑ „Cardiomyopathy: MedlinePlus Medical Encyclopedia“. www.nlm.nih.gov. Qaraldi: 2015-yil 9-sentyabr.
  4. ↑ Felker, G.Michael; Shaw, Linda K; O’Connor, Christopher M (January 2002). "A standardized definition of ischemic cardiomyopathy for use in clinical research". Journal of the American College of Cardiology 39 (2): 210–218. doi:10.1016/S0735-1097(01)01738-7. PMID 11788209. 
  5. ↑ 5,0 5,1 5,2 Reynolds Delgado. Interventional Treatment of Advanced Ischemic Heart Disease. Springer Science & Business Media, 21 April 2009 — 39–-bet. ISBN 978-1-84800-395-8. 
  6. ↑ „Silent Ischemia and Ischemic Heart Disease“.
  7. ↑ Griffin, Brian P.. Manual of Cardiovascular Medicine. Lippincott Williams & Wilkins, 2012-10-01 — 130-bet. ISBN 9781451131604. 
  8. ↑ Brant, William E.; Helms, Clyde A.. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins, 2007-01-01 — 635-bet. ISBN 9780781761352. 
  9. ↑ Anversa, Piero; Sonnenblick, Edmund H. (1990). "Ischemic cardiomyopathy: Pathophysiologic mechanisms". Progress in Cardiovascular Diseases 33 (1): 49–70. doi:10.1016/0033-0620(90)90039-5. ISSN 0033-0620. PMID 2142312. 
  10. ↑ 10,0 10,1 Yatteau, Ronald F.; Peter, Robert H.; Behar, Victor S.; Bartel, Alan G.; Rosati, Robert A.; Kong, Yihong (1974). "Ischemic cardiomyopathy: The myopathy of coronary artery disease". The American Journal of Cardiology 34 (5): 520–525. doi:10.1016/0002-9149(74)90121-0. ISSN 0002-9149. PMID 4278154. 
  11. ↑ Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences, 30 July 2014 — 1225–-bet. ISBN 978-0-323-29064-7. 
  12. ↑ ; K.J. LieRecent Views on Hypertrophic Cardiomyopathy. Springer Science & Business Media, 6 December 2012 — 43–-bet. ISBN 978-94-009-4994-2. 
  13. ↑ ; Fabio TavoraPractical Cardiovascular Pathology. Lippincott Williams & Wilkins, 8 November 2010 — 96–-bet. ISBN 978-1-60547-841-8. 
  14. ↑ Luciani, Giovanni Battista; Montalbano, Giuseppe; Casali, Gianluca; Mazzucco, Alessandro (2000). "Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy". The Journal of Thoracic and Cardiovascular Surgery 120 (3): 478–489. doi:10.1067/mtc.2000.108692. ISSN 0022-5223. PMID 10962408. 
  15. ↑ Falk, Erling; Shah, Prediman; Feyter, Pim de. Ischemic Heart Disease. CRC Press, 2007-03-28 — 226-bet. ISBN 9781840765151. 
  16. ↑ Cai, Lu; Keller, Bradley B (2014-01-03). "Cardiac regeneration and diabetes". Regenerative Medicine Research 2 (1): 1. doi:10.1186/2050-490X-2-1. ISSN 2050-490X. PMID 25984329. PMC 4422323. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=4422323. 
  17. ↑ Iskandrian, Abdulmassih S.; Helfeld, Hope; Lemlek, Joseph; Lee, Jaetae; Iskandrian, Basil; Heo, Jaekyeong (1992). "Differentiation between primary dilated cardiomyopathy and ischemic cardiomyopathy based on right ventricular performance". American Heart Journal 123 (3): 768–773. doi:10.1016/0002-8703(92)90518-Z. ISSN 0002-8703. PMID 1539529. 
  18. ↑ Hunt, S. A. (20 September 2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: Endorsed by the Heart Rhythm Society". Circulation 112 (12): 1825–1852. doi:10.1161/CIRCULATIONAHA.105.167587. 
  19. ↑ Maxey, Thomas S; Reece, T.Brett; Ellman, Peter I; Butler, Paris D; Kern, John A; Tribble, Curtis G; Kron, Irving L (2004). "Coronary artery bypass with ventricular restoration is superior to coronary artery bypass alone in people with ischemic cardiomyopathy". The Journal of Thoracic and Cardiovascular Surgery 127 (2): 428–434. doi:10.1016/j.jtcvs.2003.09.024. ISSN 0022-5223. PMID 14762351. 
  20. ↑ "Ischemic cardiomyopathy. Criteria for coronary revascularization and cardiac transplantation". Circulation 84 (5 Suppl): III290–III295. November 1991. PMID 1934422. 
  21. ↑ O’Connor, Christopher M; Velazquez, Eric J; Gardner, Laura H; Smith, Peter K; Newman, Mark F; Landolfo, Kevin P; Lee, Kerry L; Califf, Robert M et al. (2002). "Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank)". The American Journal of Cardiology 90 (2): 101–107. doi:10.1016/S0002-9149(02)02429-3. ISSN 0002-9149. PMID 12106836. 
  22. ↑ Velazquez, Eric J.; Williams, Judson B.; Yow, Eric; Shaw, Linda K.; Lee, Kerry L.; Phillips, Harry R.; O’Connor, Christopher M.; K.Smith, Peter et al. (2012-02-01). "Long-term Survival of Patients with Ischemic Cardiomyopathy Treated by CABG versus Medical Therapy". The Annals of Thoracic Surgery 93 (2): 523–530. doi:10.1016/j.athoracsur.2011.10.064. ISSN 0003-4975. PMID 22269720. PMC 3638256. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3638256. 
  23. ↑ Elefteriades, John A; Morales, David L.S; Gradel, Christophe; Tollis, George; Levi, Evelyn; Zaret, Barry L (1997). "Results of Coronary Artery Bypass Grafting by a Single Surgeon Patients With Left Ventricular Ejection Fractions ≤30%". The American Journal of Cardiology 79 (12): 1573–1578. doi:10.1016/S0002-9149(97)00201-4. ISSN 0002-9149. PMID 9202343. 

Adabiyotlar

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  • Likoff, Jessup Mariell, Chandler Sheryl L., Kay Harold R. (1987). "Clinical determinants of mortality in chronic congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy". The American Journal of Cardiology 59 (6): 634–638. doi:10.1016/0002-9149(87)91183-0. PMID 3825904. 
  • Carmeliet Peter (1999). "Impaired myocardial angiogenesis and ischemic cardiomyopathy in mice lacking the vascular endothelial growth factor isoforms VEGF164 and VEGF188". Nature Medicine 5 (5): 495–502. doi:10.1038/8379. PMID 10229225. 
  • Menasché Philippe (2008). "The myoblast autologous grafting in ischemic cardiomyopathy (MAGIC) trial first randomized Placebo-controlled study of myoblast transplantation". Circulation 117 (9): 1189–1200. doi:10.1161/circulationaha.107.734103. PMID 18285565. 
  • Beltrami Carlo Alberto (1994). "Structural basis of end-stage failure in ischemic cardiomyopathy in humans". Circulation 89 (1): 151–163. doi:10.1161/01.cir.89.1.151. PMID 8281642. 
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