Tsis khov tsis khov

Tsis ntseeg lub pob ntseg tsis khov yog qhov mob uas lub plawv tsis muaj txaus ntshav txaus thiab oxygen. Tej zaum nws tuaj yeem ua rau lub plawv nres.

Angina yog ib hom kev mob hauv siab tsis zoo los ntawm cov ntshav khiav tsis zoo los ntawm cov hlab ntshav (hlab ntshav hlab ntsha) ntawm cov leeg ntshav plawv (myocardium).

Coronary artery disease vim atherosclerosis feem ntau ua rau lub hlwb tsis khov. Atherosclerosis yog qhov tsim ntawm cov khoom siv roj, hu ua plaque, raws phab ntsa ntawm cov hlab ntsha. Qhov no ua rau cov hlab ntsha yuag thiab tsis ua dab tsi. Qhov nqaim tuaj yeem txo cov ntshav ntws mus rau lub plawv, ua rau mob hauv siab.

Cov neeg muaj lub hlwb tsis khov txaus yuav muaj feem ntau muaj mob plawv.

Tsis tshua muaj ua rau angina yog:

• Kev ua haujlwm tsis zoo ntawm cov ceg me me ntawm cov hlab ntsha yam tsis muaj qhov txig ntawm cov hlab ntsha loj dua (hu ua microvascular dysfunction lossis Syndrome X)
• Txoj hlab ntshav hlab ntaws

Qhov txaus ntshai rau cov mob rau cov hlab ntshav cov hlab ntsha muaj xws li:

• Mob ntshav qab zib
• Tsev neeg muaj keeb kwm mob plawv mob ntxov (ib tug txheeb ze xws li kwvtij los yog niam txiv muaj mob plawv ua ntej hnub nyoog 55 xyoos hauv ib tug txiv neej lossis ua ntej hnub nyoog 65 xyoos hauv poj niam)
• Ntshav siab
• Cov roj cholesterol siab LDL
• Cov roj (cholesterol) HDL tsawg
• Txiv neej nrog txiv neej pw
• Sedentary lub neej (tsis tau txais kev tawm dag zog txaus)
• Kev pham
• Muaj hnub nyoog laus dua
• Haus Yeeb

Cov tsos mob ntawm angina yuav muaj xws li:

• Kev mob hauv siab uas koj yuav hnov ​​nyob hauv xwb pwg, sab caj npab, puab tsaig, caj dab, nraub qaum, lossis lwm qhov chaw
• Kev tsis xis nyob uas hnov ​​zoo li zawm, nyem, txhaws, hlawv, txhaws txhaws lossis mob caj dab
• Kev tsis xis nyob uas tshwm sim thaum so thiab tsis yooj yim ploj mus thaum koj noj tshuaj
• Ua tsis taus pa
• Tawm hws

Nrog rau lub hauv siab ruaj khov, lub hauv siab lossis lwm yam tsos mob tsuas yog tshwm sim nrog qee qhov kev ua si lossis kev ntxhov siab. Qhov mob tsis tshwm sim ntau tshaj los yog mob heev rau lub sijhawm.

Tsis khov tsis khov yog mob hauv siab uas tam sim ntawd thiab feem ntau mob heev dua lub sijhawm luv luv. Tej zaum koj yuav txhim kho angina tsis khov yog tias lub hauv siab mob:

• Pib xav txawv, hnyav dua, los ntau zaus, lossis tshwm sim nrog tsawg kev ua ub no lossis thaum koj so
• Ntev ntev dua 15 mus rau 20 feeb
• Tshwm sim yam tsis muaj laj thawj (piv txwv li, thaum koj tsaug zog lossis zaum ntsiag to)
• Tsis teb zoo rau cov tshuaj hu ua nitroglycerin (tshwj xeeb yog tias cov tshuaj no tau ua haujlwm kom txo cov mob hauv siab yav dhau los)
• Muaj tshwm sim nrog kev poob hauv cov ntshav siab los yog txog siav

Tsis nco qab qhov npau taws yog lub cim qhia tias lub siab yuav tshwm sim sai thiab yuav tsum tau kho tam sim. Mus ntsib koj tus kws kho mob yog tias koj muaj mob ib ce.

Tus kws khomob yuav kuaj ib ce thiab kuaj xyuas koj cov ntshav siab. Tus kws kho mob yuav hnov ​​cov suab txawv txav, xws li lub siab yws lossis lub plawv dhia tsis xwm yeem, thaum mloog koj lub hauv siab nrog lub stethoscope.

Kev ntsuam xyuas rau angina suav nrog:

• Kuaj ntshav los qhia seb koj puas lub plawv puas lossis ua rau muaj kev pheej hmoo mob plawv, suav nrog troponin I thiab T-00745, creatine phosphokinase (CPK), thiab myoglobin.
• ECG.
• Echocardiography.
• Cov kev ntsuam xyuas kev ntxhov siab, xws li kev tawm dag zog ua kom lub cev muaj zog (ntsuas kev ntxhov siab lossis kuaj ntsuas), kuaj kev ntxhov siab nuclear, lossis kev nyuaj siab echocardiogram.
• Coronary angiography. Qhov kev kuaj no yuav cuam tshuam nrog thaij duab ntawm lub plawv dhia siv xoo hluav taws xob thiab zas xim. Nws yog txoj kev ntsuam xyuas ncaj qha tshaj plaws rau kev kuaj ntshav lub plawv nqaim thiab nrhiav cov txhaws.

Tej zaum koj yuav tsum tau mus rau hauv tsev kho mob kom nws mus so, kom muaj kev sim ntau ntxiv, thiab tiv thaiv kom tsis txhob muaj lwm yam mob ntxiv.

Ntshav cov ntshav ntshav (cov tshuaj tiv thaiv kab mob) yog siv los kho thiab tiv thaiv cov ntshav tsis khov. Koj yuav tau txais cov tshuaj no sai li sai tau yog tias koj tuaj yeem nqa lawv kom nyab xeeb. Cov tshuaj noj tshuaj suav nrog tshuaj aspirin thiab tshuaj clopidogrel lossis tshuaj zoo sib xws (ticagrelor, prasugrel). Cov tshuaj no tuaj yeem txo qis ntawm txoj kev pheej hmoo ntawm lub plawv nres lossis qhov tsis zoo ntawm lub plawv nres uas tau tshwm sim.

Thaum lub sijhawm tsis txaus ntseeg angina:

• Koj tuaj yeem mob heparin (lossis lwm cov ntshav ua kom ntshav) thiab nitroglycerin (hauv qab tus nplaig lossis dhau ntawm txoj IV).
• Lwm yam kev kho mob suav nrog tshuaj los tswj ntshav siab, ntxhov siab, txawv txav ntawm lub plawv, thiab cov roj (xws li cov tshuaj statin).

Cov txheej txheem hu ua angioplasty thiab stenting feem ntau tuaj yeem ua kom qhib qhov txhaws lossis txhaws txoj hlab ntshav.

• Angioplasty yog ib txoj kev los qhib kev nqaim lossis thaiv cov hlab ntshav uas xa ntshav mus rau lub plawv.
• Ib txoj hlab ntshav leeg txoj hlab ntshav yog txoj leeg me, hlau raj uas qhib (nthuav dav) sab hauv txoj hlab ntshav. Ib qho stent yog feem ntau tso tom qab angioplasty. Nws pab tiv thaiv cov leeg ntawm kev kaw ib zaug ntxiv. Ib qho tshuaj uas pom zoo ntawm cov tshuaj muaj nyob rau hauv nws uas yuav pab tiv thaiv cov leeg ntawm kev ncua sijhawm.

Kev kho mob rau lub plawv yuav ua rau qee tus neeg. Kev txiav txim siab kom muaj qhov phais mob nyob ntawm:

• Twg cov hlab ntshav twg tau txhaws
• Muaj pes tsawg txoj hlab ntsha tau koom
• Qhov twg ntawm cov hlab ntshav ntawm cov hlab ntsha yog qhov nqaim
• Cov nqaim hnyav npaum li cas

Tsis khov tsis khov yog lub cim ntawm cov kab mob plawv dua.

Koj ua tau zoo npaum li cas nyob ntawm ntau yam sib txawv, suav nrog:

• Yuav ua li cas muaj ntau yam thiab cov hlab ntsha uas nyob hauv koj lub siab tau thaiv, thiab qhov blockage yuav hnyav npaum li cas
• Yog koj tau mob plawv tas li
• Zoo li koj cov leeg mob plawv tuaj yeem tso ntshav tawm mus rau koj lub cev

Kev mob plawv tsis zoo thiab lub siab tuaj yeem ua rau tuag sai sai.

Tsis khov tsis khov yuav ua rau:

• Mob lub plawv tsis zoo (rhais ruam)
• Ib lub plawv nres
• Lub plawv tsis ua hauj lwm

Nrhiav kev kho mob yog tias koj muaj mob tshiab, qhia tsis tau hauv siab lossis mob siab. Yog tias koj tau mob angina ua ntej, hu rau koj tus kws khomob.

Hu rau 911 lossis tus npawb xov tooj xwm ceev hauv ib cheeb tsam yog koj qhov mob angina:

• Tsis zoo dua 5 feeb tom qab koj siv cov tshuaj nitroglycerin (koj tus kws kho mob yuav hais kom koj noj 3 koob tshuaj)
• Tsis ploj mus tom qab 3 koob tshuaj nitroglycerin
• Mob zuj zus
• Rov qab los tom qab nitroglycerin pab thaum xub thawj

Hu rau koj tus kws khomob yog:

• Koj muaj mob angina ntau dua
• Koj tab tom mob angina thaum koj zaum (so angina)
• Koj mloog zoo li nkees ntau
• Koj tau hnov ​​tsaus muag lossis taws, lossis koj dhau mus
• Koj lub siab ntaus qeeb heev (tsawg dua 60 yeej ib feeb) lossis nrawm heev (ntau dua 120 neeg ntaus ib feeb), lossis nws tsis khov kho
• Koj tab tom muaj teeb meem noj tshuaj mob plawv
• Koj muaj lwm cov tsos mob txawv txawv

Yog koj xav tias koj muaj mob plawv, nrhiav kev kho mob tam sim ntawd.

Qee cov kev tshawb fawb pom tau tias ua qee yam kev hloov pauv hauv lub neej tuaj yeem tiv thaiv kev thaiv los ntawm kev phem thiab yuav hloov kho lawv tiag tiag. Kev hloov hauv lub neej kuj tseem tuaj yeem pab tiv thaiv kom tsis txhob muaj qee tus mob angina. Koj tus kws khomob yuav qhia koj rau:

• Poob ceeb thawj yog tias koj rog dhau
• Txiav kev haus luam yeeb
• Ib ce muaj zog tas li
• Haus dej caw kom nyob hauv kev hauj sim
• Noj zaub mov zoo uas muaj txiaj ntsig ntawm zaub, txiv hmab txiv ntoo, cov hmoov nplej tag nrho, ntses, thiab cov nqaij rog

Koj tus kws kho mob yuav qhia koj kom tswj xyuas lwm cov kev noj qab haus huv xws li ntshav siab, ntshav qab zib, thiab cov ntshav siab tswj ntshav siab.

Yog tias koj muaj ib lossis ntau dua cov kev pheej hmoo rau mob plawv, tham nrog koj tus kws kho mob txog kev noj tshuaj aspirin lossis lwm yam tshuaj los pab tiv thaiv kev mob plawv. Tshuaj aspirin (75 txog 325 mg rau ib hnub) lossis tshuaj xws li clopidogrel, ticagrelor lossis prasugrel tuaj yeem pab tiv thaiv kev mob plawv hauv qee cov neeg. Kev pom zoo rau cov tshuaj aspirin thiab lwm cov ntshav-ua kom ntshav qab zib yog pom zoo yog tias qhov txiaj ntsig zoo yuav muaj peev xwm tshaj qhov kev pheej hmoo ntawm cov kev mob tshwm sim.

Kev nrawm angina; Tshiab-pib pib angina; Angina - tsis khov; Zaus angina; CAD - tsis khov; Kab mob rau cov hlab ntshav - tsis khov ntawm lub cev; Kab mob hauv lub plawv - tsis khov kho lub hlwb; Kev mob hauv siab - lub hauv siab tsis khov

• Angina - tawm hauv
• Angina - yuav tsum nug koj tus kws kho mob li cas
• Angina - thaum koj mob hauv siab
• Angioplasty thiab stent - lub siab - tso tawm
• Plawv nres - tso tawm
• Plawv nres - dab tsi yuav nug koj tus kws kho mob

• Angina
• Lub cev muaj ntshav txhaws zais pa angioplasty - series

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Arnett DK, Blumenthal RS, Albert MA, li al. 2019 ACC / AHA Cov Lus Taw Qhia ntawm kev tiv thaiv kab mob plawv thawj zaug: ib daim ntawv tshaj tawm ntawm Asmeskas College ntawm Cardiology / American Heart Association Task Force ntawm Kev Siv Tshuaj Ua Haujlwm. [kev hloov kho luam tawm tshwm hauv Kev ncigCov. 2019; 140 (11): e649-e650] [luam tawm kev txhim kho tshwm sim hauv Kev ncigCov. 2020; 141 (4): e60] [luam tawm kev txhim kho tshwm sim hauv Kev ncig. 2020; 141 (16): e774]. Kev ncig. 2019 2019; 140 (11): e596-e646. PMID: 30879355. pubmed.ncbi.nlm.nih.gov/30879355/.

Bonaca MP. Sabatine MS. Txoj kev mus rau tus neeg mob lub hauv siab. Hauv: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Plawv Lub Plawv: Phau Ntawv Qhia Txog Cov Tshuaj Mob plawv. 11th ed. Philadelphia, PA: Elsevier; 2019: chap 56.

Giugliano RP, Braunwald E. Tsis yog-qib kev mob siab rau txoj kev mob ntshav siab. Hauv: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Plawv Lub Plawv: Phau Ntawv Qhia Txog Cov Tshuaj Mob plawv. 11th ed. Philadelphia, PA: Elsevier; 2019: chap 60.

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