Ukuhlanganiswa komzimba

I-arterial embolism isho ihlwili (embolus) eliqhamuke kwenye ingxenye yomzimba futhi lidale ukuphazamiseka okungazelelwe kokugeleza kwegazi kutho noma isitho somzimba.

"Umbungu" yisigaxa segazi noma ucezu loqweqwe olusebenza njengehlwili. Igama "emboli" lisho ukuthi kuneqhwa elingaphezu kwelilodwa noma ucezu lwetshe. Lapho i-clot ihamba isuka lapho yakhiwa yaya kwenye indawo emzimbeni, ibizwa nge-embolism.

I-embolism ye-arterial ingabangelwa ihlwili elilodwa noma amaningi. Amahlule angabambeka emthanjeni futhi avimbe ukuphuma kwegazi. Ukuvinjelwa kubulala indlala yezicubu zegazi ne-oxygen. Lokhu kungaholela ekulimaleni noma ekufeni kwezicubu (necrosis).

I-arterial emboli ivame ukuvela emilenzeni nasezinyaweni. Ama-emboli avela ebuchosheni abangela isifo sohlangothi. Lokho okwenzeka enhliziyweni kubanga isifo senhliziyo. Amasayithi angavamile kakhulu afaka izinso, amathumbu namehlo.

Izici zobungozi be-arterial embolism zifaka:

• Isigqi senhliziyo esingajwayelekile njenge-atrial fibrillation
• Ukulimala noma ukulimala odongeni lomthambo
• Izimo ezandisa ukopha kwegazi

Esinye isimo esibeka engcupheni enkulu yokuhlanganiswa (ikakhulukazi ebuchosheni) yi-mitral stenosis. I-Endocarditis (ukutheleleka ngaphakathi kwenhliziyo) nakho kungadala ukuhlangana komzimba.

Umthombo ovamile wesibungu uvela ezindaweni zokuqina (i-atherosclerosis) e-aorta nakweminye imithambo yegazi emikhulu. Lawa mahlule angagqashuka futhi ehle aye emilenzeni nasezinyaweni.

Ukuhlanganiswa okuyindida kungenzeka lapho ihlwili emthanjeni lingena ohlangothini lokunene lwenhliziyo futhi lidlula emgodini ohlangothini lwesobunxele. Ihlwili lingabe selidlulela emthanjeni bese livimba ukugeleza kwegazi liye ebuchosheni (stroke) noma kwezinye izitho.

Uma iqhwa lihamba futhi lilala emithanjeni ehambisa ukugeleza kwegazi liye emaphashini, kubizwa ngokuthi umbungu wamaphaphu.

Ungahle ungabi nazimpawu.

Izimpawu zingaqala ngokushesha noma ngokunensa ngokuya ngosayizi we-embolus nokuthi kuvimba kangakanani ukuphuma kwegazi.

Izimpawu ze-embolism ye-arterial ezingalweni noma emilenzeni ingafaka:

• Ingalo ebandayo noma umlenze
• Kwehle noma cha ukushaya kwenhliziyo engalweni noma emlenzeni
• Ukungabi nokunyakaza engalweni noma emlenzeni
• Ubuhlungu endaweni ethintekile
• Ukuba ndikindiki nokushosheka engalweni noma emlenzeni
• Umbala ophaphathekile wengalo noma womlenze (pallor)
• Ubuthakathaka bengalo noma bomlenze

Izimpawu zakamuva:

• Amabhamuza esikhumba afakwa umthambo othintekile
• Ukuchithwa kwesikhumba
• Ukuguguleka kwesikhumba (isilonda)
• Ukufa kwezicubu (i-necrosis; isikhumba simnyama futhi sonakele)

Izimpawu zehlule egumbini liyahlukahluka emzimbeni ohilelekile kepha zingafaka:

• Ubuhlungu engxenyeni yomzimba ebandakanyekayo
• Umsebenzi wesitho owehle okwesikhashana

Umhlinzeki wezokunakekelwa kwempilo angathola ukushaya kwenhliziyo okunciphile noma cha, nokuncipha kwengcindezi yegazi engalweni noma emlenzeni. Kungaba nezimpawu zokufa kwezicubu noma ukubola.

Ukuhlolwa kokuhlonza ukubumbana komzimba noma ukuveza umthombo we-emboli kungafaka:

• I-Angiography yomkhawulo othintekile noma isitho
• Ukuhlolwa kwe-Doppler ultrasound komkhawulo
• Ukuhlolwa kwe-Duplex Doppler ultrasound komkhawulo
• I-Echocardiogram
• I-MRI yengalo noma yomlenze
• Ukuhlukahluka kwe-myocardial echocardiography (MCE)
• I-Plethysmography
• Ukuhlolwa kweTranscranial Doppler yemithambo yegazi ebuchosheni
• I-Transceophageal echocardiography (TEE)

Lesi sifo singathinta nemiphumela yokuhlolwa okulandelayo:

• I-D-dimer
• Isilinganiso se-Factor VIII
• Ucwaningo lwe-Isotope lwesitho esithintekile
• Umsebenzi wePlasminogen activator inhibitor-1 (PAI-1)
• Ukuhlolwa kokuhlanganiswa kweplatelet
• Izinga le-tissue-type plasminogen activator (t-PA)

I-arterial embolism idinga ukwelashwa ngokushesha esibhedlela. Izinhloso zokwelashwa ukulawula izimpawu nokwenza ngcono ukugeleza kwegazi okuphazamisekile kuya endaweni ethintekile yomzimba. Imbangela yehlule, uma itholakele, kufanele yelashwe ukuvimbela ezinye izinkinga.

Imithi ifaka:

• Ama-Anticoagulants (njenge-warfarin noma i-heparin) angavimbela amahlule amasha ukuthi angakhi
• Imithi ye-antiplatelet (efana ne-aspirin noma i-clopidogrel) ingavimbela amahlule amasha ukuthi angakhi
• Ama-painkillers anikezwa ngomthambo (ngu-IV)
• I-Thrombolytics (efana ne-streptokinase) ingahlakaza amahlule

Abanye abantu badinga ukuhlinzwa. Izinqubo zifaka:

• I-Bypass yomthambo (i-arterial bypass) ukwakha umthombo wesibili wokunikezwa kwegazi
• Ukususwa kwendwangu nge-catheter yebhaluni efakwe emthanjeni othintekile noma ngokuhlinzwa okuvulekile emthanjeni (embolectomy)
• Ukuvulwa komthambo nge-catheter yebhaluni (i-angioplasty) ene-stent noma ngaphandle kwayo

Ukuthi umuntu wenza kahle kangakanani kuya ngokuthi indawo ikuphi futhi iqabunga livimbe kangakanani ukuphuma kwegazi nokuthi ukuvinjelwa kube khona isikhathi esingakanani. I-arterial embolism ingaba yimbi kakhulu uma ingalashwa ngokushesha.

Indawo ethintekile ingalimala unomphela. Ukunqunywa kuyadingeka kuze kufike ku-1 ezimweni ezi-4.

Ama-arterial emboli angabuya noma ngabe sekuphumelele ukwelashwa.

Izinkinga zingafaka:

• I-MI enamandla
• Ukutheleleka ezicutshini ezithintekile
• Ukushaqeka kwe-Septic
• I-Stroke (CVA)
• Ukwehla kwesikhashana noma unomphela noma ukulahleka kweminye imisebenzi yesitho
• Ukuhluleka kwezinso okwesikhashana noma unomphela
• Ukufa kwezicubu (necrosis) nokubola
• Ukuhlaselwa kwe-ischemic kwesikhashana (i-TIA)

Iya egumbini labezimo eziphuthumayo noma ushayele inombolo yendawo ephuthumayo (efana ne-911) uma unezimpawu zokutholwa komzimba okuncane.

Ukuvimbela kuqala ngokuthola imithombo engaba khona yegazi. Umhlinzeki wakho anganquma abanciphisi begazi (njenge-warfarin noma i-heparin) ukuvimbela amahlule ukuba akheke. Izidakamizwa ze-antiplatelet nazo zingadingeka.

Unobungozi obukhulu bokuqina kwemithambo yegazi namahlule uma:

• Intuthu
• Ungazivocavoci kancane
• Yiba nomfutho wegazi ophezulu
• Unamazinga angavamile we-cholesterol
• Unesifo sikashukela
• Ukhuluphele ngokweqile
• Bacindezelekile

• Ukuhlanganiswa komzimba
• Uhlelo lokujikeleza kwegazi

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UGerhard-Herman MD, uGornik HL, uBarrett C, et al. Umhlahlandlela we-2016 AHA / ACC ekuphathweni kweziguli ezinesifo semithambo esezingeni eliphansi kakhulu: isifinyezo esiphezulu: umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice Guidelines. UJ Am Coll Cardiol. 2017; 69 (11): 1465-1508. I-PMID: 27851991 pubmed.ncbi.nlm.nih.gov/27851991/.

UGoldman L. Indlela eya esigulini enesifo senhliziyo nemithambo. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 45.

UKline JA. I-embolism ye-pulmonary kanye ne-vein thrombosis ejulile. Ku: Walls RM, Hockberger RS, Gausche-Hill M, ama-eds. Imithi Ephuthumayo yaseRosen: Imiqondo kanye Nokuzijwayeza Komtholampilo. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2018: isahluko 78.

UWyers MC, uMartin MC. Isifo se-acute mesenteric. Ku: Sidawy AN, Perler BA, ama-eds. Rutherford’s Vascular Surgery and Endovascular Therapy. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2019: isahluko 133.