I-Coronary Angiogram (CAG): Oko Ikubonisayo, Indlela Eyenziwa Ngayo, Nento Engenakukuxelela Yona

Ukuthatha okuphambili

• Injongo: I-coronary angiogram idwelisa ingaphakathi lemithambo yentliziyo ngokuchanekileyo ngaphezu kwalo naluphi na uvavanyo olungangenisi gazi.
• Imida: I-angiogram ibonisa i-lumen kuphela, ayilinganisi ukusebenza kwezihlunu zentliziyo, ukuqina kwazo, okanye ayiqikeleli ukuba i-plaque iya kugqabhuka nini.
• Iyangena: Ngokungafaniyo novavanyo lwe-echo okanye uvavanyo lwe-treadmill, i-coronary angiogram ibandakanya ukubhoboza kwemithambo, umahluko kunye nemitha, ngoko ke inomngcipheko omncinci kodwa wokwenyani.
• Ayifani ne-angioplasty: I-Angiography yindlela yokuxilonga; i-angioplasty (i-PTCA ene-stent) lunyango, ngamanye amaxesha lwenziwa ngexesha elinye.
• Ingcaciso: Iziphumo kufuneka zifundwe kunye neempawu, i-ECG, i-echo kunye novavanyo lokusebenza ngugqirha wentliziyo ocele olu phononongo. Iziphumo ziyahluka ngokuxhomekeke kwiimeko zeklinikhi nganye.

Ngokukrwaqula kanye

Kwaziwa njenge

• CAG
• Ukufakwa kwe-catheterization yentliziyo (i-angiography yinxalenye yophando lwe-cath)
• I-coronary angiography
• "I-heart ki angiography", "uvavanyo lwe-angio", "uvavanyo lwedayi", "ukuhlolwa kwemibhobho yentliziyo", amagama asetyenziswa rhoqo zizigulana kunye neentsapho eIndiya
• Ukufakwa kwe-catheterization yentliziyo yasekhohlo nge-coronary angiography

Yintoni i-angiogram yentliziyo

I-coronary angiogram yinkqubo apho ugqirha wentliziyo ebhoboza umthambo, ngokuqhelekileyo umthambo we-radial esihlahleni, aze aqhubele phambili i-catheter entle neguquguqukayo ukuya kwindawo yokuqala kwemithambo ye-coronary. Umahluko oxutywe ne-iodine uyafakwa kwaye imifanekiso ye-X-ray ekhawulezayo (ii-cine runs) irekhodwa kwii-engile ezahlukeneyo.

Ngenxa yokuba umahluko uzalisa i-lumen (umjelo apho igazi lihamba khona), imifanekiso ibonisa apho umjelo uncitshiswe khona, ungahambelani, okanye uvalwe khona, kunye nokuba isifo sisasazeka kangakanani. I-angiogram ikwabonisa imithambo yegazi edibeneyo, i-bypass graft patency kwizigulana eziye zaba ne-CABG, kunye notshintsho olufana nemvelaphi yentliziyo engaqhelekanga.

I-Coronary angiography idla ngokudityaniswa nomlinganiselo woxinzelelo lwe-ventricular yasekhohlo, kwaye ngakumbi ngezixhobo ezongezelelweyo: i-FFR/iFR (iintambo zoxinzelelo zokugweba ukuba ukunciphisa okuphakathi kuyayithintela na indlela yokuhamba) kunye ne-IVUS/OCT (ii-catheters zomfanekiso ezijonga udonga lwemithambo yegazi ngokwalo). Ezi zongezo zikhona ngokuchanekileyo kuba i-angiogram ecacileyo inemida.

Kutheni kwenziwa i-angiogram yentliziyo

• I-Acute coronary syndrome: Kwi-ST-elevation myocardial infarction, i-angiography engxamisekileyo ene-angioplasty yokuqala yindlela eqhelekileyo yokuphinda iphume igazi apho ilabhoratri yonyango ifumaneka ngexesha. Kwi-ACS engeyiyo eye-ST-elevation enomngcipheko ophezulu, uvavanyo lokuqala lokungenelela luqhelekile.
• I-Angina ayilawulwa ngamayeza: Ukuchaza i-anatomy kunye nokugqiba ekubeni kusetyenziswe i-stenting okanye i-bypass.
• Uvavanyo olungaqhelekanga okanye olunobungozi obuphezulu olungangenisi gazi: Uvavanyo loxinzelelo oluqinisekileyo, i-ischaemia enkulu kwi-echo yoxinzelelo okanye kwi-nuclear imaging, okanye i-stenosis enzima erhanelwa kwi-CT coronary angiography.
• Ngaphambi kotyando oluthile lwentliziyo: Umzekelo, ngaphambi kotyando lwevalvu, ukuze wazi ukuba isifo sentliziyo kufuneka sijongwe ngaxeshanye.
• Ubuthathaka bemisipha yentliziyo obungachazekiyo: Ukujonga ukuba ukusebenza okunciphileyo kokumpompa kubangelwa sisifo sentliziyo.
• Ukulandelelana kongenelelo lwangaphambili: Iimpawu eziphinda zivele emva kokudumba okanye ukunqandwa.

Ngubani omele aqwalasele olu vavanyo

I-angiogram yentliziyo ayilovavanyo lokuhlola kwaye ayifanelekanga kubantu abangenazo iimpawu okanye uvavanyo lomngcipheko olubonisa isifo esibalulekileyo sentliziyo. Ngokuqhelekileyo kuqwalaselwa xa:

• Intlungu yesifuba okanye ukungakwazi ukuphefumla zizinto eziqhelekileyo kwi-angina kwaye zihlala zikho nangona unyango lufanelekile.
• Kuye kwenzeka isifo sentliziyo okanye kutshanje.
• Uvavanyo olungangenisi gazi lubonisa ukuba indawo enkulu yentliziyo isengozini.
• Iimpawu zibonakala ngathi ziyabonisa kodwa uvavanyo olungenalo uhlaselo alunakuqinisekiswa okanye alunakwenzeka ngokwengcali.
• Umzimba wentliziyo kufuneka waziwe ngaphambi kokuba ivalve okanye olunye utyando lwentliziyo.
• Kukho ukungasebenzi kakuhle kwe-ventricular yasekhohlo okungachazwanga, ukungasebenzi kakuhle kwe-ventricular, okanye i-coronary anomaly erhanelwayo.

Akuqhelekanga ukuba linyathelo lokuqala elifanelekileyo leentlungu zesifuba ezizinzileyo nezingenabungozi kangako, ukuqinisekiswa ngaphandle kokubonisa, okanye njengovavanyo lwempilo "olupakishiweyo". Kwezo meko uvavanyo lweklinikhi, i-ECG, uvavanyo lwe-echo kunye novavanyo olusebenzayo okanye olusekelwe kwi-CT zezona ndawo zibalulekileyo zokuqala. Ukuba i-angiogram ifanelekile sisigqibo sengcali yentliziyo yakho.

Oko i-angiogram yentliziyo ingenakukwazi ukukubona okanye ukungakubandakanyi

Le yeyona nxalenye idla ngokungabandakanywa kulwazi lwesigulana, kwaye ibalulekile.

• Ayibonisi udonga lomthambo. I-angiogram ichaza i-lumen. I-plaque elungisiweyo ngaphandle inokuba nkulu ngelixa i-lumen isabonakala yamkelekile. I-angiogram "eqhelekileyo" ayithethi ukungabikho kwe-atherosclerosis.
• Ayinakukwazi ukuqikelela ukuhlaselwa yintliziyo. Uhlaselo oluninzi lwentliziyo luvela kwiiplaque ezazinganciphisi kakhulu. I-angiogram eqinisekisayo namhlanje ayiqinisekisi ukukhululeka kwiziganeko ezizayo, kwaye unyango lwezinto ezinobungozi lusabalulekile.
• Ayikwazi ukuyixilonga ngokuthembekileyo i-microvascular angina okanye i-coronary spasm. I-Angina enemithambo yentliziyo engathinteliyo (ANOCA/INOCA) ixhaphakile, ingakumbi kubasetyhini. Ukuxilongwa kwayo kufuna uvavanyo olongezelelweyo olufana nophando lwe-provocation okanye i-coronary physiology, kungekhona i-angiogram eqhelekileyo yodwa.
• Ayilinganisi ukusebenza kwemisipha yentliziyo okanye amandla ayo okusebenza. I-Echocardiography, i-cardiac MRI okanye i-nuclear perfusion imaging ziyaphendula loo mibuzo.
• Uqikelelo lobukhali bokubona luxhomekeke kwimbono yomntu. Abasebenzi ababini abanamava banokunika amanqaku ahlukeneyo ngokunciphisa okuphakathi. Kwizilonda eziphakathi, uvavanyo lwentambo yoxinzelelo lunolwazi olungaphezulu kunokujonga ipesenti ngamehlo.
• Ayithethi nto ingako ngemithambo emincinci kakhulu ekude, ezinokuthi zingacaci kakuhle okanye zingasombululwa.
• Ayilovavanyo lwevalvu, ipericardium okanye i-aorta. Abo bafuna i-echo okanye umfanekiso okhethekileyo.

I-angiogram ebonakala ingalunganga okanye ingaqhelekanga ichaza oko kuboniswe yimifanekiso. Ayikhuphi ngokwayo unobangela wentliziyo weempawu zakho. Ukuba iimpawu ziyaqhubeka okanye ziyanda nangona iziphumo ziqhelekile, buyela kugqirha wakho endaweni yokucinga ukuba intliziyo icocekile.

Iimviwo ezinxulumeneyo kodwa ezahlukeneyo

Akukho nanye kwezi mvavanyo ingcono kakhulu kwihlabathi liphela. Ziphendula imibuzo eyahlukeneyo, kwaye eyokuqala ixhomekeke kwindlela oziveza ngayo: umntu onesifo sentliziyo esiguqukayo uya ngqo kwi-angiography ehlaselayo, ngelixa umntu onentlungu yesifuba engapheliyo kunye nomngcipheko omncinci uhlala encedwa ngcono kuvavanyo olungenalo uhlaselo kuqala.

Ukulungiselela

Imiyalelo yokulungiselela imiselwa yilabhoratri eyenza utyando lwakho kwaye yahluka phakathi kweeyunithi. Imiyalelo ebhaliweyo enikwa liqela lakho ihlala ibaluleke ngaphezu kolwazi ngokubanzi.

• Amachiza: Zisa uluhlu olupheleleyo, kuquka amayeza okunciphisa igazi, amayeza okunciphisa iiplatelets, amayeza e-insulin kunye nesifo seswekile esithethwa ngomlomo, amayeza okukhupha isisu, i-metformin, amayeza emifuno kunye namayeza e-AYUSH, kunye nezongezo zejimu. Musa ukuyeka okanye ukutshintsha naluphi na unyango olunikiweyo ngokwakho, buza umcebisi okanye iqela lelabhoratri ye-cath into omawuyenze ngaloo mini.
• Umzimba: Xela nayiphi na impendulo yangaphambili kwi-iodine contrast, kunye nayo nayiphi na i-asthma okanye i-allergy ebalulekileyo yamayeza. Iiprotokholi zokulungiselela amayeza zahlukile phakathi kweeyunithi.
• Ukuzila ukudla: Iiyunithi ezininzi zicela ixesha lokuzila ukutya ngaphambi kwenkqubo. Ubude bexesha buyahluka ngokweyunithi kunye nokuba kucetywayo na ukuthomalalisa.
• Uvavanyo olusisiseko: Umsebenzi wezintso, i-hemoglobin, inani leeplatelet, uvavanyo lokujiya kwegazi, i-ECG kwaye ngamanye amaxesha i-echo idla ngokufunyanwa ngaphambi kokuba ivele.
• Ukhuseleko lwezintso: Umthamo owaneleyo wolwelo ngaphambi nasemva kokuthelekiswa kwawo uqhelekile, kodwa uhlobo kunye nomthamo wolwelo kufuneka zicwangciswe ngokwahlukeneyo.
• Amalungiselelo asebenzayo: Lungiselela umntu oza kuhamba nawe xa usiya ekhaya. Musa ukuqhuba imoto yakho ngaloo mini. Susa ubucwebe uze ushiye izinto ezixabisekileyo ekhaya; phatha iiCD ze-angiogram zangaphambili, amakhadi e-stent kunye nezishwankathelo zokukhululwa emsebenzini.

Ukuba unesifo seswekile kunyango lokunciphisa iswekile

Ukuzila ukutya ngelixa uqhubeka nomthamo we-insulin okanye i-sulfonylurea kunokubangela i-hypoglycemia. Buza ugqirha wakho ukuba ungayilungisa njani imithamo kusasa kwenkqubo, kwaye ukhankanye ukuba uthatha i-metformin okanye i-SGLT2 inhibitor, njengoko iiyunithi zinemigaqo ethile malunga nomahluko kunye nala mayeza.

Ukuba unesifo sezintso esinganyangekiyo

I-iodine contrast inomngcipheko wokwenzakala kwezintso okunxulumene ne-contrast, iphezulu xa i-eGFR inciphile, ukuphelelwa ngamanzi emzimbeni, isifo seswekile kunye nomthamo omkhulu we-contrast. Xelela iqela ukuba i-creatinine okanye i-eGFR yakho yamva nje inokunciphisa umthamo, kwaye ulwelo lucwangciswe ngononophelo.

Ukuba unesifo sentliziyo okanye uthintelwe kulwelo

Ingcebiso eqhelekileyo yokufunxa amanzi ngaphambi kwenkqubo inokuba yinto engakhuselekanga ukuba unesifo sentliziyo esingasebenzi kakuhle okanye umda wolwelo olumiselweyo. Ubungakanani bolwelo kufuneka bubekwe liqela lakho lokunyanga, kungekhona ngephepha lemiyalelo eliqhelekileyo.

Ngexesha lokukhulelwa

I-Coronary angiography isebenzisa i-ionizing radiation kwaye yenziwa xa ukhulelwe kuphela xa kukho isidingo esifunekayo, njengokuhlaselwa yintliziyo xa ukhulelwe, kunye nokukhuselwa kwesisu kunye nokunciphisa umthamo. Xelela iqela ukuba ukhulelwe okanye ukhulelwe.

Kubantu abadala abadala

Ubuthathaka, ubunzima bomzimba obuphantsi, i-anemia kunye nokuncipha kokugcinwa kwezintso kwandisa umngcipheko wokopha kunye nokwenzakala kwezintso okunxulumene nomahluko. Ukufikelela kwimitha ye-radial kunye nomthamo omncinci womahluko kudla ngokuthandwa.

Ebantwaneni

I-Coronary angiography ebantwaneni ayiqhelekanga kwaye idla ngokwenziwa kwi-congenital coronary anomalies, i-Kawasaki disequelae disease okanye emva kokufakelwa kwentliziyo, kwiindawo zentliziyo zabantwana kwaye idla ngokwenziwa phantsi kwe-anesthesia jikelele.

Kwenzeka ntoni ngexesha lenkqubo

Ulala uphaphile etafileni emxinwa eneeledi ze-ECG, i-blood pressure cuff kunye ne-pulse oximeter eqhotyoshelweyo. Kufakwa umgca we-intravenous. Isandla okanye i-groin iyacocwa kwaye ivalwe nge-local analgesic. Usenokunikwa i-laxation ekhaphukhaphu.

Ingcali yentliziyo ifaka isheya elifutshane kumthambo, ize ihambise ii-catheters entliziyweni. Inaliti yokwahlulahlula idla ngokukhupha ubushushu obufutshane; abanye abantu baziva imizuzwana embalwa yokungakhululeki esifubeni okanye imvakalelo yokubhabha. Usenokucelwa ukuba ubambe umphefumlo wakho, ukhohlele, okanye uhlale ungashukumi ngexesha lokufumana umfanekiso.

Uninzi lwabantu luchaza uxinzelelo kunokuba luchaze iintlungu. Xelela iqela ngokukhawuleza ukuba uziva iintlungu esifubeni, ukungonwabi okukhulu, ukurhawuzelelwa, ukungakwazi ukuphefumla okanye isicaphucaphu, ezi zinto zinokulawulwa ngexesha lenkqubo.

Ekugqibeleni, ii-catheters ziyasuswa. Ukuze kufikelelwe kwi-radial, kufakwa ibhendi yokucinezela esihlahleni; ukuze kufikelelwe kwi-femoral, kusetyenziswa isixhobo sokucinezela ngesandla okanye isixhobo sokuvalela. Ukuphumla ebhedini kudla ngokufuneka emva kokufikelela kwi-femoral, kwaye kuncinci kakhulu emva kokufikelela kwi-radial.

Ingaba ithatha ixesha elingakanani

• Ukuzicingela ngokwakho: idla ngokuba yimizuzu engama-20-45 ukuze kwenziwe uphando olucacileyo lokuxilonga.
• Nge-angioplasty kunye ne-stenting kwindawo enye: ixesha elide kakhulu, kuxhomekeke kubunzima bezilonda.
• Ukuqwalasela emva koko: iiyure ezimbalwa emva kokufikelela kwi-radial kwiiyunithi ezininzi; ixesha elide, rhoqo ngokuhlala ubusuku bonke, emva kokufikelela kwi-femoral, emva kokungenelela, okanye ukuba unezinye iingxaki zempilo.

Amaxesha achanekileyo axhomekeke kwiyunithi nganye kwaye axhomekeke kwishedyuli, ukuthomalalisa, indlela yokufikelela kunye nemeko yakho yeklinikhi.

Ukuqonda ingxelo yakho

Ingxelo ye-angiogram ichaza umthambo ngamnye omkhulu, umthambo oyintloko wasekhohlo, umthambo ongaphambili wasekhohlo (LAD), umthambo ojikelezayo wasekhohlo, umthambo wentliziyo wasekunene, kunye namasebe awo, kunye noqikelelo lokuncitshiswa njengepesenti yobubanzi be-lumen.

• Imithambo yentliziyo eqhelekileyo: Akukho kuncitshiswa okubonakalayo kwe-luminal. Oku akuthethi ukuba akukho atherosclerosis, kwaye akukho nobangela weempawu zentliziyo oye wakhutshwa.
• Isifo esibuthathaka/esingathinteliyo: Iplaque ikhona kodwa ukuhamba kwayo akuthintelwanga kangako. Ihlala iphathwa ngokwezonyango ngonyango olunemingcipheko, kungekhona ngokuyinika ivumba.
• Ukuncitshiswa okuphakathi: Ukuhlolwa kokujonga akuthembekanga kakhulu apha. Uvavanyo lwentambo yoxinzelelo (FFR/iFR) luhlala lugqiba ukuba unyango luyadingeka na.
• Ukuncitshiswa okukhulu: Isifo esithintela ukugeleza kwegazi esinokunyangwa nge-angioplasty kunye ne-stent okanye ngotyando lwe-bypass, kuxhomekeke kwindlela esebenza ngayo, inani lemithambo yegazi, imeko yesifo seswekile, kunye nomsebenzi wokumpompa.
• Ukuvaleka okupheleleyo: Umthambo uvalekile ngokupheleleyo. Imithambo yegazi ebambeneyo isenokuba inika indawo. Unyango luxhomekeke kwiimpawu kunye nokuba umsipha ongaphezulu uyasebenza na.
• Ezinye iziphumo: I-Coronary ectasia okanye i-aneurysm, ukuqhekeka, i-spasm, i-myocardial bridging, okanye imvelaphi engaqhelekanga. Ngayinye inolawulo lwayo kwaye kufuneka ichazwe kuwe ngokuthe ngqo.
• Umsebenzi we-ventricular yasekhohlo ingaqatshelwa ukuba i-ventriculography yenziwe.

Amagama anjengelithi "isifo semithambo yegazi enye" ​​okanye "isifo semithambo yegazi emithathu" achaza ukuba zingaphi imithambo yegazi emikhulu ebandakanyeka kakhulu. Achaza i-anatomy, hayi i-prognosis yodwa. Ingcali yentliziyo eyenze olu phando, eneempawu zakho kunye nezinye iimvavanyo esandleni, ngumntu oza kutolika oko kuthethwa ziziphumo kuwe.

Xa iziphumo zinokulahlekisa

Ubunzima bunokubonakala bukhulu ngokungeyonyani

• I-spasm ebangelwa yi-catheter, ingakumbi yemithambo yentliziyo ekunene, inokulinganisa ukuncitshiswa; iyaphela nge-nitrate yangaphakathi kwentliziyo.
• Ukunciphisa kunye nokudibanisa kwemikhumbi kwiprojektha enye kunokugqithisela ukuncitshiswa, yiyo loo nto kuthathwa ii-engile ezininzi.
• Uxinzelelo lwegazi oluphantsi okanye ukuxinana kwegazi ngexesha lophando kunokwenza imithambo yegazi ibonakale incinci.
• Ukusasazwa komahluko okanye ukufakwa okunganelanga ingenza inkangeleko yokuzalisa iziphene.

Ubunzima bunokubonakala bungaphantsi kobunyani

• Ukulungiswa kwangaphandle (okuhle) igcina i-lumen ibukeka iqhelekile nangona kukho umthwalo omkhulu we-plaque.
• Isifo esisasazekayo ngaphandle kwenqaku elimxinwa elicacileyo lisenokungafundwa kakuhle, kuba ukubekwa kwamanqaku kuxhomekeke ekuthelekisweni necandelo "eliqhelekileyo" elikufutshane elisenokuba nalo linesifo.
• I-calcification enzima kwaye izakhiwo ezixineneyo ezigqumayo zinokusitha i-lumen yokwenyani.
• Izilonda eziphambili zasekhohlo neze-ostial ingaphoswa ukuba indawo ye-catheter iyasigquma icandelo.
• Iinqanawa ezincinci ezikude kunye namasebe asecaleni isenokungacaci ngokwaneleyo.

Izinto zobugcisa kunye nezigulane

• Ukushukuma, ukungakwazi ukubamba umphefumlo, ukutyeba kakhulu kunye nokubetha kwentliziyo okuphezulu kakhulu okanye okungahambelaniyo kuyawuthoba umgangatho womfanekiso.
• Imida yobungakanani bomahluko kwisifo sezintso inokunciphisa inani leembono ezifunyenweyo.
• Ii-graft zangaphambili ze-bypass zinokuba nzima ukuzisebenzisa kwaye zinokuxelwa ngokungafanelekanga njengezifihliweyo ukuba aziboniswanga ngokukhetha.

Iingozi kunye nokhuseleko

I-Coronary angiography yinkqubo eyaziwayo eyenziwa ngamanani amakhulu, kwaye iingxaki ezinkulu aziqhelekanga. Ayinabungozi, kwaye umngcipheko uxhomekeke kwiminyaka yakho, ukusebenza kwezintso, ukungxamiseka kwenkqubo, indlela yokufikelela kunye nokuba unyango lwenziwa ngaxeshanye na. Iziphumo kunye neengozi ziyahluka ngokuxhomekeke kwiimeko zeklinikhi nganye.

I-angiography yodwa yokuxilonga

• Iqhelekile kwaye idla ngokuba ncinci: ukurhawuzelelwa, ukurhawuzelelwa okanye i-hematoma encinci kwindawo ehlatywe kuyo; ubushushu obufutshane okanye ukurhawuzelelwa yi-contrast; ukungonwabi kwesifuba okwethutyana okanye ukungasebenzi kakuhle kwentliziyo ngexesha lokufakwa kwenaliti.
• Ayiqhelekanga: ukopha okukhulu okufuna unyango, ukuvaleka kwemithambo yegazi eshukumayo, i-pseudoaneurysm okanye i-arteriovenous fistula (ngakumbi xa i-femoral ifikelela), ukwenzakala kwezintso okunxulumene nomahluko, ukusabela koxinzelelo oluhambelanayo, usulelo kwindawo leyo.
• Ayiqhelekanga kodwa inzulu: ukuhlaselwa yintliziyo, isifo sohlangothi, ukuqhekeka kwentliziyo, ukungasebenzi kakuhle kwentliziyo, ukusabela kakhulu kwe-allergy, kunye nokufa. Umngcipheko uphezulu kwiinkqubo zongxamiseko, kwizigulana ezingazinzanga nakwabo banesifo esibi sentloko yasekhohlo okanye isifo sezintso esiqhubele phambili.
• Imitha: Idosi igcinwa iphantsi kangangoko kunokwenzeka; idosi eqokelelweyo ibalulekile ukuba wenza iinkqubo eziphindaphindwayo.

I-Angiography ene-angioplasty kunye ne-stenting

Ukongeza ukungenelela kwandisa umngcipheko wenkqubo xa kuthelekiswa ne-angiography yokuxilonga yodwa, kubandakanya amathuba aphezulu okuqhekeka kwemithambo yegazi, ukugqobhoka, ukungaphindi kuphume, ukwenzakala kwentliziyo ejikeleze i-periprocedural, kunye nokuvezwa okukhulu komahluko kunye nokukhanya kwemitha. I-Stenting ikwakukhokelela kwixesha lonyango oluphindwe kabini lwe-antiplatelet, olunyusa umngcipheko wokopha. Ezi ziingxoxo zemvume ezahlukeneyo.

Ukufikelela kwi-radial ngokuchasene ne-femoral

Ukufikelela kwi-radial (esinqeni) kudla ngokunxulunyaniswa neengxaki ezimbalwa zokopha kwindawo yokufikelela kunye nokunyakaza kwangoko kunokufikelela kwi-femoral, yiyo loo nto iiyunithi ezininzi zikhetha oko. Ukufikelela kwi-femoral kusafuneka kwezinye iimeko, umzekelo xa kufuneka izixhobo ezinkulu, okanye xa indlela ye-radial ingafanelekanga.

Iimeko ezikhethekileyo

Women

Abafazi badla ngokuba ne-angina enemithambo yentliziyo engathinteliyo. I-angiogram "eqhelekileyo" kumfazi oneempawu eziqhelekileyo kufuneka ikhuthaze ukuba kuqwalaselwe ukungasebenzi kakuhle kwemithambo yegazi okanye ukuxinana kwemithambo yegazi endaweni yokulahla iimpawu.

Diabetes

Isifo sentliziyo kwisifo seswekile sidla ngokuba sisasazeka kakhulu kwaye sihamba ngemithambo emininzi. Oku kuchaphazela ukhetho phakathi kotyando lokusebenzisa i-stenting kunye notyando lwe-bypass, kwaye eso sigqibo sidla ngokwenziwa liqela lentliziyo.

Isifo sezintso esingapheliyo kunye ne-dialysis

Ukuvezwa komahluko phakathi komhlaza kufuna ucwangciso olucokisekileyo. Kubantu abasele besebenzisa i-dialysis, inkxalabo itshintsha ukusuka ekulimaleni kwezintso ukuya ekulinganisweni kolwelo kunye nexesha lokwenziwa kwe-dialysis ngexesha lenkqubo.

Ukusilela kwentliziyo kunye nesifo esinzima sevalvu

Ukulala phantsi kunokuba nzima, kwaye umthwalo womahluko kufuneka ulinganiselwe. Umlinganiselo owongezelelweyo we-haemodynamic unokwenziwa ngexesha lophando olufanayo.

Utyando lwangaphambi kotyando lwe-bypass

I-graft angiography ithatha ixesha elide, isebenzisa umahluko omkhulu kwaye ibandakanya imitha ephezulu kunesifundo sokuqala. Zisa amanqaku akho okusebenza kwangaphambili ukuze kwaziwe inani kunye nohlobo lwe-graft.

Abantu abadala kunye nezigulane ezingasebenzi kakuhle kwegazi

Umngcipheko wokopha yeyona nto iphambili ekufuneka iqwalaselwe. Ixesha lokusetyenziswa kwe-anticoagulants ngexesha lenkqubo kufuneka ligqitywe ngugqirha, lingalungiswa ekhaya.

I-angiogram yeCoronary kwimeko yaseIndiya

• Isifo sokuqala kwangethuba: Isifo semithambo yegazi yentliziyo sidla ngokubonakala besebancinci kubemi baseMzantsi Asia kunakubemi abaninzi baseNtshona, kwaye umngcipheko we-metabolic ubonakala kwi-body mass index ephantsi kubemi baseMzantsi Asia, ngoko ke umngcipheko akufuneki uthathwe njengento esisiseko sobunzima "obuqhelekileyo".
• Isifo sentliziyo esinerheumatism: Isifo seValvular sisaxhaphakile eIndiya. I-Coronary angiography idla ngokwenziwa ngaphambi kotyando lwevalvu kubantu abadala okanye abo baneengxaki zomngcipheko, kwaye uvavanyo lwe-echo luhlala luvavanyo lwevalvu oluphambili.
• Ixesha lonyango: Kwisifo sentliziyo, ukulibaziseka ekufikeleleni kwisibhedlele esikwaziyo ukujongana nelabhoratri kuseyingxaki enkulu. Ukuba uneentlungu zesifuba eziqhubekayo, fowunela iinkonzo zongxamiseko endaweni yokulungiselela idinga lokubonana nogqirha wangaphandle.
• Uphawu lwe-Anaemia kunye ne-thalassemia: I-anemia yokunqongophala kwe-iron kunye neempawu ze-hemoglobinopathy zixhaphakile eIndiya. I-anemia inyusa umngcipheko wokusebenza kunye nokopha kwaye inokubangela ukungakwazi ukuphefumla okufana ne-angina.
• Amayeza kunye nezongezo: Ukusetyenziswa kwezongezo zemifuno, i-AYUSH kunye ne-gym kuqhelekile kwaye akuxelwa rhoqo. Chaza yonke into oyithathayo, njengoko ezinye izinto ezichaphazela ukopha kunye nokusebenza kwesibindi okanye kwezintso.
• Izimvo zesibini: Unelungelo lokucela imifanekiso kunye nengxelo ye-angiogram, kunye nokufuna uluvo lwesibini ngaphambi kokuba uvume utyando lwe-stenting okanye lwe-bypass, ngaphandle kokuba imeko ingxamisekile.
• Imvume kunye nedatha: Imvume ebhaliweyo enolwazi iyafuneka, kwaye idatha yakho yezempilo, kuquka nemifanekiso yenkqubo, yidatha yobuqu ephathwa phantsi koMthetho woKhuseleko lweDatha yoBuqu yeDijithali, ka-2023. Amabango entengiso okunyanga isifo sentliziyo athintelwe phantsi koMthetho weDrugs and Magic Remedies (Iintengiso ezingachasekiyo), ka-1954.

Ixabiso kunye ne-inshurensi eIndiya

Iindleko zahlukile kakhulu phakathi kukarhulumente, izibhedlele zetrasti kunye nezibhedlele zabucala, phakathi kwezixeko, naphakathi kophando lokuxilonga kunye nenkqubo eba yezonyango. Cela uqikelelo olubhaliweyo ngaphambi kokungeniswa.

Izinto ezichaphazela iindleko:

• Nokuba inkqubo ihlala ixilongwa, okanye i-angioplasty kunye ne-stents zongezwa ngexesha elinye.
• Indlela yokufikelela, inani lee-catheter kunye nomthamo we-contrast esetyenzisiweyo.
• Ukusetyenziswa kwezixhobo ezincedisayo ezifana neengcingo zoxinzelelo, i-IVUS okanye i-OCT.
• Indawo yokunyamekela abantwana emini xa kuthelekiswa nokuhlala ubusuku bonke okanye i-ICU; udidi lwegumbi.
• Uphando lwangaphambi kwenkqubo kunye neentlawulo zokubonisana ngezifo zentliziyo.
• Iinkqubo zongxamiseko ngaphandle kweeyure zomsebenzi ngokuchasene nokucwangciswa kokhetho.
• Isixeko, inqanaba lesibhedlele kunye nokuba isibhedlele silawulwa phantsi kwenkqubo karhulumente.

Amanqaku e-inshorensi ekufuneka ajongwe: ukuba ipolisi yakho iyayigubungela na inkqubo yokhathalelo lwasemini okanye ukwamkelwa esibhedlele, amaxesha okulinda isifo sentliziyo esele sikhona, isithintelo sokuqeshisa igumbi kunye nezigaba zokuncitshiswa okulinganayo, ukuba ii-stents kunye nezinto ezisetyenziswayo ziyagutyungelwa na, kunye nokuba imvume yangaphambili iyafuneka na. Amaxabiso e-stent eIndiya axhomekeke kumlinganiselo wamaxabiso owaziswe yi-National Pharmaceutical Pricing Authority; cela i-invoyisi ye-stent eprintiweyo kunye nekhadi le-stent. Izicwangciso zikarhulumente ezifana ne-Ayushman Bharat PM-JAY zigubungela iipakethe zentliziyo kwizibhedlele ezifakwe kwi-empanelled ukuze kuxhamle abaxhamli abafanelekileyo.

Iintsomi nezibakala

Imibuzo ebuzwa qho

Ngaba i-angiogram yentliziyo ibuhlungu?

Uninzi lwabantu luva ukuhlaba okwethutyana ngenxa ye-anesthetic yendawo baze emva koko bacinezelwe endaweni yentlungu. Ukufakwa kwe-contrast injection kunokubangela ubushushu bemizuzwana embalwa okanye ukungonwabi okuncinci esifubeni. Intlungu engathethekiyo ayilindelwanga, xelela iqela ngoko nangoko ukuba uyayiva, njengoko inokunyangeka ngexesha lenkqubo.

Ndiza kuhlala ixesha elingakanani esibhedlele?

Uvavanyo lwemifanekiso ludla ngokuthatha imizuzu engama-20-45 ukuze kufunyanwe uvavanyo. Ukujonga emva koko kudla ngokuba ziiyure ezimbalwa xa umntu efikelela esihlahleni aze athathe ixesha elide, ngamanye amaxesha ebusuku, xa efikelela esinqeni, emva kwe-angioplasty, okanye ukuba unezinye iimeko zempilo. Iyunithi yakho iya kuqinisekisa isicwangciso sakho.

Ndingatya ndize ndisele amayeza am ngaphambi kokuba ndiqalise inkqubo?

Ixesha lokuzila ukutya kunye nemiyalelo yamayeza imiselwa licandelo elisebenzayo kwaye yahlukile kwizibhedlele. Musa ukuyeka okanye ukutshintsha naluphi na unyango olunikiweyo ngokwakho, ingakumbi amayeza okunciphisa igazi, iipilisi ze-insulin okanye zeswekile. Buza umcebisi wakho okanye iqela lelabhoratri yezonyango ukuba uza kuthatha ntoni ngaloo mini.

Ngaba i-stent iya kubekwa kwindawo enye?

Ngamanye amaxesha. Kwimeko engxamisekileyo efana nokuhlaselwa yintliziyo, unyango ludla ngokulandela ngoko nangoko. Kwiimeko ezizinzileyo ingcali yentliziyo inokuxoxa nawe okanye neqela lentliziyo kuqala ngezinto ezifunyenweyo. Imvume ye-angioplasty enokwenzeka idla ngokuthathwa kwangaphambili ngoko ke unyango akufuneki lulibaziseke.

Yintoni umahluko phakathi kwe-coronary angiogram kunye ne-CT angiogram?

I-CT coronary angiography ayingenisi ntsholongwane kwaye iluncedo ekuthinteleni ukuvaleka okukhulu xa amathuba okuba isifo sivele sincinci ukuya kuthi ga phakathi. I-invasive coronary angiography inika iinkcukacha ezicacileyo ze-lumen, ivumela uvavanyo loxinzelelo kunye nomfanekiso wentambo, kwaye ivumela unyango ngexesha elinye.

Ngaba imitha evela kwi-angiogram iyingozi?

Le nkqubo isebenzisa i-ionizing radiation, kwaye idosi incitshiswa kusetyenziswa i-shielding, useto lwedosi ephantsi kunye nexesha elincinci lokuhlola. Kwisifundo esinye esiboniswe ngokwezonyango, umngcipheko mncinane xa uthelekiswa nenzuzo yokuxilonga. Xelela iqela malunga neenkqubo zangaphambili zentliziyo ukuze kuqwalaselwe ukuvezwa kwentliziyo okuqokelelweyo.

I-angiogram yam yayiqhelekile kodwa iintlungu zesifuba ziyaqhubeka. Kuza kwenzeka ntoni emva koko?

Iimpawu ezihlala zihleli zifanele ukuvavanywa kwakhona, kungekhona ukugxothwa. Amathuba aquka i-microvascular angina, i-coronary spasm, kunye nezizathu ezingezizo ezentliziyo ezifana ne-acid reflux, iintlungu zemisipha, i-anemia okanye ixhala. Buyela kwingcali yentliziyo, enokulungiselela uvavanyo olongezelelekileyo lwentliziyo okanye iphande ezinye iinkqubo.

Ndingaqhuba imoto okanye ndibuyele emsebenzini emva koko?

Musa ukuqhuba ngemini yenkqubo ukuba ufumene i-sedation. Abantu abaninzi baphinda baqalise umsebenzi olula kungekapheli usuku okanye ezimbini emva kophando lokuxilonga, bephepha ukuphakamisa okunzima kunye nokusebenzisa nzima ilungu elibhoboziweyo kangangeentsuku ezimbalwa. Amaxesha ayahluka emva kwe-angioplasty, landela icebiso lakho lokukhupha.

I-angiogram yentliziyo ingaphindaphindwa kangaphi?

Akukho shedyuli imiselweyo. I-angiography ephindaphindwayo yenziwa xa kukho isizathu sezonyango, njengeempawu eziphindaphindayo okanye eziya ziba mandundu, uvavanyo olutsha loxinzelelo olungaqhelekanga, okanye ukungenelela okucwangcisiweyo. Izifundo eziphindaphindwayo ziyathintelwa ngaphandle kokubonisa ngenxa yokungafani kunye nokuvezwa kwimitha.

imithombo

• Isikhokelo se-ACC/AHA/SCAI sika-2021 se-Coronary Artery Revasculari