خانه / کاردیومیوپاتی ها

کاردیومیوپاتی ها


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کاردیومیوپاتی‌ها (cardiomyopathy) گروه متفاوتی از بیماری‌های عضله قلب هستند که در اثر آن‌ها قلب نمی‌تواند جریان خون کافی را برای اعضای بدن فراهم‌سازد و فرد دچار نارسایی قلبی می‌شود. کاردیو به معنی قلب، میو به معنی ماهیچه و پاتی به معنی بیماری است. کاردیومیوپاتی ایدیوپاتیک (بیماری اولیه) میوکارد بدون علت مشخص است. کاردیومیوپاتی‌های ثانویه علل متنوعی دارند که شایع‌ترین علت آن بیماری‌های ایسکمیک قلب است. هیپرتانسیون مزمن، تنگی شدید آئورت، نارسایی دریچه قلب، عفونت‌های ویروسی، آمیلوئیدوز، هموکروماتوز، بیماری‌های پریکارد، الکل، تیروتوکسیکوز، کمبود ویتامینها به خصوص ویتامین B۱ و سموم، سایر علل کاردیومیوپاتی‌های ثانویه هستند.

انواع کاردیومیوپاتی

صرف‌نظر از علت بیماری سه شکل شایع کاردیومیوپاتی : کاردیومیوپاتی گشادشده (شایع‌ترین شکل کاردیومیوپاتی )، کاردیو میوپاتی هیپرتروفیک ( همراه با رشد و ضخیم‌شدن عضله قلب )، کاردیومیوپاتی محدودسازنده Restrictive ( کاهش انعطاف‌پذیری عضلات قلب) می‌باشد.

علائم ونشانه های کاردیومیوپاتی

بعضی افراد که دچار کاردیومیوپاتی می شوند ممکن است هیچ علائم و نشانه ای در مراحل اولیه بیماری نداشته باشند. اما همینطور که بیماری پیش میرود، علائم و نشانه ها معمولا ظاهر می شوند.این علائم و نشانه ها همان هایی هستند که اغلب همراه با سندرم موسوم به نارسایی قلبی احتقانی هستند. آنها ممکن است شامل:

تنگی نفس با فعالیت و حتی در حال استراحت

-  ورم اندام تحتانی

-  باد کردن شکم با مایع

- خستگی و کوفتگی

-  ریتم نامنظم قلب

-  سرگیجه، دوران سر و غش وضعف

اهمیتی ندارد که شما کدام نوع از کاردیو میوپاتی رادارید، با مرور زمان علائم و نشانه ها گرایش به پیشرفت دارند اگر درمان نشود. در برخی افراد، این بهم خوردگی شتاب سریعی می گیرد ، در حالی که در دیگران ، بیماری ممکن است به یک سطحی برسد و برای مدتی از زمان متوقف شود. در برخی از موارد کاردیومیوپاتی گشاد شده ، شایعترین نوع از ۳ نوع ، بیماری ممکن است بخودی خود کاملا بهبود یابد.

درمان کاردیومیوپاتی

بر حسب نوع کاردیومیوپاتی، روشهای درمانی مختلفی برای درمان آن وجود دارد.

هدف غایی از درمان برای کاردیومیوپاتی عبارتند از:

- مدیریت نشانه های شما

- پیشگیری از پیشرفت بیماری شما

-  کاهش خطر عوارض شما

درمان بر اساس اینکه کدام نوع اصلی کاردیو میوپاتی را شما دارید متفاوت است:

- درمان کاردیو میوپاتی گشاد شده

پزشکان معمولا دارو برای کاردیو میوپاتی گشاد شده تجویز می کنند. مهار کننده های آنزیم آنژیو تنسین Angiotensin-converting enzyme (ACE) inhibitors مانند انلاپریل (Vasotec)، لیزینوپریل (lisinopril(Zestril,Prinivil ، رامی پریل (ramipril(Altace یا کاپتو پریل (captopril(Capoten – می توانند توانایی پمپ قلب را بهبود بخشند. ادرار آور ها ، مانند فورزاماید(لازیکس)، می تواند از تجمع مایع جلوگیری کند. بتا بلوکرها مانند اتنولول (تنورمین)، (carvedilol(Coreg و (metoprolol(Lopressor,Toprol XL – می توانند عمل قلب را بهبود بخشیده و خطر مرگ را در افراد با کاردیو میوپاتی گشاد شده کاهش دهند.

-  انتخاب دیگر برای برخی افراد با نوار قلب غیر طبیعی گذاشتن دستگاه مخصوص ضربان ساز pacemaker است که انقباضات بین بطن های چپ و راست را هماهنگ می کند(biventricular pacing) .در افرادی که ممکن است در خطر بی نظمی های شدید قلب باشند، دارو درمانی یا دستگاه قابل کاشت دیفیبریله کردن قلب (Cardiovertor-defibrillator(ICD می تواند از انتخاب ها باشد. ICDs ها کوچک و وسایلی در اندازه مینی کاست هستند که در سینه شما کاشته می شود برای مانیتور کردن دائمی ضربان قلب و تخلیه شوک های الکتریکی کالیبره شده دقیق در زمان نیاز برای کنترل ضربانات قلبی غیر طبیعی و تند. این وسیله ها همچنین می توانند به عنوان ضربان ساز pacemaker کارآیی داشته باشد.

-درمان  کاردیومیوپاتی هیپرتروفیک

پزشک شما ممکن است بتا بلوکرها مانند لوپرسورLopressor یا مسدود کننده های کانال کلسیمی مانند وراپامیل (Verapamil(Calan,Isoptin ، که می توانند قلب شما را شل Relax کنند، عمل پمپاز را آهسته کنند و ریتم قلب را پایدار کنند.

-  برای بعضی افراد ، یک ضربان ساز pacemaker یا یک ICD ممکن است توصیه شود. در موارد پیشرفته کاردیو میوپاتی هیپرتروفیک ، جراح ممکن است قسمتی از دیواره کلفت شده ماهیچه ای قلب را که تداخل با جریان خون طبیعی می کند بردارد. این شیوه عمل موسوم به میوتومی septal myotomy-myectomy ، می تواند نشانه ها را در بیشتر بیماران کاهش دهد.

پزشک شما ممکن است همچنین توصیه به درمان جدیدی به نام ریشه کنی الکلی کند. این روش غیر جراحی ، با استفاده از تزریق الکل برای نابود کردن ماهیچه های اضافی قلب استفاده می شود، ممکن است کلفتی قلب را کاهش داده و جریان خون را بهبود بخشد.

- درمان کاردیو میوپاتی محدود کننده

مانند تمامی انواع کاردیو میوپاتی ، پزشک شما به شما توصیه خواهد کرد که به میزان نمک و مایعات دریافتی خود توجه خاص داشته باشید و وزن خود را روزانه تحت نظر داشته باشید. درمان احتباس آب با ادرار آور ها است . ممکن است به شما داروهایی برای پایین آوردن فشار خون و کنترل ضربانات سریع و نامنظم قلب توصیه شود.

-  خیلی از دارو هایی که پزشک برای کاردیو میوپاتی توصیه می کند ممکن است عوارض جانبی داشته باشد . قبل از استفاده از این داروها مطمئنا با پزشک خود صحبت کنید.

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  41. سلام
    آیا گاز گرفتگی مداوم بر اثر تنفس نشت خفیف گاز در اتاق خواب می تواند باعث اسپاسم قلبی شود؟
    لطفا پاسخ را برایم ایمیل نمایید.
    با تشکر..

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