Wata mata 'yar shekara 65 ta gabatar da ma'aikatar gaggawa tare da gunaguni na gajeriyar numfashi, ciwon makogwaro, zazzabi, sanyi, tari mai amfani, da ciwon kirji. Ta gwada inganci don COVID-19 kwanaki shida da suka gabata.

A farkon gabatarwar, jikewar iskar oxygen ɗinta shine kashi 90% akan iskar ɗaki kuma rediyon ƙirji yana bayyana infiltrates na alveolar biyu da kuma fitattun cunkoso na jijiyoyin jini. A 12-lead electrocardiogram (ECG) yana bayyana girman ST na baya tare da jujjuyawar T-wave mai zurfi na gaba. Ana nuna sakamakon alamun kumburi da gwaje-gwajen dakin gwaje-gwaje a cikin Table 1.

Tebur 1. Alamomin kumburi da Sakamakon Gwajin gwaje-gwaje

Muhimman Tarihin Likita

Tarihin likitanci yana da mahimmanci ga hauhawar jini, hypothyroidism, glaucoma, da rikicewar tashin hankali gabaɗaya. Gudanar da magani ya haɗa da lisinopril 10 MG kowace rana, maganin latanoprost ophthalmic na idanu biyu kowace rana, da citalopram 20 MG kowace rana.

Nazarin jiki

Majiyyaci mace ce mai matsakaicin shekaru tare da kiba a matsakaicin matsananciyar numfashi. Mahimman alamun shiga sun haɗa da hawan jini 96/52 mm Hg, bugun zuciya 107 bugun minti daya, da yawan numfashi 28 numfashi a cikin minti daya. Jikinta na iskar oxygen yana inganta zuwa 94% tare da farawa na 4 L/min oxygen ta hanyar cannula na hanci. Jarabawar huhu yana nuna ɗan ƙaramin hushi mai ƙarewa. Ba a lura da gunaguni ko karin sautunan zuciya akan bugun zuciya. Ana lura da raunin jugular jijiyoyi mara nauyi.

Bayan an kawar da cutar sankarar mahaifa tare da angiography, an gano ta da ciwon Takotsubo (TTS).

tattaunawa

Ana tsammanin ciwo na Takotsubo yana tasowa ta hanyar matsanancin motsin rai ko damuwa ta jiki, mai yiwuwa ya shiga tsakani ta hanyar hawan catecholamine wanda ke haifar da myocardial mai ban mamaki.¹ Ciwon Takotsubo an fi gano shi a cikin postmenopausal, Farar mata. An yi la'akari da Pathophysiology na TTS don zama na biyu zuwa amsawar ƙwayar cuta,² rashin aiki na endothelial wanda ke haifar da raunin bugun jini na zuciya, da ban mamaki na myocardial,¹ da kuma wani nau'i na microvascular m myocardial infarction.^1-3 Kodayake yawancin marasa lafiya (95%) sun warke gaba ɗaya daga TTS, an kiyasta haɗarin mace-mace a cikin asibiti zuwa 5%.⁴

Alamar haɓakar al'amuran TTS ta faru tun farkon cutar ta COVID-19.^5,6 Kafin barkewar cutar ta duniya, abin da ya faru na TTS a cikin marasa lafiya da ke gabatar da cututtukan cututtukan cututtukan zuciya ya kasance tsakanin 1.5% da 1.8%.⁵ Ɗaya daga cikin binciken ya gano abin da ya faru na TTS yayin bala'in COVID-19 ya kai 7.8%.⁵ Kodayake ana iya samun rahotannin shari'o'i da yawa na kamuwa da cutar COVID-19 da kuma TTS a cikin wallafe-wallafen, an sami gagarumin ƙaruwa a yawan adadin TTS ba tare da kamuwa da cutar COVID-19 na lokaci ɗaya ba.⁶ Hanyoyin da aka ba da shawarar don haɓakar cutar TTS a cikin jama'a gabaɗaya yayin bala'in sun haɗa da ƙarin damuwa, firgita, da matakan damuwa a cikin sakandare na jama'a zuwa damuwa na tunani daga cutar.

ganewar asali

Yawancin marasa lafiya da ke nunawa tare da TTS suna koka game da ciwon kirji da dyspnea kuma suna da ECG gabatarwa na ST-segment elevation myocardial infarction (STEMI): ƙara yawan ƙwayoyin cuta na zuciya, hagu na ventricular (LV) dyskinesia, kuma a mafi yawan lokuta wasu kwanan nan na jiki ko motsin rai.^3,4 Ana yin ganewar asali na TTS lokacin da ake zargin myocardial infarction mai tsanani ba tare da wata shaidar angiographic na toshewar jini ba da kuma 4 na Mayo Clinic Criteria na Takotsubo Cardiomyopathy an hadu.⁴:

1. Dyskinesia na wucin gadi na tsakiyar ventricle na hagu; ƙananan motsi na bangon yanki fiye da rarrabawar jijiyoyin jini guda ɗaya
2. Rashin kamuwa da cututtukan jijiyoyin jini na toshewa ko fashewar plaque mai tsanani
3. Sabbin rashin daidaituwa na ECG ko girman girman troponin
4. Rashin pheochromocytoma da myocarditis

Tebur 2. Shawarar Gwajin Ganewa/Laboratory don Ciwon Takotsubo^3,7,8

Nazarin Laboratory

Matakan Troponin sun karu a mafi yawan lokuta na TTS kuma nau'in nau'in kwakwalwa na peptide natriuretic (BNP) yana da girma sosai.³

12-Gubar ECG

ECG mai jagora na 12 na iya nuna shaidar haɓakar ST-segment ko ɓacin rai na ST³; Matsayin ST-segment a cikin 2 ko fiye da jagororin masu haɗa kai shine ganowa ga STEMI.⁸ Marasa lafiya tare da TTS na iya nuna haɓakar ST na baya tare da jujjuyawar T-wave mai zurfi na gaba.⁷

Angiography na zuciya

Cibiyar Kwalejin Ilimin Cardiology ta Amurka / Ƙungiyar Zuciya ta Amirka (ACCF/AHA) jagororin sun ba da shawarar angiogram na gaggawa a cikin saitin ciwon ƙirji, haɓakar biomarkers, da haɓakar ST-segment a kan 12-lead ECG.^7,8 Angiography na jijiyoyin jini shine bincike don cututtukan cututtukan zuciya kuma yana iya gano ainihin raunukan da ke haifar da rauni na jijiyoyin jini.⁸ Idan an gano raunuka masu laifi, za a iya fara dabarun sake dawowa. Marasa lafiya tare da TTS ba za su sami wata shaida na cututtukan cututtukan cututtukan cututtukan cututtukan ƙwayar cuta a kan angiography ba.^4,7 Bayanai game da matsalolin intracardiac, aikin valvular, da nakasar tsarin kuma ana iya gano su tare da angiography. Hoton ventriculogram na hagu zai iya ba da bayani game da aikin LV systolic. Coronary angiogram a halin yanzu shine ainihin kayan aiki don bambance TTS daga ciwo mai tsanani na jijiyoyin jini.⁷

Echocardiogram transthoracic

Echocardiogram na transthoracic zai nuna rashin daidaituwa na bangon bangon LV kuma zai iya yin hukunci a ciki ko kawar da toshewar fili na LV (LVOTO).⁷ Hakanan ana amfani da echocardiogram transthoracic don kimanta LV thrombus.⁷

Gudanarwa da Jiyya

Jiyya ga TTS ya haɗa da kulawar tallafi da kulawa da rikitarwa irin su girgiza, raunin zuciya, da LV thrombus.⁶ Mummunan shari'ar na iya bambanta daga mai sauƙi, wanda maiyuwa baya buƙatar sa baki, zuwa mai tsanani, wanda na iya buƙatar sa baki mai tsanani.⁷ Shawarwari na gudanarwa sun kasu kashi 4:

1. Ciwon Takotsubo Ba Tare Da Matsala ba

Jiyya ga TTS yana tallafawa galibi har sai aikin LV ya inganta ba tare da bata lokaci ba.^4,6,7 Haɓakawa a cikin aikin LV yawanci yana faruwa a cikin kwanaki 21 na alamun bayyanar tare da yawancin marasa lafiya suna murmurewa cikin watanni 2.^4,6 Ana ba da magani yawanci har zuwa watanni 3 kuma yana iya haɗawa da maganin antiplatelet dual, anticoagulants ga marasa lafiya tare da manyan wuraren hypokinesis na zuciya, beta-blockers, angiotensin-converting enzymes inhibitors (ACEI) ko angiotensin receptor blockers (ARB), statins, da danniya. kulawar agaji.⁷

2. Ciwon Takotsubo Tare da Hypotension da Cardiogenic Shock

A cikin marasa lafiya waɗanda ke da TTS tare da hypotension da bugun jini na zuciya, ana buƙatar ci gaba da lura da alamun mahimmanci da bugun jini na ƙarshe.⁷ Ana iya yin kulawa da hankali na ruwa a cikin marasa lafiya ba tare da nuna alamun cunkoson huhu ba.⁷ Inotropes masu kyau, irin su dobutamine ko dopamine, da / ko infusions na vasopressor na iya zama ma'auni na wucin gadi a lokuta na girgiza cardiogenic ba tare da LVOTO ba.⁷ Inotropes masu kyau da vasopressors na iya ƙara matakin toshewa a lokuta masu matsakaici zuwa LVOTO mai tsanani kuma saboda haka an hana su.^4,7 Ana iya amfani da phenylephrine na alpha agonist a hankali a lokuta na LVOTO. Marasa lafiya waɗanda ke da jujjuyawar hauhawar jini duk da matakan farko na iya buƙatar na'urorin tallafi na jini kamar su famfon balloon intra-aortic ko oxygenation na membrane extracorporeal.⁷

3. Ciwon Takotsubo Tare Da Rashin Zuciya

Sai dai a lokuta na LVOTO, ana ba da shawarar kulawa da gazawar zuciya.⁷ Wannan ya haɗa da sarrafa iskar oxygen da samun iska tare da ƙaddamarwa da ƙaddamarwa da raguwa.⁷ Ana amfani da daidaitattun magungunan raunin zuciya kamar diuretics da ACEI/ARBs.⁷ A lokuta na gazawar zuciya tare da LVOTO, daidaitattun kayan aiki da kayan aikin rage nauyi ya kamata a guji.⁷

4. Ciwon Takotsubo Tare da Thromboembolism

Marasa lafiya tare da rashin aiki mai tsanani na LV suna cikin haɗari don haɓakar thrombus na ventricular. A cikin yanayin rashin aikin LV mai tsanani amma babu thrombus da ƙananan haɗarin zubar jini, ana nuna maganin rigakafi har sai an warware akinesia ko dyskinesia ko na tsawon watanni 3, duk wanda ya fi guntu.⁷ A gaban ventricular thrombus, an nuna anticoagulation na tsawon watanni 3 tare da tsawon lokaci na jiyya da aka gyara dangane da adadin dawo da aikin zuciya da ƙuduri na thrombus.⁷

Tattaunawa/Bibiya

Tsawon lokacin jiyya don TTS gabaɗaya ya bambanta daga watanni 3 zuwa shekara 1 kuma za a ƙayyade bisa ga dawowar aikin zuciya. Marasa lafiya tare da TTS waɗanda ke fuskantar matsaloli irin su bugun jini na zuciya, gazawar zuciya, ko thromboembolism na iya buƙatar kulawa na dogon lokaci. Za a buƙaci kimantawa akai-akai ta amfani da serial echocardiography don duba dawo da aikin zuciya a cikin waɗannan marasa lafiya. Abin farin ciki, yawancin marasa lafiya sun warke sosai cikin makonni.^4,7

Frances Stueben, DNP, RN, CHSE, Mataimakin farfesa ne kuma mai kula da shirin kwaikwayo a Jami'ar Louisiana a Lafayette. Tana koyarwa a shirye-shiryen aikin jinya da na digiri na biyu.

Deedra Harrington, DNP, MSN, APRN, ACNP-BC, Mataimakin farfesa ne a Kwalejin Nurse da Ƙwararrun Ƙwararrun Lafiya, Jami'ar Louisiana a Lafayette. Dr Harrington ƙwararren ma'aikacin jinya ce mai rijista wacce ke aiki tare da ƙungiyar masu ƙarfafa zuciya a cikin Louisiana.

Christy L. McDonald Lenahan, DNP, FNP-BC, ENP-C, CNE, ma'aikaciyar jinya ce ta ci gaba mai rijista a cikin iyali da likitan gaggawa wanda ke aiki ga likitan gaggawa da ma'aikatan asibiti. Ita ma abokiyar farfesa ce a Jami'ar Louisiana a Lafayette kuma tana koyarwa a cikin masters da shirye-shiryen digiri.

Hanyoyin haɗi zuwa wasu labaran cikin wannan jerin:

1. Gudanar da NSTEMI/STEMI a cikin marasa lafiya da COVID-19, danna nan
2. Gudanar da thromboembolism na jini a cikin marasa lafiya tare da COVID-19, danna nan
3. Atrial fibrillation da sauran dysrhythmias a cikin marasa lafiya tare da COVID-19, danna nan
4. M pericarditis, myopericarditis, da perimyocarditis a cikin marasa lafiya da COVID-19, danna nan
5. Ciwon zuciya a cikin marasa lafiya da COVID-19, danna nan
6. Cardiogenic shock a cikin marasa lafiya tare da COVID-19, danna nan

References

1. Chiu S, Nayak R, Lin B, Duan L, Shen AY, Lee MS. Halayen asibiti da sakamakon marasa lafiya da ciwon Takotsubo. Can J Cardiol. 2021;37(8):1191-1197. doi:10.1016/j.cjca.2021.01.014
2. Ruzzenenti G, Maloberti A, Giani V, et al; COVID-19 Niguarda Working Group. COVID da cututtukan zuciya: lahani kai tsaye da kai tsaye da hangen nesa na gaba. Hawan Jini na Cardiovasc Prev. 2021;28(5):439-445. doi:10.1007/s40292-021-00464-8
3. Lüscher TF, Templin C. Shin ciwon Takotsubo ciwo ne na ƙananan ƙwayoyin cuta na jijiyoyin jini? Zuwa ga sabon ma'anar. Zuciyar Zuciya J. 2016 Oktoba 1;37 (37):2816-2820. doi: 10.1093/eurheartj/ehw057
4. Boyd B, Solh T. Takotsubo cardiomyopathy: bita na raunin zuciya mai rauni. JAAPA. 2020;33(3):24-29. doi:10.1097/01.JAA.0000654368.35241.fc
5. Jabri A, Kalra A, Kumar A, et al. Abubuwan da ke faruwa na damuwa cardiomyopathy yayin cutar Coronavirus 2019 annoba. JAMA Netw Buɗe. 2020;3(7):e2014780. doi:10.1001/jamanetworkopen.2020.14780
6. Shah RM, Shah M, Shah S, Li A, Jauhar S. Ciwon Takotsubo da COVID-19: ƙungiyoyi da abubuwan da suka faru. Curr Probl Cardiol. 2021;46(3):100763. doi:10.1016/j.cpcardiol.2020.100763
7. Sattar Y, Siew KSW, Connerney M, Ullah W, Alraies MC. Gudanar da ciwo na Takotsubo: cikakken nazari. Cureus. 2020;12(1):e6556. doi:10.7759/cureus.6556
8. O'Gara PT, Kushner FG, Ascheim DD, et al. Jagoran ACCF / AHA na 2013 don gudanar da ST-levation myocardial infarction: rahoto na Cibiyar Kwalejin Kasuwancin Cardiology Foundation / Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru. J Am Coll Cardiol. 2013;61(4):e78-e140. doi:10.1016/j.jacc.2012.11.019

Wannan labarin ya fara fitowa Mai ba da Shawarwari na asibiti