Ganin maganin cututtukan cardiomyopathy (DCM) - ƙwayar zuciya ta mafi yawan - ya inganta sosai a cikin shekaru da suka gabata.
Abin takaici, binciken ya nuna cewa marasa lafiya da yawa tare da DCM ba su karbi maganin da ya kamata su karbi ba. Saboda wannan dalili, yana da mahimmanci a gare ka ka fahimci maganin da aka ba da shawara don DCM - idan dai don tabbatar da cewa likitanka yana rufe dukan asusu.
Bi da mahimman abu
Dokar farko ta zalunta DCM shine gano da kuma bi da mahimmancin dalilin. Yin maganin mahimmanci na iya sau da yawa jinkirin, dakatarwa, ko ma sake juya ci gaban DCM. Kuna iya karanta a nan game da dalilai masu yawa na DCM .
Drug Jiyya na DCM
Beta blockers. Beta blockers rage matsanancin damuwa a kan zuciya ta kasa, kuma an tabbatar da cewa inganta inganta aikin zuciya, bayyanar cututtuka, da kuma tsira daga marasa lafiya tare da DCM. Beta blockers yanzu dauke wani mainstay a magance DCM. Coreg (carvedilol), Toprol (metoprolol), da kuma Ziac (bisoprolol), su ne masu buƙatar beta da aka fi amfani dashi a DCM, amma akwai wasu da dama.
Diuretics. Diuretics , ko "kwayoyin kwalliyar ruwa," sune mahimmancin farfadowa ga mutanen dake fama da nakasa. Wadannan kwayoyi sun kara yawan kawar da ruwa ta hanyar kodan da kuma rage yawan riƙewar ruwa da edema wanda ke faruwa a DCM. Dabarar da ake amfani dasu sun hada da Lasix (furosemide) da Bumex (bumetanide).
Babban tasirin su shi ne cewa zasu iya haifar da matakan potassium maras nauyi, wanda zai haifar da arrhythmias cardiac .
ACE masu hanawa. Masu maganin ACE (magungunan da ke toshe sashin enzyme na angiotensin ) sun tabbatar da kasancewa tasiri a inganta ingantacciyar bayyanar cututtuka da rayuwa a marasa lafiya tare da ciwon zuciya. Babban mawuyacin sakamako shine tari ko cutar karfin jini , amma mafi yawan mutane da DCM sun yi haƙuri sosai da magungunan ACE.
Masu amfani da ACE da yawa sun haɗa da Vasotec (enalapril), Altace (ramipril), Accupril (quinapril), Lotensin (benazepril) da Prinivil (lisinopril).
Angiotensin II masu karɓar rashawa (ARBS). ARBS su ne kwayoyi da suke aiki kamar su masu hana ACE. Ana iya amfani da su a cikin mutane tare da DCM waɗanda ba za su iya ɗaukar masu hana ACE ba. ARBS da aka yarda da zuciya rashin nasara sun hada da Atacand (candesartan) da Diovan (valsartan).
Aldosterone antagonists. Aldactone (spironolactone) da Inspra (eplerenone) su ne altasterone antagonists, wani bangare na kwayoyi da tabbatar da tabbatar da inganta rayuwar a wasu mutane da zuciya rashin cin nasara. Lokacin da za'a iya amfani dasu a amince, an bada shawarar daya daga cikin wadannan kwayoyi, baya ga masu kwantar da ACE (ko maganin magunguna na ARB) da beta blocker, a cikin mutane tare da DCM. Duk da haka, idan mai haƙuri ya rage aikin koda, wadannan kwayoyi zasu iya haifar da hyperkalemia mai muhimmanci (matakan potassium masu girma). Ya kamata a yi amfani da masu adawa da Aldosterone tare da taka tsantsan, idan kullun, lokacin da aikin koda ba al'ada bane.
Hydralazine da nitrates. A cikin mutane tare da DCM wadanda ke da alamun bayyanar cututtuka duk da beta-blockers, masu hana ACE, da diuretics, hada hydralazine tare da nitrate (kamar isosorbide) zai iya inganta sakamakon gaske.
Mai maganin Neprilysin. Na farko daga cikin masu hana masu amfani da neprilysin (sabon bangare na magungunan), an yarda da su don magance rashin zuciya na zuciya daga FDA a shekara ta 2015. Wannan magani, Entresto , hakika haɗuwa da ARB (valsartan) tare da mai hana neprilysin (sacubitril) . Binciken farko tare da Entresto sun kasance masu wadatawa, wasu masana sunyi imanin cewa ya kamata a yi amfani da shi a matsayin mai hana ACE ko ARB. Duk da haka, kwarewa tare da miyagun ƙwayoyi ya rage iyakance kuma alamun sakamako na dogon lokaci har yanzu alamar tambaya . Har ila yau, miyagun ƙwayoyi yana da tsada sosai. Saboda haka a yau da kullum ana amfani da shi a marasa lafiya wanda ba zai iya jurewa ba ko kasa amsawa da kyau ga masu hana ACE ko ARB.
Kamar yadda karin kwarewa tare da Entresto ya tara, ƙwarewarta za ta ƙara ƙaruwa.
Ivabradine . Ivabradine magani ne wanda ake amfani dasu don rage yawan zuciya. An yi amfani da shi a cikin yanayi kamar ƙarancin na sinus ba daidai ba , inda zancen zuciya bai dace ba. Mutanen da ke tare da DCM kuma suna iya samun raunin zuciya mai zurfi wanda ya fi girma fiye da yadda aka saba da su, kuma akwai shaida cewa rage wannan girman zuciya da ivabradine na iya inganta sakamakon. Yawancin likitoci sunyi la'akari da yin amfani da ivabradine a cikin mutanen da ke kan maganin mafi girma tare da wasu kwayoyi (ciki har da wani beta blocker) kuma wanda har yanzu yana da kwanciyar hankali a sama da 70 na minti daya.
Digoxin. Duk da yake a shekarun da suka gabata an yi la'akari da digoxin a matsayin mahimmanci wajen magance rashin cin nasara zuciya, amfaninsa na ainihi a zalunta DCM yanzu yana da mahimmanci. Yawancin likitoci sun rubuta shi kawai idan magunguna mafi mahimmanci ba su zama daidai ba.
Inotropic kwayoyi. Inotropic kwayoyi sune magungunan maganin magunguna wanda ke motsa ƙwayar zuciya don yin aiki da wuya, don haka ya bugu da jini. Shekaru da suka shude, akwai sha'awar gaske ga wadannan kwayoyi, kamar yadda suke kusan haifar da saurin ingantaccen aikin zuciya. Magunguna guda biyu da suka hada da (milrinone da dobutamine) sunyi amfani dasu sosai wajen karfafa mutane da rashin ciwo na zuciya, kuma an yi amfani da su a cikin lokaci mai tsawo na wasu mutane da ciwon zuciya mai tsanani. Duk da haka, binciken da aka yi a baya ya nuna cewa mutane sunyi amfani da kwayoyi marasa amfani - duk da irin ci gaban da suka samu sau da yawa - sun kara yawan mace-mace. Wadannan kwayoyi an yi amfani dasu sosai sosai, kuma kawai a cikin mutanen da ke fama da mummunan zuciya wanda basu kasa amsawa da sauran maganin ba.
Cardiac Resynchronization Far
Kwayar maganin na Cardiac (CRT) wani nau'i ne na motsa zuciya na zuciya wanda yake karfafa duka ventricles (dama da hagu) a lokaci daya. (Masu daidaitattun masu kwaskwarima suna ƙarfafa ƙwararren ventricle kawai). Dalilin CRT shi ne ya jagoranci haɓakawar ventricles, domin inganta ingantaccen zuciya. Nazarin tare da CRT ya nuna cewa wannan farfadowa, a cikin marasa lafiya wanda aka zaɓa, ya haifar da ingantacciyar haɓaka a cikin aikin zuciya da alamun bayyanar, ya rage asibiti, kuma ya ƙara tsawon rai. Duk wani mai haƙuri tare da DCM da kuma wani ƙwararren reshen reshe ya kamata a yi la'akari da CRT.
Defibrillator farfadowa
Abin takaici, mutanen da ke fama da matsananciyar ƙananan DCM suna da haɗari na mutuwa daga zuciya ta zuciya daga cututtuka na ventricular arrhythmias . An nuna alamar defibrillator na cardioverter (ICD) wanda zai iya rage yawan mace-mace a cikin wasu mutane tare da DCM wadanda suka rage yawan ragowar sashin haɗin gwaninta na hagu . Idan kana da DCM, ya kamata ku tattauna da likitanku ko wani ICD wani abu ne wanda ya kamata a yi la'akari da ku a cikin akwati.
Cardiac Transplantation
Gyaran ci gaba da karuwar zuciya na zuciya ya inganta sosai a cikin shekarun da suka wuce. Duk da haka, saboda mummunan yanayi na farfadowa, da gaskiyar cewa masu ba da gudummawa suna cikin wadatacciyar ƙwayarwa, an tsara suturcin zuciya ga marasa lafiya marasa lafiya da rashin ciwo zuciya. Abin lura ne, duk da haka, yawancin cibiyoyi na zuciya sun gano cewa marasa lafiya da yawa da aka kira su da "ciwon zuciya na ƙarshen" ba su taɓa karɓar raunin rashin zuciya na zuciya ba - kuma a lokacin da aka kafa magungunan ƙetare suna inganta sosai kuma babu Yawancin lokaci yana buƙatar safar zuciya.
Gwajin gwaji
Ana gudanar da bincike mai yawa don gano ko farfadowa ko farfasa kwayoyin halitta zai iya amfani da ita ga mutanen da ke tare da DCM. Duk da yake waɗannan maganin gwaji sun nuna wasu alkawurra, sun kasance da wuri a cikin tsari na gwaji, kuma basu da cikakkiyar samuwa ga marasa lafiya da DCM.
Kalma Daga
Binciken ya ci gaba da nuna cewa yawancin mutane da rashin tausayi na zuciya saboda DCM ba su karbi duk maganin da ya kamata su samu. Saboda haka, idan kai ko ƙaunatacciyar wannan yanayin ya kamata ka tabbata ka san duk maganin da aka ba da shawarar, kuma ka tattauna da likitanka.
> Sources:
> Ƙungiyar Ayyuka don Bincike da Kula da Ƙananan Zuciya da Binciken Zuciya 2008 na Ƙungiyar Turai na Kwayoyin Halitta, Dickstein K, Cohen-Solal A, et al. ESC Jagoran Bayanai don Bincike da Gudanar da Raunuka da Ƙananan Zuciya 2008: Ƙungiyar Ƙaƙwalwar Ƙarƙashin Ƙarfafawa da Kula da Ƙananan Zuciya da Bikin Ƙasar 2008 na Ƙungiyar Harkokin Kasuwancin Turai. Ci gaba da haɗin gwiwar Ƙungiyar Harkokin Ƙasa ta ESC (HFA) da Cibiyar Harkokin Kiwon Lafiya ta Ƙasashen Turai (ESICM) ta amince. Eur Heart J 2008; 29: 2388.
> Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF / Dokar Sharuɗɗa ta AHA don Gudanar da Zuciyar Zuciya: Babban Tsarin: Rahoton Cibiyar Kasuwancin Cibiyar Kwayoyin Kayan Kwafa ta Amurka (American Academy of Cardiology Foundation / American Heart Association Task Force on Guidelines. Yanayin 2013; 128: 1810.