hrudayaaghaat

Myocardial infarction vargeekaran va baahari sansaadhan
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA).
aaiseedi-10	I21.-I22.
aaiseedi-9	410
rog daataabes	8664
medalaain+	000195
E-medisin	med/1567 emerg/327 ped/2520
emaiesaech	D009203

rodhagalan (MI) ya teevr rodhagalan (AMI) ko aamtaur par hrudayaaghaat (heart ataik) ya dil ke daure ke roop mein jaana jaata hai, jiske tahat dil ke kuchh bhaagon mein rakt sanchaar mein baadha hoti hai, jisse dil ki koshikaaen mar jaati hain. yeh aamtaur par kamjor dhamaneekalaakaathinya pattika ke vidaaran ke baad parihrud-dhamani ke rodh (rookaavat) ke kaaran hota hai, jo ki lipid (faiti esid) ka ek asthir sangrah aur dhamani patti mein shvet rakt koshika (vishesh roop se bruhatabhakshakakoshika) hota hai. sthaanik-araktata ke parinaamasvaroop (rakt sanchaar mein pratibandh) aur okseejan ki kami hoti hai, agar lambi avadhi tak ise anupachaarit chhod diya jaae, to hrudaya ki maansapeshi ootakon (maayokaardiym) ki kshati ya mrutyu (rodhagalan) ho sakti hai.

teevr rodhagalan ke shaastreeya lakshanon mein achaanak chhaati mein dard, (aamtaur par baaen haath ya gardan ke baaen or), saans ki takaleef, michli, ulti, ghabaraahat, paseena aur chinta (aksar kayaamat aasann bhaavana ke roop mein varnit) shaamil hain.^[1] mahilaaon ko purushon ke mukaabale kam vishisht lakshan anubhav ho sakta hai, aamtaur par saans ki kami, thakaan, apach aur kamjori.^[2] sabhi rodhagalan daure seene mein dard ya anya lakshan ke bina lagbhag ek chauthaai "nishkriya" hote hain.

upalabdh dil peshi ke kshati ka pata lagaane ke naidaanik ​a​apareekshanon mein ilektrokaardiyograam (iseeji), ikokaardiyograafi aur vibhinn rakt pareekshan shaamil hote hain. sabse aksar istemaal kiya jaane wala maarkar kriyetaain kines-MB (CK-MB) aur troponint star hain. sandigdh teevr rodhagalan ke liye tatkaal ilaaj mein okseejan, espirin, aur upajihva naaitroglisreen shaamil hain.^[3]

esateeiemaaai (ST utkarsh emaaai) ke adhikaansh maamalon ko thranbolaaisis ya parkyuteniyes koronari intaraveinshan (peeseeaai) ke saath ilaaj kiya jaata hai. NSTEMI (gair-ST utkarsh emaaai) ko dava ke saath prabandhit kiya jaana chaahiye, haalaanki aspataal pravesh ke dauraan PCI ka aksar istemaal kiya jaata hai. ve log jinmein kai rukaavatein aur jo apekshaakrut sthir rahe hain, ya kuchh aapaatkaaleen maamalon mein, baaipaas surgery ek vikalp ho sakta hai.

duniya bhar mein purushon aur mahilaaon donon ke liye maut ke mukhya kaaranon mein se dil ke daura pramukh hota hai.^[4] mahatvapoorn jokhim kaarak poorv ke hrudaya rog, badi aayu, tambaakoo dhoomrapaan ke kuchh lipid ke uchch rakt dabaav (traaiglisraaid, kam ghanatv lepoproteen) aur uchch ghanatv ke lepoproteen (echadeeel) ke nimn star, madhumeh, uchch raktachaap,, motaapa, gurde ki puraani beemaari, hrudaya ki vifalta, atyadhik sharaab ki khapat, drags (kokeen aur methamapetaamaain) ke durupayog aur puraani uchch tanaav ka star hain.^[5][6]

teevr rodhagalan ke do buniyaadi prakaar hote hain:

• traansamural : dhamaneekalaakaathinya ke saath sambaddh hai jismein pramukh koronari dhamani shaamil hai. ise poorvakaal, peechhe, ya heen mein up-vargeekrut kiya ja sakta hai. dil peshi ke sampoorn motaai ke maadhyam se traansamural daure vistaarit hote hain aur aamtaur par kshetr ke rakt sanchaar ka sampoorn antarrodh se parinaam saamane aate hain.^[7]
• subeindokaardiyl : baain veintrikular, nilya pat, ya illon se bhare hue maansapeshiyon ke subeindokaardiyl deevaaron mein chhote kshetron ko shaamil kiya jaata hai. subeindokaardiyl daure ko sthaaneeya roop se kam rakt ki aapoorti ke ek parinaam ke roop mein samjha jaata hai, sanbhavat: koronari dhamaniyon ki ek sankuchan se maana jaata hai. subeindokaardiyl kshetr dil ki rakt aapoorti se door hota hai aur is prakaar ke atisanvedanasheel ke liye adhik vikruti hai.^[7]

chikitsakeeya, ek rodhagalan ko iseeji parivartan ke aadhaar par ek ST oonchaai emaaai (STEMI) banaam ek gair-ST oonchaai emaaai (gair-STEMI) ke roop mein vargeekrut kiya ja sakta hai.^[8]

achaanak hrudaya maut ka varnan karne ke liye kabhi-kabhi "dil ka daura" vaakyaansh ka istemaal galat tareeke se kiya jaata hai jo ki teevr rodhagalan ke parinaamasvaroop ho sakta hai ya naheen bhi ho sakta hai. dil ka daura isse alag hota hai, lekin poornahrudrodh ka kaaran ho sakta hai jo ki dil ki dhadkan aur asaamaanya dhadkan hrud-ataalata ko rokata hai. saath hi yeh hrudpaat se bhi alag hota hai, jismein dil ko panp karne mein asamarth hota hai; gambhir rodhagalan se hrudpaat ho sakta hai, lekin aisa hona jaroori naheen hai.^{[krupaya uddharan jodein]}

2007 mein ek aam sahamati ke dastaavej ne rodhagalan ko mukhya roop se paanch prakaaron mein vargeekrut kiya hai:^[9]

• prakaar 1 - pattika kataav aur / ya vidaaran, daraar, ya vichhedan jaise praathamik koronari ghatna ke kaaran sthaanik-araktata se sambandhit sahaj rodhagalan.
• prakaar 2 -okseejan ki badhti maang ya aapoorti mein kami ke kaaran sthaanik-araktata ke liye rodhagalan maadhyamik hoti hai, jaise koronari dhamani ki ainthan, koronari dil ka aavesh, raktaalpata, erahaithamiyaas, uchch raktachaap, ya haaipoteinshan.
• prakaar 3 - poornahrudrodh sahit achaanak kaardiyk apratyaashit mrutyu, aksar rodhagalan sthaanik araktata ke vichaarottejak lakshan ke saath hota hai, sanbhaavyat: nai ST oonchaai dvaara hota hai, ya nae LBBB, ya ek koronari dhamani mein taaja thrombas ke saboot enjiyograafi dvaara hota hai aur / ya mein shav pareeksha ke saath ke saath hota hai, lekin mrutyu se pehle rakt namoone ko liya ja sakta hai ya rakt mein kaardik baayomaarkar se pehle liya ja sakta hai.
• prakaar 4 - koronari enjiyoplaasti ya steints ke saath juda hua hai:
  • prakaar 4a - PCI ke saath rodhagalan juda hua
  • prakaar 4b - steint ghanaastrata ke saath rodhagalan juda hua choonki enjiyograafi ya shav pareeksha dvaara pralekhit hai.
• prakaar 5 - CABG ke saath rodhagalan juda hua

rodhagalan mein dard kshetron ka sambhaavit chitr (gahra laal = sabse aam kshetr, halka laal = anya sambhaavit kshetr, chhaati ka drushya).

prushth dshya.

rodhagalan (emaaai) mein lakshanon ki shuruaat aamtaur par kai minton tak dheere-dheere hoti hai aur shaayad hi kabhi achaanak hoti hai.^[10] teevr rodhagalan ke lakshanon mein seene mein dard hona saamaanya hai aur aksar pakadn, dabaav, ya nichod ki sanasani mahasoos hoti hai. dil peshi ke sthaanik araktata (rakt ki kami aur fir okseejan ki kami) ke kaaran chhaati mein dard ko enajaaina pektoris kaha jaata hai. aamtaur par baane baanh mein sabse adhik dard hota hai, lekin dard nichle jabade, gardan, daane baanh,^{[not in citation given]} peeth aur adhijthar, jahaan yeh dil ke jalne ka kaarya kar sakta hai, mein fail sakta hai. levaain sign, jismein rogi ko urafalak mein modn ke dvaara chhaati mein dard mahasoos karta hai, jise aam taur par kaardiyk chhaati dard ka bhaavi soochak maana jaata hai, haalaanki ek sambhaavit avlokan adhyayan se pata chala ki iska ek kamjor sakaaraatmak bhaavi soochak moolya tha.^[11]

saans ki takaleef (dispeniya) tab hoti hai jab hrudaya kshati baane veintrikl ki utpaadan, ko seemit kar deta hai, jiske kaaran baane veintrikular asafalata aur fefade shof hota hai. anya lakshanon mein daayaforesis (atyadhik roop se paseena,)^[1] kamjori, halki sir dard, michli, ulti aur ghabaraahat, shaamil hain ye lakshan sahaanubhooti tantrika tantr se ketekolaamaains ki bhaari sambhaavana dvaara prerit hota hai^[12] jo ki dard aur himodaayanaamik asaamaantaaen ke pratikriya svaroop hota hai jo ki kaardiyk ke kaarya na karne ke parinaamasvaroop hota hai. chetna ka ghaata (hrudayajanit sadme ke kaaran aparyaapt mastishk chhidkaav) aur achaanak maut (aksar veintrikular fibrileshan vikaas ki vajah se) rodhagalan mein paae ja sakte hain.^{[krupaya uddharan jodein]}

mahilaaon aur vayask rogiyon samakakshon ke vichitr report unamein purush aur yuvaaon ki tulana mein adhik lakshan paae jaate hain.^[13] purooshon ki tulana mein mahilaaon mein lakshan ki report adhik hoti hai (ausat 2.6 banaam purushon ke lakshan 1.8).^[13] mahilaaon mein emaaai ka sabse aam lakshanon mein se dispaniya (saans ki kami), kamjori aur thakaan shaamil hai. thakaan, neend gadbadi aur dispaniya ko aksar hone vaale lakshanon mein paaya jaata hai jo ki vaastavik chikitsakeeya prakat iskeemik ghatna se pehle ek maheene ke lambe samay tak ho sakta hai. purooshon ki tulana mein mahilaaon mein seene mein dard se koronari ishemiya ke hone ki sambhaavana kam hoti hai.^[14]

rodhagalan ka lagbhag ek chauthaai shaant hote hain, bina kisi chhaati dard ya anya lakshanon ke.^[15] aise maamalon ko baad mein ilektrokaardiyograam se pata lagaaya ja sakta hai, ismein rakt enjaaim pareekshan ya sambandhit shikaayaton ke poorv itihaas ke bagair shav pareeksha ka istemaal kiya jaata hai. vruddh logon, madhumeh melits ke rogiyon mein yeh shaant lakshan adhik aam hai^[16] aur sanbhavat: dil pratyaaropan ke baad, kyonki praaptakarta ki tantrika pranaali daata dil mein poorn roop se shakti utpann karne mein asaksham hota hai.^[17] madhumeh rogiyon mein, shurooaati dard mein antar, otonomik nyooropathi aur manovaigyaanik kaarakon mein lakshanon ki kami ke liye sambhaavit spashteekaran ke roop mein uddhrut kiya gaya hai.^[16]

dil mein raktapravaah achaanak rukaavat ke saath sangat lakshan ke kisi bhi samooh ko teevr sindrom koronari kaha jaata hai.^[18]

vibhedak nidaan mein chhaati dard ke anya aapattijanak kaaran shaamil hai jaise fuffuseeya ant: shalyata, mahaadhamani vichhedan, pereekaardiyl bahaav ke kaaran hrudaya temponed, tanaav vaatilvaksh aur esofediyel tootan. anya gair aapattijanak bhinnata mein gaistroesofojiyel bhaata aur tiyetje sindrom shaamil hain.^[19]

teevr prayog ke saath judne mein dil ka daura ka dar uchch hota hai, yeh maanasik tanaav ya shaareerik parishram hota hai, khaaskar vyakti ke saamaanya parishram ki tulana mein yadi parishram teevr ho to.^[20] maatraatmak, atyadhik parishram ki avadhi aur antat: svaasthya laabh lagbhag 6 guna uchch dar ke rodhagalan ke saath (frem samay ke saath anya ki tulana mein adhik aaraam) shaareerik roop se fit logon ke saath jud jaata hai.^[20] shaareerik roop se grast logon ke liye dar antar 35 guna adhik hota hai.^[20] is ghatna ke liye vruddhi hui ek tantr dhamani naadi dabaav kheench ko dekha gaya hai aur pratyek dil ki dhadkan ke saath dhamaniyon ka vishraam jise intraavaiskular altraasaaund ke saath dekha jaata hai, atheroma aur pattika tootan ki sambhaavana par "katarani tanaav" ki yaantrik vruddhi hoti hai.^[20]

nimoniya jaise teevr gambhir sankraman rodhagalan ko badha sakte hain. chelemeedofila nimoniya sankraman aur atheroslerosis ke beech ek adhik vivaadaaspad kadi hai.^[21] jabki ise intraaselular jeev atheroslerosis sajeele tukade mein pradarshan kiya gaya hai, saboot anirnaayak hai choonki ise kaaran kaarak ke roop mein maana ja sakta hai.^[21] enteebaayotik davaaon ke saath rogiyon mein upachaar ke dauraan paaya gaya hai ki atheroslerosis dil ke dauro ya anya koronari sanvahani hamlon ke jokhim ko kam naheen karta hai.^[22]

subah ke samay mein dil ke daure ke maamalon mein vruddhi hui hai, vishesh roop se lagbhag 9 baje.^[23][24][25] kuchh jaanchakartaaon ne dhyaan diya hai ki sarkaaidiyn maap ke anusaar pletalets ko aur adhik badhaane ki kshamata hai, haalaanki unhein karaneeya saabit naheen kiya gaya hai.^[26]

jokhim kaarak

atheroslerosis ke liye jokhim kaarak rodhagalan ke liye aam kaarak hain:^{[krupaya uddharan jodein]}

• madhumeh (insulin pratirodh ke saath ya bina) - sthaanik araktata sambandhi hrudaya rog ke liye sabse mahatvapoorn jokhim kaarak (IHD).
• tambaakoo dhoomrapaan
• haaiparakolesterolemiya (adhik sangat haaiparalipoprotenemiya vishesh roop se uchch kam ghanatv lepoproteen aur kam uchch ghanatv lepoproteen)
• nyoon echadeeel
• uchch traaiglisraaids
• uchch rakt-chaap
• sthaanik araktata hrudaya rog ke parivaarik itihaas (IHD)
• motaapa^[27] (paaribhaashit baudi maas index ke 30 kg/m² se adhik ya ya vaikalpik roop se ya kamar paridhi dvaara ya hip anupaat paridhi).
• umr: 45 varsh ki umr mein purush svatantr roop se jokhim kaarak ko adhigrahan karte hain, jabki mahila 55 varsh mein svatantr roop se jokhim kaarak ko adhigrahit karti hai, iske alaava anya vyakti svatantr jokhim kaarak ko haasil karte hai yadi unke paas pratham degree purush rishtedaar (bhaai, pita) hote hain jo 55 ki umr se pehle koronari vaiskular se peedit hote hain. ek anya svatantr jokhim kaarak ko adhigrahit kiya jaata hai agar unke paas pratham degree mahila rishtedaar (maan, bahan) hoti hain jo 65 ya chhoti umr mein ek koronari sanvahani ghatna ka saamana karna pada ho.
• haaiparahomosistenamiya (uchch homosisten, ek jahareele rakt emino esid jo ki vitaamin bi₂, bi₆, bi₁₂ ke sevan karne aur folik esid aparyaapt ho)
• tanaav (uchch tanaav soochakaank ke saath vyavasaaya ko atheroslerosis ke liye sanvedanasheelata hone ke liye jaana jaata hai)
• sharaab adhyayanon se pata chalta hai ki lambe samay se sharaab ki uchch maatra dil ke daure ke jokhim ko badha sakta hai.
• mahilaaon ki tulana mein purushon mein iska khatre jyaada hota hai.^[20]

in jokhim kaarakon mein se kai parivrtaneeya hai, iseeliye kai dil ke daure ko ek svasth jeevan shaili banaae rakhane ke dvaara roka ja sakta hai. udaaharan ke liye, shaareerik gatividhi, nyoon jokhim profaail ke saath juda hai.^[28] gair parivrtaneeya jokhim kaarakon mein aayu, ling aur parivaar mein samay se pehle dil ke daure hone vaale itihaas (60 ki umr se pehle), jise aanuvanshik pravruti ke roop mein parilkshit kiya jaata hai, shaamil hain.^[20]

saamaajik aarthik kaarak jaise kam shiksha aur kam aay (vishesh kar mahilaaon mein) aur avivaahit sahavaas emaaai ki jokhim ke liye yogadaan de sakta hai.^[29] mahaamaari vigyaan ke adhyayan ke parinaamon ko samajhne ke liye yeh not karna mahatvapoorn hai ki kai emaaai ke saath jude kai kaarakon anya kaarakon ke maadhyam se iske jokhim ko badhaate hain. udaaharan ke liye, shiksha ka prabhaav iske aay aur vaivaahik sthiti par aanshik roop ke aadhaarit hoti hai.^[29]

ve mahilaaen jo ki sanyukt maukhik garbhanirodhak goli ka upayog karti hain, unamein rodhagalan ka jokhim badh jaata hai, vishesh kar jinmein anya jokhim kaarak vartamaan hote hain jaise dhoomrapaan.^[30]

soojan ko atheroslerotik pattika gathan prakriya mein mahatvapoorn kadam ke roop gyaat kiya jaata hai.^[31] si-pratikriyaasheel proteen (CRP) ek samvedansheel hota hai lekin soojan ke liye gair vishisht maarkar hota hai. uchch seeaarapi rakt star, vishesh roop se samvedansheel pareeksha ke saath maapa gaya, emaaai ke jokhim ko pehchaan sakta hai, saath hi saath daure aur madhumeh ke vikaas ke jokhim ki bhavishyavaani kar sakte hain.^[31] iske alaava, emaaai ke liye kuchh davaaen CRP staron kam karte hain.^[31] saamaanya aabaadi ek saadhan ke roop mein screening seeaarapi jaanch sanvedanasheelata uchch upayog ke viruddh salaah di hai, lekin yeh vivek chikitsak par istemaal kiya ja sakta hai vaikalpik roop se, rogiyon mein rog jo dhamani koronari pehle se hi maujood anya jokhim vaale kaarakon ke saath ya jaana jaata hai.^[32] chaahe seeaarapi naatakon ki pratyaksh bhoomika mein atheroslerosis ek anishchit bani hui ho.^[31]

kaalaavadhi rog mein soojan hone se ho sakta hai vah koronari hrudaya rog se jud sakta hai aur kyonki piriydonatitis aam baat hai, yeh saarvajanik svaasthya hone ke liye mahaan ho sakta tha.^[33] seeram vigyaani vishyon ke adhyayan mein enteebaudi star ke virooddh theth piriydonatitis ke kaaran hone vaale baikteeriya mein paaya gaya, vaise enteebaudi koronari hrudaya rog ke saath adhik maujood hote hai.^[34] eriodontitis saaitokins aadat hai aur, faaibrinojen seeaarapi ko rakt vruddhi ke star ke,^[35] is prakaar, periodontitis kaarakon ke maadhyam se anya jokhim jokhim par emaaai prabhaav ho sakta hai iski madhyasthata.^[36] poorvanaidaanik shodh bataate hain ki piriydonatal baikteeriya pletalets ke ekatreekaran ko badhaava kar sakte hain aur fom sel ke gathan ko aur badhaava dete hain.^[37][38] vishisht piriydonatal baikteeriya ki ek bhoomika ke liye sujhaav diya gaya hai lekin ise sthaapit kiya gaya.^[39] teevr rodhagalan daure ko inflooenja trigr kar sakta, iske pramaan upalabdh hain.^[40]

ganjaapan, baalon ke safed hone, ek vikrn iyaralob crease (Frank sanket^[41]) aur sanbhavat: anya tvacha suvidhaaon ko emaaai ke liye svatantr jokhim kaarak ke roop mein sujhaav diya gaya hai^[42] unki bhoomika vivaadaaspad rahati hai, in chinhon ke aam bhaajak emaaai ke jokhim apekshit hai, sanbhavat: aanuvanshik hai.^[43]

kailshiym jama gathan atheroslerotik pattika ka ek aur hissa hai. koronari dhamaniyon mein kailshiym jama seeti scan ke saath pata lagaaya ja sakta. kai adhyayanon se pata chala hai ki koronari kailshiym kaarakon ke jokhim shaastreeya se pare jaankaari pradaan kar sakte hain.^[44][45][46]

kaardiyolauji ki Europeeya samaaj aur kaardiyovaaskular rokathaam aur punarvaas ke liye Europeeya sangh ne bhavishyavaani ke liye ek intaraiktiv upakaran viksit kiya hai aur Europe mein dil ke daure ke khatre aur stroke ka prabandh kiya hai. haartaskor vyakti hrudaya jokhim mein kami ke anukoolan mein chikitsakon ka samarthan karne ke uddeshya se hai. haartaskor kaaryakram sanskaran 12 bhaashaaon upalabdh hai aur web aadhaarit ya PC sanskaran pradaan karte hai.^[47]

inhein bhi dekhein: Acute coronary syndrome

rodhagalan tab hota hai jab ek dhamaneekalaakaathinya pattika ek koronari dhamani mein dheere-dheere ek androoni parat banaata hai aur fir achaanak fat jaata hai, jiske chalte ek vipttipoorn thrombas ka gathan hota hai, jo dhamani ko poori tarah se band kar deta hai aur rakt ke neeche ki or pravaah ko rokata hai.

hrudaya ka chitr jismein poorvakaal baaen veintrikl deevaar rodhagalan ko pradarshit kiya gaya hai.

teevr rodhagalan, teevr koronari sindrom ke up-prakaar ko sandarbhit karta hai, jiska naam gair ST uchch rodhagalan aur ST uchch rodhagalan hai, jo ki koronari dhamani rog ka ek abhivyakti hai aur sabse adhik hone wala hai (lekin hamesha naheen).^[8] sabse aam trigr ghatna dhamani ki aad mein jiske parinaamasvaroop kul kabhi kabhi vyavadhaan ka ek atheroslerotik koronari epikaardiyl pattika mein ek dhamani, jharana ek thakke ko jo jaata hai.^[48][49] dhamaniyon ki deevaar (is maamale mein, koronari dhamani) mein plaaks mein atheroslerosis kolestraul aur reshedaar ootakon ke kramik vikaas hai, aamtaur par dashakon se adhik.^[50] rakt pravaah stambh aniymittaaen enjiyograafi par dikhaai deti hain jo ki ek sankachit dhamani lumen ko pratibimbit karti hai aur atheroslerosis agrim ke roop mein dashakon ka parinaam hoti hai.^[51] plaaks, asthir, videern ho sakti hai aur iske alaava ek thakka (rakt thakka) ko badhaava deti hai jo ki dhamani ko gher leti hai; yeh ek minute mein ho sakta hai. jab ek kaafi gambhir pattika videern vaiskuletar koronari mein hota hai, yeh rodhagalan (maayokaardiym suraag ke neeche ki aur pariglan) ki or agrasar hoti hai.^[48][49]

agar ashuddh rakt dil mein bahut der tak raha to yeh araktata sambandhi prapaat jaise prakriya ki or agrasar karti hai; koronari dhamani ke kshetr mein hradaya koshikaaen marne lagegi (mukhyat: pariglan ke maadhyam se) aur fir kabhi bhi iska vikaas naheen hoga. inke sthaan par ek kolejan nishaan ka nirmaan hota hai. haal ke adhyayanon se sanket milta hai ki koshikaaon ke aur ek nirmaan ki mrutyu ko apopatosis kaha jaata hai jo ki ootakon ko nuksaan pahunchaane ki prakriya mein bhi bhoomika nibhaati hai aur antat: rodhagalan ki or agrasar hoti hai.^[52] parinaamasvaroop rogi ka hrudaya sthaayi roop se kshatigrast ho jaaega. is maayokaardiyl nishaani bhi rogi ko arhethamiyaas ki sambhaavit jeevan dhamaki deta hai aur parinaamasvaroop veintrikular dhamaneevisfaar ka gathan kar sakta hai jo ki bhayaavah sthiti ke saath videern kar sakta hai.

ghaayal hrudaya ke ootak saamaanya hrudaya ke ootakon ki tulana mein dheere dheere bijli aavegon ka nirmaan karta hai. ghaayal ootak aur achhe ootakon ke beech pravaahakattv veg mein antar pun: pravesh ko badhaava de sakte hain ya ek parinaam jise kai lethal arhethamiyaas ka kaaran maana jaata hai, ka vikaas kar sakta hai. in arhethamiyaas ka sabse gambhir veinteekular faaibreeleshan (V-Fib/VF), hai, ek bahut tej aur araajak hradaya taal hai jo ki achaanak hradaya mrutyu ka mukhya kaaran hota hai. ataalata ka ek aur khatra veinteekular tekeekaardiya (V-Tach/VT) hai, jisse achaanak hrudaya mrutyu ka kaaran ho sakta hai aur naheen bhi ho sakta hai. haalaanki, veinteekular tekeekaardiya ka parinaam aam taur par dil ka dar tej hota hai jo ki hradaya ko prabhaavi roop se rakt ko panp karne se rokata hai. iske chalte kaardiyk aautaput aur raktachaap khatarnaak star mein aa sakta hai, jo ki aage koronari iskemiya aur rodhagalitaansh ka vistaar ho sakta hai.

kaardiyk defeeriletar ek aisa upakaran hai jiska vishisht taur par sambhaavit ghaatak ko samaapt karne ke liye design kiya gaya hai. is upakaran ka istemaal rogi ko bijli ka jhatka dil ke peshi ke mahatvapoorn samooh ko hilaane ke kram kiya jaata hai jisse dil ko riboot kiya jaata hai. yeh chikitsa samay par nirbhar hota hai aur kaardiyopalmonari arest ki shuruaat ke baad teji se safal defeebrileshan giraavat ka antar hota hai.

rodhagalan ka nidaan rogi ke shikaayaton aur shaareerik sthiti ka aakalan karne ke baad kiya ja sakta hai. iseeji parivartan, koronari enjiyograam aur maarkar ke star ke hrudaya ke nidaan mein madad karne ke liye ki pushti karein. iseeji suraag deta hai moolyavaan ko kshati ke daure site ki pehchaan karte hue koronari enjiyograam jahaajon dil ya avarodhon mein sankuchan ki anumati deta hai.^[53] shav pareekshan mein, ek rogavijnyaaani anaatomopaitholaujikl nishkarsh ke aadhaar par nidaan kar sakte hain.

ek chest rediyograaf aur niyamit rakt pareekshan jatiltaaon ya sheegra kaaranon ka sanket kar sakte hain aur aapaat sthiti ki sambhaavana ko darshaate hain. nai kshetreeya deevaar prastaav asaamaanyataaon par ek ikokaardiyograam bhi rodhagalan ke liye vichaarottejak hota hai. iko hrudaya rog visheshagya call ke dvaara maamalon ko golamol kiya ja sakta hai.^[54] sthir rogiyon mein jinke lakshan samay ki oochaai, teknitiym (99mTc) sesataamibi (i.e.ek "MIBI scan") ke dvaara hal kiya jaata hai ya theliym-201 kloraaid ka istemaal nyookliyr dava ke roop mein shaareerik ya faarmokolaujik tanaav ke saath rakt ke kam pravaah vaale kshetron ko dekha ja sakta hai.^[54][55] theliym ka istemaal ootak ke vyavahaaryata ka nirdhaaran karne, gair kaaryaatmak maayokaardiym ke vaastav mein mara hai ki naheen, iski jaanch karne ke liye kiya ja sakta hai ya sheet nishkriyta avastha ke keval jaanch karne ya bhauchakka hone ki jaanch karta hai.^[56]

dablyooechao maapdand^[57] 1979 mein taiyaar kiya gaya hai jiska istemaal emaaai ka nidaan ke liye kiya jaata hai; ek rogi ka ilaaj rodhagalan ke saath kiya jaata hai nimnalikhit maapdand yadi do (sambhaavit) ya teen (nishchit) ko santusht karti hai:

1. iskeemik prakaar ke seene mein 20 minute se adhik samay tak dard ka naidaanik itihaas ho
2. seeriyl iseeji tresing mein parivartan
3. kriyetin kines-emabi ansh aur troponin jaise seriym kaardiyk baayomaarkar ka oonchaav aur giraavat

dablyooechao maapdand ko 2000 mein parishkrut kiya gaya tha taaki kaardiyk baayomaarkar ko pramukhata diya ja sake.^[58] nae disha nirdeshon ke anusaar ek kaardiyk troponin ya to vishisht lakshan, petholaujikl kyoo tarangon, ST eliveshan ya avasaad ya koronari hastakshep aadi emaaai ke nidaan hain.

rodhagalan aavartak jokhim ke ek jeevan shaili mein parivartan ke saath kadaai se kam ho jaati hai raktachaap aur prabandhan, mukhyat: sevan dhoomrapaan band karne, niyamit vyaayaam ke rogiyon ke saath dil ke liye aahaar samajhdaar, ek rog hai, sharaab ki aur seema.

rogiyon emaaai hain pad aamtaur par shuroo kiya par kai deerghakaalik davaaon) CVA durghatana (sarebrovaaskula ya kanjesteev dil vifalta, infrktions, ke uddeshya se rokane maadhyamik hrudaya ki ghatnaaon jaise aage myokardial. kantenadiketed, aisi davaaon sakta hai: jab tak shaamil hain^[59][60]

• pramaan hrudadhamani hrudaya rog ko kam karne ke upaaya ke roop mein santrupt vasa ke bajaay bahuasantrupt vasa ke sevan ka samarthan karta hai.^[61]
• antiplaatelet ya klopidogrel / aur drag therepi jaise espirin rodhagalan daure aavartak chaahiye aur pattika ka tootana ja rahi karne ke liye kam jokhim. espirin pehli line hai, iski kam laagat aur tulaneeya prabhaavakaarita ke liye espirin ki asahishnu rogiyon ke liye aarakshit klopidogrel saath, kaaran. aur espirin klopidogrel sanyojan ki ghatnaaon sakta hai hrudaya ke jokhim ko kam karne aur aage hai, lekin jokhim ka nakaseer. badh jaati hai^[62]
• beeta ya kaarvedilol metoprolol ke roop mein avarodhak chikitsa jaise. chaahiye shuroo ho^[63] in. ischemiya hai uchch kiya gaya hai vishesh roop se laabhaprad mein hrudaya ko jaari rakhane ya / jokhim rogiyon jaise un logon ke saath chhod diya veintrikular mein shithilta aur^[64] β-blaukars kami mrutyu dar aur rugnata. unhonne yeh bhi NSTEMI mein hrudaya ischemiya ke lakshanon mein sudhaar hoga.

• S avarodh karanevaala chikitsa rogiyon-sthir ke baad emaaai mein hemodynaamikaalli ghante kiya jaana chaahiye shuroo 24-48 ke saboot chhod diya hai / ya (ke roop mein infarct, vishesh roop se mareejon ke saath ek itihaas, madhumeh emaaai ka ho sakta, poorvakaal, uchch raktachaap sthaan ka moolyaankan dvaara iseeji,) aur veintrikular mein shithilta. S inhibitors mrutyu dar ko kam karne, dil ki vifalta ke vikaas aur emaaai kami veintrikular remodeling ke baad.^[65]

• sataateen chikitsa emaaai ke baad kiya hai dikhaaya gaya rugnata kam karne ke liye mrutyu dar aur.^[66][67] steteens ka prabhaav unke eladeeel kam karne ke prabhaav se bhi adhik ho sakta hai. aam sahamati hai ki staatins lipids hai pattika sthireekaran aur kai anya ("pleiotropik") prabhaav rakt par unke prabhaav ke alaava rodhagalan rokane ki ho sakta hai.^[68]

• eldosteron pratipkshi agent eplerenone oopar maanak upachaar kiya gaya hai ke saath sanyojan ke roop mein veintrikular rog, jab istemaal kiya chhod diya maut hrudaya dikhaaya ko aur adhik jokhim ko kam karne ke baad aur vifalta dil se emaaai mein rogiyon.^[69] shrpironolaktone laagat hai ek aur vikalp hai ki vajah se hai eplerenone ke liye kabhi kabhi behtar hai.

• omega -3 faiti esid hai, aamtaur par machhali mein paaya, emaaai ke baad kiya hai mrutyu dar ko kam karne ke liye dikhaaya gaya.^[70] jabki vyavastha hai jiske dvaara in faiti esid mein kami mrutyu agyaat hai, yeh maane gaya hai ki uttarajeevita laabh fibrillation nilya mein se ek hai ke kaaran rokathaam aur bijli ke sthireekaran.^[71] tathaapi, jokhim sabaset-aage ke adhyayan mein ek uchch 3 faiti esid spasht kami mein naheen dikhaaya omega sambhaavit ghaatak vajah se.^[72][73]

raktadaan hrudaya rog ke jokhim ko purushon mein kam kar sakta hai,^[74] lekin yeh sambandh drudhta se sthaapit naheen kiya gaya hai.

ek kochraane sameeksha mein paaya gaya ki dil ka daura dene heparin roopon aur kuchh enajaaina ke liye logon ko jo ki tarah asthir shartein hain dil ka daura ek aur dil hone ki kam jokhim. haalaanki, heparin bhi khoon bah raha se thodi si peeda ki sambhaavana badh jaati hai.^[75]

ek emaaai dhyaan hai ek chikitsa aapaat chikitsa ki aavashyakta hai jo tatkaal. ilaaj 'ke prayaas ke roop mein jyaada maayokaardiym nistaaran karne ke liye sambhav hai aur maansapeshiyon ko rokane ke liye aage ki jatiltaaon, is prakaar vaakyaansh samay hai. "^[76] okseejan, espirin, aur naaitroglisreen dilaai ja sakti hai. afeem prabhaavi naheen tha pratishthit kiya gaya naaitroglisreen agar, lekin, yeh NSTEMI ki sthaapana mrutyu dar mein vruddhi ho sakti hai.^[77] sameeksha 2010 ki uchch rodhagalan daure pravaah mein okseejan aur ek 2009 aakaar infarkt paaya vruddhi hui mrutyu dar aur upayog mein bula apni dincharya ke baare mein savaal sifaarish.^[78][79] erkutaneaus koronari) hastakshep (peeseeaai ya fibrinolysis STEMI ek saath un logon mein hain sifaarish ki hai.

jatiltaaon ya charan sakte teevr hote turant baad mein dil ka daura, aavashyakta ho sakti hai samay ke liye viksit ek puraani samasya hai. teevr jatiltaaon dil vifalta bhi shaamil hai agar kshatigrast dil naheen rah gaya hai paryaapt roop se shareer ke chaaron or rakt panp karne mein saksham ho sakti hain dhamaneevisfaar ya maayokaardiym ka tootana, mitraal regurgittion, khaaskar agar rodhagalan illon se bhara hua maansapeshiyon ke rog ka kaaran banta hai aur veintrikular fibrillation jaise, veintrikular taachykaardiya, atrial fibrillation aur dil block. deerghakaalik jatiltaaon dil vifalta, atrial fibrillation aur ek doosare rodhagalan ki vruddhi ki jokhim shaamil hain.

rog ka nidaan pad rodhagalan bahut bhinn hota hai, ek vyakti ke svaasthya, dil ki kshati aur upachaar diya ki seema par nirbhar karta hai. 2005 ke liye avadhi - sanyukt raajya America mein 2008 mein mrutyu dar par 30 dinon ke ausat% ke saath ek 16.6% thi 10.9 se lekar 24.9% karne ke liye aspataal ke aadhaar par.^[80] kamre aapaat sthiti mein upayog char upalabdh hai, parinaam pratikool uchch jokhim ki ek logon ke saath ki pehchaan ki ja sakti hai. ek adhyayan mein paaya ki kam jokhim vaale profaail ke saath ek 0.4% ke rogiyon din se 90 mar gaya ke baad, jabki logon mein uchch jokhim yeh 21.1% thi.^[81]

adhik se kuchh mein shaamil hain reprodusad jokhim stratifying kaarakon: umr, seeram kreatinine par madhumeh, pravesh, sistolik, ya dabaav rakt killip varg ke do ya adhik se adhik khand vichlan-), anusoochit janajaati, hemodynaamik maanakon (jaise dil vifalta, kaardiyk giraftaari, sanvahani paridheeya rog aur maarkaron hrudaya ki oonchaai.^[81][82][83] ansh injekshan aakalan ki baain veintrikular shakti bhavishya kahanevaala sakte hain vruddhi.^[84] kyoo tarangon ke shakun mahatva. hai bahas^[85] rog ka nidaan ho jaata hai ya tootana kaafi daure mukt peshi illon se bhara hua badatar agar ek yaantrik jatilta jaise deevaar.^[86] rodhagalan rugnata aur mrutyu dar se upachaar karne ke liye behtar hai kaaran saal ke sudhaar par.^[87]

rodhagalan, iskeemik hrudaya rog ki ek aam prastuti hai. 2002 mein WHO ne anumaanit kiya, ki duniya bhar mein hone waali mauton mein se 12.6 pratishat iskeemik hrudaya rog se hoti thi^[4] jismein viksit deshon mein yeh maut ka agrani kaaran tha aur vikaasasheel deshon mein eds aur nimn shvasan sankraman ke baad teesare sthaan par aata tha.^[88] prati varsh duniya bhar mein 3 million se bhi adhik log STEMIs aur 4 million log NSTEMIs se grasit hote hain.^[89]

koronari hrudaya rog sanyukt raajya America mein hone waali pratyek 5 mauton mein se 1 ke liye jimmedaar hoti hai. yeh vikaasasheel deshon jaise Bhaarat mein adhik aam hota ja raha hai, jahaan hrudaya rog (seeveedi) maut ka pramukh kaaran hai.^[90] Bhaarat mein 2007 mein hone waali sabhi mauton mein seeveedi ke kaaran hone waali mauton ki sankhya 32% thi aur yeh iske badhkar 1999 mein 1.17 million aur 2000 mein 1.59 million se 2010 mein 2.03 million hone ki ummeed hai.^[91] haalaanki, yeh Bhaarat mein apekshaakrut ek nai mahaamaari hai, yeh jald hi logon mein ek pramukh svaasthya mudda ban gaya jismein seeveedi se hone waali mrutyu ki sankhya 1985-2015 mein dugani ho jaane ka anumaan hai.^[92][93] seeveedi ke kaaran hone waali mrutyu ki dar raajyon ke anusaar vyaapak roop se bhinn hoti hai, jo meghaalaya mein 10% se lekar Punjab mein 49% (sabhi mauton ka pratishat) tak hai. Punjab (49%), Goa (42%), Tamil Nadu (36%) tatha aandhr pradesh (31%) mein uchchatam seeveedi sambandhit mrutyudar anumaanit hai.^[94] raajyavaar matabhedon ko raajyon mein vishisht aahaar jokhim vaale kaarakon ki sanbhavata ke saath sahasanbaddh kiya jaata hai. Bhaarat mein halake-pulake shaareerik vyaayaam ko seeveedi ki ghatna mein kami mein ke saath joda jaata hai (jo vyaayaam karte hain ve vyaayaam na karne vaalon ki tulana mein kam jokhim uthaate hain).^[92]

lok-vidhi mein rodhagalan aam taur par ek beemaari hai, lekin kabhi kabhi ek chot bhi ho sakti hai. iska prabhaav gair-truti beema yojanaaon par padta hai jaise ki kaaryakarta muaavaja. dil ka daura aam taur par ismein samaavisht naheen hota hai,^[95] tathaapi, yeh kaarya-sambandhit chot ho sakti hai, yadi yeh udaaharan ke liye, asaamaanya bhaavanaatmak tanaav ya asaamaanya maanasik tanaav se falit hota hai.^[96] iske atirikt, kuchh nyaaya-kshetron mein, kuchh vishesh vyavasaayon mein kaaryarat vyakti jaise ki police adhikaari ko hue dil ke daure ko kaanoon ya paulisi dvaara kartavya ko line-of-duty ke roop mein vargeekrut kiya gaya hai. kuchh deshon ya raajyon mein, jis vyakti ko pehle rodhagalan ho chuka hai, use aisi gatividhi mein bhaag lene se roka ja sakta hai jo anya logon ka jeevan khatre mein daal de, udaaharan ke liye car chalaana ya havaai jahaaj udaana.^[97]

jin rogiyon ka stem sel upachaar ek rodhagalan (emaaai) ke baad unke khud ke asthi majja se vyootpann ek stem sel ke kaaronari dhamani injekshan ke dvaara kiya jaata hai unamein baane veinteekrular injekshan fraikshan mein sudhaar aur daaesatolik maatra ka ant dekha jaata hai jo plesabo ke saath dikhaai naheen deta. bada praarambhik infarkt aakaar, adhik se adhik sanchaar ko prabhaavit karta hai. chikitseeya pareekshan emaaai oonchaai karne ke liye S ti ke drushtikon ke poorvaj upachaar ek sel jalasek ke roop mein. kaaryavaahi kar rahe hain^[98]

vartamaan mein emaaai ke ilaaj ke liye 3 baayomateeriyl aur ootak engineering drushtikon hain, lekin ye anusandhaan chikitsa ke pehle charan mein hain, isliye rogiyon par aajmaae jaane se pehle kai saare savaalon aur muddon ko sambodhit kiya jaana baaki hai. pehle mein shaamil hai dil ke daure ki rokathaam ke liye bahulak baain veintrikular. doosra vitro engineer kiya hua hrudaya ootak ka upayog karti hain, jo baad mein vivo mein pratyaaropit kiya jaata hai. antim drushtikon mein shaamil hai koshikaaon aur/ya ek paad ko maayokaardiym mein daalna taaki in seetoo engineer kiya hua hrudaya ootak banaaya ja sake.^[99]