I-Sudden Racing Heart (SVT), i-Modified Valsalva Maneuver, kanye ne-Arrhythmia Red Flags¶

Lapho ingane enempilo, osemusha, noma umuntu omdala ezwa inhliziyo yakhe iphenduphenduka njengeswishi elikhanyayo bese igijima ngokushesha kokuthi \(160\text{ ukuya }250\text{ beats per minute}\) ngokushaya kwesibhamu esisheshayo entanyeni, ngokuvamile okubangelwa ukugoba ukuze kubophe isicathulo, ukusukuma ngokushesha, ukuphelelwa amanzi emzimbeni, noma ukucindezeleka okukhulu ** I-Tachycardia (PSVT / SVT)**, iluphu ye-short-circuit kagesi egxile ku-atrioventricular (AV) node*. Nakuba i-SVT engeyona inkimbinkimbi esigulini esizinzile ingashintshwa kaningi ibuyele esigqi esivamile ekhaya kumasekhondi angu-60 kusetshenziswa uphawu oluyingqopha-mlando REVERT Modified Postural Valsalva Maneuver (ephindeka ngaphezu kokuphindwe kabili izinga lokuphumelela lokukhandleka okuyisidala ngokungeza umuntu omdala ovunguza inhliziyo engama-degree angu-45), ukuphakamisa umlenze omdala oshaya kancane ngaphambi kwesikhathi isifo, nanoma ubani oisifuba, ukuphelelwa umoya, noma fainting (syncope) kungaba I-Ventricular Tachycardia (VT) noma I-Pre-Excited Atrial Fibrillation (Wolff-Parkinson-White [WPW] syndrome), engawohloka ibe ukuboshwa kwenhliziyo okubulalayo phakathi nemizuzu. Ukwazi ukuhlola ukuqina kwe-hemodynamic kuqala, yenza okufanayo imizuzwana engu-15 + imizuzwana engu-45 supine leg-lift Modified Valsalva Maneuver, yenza ngokuphepha iphakethe leqhwa ebusweni bengane, futhi ungalokothi uhlikihle imithambo yentamo kusindisa izimpilo.

Yenza lokhu manje¶

1. Hlalisa umuntu noma alale phansi ngokushesha, misa konke ukunyakaza, futhi uhlole I-5 Unstable Arrhythmia Red Flags.
2. Uma umuntu enobuhlungu besifuba, enenkinga yokuphefumula, equleka/esondela ekuqulekeni, edidekile, noma enomlando wesifo senhliziyo (isifo senhliziyo sangaphambili, ukwehluleka kwenhliziyo, noma imisipha yenhliziyo enezibazi), shayela ku-911 / 112 / 999 khona manje (bona konke izinombolo eziphuthumayo). Kunoma ubani onesifo senhliziyo esakhiwe, cabanga ukuthi inhliziyo egijima kungazelelwe ithi Ventricular Tachycardia (VT) kuze kube yilapho i-ECG ehola u-12 ifakazela okuhlukile.
3. Bheka ukushaya kwenhliziyo esihlakaleni (i-radial artery) imizuzwana engu-15 bese ubuza ukuthi ukushaya kwenhliziyo okugijima KUQALE KANJANI:
4. I-Flip-of-a-switch iqala ngokushesha + isigqi esivamile sokuqina kwe-rock ku-\(160\text{ ukuya }ku-240\text{ bpm}\) + ukushaya ngamandla okubonakalayo phansi kwentamo ("Uphawu Lwexoxo"): Okwakudala Supraventricular Tachycardia (AVNRT noma AVRT).
5. Ukusheshisa kancane kancane emaminithini ambalwa + isigqi esivamile ku-\(110\umbhalo{ ukuya }ku-160\text{bpm}\) ngesikhathi sokushisa, izinhlungu, ukuphelelwa amanzi emzimbeni, noma ukwethuka: Cishe Sinus Tachycardia noma ukwethuka (ukunyakaza kwe-vagal kuzonciphisa kancane i-sinus tachycardia imizuzwana emi-3 bese ishesha ibheke phezulu; yelapha umkhuhlane, ukuphelelwa amanzi emzimbeni, noma ukukhathazeka).
6. Isigqi esingavamile ngokwesiphithiphithi ("okungajwayelekile ngokungavamile" ukushaya kwenhliziyo okungenayo iphethini nhlobo): Cishe I-Atrial Fibrillation (AFib) Nempendulo Esheshayo Ye-Ventricular (RVR) (funa ukuhlolwa kodokotela ngokushesha ukuze ulawule izinga nokuvimbela unhlangothi).
7. Ngomuntu omdala ozinzile, ozinzile noma ingane endala ene-SVT esolwayo (kanye namafulegi abomvu angazinzile), yenza i-REVERT Modified Postural Valsalva Maneuver:
8. Isigaba 1 (I-Semi-Recumbent 15-Second Strain): Hlalisa isiguli siqonde \(45\text{-degree}\) angle. Bacele ukuthi badonse umoya ojwayelekile futhi bashaye ngamandla imizuzwana engu-15 egcwele baye esihlokweni sesirinji yomlomo engenalutho \(10\text{mL}\) yepulasitiki yomlomo bezama ukuphusha umbhobho ukuze baphume (noma bancinde ikhala labo futhi bafuthe kanzima ezindebeni ezivaliwe njengokungathi bazama ukuvula izindlebe zabo imizuzwana engu-15 egcwele).
9. Isigaba 2 (I-Immediate Flat Drop + 45-Degree Passive Leg Raise for 45 Seconds): Ekupheleni kokushaya kwemizuzwana engu-15, tshela isiguli ukuthi siyeke ukufutheka futhi siphefumule ngendlela evamile kuyilapho umsizi ngokushesha ebeka isiguli esingenhla somzimba siphansi emhlane waso ($0\imilenze phezulu amadigri aqondile{} \(45\text{-degree}\) angle imizuzwana engu-45.
10. Kungani iSigaba sesi-2 siyimfihlo: Ukuwisa phansi nokuphakamisa imilenze kulahla igagasi legazi le-venous elisuka emilenzeni liqonde ngqo enhliziyweni ngomzuzwana isifuba siyakhululeka, okudala umfutho omkhulu we-vagus nerve pressure ebuyisela i-SVT kusigqi esivamile kumaphesenti angu-43 eziguli ezihlezi (uma kuqhathaniswa namaphesenti angu-17 kuphela we-vasalva).
11. **Enganeni noma encane ene-SVT eyaziwayo noma esolwayo (izinga lenhliziyo elingu-\(220\umbhalo{ ukuya }ku-300\text{ bpm}\), uphaphathekile/ufussy, ungondleki kahle): Faka isikhwama samanzi e-ice esigoqwe ngendwangu ebusweni OKUPHEZULU (ebunzini, amehlo, nebhuloho lekhala) imizuzwana engu-15 ukuya kwangu-10 ngenkathi ubiza imizuzwana engu-15 kuya ku-109
12. Ungalokothi uvale umlomo noma amakhala wengane, futhi ungalinge ucindezele izinkomishi zamehlo omntwana. Ukugqugquzelwa okubandayo kwamagatsha enzwa ye-ophthalmic/maxillary trigeminal nerve ngaphesheya kwesiphongo kanye nebhuloho lekhala kubangela i-mammalian diving reflex, ithumela ukuqhuma kwe-vagal okumisa i-SVT yezingane ngokuphepha.
13. UNGALOKOTHI ucindezele izinhlonze zamehlo (ocular pressure) futhi UNGALOKOTHI uvumele obukele ukuthi ahlikihle noma abhucube imithambo yentamo (carotid sinus massage). Ukucindezela izinhlayiya zamehlo kungakhipha i-retina noma kulimaze i-cornea, kuyilapho ukuhlikihla umthambo we-carotid osentanyeni kungagqashula i-cholesterol plaque engaxilongwa futhi kubangele imidiya unhlangothi.
14. Uma inhliziyo egijimayo ingami ngemva kwemizamo emibili ye-Valsalva Eshintshiwe (noma kuthatha imizuzu engaphezu kwe-15 kuya kwengu-20), hamba kuMnyango Wezimo Eziphuthumayo. Shayela i-ambulensi; ungalokothi uzishayele ngenkathi uku-arrhythmia esebenzayo. Uma isiguli sinodokotela wezifo zenhliziyo, esinikezwe udokotela wenhliziyo "iphilisi-ephaketheni" imithi (efana ne-diltiazem, i-verapamil, noma i-metoprolol), yithathe ngendlela oyalelwe ngayo bese uphumula ngesikhathi usalinde ukunakekelwa kwezempilo.

Isihlahla sesinqumo se-Emergency triage: Inhliziyo egijima kungazelelwe (Tachyarrhythmia)¶

Sebenzisa leli shidi lokugeleza lomtholampilo ukuhlola ukushaya kwenhliziyo okusheshayo futhi unqume ukuthi uyenza nini i-Modified Valsalva Maneuver ngokumelene nokuvuswa kabusha kwesimo esiphuthumayo.

flowchart TD
    Start["Ukushesha Kungazelelwe, Ukushaya kwenhliziyo, noma Ukushaywa Kwenhliziyo<br/>(Isilinganiso Senhliziyo > 130 kuya ku-250+ Ukushaya Ngomzuzu)"] --> UnstableCheck{"Hlola amafulegi abomvu angu-5 ENGAZINZILE:<br/>1. Ubuhlungu besifuba, ingcindezi, noma ukucinana<br/>2. Ukuphelelwa umoya / ukuhefuzela<br/>3. Ukuquleka (syncope), ukudideka, noma isiyezi esinzima<br/>4. Isikhumba esiphaphathekile, esicwebezelayo, esibandayo (Ukwethuka)<br/>5. Umlando Wokuhlaselwa Kwenhliziyo, Ukwehluleka Kwenhliziyo, noma i-VT"}

    UnstableCheck -->|"YEBO (NOMA YILUPHI Ifulegi Elibomvu Ikhona)"| Call911["OKUSHESHAYO 911 / 112 / 999 ISIMO ESIPHUTHUMAYO:<br/>1. Suspect Ventricular Tachycardia (VT), Pre-Excited AFib,<br/> noma Hemodynamically Unstable SVT<br/>2. Lala phansi (noma uqonde uma uphefumula); ZERO ukuhamba<br/>3. Gcina i-AED inamathiselwe/ilungile; lungiselela ukuvumelanisa<br/> i-cardioversion noma i-defibrillation ekufikeni kwe-EMS"]

    UnstableCheck -->|"AWEKHO Amafulegi Abomvu (Isexwayiso Sesiguli, Azinzile,<br/>Abukho Ubuhlungu Besifuba, Ukuphefumula Okujwayelekile)"| PatternCheck{"Hlola Isigqi Se-Pulse & Iphethini Yokuqalisa"}

    PatternCheck -->|"I-PULSE ENGAQHUBEKILE OKUNGAHLANGANISI:<br/>Isigqi sokweqa esinephethini enguziro engabikezelwa"| AFib["MSOLELA I-ATRIAL FIBRILLATION (i-AFib ene-RVR):<br/>1. Ukuqondisa kwe-Vagal NGEKE kuguqule i-AFib ibe isigqi esivamile<br/>2. Funa Igumbi Lezimo Eziphuthumayo / Ukunakekelwa Okuphuthumayo Kwenhliziyo <br/> nge-ECG ehola engu-12, ukulawula izinga, kanye ne-stroke anticoagulation"]

    PatternCheck -->|"ISHESHA KANANCANE (110 kuya ku-160 bpm):<br/>Kuqale kancane ngomkhuhlane, ukuphelelwa amanzi emzimbeni, izinhlungu,<br/>i-caffeine/izikhuthazi, noma ukwethuka okukhulu"| SinusTach["UMSOLWA SINUS TACHYCARDIA:<br/>1. Yelapha i-trigger ekhona (rehydrate amanzi/electrolyte,<br/> yelapha imfiva/ubuhlungu, yenza ukuphefumula kwebhokisi lemizuzwana emi-4)<br/>2. Funa usizo lwezokwelapha uma i-HR ephumule ihlala > 120 bpm"]

    PatternCheck -->|"UKUQHUBEKA 'OKUSHINTSHA-KOKUKHANYA' OKUSHESHAYO:<br/>Ukushaya kwe-Rock-steady okujwayelekile ku-160 kuya ku-250+ bpm<br/>+ Ukugingqika entanyeni ('Uphawu Lwexoxo'):<br/>UMSOLA SUPRAVENTRICULAR TACHYCARDIA (SVT)"| AgeSplit{"Ingabe Isiguli Simdala / Ingane Endadlana<br/>noma Usana / Ujahidada?"}

    AgeSplit -->|"Umuntu omdala noma Ingane Ebambisanayo"| RevertValsalva["YENZA UMGOMO WE-VALSALVA OLUNGISIWE:<br/>1. Hlala kumadigri angu-45 futhi ufuthe ngamandla kusisirinji esingu-10 mL<br/> (noma ngokumelene nekhala elicijile/izindebe ezivaliwe) IMIZUZWANA engu-15<br/>2. Ngokushesha yehlisa i-FLAT yomzimba ongaphezulu (0 deg) bese uphakamisa<br/> yomibili imilenze uye ku-45 DEGREES 45 SECONDS<br/>3. Uma usagijima ngemuva kokuzama okungu-2 -> Shayela i-EMS / Yiya ku-ER<br/> ukuthola i-IV Adenosine noma i-Calcium Channel Blocker"]

    AgeSplit -->|"Usana noma Umntwana Osemusha<br/>(HR 220 kuya ku-300 bpm)"| InfantIce["CALL 911 / 112 / 999 + INFANT DIving REFLEX:<br/>Faka isikhwama samanzi e-ice esigoqwe ngendwangu encane phezu <br/>EBUHLENI, AMEHLO, NENASAL BRIDGE imizuzwana engu-15-20<br/>(UNGALOKO umboze umlomo noma amakhala; UNGALOKOTHI ucindezele amabhola wamehlo)"]

I-Pathophysiology: Isebenza kanjani i-SVT short-circuit nokuthi i-Vagus Nerve iyiphula kanjani iluphu¶

Enhliziyweni enempilo ephumule, konke ukushaya kwenhliziyo kuqala kusixhumi senhliziyo esingokwemvelo ekamelweni eliphezulu kwesokudla (i-sinoatrial [SA] node), linqamula amagumbi aphezulu (atria), kuma imizuzwana engu-\(0.1\text{ isekhondi}\) ku-tollbooth kagesi eyodwa phakathi nendawo yenhliziyo (klzzwxh:0015 -AV) (ama-ventricles) kokuthi \(60\umbhalo{ ukuya }ku-100\text{ amabhithi ngomzuzu}\).

Ku-Paroxysmal Supraventricular Tachycardia (PSVT / SVT), umuntu uzalwa enendlela kagesi engeyona ingozi encane encane, kungaba amathrekhi amabili ahambisanayo ngaphakathi kwenodi ye-AV ngokwayo (AV Nodal Reentrant Tachycardia [AVNRT], ibalwa ku-60% we-SVTric exhumanisa i-micro* ne-muscle* engeziwe) (I-Atrioventricular Reciprocating Tachycardia [AVRT], eyenza u-30% we-SVT, okuhlanganisa I-Wolff-Parkinson-White [WPW] syndrome): 1. Indlela "Ukushintshwa Kokukhanya" Kuvuleka: Ithrekhi eyodwa iqhuba ugesi ngokushesha kodwa ilulama kancane (indlela esheshayo), kuyilapho ithrekhi yesibili iqhuba kancane kodwa ilulama ngokushesha (indlela ehamba kancane). Uma okujwayelekile, okungenangozi ukufinyela kwe-atrial ngaphambi kwesikhathi (ibhithi eyeqiwe / PAC) ivutha ku-millisecond ngqo lapho ithrekhi eyodwa iphumule futhi enye ivuliwe, impulse kagesi ingena kumzila ovulekile futhi izungeleze kuyindingilizi kokuthi \(160\text{kuya }250\text{ revolutions ngomzuzu}\)entry (**a). 2. Okwenza Iziguli Zizizwe Zishaya Entanyeni Yazo ("Uphawu Lwexoxo"): Ku-AVNRT, amagumbi aphezulu (atria) namakamelo aphansi (ama-ventricles) avutha nge-millisecond efanayo ncamashi. Ngenxa yokuthi i-valve ye-tricuspid phakathi kwe-atrium engakwesokudla kanye ne-ventricle yesokudla iyavaleka lapho i-atrium engakwesokudla ifinyela, izibhamu zegazi zibuyela emuva phezulu emithanjeni ye-jugular yangaphakathi yentamo, okudala ukushaya okubonakalayo, okunesigqi phansi kwentamo (i-"Frog Sign") ehlukanisa kakhulu i-SVT ne-tachynic. 3. Kungani iziguli zichama kakhulu phakathi noma ngemva nje kwe-SVT: Lapho i-atria inlula ibhekene namavalvu avaliwe ngo-\(200\text{bpm}\), imisipha yenhliziyo ikhipha ihomoni ebizwa ngokuthi Atrial Natriuretic Peptide (ANP), etshela izinso ukuthi zilahle umthamo omkhulu womchamo ocacile (*tachycardia-induced) phakathi nemizuzu engu-600 ye-polyuria. 4.*Indlela I-Vagal Maneuvers (kanye ne-IV Adenosine) Ephula ngayo I-Loop* Kokubili iluphu ethi*AVNR* kanye ne*AVRkufanele kudle kunodi we-AV** kuwo wonke umlze owodwa. I- Vagus Nerve (Crial Nerve X) izintambo ziqon ngqo ku-AV node futhi ikhiphe i-acetylcholine, ebambezela kafushane ukuqhuba ngenodi ye-AV amasekhondi angu-2 ukuya kwangu-3. Uma ucupha ukuqhuma okunamandla okwanele komsebenzi womthambo we-vagus ukuze uvimbele ithanga ELILODWA ngaphakathi kwenodi ye-AV, ithrekhi yomjaho kagesi eyindilinga ishayisa umgwaqo, icime khona manjalo, futhi isiwashi senhliziyo se-SA node semvelo sibuyela emuva kokuthi \(70\text{kuya }90\text{ bpm}\).

Ukuqhathanisa okuphelele kwezimo ezi-5 zenhliziyo esheshayo¶

Sebenzisa leli thebula lokuxilonga ukuze uhlukanise i-benign sinus tachycardia kanye nokuhlaselwa kokwesaba okuvela ku-SVT, i-atrial fibrillation, kanye ne-tachycardia ye-ventricular esongela ukuphila:

Ukwenziwa kwesinyathelo ngesinyathelo kwe-REVERT Modified Postural Valsalva Maneuver¶

Emashumini eminyaka, usizo lokuqala olujwayelekile lufundise "i-classic sitting Valsalva maneuver" (ukuhlala uqondile futhi ubheke phansi njengokuphuma kwamathumbu), okwaphumelela ngaphansi kwamaphesenti angu-15 kuya kwangu-17 weziguli eziphuthumayo, okuphoqe ngaphezu kwamaphesenti angu-80 eziguli ukuthi zithole i-adenosine ** i-adenosine ** egumbini lezimo eziphuthumayo.

Ngo-2015, ingqophamlando ethi REVERT Randomized Controlled Trial eyanyatheliswa ku-The Lancet (Appelboam et al.) yashintsha imihlahlandlela yezifo zenhliziyo emhlabeni wonke (AHA, ERC, ESC, kanye ne-UK NICE/Resuscitation Council) ngokwethula I-Modified Postural Valsalva I-Postural Valsalva inyuka isuka ku-17 inyuke isuka ku-1, ikhuphuke isuka ku-1 43% enezidakamizwa eziyiziro nemiphumela engemihle eyiziro.

Kungani i-Standard Valsalva Ihluleka, nokuthi Kungani I-45-Degree Leg Lift Isebenza¶

Ukuqondisa kwe-Valsalva kusebenza ku-izigaba ezine zomzimba: - Ngesikhathi Isigaba I kanye Nesigaba II (ukushaya kwemizuzwana engu-15), umfutho ophezulu ngaphakathi kwesifuba ucindezela i-vena cava kuvaleke, ukuvimbela igazi le-venous ukuthi lingabuyeli enhliziyweni. Ngenxa yokuthi igazi elincane lingena enhliziyweni, umfutho wegazi wehla kancane, futhi umzimba empeleni uvula KU-adrenaline (ithoni ezwelayo) kuyilapho uvala UKUVALA inzwa ye-vagus. (I-SVT cishe AYIKUNEMI ngenkathi uphephetha.) - Umlingo kwenzeka Isigaba III kanye Nesigaba IV (imizuzwana emi-5 kuya kwengama-20 NGEMVA kokuba uyekile ukufutheka): Lapho uyeka ukudonsa umoya futhi uphefumula ngendlela evamile, umfutho wesifuba wehla uze ufike kuqanda futhi igazi le-venous elinqanyuliwe libuyela enhliziyweni. Lokho kugeleza kwegazi okuzumayo kwelula izinzwa zokucindezela (baroreceptors) ku-aorta arch kanye nemithambo ye-carotid, okubangela ukuphindaphinda okukhulu I-Vagus Nerve braking reflex (i-Phase IV vagal overshoot) emisa i-SVT. - Okwenza I-Standard Sitting Valsalva Yehlulekile: Uma uhlala uhlezi uqondile lapho uyeka ukuphephetha, amandla adonsela phansi abamba igazi emilenzeni yakho, ngakho-ke amanzi amancane kuphela abuyela enhliziyweni yakho (okudala i-vagal reflex yeSigaba IV esibuthakathaka). - Okwenza Ukuguqulwa Kwe-REVERT Kuphumelele Kathathu: Ngokuthi isiguli sivuthele ngenkathi sihlezi ku-\(45\text{ degrees}\), bese bese lehlisela phansi i-torso yabo ngokushesha (\(0\text{ degrees}\)) kuyilapho siphakamisa imilenze yomibili iye ku-\(45\text{ degrees}\) ngesekhondi ncamashi siyayeka ukuphephetha,\(3 0}umbhalo othi{0}ukulahla amamililitha}\) wegazi lomlenze elihlanganisiwe liqonde ngqo ku-atrium engakwesokudla ngesikhathi seSigaba III**, lishaja kakhulu ukuhlinzwa kwe-baroreceptor yeSigaba IV nokumisa i-SVT phakathi kwamasekhondi angu-10 kuya kwangu-30.

Uhlu Oluqondile Lwezinyathelo Ezi-4 Ukuze Uqhube I-REVERT Modified Valsalva Maneuver¶

   PHASE 1: SEATED STRAIN (15 SECONDS)          PHASE 2: SUPINE + LEG LIFT (45 SECONDS)
        \                                                                   /  /
         \  45 deg   [Blow hard into 10 mL                                 /  /  45 deg
          \______     syringe for 15 sec]        \________________________/  /   Leg Lift
                 \                                 0 deg Flat Back

1. Ukusethwa Kwendawo Nezisetshenziswa:
2. Hlalisa umuntu aqonde \(45\text{-degree}\) semi-recumbent angle embhedeni, esofeni, noma phansi kukhaphethi lapho kunendawo ngemva kwekhanda lakhe ukuze umlalise ngokuphelele ngomzuzwana ongu-1, futhi umsizi (noma isenabelo sezinyawo/udonga) ulungele ezinyaweni zakhe ukuze aphakamise imilenze yakhe.
3. Ungayenza kanjani ingcindezi yokuphefumula eyithagethi engu-\(40\text{ mmHg}\):
   • Izinga Legolide (Indlela Yesirinji engu-\(10\text{ mL}\)): Nikeza umuntu isipetu esihlanzekile, esingenalutho \(10\text{ mL}\) (\(2\text{ teaspoon}\)) isirinji yepulasitiki yomuthi womlomo (uhlobo olufakwe emabhokisini oketshezi e-ibuprofen/acetaminophen). Bacele bafake ithiphu lenobho elincane phakathi kwezindebe zabo futhi baphephethe ngamandla ngokwanele ukuze bazame ukusunduza ipulangwe emuva. (Izifundo zobunjiniyela be-Biomedical zifakazela ukuthi ukufutha ngokumelene ne-plunger yesirinji engu-\(10\text{mL}\) kukhiqiza cishe ncamashi \(40\text{ mmHg}\) yengcindezi ye-intrathoracic, ukucindezela okuphelele kwe-Valsalva reflex.)
   • Enye Indlela Yokungeyona Imishini: Cela umuntu acinde amakhala akhe avaleke ngokuphelele ngesandla esisodwa, avale izindebe zakhe ngokuqinile esithupheni sakhe (njengokufuthela icilongo elingeke likhiphe umoya), futhi afuthe ngamandla ngesifuba nemisipha yesisu njengokungathi uzama ukuvula izindlebe zakhe endizeni noma aqhumise ibhaluni elisha eliqinile.
4. Sebenzisa uhlobo oluqhubekayo lwamasekhondi ayi-15:
5. Yenza umuntu adonse umoya ojwayelekile futhi aphephethe kancane futhi ngamandla imizuzwana eyi-15 egcwele (bala uphimisele: "Inkulungwane eyodwa-inkulungwane, ezimbili-nenye-inkulungwane... kufika eshumini nanhlanu").
6. Bheka ukuqiniswa okubonakalayo kwemisipha yentamo nesisu kanye nokuguquguquka okuncane kobuso. Ungavumeli umoya uphume emakhaleni noma emlonyeni.
7. Sebenzisa i-Instant Postural Drop + 45-Degree Leg Lift (Amasekhondi angu-45):
8. Ku-maki angu-15 ngqo*, tshela umuntu ukuthi: "Yeka ukufutheka, yehlisa izandla zakho, bese uphefumula ngokujwayelekile."
9. Ngesikhathi esifanayo (phakathi kwesekhondi elingu-1 kuya kwemi-2 lokumisa ukushaya), lala ikhanda lomuntu kanye nomzimba wakhe phansi ngokuphelele emhlane wakhe (\(0\text{ degrees}\), susa imicamelo) futhi aphakamise imilenze yawo yomibili eqondile aze afike ku-\(45\text{-degree}\) angle, ebambe amaqakala akhe phezulu (noma uwaphumuze esitulweni*4 isitaki esigcwele).
10. Tshela umuntu ukuthi akhululeke ngokuphelele futhi aphefumule ngokujwayelekile ngenkathi imilenze yakhe iphezulu. Uma ukuqondisa kusebenza, ngokuvamile bazozwa ukushaya okukodwa okunamandla noma ukuphumuza okufushane kwesekhondi elingu-1 phakathi kuka-10 nesekhondi elingu-25 ekuphakamiseni umlenze, okulandelwa ukushaya kwenhliziyo okuzolile, okunensa ngokushesha.
11. Buyela ku-Semi-Recumbent Position bese uhlola kabusha i-Pulse:
12. Ngemuva kwemizuzwana engu-45 imilenze iphakanyisiwe, yehlisa imilenze bese ubuyisela umuntu endaweni enethezekile engu-\(45\text{-degree}\) ehlezi iminithi elingu-1, bese uhlola ukushaya kwesandla.
13. Uma inhliziyo isagijima ngo-\(160\text{ to }240\text{ bpm}\) futhi isiguli sihlale sizinzile, linda imizuzu engu-2 bese wenza isivivinyo sesibili esisodwa se-Modified Valsalva Maneuver. Uma imizamo emibili eyenziwe kahle ingasiguquli isigqi, shayela i-EMS noma uye emnyangweni wezimo eziphuthumayo.

I-Safe vs. I-Vagal Maneuvers Eyingozi: Yini Okufanele Ukusebenzise Nokufanele Ukugweme¶

Ukugxila Okukhethekile: Ukubona I-SVT Ezinsaneni Nezingane Ezincane¶

Ezinganeni ezingaphansi konyaka ongu-1 ubudala, i-Supraventricular Tachycardia (SVT) iyi-arrhythmia eyizimpawu ezivame kakhulu, izinga lokushaya kwenhliziyo elihlokoma phakathi kokuthi \(220\text{ kanye }no-300\text{ beats per minute}\) (uma kuqhathaniswa nesilinganiso senhliziyo somntwana esivamile esingu-\(110\60{}ukuya phezulu{}umbhalo othi b ukuya ku\) \(190\text{ bpm}\) uma ukhala ngomkhuhlane ophezulu). - Okwenza I-SVT Yesana Iphuthelwe Kulula Amahora angu-24: Usana alukwazi ukuthi, "Inhliziyo yami iyagijima." Ingane e-SVT engu-\(260\text{ bpm}\) ingabukeka izole ngokumangalisayo emahoreni okuqala angu-6 kuya kwangu-12, kuze kube yilapho imisipha yenhliziyo iqala ukukhathala (ukuhluleka kwenhliziyo okubangelwa i-tachycardia). - Izimpawu ze-SVT enganeni: - Ukwenqaba kungazelelwe ukuncelisa ibele noma ukuthatha ibhodlela (noma ukujuluka nokuhefuzela ngenkathi uzama ukumunca). - Ukuba nomsindo okungajwayelekile, ukucasuka, ukukhathala, noma isikhumba esimpunga esiphaphathekile/namabala. - Ukuphefumula okusheshayo, okungajulile (tachypnea) nokuphaphazela okubonakalayo kodonga lwesifuba noma izingubo zengane phezu kwesinqe. - I-smartwatch, i-pulse oximeter, noma i-stethoscope phezu kwesifuba sangakwesokunxele esibala ukushaya kwenhliziyo okuqinile ngaphezu kuka-\(220\text{ beats per minute}\) enganciphi lapho ingane izolile. - Okufanele Ukwenzele Ngokushesha Usana Olune-SVT Esolwayo: 1. Shayela u-911/112/999 ngokushesha (izinsana zingase zishintshe zibe ukushaqeka kwe-cardiogenic ngokushesha). 2. Uma umntwana eqaphela futhi ephefumula (noma eyalwe abathumeli bezimo eziphuthumayo/ udokotela wenhliziyo yezingane), gcwalisa isikhwama sepulasitiki nge iqhwa eligayiwe namanzi abandayo, usonge ngendwangu eyodwa encane emanzi, bese ulubeka ngobumnene unqamule uhhafu ongaphezulu wobuso bomntwana (ukumboza isiphongo, amehlo avaliwe, kanye nebhuloho lekhala ngokushiya*** no*** 1) KUPHELA) Amaphesenti angu-100 amboziwe futhi ayabonakala**. 3. Ungalokothi ubambe usana ulubhekise phansi futhi ungalinge ulucindezele emehlweni engane noma endaweni yomugqa.

Okwenzeka Emnyangweni We-Ambulensi Nezimo Eziphuthumayo: "I-Adenosine Moment"¶

Uma i-Modified Valsalva Maneuver ingayeki i-SVT futhi uya emnyangweni wezimo eziphuthumayo, ukwazi ukuthi yini ongayilindela kususa ukwesaba: 1. I-12-Lead ECG Recording: Ngaphambi kokunikeza noma yimiphi imithi, abezimo eziphuthumayo noma abahlengikazi be-ER barekhoda i-ECG ehamba phambili engu-12 phakathi nesigqi esisheshayo (futhi ugcine umugqa wesigqi oqhubekayo usebenza ngesikhathi sokwelashwa) ukuze udokotela wenhliziyo akwazi ukubona uhlobo olunembile lwe-SVT futhi ahlole **Wolff-Parkinson-White evamile (WPWw*thms) i-delta kanye ne-return evamile 2. I-Adenosine ye-Intravenous (\(6\text{ mg}\) bese kuba ngu-\(12\text{mg}\) I-Rapid IV Push): - Nge-SVT evamile eyinkimbinkimbi, odokotela babeka i-IV emthanjeni omkhulu eduze nokugoba kwendololwane (i-antecubital fossa) futhi bajove adenosine okulandelwa ngokushesha ukukhishwa kwesaline ka-\(20\text{mL}\) okusheshayo. - Imizwa Injani I-Adenosine (Isiqinisekiso Esibalulekile): I-Adenosine i-molecule yemvelo ye-purine ene-ultra-short half-life ngaphansi kwamasekhondi angu-10. Uma ishaya inhliziyo, ivimba ngokuphelele inodi ye-AV3 kuya kumizuzwana engu-6 ukuze iqalise kabusha uhlelo lukagesi lwenhliziyo. Amasekhondi angu-5 kuya kwangu-10, isiguli sizozwa ukufudumala okuzumayo okuguquguqukayo okuzumayo esifubeni nasebusweni, umuzwa omfushane wokuphelelwa umoya, nomuzwa ongavamile lapho inhliziyo yaso imile, bese imizuzwana engu-10 kamuva umuthi usuphelile ngamaphesenti angu-100 emzimbeni futhi inhliziyo ishaya ngokuthula ku-\(80\text{ bpm}\). - (Okunye okukhethwa kukho kwesibhedlela esithambile: Ukuhlolwa komtholampilo kwakamuva kubonisa ukuthi izithiyo zesiteshi se-calcium ezifakwa emthanjeni ezifana ne-diltiazem noma i-verapamil ezinikezwe njengokumnika okunensayo kwemizuzu engu-20 IV ziguqula i-SVT kokuthi >90% weziguli ezizinzile ngaphandle kokuphumuza isifuba kwemizuzwana engu-6 kwe-adenosine.) 3. Ukwelashwa Kwesikhathi Eside (Catheter Ablation): Ngemva kwesiqephu se-SVT, ukudluliselwa ku-cardiac electrophysiologist (EP) kuvumela inqubo yesiguli esilaliswayo ehlasela kancane ebizwa ngokuthi catheter ablation, eyelapha unomphela i-AVNRT kanye ne-AVRT/WPW ku-*95 kuya kumaphesenti angu-98 eziguli ezidinga imithi nsuku zonke.

Umbhalo oqondile wokuxhumana we-911/112/999 kanye nokuhlolwa esibhedlela¶

Sebenzisa le mibhalo ecacile yomtholampilo lapho ubiza abathumeli bezimo eziphuthumayo noma ufika esibhedlela:

• Ngenhliziyo Egijimayo Engazinzile (Ubuhlungu Besifuba, Ukuphefumula Kafushane, Ukuquleka, noma Isifo Senhliziyo Sangaphambili):

  "Ngidinga i-ambulensi yezimo eziphuthumayo enomshini wenhliziyo/i-defibrillator [Ikheli Elinembile]. Isiguli sineminyaka [Yobudala] enokushaya kwenhliziyo okugijima kungazelelwe okucishe kube [Inombolo] ukushaya ngomzuzu okuhambisana [nobuhlungu besifuba / ukuphelelwa umoya / isiyezi / ukuquleka / umlando wokuhlaselwa yinhliziyo kwangaphambili noma ukuhluleka kwenhliziyo]. phansi ngokuphumula okuphelele."

• Okwe-SVT Esolwa Ngokuzinzile (Lapho Uya ku-ER Ngemva Kwe-Valsalva Elungisiwe):

  "Ngisesimweni esiphuthumayo kanye nesiguli esineminyaka engu-[Ubudala] esiye saba ne-tachycardia 'yokushintsha ukukhanya' ngokuzumayo cishe ngokushaya okungu- [180 kuya ku-220] ngomzuzu kusukela ku- [Isikhathi ]. Isiguli siqaphile ngaphandle kobuhlungu besifuba, futhi izivivinyo ezimbili ze-REVERT Modified Postural Valsalva Maneuver azange ziguqule i-ECG. kuyilapho i-arrhythmia isebenza kanye nokuhlolwa kokuguqulwa kwe-SVT."

• Okosana Olune-SVT Esolwayo (\(>220\text{ bpm}\)):

  "Ngidinga i-ambulensi yezingane eziphuthumayo kokuthi [Ikheli Langempela]. Usana lwami [Ubudala] olunenyanga ubudala luphaphathekile, lwenqaba ukudla, futhi lushaya ngamandla ukushaya kwenhliziyo okudlula [220 kuya ku-280] ngomzuzu ngaphandle kwemfiva. Sisola ukuthi i-Infant Supraventricular Tachycardia (SVT)."

Imibuzo evame ukubuzwa¶

Kungani ukuphakamisa imilenze yami iye kumadigri angu-45 ngemva nje kokuvunguza (i-REVERT Modified Valsalva) isebenza ngaphezu kokuphindwe kabili kanye nokugoba nje lapho ngihlezi?¶

Ukuphefumula ngamandla imizuzwana eyi-15 kwakha umfutho ophezulu esifubeni ovimba igazi okwesikhashana ukuthi lingabuyeli enhliziyweni yakho; ukuhlinzwa kwangempela kwe-vagus nerve okumisa i-SVT kwenzeka imizuzwana emi-5 kuye kwengama-20 NGEMVA kokuyeka ukuphephetha, lapho igazi ligijima libuyela enhliziyweni futhi lelula izinzwa zomfutho we-aorta. Uma uhlala uqondile lapho uyeka ukuphephetha, amandla adonsela phansi abamba lelo gazi emilenzeni yakho; ngokubeka iqolo lakho ngokushesha bese uphakamisa imilenze yakho iye kuma-degree angu-45 okwesibili uyeka ukuphephetha, amandla adonsela phansi athululela igagasi elikhulu legazi lomlenze liqonde esifubeni sakho, kubangele i-vagus nerve reflex enamandla emisa i-SVT kumaphesenti angu-43 abantu.

Ngingawubona kanjani umehluko phakathi kwe-panic attack (sinus tachycardia) ne-Supraventricular Tachycardia (SVT)?¶

Nakuba kokubili kubangela inhliziyo eshaya ngamandla, ukujuluka, nomuzwa wokwesaba, i-SVT inyakaza ngokushesha ekushayeni kwenhliziyo okukodwa (ngokuvamile lapho igoba noma inyakaza ngokuzumayo) futhi ishaya ngezigqi eziqinile ezingu-160 kuya kwezingu-250 ngomzuzu ngokushaya ngamandla okubonakalayo phansi kwentamo ("Uphawu Lwexoxo"), bese lucisha ngokuzenzakalelayo ukushaya okukodwa. I-panic attack (sinus tachycardia) ikhuphuka kancane kancane emaminithini ambalwa, akuvamile ukuba idlule u-150 kuya ku-160 beats ngomzuzu kubantu abadala, futhi yehla kancane kancane emaminithini angu-10 kuya kwangu-30 njengoba wehlisa umoya.

Kungani kuyingozi ukuthi ilungu lomndeni lingihlikihle intamo (i-carotid sinus massage) noma licindezele amehlo ami ukuze limise inhliziyo egijimayo?¶

Ukuhlikihla umthambo we-carotid entanyeni kungase kuvuleke i-cholesterol plaque engatholakalanga ngaphakathi odongeni lwemithambo yegazi futhi kudubule ihlule legazi ngqo ebuchosheni, kubangele unhlangothi olusheshayo, olukhubazeke unomphela. Ukucindezela ama-eyeball (i-oculocardiac reflex) kungadabula noma kunqamule i-retina futhi kulimaze iso; akukho ukuqondisa okufanele kwenziwe ngaphandle kwezilungiselelo zesibhedlela, ikakhulukazi uma i-REVERT Modified Valsalva Maneuver ephephile isebenza ngempumelelo kakhulu.

Kungani kufanele ngichame kakhulu ngemva kwesiqephu se-SVT noma i-atrial fibrillation?¶

Lapho amagumbi angaphezulu enhliziyo yakho (i-atria) eshaya kumavalvu enhliziyo evaliwe ngamabhithi angu-180 kuya kwangu-220 ngomzuzu, izindonga zemisipha ye-atrial enwetshiwe zikhulula ihomoni yemvelo ebizwa ngokuthi i-Atrial Natriuretic Peptide (ANP) egazini lakho. I-ANP itshela izinso zakho ukuthi zikhiphe ngokushesha i-sodium namanzi ukuze kwehlise umthamo wegazi, okubangela isikhukhula esingenangozi ngokuphelele sokuchama okucacile phakathi noma phakathi nemizuzu engu-30 ngemva kwesiqephu senhliziyo esigijimayo.

Imithombo ihloliwe¶

• I-Lancet (BUYELA Isivivinyo Esilawulwa Ngokungahleliwe, e-United Kingdom): Ukuguqulwa Kweposi ku-Standard Valsalva Maneuver for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomized Controlled Trial (Appelboam et al., The Lancet 2015) isungula i-$ 2015; isungula i-$ 2015; ku-\(45^\circ\) kulandele i-45-second supine \(0^\circ\) + \(45^\circ\) leg raise protocol).
• I-American Heart Association (AHA), I-American College of Cardiology (ACC), ne-Heart Rhythm Society (HRS, United States): Isiqondiso Sokuphathwa Kweziguli Ezikhulile Ezine-Supraventricular Tachycardia kanye Ne-AHA Adult & Pediatric Advanced Life Support (ACLS / PALS) Ama-algorithms e-Tachyarrhythmia.
• ** I-European Society of Cardiology (ESC) kanye ne-European Resuscitation Council (ERC):** Imihlahlandlela ye-ESC Yokuphathwa Kweziguli ezine-Supraventricular Tachycardia (Isincomo se-Class I se-Modified Postural Valsalva Maneuver kanye nokugwema ukucindezela kwe-ocular).
• I-Resuscitation Council UK kanye ne-National Institute for Health and Care Excellence (NICE, United Kingdom): Iziqondiso ze-Peri-Arrest Tachycardia kanye ne-Pediatric SVT Facial Ice Application.

Iziqondiso ezihlobene¶

• I-defibrillator (ICD) egxiliwe yokushaqeka kwesiphepho kanye nokungasebenzi kahle kwe-pacemaker
• I-acute myocarditis, i-pericarditis, kanye nokuhlolwa kobuhlungu besifuba sendawo
• Ukuqashelwa kokuhlaselwa yinhliziyo kanye nosizo lokuqala
• Ukuquleka (i-syncope) usizo lokuqala kanye namafulegi abomvu enhliziyo
• Ukuhlaselwa kwe-panic kanye namasu okumisa i-hyperventilation