T\u00fcm d\u00fcnyada oldu\u011fu gibi \u00fclkemizde de \u00f6l\u00fcmlerin \u00e7ok b\u00fcy\u00fck b\u00f6l\u00fcm\u00fc kalp damar hastal\u0131klar\u0131ndan kaynaklan\u0131r. Kalp damar hastal\u0131klar\u0131n\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131 daha \u00f6nce ciddi bir belirti vermeksizin aniden ortaya \u00e7\u0131kar. Kalbe ait hastal\u0131klar nefes darl\u0131\u011f\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, \u00e7arp\u0131nt\u0131 ve erken yorulma gibi semptomlar ile hekime ba\u015fvurur. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 kalp damar t\u0131kan\u0131kl\u0131\u011f\u0131n\u0131n en \u00f6nemli ve olduk\u00e7a s\u0131k bir belirtisidir. Bu nedenle g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 ile ilgili \u015fikayetlerin kayna\u011f\u0131 iyice ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. Bunun d\u0131\u015f\u0131nda akci\u011ferlerden, boyun ve omuzlardan, g\u00f6\u011f\u00fcs kafesinin kemik, kas ve eklemlerinden, kar\u0131n i\u00e7i organlar\u0131ndan kaynaklanan ve g\u00f6\u011f\u00fcste duyulan a\u011fr\u0131lar da vard\u0131r. Bazen herhangi bir hastal\u0131\u011fa ba\u011fl\u0131 olmaks\u0131z\u0131n psikolojik a\u011fr\u0131lar da olabilir. Ancak t\u00fcm bunlar\u0131n d\u0131\u015f\u0131nda kalbe ait sebepler ayr\u0131 bir \u00f6nem arz etmektedir. Kalple ili\u015fkili g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131n\u0131n kalp d\u0131\u015f\u0131 g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131ndan ayr\u0131m\u0131 olduk\u00e7a \u00f6nemlidir. Kalp doktoru a\u011fr\u0131n\u0131n \u015fekli, yay\u0131l\u0131m\u0131 ve s\u00fcresine g\u00f6re s\u0131n\u0131flama yapar.<\/p>\n
Her \u015feyden \u00f6nce sigara i\u00e7en, \u015feker hastal\u0131\u011f\u0131, Hipertansiyon ve \u015feker hastal\u0131\u011f\u0131 olan, ailesinde \u00f6zellikle gen\u00e7 ya\u015fta kalp krizi hikayesi bulunan \u015fah\u0131slarda g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131n\u0131 dikkatle de\u011ferlendirmek gerekir. Ya\u015fl\u0131, \u015feker hastal\u0131\u011f\u0131, sigara kullan\u0131m\u0131, hipertansiyon ve kolesterol d\u00fczeyi y\u00fcksek olan hastalarda g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 kalp kaynakl\u0131 olmas\u0131 ihtimali y\u00fcksektir. Daha \u00f6nceden kalp krizi ge\u00e7iren, koroner k\u00f6pr\u00fcl\u00fcme (by-pass) ameliyat\u0131 veya koroner stent tak\u0131lm\u0131\u015f hastalarda \u00f6nceki ya\u015fad\u0131\u011f\u0131 a\u011fr\u0131ya benzer a\u011fr\u0131 olursa \u00f6nemlidir. Kalbe ait g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 genellikle y\u00fcr\u00fcmekle (\u00f6zellikle yoku\u015f yukar\u0131 ve yemekten sonra) ortaya \u00e7\u0131kar. G\u00f6\u011f\u00fcste a\u011fr\u0131, bask\u0131 veya s\u0131k\u0131\u015fma hissi olarak tan\u0131mlan\u0131r. \u00c7o\u011funlukla g\u00f6\u011fs\u00fcn \u00fcst k\u0131sm\u0131nda hissedilmesine ra\u011fmen bazen orta, alt k\u0131sm\u0131nda ve s\u0131kl\u0131kla sol tarafta hissedilebilir. G\u00f6\u011fs\u00fcn sol taraf\u0131ndan sol kola do\u011fru yay\u0131l\u0131m\u0131 olabilir. Anjina pektoris dedi\u011fimiz bu tip g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 kararl\u0131 ve sabit olup, eforla ortaya \u00e7\u0131km\u0131\u015fsa 5\u201310 Dakika dinlenmekle veya nitrat (isordil ) al\u0131m\u0131 ile ge\u00e7er. Anjina ata\u011f\u0131 genellikle yoku\u015f yukar\u0131 t\u0131rmanmak, \u00e7ok yemek yemek, \u00e7ok S\u0131cak veya so\u011fuk havalarda d\u0131\u015far\u0131 \u00e7\u0131kmak, a\u015f\u0131r\u0131 \u00fcz\u00fclmek gibi kalbinizin i\u015f y\u00fck\u00fcn\u00fcn artt\u0131\u011f\u0131 durumlarda meydana gelir.<\/p>\n
Uzun s\u00fcren (saatlerce) g\u00f6\u011f\u00fcs a\u011fr\u0131lar\u0131 kalp krizinin belirtisi olabilece\u011finden uyan\u0131k olmak gerekir. \u00d6ncesinde kalp krizi ge\u00e7irmi\u015f, koroner k\u00f6pr\u00fcleme veya stent i\u015flemi yap\u0131lm\u0131\u015f ki\u015fi 10 dk uzun s\u00fcren, 3 kez dilalt\u0131 nitrat (isordil 5 mg) almas\u0131na ra\u011fmen devam eden a\u011fr\u0131s\u0131 olursa acil birimlere ba\u015fvurmal\u0131d\u0131rlar m\u00fcmk\u00fcnse bir kardiyoloji uzman\u0131nca de\u011ferlendirilmelidirler. \u00c7\u00fcnk\u00fc istirahatta gelen uzun s\u00fcren g\u00f6\u011f\u00fcs a\u011fr\u0131lar\u0131 kalp krizi veya kalp krizi \u00f6ncesi (akut koroner sendrom) acil durum habercisidir.<\/p>\n
G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 istirahatta geliyorsa, al\u0131\u015f\u0131lm\u0131\u015f\u0131n d\u0131\u015f\u0131nda uzuyorsa, dilalt\u0131 ilac\u0131 almakla ge\u00e7miyorsa, daha d\u00fc\u015f\u00fck seviyeli eforlarla geliyorsa, koroner damarda daralan b\u00f6lgede \u00fclserle\u015fme ve p\u0131ht\u0131 oturma i\u015fi ba\u015flam\u0131\u015fsa tedaviye hemen ba\u015flanmazsa kalp krizinin yakla\u015ft\u0131\u011f\u0131n\u0131 haber verir. S\u00f6z\u00fcn\u00fc etti\u011fimiz belirtiler ihmal edilmemelidir.<\/p>\n
Kalbi besleyen damarlar\u0131n daralmas\u0131 sonucunda olu\u015fmaktad\u0131r. Buna ba\u011fl\u0131 olarak kalbin beslenmesinde bozukluk geli\u015fmekte ve bu bozukluk sonras\u0131 g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 hissedilmektedir. Kalp damar hastal\u0131klar\u0131n\u0131n ba\u015flang\u0131\u00e7 d\u00f6neminde \u00f6zellikle eforla artan ve istirahatta azalan g\u00f6\u011f\u00fcs a\u011fr\u0131lar\u0131 g\u00f6zlenir. Hastal\u0131k ilerledik\u00e7e, spazm veya damarda p\u0131ht\u0131 olu\u015fursa istirahatta da g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 belirlenmeye ba\u015flar. Bu a\u011fr\u0131lar \u00f6nemsenmedi\u011fi takdirde kalp krizi ile sonlanmaktad\u0131r. \u00d6zellikle ya\u015fl\u0131, diyabetik ve hipertansiyon hastalar\u0131nda bu a\u011fr\u0131lar dikkatle ele al\u0131nmal\u0131d\u0131r. Kalp spazm\u0131 ve kalp krizlerinde g\u00f6zlenen a\u011fr\u0131 genellikle sol g\u00f6\u011f\u00fcsten sol omuza ve kola, s\u0131rta yay\u0131lan yanma, ezici bask\u0131 tarz\u0131nda a\u011fr\u0131d\u0131r. Bazen a\u011fr\u0131 boyunda, di\u015f etlerinde ve mide b\u00f6lgesinde hissedilmektedir. A\u011fr\u0131 ile birlikte fenal\u0131k hissi, bulant\u0131, kusma, so\u011fuk terleme, nefes darl\u0131\u011f\u0131 g\u00f6r\u00fclebilir. Hastan\u0131n cildinde solukluluk ve terleme mevcuttur. Hastan\u0131n y\u00fcz ifadesinde endi\u015fe ve korku hakimdir. Kalp zar\u0131 iltihaplar\u0131nda da sol g\u00f6\u011f\u00fcste a\u011fr\u0131 olabilir, a\u011fr\u0131 s\u00fcreklidir ve beraberinde hafif ate\u015f ve \u00f6ks\u00fcr\u00fck vard\u0131r.<\/p>\n
AKC\u0130\u011eER HASTALIKLARINDA G\u00d6\u011e\u00dcS A\u011eRISI <\/p>\n
Akci\u011fer hastal\u0131klar\u0131nda da s\u0131kl\u0131kla ilk belirti g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 olabilir. A\u011fr\u0131 genellikle sa\u011f veya sol tarafta nefes almakla artan batma \u015feklinde a\u011fr\u0131d\u0131r. Beraberine \u00f6ks\u00fcr\u00fck ve balgam \u00e7\u0131karma genellikle vard\u0131r. Akci\u011fer Kanserinde ve akci\u011ferde Su topland\u0131\u011f\u0131 zaman \u00f6ks\u00fcr\u00fck olmaks\u0131z\u0131n kuru inat\u00e7\u0131 bir a\u011fr\u0131 olabilir. A\u011fr\u0131 ile birlikte uzun s\u00fcren kanl\u0131 balgam \u00e7\u0131karma, gece terlemesi, kilo kayb\u0131 altta k\u00f6t\u00fc huylu bir hastal\u0131k olabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcr\u00fcr. Ani ba\u015flayan \u00f6ks\u00fcr\u00fck, ate\u015f ve g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 daha \u00e7ok bron\u015fit ve zat\u00fcrreeye (pnomoni) ba\u011fl\u0131d\u0131r. Beraberinde bo\u011faz a\u011fr\u0131s\u0131, burunda akma, hap\u015f\u0131rma gibi di\u011fer enfeksiyon belirtileri de vard\u0131r. G\u00f6\u011f\u00fcs yap\u0131s\u0131 dar ince yap\u0131l\u0131 gen\u00e7 hastada nefes darl\u0131\u011f\u0131 ile birlikte g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 olmas\u0131 b\u00fcl patlamas\u0131 sonras\u0131 pn\u00f6motoraks akla getirir. Diyaliz hastalar\u0131nda, fel\u00e7li, yatalak hastalarda nefes darl\u0131\u011f\u0131 ile beraber yan a\u011fr\u0131s\u0131 olmas\u0131 kalbe p\u0131ht\u0131 atmas\u0131nda olur.<\/p>\n
KEM\u0130K VE KAS A\u011eRILARI<\/p>\n
Boyun ve s\u0131rt omurlar\u0131nda kire\u00e7lenme veya f\u0131t\u0131kla\u015fma sinir k\u00f6klerine bask\u0131 yaparak boyuna, omuza ve kola, g\u00f6\u011fse vuran a\u011fr\u0131lara sebep olabilir. Bu durum \u00f6zellikle sol tarafta oldu\u011fu zaman kalp a\u011fr\u0131lar\u0131 ile kar\u0131\u015fabilir. Bu a\u011fr\u0131lar boyun ve kol hareketleriyle ayr\u0131ca \u0131k\u0131nma ve \u00f6ks\u00fcr\u00fckle artan a\u011fr\u0131lard\u0131r. Boyun f\u0131t\u0131\u011f\u0131 olan hastalarda boyun a\u011fr\u0131s\u0131 olmaks\u0131z\u0131n s\u00fcrekli g\u00f6\u011f\u00fcs ve s\u0131rt a\u011fr\u0131s\u0131 olabilmekte ve bu hastalar tan\u0131 konulana kadar koroner anjiyografiye kadar gidebilmektedir. Kola yay\u0131lan a\u011fr\u0131n\u0131n uzun s\u00fcreli olmas\u0131, boyun hareketi ile artmas\u0131 ileri safhada uyu\u015fukluk his ve g\u00fc\u00e7 kayb\u0131n\u0131n e\u015flik etmesi ile ay\u0131rt edilir.<\/p>\n
So\u011fuk alg\u0131nl\u0131\u011f\u0131na ba\u011fl\u0131 olarak g\u00f6\u011f\u00fcs ve s\u0131rtta kas a\u011fr\u0131lar\u0131 olu\u015fabilir. Halsizlik k\u0131rg\u0131nl\u0131k omuz tutulmas\u0131 hareketlerin a\u011fr\u0131l\u0131 olmas\u0131 viral a\u011fr\u0131lar\u0131 d\u00fc\u015f\u00fcnd\u00fcr\u00fcr. D\u00f6k\u00fcnt\u00fc bir hastal\u0131k olan zonada d\u00f6k\u00fcnt\u00fcler ba\u015flamadan 1\u20132 hafta \u00f6nce s\u0131rt ve g\u00f6\u011f\u00fcste yanma, ka\u015f\u0131nma ve zonklama \u015feklinde \u015fiddetli a\u011fr\u0131 olabilir. D\u00f6k\u00fcnt\u00fclerin ba\u015flamas\u0131 ile tan\u0131 konulur. Zona hastal\u0131\u011f\u0131nda d\u00f6k\u00fcnt\u00fc ge\u00e7se de a\u011fr\u0131 aylarca s\u00fcrebilir.<\/p>\n
G\u00f6\u011f\u00fcste k\u0131k\u0131rdak ile kemik bile\u015fim yerlerinde a\u011fr\u0131 k\u0131zar\u0131kl\u0131k hassasiyetin e\u015flik etti\u011fi k\u0131k\u0131rdak iltihabi (teitze-kostakondritis) g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 yapar. Lokalize, keskin, nefesle veya pozisyonla artan g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131yla karakterizedir. G\u00f6\u011f\u00fcs duvar\u0131n\u0131n palpasyonuyla a\u011fr\u0131 artar. Kostokondrit ve Tietze Sendromu a\u011fr\u0131 nedeni olabilir.<\/p>\n
M\u0130DE RAHATSIZLIKLARI VE G\u00d6\u011e\u00dcS A\u011eRISI<\/p>\n
Yemek borusunun \u00fclserlerinde, iltihaplar\u0131nda g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 olabilir. \u00d6zellikle refl\u00fc hastal\u0131\u011f\u0131 olanlarda kar\u0131n a\u011fr\u0131s\u0131 olmaks\u0131z\u0131n nadiren sadece g\u00f6\u011f\u00fcste yanma \u015feklinde a\u011fr\u0131 olabilir. Nadir ama hayat\u0131 tehdit eden bir durum da \u00f6zefagus r\u00fcpt\u00fcr\u00fcd\u00fcr. Substernal, kusmay\u0131takiben aniden ortaya \u00e7\u0131kan \u015fiddetli a\u011fr\u0131 vard\u0131r. Hastalar genellikle hasta g\u00f6r\u00fcn\u00fcml\u00fc, terli ve dispneiktir. FM s\u0131kl\u0131kla normaldir ancak pn\u00f6mothorax veya cilt alt\u0131 amfizemi olabilir. Plevral ef\u00fczyon, pn\u00f6mothorax, pn\u00f6momediasteneum ve pn\u00f6moperiteneum olabilir.<\/p>\n
Mide \u00fclserinde ve gastritlerde g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 ile birlikte ek\u015fime, yanma, \u015fi\u015flik, kab\u0131zl\u0131k ve Gaz \u015fikayetleri mevcuttur. Gastrit, \u00d6zefagial Refl\u00fc, Peptik \u00dclser gibi nedenleray\u0131r\u0131c\u0131 tan\u0131da d\u00fc\u015f\u00fcn\u00fclmelidir.\u00a0 Duedonal \u00fclserde a\u011fr\u0131 yemeklerden sonra azal\u0131r, gastrik \u00fclserde yemekle artar. Safra kesesi ta\u015flar\u0131nda ve iltihaplar\u0131nda sa\u011f omuza, s\u0131rta, bele ve g\u00f6\u011fse vuran a\u011fr\u0131lar olabilir. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 genellikle sa\u011f tarafta olmak \u00fczere bazen sol g\u00f6\u011f\u00fcste de a\u011fr\u0131 hissedilebilir.<\/p>\n
Panik bozukluk: aniden ve beklenmedik bir bi\u00e7imde ortaya \u00e7\u0131kan; kalp \u00e7arp\u0131nt\u0131s\u0131, terleme, titreme, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, nefes almasa zorluk, ki\u015finin kendini \u00e7\u0131ld\u0131racakm\u0131\u015f gibi hissetmesi bi\u00e7iminde g\u00f6r\u00fclen yo\u011fun bir kayg\u0131 n\u00f6betidir. S\u0131k kar\u015f\u0131la\u015f\u0131lan panik atak durumunda da s\u0131kl\u0131kla g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 vard\u0131r. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131yla birlikte hastada yo\u011fun bir stres, nefes darl\u0131\u011f\u0131, \u00e7arp\u0131nt\u0131, ellerde uyu\u015fma s\u00f6z konusudur. Hastalar genellikle kalp krizi endi\u015fesiyle acil poliklini\u011fine ba\u015fvururlar.<\/p>\n
ANG\u0130NA PEKTOR\u0130S<\/p>\n
Anjina pektoris, kalp kas\u0131n\u0131n Oksijen ihtiyac\u0131 ve beslenmesi aras\u0131ndaki dengenin bozulmas\u0131 sonucunda olu\u015fan kalp k\u00f6kenli g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 ve g\u00f6\u011f\u00fcste s\u0131k\u0131nt\u0131 hissi olarak tan\u0131mlan\u0131r. G\u00f6\u011f\u00fcsteki s\u0131k\u0131nt\u0131 hissi hastalar taraf\u0131ndan s\u0131k\u0131\u015fma, \u2018bask\u0131, \u2018yanma’, \u2018a\u011f\u0131rl\u0131k’, \u2018a\u011fr\u0131’,\u2018daralma’, \u2018bo\u011fulma’, gibi tarif edilmektedir. A\u011fr\u0131n\u0131n baz\u0131 karekteristik \u00f6zellikleri anjina tan\u0131s\u0131n\u0131 desteklemektedir. A\u011fr\u0131n\u0131n yeri, s\u00fcresi, niteli\u011fi, a\u011fr\u0131y\u0131 ba\u015flatan etkenler, a\u011fr\u0131y\u0131 ge\u00e7iren etkenler a\u011fr\u0131n\u0131n anjinal a\u011fr\u0131 olup olmad\u0131\u011f\u0131 y\u00f6n\u00fcnde de\u011ferli bilgiler vermektedir.<\/p>\n
Anjinal a\u011fr\u0131 genellikle g\u00f6\u011f\u00fcste iman tahtas\u0131 ad\u0131 verilen g\u00f6\u011f\u00fcs kemi\u011finin alt\u0131nda veya hafif solunda hissedilir. A\u011fr\u0131 bazen sa\u011f g\u00f6\u011f\u00fcse, kollara, boyna, \u00e7eneye, s\u0131rta, enseye yay\u0131l\u0131m g\u00f6sterebilir. Kollarda a\u011fr\u0131, bile\u011fin i\u00e7 k\u0131sm\u0131nda yo\u011funla\u015f\u0131r ve 4., 5. parmaklara yay\u0131l\u0131r. Ba\u015fparmak ve kolun d\u0131\u015f y\u00fczeyine yay\u0131l\u0131m ise nadirdir. Hastan\u0131n a\u011fr\u0131y\u0131 tarif ederken veya yerini g\u00f6sterirken kulland\u0131\u011f\u0131 v\u00fccut dili de \u00f6nemlidir. Sol meme alt\u0131nda k\u00fc\u00e7\u00fck (Anjina pektoris nadiren 1 Dakikadan k\u0131sa veya 20 dakikadan uzun s\u00fcrer. Anjinal a\u011fr\u0131 yava\u015f yava\u015f artar ve yay\u0131l\u0131r. Bat\u0131c\u0131 veya saplan\u0131c\u0131 tarzda ani olarak maksimum \u015fiddete ula\u015fan a\u011fr\u0131lar \u00e7o\u011funlukla kalp ile ili\u015fkili olmayan kas-iskelet veya n\u00f6rolojik k\u00f6kenli a\u011fr\u0131lard\u0131r. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131n\u0131n 20 dk’dan uzun s\u00fcrmesi halinde kalp krizi ba\u015flang\u0131c\u0131 veya kalp krizi a\u011fr\u0131s\u0131 olma ihtimali y\u00fcksektir.<\/p>\n
Anjina pektoris, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 veya g\u00f6\u011f\u00fcste s\u0131k\u0131nt\u0131 hissi seklinde tan\u0131mlanabilir. S\u0131k\u0131nt\u0131 hissi, s\u0131k\u0131\u015fma, bask\u0131, yanma, a\u011f\u0131rl\u0131k, daralma, bo\u011fulma gibi tarif edilebilir. Stabil anjinas\u0131 olan baz\u0131 hastalarda, egzersizde g\u00f6\u011f\u00fcs rahats\u0131zl\u0131\u011f\u0131 yerine nefes darl\u0131\u011f\u0131, halsizlik, bitkinlik, bulant\u0131 ve tekrarlayan ge\u011firme vard\u0131r ve bu durum \u00f6zellikle yasl\u0131 hastalarda ve \u015feker hastal\u0131\u011f\u0131 olan hastalarda g\u00f6r\u00fcl\u00fcr. Bu durum \u2018anjina e\u015fde\u011feri’ olarak bilinir. Anjina esde\u011feri semptomlar, fiziksek aktivite sona erdirildi\u011finde veya dil alt\u0131 nitrogliserinle h\u0131zla kaybolurlar.<\/p>\n
Klasik olarak a\u011fr\u0131 egzersiz, duygusal nedenler, yemek sonras\u0131 ve so\u011fuk ile artar. Anjina s\u0131kl\u0131kla hasta a\u011f\u0131r bir yemek yedikten sonra veya heyecanl\u0131, \u00fcz\u00fcnt\u00fcl\u00fc oldu\u011funda geli\u015fir. So\u011fuk du\u015f kan Bas\u0131nc\u0131 ve kalp h\u0131z\u0131n\u0131 art\u0131r\u0131rken, s\u0131cak du\u015f damar geni\u015flemesi nedeniyle kalbin daha h\u0131zl\u0131 \u00e7al\u0131\u015fmas\u0131na neden olur. Her ikisi de anjinaya neden olabilir. Sigara kullan\u0131m\u0131 kalp h\u0131z\u0131n\u0131 art\u0131rarak ve kalp damarlar\u0131nda ani daralma yaparak g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131na neden olmaktad\u0131r.<\/p>\n
Nitrogliserin, a\u011fr\u0131n\u0131n d\u00fczelmesini h\u0131zland\u0131rsa da, damar geni\u015fletici ila\u00e7lar kullan\u0131lmasa dahi anjina genellikle dinlenme ile 1-5 dakika aras\u0131nda d\u00fczelir. Anjinal a\u011fr\u0131 ba\u015flay\u0131nca istirahat pozisyonuna ge\u00e7ilmesi \u00e7o\u011funlukla a\u011fr\u0131y\u0131 ge\u00e7irmekte veya 1-2 adet dil alt\u0131 ila\u00e7 kullan\u0131m\u0131 ile a\u011fr\u0131 en fazla 5-10 dakika i\u00e7inde kaybolmaktad\u0131r. Ancak a\u011fr\u0131n\u0131n istirahatta de gelmeye ba\u015flamas\u0131, dilalt\u0131 ilaca ra\u011fmen a\u011fr\u0131n\u0131n 10 dakikadan uzun s\u00fcrmesi, a\u011fr\u0131n\u0131n ge\u00e7me s\u00fcresinin uzamas\u0131 akla kalp krizi \u00f6nc\u00fcs\u00fc olan karars\u0131z anjinal hastal\u0131\u011f\u0131n ba\u015flad\u0131\u011f\u0131n\u0131 getirmelidir.<\/p>\n
TANI<\/p>\n
Yukar\u0131da anlat\u0131lan \u015fikayetleri olan bir hasta \u00f6ncelikle bir kalp ve damar hastal\u0131klar\u0131 uzman\u0131n\u0131n muayenesi gerekir. Doktora \u015fikayetlerle ilgili verilen bilgiler tan\u0131 konulmas\u0131nda \u00f6nemlidir. Bu muayene sonras\u0131nda elektrokardiyografi ve akci\u011fer filmi \u00e7ekilir. Elektrokardiyografi kalpteki at\u0131m bozukluklar\u0131 ve koroner arter hastal\u0131\u011f\u0131 ya da ge\u00e7irilmi\u015f enfarkt\u00fcs hakk\u0131nda \u00f6nemli bilgiler verebilir. Bundan sonra e\u011fer doktor gerekli g\u00f6r\u00fcrse eforlu elektrokardiyografi denilen inceleme yap\u0131labilir. Bu incelemede hasta bir ko\u015fu band\u0131 \u00fczerinde ko\u015farken kalp elektrosu kaydedilir. Koroner arterlerin kalbi besleme d\u00fczeyini g\u00f6steren bir tetkiktir. Yine doktor gerekli g\u00f6r\u00fcrse, miyokard perf\u00fczyon sintigrafisi denilen ve n\u00fckleer Maddelerin kullan\u0131ld\u0131\u011f\u0131 bir y\u00f6ntemle kalp kas\u0131n\u0131n nas\u0131l beslendi\u011fi g\u00f6sterilebilir, iyi beslenmeyen alanlar tespit edilebilir. Ayr\u0131ca kalp kapak\u00e7\u0131klar\u0131n\u0131n durumu ve kalp kas\u0131n\u0131n kas\u0131lmas\u0131n\u0131 g\u00f6rmek amac\u0131yla kalbin ultrasonik incelemesi olan ekokardiyografik inceleme yap\u0131labilir. Bu y\u00f6ntemlerle tan\u0131 koyulamam\u0131\u015fsa ya da tedavi amac\u0131yla yap\u0131labilecek giri\u015fim i\u00e7in (cerrahi, balon ile geni\u015fletme, stent uygulama gibi) damar sisteminin net olarak g\u00f6r\u00fcnt\u00fclenmesi gerekiyorsa, koroner arter anatomisini tam olarak g\u00f6sterecek koroner anjiografi yap\u0131labilir. Son y\u0131llarda geli\u015ftirilen BT Anjiyografi y\u00f6ntemiyle de 5 dakika i\u00e7inde kalp damarlar\u0131 kolayl\u0131kla g\u00f6r\u00fcnt\u00fclenebilmektedir. Ancak bu y\u00f6ntem halihaz\u0131rda klasik anjiyonun yerini alm\u0131\u015f de\u011fildir.<\/p>\n
TEDAV\u0130 <\/p>\n
Anjina pektoriste \u00f6ncelikle ya\u015fam tarz\u0131n\u0131 de\u011fi\u015ftirmek gereklidir. Sigaran\u0131n b\u0131rak\u0131lmas\u0131, Alkol\u00fcn s\u0131n\u0131rland\u0131r\u0131lmas\u0131 veya hi\u00e7 kullan\u0131lmamas\u0131, \u015feker hastal\u0131\u011f\u0131 ve hipertansiyonu olan hastalar\u0131n diyet ve egzersiz \u00f6nerilerini \u00e7ok daha fazla ciddiye almalar\u0131 gereklidir. Kolesterol d\u00fc\u015f\u00fcr\u00fcc\u00fc, hipertansiyon ve \u015feker tedavisinin yan\u0131 s\u0131ra koroner arterlerin geni\u015fletilerek ya da kalbin oksijen ihtiyac\u0131n\u0131n azalt\u0131larak anjina pektoris ataklar\u0131n\u0131n \u00f6nlenmeye y\u00f6nelik ila\u00e7lar da tedavide kullan\u0131lmaktad\u0131r. Ayr\u0131ca kan\u0131 suland\u0131ran ve p\u0131ht\u0131 olu\u015fumunu engelleyen ila\u00e7lar (asetilsalisilik Asit ve di\u011ferleri) infarkt\u00fcs ge\u00e7irme riskini azalt\u0131r. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131n\u0131 ba\u015flatabilecek efordan 5 dakika \u00f6nce al\u0131nan dilalt\u0131 damar geni\u015fletici ila\u00e7lar anjina pektoris’in ortaya \u00e7\u0131kmas\u0131n\u0131 engelleyebilir ya da ortaya \u00e7\u0131km\u0131\u015f bir anjina pektoris ata\u011f\u0131n\u0131 sonland\u0131rabilir. Ancak genellikle ila\u00e7 tedavisi yetersiz kalmakta ve bu nedenle hastalar\u0131n b\u00fcy\u00fck k\u0131sm\u0131na anjinal a\u011fr\u0131n\u0131n giderilmesi i\u00e7in balon anjiyoplasti, koroner stent uygulama hatta koroner by pass ameliyat\u0131 gerekebilmektedir.<\/p>\n
Koroner arter hastal\u0131\u011f\u0131 en \u00f6nemli Sa\u011fl\u0131k sorunlar\u0131ndan biridir. \u00d6m\u00fcr boyu tedavi gerektiren kronik ve ilerleyici bir hastal\u0131kt\u0131r. kad\u0131nlarda menopoz sonras\u0131nda risk artar.<\/p>\n
Genellikle 40 ya\u015f sonras\u0131nda g\u00f6r\u00fcl\u00fcr. Erkeklerde kad\u0131nlara g\u00f6re d\u00f6rt kat daha s\u0131k g\u00f6r\u00fcl\u00fcr. Hastal\u0131k hi\u00e7bir bulgu vermeyebilir. En s\u0131k bulgu anjina pektoris denilen eforla ortaya \u00e7\u0131kan g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131d\u0131r.<\/p>\n
Risk fakt\u00f6rleri sigara, y\u00fcksek kolesterol, hipertansiyon, fiziksel aktivite azl\u0131\u011f\u0131, ileri ya\u015f, Alkol t\u00fcketimi, \u015feker hastal\u0131\u011f\u0131, Aile \u00f6yk\u00fcs\u00fc ve stresli ya\u015fant\u0131d\u0131r. Bu risk fakt\u00f6rlerinden d\u00fczeltilebilir olanlar\u0131n kontrol alt\u0131na al\u0131nmas\u0131 en az tedavi kadar \u00f6nemlidir.<\/p>\n
Tedavide damar geni\u015fletici ve kan\u0131 suland\u0131r\u0131c\u0131 ila\u00e7lar kullan\u0131l\u0131r. Uygun hastalarda koroner bypass, balon anjioplasti ya da stent uygulamas\u0131 kullan\u0131labilir. En \u00f6nemli sonucu hayati tehdit eden miyokard enfarkt\u00fcs\u00fc’d\u00fcr.<\/p>\n
HAZIRLAYANLAR; Do\u00e7. Dr. Cevat KIRMA, Do\u00e7. Dr. Mehmet \u00d6ZKAN, Do\u00e7. Dr. Cihangir KAYMAZ, Do\u00e7. Dr. M. Muhsin T\u00dcRKMEN, Do\u00e7. Dr. Nihal \u00d6ZDEM\u0130R, Do\u00e7. Dr. Ali Metin ESEN<\/p>\n","protected":false},"excerpt":{"rendered":"
T\u00fcm d\u00fcnyada oldu\u011fu gibi \u00fclkemizde de \u00f6l\u00fcmlerin \u00e7ok b\u00fcy\u00fck b\u00f6l\u00fcm\u00fc kalp damar hastal\u0131klar\u0131ndan kaynaklan\u0131r. Kalp damar hastal\u0131klar\u0131n\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131 daha \u00f6nce ciddi bir belirti vermeksizin aniden ortaya \u00e7\u0131kar. Kalbe ait hastal\u0131klar nefes darl\u0131\u011f\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131, \u00e7arp\u0131nt\u0131 ve erken yorulma gibi semptomlar ile hekime ba\u015fvurur. G\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 kalp damar t\u0131kan\u0131kl\u0131\u011f\u0131n\u0131n en \u00f6nemli ve olduk\u00e7a s\u0131k bir belirtisidir. Bu nedenle g\u00f6\u011f\u00fcs[Devam\u0131n\u0131 Oku…]<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[22524],"tags":[23223,23222,23220],"_links":{"self":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13249"}],"collection":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/comments?post=13249"}],"version-history":[{"count":0,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/posts\/13249\/revisions"}],"wp:attachment":[{"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/media?parent=13249"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/categories?post=13249"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gncz.net\/index.php\/wp-json\/wp\/v2\/tags?post=13249"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}