{"id":11385604,"date":"2014-04-15T00:00:00","date_gmt":"2014-04-14T22:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized-cs_cz\/srdce-pod-tlakem\/"},"modified":"2014-04-15T00:00:00","modified_gmt":"2014-04-14T22:00:00","slug":"srdce-pod-tlakem","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/srdce-pod-tlakem\/","title":{"rendered":"Srdce pod tlakem"},"content":{"rendered":"


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Pot\u00e1p\u011bn\u00ed je vysoce relaxa\u010dn\u00edm, ale z\u00e1rove\u0148 fyzicky n\u00e1ro\u010dn\u00fdm kon\u00ed\u010dkem a sestup do hloubky n\u011bkolik metr\u016f pod vodn\u00ed hladinu znamen\u00e1, \u017ee se t\u011blo pot\u00e1p\u011b\u010de vystavuje tlaku nezm\u011b\u0159iteln\u00e9ho mno\u017estv\u00ed vody. Proto se pot\u00e1p\u011b\u010di u\u010d\u00ed, jak maj\u00ed pom\u00e1hat sv\u00e9mu t\u011blu, aby se vypo\u0159\u00e1dalo s nezvykl\u00fdm okol\u00edm a jak se vyrovn\u00e1v\u00e1 tlak ve st\u0159edn\u00edm uchu s tlakem okoln\u00ed vody. Tyto metody spou\u0161t\u011bj\u00ed cel\u00fd \u0159et\u011bzec zm\u011bn tlaku i uvnit\u0159 t\u011bla, co\u017e pot\u00e1p\u011b\u010di umo\u017e\u0148uje p\u0159izp\u016fsobit se nov\u00e9mu prost\u0159ed\u00ed. Co se v\u0161ak stane, kdy\u017e se v t\u011ble nach\u00e1z\u00ed n\u011bjak\u00e1 vada, nap\u0159. v srdci, kter\u00e1 naru\u0161\u00ed ucelen\u00fd \u0159et\u011bzec krok\u016f automatick\u00e9 adaptace t\u011bla na okoln\u00ed prost\u0159ed\u00ed? Jak\u00e9 dopady m\u016f\u017ee m\u00edt srde\u010dn\u00ed vada tak mal\u00e1, \u017ee je za norm\u00e1ln\u00edch okolnost\u00ed prakticky nepozorovateln\u00e1? M\u016f\u017ee p\u0159i vystaven\u00ed t\u011bla tlaku b\u011bhem ponoru znamenat v\u00e1\u017en\u00e9 nebezpe\u010d\u00ed? Na mysli m\u00e1me defekt uz\u00e1v\u011bru pr\u016fchodn\u00e9ho ov\u00e1ln\u00e9ho ok\u00e9nka (Patent Foramen Ovale – PFO) t. j. mal\u00e9ho otvoru v p\u0159ep\u00e1\u017ece, kter\u00e1 od sebe odd\u011bluje srde\u010dn\u00ed s\u00edn\u011b a zdali m\u016f\u017ee tato vada n\u011bjak v\u00fdrazn\u011b ovlivnit zdrav\u00ed pot\u00e1p\u011b\u010de.<\/p>\n

V\u011bdeck\u00e9 v\u00fdzkumy prok\u00e1zaly, \u017ee man\u00e9vr Valsalva, kter\u00fd se prov\u00e1d\u00ed ucp\u00e1n\u00edm nosn\u00edch d\u00edrek stiskem prst\u016f a n\u00e1sledn\u00fdm v\u00fddechem proti zav\u0159en\u00fdm \u00fast\u016fm a stisknut\u00e9mu nosu, vyvol\u00e1 celou \u0159adu zm\u011bn tlaku uvnit\u0159 t\u011bla. Man\u00e9vr Valsalva za\u010d\u00edn\u00e1 hlubok\u00fdm n\u00e1dechem, p\u0159i kter\u00e9m se v\u00fdznamn\u011b sni\u017euje tlak v pleur\u00e1ln\u00ed (hrudn\u00ed) dutin\u011b mezi pl\u00edcemi (tzv. nitrohrudn\u00ed tlak). Pot\u00e9 n\u00e1sleduje n\u011bkolikavte\u0159inov\u00fd v\u00fddech proti odporu uzav\u0159en\u00e9ho nosu a \u00fast. Takto proveden\u00fd man\u00e9vr m\u00e1 za n\u00e1sledek zv\u00fd\u0161en\u00ed nitrohrudn\u00edho tlaku. V\u00fdsledn\u00fd tlak v hrudn\u00edku neumo\u017e\u0148uje po dobu n\u011bkolika vte\u0159in t\u00e9m\u011b\u0159 \u017e\u00e1dn\u00e9 proud\u011bn\u00ed krve do srdce. Pot\u00e9, kdy\u017e se man\u00e9vr Valsalva uvoln\u00ed a nastane prudk\u00fd pokles tlaku v hrudn\u00edku, se krev (kter\u00e1 b\u011bhem man\u00e9vru nemohla proudit do srdce) shrom\u00e1\u017ed\u00ed v prav\u00e9 horn\u00ed srde\u010dn\u00ed komo\u0159e. Nashrom\u00e1\u017ed\u011bn\u00e1 krev zvy\u0161uje tlak v prav\u00e9 \u010d\u00e1sti srdce na \u00fakor strany lev\u00e9 a tla\u010d\u00ed na p\u0159ep\u00e1\u017eku odd\u011bluj\u00edc\u00ed srde\u010dn\u00ed s\u00edn\u011b. V\u00fdsledkem je vyklenut\u00ed s\u00ed\u0148ov\u00e9 p\u0159ep\u00e1\u017eky sm\u011brem do lev\u00e9 s\u00edn\u011b. V p\u0159\u00edpad\u011b defektu PFO bylo pomoc\u00ed j\u00edcnov\u00e9 echokardiografie zji\u0161t\u011bno, \u017ee tento zp\u011btn\u00fd tlak (t. j. sm\u011brem z prav\u00e9 s\u00edn\u011b do lev\u00e9) znateln\u011b roz\u0161i\u0159uje otvor PFO.<\/p>\n

PFO se vyskytuje pom\u011brn\u011b \u010dasto a mnoho pot\u00e1p\u011b\u010d\u016f m\u00e1 otvor v srde\u010dn\u00ed s\u00ed\u0148ov\u00e9 p\u0159ep\u00e1\u017ece, ani\u017e by o n\u011bm v\u011bd\u011bli. Vzhledem k tomu, \u017ee man\u00e9vr Valsalva se b\u011b\u017en\u011b p\u0159i pot\u00e1p\u011bn\u00ed vyu\u017e\u00edv\u00e1 a jin\u00e9 metody vyrovn\u00e1v\u00e1n\u00ed tlaku mohou m\u00edt podobn\u00e9 dopady na zm\u011bny tlakov\u00fdch pom\u011br\u016f v srdci, uv\u011bdomili si v\u00fdzkumn\u00edci si nadace DAN Europe pot\u0159ebu d\u016fkladn\u00e9ho v\u00fdzkumu v\u0161ech \u010dasto pou\u017e\u00edvan\u00fdch man\u00e9vr\u016f, za \u00fa\u010delem zji\u0161t\u011bn\u00ed, zda mohou podobn\u00e9 zm\u011bny vnit\u0159n\u00edho tlaku zp\u016fsobovat a m\u00edt dopad na PFO u pot\u00e1p\u011b\u010d\u016f. DAN tedy provedla v\u00fdzkum u \u0161estn\u00e1cti zku\u0161en\u00fdch pot\u00e1p\u011b\u010d\u016f, 4 \u017een a 12 mu\u017e\u016f, ve v\u011bku od 22 do 39 let. Tito pot\u00e1p\u011b\u010di byli po\u017e\u00e1d\u00e1ni, aby provedli n\u00e1sleduj\u00edc\u00ed \u010dinnosti \u010dasto se vyskytuj\u00edc\u00ed p\u0159i pot\u00e1p\u011bn\u00ed: klidov\u00fd stav, m\u00edrn\u00fd, silov\u00fd a kalibrovan\u00fd man\u00e9vr Valsalva, ka\u0161l\u00e1n\u00ed, d\u0159ep s man\u00e9vrem Valsalva, d\u0159ep s voln\u00fdm d\u00fdch\u00e1n\u00edm a z\u00e1v\u011bre\u010dnou isometrickou kontrakci. V\u00fdzkumn\u00ed pracovn\u00edci analyzovali \u00farovn\u011b nitrohrudn\u00edho tlaku vyvolan\u00e9 shora uveden\u00fdmi \u010dinnostmi a nam\u011b\u0159en\u00e9 hodnoty porovn\u00e1vali s p\u016fvodn\u00ed hodnotou tlaku nam\u011b\u0159enou p\u0159i klidov\u00e9m stavu. Takto se zji\u0161\u0165ovalo, zdali ur\u010dit\u00fd man\u00e9vr zp\u016fsobil zv\u00fd\u0161en\u00ed nebo sn\u00ed\u017een\u00ed nitrohrudn\u00edho tlaku. \u00dadaje z\u00edskan\u00e9 p\u0159i jednotliv\u00fdch man\u00e9vrech se tak\u00e9 porovn\u00e1valy navz\u00e1jem a zji\u0161t\u011bn\u00e9 v\u00fdsledky prok\u00e1zaly, \u017ee jak „norm\u00e1ln\u00ed“ man\u00e9vr Valsalva, tak i dal\u0161\u00ed metody b\u011b\u017en\u011b pou\u017e\u00edvan\u00e9 p\u0159i pot\u00e1p\u011bn\u00ed k vyrovn\u00e1v\u00e1n\u00ed tlaku, zp\u016fsobuj\u00ed jen mal\u00e9 zv\u00fd\u0161en\u00ed nitrohrudn\u00edho tlaku. Je tedy nepravd\u011bpodobn\u00e9, \u017ee by tyto mal\u00e9 zm\u011bny tlaku mohly zap\u0159\u00ed\u010dinit v\u00fdznamn\u00fd zp\u011btn\u00fd p\u0159esun krve otvorem PFO. Naproti tomu v\u0161ak u silov\u00e9ho man\u00e9vru Valsalva (p\u0159i vyu\u017eit\u00ed b\u0159i\u0161n\u00edch sval\u016f) v\u00fdzkumn\u00edci DAN zjistili, \u017ee doch\u00e1z\u00ed k v\u00fdrazn\u00fdm zm\u011bn\u00e1m tlaku a to m\u00e1 za n\u00e1sledek siln\u00e9 proud\u011bn\u00ed krve do prav\u00e9 \u010d\u00e1sti srdce a n\u00e1sledn\u00e9 dostate\u010dn\u00e9 zv\u011bt\u0161en\u00ed otvoru v s\u00ed\u0148ov\u00e9 p\u0159ep\u00e1\u017ece, aby to umo\u017e\u0148ovalo \u010d\u00e1ste\u010dn\u00fd zp\u011btn\u00fd pr\u016ftok krve skrze „ok\u00e9nko“ PFO.<\/p>\n

Jak ji\u017e bylo zm\u00edn\u011bno, otvor v srde\u010dn\u00ed s\u00ed\u0148ov\u00e9 p\u0159ep\u00e1\u017ece nen\u00ed nic mimo\u0159\u00e1dn\u00e9ho a lid\u00e9 s t\u00edmto defektem prov\u00e1d\u011bj\u00ed n\u00e1ro\u010dn\u00e9 fyzick\u00e9 \u010dinnosti, kter\u00e9 zp\u016fsobuj\u00ed \u010d\u00e1ste\u010dn\u00fd pr\u016ftok krve otvorem z prav\u00e9 do lev\u00e9 s\u00edn\u011b, prakticky ka\u017edodenn\u011b. Pro\u010d je tedy PFO nebezpe\u010dn\u00e9 pr\u00e1v\u011b p\u0159i pot\u00e1p\u011bn\u00ed? D\u016fvodem je skute\u010dnost, \u017ee tento defekt umo\u017e\u0148uje p\u0159esun bublinek! Krev obsahuj\u00edc\u00ed bublinky vytvo\u0159en\u00e9 b\u011bhem ponoru proch\u00e1z\u00ed pravou srde\u010dn\u00ed s\u00edn\u00ed a m\u00ed\u0159\u00ed do plic, kde se tyto bublinky zachyt\u00ed a dojde k vydechnut\u00ed dus\u00edku. Jestli\u017ee v\u0161ak krev projde skrze PFO, dost\u00e1vaj\u00ed se bublinky dus\u00edku z prav\u00e9 s\u00edn\u011b do lev\u00e9 a ta je pak ode\u0161le zp\u011bt do ob\u011bhu. Bublinky tak z\u016fst\u00e1vaj\u00ed v krevn\u00edm \u0159e\u010di\u0161ti mnohem d\u00e9le, co\u017e vyvol\u00e1v\u00e1 nebezpe\u010d\u00ed dus\u00edkat\u00e9 krevn\u00ed embolie. V\u00fdzkumn\u00ed pracovn\u00edci DAN zaznamenali p\u0159\u00edpady, kdy byli star\u0161\u00ed a zku\u0161en\u00ed pot\u00e1p\u011b\u010di posti\u017eeni nevysv\u011btliteln\u00fdm dekompresn\u00edm onemocn\u011bn\u00edm po b\u011b\u017en\u00e9m ponoru, navzdory skute\u010dnosti, \u017ee dodr\u017eeli v\u0161echna bezpe\u010dnostn\u00ed pravidla souvisej\u00edc\u00ed s pot\u00e1p\u011bn\u00edm. Ve v\u0161ech t\u011bchto p\u0159\u00edpadech se b\u011bhem j\u00edcnov\u00e9 echokardiografie zjistilo velk\u00e9 PFO.<\/p>\n

Zm\u00edn\u011bn\u00fd v\u00fdzkum DAN prok\u00e1zal, \u017ee silov\u00fd man\u00e9vr Valsalva zap\u0159i\u010di\u0148uje dostate\u010dn\u00fd vzestup nitrohrudn\u00edho tlaku, aby n\u00e1sledn\u00fd n\u00e1vrat krve do prav\u00e9 s\u00edn\u011b zp\u016fsobil otev\u0159en\u00ed PFO. Proto by m\u011bl b\u00fdt ka\u017ed\u00fd pot\u00e1p\u011b\u010d pou\u010den, aby v \u017e\u00e1dn\u00e9m p\u0159\u00edpad\u011b neprov\u00e1d\u011bl silov\u00e9 man\u00e9vry Valsalva. Pr\u016fzkum rovn\u011b\u017e prok\u00e1zal, \u017ee ostatn\u00ed, m\u00e9n\u011b n\u00e1ro\u010dn\u00e9 man\u00e9vry pou\u017e\u00edvan\u00e9 pro vyrovn\u00e1v\u00e1n\u00ed tlaku, nevyvol\u00e1vaj\u00ed prakticky \u017e\u00e1dn\u00e9 v\u00fdznamn\u00e9 zm\u011bny nitrohrudn\u00edho tlaku, tud\u00ed\u017e nep\u0159edstavuj\u00ed \u017e\u00e1dn\u00e9 nebezpe\u010d\u00ed pro pot\u00e1p\u011b\u010de s vadou PFO. P\u0159i \u0161kolen\u00edch a tr\u00e9ninc\u00edch pro pot\u00e1p\u011b\u010de by se tedy m\u011blo zd\u016fraz\u0148ovat, aby pro vyrovn\u00e1v\u00e1n\u00ed tlaku prov\u00e1d\u011bli pouze man\u00e9vry, p\u0159i kter\u00fdch se pou\u017e\u00edv\u00e1 jen \u010delist a hrdlo, nikoliv b\u0159i\u0161n\u00ed svaly. Konkr\u00e9tn\u00edm v\u00fdsledkem tohoto v\u00fdzkumu jsou doporu\u010den\u00ed v\u00fdzkumn\u00fdch pracovn\u00edk\u016f DAN pro pot\u00e1p\u011b\u010de s vadou PFO, aby nikdy neprov\u00e1d\u011bli man\u00e9vry, kter\u00e9 p\u0159i v\u00fdstupu k hladin\u011b zvy\u0161uj\u00ed nitrohrudn\u00ed tlak. Rovn\u011b\u017e se doporu\u010duje vyh\u00fdbat se nam\u00e1hav\u00fdm fyzick\u00fdm \u00fakon\u016fm, kter\u00e9 p\u0159\u00edli\u0161 zat\u011b\u017euj\u00ed b\u0159i\u0161n\u00ed svaly – nap\u0159. nevystupovat po \u017eeb\u0159\u00edku s plnou v\u00fdstroj\u00ed, nenafukovat kompenz\u00e1tor vztlaku \u00fastn\u011b, a tak\u00e9 neprov\u00e1d\u011bt \u017e\u00e1dn\u00e1 nam\u00e1hav\u00e1 cvi\u010den\u00ed rukou \u010di nohou brzy po ponoru. „Tich\u00e9“ bublinky mohou setrv\u00e1vat v krevn\u00edm \u0159e\u010di\u0161ti a\u017e dv\u011b hodiny po ponoru a fyzick\u00e9 \u00fakony zat\u011b\u017euj\u00edc\u00ed b\u0159i\u0161n\u00ed svaly mohou vyvolat takov\u00fd tlak na srdce, \u017ee dojde k otev\u0159en\u00ed PFO a umo\u017en\u00ed se tok krve i s bublinkami \u0161patn\u00fdm sm\u011brem. Zkr\u00e1tka a dob\u0159e, po ponoru relaxujte a nevystavujte sv\u00e9 srdce \u017e\u00e1dn\u00e9 zbyte\u010dn\u00e9 n\u00e1maze!<\/p>\n


<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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