Tachycardie Ventriculaire

Mu tachycardia ya ventricular, impinduka y'amashanyarazi itangira mu byumba byo hasi by'umutima ituma umutima ukubita cyane.

Tachycardia ya ventricular ni ubwoko bw'umutima utabita neza, bita arrhythmia. Itangira mu byumba byo hasi by'umutima, bita ventricles. Iyi ndwara kandi ishobora kwitwa V-tach cyangwa VT.

Umutima muzima ubusanzwe ukubita hafi igihe cya 60 kugeza kuri 100 ku munota uri amahoro. Muri tachycardia ya ventricular, umutima ukubita cyane, ubusanzwe ni 100 cyangwa byinshi kurushaho ku munota.

Hari igihe umutima ukubita vuba ubuza byumba by'umutima kuzura neza amaraso. Umutima ushobora kutagera ku rugero rwo kohereza amaraso ahagije mu mubiri. Ibi nibyo bibaye, ushobora kumva uhumeka nabi cyangwa ugira ubusembwa. Bamwe bahita babura ubwenge.

Ibihe bya tachycardia ya ventricular bishobora kuba bigufi kandi bikamara amasegonda make gusa bitateza akaga. Ariko ibihe bikamara igihe kirekire kurusha amasegonda make, bita sustained V-tach, bishobora guhitana ubuzima. Hari igihe tachycardia ya ventricular ishobora gutuma ibikorwa byose by'umutima bihagarara. Iyi ngorane bita sudden cardiac arrest.

Ubuvuzi bwa tachycardia ya ventricular burimo imiti, ishoke ku mutima, igikoresho cy'umutima, ndetse n'uburyo cyangwa kubaga.

Arrhythmias ya ventricular ishobora kuba mu mitima isanzwe ndetse n'itishoboye neza. Icyo dushaka kuvuga ni uko hari abarwayi badafite izindi ndwara z'umutima uretse ikibazo mu mikorere y'amashanyarazi y'ibyumba byo hasi by'umutima, cyangwa ventricles, bishobora gutuma umutima utabita neza. Ibi bishobora kugaragara nk'inkubito z'inyongera rimwe na rimwe umuntu ashobora kumva nk'aho umutima ucika, cyangwa nk'inkubito nyinshi zikubita zikurikirana, bita tachycardia ya ventricular. Mu bihe bitoroshye, niba umutima ari muzima, ibi bishobora gutera umuvuduko w'umutima uteye akaga, nubwo ari gake cyane niba nta yindi ndwara y'umutima ishobora kuba itera.

Ariko kandi, hari abarwayi bafite umutima utari muzima kubera izindi mpamvu. Hari impamvu nyinshi zishobora gutuma umutima utabasha gukora neza, nko kwibasirwa n'indwara y'umutima mu gihe cyashize, niba ufite ikibazo cy'umuzuko ushobora kuba warakuwe kuri nyoko cyangwa se kuri so. Ushobora kugira ikibazo cy'umuriro ku mutima, nka sarcoidosis cyangwa myocarditis. Ibyo bimenyetso byose bishobora gutera ibibazo by'amashanyarazi mu cyumba cyo hasi cy'umutima, ariko hari igihe, iyo abantu bafite ibyo twita substrate, cyangwa ibibazo by'ubwubatsi busanzwe bw'umutima, ibi bishobora gutera arrhythmias ya ventricular. Kandi kuri abo barwayi, izi arrhythmias ya ventricular zishobora guhitana ubuzima.

Ariko iyo turebye izi arrhythmias, tugomba gukoresha uburyo buteguye mu kuzisuzuma no kuzivura. Icyo nashaka kuvuga ni iki? Iyo tuvuga isuzuma, tureba niba hari indi mpamvu zabiteye? Hari imiti wari ufashe, hari ikibazo mu mubiri wawe, cyangwa ibyo wafashe kubera izindi mpamvu, nko gukoresha imiti y'ibimera idafite amabwiriza, bishobora kuba byarateye izi arrhythmias, kandi mu by'ukuri zishobora guhita zigenda tudakora ikindi?

Turangiza kandi tureba uko arrhythmia ikomeye. Ese ni ikintu gishobora guhitana ubuzima, cyangwa oya, kuko atari byose biba bibi. Kandi iyo tuvuga ku buvuzi, tureba ibice bibiri bikomeye. Kuri abo barwayi badafite arrhythmias ya ventricular iteye akaga, tureba uburyo bwo kuvura kugira ngo turusheho kubaho neza, cyangwa kugabanya ibimenyetso, kuko bamwe mu barwayi bashobora kugira ibimenyetso bitandukanye byaterwa n'izi arrhythmias, birimo kumva umutima ucika cyangwa ukubita cyane, cyangwa se guhinda umushyitsi. Ariko bamwe bashobora kumva gusa bananiwe.

Ariko undi itsinda duhangayikishijwe na ryo ni abafite izi arrhythmias zishobora guhitana ubuzima. Mu yandi magambo, zishobora gutera urupfu rutunguranye. Kuri abo barwayi, twifuza kubona uko izi arrhythmias ziteye akaga, kandi uko twakwirinda ko abo barwayi bapfa batunguranye.

Mu rwego rwo gukumira ko arrhythmias zibaho, hari uburyo bubiri bw'ingenzi bwo kuvura. Niba tudashobora kubona indi mpamvu ishobora kuvurwa, dushobora kugutera imiti, kandi hari imiti myinshi dushobora gukoresha. Iyi miti bita anti-arrhythmic drugs, kandi ikunda kugira umumaro ku barwayi bagera kuri 50% kugeza kuri 60%. Ariko ishobora kugira ingaruka mbi, kandi kuri bamwe mu barwayi ishobora gutera izindi arrhythmias, ndetse rimwe na rimwe iziteye akaga zishobora gutera urupfu rutunguranye. Igihe abarwayi bakurikiranwa neza kandi gutangira imiti bikorwa neza, ariko, ibyago byabyo ni bike cyane.

Murakoze kuba muri kumwe nanjye uyu munsi kugira ngo mumenye byinshi kuri tachycardia ya ventricular. Muri videwo itaha, nzajya muburyo burambuye icyo uburyo bwo kuvura bwa ablation burimo.

"Iyo umutima ukubise cyane, ushobora kudatanga amaraso ahagije mu bindi bice by'umubiri. Bityo, ingingo n'imikaya bishobora kutabona ogisijeni ihagije. Ibimenyetso bya tachycardia ya ventricular biterwa n'ibura ry'ogisijeni. Bishobora kuba birimo: Kubabara mu kifuba, bitwa angina. Kuzenguruka. Gukubita kw'umutima cyane, bitwa palpitations. Kugira ubwoba. Guhumeka nabi. Tachycardia ya ventricular ishobora kuba ikibazo cy'ubuzima cyihutirwa, kabone nubwo ibimenyetso byawe ari bito. Tachycardia ya ventricular, rimwe na rimwe yitwa V-tach cyangwa VT, ihurizwa hamwe bitewe n'igihe icyiciro kimara. V-tach idakomeza ihagarara yonyine mbere y'amasegonda 30. Ibihe bigufi bishobora kutababaza. V-tach ikomeza imara igihe kirenga amasegonda 30. Ubu bwoko bwa tachycardia ya ventricular bushobora gutera ibibazo bikomeye by'ubuzima. Ibimenyetso bya V-tach ikomeza bishobora kuba birimo: Kugwa. Kubura ubwenge. Guhagarara kw'umutima cyangwa urupfu rutunguranye. Ibintu byinshi bitandukanye bishobora gutera tachycardia ya ventricular, rimwe na rimwe yitwa V-tach cyangwa VT. Ni ngombwa kubona isuzuma ryihuse, ryizewe kandi ubufasha bukwiye. Nubwo ufite umutima muzima, ugomba kubona ubufasha bwa muganga vuba niba ufite ibimenyetso bya V-tach. Fata gahunda yo gusuzuma ubuzima niba utekereza ko ufite ikibazo cy'umutima udakora neza. Rimwe na rimwe, hakenewe ubufasha bwihuse cyangwa ubwo mu bitaro. Hamagara 911 cyangwa nimero y'ubufasha bw'ibitaro byo mu gace k'iwanyu kubimenyetso bikurikira: Kubabara mu kifuba bikomeza iminota irenga mike. Kugira ikibazo cyo guhumeka. Kugwa. Guhumeka nabi."

Ibintu byinshi bitandukanye bishobora gutera tachycardia ya ventricular, rimwe na rimwe yitwa V-tach cyangwa VT. Ni ngombwa kubona ubuvuzi bwihuse, bunoze kandi bujyanye n'uburwayi. Nubwo ufite umutima muzima, ugomba kubona ubufasha bwa muganga vuba uramutse ufite ibimenyetso bya V-tach. Tegura gahunda yo kwisuzumisha ubuzima niba utekereza ko ufite ikibazo cy'umutima udadoda. Rimwe na rimwe, hakenewe ubuvuzi bwihuse cyangwa bwo mu bitaro. Hamagara 911 cyangwa nimero y'ubufasha bw'ihutirwa muri aka karere ufite ibi bimenyetso:

• Kubabara mu gituza bikamara iminota irenga mike.
• Kugira ikibazo cyo guhumeka.
• Kugwa cyane.
• Guhumeka nabi. Kwiyandikisha ubuntu, kandi ubone amakuru yerekeye ikuzimwa ry'umutima n'ibibazo by'umutima, ndetse n'uburambe ku buzima bw'umutima. Hataha amakosaHitamo Aho uherereye

Tachycardie ventriculaire iterwa no guhanahana nabi kw'umutima gutuma umutima ukubita cyane mu byumba byo hasi by'umutima. Ibyumba byo hasi by'umutima byitwa ventricles. Umuvuduko w'umutima udasanzwe ntutuma ventricles zuzura kandi zikama kandi zikamanuka kugira ngo zizamure amaraso ahagije mu mubiri.

Hari ibintu byinshi bishobora gutera cyangwa gutuma haba ibibazo mu guhanahana kw'umutima kandi bigatuma haba tachycardia ventriculaire. Ibi birimo:

• Ikiro cy'umutima cyabanje.
• Uburwayi ubwo aribwo bwose bw'umutima bwatumye haba udukoba mu mubiri w'umutima, bita indwara y'umutima ifatika.
• Amaraso make ajya mu gikomere cy'umutima kubera indwara y'imitsi y'umutima.
• Ibibazo by'umutima biriho kuva ku ivuka, harimo na syndrome ya long QT.
• Impinduka mu rugero rw'imyunyungugu y'umubiri yitwa electrolytes. Ibi birimo potasiyumu, sodium, calcium na magnésium.
• Ingaruka mbi z'imiti.
• Gukoresha ibiyobyabwenge nk'ukocaïne cyangwa methamphetamine.

Rimwe na rimwe, impamvu nyamukuru ya tachycardia ventriculaire ntishobora kumenyekana. Ibi bita tachycardia ventriculaire idiopathic.

Mu buryo busanzwe bw'umutima, agace gato k'uturemangingo muri sinus node kohereza umuyoboro w'amashanyarazi. Uwo muyoboro ubundi uca mu atria ujya muri atrioventricular (AV) node hanyuma uca mu ventricles, ugatuma zikama kandi zikamanuka zikazamura amaraso.

Kugira ngo dusobanukirwe neza impamvu ya tachycardia ventriculaire, bishobora gufasha kumenya uko umutima ukora.

Umutima usanzwe ufite ibyumba bine.

• Ibyumba bibiri byo hejuru byitwa atria.
• Ibyumba bibiri byo hasi byitwa ventricles.

Sisitemu y'amashanyarazi y'umutima igenzura ukuntu umutima ukubita. Ibimenyetso by'amashanyarazi by'umutima bitangira mu itsinda ry'uturemangingo hejuru y'umutima bita sinus node. Bicamo inzira iri hagati y'ibyumba byo hejuru n'ibyo hasi by'umutima bita atrioventricular (AV) node. Kugenda kw'ibimenyetso bituma umutima ukama kandi ukamanuka ukamurira amaraso.

Mu mutima muzima, uyu muhanda wo guhanahana kw'umutima ubusanzwe ugendera neza, bigatuma umuvuduko w'umutima uri mu mutuzo uba hagati ya 60 na 100 ku munota.

Ariko hari ibintu bishobora guhindura uko ibimenyetso by'amashanyarazi bicamo umutima. Muri tachycardia ventriculaire, guhanahana nabi kw'amashanyarazi mu byumba byo hasi by'umutima bituma umutima ukubita inshuro 100 cyangwa zirenze ku munota.

Iyo ubuzima bugira ingaruka ku mutima cyangwa bukaba bwangiza imyanya y'umutima, bishobora kongera ibyago byo kugira tachycardia ya ventricular. Impinduka mu mibereho nko kurya indyo yuzuye no kutaka, bishobora kugabanya ibyago. Ni ngombwa kandi kubona ubuvuzi bukwiye niba ufite ubumwe muri ibi bibazo:

• Indwara y'umutima.
• Ingaruka mbi z'imiti.
• Impinduka zikomeye mu kigero cy'imyunyu y'umubiri, bizwi nka electrolyte imbalances.
• Amateka yo gukoresha ibiyobyabwenge nk'ibiyobyabwenge nk'cocaïne cyangwa methamphetamine.

Amateka y'umuryango wa tachycardia cyangwa izindi ndwara z'umutima, na byo bituma umuntu aba afite ibyago byinshi byo kugira tachycardia ya ventricular.

Ingaruka z'umutima uhagaze cyane (ventricular tachycardia) ziterwa na:

• Umuvuduko w'umutima.
• Igihe umutima uhagaze cyane umaze.
• Niba hari izindi ndwara z'umutima.

Ingaruka ikomeye iterwa na V-tach ni umutima guhagarara (ventricular fibrillation), bizwi kandi nka V-fib. V-fib ishobora gutuma umutima uhagarara burundu, bikitwa guhagarara kw'umutima (sudden cardiac arrest). Hakenewe ubutabazi bwihuse kugira ngo urupfu rwirindwe. V-fib iba kenshi mu bantu barwaye indwara z'umutima cyangwa abagize ikibazo cy'umutima. Rimwe na rimwe iba mu bantu bafite umunyu wa potasiyumu mwinshi cyangwa muke cyangwa ibindi bihinduka mu mubiri.

Izindi ngaruka zishoboka za ventricular tachycardia zirimo:

• Kugwa cyane cyangwa kubura ubwenge.
• Gucika intege kw'umutima.
• Urwo gupfa rutunguranye ruterwa no guhagarara kw'umutima.

Kwirinda tachycardia ya ventricular bitangira no kugumisha umutima ubuzima bwiza. Niba ufite indwara y'umutima, jya ukora isuzuma buri gihe kandi ukore gahunda yawe y'ubuvuzi. Fata imiti yose nkuko byategetswe. Fata ingamba zikurikira kugira ngo ugumishe umutima ubuzima bwiza. Ihuriro ry'umutima rya Amerika risaba ibi bice umunani: - Funga indyo yuzuye, ifite intungamubiri. Funga indyo iboneye idafite umunyu mwinshi n'amavuta akomeye kandi yuzuye imbuto, imboga n'ibinyampeke byuzuye. - Kora imyitozo ngororamubiri buri gihe. Gerageza gukora imyitozo imara byibuze iminota 30 ku manywa menshi. Baza itsinda ryawe ry'ubuvuzi imyitozo ikubereye. - Kugumisha ibiro byiza. Kurenza ibiro byongera ibyago by'indwara y'umutima. Ganira n'itsinda ryawe ryita ku buzima kugira ngo ushyireho intego zifatika ku kigero cy'umubyibuho (BMI) n'ibiro. - Genzura umunaniro. Umunaniro ushobora gutuma umutima ukubita cyane. Gukora imyitozo ngororamubiri, gukora imyitozo yo kwiyumvisha no guhuza n'abandi mu matsinda y'ubufasha ni bimwe mu buryo bwo kugabanya no gucunga umunaniro. - Gufata inzoga mu rugero. Niba uhisemo kunywa inzoga, ubikore mu rugero. Ku bantu bakuze bafite ubuzima bwiza, bisobanura inzoga imwe ku munsi ku bagore n'inzoga ebyiri ku munsi ku bagabo. - Reka kunywa itabi. Niba unywa itabi kandi udashobora kureka wenyine, vugana n'umuganga ku buryo bwo kugufasha kureka. - Kugira imyifatire myiza yo kuryama. Kuryama nabi bishobora kongera ibyago by'indwara y'umutima n'izindi ndwara z'ubuzima z'igihe kirekire. Abakuze bagomba kugerageza kuryama amasaha 7 kugeza kuri 9 buri munsi. Ryama kandi ukangukire igihe kimwe buri munsi, harimo no mu mpera z'icyumweru. Niba ugira ibibazo byo kuryama, vugana n'umuganga ku buryo bushobora kugufasha. Ibindi bihinduka mu mibereho bishobora kandi gufasha kurinda ubuzima bw'umutima kandi bishobora gukumira ibibazo by'umutima: - Gufata caffeine mu rugero. Caffeine ni igisigaragiza. Bishobora gutuma umutima ukubita cyane. - Ntukore ibiyobyabwenge bitemewe. Ibinyabutabire nk'ukocaine na methamphetamine bishobora kongera umuvuduko w'umutima. Niba ukeneye ubufasha bwo kureka, vugana n'itsinda ryawe ry'ubuvuzi kuri gahunda ikubereye. - Suzuma ibintu biri mu miti. Imiti yo kurwanya ubukonje n'inkorora igura nta rupapuro rw'umuganga irimo ibinyabutabire bishobora kongera umuvuduko w'umutima. Buri gihe, bwira itsinda ryawe ry'ubuvuzi imiti yose ufata. - Jya ku isuzuma ry'ubuzima riteganijwe. Jya ukora isuzuma rya buri gihe kandi ubwira itsinda ryawe ry'ubuvuzi ibimenyetso byose bishya.

Isuzuma ry'umubiri ryuzuye, amateka y'ubuzima n'ibizamini birakenewe kugira ngo hamenyekane tachycardia ya ventricular.\n\nTachycardia ya ventricular rimwe na rimwe isaba ubutabazi bwihuse bw'abaganga kandi ishobora kuvurwa mu bitaro. Iyo bishoboka, umuhanga mu buvuzi ashobora kubaza wowe cyangwa umuryango wawe ibibazo ku bimenyetso, imyifatire y'ubuzima n'amateka y'ubuzima.\n\nElectrocardiogram (ECG cyangwa EKG) ni ikizamini cyo kwandika ibimenyetso by'amashanyarazi mu mutima. Kigaragaza uko umutima ukubita. Ibitambara bito bita electrodes bishyirwa ku gatuza, rimwe na rimwe no ku maboko cyangwa amaguru. Uturango duhuza ibitambara n'ikoranabuhanga, ricapa cyangwa rigaragaza ibyavuye mu bizamini.\n\nMonitor ya Holter ni igikoresho gito, cyambarwa, gikomeza kwandika umuvuduko w'umutima umunsi umwe cyangwa irenga. Umuhanga mu buvuzi arashobora kureba amakuru yakusanyijwe kuri icyo gikoresho kugira ngo amenye niba hari umuvuduko w'umutima utari mwiza, witwa arrhythmia, wabonetse.\n\nMonitor yambarwa y'ibikorwa by'umutima ishobora gukoreshwa mu kuvura tachycardia. Ubwo bwoko bw'igikoresho cya ECG gikora cyane cya ECG gikora gusa mu gihe cy'ibibazo by'umuvuduko w'umutima utari mwiza, witwa arrhythmias.\n\nIbizamini bikorwa kugira ngo harebwe umutima kandi hameze neza uburwayi bwa tachycardia ya ventricular, bitwa kandi V-tach cyangwa VT. Ibyavuye mu bizamini bishobora kandi gufasha kumenya niba hari ikindi kibazo cy'ubuzima gitera V-tach.\n\n- Electrocardiogram (ECG cyangwa EKG). Iri ni ikizamini gisanzwe cyo kuvura tachycardia. ECG igaragaza uko umutima ukubita. Ibyuma bito, bitwa electrodes, bihambirwa ku gatuza, rimwe na rimwe no ku maboko n'amaguru. Uturango duhuza ibyuma n'ikoranabuhanga, ricapa cyangwa rigaragaza ibyavuye mu bizamini. Iki kizamini gishobora gufasha kumenya ubwoko bwa tachycardia.\n- Monitor ya Holter. Niba ECG isanzwe itanga amakuru adahagije, itsinda ry'abaganga bashobora gusaba kwambara monitor y'umutima mu rugo. Monitor ya Holter ni igikoresho gito cya ECG. Cyambarwa umunsi umwe cyangwa irenga kugira ngo kwandike ibikorwa by'umutima mu bikorwa bya buri munsi. Bimwe mu bikoresho bya buri muntu, nka smartwatches, bitanga uburyo bwo gukurikirana ECG. Baza itsinda ry'abaganga bawe niba ibi ari amahitamo kuri wowe.\n- Implantable loop recorder. Iki gikoresho gito gikomeza kwandika umuvuduko w'umutima kugeza imyaka itatu. Bita kandi cardiac event recorder. Iki gikoresho kibwira itsinda ry'abaganga bawe uko umutima wawe ukubita mu bikorwa bya buri munsi. Gishyirwa munsi y'uruhu rw'igituza mu gihe cy'ubuvuzi buto.\n\nMu isuzuma ry'imikino, ibyuma bitwa electrodes bishyirwa ku gatuza, rimwe na rimwe no ku maboko n'amaguru. Ibyuma bindika amakuru yerekeye umuvuduko w'umutima. Umuhanga mu buvuzi areba umutima mu gihe umuntu agendera kuri treadmill cyangwa atemba igare rihagaze.\n\nIbizamini byo kubona amashusho bishobora gufasha itsinda ry'abaganga bawe kureba imiterere y'umutima wawe. Ibizamini byo kubona amashusho by'umutima bikoresha kuvura tachycardia ya ventricular birimo:\n\n- X-ray y'igituza. X-ray y'igituza igaragaza uko umutima n'ibihaha biri.\n- Echocardiogram. Iki kizamini ni ultrasound y'umutima. Ikora ikoresheje amajwi kugira ngo ikore ishusho y'umutima ukubita. Ishobora kwerekana ibice bitagira amaraso ahagije n'ibibazo by'amavavu y'umutima.\n- Isuzuma ry'imikino. Iki si ikizamini cyo kubona amashusho, ariko gishobora gukorwa mu gihe cy'ikizamini cyo kubona amashusho cyitwa echocardiogram. Iki kizamini gisanzwe gikubiyemo kugenda kuri treadmill cyangwa gutemba igare rihagaze mu gihe umuhanga mu buvuzi areba umuvuduko w'umutima. Amwe mu moko ya tachycardia atangizwa cyangwa arushaho kuba mabi kubera imyitozo. Niba udashobora gukora imyitozo, ushobora guhabwa imiti igira ingaruka ku muvuduko w'umutima nk'uko imyitozo ikora.\n- Cardiac magnetic resonance imaging (MRI). Iki kizamini gikora amashusho ahagaze cyangwa yimuka y'amaraso anyura mu mutima. Akenshi gikorwa kugira ngo hamenyekane icyateye tachycardia ya ventricular cyangwa ventricular fibrillation.\n- Cardiac computerized tomography (CT). CT scan ihuza amashusho menshi ya X-ray kugira ngo ibone uburyo burambuye bw'agace karimo kwiga. CT scan y'umutima, yitwa cardiac CT scan, ishobora gukorwa kugira ngo hamenyekane icyateye tachycardia ya ventricular.\n- Coronary angiogram. Coronary angiogram ikorwa kugira ngo harebwe imiyoboro y'amaraso ifunze cyangwa yagabanutse mu mutima. Ikoresha ibara n'amashusho yihariye ya X-ray kugira ngo igaragaze imbere y'imitsi ya coronary. Iki kizamini gishobora gukorwa kugira ngo harebwe imiterere y'amaraso y'umutima mu bantu bafite tachycardia ya ventricular cyangwa ventricular fibrillation.\n\Reba uko heart MRI, bitwa kandi cardiac MRI, ikoreshwa mu kureba umutima.\n\Ibindi bizamini bikorwa kugira ngo hameze neza tachycardia n'icyayiteye no kumenya uko bigira ingaruka ku bindi bibazo by'ubuzima. Ibyo bizamini birimo:\n\n- Electrophysiological (EP) study. EP study ni urukurikirane rw'ibizamini bifasha gukora ikarita irambuye cyane y'uko ibimenyetso bimuka hagati y'umutima buri wese. Bishobora gukorwa kugira ngo hameze neza tachycardia cyangwa kugira ngo hamenyekane aho mu mutima ibimenyetso bibi biba. Bisanzwe bikorwa kugira ngo hamenyekane umuvuduko w'umutima utari mwiza. Muganga ashyira imiyoboro imwe cyangwa irenga mito, yoroshye mu mubiri w'amaraso akayijyana ku mutima. Ibyuma biri ku mpera y'imiyoboro byohereza ibimenyetso by'amashanyarazi ku mutima kandi bindika ibikorwa by'amashanyarazi by'umutima.