Wo koma ‘nneɛma’ te dɛn? Momma yɛnka Coronary Flow Reserve (CFR) ho asɛm!

So woasusuw ho pɛn sɛ ebia wo koma renya mogya a ɛboro so a ehia bere a adwennwen ahyɛ no ma, te sɛ bere a woteɛteɛ w’apɔw mu no anaa? Yɛn koma yɛ akwaa a ɛyɛ nwonwa. Ehia mogya pa na ama ayɛ adwuma yiye. Ɛno ne nea yɛbɛka ho asɛm nnɛ, na ɛka pii fa wo koma akwahosan ho: `Coronary Flow Reserve` anaa `CFR`. Mma ɛnhaw wo, ebia nsɛmfua yi bɛyɛ te sɛ nea ɛyɛ den kakra, nanso momma yɛmma ɛnyɛ mmerɛw.

Dɛn ne `Coronary Flow Reserve (CFR)`? Sɛ yɛbɛka no tiawa a...

Fa wo koma sɛ kar engine. Sɛ ɛreyɛ adwuma sɛnea ɛsɛ a, engine no hia pɛtro dodow bi. Nanso sɛ woreforo bepɔw bi, anaasɛ worekɔ ntɛmntɛm a, engine no hia pɛtro pii, ɛnte saa? Saa na yɛn koma te. Sɛ yɛregye yɛn ahome a, koma no hia mogya dodow bi. Nanso sɛ yɛteɛteɛ yɛn apɔw mu, yetu mmirika, yehuruw, yɛma nneɛma a emu yɛ duru so, anaasɛ yɛwɔ adwennwen mu a, koma no hia mframa pa ne aduannuru pii . Sɛnea ɛbɛyɛ na wɔadi ahwehwɛde a ɛkɔ soro yi ho dwuma no, ɛsɛ sɛ mogya a ɛkɔ koma no mu no kɔ soro.

Wɔfrɛ mogya ntini atitiriw a ɛde mogya kɔ koma no mu no sɛ coronary arteries . Coronary Flow Reserve (CFR) yɛ nea ɛkyerɛ sɛnea wo koma ntini no betumi ama wɔn mogya akɔ soro bere a koma no hia mogya pii no. Ɛte sɛ nea worehwɛ koma no ‘nneɛma’ a wɔde asie.

Wɔsan frɛ eyi sɛ `Myocardial blood flow reserve`. Efisɛ mogya fi saa ntini a ɛma mogya tu yi mu kɔ wo koma ntini mu, kyerɛ sɛ, ɛkɔ koma ntini `(Myocardium)` . Enti ɛnam CFR gyinapɛn yi so no, nnuruyɛfo betumi ahwɛ sɛ ebia wo koma ntini no renya mogya a ɛdɔɔso bere a ehia no anaa.

Ɔkwan bɛn so na wobu CFR bo yi ho akontaa?

Eyi yɛ akontaabu a ɛyɛ mmerɛw yiye. Nanso egye sɔhwɛ titiriw bi na ama wɔatumi ayɛ eyi. Sɛ yɛbɛka no tiawa a, CFR ne mogya a ɛsen biara a ebetumi afa wo koma ntini mu , a wɔakyekyɛ mu denam mogya a ɛsen fa wo mu bere a woagye w’ahome no so, a wommɔ mmɔden biara .

Sɛ nhwɛso no, sɛ woregye w’ahome a, wo koma bɔ mogya mililita X simma biara. Sɛ worebɔ mmɔden kɛse (anaasɛ bere a wɔde nsa ayɛ saa tebea no) a, wo koma no de mogya Y mililita. Afei CFR = Y / X.

Eyi ne mogya pii a wo koma betumi abɔ sen sɛnea ɛte daa.

Wɔ tebea horow bɛn mu na wɔyɛ CFR nhwehwɛmu?

Nneɛma pii nti na oduruyɛfo betumi akamfo CFR nhwehwɛmu akyerɛ wo:

• Hwehwɛ sɛ wowɔ ahrawa mu yare (CAD): Ɛtɔ mmere bi a, ɛyɛ wo koko mu yaw (angina), ɛyɛ den sɛ wobɛhomeSɛ sɛnkyerɛnne ahorow te sɛ eyinom ba a, sɔhwɛ yi boa ma wohu sɛ ebia nea ɛde ba no yɛ ntini a ɛma mogya tu no siw anaa.
• Hwɛ sɛnea CAD no mu yɛ den: Eyi ho hia na ama woate ntini ahorow no fã kɛse a ɛka ne mogya dodow a esiw obi a ɔwɔ CAD dedaw no ase.
• Hyɛ asiane a ɛwɔ hɔ sɛ komayare daakye ho nkɔm : Bere a CFR bo no so tew no, asiane a ɛwɔ hɔ sɛ wubenya komayare anaa komayare foforo daakye no betumi ayɛ kɛse.
• Susuw sɛnea ayaresa ahorow no di yiye: Wobetumi nso de nhwehwɛmu yi adi dwuma de ahwɛ sɛ mogya a ɛkɔ koma no mu asan aba bio wɔ ayaresa ahorow bi akyi (e.g. angioplasty, bypass surgery).

Sɛ wɔkyekyem pɛpɛɛpɛ a, dɛn ne CFR bo?

Mpɛn pii no, obi a ɔwɔ apɔwmuden CFR yɛ 2.0 kosi 2.5 anaa nea ɛboro saa . Eyi kyerɛ sɛ, sɛ woreyɛ adwumaden a, anyɛ yiye koraa no, mogya a ɛkɔ wo koma mu no boro bere a woregye w’ahome no so mmɔho abien. Obi a ɔwɔ apɔwmuden betumi anya saa bo yi a ɛkɔ soro akodu 3. Eyi kyerɛ sɛ wɔwɔ tumi a ɛma mogya a wɔde ma no kɔ soro mprɛnsa.

Nhwehwɛmu bi daa no adi sɛ nnipa a wɔn CFR boro 2 no ho tɔɔ wɔn yiye asram asia wɔ komayare akyi. CFR a ennu 2 kyerɛ sɛ asiane kɛse wɔ hɔ sɛ obi benya komayare.

Nanso ɛho hia sɛ yɛte ase sɛ saa gyinapɛn "a ɛyɛ daa" yi betumi asesa bere a obi nyin no. Ebia aberante a ɔwɔ apɔwmuden benya CFR 5 anaa 6. Nanso ebia obi a wadi mfe 80 a ɔwɔ apɔwmuden mpo benya CFR a ennu 2. Afei nso, abofra a wɔayɛ no oprehyɛn wɔ komayare a wɔde awo no ho no betumi anya CFR a ɛba fam. Enti, wo duruyɛfo begyina w’akwahosan nyinaa ne nneɛma afoforo so asi gyinae sɛ ebia wo CFR no te sɛ nea ɛfata anaasɛ ɛnte saa.

Ɔkwan bɛn so na wɔyɛ CFR sɔhwɛ no? Ɔkwan bɛn so na yebetumi asiesie yɛn ho ama no?

Akwan titiriw abien na ɛwɔ hɔ a wɔfa so susuw CFR. Biako ne ɔkwan a wɔfa so hyɛ nipadua no mu , a nea ɛka ho ne sɛ wɔde biribi hyɛ nipadua no mu. Eyi fa biribi a wɔfrɛ no `Cardiac Catheterization` ho. Ɔfoforo no yɛ ɔkwan a ɛnyɛ nea wɔde hyɛ nipadua mu , a nea ɛka ho ne sɛ wɔde `Nuclear Stress Test` soronko bi bedi dwuma, a ɛyɛ `Rubidium-82 Positron Emission Tomography (PET) scan`. Ɛntaa mma sɛ wobetumi de `Magnetic Resonance Imaging (MRI) scan` nso adi dwuma de ayɛ eyi.

Afei ma yɛnhwɛ sɛnea yebesiesie yɛn ho ama sɔhwɛ yi ne nea ɛbɛba da a wɔbɛyɛ sɔhwɛ no.

Nneɛma a ɛsɛ sɛ wuhu ansa na woayɛ sɔhwɛ no

• Ka nnuru a worenom ho asɛm kyerɛ wo duruyɛfo: a nnuru a wɔkyerɛw ma wo, nnuru a wɔtɔn, ne vitamin ahorow ka ho.Ɛsɛ sɛ woka nhabannuru biara a wonom nso kyerɛ wo duruyɛfo, efisɛ nnuru bi betumi aka mogya a ɛkɔ nipadua no mu.
• Ka wo akisikuru ho asɛm kyerɛ yɛn: Sɛ wo ho yɛ wo hyew wɔ nnuru biara ho, contrast dye a wɔde di dwuma wɔ nhwehwɛmu mu, anaa latex ho a, di kan ma yɛnhu.
• Aduan ne Nsã ho Afotu: Sɛ wɔreyɛ wo koma mu catheteration anaa PET scan a, bisa wo duruyɛfo nnɔnhwerew dodow a ɛsɛ sɛ wugyae adidi anaa anonne ansa na wɔayɛ nhwehwɛmu no. Mpɛn pii no, wɔremma wo nnidi anaa nnom biribiara nnɔnhwerew 6 kosi 8 ansa na wɔayɛ sɔhwɛ no.

Dɛn na wobɛhwɛ kwan wɔ sɔhwɛ da no?

• Sɛ wopɛ MRI scan a: Ɛnsɛ sɛ wode dade nneɛma biara (te sɛ agude anaa nwi a wɔde hyɛ wo ti nhwi) wɔ wo nipadua mu. Ebia nnuruyɛ mfiri bi (te sɛ nea ɛma obi koma bɔ kɛse) ne MRI nhyia. Enti sɛ wowɔ afiri a ɛte saa a, di kan bisa wo duruyɛfo ma ɔnhwɛ sɛ ɛyɛ nea asiane biara nni ho sɛ wɔde bɛyɛ MRI.
• Koma mu Catheterization: Wɔ saa adeyɛ yi mu no, wɔde afiri a ɛyɛ tratraa paa (catheter) fa mogya ntini bi a ɛwɔ wo kɔn, wo srɛ, anaa wo nsa mu kɔ wo koma mu ntini a ɛma mogya tu no mu. Wɔbɛma wo aduru a ɛnyɛ den a ɛma wo ho dwo wo na ama wo ho atɔ wo kɛse.
• IV nhama: Ɛmfa ho ɔkwan a wɔfa so yɛ sɔhwɛ no, wɔde ``Intravenous line (IV)`` bɛbata ntini bi a ɛwɔ wo basa mu ho. Saa IV yi ne baabi a wɔde nnuru (vasodilator) ma na ama mogya akɔ koma no mu kɛse na ɛtɔ mmere bi a wɔde ``Contrast dye`` ma na ama ahurututu mu ntini ahorow no ada adi yiye. Sɛ woreyɛ ``PET scan`` a, wɔde radioactive substance ``Radiotracer`` nso nam saa IV yi so ma.

Ma menkyerɛkyerɛ mu kakra fa sɛnea wɔsusuw CFR no ho...

Wo duruyɛfo de mfoninitwa akwan horow bedi dwuma de asusuw mogya a ɛkɔ wo koma ntini mu bere a woagye w’ahome ne bere a worebɔ mmɔden kɛse no. Wɔn titiriw ne:

• `PET scan`: Wɔ eyi mu no, sɛ `Radiotracer` a wɔde fa IV so ma no du koma no mu a, wɔde mfoninitwa afiri soronko bi kyere nsɛnkyerɛnne a ɛde ba no, na ɛdenam kɔmputa mmoa so no, wonya mogya a ɛkɔ koma no mu no ho mfonini a emu da hɔ.
• ` Cardiac MRI` : Eyi nso yɛ mfoninitwa kwan. Nanso, wɔmfa nni dwuma pii mfa nsusuw CFR.

Ɛho hia yiye sɛ wobɛtra hɔ dinn wɔ saa scan yi mu, anyɛ saa a ebia mfonini ahorow a wubenya no mu nna hɔ.

`Cardiac Catheterization` kwan no yɛ soronko kakra. Ɛfa:

1. Sɛ wɔde catheter no hyɛ coronary artery no mu wie a, wɔde hama soronko bi fa mu. Wɔ saa waya yi ano no, `Ultrasound transducer` (afiri ketewa bi a ɛma ultrasound asorɔkye na ɛgye). Eyi betumi asusuw ahoɔhare a mogya sen kɔ ahrawa mu ntini no mu.

2. Wɔ saa adeyɛ yi mu no, wɔde aduru bi a wɔfrɛ no `Heparin` fa IV no so ma na amma mogya antɔ.

3. Nhama afoforo wɔ hɔ a wɔde mfiri abien a ɛma wohu ɔhyew ne nkyene a wɔde twitwiw mogya no susuw mogya a ɛkɔ mu.

Dɛn ankasa na ɛba bere a wɔreyɛ sɔhwɛ no?

Bere a woreyɛ wo nhwehwɛmu no, nnuruyɛfo kuw no bɛyɛ nea edidi so yi:

1. Nea edi kan no, wɔsusuw mogya a ɛkɔ wo koma ntini mu bere a woregye w’ahome no .

2. Afei, wɔde aduru bi a ɛyɛ `Vasodilator` (te sɛ `Adenosine (Adenocard® anaa Adenoscan®)`) fa wo IV so ma, a ɛma koma bɔ ne mogya a ɛkɔ soro. Saa aduru yi ma mogya no kɔ soro mpɛn anan kosi anum bere a wode toto bere a woagye w’ahome no ho no. Egye bere tiaa bi, bɛyɛ simma abien kosi abiɛsa ansa na aduru yi atumi ayɛ adwuma. Wɔfrɛ eyi `Cardiac Catheterization`, na ɛtɔ da bi a wobetumi de saa aduru yi afa catheter no so ama sen sɛ wɔde IV bɛma.

3. Sɛ wɔde aduru no ma wie a, wɔsan susuw mogya a ɛkɔ ntini a ɛma mogya tu no mu. Eyi ne mogya a ɛsen sen biara.

4. Awiei koraa no, wobu wo `Coronary Flow Reserve (CFR)` bo denam mogya a ɛsen kɛse yi ne wo mogya a ɛkɔ ahomegye mu a wɔde toto ho no so .

Dɛn na ɛba wɔ sɔhwɛ no akyi?

• Sɛ wode catheter ahyɛ mu (titiriw wɔ asen anaa abasa mu) a, ɛho behia sɛ woma baabi a wɔatwa no gyina hɔ dɔnhwerew biako anaa nea ɛboro saa na amma mogya antɔ.
• Ebia wo duruyɛfo bɛka akyerɛ wo sɛ nom nsu pii na aboa ma woayi aduru a ɛne ne ho bɔ abira no afi wo nipadua mu.
• Sɛ wɔama wo aduru a ɛma obi dwo a, worentumi nka kar mma saa da no. Enti ɛho behia sɛ wode obi ka wo ho ba fie .

Asiane ne nsunsuanso bɔne bɛn na ɛwɔ CFR nhwehwɛmu yi mu?

Mpɛn pii no, CFR nhwehwɛmu yɛ ɔkwan a ahobammɔ wom, nanso te sɛ aduruyɛ biara no, asiane nketenkete bi wɔ hɔ.

• Esiane sɛ wɔde catheter ne nhama hyehyɛ ntini a ɛma mogya tu no mu nti, ɛntaa mma koraa sɛ mogya bɛtɔ, ntini no mu ayɛ mmerɛw, anaa mogya atɔ.
• Asiane kakraa bi pɛ na ɛwɔ hɔ sɛ mogya ntini bɛsɛe. Sɛ eyi ba a, ebia ɛho behia sɛ wɔyɛ oprehyɛn de siesie , na ɛntaa nsi koraa.

Sɛ wɔma nnipa binom aduru `Adenosine` a, wobetumi anya nsunsuanso bɔne a edidi so yi, a ɛtra hɔ sikani kakraa bi pɛ:

• Koma mu nnyigyei a ɛnyɛ ne kwan so
• Mogya mmoroso a ɛba fam (Hypotension) .
• Ahome a ɛyɛ tiaa
• Koko mu a ɛyɛ mmerɛw

Nea ɛho hia: Wɔmfa saa `Adenosine` aduru yi mma nnipa a wɔwɔ ayamtu. Efisɛ ebetumi ama ahurututu mu yare aba. Wɔ tebea a ɛte saa mu no, oduruyɛfo no betumi de aduru foforo a wɔde IV te sɛ `Dobutamine` adi dwuma.

Nea afi mu aba no te dɛn? Dɛn na wɔka kyerɛ yɛn?

Wo CFR sɔhwɛ no ma wo nɔma. Saa nɔma yi kyerɛ wo sɛnea wo koma ntini no betumi ama mogya akɔ soro bere a worebɔ mmɔden no.

Sɛnea yɛadi kan aka ho asɛm no, saa bo yi betumi atew bere a obi nyin no. Ebia aberante a ɔwɔ apɔwmuden benya CFR 5 anaa 6. Nanso ebia obi a ne mfe akɔ anim a ɔwɔ apɔwmuden benya CFR a ennu 2.

Mogya a ɛkɔ so tew (i.e., asiane bi) betumi aba wɔ CFR bo biara a ɛwɔ 1.6 ne 3.3 ntam. Ebia nea ɛyɛ ade a ɛfata ma obiako no renyɛ nea ɛfata mma ɔfoforo. Enti, wo duruyɛfo nkutoo na obetumi akyerɛ nea efi mu ba no ase pɛpɛɛpɛ. Obesusuw nneɛma pii te sɛ mfe a woadi, w’akwahosan, ne yare no ho sɛnkyerɛnne ahorow ho na ama watumi de asɛm bi aba awiei.

Bere tenten ahe na egye ansa na wɔahu nea efi mu ba?

Ebia ebegye nna kakraa bi ansa na wo duruyɛfo no ahwehwɛ nea efii wo CFR nhwehwɛmu no mu bae no mu na wama woahu. Sɛ nea efi mu ba no yɛ borderline a, ebia wo duruyɛfo bɛpɛ sɛ ɔne nnuruyɛfo afoforo susuw ho. Sɛ nea efi mu ba no kyerɛ sɛ asiane a ɛwɔ hɔ sɛ wubenya komayare a, wo duruyɛfo no nso ne wo bɛkasa afa nhyehyɛe bi a wɔbɛyɛ de atew asiane a ɛwɔ hɔ no so ho.

Bere bɛn na ɛsɛ sɛ me ne oduruyɛfo di nkitaho?

Sɛ wowɔ nsɛmmisa bi ansa na CFR nhwehwɛmu no afi ase a, bisa wo duruyɛfo. Afei nso, sɛ wuhu sɛnkyerɛnne biara a ɛyɛ soronko, nneɛma bɔne bi, anaasɛ wo ho nyɛ wo dɛ wɔ nhwehwɛmu no akyi , bɔ wo duruyɛfo amanneɛ ntɛm ara.

Nkrasɛm a Wɔde Kɔ Fie

`Coronary Flow Reserve (CFR)` sɔhwɛ yɛ sɔhwɛ a ɛma nsɛm a ɛsom bo fa ntini a ɛma mogya kɔ wo koma no akwahosan ho. Ebetumi ahwɛ sɛ ebia wo koma renya mogya a ɛboro so a ehia bere a ɛreyɛ adwumaden no anaa.

CFR bo a ɛba fam betumi ayɛ ahrawa mu ntini mu yare ho sɛnkyerɛnne. Ebetumi ama woanya asiane a ɛwɔ hɔ sɛ wubenya komayare daakye nso ho adwene.

Sɛ biribi wɔ hɔ a wonte aseɛ wɔ sɔhwɛ yi ho a, nsuro sɛ wobɛbisa wo duruyɛfoɔ. Wɔbɛkyerɛkyerɛ biribiara mu akyerɛ wo na wɔaboa wo ma sɔhwɛ no ayɛ nea ahotɔ wom sɛnea wubetumi. Kae sɛ wo koma a wobɛhwɛ so yiye no ho hia paa!

`Komayare, koma mu ntini, mogya a wɔde ma, CFR nhwehwɛmu, komayare, koma akwahosan, aduruyɛ mu nhwehwɛmu