Sɛ wosɔre mpofirim a, wo nso wo tirim yɛ wo yaw? Ebetumi ayɛ (Orthostatic Hypotension)! Momma yɛnkasa.

So wote nka sɛ wo ti yɛ wo yaw anaasɛ wo ti yɛ hare bere a wugyina hɔ mpofirim, sɛ́ wote hɔ anaasɛ woda fam no? Ɛtɔ da mpo a, wote nka sɛ wobɛtotɔ piti kakra, ɛnte saa? Eyi ne tebea a yɛrebɛka ho asɛm nnɛ, a wɔfrɛ no ``Orthostatic Hypotension''. Nnipa binom nso frɛ no ``Postural Hypotension.'' Mma ɛnhaw wo, eyi yɛ biribi a ebetumi ato nnipa pii, titiriw bere a wɔrenyin no. Momma yɛnka eyi ho asɛm nkɔ akyiri na yɛnka no tiawa.

Dɛn ne `(Orthostatic Hypotension)`? Sɛ yɛbɛka no tiawa a...

Sɛ yɛbɛka no tiawa a, `(Orthostatic Hypotension)` yɛ bere a wo mogya mmoroso so tew mpofirim bere a wosɔre fi baabi a wote anaa woda hɔ no. Fa no sɛ, wote akongua so rekenkan atesɛm krataa na mpofirim ara wosɔre gyina hɔ esiane sɛ obi rekasa nti. Ɛno ne bere a wote nka sɛ wo ho ayɛ wo yaw. `(Orthostatic)` kyerɛ gyinabea a ɛteɛ. `(Hypotension)` kyerɛ mogya mmoroso a ɛba fam. Enti, eyi ne bere a wo mogya mmoroso so tew bere a wosakra wo gyinabea no.

Enti, dɛn ne mogya mmoroso yi?

Yɛtaa te mogya mmoroso, anaa ``Mogya Nhyɛso'' ho asɛm. Eyi susuw nhyɛso a mogya de ba ntini ahorow no afasu so bere a yɛn koma bɔ no. Ɛte sɛ nhyɛso a nsu de ba nsu afiri no so bere a ɛsen fa nsu pɔmpɛ mu no. Wɔsusu eyi wɔ milimita mercury ``(mmHg)`` mu.

Sɛ wokɔ oduruyɛfo nkyɛn a, wɔka nɔma abien kyerɛ wo bere a wɔhwɛ wo mogya so no, ɛnte saa?

• Nnɔmba a ɛwɔ soro `(Systolic)`: Eyi kyerɛ nhyɛso a ɛba bere a wo koma bɔ na ɛde mogya kɔ wo ntini mu no.
• Nnɔmba a ɛwɔ aseɛ `(Diastolic)`: Eyi kyerɛ nhyɛsoɔ a ɛwɔ ntini a ɛwɔ koma bɔ mmienu ntam, kyerɛ sɛ, berɛ a koma no dwo kakra.

Nnuruyɛfo kyerɛw no sɛ nɔma a ɛwɔ soro/ase nɔma (e.g. 120/80 mmHg). Nnipa dodow no ara mogya mmoroso a ɛyɛ papa no nnu 120/80 mmHg. Wobu akenkan a ɛba fam sen 90/60 mmHg sɛ mogya mmoroso a ɛba fam.

Mogya mmoroso so tew dodow ahe wɔ ``Orthostatic Hypotension'' mu?

Mfaso biara nni eyi so pɛpɛɛpɛ. Nanso, nnuruyɛfo na wohu eyi denam wo mogya mmoroso a ɛfata ne dodow a ɛkɔ fam bere a wugyina hɔ a wobɛhwɛ so. Mpɛn pii no, sɛ nɔma a ɛwɔ soro ``Systolic`` no so tew mmHg 20 anaasɛ nɔma a ɛwɔ ase ``Diastolic`` no so tew mmHg 10 wɔ simma abiɛsa a wogyina hɔ akyi a , wobu no sɛ ``Orthostatic Hypotension``.

Hena na ɛda adi kɛse sɛ obenya Orthostatic Hypotension?

Saa tebea yi betumi aba obiara mu ankasa, nanso ɛtaa ba bere a worenyin no. Nneɛma a edidi so yi betumi ama asiane a ɛwɔ hɔ sɛ wubenya bi no ayɛ kɛse:

• Mogya a ɛtɔ mogya anaa Vitamin B12 a enni nipadua mu: Saa tebea yi betumi aba bere a mogya dodow so tew anaasɛ vitamin B12 so tew no.
• Nsu a ɛba nipadua no mu esiane nnuru a ɛma obi ho yɛ hyew, ɔfe, anaa nnuru a ɛma obi ho popo nti: Sɛ nsu dodow a ɛwɔ nipadua no mu so tew a, mogya mmoroso betumi akɔ fam.
• Nkwammoaa mu ɔhaw ahorow:Tebea horow te sɛ asikreyare, thyroid yare, ne Addison yare.
• Koma mu tebea horow: Nneɛma te sɛ koma mu yare (Arrhythmias), koma mu ntini mu yare.
• Nnuru bi: Ebetumi nso afi nnuru bi a wɔnom ma mogya mmoroso, komayare, anaa adwenemhaw.
• Ntini mu haw ahorow: Nyarewa te sɛ Parkinson yare ne adwenemhaw.
• Nyinsɛn: Titiriw wɔ adapɛn 24 a edi kan no mu.
• Mpa so a wobɛtra bere tenten esiane yare bi nti: Te sɛ mpa so a wobɛtra bere a nyinsɛn no.

Fa no sɛ, Onua Somapala a ofi yɛn akuraa ase. Ɔwɔ asikreyare na ɔnom nnuru a wɔde sa mogya mmoroso. Ɔka sɛ sɛ ɔsɔre fi mpa so anɔpa a, ɔte nka sɛ n’adwene tu fra. Nnipa a wɔte saa no taa nya saa tebea yi.

Saa tebea yi abu so dɛn?

Orthostatic hypotension ka nkwakoraa ne mmerewa bɛyɛ 20% , titiriw wɔn a wɔte nkwakoraa ne mmerewa afie. Ɛtaa ba nnipa a wɔada mpa so akyɛ, ne ɛnanom foforo a wɔawo akokoaa nso mu. Ebetumi aba mmabun a wɔrenya nkɔso ntɛmntɛm nso so.

Dɛn ne eyi ho sɛnkyerɛnne?

Mpɛn pii no, mogya mmoroso a ɛwɔ nipadua no mu no na ɛda adi kɛse na yare no ho sɛnkyerɛnne no yɛ kɛse anɔpa. Nea enti a ɛte saa ne sɛ, sɛ yɛsɔre anɔpa a, yɛn mogya mmoroso taa ba fam kakra.

Ebia nnipa binom rennya yare no ho sɛnkyerɛnne biara koraa. Wɔ afoforo fam no, saa sɛnkyerɛnne ahorow yi mu yɛ den bere a wim yɛ hyew, atiridiinini, anaa nsu a ɛyɛ hyew a wɔreguare no.

Nsɛnkyerɛnne titiriw ne adwenemhaw anaasɛ ne ti a ɛyɛ hare bere a ogyina hɔ no . Ɛsɛ sɛ eyi fi hɔ bere a wotena ase anaasɛ woda hɔ bio no. Ebia nnipa binom mpo bɛyera wɔn adwene (syncope).

Nsɛnkyerɛnne afoforo ne:

• Anisoadehu a ɛyɛ kusuu
• Koko mu yaw, mmati mu yaw anaa kɔn mu yaw
• Ɛyɛ den sɛ wode w’adwene besi biribi so
• Ɔbrɛ anaa mmerɛwyɛ
• Tiyɛ (Pa kyɛw, wɔde asɛmfua bi a efi kasa foforo mu hyɛɛ ha wɔ akwanhyia mu. Asɛmfua a ɛteɛ: Tiyɛ )
• Koma a ɛbɔ denneennen
• Akisikuru anaasɛ ɔhyew ne fifiri a wɔte nka
• Ɔhome a ɛyɛ tiaa / Dyspnea

Dɛn nti na saa `(Orthostatic Hypotension)` yi ba? Dɛn na ɛde ba?

Sɛ yɛtena ase anaa yɛda fam a, ɛnyɛ den sɛ mogya a ɛwɔ yɛn nan ntini mu no san kɔ yɛn koma mu. Nanso sɛ yegyina hɔ a, tumi a ɛtwe ade ba fam no ma ɛyɛ den ma mogya a ɛwɔ yɛn nan ne yɛn nan mu no sɛ ebedu yɛn koma mu. Eyi ma mogya dodow a wotumi de kɔ yɛn koma, akwaa afoforo, ne yɛn ntini mu no so tew. Ne saa nti, yɛn mogya so tew bere tiaa bi.

Ebia nneɛma pii nti na ɛte saa:

• Wo koma ntumi nkɔ mogya a ɛdɔɔso.
• Wo autonomic nervous system (a ɛtaa hwɛ mogya mmoroso so) no ntumi nyɛ adwuma yiye.
• Sɛ wowɔ nyarewa te sɛ Parkinson yare, Lewy nipadua mu adwenemhaw, anaa multiple system atrophy a .
• Sɛ woakɔ tebea koro no ara mu (e.g. woda fam) akyɛ (te sɛ mpa so a wobɛda bere a woanyinsɛn).
• Sɛ wo mogya dodow so tew esiane mogya anaa nsu a ɛyera (dehydration) nti a.
• Sɛ wowɔ ɔhaw bi wɔ wo adrenal gland no ho a .
• Esiane sɛnea wo nipadua yɛ n'ade wɔ aduru pɔtee bi a wonom ho nti .

Wobɛyɛ dɛn ahu orthostatic hypotension pɛpɛɛpɛ?

Sɛ wokɔ oduruyɛfo nkyɛn a, wobedi kan asusuw wo mogya mmoroso bere a wote hɔ, afei woda fam, na afei wogyina hɔ. Ɛnyɛ ɛno nko, wobebisa wo w’ayaresa tebea ne nnuru a worenom nso ho asɛm.

Bio nso, wobetumi ayɛ sɔhwɛ ahorow a edidi so yi mu biako anaa nea ɛboro saa:

• Mogya mu nhwehwɛmu: Hwɛ tebea horow te sɛ asikreyare ne mogya a ɛtɔ kɔ nipadua mu anaa.
• Echocardiogram (Echocardiogram / echo): Hwɛ sɛnea koma no bɔ mogya.
• Electrocardiogram (EKG): Hwehwɛ nsakrae a ɛba koma no mu.
• Apɔw-mu-teɛteɛ mu adwennwen ho sɔhwɛ: Susuw wo koma bɔ bere a woreyɛ apɔw-mu-teɛteɛ no.
• Portable EKG devices / Holter monitor: Sua koma no nnyigyei da mũ no nyinaa.
• Tilt table test: Sɔhwɛ a wɔde susuw mogya mmoroso, koma bɔ, ne koma a ɛbɔ dwoodwoo denam ma a wobɛda pon so na woadan pon no akɔ baabi a ɛda hɔ no so.

Dɛn ne ayaresa ahorow a wɔde sa Orthostatic Hypotension?

Ayaresa ahorow gyina nea ɛde tebea yi ba so.

Wobetumi ayɛ nea edidi so yi sɛ ayaresa:

• Sɛ yare anaa tebea bi wɔ hɔ a ɛde orthostatic hypotension reba a, sa.
• Aduru bi a ɛde tebea yi reba no dodow a wobɛsesa anaasɛ wobɛdan akɔ aduru foforo so (ɛsɛ sɛ woyɛ eyi bere a wo ne wo duruyɛfo akasa awie no).
• Sɛ woda mpa so a, fa yɛ wo su sɛ wobɛsɔre atra mpa so.
• Ɔhyɛ stokɛ a ɛyɛ den. Eyinom ma mogya a ɛboaboa ano wɔ nan no mu no so tew.
• Sɛ wo ho nsu atɔ wo a, nom nsu ne nsu a nkyene wom pii.

Nnuru bɛn na wɔde ma wɔ eyi ho?

Mpɛn pii no, wobetumi de asetra mu nsakrae adi eyi so. Nanso, ebia ebehia sɛ nnipa binom nom nnuru na ama mogya dodow ne mogya mmoroso akɔ soro. Nanso, eyinom ho yɛ na koraa.

Nnuru ahorow yi bi ne:

• `Droxidopa a ɛyɛ adwuma wɔ hɔ`
• Nnuru a ɛkanyan mogya mu ntini a ɛma mogya tu (ESAs) (e.g. Procrit® anaa Epogen®) .
• `Desmopressin (Nocdurna® anaa `DDAVP®)`
• `Octreotide (Bynfezia PenTM` anaa `Mycapssa®)`
• `Fludrocortisone a wɔde yɛ aduru`
• `Midodrine hydrochloride a wɔde yɛ adwuma`
• `Pyridostigmine (Mestinon®` anaa `Regonol®)`

Nea ɛho hia: Ɛsɛ sɛ wɔnom nnuru yi wɔ oduruyɛfo afotu ase nkutoo. Sɛ w’ankasa wonom nnuru a, ebetumi de asiane aba.

So ayaresa no mu nsunsuanso bɔne bi wɔ hɔ?

Nnuru bi a wɔde di dwuma ma Orthostatic Hypotension betumi de ɔhaw ahorow te sɛ:

• Nnipa a wɔyɛ mmerɛw
• Ɛyɛ akisikuru
• Ti a ɛyɛ yaw
• Rehono
• Potassium dodow a ɛba fam
• Koma a entumi nyɛ adwuma yiye (eyi ntaa nsi koraa) .

Ɛno nti na ɛho hia sɛ wonya ayaresa wɔ oduruyɛfo hwɛ ase no.

Dɛn ne nsɛnnennen a ebetumi aba esiane Orthostatic Hypotension nti?

Ebia nnipa a wɔwɔ saa tebea yi bɛkɔ asiane kɛse mu ama nea edidi so yi:

• Nnompe a ɛpaapae anaa ti a wopirapira (akisikuru) betumi afi asehwe bere a n’adwene atu afra anaasɛ onnim hwee mu aba .
• Adidi akyi mogya mmoroso: Eyi yɛ mogya mmoroso a ɛkɔ fam wɔ simma 30 kosi nnɔnhwerew abien mu bere a woadi aduan bi akyi (titiriw aduan a carbohydrates pii wom).
• Sɛ mogya mmoroso kɔ so brɛ ase dodo a, ahodwiriw anaa akwaa a entumi nyɛ adwuma yiye (eyi ntaa nsi koraa).
• Asiane a ɛwɔ hɔ sɛ obi benya akisikuru anaa komayare esiane mogya mmoroso a ɛsakrasakra nti .
• Supine hypotension: Eyi kyerɛ sɛ mogya mmoroso so tew bere a ɔda fam (eyi betumi afi nnuru bi mu aba).

Sɛ mewɔ `(Orthostatic Hypotension)` a, dɛn na ɛba?

Nnipa pii betumi adi tebea yi ho sɛnkyerɛnne ahorow so (Orthostatic Hypotension) denam akwan bi a wɔfa so siw ano a wobedi akyi so. Sɛ nhwɛso no, ɛsɛ sɛ wugye wo bere bere a woasɔre no. Ɛnyɛ nea ɛda adi koraa sɛ eyi de ɔhaw ahorow a emu yɛ den a ɛtra hɔ kyɛ bɛba.

So ɛrentumi nyɛ yiye sɛ obi benya ahoɔden afi tebea yi mu koraa?

"Aduru" biara nni hɔ a wɔde sa orthostatic hypotension. Nanso, wobetumi adi sɛnkyerɛnne ahorow no so kɛse denam afotu a wo duruyɛfo de ma wo a wubedi so no so. Ebia afotu yi bi ne:

• Aduru a wɔakyerɛw ama wɔn no a wɔbɛnom no yiye.
• Di nnuan nketenkete mmom sen sɛ wubedi nnuan akɛse prɛko pɛ.
• Nom nsu ne nsu pii.
• Sɔks ahorow soronko a wɔhyɛ (Compression stockings).

Mɛyɛ dɛn atumi atew asiane a ɛwɔ hɔ sɛ menya Orthostatic Hypotension no so?

Sɛ wo ho yɛ wo yaw te sɛ eyi a, anammɔn yi a wubedi akyi no betumi aboa ma woatew sɛnkyerɛnne ahorow no so:

• Hwɛ wo nipadua mu hyew so: Nguare nsu a ɛyɛ hyew paa mu.
• Kɔ so nya nsu: Nom nsu pii. To nsa ano hye. Nni aduan a emu yɛ duru a carbohydrates pii wom prɛko pɛ.
• Ma wo ti so kakra bere a woda mpa so no: fa pillow biako anaa abien foforo di dwuma, anaa ma mattress no ti so kakra.
• Siesie wo ho ansa na woasɔre: Gye bere kakra sɔre fi baabi a wote anaa woda. Nya biribi a ɛyɛ den a wobɛkura mu bere a woasɔre no.
• Fa wo ntini teɛteɛ w’apɔw mu: Sɛ ɛsɛ sɛ wugyina hɔ kyɛ a, sɛ́ anka wubegyina hɔ no, nantew tiawa denam wo nan a wobɛma so sesa so. Ansa na wobɛsɔre no, yɛ isometric apɔw-mu-teɛteɛ (e.g., rɔba bɔɔl ketewa bi a wobɛpiapia). Eyi betumi ama wo mogya mmoroso akɔ soro kakra.
• Ma mogya a ɛkɔ nipadua no mu ne nhyɛso tu mpɔn: Hyɛ compression stockings soronko anaa nea wɔde kyekyere yafunu.

Bere bɛn na ɛsɛ sɛ mekɔ oduruyɛfo nkyɛn?

Sɛ wotaa te nka sɛ w’adwene tu fra bere a wosɔre a, akyinnye biara nni ho sɛ ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn . Sɛ ɛtɔ mmere bi a eyi ba nkutoo mpo a, ɛyɛ papa sɛ wobɛka ho asɛm akyerɛ wo duruyɛfo .

Bere bɛn na ɛsɛ sɛ mekɔ Emergency Treatment Unit (ETU) ?

Sɛ wowɔ saa sɛnkyerɛnne ahorow yi a, hwehwɛ ayaresa ntɛm ara :

• Koko mu yaw.
• Ɔhwe ase anaasɛ ɔtotɔ piti.
• Ɔhaw ahorow a ɛfa kari pɛ anaasɛ nhyehyɛe a wɔyɛ no pɛpɛɛpɛ ho.
• Sɛ wosusuw sɛ obi abubu anaasɛ ne ti apira esiane sɛ obi ahwe ase nti a.
• Sɛ wo nsu mu yɛ mogya anaasɛ tuntum a.
• Nsɛnkyerɛnne a ɛkyerɛ sɛ obi ho popo (nipadua a ɛyɛ nwini, fifiri, ɔhome ntɛmntɛm, honam ani bruu, ne koma a ɛyɛ mmerɛw).

Nsɛm bɛn na ɛsɛ sɛ mibisa oduruyɛfo no?

Sɛ wokɔ oduruyɛfo nkyɛn a, wubetumi abisa nsɛm te sɛ eyinom:

• Adɛn nti na mewɔ saa tebea yi a wɔfrɛ no ``Orthostatic Hypotension''?
• Dɛn ne ayaresa a eye sen biara ma eyi?
• So nnuru a menom no na ɛde saa sɛnkyerɛnne ahorow yi ba? So ɛsɛ sɛ mesesa nnuru a mede di dwuma no?
• Nsakrae bɛn na ɛsɛ sɛ meyɛ na ama madi saa sɛnkyerɛnne ahorow yi ho dwuma?
• Nsɛnnennen ho sɛnkyerɛnne bɛn na ɛsɛ sɛ mehwɛ yiye?

So `(Orthostatic Hypotension)` ne `(Postural Tachycardia Syndrome - POTS)` yɛ ade koro?

Tebea bi a wɔfrɛ no `(Postural Tachycardia Syndrome)` anaa `(POTS)` ho sɛnkyerɛnne te sɛ `(Orthostatic Hypotension).` Wɔ nsɛm abien no nyinaa mu no, adwenemhaw ne akisikuru betumi aba bere a wogyina hɔ no. Nanso, wɔ `(POTS)` mu no, wɔ mogya mmoroso a ɛkɔ fam akyi no, koma no bɔ kɔ soro bɛyɛ 30-40 wɔ simma biara mu wɔ simma 10 akyi bere a wogyina hɔ no. Wɔ `(Orthostatic Hypotension)` mu no, koma no bɔ ntaa nkɔ soro saa.

Tebea ``POTS'' no, wohu no kakra sen ``Orthostatic Hypotension''.

Orthostatic hypotension (Hypotension) betumi ayɛ tebea a emu yɛ den yiye. Sɛ woankari pɛ na wohwe ase anaasɛ w’adwene mu yɛ wo naa a, ebetumi ayɛ asiane. Nanso, mpɛn pii no, yare no ho sɛnkyerɛnne no tu mpɔn bere a wosakra ɔkwan a wofa so gyina hɔ no. Wo ne wo duruyɛfo nkasa mfa wo yare no ho sɛnkyerɛnne ahorow ho asɛm. Ebia ɛho behia sɛ wosakra nnuru a wode di dwuma no. Wɔ tebea horow a emu yɛ den kɛse mu no, ebia wo duruyɛfo bɛkyerɛw nnuru a ɛbɛma mogya a ɛkɔ ne mogya mmoroso atu mpɔn.

Nneɛma a ɛho hia sen biara a ɛsɛ sɛ wokae (Take-Home Message) .

Okay, enti seesei woanya nteaseɛ pa wɔ deɛ yɛaka ho asɛm no ho, Orthostatic Hypotension. Ɛnyɛ biribiara a ɛsɛ sɛ wohaw wo ho, ɛyɛ tebea a ɛto nnipa pii. Ade a ɛho hia sen biara ne sɛ:

• Sɛ mpofirim ara wote nka sɛ w’ani reyɛ ayɛ wo yaw anaa w’ani ayɛ kusuu a, mmu w’ani ngu so. Hwehwɛ aduruyɛ mu afotu.
• Sɔn ntɛm, titiriw bere a woresɔre afi mpa so anɔpa, anaasɛ sɛ wosɔre bere a woatra ase akyɛ a, gye bere kakra na fa biribi sɔre gyina hɔ.
• Nom nsu pii. Eyi nso betumi aba sɛ wo ho nsu atɔ wo a.
• Wo ne wo duruyɛfo nka nnuru a worenom no ho asɛm. Nnuru bi nso betumi de saa tebea yi aba.
• Kwati mmeae a ɛhɔ yɛ hyew na woguare wɔ nsu a ɛyɛ hyew mu.
• Hwɛ yiye sɛnea wubetumi ahwe ase no. Sɛ wote nka sɛ wo ho ayɛ wo yaw a, bɔ mmɔden sɛ wobɛtra ase anaa wobɛda ntɛm.

Yɛwɔ anidaso sɛ saa nsɛm yi bɛboa wo. Ɛyɛ papa sɛ wobɛhwehwɛ oduruyɛfo afotu wɔ akwahosan ho haw biara a ebia wowɔ ho.

` Orthostatic hypotension, postural hypotension, mogya mmoroso a ɛba fam, adwenemhaw, akisikuru, mogya mmoroso a ɛkɔ fam, mogya mmoroso, koma akwahosan, nkwakoraa ne mmerewa akwahosan, nsu a ɛtɔ, nnuru a ɛde ba, Sinhala akwahosan ho nsɛm