So wo koma ayɛ mmerɛw? Momma yensua Systolic Heart Failure ho ade.

So ɛtɔ mmere bi a wote nka sɛ wo home yɛ wo yaw? So wote nka sɛ woabrɛ bere a woayɛ adwuma kakra mpo awie no? Anaasɛ wo nan hohoro? Eyinom betumi ayɛ nsɛnkyerɛnne a ɛkyerɛ sɛ wo koma ayɛ mmerɛw kakra. Ɛnnɛ, yɛbɛka saa komayareɛ yi ho asɛm, ‘Systolic Heart Failure’. Ɛwom sɛ eyi yɛ aniberesɛm kakra de, nanso ɛyɛ tebea a sɛ wohu ntɛm na wɔsa no yiye a, wobetumi adi so.

Dɛn ne Systolic Heart Failure?

Sɛ yɛbɛka no tiawa a, wo koma wɔ adan atitiriw anan. Pia a ɛwɔ fam a ɛwɔ benkum so a wɔfrɛ no benkum ventricle no de mogya a oxygen wom kɔ nipadua no nyinaa mu. Ɛyɛ adwuma te sɛ nsu pɔmpɛ. Mprempren, wɔ tebea a wɔfrɛ no systolic heart failure yi mu no, benkum so ahurututu no yɛ mmerɛw. Ɛno kyerɛ sɛ entumi mfa mogya nkɔ yiye na ɛnyɛ adwuma yiye.

Dɛn na ɛba saa bere no? Fa no sɛ sɛ nsu mfiri no mu nyɛ den sɛnea ɛsɛ a, nsu no rensen yiye. Saa ara na sɛ koma no ntumi nkɔ mogya no yiye a, nsu betumi aboaboa ano wɔ ahurututu no mu. That is when things like difficulty breathing and fatigue occur. Nipadua no afã afoforo, titiriw nan, nansoaa, ne yafunu nso betumi ahonhon . Nea enti a ɛte saa ne sɛ nsu a ɛwɔ nipadua no mu no ntumi nkɔ yiye.

Enti dɛn ne saa Ejection Fraction yi?

Afei momma yɛnka nea Ejection Fraction (EF) yɛ ho asɛm. Wɔfrɛ eyi sɛ ‘Ejection Fraction’ wɔ Sinhala kasa mu. Ɛwom sɛ eyi yɛ aduruyɛ mu asɛmfua kakra de, nanso ɛnyɛ den sɛ yɛbɛte ase. Sɛ yɛbɛka no tiawa a, eyi ne mogya dodow a wo benkum ahurututu no de kɔ nipadua no mu bere a ɛbɔ pɛnkoro no ɔha biara mu nkyem 100.

Ɛsɛ sɛ koma a ɛwɔ apɔwmuden na ɛyɛ adwuma yiye no nya EF bo a ɛyɛ 55% kosi 70% . Eyi kyerɛ sɛ mogya a ɛkɔ koma no benkum mu ntini no mu bɛboro fã na wɔde bɔ biako. Nanso, sɛ saa EF bo yi kɔ fam sen 40% , ebetumi ayɛ systolic komayare ho sɛnkyerɛnne. Eyi kyerɛ sɛ tumi a koma no tumi de pɔmpɔ no so atew. Ɛno nti na ɛtɔ mmere bi a wɔfrɛ saa tebea yi ‘Koma a Ɛyɛ Adwuma a Ɛho Tew’ (HFrEF) .

Hena na ɛda adi sɛ obenya saa tebea yi?

Koma a ɛyɛ mmerɛw no betumi aka obiara, nanso asiane no kɔ soro bere a obi nyin no. Ɛtaa ba nnipa a wɔwɔ komayare afoforo te sɛ nea wɔadi kan anya komayare anaa mogya mmoroso nso mu.

Dɛn na ɛde koma a ɛma mogya tu (HFrEF) ba?

Mpɛn pii no, koma a ɛyɛ mmerɛw no ba bere a yare foforo asɛe koma no benkum so ahurututu no. Susuw ho saa kwan yi so: koma ntini no te sɛ rɔba. Ɛtrɛw na ɛtwetwe. Nanso sɛ ɛsɛe a, entumi nyɛ saa adwuma no yiye.

Nneɛma atitiriw a ebetumi aka eyi ni:

• Coronary Artery Disease: Eyi ne nea ɛtaa de ba. Ntini a ɛde mogya kɔ koma no mu (coronary arteries) no yɛ teateaa anaasɛ srade a ɛwɔ hɔ no siw, na ɛmma koma no ntini no nnya mframa pa ne aduannuru a ehia. Eyi ma ntini no yɛ mmerɛw.
• Mogya mmoroso (Hypertension): Sɛ mogya mmoroso kɔ soro bere tenten a, ɛsɛ sɛ koma no yɛ adwumaden de bɔ mogya. Ɛte sɛ nea worebɔ nsu akɔ ntini bi a asiw mu. Bere kɔ so no, eyi betumi ama koma ntini no ayɛ kɛse na awiei koraa no ayɛ mmerɛw.
• Myocardial Infarction a atwam: Koma mu yare yɛ bere a wotwa mogya a ɛkɔ koma no fã bi mu, na ɛma ntini mu nkwammoaa wuwu. Afei baabi a awu no yɛ akuru, na ɛma koma no tumi a ɛbɔ no so tew.
• Asikreyare: Asikreyare nso betumi asɛe mogya ntini na aka koma ntini no tẽẽ.
• Koma no Nkɔmmɔbɔ a Ɛnyɛ Ne kwan so: Sɛ koma no bɔ nkɔ so daa a, koma no ntumi mfa mogya nkɔ yiye.
• Koma mu Ntini Yare: Sɛ ntini a ɛwɔ koma no mu no ntumi nyɛ adwuma yiye a, mogya tumi kɔ akyi anaa n’anim, na ɛno betumi de nhyɛso foforo aba koma no so.
• Myocarditis: Koma mu ntini a ɛyɛ hyew. Eyi betumi afi nneɛma te sɛ ɔyare mmoawa a wɔde nyarewa ba mu.

Saa ɔsɛe yi betumi ama koma no ntini no mu akuru, atrɛw, anaasɛ ahurututu no ayɛ den. Saa nneɛma yi nyinaa ma benkum so ahurututu no yɛ mmerɛw na ɛtew EF so. Asɛmpa no ne sɛ, mpɛn pii no, sɛ wɔsa nea ɛde ba no yiye a, koma no dwumadi betumi atu mpɔn kakra.

Dɛn ne tebea yi ho sɛnkyerɛnne?

Wiɛ, wobɛyɛ dɛn ahu sɛ ebia wowɔ saa ɔhaw yi? Nsɛnkyerɛnne ahorow bi a ɛsɛ sɛ wohwɛ yiye wɔ ho ni:

• Ahome tiaa (Dyspnea): Ebia ɛbɛyɛ den ama wo sɛ wobɛhome, titiriw bere a woreteɛteɛ w’apɔw mu, woreforo antweri, anaa mpo woda mpa so no. Sɛ ɛho hia sɛ wode pillow abien anaa abiɛsa da anadwo a, ɛno nso yɛ sɛnkyerɛnne.
• Ɔbrɛ ne mmerɛwyɛ a ɛtaa ba: Sɛ wote nka sɛ woabrɛ kɛse bere a woayɛ nnwuma a kan no na ɛnyɛ den mpo akyi a.
• Nan, anan, ne nan a ɛho ahonhon: Saa ɔfe yi betumi aba esiane nsu a ɛkɔ nipadua no mu nti. Ɛtɔ da bi a, yafunu no nso tumi hohoro.
• Koma a ɛbɔ ntɛmntɛm anaasɛ ɛnteɛ: Sɛ wote nka sɛ nsakrae bi aba sɛnea wo koma bɔ no mu a.
• Ɔfe anaa ahurututu a ɛkɔ so tra hɔ: Ɔfe a nsu fitaa ka ho titiriw.
• Tumi a obi tumi teɛteɛ n’apɔw mu a ɛso tew.
• Akisikuru anaasɛ aduan ho akɔnnɔ a wonnya.
• Koko mu yaw: Eyi betumi afi biribi a ɛde ba te sɛ ahrawa mu ntini mu yare.
• Adwene a ɛyɛ basaa.

Sɛ wowɔ saa sɛnkyerɛnne ahorow yi mu biako anaa nea ɛboro saa a, yɛsrɛ sɛ mmu w’ani ngu so na kɔ oduruyɛfo nkyɛn. Dodow a wuhu wɔn ntɛm no, dodow no ara na ɛyɛ mmerɛw sɛ wobɛsa.

Ɔkwan bɛn so na nnuruyɛfo hu eyi?

Sɛ wokɔ oduruyɛfo nkyɛn a, ɔbɛyɛ nhwehwɛmu ahorow pii de ahu sɛ ebia wowɔ komayare a ɛma mogya tu anaa. Nea ɛho hia sen biara ne sɛ wubehu nea ɛde ba no na ama woatumi adi ho dwuma yiye.

Saa sɔhwɛ nhyehyɛe yi taa yɛ:

1. Nipadua mu sɔhwɛ:

• Oduruyɛfo no bebisa wo wo yare no ho sɛnkyerɛnne (bere tenten a ɛwɔ hɔ, sɛnea wɔte nka) ho asɛm.
• Wobisa wo nyarewa a atwam, te sɛ sɛ ebia obi wɔ w’abusua mu a ɔwɔ komayare ho asɛm.
• Wɔde afiri a wɔde tie asɛm di dwuma de tie koma ne ahurututu (de hwɛ sɛ nnyigyei ne nsu a ɛnteɛ wɔ ahurututu mu anaa).
• Wɔsusuw wo mogya mmoroso.
• Wɔbɛkari wo (sɛ wɔbɛhwɛ sɛ wo mu duru akɔ soro mpofirim, esiane nsu a ɛwɔ wo mu nti).

2. Mogya mu nhwehwɛmu (Mogya adwuma): .

• Saa mogya mu nhwehwɛmu ahorow yi betumi ahwɛ sɛ ebia akwaa afoforo (te sɛ asaabo ne mmerɛbo) anya koma no mu mmerɛwyɛ yi so nkɛntɛnso anaa.
• Mpɛn pii no, wɔsusuw nneɛma te sɛ `Albumin` (protein bi), `Creatinine` (asaabo dwumadi ho susudua), ne sodium ne potassium (electrolytes).
• Mogya mu nhwehwɛmu titiriw bi wɔ hɔ a wɔfrɛ no BNP (B-type Natriuretic Peptide). Sɛ koma no yɛ basaa a, saa BNP yi dodow kɔ soro wɔ mogya no mu. Eyi boa kɛse wɔ komayare a wohu mu.

3. Mfoniniyɛ ho sɔhwɛ ahorow a wɔyɛ wɔ koma no ho:

• Saa nhwehwɛmu ahorow yi betumi ahwɛ nneɛma pii, te sɛ koma no nsusuwii ne ne kɛse, sɛnea nkwammoaa no afasu mu yɛ duru, sɛ ebia ntini no reyɛ adwuma yiye, ne sɛ ebia komayare a atwam no asɛe anaa.
• Chest X-ray: Sɛnea ɛbɛyɛ a wobehu sɛ koma no ayɛ kɛse anaasɛ nsu aboaboa ano wɔ ahurututu no mu.
• `Echocardiogram (Echo)`: Eyi ne sɔhwɛ a ɛho hia sen biara. Ɛte sɛ nea wɔde ultrasound scan yɛ koma no. Ebetumi asusuw EF bo no pɛpɛɛpɛ. Etumi hu sɛnea koma no mu adan ne ne ntini ahorow no yɛ adwuma no pefee.
• Electrocardiogram (EKG/ECG): Sɔhwɛ a ɛkyerɛ sɛnea koma no anyinam ahoɔden yɛ adwuma. Etumi hu nneɛma te sɛ sɛnea koma no bɔ denneennen ne sɛnea ɛbɔ ntɛmntɛm, ne sɛnkyerɛnne ahorow a ɛkyerɛ sɛ obi adi kan anya komayare.
• Ɛtɔ da bi a, wobetumi ayɛ nhwehwɛmu titiriw afoforo te sɛ `Koma MRI`, `Koma CT scan`, `Koma mu Catheterization` (Angiogram), `Apɔw-mu-teɛteɛ mu Adwennwen Sɔhwɛ` anaa `Nuclear Apɔw-mu-teɛteɛ Adwennwen Sɔhwɛ`, `Multigated Acquisition Scan` (MUGA)` nso.

Ɔkwan bɛn so na wɔsa eyi?

Okay, afei momma yɛnhwɛ sɛnea yɛbɛsa tebea a ɛne systolic heart failure yi. Botae atitiriw pii wɔ ayaresa ho:

• Nsɛnkyerɛnne a ɛtew so (te sɛ ahome a ɛyɛ tiaa, ɔfe).
• Koma no a wobesiw ano anaasɛ wobedi so sɛnea ɛbɛyɛ a ɛbɛyɛ mmerɛw kɛse.
• Asetra pa a wɔbɛma atu mpɔn.
• Boa a wɔboa ma nkwa nna kyɛ.

Wobetumi akyekyɛ akwan a wɔfa so sa yare no mu akuw atitiriw pii:

1. Asetra mu nsakrae

Eyinom ho hia paa. Ɛnyɛ nea ɛdɔɔso sɛ wobɛnom nnuru kɛkɛ, ɛsɛ sɛ woyɛ saa nneɛma yi wɔ w’afã nso.

• To nkyene a wobɛnom ano hye: Nkyene (sodium) ma nipadua no kura nsu a ɛboro so. Eyi ma akisikuru no yɛ kɛse na ɛde nhyɛso kɛse ba koma no so. Tew nkyene a wonom so sɛnea wo duruyɛfo kyerɛ no. Mpɛn pii no, wɔmfa nhyɛ sodium bɛboro miligram 1500-2000 da biara.
• Nsu a wɔbɛtew so: Wɔka kyerɛ nnipa binom nso sɛ wɔnto nsu dodow a wɔnom da biara no ano. Eyi yɛ biribi a ɛsɛ sɛ wo ne wo duruyɛfo susuw ho na wusi ho gyinae.
• Kura mu duru a ɛfata mu: Sɛ wo mu duru boro so a, bɔ mmɔden sɛ wobɛtew wo mu duru so. Ɛyɛ adwene pa sɛ wobɛkari wo ho da biara da. Sɛ wo mu duru yɛ kɛse mpofirim (kilo biako anaa abien da koro) a, ebetumi ayɛ sɛnkyerɛnne a ɛkyerɛ sɛ nsu a ɛwɔ wo mu no akɔ mu. Sɛ eyi ba a, ka kyerɛ wo duruyɛfo .
• Kwati sigaretnom: Sigaretnom pira koma ne mogya ntini kɛse.
• To nsa ano hye anaa gyae: Nsã nso betumi ama koma ntini no ayɛ mmerɛw.
• Apɔw-mu-teɛteɛ daa: Wo ne wo duruyɛfo nkasa mfa apɔw-mu-teɛteɛ a ɛfata wo ho asɛm. Fi ase ketewaa bi na nkakrankakra ma wo dwumadi no nkɔ anim. Nantew yɛ apɔw-mu-teɛteɛ pa. Sɛ wubetumi de wo ho ahyɛ nhyehyɛe bi a wɔde siesie koma no mu a, ɛbɛyɛ papa.
• Tew adwennwen so, gye w’ahome yiye, na da sɛnea ɛsɛ.
• Di aduan a ahoɔden wom: di nhabannuru, nnuaba, nnuan a ahoɔdennuru wom, ne nnuan a srade nnim.

2. Nnuru (nnuru ahorow) .

Nnuru pii wɔ hɔ a etu mpɔn a wɔde sa komayare a ɛma mogya tu. Saa nnuru yi betumi ama wo EF, wo yare no ho sɛnkyerɛnne, ne wo koma dwumadi nyinaa atu mpɔn. Ebia wo duruyɛfo bɛbom akyerɛw nnuru yi biako anaa nea ɛboro saa.

• Beta-blockers: Eyinom ma koma no yɛ adwuma yiye denam koma no a ɛbɔ brɛoo so, na ɛtew adwuma dodow a ɛsɛ sɛ koma no yɛ so. Wobetumi aboa ma wɔadi mogya mmoroso so, atew asiane a ɛwɔ hɔ sɛ obi benya komayare so, na wɔatumi asiw koma a ɛbɔ a ɛnteɛ no so.
• Angiotensin-Converting Enzyme (ACE) inhibitors: Eyinom hwɛ mogya mmoroso so, ɛtrɛw mogya ntini mu, na esiw adwennwen hormone ahorow a ɛwɔ nipadua no mu ano, na ɛma koma no yɛ adwuma yiye bere a bere kɔ so no.
• Angiotensin-II Receptor Blockers (ARBs): Wɔde eyinom ma nnipa a wɔwɔ nsunsuanso bɔne te sɛ ɔfe a efi nnuru a esiw ACE ano mu ba. Wɔyɛ adwuma wɔ ɔkwan a ɛte sɛ nnuru a esiw ACE ano no so.
• Angiotensin Receptor-Neprilysin Inhibitors (ARNIs): Eyi yɛ nnuru foforo koraa a etu mpɔn yiye. Eyinom nso brɛ adwennwen hormone ase, ɛma mogya ntini bue, na ɛma koma no yɛ adwuma yiye.
• Aldosterone Antagonists (Mineralocorticoid Receptor Antagonists - MRAs): Eyinom tew adwennwen mu nkwaadɔm so na ɛboa ma asaabo no yi nsu ne nkyene a ɛboro so fi nipadua no mu. Ɛsɛ sɛ wohwɛ yiye wɔ wo potassium dodow ho bere a worenom nnuru yi no.
• Nnuru a ɛma obi ho yɛ hyew (nsu mu nnuru): Eyinom ma yare no ho sɛnkyerɛnne (titiriw ɔfe ne ahome a ɛyɛ tiaa) fi hɔ ntɛm denam nsu ne nkyene a ɛboro so a woyi fi asaabo no mu no so. Sɛ nsu so tew a, ɛyɛ mmerɛw sɛ koma no bɛbɔ mogya.
• SGLT-2 inhibitors: Mfiase no, eyinom yɛ nnuru bi a wɔde sa asikreyare. Nanso akyiri yi wohui sɛ eye paa ma ayarefo a wɔn koma ntumi nyɛ adwuma yiye a wonni asikreyare nso. Wɔyi nsu a ɛboro so ka asikre a ɛwɔ nsuo mu no ho.

Ade a ɛho hia sen biara ne sɛ wobɛnom aduru a wo duruyɛfo akyerɛw ama wo no pɛpɛɛpɛ, bere ne dodow a wɔakyerɛw ama wo no. Nnyae aduru no nom da anaasɛ w’ankasa nnsesa dodow a wɔde ma no.

3. Nnwinnade ne oprehyɛn

Ebia ayarefo binom rentumi mfa nnuru ne asetra mu nsakrae nkutoo nni wɔn tebea no so. Ebia wobehia nneɛma te sɛ:

• ICD (Implantable Cardioverter-Defibrillator): Mfiri ketewaa bi a ehu koma a ɛbɔ a ɛnteɛ a ɛyɛ hu (arrhythmia) na ɛde anyinam ahoɔden ketewaa bi kɔ koma no mu ma ɛsan yɛ nea ɛfata. Wɔde eyi hyɛ koko no honam ani hwɛbea ase.
• CRT (Cardiac Resynchronization Therapy) / Biventricular Pacemaker: Saa afiri yi boa ma wosiesie koma no benkum ne nifa adan a ɛnkari pɛ no. Eyi nso ma koma no tumi a ɛbɔ pɔmpɛ no tu mpɔn.
• Coronary Artery Bypass Grafting (CABG) anaa Angioplasty a wɔde stenting ahyɛ mu: Sɛ wɔasiw a, sa coronary artery no yare.
• Koma mu valve a wosiesie anaa oprehyɛn a wɔde besi ananmu.
• Koma a wɔde si ananmu anaa LVAD (Left Ventricular Assist Device): Eyinom ne ayaresa ahorow a wɔtaa susuw ho ma ayarefo a wɔn yare mu yɛ den.

Ɔkwan bɛn so na wobetumi atew asiane a ɛwɔ tebea yi mu no so?

Wɔka sɛ: "Siw ano ye sen ayaresa." Enti, nneɛma bi wɔ hɔ a wubetumi ayɛ de asiw asiane a ɛwɔ hɔ sɛ wubenya komayare a ɛma mogya tu no ano anaasɛ wobɛtew so. Akwahosan ho su pa ne ade titiriw.

• Di aduan a ɛkari pɛ na ahoɔden wom (nkyene kakraa bi, ngo kakraa bi, nhabannuru ne nnuaba pii).
• Yɛ apɔw-mu-teɛteɛ daa.
• Kura mu duru a ɛfata mu.
• Kwati sigaretnom koraa.
• To nsa a wonom ano hye.
• Sɛ wowɔ ayaresa tebea biara te sɛ mogya mmoroso, asikreyare, anaa srade a, di so yiye. Di wo duruyɛfo akwankyerɛ akyi yiye.
• Tew adwennwen so na da sɛnea ɛsɛ.

Akwanhwɛ bɛn na wubetumi anya bere a wo ne tebea yi te no?

Koma a ɛyɛ mmerɛw no yɛ tebea a enni sabea, ɛtra hɔ kyɛ, na emu yɛ den. Ebia ɛnyɛ nea wobetumi asa koraa. Nanso, sɛ wɔsa yare no yiye na wɔsakra asetra kwan a, wobetumi adi sɛnkyerɛnne ahorow no so na wɔatra ase pa.

Nea ebefi mu aba no gyina nneɛma pii so:

• Hwɛ sɛnea komayare no mu yɛ den.
• W’akwahosan nyinaa ne sɛ ebia wowɔ nyarewa foforo biara (te sɛ asaabo mu yare, asikreyare).
• Sɛnea woyɛ w’ade wɔ ayaresa ho.
• Dɛn titiriw nti na ɛte saa?

Enti, ɛho hia paa sɛ ɛnsɛ sɛ wosuro anaa w’abam mmu, na mmom wubedi oduruyɛfo no akwankyerɛ akyi pɛpɛɛpɛ na woayɛ nsakrae wɔ w’asetra kwan mu. Wo ne w’aduruyɛ kuw no bom nyɛ adwuma.

Bere bɛn na ɛsɛ sɛ wokɔ ayaresabea ntɛm ara?

, , ‍ :

• Koko mu yaw a ɛba mpofirim na emu yɛ den.
• Ɔhome a ɛyɛ den mpofirim na emu yɛ den.
• Ɔtotɔ piti anaa mmerɛwyɛ a ɛtra so.
• Koko mu yaw, adwenemhaw, anaa ahome a ɛyɛ tiaa a koma bɔ ntɛmntɛm anaasɛ ɛnteɛ.
• Nan a ɛho ahonhon mpofirim anaasɛ mu duru a ɛkɔ soro.

Nsɛm bɛn na wubetumi abisa oduruyɛfo no?

Sɛ wokɔ wo duruyɛfo nkyɛn a, wubetumi abisa nsɛm te sɛ eyinom na ama woate wo tebea no ase yiye:

• Dɛn ankasa na ɛde me koma a ɛyɛ mmerɛw no ba?
• Dɛn ne me ejection fraction (EF) bo? Ɛkyerɛ dɛn?
• So tebea yi aka m’akwaa afoforo (te sɛ asaabo, mmerɛbo)?
• Ayaresa ahorow bɛn na ɛfata me? Dɛn ne mfaso ne ɔhaw ahorow a ɛwom?
• Nsakrae bɛn na ɛho hia sen biara a ɛsɛ sɛ meyɛ wɔ m’asetra kwan mu?
• Aduan ne anonne bɛn na ɛsɛ sɛ midi na dɛn na ɛsɛ sɛ mekwati?
• Apɔw-mu-teɛteɛ bɛn na metumi ayɛ? Bere tenten ahe na ɛsɛ sɛ meyɛ wɔn?
• Dɛn na ɛnsɛ sɛ meyɛ?
• Dɛn ne aduru yi mu nsunsuanso bɔne a ebetumi afi mu aba? Sɛ ɛba a, dɛn na ɛsɛ sɛ meyɛ?
• Mpɛn ahe na ɛsɛ sɛ meba bɛhwɛ me? Bere bɛn na wɔbɛsan ahwɛ me EF nkyerɛwde no bio?
• Dɛn na ɛsɛ sɛ meyɛ wɔ tebea a egye ntɛmpɛ mu?

Nneɛma a ɛho hia paa a ɛsɛ sɛ yɛkae

Systolic komayare yɛ tebea a emu yɛ den a ɛtra hɔ kyɛ a koma no benkum so ahurututu no ntumi mfa mogya nkɔ yiye. Sɛ wowɔ saa sɛnkyerɛnne yi bi a, yɛsrɛ wo kɔ oduruyɛfo nkyɛn. Dodow a wohu no ntɛm no, dodow no ara na ɛyɛ mmerɛw sɛ wɔbɛsa na nea efi mu ba no ye.

Ɛdenam nea ɛde ba no a wobɛsa, nnuru a wo duruyɛfo akyerɛw ama wo no a wobɛnom, na woanya asetra mu su pa so no, wubetumi aboa ma woadi wo yare no ho sɛnkyerɛnne ahorow so na woatra ase a ahoɔden wom, ɛyɛ nnam, na ɛtra hɔ kyɛ. Nsuro, kɔ so yɛ den! Ɛnyɛ wo nko ara, wo nnuruyɛfo, w’abusuafo, ne wo nnamfo nyinaa wɔ hɔ sɛ wɔbɛboa wo.

` Koma mu yare, systolic komayare, ejection fraction, koma mmerɛwyɛ, ahome a ɛyɛ tiaa, nan a ɛho ahonhon, koma mu sɛnkyerɛnne