Ke manaʻo nei paha ʻoe i kahi manaʻo koke o ka poʻo māmā a i ʻole ka ʻike ʻana i nā manawa heʻe ? Ua ʻike paha ʻoe i kou puʻuwai e lohi loa ana, wikiwiki, a i ʻole kūlike ʻole. Ua ʻike paha ʻoe i kekahi i loaʻa i kēia mau hōʻailona. I kekahi manawa, ua hoʻokumu ʻia kēia mau manaʻo e nā hoʻopilikia liʻiliʻi i loko o ka ʻōnaehana uila o kou puʻuwai—e like me kahi ʻōnaehana uea hewa i loko o kahi hale. Ma ke ʻano kikoʻī, ke kūkākūkā nei mākou i kahi kūlana i kapa ʻia ʻo Bifascicular Block , kahi e lohi ai a ālai ʻia paha nā hōʻailona uila ma ʻelua o nā ala nui ʻekolu o ka pūnaewele uila o kou puʻuwai.
He aha ka Bifascicular Block? E wehewehe maʻalahi kākou.
I ka ʻōlelo maʻalahi, ʻo ka `(Bifascicular Block)` he ʻano kikoʻī o ka poloka puʻuwai. I mea e paipa ai kou puʻuwai i ke koko me ka maikaʻi, pono ia i nā hōʻailona uila i hoʻonohonoho pono ʻia e hele ana ma nā ala kūikawā i kapa ʻia ʻo "bundle branchs" - e noʻonoʻo i kēia mau mea ʻo ia nā laina uila nui e hoʻoikaika ana i kou home.
E noʻonoʻo he ʻekolu mau ala nui ko kou puʻuwai no kēia mau hōʻailona uila. I loko o kahi `(Bifascicular Block)`, ʻelua o kēia mau ala ʻekolu i ālai ʻia a i ʻole i ālai ʻia. ʻO "Bi" ke ʻano he "ʻelua," a ʻo "fascicle" e pili ana i nā olonā ʻiʻo e hana ana i kēia mau lālā. No ka mea, ua lohi a ālai ʻia paha ka hōʻailona i nā keʻena haʻahaʻa o kou puʻuwai—ʻo ia hoʻi nā `(ventricles)`—hiki ke hoʻopilikia ʻia ka rhythm a me ka pono o ka pumping o kou puʻuwai.
Hoʻokaʻawale nā kauka i kēia ma ke ʻano he "pale puʻuwai piha ʻole." Hiki ke hana ʻia e nā maʻi puʻuwai hānau ʻole a i ʻole nā maʻi puʻuwai ʻē aʻe. ʻOiai ʻaʻohe hōʻailona o kekahi poʻe, ʻo ka poʻe e ʻike nei i nā hōʻailona koʻikoʻi a i ʻole nā pale holomua e pono ai ka loiloi lapaʻau a me ka mālama ʻana mai ka hui loea o Nirogi Lanka.
Aia i hea kēia mau ʻāpana palupalu i loko o kou puʻuwai?
E like me kou ʻike, aia kou puʻuwai i ʻehā mau keʻena. ʻO nā keʻena luna ʻelua ʻo ia ka `(atria)`, a ʻo nā keʻena lalo ʻelua ʻo ia ka `(ventricles)`. Pono kēia mau keʻena e hoʻonohonoho i ko lākou mau ʻūlū e hoʻopuni i ke koko ma loko o kou kino.
Hoʻopilikia kūikawā ka `(Bifascicular Block)` i ka hoʻoili uila i nā `(ventricles)`.
- ʻAna ʻākau: Aia ma ka ʻaoʻao ʻākau haʻahaʻa, hoʻopuka kēia keʻena i ke koko i pau i ka oxygen i nā māmā. Lawelawe ʻia e hoʻokahi ala uila mua: ka lālā pūʻolo ʻākau .
- ʻO ka ventricle hema : ʻO kēia ke keʻena pamu ikaika loa. Hoʻouna ia i ke koko momona i ka oxygen ma o ka aorta i ke kino holoʻokoʻa. ʻO kāna ʻōnaehana uila he ʻelua mau fascicles mua: ka fascicle mua hema a me ka fascicle hope hema . I ka hui pū ʻana, hana lākou i ka lālā pūʻolo hema , kahi e māhele hou aku ai i miliona o nā '(nā olonā Purkinje)' liʻiliʻi.
He aha nā Poloka Puʻuwai a me nā Poloka Lālā Pūʻulu?
Hana ʻia kahi `(Heart Block)` ke loaʻa kahi haunaele i loko o ka `(conduction system)` o ka puʻuwai. Hoʻopaneʻe kēia i ka hoʻouna ʻana o nā hōʻailona, e alakaʻi ana i nā ʻano puʻuwai kūpono ʻole. Hoʻopilikia pololei ia i kou puʻuwai, ka helu o ka puʻuwai , a me ke ʻano o ka hoʻopuka ʻia ʻana o ke koko.
ʻOiai ʻo `(Heart Block)` a me `(Atrioventricular Block / AV Block)` e hoʻohana pinepine ʻia me ke ʻano like, ʻo ka `(Bundle Branch Block)` he ʻano kikoʻī kahi e hana ʻia ai ke ālai ʻana i loko o kēlā mau puʻupuʻu i koho ʻia.
Pehea ka hana ʻana o ka ʻōnaehana uila o kou puʻuwai? He mea hoihoi maoli nō ia!
Ke hilinaʻi nei kou puʻuwai i kahi ʻōnaehana uea kūloko akamai e hana nei me ka pololei kupaianaha:
1. Hoʻomaka ka hōʻailona ma ka `(SA node)` ma ka atrium ʻākau, i ʻike ʻia ʻo ia ka `(pacemaker)` kūlohelohe o ka puʻuwai.
2. Hele ka hōʻailona ma waena o ka `(atria)` a i ka `(AV node)`.
3. Mai ka `(AV node)`, komo ia i ka `(Bundle of His)`.
4. A laila māhele ke ala i nā lālā pūʻolo ʻākau a me hema, a hiki i ka `(Purkinje fibers)` i loko o nā `(ventricles)`.
5. Ma ka loaʻa ʻana o kēia mau hōʻailona, e ʻūlū nā `(ventricles)`, e pamu ana i ke koko ma mua o ka hana hou ʻana o ke kaʻina hana.
Hana ʻia kēia kaʻina holoʻokoʻa i loko o ka hapa liʻiliʻi o ke kekona, me ke ʻano mele a mau.
Aia kekahi mau ʻano like ʻole o nā Poloka Puʻuwai?
ʻAe, hoʻokaʻawale nā kauka i nā `(AV blocks)` ma muli o ko lākou koʻikoʻi:
- Poloka kekelē mua: Hoʻopaneʻe ʻia ka hōʻailona uila i kona neʻe ʻana mai ka atria a i nā ventricles. ʻO ka maʻamau, ʻaʻohe hōʻailona, a ʻaʻole pono ka lāʻau lapaʻau.
- Poloka kekelē lua: Hiki i kekahi mau hōʻailona uila, akā ʻaʻole nā mea āpau, ke hōʻea i nā ventricles. Hiki i kēia ke alakaʻi i kahi puʻuwai lohi '( bradycardia )' a i ʻole ka puʻuwai '(arrhythmia)' kūpono ʻole. Inā hoʻopilikia nā hōʻailona, pono ke komo ʻana o ka lāʻau lapaʻau.
- Poloka kekelē ʻekolu: Ua kapa ʻia hoʻi he "poloka puʻuwai piha." Hoʻōki loa nā keʻena o luna a me lalo i ke kamaʻilio ʻana, e kuʻi ana kēlā me kēia i ko lākou wikiwiki ponoʻī. He pilikia olakino kēia e pono ai kahi `(pacemaker)`. Hiki i kahi `(Bifascicular block)` ke holomua i kēia kūlana i kekahi manawa.
Aia kekahi mau ʻano like ʻole o nā poloka bifascicular?
ʻAe, aia kekahi mau ʻano maʻamau:
- ʻO kahi poloka lālā pūʻolo ʻākau i hui pū ʻia me kahi poloka fascicular mua hema.
- ʻO kahi poloka lālā pūʻolo ʻākau i hui pū ʻia me kahi poloka fascicular hope hema.
- I kekahi manawa, ua ālai loa ʻia ka lālā pūʻolo hema (ʻo ia hoʻi, ua hoʻopilikia ʻia nā fascicles mua a me hope, ʻoiai ke hana mau nei ka lālā pūʻolo ʻākau).
Pehea ka maʻamau o kēia ʻano?
Ua hōʻike ʻia nā noiʻi ma kahi o 1.5% o ka poʻe e hana ana i kahi `( ECG )` ua loaʻa iā lākou kahi `(Bifascicular Block)`. Inā ʻeha kou umauma, nāwaliwali, a i ʻole ka poniuniu nui, e ʻoluʻolu e kelepona i nā lawelawe ulia pōpilikia a i ʻole e hele koke i ka lumi ulia pōpilikia kokoke loa.
He aha ke kumu o ka poloka bifascicular? Ke hoʻomaopopo nei i nā kumu
I nā hihia he nui, ua pili ka poloka bifascicular i ka maʻi puʻuwai hānau, ʻo ia hoʻi ua hānau ʻia ʻoe me nā ʻokoʻa kūkulu i loko o kou puʻuwai. ʻOiai ke kū nei kēia mau kūlana mai ka hānau ʻana mai, ʻaʻole paha lākou e hōʻike i nā hōʻailona a hiki i ka wā ʻōpio a i ʻole ka makahiki waena. I kou wā ʻelemakule , piʻi pū ka pilikia o ka hoʻomohala ʻana i nā lohi o ka hoʻokele puʻuwai.
I nā hihia kakaikahi, hiki ke hoʻoilina ʻia kēia maʻi ma muli o kahi mutation gene, i kapa pinepine ʻia ʻo ka progressive familial heart block. Hiki i kēia ʻano loli genetic ke alakaʻi i ka ulu ʻana o ka ʻiʻo scar(fibrosis) a i ʻole nā waihona calcium (calcification) i loko o nā ala uila o ka puʻuwai, e hana pono ana i kahi poloka.
Eia kekahi, hiki i ka hōʻino ʻana i ka puʻuwai ke alakaʻi i kahi poloka bifascicular. ʻO nā mea kōkua maʻamau:
- ʻO ka hāʻule puʻuwai ma mua (myocardial infarction).
- Nā maʻi ʻē aʻe o ka ʻōnaehana cardiovascular .
- Maʻi kīwila puʻuwai .
- Kiʻekiʻe o ka potassium i loko o kou koko (hyperkalemia).
Nā Hōʻailona o ka Poloka Bifascicular: Ke ʻike nei ʻoe i kēia mau hōʻailona?
ʻAʻole paha e hōʻike pinepine ʻia nā poloka puʻuwai piha ʻole (kekelē mua a ʻelua paha). Ke kū mai nā hōʻailona, ʻo ka hōʻailona lapaʻau maʻamau ka nāwaliwali i wehewehe ʻole ʻia (syncope). Hana ʻia kēia i ka wā e paʻi mālie ai ka puʻuwai (bradycardia) a i ʻole ke ʻano ʻē (arrhythmia), e pale ana i ke koko lawa mai ka hiki ʻana i kou lolo.
I kekahi manawa, hiki i kahi poloka bifascicular ke holomua i kahi poloka puʻuwai piha (ʻekolu kekelē). Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, he mea nui ka ʻimi koke ʻana i ke kōkua lapaʻau :
- ʻEha a kaomi paha o ka umauma (angina).
- Manaʻo māmā a poniuniu paha.
- Luhi mau, hiki ʻole ke wehewehe ʻia.
- Nā manaʻo o ka puʻuwai puʻuwai kūpono ʻole a i ʻole ke kuʻi ʻana (palpitations).
- Ka luaʻi.
- Paʻakikī ka hanu ʻana (pōkole o ka hanu).
He aha nā pilikia e hiki ke kū mai?
Hiki i ka poloka puʻuwai ke keakea i ka hiki o kou puʻuwai ke pamu koko me ka maikaʻi. Inā holomua ka poloka bifascicular i kahi poloka piha o ke kolu o ke kekelē, hiki iā ia ke alakaʻi i nā pilikia koʻikoʻi e hoʻoweliweli ana i ke ola, e like me:
- Arrhythmia (ʻano kūlike ʻole o ka puʻuwai).
- Maʻi hohola.
- Ka hāʻule ʻana o ka puʻuwai.
- Paʻa koke ka puʻuwai.
Mai hopohopo! ʻAʻole hiki kēia mau pilikia i nā kānaka a pau. Me ka mālama pono ʻana i nā lāʻau lapaʻau a me ka mālama ʻana mai nā loea Nirogi Lanka, hiki ke hoʻemi nui ʻia kou mau pilikia.
Pehea e ʻike ʻia ai kahi poloka bifascicular?
ʻO ka mea hana hōʻoia mua he Electrocardiogram (ECG/EKG) . Hoʻopaʻa kēia hoʻāʻo maʻalahi, ʻeha ʻole, 15 mau minuke i ka hana uila o kou puʻuwai.
E kau ana kāu kauka i nā mea ʻike liʻiliʻi (electrodes) ma kou umauma, nā lima, a me nā wāwae. Hoʻopili ʻia kēia mau mea i kahi mīkini ECG, nāna e kaha kiʻi i ke kani uila o kou puʻuwai. E ʻoluʻolu e hoʻomaopopo ʻaʻohe uila i hoʻouna ʻia i loko o kou kino; hoʻopaʻa wale ka hāmeʻa i nā hōʻailona uila i hana ʻia e kou puʻuwai. Hiki i kēia kiʻi i kāu kauka ke kuhikuhi pololei i kahi e ālai ʻia ai a hoʻopaneʻe ʻia paha nā hōʻailona uila.
He aha nā lāʻau lapaʻau i loaʻa?
Inā loaʻa iā ʻoe kahi poloka bifascicular akā ʻaʻohe hōʻailona, ʻaʻole paha e koi ʻia ka lāʻau lapaʻau ikaika. Eia nō naʻe, e nānā pono kāu kauka i ke olakino o kou puʻuwai, ma o nā ECG hou paha e nānā i kekahi holomua i kahi poloka puʻuwai piha.
Inā ʻike ʻoe i nā hōʻailona e like me ka nāwaliwali a i ʻole nā arrhythmias mau loa, hiki i kāu kauka ke ʻōlelo i kahi kaʻina hana e hoʻoponopono i kou puʻuwai puʻuwai me ka hoʻohana ʻana i kekahi o kēia mau mea:
- Nā Pacemaker: Hoʻouna kēia mau mea liʻiliʻi i nā hōʻailona uila i kou puʻuwai e kōkua i ka mālama ʻana i kahi mele paʻa a olakino.
- Nā Implantable Cardioverter Defibrillators (ICDs): Hana kēia e like me nā pacemakers akā nānā pū kekahi no nā arrhythmias e hoʻoweliweli ana i ke ola. Inā ʻike ʻia, hāʻawi ka ICD i kahi haʻalulu uila liʻiliʻi e hoʻoponopono ai e hoʻihoʻi i kahi ʻano puʻuwai maʻamau, e hana maoli ana ma ke ʻano he pale aku i ka hopu koke ʻana o ka puʻuwai.
Hoʻokomo ʻia kēia mau mea hana e kahi electrophysiologist cardiac.
Hiki iā ʻoe ke pale i kahi poloka bifascicular?
ʻAʻole hiki ke pale ʻia nā kumu he nui o nā poloka puʻuwai, e like me nā pilikia hānau a i ʻole ke kaʻina hana ʻelemakule maoli. Eia nō naʻe, hiki iā ʻoe ke hana i nā hana proactive e mālama i ke olakino puʻuwai maikaʻi loa a hoʻēmi i kāu mau pilikia. ʻO kēia mau mea:
- Inā ʻoe e puhipaka ana, e ʻoluʻolu e noi i ke kōkua e haʻalele. He mea nui hoʻi e pale iā ʻoe iho mai ka uahi lua.
- E kālele i ka ʻai ʻana i meaʻai olakino no ka puʻuwai a hoʻokomo i ka hoʻoikaika kino i kēlā me kēia lā i kāu hana maʻamau.
- E hōʻemi i kāu inu ʻona.
- E mālama i ka mana maikaʻi loa ma luna o nā kūlana e hiki ke hoʻoluhi i kou puʻuwai, e like me ke koko kiʻekiʻe, ka maʻi diabetes, a me ka cholesterol kiʻekiʻe.
- E ʻimi i nā ala olakino a hoʻomau e hoʻokele ai i kou kaumaha.
- E hoʻoikaika e mālama i ke kaumaha olakino.
ʻOiai ʻaʻole hiki i kēia mau ʻanuʻu ke pale loa i ka Bifascicular Block, he mea nui lākou i ka mālama ʻana i ke olakino puʻuwai holoʻokoʻa.
Hiki iā ʻoe ke ola me kēia maʻi? Pehea ka nānā ʻana?
ʻAʻole pono ka nui o nā kānaka me ka Bifascicular Block i ka lāʻau lapaʻau. ʻOiai inā pono ka lāʻau lapaʻau, hoʻopau maikaʻi nā hōʻailona ma hope o ke kau ʻana o kahi pacemaker.
Me ka mālama lapaʻau kūpono, haʻahaʻa loa ka likelika o kēia kūlana e holomua i kahi poloka puʻuwai piha. ʻO ka ʻoiaʻiʻo, ʻoi aku ka nui o ka pilikia o ka puʻuwai puʻuwai i mālama ʻole ʻia a kūpono ʻole (arrhythmia) ma mua o ka poloka ponoʻī. No laila, ʻo ka ʻimi ʻana i ka ʻōlelo aʻoaʻo lapaʻau i ka manawa kūpono a me ka hahai ʻana i nā lāʻau lapaʻau i kuhikuhi ʻia ka hana nui loa hiki iā ʻoe ke hana.
Āhea ʻoe e ʻike ai i ke kauka?
Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, e ʻoluʻolu e ʻimi koke i ke kōkua lapaʻau a i ʻole e kelepona i nā lawelawe ulia pōpilikia (911):
- Ka luhi nui loa.
- Ka puʻuwai kūpono ʻole a i ʻole nā palpitations.
- ʻEha nui o ka umauma.
- Pōkole o ka hanu.
- Nā hōʻailona o ka hōʻeha puʻuwai (e laʻa, ke kaomi nui ma waenakonu o ka umauma e pālahalaha ana i ka lima).
- Ka luaʻi i wehewehe ʻole ʻia.
Nā nīnau koʻikoʻi e nīnau aku i kāu kauka
Ke hele ʻoe i kāu kauka, makemake paha ʻoe e nīnau i kēia mau nīnau:
- No ke aha wau i hoʻomohala ai i kēia Bifascicular Block?
- He aha nā hana e pono ai iaʻu e hana e hōʻemi i ka pilikia o ka hōʻeha puʻuwai a i ʻole nā maʻi puʻuwai ʻē aʻe?
- Pono anei au i kahi pacemaker a i ʻole ICD?
- He aha nā pilikia e pili ana i ka loaʻa ʻana o kahi pacemaker a i ʻole ICD?
- Aia kekahi mau pilikia kikoʻī e pono iaʻu e makaʻala? He aha kēlā mau hōʻailona?
ʻO ka nīnau ʻana i kēia mau nīnau e kōkua iā ʻoe e loaʻa kahi ʻike maikaʻi aʻe i kou kūlana a e hōʻoia i kou maopopo i kāu mau hana e hiki mai ana.
Nā manaʻo hope loa: Nā mea e pono ai ʻoe e hoʻomanaʻo
ʻO ka Bifascicular Block e pili ana i kahi haunaele i ʻelua o nā ala nui ʻekolu e alakaʻi ana i nā hōʻailona uila ma o ka puʻuwai. Hiki i kēia ke hoʻololi i ke ʻano o kou puʻuwai a me ke kaʻina o ka hoʻokuʻu ʻana o ke koko. ʻOiai he asymptomatic paha kekahi poʻe, hiki i kekahi ke ʻike i nā hōʻailona e like me ka hiolo ʻana.
ʻO ka mea nui loa, ʻo ia ke noho mālie a hahai i nā ʻōlelo aʻoaʻo lapaʻau loea. Hiki ke ʻike maʻalahi ʻia kēia kūlana ma o kahi hoʻāʻo maʻalahi e like me ka ECG. Inā pono, hiki ke mālama pono ʻia ma o nā lāʻau lapaʻau e like me ka pacemaker. E mālama i kou puʻuwai, e alakaʻi i kahi nohona olakino, a hiki iā ʻoe ke ola maikaʻi. Me Nirogi Lanka, aia ʻoe i nā lima maikaʻi.
