Ua lohe paha ʻoe i ka maʻi ʻaʻa coronary? Ua lohe ka hapa nui o kākou i ia mea. Ma ke ʻano lapaʻau, ua kapa ʻia kēia he Coronary Artery Disease ( CAD ). I ka ʻōlelo maʻalahi, he ʻano ia kahi e hōʻiliʻili ai ka momona a me ka cholesterol i loko o nā aʻa e lawe ana i ke koko i ka puʻuwai, e hoʻohaiki ana i ke kahe ʻana o ke koko. Akā hiki ke ālai ʻia kēia mau aʻa ma nā ʻano like ʻole. I kēia lā, e kamaʻilio mākou e pili ana i kahi ʻano paʻakikī iki e pono ai ka nānā kūikawā. ʻO ia hoʻi, i ka wā e hōʻiliʻili ai ka momona a ālai i ke aʻa kahi e māhele ai kahi aʻa nui i loko o ka puʻuwai i kahi lālā liʻiliʻi. E noʻonoʻo i kahi kaʻa ma ke alanui ʻano Y, ma kahi e māhele ai nā alanui ʻelua. Ua kapa nā kauka i kēia he 'Bifurcation Blockage'.
He aha maoli kēia mea i kapa ʻia ʻo Bifurcation Blockage?
ʻAe, e wehewehe kākou i kēia i kahi ala maʻalahi. He ʻiʻo kou puʻuwai e hana mau ana. Loaʻa iā ia ka ikehu a me ka oxygen e pono ai mai nā kīʻaha koko i kapa ʻia ʻo nā aʻa coronary. Hoʻomaka kēia mau aʻa nui i nā lālā liʻiliʻi e lawe i ke koko i nā ʻāpana āpau o ka puʻuwai.
I kēia manawa, hana ʻia kēia Bifurcation Blockage ke hana ʻia kahi waihona momona (kapa mākou he plaque ) kahi e māhele ai kahi aʻa nui i kahi lālā liʻiliʻi, ʻo ia hoʻi, ma kahi Y-junction. Ke ālai nei kēia plaque i ke kahe ʻana o ke koko. Kāhea nā kauka i kēia lālā liʻiliʻi he "ʻaoʻao-lālā moku." Ua kapa ʻia hoʻi kēia plaque he "bifurcation lesion."
He ʻoi aku ka paʻakikī o kēia wahi e pani ʻia ma mua o nā wahi ʻē aʻe. No ka mea he ʻokoʻa ke kahe koko a me ke kaomi ma ʻaneʻi, ʻoi aku ka nui o ka hōʻiliʻili ʻana o ka plaque ma kēia mau wahi. A hiki ke lilo i mea paʻakikī iki ke mālama.
Aia kekahi mau ʻano nui o kēia ālai ʻana?
ʻAe, hoʻokaʻawale nā kauka i kēia paʻa ʻana e like me ke koʻikoʻi, ʻo ia hoʻi, ka nui o ke aʻa i paʻa. Ua kapa ʻia kēia he stenosis . ʻElua ʻano nui.
| ʻAno o ke ālai ʻana | He wehewehe maʻalahi |
|---|---|
| He ālai maʻalahi | ʻO kēia ka manawa i paʻa ai ke kīʻaha koko ma lalo o 70%. ʻO ke ʻano kēia, aia nō kahi wahi no ke kahe ʻana o ke koko. He mea maʻalahi kēia e mālama. |
| Ka ālai paʻakikī | Maanei, ua ʻoi aku ka paʻa o ke kīʻaha koko ma mua o 70%, ʻo ia hoʻi ua paʻa loa ia. I kekahi manawa hiki ke loaʻa ma mua o hoʻokahi paʻa. A i ʻole hiki ke hana ʻia kēia paʻa e kahi ʻūpā koko a i ʻole ka calcification. ʻO kekahi mea ʻē aʻe, i kekahi manawa inā māhele ʻia kēlā lālā liʻiliʻi ma kahi kihi ʻoi loa (ʻoi aku ma mua o 70 degere), he mea paʻakikī loa ke hoʻokomo i nā mea hana a mālama i kēlā wahi. |
Pehea ka maʻamau o kēia kūlana ma ko kākou ʻāina?
He kūlana maʻamau loa kēia. Manaʻo nā kuhi he ma waena o 15% a me 20% o nā hihia āpau o ka maʻi ʻaʻa coronary (CAD) e pono ai ka mālama lapaʻau e hāʻule i loko o kēia māhele, i ʻike ʻia ʻo nā blockages bifurcation. I ka ʻōlelo maʻalahi, mai kēlā me kēia 100 mau maʻi e hele mai i ka haukapila me kahi aʻa coronary i ālai ʻia, ma kahi o 15-20 he blockaged ma kēia hui ʻana. No laila, ʻaʻole kēia he mea e lawe māmā ʻia.
No ke aha lā kēia e hana nei? He aha ke kumu maoli o kēia?
ʻO ke kumu nui o kēia, ʻo ia nā waihona momona i kapa ʻia he plaque a mākou i kamaʻilio ai ma mua. Ua like kēia me ka hōʻiliʻili ʻana o ka ʻōpala a me ka lepo i loko o kahi paipu wai i ka hala ʻana o ka manawa, e hana ana i nā lua i loko o ka paipu. Hoʻokumu ʻia kēia plaque e ka hōʻiliʻili ʻana o ka cholesterol, ka momona, a me ka calcium i loko o nā paia o ko mākou mau kīʻaha koko. I ka hala ʻana o ka manawa, ulu nui kēia plaque a hoʻohaiki i ke kahe ʻana o ke koko ma o nā aa koko. I ka hopena, ʻaʻole loaʻa i ka puʻuwai ka nui o ke koko e pono ai. Kāhea mākou i kēia ʻano he atherosclerosis . ʻO ka pale ʻana o ka bifurcation kekahi hopena o kēia ʻano atherosclerosis.
ʻO wai ka mea i pilikia nui?
ʻOiai hiki ke ulu kēia ʻano maʻi i kekahi kanaka, ʻoi aku ka nui o ka pilikia o kekahi poʻe. Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau mea pilikia, he manaʻo maikaʻi e makaʻala iki aʻe.
| Kumu pilikia | He wehewehe maʻalahi |
|---|---|
| Makahiki a me ke kāne | ʻOi aku ka kiʻekiʻe o ka pilikia no nā wahine ma hope o ka menopause a me nā kāne ma luna o 45 mau makahiki. |
| Maʻi diabetes | Hiki i ka maʻi diabetes ke hōʻino i nā kīʻaha koko, e maʻalahi ai ka hōʻiliʻili ʻana o ka plaque. |
| Kaumaha loa a momona paha | I ka piʻi ʻana o ke kaumaha o ke kino, piʻi pū kekahi mau mea pilikia e like me ka cholesterol a me ke koko kiʻekiʻe. |
| Moʻolelo ʻohana | Inā loaʻa i kekahi o kou ʻohana (makuahine, makuakāne, kaikaina) ka maʻi puʻuwai, ʻoi aku kou pilikia. |
| Ke koko kiʻekiʻe (Hypertension) | Ke piʻi aʻe ke kaomi, ua hōʻino ʻia nā paia o nā kīʻaha koko a hiki ke hana maʻalahi ʻia ka plaque. |
| Kolesterol kiʻekiʻe | ʻO kēia ke kumu nui no ka hoʻokumu ʻia ʻana o ka plaque. ʻOi aku ka nui o ka pilikia inā he kiʻekiʻe ka pae o ka cholesterol maikaʻi ʻole (LDL) i loko o ke koko. |
| Ka nele i ka hoʻoikaika kino a me ka ʻai maikaʻi ʻole | ʻO ka poʻe hana ʻole kino a ʻai i ka meaʻai kiʻekiʻe i ka ʻaila, ke kō, a me ka paʻakai, ʻoi aku ka nui o ka pilikia. |
| Puhipaka | Hoʻopōʻino pololei ka puhipaka i nā kīʻaha koko a hoʻonui i ka pilikia o ke kāpili ʻana o ke koko. |
He aha nā hōʻailona āu e ʻike ai?
ʻO ka bifurcation blockade kahi ʻano maʻi coronary artery (CAD), no laila ua like nā hōʻailona. Inā loaʻa iā ʻoe kekahi a ʻoi aku paha o kēia mau hōʻailona, e ʻike koke i ke kauka.
- ʻEha a kaomi paha o ka umauma (Angina): ʻO kēia ka hōʻailona nui. Hiki ke like me ka ʻūmiʻi a i ʻole ke kaomi ʻana ma waenakonu o ka umauma.
- Pōkole o ka hanu: Manaʻo i ka pōkole o ka hanu ke luhi iki ʻoe, a i ʻole ke piʻi ʻana i ke alapiʻi.
- Manaʻo luhi loa: Manaʻo luhi loa a nāwaliwali paha me ke kumu ʻole.
- ʻEha poʻohiwi a lima paha: ʻEha e hele ana i lalo i ka lima hema, ʻoi aku hoʻi.
- Pōniuniu (vertigo) a i ʻole ka nāwaliwali: He manaʻo o ka wili ʻana a me ka hiki ʻole ke kū.
- Nausea: Manaʻo e like me ka luaʻi ʻana.
- Ke anu nei a me ka hou.
- Manaʻo o ka puʻuwai puʻuwai ʻē aʻe (Heart Palpitations).
ʻO ka mea nui, ʻaʻole e ʻike nā kānaka a pau i kēia mau hōʻailona āpau. Loaʻa paha i kekahi poʻe ke ʻano me ka ʻole o nā hōʻailona. No laila, he mea naʻauao ke kiʻi i nā nānā lapaʻau maʻamau inā he mau mea pilikia kou.
Pehea e ʻike ai ke kauka i kēia?
Ke haʻi aku ʻoe i kāu kauka e pili ana i nā hōʻailona āu i ʻōlelo ai ma luna, e nānā ʻo ia iā ʻoe a kuhikuhi iā ʻoe no kekahi mau hoʻokolohua e hōʻoia i kēia kūlana.
- ECG (Electrocardiogram): Hoʻāʻo kēia i ka hana uila o ka puʻuwai e ʻike inā he pōʻino i ka puʻuwai.
- Hoʻāʻo Koʻikoʻi: Lawe ʻia kahi ECG i kou hele ʻana ma luna o ka treadmill, e nānā ana i ka hana a kou puʻuwai ke kaumaha ʻoe.
- Echocardiogram: He scan ultrasound o ka puʻuwai.
- ʻO ka Catheterization Cardiac (Coronary Angiogram): ʻO kēia ka hoʻāʻo nui e ʻike ai inā he mau mea e ālai ana i loko o kou mau aʻa. Hoʻokomo ʻia kahi paipu liʻiliʻi ma kou wāwae a lima paha, e hoʻokomo ʻia i loko o nā aʻa koko i loko o kou puʻuwai, a hoʻokomo ʻia kahi wai kūikawā, a lawe ʻia nā kiʻi X-ray. Hiki iā ʻoe ke ʻike maopopo i kahi o nā mea e ālai ana.
- CCTA (Coronary Computed Tomography Angiogram): Ua like kēia me ka angiogram, akā he hoʻāʻo ia i hana ʻia me ka hoʻohana ʻana i kahi mīkini scan CT me ka ʻole o ka hoʻokomo ʻana i kahi ʻōmole i loko o ke kino.
E ʻae kēia mau hoʻokolohua i kāu kauka e hoʻoholo pono inā he poloka bifurcation kāu a pehea ke koʻikoʻi.
He aha nā lāʻau lapaʻau no kēia?
ʻOi aku ka paʻakikī o ka mālama ʻana i kahi ālai ʻana o ka bifurcation no ka mea he liʻiliʻi loa ka moku o ka lālā ʻaoʻao, e ʻoi aku ai ka paʻakikī o ka mālama ʻana me nā mea hana ma mua o ka aa nui.
ʻO ka lāʻau lapaʻau nui ka angioplasty a me ka stenting . ʻAʻole kēia he ʻoki kino. Ua kapa ʻia kēia ʻo Percutaneous Coronary Intervention (PCI).
Eia nā mea e hana nei ma ʻaneʻi:
1. E hoʻomāno ke kauka i ka ʻili ma kou lima a i ʻole kou wāwae, e hana i kahi ʻoki liʻiliʻi, a e hoʻokomo i kahi catheter ma loko.Hoʻokomo ʻia kahi ʻōmole lahilahi a palupalu i kapa ʻia he catheter i loko o kahi kīʻaha koko.
2. A laila, ʻoiai e nānā ana i kahi pale X-ray, alakaʻi ʻia ka ʻōmole i kahi kikoʻī o ke aʻa i paʻa i loko o ka puʻuwai.
3. Aia kahi pōpō liʻiliʻi ma ka hopena o ke catheter. Ke hiki i kahi i pani ʻia ai, e pehu ka pōpō. A laila kaomi ka plaque i ka paia o ke aʻa, e wehe hou ana i ke ala i pani ʻia.
4. A laila, i mea e pale ai i ka puka mai ka pani hou ʻana, ua kau ʻia kahi ʻōmole ʻupena liʻiliʻi i kapa ʻia he stent ma ia wahi.
Ma hope o kēia lāʻau lapaʻau, e kuhikuhi kāu kauka iā ʻoe i nā lāʻau lapaʻau kūikawā (dual antiplatelet therapy) e pale aku i ke kūkulu ʻia ʻana o nā ʻōpū koko i loko o ka stent. He mea nui e lawe ʻoe i kēia mau lāʻau lapaʻau no ka manawa i kuhikuhi ʻia.
He aha nā ʻano lapaʻau?
ʻElua mau ala nui e pale ai i ka bifurcation stenting:
- ʻO ka Stenting Kūikawā: Ma kēia ʻano hana, kau wale ke kauka i kahi stent i loko o ke aʻa nui. ʻAʻole kau ʻia ka lālā liʻiliʻi. Hiki ke kau ʻia kahi stent i loko o ka lālā liʻiliʻi ma kahi lā ma hope, inā loaʻa hou nā hōʻailona.
- Nā Kaʻina Hana ʻElua-Stent: Inā paʻakikī loa ka paʻa ʻana, hiki i ke kauka ke hoʻoholo e kau i nā stents i loko o ke aʻa nui a me ka lālā liʻiliʻi e lālā ana.
Aia kekahi mau pilikia e hiki mai ana ma hope o ka mālama ʻana?
ʻOiai he mau lāʻau lapaʻau kūleʻa ka angioplasty a me ka stenting, hiki ke loaʻa nā pilikia i kahi poʻe liʻiliʻi loa .
| Ka pilikia | He wehewehe maʻalahi |
|---|---|
| Hoʻomaha hou ʻana i loko o ka stent | ʻO ke ʻano kēia, hana ʻia nā ʻiʻo ʻeha ma lalo o ka stent, e hoʻohāiki hou ana i ke aʻa. Hana pinepine ʻia kēia i loko o 6 mau mahina o ka mālama ʻana. Inā hana ʻia kēia, pono paha ʻoe e loaʻa i kahi angioplasty ʻē aʻe a i ʻole kekahi lāʻau ʻē aʻe. |
| ʻO ka Thrombosis Stent | He kūlana koʻikoʻi kēia, akā he mea kakaikahi loa, kahi e hana ʻia ai kahi ʻūpā koko i loko o ka stent a ālai koke i ke aʻa. I mea e pale aku ai i kēia, pono ʻoe e lawe i ka lāʻau lapaʻau e hoʻōki pono ai i ke kāpili ʻana o ke koko. |
ʻAʻole anei hiki ke pale ʻia kēia ʻano kūlana?
He mea hiki nō ia. Pili nui ka maʻi puʻuwai i ko kākou nohona. No laila, ʻo ka lawe ʻana i kahi nohona olakino puʻuwai hiki ke hōʻemi nui i ka pilikia o ka loaʻa ʻana o kēia maʻi.
- E ʻai i ka meaʻai olakino no ka puʻuwai. E hōʻemi i nā meaʻai kiʻekiʻe i ka ʻaila, ka paʻakai, a me ke kō i ka hiki. E hoʻokomo i nā huaʻai, nā mea kanu, nā legume, nā iʻa liʻiliʻi, a me nā palaoa piha i kāu papaʻai.
- Inā ʻoe e puhipaka, e hoʻōki i kēia lā. ʻO ka puhipaka kekahi o nā ʻenemi nui loa o ka puʻuwai.
- E hoʻoikaika kino mau. E hana i kekahi mea e like me ka hele wāwae a i ʻole ke kaʻa paikikala no 30 mau minuke i ka lā.
- E kāohi i ke kaumaha o kou kino. Aia kekahi kaumaha kūpono no kou kiʻekiʻe. E hoʻāʻo e mālama iā ia.
- Inā loaʻa iā ʻoe ka maʻi diabetes, ke koko kiʻekiʻe, a i ʻole ka cholesterol, e kaohi iā lākou ma ka lawe ʻana i nā lāʻau lapaʻau a kāu kauka i kuhikuhi ai.
- E hōʻemi i ke kaumaha. He mea maikaʻi loa ke komo ʻana i nā mea e like me ka yoga a me ka noʻonoʻo ʻana.
- E kaupalena i ka inu ʻana i ka waiʻona.
Āhea ʻoe e ʻike koke ai i ke kauka?
E hoʻomanaʻo i kēia: Inā ʻike ʻoe i nā hōʻailona o ka hōʻeha puʻuwai, e like me ka ʻeha umauma koke a koʻikoʻi, ka pōkole o ka hanu, a i ʻole ka hou ʻana, mai hoʻokaʻulua no kekahi kekona. E kelepona koke i ka 911 a i ʻole e lawe i ka mea maʻi i ka Emergency Department (ETU) o ka haukapila kokoke loa.
Eia kekahi, inā loaʻa pinepine iā ʻoe nā hōʻailona ma lalo nei, e ʻike pono i ke kauka no ka ʻōlelo aʻo.
- ʻEha umauma (angina), ʻeha lima a poʻohiwi paha
- Ke anu nei a me ka hou ʻana
- Paʻakikī ka hanu ʻana
- Ka luhi a nāwaliwali paha i wehewehe ʻole ʻia
Nā nīnau e nīnau aku ai i kāu kauka
Ke ʻike ʻoe ua loaʻa iā ʻoe kēia maʻi, he mea maʻamau ka loaʻa ʻana o nā nīnau he nui i loko o kou manaʻo. Mai hūnā i kekahi mea, e nīnau i kāu kauka a e ʻike.
- He aha ka mea e hoʻopilikia nei iaʻu e like me kēia?
- Aia kekahi pilikia o nā ālai like i loko o koʻu mau kīʻaha koko ʻē aʻe?
- Hiki i ka angioplasty a me ka stenting ke ho'ōla loa i kēia ālai ʻana?
- He aha ke ʻano o ka stent āu e ʻōlelo mai ai noʻu?
- ʻEhia mau stents e pono iaʻu e kau?
- He aha kaʻu e hana ai e pale aku i koʻu puʻuwai?
- He aha nā pilikia e pono iaʻu e hopohopo ma hope o ka mālama ʻana?
Manaʻolana wau e kōkua kēia ʻike iā ʻoe e hoʻomaopopo maikaʻi i kēia kūlana. E hoʻomanaʻo, ʻaʻole kēia he mea e makaʻu ai, akā he mea e mālama pono ʻia.
Leka Lawe-Home
- ʻO ka pāpā ʻana o ka bifurcation kahi ʻano pāpā kikoʻī e hana ʻia ma kahi e māhele ai kahi kīʻaha koko i loko o ka puʻuwai i nā lālā. He ʻoi aku ka paʻakikī o kēia ma mua o kahi pāpā maʻamau.
- Ua like nā hōʻailona me nā maʻi puʻuwai maʻamau. ʻO ka ʻeha o ka umauma a me ka pōkole o ka hanu nā mea nui. Mai hoʻowahāwahā i kēia mau mea.
- He lāʻau lapaʻau holomua ke kau ʻana o ka stent, akā pono ia i ke komo ʻana o ke kauka akamai.
- ʻOi aku ka nui ma mua o ka lāʻau lapaʻau ka hoʻololi ʻana i kou nohona. He mea nui ka ʻai pono ʻana, ka hoʻoikaika kino ʻana, a me ka pale ʻana i nā hana maikaʻi ʻole.
- He pilikia ka ʻeha nui o ka umauma. E hele koke i ka ʻOihana Pilikia o ka haukapila (ETU).
Maʻi Puʻuwai, Pale ʻana o ka Bifurcation, Maʻi ʻAʻa Coronary, Stenting, Angioplasty, ʻEha Umauma, Hoʻouka Puʻuwai
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