Ke lohi iki nei anei kou puʻuwai? Ma muli paha o ka Junctional Escape Rhythm (Junctional Escape Rhythm)!

Ke manaʻo nei ʻoe i kekahi manawa e like me ka lohi iki o kou puʻuwai, a i ʻole ma ke ʻano ʻē? E noʻonoʻo, ke hele nei ʻoe i kāu hana maʻamau i kēlā me kēia lā a manaʻo koke ʻoe i ka luhi loa , pau kou hanu i kou piʻi ʻana i kahi alapiʻi, a manaʻo ʻoe e hāʻule ana ʻoe me kou poʻo e wili ana. ʻAʻole hana wale ʻia kēia ʻano mea, ʻeā? He loli liʻiliʻi paha ia i ka ʻōnaehana hōʻailona o kou puʻuwai. I kēia lā e kamaʻilio mākou e pili ana i kekahi ʻano maʻi, i kapa ʻia ʻo Junctional Escape Rhythm . Mai hopohopo, e kamaʻilio maʻalahi mākou e pili ana i kēia.

He aha maoli kēia Junctional Escape Rhythm?

I ka ʻōlelo maʻalahi, ua hāʻawi ʻia kēia inoa i ka ʻoiaʻiʻo e hoʻomaka ana kou puʻuwai e kuʻi haʻahaʻa iki ma mua o kahi e pono ai. E noʻonoʻo iā ia e like me kahi mīkini liʻiliʻi e hana me kahi ʻōnaehana uila. Pono ia i kahi 'hōʻailona uila' e kuʻi pono ai. Hoʻomaka pinepine kēia hōʻailona ma ka piko o ka puʻuwai i kapa ʻia ʻo ka node sinoatrial (a i ʻole 'SA node'). Ua like ia me ke alakaʻi nui ma ke kahua mua ma ke kaʻaahi. ʻO ia ka mea nāna e hāʻawi i ke kauoha, 'ʻAe, e kuʻi i kēia manawa.'

Eia nō naʻe, inā loaʻa kekahi mea i kēia `SA node`, ua like ia me he mea lā ua hiamoe ke alakaʻi. A laila, ʻaʻole hiki iā ia ke hoʻomaka pono i ka puʻuwai, a inā paha e hana ia, ʻaʻole ia e lawa ka ikaika.

No laila, he aha ka mea e hana ʻia ke hana ʻia kēlā? ʻAʻole noho wale ka puʻuwai ma laila. Ma kahi iki aʻe i lalo o ka puʻuwai, ma ka hui ʻana o nā keʻena o luna (atria) a me nā keʻena o lalo (ventricles), ʻōlelo ka node atrioventricular (a i ʻole AV node), "ʻAe, e lawe wau i ke kuleana," a hoʻomaka ka puʻuwai e kuʻi. Me he mea lā inā hiamoe ke alakaʻi ma ke kahua mua, lawe ke alakaʻi ma ke kahua aʻe a huki i ke kaʻaahi. ʻAʻole kēia kāna hana maʻamau, akā hana ʻo ia no ka mea ʻaʻole hiki iā ia ke hoʻōki i ka hana.

Eia naʻe, ʻaʻole wikiwiki ka puʻuwai e hana ʻia ma kēia ʻano e like me ka mea e puka mai ana mai ka `SA node`. ʻOiai ʻo ka helu puʻuwai maʻamau o ke kanaka olakino ma waena o 60 a me 100 mau kuʻi i kēlā me kēia minuke, ma kēia `Junctional Escape Rhythm` ʻo ka helu ma waena o 40 a me 60 mau kuʻi i kēlā me kēia minuke . ʻO ia hoʻi, lohi iki.

ʻO wai ka mea i ʻoi aku ka pilikia o kēia kūlana?

ʻOiai hiki i kēia maʻi ke hoʻopilikia i kekahi, ʻoi aku ka nui o ka pilikia o kekahi poʻe. No ka laʻana, ua ʻike ʻia nā noiʻi he nui ka poʻe ma luna o 65 mau makahiki me ka maʻi puʻuwai e loaʻa paha kekahi kekelē o ka hana ʻino o ka node SA. No laila, me ia pilikia, ʻoi aku ka kiʻekiʻe o ka manawa e hoʻomohala ai i kahi mele junctional.

ʻAʻole wale kēlā, hiki i kēia kūlana ke hoʻopilikia i kekahi poʻe ʻē aʻe:

• Nā mea pāʻani e hoʻomaʻamaʻa maikaʻi ana: I kekahi manawa ʻike ʻia kēia ʻano mele no ka mea he haʻahaʻa ko lākou puʻuwai hoʻomaha.
• Nā kamaliʻi ʻōpio: I kekahi manawa hiki i nā keiki ke loaʻa i kēia, akā ʻaʻole maʻamau loa.
• ʻO nā kānaka me ke ʻano i kapa ʻia ʻo 'Sick Sinus Syndrome':I kēia hihia hoʻi, ʻaʻole hana pono ka node SA, no laila pono nā ʻāpana ʻē aʻe o ka puʻuwai e kaohi i ka puʻuwai.

He aha nā hōʻailona o kēia?

ʻO ka hapa nui o ka manawa, ʻaʻole paha ʻoe e loaʻa i kekahi mau hōʻailona . Hiki ke ʻike ʻia ma kahi hanana i ka wā o kahi hoʻāʻo ECG i hana ʻia no kekahi kumu ʻē aʻe. Eia nō naʻe, inā loaʻa nā hōʻailona, ​​​​hiki iā lākou ke komo pū me:

• Manaʻo luhi loa ('Luhi'): Manaʻo e like me ka nele o ka ikaika, luhi loa ʻoe a makemake ʻoe e hiamoe i ka lā a pau.
• Nāwaliwali a i ʻole syncope: Hiki ke hana kēia inā lohi nui ka puʻuwai, e hoʻemi ana i ka nui o ke koko e kahe ana i ka lolo.
• Pōniuniu a poʻo māmā paha: Hiki ke hana kēia i kou kū ʻana a i ʻole kou ala koke ʻana.
• Nā Palpitations: Hiki paha ke manaʻo e like me ke kuʻi ʻana o kou puʻuwai i loko o kou umauma, a i ʻole e like paha me ka lele koke ʻana o kahi kuʻi.
• Pōkole o ka hanu: Hiki i kekahi poʻe ke loaʻa ka pōkole o ka hanu ke luhi iki lākou.

No ke aha lā kēia e hana nei? He aha nā kumu?

Aia kekahi mau kumu e hiki ai i kāu SA node ke oki i ka hoʻouna ʻana i nā hōʻailona uila a nāwaliwali paha. ʻO kēia ke kumu o ka Junctional Escape Rhythm. E nānā kākou i nā kumu nui.

Hiki i kekahi mau kūlana olakino a me nā lāʻau lapaʻau ke hana i kēia:

• ʻAneʻane hiamoe: He kūlana kēia kahi e pau ai kou hanu ʻana no nā manawa pōkole i kou hiamoe ʻana. Hiki i kēia ke hoʻopilikia i kou puʻuwai.
• Lapaʻau radiation: ʻO ka lāʻau radiation, ʻoi aku hoʻi no ka maʻi kanesa ma ka umauma, hiki ke hōʻino i ka ʻōnaehana uila o ka puʻuwai.
• Hoʻouka puʻuwai: Hiki i ka hoʻouka puʻuwai ke hōʻino i ka ʻiʻo o ka puʻuwai a me ka node SA.
• Myocarditis: ʻO ka mumū o ka ʻiʻo o ka puʻuwai i hoʻokumu ʻia e kahi mea e like me ka maʻi viral.
• ʻO ka mumū o ka ʻeke a puni ka puʻuwai (pericarditis): Hiki i kēia ke hoʻopilikia i ka hana o ka puʻuwai.
• ʻEha i kou umauma: Inā loaʻa iā ʻoe kahi hahau ʻoi i ka umauma, e like me kahi ulia.
• Maʻi Lyme: Hiki i kēia maʻi i lawe ʻia e ka ʻūlū ke hoʻopilikia i ka puʻuwai.
• Hypothyroidism: Hoʻemi ʻia ka hana o ka thyroid gland.
• ʻO kekahi mau ʻoki kino: ʻOi loa ma hope o nā ʻoki kino e pili ana i ka puʻuwai.

Hiki ke hana ʻia kēia e kekahi mau lāʻau lapaʻau:

Hoʻemi kekahi mau lāʻau lapaʻau i ka hana o ka node SA, a hiki nō hoʻi ke hana ʻia kēia ʻano pakele junctional.

• Lithium: He lāʻau lapaʻau i hoʻohana ʻia e mālama ai i nā maʻi noʻonoʻo.
• Nā mea pale Beta: He ʻano lāʻau lapaʻau maʻamau i hoʻohana ʻia e mālama i ke koko kiʻekiʻe a me nā maʻi puʻuwai.
• Nā mea pale i ke kahawai calcium: Hāʻawi ʻia kēia mau mea no ke koko kiʻekiʻe a me nā maʻi puʻuwai.
• ʻO Digoxin: He lāʻau lapaʻau i hoʻohana ʻia e mālama i ka hāʻule ʻana o ka puʻuwai a me kekahi mau maʻi puʻuwai.
• ʻOpioids: Nā lāʻau hoʻomaha ʻeha ikaika.
• Adenosine: He lāʻau lapaʻau i hoʻohana ʻia e ʻike a mālama i nā maʻi o ka puʻuwai.
• ʻO Clonidine (no ka laʻana, Catapres® a i ʻole Kapvay®): He lāʻau lapaʻau i hoʻohana ʻia e mālama ai i ke koko kiʻekiʻe.

Pehea ʻoe e ʻike ai i kēia?

Inā loaʻa iā ʻoe nā hōʻailona i ʻōlelo ʻia ma luna, a inā paha e kānalua kāu kauka i kēia, e nānā lākou iā ʻoe.

• Mōʻaukala lapaʻau a me ka hoʻokolokolo kino: ʻO ka mea mua, e nīnau lākou e pili ana i kāu mau hōʻailona, ​​​​nā lāʻau lapaʻau āu e lawe nei, a inā he maʻi puʻuwai kekahi o kou ʻohana. A laila, e hana lākou i kahi hoʻokolokolo kino maʻamau.
• ʻO ka Electrocardiogram (i kapa ʻia hoʻi ʻo ECG a i ʻole EKG): ʻO kēia ka hoʻāʻo koʻikoʻi loa. Hoʻopaʻa ia i ka hana uila o ka puʻuwai. Inā loaʻa kahi ʻano pakele junctional, e ʻike ʻia kona ʻano hiʻohiʻona ma ka ECG (no ka laʻana, nā nalu P i nele a i ʻole i hoʻololi ʻia, ka wikiwiki o ka puʻuwai).
• Nā hoʻāʻo koko: Hiki i kēia ke kōkua i ka hoʻoponopono ʻana i nā kumu ʻē aʻe, e like me nā pilikia thyroid a i ʻole nā ​​​​​​mea kaulike ʻole electrolyte.
• ʻO ke kani ultrasound o ka puʻuwai (Echocardiogram): Hiki i kēia ke nānā aku i nā mea e like me ke ʻano o ka puʻuwai, ka hana o nā valves, a me ka ikaika o nā ʻūmiʻi o ka ʻiʻo o ka puʻuwai.
• Nānā Holter: I kekahi manawa, inā ʻaʻole i loaʻa mau nā hōʻailona, ​​​​hiki ke hoʻohana ʻia kahi mea e like me kēia e hoʻopaʻa i ka ECG ma luna o 24 a 48 mau hola.

He aha nā lāʻau lapaʻau no kēia?

Hoʻoholo ʻia ka lāʻau lapaʻau i ka loaʻa ʻana o nā hōʻailona a me ke kumu o ke kūlana.

• Inā ʻaʻohe ou hōʻailona: I ka hapanui o nā hihia, inā olakino ʻoe a ʻaʻohe ou hōʻailona, ​​ʻaʻohe pono o kahi lāʻau kūikawā. E nānā wale aku paha kāu kauka iā ʻoe.
• Inā he mau hōʻailona:
• Ke mālama ʻana i ke kumu kumu: No ka laʻana, inā ua hoʻokumu ʻia ke kūlana e kahi lāʻau lapaʻau, hiki i ke kauka ke hoʻōki i ka lāʻau lapaʻau a hoʻololi paha i kahi lāʻau lapaʻau ʻē aʻe. Inā he kūlana ia e like me ka "sleep apnea," pono e mālama ʻia.
• Lāʻau lapaʻau: Inā haʻahaʻa loa ka helu o ka puʻuwai a aia nā hōʻailona e like me ka poniuniu, hiki ke hāʻawi ʻia kahi lāʻau lapaʻau e like me ka atropine (e.g., Atreza® a i ʻole Sal-Tropine®) no kahi manawa pōkole e hoʻonui iki i ka helu o ka puʻuwai.
• Pacemaker: Inā hoʻomau nā hōʻailona, ​​​​ua haʻahaʻa loa ka helu o ka puʻuwai, a i ʻole ʻaʻole hoʻi e hoʻomaikaʻi ke kumu kumu me ka mālama ʻole ʻia, pono paha kahi pacemaker mau loa .Hiki ke ʻōlelo ʻia e hoʻokomo i kahi pacemaker. He mea liʻiliʻi kēia i hoʻokomo ʻia ma lalo o ka ʻili o ka umauma ma ke ʻoki ʻana. Hoʻouna ia i nā hōʻailona uila i ka puʻuwai, e kōkua ana i ka mālama ʻana i ka helu puʻuwai maʻamau. Pono paha e hoʻokomo ʻia kēia i ka wā ʻōpiopio.
• ʻO ka hoʻopau ʻana o ka catheter: ʻAʻole kēia he lāʻau maʻamau no ka junctional escape rhythm, akā hiki ke noʻonoʻo ʻia i kekahi mau hihia kūikawā (no ka laʻana, inā pili ia me nā pilikia rhythm ʻē aʻe e like me ka AV nodal reentrant tachycardia). Pili kēia i ka hana ʻana i nā ʻoki liʻiliʻi ma nā wahi o ka puʻuwai e hoʻoulu ai i nā hōʻailona uila ʻē aʻe, e hoʻōki ana iā lākou.

Aia kekahi mau pilikia me ka lāʻau lapaʻau?

E like me nā lāʻau lapaʻau āpau, aia kekahi mau pilikia e pili ana, ʻoiai ke kau ʻana i kahi pacemaker:

• Ka maʻi ma kahi i hana ʻia ai ke ʻoki.
• Nā ʻūpā koko.
• Ka hoʻokumu ʻia ʻana o nā ʻiʻo ʻeha a puni ka pacemaker.
• Ke neʻe nei a haki paha nā uea o ka hāmeʻa ma kahi e pono ai lākou.
• Ka hōʻino ʻana o ka māmā (kākaʻikahi).

Eia nō naʻe, he mau pilikia liʻiliʻi kēia, a ʻike nā kauka pehea e hoʻokele ai iā lākou. ʻO ka hoʻokomo ʻana i ka pacemaker he hana palekana loa ia.

ʻEhia ka lōʻihi e hoʻōla ai ma hope o ka lāʻau lapaʻau?

Inā he pacemaker kāu, hiki iā ʻoe ke hoʻi i kāu mau hana maʻamau i loko o kekahi mau lā. Eia nō naʻe , pono paha ʻoe e kali i hoʻokahi a ʻelua paha pule ma mua o ka hana ʻana i kekahi mea ʻē aʻe, e like me ka hāpai ʻana i nā kaumaha a i ʻole ka hoʻokele ʻana , ma muli o nā kuhikuhi a kāu kauka. Inā mālama ʻia ʻoe me ka lāʻau lapaʻau, e ʻoluʻolu ʻoe i ka hoʻomaka ʻana o kāu mau hōʻailona e emi.

He aha kā mākou e hana ai e hōʻemi i kēia pilikia?

ʻAʻole hiki iā mākou ke kāohi i kekahi o nā kumu e hoʻoulu ai i ka Junctional Escape Rhythm (e.g. nā kūlana genetic). Eia nō naʻe, aia kekahi mau mea hiki iā mākou ke hana e hōʻemi i ko mākou pilikia:

• Ke hahai nei i kahi nohona olakino: ʻO ka ʻai ʻana i ka meaʻai kaulike, ka hoʻoikaika kino mau , a me ka pale ʻana i ka puhipaka e hiki ke kōkua i ka mālama ʻana i kou puʻuwai i ke olakino.
• E mālama pono i nā maʻi kumu: Inā loaʻa iā ʻoe nā maʻi e like me ka maʻi diabetes, ke koko kiʻekiʻe, a me ka apnea hiamoe, e mālama pono iā lākou.
• Nā Manaʻo no ka Lāʻau Lapaʻau: E kamaʻilio me kāu kauka e pili ana i nā lāʻau lapaʻau āu e lawe nei. Inā he kānalua e hoʻopilikia ana kahi lāʻau lapaʻau, e ʻimi kāu kauka i kahi ʻē aʻe. Mai ho'ōki i ka lawe ʻana i kahi lāʻau lapaʻau me ka ʻole o ka ʻōlelo aʻoaʻo lapaʻau.

He aha ka mea e hana ʻia inā he ʻano pakele hui pū ʻana? He aha ka wā e hiki mai ana?

ʻO ka wānana no ka poʻe me ka Junctional Escape Rhythm he maikaʻi ma ke ʻano laulā, ʻoiai inā he asymptomatic lākou a inā hiki ke kāohi ʻia ko lākou mau hōʻailona me ka lāʻau lapaʻau. Inā he pacemaker kāu, hiki iā ʻoe ke ola i kahi ola maʻamau. ʻO ka mea nui loa, ʻo ia ka hahai ʻana i nā ʻōlelo a kāu kauka a hele i nā nānā maʻamau.

Pehea lā wau e mālama ai iaʻu iho?

Ke loaʻa iā ʻoe ka Junctional Escape Rhythm, e nānā paha kāu kauka i ke kūlana kumu e hoʻoulu ai. No laila, ma muli o ke kūlana a i ʻole ka lāʻau lapaʻau e hoʻoulu ai i ka pilikia, pono paha ʻoe e lawe i kahi lāʻau lapaʻau ʻokoʻa a i ʻole e loaʻa i ka lāʻau lapaʻau a kāu kauka e ʻōlelo ai.

• E hahai pono i nā ʻōlelo aʻoaʻo lapaʻau.
• E lawe i kāu lāʻau lapaʻau i ka manawa kūpono.
• Inā he pacemaker kāu, e hahai i nā ʻōlelo a kāu kauka e pili ana i ia mea (e laʻa, e noho mamao aku mai kekahi mau mea uila).
• Inā he loli o nā hōʻailona (hoʻonui ʻia, ʻike ʻia nā hōʻailona hou), e hoʻomaopopo koke i ke kauka.

Āhea wau e ʻimi ai i ke aʻo lapaʻau?

• Inā loaʻa iā ʻoe nā hōʻailona i ʻōlelo ʻia ma mua (luhi, poʻo hina, poʻo māmā, ʻūlū umauma).
• Inā he pacemaker kāu, pono ʻoe e ʻike i kāu kauka ma kahi o hoʻokahi mahina ma hope o ke ʻoki kino. Ma hope o kēlā, pono ʻoe e hele no nā manawa hoʻopaʻa i hoʻokahi a ʻelua paha i ka makahiki.
• Inā manaʻo ʻoe ʻaʻole hana pono kāu pacemaker (e laʻa, inā hoʻi mai nā hōʻailona kahiko), a inā he maʻi kou (ʻulaʻula, pehu, pus) kahi i hoʻokomo ʻia ai kāu pacemaker, pono ʻoe e hoʻokaʻaʻike koke aku i kāu kauka.

He aha nā nīnau āu e nīnau ai i ke kauka?

Mai poina e nīnau i kēia mau nīnau ke ʻike ʻoe i ke kauka:

• "Pono anei iaʻu ka lāʻau lapaʻau no kēia `Junctional Escape Rhythm`?"
• "He aha ke kumu kikoʻī no kaʻu `Junctional Escape Rhythm`?"
• "He aha nā hoʻololi o ke ʻano o ka nohona e pono ai iaʻu ke hana?"
• "Inā e hana hou ʻia ke kūlana i hoʻokumu ai i kēia, e loaʻa hou anei iaʻu ʻo `Junctional Escape Rhythm`?"
• "Inā pono kahi `pacemaker`, he aha nā pōmaikaʻi a me nā pōʻino?"
• "He aha nā hana e pono iaʻu ke pale aku?"

Eia kahi hōʻuluʻulu manaʻo o nā mea a mākou i kūkākūkā ai (Leka Lawe-Home):

ʻAe, i kēia manawa ua maopopo iā ʻoe ka mea a mākou i kamaʻilio ai i kapa ʻia ʻo `Junctional Escape Rhythm`. ʻO ka mea e hana ʻia ma kēia, ʻo ia ka wā e hāʻule ai ka `SA node`, kahi e hoʻomaka ai ka puʻuwai o ka puʻuwai, hoʻomaka ka puʻuwai e kuʻi mai ka `AV node`, a i ʻole ka junction, aia ma ka ʻaoʻao haʻahaʻa o ka puʻuwai. Hoʻolohi pinepine kēia i ka helu o ka puʻuwai (ma kahi o 40-60 beats i kēlā me kēia minuke).

ʻAʻole paha e loaʻa i kekahi poʻe kekahi mau hōʻailona, ​​akā hiki i kekahi poʻe ke loaʻa ka luhi, ka poniuniu, ka māmā o ke poʻo, a me ka ʻūlū o ka umauma. Hiki i kekahi mau maʻi (e laʻa, ka hiamoe apnea, ka hāʻule ʻana o ka puʻuwai) a me kekahi mau lāʻau lapaʻau (e laʻa, nā beta-blockers) ke hana i kēia.

ʻO ka mea nui loa, inā loaʻa iā ʻoe kēia mau hōʻailona, ​​mai hoʻowahāwahā iā lākou a e ʻike i ke kauka e ʻike pono i ke ʻano o ka maʻi. Hiki ke ʻike ʻia kēia me kahi hoʻāʻo maʻalahi e like me ka ECG.

Hiki i ka lāʻau lapaʻau ke komo pū me nā lāʻau lapaʻau, a i kekahi manawa he pacemaker, ma muli o ke kumu. Inā ʻaʻohe ou hōʻailona, ​​ʻaʻole paha ʻoe e pono i ka lāʻau lapaʻau. Eia nō naʻe, inā loaʻa iā ʻoe nā hōʻailona, ​​​​e kālele ana kāu kauka i ka mālama ʻana i ke kumu kumu. E kamaʻilio me ʻoe e pili ana i kāu mau koho lapaʻau, a e nīnau i nā nīnau inā ʻaʻole maopopo kekahi mea. Ma hope o kēlā, he mea nui e lawe i kāu mau lāʻau lapaʻau a loaʻa nā nānā maʻamau. A laila hiki iā ʻoe ke noho olakino a hopohopo ʻole.

ʻO ke ʻano o ka pakele ʻana o ka Junctional, ka ʻano o ka puʻuwai, ka puʻuwai, ka SA Node, ka AV Node, ka Pacemaker, ke olakino o ka puʻuwai