Ua lohe pinepine kākou a pau i ka huaʻōlelo "hōʻeha puʻuwai", ʻeā? Malia paha ua loaʻa i kekahi o ko kākou ʻohana a i ʻole he hoaaloha kekahi. Akā, ua ʻike anei ʻoe he ʻano like ʻole o nā hōʻeha puʻuwai? I kēia lā, e kamaʻilio kākou e pili ana i kahi ʻano i ʻoi aku ka koʻikoʻi a pono e mālama koke ʻia. Kāhea nā kauka i kēia he STEMI. Mai hopohopo, e kamaʻilio maʻalahi kākou e pili ana i kēia.
No ke aha i kapa ʻia ai ʻo STEMI? He aha kona manaʻo?
I ka ʻōlelo maʻalahi, ʻo ka hōʻeha puʻuwai ka wā e ālai koke ʻia ai kahi aʻa e hoʻolako ana i ke koko i ka puʻuwai, e ʻoki ana i ke kahe koko i ka ʻiʻo puʻuwai. Ma nā ʻōlelo lapaʻau, ua kapa ʻia kēia he "Myocardial Infarction".
I kēia manawa, e nānā kākou pehea i loaʻa ai ka inoa STEMI. Ua ʻike paha ʻoe i kahi ECG i lawe ʻia ma kahi haukapila. He hoʻāʻo kēlā e nānā i ka hana uila o ka puʻuwai. Ma kēia, ua hōʻike ʻia ka puʻuwai ma ke ʻano he kiʻi laina. Ua like ia me kahi laina nalu, e like me kahi puʻu a i ʻole kahi pali.
Aia kekahi ʻāpana kūikawā o kēia ECG, i kapa ʻia ʻo ka "segment-ST". I ke kanaka olakino, he pālahalaha kēia ʻāpana maʻamau. Eia naʻe, i ka wā e ālai loa ʻia ai kahi aʻa nui e hoʻolako ana i ke koko i ka puʻuwai, ʻo ia hoʻi, i ka wā e loaʻa ai kahi hōʻeha puʻuwai koʻikoʻi, piʻi aʻe kēia ʻāpana ST. E like me kahi puʻu liʻiliʻi.
Ua kapa ʻia kēia ʻo ST-Elevation Myocardial Infarction no ka mea ua kiʻekiʻe ka ʻāpana ST ma ka ECG. ʻO kona pōkole ʻo STEMI .
He hōʻailona koʻikoʻi loa kēia hoʻololi ECG no nā kauka, no ka mea, ʻo ia hoʻi, ʻaʻole lawa ke koko o ka hapa nui o ka puʻuwai, a ke make nei kēlā ʻāpana o ka puʻuwai. ʻO ke ʻano kēia, pono e hoʻomaka koke ʻia ka lāʻau lapaʻau, me ka hoʻokaʻulua ʻole i hoʻokahi minute .
Pehea e hana ai kahi STEMI? He aha ka mea e hana ʻia i loko o ke kino?
ʻO ka hapa nui o ka manawa, ua hana ʻia kēia e ka plaque, kahi hōʻiliʻili o ka momona a me ka cholesterol i loko o nā kīʻaha koko o ka puʻuwai (nā ʻaʻa coronary). E noʻonoʻo e like me ka ʻōpala e hana mālie ana i loko o kahi paipu wai.
E ulu mālie ana kēia mau palaki. I kekahi lā, hiki i kekahi o kēia mau palaki ke pohā koke. A laila manaʻo ko mākou kino aia kahi ʻeha ma laila. No laila hana ia i kahi ʻūpā koko e ho'ōla i kēlā ʻeha. Akā, e ulu koke ana kēia ʻūpā koko a ālai loa i kēlā aa koko.
ʻO ia ka manawa e hoʻomaka ai ka pilikia maoli.
1. Ke ālai loa ʻia ke aʻa, ua nele nā ʻiʻo puʻuwai e loaʻa ana ke koko mai ia mea i ka oxygen. Kāhea mākou i kēia kūlana '(ischemia)'.
2. Me ka ʻole o ka oxygen, hoʻomaka mālie kēia mau ʻāpana ʻiʻo e make.
3. Inā hāʻule kahi hapa nui o ka puʻuwai ma kēia ʻano, ʻaʻole hiki i ka puʻuwai ke pamu i ke koko kūpono i ke kino. Hiki i kēia ke alakaʻi i kahi maʻi make i kapa ʻia ʻo "cardiogenic shock".
4. Eia kekahi, hiki i ka ʻiʻo puʻuwai i hōʻino ʻia ke hoʻopilikia i ka hana uila o ka puʻuwai, e hoʻōki koke ai ka puʻuwai i ke kuʻi ʻana (cardiac arrest).
ʻO ka maʻamau, he hōʻeha puʻuwai koʻikoʻi ka STEMI. No laila he mea nui e hele i ka haukapila i ka wā e hoʻomaka ai nā hōʻailona. Inā hiki iā ʻoe ke wehe koke i ke aʻa i paʻa a hoʻihoʻi i ke kahe koko, hiki iā ʻoe ke hōʻemi nui i ka pōʻino o ka puʻuwai.
He aha ka ʻokoʻa ma waena o STEMI a me NSTEMI?
Ua lohe paha ʻoe iā NSTEMI. Aia kekahi mau ʻokoʻa koʻikoʻi ma waena o nā mea ʻelua.
| ʻAno | STEMI (ʻano koʻikoʻi) | NSTEMI (ʻano ʻoi aku ka ʻino) |
|---|---|---|
| Ka paʻa ʻana o nā kīʻaha koko | Ua ālai loa ʻia. Ua pau loa ke kahe ʻana o ke koko. | ʻO kahi hapa wale nō i ālai ʻia. Ke holo nei kekahi kahe koko. |
| Hoʻololi ECG | Ua maopopo ka hoʻokiʻekiʻe ʻia ʻana o ka ʻāpana ST (ST-Elevation). | ʻAʻole ʻike ʻia ka piʻi ʻana o ka ʻāpana ST. Hiki ke ʻike ʻia nā loli liʻiliʻi ʻē aʻe. |
| Ka pōʻino o ka puʻuwai | ʻO ka maʻamau, ʻoi aku ka nui o ka pōʻino e hana ʻia. | Ua haʻahaʻa iki ka pōʻino. |
| Ka ʻike ʻana | Hiki ke ʻike koke ʻia me kahi ECG. | No ka ʻike ʻana, pono kahi hoʻokolohua e nānā ai i kahi enzyme i kapa ʻia ʻo Troponin i loko o ke koko. |
ʻO wai ka mea i pilikia nui i ka hoʻomohala ʻana i kēia?
Hiki ke puʻunaue ʻia nā kumu pilikia no ka loaʻa ʻana o ka hāʻule puʻuwai i ʻelua mau ʻāpana: nā mea hiki iā mākou ke kaohi a me nā mea hiki ʻole iā mākou ke kaohi.
| Nā kumu pilikia hiki iā mākou ke hoʻololi | Nā kumu pilikia hiki ʻole iā mākou ke hoʻololi |
|---|---|
| 🚬 Puhipaka: ʻO kēia ka ʻenemi nui loa. | 👴 Makahiki: Piʻi ka pilikia me ka makahiki. |
| 🍔 Kolesterol kiʻekiʻe: Nā meaʻai i kiʻekiʻe i ka ʻaila a me ka momona. | 👨👩👧 Moʻolelo ʻohana: Nā mākua, nā kaikaina a me nā kaikaina i loaʻa i ka maʻi puʻuwai i ka wā ʻōpiopio. |
| 🩺 Ke koko kiʻekiʻe: ʻAʻole i kāohi ʻia. | 🧍♂️ Kāne: ʻOi aku ka nui o ka pilikia o nā kāne i ka wā ʻōpiopio. ʻOi aku ka nui o ka pilikia o nā wahine ma hope o ka menopause. |
| 🍬 Maʻi diabetes: ʻAʻole ke kaohi ʻana i nā pae kō koko. | 🧬 Nā kumu hoʻoilina: Ua hoʻoilina ʻia kekahi mau maʻi. |
| ⚖️ Ka momona nui a me ka ʻōpū e kūlou ana. | |
| 🏃 Ka nele i ka hoʻoikaika kino a me ke ʻano noho noho ʻole. | |
| 😥 Ke kaumaha nui loa. |
He aha nā hōʻailona e hiki ke ʻike ʻia?
ʻAʻole like nā hōʻailona o ka hāʻule puʻuwai no kēlā me kēia kanaka, akā ʻo nā hōʻailona maʻamau:
- ʻEha a ʻeha paha ka umauma: ʻO kēia ka hōʻailona nui. Hiki ke manaʻo ʻia he ʻeha paʻa, kaumaha, a ʻūmiʻi paha ma waenakonu o ka umauma. Hiki ke mau kēia ʻeha no kekahi mau minuke.
- Ka laha ʻana o ka ʻeha i nā wahi ʻē aʻe: Hiki ke pālahalaha ka ʻeha o ka umauma i ka lima hema, nā lima ʻelua, nā poʻohiwi, ka ʻāʻī, ka ʻāʻī, ke kua, a i ʻole ka ʻōpū o luna.
- Paʻakikī ka hanu ʻana: Hiki paha iā ʻoe ke manaʻo i ka pōkole o ka hanu, me ka ʻeha o ka umauma a i ʻole me ka ʻole.
- Ka hou ʻana: Hiki paha iā ʻoe ke anu koke a hoʻomaka ka hou ʻana.
- Ka luaʻi a me ka luaʻi: Hiki ke manaʻo e like me ka ʻōpū huhū, e like me ka gastritis.
- Pōniuniu a me ka māʻule ʻana: Manaʻo pōniuniu a hiki ʻole ke kū.
- Ke manaʻo nei i ka makaʻu nui: Hiki iā ʻoe ke makaʻu nui, a me ka makaʻu i ka make, me ke kumu ʻole.
Nā ʻano kikoʻī i nā wahine
I kekahi manawa, ʻaʻole paha e ʻike nui nā wāhine i ka ʻeha umauma maʻamau. Akā, hiki iā lākou ke ʻike i nā hōʻailona e like me kēia.
- Luhi nui: Manaʻo nui i ka luhi no kekahi mau lā.
- ʻAʻole hiki ke hiamoe.
- Paʻakikī ka hanu ʻana.
- ʻEha ma ke kua, nā poʻohiwi, a me ka ʻauwae.
- Ka luaʻi a me ka luaʻi.
ʻO ka mea nui loa, inā ʻike ʻoe i nā hōʻailona e like me kēia, mai manaʻo wale, "He gastritis paha kēia," akā e hele koke i ka Emergency Department (ETU) o ka haukapila.
He aha ke ʻano o ka lāʻau lapaʻau e hana ʻia ana ma ka haukapila?
I loko o kahi STEMI, he mea nui ka manawa i ka hoʻopakele ʻana i nā ola, no laila he wikiwiki loa ka mālama ʻana.
1. Ka hōʻoia koke ʻana: Ke lawe ʻia ʻoe i ka ETU, lawe ʻia kahi ECG e hōʻoia inā he STEMI ia.
2. Lāʻau lapaʻau hoʻoheheʻe koko: Ma kekahi mau haukapila, hāʻawi ʻia kahi inikini (thrombolysis) e hoʻoheheʻe i ke koko i paʻa.
3. Angioplasty a me ke kau ʻana o ka stent (PCI): ʻO kēia ka lāʻau lapaʻau maikaʻi loa a hou loa no STEMI. Ma kēia, ua hoʻokomo ʻia kahi ʻōmole lahilahi loa ma o kahi aʻa koko ma ka lima a i ʻole ka wāwae i loko o ka puʻuwai i ke aʻa i paʻa. A laila, ua hoʻopiha ʻia kahi pōpō liʻiliʻi ma ka hopena o ka ʻōmole e wehe i ke aʻa i paʻa, a ua kau ʻia kahi mea like me ka mesh i kapa ʻia he "stent" ma ia wahi e pale aku ai mai ka paʻa hou ʻana. Ua kapa ʻia kēia ʻo "(Percutaneous Coronary Intervention - PCI)".
4. ʻO ke ʻoki ʻana ma o ka bypass (CABG Surgery): Inā ua ālai ʻia nā kīʻaha koko he nui a ʻaʻole hiki ke PCI, hana ʻia ke ʻoki ʻana e hana i nā kīʻaha koko hou. Ua like kēia me ke kūkulu ʻana i kahi 'flyover' hou e kāpae i ke alanui i ālai ʻia.
5. Nā lāʻau lapaʻau ʻē aʻe:Ma waho aʻe o kēia mau lāʻau lapaʻau, pono e lawe ʻia kekahi mau lāʻau lapaʻau, e like me nā lāʻau hoʻokahe koko (e like me ka aspirin), nā lāʻau hoʻohaʻahaʻa cholesterol (statins), a me nā lāʻau hoʻomalu puʻuwai (beta-blockers), no ke koena o kou ola.
He aha kaʻu e hana ai inā he pilikia? E kāhea anei au iā 1990? A i ʻole e holo au i loko o ke kaʻa?
He nīnau koʻikoʻi loa kēia. Inā manaʻo ʻoe ua loaʻa iā ʻoe a i ʻole kekahi mea kokoke iā ʻoe nā hōʻailona o ka hāʻule puʻuwai, mai hoʻokele iā ʻoe iho i ka haukapila. Mai noi aku i kekahi e hoʻokele iā ʻoe.
ʻO ka mea maikaʻi loa e hana ai, ʻo ke kāhea koke ʻana i kahi lawelawe ambulance, e like me 1990.
No ke aha lā ia?
- Ua hoʻomaʻamaʻa kūikawā ʻia nā luna ma luna o ka ambulance no kēia ʻano pilikia. Hiki iā lākou ke hoʻomaka e hāʻawi i ka lāʻau lapaʻau maʻamau (e like me ka oxygen) ʻoiai ʻoe e lawe ʻia ana i ka haukapila.
- Hiki iā lākou ke hoʻomaopopo i ka ETU o ka haukapila ma mua a hāʻawi i nā kikoʻī e pili ana i ka mea maʻi. A laila, i kou hōʻea ʻana, e mākaukau nā kauka a me nā kahu maʻi e mālama iā ʻoe. Mālama kēlā i ka manawa waiwai nui.
- Inā loaʻa kahi pilikia, e like me ka hopu ʻana o ka puʻuwai, loaʻa i ka ambulance nā lako e pono ai (e like me ka defibrillator) e mālama ai. ʻAʻole hiki iā ʻoe ke hana i kēlā i loko o kahi kaʻa home.
E hoʻomanaʻo, he mea nui kēlā me kēia kekona i loko o kahi STEMI. No laila, ʻo ka hoʻoholo ʻana i ka hoʻoholo kūpono e hiki ke hoʻopakele i ke ola.
Leka Lawe-Home
- He ʻano hōʻeha puʻuwai koʻikoʻi loa ka STEMI i hana ʻia e ka pani piha ʻana o kahi aʻa e hoʻolako ana i ke koko i ka puʻuwai.
- ʻO nā hōʻailona nui ka ʻeha nui ma waenakonu o ka umauma, ka pōkole o ka hanu, a me ka hou. Mai hoʻowahāwahā iā ia no ka mea he gastritis ia.
- Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, e kāhea koke aku i kahi ambulance a hele i ka Emergency Treatment Unit (ETU) o ka haukapila.
- He mea nui ka manawa. Inā hiki ke hoʻomaka koke ʻia ka lāʻau lapaʻau, hiki ke hoʻēmi nui ʻia ka pōʻino o ka puʻuwai.
- Hiki ke pale ʻia kēia maʻi ma ka pale ʻana i ka puhipaka, ka kaohi ʻana i ka cholesterol, ke koko, a me ka maʻi diabetes, ka ʻai ʻana i ka meaʻai olakino, a me ka hoʻoikaika kino. E kamaʻilio pinepine me kāu kauka e pili ana i kēia.
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