Ke manaʻo nei ʻoe i kekahi manawa ua pōkole kou hanu, luhi mau, a pehu paha kou mau wāwae? Hiki i kēia ke lilo i mau hōʻailona o kahi pilikia me kou puʻuwai. I kēia lā e kamaʻilio mākou e pili ana i kahi kūlana e hoʻopilikia ai i ka hana o ka puʻuwai, akā ʻaʻole paha mākou i lohe nui e pili ana i ia mea. ʻO ia ka ventricular dyssynchrony , a i ʻole e like me ka kapa ʻana o nā kauka, (Ventricular Dyssynchrony). ʻOiai paha he paʻakikī iki ka inoa, e wehewehe maʻalahi kākou.
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He aha ka Ventricular Dysschony?
I ka ʻōlelo maʻalahi, ʻo ka arrhythmia ventricular ka wā e kuʻi like ʻole ai kekahi a ʻoi aku paha o nā keʻena haʻahaʻa o kou puʻuwai, i kapa ʻia ʻo ventricles , me ke kūlike ʻole a me ka ʻole o ka hoʻonohonoho ʻana. E noʻonoʻo he lohi iki ma kahi o 40 milliseconds ma waena o nā ʻāpana like ʻole o nā cell o kou puʻuwai e hoʻomaka ana e ʻaelike, a i ʻole ma waena o kekahi cell e hoʻomaka ana e ʻaelike e pili ana i kekahi. Hiki ke manaʻo ʻia he arrhythmia.
Hana pono wale nō ko kākou puʻuwai ke ʻūlū nā ʻiʻo i loko o kona mau keʻena i ka manawa like a ma ke ʻano like. ʻO ka maʻamau, hele nā hōʻailona uila ma o ka puʻuwai ma ke ʻano maʻamau. Ke loaʻa i nā keʻena nui ʻelua o ka puʻuwai kahi hōʻailona e ʻūlū, pono e ʻūlū nā ʻiʻo i loko o kēlā mau keʻena i ka nui like a i ka manawa like. ʻOi aku hoʻi, ʻo kou ventricle hema, ke keʻena pamu nui o ka puʻuwai, pono e ʻūlū ma ke ʻano i hoʻonohonoho pono ʻia. Ua like ia me ka paʻi ʻana mai nā ʻaoʻao ʻelua i ke kikowaena.
Eia nō naʻe, inā ʻaʻole hiki kēia hōʻailona i nā hunaola puʻuwai ʻelua i ka manawa like, ʻaʻole hiki i nā ʻiʻo ke ʻaelike i ka manawa like. ʻO ia ka mea a mākou e kapa nei i kēia dyssynchrony .
Hiki i ka dyssynchrony cellular ke hoʻopilikia i kou kino ma nā ʻano penei:
- Hoʻemi ia i ka pono o kou puʻuwai.
- ʻO nā valves e kōkua maʻamau i ke kahe ʻana o ke koko i hoʻokahi ala wale nō e hiki ke hoʻoulu i ke koko e kahe i hope (ma ke ala kūpono ʻole).
- Hoʻemi ʻia ka nui o ke koko e hiki i kou puʻuwai ke pamu (Cardiac Output).
He aha nā ʻano o nā arrhythmias cardiac?
Aia kekahi mau ʻano nui o ka asynchrony cell:
- ʻO Atrioventricular Dyssynchrony: ʻO kēia ka manawa e ʻaelike ai nā keʻena o luna (atria) a me nā keʻena haʻahaʻa (ventricles) o kou puʻuwai me ka ʻole o ka hoʻonohonoho ʻana.
- ʻO Interventricular Dysschony: Ma kēia, ʻaelike kāu ventricles hema a me ka ʻākau (nā keʻena haʻahaʻa) i nā manawa like ʻole.
- Intraventricular Dysschony: Ma kēia, ʻūlū nā ʻiʻo ma nā ʻāpana like ʻole o ka cell like i nā manawa like ʻole. E noʻonoʻo iā ia e like me nā paia o kahi lumi e ʻūlū ana i nā manawa like ʻole, ma mua o ka hoʻokuke ʻia ʻana i loko i ka manawa like.
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Check Availability →ʻO wai ka mea i hoʻopilikia nui ʻia e ka asynchrony cell?
ʻIke pinepine ʻia kēia ʻano i nā poʻe me nā kūlana olakino e hiki mai ana:
- Nā kānaka me ka puʻuwai palupalu.
- Poloka Lālā Pūʻolo Hema (LBBB).
- Poloka Lālā Pūʻolo ʻĀkau (RBBB).
- Ka maʻi ʻōpū.
- Ke koko kiʻekiʻe.
- Nā maʻi puʻuwai ʻē aʻe.
E hoʻomanaʻo iā ʻAnakala Somapala mai ko mākou kauhale. Ua loaʻa iā ia ka maʻi ʻo (Heart Failure) no kekahi manawa. I kēia mau lā, ua paʻakikī ʻo ia i ka hanu ʻana a ua luhi nui ʻo ia. I ka nānā ʻana o ke kauka iā ia, ua ʻōlelo ʻo ia he maʻi kona i kapa ʻia ʻo (Ventricular Dyssynchrony) i loko o kona puʻuwai, ʻo ia ke kumu i ʻoi aku ai ka ʻino o kāna mau hōʻailona.
Pehea ka maʻamau o kēia ʻano?
Ma kahi o hoʻokahi hapakolu o ka poʻe me kekahi ʻano o ka hāʻule ʻana o ka puʻuwai e ʻike paha i kēia ʻano asynchrony cell. Ma kahi o 2% o nā pākeke ma nā ʻāina i hoʻomohala ʻia e ʻeha nei i ka hāʻule ʻana o ka puʻuwai. Eia kekahi, ma waena o 6% a me 10% o ka poʻe ma luna o 65 mau makahiki he hāʻule ka puʻuwai. No laila, ʻo kēia ʻano kekahi mea i ʻike ʻia e pili ana i kēlā.
He aha nā hōʻailona?
Hiki i ka dyssynchrony cellular ke hoʻonui i nā hōʻailona o ka hāʻule ʻana o ka puʻuwai, a i ʻole e hana i nā hōʻailona kū hoʻokahi iā ia. Eia nā mea nui:
- Ka paʻakikī o ka hanu ʻana (ʻoi aku hoʻi i ka wā e luhi ai ʻoe).
- Manaʻo luhi loa (ʻoiai no kekahi manawa pōkole wale nō).
- Kuke (hiki ke hoʻomau).
- Ka pehu ʻana (edema) i ke kino (ʻoi aku hoʻi ma nā wahi e like me nā wāwae a me nā kuʻekuʻe wāwae).
He aha nā kumu o ka asynchrony o nā cell?
Hiki i kekahi mau pilikia puʻuwai like ʻole ke hana i kēia. ʻO kekahi o lākou:
- Ka Hana ʻole o ka Ventricular.
- ʻIʻo ʻeha i hoʻokumu ʻia e ka hānō puʻuwai.
- Ka Lohi Hoʻokele Uila, ʻo ia hoʻi nā kūlana e like me ka Left Bundle Branch Block a me ka Right Bundle Branch Block.
- ʻIʻo puʻuwai maʻi.
- ʻAʻole lawa ke kahe o ke koko i ka ʻiʻo o ka puʻuwai (Ischemia).
He aha nā hoʻokolohua e hana ʻia e ʻike ai i kēia maʻi?
E nīnau mua kāu kauka iā ʻoe e pili ana i kāu mau hōʻailona a hana i kahi hoʻokolohua kino e loiloi i ka hana o kou puʻuwai. I kekahi manawa , hiki i ka hoʻolohe ʻana i kou puʻuwai me kahi stethoscope ke hāʻawi iā ʻoe i kahi manaʻo o kēia asynchrony.
ʻO ka hoʻāʻo nui i hoʻohana ʻia no ka ʻike ʻana i nā pilikia me ka ʻōnaehana hoʻokele uila o ka puʻuwai he electrocardiogram (ECG) . Hiki iā ia ke ʻike i nā kūlana e like me ka Right Bundle Branch Block a me ka Left Bundle Branch Block, ka mea e hoʻoulu ai i ka puʻuwai e kuʻi ʻole. Inā loaʻa kēia mau kūlana ma ka ECG, e kuhikuhi ke kauka iā ʻoe no nā hoʻokolohua hou aku.
Hoʻohana pinepine nā kauka i kahi echocardiogram e ʻike i nā arrhythmias cardiac . Hiki iā lākou ke ʻike pehea e ʻaelike ai nā keʻena o ka puʻuwai, nā valves, a me nā ʻiʻo.
Hiki ke hana ʻia nā hoʻokolohua ʻē aʻe:
- Ke nānā ʻana o ka Positron Emission Tomography (PET).
- Nānā ʻana i ka Multigated Acquisition (MUGA).
- Kiʻi Hoʻohui Magnetika Puʻuwai (MRI).
- ʻO ke kiʻi ʻana o ka Tomography Kamepiula (CT).
- ʻO ke kiʻi ʻana o ka Tomography Hoʻopili ʻia o ka Photon Hoʻokahi (SPECT).
Pehea e mālama ʻia ai ka asynchrony o nā cell?
Hiki paha i nā mea mālama ola ke mālama i ke kūlana olakino ma lalo e hoʻoulu ai i kāu asynchrony cell.
I nā hihia he nui, hiki i ka cardiac resynchronization therapy (CRT) (i kapa ʻia ʻo CRT a i ʻole biventricular pacemaker) ke kōkua i ka puʻuwai e pamu maikaʻi ma ka kaohi ʻana i ke ʻano o nā ʻaoʻao ʻelua o ka puʻuwai. Eia nō naʻe, hoʻomaikaʻi wale kēia lāʻau i nā hōʻailona ma 50% a 70% o ka poʻe e loaʻa ana i kēia lāʻau. ʻOi aku ka holomua o ka poʻe me ka asynchrony koʻikoʻi .
Nā pilikia o ka mālama ʻana o CRT
Hiki ke loaʻa nā pilikia ma lalo nei i ka wā e hoʻokomo ai i kahi CRT (kahi pacemaker bi-polar) (he mea kākaʻikahi kēia, akā he mea maikaʻi ke makaʻala):
- ʻO ka puʻu koko.
- Ka hōʻiliʻili ʻana o ke koko ma waena o ka paia o ka umauma a me ka māmā (Hemothorax).
- Puʻu puʻuwai.
- Ka hoʻoulu ʻana i nā ʻiʻo ʻē aʻe ma mua o ka puʻuwai.
- Ke neʻe nei nā alakaʻi pacemaker ma waho o ko lākou wahi.
Pehea ka wikiwiki o koʻu ʻoluʻolu ma hope o ka lāʻau lapaʻau?
Hoʻemi koke ka lāʻau lapaʻau CRT i ka asynchrony cell. Hoʻomaka kekahi poʻe e ʻoluʻolu i loko o kekahi mau pule o ke kau ʻia ʻana o ka hāmeʻa. Aia kekahi mau pono lōʻihi:
- Ka hoʻomaikaʻi ʻana i ka nui o ke koko i pamu ʻia e kou puʻuwai (Cardiac Output).
- Hoʻemi ʻia ke kahe ʻana o ke koko mai ka valve mitral.
- Ka hoʻomaikaʻi ʻana i ka maikaʻi o kou ola.
- Hoʻonui ʻia ka mamao hiki iā ʻoe ke hele i loko o ʻeono mau minuke.
He aha ka lāʻau lapaʻau i hoʻohana ʻia?
No nā kūlana e hoʻoulu ai i ka fibrillation atrial, e like me ka puʻuwai puʻuwai, cardiomyopathy, a i ʻole ke koko kiʻekiʻe, hiki i ke kauka ke kuhikuhi i nā lāʻau lapaʻau e like me:
- Nā mea hoʻopale i ka ʻenzyme hoʻololi-Angiotensin (ACE).
- Nā mea pale i ka mea hoʻokipa Angiotensin II (ARBs).
- Nā mea pale beta.
- Nā lāʻau lapaʻau (diuretics).
ʻOiai paha e hoʻomaikaʻi kēia mau lāʻau lapaʻau i ka hana o kou puʻuwai i kekahi ʻano, ʻaʻole hiki iā lākou ke hoʻohuli loa i ka asynchrony i hoʻokumu ʻia e nā hewa o ka hoʻokele uila. ʻO ia ke kumu e pono ai nā lāʻau lapaʻau e like me CRT.
Pehea e hiki ai iā ʻoe ke hōʻemi i ka pilikia o ka asynchrony cell?
ʻO ka mea maikaʻi loa hiki iā ʻoe ke hana, ʻo ia ka mālama pono ʻana i kou puʻuwai. Inā ʻoe e hana pēlā, e hiki iā ʻoe ke pale aku i kekahi o nā kūlana e hoʻoulu ai i ka asynchrony cell.
ʻEkolu mau ala e mālama ai i kou puʻuwai:
- E ʻai i ka papaʻai haʻahaʻa i ka momona paʻa (e hoʻēmi i ka ʻaila a me nā meaʻai palai).
- E hoʻoikaika kino no 30 mau minuke ma ka liʻiliʻi i ka hapa nui o nā lā (maikaʻi ka hele wāwae ʻana).
- Ka mālama ʻana i ke kaumaha olakino nou.
- Ke lawe ʻana i ka lāʻau lapaʻau e like me ke kauoha a ke kauka.
He aha ka mea e hana inā loaʻa iaʻu ka asynchrony cell?
ʻAʻole mālama ʻia ka Left Ventricular Dyssynchrony (LVD), a ʻaʻole maikaʻi ka hopena. ʻOi aku ka nui o ka pilikia o ka poʻe me LVD i nā hanana puʻuwai ma mua o ka poʻe me ka ʻole o ke ʻano. Hiki iā ʻoe ke loaʻa ka dyssynchrony i loko o kekahi (a i ʻole nā mea ʻelua) o kou ventricles, akā ʻo kou ventricle hema ka ʻāpana nui e pamu i ke koko momona oxygen ma kou kino. He hana koʻikoʻi loa kēia.
Hiki i kahi lāʻau i kapa ʻia ʻo CRT (dual-cell pacemaker) ke kōkua i ka poʻe me ka puʻuwai puʻuwai e hōʻemi i ka noho ʻana ma ka haukapila a ola lōʻihi.
E hoʻomanaʻo, ʻo ke kumu nui o ka asynchrony e hoʻopilikia pū i ka hopena. ʻOi aku ka ʻino o ke kūlana o kekahi poʻe ma mua o kekahi.
Pehea wau e mālama ai iaʻu iho?
- Inā ua kuhikuhi kāu kauka i ka lāʻau lapaʻau nāu, e lawe pono e like me ke kuhikuhi ʻana . E lawe i ka lāʻau lapaʻau e like me ke kuhikuhi ʻana a hiki i ka wā e ʻōlelo ai kāu kauka iā ʻoe e hoʻōki.
- Inā he pacemaker biventricular kāu, e hoʻomanaʻo e hele i nā keʻena lapaʻau i nā lā i hoʻonohonoho ʻia . ʻO kēia kahi e hiki ai i kāu kauka ke nānā inā e hana pono ana kāu pacemaker. Loaʻa i kekahi mau haukapila nā keʻena lapaʻau kūikawā i kapa ʻia ʻo CRT clinics. Ma laila, hana pū nā cardiologists a me nā loea puʻuwai e hōʻoia i ka loaʻa ʻana o ka hapa nui o kāu pacemaker.
Āhea wau e ʻike ai i kaʻu kauka?
- Inā ʻaʻole ʻoe e ʻoi aku ka maikaʻi me ka lāʻau lapaʻau i kuhikuhi ʻia.
- Inā he pilikia me kāu pacemaker biventricular.
I kēlā mau hihia, e ʻike koke i ke kauka.
Āhea wau e hele ai i ka Emergency Treatment Unit (ETU) ?
Inā ʻike ʻoe i kekahi o kēia mau hōʻailona , e ʻimi koke i ke kōkua lapaʻau:
- ʻEha a ʻoluʻolu ʻole paha ka umauma.
- Vertigo (manaʻo e like me ʻoe e milo ana).
- Paʻakikī nui ka hanu ʻana.
- ʻEha ka ʻōpū, luaʻi.
- ʻEha ke kua, ka ʻāʻī, a i ʻole ka ʻauwae.
He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka?
Mai poina e nīnau i kēia mau nīnau ke ʻike ʻoe i kāu kauka:
- No ke aha i hoʻomohala ai au i ka asynchrony cell?
- He kūpono anei au no ka lāʻau CRT?
- Aia kekahi mau hui kākoʻo e kōkua ana i nā poʻe me ka maʻi puʻuwai?
He mea maʻamau ke hopohopo iki i ka wā e ʻike ai ʻoe ʻaʻole hana pono kou puʻuwai. Akā, mai hopohopo. Hiki i kāu kauka ke ʻike i ke kumu o kou arrhythmia a koho i ka lāʻau lapaʻau maikaʻi loa nāu. E hahai pono i nā kuhikuhi ma ka ʻōmole lāʻau. ʻO ka lawe ʻana i kāu lāʻau i ka manawa like i kēlā me kēia lā e kōkua iā ʻoe e hoʻomanaʻo e lawe. E kaha i kāu mau lā hoʻonohonoho ma kahi kalena a i ʻole e hoʻonohonoho i kahi hoʻomanaʻo ma kāu kelepona. E kōkua kēia iā ʻoe e pale i ka haʻalele ʻana iā lākou.
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ʻAe, ke lana nei koʻu manaʻo ua ʻike maikaʻi ʻoe i ka "Ventricular Dyssynchrony" a mākou i kamaʻilio ai i kēia lā.
I ka ʻōlelo maʻalahi, he ʻano kēia kahi e kuʻi like ʻole ai nā keʻena haʻahaʻa (nā cell) o ka puʻuwai, ʻaʻole like me kekahi. Hiki i kēia ke hōʻemi i ka pono o ka puʻuwai, a hiki nō hoʻi ke hana i nā hōʻailona e like me ka pōkole o ka hanu a me ka luhi.
- Kōkua nā hoʻokolohua e like me (ECG) a me (Echocardiogram) i ka ʻike ʻana i kēia maʻi.
- Ma ke ʻano he lāʻau lapaʻau, ma waho aʻe o ka mālama ʻana i ka maʻi kumu, he mea nui loa nō hoʻi ka lāʻau pacemaker i kapa ʻia ʻo "Cardiac Resynchronization Therapy (CRT)" .
- ʻO ka mālama ʻana i kou puʻuwai a me ka hahai ʻana i kahi nohona olakino e kōkua nui i ka pale ʻana i ia mau ʻano maʻi.
- Inā loaʻa iā ʻoe kēia mau hōʻailona, mai kānalua e ʻimi i ke kōkua lapaʻau. ʻO ka wikiwiki o ka ʻike ʻia ʻana a me ka mālama ʻia ʻana o ka maʻi, ʻoi aku ka maikaʻi o ka hopena.
E hoʻomanaʻo, ʻo kou puʻuwai kou waiwai makamae loa. ʻO kou kuleana ke mālama iā ia.
ʻO ka maʻi puʻuwai, ka dyssynchrony ventricular, ka tachycardia ventricular, ka hōʻeha puʻuwai, CRT, pacemaker
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