Okukutuka kw’omutima gwo kuzibiddwa? (Bifurcation Blockage) Ka twogere ku nsonga eno!

Leero tugenda kwogera ku kintu ekikulu eri abantu bangi, naye mpozzi nga tebakimanyi nnyo. Oluusi owulira ng’ekifuba kikunyiga, okukaluubirirwa okussa? Oba wali owuliddeko mukwano gwo ng’ayogera ku bulwadde bw’omutima? Mu biseera ng’ebyo, ekimu ku bizibu bye tuwulira kye kizibu ekikwatagana n’emisuwa gy’omusaayi gy’omutima ekiyitibwa ‘Bifurcation Blockage’. Mu ngeri ennyangu, kino kizibikira ekibaawo mu kifo ettabi ly’omusuwa erigaba omusaayi eri omutima we litabikira amatabi. Kino ka tukitunuulire mu bujjuvu katono, nedda?

Kino ‘Bifurcation Blockage’ kye ki?

Okay, kati ka tulabe 'Bifurcation Blockage' eno ky'eri mu ngeri ennyangu. Teebereza omutima gwaffe gulinga ppampu y’amazzi. Pampu eno okusobola okugenda mu maaso n’okukola, yeetaaga okuweebwa omusaayi buli kiseera. Omusaayi ogwo gutwalibwa mu binywa by'omutima enkola ey'enjawulo ey'emisuwa eyitibwa Coronary Arteries . Emisuwa gino emikulu gyeyawulamu amatabi amatonotono mu bifo ebimu, okufaananako n’amatabi g’omuti omunene agakutuka amatabi. Oba, oyinza okukirowoozaako ng’enkulungo ng’oluguudo lwawukana mu bibiri.

Ekifo omusuwa omukulu we gwawukana ne gufuuka ettabi ettono kiyitibwa ‘bifurcation’ . Kale, singa okugabanya kuno, okubeera okutuufu, kuba ku kifo ng’enkulungo eringa ‘Y’-shaped junction, era okuzibikira kubaawo munda mu musuwa olw’okuzimba amasavu (kino tukiyita ‘plaque’ ), olwo ekyo kiyitibwa ‘bifurcation blockage’ . ‘Ekipande’ kino kibeera kitereke ekikolebwa kolesterol, amasavu, ne kalisiyamu. Abasawo era emisuwa gino emitono egy’amatabi bagiyita ‘side-branch vessels’ . Amasavu agavaako okuzibikira kuno era gayitibwa ‘bifurcation lesions’ . Otegedde? Kino kiringa akalippagano k’ebidduka ku nkulungo ku luguudo.

Waliwo ebika by’ebiziyiza bino?

Yee, okuzibikira kuno era kuyinza okuba okw’ebika eby’enjawulo. Kwe kugamba, abasawo basalawo obuzibu bwa kino okusinziira ku bungi bw’omusuwa bwe guzibiddwa. Omusuwa bwe gufunda, era tuguyita ‘Stenosis’ mu ngeri y’obusawo. Okusinga waliwo ebika bibiri ebya ‘Bifurcation Blockage’:

• Okuzibikira okwangu: Kino kibaawo nga ebitundu ebitakka wansi wa 70% ku dayamita ey’omunda ey’omusuwa ezibiddwa. Kino kitegeeza nti okutambula kw’omusaayi kukyalimu okuziyizibwa, naye wayinza okubaawo ekiziyiza.
• Complex occlusion: Wano ekizibu we kyeyongera katono. Ebitundu ebisukka mu 70% eby’omusuwa, oba ebitundu ebisukka mu bisatu ku bina eby’omunda mu musuwa, bisobola okuzibikira. Oluusi wayinza okubaawo okuzibikira okusukka mu kumu mu bifo ebiwerako. Oba ekizimba ky’omusaayi kiyinza okusibira, oba ebitereke bya kalisiyamu biyinza okuba nga byatondebwawo (kino tukiyita ‘calcification’).(gamba) Ekisenge ky’emisuwa kiyinza okuba nga kikaluba era nga tekikyukakyuka nnyo. Ekirala, oluusi okuzibikira kuno kuyinza okuba mu kifo omusuwa gw’ettabi omutono we gukubiddwa mu nkoona ensongovu ennyo (diguli ezisukka mu 70). Ekyo bwe kibaawo, kiba kizibu katono okujjanjaba, kubanga kizibu okujjanjaba n’ebikozesebwa mu by’obujjanjabi.

‘Bfurcation blockage’ eno ya bulijjo etya?

Oyinza okuba nga weebuuza engeri kino gye kitera okubaawo. Mu butuufu, kiteeberezebwa nti wakati wa 15% ne 20% ku balwadde bonna abakwatibwa obulwadde bw’emisuwa gy’omutima (CAD) abeetaaga okujjanjabibwa, oba nga omu ku buli bataano, bava ku ‘bifurcation blockage’ eno. Kale, wadde nga kiyinza obutaba kya bulijjo bwe kityo, mbeera eyinza okukosa abantu bangi.

Kiki ekivaako kino?

Well, kiki ekikulu ekivaako okuzibikira kuno? Nga bwe nnagambye emabegako, ekikolo ekivaako kino kwe kukuŋŋaanyizibwa kw’amafuta n’amasavu, kwe kugamba, ‘plaque’ eyo , munda mu bisenge by’emisuwa gyaffe. Kiringa payipu y’amazzi enkadde ekiseera bwe kigenda kiyitawo n’efuumuuka n’ekuŋŋaanya obucaafu n’ezibikira mu payipu. Ekiseera bwe kigenda kiyitawo, ‘ekikuta’ kino kizimba ne kifunda omukutu oguli munda mu musuwa. Olwo omuwendo gw’omusaayi omutima gwe gwetaaga, kwe kugamba, omukka gwa oxygen n’ebiriisa, tebitambula bulungi. ‘Bifurcation Blockage’ eno nayo eri mu kiti kye kimu eky’obulwadde bw’emisuwa gy’omutima (CAD) .

Ani asinga okubeera mu bulabe bw’okufuna embeera eno?

Kati ka tulabe ani asinga okulwala embeera eno, oba kiki ekiyinza okuvaako embeera eno. Kikulu nnyo okubeera nga tumanyi bino, kubanga ebintu ebimu tusobola okufuga.

Okutwalira awamu, abakyala batera okufuna CAD ne Bifurcation Blockage oluvannyuma lw’okuggwaamu amaanyi mu nsonga , ekitegeeza nti balekera awo okugenda mu nsonga buli mwezi, ate abasajja batera okufuna CAD oluvannyuma lw’emyaka 45.

Okugatta ku ekyo, waliwo ebintu ebirala ebiwerako ebiyinza okuleeta akabi:

• Ssukaali: Abantu abalina ssukaali batera okufuna obuzibu mu misuwa kubanga ssukaali asobola okwonoona ebisenge by’emisuwa.
• Omugejjo oba Omugejjo: Omubiri bwe gweyongera, kizibuwalira omutima okugukwata era gulina okukola ennyo.
• Ebyafaayo by’amaka eby’obulwadde bw’emisuwa: Oluusi kino kiyinza okuba nga kiva ku buzaale.
• Puleesa (Hypertension): Puleesa kitegeeza nti buli kiseera wabaawo puleesa eteetaagisa ku misuwa. Kino kiyinza okwonoona emisuwa.
• Cholesterol omungi: Cholesterol y’asinga okuvaako okukola obuwuka naddala kolesterol "omubi" (LDL) omungi.
• Obutakola dduyiro:Omubiri bwe guba tegulina dduyiro, gutera okukung’aanya amasavu era obulamu bw’omutima nabwo bunafuwa.
• Endya embi: Singa buli kiseera olya emmere erimu amafuta, ssukaali n’omunnyo, akabi kali mungi. Lowooza ku mmere etali nnungi gye tulya, emmere ey’amangu, ebyokunywa ebirimu ssukaali, n’emmere enkasiike... Singa osigala ng’olya bino, obuzibu buyinza okuvaamu.
• Okunywa sigala oba okukozesa ebintu ebikolebwa mu taaba: Okunywa sigala kye kimu ku balabe b’omutima abakulu. Eddagala eriri mu taaba lyonoona butereevu emisuwa.

Bubonero ki obulaga kino?

Okuva bwe kiri nti Bifurcation Blockage nayo kika kya bulwadde bwa coronary artery disease (CAD) , obubonero bufaanagana. Wabula oluusi embeera eno esobola okubaawo nga tewali bubonero bwonna. Wabula obubonero obusinga okulabika bwe buno:

• Angina: Kino kwe kuwulira obulumi oba okunyiga mu kifuba, okuwulira ng’ozibye. Abantu abamu babyogerako ng’obuzito ku kifuba, oba ng’ekifuba kinyiga. Obulumi buno butera okubeera obubi ng’okola dduyiro, ng’olinnya amadaala oba nga waliwo okunyigirizibwa ku mutima.
• Entuuyo ennyogovu: Oyinza okuwulira obunnyogovu n’okutuuyana mu bwangu naddala ng’olina obulumi mu kifuba.
• Okuziyira oba okuwulira ng’omutwe gukutte: Owulira ng’olinga atasobola kuyimirira, amaaso go gafuuka ga bbululu.
• Obukoowu n’obunafu: Oyinza okuwulira ng’okooye era nga tolina ky’osobola kukola. Ate era oyinza okukisanga nga kizibu okukola emirimu egyali gyangu edda.
• Omutima okukuba: Okuwulira ng’owulira omutima nga gukuba, oba omutima nga gukuba amangu, ng’ekifuba kikuba.
• Okuziyira: Okuwulira ng’oziyira, oboolyawo n’okusesema.
• Okussa obubi: Owulira ng’ossa bulungi ne bw’omala okukola akatono. Oluusi, oyinza okukaluubirirwa okussa ne bw’oba ​​weebase.
• Obulumi mu bibegabega oba omukono: Oluusi obulumi buno buyinza okutandikira mu kifuba ne butambula wansi mu bulago, akawanga, ekibegabega oba omukono ogwa kkono.

Ekikulu: Bw’oba ​​olina obubonero buno bumu oba obusingawo, tomala gakitwala nti bulwadde bwa mubiri. Laba omusawo amangu ago.

Kino abasawo bakizuula batya?

Bw’oba ​​olina obubonero buno, bw’olaba omusawo, ayinza okukola okukeberebwa okuwerako okuzuula oba kino ‘bifurcation blockage’ oba embeera endala ey’omutima. Ebimu ku bino mulimu:

• Okuteekebwamu emisuwa gy’omutima n’okukebera emisuwa:Kino kizingiramu okuyisa akatuli akatono (catheter) okuyita mu musuwa gw’omusaayi mu mukono gwo oba ku kigere kyo okutuuka ku misuwa gy’omutima gwo, n’ogikubamu langi ey’enjawulo, n’okukuba ebifaananyi bya X-ray. Kino kikusobozesa okulaba obulungi oba waliwo okuzibikira kwonna mu misuwa n’obungi.
• Coronary computed tomography angiogram (CCTA): Eno CT scan ey’enjawulo ekozesa ebifaananyi eby’ebitundu bisatu (3D) okulaba engeri omusaayi gye gukulukuta okutuuka ku mutima n’okumanya oba waliwo ebizibikira mu misuwa.
• Intravascular optical coherence tomography (IVOCT): Eno nkola ya mulembe nnyo. Amangu ddala nga ekituli kiyingiziddwa, ekintu ekirala ekigonvu kiyisibwa mu kyo era ebipande ebiterekeddwa munda mu musuwa, layers z’ekisenge ky’omusuwa, bisobola okulabibwa mu bifaananyi ebitegeerekeka obulungi ennyo, ebitegeerekeka obulungi.
• Intravascular ultrasound (IVUS): Kino nakyo kigezo kya ultrasound ekitunula munda mu misuwa. Okufaananako ne IVOCT, esobola okuwa okutunula okulungi ku mbeera y’ebisenge by’emisuwa n’obutonde bwa ‘plaque’.
• Fractional flow reserve (FFR): Kino kipima enjawulo mu puleesa munda mu musuwa, ku buli ludda lw’omusuwa oguzibiddwa. Kisobola okwekenneenya obulungi obunene bw’okuzibikira n’okuzuula oba obujjanjabi bwetaagibwa.

Bujjanjabi ki obukolebwa ku kino?

Okujjanjaba ‘bifurcation blockage’ oluusi kiyinza okusoomoozebwako katono. Kubanga emisuwa egy’amatabi ag’ebbali gye njogeddeko mitono nnyo, era n’enkoona gye gitabikira okuva ku musuwa omukulu nayo ekosebwa. Kale kiyinza okukaluba katono okutuuka n’okujjanjaba okusinga emisuwa emikulu.

Abasawo batera okukola enkola eyitibwa angioplasty . Kino kizingiramu okugaziya omusuwa ogufunda. Oluvannyuma, akatundu akatono akayitibwa stent kayingizibwa mu musuwa okukuuma omusaayi nga gukulukuta nga teguzzeemu kuguziyiza. Okulongoosa emisuwa n’okussa stent byombi biyitibwa enkola y’okuyingira mu mutima (percutaneous coronary interventions - PCI) .

Mu ngeri ennyangu, kino kye kibaawo mu kiseera ky’okulongoosa emisuwa n’okuteeka stent:

1. Omusawo akusala akatundu akatono mu lususu lwo, oba ku mukono oba mu kisambi, n’ayitamu ekituli (ekituli ekigonvu era ekigonvu) n’ayita mu musuwa.

2. Olwo ekituli kino kilungamizibwa n’obwegendereza okuyita mu misuwa okutuuka mu kifo we kyazibikira mu mutima. Kino kikolebwa wansi w’obulagirizi bwa X-ray.

3. Waliwo akapiira akatono ku nkomerero ya catheter. Bwe kituuka mu kifo ekizibiddwa, bbaatule bw’efuumuulwa, ekipande ekikwatiddwa mu musuwa ogwo kinywerera ku bisenge by’omusuwa, era omusuwa ne gugaziwa.

4. Ate waliwo ne stent.Ekimu (oba waggulu wa bbaatule oba nga kyawuddwamu) kiyingizibwa mu musuwa, bbaatule n’efuuwa, era stent n’anyigirizibwa ku bbugwe w’omusuwa. Olwo bbaatule eno eggyibwamu, ne baleka stent mu kifo kyayo munda mu musuwa, ekiziyiza omusuwa okuddamu okufunda.

Oluvannyuma lw’obujjanjabi buno, omusawo ajja kukuwa ekika ky’eddagala erikendeeza omusaayi eriyitibwa ‘dual antiplatelet therapy’ (nga aspirin ne clopidogrel) okumala ekiseera okuziyiza okuzimba omusaayi okutondebwa munda mu stent. Kikulu nnyo okumira eddagala lino ddala nga omusawo bw’akugamba, okumala ebbanga lyonna.

Obukodyo obw’enjawulo obwa stent ku ‘bifurcation blockage’.

Waliwo ebika bya stents bibiri ebikozesebwa okujjanjaba obulwadde bw’emisuwa gy’omutima (CAD) . Ekimu ye stent ey’ekyuma ekitaliiko kintu kyonna. Endala ye stent efulumya eddagala . Stent eno efulumya eddagala ekola okukendeeza ku bulabe bw’emisuwa okuddamu okufunda (restenosis).

Waliwo obukodyo obukulu obuwerako obw’okussaako stent obukozesebwa okujjanjaba ebizibu by’okuzibikira ebitundu bibiri:

• Okussaako stent ey’ekiseera: Mu kino, omusawo ateeka stent mu musuwa omukulu gwokka. Ekibya ky’ettabi ery’ebbali tekiteekebwako stent. Kyokka singa omusuwa omukulu guzibikira, oba bw’osigala ng’olina obubonero, oluvannyuma osobola okuteekebwamu stent mu musuwa ogwo.
• Enkola za stent bbiri: Mu kuzibikira okuzibu ennyo, oba singa okuzibikira mu musuwa gw’amatabi nakyo kiba kinene, omusawo ajja kuteeka stents mu musuwa omukulu n’omusuwa omutono ogw’ettabi. Waliwo obukodyo obw’enjawulo ku kino (e.g., Culotte, T-stenting, Crush).

Mu kiseera kino okugezesebwa mu malwaliro kugenda mu maaso ku stent ezeetongodde ez’amatabi ag’ebbali ezikoleddwa okutuuka mu misuwa egyo emitono egy’amatabi.

Obujjanjabi busobola okuleeta ebizibu?

Ebizibu oluusi bisobola okubaawo mu bantu abamu, naye si bonna, ababadde balongoosebwa emisuwa n’okuteekebwako stent olw’okuziyiza ‘Bifurcation Blockage’ . Ebikulu bibiri bye bino:

• In-stent restenosis: Kino bwe kiba nti enkovu zitondebwa mu kifo we ziteekebwa, wansi oba munda mu stent, ne kireetera omusuwa okuddamu okufunda. Kino kitera okubaawo mu myezi mukaaga ku kkumi n’ebiri nga bamaze okuteekebwako stent. Kino bwe kibaawo, omusuwa gujja kwetaaga okuddamu okugaziwa nga bakozesa okulongoosa emisuwa oba obujjanjabi obulala. Stents ezifulumya eddagala zikendeezezza nnyo ku bulabe buno.
• Stent thrombosis: Kino kibaawo omusaayi bwe gukola mu kifo stent we yateekebwa ne munda mu misuwa. Kino kiyitibwa ‘Thrombosis’.Eno mbeera ya bulabe katono, kubanga omusaayi guno oguzimba guyinza okuzibikira ddala omusuwa mu bwangu ne guvaako omutima okulwala. Okumira ‘dual antiplatelet therapy’ mu butuufu kiyinza okukendeeza ennyo ku bulabe buno.

Jaamu ez’ekika kino teziyinza kuziyizibwa?

Ddala waliwo bye tuyinza okukola okutangira ebizibiti eby’ekika kino? Butereevu! Okugoberera emitendera gino okukuuma omutima gwo kiyinza okukendeeza ku bulabe bw’okulwala obulwadde bw’emisuwa gy’omusaayi (CAD) n’okuzimba emisuwa – embeera ng’amasavu gazimba munda mu misuwa, ekigireetera okugonza n’okufiirwa obugumu bwagyo.

• Fuga puleesa: Kikulu okukendeeza ku munnyo mu mmere gy’olya, okumira eddagala ng’omusawo bw’akulagidde, n’okukeberebwa puleesa buli kiseera.
• Ekkomo ku kunywa omwenge: Kendeeza ku mwenge nga bwe kisoboka. Weewale okunywa omwenge buli lunaku. Bw’oba ​​olina omuze, funa obuyambi.
• Lya emmere eyamba omutima: Kino kikulu nnyo okukendeeza ku kolesterol. Weewale emmere erimu amasavu amangi, ssukaali omungi, n’emmere erongooseddwa, era olye ebibala, enva endiirwa, ebinyeebwa, emmere erimu ebiwuziwuzi (nga omuceere ogwa kitaka, oats, n’entangawuuzi), n’ebyennyanja (naddala ebyennyanja ebirimu omega-3s nga salmon ne mackerel) .
• Weegendereze amasavu go: Kendeeza ku mmere gy’olya erimu amasavu amangi n’amasavu aga trans (e.g., ennyama emmyufu, ennyama erongooseddwa, ebifumbibwa, emmere efumbiddwa mu buziba). Okugeza amafuta ga muwogo si malungi gy’oli ng’osusse. Kozesa amafuta amalungi nga olive oil ne canola oil mu kigero.
• Okufuga obulwadde bwa sukaali: Bw’oba ​​olina obulwadde bwa sukaali, kyetaagisa okubufuga obulungi. Endya, dduyiro, n’okumira eddagala eriwandiikiddwa kikulu.
• Weewale okunywa ssigala: Bw’oba ​​onywa ssigala, noonya obuyambi okulekera awo. Okubeera n’abantu abanywa sigala (passive smoking) nakyo kiyinza okuba eky’obulabe.
• Beera omubiri: Okukola dduyiro okumala eddakiika ezitakka wansi wa 30 olunaku, ennaku 5 mu wiiki, kiyinza okuyamba okukuuma omugejjo omulamu n’okunyweza omutima gwo. Osobola okukola ebintu ng’okutambula, obugaali oba okuwuga.
• Kendeeza ku situleesi: Fuba okuwummuza ebirowoozo byo ng’oyita mu bintu nga yoga n’okufumiitiriza.

Embeera y’obulamu bw’omuntu alina ‘bifurcation blockage’ eri etya?

Okunoonyereza okumu kulaga nti obuwanguzi bw’okujjanjaba okuzibikira kw’ebitundu bibiri (bifurcation blockage) n’okulongoosa emisuwa (angioplasty) n’okussaako stent (stenting) buli nga 40%. Wabula kino kiyinza okwawukana okusinziira ku mulwadde okusinziira ku ngeri y’okuzibikira. Kino kitegeeza nti abantu abamu bayinza okuba nga bakyalina obubonero bw’omutima oluvannyuma lw’okujjanjabwa. N’olwekyo, kikulu nnyo okugenda mu maaso n’okukuuma omutima gwo ng’olya emmere eyamba omutima, okugejja bwe kiba kyetaagisa, n’okumira eddagala lye yakulagidde. Era kikulu okukwatagana n’omusawo buli kiseera n’okukeberebwa okwetaagisa.

Ddi lw’osaanidde okulaba omusawo?

Bw’oba ​​olowooza bw’otyo, ggweBw’oba ​​olina obulwadde bw’omutima (e.g. okulumwa ennyo mu kifuba, okukaluubirirwa okussa, okutuuyana, okusesema), kuba 911 oba empeereza ya ambyulensi ey’amangu ekuli okumpi (e.g. 1990 Suwaseriya) mu bwangu. Tomala biseera!

Okugatta ku ekyo, laba omusawo bw’oba ​​olina obubonero buno obuwangaala oba obutera okulabika:

• Obulumi mu kifuba (angina) , okulumwa omukono oba ebibegabega.
• Entuuyo ennyogovu.
• Okukaluubirirwa okussa.
• Obukoowu obuyitiridde oba obunafu awatali nsonga.
• Okuziyira oba okuwulira ng’omutima gukuba mangu.

Kiki kye nsaana okubuuza omusawo?

Kirungi okubuuza ebibuuzo bino ng’ogenda ew’omusawo. Kino kijja kukuyamba okutegeera obulungi embeera yo:

• Kiki ekiyinza okuba ensonga lwaki nakola 'Bifurcation Blockage' eno ?
• Ndi mu bulabe bw’okuzibikira emisuwa emirala egy’engeri eno?
• Bujjanjabi ki obunteesebwako? Okulongoosa emisuwa n’okussa stent bijja kulongoosa kitya okuzibikira kuno?
• Stent ya kika ki gy’ogamba? (e.g., stent efulumya eddagala?)
• Stents mmeka ze nja okwetaaga?
• Obulabe n’emigaso ki ebiri mu bujjanjabi buno?
• Nze nneetaaga okumira eddagala okumala bbanga ki nga mmaze okujjanjabibwa?
• Nkyukakyuka ki ze nsaanidde okukola mu bulamu bwange okusobola okukuuma omutima gwange?
• Bizibu ki ebiyinza okuvaamu oluvannyuma lw’okujjanjabwa, era nsaanidde kubirabirira ntya?

Ekintu ekisinga obukulu kye tuyinza okuyigira ku kino (Take-Home Message)

Bifurcation Blockage kwe kuzibikira okubaawo ku nkulungo y’omusuwa gw’omusaayi mu mutima, ne kiziyiza omusaayi okutambula okutuuka ku mutima. Wadde oluusi kiyinza okuba ekizibu okujjanjaba, waliwo obujjanjabi obw’omulembe nga okulongoosa emisuwa n’okussa stent.

Wabula ekisinga obukulu kwe kugezaako okuziyiza embeera eno okubaawo era ne bw’ofuna obujjanjabi, okukuuma omutima gwo ng’okola enkyukakyuka ennungi mu bulamu (endya ennungi, dduyiro, n’okulekera awo okunywa sigala). Bw’oba ​​olina obubonero ng’okulumwa mu kifuba oba okussa obubi, kikulu okugenda ew’abasawo nga tobubuusa maaso. Jjukira nti omutima gwo kye kintu kyo ekisinga okuba eky’omuwendo! Buvunaanyizibwa bwo okubulabirira.

` Obulwadde bw’omutima, okuzibikira mu bitundu bibiri, CAD, angioplasty, stent, obulumi mu kifuba, omutima