I thinlung bifurcation chu a block em? (Bifurcation Blockage) Hemi chungchang hi han sawi ila!

Vawiin hian mi tam tak tan thil pawimawh tak tak kan sawi dawn a, mahse an hriat chian vak loh pawh a ni mai thei. A chang chuan i rilru a na, thawk harsa i ti em? A nih loh leh i ṭhian pakhatin lung natna chungchang a sawi i hre ngai em? Chutiang hunah chuan harsatna kan hriat zinga pakhat chu thinlung thisen kalna kawng nena inzawm harsatna ‘Bifurcation Blockage’ an tih hi a ni. A awlsam zawngin, hei hi thisen petu vein branch pakhatin thinlung branch a siamna hmuna blockage a ni. Hei hi chipchiar deuhin han thlir ila, kan ti ang em?

He ‘Bifurcation Blockage’ hi eng nge ni?

Okay, tunah chuan he ‘Bifurcation Blockage’ hi eng nge a nih mai mai hi han en ila. Ngaihtuah teh, kan thinlung hi tui pump ang mai a ni. He pump hian hna a thawh chhunzawm theih nan thisen supply reng reng a mamawh a ni. Chu thisen chu thisen kalna kawng bik pakhat Coronary Arteries tih hmangin thinlung ruh lamah a kal a ni. Hêng thisen kalna kawng lian ber berte hi hmun ṭhenkhatah chuan thing lian tak zung chhuak ang maiin hnah te tak teah an inthen a ni. A nih loh leh, kawngpui pahnih a inthen chhuahna kawngpui inkar ang maiin i ngaihtuah thei bawk.

Main artery pakhat chu branch tenau zawka a inthen na hmun chu ‘bifurcation’ an ti a. Chuvangin, he inthenna hi, a dik zawka sawi chuan, ‘Y’ ang chi junction ang chi hmunah a awm a, thau a punkhawm avangin artery chhungah blockage a awm a nih chuan (hei hi ‘plaque’ kan ti a), chu chu ‘bifurcation blockage’ an ti a ni. He ‘plaque’ hi cholesterol, thau, leh calcium atanga siam deposit a ni. Doctor-te chuan heng branch artery te zawkte hi ‘side-branch vessels’ an ti bawk. Hetiang blockage thlentu thau awmte hi ‘bifurcation lesions’ an ti bawk. I hrethiam em? Kawngpui junction-a traffic jam ang mai a ni.

Heng blockage chi hrang hrang hi a awm em?

Ni e, he blockage hi chi hrang hrang pawh a awm thei bawk. Chu chu, doctor-te chuan he natna hi a nasat dan chu thisen kalna kawng (vein) a block nasat dan azirin an rel tihna a ni. Vein a zim chuan damdawi lam hawi chuan ‘Stenosis’ kan ti bawk. ‘Bifurcation Blockage’ hi chi hnih a awm ber a, chungte chu:

• Simple occlusion: Hei hi vein chhung lam diameter 70% aia tlem a block chuan a thleng thin. Chumi awmzia chu thisen kal dan chu eng emaw chen a la tihkhawtlai a, mahse tihkhawtlai engemaw zat a awm thei tihna a ni.
• Complex occlusion: Hetah hian harsatna chu a na zual deuh deuh thin. Vein 70% aia tam, a nih loh leh vein chhung hmun li a\anga hmun thum aia tam chu a block thei a ni. A châng chuan hmun engemaw zatah occlusion pakhat aia tam a awm thei bawk. A nih loh leh thisen zam a tang thei a, a nih loh leh calcium deposit a lo awm thei bawk (hei hi ‘calcification’ kan ti).(say) Vein wall chu a nghet lo thei a, a flexible lo thei bawk. Thil dang pakhat chu, a chang chuan he blockage hi branch vein te tak te chu angle na tak (70 degree aia tam)-a an lakna hmunah a awm thei bawk. Chutiang a lo thlen chuan enkawl a harsa deuh a, a chhan chu damdawi hmanrua hmanga enkawl a harsat vang a ni.

He ‘bifurcation blockage’ hi engtiang chiahin nge a awm?

Hei hi engtiang chiahin nge a awm tih i ngaihtuah mai thei. Dik tak chuan, coronary artery disease (CAD) damdawi lam pan ngai zawng zawng zinga 15% leh 20% inkar, a nih loh leh mi panga zinga pakhat vel chu he ‘bifurcation blockage’ vang niin an chhut. Chuvangin, chutiang chuan a awm lo mai thei a, mahse mi tam tak nghawng thei dinhmun a ni.

Eng thilin nge hei hi a thlen?

Awle, he blockage awm chhan ber chu eng nge ni? Ka sawi tawh ang khan, hei hi a bulpui ber chu kan thisen kalna kawng bang chhunga hriak leh thau, chu chu chu ‘plaque’ , a awm khawm vang a ni. Tui pipe hlui, hun kal zelah a hrual a, bawlhhlawh a khawlkhawm a, pipe chhungah a inkhar ang mai a ni. Hun a kal zel a, he ‘plaque’ hi a lo piang a, thisen kalna kawng chu a ti tawi a ni. Tichuan thinlungin thisen a mamawh zat, chu chu oxygen leh nutrients te hi a luang tha lo hle a ni. He ‘Bifurcation Blockage’ pawh hi coronary artery disease (CAD) category khatah a tel ve bawk .

He natna hi tuin nge vei thei zawk?

Tunah chuan tute nge he natna hi vei tam zawk tih kan en ang a, a nih loh leh a risk factors te hi eng nge ni tih kan en ang. Hengte hi kan fimkhur a pawimawh hle a, a chhan chu thil thenkhat chu kan thunun thei a ni.

A tlangpuiin hmeichhiate hian menopause hnuah CAD leh Bifurcation Blockage an nei tam zawk a, chu chu thla tin period an nei tawh lo tihna a ni a, mipa pawhin kum 45 an tlin hnuah CAD an nei tam zawk bawk.

Chu bakah, risk factor dang engemaw zat a awm bawk:

• Diabetes Mellitus: Zunthlum vei te hian thisen kalna kawngah harsatna an nei tam zawk a, a chhan chu zunthlum hian thisen kalna bang a tichhe thei a ni.
• Overweight or Obesity: Taksa rihna a san chuan thinlung tan a buaithlak a, a thawkrim zual a ngai thin.
• Chhungkaw zingah rilru lam natna: A chang chuan hei hi genetic influence vang pawh a ni thei.
• Thisen sang (Hypertension): Thisen sang tih awmzia chu a tul lova thisen kalna kawng (veins)-ah pressure a awm reng tihna a ni. Hei hian veins a tichhe thei a ni.
• Cholesterol sang: Cholesterol hi plaque siam chhan ber a ni a, a bik takin cholesterol "bad" (LDL) sang lutuk hi a ni.
• Exercise neih loh: 1.1.Taksa hian exercise a tlakchham chuan thau a khawlkhawm tam zawk a, thinlung hriselna pawh a chak lo bawk.
• Ei leh in \ha lo: Oil, sugar leh chi tamna ei tur i ei fo chuan a hlauhawmna a sang hle. Kan ei thin junk food te, fast food te, sugary drinks te, leh fried foods te hi han ngaihtuah teh... Hengte hi i ei chhunzawm zel chuan harsatna a awm thei.
• Meizial zu emaw, zuk leh hmuam hman emaw: Meizial hi thinlung hmelma lian ber pakhat a ni. Zuk leh hmuam chhunga chemical awmte hian thisen kalna kawng a tichhe nghal vek a ni.

Hei hi eng symptoms nge ni?

Bifurcation Blockage pawh hi coronary artery disease (CAD) chi khat a nih avangin a symptoms pawh a inang vek. Mahse, a chang chuan he natna hi chhinchhiahna awm lovin a awm thei bawk. Mahse, a lan chhuah dan tlangpui chu:

• Angina: Hei hi rilru natna emaw, tightness emaw hriatna, constriction tih hriatna a ni. Mi thenkhat chuan a rilruah rit ang maiin an sawi a, a nih loh leh beng chu an hrual ang maiin an sawi bawk. He natna hi exercise lai te, stairs chhoh lai te, thinlunga pressure awm lai te hian a na zual tlangpui.
• Khawsik thawmhnaw: Khawsik leh thawmhnaw i nei nghal mai thei a, a bik takin i rilru natna nen.
• Luak chhuak emaw, lu hah emaw: Ding thei lo ang maia inhriatna, i mit a sen vek.
• Chauhna leh chak lohna: I chau a, engmah ti thei loin i inhria thei. Tûn hmaa hna awlsam tak thawh chu i harsat phah thei bawk.
• Heart palpitations: I thinlung thawk ri hriat theih ang maia inhriatna , emaw, i thinlung thawk chak leh chak zawk, i rilru a na ang maia inhriatna.
• Nausea: Natna nei anga inhriatna, luak chhuak pawh a ni thei.
• Thâwk lak tawi: Thiltih tlem i tih hnuah pawh thawk harsa i ti hle. A châng chuan, mut lai pawhin thawk harsa i nei thei.
• Shoulder emaw arm na: A chang chuan he natna hi rilru atanga intan a, kawr, hmui, kekawrte emaw, kut veilam emaw thlengin a kal thei bawk.

Pawimawh: Heng symptoms pakhat emaw a aia tam emaw i neih chuan taksa natnaah chauh ngai suh. Doctor hmu nghal rawh.

Engtin nge doctor-te hian hei hi an hriat chhuah?

Heng symptoms te hi i neih chuan doctor i hmuh hian test eng emaw zat a kalpui thei a, hei hi ‘bifurcation blockage’ emaw heart condition dang emaw a ni em tih a hriat theih. Chung zinga ṭhenkhat chu:

• Cardiac catheterization leh angiogram hmanga tihchhuah te:Hei hian i kut emaw, i ke emawa thisen kalna kawng (tube) te tak te (catheter) hmanga i thinlung coronary arteries-a kaltir a, chutah chuan dye bik inject a, X-ray image lak a huam a ni. Hei hian arteries-ah blockage a awm em tih leh engzat nge tih chiang takin a hmu thei a ni.
• Coronary computed tomography angiogram (CCTA): Hei hi CT scan bik a ni a, three-dimensional (3D) images hmangin thinlungah thisen a kal dan leh thisen kalna kawng (arteries)-ah blockage a awm leh awm loh enfiah a ni.
• Intravascular optical coherence tomography (IVOCT): Hei hi hmanraw changkang tak a ni. Catheter an dah meuh chuan hmanraw te tak te dang a kal tlang a, thisen kalna kawng chhunga plaque awmte, thisen kalna kawngkhar layer te chu thlalak chiang tak, high-definition-ah hmuh theih a ni.
• Intravascular ultrasound (IVUS): Hei hi ultrasound test a ni bawk a, thisen kalna kawng chhung lam a en thin. IVOCT ang bawkin vein bang dinhmun leh ‘plaque’ awm dan te pawh a chiang thei hle.
• Fractional flow reserve (FFR): Hei hian thisen kalna kawng chhunga pressure danglamna a teh a, a blockage sir lehlamah a teh a ni. A blockage nasat zia dik takin a zirchiang thei a, enkawlna a ngai em tih pawh a hre thei bawk.

Hei hi eng enkawlna nge ni?

‘Bifurcation blockage’ enkawl hi a chang chuan a harsa deuh thei. A chhan chu ka sawi tawh side-branch vessels te hi an te zawk hle a, main artery atanga an branch off na angle pawh a nghawng bawk. Chuvangin thisen kalna kawng bulpui aiin thlen leh enkawl chu a buaithlak deuh thei.

Doctor te hian angioplasty tih hi an ti tlangpui thin . Hei hian thisen kalna kawng (artery) tawi (narrowed artery) chu tihzauh a huam a ni. Tichuan, thisen chu constrict leh lovin a kal zel theih nan wire mesh tube te tak te , stent an tih chu artery chhungah dah a ni. Angioplasty leh stenting pahnih hi percutaneous coronary interventions (PCI) an ti a.

A awlsam zawngin, angioplasty leh stent dah lai hian hetiang hi a thleng thin:

1. Doctor chuan i vunah, i kutphah emaw, i kawrfual emaw-ah cut te tak te a siam a, chuta tang chuan catheter (tube te tak te, flexible tak) chu thisen kalna kawngah a dah lut a.

2. Chumi hnuah he catheter hi uluk takin thisen kaltlangin thinlung chhunga blockage awmna hmunah a hruai a. Hei hi X-ray kaihhruaina hnuaiah tih a ni.

3. Catheter tawp lamah balloon te tak te a awm a. Blocked area a thlen chuan balloon chu a inflated chuan chu vein-a plaque tang chu vein bang-ah a innghat a, vein chu a zau ta hle a ni.

4. Tichuan stent a awm bawk.Pakhat (balloon chungah emaw, a hranpa emaw) chu vein chhungah dahin, balloon chu inflated a ni a, stent chu vein bang-ah an press a. Chumi hnuah balloon chu lakchhuah a ni a, stent chu vein chhungah a hmunah dahin, vein chu a zim leh tawh lo.

Hetianga enkawl zawh hian i doctor chuan thisen tihthianghlimna damdawi chi khat ‘dual antiplatelet therapy’ (Aspirin leh clopidogrel ang chi) chu hun engemaw chen a pe ang che, chu chu stent chhunga thisen zam a lo awm loh nan a ni. He damdawi hi i doctor-in a sawi ang chiah, a hun chhung zawnga ei a pawimawh hle.

'Bifurcation blockage' atana stent hman dan bik.

Coronary artery disease (CAD) enkawlna atan hian stent chi hnih hman a ni a . Pakhat chu bare metal stent a ni. A dang chu drug- eluting stent a ni. He drug-eluting stent hian artery a narrow leh theihna tur (restenosis) a tihziaawm nan hna a thawk a ni.

Bifurcation blockage enkawlna atana stent hman dan tlangpui engemaw zat a awm a:

• Provisional stenting: Hetah hian doctor chuan main artery-ah chauh stent a dah a. Side-branch vessel hi stent dah a ni lo. Mahse, main artery a block a nih chuan, emaw, symptoms i neih chhunzawm chuan, chu artery-ah chuan a hnuah stent dah theih a ni.
• Stent pahnih hmanga tih dan: Blockage complex tak takah emaw, branch vein-a blockage pawh a nasa hle a nih chuan doctor chuan thisen kalna kawng lian ber leh branch vein te zawkah te stent a dah ang. Chumi atan chuan technique hrang hrang a awm a (e.g., Culotte, T-stenting, Crush).

Tunah hian chutiang branch vein te tak te chhunga fit thei tura siam, dedicated side-branch stent -ah clinical trial neih mek a ni.

Enkawlna hian harsatna a thlen thei em?

‘Bifurcation Blockage’ atana angioplasty leh stenting nei tawh thenkhatah chuan harsatna a awm thei a, mahse a zawng zawngah erawh a awm lo. A lian ber pahnih chu:

• In-stent restenosis: Hei hi stent awmna hmunah, stent hnuaiah emaw, a chhungah emaw scar tissue a lo awm a, chu chuan artery a ti tawi leh thin. Hei hi stent dah atanga thla ruk atanga thla sawm leh pahnih chhungin a thleng tlangpui. Chutiang a nih chuan angioplasty emaw, enkawlna dang emaw hmangin artery chu tihzauh leh a ngai dawn a ni. Drug-eluting stent hian he hlauhawmna hi nasa takin a tihziaawm a ni.
• Stent thrombosis: Hei hi stent awmna hmun leh thisen kalna kawng chhunga thisen zam a lo awm hian a ni. Hei hi ‘Thrombosis’ an ti a.Hei hi thil hlauhawm deuh a ni a, a chhan chu he thisen zam hian rang takin thisen kalna kawng chu a tikhawlo vek thei a, heart attack a thlen thei a ni. ‘Dual antiplatelet therapy’ dik taka ei hian he hlauhawmna hi nasa takin a tihziaawm thei a ni.

Hetiang jam hi a veng thei lo em ni?

Hetiang blockage chi hrang hrang ven nan hian kan tih theih tur a awm tak tak em? Ni chiah e! I thinlung venhimna atana heng step te hi zawm hian coronary artery disease (CAD) leh atherosclerosis – thisen kalna chhungah thau a awm khawm a, chu chuan a thick a, a elasticity a hloh thei a ni.

• Thisen sang control: I ei leh in-a chi (salt) tihtlem a pawimawh a, doctor-in a tih angin i damdawi ei a, i thisen sang enfiah fo a pawimawh.
• Zu in tlem: A theih ang anga zu in tlem. Nitin zu in loh tur. Addict i nih chuan tanpuina la rawh.
• Lung hrisel ei rawh: Hei hi cholesterol level tihhniam nan a pawimawh hle. Thau tamna, sugar tamna leh processed foods te chu hlat la , thei, thlai, legumes, fiber tamna ei tur (brown rice, oats, leh lentils ang chi), leh sangha (a bik takin omega-3s tamna sangha salmon leh mackerel ang chi) te ei tam rawh
• I thau te fimkhur rawh: Saturated leh trans fats tamna ei tur (e.g., sa sen, sa processed, baked goods, deep-fried foods) i ei tlem thin. Entirnan, coconut oil hi a tam lutuk chuan i tan a tha lo. Olive oil leh canola oil ang chi hriak hrisel tak tak te chu a tlem berah hmang thin ang che.
• Diabetes control: Zunthlum i vei chuan tha taka control a pawimawh. Ei leh in, exercise leh damdawi ei tur pek te hi a pawimawh hle.
• Meizial zu pumpelh: Meizial i zuk chuan bânsan tûrin ṭanpuina zawng rawh. Meizial zu thinte bula awm (passive smoking) pawh a pawi thei hle.
• Taksa chak takin awm rawh: Ni khatah minute 30 tal, kar khatah ni 5 chhung exercise i tih hian i taksa rihna hrisel tak vawng reng turin a pui thei a, i thinlung a tichak thei bawk. Kea kal, cycle khalh, tui chawi ang chi thil i ti thei.
• Stress tihtlem: Yoga leh meditation ang chi thil hmangin i rilru tih hahdam tum ang che.

‘Bifurcation blockage’ nei mi pakhat hriselna dinhmun chu eng nge ni?

Zirna thenkhatah chuan bifurcation blockage angioplasty leh stenting hmanga enkawl hlawhtlinna chu 40% vel a ni tih an sawi. Mahse, hei hi damlo hrang hrangah a danglam thei a, chu chu blockage awm dan azirin a ni. Chumi awmzia chu mi thenkhat chuan enkawl an nih hnuah pawh lung lam natna an la nei thei tihna a ni. Chuvang chuan thinlung hrisel ei leh in, a tul chuan taksa rihna tihtlem, leh i damdawi pek te ei a, i thinlung venhim chhunzawm zel a pawimawh hle. Doctor nena inbiak reng a, a tul anga test neih tir a pawimawh bawk.

Engtikah nge doctor i hmuh ang?

Chutianga i ngaih chuan nangHeart attack (e.g. rilru natna nasa tak, thawk harsa, thawk hah, luak chhuak) i neih chuan 911 emaw emergency ambulance service hnai ber (e.g. 1990 Suwaseriya) emaw call nghal rawh. Hun khawhral suh!

Tin, heng symptoms te hi i neih reng emaw, lo lang fo emaw i neih chuan doctor pan rawh:

• Chest pain (angina) , kut emaw, ke emaw a na.
• Cold sweats a ni.
• Thâwk harsa.
• Chhan awm lova hah lutuk emaw chak lohna emaw.
• Luak chhuak emaw, thinlung na chak tak hriatna emaw.

Doctor hnenah eng nge ka zawh ang?

Doctor i tlawh dawnin heng zawhnate hi zawh a tha. Hei hian i dinhmun hriatthiamna tha zawk i neih theih nan a pui ang che:

• He 'Bifurcation Blockage' ka siam chhan hi eng nge ni thei ang ?
• Thisen kalna kawng dangah pawh hetiang blockage hi ka nei thei em?
• Eng enkawlna nge ka tan a rawt? Angioplasty leh stenting hian engzat nge he blockage hi a tihchangtlun ang?
• Eng ang stent nge i hman tur? (e.g., damdawi-eluting stent?)
• Stent engzat nge ka mamawh ang?
• Enkawlna hian eng hlauhawmna leh hlawkna nge a neih?
• Enkawl zawhah eng chen nge damdawi ka ei a ngaih?
• Ka thinlung vênhim nân ka nun dânah eng inthlâk danglamna nge ka siam ang?
• Enkawlna hnua harsatna awm thei te chu engte nge ni a, engtin nge ka enkawl ang?

Hemi atanga kan zir theih pawimawh ber (Take-Home Message) .

Bifurcation Blockage hi thinlung chhunga coronary artery inzawmna hmuna blockage a awm a, heart-a thisen kal tur a tikhawlo a ni. A chang chuan enkawl harsa tak ni thei mahse, enkawlna hmasawn tak tak, angioplasty leh stenting te pawh a awm.

Mahse, a pawimawh ber chu he natna hi lo awm lo tura beih hi a ni a, enkawlna pawh nise, nunphung tha tak tak (ei leh in tha, exercise, leh meizuk bânsan) hmanga i thinlung humhim hi a ni. I rilru natna emaw, thawk hah emaw ang chi symptom i neih chuan ngaihthah lova damdawi lam thurawn lak a pawimawh. I thinlung hi i thil neih hlu ber a ni tih hre reng ang che! I enkawl hi i mawhphurhna a ni.

` Lung natna, bifurcation blockage, CAD, angioplasty, stent, rilru natna, thinlung