Hoʻoweliweli Cardiogenic

Kū ka haʻalulu Cardiogenic ke hōʻino ʻia ka puʻuwai a hiki ʻole ke hāʻawi i ke koko i nā ʻokena o ke kino.

ʻO nā kumu maʻamau nā kūlana puʻuwai koʻikoʻi. ʻO ka hapa nui o kēia mau mea i ka wā a ma hope paha o ka hōʻeha puʻuwai (myocardial infarction). Loaʻa kēia mau pilikia:

• ʻO kahi ʻāpana nui o ka puʻuwai puʻuwai e neʻe hou ʻole a neʻe iki
• ʻO ka haki hāmama (haki) o ka mākala puʻuwai ma muli o ka hōʻino ʻana mai ka puʻuwai puʻuwai
• ʻO nā mele puʻuwai weliweli, e like me ka tachycardia ventricular, ka fibrillation ventricular, a i ʻole ka tachycardia supraventricular
• Kaomi ma ka puʻuwai ma muli o ke kūkulu ʻana o ka wai a puni ia (tampicade pericardial)
• Haehae a wāwahi paha o nā mākala a i ʻole nā ​​ʻāʻī e kākoʻo i nā kiʻina puʻuwai, ʻo ia hoʻi ka mitral valve
• Haehae a wāwahi paha o ka paia (septum) ma waena o ka ventricle hema a me ka akau (nā keʻena puʻuwai haʻahaʻa)
• Pāloli loa ka puʻuwai puʻuwai (bradycardia) a i ʻole pilikia me ka ʻōnaehana uila o ka puʻuwai (palaka puʻuwai)

Kū ka haʻalulu Cardiogenic ke hiki ʻole i ka puʻuwai ke pauma i ke koko e like me ke kino e pono ai. Hiki ke hana inā ʻaʻole i loaʻa kahi puʻuwai puʻuwai inā kū kekahi o kēia mau pilikia a hāʻule koke kāu hana puʻuwai.

ʻO nā hōʻailona me:

• ʻEhaʻeha a ʻeha paha
• Koma
• Hoemi i ka urination
• Hanu wikiwiki
• Pākuʻi wikiwiki
• ʻO ka hou sweating, ʻili ʻili
• ʻĀlohilohi
• Loaʻa ka makaʻala a me ka hiki ke noʻonoʻo
• Hoʻomaha ʻole, hoʻonāukiuki, huikau
• Pokole o ka hanu
• ʻIli e ʻoluʻolu i ka paʻi ʻana
• ʻO kaʻili o kaʻili pale a me kaʻili blotchy
• Nalu nāwaliwali (hoʻomākaukau)

E hōʻike ʻia kahi hōʻike:

• Ke koko haʻahaʻa (ʻoi aku ka emi ma mua o 90 systolic)
• ʻO ke kaomi koko e hāʻule ma mua o 10 mau kiko ke kū ʻoe ma hope o ka moe ʻana i lalo (orthostatic hypotension)
• Nalu nāwaliwali (hoʻomākaukau)
• ʻO kaʻili anuanu a paʻakikī

No ke kuhi ʻana i ka haʻalulu kolohe, hiki ke kau ʻia kahi catheter (Tube) i loko o ke aʻa o ke akemā (catheterization naʻau ʻākau). Hōʻike paha nā hoʻokolohua ke hoʻi nei ke koko i loko o nā akemāmā a ʻaʻole maikaʻi ka pauma ʻana o ka puʻuwai.

Loaʻa i nā hoʻāʻo:

• ʻO ka catheterization Cardiac
• Pākuʻi x-ray
• Angiography Coronary
• ʻEchocardiogram
• Uila uila
• Nuclear scan o ka naʻau

Hana ʻia kekahi mau noiʻi ʻē aʻe e ʻike i ke kumu o ka hana pono ʻole o ka puʻuwai.

ʻO nā hoʻokolohua lab:

• Ke kinoea koko arterial
• ʻO ke kemika koko (chem-7, chem-20, electrolytes)
• ʻO nā enzymes Cardiac (troponin, CKMB)
• Helu piha koko (CBC)
• ʻO ka hormone stimulate hormone (TSH)

ʻO ka haʻalulu Cardiogenic kahi pilikia olakino. Pono ʻoe e noho i ka haukapila, pinepine i ka Intensive Care Unit (ICU). ʻO ka pahuhopu o ka mālama ʻana e ʻike a mālama i ke kumu o ka haʻalulu e hoʻopakele ai i kou ola.

Pono ʻoe i nā lāʻau e hoʻonui i ke kaomi koko a hoʻomaikaʻi i ka hana o ka puʻuwai, e like me:

• ʻO Dobutamine
• ʻO Dopamine
• Epinephrine
• ʻO Levosimendan
• Milrinone
• Norepinephrine
• ʻO Vasopressin

Hiki ke kōkua i kēia mau lāʻau i ka wā pōkole. ʻAʻole hoʻohana pinepine ʻia lākou no ka manawa lōʻihi.

Ke koʻikoʻi ka hoʻohaunaele o ka puʻuwai (dysrhythmia), pono ʻia kahi lāʻau wikiwiki e hoʻihoʻi i kahi puʻuwai puʻuwai maʻamau. Hoʻopili paha kēia:

• Uila "haʻalulu" therapy (defibrillation a cardioversion)
• Ke kanu nei i kahu mālama wā
• Hāʻawi ʻia nā lāʻau i loko o ke aa (IV)

E loaʻa paha iā ʻoe:

• Lapaʻau ʻeha
• Oxygen
• Nā wai, ke koko, a me nā huahana o ke koko ma o ke aa (IV)

Hiki i nā hana ʻē aʻe no ka haʻalulu ke hoʻopili pū i

• Kāleka Cardiac me ka angioplasty coronary a me ka stenting
• Nānā ka naʻau e alakaʻi i ka lāʻau
• Puʻuwai puʻuwai (coronary artery bypass surgery, puʻuwai pani pani, hema ventricular assist device)
• Intra-aortic balloon counterpulsation (IABP) e kōkua i ka puʻuwai e hana ʻoi aku ka maikaʻi
• Pāʻalāʻau
• Kōkua i ka Ventricular a i ʻole ke kākoʻo mechanical

I ka wā ma mua, ʻo ka nui o ka make mai ka haʻalulu cardiogenic mai 80% a 90%. I nā noi hou aku nei, ua iho kēia helu i 50% a 75%.

Ke mālama ʻole ʻia ka pīhoihoi o ka maʻi kuniō, ʻilihuna loa ka maka.

Komo pū nā pilikia:

• Poino lolo
• Poino hakuʻala
• Poino ke ake

E hele i ka lumi pilikia a kāhea paha i ka helu kūloko kūloko (e like me 911) inā loaʻa iā ʻoe nā ʻōuli o ka hoʻopūʻiwa ʻana i ka naʻau kolo. ʻO ka haʻalulu Cardiogenic kahi pilikia olakino.

Hiki iā ʻoe ke hoʻēmi i ka makaʻu o ka hoʻomohala ʻana i ka haʻalulu kuniogenic e:

• Mālama koke i kāna kumu (e like me ka hōʻeha puʻuwai a i ʻole ka pilikia puʻuwai puʻuwai)
• Kāohi a mālama ʻana i nā kumu pilikia no nā maʻi puʻuwai, e like me ka maʻi kō, ke koko kiʻekiʻe, ke kiʻekiʻe o ke kolesterol a me nā triglycerides, a i ʻole ka hoʻohana paka ʻana.

Pāhaʻi - cardiogenic

• Puʻuwai - ʻāpana ma waena o ka waena

ʻO Felker GM, ʻo Teerlink JR. ʻIke a me ka hoʻokele o ka hōʻeha puʻuwai koʻikoʻi. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 24.

ʻO Hollenberg SM. Hoʻoweliweli Cardiogenic. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 99.