Angina paʻa ʻole

ʻO ka angina kūpaʻa kahi kūlana kahi i lawa ʻole ai ka puʻuwai a me ka oxygen i kou puʻuwai. Hiki iā ia ke alakaʻi i kahi puʻuwai puʻuwai.

ʻO Angina kahi ʻano o ka hōʻoluʻolu o ka umauma i hoʻokumu ʻia e ke kahe koko maikaʻi ma o nā kīʻaha koko (coronary vessel) o ka puʻuwai puʻuwai (myocardium).

ʻO ka maʻi o ke aʻa coronary ma muli o ka atherosclerosis ke kumu maʻamau o ka angina paʻa ʻole. ʻO Atherosclerosis ka kūkulu ʻana o nā mea momona, i kapa ʻia he pāka, ma nā paia o nā aʻa. Kuhi kēia i nā aʻa e lilo i mea liʻiliʻi a liʻiliʻi hoʻi. Hiki i ka hoʻopili ʻana ke hōʻemi i ke kahe o ke koko i ka puʻuwai, e ʻeha ai ka umauma.

ʻO ka poʻe me ka angina kūpaʻa ka nui o ka makaʻu o ka puʻuwai.

ʻO nā kumu maʻamau o ka angina:

• ʻO ka hana maʻamau o nā aʻa lālā liʻiliʻi me ka liʻiliʻi ʻole o nā aʻa ʻoi aku ka nui (i kapa ʻia ʻo microvascular dysfunction a i ʻole Syndrome X)
• Spasm artery spasm

ʻO nā kumu pilikia no ka maʻi o ke aʻa coronary:

• Diabetes
• ʻO ka moʻolelo ʻohana o ka maʻi puʻuwai coronary mua (kahi hoahānau e like me ke kaikaina a makua paha i loaʻa i ka maʻi puʻuwai ma mua o ka makahiki 55 i ke kāne a i ʻole ma mua o 65 mau makahiki i kahi wahine)
• Piʻi koko kiʻekiʻe
• Kolesterol kiʻekiʻe LDL
• Kolesterol HDL haʻahaʻa
• Moekolohe kāne
• Nohona sedentary (ʻaʻole loaʻa lawa o ka hoʻoikaika kino)
• Ka momona
• Makahiki
• Puhipaka

Pākuʻi ʻia paha nā ʻōuli o angina:

• ʻO ka ʻeha o ka umauma āu e ʻike ai i ka poʻohiwi, ka lima, ka ʻāʻī, ʻāʻī, kua, a i ʻole nā ​​wahi ʻē aʻe
• Hōʻoluʻolu ʻole e like me ka ʻūikiʻi, kaomi ʻana, ka ʻūlū ʻana, ke puhi ʻana, a me ke ʻeha ʻana
• Hōʻoluʻolu ʻole i ka hoʻomaha a ʻaʻole hele maʻalahi ke lawe ʻoe i ka lāʻau
• Pokole o ka hanu
• Hoʻoulu

Me ka angina paʻa, ʻeha wale ka umauma a i ʻole nā ​​ʻōuli ʻē aʻe me kahi nui o ka hana a i ʻole ke koʻikoʻi. ʻAʻole pinepine ka ʻeha a hele a ʻoi aku ka maikaʻi ma mua o ka manawa.

ʻO ka angina paʻa ʻole ka ʻeha o ka umauma i hiki wawe a hele pinepine i loko o kahi manawa pōkole. Ke hoʻomohala nei ʻoe i angina kūpaʻa ʻole inā ʻeha ka umauma.

• Hoʻomaka e ʻano ʻokoʻa, ʻoi aku ke koʻikoʻi, hele pinepine mai, a i ʻole hanana me ka liʻiliʻi o ka hana a ʻoiai ʻoe e hoʻomaha ana
• Lōʻihi ma mua o 15 a 20 mau minuke
• Hana kumu ʻole ʻia (ʻo kahi laʻana, ʻoiai ʻoe e hiamoe ana a noho mālie paha)
• ʻAʻole pane maikaʻi i kahi lāʻau i kapa ʻia ʻo nitroglycerin (ʻoi loa inā hana kēia lāʻau e hōʻoluʻolu i ka ʻeha o ka umauma i ka wā i hala)
• Hana ʻia me ke kulu o ke kaomi koko a i ʻole ka liʻiliʻi o ka hanu

ʻO ka angina kūpaʻa kahi hōʻailona hōʻailona e hiki koke mai kahi puʻuwai puʻuwai a pono e mālama koke. E ʻike i kāu mea mālama ola inā loaʻa iā ʻoe kahi ʻeha o ka umauma.

E hana ka mea hāʻawi i kahi hoʻokolohua kino a nānā i kou kaomi koko. Lohe paha ka mea hāʻawi i nā leo kūpono ʻole, e like me ka ʻōhumu o ka puʻuwai a i ʻole ka puʻuwai puʻuwai ʻole, ke hoʻolohe nei i kāu umauma me kahi stethoscope.

ʻO nā hoʻāʻo no angina me:

• Hōʻike nā hōʻike koko inā loaʻa iā ʻoe ka hōʻino o ka puʻuwai a i ʻole makaʻu nui i ka hōʻeha puʻuwai, e like me troponin I a me T-00745, creatine phosphokinase (CPK), a me myoglobin.
• ECG.
• ʻ .lelo Echocardiography.
• Nā hoʻāʻo koʻikoʻi, e like me ka hoʻowalewale hoʻowalewale hoʻāʻo (hoʻāʻo koʻikoʻi a hoʻāʻo treadmill), hoʻāʻo koʻikoʻi nukelea, a i ʻole stress echocardiogram.
• Angiography Coronary. Pili kēia hōʻike i ke kiʻi ʻana i nā kiʻi o nā puʻuwai puʻuwai e hoʻohana ana i nā kukuna x a me ke kala. ʻO ia kahi hōʻike pololei loa e kuhikuhi ai i ka hoʻopili ʻana o ke aʻa puʻuwai a loaʻa i nā clots.

Pono ʻoe e nānā i ka haukapila e hoʻomaha ai, e loaʻa hou ai nā hoʻokolohua, a pale i nā pilikia.

Hoʻohana ʻia nā mea hōʻemi koko (nā lāʻau antiplatelet) e mālama a pale i ka angina kūpaʻa ʻole. E loaʻa iā ʻoe kēia mau lāʻau i ka wā hiki ke hiki ke lawe iā lākou me ka palekana. Hoʻopili nā lāʻau i ka aspirin a me ka lāʻau lapaʻau i kapa ʻia ʻo clopidogrel a i ʻole kekahi mea like (ticagrelor, prasugrel). Hiki paha i kēia mau lāʻau ke hōʻemi i ka manawa o ka puʻuwai a i ʻole ke koʻikoʻi o ka puʻuwai e kū.

Ma kahi hanana angina kūpaʻa ʻole:

• Hiki iā ʻoe ke loaʻa heparin (a i ʻole ka lahilahi o ke koko) a me nitroglycerin (ma lalo o ke alelo a i ʻole ma o ka IV).
• Hiki i nā ʻano lāʻau ʻē aʻe ke hoʻopili i nā lāʻau e kāohi ai i ke kahe o ke koko, ka hopohopo, nā puʻuwai puʻuwai ʻino, a me ka cholesterol (e like me ka lāʻau statin).

ʻO ke kaʻina hana i kapa ʻia angioplasty a me ka stenting hiki ke hana pinepine ʻia e wehe i kahi aʻa a i ʻole ke ākea o ke aʻa.

• ʻO Angioplasty kahi hana e wehe ai i nā kīʻaha koko ākea a i ʻole nā ​​poloka e hāʻawi i ke koko i ka puʻuwai.
• ʻO kahi stent artery corentary kahi liʻiliʻi, mesh Tube Tube e wehe ana (hoʻonui) i loko o ke aʻa coronary. Hoʻokomo pinepine ʻia kahi stent ma hope o ka angioplasty. Kōkua ia i ka pale ʻana i ke aʻa o ke pani hou ʻana. Loaʻa kahi lāʻau i loko o laila i lāʻau lapaʻau e kōkua ai i ka pale ʻana i ke aʻa mai ka pani ʻana o ka manawa.

Hiki ke hana i ke kīpoki bypass naʻau no kekahi poʻe. ʻO ka hoʻoholo e hana i kēia ʻoki kaukaʻi:

• ʻO nā aʻa hea i ālai ʻia
• Ehia mau aʻa i pili
• ʻO nā ʻāpana o nā ʻāpana coronary i hoʻopili ʻia
• Pehea ke koʻikoʻi o nā hāiki

ʻO ka angina kūpaʻa kahi hōʻailona o nā maʻi puʻuwai ʻoi loa.

Maikaʻi kāu hilinaʻi ʻana i nā mea like ʻole, e like me:

• Ehia a ʻo nā aʻa hea i loko o kou puʻuwai i ālai ʻia, a pehea ka nui o ka paʻa ʻana
• Inā ua loaʻa ʻoe i kahi puʻuwai puʻuwai
• Pehea ka maikaʻi o kou puʻuwai puʻuwai e hiki ke pauma i ke koko i kou kino

Hiki i nā puʻuwai maʻamau a me nā puʻuwai puʻuwai ke kumu o ka make koke.

Hiki i ka angina kūpaʻa ke alakaʻi i:

• Rhythm puʻuwai maʻamau (arrhythmia)
• He puʻuwai puʻuwai
• Hewa puʻuwai

E ʻimi i ka lāʻau inā loaʻa iā ʻoe ka ʻeha o ka umauma hou a wehewehe ʻole ʻia. Inā loaʻa iā angina ma mua, e kāhea i kāu mea hāʻawi.

Kāhea iā 911 a i ʻole ka helu pilikia kūloko inā ʻeha kou angina:

• ʻAʻole ʻoi aku ka maikaʻi ma mua o 5 mau minuke ma hope o kou lawe ʻana i nitroglycerin (e haʻi paha kāu mea hāʻawi iā ʻoe e lawe i nā huina piha he 3)
• ʻAʻole hele aku ma hope o 3 mau kaha o nitroglycerin
• Ke hele nei a ʻino
• Hoʻi ma hope o ke kōkua o ka nitroglycerin i ka mua

Kāhea i kāu mea hāʻawi inā:

• Ke loaʻa pinepine nei ʻoe i nā hōʻailona angina
• Ke loaʻa nei ʻoe i ka angina ke noho ʻoe (hoʻomaha angina)
• Luhi pinepine ʻoe
• Ke maʻule a maʻaleʻale paha ʻoe, a i ʻole hele i waho
• Ke kuʻi nei kou puʻuwai me ka lohi (ma lalo o 60 mau kuʻi i hoʻokahi minuke) a i ʻole wikiwiki loa (ʻoi aku ma mua o 120 mau kuʻi i hoʻokahi minuke), a i ʻole ʻaʻole paʻa
• Ke pilikia nei ʻoe i ka lawe ʻana i nā lāʻau o kou puʻuwai
• Loaʻa iā ʻoe nā hōʻailona ʻokoʻa ʻē aʻe

Inā manaʻo ʻoe he kuʻi puʻuwai kou, e kiʻi koke i ka lāʻau lapaʻau.

Ua hōʻike ʻia kekahi mau noiʻi ʻana i ka hana ʻana i kekahi mau loli nohona hiki ke pale aku i nā palaka mai ka ʻino a hoʻomaikaʻi maoli paha iā lākou. Hiki i nā loli nohona ke kōkua i ka pale ʻana i kekahi mau hōʻeha angina. E haʻi paha kāu mea hāʻawi iā ʻoe e:

• Lilo i ke kaupaona inā ʻoi nui ʻoe
• Uoki ka puhipaka
• Hoʻomaʻamaʻa pinepine
• Inu ʻalekika i ke kaulike wale nō
• ʻAi i kahi papaʻai olakino i kiʻekiʻe i nā mea kanu, nā huaʻai, nā kīʻaha holoʻokoʻa, nā iʻa, a me nāʻiʻo momona

E paipai pū kāu mea lawelawe iā ʻoe e mālama i nā kūlana olakino ʻē aʻe e like me ke kiʻekiʻe o ke koko, diabetes, a me nā kiʻekiʻe o ke kolesterol i lalo o ka kaohi.

Inā loaʻa iā ʻoe hoʻokahi a ʻoi paha mau mea pilikia no ka maʻi puʻuwai, e kamaʻilio me kāu mea hoʻolako e pili ana i ka lawe ʻana i ka aspirin a i ʻole nā ​​lāʻau ʻē aʻe e pale ai i ka hōʻeha puʻuwai. Hiki ke kōkua iā Aspirin therapy (75 a 325 mg i ka lā) a i ʻole nā ​​lāʻau e like me clopidogrel, ticagrelor a i ʻole prasugrel ke pale aku i ka hōʻeha puʻuwai i kekahi poʻe. Paipai ʻia ʻo ʻAspirin a me nā lāʻau hoʻomāliʻi koko ʻē aʻe inā ʻoi aku ka maikaʻi ma mua o ka hopena o nā hopena ʻaoʻao.

Hoʻoholomua i ka angina; Angina hoʻomaka hou; Angina - kūpaʻa ʻole; Angina holomua; CAD - angina paʻa ʻole; Maʻi maʻi ʻaʻai Coronary - stable angina; Maʻi maʻi puʻuwai - angina paʻa ʻole; ʻEha o ka umauma - angina paʻa ʻole

• Angina - hoʻokuʻu
• Angina - he aha e nīnau aku ai i kāu kauka
• Angina - ke loaʻa iā ʻoe ka ʻeha o ka umauma
• Angioplasty a me stent - puʻuwai - hoʻokuʻu
• Puʻuwai puʻuwai - hoʻokuʻu
• Ka hōʻeha puʻuwai - he aha e nīnau aku ai i kāu kauka

• Angina
• Coronary artery balloon angioplasty - moʻo

Amsterdam EA, Wenger NK, Brindis RG, a me al. 2014 AHA / ACC alakaʻi no ka mālama ʻana i nā mea maʻi me ka ʻole ST-kiʻekiʻe kiʻekiʻe syndromes coronary: kahi hōʻike o ka American College of Cardiology / American Heart Association Task Force ma nā Kumu Alakaʻi. [Puka ʻia ka hoʻoponopono i paʻi ʻia ma ʻO J Am Coll Cardiol. 2014; 64 (24): 2713-2714. Hewa o ka hana ma ka ʻōlelo ʻatikala]. ʻO J Am Coll Cardiol. 2014; 64 (24): e139-e228. PMID: 25260718 pubmed.ncbi.nlm.nih.gov/25260718/.

Arnett DK, Blumenthal RS, Albert MA, et al. ʻO 2019 ACC / AHA Kuhi e pili ana i ka pale mua ʻana i ka maʻi maʻi ʻōpū: kahi hōʻike o ke Kulanui ʻAmelika o Cardiology / ʻAmelika ʻAmelika Hui Pū ʻIa Hana Hana e pili ana i nā ʻōkuhi Clinical. [paʻi ʻia ka hoʻopololei ma Kaapuni. 2019; 140 (11): e649-e650] [hoʻopuka ʻia ka hoʻoponopono ʻana i Kaapuni. 2020; 141 (4): e60] [hoʻopuka ʻia ka hoʻoponopono ʻana i Kaapuni. 2020; 141 (16): e774]. Kaapuni. 2019 2019; 140 (11): e596-e646. PMID: 30879355. pubmed.ncbi.nlm.nih.gov/30879355/.

ʻO MP MPaca. ʻO Sabatine MS. Ke hoʻokokoke ʻana i ka mea maʻi me ka ʻeha o ka umauma. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: kahi puke o ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 56.

Giugliano RP, Braunwald E. Non-ST kiʻekiʻe a me nā syndrome coronary. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: kahi puke o ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 60.

Ibanez B, James S, Agewall S, et al. Nā Kūkākūkā ESC 2017 no ka mālama ʻana i ka infarction myocardial koʻikoʻi i nā mea maʻi e hōʻike ana me kahi kiʻekiʻe ST-ʻāpana: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-segment Elevation of the European Society of Cardiology (ESC). ʻO Eur Heart J. 2018; 39 (2): 119-177. PMID: 28886621 pubmed.ncbi.nlm.nih.gov/28886621/.

Jang J-S, Spertus JA, Arnold SV, et al. Ka hopena o ka revascularization multivessel ma nā hopena kūlana olakino i nā mea maʻi me ka infarction myocardial kiʻekiʻe ST-ʻāpana a me ka maʻi coronary artery multivessel. ʻO J Am Coll Cardiol. 2015; 66 (19): 2104-2113. PMID: 26541921 pubmed.ncbi.nlm.nih.gov/26541921/.

Lange RA, Mukherjee D. Acute coronary syndrome: angina paʻa ʻole a me ka ST ʻole myocardial infarction kiʻekiʻe. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 63.