ʻO Arrhythmias

ʻO kahi arrhythmia kahi maʻi o ka puʻuwai (pulse) a i ʻole ka puʻuwai puʻuwai. Hiki i ka puʻuwai ke paʻi wikiwiki (tachycardia), lohi loa (bradycardia), a i ʻole kūleʻa.

Hiki ke hōʻeha ʻole kahi arrhythmia, kahi hōʻailona o nā pilikia puʻuwai ʻē aʻe, a i ʻole kahi weliweli koke i kou olakino.

ʻO ka maʻamau, hana kou puʻuwai ma ke ʻano he pauma e lawe i ke koko i nā ake māmā a me ke koena o ke kino.

I mea e kō ai i kēia, loaʻa i kou puʻuwai kahi ʻōnaehana uila e hōʻoia i ka ʻaelike (kaomi) ʻana ma ke ʻano kaʻina.

• Hoʻomaka ka impulse uila e hōʻailona i kou puʻuwai e hana i kahi ʻāpana o ka puʻuwai i kapa ʻia ʻo node sinoatrial (i kapa ʻia hoʻi ʻo sinus sinus a i ʻole SA node). ʻO kēia ka pacemaker maoli o kou puʻuwai.
• Haʻalele ka hōʻailona i ka piko SA a hele ma waena o ka puʻuwai ma ke ala uila i hoʻonohonoho ʻia.
• Hōʻailona nā leka nerve ʻokoʻa i kou puʻuwai e paʻi lohi a wikiwiki paha.

Hoʻokumu ʻia nā arrhythmias e nā pilikia me ka ʻōnaehana hoʻoliʻiliʻi uila o ka puʻuwai.

• Kū paha nā hōʻailona maʻamau (keu).
• Pākuʻi ʻia a hoʻolohi ʻia paha nā hōʻailona uila.
• Hele nā ​​hōʻailona uila i nā ala hou a i ʻole ʻokoʻa ma o ka puʻuwai.

ʻO kekahi mau kumu maʻamau o nā puʻuwai maʻamau he:

• Nā pae kūpono ʻole o ka potassium a i ʻole nā ​​mea ʻē aʻe i ke kino
• ʻO ka puʻuwai puʻuwai, a i ʻole kahi puʻuwai puʻuwai i hōʻino ʻia mai kahi puʻuwai i hala
• Nā maʻi puʻuwai e kū nei i ka wā hānau (congenital)
• Hewa ʻole ka puʻuwai a i ʻole he puʻuwai hoʻonui
• Kelepona thyroid overactive

Hoʻokumu pū ʻia paha nā arrhythmias e kekahi mau mea a lāʻau paha, e like me:

• ʻAlekohola a lāʻau stimulant paha
• Nā lāʻau lapaʻau kekahi
• Puhi paka (nikotine)

ʻO kekahi o nā mele puʻuwai maʻamau maʻamau ʻole:

• Aibrial fibrillation a i ʻole flutter
• ʻO Atrioventricular nodal reentry tachycardia (AVNRT)
• Paukū naʻau a palaka atrioventricular
• Tachycardia atrial multifocal
• ʻO ka tachycardia supraventricular Paroxysmal
• Maʻi maʻi sinus
• Ventricular fibrillation a i ʻole ventricular tachycardia
• Wolff-Parkinson-White maʻi maʻi

Ke loaʻa ʻoe i kahi arrhythmia, kou puʻuwai puʻuwai paha:

• Lohi loa (bradycardia)
• Wikiwiki (tachycardia)
• Hewa ʻole, pāewaewa, malia me keu keu a i ʻole ka hemo ʻana

Aia paha kahi arrhythmia i nā manawa āpau a i ʻole hiki mai a hele paha. ʻAʻole paha ʻoe e ʻike i nā ʻōuli ke loaʻa ka arrhythmia. A i ʻole, ʻike paha ʻoe i nā ʻōuli ke hana nui ʻoe.

Hiki ke hōʻoluʻolu loa nā ʻōuli, a i ʻole kaumaha a i ʻole hoʻoweliweli i ke ola.

ʻO nā ʻōuli maʻamau e hiki ke hana ʻia inā loaʻa ka arrhythmia i hiki ke hoʻopili ʻia:

• ʻEha ʻeha
• Mauleʻa
• ʻĀlohilohi, ʻōpuu
• Maʻaleʻa
• Palpitations (ke kuʻi wikiwiki nei kou puʻuwai a i ʻole kūlike ʻole)
• Pokole o ka hanu
• Hoʻoulu

E hoʻolohe ka mea mālama ola i kou puʻuwai me kahi stethoscope a manaʻo i kou pulsa. Hiki ke haʻahaʻa a maʻamau paha kou kaomi koko a i ʻole ke kiʻekiʻe ma muli o ka hōʻoluʻolu ʻole.

ʻO kahi ECG ka hōʻike mua i hana ʻia.

Hoʻohana pinepine ʻia nā mea loiloi puʻuwai e ʻike i ka pilikia o ka ritme, e like me a:

• Holter monitor (kahi e komo ai ʻoe i kahi hāmeʻa e hoʻopaʻa a mālama i kāu mele naʻau no 24 a ʻoi paha mau hola)
• Mea nānā hanana a mea hoʻopaʻa moʻoho paha (i hoʻopaʻa ʻia no 2 mau pule a ʻoi aku paha, kahi e hoʻopaʻa ai i kou puʻuwai puʻuwai ke ʻike ʻoe i kahi mele maʻamau)
• Nā koho koho manawa lōʻihi ʻē aʻe

Kauoha ʻia kahi echocardiogram i kekahi manawa e nānā i ka nui a i ʻole ka hanana o kou puʻuwai.

I nā hihia i koho ʻia, hana ʻia paha ka angiography coronary e ʻike ai i ke kahe ʻana o ke koko ma o nā aʻa i loko o kou puʻuwai.

ʻO kahi hoʻokolohua kūikawā, i kapa ʻia kahi noiʻi electrophysiology (EPS), hana ʻia i kekahi manawa e nānā pono i ka ʻōnaehana uila o ka puʻuwai.

Ke koʻikoʻi ka arrhythmia, pono ʻoe i kahi lāʻau wikiwiki e hoʻihoʻi i kahi mele maʻamau. Hoʻopili paha kēia:

• Uila uila (defibrillation a cardioversion)
• Ke kanu nei i kahi mea kanu puʻuwai manawa pokole
• Hāʻawi ʻia nā lāʻau i loko o ka aa a i ʻole ka waha

I kekahi manawa, ʻo ka hoʻomaʻamaʻa maikaʻi ʻana no kāu angina a i ʻole ʻole ka puʻuwai e hoʻohaʻahaʻa ai i kou manawa e loaʻa ai kahi arrhythmia.

ʻO nā lāʻau i kapa ʻia he lāʻau anti-arrhythmic:

• E pale i ka arrhythmia mai ka hana hou ʻana
• E mālama i ka helu o kou puʻuwai mai ka wikiwiki a lohi paha

Hiki i kekahi o kēia mau lāʻau ke loaʻa nā hopena. Lawe iā lākou e like me ke kauoha a kāu mea hāʻawi. Mai hōʻoki i ka lawe ʻana i ka lāʻau a hoʻololi paha i ka lāʻau me ka ʻole e kamaʻilio mua i kāu mea hāʻawi.

Nā mālama ʻē aʻe e pale a mālama ʻole i nā rhythm puʻuwai maʻamau me:

• Hoʻopau ka Cardiac, hoʻohana ʻia e māka i nā wahi i kou puʻuwai e hoʻopilikia paha i kou puʻuwai puʻuwai
• ʻO kahi defibrillator cardioverter implantable, hoʻonoho ʻia i loko o ka poʻe e makaʻu nui ana i ka make koke o ka naʻau
• ʻO ka pacemaker paʻa, kahi mea ʻike i ka wā e kuʻi lohi nei kou puʻuwai. Hoʻouna ia i kahi hōʻailona i kou puʻuwai e hoʻokuʻi i kou puʻuwai i ka wikiwiki pololei.

Pili ka hopena i kekahi mau kumu:

• Ke ʻano o ka arrhythmia āu.
• Inā loaʻa ʻoe i ka maʻi coronary artery, puʻuwai puʻuwai, a i ʻole nā ​​maʻi puʻuwai valvular.

Kāhea i kāu mea hāʻawi inā:

• Hoʻokumu ʻoe i kekahi o nā ʻōuli o ka arrhythmia hiki.
• Ua ʻike ʻia ʻoe me ka arrhythmia a piʻi hewa aʻe kāu mau ʻōuli a i ʻole MAI hoʻomaikaʻi me ka lāʻau.

ʻO ka hana ʻana i nā mea e pale ai i ka maʻi o ke aʻa coronary e hōʻemi paha i kou manawa o ka hoʻomohala ʻana i kahi arrhythmia.

Nā ritme naʻau maʻamau; Bradycardia; Kāleka Kāleka; Fibrillation

• Aibrial fibrillation - hoʻokuʻu
• Hoʻomaʻamaʻa i ka puʻuwai - hoʻokuʻu
• Lawe iā warfarin (Coumadin, Jantoven) - he aha e nīnau aku ai i kāu kauka

• Puʻuwai - ʻāpana ma waena o ka waena
• Puʻuwai - ʻike mua
• Pāʻani puʻuwai maʻamau
• Bradycardia
• Tachycardia hāhā
• Palaka Atrioventricular - huli ʻo ECG
• ʻŌnaehana hoʻoneʻe o ka puʻuwai

Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA / ACC / HRS alakaʻi no ka mālama ʻana i nā mea maʻi me nā arrhythmia ventricular a me ka pale ʻana i ka make o ka puʻuwai. Puʻuwai Heart. 2018; 15 (10): e190-e252. PMID: 29097320 pubmed.ncbi.nlm.nih.gov/29097320/.

ʻO Olgin JE. Hele i ka mea maʻi me ka arrhythmia i manaʻo ʻia. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 56.

ʻO Tomaselli GF, Rubart M, Zipe DP. Nā hana o arrhythmia naʻau. 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 34.

Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF / AHA / HRS hoʻomālama nānā hou o nā kulekele 2008 no ka hoʻomaʻamaʻa ʻana i nā mea hana o nā maʻi maʻamau o ka puʻuwai puʻuwai: kahi hōʻike o ka American College of Cardiology Foundation / American Heart Association Task Force e pili ana i nā kulekele hana. ʻO J Am Coll Cardiol. 2012; 60 (14): 1297-1313. PMID: 22975230 pubmed.ncbi.nlm.nih.gov/22975230/.