He aha te Implantable Cardioverter Defibrillator (ICD)? Te Whāinga, te Hātepe me ngā Hua

He pūrere hiko iti te implantable cardioverter defibrillator (ICD) ka whakanohohia ki raro i tō kiri hei aroturuki i te manawataki o tō ngākau me te tuku i ngā ohorere whakaora-ora ina hiahiatia. Whakaarohia he kaitiaki whaiaro e tū ana ki te titiro ki tō ngākau 24/7, e rite ana ki te takahi i te wā ka puta ngā manawataki mōrearea. Kua āwhina tēnei pūrere whakamīharo i miriona tāngata ki te noho i ngā oranga whānui, māia ake ahakoa te whai i ngā āhuatanga o te ngākau e tūpono ai rātou ki te mate ohorere o te ngākau.

He aha te implantable cardioverter defibrillator?

He pūrere e whakahaerehia ana e te pākahiko te ICD, tata ki te rahi o te waea pūkoro iti, ka whakanohohia ki raro i te kiri tata ki tō koiwi kara. E hono ana ki tō ngākau mā ngā waea angiangi, ngā waea ngawari e kīia ana he arahi e aroturuki ana i te mahi hiko o tō ngākau i ngā wā katoa. Ina kitea e te pūrere he manawataki ngākau mōrearea, ka taea e ia te tuku momo rongoā rerekē mai i te whakatere ngawari ki ngā ohorere hiko whakaora-ora.

E mahi ana te pūrere mā te tātari tonu i ngā tauira manawataki o tō ngākau. Ki te rongo ia i te ventricular tachycardia (he manawataki ngākau tere rawa) rānei i te ventricular fibrillation (he manawataki ngākau kōaro, kāore e whai hua), ka urupare tonu ia. Ka taea e ēnei āhuatanga te aukati i tō ngākau ki te pōmpu i te toto, koinei te take he mea nui te urupare tere o te ICD mō tō oranga.

He tino matatau ngā ICD hou, ā, ka taea te hōtaka motuhake mō ngā hiahia o tō ngākau. Ka taea e tō tākuta te whakatika i ngā tautuhinga mai i tawhiti, ā, ka whiwhi raraunga mō te mahi o tō ngākau i waenga i ngā haerenga tari. Ka taea e tēnei hangarau te manaaki whaiaro e urutau ana ki te huri o tō āhuatanga i te roanga o te wā.

He aha te take i mahia ai he implantable cardioverter defibrillator?

E taunaki ana nga tākuta i nga ICD mo te hunga i ora i te ohorere o te ngakau, kei te nui ranei te tūponotanga ki nga manawataki morearea. Ko te whāinga tuatahi ko te ārai i te mate ohorere o te ngakau, ka puta i te wā e kore e pai te mahi o te pūnaha hiko o tō ngakau, ka mutu te papu toto. Tera pea koe he kaitono mēnā kua pā koe ki te tachycardia ventricular, ki te fibrillation ventricular rānei, ki te tino iti rānei te mahi o tō ngakau.

He maha ngā āhuatanga o te ngakau ka nui ake te hiahia ki te ICD. Ko te cardiomyopathy, te wā e ngoikore ana, e whānui ana rānei te uaua o tō ngakau, ko tētahi o ngā take tino nui. Ko ngā tūroro e mate ana i te ngoikore o te ngakau me te hautanga o te pana i raro iho i te 35% ahakoa te rongoā pai, he maha ngā wā ka whai hua mai i te whakamarumaru ICD. Ko ngā whakaeke ngakau o mua ka waiho i te kiko whara e hanga ana i te korenga o te hiko, ka nui ake te tūponotanga o ngā manawataki morearea.

Ko ētahi tāngata ka riro i a rātou ngā āhuatanga ira e tūpono ana ki te mate ohorere o te ngakau. Ko te hypertrophic cardiomyopathy, te arrhythmogenic right ventricular cardiomyopathy, me ētahi mate hongere katote ka nui ake te tūponotanga. Ko te Long QT syndrome me te Brugada syndrome he tauira o ngā āhuatanga ira e whakarato ana i te whakamarumaru nui a ICD, tae noa ki ngā tūroro tamariki.

Ko ngā take kāore i te nui engari he mea nui ko te cardiac sarcoidosis, te wā e pā ana ngā pūtau mumura ki te pūnaha hiko o tō ngakau. Ko te mate Chagas, ētahi rongoā, me ngā taurite electrolyte kino rawa atu ka hanga hoki i ngā āhuatanga e tika ana te ICD. Ka whakaaro tō tākuta ki tō hauora whānui, te roa o te ora, me te kounga o te ora i te wā e whakatau ana i tēnei tūtohu.

He aha te tikanga mō te implantable cardioverter defibrillator?

Ko te whakaurunga ICD te tikanga ka mahia hei tikanga i te ra kotahi i roto i te taiwhanga hiko-whakawhanaunga o te hōhipera, i te ruma whakawhanaunga ngakau ranei. Ka whiwhi koe i te whakamaarama mohio, ko te tikanga ka okioki koe, ka pai hoki, engari kaore i te tino kore mohio. Ko te tikanga ka 1-3 haora te roa, i runga i te uaua o to keehi me te hiahia koe i etahi atu arahi, i nga tikanga ranei.

Ka hanga e to taakuta he tapahi iti, i te nuinga o te wa i te taha maui i raro i to koiwi kara, ka hanga he pute i raro i to kiri hei pupuri i te ICD. Ka whiria nga arahi i roto i nga oko toto ki roto i to ngakau ma te whakamahi i te arahi X-ray. E hiahia ana tenei tukanga kia tika te mahi na te mea me tuu nga arahi kia tika ai te rongo i te mahi hiko o to ngakau me te tuku rongoa i runga i te whai hua.

Ka oti nga arahi, ka whakamatautau to taakuta i te punaha kia mohio kei te pai nga mea katoa. Kei roto i tenei ko te tirotiro kei te tika te rongo i te manawataki o to ngakau me te tuku rongoa tika. Katahi ka whakanohohia te ICD ki roto i te pute i raro i to kiri, ka katia te tapahi ki nga tuitui, ki te kāpia rānei.

I muri i te tikanga, ka aroturukihia koe mo etahi haora kia mohio kaore he raruraru tonu. Ka taea e te nuinga o nga tangata te haere ki te kainga i te ra kotahi, ahakoa me noho etahi mo te po mo te mataki. Ka whakarite to taakuta i tetahi hui whai muri i roto i etahi wiki ki te tirotiro i to oranga me te whakatika i nga tautuhinga o to taputapu.

Me pehea te whakarite mo to tikanga whakauru cardioverter defibrillator?

Ka timata te whakarite mo to whakaurunga ICD me te korerorero hohonu me to roopu rongoa mo nga mea e tumanakohia ana. Me mutu te kai me te inu mo te 8 haora i mua i te tikanga, he rite ki te whakarite mo etahi atu tikanga pokanga. Ka arotakehia e to taakuta o rongoa katoa, ka tono pea koe ki te whakamutu i etahi mea whakaheke toto, ki te whakatika ranei i etahi atu rongoa i mua i te pokanga.

Whakamōhiotia tō rōpū hauora mō ngā mate pāwera kei a koe, inā koa ki ngā rongoā, ngā tae rerekē, rānei, ki te rākau rānei. Ki te whai koe i te mate huka, ka whiwhi koe i ngā tohutohu motuhake mō te whakahaere i tō huka toto i mua, i muri hoki i te tikanga. Ka hiahia anō tō tākuta ki te mōhio mō ngā mate tata nei, nā te mea ka uaua te mahi whakaora i ngā mate.

Whakaritea tō wā whakaora mā te whakarite i tētahi tangata hei taraiwa i a koe ki te kāinga i muri i te tikanga. Ka hiahia koe ki te āwhina i ngā mahi o ia rā mō ngā rā tuatahi, inā koa ngā mea katoa e hiahia ana ki te hiki i tō ringa i te taha i whakatakotoria ai te ICD. Whakakiia ngā kākahu pai, ngā kākahu whānui e kore e pēhi i te wāhi tapahi.

Me mōhio koe ki ngā here i muri i te tikanga, e pā ana ki te karo i te hiki taumaha me ngā nekehanga kaha o te ringa mō te 4-6 wiki. Ka hoatu e tō tākuta ngā aratohu motuhake mō te wā ka taea e koe te hoki ki te mahi, te taraiwa, me te hoki ki ngā mahi noa. Mā te whai i ngā tūmanako tūturu mō te mahi whakaora ka āwhina koe ki te whakaora i te pai ake.

Me pēhea te pānui i ngā hua o tō pūrere whakawhitiwhiti ngākau whakato?

Ko te māramatanga ki te mahi a tō ICD e pā ana ki te ako mō ngā momo rerekē o ngā wawaotanga ka taea e ia te whakarato me te aha te tikanga o ngā raraunga mō tō hauora. Ka rongoa e tō pūrere ngā mōhiohio taipitopito mō ō manawataki ngākau, ngā rongoā i tukuna, me te pēhea te urupare a tō ngākau. Ka arotakehia ēnei raraunga i ngā wā whakarite whai-muri, i te nuinga o te wā ia 3-6 marama.

Ko te mea nui kia mārama ko te tuku a tō ICD i ngā taumata rerekē o te rongoā i runga i te hiahia o tō ngākau. Ko te whakatere anti-tachycardia (ATP) e pā ana ki ngā ngaru tere, kore mamae e taea ai te aukati i ngā manawataki ngākau tere i te nuinga o te wā, kāore koe e rongo i tētahi mea. Ka tukuna e te cardioversion he ru hiko ngawari ka rongo koe, engari kāore i te kaha pērā i te defibrillation. Ko te defibrillation te rongoā kaha rawa atu, i hangaia hei aukati i ngā manawataki tino mōrearea.

Ka whakaatu te pūrongo o tō pūrere i te auau o te hiahia o ēnei rongoā me te angitu. Ko ngā ruinga tika te tikanga i tautohu tika, i rongoā tika hoki tō ICD i tētahi manawataki mōrearea. Ka puta ngā ruinga hē i te wā e hē ana te pūrere i tētahi manawataki tere noa, kāore hoki i te mōrearea, e mōrearea ana, he mea ka puta, engari he mea kāore i te nuinga i ngā pūrere hou.

Ka taea e te aroturuki mamao te tākuta ki te tirotiro i te mahi o tō pūrere me te mahi o tō ngākau i waenga i ngā haerenga ki te tari. Ka taea e tēnei hangarau te kite i ngā raruraru i te wā tuatahi, ā, ka āwhina i tō rōpū hauora ki te whakatika i ngā mea hei whakapai ake i tō manaaki. Ka ako koe ki te mōhio i te wā i tukuna ai e tō pūrere te rongoā me te wā ki te whakapā atu ki tō kaiwhakarato hauora.

Me pēhea te whakahaere i te oranga me tō whakauru cardioverter defibrillator?

Ko te noho me tētahi ICD e hiahia ana ētahi whakatikatika, engari ka hoki te nuinga o te tangata ki ngā oranga kaha, whai hua i roto i ētahi marama i muri i te whakaurunga. Ko te kī ko te māramatanga ki ngā mahi e haumaru ana me ngā whakatūpato e hiahia ana koe ki te whai. Ka whakarato tō tākuta i ngā aratohu motuhake i runga i tō āhuatanga takitahi, engari ka pā ngā mātāpono whānui ki te nuinga o ngā tūroro ICD.

I te nuinga o te wā ka whakahihiri te mahi tinana nā te mea ka whai hua te korikori tinana ki te hauora o tō ngākau. Me karo koe i ngā hākinakina whakapā ka whara i tō pūrere, engari ko te hīkoi, te kauhoe, te pahikara, me te nuinga atu o ngā mahi he tino haumaru. Me tīmata pōturi, ā, me whakanui haere i tō taumata mahi i a koe e ora ana, e whiwhi ana i te māia ki tō pūrere.

Ka taea e ētahi pūrere hiko-ā-mōkā te whakararu i tō ICD, ahakoa he iti ake tēnei i ngā tauira hou. Me karo koe i te roa o te pānga ki ngā pānga ā-mōkā kaha, pērā i ngā mea e kitea ana i ngā mīhini MRI (ki te kore koe i te pūrere e hototahi ana ki te MRI), ngā taputapu whāwera, me ētahi mīhini ahumahi. Ko te nuinga o ngā taputapu o te whare, tae atu ki ngā ngaruiti me ngā waea pūkoro, he haumaru ki te whakamahi noa.

He pai te haere rererangi me te ICD, engari me whakamōhio koe ki ngā kaimahi haumaru mō tō pūrere i mua i te haere mā ngā kaitātai whakarewa. Ka mau koe i tētahi kāri e tohu ana i tō ICD e whakamārama ana i ngā whakaaro motuhake. Ko te nuinga o te tangata e kite ana kāore te pūrere e pā ana ki ā rātou mahi o ia rā i te wā e urutau ana rātou ki te noho tahi.

He aha ngā āhuatanga tūpono mō te hiahia ki te whakauru i tētahi implantable cardioverter defibrillator?

He maha ngā āhuatanga e whakanui ana i tō tūponotanga ki te hiahia ki te ICD, ko te ngoikore o te uaua o te ngākau te take tino nui. Ki te heke iho te mahi papu o tō ngākau i raro i te 35% o te tikanga (ka inea hei hautanga pana), kei te tūpono koe ki ngā manawataki mōrearea ahakoa te take i raro. Ka taea tēnei te tupu nā te whakaeke ngākau, ngā mate huaketo, ngā āhuatanga ira, rānei ngā take kāore i te mōhiotia.

Ko ngā whakaeke ngākau o mua e hanga ana i te kiko kiko e taea ai te whakaoho i te mahi hiko rereke i roto i tō ngākau. Ko te nui ake o te kiko kiko, ka nui ake tō tūponotanga. Ahakoa i pā tō whakaeke ngākau i ngā tau ki muri, ka noho tonu te kiko kiko, ā, ka nui ake te raruraru i te wā. Ko te hītori o te whānau mō te mate ohorere o te ngākau, ina koa i roto i ngā whanaunga i raro i te 50 tau, e whakaatu ana tērā pea i riro mai i a koe tētahi āhuatanga e whakanui ana i tō tūponotanga.

Ko ētahi āhuatanga hauora e whakanui ana i tō kōtaha tūponotanga. Ko te ngoikore o te ngākau mai i ngā take katoa, ina koa ka honoa ki ngā tohu ahakoa te rongoā, ka arahina ki te whakaaro ICD. Ko te Cardiomyopathy, ahakoa te whānui, te hypertrophic, te whakawhāiti rānei, ka taea te hanga i te korenga hiko. Ko ngā āhuatanga ira pēnei i te arrhythmogenic right ventricular cardiomyopathy, ētahi mate ara ioni rānei, ka hiahia pea ki te whakamarumaru ICD ahakoa i roto i ngā tāngata e taitamariki ana.

Ko ngā āhuatanga mōrearea e kore e pāhorahia engari he mea nui ko te sarcoidosis o te ngākau, e pā ana ki te mumura i roto i te uaua o tō ngākau. Ko te mate Chagas, e pāhorahia ana i ētahi rohe matawhenua, ka taea te whakangaro i te pūnaha hiko o tō ngākau. Ētahi rongoā, ina koa ko ētahi rongoā matū, ka taea te whakaiti i te uaua o tō ngākau me te whakanui i tō tūponotanga. Ko te mate tākihi nui me ētahi āhuatanga autoimmune ka taea hoki te whai wāhi ki ngā raruraru o te manawataki o te ngākau.

He aha ngā raruraru ka puta mai i te whakaurunga o te implantable cardioverter defibrillator?

Ahakoa te nuinga o te wā he haumaru te whakaurunga o te ICD, mā te māramatanga ki ngā raruraru ka taea te āwhina i a koe ki te whakatau whakatau mōhio me te mōhio wawe ki ngā raruraru. Ko ngā take e pāhorahia ana he mea iti, he mea e pā ana ki te tikanga pokanga tonu. Kei roto i ēnei ko te toto, te pānga, me te mamae rangitahi i te wāhi tapahi, e ngaro ana i roto i ētahi wiki.

Ko te mate he raruraru nui engari e kore e pāhorahia, ka puta i te wāhi tapahi, i te taha rānei o te pūrere tonu. Ko ngā tohu ko te whakanui i te whero, te mahana, te pūhi, te wai rānei mai i te tapahi, me te kirika, te kore rānei e pai. Ko ngā mate pūrere te tikanga me rongoā paturopi, i ētahi wā ka tangohia te pūnaha katoa, koinei te take he mea nui te whai i ngā tohutohu tiaki i muri i te tikanga.

Ka puta ngā raruraru e pā ana ki te mata i te wā, i muri rānei i te whakaurunga. Ko te Pneumothorax, e uru ana te hau ki te wāhi huri noa i tō pūkahukahu, ka puta i te 1-2% o ngā tikanga, ā, me rongoā pea. Ko te nekehanga o te mata, e neke ana ngā waea mai i tō rātou tūnga i whakaritea, ka pā ki te mahi pūrere, ā, me whakatū anō pea. He mea onge te whati o te mata, engari ka puta i ngā tau i muri i te whakaurunga, ina koa i ngā tūroro kaha.

He mea noa te kore mahi o te taputapu ki nga ICD hou engari ka uru pea ki nga ru hiko kore tika, te kore e kite i nga manawataki kino, i nga raruraru pākahiko ranei. Ka taea e te pokanoa hiko mai i etahi taputapu te pānga rangitahi ki te mahi, ahakoa he mea onge tenei. Ka pā te wairua o ētahi tāngata, tae atu ki te āwangawanga mō te whiwhi ru hiko, te pōuri rānei e pā ana ki te mate ngākau. He mea noa ēnei urupare ā-whatumanawa, ā, ka taea te rongoā mā te tautoko tika.

Āhea ahau e kite ai i te tākuta mō taku defibrillator cardioverter whakato?

Me whakapā atu koe ki tō kaiwhakarato hauora tonu mēnā ka whiwhi koe i te ru hiko mai i tō ICD, ahakoa kei te pai koe i muri mai. Ahakoa te nuinga o te wā e tohu ana te ru hiko kei te tika te mahi o tō taputapu, me arotake tō tākuta i ngā mea i pā, me te whakatau mēnā e hiahiatia ana ētahi whakatikatika. Ko te maha o ngā ru hiko i roto i te wā poto, e kiia ana he tūāwhiorangi hiko, e hiahia ana ki te āwhina hauora ohorere.

Ko ngā tohu o te mate pāwera huri noa i tō taputapu e hiahia ana kia arotakea tonu e te tākuta. Kia mātaki mō te whero haere, te mahana, te pūhi, te ngawari rānei i te wāhi tapahi, ina koa ki te whai kirika, te wiri, te kore rānei e pai. Ko ngā wai e puta mai i te tapahi, ina koa he pōkaikaha, he haunga rānei, e hiahia ana kia aro tonu. Ka taea e ēnei tohu te tohu i te mate pāwera o te taputapu, e hiahia ana ki te rongoā kaha.

Ko ngā tohu o te kore mahi o te taputapu ko te rongo i tō ngākau e tere ana me te kore e whiwhi rongoā tika, te whiwhi rānei i ngā ru hiko i te wā e kore koe e rongo i tō ngākau e pōrearea ana. Mēnā ka pā koe i te whanoke, te ngaro rānei o te mahara, te mamae rānei o te uma e rite ana ki tō i rongo i mua i te whiwhi i tō ICD, ka tohu pea tēnei kāore i te tika te mahi o tō taputapu, kua huri rānei tō āhuatanga.

Whaia tō hōtaka aroturuki auau, e pā ana ki te tirotiro i te pūrere i ngā marama 3-6. I waenga i ngā whakaritenga, whakapā atu ki tō tākuta mēnā he āwangawanga koe mō tō pūrere, ka kite i ngā huringa i ō tohumate, ka pā rānei i ngā raruraru hou e pā ana ki te ngākau. Kaua e whakaroa ki te whakapā mai mō ngā pātai – e hiahia ana tō rōpū hauora kia mōhio koe he māia, he haumaru hoki koe ki tō ICD.

Ngā pātai auau mō ngā defibrillators cardioverter whakato

Q.1 He pai te defibrillator cardioverter whakato mō te ngoikore o te ngākau?

Āe, he tino whai hua ngā ICD mō te hunga e mate ana i te ngoikore o te ngākau, ina koa ko te hunga he iti iho te hautanga pana i te 35%. Ka piki ake te ngoikore o te ngākau i tō tūponotanga ki te mate ohorere o te ngākau nā te manawataki kino o te ngākau, ā, he whakamarumaru nui te ICD ki ēnei tūponotanga e raru ana te ora. He maha ngā tūroro ngoikore o te ngākau e whiwhi ana i ngā pūrere whakakotahi e kiia nei ko CRT-D (te rongoā whakawhitiwhiti ngākau me te defibrillator) e whakapai ana i te mahi o te ngākau me te whakarato i te whakamarumaru manawataki.

Q.2 Ka pā mai ngā raruraru o te ngākau i te whai ICD?

Kāore, kāore ngā ICD e pā mai i ngā raruraru o te ngākau – ka whakato rātou ki te rongoā i ngā āhuatanga o te ngākau e noho ana, me te ārai i ngā raruraru kino. Kāore te pūrere tonu e kino i tō ngākau, e hanga rānei i ngā raruraru hou. Heoi, ka puta mai i ngā waea ngā raruraru iti pēnei i te kōpuku toto, i te mate rānei, engari he onge ēnei, ā, ko ngā painga o te whakamarumaru mai i te mate ohorere o te ngākau ka nui ake i ēnei tūponotanga mō ngā kaitono tika.

Q.3 Ka taea e koe te noho i te ora noa me te ICD?

Ko te nuinga o te hunga e whai ana i nga ICD e noho ana i nga oranga kaha, whai hua me nga whakarereketanga iti noa i roto i o raatau mahi o ia ra. Ka taea e koe te mahi, te haere, te korikori tinana, me te whai waahi ki te nuinga o nga mahi i pai ai koe i mua. Ko nga here nui ko te karo i nga hakinakina whakapā me te tupato i nga waahi kaha o te hiko. He maha nga tangata e kii ana he nui ake te maia me te haumaru ki te mohio kei te tiaki to raatau taputapu i a raatau mai i nga manawataki ngakau e whakatuma ana i te oranga.

Q.4 E hia te mamae o te ru ICD?

Ko te ru ICD he rite ki te pupuhi ohorere, kaha ranei i roto i to uma, he maha nga wa e whakaahuatia ana he rite ki te patu i te poipoi. He iti noa te roa o te ahua, ahakoa ka mamae pea koe i muri mai. Ahakoa te kino, ka pai te nuinga o nga tangata ki nga ru, ka koa ki te whakamarumaru e whakaratohia ana e ratou. Ka taea e to taakuta te whakatika i nga tautuhinga hei whakaiti i nga ru e kore e tika ana i te wa e mau tonu ana to haumaru.

Q.5 Kia pehea te roa o te pākahiko ICD?

Ko nga pākahiko ICD hou e 7-10 tau te roa, ahakoa he rereke tenei i runga i te maha o nga wa e tuku ana to taputapu i te rongoa me o tautuhinga taputapu takitahi. Ka aroturukihia e to taakuta te ora o te pākahiko i nga wa o te tirotirohanga auau, ka whakarite i te pokanga whakakapinga ina hiahiatia. Ko te whakakapinga pākahiko he maamaa ake i te whakato tuatahi na te mea karekau nga arahi e hiahia ana kia huri, ko te wae whakangao anake.