He aha te wehenga o te uaua pūkahukahu? Te Whāinga, te Hātepe me ngā Hua

Ko te wehenga o te uaua pūkahukahu he hātepe ngākau iti e rongoā ana i te wiri o te ngākau mā te hanga i ngā kiko whara i te taha o ngā uaua pūkahukahu. Ko ēnei kiko whara e aukati ana i ngā tohu hiko hē e pā ana ki te pōrearea o te ngākau, e āwhina ana ki te whakahoki i te manawataki noa o te ngākau.

Whakaarohia me te mea kei te whakahou i te pūnaha hiko o tō ngākau. Ka whakamahia e te hātepe te wera, te makariri rānei hei hanga i ngā arai iti, tika e aukati ana i ngā ngaru hiko ohorere mai i te whakararuraru i te manawataki tūturu o tō ngākau.

He aha te wehenga o te uaua pūkahukahu?

Ko te wehenga o te uaua pūkahukahu (PVI) he hātepe e whakamahia ana te katita hei rongoā i te wiri o te ngākau mā te wehe i ngā uaua pūkahukahu mai i te atrium mauī. Ko ngā uaua pūkahukahu e whā ngā oko toto e kawe ana i te toto whai hāora mai i ō pūkahukahu ki tō ngākau.

I te wā o te hātepe, ka hangaia e tō tākuta tētahi tauira porohita o te kiko whara i te taha o ia waha uaua pūkahukahu. Ko tēnei kiko whara e mahi ana me te mea he taiapa hiko, e aukati ana i ngā tohu hiko hē mai i ngā uaua mai i te tae ki ngā ruma o runga o tō ngākau.

Ka karangatia hoki te hātepe ko te whakakorenga o te uaua pūkahukahu, te whakakorenga katita rānei. Ka mahia i roto i te taiwhanga katitahinga ngākau motuhake e tētahi tohunga hiko, he tohunga ngākau e tohunga ana ki ngā mate manawataki ngākau.

He aha te take e mahia ai te wehenga o te uaua pūkahukahu?

Ko te wehenga o te uaua pūkahukahu te mea nui e mahia ana hei rongoā i te wiri o te ngākau (AFib), he mate manawataki ngākau noa e pā ana ki te pōrearea me te tere o te manawataki. Ka puta te AFib i te wā e raruraru ana ngā tohu hiko i tō ngākau, e pā ana ki te wiri o ngā ruma o runga, kaua ki te patu whai hua.

Ka tūtohu pea tō tākuta i te PVI mēnā he AFib tohu tōu kāore e pai te urupare ki ngā rongoā. Kei roto i tēnei ngā tūāhua e pā ana ki a koe te maha o ngā wā o te tere o te ngākau, te poto o te manawa, te mamae o te uma, te ngenge, te whanoke rānei e pā ana ki tō oranga o ia rā.

He tino whai hua te tikanga mō te hunga whai paroxysmal AFib, e haere mai ana, e ngaro ana ngā wāhanga i te kore e kitea. Ka āwhina hoki i te hunga whai AFib tonu e hiahia ana ki te whakaiti i te whakawhirinaki ki ngā rongoā wā-roa, ki te hunga rānei kāore e taea te rongoā AFib nā te pānga kino.

I ētahi wā, ka tūtohu pea te PVI hei whakaiti i tō tūponotanga ki te whiu. Ka whakanui te AFib i te tūponotanga o te whiu nā te mea ka taea e ngā ngākau kōaro te hanga i ngā toto toto i roto i tō ngākau, ka taea e te toto toto te haere ki tō roro.

He aha te tikanga mō te wehenga o te uaua pūkahukahu?

Ka mahia te wehenga o te uaua pūkahukahu i roto i te taiwhanga whakawhiti ngākau i te wā e noho ana koe i raro i te whakamaaramatanga mārama, i te rongoā whānui rānei. Ko te tikanga e rua ki te whā haora te roa, i runga i te uaua o tō tūāhua.

Ka tīmata tō tākuta mā te whakauru i ngā ngongo angiangi, ngāwari e kīia ana ko ngā katetā mā ngā oko toto i tō waewae, i tō kaki rānei. Ka ārahina ēnei katetā ki tō ngākau mā te whakamahi i ngā whakaahua X-ray me ngā pūnaha mahere matatau e hanga ana i te pikitia 3D o te mahi hiko o tō ngākau.

Koinei te mea e pā ana i ngā mahi matua o te tikanga:

1. Te mahere i te pūnaha hiko o tō ngākau hei tautuhi i ngā wāhi tika e puta mai ai ngā tohu kōaro
2. Te tūnga i te katetā whakawātea i te waha o ia uaua pūkahukahu
3. Te tuku i te pūngao auau irirangi (wera) i te pūngao cryo rānei (makariri) hei hanga i te kiko kiko
4. Te whakamātau i te wehenga mā te tirotiro i te aukati katoa i ngā tohu hiko mai i ngā uaua pūkahukahu
5. Te aroturuki i te manawataki o tō ngākau kia mōhio ai kua angitu te tikanga

Ka hanga tonu te kiko kiko i muri tonu mai, engari ka haere tonu te pakeketanga i roto i nga wiki maha. Ma tenei tukanga whakaora e awhina kia mau tonu te wehenga hiko, kia pumau, kia whai hua hoki mo te wa roa.

Me pehea te whakarite mo to wehenga uaua pūkahukahu?

Ko te whakarite mo te wehenga uaua pūkahukahu ka timata i nga wiki maha i mua i to tikanga. Ka hoatu e to taakuta nga tohutohu motuhake i hangaia kia rite ki o hiahia takitahi me to hitori rongoa.

Tera pea ka hiahia koe ki te whakamutu i etahi rongoa i mua i te tikanga, ina koa nga mea whakaheke toto. Heoi, kaua rawa e whakamutu i tetahi rongoa me te kore he tohutohu marama mai i to roopu hauora, na te mea he mea nui tenei wa mo to haumaru.

Ka uru pea to whakaritenga ki enei mahi nui:

• Te haere i nga whakamatautau i mua i te tikanga penei i te mahi toto, te hihi-X o te uma, me te echocardiogram
• Te tango i nga paturopi kua tohua mena he mate ngakau koe
• Te nohopuku mo te 8-12 haora i mua i te tikanga (kaore he kai, he inu ranei engari he wai iti me nga rongoa)
• Te whakarite i tetahi hei taraiwa i a koe ki te kainga i muri i te tikanga
• Te tango i nga whakapaipai, te peita whao, me nga arotahi i mua i te taenga mai

Ka tohutohu pea to taakuta i te echocardiogram transesophageal (TEE) hei tirotiro i nga toto toto i roto i to ngakau i mua i te tikanga. He tikanga haumaru tenei hei whakarite kia taea te mahi i te tikanga.

Me pehea te panui i o hua wehenga uaua pūkahukahu?

Ko te angitu o te wehenga uaua pūkahukahu ka inehia e te pai o te whakahaere i o tohu atrial fibrillation me te aukati i nga wahanga a meake nei. Ka aroturukihia e to taakuta to ahunga whakamua ma nga wa whakarite whai muri me te aroturuki i te manawataki o te ngakau.

Ka whakatauhia te angitu tonu i te wa o te tikanga. Ka whakamatauria e to taakuta mena kua tino wehea nga uaua pūkahukahu ma te tirotiro kaore he tohu hiko e pa ana i waenga i nga uaua me te atrium maui o to ngakau.

Ka arotakehia te angitu wā-roa i roto i ngā marama me ngā tau mā ēnei tikanga:

• Ngā whakamātautau EKG auau hei tirotiro i tō manawataki i ngā haerenga ki te tari
• Ngā aroturuki Holter, ngā aroturuki rānei i ngā kaupapa e tuhi ana i tō manawataki mō te 24-48 haora, neke atu rānei
• Te aroturuki i ngā tohu hei kite mena he iti ake ngā wā o te manawataki tere, te poto o te manawa, te mamae rānei o te uma
• Ngā whakamātautau whakanui i te pēhanga hei whakarite kia tū tonu tō manawataki i te wā o te mahi tinana

He rerekē ngā reiti angitu, engari e whakaatu ana ngā rangahau e 70-80% o ngā tāngata e pā ana ki te paroxysmal AFib e noho ana i te kore o ngā wā AFib kotahi tau i muri i te tikanga. Akene pea ka hiahia ētahi tāngata ki tētahi tikanga tukurua mēnā ka hoki mai te AFib, he mea noa tēnei, ā, kāore i te kī kua rahua te tikanga tuatahi.

He aha te putanga pai mō te wehenga uaua pūkahukahu?

Ko te putanga pai mō te wehenga uaua pūkahukahu ko te herekoretanga katoa i ngā wā o te atrial fibrillation i te wā e mau ana te mahi ngākau noa. Ko te tikanga kāore koe e pā ana ki ngā manawataki kōaro, ngā pākia, ngā tohu rānei e pā ana ki te AFib i tō oranga o ia rā.

Kei roto hoki i te hua pai te kounga o te oranga kua pai ake. He maha ngā tāngata e kī ana he pai ake te manawanui ki te mahi, te iti o te ngenge, me te iti o te āwangawanga mō tō rātou āhua ngākau i muri i te PVI angitu.

Kei roto i te putanga wā-roa pai ēnei mea matua:

• Te manawataki ngākau noa e mau tonu ana, kāore he wā AFib
• Te iti o te hiahia mō ngā rongoā manawataki ngākau
• Te iti o te tūponotanga o te whiu nā te manawataki ngākau noa e mau ana
• Te kaha o te mahi me te taumata pūngao kua pai ake
• Te kounga o te oranga whānui me te māia i ngā mahi o ia rā

Ahakoa me haere tonu koe i ētahi rongoā i muri i te PVI, ka taea e tētahi tikanga angitu te whakamahi i ngā horopeta iti ake, i te iti rānei o ngā rongoā i mua. Ka mahi tō tākuta ki a koe ki te kimi i te taurite tika mō tō āhuatanga takitahi.

He aha ngā āhuatanga tūpono mō te hiahia ki te wehenga uaua pūkahukahu?

He maha ngā āhuatanga ka whakanui ake i tō tūponotanga ki te whakawhanake i te atrial fibrillation (AFib) e kaha ana ki te hiahia ki te wehe i te uaua pūkahukahu. Mā te māramatanga ki ēnei āhuatanga tūpono ka āwhina i a koe me tō tākuta ki te whakatau i ngā whakatau mō te rongoā.

Ko te pakeke te āhuatanga tūpono nui rawa atu, i te mea ka nui ake te AFib i te wā e pakeke ana koe. Heoi anō, ka taea e ngā tāngata tamariki te whakawhanake i te AFib, ina koa he ētahi atu āhuatanga kei raro iho.

Ngā āhuatanga tūpono noa ka puta pea ki te hiahia PVI ko:

• Te toto tiketike kāore i te pai te whakahaere i te roanga o te wā
• Te mate ngākau tae atu ki te mate uaua coronary, ngā raruraru o te pūwāhi ngākau, te korenga o te ngākau rānei
• Te mate huka, ina koa ka nui te huka toto i ngā wā katoa
• Te momomo, e whakatakoto ana i te pēhanga anō ki tō ngākau
• Te moe apnea, ka taea te whakaoho i ngā manawataki ngākau kōaro
• Ngā raruraru thyroid, ina koa te thyroid kaha rawa
• Te inu waipiro nui, te inu waipiro rānei
• Te hītori o te whānau mō te atrial fibrillation, ētahi atu raruraru manawataki ngākau rānei

Ka whakawhanake ētahi tāngata i te AFib kāore he āhuatanga tūpono mārama, he mea noa tēnā. Ko te mea nui ko te whiwhi rongoā tika ina tino pānga ngā tohumate ki tō kounga o te oranga.

He aha ngā raruraru ka puta mai i te wehenga o te uaua pūkahukahu?

Ahakoa te wehenga o te uaua pūkahukahu he mea haumaru i te nuinga o te wā, pērā i ētahi atu mahi rongoā, he ētahi tūponotanga. Ko te nuinga o ngā raruraru he mea onge, ā, ka taea te whakahaere pai ina puta mai.

Ko ngā raruraru noa he mea iti noa iho, ā, ka tere te whakatika. Ko ēnei pea ko te pānga o te pānga o te katetā, e ora ana i roto i ngā rā torutoru.

Ngā raruraru nui engari he mea onge ka uru:

• Te toto i te wāhi whakauru ngira, tērā pea ka hiahiatia te pēhi, te rongoā atu rānei
• Ngā pūhui toto, tērā pea ka haere ki ētahi atu wāhi o tō tinana
• Te whara i ngā oko toto i te wā whakauru ngira
• Te whara o te kōpū, e tata ana ki te ngākau
• Te whāiti o te uaua pūkahukahu, ka whāiti ngā uaua i rongoatia
• Te pericarditis, he mumura o te pūpū e karapoti ana i tō ngākau
• Ngā raruraru manawa hou, engari he wā poto noa iho tēnei

He tino onge, engari he raruraru nui ko te whiu, te whakaeke ngākau, te whara rānei i ngā hanganga tata. Mā tō tākuta hiko e kōrero ēnei tūponotanga ki a koe, me te whakamārama me pēhea te whakaiti i a rātou i te wā o tō tikanga.

Āhea ahau e kite ai i te tākuta i muri i te wehenga o te uaua pūkahukahu?

Me whakapā atu koe ki tō tākuta tonu mēnā ka pā tētahi tohumate e pā ana ki a koe i muri i te wehenga o te uaua pūkahukahu. Ahakoa he āwangawanga noa iho ētahi, he tohu e hiahia ana kia rongoatia tonu.

Waea atu ki tō tākuta tonu mēnā ka kite koe i te nui o te toto, te pūpū, te nui haere rānei o te mamae i te wāhi whakauru ngira. Me rapu tonu hoki i te rongoā mēnā ka pā tō mamae i te uma, te tino poto o te manawa, ngā tohu rānei o te mate, pērā i te kirika, te wiri rānei.

Ko ēnei ngā āhuatanga e tika ana kia rongoatia tonu:

• Te nui o te toto i te wāhi whakauru, kāore e mutu i te pēhi ngawari
• Ngā tohu o te mate tae atu ki te kirika, te whero, te mahana, te wai rānei i te wāhi whakauru
• Te mamae nui i te uma, te pēhi rānei, he rerekē i ō tohumate AFib
• Te ohorere o te poto o te manawa, te uaua rānei ki te manawa
• Ngā tohumate o te whiu, pērā i te ngoikoretanga ohorere, ngā uaua ki te kōrero, ngā rerekētanga rānei o te tirohanga
• Te whakapairuaki tonu, te ruaki, te kore rānei e taea te pupuri i ngā wai

Mō te aroturuki i ngā wā katoa, ka kite koe i tō tākuta i roto i te 1-2 wiki i muri i te tikanga. Mā tēnei tūtohinga e āhei ai tō rōpū hauora ki te tirotiro i tō haere whakamua o te whakaora me te whakautu i ngā pātai, i ngā āwangawanga rānei kei a koe.

Ngā pātai e pā ana ki te wehenga o te uaua pūkahukahu

He pai te wehenga o te uaua pūkahukahu mō ngā momo katoa o te wiri o te ngākau?

He pai te wehenga o te uaua pūkahukahu mō te wiri o te ngākau e puta ana, e ngaro ana i a rātou anō. Ko te nuinga o te wā ka nui te angitu i roto i tēnei rōpū, ā, 70-80% o te hunga e noho ana i te kore o ngā wāhanga AFib i muri i te tau kotahi.

Mō te AFib tonu, e roa ana ngā wāhanga i te whitu rā, ka whai hua tonu te PVI engari me whai tikanga whakawātea anō. Me waihanga pea e tō tākuta ētahi atu rārangi kiko i tō ngākau i tua atu i te wehe noa i ngā uaua pūkahukahu.

Ko te hunga e roa ana te AFib tonu, ka iti pea te angitu ki te PVI anake. Heoi, ka taea e te tikanga te whakarato i te whakamaoritanga nui o ngā tohu me te whakapai ake i te kounga o te oranga, ahakoa kāore i tutuki te rongoā katoa.

Ka rongoā tonu te wehenga o te uaua pūkahukahu i te wiri o te ngākau?

Ka taea e te wehenga o te uaua pūkahukahu te whakarato i te herekore roa mai i te wiri o te ngākau, engari ehara i te rongoā tonu. He maha ngā tāngata e noho ana i te kore AFib mō ngā tau i muri i te tikanga, i te wā e pā ana ētahi atu i ngā wāhanga i ētahi wā.

Ko te angitu o te PVI e whakawhirinaki ana ki ētahi mea tae atu ki te momo AFib kei a koe, te roa o tō whai, me tō hauora ngākau whānui. Me whai tikanga anō pea ētahi tāngata mēnā ka hoki mai te AFib, he wāhanga noa tēnei o te rongoā.

Ahakoa ka hoki mai te AFib i ētahi wā, ka nui tonu te whakapai ake o te nuinga o te tāngata i ō rātou tohu me te kounga o te oranga. He iti ake te auau o ngā wāhanga, he poto ake te roa, ā, he māmā ake te whakahaere ki ngā rongoā.

Ka taea e au te whakakori tinana i muri i te wehenga o te uaua pūkahukahu?

Ka taea e te nuinga o te tangata te hoki haere ki ngā mahi whakakori tinana me ngā mahi tinana noa i muri i te wehenga o te uaua pūkahukahu. Heoi, me whai koe i tētahi wā tika mō te hoki ki ngā momo mahi rerekē.

Mō ngā rā tuatahi i muri i te mahi, me karo koe i te hiki taumaha, te whakakori tinana kaha, me ngā mahi ka pēhi i te wāhi kuhu o te katita. Ko te hikoi māmā te tikanga e whakahihiri ana hei whakatairanga i te whakaora me te ārai i ngā pūtau toto.

Ka hoatu e tō tākuta ngā aratohu motuhake i runga i tō āhuatanga takitahi. He tokomaha ngā tāngata e kite ana ka taea e rātou te whakakori tinana mā te pai ake i muri i te PVI angitu nā te mea he mārama ake te manawataki o tō rātou ngākau, ā, he iti ake te pōkae manawa i te wā o te mahi tinana.

Me tango tonu au i ngā whakaheke toto i muri i te wehenga o te uaua pūkahukahu?

Ko te haere tonu o te tango i ngā whakaheke toto i muri i te wehenga o te uaua pūkahukahu kei runga i ō āhuatanga tūpono mō te whiu takitahi. Kāore te whakatau e whakatakoto ana i runga i te angitu o te mahi ki te whakahaere i tō AFib.

Ka whakamahi tō tākuta i ngā pūnaha whakatau pēnei i te kaute CHA2DS2-VASc hei aromatawai i tō tūpono mō te whiu i runga i ngā āhuatanga pēnei i te pakeke, te ira tangata, te mate huka, te toto tiketike, me te hītori whiu o mua. Mēnā e tohu ana tō kaute i te tūpono nui, me haere tonu pea koe i ngā whakaheke toto mō te wā roa.

Ko ētahi tāngata he iti ngā kaute tūpono mō te whiu ka mutu pea te tango i ngā whakaheke toto i muri i te PVI angitu, engari me whakatau tonu tēnei whakatau i te kōrero tahi me tō rōpū hauora. Ka whakaarohia e rātou tō pikitia hauora katoa i te wā e whakatakoto ana i tēnei tūtohu.

Kia pēhea te roa o te whakaora i te wehenga o te uaua pūkahukahu?

Ka taea e te nuinga o te tangata te hoki ki ngā mahi o ia rā i roto i ngā rā torutoru ki te wiki i muri i te wehenga o te uaua pūkahukahu. Heoi, ka roa pea te whakaora katoa me ngā painga katoa o te mahi i ngā wiki ki ngā marama.

Ko ngā wāhi whakauru kātere te tikanga ka ora i roto i te 3-5 rā, ahakoa ka paku pāpāringa, ngāwari rānei mō te rua wiki. Me karo koe i te hiki taumaha me te whakakori tinana kaha mō te wiki pea kia pai ai te ora.

Ko te kiko kiko i hangaia i te wā o te tikanga ka haere tonu te pakeke mō te 2-3 marama i muri i te PVI. I tēnei wā, ka paku raru pea koe i te manawa, i ngā wā rānei o te AFib, ā, he maha ngā wā ka ngaro i te wā e oti ana te ora. Ka āta titiro tō tākuta i tō haere i tēnei wā.