1

KERALA HEART FOUNDATION

is a charity organisation registered in 2011.

It is active in the fields of cardiovascular research, bringing in excellence

cardiovascular services, social researches, free heart treatment programmes

for poor, seminars, school programmes, corporate programmes, 

CPR training sessions, medical camps 

and spreading awareness towards

KERALA
HEART
FOUNDATION

2
 lrZ-b-tcm-K-§-sf-¡p-dn¨v
tcm-Kn A-dn-ªn-cn-t¡-≠ ­ FÃm-Im-cy-§fpw
Cu ]p-kv-X-I-¯n Np-cp-¡n hnh-cn-¨n-cn-¡p¶p.
ikv-{X-{Inb¡v ap-¼v
FÃm tcm-Kn-Ifpw Cu ]p-kvX-Iw
hm-bn-¨n-cn-t¡≠-Xm-Wv.

tUm. IpÂ-Zo-]v Ip-amÀ NpÅn-¸-d-¼nÂ

ko-\n-bÀ ImÀ-Un-bm-Iv kÀP³
h-Ip-¸v ta-[m-hn
Tel: 99610 14446
www.ckkkuldeep@yahoo.com
www.heartsurgeonindia.com

ap-¸-¯nb-©v h-b-Êp-I-gn-ª FÃm-hcpw

hmÀ-jn-I-lr-Z-b-]cn-tim-[-\-bv-¡v
hn-t[-b-cm-hp-I-bm-Wv lr-Z-bm-Lm-X-¯nÂ
\n¶pw c-£-s¸-Sm-\p-Å
G-ä-hpw \à amÀ¤w.

- W.H.O -

3
 DÅS¡w
1. F-´m-Wv t\m tamÀ lmÀ-«v A-äm-¡v 2025 ? ............................................. 7
2. lrZ-bm-Lm-X-w h¶ tcmKn A-dn-ªn-cn-t¡≠ - Im-cy-§Ä ? ........... 13
3 F-´mWv B³-Pn-tbm-¹mÌn ? ........................................................................ 33
4. F´n-\m-Wv ss_-¸m-kv kÀPdn ................................................................... 45
5. lrZ-b-hmÂ-hn-\v A-kp-J-ap-Å-hÀ, am-än-sh¨hÀ .................................... 54
A-dn-ªn-cn-t¡≠- Im-cy-§sfs´Ãmw ?
6. Ft¸m-gm-Wv s\©-aÀ-¯epw Ir-{Xn-a- izm-tkm-Ñm-kh-pw .................... 56
\Â-tI≠n h-cp¶-Xv
7. lr-Z-bm-Lm-X-s¯Ip-dn-¨v A-dn-ªn-cn-t¡≠ Im-cy§Ä .................... 58
8. lmÀ-«v s^-bv-eÀ A-dn-ªn-cn-t¡≠ Im-cy§Ä ...................................... 63
9. lrZ-bw am-än-sh-¨-hÀ Fs´Ãmw {i-²n-¡-Ww ? .................................. 66
10. F´m-Wv t]kv-ta-¡À, AICD, CRT-D ap-Xem-b ? ......................... 76
11. F´m-Wv A-tbmÀ-«n-¡v A-\yq-dn-kw ? ........................................................ 79
12. lr-Z-bm-Lm-Xw hcm-sX t\m-¡p-¶-sX§s\? ........................................ 80

4
AhXmcnI

5
 CHAPTER
I

F-´m-Wv ]m-Ým-Xy- cm-Py-§f

NO MORE HEART ATTACK 2025?
2016 Â tem-I lr-Z-b-Zn-\amb sk-]v-Xw-_À 29 \v
tI-c-f lmÀ-«v ^u≠t-j³ F-¶ kw-L-S-\-bp-sS
B-lzm-\-amWv NO MORE HEART ATTACK - 2025.
2025þmw B-t≠-m-sS 80 h-bkn Xm-sg BÀ¡pw
lr-Z-bm-Lm-Xw h-c-cp-sX-¶-Xm-Wv e-£yw.
tI-cf - ¯n lr-Zb
- m-Lm-X¯
- n-sâ
\n-cs
- ¡-´v ?
tI-c-f¯n Zn-\w-{]-Xn 600 Hm-fw lr-Z-bm-Lm-
X§Ä kw-`-hn-¡p-¶-Xmbpw AXn 120 t]-tcm-fw
a-c-W-s¸-Sp-¶p-s≠¶p-am-Wv I-W¡v.
- n-emtWm
C-´y-bn-emtWm lr-Zb - m-LmX-
§Ä Iq-Sp-X ?
C-´ym-¡mÀ-¡v ]m-Ým-Xy- cm-Py-¯p-Å-h-
tc¡mÄ aq-¶p aS-§v lr-Z-bm-Lm-X km-[y-X-
bps≠¶v Im-Wp-¶p.
F-´p-sIm≠m-Wv C-´ym-¡mÀ-¡v
]m-Ým-Xy-cm-Py-¡m-tc¡mÄ Iq-Sp-
XÂ lr-Zb- mLm-X km[yX ?
sNdn-b c-à-¡p-g-epIÄ, ]m-c-¼-cyw, {]-ta-l,
c-à-k-½À-±w ap-X-em-b-h-bm-Wv C-´ym-¡mc-
n lr-Z-bm-Lm-Xw Iq-Sp-X Im-Wp-¶-Xn-\v
Im-c-W§Ä.

6
F-§s - \-bm-Wv NO MORE HEART F-´mWv Golden Hour Treatment ?
ATTACK - 2025 {]m-hÀ-¯n-Ia
- m¡m³ lrZ-bm-Lm-Xw h¶m B-Zy-s¯ H-cp a-Wn-
D-t±-in-¡p¶-Xv ? ¡q-dn-\pÅn i-cn-bm-b Nn-In-Õ e-`y-am-¡p-I-
bm-sW¦n a-c-W-\nc-¡v Xo-sc Ip-d-bv-¡p-hm-\
• lr-Z-b-t»m-¡p-I-f-p-sS 9 Im-cW-§Ä a-\-kn-
pw, lr-Z-b-t]-in-IÄ-¡v H«pw £-Xw Iq-Sm-sX
em¡-Ww
X-s¶ lr-Z-b-s¯ c-£n-¡p-hm\pw I-gn-bpw.
• 40 hb-kv I-gnª-h-À hmÀjn-I TMT sN-bv-Xv C-Xn-s\-bm-Wv Golden Hour Treatment F-¶v
lr-Z-bmLm-X km[y-X a-\-kn-em¡p-I ]-d-bp-¶Xv.
• lr-Z-bm-Lm-Xw kw-`-hn-¡p-¶-hÀ-¡v Golden Hour
Treatment e-`y-am¡pI (AXm-b-Xv 25 In.ao. F-§s - \-bm-Wv H-cp hy-àn-¡v lr-
DÅn Nn-In-Õm kw-hn-[m\w) Z-bm-Lm-X km-[y-Xb - p-t≠m-sb-¶v
• ss{]a-dn slÂ-¯v skâ-dp-Ifn TMT sS-Ìv a-\k
- n-em-¡p¶-Xv?
e-`y-am¡pI
C-Xn-\v G-ähpw \Ã-Xv hym-bm-aw sN-bv-Xp-
F-´mWv CARE MY MOM’N DAD sIm-≠p-Å ECG BWv. km-[m-c-W In-S-¶p-
sIm≠-v sN-¿p-¶ ECG H-cp lr-Z-bm-Lm-Xw
t{]m-{Kmw ?
\-S-¡p-t¼mÄ am-{X-ta hy-Xn-bm\-§Ä Im-Wn-
AÑ\-½a - mÀ-¡v lr-Zb - m-Lm-Xw h¶m G-ähpw ¡p-I-bpÅq. Nn-e-t¸mÄ h-f-sc-b-[n-Iw t»m-
Iq-Sp-XÂ _p-²n-ap-«\ - p-`h
- n-t¡≠--n h-cp¶-Xv Ip-«n-I- ¡p-I-fpw, \m-sf-¯-s¶-sbm-cp lr-Z-bm-Lm-Xw
fm-Wv. A-Ñt\m A-½tbm \-ãs - ¸«m A-hc - p-sS kw-`-hn-¡m-\p-ap-Å hy-àn-¡v C-¶-s¯ C-kn-
`m-hn-bn-ep≠mIp-¶ \ã-§Ä \n-I¯m³ ]-äm-¯- Pn hf-sc hf-sc t\mÀ-a B-bn h-t¶-¡mw.
XmWv. A-Xp-sIm-≠p- X - s¶, lr-Zb - m-Lm-XI- m-cW - §- ]-t£ A-t±-lw hym-bm-aw sN-bv-Xp-sIm-≠-p-Å
sf Ip-«nI-sf ]Tn-¸n-¡p-Ib - pw, X-sâ A-Ñ\ - ½ - a- mcn ECG (TMT) F-Sp-¡p-I-bm-sW¦n ECG bnÂ
B Im-cW - §-sf sN-dp-¡p-¶X - n-sâ D-¯c - h- m-ZnXzw hy-Xn-bm\-§Ä Im-Wn-¡pw.
Ip-«nI-sf Np-aX - e
- s- ¸-Sp-¯p-Ib - p-am-Wv CARE MY
MOM’N DAD F-¶X - p-sIm≠-pt±-in-¡p-¶Xv.

7
 CHAPTER
II
F-´m-Wv lr-Z-bm-Lm-Xw ?
t»m-¡p-IÄ Imc-Ww lr-Z-b-¯n-se c-à-¡p-g-ep-
IÄ s]-s«-¶-S-bp-t¼mÄ lr-Z-b-t]-in-bp-sS H-cp-
`m-Kw \-in-¡p¶p. X-Xv-^-e-am-bn tcm-Kn-¡v s]-
lrZ-bm-Lm-X-w
h¶ tcmKn
A-dn-ªn-cn-t¡≠ -
Im-cy-§Ä ?
s«-¶v s\-©p-th-Z-\bpw X-fÀ-¨bpw D-≠m-Ip¶p.
Nn-e-t¸mÄ lr-Z-b-kv-Xw-`-\hpw a-c-Whpw kw-`-hn-t¨-
¡mw. Hmtcm lr-Z-bm-Lm-Xw h-cp-t¼mgpw lrZ-b-¯n-
sâ `n-¯n-bn-se t]-inI-sf _m-[n-¡p¶p. Nn-In-Õ
e-`n-¨n-sæn Cu t]-in-IÄ \-in-¡p¶p. t]-in-
IÄ \-in-¡p-t¼mÄ ]-¼n-§v-ti-jn Ipd-ªv lmÀ-«v
s^-bv-e-dn-tem-«v t]m-Ip¶p.
lr-Z-bm-Lm-X-¯n-sâ e-£W-§Ä
F-s´Ãmw ?
km-[m-c-W s\-©n-sâ C-S-¯v `m-K-¯m-bn h-en-sbm-
cp `m-cw I-b-än-h-¨-Xp- t]m-se-bm-Wv lr-Z-bmLm-X
thZ-\. {]-ta-l-tcm-K-ap-Å-h-cnepw a-äp Nn-e-cn-epw
8
thZ\ H-«pw A-\p-`-h-s¸-S-W-sa-¶nÃ. Nn-e-
t¸mÄ s\-©p-th-Z-\-bv¡p ]I-cw taÂ-h-
bän th-Z-\-tbm, h-b-sd-cn-¨ntem CS-Xv
tXm-f-¯v th-Z-\-tbm, Xm-Sn-bn-tem, I-gp-¯n-
sâ ]p-d-t¯m, s\-©n-sâ ]n ³-`m-Kt¯m
th-Z-\-bp-am-bn lr-Z-bm-Lm-Xw kw-`-hn-¡mw.
{]ta-lw ap-X-em-bhbp-Å-hcn s\-©p-th-Z-
\-bp≠-m-I-W-sa-¶nÃ. th-Z-\-tbm-sSm-¸w izm-
kw-h-en¡m³ _p-²n-ap«pw A-\p-`-h-s¸-Sp¶p.
lr-Z-bm-Lm-X-ambn sXän²cn¡p¶-
a-äv A-kpJ-§Ä F-s´-Ãmw ?
\m¸-Xp hb-Êp I-gn-ªh - cn s\-©t- ¯m,
h-bd - n-sâ taÂ-`m-Kt- ¯m, I-gp-¯v ap-XÂ Xm-Sn-
bn-tem, ]p-dt- ¯m, CS-Xp tXm-fntem A-km-[m-
c-Wam-b F-s´-¦nepw _p-²n-ap-«v A-\p-`h - s
- ¸-
Sp-Ib- m-sW¦n lr-Zb - m-Lm-Xa- à F-¶v Dd-¸v
h-cp-¯W - w. Kym-k{v- S-_nÄ, ]n-¯m-ib - ¯
- n-se
IÃv, ]p-fn-¨p XnI«Â ap-Xem-b ]-e A-kp-J§ - -
fpw lr-Z-bm-Lm-X-am-bn sX-än-²-cn-¡-s¸-Smw.
X-\n-¡v lr-Zb
- m-Lm-Xa
- m-sW-¶v • lr-Z-b-an-Sn-¸v {i-²n¡pI
kwi-bw h¶m H-cp hy-àn • lr-Z-b-an-Sn¸pw izm-tkm-Ñm-khpw \n-e-bv-¡p-
sN-t¿≠sX-s´-Ãmw ? I-bm-sW¦n Iq-Sp-X k-lm-bnI-sf hn-
• DS-s\ C-cpt¶m, In-St¶m hn-{i-an¡m³ fn¨v CPR (s\©n-e-aÀ-¯epw Ir-{Xn-a-izm-
{i-an¡p-I tkm-Ñm-khpw) F¶ {]-{In-b Xp-S§pI
• a-\k
- m¶n²yw hn-Sm-sX k-lm-b¯
- n-\`- yÀ-°n¡pI • tcm-Kn-sb F-{Xbpw s]s«¶v, lr-Zb
- m-Lm-X-
• ho«n B-kv-]n-cn³, Sorbitrate, GNT Spary Kp- ¯n-\v \à Nn-In-Õ \ÂIp¶ B-ip-]{- XnbnÂ
fnI-IÄ D-s≠¦n I-gn-¡pI. (Aspirin 75mg Bw-¼p-e³-kn-tem, Im-dntem F-¯n-¡p-I.
shÅ-t¯m-SpIq-sSbpw Sorbitrate ap-X-em-b-h
\m-¡n-\-Sn-bnepw, GNT Spary Bbpw)
• k-lm-bn lr-Z-b-an-Sn-¸v, ]-äp-sa¦n c-à-k-½À±w
(Electronic BP apparatus) sh-¨v A-f-¡phm³
]-d-bp-I.
• izm-k-w ap-«ps≠¦n I-tk-cbn apt¶m«v Nm-
ªv C-cn-¡p-I.
• £o-Ww h-cn-I-bm-sW¦n In-S¡pI
• ssh-Im-sX Bw-¼p-e³-kntem Im-dntem lr-
Z-b-Nn-InÕ-¡v ku-I-cy-ap-Å B-ip-]-{XnbnÂ
F-¯n-¡pI.
• izm-kX-SÊaps≠¦n Im-dn C-cn¡m³
{i-an¡pI
• Bw-¼p-e³-kn-em-sW¦n Hm-Iv-kn-P³ \ÂIp-I
F-t¸m-gm-Wv lr-Zb
- m-Lm-X¯nÂ
• X-\n-sb ss{U-hv sN-¿m-Xn-cn-¡phm³ {i-²n¡pI
s\©n ssIsIm≠-v A-aÀ-¯p¶-Xv
H-cp hy-àn-¡v lr-Zb
- m-Lm-Xa
- m-sW¶p (CPR- Cardio Pulmonary Resuscitation) ?
I≠m A-Sp-¯p-Å _-Ôpthm s\©n ssI sIm≠v A-aÀ-¯p¶-Xv
k-lm-bntbm F-´p sN¿Ww ? A-sæn sN-Ìv Iw-{]-j³ \-S-¯p-¶Xv,
• tcm-Kn-¡v ss[cyw \ÂIpI lrZ-bw \n-e-¨-Xm-bn kwi-bw tXm-¶p-
t¼mÄ, {]-[m-\s¸-« A-h-b-h-§Ä-¡v c-à-sa-
• \-½p-sS a-\-km¶n²yw \-ã-s¸-Sm-sX t\m¡pI
¯n¡m³ th≠-n-bmWv. th≠-hn-[¯n C-Xp
• B-kv-]n-cn³, Sorbitrate, GNT Spary ap-Xem-b Kp- sN-bvXm lrZ-bw \n-e-¨mepw {][m-\ A-h-
fnI-IÄ \ÂIpI (Aspirin 75mg shÅ-t¯m-sS- b-h-§fm-b X-e-t¨m-dv, hr-¡, I-cÄ ap-X-em-b-
m¸w Ign-¡m\pw Sorbitrate 5mg \m-¡n-\-Sn-bn h-bn-te-bv-¡v A-Xymh-iy c-àw F-¯n¡m³
sh-bv-¡m-\pw, GNT Spary hm-bn-e-Sn-¡m\pw) I-gn-bpw. C-tXm-sSm-¸w Ir-{Xn-a izm-tkm-Ñm-
• izm-k-X-S-Ê-ap-s≠¦n apt¶m«v B-ªv khpw \Â-IWw. sN-Ìv Iw-{]-j³ an-\p-«nÂ
C-cp¯pI 100 X-h-Wbpw Ir-{Xn-a izm-tkm-Ñm-kw an-\p-
• Xo-sc £o-W-am-sW¦n In-S¯p-I «n 16 X-h-Wbpw \Â-IWw.
• OÀ-±n-¡p-I-bm-sW¦n X-e H-cp hi-¯v N-cn-¨v
]n-Sn¡pI

9
 lr-Z-bm-Lm-X-¯n-sâ
A]-I-S e-£W-§Ä F-s´Ãmw ?
• lr-Z-b-an-Sn-¸v Iq-SÂ þ 100 Â Iq-SpXÂ
• lr-Z-b-an-Sn-¸v Xm-g þ 40 \pw Xm-sg
• izm-tkmÑm-k \nc-¡v Iq-SÂ þ 16 \p taÂ
• izm-kw In«m³ _-Ô-s¸-SÂ
• t_m-[w \-ã-amIpI
• c-à-k-½À-±w Ip-dbpI

lrZ-bm-Lm-X¯n izm-kw-ap-«v
F-´p-sIm≠v ?
h-en-sbm-cp lr-Z-bm-Lm-Xw \-S-¡p-t¼mÄ, lr-Z-b-¯n-
sâ ]-¼n-§v ti-jn Ip-d-bp-Ibpw izm-k-tIm-i-§fnÂ
càw sI-«n-In-S¡m³ C-S-h-cp-Ibpw sN-¿p¶p. Cu
A-hØ-sb e-§v I³-P-j³, ]Ä-tamW-dn F-Un-a
ap-Xem-b t]cpIfn A-dn-b-s¸-Sp¶p. Iq-Sp-X-em-hp-
I-bm-sW¦n izm-k-tIm-iw H-cp \-\-ª kv-t]
m-©v t]m-se B-Ip¶p. C¯cw k-μÀ-`-§fn iz-
kn-¡m³ _p-²n-ap-«pw, Np-abpw, Nn-e-t¸mÄ aq¡nÂ
Iq-Sn c-àw IeÀ-¶ ]-Xbpw h-cmw.
lr-Z-bm-Lm-X¯n _n-]n Iq-Sp-Itbm Ip-
d-bp-Itbm sN-¿p-¶-Xv F-´p-sIm≠-v?
lr-Z-bm-Lm-Xw h-f-sc h-ep-Xm-Ip-t¼mÄ, lr-Z-b-¯n-
\v c-àw ap-t¶m-«v ]-¼v sN-¿m-\p-Å ti-jn Ip-d-
bp¶p. A-t¸mÄ c-à-k-½À-±w Xm-tgm-«p h-t¶-¡mw.
lr-Z-bm-Lm-Xw A-{X h-en-b-X-sæn `-bw, t]-Sn
ap-X-em-b-hbm c-à-k-½À-±w Nn-e-t¸mÄ Iq-Sp¶-
Xm-bn Im-Wmw.
lr-Z-bm-Lm-X¯n lr-Z-b \nc-¡v
Iq-Sp-Itbm Ip-d-bp-Itbm sN-¿p¶-Xv
F-´p-sIm≠-v ?
t]-Sn, ]-¼n-§vti-jn Ipd-b F¶n-h sIm≠-v km-
[m-c-W lr-Z-bm-Lm-X¯n lr-Z-b-an-Sn-¸v Iq-Sp-I-bm-
Wv ]-Xnhv. km-[m-c-W lr-Z-b-an-Sn-¸v 70þ100 h-sc-bm-
Wv. Nn-e k-μÀ-`-§fn lr-Z-b-an-Sn-¸v 30þ40 h-sc
Xm-gmw. Cu A-hØ-sb lmÀ-«v t»m-¡v F-¶m-Wv
]-d-bp-¶-Xv.
lr-Zb
- m-Lm-X¯n hn-bÀ¡p¶-Xv
F-´p-sIm≠v ?
lr-Z-bm-Lm-X-¯n-sâ kv-s{S-Êpw, th-Z-\-bpw,
`-bhpw Imc-Ww c-à¯n Nn-e tlmÀ-tam-
Wp-IÄ D-Xv-¸m-Zn-¸n-¡-s¸-Sp¶p. Cu tlmÀ-
tam-Wp-IÄ aq-e-am-Wv B-Lm-X¯n hn-bÀ-
¸v A-\p-`-h-s¸-Sp-¶-Xv.
F-´p-sIm-≠m-Wv Nn-e B-ip-]-{Xn-
IÄ lr-Z-bmLm-X tcm-KnI-sf
kzo-I-cn-¡m¯-Xv ?
lr-Z-bm-Lm-Xw h-¶m 10 i-X-am-\w a-c-W-
km-²y-X-bp≠v lr-Z-b-tcm-K hn-Z-Kv-²-tcm,
Ft¡m-ImÀ-Untbm-{Kmw, kn-kn-bp (sIm-td-
mW-dn sI-bÀ bq-Wn-äv), Im-¯v-em-_v ap-Xem-b
ku-I-cy-§-fnÃm-¯ B-ip-]-{Xn-Ifn a-c-W
\nc-¡v Iq-Sp-X-em-bn-cn-¡pw. Nn-e-t¸mÄ Po-h-
t\m-sS B-ip-]-{Xn-bn-se-¯n-¨m-epw, Nn-In-Õ-
bv-¡n-Sbn ]-e Im-c-W-§-fmepw ac-Ww kw-
`-hn-t¨-¡mw. G-ä-hpw an-I-¨ ku-I-cy-§fpw
hn-Z-Kv-²cpw D-Å B-ip-]-{Xn-bn F-¯n¨mÂ
t]mepw Nn-e Im-c-W-§fm ac-Ww kw-`-hn-
t¨-¡mw.

10
 G-ähpw ^-e-{]-Z-amIq. lrZ-bmLm-X Nn-In-Õ
In-«m-\n-S-bnÃm-¯ B-ip-]-{Xn-Ifn t]m-bn
ka-bw I-f-bp¶-Xv H-gn-hm-¡Ww.

lr-Z-bmLm-X tcm-Kn-¡v A-Xymln-X

hn-`m-K¯n \Â-Ip-¶ Nn-InÕ-IÄ
F-s´Ãmw ?
\-gk
v- p-am-cpw, tUm-ÎÀ-amcpw Gähpw Iq-Sp-XÂ
{i-²n-¡p¶-Xv tcm-Kn-bp-sS HmÀ-½, izm-tkm-
Ñmkw, c-௠- n-se Hm-Ik v- nP-sâ A-fhv, lr-Z-
b-an-Sn¸v, c-àk-½À-±w ap-Xe - m-bh - b
- m-Wv. C-hb-
n Gähpw {]-[m-\w i-co-c¯ - n-se Hm-Ik v- n-P³
\nc-¡v t\mÀ-a B-¡p-Ibpw c-àk - ½ - À-±h - pw,
lr-Zb - a
- n-Sn¸pw km-[m-cW - b- m-¡e - p-amWv. th-Z\ - b
- v-
¡v a-cp-¶v \Â-Ipw. BZyw Hm-Ik v- n-P³ \Â-Ipw.
lr-Zb - a
- n-Sn-¸v t\m-¡m-\m-bn i-co-c¯n C.kn.Pn
eo-Up-IÄ L-Sn-¸n-¡pw. i-co-c¯ - n-se Hm-Ik v- n-P³
se-h t\m-¡m-\m-bn ssI-hn-cen sN-dn-sbm-cp
lr-Z-bm-Lm-X-¯n-sâ A-]-IS-§Ä ]Ä-kv Hm-Ik v- n-sa{Sn F-¶ D-]I - c-Ww L-Sn-¸n-
F-s´Ãmw ? ¡pw. c-àk - ½ - À-±w Xp-SÀ-¨b - m-bn t\m-¡p-hm-\
• ac-Ww kw-`-hn-¡m-\p-Å km-[y-X : 15 i-X-am\w p-Å I^v ssI¿n sI-«p-¶p. i-co-c¯ - n-se Hm-Iv-
({Km-a-§-fn-em-sW-¦n 20% Dw Urban area I-fn kn-P³ \n-c¡ - pw, c-àk - ½- À-±h - pw, lr-Zb - a- n-Sn¸pw
10%hpw) km-[m-cW - b- m-¡n-bX - n-\p ti-jw lr-Zb - m-Lm-Xw
X-s¶-bm-tWm-sb-¶v Øn-co-Ic - n-¡m-\p-Å C.kn.
• izm-k-tIm-i¯n sh-Åw-sI«Â (]-Ä-saW-dn
Pn, c-IX v- s - S-kä v- pIÄ, F-t¡m-ImÀ-Un-tbm-{Kmw
F-Una)
F-¶o ]-cn-tim-[\-IÄ \-S¯ - pw.
• tjm¡v (c-à-k-½À-±w hf-sc Ip-d-ª AhØ)
• lr-Z-b-¯n-sâ `n-¯n-¡v \miw kn-kn-bphn s\-©n Nn-e h-b-dp-
• lr-Z-b hmÂ-hn-\v eo-¡v kw-`-hn¡mw IÄ L-Sn-¸n-¡p¶-Xv F-´n-\m-Wv ?
• lmÀ-«v t»m-¡v ( lr-Z-b-an-Sn-¸v hf-sc Xm-gp-¶Xv) C-kn-Pn Xp-SÀ-¨-bm-bn tam-Wn-ädn Im-Wp-
• hr-¡ X-I-cm-dn-emh (In-Uv-\n s^-bveÀ) hm\pw lr-Z-b-an-Sn-¸v \n-co-£n-¡p-hm\pw th
≠n-bm-WnXv.
lr-Z-bm-Lm-Xw h¶m G-Xv B-ip-]-{Xn-
bn sIm≠pt]m-IWw ?
lr-Z-bmLm-X ac-Ww H-gn-hm¡m³ B-[p\n-I ku-
I-cy-§-fp-Å B-ip-]-{Xn-bn F-{Xbpw th-Kw
F-¯n-¡p-I F-¶-Xm-Wv G-ähpw {]-[m\w. lr-Z-
b-tcm-K hn-Z-Kv-²-tcm, Im-¯v-em-_v ku-I-cy-§tfm
D-Å A-Sp-¯p-Å B-ip-]{Xn sX-c-sª-Sp-¡Ww.
s\-©p-th-Z-\ h-¶v H-cp a-Wn-¡q-dn-\pÅn B-ip-
]-{Xn-bn-se-¯n-bm-em-Wv lr-Z-bmLm-X Nn-In-Õ

11
 lr-Z-bm-Lm-X¯n apJ-¯v am-kv-Iv
sh-¨v Hm-Iv-kn-P³ \Â-Ip¶-Xv F-´n-\v ?
lr-Z-bm-Lm-X Nn-In-Õ-bn-se G-ähpw {][m-\ `m-K-
am-Wv Hm-Iv-kn-P³ \ÂIp-I F-¶-Xv. lr-Z-bm-Lm-
X¯n t]-in-IÄ-¡v t»m-¡v aq-ew Hm-Iv-kn-P³ In-
«m-Xn-cn-¡p-I-bm-Wv sN-¿p-¶-Xv.
kn-kn-bphn hn-c-ep-IfnÂ
L-Sn-¸n¡p-¶ D-]-Ic-Ww F-´m-Wv ?
]Ä-kv Hm-Iv-kn-sa{Sn F¶- D-]-I-c-W-am-WnXv. Cu
D-]-Ic-Ww tam-Wn-«dn L-Sn-¸n-¨v c-à-¯n-se Hm-
Iv-knP-sâ Af-hv Im-Wphm\pw A-X-\p-k-cn-¨v Hm-
Iv-kn-P³ \Â-Ip-¶-Xn-sâ Af-hv \n-b-{´n-¡phm\pw
km-[n-¡pw.
kn-kn-bphn tcm-Kn-bp-sS
Øn-Xn ho-£n-¡p¶-Xv F§-s\ ?
tcm-Kn-bp-sS izm-k-\n-c¡v, lr-Z-b-an-Sn¸v, c-à-k-
½À±w, C-knPn, c-à¯n Hm-Iv-knP-sâ Af-hv
F¶n-h tcm-Kn-sb L-Sn-¸n¡p-¶ tam-Wn-ädn A-dn-
bm³ I-gn-bpw. C-sXÃmw t\m-¡n-bm-Wv tUm-ÎÀ-am-
cpw, \-gv-kp-amcpw Nn-In-Õ \n-Ý-bn-¡p-¶Xv.
s\-©p-th-Z-\-bv-¡v G-Xv a-cp-¶m-Wv
\Â-Ip¶-Xv ?
s\-©p-th-Z-\-bv-¡v km-[m-c-W \ÂIp-¶ a-cp-¶p-IÄ
tamÀ^n³ F-¶ th-Z-\ kw-lm-cn-tbm A-h-bp-sS
h-I-t`-Z-§tfm c-à-¡p-g-epI-sf hn-I-kn-¸n¡m³
12
I-gnbp-¶ s\-t{Sm-¥n-k-dn³, tkmÀ-_n-t«-äv ap-
Xem-b a-cp-¶p-I-tfm BWv. tamÀ^n³ F-¶
th-Z-\ kw-lm-cn i-co-c-¯n-se-¯p-t¼mÄ th-
Z-\ Ip-d-bp-¶-Xn-\p ]pd-sa sN-dp-Xm-bn a-b-¡w
In-«p-Ibpw C-Xp-aq-ew t]Sn, B-Imw-j ap-X-em-
b-h Ip-d-bp-Ibpw sN-¿pw.
lr-Z-bm-Lm-X¯n izm-kw-ap-«Â Nn-
In-Õn-¡p¶-Xv F§-s\ ?
izm-k-tIm-i-¯n sh-Åw sI-«n-b-Xm-Wv
izm-kw-ap-«-en-\p Im-cWw. [m-cm-fw aq{Xw t]
m-Im-\p-Å Ubqd-än-Iv F-¶ a-cp-¶m-Wv C-Xn-
\v \Â-Ip-¶Xv. F-¶n«pw B-izm-kw e-`n-¡p-
¶n-sæn Ir-{Xn-a izm-tkm-Ñm-kw \Â-Ip-¶
CPAP Machine A-sæn shân-te-äÀ F-¶
D-]-I-c-W-§-tfm-Sv L-Sn-¸n-¡p-¶p.
lr-Z-bm-Lm-X-¯n c-à-k-½À-±-s¯
Øn-c-s¸-Sp-¯p¶-Xv F§-s\ ?
lr-Z-bm-Lm-X-¯n c-à-k-½À-±w Iq-Sp-It-
bm Ip-d-bp-Itbm sN-¿mw. Iq-Snbm e-§v
I³-P-j³ aq-e-ap-Å izm-kw-ap-«epw Ip-
dªm hr-¡, IcÄ, X-e-t¨m-dv ap-Xem-b
A-h-b-h-§Ä-¡v A-]-I-Shpw kw-`-hn-¡mw.
c-à-k-½À-±w Ip-d-bv-¡m³ c-à-¡p-g-epI-
sf hn-I-kn-¸n¡p-¶ a-cp-¶p-IÄ \Â-Ip¶p.
c-à-k-½À-±w Ip-d-bp¶-Xv lr-Z-b-¯n-sâ
]-¼n-§v ti-jn Ip-d-bp¶-Xp sIm≠m-Wv.
]-¼n-§v ti-jn Iq-Sp-¶ t\mÀA-s{U\m-
en³, A-s{U-\m-en³, tUm-_p-Sman³ ap-
Xem-b a-cp-¶p-I-fm-Wv c-à-k-½À-±-s¯
D-bÀ¯m³ D-]-tbm-Kn-¡p-¶-Xv. F-¶n«pw
c-à-k-½À-±w D-b-cp-¶n-sæn IABP (
Intra-aortic Balloon Pump), ECMO (Extracor-
poreal Membrane Oxygenation) apXem-b D-]-
I-c-W-§-fp-sS k-lm-b-t¯m-sS c-à-k-½À-
±-s¯ D-bÀ-¯m-\m-Ipw.
lr-Z-b-an-Sn-¸n-s\ Øn-c-s¸-Sp-¯p¶-Xv
F-§-s\ ?
lr-Z-b-an-Sn-¸v Iq-Sp-Itbm Ip-d-bp-Itbm B-hmw.
th-Z-\-bp-sS a-cp¶pw a-b-¡-¯n-\p-Å a-cp¶pw
Iq-Sn I-gn-¡p-t¼mÄ lr-Z-b-an-Sn-¸v km-[m-c-W
\n-e-bn-te-¡v h-cmw. \n-c-¡v 30þ40 te-¡v Xm-
gp-I-bm-sW-¦n-epw A-s{U-\m-en³, tUm-]an³
ap-Xem-b a-cp-¶p-Ifm D-b-cp-¶n-sÃ-¶p ImÂ
sSw-]d-dn t]-kv-ta-¡À F-¶ D-]-Ic-Ww L-Sn-
¸n-t¡-n h-cpw. Im-¯v-em_n h-¨m-Wv C-Xv
sN-¿m-dp-ÅXv.

lr-Z-bmLm-X tcm-Kn-¡v kw-`-hn-¡m-

hp-¶ am-\-kn-I k-½À±-§Ä
lr-Z-bmLm-X tcm-Kn-¡v a-c-W-`bw, t]Sn,
Bi-¦, \n-cm-i, tZ-jyw ap-X-em-b-h km-[m-c-
W-am-Wv. {I-ao-I-cn¡m³ {]-bm-k-ap-Å-Xm-sW-
¦nepw C¯-cw a-\-{]-bm-k-§Ä lr-Z-b-s¯
lm-\n-I-c-am-bn _m-[n-¡p-sa-¶-Xn\m ]-c-amh-
[n a-\-Ên-s\ im-´-am¡m³ {i-an-¡-Ww. {]
mÀ°-\, [ym-\w ap-X-e-bm-b-h Cu A-h-Ø-
bn io-en¡m³ {i-an-¡-Ww. A]I-S-sam¶pw
kw-`-hn-¡m-sX B-ip-]-{Xnbn F¯m³ I-gn-
ª-tÃm, C-\n tUm-ÎÀamÀ th≠-Xp sN¿pw
F-¶v B-iz-kn¡m³ t\m-¡Ww.

sIm-tdmW-dn sI-bÀ bq-Wn-äv (CCU)

A-Xymln-X hn-`m-K¯n h-¶ lr-Z-bm-

Lm-X tcm-Kn-bp-sS B-tcm-Ky\n-e {I-ao-I-cn-¨p
I-gnªm Xp-SÀ-¶p-Å Nn-In-Õ \ÂIp-¶
Ø-e-amWv knknbp. lr-Z-bm-Lm-X-¯n-sâ
F-Ãm A-]-I-Sm-h-Ø-I-tfbpw t\-cn-Sm-\p-Å
k-Öo-I-cW-§Ä knknbphn D-≠m-Ipw.

lr-Z-bm-Lm-X-am-sW-¶v
Dd-¸ph-cp-¯p¶-Xv F§-s\ ?
C-kn-Pnbn hy-Xn-bm\-§Ä I-m Trop-T,
ImÀ-Un-bm-Iv F³-ssk-ap-IÄ F-¶ »-Uv
sS-Ìp-IÄ sN-¿pw. Cu »-Uv sS-Ìp-IÄ t]
m-kn-äo-hv B-bn h-¶mÂ, lr-Z-b-t]-in-IÄ¡v
\m-iw h-¶n-«p≠-v A-Xmb-Xv lr-Z-bm-Lm-X-am-
sW-¶À-°w. B ³ssP-\bn (Angina)
13
 C-kn-Pn bn hy-Xymk-§Ä Im-Wm-sa-¦n-epw Trop-T ap-
Xem-b ImÀ-Un-bm-Iv F³-ssk-ap-IÄ c-à¯n Im-
WnÃ. Ckn-Pnbn t\m-¡n lr-Zb - ¯
- n-sâ G-Xp `m-K-
¯m-Wv B-Lm-Xw \-S¡ - p-¶s
- X-¶v a-\Ê
- n-em-¡mw.
FÃm s\-©p-th-Z-\bpw lr-Z-bm-Lm-X-
amtWm ?
B-h-W-sa-¶nÃ. lr-Z-b-t]-in-IÄ-¡v \m-iw h-cp-
t¼mÄ am-{X-am-Wv lr-Z-bm-Lm-Xw F-¶v hn-fn-bv-¡p-
¶Xv. B³ssP-\ (Angina) F-¶p hn-fn-bv-¡-s¸-Sp¶-Xv
lr-Z-bm-Lm-X-¯n-\v -ap-¼p-Å s\-©p-th-Z-\-sbbm-
Wv. t»m-¡p-IÄ aq-ew lr-Z-b-t]-in-IÄ-¡v c-àw
Ip-d-bp¶-Xv aq-e-am-Wv C-Xp-≠m-Ip-¶Xv. \-S-¡p-t¼m-
tgm, hym-bm-aw sN-¿p-t¼mtgm B-Wv Cu th-Z-\-bp-
≠m-Ip-¶Xv. Cu k-μÀ-`¯n lr-Z-b-t]-in-IÄ-¡v
\m-iw kw-`-hn-¡p-¶nÃ.
14
F-´m-Wv
tKmÄ-U³
AhÀ? (Golden Hour)
lr-Z-bm-Lm-X-s¯ Xp-SÀ-¶p-Å B-Zy-
s¯ H-cp a-Wn-¡q-dn-s\-bm-Wv tK-
mÄ-U³ AhÀ F-¶v ]-d-bp-¶Xv. Cu
B-Zy-s¯ H-cp a-Wn-¡q-dn-\pÅnÂ
i-cnbm-b Nn-In-Õ \Â-Inbm lr-
Z-b-¯n-\v H«pw \m-iw kw-`-hn-bv-¡m-
sX lr-Z-b-s¯ kw-c-£n-¡mw. Cu
k-a-bw ac-Ww kw-`-hn-¡m-\p-Å km-
[y-Xbpw Iq-Sp-X-emWv.
BkvX-a, c-à-k-½À±w, {]-ta-lw,
hr-¡-tcmKw, I-cÄ tcm-Kw ap-X-em-b-
h-bp-Å tcm-Kn-IÄ-¡v lr-Z-bm-Lm-Xw
kw-`-hn-¡p-t¼mÄ {i²nt¡≠sX-
s´Ãmw ?
Cu tcm-K-§-sfÃmw lr-Z-bm-Lm-X k-ab-¯v
i-co-c-s¯ {]-Xn-Iq-e-am-bn _m-[n-¡mw. lr-Z-
bm-Lm-X-¯n-\v D-]-tbm-Kn¡p-¶ a-cp-¶p-I-fpw,
B³-Pn-tbm-{Kmw, B³-Pn-tbm-¹m-Ìn ap-X-em-b-
hbn D-]-tbm-Kn¡p-¶ ssU F-¶ a-cp¶pw
aäpw hr-¡I-sf Im-cy-am-bn _m-[n-¡mw. {]-ta-
lw \n-b-{´n¡m³ _p-²n-ap-«p-≠m-tb-¡mw.
 Im-¯v- em_n Ib-än F-¶-Xm-Wv.

lr-Zb
- m-Lm-X¯
- n-sâ aq-¶v {][m-\
X-c¯
- n-ep-Å Nn-InÕ-IÄ ?
• t{Xmw-t_m-sse-knkv (Thrombolysis) AY-
hm a-cp-¶v D-]-tbm-Kn-¨v [-a-\nbn I-«-]n-Sn-
¨ c-à-¯n-s\ A-en-bn¡pI
• ss{]a-dn B³-Pn-tbm-¹m-Ìn (Primary Angio-
plasty)
F-´n-\m-Wv lr-Z-bm-Lm-X¯n Ft¡m
• A-Sn-b´n-c ss_-¸m-kv kÀP-dn (Emergen-
sS-Ìv sN-¿p-¶-Xv ?
cy Bypas Surgery)
Ft¡m sS-Ìv F-¶v ]-d-bp¶-Xv i-Ð-X-cwK-§Ä
D-]-tbm-Kn-¨v lr-Z-b-¯n-sâ {]-Xn-_nw-_w Im-Wp- F-´m-Wv t{Xmw-t_m-sse-kn-kv ?
¶-Xm-Wv. lr-Z-b-¯n-sâ h-ep¸w, `n-¯n-I-fp-sS (Thrombolysis)
A-\-¡§Ä, lr-Z-b-¯n-sâ A-d-IÄ-¡pÄ-`mKw,
s]-s«-¶p-≠m-Im-\p-Å lr-Z-bm-Lm-X-¯n-\p
lr-Z-b-¯n-sâ hmÂ-hp-IÄ ap-X-em-b-h Ft¡m
Imc-Ww lr-Z-b-[-a-\n-Ifn s]-s«-¶v c-àw
ImÀ-Un-tbm-{Kmw h-gn a-\-kn-em-¡mw. lr-Z-bm-Lm-
I-«-]n-Sn-¡p-¶-Xm-Wv t{Xmw-t¼m-ssI-s\-bv-kv,
Xw \-S¡p-¶ `n-¯n G-Xm-sW-¶v Ft¡m ImÀ-Un-
bq-tdm-ssI-s\-bvkv ap-Xem-b Nn-e a-cp-¶p-IÄ
tbm-{Kmw h-gn A-dn-bm-\m-Ipw. ]pd-sa `n-¯n-bnÂ
C³-P-£-³ h-gn \Â-In c-à-[-a-\n-I-fn-se
Zzm-cw ho-Wn-«pt≠m, B-Lm-X-¯n-sâ `m-K-am-bn
c-à-¡-«I-sf A-en-bn¡m³ I-gn-bpw. lr-Z-
hmÂ-hn-\v eo-¡v kw-`-hn-¨n-«p-t≠m, lr-Z-b¯nÂ
bm-Lm-Xw h-¶v B-dv a-Wn-¡q-dn-\pÅn Cu
c-àw I-«-]n-Sn-¨n-«pt≠m ap-X-em-b-hbpw Ft¡m
a-cp-¶v \Â-IWw. Gähpw Kp-Ww e-`n-¡p¶-Xv
ImÀ-Un-tbm-{Kmw h-gn Xn-cn-¨-dn-bmw.
H-cp a-Wn-¡q-dn-\pÅn \Â-In-bm-emWv.
lr-Z-bm-Lm-X¯n `n-¯nbn kp-jn-cw
ho-gp-¶Xpw hmÂ-hn-\v eo-¡v kw-`-hn-¡p-
¶Xpw F-´p-sIm≠-v ?
`n-¯n-bn-se t]-in-IÄ \-in-¨mÂ, B `m-Kw ZpÀ-_-
e-am-bn kp-jnc-§Ä ho-gmw. lr-Z-b-hmÂ-hpI-sf ]
n-Sn-¨p \nÀ¯p-¶ t]-in-IÄ B-Lm-X¯m ZpÀ-_-
e-ambm hmÂ-hp-IÄ¡v eo-¡v kw-`-hn-¡mw.

F-´m-Wv tUmÀ Sp \o-UnÂ, tUmÀ Sp

tUmÀ ssSw F¶nh ? (Door to Needle,
Door to Door)
lr-Z-bm-Lm-Xw h¶m G-ähpw s]-s«-¶v Nn-In-Õ
\Â-I-Ww. tUmÀ Sp \oUn ssSw F-¶mÂ, B-ip-
]-{Xn-bn-se-¯n F-{X an-\p-«n-\pÅn cà-¡-«
A-en-bn-¡m-\p-Å a-cp-¶v \Â-In F-¶-XmWv. tUmÀ
Sp tUmÀ ssSw F-¶mÂ, F-{X k-a-b-¯n-\pÅnÂ

15

F-´m-Wv ss{]a-dn B³-Pn-tbm-¹m-Ìn ?
Primary Angioplasty
t{Xmw-t_m-sse-kn-kn-t\-¡mfpw Iq-Sp-XÂ ^-e-{]-
Zam-b Nn-In-Õ-bm-Wv Cu Nn-In-Õ. Cu Nn-In-Õb-
n Im-¯v em-_v F-¶ D-]-I-c-W-ap-Å ap-dn-bn-te-¡v
tcm-Kn-sb am-äp¶p. ssI-bn-te-tbm Im-en-tetbm
c-à-¡p-g h-gn lr-Z-b-[-a-\n-I-fn-te-¡v hbÀ Ibän
FIvktd F-Sp-¡p¶p. Cu FIvktdbn lr-Z-bm-
Lm-X-ap≠m¡n-b X-S-ʧ-sf hr-à-am-bn ImWm³
km-[n-¡pw. Cu X-S-ʧ-sf _-eq¬ sh-¨v hn-I-kn-
¸n-¨v kv-säâ v C-«v t»m-¡v am-äm³ I-gn-bpw. cà¡-«-
I-fp-s≠¦n h-en-s¨-Sp-¡p-hm-\pw I-gn-bpw.
F-´m-Wv Im-¯v-em_v ?
B³-Pn-tbm-{Kmw, B³-Pn-tbm-¹m-Ìn ap-X-em-b-h Im-
¯v-em_n h-¨m-Wv \-S-¯p-¶Xv. c-à-¡p-g-en-te-¡v
H-cp hbÀ IS-¯n F-Ivk-td D-]-tbm-Kn-¨v c-à-¡p-g-
16
en-sâ {]-Xn-_nw-_-sa-Sp-¡p-I-bm-Wv Cu D-]-
Ic-Ww sN-¿p-¶-Xv.
F-t¸m-gm-Wv F-aÀ-P³-kn
ss_-]mÊv kÀ-Pdn ?
lr-Z-bmLm-X k-ab-¯v km-[m-c-W ss_-]
mÊv Hm-¸-td-j³ H-gn-hm-¡p-I-bm-Wv ]-Xnhv.
F-¦nepw Nn-e-t¸mÄ t»m-¡p-IÄ B³-Pn-
tbm-¹m-Ìn h-gn \o¡m³ I-gn-bm-sX h-cp-I-
bpw, DS-s\ X-s¶ c-≠m-a-sXm-cp lr-Z-bm-Lm-
X-¯n-\v km[y-X Im-Wp-I-bpw, lr-Z-b¯nÂ
kp-jn-c-tam, hmÂ-hn-\v eot¡m h-cn-Itbm
B-sW¦n Po-h³ c-£n¡m³ A-Sn-b´n-c
ss_-¸m-kv kÀP-dn B-h-iy-am-bn h-cpw.
F-{X Znhkw knknbphn I-gnb-Ww ?
lr-Z-bmLm-X Nn-In-Õ t{Xmw-t_m-sse-
knkv, B³-Pn-tbm-¹m-Ìn ap-X-em-b-h h-gn-bm-
sW¦n aqt¶m \mtem Znhkw CCU hnÂ
I-gn-tb≠-n h-cpw. lr-Z-b-an-Sn-¸pw, c-à-k-½À-±-
hpw, s\-©p-th-Z-\-bpw, izm-k-X-S-k-hpw Øn-
co-I-cn¨m a-cp-¶p-I-sfm-s¡ Ipd-¨v {I-ta-W
C-cn-¡m\pw \-S-¡m-\pw Xp-S-§pw. CXn-s\
dolm-_n-en-tä-j³ (Rehabilitation) F-¶v
]-d-bp¶p. \-S-¡m-\m-bm ap-dn-bn-te-¡v am-äpw.

ap-dnbn sN¶m {i-²nt¡≠

­-I
­- m-cy§Ä ?
lr-Z-b-¯n-sâ A-h-Ø Øn-co-I-cn¨ ti-j-am-Wv
ap-dn-bn-te-¡v am-äp-¶Xv. ho≠pw s\-©p-th-Z-\-tbm,
izm-kw-ap-«-tem, a-äv _p-²n-ap-«p-Itfm D-≠m-hm-\p-Å
km[y-X hf-sc Ip-d-hmWv. {Ita-W \-S-¡m\pw
_m-¯v-dqan t]m-Im\pw {i-an-¡Ww. e-Lphm-b
B-lmc-§Ä I-gn-¡m³ {i-an-¡p-I. ]-I ka-bw
D-d-§p-I-tbm, Iq-Sp-XÂ th-h-em-Xn-s¸-Sp-Itbm sN-
¿p-I-bm-sW¦n cm-{Xnbn D-d-¡-¡pd-hv A-\p-`-h-
s¸-Spw. a-e_-Ôw D-≠m-Im-Xn-cn-¡m-\m-bn ^-e-§f-
pw k-meUp-Ifpw I-gn-¡p-I. hmÀ-Un h-¶v H-¶v
c≠-v Zn-h-k-§Ä¡-Iw Ip-fn¡m³ km-[n-¡pw. B³-
Pn-tbm-¹m-Ìn sNbv-X ap-dn-hp-IÄ \-gv-kn-tâtbm
tUm-Î-dp-tStbm \nÀ-t±-i-{]-Im-cw {i-²n-¡p-I. ho-«n-
te-¡v t]m-Ip-¶-Xn-\v ap-¼v tUm-Î-dp-sS \nÀ-t±-i-{]-
Im-cw tIm-Wn-IÄ Ib-dn ]-cn-io-en-¡m-hp-¶-Xm-Wv.

km-[mcW Ignt¡≠
a-cp-¶p-IÄ F-s´Ãmw ?
• B-kv-]n-cn³/ t¢m-]n-tUm{KÂ (Aspirin, Clopi-
dogrel )
Cu c≠-v a-cp-¶p-Ifpw c-àw I-«-]n-Sn-¡m-Xn-cn- B-Lm-X-¯n-\p ti-jw lr-Z-b-¯n-\v
¡p-¶-Xn-\p th-n-bm-Wv. CXn B-kv-]n-cn-\v h-b- F-´v kw-`-hn-¡p-¶p ?
sd-cn¨n Iq-Sp-X-emWv. D¨`-£-W-¯n-\p ti- B-Lm-Xw h-¶mepw H-cp a-Wn-¡q-dn-\pÅn i-cn-
jw am{Xw I-gn-¡p-I. bm-b Nn-In-Õ e-`y-am-¡nbm lr-Zb - t- ]-in-IÄ-
• sat{Sm-t{]m-temÂ, A-ä-t\m-temÄ, _ntkm-{]- ¡v H«pw \miw Iq-Sm-sX c-£n-¡mw. i-cnbm-b
temÄ Nn-In-Õ e-`n-¨n-sæn H-cp `n-¯n ZpÀ-_e - a
- m-
_o-äm-t»m-¡À F-¶ {Kq-¸nÂ-s¸-Sp-¶-Xm-Wv Cu tb-¡pw. FÃm `n-¯n-Ifpw i-àa - m-sW¦nÂ
a-cp-¶pIÄ. lr-Z-b-an-Sn¸pw, c-à-k-½À-±hpw Ip- lr-Zb - ¯ - n-sâ {]-hÀ-¯\ - t- i-jn 70 i-Xa - m-\w
d-bv-¡pw. BWv. B-Zy-s¯ lr-Zb - m-Lm-Xw i-cnbmw hn-[w
• dman-{]nÂ, tem-kmÀSm³ (Ramipril, Telsan, Losar) Nn-In-Õn-¨n-sæn ti-jn 30þ40 i-Xa - m-\a- m-bn
c-à-k-½À-±w Ip-d-bv-¡p-¶p Ip-db- pw. c≠-ma - Xpw h-¶m 20 i-Xa - m-\a- m-bn
Ip-dt- ª-¡mw. am-{X-aà lr-Zb - Ad-IÄ h-ep-
• em-kn-Ivkv, ssU-sSÀ, A-an-{^p-w ( Lasix, Dytor,
Xm-hm\pw Xp-S§ - pw. Cu A-hØ - bn lmÀ-«v
Amifru)
s^-be v- d
- n-sâ izm-kw-ap-«Â B-cw-`n-¡pw. lrZ-bw
aq{Xw Iq-SpX t]mbn, izm-k-tIm-i-¯n-sâ h-ep-Xmhm³ Xp-S§ - nbm {Ita-W hmÂ-hp-IÄ
I³Pj³ Ipd-¨v lr-Z-b-¯n-sâ ]-¼n-§v ti-jn Iq- eo-¡v sN-¿m\pw Xp-S§ - pw.
«p-¶-Xn-\p th≠-n-bm-Wv Cu a-cp-¶v \Â-Ip-¶-Xv.

17
 F-´m-Wv lmÀ-«v s^-bveÀ ?
(Heart Failure)
lrZ-bw A-Xn-sâ [À-½am-b ]-¼n-§v F-¶
{]-hÀ¯-\w Ip-d-bv-¡p-t¼mÄ D≠-mIp-¶ izm-k-X-
Skw, ssI-Im-ep-IÄ \o-cp-sh-bv-¡Â ap-X-em-bh-sb
B-Wv lmÀ-«v s^-bv-eÀ F-¶v ]-d-bp-¶Xv. C-Xv H-cp
lmÀ-«v A-äm-¡v \-S-¡p-t¼m-tgm, i-cnbm-b Nn-In-Õ
e-`n-¡m-Xn-cp¶m lr-Z-bm-Lm-X-¯n-\p ti-jtam
kw-`-hn-¡mw. Ht¶m ct≠m lmÀ-«v A-äm-¡p-IÄ
kw-`-hn-¡p-t¼m-gpw i-cnbm-b Nn-In-Õ e-`n-¡m-Xn-cn-
¡p-t¼mgpw lmÀ-«v s^-bv-eÀ kw-`-hn-¡pw.
ho«n t]mbm F-s´m-s¡
{i-²n¡-Ww ?
B-Zy-s¯ c≠-m-gv-¨ ho«n X-s¶ I-gn-¨p Iq«m³
{i-²n-¡p-I. sNdn-b sNdn-b ho-«p-tPm-en-IÄ B-hmw.
F-t¸mgpw I-«n-en In-S-¡p¶-Xv \Ã-XÃ. c-≠m-gv¨-
¡p ti-jw ho-Sn-\v ]p-d-¯nd-§n Nn-e-h-gn¡m³ {i-an-
¡Ww. B-dm-gv-¨-bv-¡p ti-jw tUm-Î-sd I-≠ti-
jw tPm-en ]p-\-cm-cw-`n-¡p-hmt\m bm-{X-bv-¡v t]
m-Ip-hmt\m {i-an-¡-Ww.
A-Sp-¯ sN-¡-¸p-IÄ F-s´ms¡,
F-t¸mÄ ?
H-cp lr-Z-bm-Lm-Xw I-gn-ªm lr-Z-b-¯n-\v hn-{i-
aw sIm-Sp-¡p-I, lr-Z-b-¯n-\v Iq-Sp-XÂ _-e-£o-
Ww h-cm-sX t\m-¡p-I, c≠-m-a-sXm-cp lr-Z-bm-
Lm-Xw H-gn-hm¡p-I ap-X-em-b-h-bm-Wv {]-[m\w.
lr-Z-b-¯n-sâ £-Xw D-W§m³ G-I-tZ-iw H-¶-c-
am-kw F-Sp-¡pw. {Ita-W Po-hn-X-¯n-te-¡v aS-§n
hcm³ do-lm-_n-en-tä-j³ D-]-I-cn-¡pw. ho«n sh-
¨v lr-Z-b-an-Sn-¸v, c-à-k-½À-±-w, c-à¯n ]-©-km-
c-bp-sS Af-hv ap-X-em-b-h {I-ao-I-cn-¡Ww. H-cm-gv-¨-
bv-¡p ti-j-ap-Å C-kn-Pn, Ft¡m ImÀ-Un-tbm-{Kmw
ap-Xem-b sS-Ìp-IÄ h-gn lr-Z-b-¯n-sâ Øn-Xn-¡v
F-´m-Wv kw-`-hn-¡p¶-Xv F-¶v a-\-kn-em-¡phm³
km-[n-¡pw.
18
ho«n t]m-Ip-¶-Xn-\p ap-¼v
F-s´Ãmw a-\-Ên-em-¡-Ww ?
F-{X t»m-¡p-IÄ D≠v, F-{X F-®w amän,
lr-Z-b-¯n-\v F-{X-am-{Xw \m-iw kw-`-hn¨p,
lr-Z-b-¯n-sâ ^w-Kv-j³ F-{X-bmWv, C-\n-
bp-Å t»m-¡p-IÄ A-äm-¡v D-≠m-¡p-hm-\
p-Å km-[y-X-bp-t≠m, c-à-k-½À±w, {]-ta-lw
ap-X-em-b-h-bp-t≠m, In-Uv\n, en-hÀ F-¶n-h-
bp-sS Øn-Xn F-´mWv, G-sXÃmw a-cp-¶p-
IÄ F-{X \mÄ I-gn-¡Ww, Hmtcm a-cp¶pw
F-´n-\m-Wv I-gn-¡p-¶Xv, a-cp-¶p-I-fpsS ]
mÀ-iz-^e-§Ä F-´m-Wv F¶n-h a-\-Ên-em-
¡Ww.
lr-Z-bm-Lm-X-¯n-\p ti-jw
`-£-W-{Ia-§Ä F-s´Ãmw ?
B-Zy-s¯ B-gv-¨-Ifn F-fp-¸w Z-ln¡p-¶
e-Lphm-b `£-Ww D-]-tbm-Kn-¡p-I. a-cp-¶p-I-
fp-sS ]mÀ-iz-^e-§Ä Imc-Ww `-£-W-t¯m-
Sv hnc-àn D≠-m-tb-¡mw. a-e_-Ôw D≠-
m-Im-Xn-cn¡m³ ^-e-§fpw km-e-Up-Ifpw
D-]-tbm-Kn-¡p-I. h-dp-¯ a-Õy-amw-k§Ä,
t_¡-dn ]-e-lm-c§Ä, Np-h-¶ amw-kw, sXm-
≠p-Å a-Õy-§Ä (sN-½o³, I-¡, R≠-
v), ap-«-bp-sS a-ª, A-[n-Iw F-®, _n-cn-bm-
Wn, s\-bv-t¨m-dv F¶n-h D-t]-£n-¡p-I. ]
Icw [m-cm-fw ^-e-hÀ-¤-§-Ä, km-e-Up-I-Ä,
a-Õy-§-Ä, ]-b-dp-hÀ-K§Ä, _-Zmw, hmÂ-\«v,
]nkv-X ap-X-em-b-h D-]-tbm-Kn-¡pI.
ho≠pw s\-©p-th-Z-\ h¶mÂ
F-´p- sN¿-Ww ?
ho≠pw th-Z-\ h¶m A-Xv B³-ssP-\ BtWm
c≠-m-a-sXm-cp B-Lm-X-amtWm F-¶v a-\-Ên-em-
¡Ww. C-Xv a-\-kn-em¡m³ B-ip-]-{Xnbn sN-¶v
C-knPn, F³-sskwkv, Ft¡m sS-Ìv ap-X-em-b sS-
Ìp-IÄ ho≠pw sN-t¿≠-Xm-bn h-cpw. \o-¡w sN-
¿-s¸-Sm-¯ t»m-¡p-I-fn \n-t¶m, B³-Pn-tbm-¹m-
Ìn h-gn-bn-« kv-säâp-IÄ-¡v t»m-¡p-IÄ h-¶mtem
C§-s\ kw-`-hn-¡m-sa-¦nepw hf-sc A-]qÀ-Æ-am-Wv.
ho≠pw lr-Z-bm-Lm-Xw h-cptam ?
t\-c-s¯ ]-d-ª-Xp-t]m-se \o-¡w sN-¿-s¸-Sm-¯
t»m-¡p-I-fp-s≠-¦n-tem, a-cp-¶p-IÄ ap-S-¡n-bm-
tem, B³-Pn-tbm-¹m-Ìnbn D-]-tbm-Kn-¨ kv-säâp-
IÄ A-S-ªm-tem, sNbv-X ss_-¸m-kp-IÄ A-S-
ªmtem ho≠pw s\-©p-th-Z-\bpw B-Lm-Xhpw
h-cmw.
ho≠pw lr-Z-bm-Lm-Xw kw-`-hn-¡m-Xn-
cn¡m³ F-´p sN¿-Ww ?
• B-Lm-X-¯n-\p ti-jw G-I-tZ-iw H-¶-c am-k-
t¯m-fw lr-Z-b-¯n-\v hn-{i-aw \ÂIp-I
• a-cp-¶p-IÄ ap-S-§m-sX I-gn¡p-I
• i-cnbm-b `-£-W-{I-aw io-en¡p-I
• c-à-k-½À±w, {]-ta-lw ap-X-em-b-h \-¶m-bn
{i-²n¡p-I
• ]p-Ih-en D-t]-£n¡p-I
• am-\-kn-I-k-½À-±w Ip-d-bv¡p-¶ hn-[w
Po-hn-XN-cy {I-ao-I-cn¡p-I
• ap-S-§m-sX sN-¡-¸p-IÄ \-S¯pI
C-\n lr-Z-bm-Lm-Xw h-cm-Xn-cn¡m³
F-s´Ãmw {i-²n¡-Ww
tUm-ÎÀ \nÀ-t±-in-¨n-cn-¡p¶-Xp t]m-se Øn-
cam-b sN-¡-¸p-Ifpw a-cp-¶p-Ifpw B-h-iy-am-
Wv. am-\kn-I _p-²n-ap-«p-Ifpw kv-s{S-Êp-am-Wv
lr-Z-b-¯n-\v {]-[m-\-lm-\n F-¶n-cn-s¡ tbm-K,
sa-Un-täj³, {]mÀ-°\-IÄ ap-X-em-b-h h-gn
a-\-Ên-s\ im-´-am-bn h-bv¡m³ {i-an-¡-Ww.
Zn-\w-{]-Xn e-Lp-hym-bm-a-¯n GÀ-s¸-SWw.
c-à-k-½À-±-hpw, ]-©-km-c-bp-sS A-f-hpw, sIm-
gp-¸n-sâ A-fhpw t\mÀ-a B-¡p-I. i-co-c-`m-cw
\n-b-{´n-¡p-I. No-¯ sIm-gp-¸p-IÄ Ipd-ª,
^-e-§fpw km-e-Up-I-fp-a-S§p-¶ B-lm-c-co-Xn
]-cn-io-en-¡pI. Aan-X-h-®-ap-s≠¦n A¶-
Pw Iq-Sp-X-e-S§n-b tNmdv, N-¸m¯n, D-cp-f-¡n-
g-§v, t\-{´¸-gw ap-X-em-b-h Ip-d-bv¡m³ {i-an-
¡pI.
19
 lr-Z-bm-Lm-X-¯n-sâ
A]-I-S e-£W-§Ä F-s´Ãmw ?
• s\-©p-th-Z\
• lr-Z-b-an-Sn-¸v Iq-S þ 80 Xn Iq-SpXÂ
• lr-Z-b-an-Sn-¸v Xm-g þ 40 \pw Xm-sg
• izm-tkmÑm-k \nc-¡v Iq-SÂ þ 16 \p taÂ
• izm-kw In«m³ _-Ô-s¸-SÂ
• t_m-[w \-ã-amIpI
• c-à-k-½À-±w Ip-dbpI

20
Space for

AD

21
 CHAPTER
III
B³-Pn-tbm-{Kman [-a-\nbn X-S-k-ap-s≠-¶v
I≠mÂ, _eq¬ sh-¨v hn-I-kn-¸n-¨v kv-säâ v C-Sp-
¶-Xn-s\-bmWv B³-Pn-tbm-¹m-Ìn F-¶v ]-d-bp-¶Xv.
F´m-Wv B³-Pn-tbm-{Kmw ?
lr-Z-b¯n t»m-¡pt≠m F-¶-dnbm³ sN¿p-¶
sS-Ìm-Wv B³-Pn-tbm-{Kmw. I¿n-tetbm Im-en-tet-
bm c-à- [-a-\n-bnÂ-¡q-Sn h-bÀ- IS-¯n lr-Z-b-¯n-
sâ [-a-\nbn {]-th-in-¨v ssU F-¶p ]-dbp-¶
a-cp-¶p Ib-än F-Ivk-td F-Sp-¡p-¶-Xm-Wv B³-Pn-
tbm-{Kmw. B³-Pn-tbm-{Kmw t\m-¡n-bm-Wv t»m-¡p-
IÄ-¡v B³-Pn-tbm-¹m-Ìn-bmtWm ss_-¸m-kmtWm
\Ã-sX-¶v \n-Ý-bn-¡p-¶-Xv.
22
F-´mWv
B³-Pn-tbm-
¹mÌn ?
F-´m-Wv Im-¯e
v- m-_v ?
lr-Z-b-c-à-¡p-g-ep-I-fn-se t»m-¡p-IÄ Im-
Wp-¶-Xn\pw t»m-¡p-IÄ am-äp-hm-\p-am-bn kv-
säâp-Ifpw aäpw C-Sp-¶-Xn-\v D-]-tbm-Kn¡p-¶
D-]-I-c-W-am-Wv Im-¯v-em_v. ssI-¿n-tetbm
Im-en-tetbm c-à-¡p-g-en Iq-Sn H-cp h-bÀ
IS-¯n lr-Z-b-[-a-\n-I-fn-te-bv-¡v a-cp-¶v C³-
P-Îv sN-bv-Xv F-Ivk-td F-Sp-¡p-I-bm-Wv C-hn-
sS sN-¿p-¶Xv. C-Xn-eqsS t»m-¡pI-sf Ir-
Xy-am-bn ImWm³ I-gn-bpw.
B³-Pn-tbm-{Kmapw B³-Pn-tbm-¹m-Ìn bpw
X-½n-ep-Å hy-Xym-k-sa-´v ?
B³-Pn-tbm-{Kmw sS-kä
v- pw B³-Pn-tbm-¹m-Ìn Nn-In-
Õ-bp-amWv. B³-Pn-tbm-{Kman t»m-¡pI-sf am{Xw
Im-Wp¶p. B³-Pn-tbm-¹m-Ìnbn t»m-¡pI-sf
F-´m-Wv ss{]a-dn B³-Pn-tbm-¹m-Ìn?
lr-Z-bm-Lm-X-¯n-\v ap-¼p-Å B³-ssP-\, lr-
Z-bm-Lm-Xw ap-X-em-bh-sb C-t¸mÄ “Acute
Coronary Syndrome” F¶m-Wv hn-fn-¡p-¶Xv.
C¯-cw k-μÀ-`-§fn A-Sn-b-´n-c-am-bn

am-äp¶p. an-¡h - mdpw B³-Pn-tbm-¹m-Ìnbn t»m-
¡p-IÄ D-ÅnS-¯v _eq¬ sh-¨v hoÀ-¸n¨v, ho≠pw
A-Sb- m-Xn-cn¡m³ A-hn-sS tem-lw sIm-≠p-≠m-¡n-bn-
cn-¡p-¶ kv{- ]nw-Kv t]m-ep-Å kvs
- äâ v C-Sp-¶p.
A-Xymln-X hn-`m-K¯n \n-¶v t\-cn-«v Im-
¯v-em-_n-te-¡v am-än B³-Pn-tbm-¹m-Ìn sN-
¿p-¶-Xn-s\ B-Wv ss{]a-dn B³-Pn-tbm-¹m-Ìn
F-¶p ]-d-bp-¶-Xv.

F-´m-Wv C.T B³-Pn-tbm-{Kmw ? F-´m-Wv C-eÎ

- o-hv B³-Pn-tbm-¹m-Ìn ?
hmÀjn-I ]-cn-tim-[-\-I-fnepw aäpw Sn.Fw.Sn
c-à¡- p-ge - n-te-¡v t\-cn-«v a-cp-¶v I-S¯ - p-¶X - n-\p
sS-kv-äv t]m-kn-äo-hv B-bn Im t»m-¡p-I-fp-
]I-cw kn-cI - fn a-cp-¶v C³P-Îv sN-bvX - v kn.än
t-≠m-sb-¶v D-d-¸m¡m³ ap³-Iq-«n \n-Ý-bn-¨v
kvIm³ F-Sp-¯mepw G-sd-¡p-sd lr-Zb - [- a-\o t»m-
sN-¿p-¶ B³-Pn-tbm-{Km-an-s\-bm-Wv C-e-Îo-hv
¡pI-sf ImWm³ I-gn-bpw. F-¦nepw Im-¯ve - m_nÂ
B³-Pn-tbm-{Kmw F-¶v hn-fn-¡p-¶Xv. C¯-cw
sN¿p-¶ B³-Pn-tbm-{Km-an-sâ A{X-bv¡ - v hn-izm-k-
sS-Ìp-Ifn t»m-¡p-I-fp-s-¶v Im A-Xp-t]
tbm-KyaÃ. kn.än kvI - p-sS Slices Iq-Sp-¶X
- m-\p-If - n-\-
m-se X-s¶ ap³-Iq-«n \n-Ý-bn-¨ hn-[¯nÂ
\p-kc- n¨v (90 Slices ap-XÂ) hn-izmky-X Iq-Spw.
sN¿p-¶ B³-Pn-tbm-¹m-Ìn-bm-Wv C-e-Îo-hv
B³-Pn-tbm-¹m-Ìn.

23
 B³-Pn-tbm-{Km-an-sâ
dn-kv-¡p-IÄ F-s´Ãmw ?
hf-sc Ip-d-hmWv. ssI¿n Iq-Sntbm ImenÂ
Iq-Sntbm sN-¿mw. sN-¿p-¶nS-¯v sN-dn-sbm-cp th-
Z-\bpw c-àw I-«-]n-Sn-¡epw km-[m-c-W-amWv. ssU
F-¶ a-cp-¶m-Wv c-à-¡p-g-en-te-¡v C³P-Îv sN-¿-
s¸-Sp-¶Xv. Cu a-cp-¶n-t\m-Sv A-eÀ-Pn D-≠m-tb-¡mw.
A-eÀ-Pn D-≠mbm hn-d-b-tem, hn-bÀ-t¸m, i-co-cw
Nq-Sp-]n-Sn-¡p¶-Xp t]m-setbm tXm-¶mw. Cu a-cp-¶v
hr-¡I-sf {]-Xn-Iq-e-am-bn _m-[n-¡pw.
B³-Pn-tbm-¹m-Ìn-bp-sS dn-kv-¡p-IÄ
F-s´Ãmw ?
H-cp sNdn-b km-[y-X-bp≠v. Cu Im-e-b-fh-
n B-kv-]n-cn³, t¢m-]n-tUm{K F¶ Kp-
fnI-IÄ H-cp Im-c-W-h-imepw \nÀ-¯-cpXv.
B³-Pn-tbm-¹m-Ìntbm
ss_-¸mtkm \ÃXv ?
Xm-cX
- t- ay-\ e-Lphm-b t»m-¡p-IÄ¡v B³-
Pn-tbm-¹m-Ìnbpw k-¦oÀ-®am-b t»m¡p-IÄ-
¡v ss_-]m-Êv kÀ-Pd - n-bp-am-Wv \-ÃXv. t»m-
¡p-If - p-sS F-®hpw L-S\ - bpw t\m-¡n ct≠m
AXn Iq-Sp-Xtem hn-ZK - ²v- tUm-ÎÀamÀ NÀ-¨
sN-bv-X-Xn-\p ti-j-am-Wv Hm-tcm tcm-Kn-¡p-
ap-Å Nn-In-Õm co-Xn-IÄ \nÀ-t±-in-¡p¶-Xv.

h-bÀ I-b-äp-¶nS-¯v thZ-\, c-àw I-«-]n-Sn-¡Â,

\ocv, a-cp-¶n-\p-Å A-eÀ-Pn F-¶n-h-bv-¡p ]pd-sa
ssU F-¶ a-cp-¶v Ipd-¨v Iq-Sp-XÂ D-]-tbm-Kn-¡p-¶-
Xn\m hr-¡-I-fp-sS {]-hÀ-¯-\-s¯ {i-²n-¡-Ww.
hr-¡-I-fp-sS {]-hÀ¯-\w t\m-¡p-¶-Xv »-Uv bq-dn-b
(Blood Urea), ko-dw {In-bm-än\n (Serum Creatinine)
F-¶o c≠-v c-à- sS-Ìp-IÄ h-gn-bmWv. hr-¡-IÄ-
¡v ap³-t] X-s¶ tcm-K-ap-Å hr-àn-bm-sW¦nÂ
{]-tXy-In-¨v {i-²-thWw. A-]qÀ-Æw Nn-e k-μÀ-`-
§fn U-bm-en-kn-kv th-≠n h-t¶-¡mw.

F-´m-Wv tU sI-bÀ B³-Pn-tbm-{Kmw

cm-hn-se h-¶v B³-Pn-tbm-{Kmw sN-bv-Xv ssh-In-«p
X-s¶ ho«n t]mIp-¶ co-Xn-bm-Wv tU sI-bÀ
B³-Pn-tbm-{Kmw F-¶v A-dn-b-s¸-Sp-¶Xv.
ss_-]m-Êv kÀP-dn \nÀ-t±-in-¡s - ¸-Sp-t¼mÄ
B³-Pn-tbm-¹m-Ìn F-t¸m-sgm-s¡? `-bw Imc-Ww Nn-eÀ hn-k½ - X
- n-¡p-¶Xv ZoÀ-L-
Im-et- ¯-¡v tZm-ja
- m-tb-¡pw.
• ss{]a-dn B³-Pn-tbm-¹m-Ìn AYhm F-aÀ-P³kn
B³-Pn-tbm-¹mÌn: lr-Z-bm-Lm-X k-ab-¯v F´m-Wv ssl dn-kv-¡v
B-dp a-Wn-¡q-dn-\pÅn lr-Z-b-t]-inI-sf c-£n- B³-Pn-tbm-¹m-Ìn ?
¡phm³ sN-¿p-¶Xv.
t»m-¡p-I-fp-sS k-¦oÀ-®-X-bpw, tcm-Kn-bp-
• C-e-Îohv B³-Pn-tbm-¹mÌn: hym-bm-aw sN-¿p-
sS h-b-kv, lr-Z-b-¯n-tâbpw a-ä-h-b-h-§-fp-
t¼mÄ s\-©p-th-Z-\-bp-Å A-Y-hm B³-ssP-\
tSbpw A-h-Ø F¶n-h A-\p-k-cn-¨v hf-sc
F¶- th-Z-\-bp-Å tcm-Kn-IÄ-¡v ap³-Iq-«n \n-Ý-
e-Lp-hm-bn \nÀ-Æ-ln-¡mhp-¶ B³-Pn-tbm-
bn-¨ Zn-h-k¯n \-S-¯p-¶Xv.
¹m-Ìn-Ifpw hf-sc k-¦oÀ-®am-b B³-Pn-tbm-
kv-säâp-IÄ ho-≠pw A-S-bptam ? ¹m-Ìn-Ifpw D≠v. lr-Z-bmLm-X k-ab-¯v
sN¿p-¶ ss{]adn B³-Pn-tbm-¹m-Ìn-¡v s]
B-Zy-s¯ B-dp am-k-¯n-\pÅn A-S-bp-hm-\p-Å
m-Xp-sh dn-kv-¡v Iq-Sp-X-emWv. h-f-sc-b-[n-Iw
24
t»m-¡p-I-fp-Å-t¸m-gpw, t»m-¡p-I-fn ImÕyw ap- _-Ôp-¡fpw H-cp-an-¨n-cp-¶v NÀ-¨ sN-bs v- X-Sp-
X-em-b-h A-Sn-ªn-cn-¡p-t¼m-gpw, t»m-¡p-IÄ {] ¡p-¶X- m-Wv \ÃXv. tUm-ÎÀ-am-cp-sS C-SbnÂ
[m-\ c-à-¡p-g hn-`-Pn-¡p-¶n-S-¯m-Ip-t¼mgpw X-s¶ A-`n-{]m-b hy-Xym-k§ - f- p≠m-tb-¡mw.
B³-Pn-tbm-¹m-Ìn-¡v _p-²n-ap-«v Iq-Sp¶p. Cu Soan H-cp ImÀ-Un-tbm-fP - n-Ìpw, H-cp lmÀ-
«v kÀ-P\
- pw H-cp ImÀ-Un-bm-¡v Câ³-kn-hn-Ìpw
B³-Pn-tbm-¹m-Ìn-bpw B³-Pn-tbm-{Km-apw th-Ww.
F-{X t\-cw \o-≠p \n¡pw ?
B³-Pn-tbm-{Kmw G-I-tZ-iw A-c-a-Wn-¡q-dn-\pÅn C-e-Îo-hv B³-Pn-tbm-¹m-Ìn-¡v
I-gn-bpw. C-e-Îo-hv B³-Pn-tbm-{Km-an-\v ap³]pw ] F-{X\mÄ B-ip-]-{XnbnÂ
n³-]pw {]o Im-¯v F-¶ dq-an-em-Wv In-S-¯pI. B³- In-S-¡-Ww ?
Pn-tbm-¹m-Ìn- t»m-¡p-I-fp-sS F-®hpw k-¦oÀ-®- tImw-¹n-t¡-j³ H-¶p-ap-≠m- b
- n-sÃ-¦n Ht¶m
Xbpw A-\p-k-cn-¨v H-cp a-Wn-¡q-À ap-XÂ aqt¶m \ ct-≠m Znh-kw kn-kn-bp-hnepw ]pd-sa Ht¶m ct-
mtem a-Wn¡qÀ h-sc \o-≠p-\n-t¶-¡mw. ≠m Zn-hk - w hmÀ-Unepw I-gn-bWw. BsI 4þ5

B³-Pn-tbm-{Km-apw B³-Pn-tbm-¹m-Ìn-bpw Znh-kw B-ip-]{- Xnbn X-t§-≠n- h-cpw.

H-cp k-ab-¯p X-s¶ sN-¿mtam ?
ss{]adn B³-Pn-tbm-¹m-Ìn-¡v F-{X\
A§-s\ sN-¿p-Ib - m-sW¦n hopw hopw i-co-c¯
- n mÄ B-ip-]-{Xnbn I-gnb-Ww ?
kq-Nn-IÄ Ip-¯p¶-Xv H-gn-hm-¡mw. t»m-¡p-If - p-sS
F-®h - pw, k-¦oÀ-®X - bpw aq-ew ctm aqt¶m hn-ZK
- ²v- - ss{]adn B³- P n- t bm- ¹ m- Ì n- lmÀ- « v A- ä m-
cp-sS A-`n-{]m-bw tXSm³ C¯-cw k-μÀ-`§ - fn I-gn- ¡v D- Å - h - c n- e m- W v \- S - ¯ p- ¶ Xv . C- e - Î o- h v
ªn-sÃ-¶p h-cpw. B³-Pn-tbm-¹m-Ìn-sb A-t]-£n-¨v Iq-Sp-XÂ
Znh-kw kn-kn-bphn I-gn-tb≠Xm-bn h-cpw.
F-´m-Wv {Kq-¸v Un-kn-j³ ta-¡n-§v ? (Heart lmÀ-«n-tâbpw izm-kt- Im-i¯ - n-tâbpw A-hØ -
Team Approach) A-\p-kc - n-¨m-Wv hmÀ-Un-te-¡v am-äp-¶Xv. G-It- Z-
iw Gtgm F-t«m Znh-kw B-ip-]{- Xnbn I-gn-
t»m-¡p-If - p-sS F-®hpw k-¦oÀ-®X - bpw Iq-Sp-t¼mÄ tb-≠n- h-cpw.
kvs- äânw-Kv BtWm ss_-¸m-kv kÀP-dn BtWm \
ÃXv, G-XpX-cw kvs - äânw-Kv BWv \Ã-sX¶v Xo-cp-
am-\n-¡p¶-Xv H-¶n-e[ - n-Iw tUm-ÎÀ-amcpw tcm-Knbpw
25
 CeÎohv B³-Pn-tbm-¹m-Ìn-¡v th-≠n- bp--≠mIp-¶ kvs
- äâ v t»m-¡v B-Wv.
bp-Å A-Uv-an-j³
km-[m-c-W X-te-Znh-kw A-Uv-an-j³ \-S-¯p¶p. kvs
- äâ v t»m-¡m-hm-\p-Å km-[y-Xs
- b-
C-Xn\p ap³-]m-bn C-kn-Pn, F-t¡m-, »-Uv sS-ÌpIÄ, ´v ?
hr-¡-I-fp-sS sS-kv-äpIÄ, en-h-dn-sâ sS-Ìp-IÄ ap- kvs- äâp-IÄ aqew B-dp-am-k¡ - mew t»m-¡v
X-em-b-h \nÀ-_-Ô-am-bn sN-¿p¶p. hr-¡-I-fp-sS D≠m-Im-\p-Å km-²yX 2 ap-XÂ 5 i-Xa - m-\w
sS-kv-äp-IÄ km-[m-c-Wbn Iq-Sp-X-em-sW¦n Iq- am-{X-am-Wv. (`q-cn-`m-Kw tcm-Kn-If - nepw ZoÀ-LI - m-
Sp-XÂ {i-² B-h-iy-amWv. B³-Pn-tbm-¹m-Ìn-¡v D-]- e-¯n-sâ Kp-Ww In-«pw). {]ta-l tcm-Kn-IÄ,
tbm-Kn-¡p-¶ Nn-e a-cp¶-p-IÄ hr-¡I-sf tZm-j-I-c- hf-sc sNdn-b c-à¡ - p-ge
- p-If- p-Åh - À, Im-Õy-
am-bn _m-[n-¡pw. ap-Å t»m-¡p-IÄ ap-Xem-b k-μÀ-`§ - fnÂ
A-Sb - m-\p-Å km[y-X Iq-Sp-Xe - mWv.
B³-Pn-tbm-¹m-Ìn-bp-sS X-te-Znh-kw
B³-Pn-tbm-¹m-Ìn Xm-c\
- X
- t- ay-\ dn-k¡
v- p-IÄ Ip-dª
- kv-säâp-IÄ A-Sªm F§-s\

H-cp Nn-In-Õb - m-sW-¶v a-\Ê- n-em-¡n a-\Ê

- n-s\ im-´- a-\-Ên-em¡mw ?
am-bn sh-b¡ v- Ww. Nn-eÀ-¡v B-Imw-j, t]Sn, \ncm-i s\-©p-thZ-\, izm-kw-ap«Â, C.kn.Pn bntem
ap-Xe- m-bh
- h-t¶-¡mw. D-d¡ - ¡- p-dh
- p-s≠¦n Kpfn-I F-t¡m-bntem hy-Xn-bm\-§Ä ap-Xe - m-bh
- b
- m-Wv
I-gn-¡Ww. X-te-Znh-kw A-Wp-\m-in-\n D-]t- bm-Kn- kvs
- äâp-IÄ A-Sb
- p-¶X
- n-sâ e-£W
- §Ä.
¨p-Å Ip-fnbpw tj-hn-§pw th-Ww. B³-Pn-tbm-¹m-Ìn-
kv-säâp-IÄ A-Sbm³ Im-c-W-sa-´v?
bv¡- v B-dp a-Wn¡qÀ ap-t¶ `-£W - s- am¶pw I-gn¡m³
]m-Sp-ÅXÃ. hf-sc sNdn-b c-à¡ - p-ge- pIÄ, ImÕyw h-f-
sc-bp-Å t»m-¡p-IÄ, {]-ta-lw hf-sc k-¦oÀ-
ssI¿n IqsStbm Imen IqsSbm? ®am-b t»m-¡p-IÄ, B-k] -v n-cn³, t¢m-]
ssI¿n Iq-sS sN¿m³ ]-äp-Ib - m-sW¦n ZoÀ- n-tUm{K ap-Xem-b a-cp-¶p-IÄ apS-¡Â ap-Xe - m-
L-t\-cw H-tc In-S¸ - n _Un In-St- ¡≠n h-cnÃ. b-hb- m-Wv {]-[m-\ Im-cW
- § - Ä.
ssI¿n Iq-Sn ]-äm-sX h-cn-Ib - m-sW¦n am-{X-am-Wv
Imen Iq-Sn sN-¿p-¶X - v. Syq-_v I-bäp-¶ Øe-¯v kv-säâp-IÄ A-S-bm-Xn-cn-¡phm³
c-à{- km-ht- am, c-à¡ - «- b
- p≠m-hp-Itbm am-{X-am-Wv F-s´m-s¡ {i-²n¡-Ww ?
km-[m-cW- b
- p-≠m- Ip-¶ A-]I - S-§Ä. B³-Pn-tbm-¹m- ]-d-ª a-cp-¶p-IÄ {]-tXy-In¨pw B-kv-]
Ìn-bp-sS Gähpw hen-b A-]I-Sw hf-sc A-]qÀ-Æa - m- n-cn³, t¢m-]n-tUm{KÂ ap-X-em-b-h H-cn-¡epw

26
ap-S-§m-sX I-gn-¡pI.

ZoÀ-L-Im-e-t¯-¡v kv-säâp-IÄ-¡v F-´v

kw-`-hn¡pw ?
B-Zy-s¯ B-dp-am-k-am-Wv kv-säâp-IÄ t»m-¡m-
hm-\p-Å km-[y-X. A-Xn-\p ti-jw c-à-¡p-g-en-sâ
A-I-¯p X-s¶-bp-Å tImi-§Ä h-¶v kv-säâpI-
sf aq-Spw.

F-{X \mÄ CCU hn I-gnb-Ww IÄ A-Sb - m-Xn-cn-¡pI A-Xym-hi - y-am-Wv. CXnÂ
km-[mcW B³-Pn-tbm-¹m-Ìn-¡p ti-jw aq-¶p Zn-
B-k]v- n-cn-\v h-bs - d-cn-¨nÂ, internal »o-Un-§v ap-
h-k-¯n-\pÅn CCU hn \n-¶v ap-dn-bn-tem-«v t]
Xem-b ]mÀ-iz-^e - §
- f - p≠-v.
m-Im-\m-Ipw. k-¦oÀ-®amb B³-Pn-tbm-¹m-Ìn-tbm,
Betablocker : Cu hn-`m-K¯ - nÂ-s¸Sp-¶ Metpr-
lr-Z-bmLm-X k-ab-¯p sN¿p-¶ ss{]adn B³-
olol, Bisoprolol ap-Xe - m-bh - c-àk - ½
- À-±w Ip-db
- v-
Pn-tbm-¹m-Ìntbm B-sW¦n ssh-In-tb-¡mw.
¡p-hm\pw lr-Zb - a- n-Sn-¸v Ipd-¨p sh-b¡v- p-hm\pw
B³-Pn-tbm-¹m-Ìn ssI¿n Iq-Sn-bm-sW¦nÂ
k-lm-bn-¡p-¶p.
_m-¯v-dqan t]mIÂ, \S-¡Â ap-X-em-b-h Ipd-¨v
t\-c-s¯-bm-Imw. Nitroglycerine :ap-Xem-b a-cp-¶p-IÄ c-à¡
- p-g-
epI-sf hn-Ik
- n-¸n-¨p \nÀ-¯phm³ k-lm-bn-¡p-
ap-dnbn h¶m {i-²n-t¡≠ -Im-cy- ¶p.
§Ä F-s´Ãmw ? Ramipril, Losarta : ap-Xem-b a-cp-¶p-IÄ c-à-
ap-dn-bn-se-¯nbm Ip-ds- ¨m-s¡ \-S¯ - h
- pw, hym-bm-ah- k-½À-±w Ip-db
- ¡
v- p-hm\pw c-à¡ - p-ge
- pI-sf hn-I-
pw B-Imw. e-Lphm-b `-£W-§Ä I-gn-¡m-\m-bn {i-an- kn-¸n-¡p-hm\pw k-lm-bn-¡p¶p.
¡Ww. tUm-ÎÀamÀ Zn-hk - hpw ECG bpw a-äpw ]-cn-tim-
[n-¡pw. FÃmw i-cnbm-b co-Xnbn B-sW-¦n Ht¶m ZoÀ-L-Im-e-t¯-¡v {i-²n-t¡≠
ct≠m Zn-hk - ¯
- n-\pÅn ho-«n-te-b¡
-v p a-S§
- mw. -Im-cy-§Ä ?
kvs- äâp-IÄ A-Sb - m-\p-Å sN-dn-sbm-cp km[y-X
ho«n {i-²n-t¡-≠ Im-cy-§Ä FÃm-btv- ¸m-gp-ap≠v. A-Xp-sIm≠v B-k] v- n-cn³,
B-Zy-s¯ c≠mgv¨ ho-Sn-\I - ¯pw ]p-d¯ - p-am-bn t¢m-]n-tUm{KÂ F-¶o a-cp-¶p-IÄ ap-S¡ - c - pXv.
sNdn-b hym-bma-§Ä sN-bX v- v I-gn-¨p Iq-«Ww. B³-Pn-tbm-¹m-Ìntbm ss_-]m-Êv kÀ-Pd - ntbm
e-Lphm-b B-lm-c{- I-aw. c≠-mg- ¨v- b- ¡v- p ti-jw ho-Sn- t»m-¡p-I-sf XmÂ-¡m-en-I-am-bn amäp-I am-{X-
\v ]p-dt- ¯¡v, {]mÀ°-\m Ø-e§ - f - n-te¡v, I-SI - f - n- am-Wv sN-bX v- n-cn-¡p-¶Xv. F-´p-sIm≠-v t»m-
te-¡v ap-Xem-b bm-{X-IÄ B-Imw. B-dv B-g¨ v- b
- ¡v- p ¡p-IÄ h-¶p F-¶X - n-sâ Imc-Ww A-§s - \-X-
ti-jw tPm-enbn Xn-cn-¨v {]-th-in-¡p-It- bm, Zq-cb - m- s¶-bn-cn-¡p¶p. A-Xv \-½p-sS i-co-c{- ]-Ir-Xt- am,
{X-IÄ ap-Xe- m-bh
- tbm sN-¿m-hp-¶X - m-Wv. B-lm-cc - o-Xn-tbm, Po-hn-Xs - si-entbm B-Imw.
Cu L-SI - §-sf Iq-Sn {i-²n-¡p-Ib - m-sW¦nÂ
B³-Pn-tbm-¹m-Ìn-bv-¡p ti-jw ho-«n-te- C-\n lr-Zb - m-Lm-Xa - p≠-m¡p-¶ t»m-¡p-If - p-m-
¡v t]m-Ip-t¼mÄ Xp-S-tc≠ -a-cp-¶p-I-sf- Im-sX kp-Ja - m-bn Po-hn¡m³ km-[n-¡pw. c-à-
s´Ãmw ? k-½À±w, {]-ta-lw Xp-S§ - n-bh- Ir-Xy-am-bn \n-b-
B-k] v- n-cn³, t¢m-]n-tUm-{K : c-௠- n-se t¹-äs v- e- {´n-¡Ww. am-\kn-I k-½À-±a - p-Åh
- c- m-sW¦nÂ
ävk
- v F-¶ L-SI-§Ä A-Sn-ªp Iq-Sn kvs - äâ v t»m- tbm-K, [ym\w, {]mÀ°-\, dn-em-Itv- k-j³ sX-
¡v B-hm-Xn-cn-¡m-\p-Å a-cp-¶p-If - m-WnXv. kvs - äâp- dm-¸n ap-Xe - m-bh - h-gn a-\k - n-s\ \n-b{- ´n¡m³
]Tn-¡W - w.

27
 CHAPTER
IV

ss_-¸m-kv
kÀPdn
Adnªncnt¡≠-
Im-cy§Ä

lrZb i-kv-{X-{In-b F-¶p-tIÄ-¡p-t¼mÄ a-\- lr-t{Zm-Kw _m-[n-¨ G-sXm-cmÄ¡pw ]-cn-]

Ên t]-Snbpw B-i-¦bpw km-[m-c-W-amWv. qÀ-®-{i-²-sIm-Sp-¯m k-¼qÀ-® B-bp-
ikv{- X-{Inb¡pti-jw X-sâ A-kp-Jw t`-Zs
- ¸-Sp- Êv km-[y-amWv. \n§-sf Nn-In-Õn-¡p-¶
atÃm F-t¶mÀ-¯v a-äp NneÀ k-am-[m-\n-¡p¶p. `q-cn-`m-Kw tUm-ÎÀ-amcpw C-´y-¡p -]pd-sa
Cw-¥≠­v, A-ta-cn-¡ ap-Xem-b cm-Py-§-fnÂ
lrZb i-kv-{X-{In-b k-¦oÀ-®-am-sW-¦nepw
\n-¶v ]-cn-ioe-\w t\-Sn-b-hcpw hn-tZ-i-cm-
tUm-ÎÀ- am-cp-sSbpw \-gv-kp-am-cp-sSbpw A-\p-`-
Py-§-fn \-S-¡p-¶ NÀ-¨-I-fn \n-c´-cw
h-k-¼¯pw \q-X-\ D-]-I-c-W-§-fp-sS km-t¦-
]-s¦-Sp-¡p-¶-h-cp-amWv. lr-Z-b-i-kv-{X-{In-
Xn-I-Xbpw ImcWw Cu Hm-¸-td-j³ C-t¸mÄ
b-bp-sS Im-cy-¯n tem-I-s¯-hn-sSbpw
kp-c-£n-X-am-bn sN-¿p-hm³ I-gn-bpw. Hm-¸-td-
\-S-¡p¶ t]m-se G-ähpw \Ã Hm-¸-td-j³
j-\p-ti-jw H-¶-c-am-k-¯n\p-Ån Xn-cn-sI
C-t¸mÄ dn-ss\ sa-Un-kn-än- t]m-ep-Å Øm-
tPm-en-bn {]-th-in-¡p-hm³ I-gn-bpw.
]-\-§-fn e-`y-amWv.
Iym³kÀ, ]£]mXw ap-Xemb tcm-K-§-sf-
t¸m-se `-b-s¸-tS-­≠ H-cp tcm-K-aà lr-t{ZmKw.

28 28
ss_-¸m-kv i-kv-{X-{In-b-sb-
¡p-dn-¨p-Å `bw a-dn-I-S-¡p-¶-
sX§-s\ ?
ss_-¸m-kv i-kv-{X-{In-b \n§-sf
B-tcm-Ky-hm-\m-¡m\pw \n-§-fp-sS
B-bp-Êv Iq-«m\pw th≠-­nbp-Å-XmWv.
Cu Nn-´ \n-§Ä-¡v kam-[m-\-amWvv
\Â-tI-­-≠Xv.
Cu Hm-¸-td-j-³ C-t¸mÄ hf-sc kp-
c-£n-X-am-bn sN-¿p-hm³ I-gn-bpw.
Hm-¸-td-j³ I-gn-ª ]-ecpw Hm-¸-
tdj-\v hn-t[-b-cm-hm-¯-h-tc-¡mfpw
ZoÀ-L- Im-ew Po-hn-¡p-¶-h-cm-bn-«m-Wv
I≠p-h-cp-¶Xv. Hm-¸-td-j-\-Sp-¯p-Å
tZ-lm-kzm-Øy-§-Ä hf-sc Xm-Xv-Im-
en-Ihpw k-ln-¡m³ {]-bm-k-anÃm-
¯-Xp-amWv. a-säm-cp kXyw Hm-¸-td-
j-\p-ti-jw ]-ecpw ap-¼-s¯-¡mÄ
k-t´m-j-hm·mcpw B-ß-hn-izm-k
-ap-Å-hcpw i-cn-bm-b Zn-\-N-cybpw
B-lm-c-{I-ahpw ]m-en-¡p-Ibpw, Np-
äp-ap-Å-h-cp-sS B-tcm-Ky-Im-cy- ¯nÂ
{i-²n-¡p-¶-h-cp-am-bn- Im-Wp¶p. Cu
Hm-¸-td-j-\p-ti-j-ap-≠
­ m-hp-¶ FÃm
tIm-¹n-t¡-j\pw C-t¸mÄ Nn-In-Õn-¨p-
am-äm-hp-¶-XmWv
Saphenous
vein bypass
F´m-Wv
ss_-¸m-kv i-k{v- X-{In-b ?
lr-Z-b-t]-in-IÄ-¡v c-à-sa-¯n-¡p-¶ c-à-¡p-
g-ep-I-fn X-S-Ê-ap-­
≠m-hp-t¼mÄ lr-Z-b-th-Z-\
bpw lr-Z-bm-Lm-X-hpap≠m-Ip¶p. ]-eX-h-W
lr-Z-bm-Lm-X-ap≠m-Ip-t¼mÄ lr-Z-b-¯n-sâ
ti-jn Ipd-ªv lmÀ-«v s^-bv-eÀ D-≠m-Ip¶p.
Cu X-S-Ê-§-fp-sS A-¸p-d-t¯-¡v ]pXn-b c-à-
¡p-g-ep-IÄ Xp-¶n-¸n-Sn-¸n-¡p-I-bm-Wv ss_-¸m-
kv i-kv-{X-{In-b F-¶Xp-sIm≠p-t±-in-¡p-¶-Xv.
]pXn-b c-à-¡p-g-ep-IÄ Im-en \n-s¶-Sp-
¡p-¶ c-à-¡p-g-ep-I-tfm (Veins), s\-©n \n
t¶m ssI-bn \nt¶m F-Sp-¡p-¶ c-à-¡p-g-
ep-I-tfm (Arteries) B-Imw.
Coronary Artery Bypass
Aorta
Internal
mammary
Cholesterol artery bypass
build-up
Sites of
Blockage
29 29
 B³Pn-tbm-¹mkväntbm
ss_¸mtkm ?
km-[m-c-W k-¦oÀ-®-aÃm-¯ t»m-¡p-IÄ-¡v
B³Pn -tbm-¹m-kvänbpw k-¦oÀ-®am-b t»m-¡p-
IÄ¡v ss_-]m-Êp-amWv {]-Xn-hn[n. Nne tcm-Kn-
IÄ-¡v B³Pn-tbm -¹mkvänbmtWm Hm-¸-td-j\m-
30
tWm \Ã-sX¶Xn tUm-ÎÀ-am-cn X-s¶
A-`n-{]m-b-hy-Xym-k-ap-≠
­ mImw. kz´w B-tc-
mKyw Hm-tcm-cp¯-cp-tSbpw {]-[m-\ -{]-iv-\-am-
b-Xn-\m H-¶n Iq-Sp-X tUm-ÎÀ-am-cp-sS
A-`n-{]m-bw tX-Sp¶-Xv \Ã-Xm-bn-cn-¡pw. FÃm-
bv-t¸mgpw `q-cn-]-£m-`n-{]m-b-am-bn-cn¡pw H-cp hy-
àn-bp-sS A-`n{]m-b-t¯-¡mfpw \ÃXv.
ss_-¸mÊv Hm-¸-td-j³ F-t¸mÄ thWw ?
B³Pn-tbm-{Km-an-\v ti-jw \n-§-fp-sS tUm-ÎÀ
ss_-¸mkv ikv-{X-{Inb th-Ww F-¶v ]-d-ªmÂ
F-t¸mÄ A-Xv th-Ww F-¶pÅ-Xv {]m-[m-\-amWv. Xp-
S-À-¨-bm-bn th-Z-\ A-\p-`-h-s¸-Sp-Itbm CS-¯p c-à-
¡p-g-en-se {][m-\ [-a-\n-bn t»m-¡p-≠ ­ m-hp-Itbm
B-sW-¦n DSs\ Hm-¸-td-j³ sN-¿p-¶-Xm-Wv \ÃXv.
Imc-Ww C¯-cw tcm-Kn-IÄ-¡v s]-s«-¶v lmÀ-«v A-äm-
¡v kw-`-hn-¡pw. thZ-\-sbm-¶p-an-sÃ-¦n t»m-¡p-I
fpw A-{X ITn-\-a-sÃ-¦n km-h-Im-iw ho-«nÂ-t]m-bn
ap³-Iq-«n ]-d-ª Znhkw Hm-¸-td-j³ sN-¿p-¶-Xm-Wv i-kv-{X-{Inb-¡v ap-¼v F-s´Ãmw
\ÃXv. H-cp hen-b lmÀ-«v A-äm-¡n-\p-ti-jw Xp-SÀ- X-¿m-sd-Sp-¸p-IÄ thWw.
¨bm-b thZ-\-sbm-¶p-an-sÃ-¦n H-¶-c amk-s¯ hn-
{i-a-¯n-\v tijw Hm-¸-td-j³ sN-¿p-¶-Xm-Wv \ÃXv. i-kv-{X-{In-b Znh-kw Xo-cp-am-\n-¨p-I-gn-ªmÂ
am-\-kn-I-ambpw im-co-cn-I-ambpw km-¼-¯n-
{][m-\-ambpw ss_-]m-Êv i-kv-{X-{In-b \m-em-bn X-cw- I-ambpw X-¿m-sd-Sp-¸v \-S-¯Ww. ss_-¸m-kv
Xn-cn-¡mw. i-kv-{X-{In-b C-t¸mÄ km-[m-c-W h-b-dn-sâ
i-kv-{X-{In-b-tb-¡mfpw kp-c-£n-X-am-bn sN-
1. Elective Operation
¿mhp-¶-Xm-Wv. i-kv-{X-{Inb-¡v ap¼pw ti-
2. Urgent Operation
3. Emergency Operation
j-hp-ap-Å aq-¶m-gv-N-tbm-f-ap-Å im-cocn-I
4. High Risk operation am-\kn-I A-kzm-Øy-§-sfm-gn-¨m \n-§Ä-
¡v \-sÃm-cp Po-hn-Xw In-«m³ t]m-hp-I-bm-
F-´n-\m-Wv A-Sn-b´nc ss_-¸mkv ikv-{X- sW-¶ Nn-´ a-\-Ên h-cp-¯Ww. ss_-
{Inb ¸m-kv i-kv-{X-{In-b I-gn-ª-hÀ ss_-¸m-kv
i-kv-{X-{In-b I-gn-bm-¯-h-tc-¡mÄ Iq-Sp-XÂ
\n-§Ä-¡v hf-sc A-]-I-S-I-cam-b t»m-¡p-I-tfm,
Im-ew Po-hn-¡p-¶p- F¶-Xv k-Xy-amWv. im-
C-S-Xp-hi-s¯ {][m-\[-a-\n-bn t»m-t¡m, lr-
co-cn-Iam-b X-¿m-sd-Sp-¸n G-ähpw {]-[m\yw
Z-bm-Lm-X-¯n-\p-ti-jw Xp-SÀ-¨bm-b thZ-\tbm
\-½p-sS izm-k-tImi-s¯ _-e-s¸-Sp¯p-I
D-s≠¦n AXv c-≠ ­ ma-sXm-cp lmÀ-«v A-äm-¡n-\v km-
F-¶-XmWv. kv-ss]-tdm-sa{Sn hym-bm-ahpw
[y-X-bp-s≠¶m-Wv Im-Wn-¡p-¶Xv. C¯-cw k-µÀ-`-
{]m-Wm-bm-ahpw C-Xn-s\ k-lm-bn-¡pw. {]
§-fn A-Sn-b´n-c ikv-{X-{Inb th≠-­n-h-cpw. C-Xv
talw, c-àk-½À-±w hr-¡-tcm-K§Ä, h-en-
Po-h³ c-£n-¡m-\p-Å ikv-{X-{InbbmWv.
hv ap-X-em-b-h D-Å-hÀ-¡v {]-tXy-I X-¿m-sd-
Sp-¸v th-Ww.
ss_-¸m-kn-sâ hn-P-b-i-X-am-\w
dnss\ sa-Un-kn-än-bn 99% hn-P-b-i-X-am-\-t¯m-sS
Znh-kw aqt¶m \mtem Hm-¸-td-j-\p-IÄ \-S-¡p¶p.
Hm-¸-td-j-\-Sp-¯p-≠
­ m-Ip-¶ Xm-c-X-tay-\ e-Lphm-b
am-\-kn-I þ im-cocn-I A-kzm-Øy§-sf A-Xn-Po-hn-
¨m \n-§Ä-¡v \-sÃm-cp Po-hn-Xw In-«m³ t]m-Ip-I-
bmWv. ss_-]m-Êv I-gn-ª-hÀ I-gn-bm-¯-h-tc-¡mÄ
ZoÀ-L-Im-ew k-´p-ã-cm-bn Po-hn-¡p-¶-Xm-bn-«m-Wv Im-
Wp-¶Xv.

31
 F{X Ip-¸n c-àw th-Ww ?
km-[m-cW ss_-¸m-kv i-kv-{X-{Inb¡v H-t¶m
ct≠m Ip-¸n-bp-sS B-h-iy-ta-bpÅp. ]-s£ H-cp ap³-
I-cp-XÂ F-¶ \n-e-bv-¡v B-dp-t]-cp-sS c-àw I-cp-Xn
sh-¡p¶p. h-f-sc A-]qÀ-Æ-am-bn \mtem A-t©m Ip-
¸n D-]-tbm-Kn-t¡≠-­n h-¶m \n-§tfm-Sv Iq-Sp-XÂ
c-à-¯n-\v B-h-iy-s¸-t«-¡mw. km-[m-c-W A-Sn-b
´n-c i-kv-{X-{In-b-bn c-à-¯n-sâ B-hiyw Iq-Sp-
i-kv-{X-{Inb-¡v hn-t[-b-am-hpt¼mÄ ap-dn-hp-I-
X-emWv. I-gn-bp-¶Xpw _-Ôp-¡-fp-sS c-àw \Â-Ip-
fn A-Wp-_m-[-bp-≠ ­ m-hm³ km[y-X Iq-Sp-X-
¶-Xm-Wv \ÃXv. ]-Ww \Â-In c-à-_m-¦n \nt¶m
emWv.
A-]-cn-Nn-X-cn \nt¶m c-àw kzo-I-cn-¡p¶-Xv \
ÃXÃ. i-kv-{X-{Inb-¡v ap³-]p-Å Zn-h-k-§-fn ho-
«n X-s¶ H-cp {]ta-l NmÀ-«v sh-¡p-I.
H-tc {Kq-¸n-ep-Å c-àw In-«n-bn-sÃ-¦n {Kq-¸v am-än X-cp-
¥q-t¡m-ao-äÀ D-]-tbm-Kn-¨v ho-«n X-s¶
hm-\p-Å kw-hn-[m-\w c-à_ - m-¦n-ep≠­v. km-[m-cW- Hm-
]-©-km-c-bp-sS Af-hv A-f-¡m³ km-[n-
¸-tdj-sâ X-te Znh-kw \m-ep-Ip-¸n c-àhpw Hm-¸-td-
¡pw. Iq-sS Iq-sS H-cp {]-ta-l-hn-Z-Kv-[t\-tbm,
j-sâ Znh-kw c-≠­p-Ip-¸nbpw \Â-Ip-I.
\n-§-fp-sS Ip-Spw-_-tUm-Îsdtbm Im-Wn-¨v
a-cp-¶ntâ-tbm, C³-kp-entâtbm Af-hv hy-
Xym-k-s¸-Sp-¯p-I. Kp-fn-Ibpw B-lm-c-{I-a
hpw sIm≠-v­{]-ta-lw \n-b-{´n-¡m³ ]-äp-¶n-
sÃ-¦n C³-kp-en³ Xp-S-§mw.

D-bÀ-¶ c-à-k-½À-±-ap-Å-hÀ i-kv-{X-

{Inb-¡v ap³-]v F-s´Ãmw sN¿Ww
ZoÀ-L-\m-fm-bp-Å c-à-k-½À-±w \-½p-sS lr-
Zbw, I®v, X-e-t¨m-dv ap-X-em-bh-sb _m-[n-
¡p¶p. D-¸v Ip-d¨ `-£Ww, hym-bmaw, tbm-K,
sa-Un-tä-j³, a-cp-¶p-IÄ ap-X-em-b-h-bm-Wv
{][m-\ {]-Xn-hn[n. Nn-eÀ-¡v ct≠­m aqt¶m
{]-ta-l-ap-Å-hÀ i-kv-{X-{Inb-¡v ap³-]v
F-s´Ãmw sN-¿-Ww ?
ZoÀ-L-\mÄ {]-ta-lw A-sÃ-¦n c-à-¯nÂ
]-©-km-c-bp-sS A-kp-J-ap-ÅhÀ, Cu tcm-Kw \-½p-
sS lr-Zbw, c-à-¡p-g-epIÄ, hr-¡, I®v, X-e-t¨m-
dv ap-X-em-bh-sb _m-[n-¡p-sa-¶v A-dn-bpI. Cu
A-kp-J-ap-Å-h-cn lr-Z-bm-Lm-Xw th-Z-\-bnÃm-sX
kw-`-hn-¡pw. c-à-¯n D-bÀ-¶ ]-©-km-c-bp-am-bn

32
a-cp-¶p-IÄ I-gn-t¡≠-­n-h-cpw. ikv-{X-{Inb-¡v ap-¼p-Å dn-em-Iv-
tk-j³ sX-dm¸n
s]-s«-¶p≠-m­ -Ip-¶ am-c-Iam-b ]-£m-Lm-X-¯n-
\v {]-[m-\-Imc-Ww D-bÀ-¶ c-à-k-½À-±w BWv. i-kv-{X-{Inb-¡v ap-¼p-Å Zn-h-k-§-fn i-co-c-
i-kv-{X-{Inb-¡v ap-¼p-Å Zn-h-k-§-fn am-\kn-I ¯n-se FÃm t]-in-I-tfbpw X-fÀ-¯n-bn-Sp-¶
{]-bm-k-§Ä Imc-Ww c-à-k-½À-±w D-b-cm³ km- dn-em-Iv-tk-j³ sX-dm-¸n ]-cn-io-en-¡-Ww.
[y-X-bp≠­ v. càk-½À-±w A-f-¡p-¶ H-cp D-]-Ic- i-kv-{X-{Inb-¡v ti-jw ap-dn-hp-I-fn th-Z-\
Ww ho-«n hm-§n-sh-¨v Zn-h-khpw c-à-k-½À-±w A-\p-`-h-s¸-Sp-I-bm-sW-¦n A-Xp-Ip-d-¡m³
Af-¶v H-cp ]p-kv-X-I-¯n F-gp-Xn-sh¡p¶-Xv dn-em-Iv-tk-j³ sX-dm-¸n k-lm-bn-¡pw. ap-dn-hp-
\-¶m-bn-cn-¡pw. c-à-k-½À-±w Iq-Sp-X-em-bn Im-Wp- I-fnÂ- th-Z-\-bp-­≠m-Ip-¶ {]-[m-\ -Imc-Ww ap-
¶p-s-­¦n \n-§-fp-sS Ip-Spw_ tUmÎ-sd Im-Wn-¨v dn-hn-\-v Np-äp-ap-Å t]-in-I-fp-sS _-ew -]n-Sp-¯-
a-cp-¶v hy-Xym-k-s¸-Sp-¯m³ {i-an-¡p-I. km-[m- am-Wv.
c-W H-cm-fp-sS c-à-k-½À-±w 120/80 ap-X 140/90
h-sc BWv. am-\kn-I ]n-cn-ap-dp-¡tam I-Sp-¯ im-
cocn-I {]-b-Xv-\-§tfm sN-¿p-t¼mÄ c-à-k-½À-
±w Iq-Spw. P-e-tZmjw, ]-\n ap-Xem-b km-[m-cW
tcm-K-§Ä ]n-Sn-¡p-t¼mÄ c-à-k-½À±-s¯ Iq-Sp-
X-em-bn {i-²n-¡Ww. Iq-sS-Iq-sS-h-cp-¶ X-e-th-Z-\-
bm-Wv c-à-k-½À-±w Iq-Sp-t¼m-gp-­≠m-Ip-¶ {][m-\
e-£Ww.

hr-¡-tcm-K-ap-Å-hÀ i-kv-{X-{Inb-¡v ap-¼v

F-s´Ãmw sN¿Ww
{]-talw, c-à-k-½À±w, IÃpIÄ, t{]m-kv-
tääv{KÙnbp-sS ho-¡w ap-X-em-b-h-bm-Wv hr¡-sb
_m-[n-¡p-¶ {]-[m-\-tcm-K§Ä. ]-eÀ¡pw lr-Z-b-
i-kv-{X-{Inb-¡v ap-¼p-Å ]cn-tim-[-\-bn-em-Wv hr-
¡-bv-¡v A-kp-J-ap-Å Imcyw a-\-Ên-em-Ip-¶Xv.

hr-¡-tcm-K-ap-s≠­-¶v I-­≠­m hr-¡-tUm-Î-dp-sS

D-]-tZ-iw tX-SWw. km-[m-c-W lr-Z-b-¯n-sâ
t»m-¡p-I-fm-Wv amc-Iw. lr-Z-b-¯n t»m-¡p-I- lr-Z-b-¯n-sâ c-à-¡p-g-epIÄ
fp-Å-t¸mÄ a-äv i-kv-{X-{In-b-IÄ kp-c-£n-XaÃ.
lr-Z-b-¯n-\v {]-[m-\-am-bn c≠­-­v c-à-¡p-g-ep-
Imc-Ww a-äv i-kv-{X-{In-b-I-fp-sS k-ab-¯v lr-Z-bm-
I-fm-Wp-ÅXv. C-SXpw h-e-Xpw. CS-Xv c-à-¡p-
Lm-Xw kw-`-hn-¡mw. AXp-sIm≠-­v lr-Z-b-t»m-¡p-
g-em-Wv G-ähpw {]-[m\w. CS-Xv c-à-¡p-gÂ
IÄ am-än-b-Xn-\v tij-ta an-¡-hmdpw hr-¡-bp-sS
c-­≠m­ bn hn-`-Pn-¡p-¶-Xn-\v ap-¼p-Å `m-K-am-Wv
A-kp-J-§Ä Nn-In-Õn-¡m³ ]äq. hr¡-¡v A-kp-
se-^v-äv sh-bv³. CS-Xp c-à-¡p-g lr-Z-b-¯n-
J-ap-Å-hÀ-¡v ss_-¸m-kv i-kv-{X-{Inb-¡v ti-jw
sâ `q-cn-`m-K-t¯¡pw c-à-sa-¯n-¡p-¶p.
Nn-e-t¸mÄ U-bm-en-knkv th≠-n h-cp-hm-\p-Å km-
[y-X-bp≠-­v.

33
 ss_-¸m-kv \nÀ-t±-in¨ tcm-Kn
imTyw ]n-Sn¡Â
tUm-ÎÀ-amÀ im-kv-{Xo-b-]T-\-§-fp-sS A-Sn-Øm-
\-¯nem-Wv H-cp tcm-Kn-¡v ss_-¸m-kv kÀ-P-dn-
bm-Wv \Ã-sX-¶v \nÀ-t±-in-¡p-¶Xv. ]-t£ Nn-eÀ
`-bw Imc-Ww ss_-]m-kv th≠ F-¶v \nÀ_-Ôw
]n-Sn-¡m-dp≠­-v­. C-Xv ZoÀ-L-Im-e-t¯-¡v A-h-cp-sS Po-
hnX-s¯ lm-\n-I-c-am-bn _m-[n-¡p-¶-Xm-bn Im-Wp-
¶p.
F-´m-Wv i-kv-{X-{In-b-bnÂ
sN-¿p¶Xv?
ss_-¸m-kv i-kv-{X-{In-b-bn s\-©nepw
ssI-¿nepw Im-en-ep-am-bn ct≠­m aqt¶m ap-
dn-hp-IÄ D≠-m­-Ipw. s\-©n-se ap-dn-hn Iq-
Sn \n-§-fp-sS lr-Zb-s¯ Im-Wm-\m-Ipw.

lrZ-b-tcm-K-ap-s≠­-¶-dn-bp-t¼m-gp-Å
am-\kn-I k-½À-±w
\½-sf am-\-kn-I-am-bpw im-co-cn-I-ambpw X-fÀ-¯p-¶
H-cp kw-`-h-am-Wv lrZ-b-tcm-K-ap-s­≠-¶p-Å Xn-cn-¨-dn-
hv. ]-t£ C-Xn-s\ a-dn-I-S-¡p-hm³ km-[n-¡pw. i-co-
c-t]-in-IÄ tIm-¨n-h-en¡Â, c-à-k-½À-±w IqSÂ,
lr-Z-b-an-Sn-¸v IqSÂ, h-b-sd-cn-¨nÂ, D-d-¡-anÃmbv-a
ap-X-em-b-h am-\kn-I k-½À-±-¯n-sâ e-£-W-§-fm-
Wv.

Hm-¸-td-j³ Xo-tbäÀ
Hm-¸-td-j³ Xo-tb-ä-dn \n-§-fp-sS kp-c-£-bv-¡p-
th≠-n­ ]-e D-]-I-c-W-§fpw B-fp-Ifpw D-≠­m-hpw.
C-h-sbÃmw \n-§-fp-sS k-cp-£-bv-¡v th-­≠n-bp-Å-
XmWv. C-h-sbÃmw I≠-­ v H-cn-¡epw B-i-¦-bp-≠m­ -
I-cp-Xv. i-kv-{X{In-b ta-i-bn-te-¡v am-än I-gn-ªmÂ
sNdn-sbm-cp Ip-¯n-h-bv-¸v X-¶v \n§-sf D-d-¡pw.
C-Xn-\p-ti-jw \n-§Ä-¡v bm-sXm-cp-hn-[-¯n-ep-Å
th-Z-\bpw A-\p-`-h-s¸-SnÃ.

i-kv-{X-{Inb-¡v B-scm-s¡-bp-≠
­ mIpw ?
i-kv-{X-{In-b-bp-sS kp-c-£n-X-Xz¯n-\m-bn c≠-­v kÀ-
P³-amcpw c≠v A-\-kv-X-än-Ìp-amcpw FÃm-bv-t¸m
kp£v-a ]cn-tim-[-\-bn \n-§-fp-sS lr-Z-b-
gpw Iq-sS-bp≠­m-Ipw. C-Xn-\v ]pd-sa c≠v \-gv-kp-amcpw
¯n t»m-¡p-Å `mK-s¯ Im-Wm³ km-
kÀ-P-³amsc i-kv-{X-{Inb¡v k-lm-bn-¡pw. i-kv-{X-
[n-¡pw. ssI-¿n \nt¶m Im-en \nt¶m
{Inb-¡v th-≠­lr-Z-b-izm-k-tIm-i sajo-\n "s]
F-Sp-¯ c-à-¡p-g-ep-IÄ lr-Z-b-¯n-sâ
À-^yq-j-\n-Ìv' F-¶p-]-d-bp-¶-h-cm-Wv \-S-¯p-I.
t»m-¡p-Å c-à-¡p-g-en-te-¡v Xp-¶n-tNÀ-
¡p-t¼mÄ [m-cm-fw c-àw lr-Z-b-¯n-te-¡v
H-gp-Ip-hm³ Xp-S-§pw. \n-§-fp-sS lrZ-bw
]-g-bXp-t]m-se-bm-Ip¶p. C-Xn-\v ti-jw ap-dn-

34
hp-IÄ Xp-¶n-t¨À-¯v \n§-sf i-kv-{X-{Inb-¡v ti-
jw ip-{iq-jn-¡p-¶ sF-.kn.-bp-hn-te-¡v am-äp¶p.
i-kv-{X-{In-b F-{X ka-bw \o-­≠p-
\n¡pw ?
km-[mc-W Hm-¸-td-j³ A-©v a-Wn¡q-tdm-fw \o
≠p -\nÂ-¡pw. C-Xn Xp-S-¡-¯n-se H-cp a-Wn¡q-
tdm-fw D-d-¡n-¡n-S-¯p-¶-Xn\pw iz-kn-¡m³ th-­
≠n Syq-_v C-Sp-¶-Xn-\pw a-äp-am-Wv. A-Xn-\v-ti-jw
G-I-tZ-iw H-cp a-Wn¡q-tdm-fw ss_-¸m-kn-\p-Å
c-à-\m-fn-IÄ X-¿m-dm-¡p-¶-Xn-\v th≠-­n-bp-Å
k-a-b-amWv. lr-Z-b-¯n-Â c-à-\m-fn-IÄ Xp-¶n-¸n-
Sn-¸n-¡p-¶-Xn-\p- th≠-­n-bm-Wv i-kv-{X-{In-b-bp-sS
G-ähpw {]-[m-\am-b `mKw. Cu {]-{In-b G-I-tZ-iw
c-­≠pa-Wn¡q-tdm-fw \nÂ-¡pw. C-Xn-\p-ti-jw ap-dn-
hp-IÄ Xp-¶n-¸n-Sn-¸n-¡p-¶-Xn-\m-bn G-I-tZ-iw
H-cp a-Wn¡q-tdm-fw th-Ww. A-]qÀ-Æw Nn-e-
t¸mÄ i-kv-{X-{In-b C-Xn Iq-Sp-X ka-bw
\o-­≠p- \nÂ-¡m-dp≠­v.
F-´mWv sF.kn.bp. ?
i-kv-{X-{Inb-¡v ti-jw \n§-sf ip-{iq-jn-
¡p-¶ Ø-e-amWv sF.kn..bp. C-hn-sS [m-cm-
fw \-gv-kp-amcpw tUm-ÎÀ-amcpw D-]-I-c-W-§fpw
D-­≠m-bn-cn-¡pw. Hmtcm tcm-Kn¡pw H-cp \-gv-kv
F-¶ hn-[-¯n F-t¸mgpw Iq-sSbp≠m-bn-cn-
¡pw. Hm-¸-tdj-\v ti-jw \n§-sf ip-{iq-jn-
¡p¶Xv sF.kn.bp-hn h-¨m-bn-cn-¡pw. 24
a-Wn-¡qÀ tUm-ÎÀ A-Sp-¯p-­≠mbn-cn-¡pw.
35
 F-´n-\m-Wv i-co-c-¯n h-b-dp-Ifpw Syq-
_p-Ifpw L-Sn-¸n-¨n-«p-Å-Xv
tcm-Kn-bp-sS \q-dp-i-X-am-\w kp-c-£n-X-Xz-¯n-\v th-
≠­n Nn-e h-b-dp-Ifpw Syq-_p-Ifpw i-co-c-¯n \n
¶pw hnhn-[ D-]I-c-W-§-fn-te-¡v L-Sn-¸n-¡p¶p.
C-h-bn izm-k-tIm-i-¯nte-¡p-Å Syq_pw, aq{Xw
t]m-Im-\p-Å Syq_pw \n-§Ä-¡v sNdn-sbm-cp A-kz-
Ø-X D≠-m-¡n-tb-¡mw. ap-dn-hn-\-Sp-¯v th-sd c≠v
Syq-_p-IÄ. s\-©n-\I-s¯ c-àw ]pd-¯v h-cp-¶-
Xn-\v Iq-Sn-bm-WnXv. th-sd Nn-e h-b-dp-IÄ \n-§-fp-
sS lr-Z-b-an-Sn¸v, c-à-k-½À±w, c-à-¯nse Hm-Iv-
kn-P³ ap-X-em-bh t\m-¡m-\mWv.
F{X ka-bw I-gn-ªmWv HmÀ-½
Xn-cn-¨p-h-cp¶Xv ?
Hm-¸-td-j³ Zn-h-kw ap-gp-h³ \n-§Ä D-d-¡-am-bn-cn-
¡pw. bm-sXm¶pw A-dn-bp-I-bp-anÃ. i-kv-{X-{Inb-¡v
ti-jw tcm-Knsb sF.kn.bp-hn-te-¡v am-äpw. ]n-tä-
Znh-kw {Ita-W \n-§Ä D-W-cm³ Xp-S§pw. sF.kn.
bp-hn h-¨v \n-§Ä D-W-cp-t¼mÄ \gvkpamtcbpw
tUm-ÎÀ-am-tcbpw a-äv tcm-Kn-I-sfbpw Im-Wm³ km-
[n-¡p-¶p.
i-co-c-¯n Nn-e h-b-dp-Ifpw Syq-_p-Ifpw D-≠­m-
Ipw. C-sXÃmw \n-§-fp-sS \q-dp-i-X-am-\w kp-c-£n-X-
Xz¯n-\p-th≠-­n-bmWv. ap-dn-hn \n-¶p-Å th-Z-\bpw
36
h-b-dp-If-pw Syq-_p-Ifpw sIm-­≠p -Å A-kz-
Ø-Xbpw Xm-c-X-tay-\ k-ln-¡m³ ]-äp-¶-Xm-
Wv. sF.kn.bp-hn-se Nn-e D-]-I-c-W-§-fp-sS
i-Ðhpw aäp-tcm-Kn-I-fp-sS i-Ð hpw \n-§Ä-
¡v tIÄ-¡mw.
HmÀ-½-h-¶m G-ähpw {]-[m-\w ZoÀ-L-am-bn
iz-kn-¡p-Ibpw Np-a h-cn-I-bm-sW-¦n Npa-¨v
I-^w I-f-bp-Ibpw sN¿p-I F-¶-Xm-Wv. \n-
§Ä F-{X-am{Xw {i-an-¡p¶pthm A-{Xbpw
th-K-¯n \n-§Ä-¡v kp-J-s¸-Spw. apdn-hp-
IÄ D-ÅXp-sIm-≠ ­ ­-v tcm-Kn-IÄ i-co-c-t]-in-
IÄ _-ew- ]n-Sn-¨n-cn-¡m³ km-[y-X-bp-­≠­­v.
C-Xv \ÃXÃ. i-co-c-¯n-se FÃm-t]-in-Ifpw
X-fÀ-¯n-bn-Sm³ {i-an-¡pI.
F-t¸mÄ _-Ôp¡-sf Im-Wm³ km-
[n¡pw
i-kv-{X-{In-b-bp-sS ]n-tä Znhkw HmÀ-½-h-
¶m DS-s\ \n§-sf izm-tkm-Ñm-k-¯n-\p
-Å sa-jo-\n \n-¶v am-äpw. sa-jo-\n \n¶v
am-än¡-gn-bp-t¼mÄ \n-§Ä-¡v kw-km-cn-¡m-
\pw `£-Ww I-gn-¡m\pw ]-äpw. km-[m-c-W
i-kv-{X-{In-b-bp-sS ]n-tä-Znh-kw \n-§-fp-sS
G-ähpw A-Sp-¯ _-Ôp-¡-Ä \n§-sf h-¶p-
Im-Wp¶p. sNdn-b A-kzm-Øy§-sf k-ln-
¡p-Ibpw a-\-Ên-s\ im-´-am-¡p-I-bpw Xp-SÀ-¨-bm-
bn ]-cn-{i-an-¡p-Ibpw sN¿p-I F-¶-Xm-Wv th-Kw
kp-Jw {]m-]n-¡p-hm-\p-Å G-ähpw \Ã amÀ-¤w. ico-
cw F-t¸mgpw X-fÀ-¯n-bn-Sp-I-bm-sW-¦n th-Z-\
hf-sc Ip-d-bpw. {Xn ]-cn-N-b-s¸-Sm\pw a-äv tcm-Kn-I-tfm-Sv kw-km-
cn-¡m-\p-ap-Å A-hk-cw D-]-tbm-Kn-¡pI
i-kv-{X-{Inb-¡v a-\-Ên-s\ X-¿m-dm-¡p-¶-
sX-§s\? ikv-{X-{In-b-¡p-th≠-­
t\c-s¯ ]-d-ªXp-t]m-se i-kv-{X-{In-b \n-§Ä¡v sS-kv-äpIÄ
\Ã Po-hn-Xw X-cm³ th≠nbp-ÅXmWv. G-I-tZ-iw
Hm-¸-tdj-\v ap-¼v \-½p-sS i-co-c-¯n-se {]-[m-
H-cp amk-s¯ am-\kn-I {]-iv-\-§fpw im-cocn-I
\ A-h-b-h-§fm-b izm-k-tIm-i§Ä, hr-¡,
{]-iv-\-§fpw A-Xn-Po-hn-¨m \n-§Ä-¡v ]t¯m
IcÄ, X-e-t¨m-dv ap-X-em-b-h-bv-¡v F-s´-¦nepw
]-Xn-\t©m hÀj-s¯ kp-J-Po-hn-Xw D-d-¸mWv.
tcm-K-ap-t≠­m F-¶v ]cn-tim-[n-¡Ww.
ss_-¸m-kv I-gn-ª-hÀ ss_-¸m-kv I-gn-bm-¯-h-tc-
C-Xn-\m-bn c-à-¯n-tâbpw aq-{X-¯n-tâbpw
¡mÄ Iq-Sp-XÂ Im-ew Po-hn-¡p-¶p. ss_-¸m-kn-\v
sS-kv-än-\v ]pd-sa h-b-dn-sâ kv-Im³, X-e-t¨mdn-
ti-j-ap-Å hmÀjn-I ]cn-tim-[-\-bn- \n-§Ä-¡v
tem-«v t]m-Ip-¶ c-à-¡p-g-en t»m-¡p-t≠­m-
`m-hn-bn D-≠m­ -tb-¡m-hp-¶ Iym³-kÀ ap-X-em-b-h
sb-¶-dn-bp-¶ Im-tcm-«n-Iv tUm¹À, izm-k-tIm-
t\c-s¯ a-\-Ên-em-¡m³ I-gn-bp¶p. ss_-¸m-kv
i-¯n-sâ ti-jn A-f-¡p-¶ e-§v ^-Mv-j³
I-gn-ª-hÀ X-sâbpw X-sâ Np-äp-ap-Å-h-cpsSbpw
sS-Ìp-IÄ ap-X-em-b-h sN-¿Ww. Cu sS-Ìp-I-
B-tcm-Ky-{]-iv-\-§-fn {i-²-Im-Wn-¡p¶p. C-Xph-
fn F-s´-¦nepw {]-iv-\-ap-s-­≠­¦n A-Xn-sâ
gn Ip-Spw-_-¯n-ep-Å FÃm-h-cp-tSbpw B-tcm-Ky-\n-
hn-Z-Kv-Zcmb tUm-ÎÀ-am-cp-sS A-`n-{]m-bw tX-Sn-
e-hm-cw sa-¨-s¸-Sp-¯p¶p. ss_-¸m-kv I-gn-ª H-cm-
b-Xn-\v ti-jw am-{X-sa i-kv-{X-{In-b \-S-¯p-
fp-sS Ip-Spw-_-¯n-se B-lm-c-co-Xn X-s¶ am-dp-¶p.
I-bpÅq.
Ip-Spw-_-¯n-se 35 h-b-Êp-I-gn-ª FÃm-hcpw lr-
Z-b ]cn-tim-[\-¡v hn-t[-b-cm-¡Ww.

i-kv-{X-{In-b-¡p-th-≠
­ n-bp-Å
A-Uv-anj³
ap³-]v ]-d-ªXp-t]m-se a-\-Ên-t\bpw i-co-c-
¯n-t\bpw \Ã-t]m-se X-¿m-sd-Sp-¸n-¨-Xn-\v ti-jw-
th-Ww i-kv-{X-{Inb-¡v h-tc-­≠Xv. A-Uv-anj-\v c≠-­v
Znh-kw ap³-]pX-s¶ B-kv-]n-cn³, t¢m-¸n-t{Um-KÂ
F-¶ Kp-fn-I-IÄ \nÀ-¯Ww. F-¶m thZ-\tbm
hf-sc I-Sp-¯ t»m-¡p-Itfm D-Å-hÀ Kp-fn-IÄ
\n À-t¯≠-XnÃ. A-Uv-an-j³ ti-jhpw Ht¶m
ct­≠m Zn-h-k-¯n-\v tijta Hm-¸-td-j³ \-S-¡p-I-
bpÅp. Cu Zn-h-k-§Ä sS-kv-äp-IÄ¡pw hym-bm-a-
§Ä¡pw th≠-n­-bmWv. Cu Zn-h-k-§Ä B-ip-]

37
 i-kv-{X-{In-b-bp-sS X-te-Zn-hkw
i-kv-{X-{In-b-bp-sS X-te-Zn-h-k-am-Wv tcm-Kn-IÄ
G-ähpw Iq-Sp-X am-\kn-I k-½À-±-¯n-\v hn-t[-
b-am-Ip-¶Xv. ap³-]v ]-d-ªXp-t]m-se a-\-ÊnÂ
t]m-kn-äo-hv Nn-´ -h-cp-¯n im-´-am-¡m³ {i-an-¡pI.
Cu Znh-kw kÀ-P\pw A-\-kv-X-än-kväpw h-¶v i-kv-
{X-{In-b-sb-¡p-dn-¨v ]-d-ªp-X-cpw. ssh-In-«v i-co-cw
ap-gp-h³ tj-hn-Mv sN-¿p-Ibpw Bân-_-tbm-«n-Iv D-]-
tbm-Kn-¨v Ip-fn-¡p-I-bpw thWw.

cm{Xn B-i-¦ Ip-d-bv-¡m\pw \Ãh-®w D-d-§m-\p-am-

bn \n-§Ä-¡v H-cp D-d-¡-Kpfn-I X-cpw. i-kv-{X-{In-b
cm-hn-se-bm-sW-¦n cm{Xn ]-¯v a-Wn-¡p-ti-jw
H¶pw I-gn-¡m³ ]m-SnÃ. D-¨-¡m-Wv i-kv-{X-{In-b-sb-
¦n sNdn-sbm-cp {]m-X-em-Imw.

i-kv-{X-{In-b Znhkw
km-[m-c-W c≠­-­v jn-^v-äp-I-fn-em-bm-Wv i-kv-{X-{In-b
\-S-¡p-I. cm-hn-se-bm-Wv i-kv-{X-{In-b-sb-¦n \n
§-sf F-«p-aWn-tbmsS Hm-¸-td-j³ Xo-tb-ä-dn-te-¡v
sIm­≠­p-t]m-Ipw. D-¨-¡m-sW-¦n G-I-tZ-iw H-cp
a-Wn-¡v ti-j-amWv Hm-¸-td-j³ Xo-tb-ä-dn-te-
¡v sIm­ ≠­p-t]m-Ip-¶Xv. Hm-¸-td-j³ Xo-b-ä-
dn h-f-sc-b-[n-Iw D-]-I-c-W-§fpw Ipd-¨v
B-fp-Ifpw D≠­-­m-Ipw.

38
F-t¸mÄ `£-Ww I-gn¡mw
Hm-¸-tdj-sâ ]n-sä Znhkw HmÀ-½-h-¶ DS-s\ shân-
te-äÀ sa-jo-\n \n-¶v \n§-sf am-äp¶p. A-Xn-\v
ti-jw ]Ãpw hm-bbpw \-gv-kp-amÀX-s¶ hr-¯n-bm-
¡n X-cp¶p. Ip-d-¨p-I-gn-ªm F-s´-¦nepw Ip-Sn-
¡m³ X-cp¶p. {Ita-W {Zm-h-I-cq-]-¯n-ep-Å `-£-
W-§Ä X-¶p-Xp-S-§pw. aeaq-{X hn-kÀ-Ö-\-¯n\v
ICUþÂ X-s¶ ku-I-cy-ap≠­-­m-Ipw. C-ã `£-Ww
X-s¶ I-gn-¡mw.
F-t¸mÄ hmÀ-Un-te-¡v amäpw
i-kv-{X-{Inb-¡v aqt¶m \mtem Zn-h-k-¯n-
\p-ti-jw \n-§Ä-¡v ]-cn-]qÀ-®-kp-J-am-b-Xn-
\p-ti-jw hmÀUnte¡v amäpw. kz-bw \-S-¡p-
¶-Xn\pw tSm-bv-e-än t]m-Ip-¶-Xn\pw aäpw
X-¿m-dm-¡n-b-Xn-\p-ti-j-am-Wv hmÀ-Un-te-¡v
am-äp-¶Xv.
F-t¸mÄ ho-«n-te-¡v t]mImw
hmÀ-UnÂ-sh-¨v \Ãh-®w \-S-¡p-hm\pw hym-
bm-aw sN-¿p-hm\pw {i-an-¡Ww. ap-dn-hn sNdn-
sbm-cp thZ-\, sNdn-sbm-cp Np-a, \-S-¡p-t¼mÄ
sNdn-sbm-cp In-X¸v, a-e-_Ôw, Im-enÂ
\ocv, `£-Ww th≠­-­mbv-I ap-X-em-b-h km-[m-c-
W-amWv. i-kv-{X-{In-b-bp-sS A-©mw-Znh-kw \n
§-sf C.kn.Pn., Ft¡m sS-kväv, F-Iv-kvþtd,
c-à-]cn-tim-[-\ ap-X-em-b-h-bv-¡v hn-t[-b-am-
¡pw. FÃmw km-[m-c-W-bm-sW-¶v I≠­­­-­m- Â
\n-§-fp-sS ho«n-te¡v t]m-Im-\p-Å Xo¿-Xn ]
d-ªp X-cpw.

ikv-{X-{Inb-¡v ti-j-ap-Å thZ-\

ap-dn-hp-I-fn sNdn-sbm-cp th-Z-\ km-[m-c-W-am-
Wv. ap-dn-hp-IÄ-¡-Sp-¯p-Å amw-k-t]-in-IÄ _-ew
]nSn-¡m-sX X-fÀ-¯n-bn-Sm³ {i-²n-¡Ww. t]-in-
IÄ X-fÀ-¯n-bn-«v ZoÀ-L-izm-kw h-en-¨v tXm-fpIÄ,
I-gp¯v, ssI-Im-ep-IÄ ap-X-em-b-h hym-bm-aw sN-bv-
Xm th-Z-\ H«pw A-dn-bp-I-bnÃ.

F-t¸mÄ Syq-_p-IÄ amäpw

t\c-s¯ ]-d-ªXp-t]m-se Syq-_p-I-sfÃmw \n-§-
fp-sS kp-c-£n-X-Xz-¯n-\v th≠­-­n-bp-Å-XmWv.
\n-§Ä¡v HmÀ-½-h-¶ D-S-s\ hm-b-bn Iq-Sn-
bp-Å Syq-_p-IÄ am-äpw. ap-dn-hn-sâ hi-s¯ Syq-_v
c-à-sam¶pw h-cp-¶n-sÃ-¶p-I≠­­m am-äp¶p. km-
[mc-W Hm-¸-td-j-sâ c­ ≠­ mw Zn-h-k-am-Wv C-Xv am-
äp-¶Xv. aq¶mw Zn-h-k-t¯m-SpI-Sn \n-§-fp-sS FÃm
Syq-_p-Ifpw am-än hmÀ-Un-te-¡v am-äm-\m-Ipw.

39
 hmÀ-UnÂh-¨v F-s´Ãmw
{i-²n¡-Ww
• ico-c-th-Z-\ : tXm-fpIÄ, I-gp¯v, ssI-Im-ep-IÄ
ap-X-em-b-h X-fÀ-¯n-bn-Sp-Ibpw hym-bm-aw sN-¿p-
Ibpw thWw.
• I-«n-en \n-¶v F-gp-t¶Â-¡Â: H-cp h-i-t¯m-«v
N-cnªv, ssI-sIm-­≠­vI-«n-en-sâ Aä-¯v ]n-Sn¨v.
• c≠­-­p-a-Wn-¡qÀ C-S-hn-«v 10 an-\n-äv \-S-¡p-I.
•
a-Wn-¡q-dn ]-¯pX-h-W kv-ss]-tdm-sa{Sn
sN-¿p-I. t¼mÄ Im-en-\S- n-bn X-ebn-W h-b¡ v- p-I,
• `£-Ww th≠mbv-I h-¶mÂ: ]p-fn-bp-Å Im-ev Xq-¡n-bn-Sm-Xn-cn-¡p-I, ]-IÂ k-ab - §
- -
`-£Ww, ssXcv, ]-g-hÀ-¤-§Ä ap-X-em-b-h I-gn- fn _m³-tU-Pv sI«p-I ap-Xe - m-bh
- h-gn
¡p-I. [m-cm-fw shÅw, C-f-\ocv, \m-c-§ Pyq-kv Im-en-se \o-cv Ip-d¡
- p-hm³ km-[n-¡pw.
ap-X-em-b-h Ip-Sn-¡p-I.
• D-d-¡-Ipd-hv: ]IÂ ka-bw D-d-§m-Xn-cn-
• ae_Ôw: km-[m-c-W-amWv. shÅw, Pyqkv, ap-X- ¡p-I. cm{Xn ssh-In D-d-§pI.
em-b-h Ip-Sn-¡p-I. ]-g-hÀ-¤-§Ä I-gn-¡pI.
ho-«n t]m-bm F-s´Ãmw
• Np-a h-¶mÂ: s\-©n I-^-ap-ÅXp-sIm≠­-­m-Wv
{i-²n¡Ww
Np-a h-cp-¶Xv. [m-cm-fw B-hn-bpw, ss\_p-ss-
etk-j-\pw, kv-ss]-tdm-sa{Snbpw sN-bv-Xv I-^w km-[m-c-W ap-dn-hp-IÄ D-W-§p-hm³ c≠m-gv-
]p-d-s¯-Sp-¡p-I. sN-Ìv ss_³-UÀ [-cn-¡p-I. Nbpw s\-©n-se FÃv D-W-§p-hm³ c≠p-am-
Np-a-¡p-t¼mÄ ap-dn-hn sNdn-sbm-cp th-Z-\-bp- khpw F-Sp-¡pw. ho-«n-se-¯n H-cm-gv-N-tbm-fw
≠­­m-Ip-sa-¦nepw A-]-I-S-Im-cnbÃ. Ip-Spw-_ -tUm-Î-dp-sS A-Sp-s¯-¯n ap-dn-hnÂ
• InX-¸v h-¶mÂ: sNdn-sbm-cp InX-¸v km-[m-c-W- a-cp-¶p -sh-bv¡Â, _n.]n., jp-KÀ ap-X-em-b-
amWv. Iq-Sp-X-ep-s≠­­-¦n Im-c-W-§Ä þ i-co-c- h-bp-sS sN-¡-¸p-IÄ sN-¿Ww. _n.]n-bpw,
¯nse Pew, s\-©n sh-Åw-sI«Â, B-kv-ß, jp-Kdpw Iq-Sp-X-em-sW-¦n Ip-Spw-_-tUm-Î-
lmÀ-«v s^-bv-eÀ ap-X-em-b-h-bmWv. InX-¸v Iq-Sp- dp-sS D-]-tZ-i-{]-Im-cw a-cp-¶p-I-fp-sS tUm-kv
X-em-sW-¦n tUm-ÎÀam-tcm-Sv ]-d-bWw. Iq-«mw. H-¶-c-am-k-t¯m-fw sN-kv-äv ss_³-U-
dpw, Im-en-se _m³-tUPpw [-cn-¡-Ww. ho-
• Im-en-se \o-cv: Im-en \n-¶v knc F-Sp-¡p-¶Xp-
«nÂh-¨v In-X-¸v, Np-a ap-X-em-b-h Iq-Sp-X-em-bn
sIm≠­ v­
- c-àt- bm-«w Ip-dh
- m-bn-cn-¡pw. In-S¡
- p-
h-cn-I-bm-sW-¦n B-ip-]-{Xn-bn h-cWw.

A-Sp-¯ sN-¡-¸v F-t¸mÄ

ho-«n-te-¡v hn-Sp-t¼mÄ Ip-Spw-_-tUm-ÎÀ-¡v
H-cp F-gp-¯v X-¶p-hn-Spw. FÃm-Zn-h-khpw
c-à-¯n-se ]-©-km-c-bpw, {]-j-dpw, ]Äkpw
t\m-¡n H-cp NmÀ-«n F-gp-Xn-sh-¡Ww. ap-dn-
hp-IÄ a-cp-¶v h-¨v sI-«p-Ibpw th-Ww.

H-cm-gv-N -I-gn-ªv B-ip-]-{Xn-bn B-Zy-s¯

sN-¡-¸n-\v h-cWw. A-Sp-¯ sN¡-¸v H-¶-
c-am-k-¯n-\v ti-j-amWv. Cu sN-¡-¸nÂ
F-Iv-kvþtd, F-t¡m, C.kn.Pn-, en-Izn-Uv s{]

40
m-ss^Â ap-Xem-b sS-Ìp-I fpw sN-¿Ww. A-Sp-¯
sN¡-¸v B-dp-am-k-¯n-\v ti-j-amWv Cu sN-¡-
¸n Sn.Fw.Sn. sS-Ìv Iq-Sn DÄ-s¸-Sp-¯-Ww. C-Xn-\v
ti-jw FÃm sImÃhpw lmÀ-«v sN¡-¸v th-Ww.
Hm-¸-tdj-\v FÃm-hÀ¡pw TMT s\-K-äo-hv B-h-W-
sa-¶nÃ. F-¦nepw TMT t]m-kn-äo-hv B-sW-¦nÂ
sN-¡v B-³Pn-tbm-{Kmw sN-¿-Ww.
lrZ-b-tcm-Kn-IÄ-¡v ]-äm-¯ `-£-W-§Ä
F-s´Ãmw
s]m-tdm-«, _n-cn-bmWn, s\bvt- NmÀ, amw-kw, \m-fn-
tIcw, sh-fn-s¨-®, t_¡-dn ]-el - m-c§Ä, ap-«b - p-
sS a-ª, ]mÂ, a-äv F-®I - Ä ap-Xe- m-bh
- Ip-d¡
- pI.
I-d-n-sh-¨ a-Õyw, ap-«-bp-sS sh-Å, ]-g-hÀ-¤§Ä,
km-e-UpIÄ, ]-b-dp-hÀ-¤§Ä, I-¸-e­≠n, _-Zmw,
]-¨-¡-dn-IÄ ap-X-em-b-h [m-cm-fw I-gn-¡p-I. [m-cm-
fw sh-Åw Ip-Sn-¡p-I.
C-\n lmÀ-«v A-äm-¡v hcptam ?
ss_-¸m-kv i-kv-{X-{Inb-¡v ti-jw ]t¯m ]-Xn-\
t©m hÀ-j-t¯-¡v lr-Z-bm-Lm-Xw h-cm-\p-Å
km[y-X hf-sc Ip-d-hmWv.
F-t¸mÄ tPm-en¡p-t]m-Imw ?
km-[m-cW ss_-]m-Êv i-kv-{X-{In-b-¡p-ti-jw H-¶-
c-am-kw I-gn-ªv H-cp lr-Z-b-sN¡-¸v \-S-¯pw. C-Xn-
seÃmw t\mÀ-a-em-sW-¦n DS-s\ tPm-en-bn I-b-
dmw. H-¶-c-am-k-¯n Iq-Sp-X ho-«n sd-kv-äv
sN-¿p¶-Xv s]m-Xp-sh i-co-c-¯n\pw a-\-Ên\
pw \ÃXÃ.
sN-Ìv ss_³-UÀ F-{X-\mÄ sI«Ww
ss_-]m-Êv i-kv-{X-{In-b s\-©n-se FÃp-ap-
dn-¨m-Wv sN-¿p-¶Xv. ap-dn-¨ FÃv Ìo I¼n-
sIm≠­­-v - sI-«n-h-bv-¡p¶p. s\-©n-sâ k-t¸mÀ-
«n-\p-th-­≠n-bm-Wv ss_³UÀ. km-[m-c-W
ap-dn-¨nS-¯v c-≠ ­ p -am-k-t¯m-fw sNdn-sbm-cp
th-Z-\-bpw. X-cn¸pw km-[m-c-W-amWv. cm-{Xn-
bn sN-Ìv ss_³-UÀ B-h-iy-anÃ.
Im-en-se _m³-tU-Pv F-{X-\mÄ
th-Ww?
Im-en-se R-c-s¼-Sp-¡p-t¼mÄ \o-cp-h-cm-Xn-
cn-¡m³ th≠­­-n- bm-Wv Im-en _m³-tU-Pv
sI-«p-¶Xv. ap-dn-hv D-W-§n-bn-«n-sÃ-¦n {U-Ên-
§n-\p ap-I-fn am-{X-sa _m³-tU-Pv sI-«mhq.
_m³-tU-Pv FÃm-Zn-h-khpw I-gp-In hr-¯n-
bm-¡Ww. sI-«p-t¼mÄ hn-c-ep-I-fp-sS A-äw
H-gn-sI ]m-Zw ap-XÂ sI-«m³ {i-an-¡Ww. cm-
{Xn-bn _m³-tU-Pv A-gn-¨v I-gp-Im-\nSmw.
km-[m-c-W H-¶-c-am-k¯n-\p-ti-jw Im-enÂ
\o-cn-sÃ-¦n _m³-tU-Pv D-t]-£n-¡mw. ]n-¶o-
sS-t¸m-sg-¦nepw \o-cp-h-cn-I-bm-sW-¦n _m³-
tU-Pv Xn-cn-sI D-]-tbm-Kn-¡mw.
41
 apdn-hp-IÄ ]-gp-¡m-Xn-cn-¡m³
F-´p-sN¿Ww
ap-dn-hp-IÄ ]-gp-¡m-\p-Å km[y-X H-cp i-X-am-\w am-
{X-amWv. FÃm Zn-h-khpw Ip-fn-¡p-t¼mÄ ap-dn-hp-I
fpw tkm-¸n-«v I-gp-Ip-I. A-\m-h-iy-am-bn ssI-sIm≠-­v
sXm-Sm-Xn-cn-¡p-I. FÃm Zn-h-khpw ]pXn-b h-kv-{X
-§-f-Wn-bp-I. {]-ta-l-ap-s≠¦n c-à-¯n-se jp-
KÀ Ip-Spw-_-tUm-Î-dp-sS \n-À-t±-i-{]-Im-cw {I-ao-I-
cn¡p-I ap-X-em-b-h-bm-Wv ap-dn-hv ]-gp-¡m-Xn-cn-¡p-
hm³ G-ähpw \à amÀ¤w. ikv-{X-{In-b-¡p-ti-jw
Iq-Sp-XÂ _-Ôp¡Ä, {]-tXy-In¨pw Ip-«n-IÄ A-an-
X-am-bn A-Sp-¯p-h-cp¶-Xv \ÃXÃ.

ss_-¸m-kn-sâ Kp-Ww
F-{X-\mÄ \n¡pw
ss_-¸mkv Hm-¸-td-j-\n \n-e-hn-ep-Å t»m-¡p-
IÄ am-{X-am-Wv ss_-]m-kv sN-¿p-¶Xv. t»m-¡p-
IÄ D-≠mIm-\p-Å Im-c-W-§Ä tUm-ÎÀ-am-cp-sS \
nÀ-t±-i-{]-Im-cw \n-§ÄX-s¶ {I-ao-I-cn-¡p-I-bm-sW-
¦n ss_-]m-kn-sâ Kp-Ww ]t¯m ]-Xn-\t©m
hÀ-jw \o≠-p­-\nÂ-¡pw. Np-cp-¡w Nn-eÀ-¡p-am{Xw
C-Xn-\p-Ån ho≠­ pw B³Pn-tbm-{Kmw sN-bv-Xv ]
F´m-Wv G-ähpw
pXn-b t»m-¡p-IÄ-¡v Nn-In-Õ th≠-­n-h-cpw. \Ã ss_-¸m-kv
C-\n a-cp-¶p-IÄ I-gn-¡p¶-Xv XpS-ctWm ? i-kv-{X-{In-b ?
c-t≠­m aqt¶m Xp-SÀ-¨b - m-bn I-gn-t¡≠nh-cpw. C-XnÂ
ss_-]m-Êv i-kv-{X-{In-b-bp-sS D-t±-iw lr-
{]-[m-\s
- ¸«-Xv B-k] v- n-cn\pw, sIm-fk- tv- {SmÄ Ip-db
- ¡
v- p-
¶-Xn-\p-Å kvä - m-än-\pamW-v. Iq-Sm-sX _n.]ntbm jp- Z-bm-Lm-X-¯n \n-¶v c-£-t\-Sp-I, ZoÀ-
Ktdm Ds­ ≠-¦n A-Xn-\p-Å a-cp-¶v I-gn-t¡-≠­n-h- L-Im-ew Po-hn-¡p-I, a-cp-¶p-IÄ Ip-d¡p-I
cpw. ap-X-em-b-h-bmWv. i-co-c-¯nse ap-dn-hp-IÄ
Ip-d¨v, [-a-\n-IÄ am-{X-ap-]-tbm-Kn-¨v FÃm
ap³-I-cp-X-ep-Ifpw kzo-I-cn-¨v tImw-¹n-t¡-
j-\p-I-fnÂ-s¸-Sm-sX sN-¿-s¸-Sp-¶ i-kv-
{X-{In-b-bm-Wv G-ähpw \Ã ss_-¸m-kv
i-kv-{X-{In-b. C-¯-c-¯n i-kv-{X-{Inb-
¡v hn-t[-b-\m-bm H-cm-gv-N-¡p -Ån ho-
«n-se-¯m-\mIpw H-cp am-k-¯n-\p-ÅnÂ
tPm-en-bn Xn-cn-sI {]-th-in-¡p-hm\pw
I-gn-bpw.

42
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43
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44

lrZ-b-hmÂ-hn-\v
A-kp-J-ap-Å-hÀ,
am-än-sh¨hÀ
A-dn-ªn-cn-t¡≠-
Im-cy-§sfs´Ãmw ?
lr-Z-b-¯n-se hmÂ-hp-IÄ G-sXm-s¡ ?
\m-ev hmÂ-hp-I-fm-Wv lr-Z-b-¯n-ep-ÅXv. A-tbmÀ-«n-
Iv hmÂhv, ssa{-SÂ hmÂhv, ss{S-I-kv-]n-Uv hmÂhv,
]Ä-samW-dn hmÂhv. CXn CS-Xv B-{Sn-b-¯n\
pw sh³-{Sn-¡n-fn\pw C-S-bn-ep-Å ssa{SÂ hmÂ-hn\
pw CS-Xv sh³-{Sn-¡n-fn\pw A-tbmÀ-«-¡n-S-bn-ep-ap-Å
AtbmÀ-«n-Iv hmÂ-hn-\p-am-Wv Iq-Sp-XÂ A-kpJ-
§Ä h-cm-dp-Å-Xv.
hmÂ-hp-I-fp-sS A-kpJ-§Ä
F-s´m-s¡?
sN-dp-{]m-b¯n kw-`-hn-¡p-¶ dq-am-än-Iv ^ohÀ,
{]m-bw sN-¶-hcn ImWp-¶ ImÕn-^n-t¡-j³,
lr-Z-bm-Lm-X-tcm-Kn-I-fn ImWp-¶ ssa{S hmÂ-
hv eo-¡v ap-X-em-b-h-bm-Wv {][m-\ A-kp-J§Ä.
F-´m-Wv Mital stenosis and Mitral Regur-
gitation ?
CS-Xp lr-Z-b-¯n-se B-{Sn-b-¯n\pw sh³-{Sn-¡n-
fn\pw C-Sbn Øn-Xn-sN¿p-¶ ssa-{S hmÂ-hv
Np-cp-§p-¶-Xn-s\ Mital stenosis F¶pw h-ep-Xm-bn
CHAPTER
V
eo-¡v h-cp-¶-Xn-s\ ssa{SÂ Mitral Regurgitation
F¶pw ]-d-bp¶p. Cu c≠v A-kpJ-§Ä h-cp-
t¼mÄ e-§v I³P-j³ h-¶v izm-kw-ap-«epw
{Ita-W lrZ-bw h-ep-Xm-bn lmÀ-«v s^-bv-e-dpw
D≠-m-Ip-¶p.
F-´m-Wv Aortic Stenosis and Aortic Regur-
gitation ?
CS-Xv lr-Z-b-¯n-sâ sh³-{Sn-¡n-fn\pw A-tb-
mÀ-«-bv¡pw C-S-bn-ep-Å hmÂhm-b Atb-
mÀ-«n-Iv hmÂ-hv Np-cp-§p-¶-Xn-s\ Aortic Stenosis
F¶pw eo-¡v sN-¿p-¶-Xn-s\ Aortic Regurgita-
tion F¶pw ]-d-bp-¶p. Cu c≠-v A-h-Ø-I-
fnepw lrZ-bw h-ep-Xm-Ip-Ibpw lmÀ-«v s^-bv-
e-dn-sâ `m-K-am-bn izm-k-X-S-k-ap≠mIp-Ibpw
sN-¿p-¶p.
lr-Z-bm-Lm-X-¯n G-Xp hmÂ-hn-\m-
Wv tI-Sv h-cp¶-Xv ?
km-[m-c-W lr-Z-bm-Lm-X-tijw, se-^v-äv
sh³-{Sn¡nÄ h-ep-Xm-Ip-t¼mÄ ssa{SÂ hmÂ-
hn-\v h-en-hv h-¶v eo-¡v sN¿m³ Xp-S-§p¶p.
45
 lr-Z-bm-Lm-Xw h-cp-¶-Xn-\p ap¼pw Nn-e-t¸mÄ C-Xp
kw-`-hn-¡mw. hmÂ-hn-s\ ]n-Sn-¨v \n-dp¯p-¶ t]-in-
IÄ-¡v c-à-sa-¯m-¯-Xv aq-e-am-Wn-Xv.

F-t¸m-gm-Wv ssa{SÂ hmÂthm BÀ-«n-Iv hmÂ-hp-

Itfm am-än-sh-bv-¡-W-sa-¶v ]-d-bp¶-Xv ?
{]-[m-\-ambpw izm-kw-ap-«v Iq-Sp-Itbm, lr-Z-b Ad-
IÄ hf-sc h-ep-Xm-hp-¶-Xm-bn Ft¡m sSÌn Im-
Wp-I-tbm, Np-cp-§-en-tâtbm eo-¡n-tâtbm Af-hv
A-ä-¯p-Å _eq¬ hoÀ-¸n-¨v A-S-ª hmÂ-
hf-sc Iq-Sp-X-em-bn Im-Wp-Itbm sN-¿p-t¼m-gm-Wv
hv Xp-d-¡p-¶-Xn-s\-bm-Wv Baloon Mitral Valvoto-
hmÂ-hv am-än-sh-bv-¡p-Itbm dn¸-bÀ sN-¿p-Itbm
my F-¶v ]-d-bp-¶-Xv.
th-W-sa-¶v ]-d-bp-¶-Xv.
hmÂ-hv am-än-sh-bv¡p-¶ Hm-¸-td-j\pw
hmÂ-hn-s\ Ip-dn-¨v a-\-Ên-em¡m³ G-ähpw \Ã
ss_-¸m-kv Hm-¸-td-j\pw X-½n-ep-Å
sS-Ìv G-Xv ?
{][m-\ hy-Xym-k-sa-´v ?
Ft¡m sSÌv. lr-Z-b-¯n-sâ DÄ-`m-K-hpw, hmÂ-
ss_-¸m-kv Hm-¸-td-j³ lr-Z-b-kv-]μ-\w \
hn-t\bpw ImWm³ I-gn-bp-¶p.
nÀ-¯ntbm kv-]-μn¡p-¶ lr-Z-b-¯ntem sN-
hmÂ-hn-\v A-kp-J-ap-Å-hÀ-¡v km-[m-c-W \ÂIp- ¿mw. ss_-¸m-kv Hm-¸-td-j\n lr-Z-b-¯n-
¶ a-cp-¶p-IÄ G-sXm-s¡-bm-Wv ? sâ Ad-IÄ ap-dn-¡p-¶nÃ. hmÂ-hv am-än-sh-bv-
¡p-¶-Xn-\v lr-Z-b-s¯ lmÀ-«v e-§v sa-jo\
e-§v I³P-j³ Ip-d-bv¡m³ aq{Xw A-[n-Iw t]m-Im-
n L-Sn-¸n-¨v lr-Z-b A-dI-sf ap-dn-¨n-«m-Wv
\p-Å Diuretic F-¶ a-cp-¶pIÄ, lr-Z-b-an-Sn-¸v Xm-gv-
sN-¿p-¶-Xv.
¯n sh-bv-¡m-\p-Å _oäm t»m¡À F-¶ a-cp-¶p-
IÄ \Â-Ipw. F-´m-Wv Un.hn.BÀ Hm-¸-td-j³ (DVR) ?
hmÂ-hn-\v A-kp-J-ap-Å-hÀ-¡v lr-Z-b-an-Sn-¸v c≠-v hmÂ-hp-I-fpw Aortic valve and Mitral valve
Iq-Sp¶-Xv F-´p-sIm≠v ? am-än-sh-bv-¡p-¶-Xn-s\-bm-Wv U_nÄ hmÂ-hv
lr-Z-b-¯n-sâ h-ep-¸w Iq-Sp-¶-Xv sIm≠-v do-s¹-bv-kv-saâ v AY-hm Un.hn.BÀ F-¶v
]-d-bp-¶-Xv.
hmÂ-hn-\v A-kp-J-ap-Å-hÀ-¡v ]£]mX
hpw, ssI-Im-ep-Ifn c-àw I-«-]n-Sn-¡epw Hm-¸-td-j³ F-{X-ka-bw
hcp¶-Xv F-´p-sIm≠v ? \o≠p-\n¡pw ?

hmÂ-hn-\v X-IcmÀ D-Å-hÀ-¡v lr-Z-b-an-Sn-¸v {I-am- 4þ5 a-Wn¡qÀ

Xo-X-am-bn Iq-Sp-¶-Xn-s\ Atrial Fibrillation F-¶m-Wv
]-d-bp-¶Xv. C¯-cw k-μÀ-`-§fn A-d-Ifn c-à-
¡-« D≠m-Ip-I-bpw A-Xv X-e-t¨m-dn-tem, ssI-Im-ep-
I-fn-se c-à-¡p-g-entem A-Sn-bp-t¼m-gm-Wv ]-£-]
m-Xw ap-X-em-b-h D-≠mIpI.
F-´m-Wv Baloon Mitral Valvotomy ?
hm-Xt- cm-Kw h-¶v ssa{SÂ hmÂ-hv Np-cp-§p-¶h - À-¡v
Im-en-se c-à¡ - p-ge
- n-eq-sS H-cp h-bÀ IS-¯n A-Xn-sâ
hmÂ-hv am-än-sh-bv¡p-¶ Hm-¸-td-j³-kv
ap³-]v sN-t¿-sS-kv-äp-IÄ F-s´Ãmw ?
ss_-¸m-kv Hm-¸-tdj-\v sN-¿p¶-Xp t]m-se
i-co-c¯n th-sd F-s´-¦nepw A-kp-J-ap-
t≠msb-¶-dn-bm-\p-Å FÃm sS-Ìp-Ifpw sN-
¿Ww.
hmÂ-hv Hm-¸-tdj-\v ap³]v F-´n-\m-Wv ]
Ãv sN-¡-¸p-IÄ sN-¿p¶-Xv ?

46
hmÂ-hp-IÄ am-än-sh-¨-Xn-\p ti-j-ap-Å {]-[m-\-
am-sbm-cp A-]I-Sw am-än-sh-¨ hmÂ-hn-\p A-Wp-
_m-[ h-cp-¶-XmWv. tI-Sp-h-¶ ]Ãp-Ifn H-fn-
ªn-cn¡p-¶ A-Wp-¡-fm-Wv C-Xn-s\m-cp {][m-\
Im-cWw.
hmÂ-hv Hm-¸-td-j-sâ dn-kv-Iv F-{X ?
km-[m-c-W H-cp i-X-am-\¯n Xm-sg
am-än-sh-bv-¡-s¸Sp-¶ hmÂ-hp-IÄ G-sXm-s¡ ?
• teml-§Ä sIm≠p≠m¡n-b-h-bpw (Metal
Valves) DZm: Chitral Valve, St. Jude Valve, etc
• ar-K-§fn \n-s¶-Sp-¡p-¶-h-bpw (Tissue Valve)
D-Zm: Permenent Valve, Magna Valve, etc
sa-ä hmÂ-hp-I-fp-sS Kp-W-§fpw tZm-j-§fpw
F-s´Ãmw ?
Kp-W-§Ä:
• ZoÀ-L-Imew (Po-hn-X-Im-ew ap-gph³)
\n-e-\n¡pw
• hn-e Ip-d-hm-Wv
tZm-j-§Ä:
• Po-hn-X-Im-ew ap-gp-h³ c-àw -I-«-]n-Sn-¡m-Xn-cn-
¡m-\p-Å a-cp-¶v I-gn-¡Ww.
• A-]qÀ-Æ-am-bn s]-s«-¶v t»m-¡v h-cm-\p-Å
km[y-X
• c-àw I-«-]n-Sn-¡m-Xn-cn-¡m-\p-Å a-cp-¶v AY-
hm Anticoagulant Acitrom, Warfarin I-gn-¨n-sænÂ
hmÂ-hv t»m-¡m-Ipw.
Snjyq hmÂ-hp-I-fp-sS Kp-W-§fpw tZm-j-§-
fpw F-s´Ãmw ?
Kp-W-§Ä:
• aq-¶p am-k-¯n-\-¸p-dw c-àw I-«-]n-Sn-¡m-Xn-
cn-¡m-\p-Å a-cp-¶v I-gn¡≠
• s]s«-¶v t»m-¡p-≠m-InÃ
tZm-j-§Ä :
• 10þ15 hÀ-j-§Ä-¡p ti-jw X-I-cm-dv kw-`-
hn-¡p¶p
• hn-e Iq-Sp-X-em-Wv
F-{X\mÄ sF-kn-bp hn I-gn-bWw,
F{X\mÄ Bip]{Xnbn IgnbWw ?
km[m-c-W aq-¶v Znh-kw sF-kn-bp-hnepw
A-Sp-¯ \m-ep Znh-kw dq-anepw I-gn-bWw.
G-I-tZiw 7þ8 Zn-h-k-¯n-\pÅn ho-«n-te-¡v
a-S-§mw.
ho«n sN¶m {i²nt¡≠ Imcy§Ä?
B-Zy-s¯ B-gv-¨ ho-Sn-\-I-¯pw, A-Xn-\pti-
jw ho-Sn-\p ]p-d¯pw sN-dp-hym-bm-a-§fpw
\-S-¯hpw {]m-hÀ-¯n-I-am-¡p-I. izm-k-tIm-i
hym-bm-a§Ä I-gp¯v, tXm-fpIÄ, ssI-Im-ep-
I-fp-sS hym-bma-§Ä sN-¿p-I. ap-dn-hv ]-gp-¡m-
sX t\m-¡p-I.
F-´m-Wv IotlmÄ hmÂ-hv do-s¹-bvks
v- aâ v ?
s\-©n-sâ sskUn Iq-Sn sN-dn-sbm-cp ap-
dnhn Iq-Sn hmÂ-hv am-än-sh-bv¡m³ I-gn-bpw.
47

F-´m-Wv tdm-t_m-«n-Iv hmÂ-hv
do-s¹-bv-kv-saâ v ?
s\-©n-sâ ssk-Un-se H-cp skâo-ao-äÀ am-{Xw h-ep-
¸-ap-Å ct≠m aqt¶m ap-dnhn Iq-Sn hmÂ-hv am-än-
sh-bv¡m³ km-[n-¡pw.
F-´m-Wv Bân-sIm-bm-Kpeâ v?
(Anticoagulant )
am-än-sh-¨ hmÂ-hp-IÄ {]-tXy-In¨pw tem-lw sIm≠-
p-Å-Xm-sW-¦nÂ, Po-hn-X-Im-ew ap-gp-h³ c-àw I-«-]
n-Sn-¡m-Xn-cn-¡m-\p-Å a-cp-¶v I-gn-¡-Ww. Acitrom, War-
tarin ap-X-em-b-h-bm-Wv {]-[m-\-am-bh.
F-´m-Wv sF.F³.BÀ ? (I.N.R)
International Normalisation Ratio
Hcp tcm-Kn-¡v F-{X-
am{Xw Bân-sIm-bm-Kpeâ v a-cp-¶v I-gn-¡-W-sa¶-Xv
sF.F³.BÀ F-¶ sS-kv-än-sâ A-Sn-Øm-\-¯n-em-
Wv \n-Ý-bn-¡p-¶-Xv. sF.F³.BÀ c≠-n\pw aq-¶n\
pw C-S-bn-em¡m³ tUm-kv A-Uv-P-Ìv sN-¿-Ww.
sF.F³.BÀ \men Iq-S-X-embmÂ
A-]-IS-§Ä F-s´-Ãmw ?
X-e-t¨mdv, B-am-ibw, Ip-S-epIÄ, tam-WIÄ, k-Ôn-
IÄ F-¶n-hbn c-à-{km-h-ap-≠m-Im-\p-Å km-[y-
X-bp≠v. Ipdªm h-¨-hmÂhn c-àw I-«-]n-Sn-
¡m³ km-[y-X-bp≠v.
hmÂ-hv am-än-sh-¨ tcm-Kn-bp-sS a-ew I-dp-¯
\n-d¯n t]mbm Imc-Ww ?
B-am-i-b¯n c-à-{km-h-ap≠-v F-¶À-°w
hmÂ-hv am-än-sh¨m G-sX-¦nepw `£-Ww
I-gn-¡m-Xn-cn-¡tWm ?
{Ko³ eo-^n sh-Pn-ä-_nÄ-kv þ No-c ap-X-em-b-h
sF.F³.BÀ IqSm³ C-S-bm-¡pw.
48
hmÂ-hv am-än-sh¨m {i-²n-t¡-≠
a-äp Im-cy-§Ä F-s´Ãmw ?
kv-{Xo-IÄ KÀ-`n-Wn-bm-hp-I-bm-sW¦nÂ
B-Zy-s¯ aq-¶p am-k-hpw, {]-k-h-¯n-t\m-S-
Sp¯pw Bân-sIm-bm-Kpeâ v I-gn-¡-cpXv. KÀ-
`-Ø in-ip-hn tZm-j-^-e-§-fp-≠m-¡pw.
ap-dn-hpIÄ, A-]-IS-§Ä ap-X-em-b-h-bv-¡v
km-[y-X-bp-Å tPm-en-Ifn \n-¶v am-dn \nÂ-
¡Ww. c-à-{km-hw \n-b-{´n-¡phm³ _p-²n-
ap-«p-≠m-Ipw.
a-äv Hm-¸-td-j-\p-IÄ-t¡m, dental procedure
IÄ-¡v apt¼m aqt¶m \mtem Znh-kw Bân-
sIm-bm-Kpeâ v \nÀ-¯n Heparin F-¶ C³-P-
£-\n-te-¡v am-dWw.
i-co-c-¯n-se-s´-¦nepw A-Wp-_m-[-bp-≠m-
Ip-I-bm-sW¦n tUm-Î-dp-sS D-]-tZ-iw tX-Sn
Bân-_-tbm-«n-Iv Xp-S-§Ww. C-Xn-s\ Infec-
tive Endocarditis prophylaxis F-¶v ]-d-bp¶p.
amän-sh-¨ tem-l-hmÂ-hv s]-s«-¶v
A-S-bp-¶-Xn-sâ e-£W-§Ä F-s´Ãmw ?
izm-k-X-Skw, X-e-Np-än ho-gÂ
hmÂ-hv am-än-sh-bv-¡Â i-kv-{X-{In-b-bv-¡p
ti-j-ap-Å {][m-\ tIm-w-¹n-t¡-j-\p-IÄ
F-s´Ãmw ?
• ]pXn-b hmÂ-hn-s\ A-Wp-_m-[n¡p-I
• ]pXn-b hmÂ-hn-\v X-IcmÀ kw-`-hn¡p-I
• hmÂhn c-àw I-«-]n-Sn¡p-I
• Bân-sIm-bm-Kpeâ v a-cp-¶n-sâ ]mÀ-iz-
^e-§Ä
Heart Valves
Pulmonary
Valve
Aortic
Valve
Bicuspid
Valve
Tricuspid
Valve
A superior view of the heart
]p-Xn-b hmÂ-hn-s\ A-Wp-_m-[n-¨mÂ
Nn-In-Õ F-´v ?
]Ãv, Xz-¡v tcmK-§Ä ap-X-em-b-hbn \n-¶mWv
km-[m-c-W A-Wp-_m-[n-¡p-¶-Xv. ZoÀ-L-Im-ew
Bân-_-tbm-«n-Iv a-cp-¶v I-gn-¨n«pw ]-\n hn-«p-am-dp-
¶n-sæn A-Wp-_m-[n-¨ hmÂ-hv F-Sp-¯p am-än
]pXn-b hmÂ-hv sh-t¡≠-Xm-bn h-cpw.
]pXn-b hmÂ-hv Ì-¡v B-bn I-gnªmÂ
F-´m-Wv Nn-InÕ ?
C-Xv Po-h³ \-ã-s¸-t«-¡mhp-¶ H-cp A-h-Ø-bm-
Wv. c-àw I-«-]n-Sn-t¨m, sa-¡m-\n-¡Â s^-bv-eÀ
sImt≠m B-Wv C-Xv kw-`-hn-¡p-¶Xv. Im-¯v-em-
_n-sâ k-lm-b-t¯m-sS Thrombolysin a-cp-¶p-IÄ
D-]-tbm-Kn-¨v I-«-]n-Sn-¨ c-à-s¯ amäm³ ]-äp-¶n-
sæn A-Sn-b-´n-c-am-bn ho≠pw hmÂ-hv am-än-sh-
bv-t¡≠Xm-bn h-cpw.
hmÂ-hv am-än-sh-bv-¡p-¶-Xm-tWm, dn-s¸-bÀ
sN-¿p-¶-XmtWm \Ã-Xv ?
dn-s¸-bÀ sN¿m³ ]-äp-sa¦n A-Xp-X-s¶-bm-Wv
\ÃXv. Im-cWw, ]pXn-b hmÂ-hv h-bv-t¡≠-,
A-Wp-_m-[-bp≠-m-Im-\p-Å km-[y-X-bnÃ,
c-àw-I-«-]n-Sn-¡m-Xn-cn-¡m-\p-Å a-cp-¶v I-gn-
bv¡≠-. ]-t£ Nn-e tI-Sp-h-¶ hmÂ-hp-IÄ
kÀ-P³-amÀ-¡v dn-s¸-bÀ sN¿m³ ]-ä-W-sa-
¶nÃ. dn-s¸-bÀ i-cnbm-b hn-[¯n sN¿m³
]-än-bn-sæn Ht¶m ct≠m hÀ-j-¯n-\
pÅn ho≠pw Hm-¸-td-j³ th≠-n h-t¶-¡mw.
F-´m-Wv TAVR ? (Transcatheter Aortic-
Valve Replacement)
C-t¸mÄ Hm-¸-td-j³ Iq-Sm-sX X-s¶ Xp-S-bn-
se c-à-¡p-g h-gn A-tbmÀ-«n-¡v hmÂ-hv am-
än-sh-bv¡m³ km-[n-¡pw. C-Xn-s\ TAVR F-¶p
]-d-bp-¶p. sNe-hv Iq-Sp-X-emWv. Hm-¸-tdj-\v dn-
kv-¡v Iq-Sn-b-hcn am-{X-am-Wv C-t¸mÄ C-Xv
D-]-tbm-Kn-¡p-¶Xv.
49
 CHAPTER
VI
F-t¸m-gm-Wv lrZ-bw \n-eb
- ¡
v- p-¶X
- v?
(Cardiac arrest)
ITn-\am-b lr-Z-bm-Lm-Xw kw-`-hn-¡p-t¼mÄ lr-Z-
b-kv-]μ-\w Xo-sc \n-e-bv-¡p-I-tbm, c-àw ]-¼p-sN-
¿-s¸-Sm-\m-Im-sX lrZ-bw hf-sc th-K¯n A-Sn-
¡p-¶tXm B-Wv ImÀ-Un-bm-Iv A-d-Ìv. A-©p
an-\p«n Iq-Sp-X lrZ-bw \n-e¨m a-kv-Xn-jv-¡
ac-Ww kw-`-hn-¡pw. A-Xp-sIm≠-v lrZ-bw \n-e-¨-
bm-sf c-£n-¡m³ 5 an-\p-«v am-{X-ta \-ap-¡v In-«p-
¶p-Åq.
lrZ-bw \n-e¨mÂ
Ip-g-¸-§-sf-s´Ãmw ?
lr-Z-b-¯n-sâ {][m-\ e£yw i-co-c-`m-K-§-fn-te-
¡v c-à-sa-¯n-¡p-I-bm-W-tÃm. 5 an-\p-«v t\-c-t¯
c-à-sa-¯n-bn-sæn a-kv-Xn-jv-¡-ac-Ww kw-`-hn-
¡pw. X-e-t¨m-dm-Wv Hm-Iv-kn-P³ In-«m-sX \n-e-\
50
Ft¸m-gm-Wv
s\©-aÀ-¯epw
Ir-{Xn-a-
izm-tkm-Ñm-kh-pw
\Â-tI≠-n h-cp¶-Xv
n¡m³ ]-äm-¯ G-ähpw {]-[m-\s¸-« A-h-
b-hw. Iq-Sp-X t\-cw c-à-k-½À-±w Ip-d-ª
\n-e-bn-em-sW¦n hr-¡-IÄ¡pw en-h-dn-\pw
\m-iw kw-`-hn-¡pw. lrZ-bw \n-e¨m DS-s\
X-s¶ izm-tkm-Ñm-khpw \n-e-bv-¡pw.
lrZ-bw \n-e-¨p-sh-¶v a-\-Ên-em-
¡p-¶-sX-§s\, lrZ-bw \n-e-¨
tcm-Kn-sb I≠m sNt¿≠sX-
s´Ãmw ?
HmÀ-½ \-ã-am-Ip-¶p. izm-tkm-Ñm-kw \n-e-bv-
¡p¶p. ]Äkv, _n-]n ap-X-em-b-h D-≠m-InÃ.
C-Xn-s\ ImÀ-Un-bm-Iv AdÌv F¶v ]-d-bp¶p.
C¯-cw tcm-KnI-sf c-£n-¡m³ 5 an-\p-«v am-
{X-ta ka-bw e-`n-¡p-¶pÅq. Cu k-a-b-¯n-\
pÅn Ir-{Xn-a izm-tkm-Ñm-khpw s\-©-aÀ-¯-
epw \-S-¯Ww. C-Xn-s\ CPR (Cardio Pulmo-
nary Resuscitation) F¶v ]-d-bp¶p.

a. Ir-{Xn-a izm-tkm-Ñm-kw (Artificial Breathing)
X-e ]-c-amh-[n ]p-d-In-te-¡v h-f-¡p-I, Xm-Sn ap-
t¶m-«v s]m-¡p-Ibpw sN-bvXm \m-hv Xm-tgm-«v
ho-Wv izm-k-X-S-Ê-ap-≠m-Ip¶-Xv X-Sbm³ I-gn-
bpw. tcm-Kn-bp-sS aq-¡S-¨v hmbn Iq-sS an-\p-«nÂ
16 X-h-W izm-kw sIm-Sp-¡p-I. i-co-c¯n Hm-Iv-
kn-P³ I-bäm³ th-≠n-bm-WnXv.
b. s\-©v A-aÀ¯Â (Chest compression )
C-cp-ssI-IÄ tImÀ-¯v ]n-Sn-¨v h-e-Xp ssI-bn-sâ
D-¸q-änsIm≠-v am-sdÃn-sâ Xm-gv `mK-¯v CS-Xp
h-i-¯m-bn an-\p-«n \q-dp-X-h-W-tbm-fw A-aÀ-
¯p-I. ]-¼n-§v F-¶ lr-Z-b-¯n-sâ {]-hÀ¯-\w
\n-e\- nÀ-¯p-¶X
- n\pw th-≠n-bm-Wn-Xv.
lrZ-bw \n-e-¨ tcm-Kn-sb B-ip-]-{Xn-
bn-te-¡v am-äp-¶-sX-§s\ ?
lrZ-bw \n-e-¨ tcm-Kn-sb Bw-¼p-e³kpw ]m-cm-sa-
Un-¡Â Ìm^pw F-¯n-b-Xn-\p ti-jw am-{X-
ta B-ip-]-{Xn-bn-te-¡v am-äphm³ {i-an-¡mhq.
Im-dntem a-täm t]m-Ip-t¼mÄ Ir-{Xn-a izm-
tkm-Ñm-khpw sN-kv-äv Iw{]j\pw \ÂIm³
_p-²n-ap-«p-≠m-Ipw. A©p-an-\n-än-Â IqSp-XÂ
Ir-{Xn-a-izm-tkm-Ñm-k-hpw, sN-kv-äv Iw-{]-j\
pw \Â-Im-Xn-cp¶m a-kv-Xn-jv-¡- ac-Ww kw-
`-hn-¡mw.
]m-cm-sa-Un-¡Â Ìm-^v
sNt¿≠sX-s´Ãmw ?
hm-bnÂ-¡q-sS-bp-Å Ir-{Xn-a izm-tkm-Ñm-kw
A-{X ^-e-{]-ZaÃ. ]m-cm-sa-Un-¡Â Ìm-^n-\v
Iq-Sp-XÂ ^-e-{]-Z-am-bp-Å Hm-Iv-kn-P³ am-kv-
Iv izm-tkm-Ñm-k-hpw, izm-k-\m-f-¯n-te-¡v
Ip-g-en-«v Hm-Iv-kn-P³ \Â-Ip-¶ izm-tkm-Ñm-
khpw \Â-Im-\m-Ipw. lr-Z-b-an-Sn-¸v hf-sc
h-ep-Xm-bp-Å sh³-{Sn-¡pemÀ ^n-{^n-tÃ-j³
B-sW-¦n ]m-cm-sa-Un-¡Â Ìm-^n-\pw Uo-
{^n-_n-tÃ-äÀ F-¶ D-]-I-c-W-ap-]-tbm-Kn¨v
D.C tjm-¡v \Â-In lr-Z-b-s¯ D-t¯-Pn-¸n-
¡m-\m-Ipw. D.C tjm-¡v ^-e-{]-Z-amtbm F-¶v
\m-Sn-bn-Sn-¸v t\m-¡n a-\-Ên-em-¡mw. ^-e-{]-Z-
am-bn-sæn sN-Ìv I-{_-j³-kv Xp-S-c-Ww.
A-Xymln-X hn-`m-K¯n lrZ-bw
\n-e-¨ tcm-Kn-sb ip-{iq-jn-¡p-¶-
sX§-s\ ?
A-Xymln-X hn-`m-K-¯n-se¯p-¶ C¯-cw tcm-
KnI-sf c-£n¡p-¶ L-SI-§Ä i-co-c-¯n-se
Hm-Iv-knP-sâ Af-hv Ir-Xy-am-¡p-I, lr-Z-b-
kv-]μ-\w t\-sc-bm-¡p-I, c-à-k-½À-±w t\-sc-
bm¡p-I F-¶n-h-bm-Wv. izm-k-\m-fn-bn-te-¡v
Syq-_n-«v Hm-Iv-kn-P³ \Â-In Ir-{Xn-a izm-tkm-
Ñm-kw \Â-Ip-¶p. lr-Z-b-an-Sn-¸v km-[m-c-W
\n-e-bn-em¡m³ t]-kv-ta-¡À, Uo-^n-{_n-te-
äÀ ap-Xem-b D-]-I-cW-§Ä k-lm-b-I-am-Ipw.
c-à-k-½À-±w km-[m-c-W\n-e-bn-em¡m³ a-cp-
¶p-I-tfm, IABP F-¶ _eq¬ ]t¼m Nn-e
L-«-§fn lr-Z-b-¯n\pw izm-k-tIm-i-¯n\
pw ]-c-amh-[n sd-kv-äv \Â-Ip¶ ECMO (Extra
Corporeal Membrane Oxygenation) F-¶ Nn-In-
Õm-hn-[ntbm \Â-Iphm³ I-gn-bpw.
51
Space for

AD
 CHAPTER
VIII

lmÀ-«v s^-bv-eÀ
A-dn-ªn-cn-t¡≠
Im-cy§Ä
F-´m-Wv lmÀ-«v s^-bveÀ ? lmÀ-«v s^-bv-e-dn-sâ e£-§Ä
lr-Z-b-¯n-sâ tPm-en c-à-s¯ kzo-I-c-n-¨v A-h- F-s´-Ãmw ?
b-h-§-fn-te-¡v ]-¼v sN-¿p-I-bm-W-tÃm. lr-Z-b ssd-äv lmÀ-«v s^-bv-eÀ
t]-in-I-fm-Wv Cu [À-½w \nÀ-Æ-ln-¡p-¶Xv. Cu ssI-Im-ep-Ifn \o-cp-sh-bv-¡Â, I-cÄ-ho-¡w
{]-{Inb-¡v XS-kw h-cp-t¼mÄ ]n-¶m-¼pd-¯v c-àw sIm≠p≠m-Ip-¶ h-b-dp-thZ-\, s\-©nepw
sI-«n-¡n-S-¡p-Ibpw A-h-b-h-§-fn-te-¡v th≠{X h-b-dnepw sh-Åw sI-«Â ap-X-em-bh
c-àw e-`n-¡m-sX h-cn-Ibpw sN-¿p¶p. Cu A-h-
se-^v-äv lmÀ-«v s^-bv-eÀ
Ø-bm-Wv lmÀ-«v s^-bv-eÀ. lr-Z-b-¯n-sâ CS-Xp
izm-k-tIm-i-§fn c-àw-sI-«n-¡n-¡p¶-Xp
`m-K-¯n\pw he-Xp `m-K-¯n\pw s^-bv-eÀ kw-`-
aq-e-ap≠mIp-¶ izm-kw-ap«Â (Nn-e-t¸mÄ sN-
hn¡mw km-[m-cW 70% ]-¼n-§v ti-jn-bp-Å lr-Z-
dp-hym-bm-a-¯n-epw, Iq-Sp-t¼mÄ In-S-¡p-t¼mÄ
b-¯n-\v B-Zy-s¯ lr-Z-bm-Lm-X¯n Ipd-¨p t]-
t]m-epw) £o-Ww ap-X-em-b-h-bm-Wv {][m-\
in-IÄ \-in-¡p-¶-Xp Imc-Ww ]-¼n-§v 40% B-bn
e-£W-§Ä
Ip-d-tª-¡mw. ]n-s¶bpw lr-Z-bm-Lm-Xw h¶mÂ
lmÀ-«v s^-bv-eÀ kw-`-hn-¡p-¶p.
Pulmonary
lmÀ-«v s^-bv-e-dn-sâ Im-cW-§Ä Aortic valve valve

F-s´Ãmw ?
CS-Xp lmÀ-«v s^-bv-eÀ F¶pw he-Xv lmÀ-«v s^- Mitral valve
bv-eÀ F¶pw c-≠p hn-[-ap≠v. Xp-S-sc-bp-Å lr-Z-
Tricuspid
bm-Lm-X-§Ä, lr-Z-b hmÂ-hp-IÄ-¡v tI-Sp-hcÂ, valve
A-an-Xam-b c-à-k-½À±w, Ip-«n-¡m-e-t¯ Xp-
S§p-¶ Nn-e lr-Z-b A-kp-J§Ä, {]-tXy-I Im-
c-W-anÃm-sX lrZ-bw hoÀ-¡Â ap-X-em-b-h-bm-Wv
lmÀ-«v s^-bv-e-dn-sâ {][m-\ Im-c-W§Ä.

53
 Nn-In-Õ-I-sf-s´Ãmw?
Imc-Ww I-s≠¯n Nn-In-Õn¡m³ {i-an-¡p-I, a-cp-
¶p-IÄ sIm≠v A-dp-Xn h-cp-¯p-I, ]-äp-¶n-sænÂ
hmÂ-hv am-än-sh-bv¡Â, t]-kv-ta¡À, AICD, do-knw-
{I-ssW-tk-j³ sX-dm¸n, lr-Z-bw-am-än-sh-bv-¡Â
a-cp-¶p-I-sf-s´Ãmw ?
i-co-c¯n \n-¶v P-ew \o-¡w sN-¿m-\p-Å a-cp-¶p-
IÄ AY-hm ssk-bp-d-än-¡v-kv lr-Z-b-t]-in-IÄ-¡v
i-àn \ÂIp-¶ Un-t_m-Iv-kn³, _o-äm t»m-¡-
dpIÄ, B³-Pn-tbm-sS³kn t»m-¡-dp-IÄ F-¶o
C-\-¯nÂ-s¸-Sp-¶h
F-{X-am{Xw \-S¡mw ?
lmÀ-«v s^-bv-eÀ h-¶ hy-àn-¡v km-[m-c-W hy-
ànI-sf t]m-se Po-hn-Xm-bm-kw km-[y-a-sÃ-¦n-epw
kq-£n-¨v kp-c-£n-X-am-bn ap-t¶m-«v t]m-Im³ I-gn-
bpw.
Hm-tcm-cp-¯cpw X-\n-¡v F-{X-am{Xw i-co-cm-²zm-\w
km-[y-am-sW-¶v I-s≠¯Ww. {Ita-W i-co-cm-²zm-
\w hÀ-[n-¸n-¡m³ I-gn-bpw.
`-£-W-{Ia-§Ä F-s´-Ãmw ?
lmÀ-«v s^-bv-edn i-co-c-¯n-ep≠m¡p-¶ H-cp {]
54
[m-\ hy-Xn-bm-\w D¸pw sh-Å-w sI-«-ep-ap-
≠mIp-¶ \o-cp-h-cepw izm-kw-ap-«-ep-am-Wv.
D¸pw sh-Åhpw \n-b-{´n-¡Ww. lr-Z-bm-
LmX-§Ä sIm≠p≠m-b lmÀ-«v s^-bv-eÀ
B-sW¦n sIm-f-kv-t{SmÄ Ip-d-ª B-lm-
cw I-gn-¡-Ww.
F-´m-Wv do-knw-{I-ssW-tk-
j³Nn-InÕ ?
Nn-e lmÀ-«v s^-bv-e-dp-Ifn C-S-t¯ lr-Z-
bhpw he-Xp h-i-s¯ lr-Z-bhpw hn-I-kn-¡p-
¶-Xpw k-t¦m-Nn-¡p-¶Xpw X½n Ipd-¨v hy-
Xn-bm-\w h-t¶-¡mw. t]-kv-ta-¡À t]m-ep-Å
H-cp-]-Ic-Ww L-Sn-¸n-¨v C-Xv i-cn-bm-¡p-¶-
Xn-s\-bm-Wv do-knw-{I-ssW-tk-j³ F-¶p
]-d-bp-¶-Xv.
F-´m-Wv t]-kv-ta-¡À ?
lr-Z-b-an-Sn-¸v 40þ50 h-sc Ip-d-bp-I-bm-sW¦nÂ
lmÀ-«v t»m-¡v F-¶ A-h-Ø-bm-Imw. C-¯-
cw k-μÀ-`-§fn sN-dn-sbm-cp C-e-Iv-t{Sm-
Wn-¡v D-]-Ic-Ww lr-Z-b-hp-am-bn _-Ô-s¸-«v
i-co-c¯n L-Sn-¸n¨m lr-Z-b \nc-¡v Iq-«n
70þ80 h-sc B-¡phm³ I-gn-bpw.
F-´mWv AICD ? F-t¸m-gm-Wv lrZ-bw
Nn-e tcm-Kn-IÄ-¡v lr-Z-b-kv-]μ-\w \n-e-¡p-I-tbm, am-än-sh-bv-t¡≠­­n- h-cp¶-Xv ?
hf-sc Iq-Sp-X-em-bn A-Sn-¡p-Itbm sN¿p-¶ A-h- a-cp-¶pIÄ, do-knw-{I-ssW-tk-j³ sX-dm¸n,
Ø-bp-≠m-Imw. C-Xv am-c-Iam-b A-h-Ø-bmWv. C-Xv AICD ap-Xem-b Nn-InÕ-IÄ sIm≠v
km-[y-X-bp-Å tcm-KnIÄ AICD .............. F-¶ D-]- lmÀ-«v s^-bv-eÀ tcm-Kn-IÄ-¡v Po-h³ \n-e-
Ic-Ww Xz-¡n-\-Snbn L-Sn-¸n-¨mÂ, Cu D-]-Ic-Ww \nÀ¯m³ I-gn-bnà F-¶v h-cp-t¼mÄ lrZ-
t]-kv-ta-¡-dm-tbm, tjm-¡v \ÂIp-¶ Uo-^n-{_n-tÃ- bw am-än-sh-bv-t¡≠n h-cp-¶p. km-[mc-W,
ä-dmtbm {]-hÀ-¯n-¡pw. k-a-{]m-b-¡m-cm-b, A]-I-S a-c-W¯n a-c-W-

F-´m-Wv LNAD s¸-Sp-¶-h-cp-sS lr-Z-b-am-Wv lmÀ-«v s^-bv-eÀ

(Left Verticular Assist Device) tcm-Kn-IÄ-¡v D-]-Im-c-am-Ip-¶-Xv.
CS-Xp lrZ-bw Z-b\ - o-ba- m-bn ]-cm-Nb- s
- ¸-Sp-t¼mÄ Ip-
d-¨p \m-ft- ¯-¡v lr-Zb - s- ¯ k-lm-bn¡m³ s\-©n-\
pÅn L-Sn-¸n-¡p-¶ D-]I - c
- W - m-Wv LVAD. lrZ-bw
- a
am-än-sh-b¡v- m³ Xm-ak
- n¡p-¶ tcm-Kn-IÄ-¡v Cu D-]-
Ic-Ww XmÂ-¡men-I Po-h³ c-£ \Â-Ipw.

F-´m-Wv BÀ-«n-^njy lmÀ«v ?

lrZ-bw ap-gp-h³ F-Sp-¯v am-än A-Xn-sâ Øm\-¯v
Ir{Xn-a lrZ-bw ]n-Sn-¸n-¨v am-k-§-tfm-fhpw hÀ-
j-§-tfm-fhpw Po-hn¡m³ I-gn-bpw. lrZ-bw am-än-
sh-bv-t¡≠- tcm-Kn-bv-¡v tbm-Pn-¨ lrZ-bw In«m³
Xma-kw h-cp-t¼mÄ Ir-{Xn-a lrZ-bw D-]-tbm-K-{]-Z-
am-bn-cn-¡pw.

55
 Space for

AD

56
 CHAPTER
IX

lrZ-bw
am-än-sh-¨-hÀ
Fs´Ãmw
{i-²n-¡-Ww ?

F-t¸m-gm-Wv lr-Z-bw-am-än sh-bv-t¡≠Xm- ¼v a-äv {][m-\ A-h-b-h-§fm-b hr-¡IÄ,

bn h-cp-¶-Xv ?
lmÀ-«v-s^-bv-eÀ aq-ew ssZ-\wZn-\ {]-hr¯n-IÄ
sN¿m³ ]-äm-sX h-cn-I-bpw, a-cp-¶p-Itfm a-äp Nn-
In-Õ-I-tfm (t]kv-ta¡À, hmÂ-hv do-s¹-bv-kv-saâ v,
CRT-D) ]-äm-sX h-cp-t¼m-gm-Wv lrZ-bw am-än-sh-bv-
¡-W-sa-¶v ]-d-bp-¶Xv.
lr-Z-bw-am-än sh-bv-¡p-¶-Xn-sâ hn-P-b
i-X-am-\-sa-{X?
G-I-tZ-iw 90 i-X-am-\w tcm-Kn-IÄ¡pw i-kv-{X-{In-
b-bn-eq-sS A-Xn-Po-hn-¡phm³ I-gn-bpw. ]-¯v hÀ-j-
¯n-\p ti-j-hpw 60 i-X-am-\w tcm-Kn-I-Ä¡pw kp-J-
am-bn Po-hn¡m³ I-gn-bpw.
FÃm lmÀ-«v s^-bv-eÀ tcm-Kn-IÄ¡pw
lrZ-bw am-än-sh-bv¡m³ km-[n-¡ptam ?
lrZ-bw am-än-sh-bv¡m³ Xo-cp-am-\n-¡p-¶-Xn-\p ap-
IcÄ, izm-k-tIm-iw ap-X-em-b-h \Ã Øn-
Xn-bn-em-sW-¶v D-d-¸p-h-cp-¯Ww. km-[m-c-W
lmÀ-«v-s^-bv-eÀ h-cp-t¼mÄ izm-k-tIm-i-¯n-
se c-à-k-½À-±w D-b-cp-¶p, hr-¡-I-fp-sS
^w-Kv-j³ Xm-tgm-«p-h-cp-¶p, en-hÀ ^w-Kv-j³
i-cnbm-b co-Xn-bn-e-sæn ko-tdm-kn\p
h-sc Im-c-W-am-tb-¡mw. sshd-kv A-Wp-_m-
[-Ifm-b sl¸-sä-änkvþ _n, F-bv-Uvkv ap-X-
em-b-hbpw a-äv _m-Îo-cn-b A-kp-J-§fm-b
Sq_À-Ip-tem-knkv, Iym³kÀ F¶n-h D-Å-h-
cnepw {]m-bw Iq-Sn-b-h-cnepw km-[m-c-W lrZ-
bw am-än-sh-bv-¡m-dnÃ.
am-än-sh-bv-¡m-\p-Å lrZ-bw BcnÂ
\n-¶m-Wv In-«p¶-Xv ?
tdm-U-]-I-S-§fn a-kv-Xn-jv-¡-ac-Ww kw`-
hn¨ tcm-Kn-Ifn \n-¶m-Wv lrZ-bw F-Sp-¡p-
¶-Xv.
57
 ]pXn-b lrZ-bw tbm-Pn-¡ptam
F-s¶§-s\ A-dnbmw ?
c-≠p-t]-cp-tSbpw c-à-{Kq-¸p-IÄ H-¶m-IWw. i-co-c-
`m-chpw h-ep-¸hpw G-I-tZ-iw tbm-Pn-¡Ww. hr¡-
IÄ am-än-sh-bv-¡p-t¼mÄ, Po-hn-¨n-cn-¡p-¶ BfnÂ
\n-¶v H-cp hr-¡ F-Sp-¡p-t¼mÄ sN¿p-¶ HLA sS-
Ìp-IÄ lrZ-bw am-än-sh-bv-¡p-t¼mÄ sN-¿m-dnÃ.
lrZ-bw Xcp-¶ tcm-Kn-I-fp-sS F-s´Ãm-am-
Wv ]-cn-tim-[n-¡p¶-Xv ?
]pXn-b lr-Z-b-¯n-sâ {]-hÀ¯-\w \Ã-Xm-tWm,
t»m-¡p-I-fp-t≠m, hmÂ-hp-I-fp-sS {]-hÀ-¯\w, tcm-
Kn-¡v F-s´-¦nepw A-Wp-_m-[-I-fpt≠m ap-X-em-b-
h-bm-Wv ]-cn-tim-[n-¡p-¶-Xv.
lrZ-bw am-än-sh-bv¡m³ X-¿m-sd-Sp-¯n-
cn¡p-¶ tcm-Kn-IÄ sN-t¿≠sX-s´Ãmw ?
]pXn-b lrZ-bw e-`n-¡p-t¼mÄ, F-t¸mÄ th-Ws - a-
¦nepw B-ip-]{- Xnbn \n-¶v t^m¬ tImÄ h-cmw.
G-Xp k-ab
- ¯pw B-ip-]{- Xn-bn-se¯m³ X-¿m-dm-bn-cn-
¡Ww. i-co-c¯- n A-Wp-_m-[s - Im≠-pÅ - A-kp-J-
sa-s´-¦nepw D-s≠¦n Nn-In-Õs - b-Sp-¯n-cn-¡Ww,
A-¡mcyw tUm-ÎÀ-am-sc A-dn-bn-¡p-Ibpw thWw.
Zq-sc \n-¶m-Wv ]p-Xn-b lrZ-bw F-¯p-¶-
sX-¦n F-{X-ka-bw h-sc sshImw ?
]pXn-b lrZ-bw F-Sp¯m DS-s\ X-s¶ tcm-Kn-
bn Xp-¶n-¸n-Sn-¸n-¡p-¶-Xm-Wv G-ähpw D-¯aw.
C-Xv ]-äm-¯ km-l-N-cy-§fn G-I-tZ-iw \m-ep-
a-Wn¡qÀ h-sc ssh-Imw. C-{Xbpw ka-bw H-cp
{]-tXy-I {Zm-h-I-¯n-en-«v sF-kv sIm≠-v ]m-bv-¡v
sN-bv-Xm-Wv lrZbw sIm≠-ph-tc≠Xv.
i-k{v- X-{In-b F-{X-t\-cw \o-≠p-\n¡pw ?
G-I-tZ-iw A-©v a-Wn-¡qÀ. tcm-Kn-sb lmÀ-«v ew-§v
sa-jo\n L-Sn-¸n-¨v tI-Sp-h-¶ lrZ-bw F-Sp-¯p-am-
än ]pXn-b lrZ-bw Xp-¶n-t¨À-¡p¶p
58
lr-Zb
- am-ä i-k{v- X-{Inb-¡p ti-jw In-
S¯p-¶ sF-kn-bp- hn-sâ {]-tXy-IX - -
sb-´v ?
tcm-K-{]-Xn-tcm-[-ti-jn Ip-d-bv-¡m-\p-Å a-cp-
¶v A-Xy-´m-t]-£n-X-amb-Xp sIm≠-v sF-
kn-bp hn G-ähpw Iq-Sp-X {i-²n-t¡≠-Xv
A-Wp-_m-[b - m-Wv.
lr-Z-bam-ä i-kv-{X-{In-b-bp-sS
{][m-\ dn-kv-Iv F-´v ?
tcm-K-{]-Xn-tcm-[-ti-jn Ip-d-bv-¡m-\p-Å a-cp-
¶v \Â-Ip¶-Xp sIm≠-v A-Wp-_m-[- h-cm-\
p-Å km-[y-X-bpw, ]pXn-b lr-Z-b-s¯ i-co-cw
XyPn-¡p-hm-\p-Å km-[y-X-bpw (dn-P-£³),
a-cp-¶p-IÄ sIm≠-v hr-¡-IÄ-¡v A-]I-Sw
h-cm-\p-Å km-[y-X-bpw, izm-k-tIm-i-c-à-k-
½À-±w Iq-Sp-X-emb-Xp sIm≠p-≠mIp-¶ ssd-
äv lmÀ-«v s^-bv-edpw B-Wv {][m-\ A-]-I-S
km-[y-X-IÄ.
F-´m-Wv dnP-£³ ?
tcm-Kn-bp-sS i-co-cw ]pXn-b lr-Z-b-s¯ Xy-
Pn-¡m-\p-Å km-[y-X-bm-Wv lr-Z-b-i-kv-{X-
{In-bbp-sS G-ähpw hen-b A-]-ISw. C-Xv
B-Zy-s¯ hÀ-j¯n Iq-Sp-X-em-bn-cn-¡pw
(Early Rejection). A-Xn-\pti-jhpw Po-hn-X-Im-
ew ap-gp-h³ C-Xv kw-`-hn-¨p-sIm-t≠-bn-cn-¡pw.
C-Xv X-S-bm-\p-Å hgn Immunosuppressant
F-¶ a-cp-¶p-IÄ h-gn tcm-Kn-bp-sS tcm-K-{]-Xn-
tcm-[-ti-jn \-in-¸n-¡p-I F-¶-XmWv. ]-t£ C-Xv
sN-¿p-t¼mÄ tcm-Kn-¡v A-Wp-_m[-IÄ h-cp-¶-tXm-
sSm-¸w hr-¡-IÄ-¡pw A-]I-Sw kw-`-hn-¡p-¶p.

Early Rejection sâ e-£W-§Ä

F-s´Ãmw ?
£oWw, ]\n, izm-kX - S- kw, \o-cp-sh-b¡ v- Â ap-Xe- m-
b-hb
- m-Wv {][m-\ e-£W - §Ä. B-Zy-s¯ H-cp hÀ-
j¯n F-t¸mÄ th-Ws - a-¦nepw C-Xv kw-`h
- n-¡mw.

Early Rejection I≠-p-]n-Sn-¡p-¶-sX§-s\?

F-t¡m-ImÀ-Un-tbm-{Kmw sN-¿p-t¼mÄ lmÀ-«v-

^wKvj³ Ip-d-bp-¶-Xmbpw aäpw I≠m Myocardi-
al Biopsy F-¶ sS-Ìp h-gn C-Xv I-≠p-]n-Sn-¡m-\m-Ipw. lr-Zb
- am-ä i-k{v- X-{In-b I-gn-ªv
ho«n t]mbm {i-²n-t¡≠ -
Early Rejection Nn-In-Õn-¡p-¶-sX§-s\ ?
Im-cy-§s- f-s´Ãmw ?
{]-Xn-tcm-[-ti-jn Ip-d-bv-¡m-\p-Å a-cp-¶n-sâ tUm-
A-Wp-_m-[b - p≠-mI - m-Xn-cn-¡m-\m-bn ]Ãv, i-co-
kv Iq-Sp-Itbm ]pXn-b a-cp-¶p-IÄ \Â-Intbm Nn-
c-`m-K§Ä, ssI-Im-ep-IÄ F¶n-h ip-Nn-bm-bn
In-Õn-¡mw.
kq-£n-¡p-I. Ip-«nIÄ, h-fÀ-¯p-\m-bIÄ, ]
F-´m-Wv Late Rejection ? q-¨IÄ, ]-£n-IÄ F-¶n-hb - p-am-bp-Å k-¼À-¡w
Ip-db- ¡ v- p-I. `-£W - § - fn \n-¶p-Å A-Wp-_m-
i-kv-{X-{In-b \S¶v H-cp-sImÃ-¯n-\p ti-jw \-S¡p-
[-bp-≠mIm-Xn-cn¡m³ {i-²n-¡Ww. {]-talw,
¶ Xy-Pn-¡-en-s\-bm-Wv Late Rejection F-¶v ]-d-bp-
c-àk - ½ - À-±w ap-Xe - m-bh - \Ãh-®w {I-ao-Ic- n-
¶-Xv. ]pXn-b lr-Z-b-¯n-sâ [-a-\n-Ifn t»m-¡p-
¡p-I. Early Rejection sâ e-£W-§Ä Im-Wp-I-
I-fp≠m-bn s\-©p-th-Z-\-tbm, lr-Z-b-Lm-Xtam
bm-sW-¦n tUmÎ-sd k-ao-]n-¡p-I. {]Xn-tcm-[-
\-S-¡p-¶-Xm-Wv {][m-\ e-£Ww.
iàn Ip-db - ¡-v p-hm-\pÅ a-cp-¶p-IÄ Bkv] - n-cn³,
lr-Z-bam-ä i-kv-{X-{Inb-¡v F-{X\mÄ sIm-fk - t-v {SmÄ Ip-db - ¡ -v p-hm-\p-Å a-cp-¶p-IÄ ap-X-
B-ip-]-{Xnbn I-gn-tb≠-n hcpw ? em-bh - ap-S§ - m-sX I-gn-¡p-I. tUm-ÎÀamÀ ]-dª-
Xp t]m-se Øn-ca- m-b sN-¡¸ - pIÄ \-S¯- pI.
G-I-tZ-iw H-cp- amkw

F-{X\mÄ sF-kn-bp hn I-gn-tb-≠n

F-´m-Wv LVAD ?
hcpw ?
LVAD F¶m Left Ventricular arrest device
G-I-tZ-iw 15 Znh-kw
AY-hm C-S-t¯ sh³-{Sn¡nÄ F-¶ Ad-sb
{]Xn-tcm-[-ti-jn Ip-d-bv-¡m³ D-]-tbm- k-lm-bn¡p-¶ D-]-I-cWw. C-Xv XmÂ-¡m-en-
Kn¡p-¶ {][m-\ a-cp-¶p-IÄ F-s´Ãmw ? I-am-bn CS-Xp lr-Z-b-¯n-s\ i-àn-s¸-Sp-¯p-
hmt\m Nn-e-t¸mÄ lrZ-bw am-än-sh-bv-¡p¶-
• Steroids Xp h-sc lr-Z-b-s¯ k-lm-bn-¡p-hm-t\m, a-äp
• Cyclosporine Nn-e-t¸mÄ lrZ-bw am-än-sh-bv¡m³ ]-äm-¯
km-l-N-cy-am-sW¦n Øn-c-am-bn lr-Z-b-s¯
k-lm-bn-¡p-¶-Xnt\m D-]-tbm-Kn-¡mw.

59
 Ir-{Xn-a lr-Zb
- §
- f
- n-d¡
- p-¶ I-¼\
- n-It- f-
sXm-s¡ ?
Burlin Heart, Syncardic, Heart mate
ap-X-em-b-
h-bm-Wv km-[m-c-W D-]-tbm-Kn¡p-¶ Ir-{Xn-a
lr-Z-b§Ä.

Ir-{Xn-a lr-Z-b-am-tWm, lr-Z-bw am-än-sh-bv-

¡-emtWm \Ã-Xv ?
Ir-{Xn-a lr-Zb - ¯- n-\v i-co-c¯ - n \n-¶v ]p-d¯ - p-
hcp-¶ ss{U-hv sse-\p-Ifpw _m-äd - nbpw k-Zm-k-
a-bhpw h-ln-¨p-sIm≠-v \-St- ¡-≠n-hc - pw. Ipfn,
bm{X, Im-bn-Ih - n-t\mZ-§Ä ap-Xe - m-bh - A-hk - -
c-§fn A-ku-Ic - y-ap-≠m-tb-¡mw. ]-t£ lrZ-
F§s\-bm-Wv LVAD L-Sn-¸n-¡p¶-Xv ? bw am-än-sh-¨h-sc t]m-se A-Wp-_m-[m `o-Xn-,
Iym³-kÀ - km-[y-X, Xy-Pn-¡Â km[y-X ap-Xe - m-
15 skâo-ao-äÀ hcp-¶ Cu Ir-{Xn-a ]-¼n-sâ Hc-äw b-hb- nÃ. lrZ-bw am-än-sh-¨ Nn-e tcm-Kn-IÄ¡v
se-^v-äv sh³-{Sn-¡n-fnepw a-tä A-äw A-tbmÀ-«-bn-epw ]qÀ-® B-tcmKyw hos≠-Sp-¡mw. lrZ-bw am-än-
L-Sn-¸n-¡Ww. c≠-v C-e-Iv-t{Sm-am-Kv-s\-äp-IÄ {I-ao- sh-¨v H-fnw-¼n-Ivkn ]-s¦-Sp-¯h - À h-scbp≠v.
I-cn-¨p-≠m¡p-¶ sk³-{Sn-^yq-K t^m-gv-kv B-Wv A-Wp-_m-[m km[y-X D-s≠ - s¶m-gn¨m a-äv
Cu D-]-I-c-W¯n c-à-¯n-s\ ]-¼p sN¿m³ A-ku-Ic - y-§f - nÃ.
k-lm-bn-¡p-¶Xv. ]¼n \n-¶v i-co-c-¯n-\v ]p-d-
t¯-¡v hcp-¶ ss{U-hv sse-\p-IÄ ]p-d-¯p-Å
_m-ä-dn-bn-te-¡v L-Sn-¸n-¨n-cn-¡p-¶p.

LVAD sâ A-ku-I-cy-§Ä F-s´Ãmw ?

i-co-c-¯n \n-¶v ]pd-¯p h-cp-¶ ss{U-hv sse-
\p-Ifpw FÃm k-a-bhpw _m-ä-dn-IÄ sIm≠-p\-
S-t¡≠-Xpw, ss{U-hv- sse-sâ Np-äp-ap-Å kvIn³
C³^-£-\pw, c-àw-I-«-]n-Sn-¡m-\p-Å a-cp-¶v I-gn-¡-
ep-am-Wv LVAD I-fp-sS {][m-\ A-ku-I-cy-§Ä.

F-´m-Wv Total artificial heart AY-hm

Ir-{Xn-a lrZbw ?
£-bn-¨ lr-Z-b-s¯ ]qÀ-®-am-bn F-Sp-¯p-am-än
]-cn-]qÀ-® Ir-{Xn-a-lrZ-bw Xp-¶n-¸n-Sn-¸n-¨v ZoÀ-L-
Im-ew Po-hn-¡phm³ I-gn-bpw. C-SXpw h-e-Xpw lr-
Zb-§Ä £-bn-¡p-I-bpw, lrZ-bw am-än-sh-bv-¡-en-\v
Xma-kw t\-cn-Sp-Ibpw B-tcm-Ky-Øn-Xn hf-sc tam-
i-am-Ip-Ibpw sN-¿p-t¼m-gm-Wv Ir-{Xn-a lrZ-bw h-bv-
¡p-¶Xv. Ir{Xn-a lrZ-bw sh-b¡ v- p-t¼mgpw LVAD sâ
FÃm A-ku-Ic - y-§f- p-ap-≠m-bn-cn-¡pw.

60
 CHAPTER
X

F´m-Wv
t]kv-ta-¡À,
AICD, CRT-D
ap-Xem-b ?

F´m-Wv t]-kv-ta-¡À ? C-¯-cw lr-Z-b-an-Sn-¸v D-S³ I≠-p-]n-Sn-¨v Nn-

In-Õ-bm-b C-e-Iv{Sn¡v tjm-¡v, Hm-t«m-am-än-
km-[m-cW - lr-Zb- a
- n-Sn-¸v 70 ap-XÂ 100 h-sc-bmWv.
Iv B-bn \Â-Ip-¶-Xn-\v t]-kv-ta-¡À t]m-se
Nn-e A-kp-J§ - fn C-Xv hf-sc ta-tem«pw a-äp
lr-Z-b-¯n-tem-«v h-b-dn-«v Xz-¡n-\-Sn-bntem t]-
Nn-e k-μÀ-`§ - fn hf-sc Xm-tgm«pw t]m-Imw. lr-
in-IÄ-¡n-S-bntem Xp-¶n tNÀ-¡p-¶ t]-kv-ta-
Z-ba
- n-Sn-¸v 30þ40 te-¡v Xm-gp-t¼mÄ lmÀ-«v t»m-¡v
¡À t]m-ep-Å D-]-I-c-W-amWv AICD. s]s«-
F-¶p hn-fn-¡p¶p. C¯-cw k-μÀ-`§ - fn HmÀ-½
¶p-Å ac-Ww H-gn-hm-¡m-\m-bn sN¿p-¶ H-cp
\-ãa - m-Ip-It- bm, c-àk - ½ - À-±w Xm-gp-Itbm sN-¿mw.
Nn-In-Õ-bm-WnXv.
lr-Zb - a- n-Sn-¸v 30þ40  Xp-SÀ¶m A-Xv Iq-«p-¶X - n-\v
lr-Zb - ¯- n-tem-«v H-cp h-bd - n-«v sXm-en-bvt¡m t]-in- F-´m-Wv CRT-D ? (Cardiac resynchronisa-
IÄ-¡S- n-bntem Xp-¶n tNÀ-¡p-¶ sN-dn-sbm-cp D-]- tion therapy with defibrillation)
I-cW- a - m-Wv t]-kvt- a¡À. C-Xn-ep-Å C-eI - vt- {Sm-Wn-Iv
kÀ-Iyq-«v h-gn lr-Zb - ¯- n-te-¡v C-eI - v{- Sn-Iv C-¼Äk- Nne lmÀ-«v s^-bv-eÀ k-μÀ-`-§fn C-SXpw
kv I-S¯ - n-hn-«v lr-Zb - a- n-Sn-¸v D-bÀ¯m³ I-gn-bpw. h-e-Xpw sh³-{Sn-¡n-fp-IÄ hn-I-kn-¡p-¶Xpw
k-t¦m-Nn-¡p-¶Xpw X½n incordination Dm-
tb-¡mw. C-Xv lmÀ-«v s^-bv-e-dn-\v Im-c-W-tam,
F-´m-Wv AICD?
e-£W-§Ä Iq-Sp-¶-Xn-\v Im-c-Wtam B-tb-
(Automatic Implantable Cardiac Defibrillator)
¡mw. C¯-cw k-μÀ-`-§fn i-co-c¯nÂ
Ventricular tachycardia, Ventricular fibrillation, Atrial fibril- L-Sn-¸n¡p-¶ t]-kv-ta-¡À t]m-ep-Å D-]-I-
lation apXem-bh lr-Z-b-an-Sn-¸v Iq«p-¶ am-c-I A-kp- c-W-amWv CRT-D. CXp-sh-¨v lmÀ-«v-s^-bv-eÀ
J-§f- mWv. C¯-cw A-kpJ-§Ä lr-Zb - m-Lm-X¯ - n- Ip-d-s¨m-s¡ Ip-d-bv-¡m-\m-Ipw. lrZ-bw A-an-
sâ `m-Ka - m-tbm, lmÀ-«v s^-be v- d- n-sâ `m-Ka
- m-tbm, X-th-K¯n kv-]-μn-¡p-I-bm-sW¦n Auto-
lmÀ-«n-sâ A-Wp-_m-[b - p-sS `m-Ka - mtbm h-cmw. matic defibrillation \pw km-²y-am-Ipw.

61
 t]-kv-ta-¡-dn-sâ `mK-§Ä F-s´Ãmw?
a. Pulse generater - s-- Xm-en-¡-Snbn Xp-¶n tNÀ¡p-¶
Xo-s¸-«n t]m-ep-Å D-]-I-c-Ww
b. Lead- ]Äkv P-\-td-ädpw lr-Z-bhpw _-Ôn¸n-
¡p-¶ C-e-Iv-{Sn-Iv hbÀ
t]-kv-ta-¡À F-{XX-cw ?
a. Single Chamber Pacemaker þ H-c-dbn am{Xw
b. Double Chamber Pacemaker þ c≠d-bn lead
c. Biventricular Pacemakerþ c≠-v sh³-{Sn-¡n-fp-I-
fnepw H-cp B-{Sn-b-¯nepw lead
Pulse generater an¡-hmdpw CS-Xv tXm-sfÃn-
\p Xm-sg sh-b¡
v- p¶-Xv F-´p-sIm≠v?
lrZ-b-¯n-tem-«v G-ähpw Ip-d-ª Zq-cw
F-´m-Wv sS-w]d-dn t]-kv-ta-¡À ?
lr-Z-bmLm-X k-a-b-t¯m, lr-Z-b kÀP-dn k-a-
bt¯m XmÂ-¡m-en-I-am-bn lr-Z-b-¯n-te-¡v L-Sn-
¸n¨v i-co-c-¯n-\p ]p-d-¯p-Å ]Ä-kv P-\-td-ä-dn-te-
¡v L-Sn-¸n-¡p-¶-XmWv Temporay Pacing.
PPI AYhm Permanent Pacemaker
Implantation sN¿p-¶-sX§-s\ ?
GItZ-iw Ht¶m ct≠m a-Wn¡qÀ F-Sp¡p-¶ Cu
Hm-¸-td-j³ Im-¯v-em_n sh-¨m-Wv sN-¿p-¶Xv.
sN-dp-Xm-bn D-d§m³ a-cp-¶p \Â-In tem-¡Â A-\-
kv-tX-jy-bn-em-Wv C-Xv sN-¿p-¶Xv. BZyw Im-¯v-
em-_n-sâ k-lm-b-t¯m-sS lr-Z-b A-d-I-fn-te-¡v
eo-Uv h-bÀ I-S-¯p¶p. A-Xn-\p-ti-jw Xz-¡n-\-Sn-bn-
tem pectoralis muscle A-Sn-bntem t]m-¡-äp≠-m-¡n
]Ä-kv P-\-td-äÀ sh-¨v eo-Uv h-b-dp-IÄ A-Xn-te-¡v
L-Sn-¸n-¡p-¶p.
B-cm-Wv Cardiac Physiologist ?
Pulse generaterF¶v ]-d-bp¶-Xv tem-l-I-h-N-¯n-
\p-Ån-ep-Å H-cp C-e-Iv-t{Sm-Wn-Iv kÀ-Iyq«pw A-Xn-
\p th-_m-ä-dn-bp-amWv. i-co-c-¯n-\v ]p-d-¯p-Å D-]-
I-cW-§Ä h-gn ]Ä-kv P-\-td-ä-dn-s\ t{]m-{Kmw
sN¿m³ I-gn-bpw. CXp sN¿p-¶ kv-s]-jy-en-Ìp-I-
fmWv Cardiac Physiologist.
62
t]kv-ta-¡À h-¨-Xn-\p ti-jw
{i-²n-t¡≠ -Im-cy-§Ä F-s´Ãmw ?
• A-d-Ifn Implant sN-bv-Xn-cn-¡p-¶ eo-Up-
IÄ Un-kv-s¹-b-kv (eo-Uv Un-kv-s¹-bv-kv-saâ v)
sN¿m³ km-[y-X-bpÅ-Xp sIm≠-v ]Ä-kv P-\-
td-äÀ h-¨ tjmÄ-UÀ B-dm-gv-¨-t¯m-fw A-[n-
Iw C-f-¡phm³ ]m-SnÃ.
• ]Ä-kv P-\-td-ä-dn-\v Npäpw c-àw sI-«m\pw ]-gp-
¸v sI-«m\pw km-[y-X-bp≠v.
t]kv-ta-¡-dn-sâ _mä-dn F-{X\mÄ
\n¡pw ?
GItZ-iw 10þ15 hÀjw
t]kv-ta-¡À sh-¨-Xn-\p ti-jw ZoÀ-L-Im-
ew {i²n-t¡≠ Im-cy-§Ä F-s´Ãmw ?
• hf-sc magnetic field D-Å Fw.BÀ.sF sS-Ìp-
IÄ-¡v hn-t[-b-amIm³ ]m-SnÃ.
• Microvave oven, induction cooker ap-X-em-b-hb-
n \n-¶v AI-ew sh-bv¡-Ww
• Metal detecter, Airport Security System ap-X-
em-b-h t]-kv-ta-¡-dn-s\ {]-hÀ-¯-\-c-ln-X-
am¡m³ km-[y-X-bp≠v.
• Hm-¸t- d-j\
- p-Ifn D-]t- bm-Kn¡p-¶ Electro
Cautry Current t]-ktv- a-¡dn Iq-Sn I-S¡
- m-Xn-cn-
¡m-¯ hn[¯n D-]t- bm-Kn¡Ww.
• Hm¸-td-j-\p-Ifn {]-tXy-I {i-²sIm-Sp-¡Ww.
• sam-ss_Â t^m¬ ap-Xem-b Im-´n-I-i-
àn-bp-Å D-]-I-cW-§Ä t]-kv-ta-¡À t_m-
Iv-knsâ A-Sp-¯v sIm-≠p-h-cm-Xn-cn-bv¡m³
{i-²n-¡pI.
• t]-kv-ta-¡À CS-Xp h-i-¯m-sW-¦nÂ, sam-
ss_ t^m¬ he-Xp sN-hn-bn Iq-sS D-]-
tbm-Kn-¡pI.
 CHAPTER
XI

F´m-Wv
A-tbmÀ-«n-¡v
A-\yq-dn-kw

F-´m-Wv A-tbmÀ-« ? F-´m-Wv BÀ-«n-Iv A-\yq-dn-kw

(Aortic Aneurysm rupture) ?
lr-Z-b-¯n \n-¶p-Û-hn¡p-¶ G-ähpw hen-b c-à-
¡p-g-em-Wv a-lm-[a-\n F-¶ t]cn A-dn-b-s¸Sp-¶ A-tbmÀ-«n-¡v A-\yq-dn-kw hn-I-kn-¨v s]m-«p-¶-
A-tbmÀ-«. lr-Z-b¯n \n-¶p-Û-hn-¨v X-e-t¨m-dn- Xm-Wv Artic Aneurysm rupture s]-s«-¶v ac-Ww
te¡pw ssI-I-fn-te¡pw c-à-¡p-g-ep-IÄ \Â-In t]mepw kw-`-hn-¡mhp-¶ A-Sn-b´n-c A-h-Ø-
hf-ªv s\-©nÂ-Iq-sS Xm-tgm-«n-d-§n U-b-{^-s¯ bm-WnXv.
Xpf-¨v h-b-dn-se-¯p¶p. A-hn-sS hr-¡IÄ, Ip-S-ep-
IÄ ap-X-em-b-h-bv-¡v c-à-¡p-g-ep-IÄ \Â-In c≠-
m-bn hn-`-Pn-¨v c≠-v Im-ep-I-fn-te-bv¡pw c-à-¡p-g-
ep-IÄ \Â-Ip¶p. C§-s\ i-co-c-¯n-sâ FÃm
`m-K-t¯¡pw c-à-sa-¯n-¡p¶-Xv A-tbmÀ-« F-¶
a-lm-[-a-\n-bm-Wv.

F-´m-Wv A-tbmÀ-«n-¡v A-\yq-dn-kw

(Aortic Aneurysm) ?

A-tbmÀ-« hn-I-kn-¨v _eq¬ t]m-se s]m-«m-dm-

hp-¶ A-h-Ø-bv-¡m-Wv A-tbmÀ-«n-Iv A-\yq-dn-kw
F-¶v ]-d-bp-¶-Xv.

63
 F-´m-Wv A-tbmÀ-« ?
lr-Z-b-¯n \n-¶p-Û-hn¡p-¶ G-ähpw hen-b c-à-
¡p-g-em-Wv a-lm-[a-\n F-¶ t]cn A-dn-b-s¸Sp-¶
A-tbmÀ-«. lr-Z-b¯n \n-¶p-Û-hn-¨v X-e-t¨m-dn-
te¡pw ssI-I-fn-te¡pw c-à-¡p-g-ep-IÄ \Â-In
hf-ªv s\-©nÂ-Iq-sS Xm-tgm-«n-d-§n U-b-{^-s¯
Xpf-¨v h-b-dn-se-¯p¶p. A-hn-sS hr-¡IÄ, Ip-S-ep-
IÄ ap-X-em-b-h-bv-¡v c-à-¡p-g-ep-IÄ \Â-In c≠-
m-bn hn-`-Pn-¨v c≠-v Im-ep-I-fn-te-bv¡pw c-à-¡p-g-
ep-IÄ \Â-Ip¶p. C§-s\ i-co-c-¯n-sâ FÃm
`m-K-t¯¡pw c-à-sa-¯n-¡p¶-Xv A-tbmÀ-« F-¶
a-lm-[-a-\n-bm-Wv.
F-´m-Wv A-tbmÀ-«n-¡v A-\yq-dn-kw
(Aortic Aneurysm) ?
A-tbmÀ-« hn-I-kn-¨v _eq¬ t]m-se s]m-«m-dm-
hp-¶ A-h-Ø-bv-¡m-Wv A-tbmÀ-«n-Iv A-\yq-dn-kw
F-¶v ]-d-bp-¶-Xv.
F-´m-Wv BÀ-«n-Iv A-\yq-dn-kw
(Aortic Aneurysm rupture) ?
A-tbmÀ-«n-¡v A-\yq-dn-kw hn-I-kn-¨v s]m-«p-¶-Xm-Wv
Artic Aneurysm rupture s]-s«-¶v ac-Ww t]mepw kw-
`-hn-¡mhp-¶ A-Sn-b´n-c A-h-Ø-bm-WnXv.
F´m-Wv A-tbmÀ-«n-¡v ssU-sk-£³
(Aortic Dissection) ?
hÀ-²n-¨ c-à-k-½À-±w aq-ew a-lm-[a-\n A-sænÂ
64
A-tbmÀ-«-bp-sS `n-¯n c-≠m-bn ]n-f-cp-¶-Xn-
s\-bmWv A-tbmÀ-«n-¡v ssU-sk-£³ F-¶v
]-d-bp-¶Xv. CXpw Aortic rupture t]m-se s]-
s«-¶v a-c-W-ap≠-m-tb-¡mhp-¶ A-h-Ø-bm-
Wv.
A-tbmÀ-«n-¡v A-\yq-dn-k-¯n-sâ Im-
cW-§Ä F-s´Ãmw ?
A-tbmÀ-«-bp-sS `n-¯n-bn-se Collagen F-¶
ss^-_-dp-IÄ-¡v P\-\w ap-Xtem ti-jtam
D≠-mIp-¶ _-e-lo-\-X-I-fm-Wv Cu A-h-Ø-
bv-¡p Im-cWw.
A-tbmÀ-«n-¡v A-\yq-dn-k-¯n-sâ t]-
cp-IÄ F-s´Ãmw ?
A-tbmÀ-«-bp-sS G-Xp `m-K-am-Wv hoÀ¯-Xv
F-¶-\p-k-cn-¨m-Wv t]-cp \Â-Ip-¶Xv. Thorac-
ic aorta aneurysm (Ascending aorta aneurysm,
Arch of aorta aneurysm , Descending thoracic
aneurysm) Abdominal aorta aneurysm (Spra-re-
nal aneurysm, intra-renal aneurysm) F-¶n-§-
s\-bm-Wv t]-cpIÄ.
A-tbmÀ-«n-¡v ssU-sk-£-sâ (Dis-
section) t]-cp-IÄ F-s´Ãmw ?
Type 1 - Dissection ascending aorta
Type 2 - Dissection of Entire aorta
Type 3 - Dissection of descending thoracic aorta

A-tbmÀ-«n-¡v A-\yq-dn-k-¯n-sâ e£W-

§Ä F-s´Ãmw ?
A-\yq-dn-kw s\©n-em-sW¦n sN-dn-sbm-cp In-
X¸v, s\©pth-Z-\ ap-X-em-b-h D≠-m-Ipw. hf-sc
h-ep-Xm-bn s]m-«p-I-bm-sW¦n s]-s«-¶v X-fÀ-¨,
c-à-k-½À-±w Xm-g F¶n-h A-\p-`-h-s¸-Spw. A-\
yq-dn-kw h-b-dnemsW¦n sN-dn-sbm-cp hbdpth-Z-\
bpw s]m-«p-I-bm-sW¦n s]-s«-¶v X-fÀ-¨-bpw A-\
p-`-h-s¸-Spw.

A-\yq-dn-kw U-b-Kv-t\m-kn-kv sN-¿p-¶-sX-

§-s\ ?
s\-©n-se A-\yq-dn-kw Echo Cardiography, CT-
Scan, MRI ap-X-em-b-h h-gnbpw h-b-dn-se A-\yq-dn-
kw Ultrasonogram, CT Scan ap-X-em-b-h h-gnbpw
I-s≠¯mw.
A-\yq-dn-kw F-t¸mÄ Nn-In-Õn¡-Ww ?
{]m-b-]qÀ-¯n-bm-b-hcn km-[m-c-W A-tbmÀ-«-
bp-sS diameter 3 sk.ao BWv. CXv 4.5 sk.ao
I-S¶m s]m-«m-\p-Å km[y-X Iq-Sp-X-emWv.
A-t¸mÄ Nn-InÕ-sb Ip-dn-¨m-tem-Nn-¡Ww.
A-tbmÀ-«nIv A-\yq-dn-k-¯n-sâ Nn-In-Õ-
I-sf-s´Ãmw ?
• Hm-¸-td-j³
• kv-säân-§v
• Hybrid Procedure (ssl-{_n-Uv coXn)
F-´mWv Hybrid Procedure ?
Hm¸-td-j-\pw kv-säân§pw D-]-tbm-Kn-¨v tcm-Kn-¡v
A-[n-Iw im-cocn-I _p-²n-ap-«nÃm-sX tcm-Kw am-äp-¶-
Xn-s\-bm-Wv Hybrid Procedure F-¶v ]-d-bp-¶Xv.
Hm-¸t- d-j\
- mtWm kvs
- äân-§mtWm \Ã-Xv ?
Hm-¸-td-j-\n thZ-\, c-à-¯n-sâ D-]-tbm-Kw,
A-Wp_m-[ ap-X-em-b-h-bp-sS km-[y-X-bp-s-
≠¦nepw G-sd-¡p-sd ap-gp-h-\mbpw A-kp-
J-s¯ kp-J-s¸-Sp¯m³ I-gn-bpw. Hm-¸-tdj-\v
F-t«m ]t¯m Znh-kw B-ip-]-{Xnbn I-gn-
tb--≠Xm-bn h-cpw. kv-säân§n km-[m-c-W
thZ-\, A-Wp_m-[ ap-X-em-b km-[y-X-I-fnÃ.
]-t£ Hm-¸-td-j-\n-se-t¸m-se Ir-Xy-am-bn sN-
¿m³ FÃm A-\yq-dn-k-§Ä¡pw ]-änÃ. hr-
¡I-sf _m-[n¡p-¶ ssU F-¶ a-cp-¶v D-]-
tbm-Kn-¡p-¶-Xn\m hr-¡-tcm-Kn-IÄ-¡v \
ÃXÃ. Hm-¸-td-j-tâbpw kv-säân-§n-tâbpw
km-[yX-IÄ D-]-tbm-K-s¸-Sp-¯n Hybrid Proce-
dure F-¶ Nn-In-Õ tcm-Kn-bp-sS I-ã-¸m-Sp-IÄ
Ipd¨v A-kp-Jw t`-Z-am-¡p¶p.
A-tbmÀ-«n-Iv kv-säân-\v tZm-j-§-fpt≠m ?
sNe-hv Iq-Sp-X-emWv. Hm-¸-td-j\n sN-¿p-
¶-Xp-t]m-se Ir-Xy-am-bn sN¿m³ I-gn-bm-
dnÃ. Endoleak F-¶ Ipg-¸w D≠-v. kv-säân\pw
A-tbmÀ-«-bp-sS `n-¯n¡pw C-Sbn c-àw sI-
«p-¶-Xm-Wv Cu Ah-Ø. hr-¡-IÄ-¡v tZm-jw
sN¿p-¶ ssU Iq-Sp-X-em-bn D-]-tbm-Kn-t¡≠-n-
h-cn-I-bm-sW-¦nepw _p-²n-ap-«p≠mtb-¡mw.

65
 Space for

AD

66
 CHAPTER
XII

lr-Z-bm-Lm-Xw
hcm-sX
t\m-¡p-¶-sX§s\?

lr-Z-b-t»m-¡p-IÄ-¡v c-à-k-½À-±w lr-Z-b-t»m-¡p-IÄ-¡v

Im-c-W-§-sf-s´Ãmw ? Im-c-W-am-Ip-¶-sX§-s\ ?
• {]m-bw c-à-[-a-\n-¡v hn-I-kn-¡p-hm\pw k-t¦m-Nn-¡p-
• a-\-{]-bm-k§Ä hm\pw I-gn-hp≠-v. c-à-k-½À-±w Iq-Sp-t¼m-Ä
• {]-ta-lw c-à-¡p-g-ep-I-fp-sS DÄ-`mK-¯v ap-dn-hp-Ifpw
• c-à-k-½À-±w (Endothelial injury) aäpw D≠mIm³ km-[y-X-
bp≠v. c-à-¡p-g-en-sâ C¯-cw ap-dn-hp-IÄ
• ]p-Ih-en
D-W-§p-t¼mÄ A-hn-sS Im-Õyw, sIm-f-kv-
• sIm-gp-¸v IqSn-b `-£W-§Ä t{SmÄ ap-Xem-b L-SI-§Ä A-Sn-ªp-Iq-Sn
• ]m-c-¼cyw t»m-¡p-I-fmbn am-dp-¶p.
• hym-bm-a-anÃmbva
• Aan-Xh®w

{]-ta-lw lr-Z-b-t»m-¡p-IÄ-¡v
Im-c-W-am-hp-¶-sX§-s\ ?
{]-ta-l¯n c-à-¯n-se ]-©km-c t]m-se a-äv
L-S-I-§-fp-sS A-f-hnepw hy-Xym-kw h-cp¶p. c-à-
¯n-sâ L-S-\-bn-ep-Å Cu hy-Xym-k-§Ä sIm-f-
kv-t{SmÄ ap-Xem-b Nn-e L-S-I§-sf c-à-¡p-g-en-
sâ `n-¯nbn A-Sn-ªp IqSm³ A-\p-h-Zn-¡p-¶p.

67
 c-à-k-½À-±-ap-Å tcm-Kn-IÄ
A-dn-ªn-cn-t¡-≠ Imcy§Ä
i-co-c-¯n-se FÃm `m-K¯pw hym-]n-¨n-cn¡p-¶ iyw-
J-e-bm-Wv h-epXpw sN-dp-Xpam-b c-à-¡p-g-epIÄ.
Cu c-à-¡p-g-ep-IÄ-¡v A-h-bp-sS `n-¯n-bn-ep-Å
sNdn-b t]-in-I-fp-sS k-lm-b¯m hn-I-kn-¡m\pw
k-t¦m-Nn-¡m\pw I-gn-bpw. Cu I-gn-hv R-c-¼p-I-fp-sS-
bpw tlmÀ-tam-Wp-I-fp-sSbpw \n-b-{´-W-¯n-emWv.
c-à-¡p-g-en-sâ `n-¯nbn c-à-tbm-«w aq-e-ap-mIp-¶
i-àn-bm-Wv c-à-k-½À±w. {]m-b-¯n-\-\p-k-cn-¨v
c-à-k-½À-±w hy-Xym-k-s¸-Spw. {]m-bam-b H-cp hy-
àn-bp-sS c-à-k-½À-±w 120/80 mHg B-Wv. CXnÂ
ap-IÄ `m-K-s¯ 120 F¶-Xv kn-kv-täm-fn-¡v {]-jÀ
F¶pw Xm-g-s¯ 80 F¶-Xv U-b-kv-täm-fn-¡v {]-jÀ
F¶pw hn-fn-¡-s¸-Sp¶p. U-b-kv-täm-fn-¡v {]-j-dn-\m-
Wv Iq-Sp-XÂ {]m-[m-\yw.
a-²y-hb-Êv I-gn-bp-t¼mÄ {]-jÀ 140/90 I-S-¡p-t¼m-
gm-Wv _n.]n Iq-Sp-X-em-bn F-¶v ]-d-bp-¶Xv. sN-dp-¸-
¡mÀ-¡v Nn-e-t¸mÄ hr-¡-I-fp-sS A-kpJw, A-tbm-«-
bp-sS A-kpJw, Nn-e tlmÀ-tam-Wp-I-fp-sS Imc-Ww
ap-X-em-b-h h-gn-bpw c-à-k-½À-±w Iq-Sm-dp-v. FÃm-h-
cnepw hym-bm-a-¯n-\p ti-jhpw hn-Im-c-hn-t£m-]-
§Ä-¡p ti-jhpw {]-jÀ Iq-Spw. s]-s«-¶v {]-jÀ
hf-sc Iq-Sp-X-em-bn DbÀ-¶m-epÅ G-ähpw hen-b
A-]I-Sw a-kv-Xn-jv-¡-¯n-se c-à-{km-h-amWv. s{_
bn³ A-äm-¡v AY-hm kv-t{Sm-¡v F-¶ A-kp-J-¯n-
68
\v {][m-\ Imc-Ww D-bÀ-¶ c-à-k-½À-±-am-
Wv.
c-à-k-½À-±w hf-sc \m-fp-IÄ D-bÀ-¶v \nÂ-
¡p-I-bm-sW¦n lr-Z-b-¯n-sâ `n-¯n-X-Sn-
¡Â, hr-¡¡pw I-®n\pw X-I-cmÀ, kv-t{Sm-
¡n-\v km[y-X ap-X-em-b-h Iq-Sp-X-em-Wv.
D-¸v Ip-d-¨v I-gn-¡p-I, sN-dp-hym-bm-aw sN-
¿p-I, [ym\w, {]mÀ°-\, dn-em-Iv-tk-j³
sX-dm-¸n ap-X-em-b-h h-gn a-\-kn-s\ im-´-am-
¡p-I, Øn-c-am-bn a-cp-¶p-IÄ I-gn¡p-I ap-X-
em-b-h-bm-Wv c-à-k-½À-±-s¯ Io-gv-s¸-Sp¯m-
\p-Å {]-Xn-hn-[n.
{]ta-l tcm-K-ap-Å-hÀ
A-dn-ªn-cn-t¡-≠
Im-cy-§Ä
i-co-c-¯n-sâ DuÀ-Ö B-h-iy-§-fp-sS
D-d-hn-Sam-b ¥q-t¡m-kn-sâ i-co-c-¯n-se
A-f-hn-s\ {I-ao-I-cn-¡p¶-Xv \-½p-sS
]m³-{In-bm-kv {K-Ùnbn \n-¶pÂ-¸m-
Zn-¸n¡p-¶ C³-kpen³ F-¶ tlmÀ-
tam¬ BWv. Cu tlmÀ-tam-Wn-sâ
Ipd-hv aq-ew c-à¯n ]-©-km-c-
bp-sS Af-hv Iq-Sp-¶-Xm-Wv {]-talw.
Cu A-h-Øbn c-à-¡p-g-epIÄ,
I-®pIÄ, hr-¡IÄ, lr-Zbw, X-e-t¨m-
dv ap-X-em-b H-«p-an-¡ FÃm A-h-b-h-§-
fnepw \m-iw kw-`-hn-¡p-¶p.
{]-tXy-In-¨v e-£-W-sam-¶p-anÃm-¯ A-kp-J-am-b-
Xn\m c-à-¯n-se ]-©-km-c-bp-sS Af-hv t\m-
¡n-bm-Wv Cu A-kp-J-¯n-sâ I-≠p-]n-Sp-¯h-
pw Nn-In-Õ-bpw. `-£-W-¯n-\v ap-¼v c-à-¯n-se
¥q-t¡m-kn-sâ A-h-Ø 110 Â Xm-sgbpw `-£-W-¯n-
\p ti-jw 170  Xm-sgbpw A-Xn-\n-Sbn F-Sp-¡p-
t¼mÄ 150 Â Xm-sgbpw B-bn-cn-¡-Ww.

{]-ta-l-ap-s≠-¶v a-\-Ên-em-¡n I-gnªm \-½p-sS

hr-¡IÄ, lr-Zbw, I®v, X-e-t¨m-dv ap-Xem-b A-h-
b-h§-sf c-£n¡m³ G-Xp hn-t[-\bpw c-à-¯n-
se ]-©-km-c-bp-sS Af-hv {I-ao-I-cn-¨v sh-bv-¡Ww.
C-Xn-\m-bn `-£-W-{Iaw, sN-dp-hym-bm-aw, Nn-e Kp-fn-
IIÄ, C³-kpen³ ap-X-em-b-h D-]-tbm-Kn-¡mw.

H-cp Ø-n-co-I-cn-¨ {]ta-l tcm-Kn-bm-sW¦nÂ

ho«n X-s¶ H-cp ¥q-t¡m-ao-äÀ sh-¨v C-S-bv-¡n-sS
jp-KÀ Af-¶v H-cp ]p-kv-X-I¯n F-gp-Xn tUm-Î-
dp-sS k-lm-b-t¯m-sS kz-bw \n-b-{´n-¡p-¶-Xm-Wv
G-ähpw \Ã-hgn.
{]-Xn-Imcw, \ncm-i ap-Xem-b X-e-§-fn-se-
ssI-Im-epIÄ, tam-W ap-Xem-b C-S§ - fn ]-gp-¸v
¯n-¡p¶p. Xp-SÀ-¶v i-co-c¯n lr-Z-b-an-Sn-
h-cm-sX kq-£n-¡W - w. I-®v, hr¡-IÄ ap-Xe
- m-bh
-
¸v Iq-SpXÂ, h-b-sd-cn-¨nÂ, hn-b¸v, t]-in-IÄ
Øn-ca - m-bn ]-cn-tim-[n-¡W
- w.
tIm-¨n-h-en¡Â, Iq-sS-¡q-sS h-b-dn-f¡w, hn-i-
Iq-Sp-XÂ s¥-¡o-an-¡v C³-UIv-kv D-Å A-cn-`£- ¸nÃm-bv-a, Iq-Sp-XÂ `£-Ww I-gn-¡Â, D-d-¡-
Ww H-gn-hm-¡n s]-s«-¶v c-à-¯n-se ]-©-km-c-bp- anÃmbv-a ap-X-em-b-h {]-I-S-am-Ip¶p.
sS Af-hv Iq-«m-¯ tKmX-¼v, dmKn, tNmfw apX-em-
a\-Êv \n-tj-[m-ßI - X- b
- n-te-b¡ v- v t]m-Ip-t¼mÄ
bh Iq-Sp-X-em-bn D-]-tbm-Kn¡m³ {i-²n-¡Ww.
kz-`m-h¯
- n-ep-Å hy-Xn-bm-\§ - f - m-Wv tZ-jy-
A-[n-Iw a-[p-c-ap-Å ap-´n-cn, ]-gp-¯ am-§, t\ s¸SÂ, {Iqc-X, a-cym-Zb - nÃm-ba
v- , A-{I-ah - mk-\,
{´¸gw, ]-gp-¯ N-¡, ]-©-km-c, Ing-§p hÀK- hn-apJ-X, a-äp-Åh- cn \n-¶p-Å H-fn-t¨m-SÂ
§Ä ap-X-em-b-h-bp-sS D-]-tbm-Kw Ip-d-bv-¡Ww. hn-jmZw, `-bw {]-IS- n-¸n-¡Â ap-Xe - m-bh.
a[p-cw Ip-d-ª ]-g-§fm-b X-®oÀ-a¯³, t]-c-
A§-s\ t\m-¡p-t¼mÄ FÃm-¯n\pw Imc-
bv-¡, Hm-d©v, am-Xfw, H-cp sN-dp-]gw, ]-¸m-b ap-X-
Ww CãanÃm¯ im-co-cn-Itam am-\-kn-Itam
em-b-h {]-ta-l- tcm-Kn-IÄ-¡v I-gn-¡mw.
B-b _m-ly-t{]-c-W-I-fm-Wv FÃm a-\m-hn-
A-an-X am-\kn-I k-½À-±-apÅ-hÀ j-a-§Ä¡pw Im-cWw. ]-t£ Cu _m-ly-
A-dn-ªn-cn-t¡≠ Im-cy-§Ä t{]-cW-IÄ \-½p-sS ssI-]n-Sn-bneÃ. Cu
im-co-cn-Itam am-\-kn-Itam B-b th-Z-\m-P-\-Iam-b tem-I¯n Po-hn¡p-¶ FÃm-hÀ¡pw Cu
t{]-cW-IÄ a-\-kn-sâ im-´X-tb \n-tj-[m-ß-I _m-ly-t{]-c-WI-sf A-`n-ap-Jo-I-cn-t¡≠Xm-
hn-Im-c-§fm-b tZ-jyw, t]Sn, D-Xv-¡-WvT, A-kq-b, bn h-cpw.

69
 ]-t£ _m-ly-t{]-cW - I
- t- fm-Sv \-½Ä F§-s\ {]-Xn-
I-cn-¡p-¶p-sh-¶pw, F-s´m-s¡ _m-ly-t{]-cW-IÄ
h-¶mepw a-t\m-\n-etbm \n-tj-[m-ßI - b
- n-tem-«v Xm-
gm-Xn-cn-¡m\pw \-½Ä hn-Nm-cn¨m I-gn-bpw.

a-\-{]-bm-k-§fpw lr-Z-b-tcm-K-§fpw c-à-k-½À-

±hpw X½n hy-àam-b _-Ô-§-fp≠-v. a-\-{]-bm-
k-§-fp≠m-Ip-t¼mÄ i-co-c-¯n-ep-Û-hn-¡p-¶ Nn-e
tlmÀ-tam-Wp-IÄ c-à-¡p-g-epI-sf Np-cp-¡p-Ibpw
c-à-k-½À-±-s¯ Iq-«p-I-bpw \m-Un-bn-Sn-¸n-s\ hÀ- hmÀjn-I ]-cn-tim-[-\bnÂ
²n-¸n-¡p-Ibpw sN-¿p-¶p. F-s´m-s¡ sS-Ìp-IÄ sN¿Ww?
tbm-K, {]mÀ°-\, [ym-\w, dn-em-Iv-tk-j³ sX-dm-¸n lr-Z-bm-LmXw, Iym³kÀ, ]-£m-Lm-Xw ap-
ap-X-em-b {]-{In-b-Ifn D-Û-hn¡p-¶ tlmÀ-tam-Wp- Xem-b am-c-I A-kpJ-§Ä X-S-bm\pw ap³-Iq-
IÄ c-à-¡p-g-epI-sf hn-I-kn-¸n-¡p-I-bpw, c-à-k- «n I-≠p-]n-Sn-¡m\pw G-ähpw \Ã-Xv ap-S-§m-sX-
½À-±w Ip-d-bv-¡p-Ibpw \m-Un-bn-Sn-¸v Ip-d-bv-¡p-Ibpw bp-Å hmÀjn-I ]-cn-tim-[-\-bm-Wv. hmÀjn-I
sN-¿p-¶p. ]-cn-tim-[-\bn hr-¡-bp-sS sS-ÌpIÄ, en-h-
dn-sâ sS-ÌpIÄ, lr-Z-b-¯n-sâ sS-Ìp-Ifm-b
A-an-X-h-®-apÅ-hÀ A-dn-ªn-cn-t¡≠ F-t¡m-ImÀ-Un-tbm-{Kmw, s{S-Uvan sSÌv
Im-cy-§Ä (Treadmill test), h-b-dn-sâ kv-Im³, X-e-t¨m-dn-
Hm-tcm-cp-¯cpw A-h-cp-sS {]m-b-hpw, D-b-c-hpw A-\p- tem-t«m, Im-ep-I-fn-tet¡m t]mIp-¶ [-a-\n-
k-cn-¨v F-{X-am-{Xw i-co-c-`m-c-amhm-sa-¶v A-dn-ªn- Ifn X-S-k-ap-t≠m-sb-¶-dn-bm-\p-Å tUm-¹À
cn-¡Ww. B-h-iy-¯n-e-[n-Iw A¶-Pw A-S-§n-bn- sS-Ìp-IÄ ap-X-em-b-h \-S-¯Ww.
cn-¡p-¶ B-lm-c-§fmb (Acn, tKm-X¼v, {_Uv,
N-¸m¯n, D-cp-f-¡n-g§v, t\-{´-¸gw) F¶n-h I-gn-
¡p-Ibpw A-Xn-\-\p-k-cn-¨v i-co-cw N-en-¸n-¡m-¯-
Xp-am-Wv A-an-X-h-®-¯n-\v Im-c-Ww. B-lm-c¯nÂ
A-¶Pw, sIm-gp-¸v, t{]m«o³ F-¶o aq-¶v {][m-\
L-S-I-§-fm-Wv D-ÅXv. CXn A¶-Pw `-£-W-§-
fm-Wv i-co-c¯n sIm-gp-¸v A-Sn-ªp Iq-Sp-¶-Xn-\p
Im-cWw. A-[n-Iw A¶-Pw I-gn-¡p-Ibpw B-h-iy-
¯n-\v hym-bm-aw sN-¿m-Xn-cn-¡p-Ibpw sN-¿p-t¼mÄ
A¶-Pw sIm-gp-¸p-I-fm-bn i-co-c-¯n kw-`-cn-¡-s¸-
Sp¶p. t\-sc a-dn-¨v ]-b-dp-hÀ-K§Ä, C-d-¨n, aÕyw
ap-X-em-b-h km-[m-c-W A-an-X-h-®-¯n-\v C-S-bm-
¡nÃ. X-Sn Iq-Sp-X-epÅ-hÀ H-cp \yq-{So-j-Wn-Ìn-tâb-
pw H-cp hymbm-a hn-Z-Kv-²-tâbpw k-lm-bw tX-SWw.

70
F-´m-Wv TMT sSÌv ? lr-Z-b-t»m-¡p-IÄ-¡p-Å
(Treadmill test) Nn-InÕ-IÄ
hym-bm-aw sN-bvXv, Xp-SÀ-¨-bm-bn sN¿p-¶ C.kn. t»m-¡p-I-fp-sS ImTn-\yhpw lr-Z-bmLm-X
Pn-bm-Wv s-{S-Uvan sS-Ìv AY-hm TMT AY-hm km-[y-Xbpw I-W-¡n-se-Sp-¯m-Wv Nn-In-Õ \
hymbm-a ECG. t»m-¡p-I-fp-Å ]-e-cnepw sd-Ìn- nÀ-t±-in-¡-s¸-Sp-¶Xv. {][m-\ Nn-In-Õm-co-Xn-
§v C.kn.Pn t\mÀ-a B-bn-cn-¡pw. \m-sf lr-Z- IÄ Xm-sg ]-d-bp-¶-h-bm-Wv.
bm-Lm-Xw kw-`-hn¡m³ t]m-Ip-¶ hy-àn-bp-sS • a-cp-¶p-IÄ
C-¶-s¯ C.kn.Pn H-cp ]-t£ C-¶v t\mÀ-a • B³-Pn-tbm-¹m-Ìn
B-bn-cn-¡pw. ]-t£ t»m-¡p-I-fp-Å-t¸mÄ hym- • ss_-]m-Êv kÀP-dn
bm-a¯n {Ita-W C.kn.Pnbn hy-Xn-bm\-§Ä • ECCP
{]-Xy-£-s¸-«p- Xp-S-§pw. • sse-^v kvvsä tam-Un-^n-t¡-j³
• Iote-j³ sX-dm¸n (Chelation Therapy)
F-´m-Wv Ft¡m sS-Ìv ?
(Echo Cardiogram)

lr-Z-b-¯n-sâ DÄ-`m-K-hpw, lr-Z-b-hmÂ-hp-I-fpw,

lr-Z-b-`n-¯n-I-fn-ep-mIp-¶ kp-jn-c-§-fpw, lr-Z-
b-¯n-sâ ]-¼nMvv I-¸m-kn-än-bpw ho-£n-¡p-¶-
Xn-\m-bn i-Ð-X-cwK-§Ä D-]-tbm-Kn-¨v sN¿p-¶
sS-Ìm-Wv Ft¡m sSÌv. A-Xmb-Xv h-b-dn AÄ-
{Sm-tkm-tWm-{Kmw sN-¿p¶-Xp t]m-se lr-Z-b-¯n-
\p sN¿p-¶ sS-Ìm-Wv Ft¡m sSÌv. km-[m-c-W
F-Iv-kvþtd, kn.än kv-Im³- ap-X-em-b-h t]m-se
F-t¡m sS-Ìv i-co-c-¯n-\v lm-\n-I-caÃ. sN-dp-{]
m-b-¯n-te Ip-«n-I-fn Ft¡m sS-Ìv sN-¿p-I-bm-
sW¦n ]-e A-kp-J-§-tfbpw t\-c-s¯ I-≠p-]
n-Sn-¡mw.
{]-[m-\s¸-« a-cp-¶p-IÄ F-s´Ãmw ?
F-t¸m-gm-Wv B³-Pn-tbm-{Kmw sN-¿m-\m- • B-k] v- n-cn³, t¢m-]n-tUm-{KÂ (Aspirin, Clopi-
h-iy-s¸-Sp-¶-Xv ? dogrel) - c-àw I-«-]n-Sn-¡m-Xn-cn¡m³ k-lm-
bn-¡p-¶p. B-kv-]n-cn-\v h-b-sd-cn-¨nÂ, s\-
lr-Z-bm-Lm-X-¯n-sâ `m-K-am-bn I-Sp-¯ s\-©p- s©-cn¨n ap-X-em-b-h Iq-Sp-X-em-Wv.
th-Z-\-tbm-sS hcp-¶ tcm-Kn-IÄ-¡v D-S³ X-s¶
• Nitroglycerine, Sorbitrate - C-h lr-Z-b-[-a-\
B³-Pn-tbm-{Kmw thWw. s\-©p-th-Z-\-bnÃm-¯
nI-sf hn-I-kn-¸n-¡p¶p. Nn-eÀ-¡v X-e-
tcm-Kn-I-fnÂ, TMT sSÌpw F-t¡m-ImÀ-Un-bmapw
th-Z-\ A-\p-`-h-s¸-Smw.
hy-Xn-bm-\w Im-Wn-¡p-I-bm-sW¦n B³-Pn-tbm-
{Kmw sN-¿Ww. t»m-¡p-I-Ä 70% Iq-Snbm am-{X- • Metoprolol, Bisoprolol - lr- Z - b - a n- S n- ¸ v ,
ta th-Z-\ A-\p-`-h-s¸-Sp-I-bpÅq. {]ta-l tcm-Kn- c-à-k-½À-±w ap-X-em-b-h Ipd-¨v lr-Z-b-¯n-
Ifn A-Xnepw ImTn-\y-ap-Å t»m-¡p-IÄ t] sâ Hm-Iv-kn-P³ B-h-iy-I-X Ip-d-bv-¡p-¶p.
mepw s\-©p-th-Z-\-bp-≠m-¡-W-sa-¶nÃ. • Digoxin - lr-Zb
- ¯
- n-sâ ]-¼n-§v ti-jn sa-¨-
s¸-Sp-¯p-¶p.

71
 B³-Pn-tbm-¹m-Ìntbm ss_-]m-Êv kÀ-P-
dntbm B-h-iy-am-Ip¶-Xv F-t¸mÄ ?
B³-Pn-tbm-{Kman t»m-¡p-I-fp-sS ImTn-\yhpw
lr-Z-bm-Lm-Xw h-cm-\p-Å km-[y-Xbpw I-W-¡n-
se-Sp-¯m-Wv Nn-In-Õ \nÀ-t±-in-¡p-¶-Xv. lr-Z-bm-
LmX-§Ä h-¶v lrZ-bw s^-bv-eÀ BIm-Xn-cn-
¡p-I-bm-Wv Nn-In-Õ-bp-sS e-£yw. Xm-c-X-tay-\
k-¦oÀ-®-aÃm-¯ t»m-¡p-IÄ-¡v B³-Pn-tbm-¹m-Ìn-
bpw k-¦oÀ-®am-b t»m-¡p-IÄ-¡v ss_-]m-Êv kÀ-
P-dn-bp-am-Wv \nÀ-t±-in-¡-s¸-Sp-¶Xv.

F-´mWv ECCP Nn-InÕ ?

(Extra Corporeal Counter Pulsation)

BÂ-ssP-\ F-¶ s\-©p-th-Z\ - b

- p-Åt- ¸mÄ, B³-
Pn-tbm-{Kmw sN-bX v- v lr-Zb - m-Lm-Xw hcm³ km-[y-X-
bnÃm-¯ t»m-¡p-If - m-sW-¦n-epw, B³-Pn-tbm-¹m-Ìn,
ss_-]m-Êv kÀP-dn ap-Xe - m-bh - \nÀ-Æl - n¡m³ km-
[y-aÃm-¯X - pam-b tcm-Kn-Ifn D-]t- bm-Ks - ¸-Sp--¶X
- m-
Wv ECCP F-¶ Cu Nn-In-Õm coXn. i-co-c`- m-K§-sf
A-aÀ-¯n lr-Zb - ¯- n-te-¡p-Å c-àt- bm-«w hÀ-²n-¸n-
¡p-I, c-à¡ - p-ge
- pI-sf hn-Ik - n-¸n¡p-I F-¶X - m-Wv
Cu Nn-In-Õbn \Â-Ip-¶Xv. hf-sc ITn-\am-b t»m-
¡p-If- p-Åt- ¸m-gpw, lr-Zb - ¯- n-sâ {]-hÀ¯-\w Ip-db - p-
t¼mgpw Cu Nn-In-Õm-co-Xn \ÃXÃ.

F-´m-Wv Io-te-j³ Nn-InÕ ? (Chelation

Therapy)

Nn-e cm-k-h-kv-Xp-¡Ä C©£-\m-bn \Â-In lr-

Z-b t»m-¡p-I-fn-se ImÕyw ap-Xem-b L-SI-§Ä
\o-¡w sN-¿-s¸-Sp-sa-¶v ]-dbp-¶ Cu Nn-In-Õ-co-
Xn \Ã-Xm-sW-¶v Im-Wn¡p-¶ ]T\-§Ä C-t¸mÄ
e-`yaÃ. càw kq-£n-¡m-\p-Å _m-Kp-Ifn c-àw
I-«-]n-Sn-¡m-Xn-cn¡m³ tNÀ¡p-¶ a-cp-¶m-b EDTA
BWv C-Xn-\p-]-tbm-Kn-¡p-¶Xv.

72
lr-Z-b-t»m-¡p-IÄ I-≠m-ep-Å
`-£-W-{Ia-§Ä F-s´Ãmw ?
• A-an-X-`m-c-apÅ-hÀ A-¶-P-§fm-b A-cn-`-£-
W§Ä, tKm-X¼v, D-cp-f-¡n-g§v, t\-{´-¸-g§Ä,
C-S-bv-¡n-sS-bp-Å kv-\m-Iv-kp-IÄ Ip-d-bv-¡p-I.
t{]m«o³ Iq-Sp-X-ep-Å ap-«-bp-sS sh-Å-¡cp,
]-b-dp-hÀ-¤-§Ä, tkm-b, a-Õyw, amw-kw ap-X-em-
b-h Iq-Sp-X-em-bn D-]-tbm-Kn-¡p-I.
• {]-ta-l-apÅ-hÀ A-cn-`£-Ww Ip-d-¨v tKmX-¼v,
dmKn, tNm-fw ap-Xemb `-£-W-w io-e-am-¡p-I.
]-g-hÀ-¤-§fn ap-´n-cn, ]-gp-¯ am-§, ]-gp-¯
N-¡ ap-X-em-b-h Ip-d-bv-¡p-I. Hmd©v, ]-¸m-b,
X-®oÀ-a¯³, B-¸nÄ, t]-c-bv-¡, amX-fw ap-X-
em-b-h D-]-tbm-Kn-¡mw.
• c-à-k-½À-±-apÅ-hÀ, D-¸v Iq-Sp-X-epÅ-
`£W§Ä Np-h-¶ C-d-¨n (_o^v, B-Sv, ]-¶n) Ip-
d-bv-¡p-I. B-h-iy-am-sW¦n sXm-en-I-f-ª tIm-
gn am{Xw D-]-tbm-Kn-¡p-I. a-Õy-§-fn s]m-Xp-th
sN-½o³, R-v ap-X-em-b-h D-]-tbm-Kn-¡m-Xn-cn-¡p-I.
F-®bn h-dp-¯v D-]-tbm-Kn-¡p-¶-Xn\p ]I-cw
I-dn-sh-t¨m, t_-¡nwKv, {KnÃn-§v ap-X-em-b co-
Xn-IÄ D-]-tbm-Kn-¨v ]m-Iw sN-¿p-I.
sIm-f-kv-t{SmÄ Iq-Sp-X-ep-Å a-äp B-lm-c-
§-fm-Wv _n-cn-bmWn, s\-bv-t¨mdv, t_¡-dn
]-e-lmc-§Ä ap-X-em-bh.
F-®IÄ, s\¿v, sh-®, No-kv, ap-«-bp-sS a-ª
ap-X-em-b-h Ip-d-bv¡m³ {i-an-¡Ww.
`-£-W¯n Iq-Sp-X ]-b-dp-hÀ-¤§Ä,
\-«v-kpIÄ (_-Zmw, ]n-kv-X, I-¸-e-≠n, I-ip-
h≠n) ^-e-hÀ-¤§Ä, k-em-Up-IÄ ap-X-em-
b-h Iq-Sp-XÂ DÄ-s¸-Sp¯m³ {i-an-¡Ww.
lr-Z-bm-Lm-Xw X-Sbm³ hym-bm-aw
k-lm-bn-¡p¶-sX§-s\ ?
Zn-\w-{]-Xn-bp-Å an-X-hym-bma-§Ä lr-Z-b-¯n-
\v H-cp-]m-Sv D-]-I-cn-¡pw. Natural Bypasses
F-¶ ]pXn-b c-à-¡p-g-ep-IÄ Zn-\w-{]-Xn hym-
73
 bm-aw sN-¿p-¶-hcn Iq-Sp-X-emWv. Iq-Sm-sX {]-ta-
lw, c-à-k-½À±w, sIm-f-kv-t{SmÄ ap-X-em-b-h Ip-d-
bv-¡p-¶-Xn\pw hym-bm-aw D-]-I-cn-¡p-¶p.

lr-Z-bm-Lm-Xw X-Sbm³ tbm-K, [ym-\w

Sexual life
ap-X-em-b-h D-]-I-cn-¡p-¶-sX-§-s\ ?
lr-Zb - [
- a
- \
- n-IÄ-¡v hn-Ik - n-¡p-hm-\pw k-t¦m-Nn-¡p-hm-
\p-ap-Å I-gn-hp≠v. [ym\w, tbm-K ap-Xe - m-bh
- sN-¿p-

after Heart
t¼mÄ i-co-c¯ - n-epÂ-¸m-Zn-¸n-¡s- ¸Sp-¶ Nn-e tlmÀ-
tam-Wp-IÄ lr-Zb - [
- a
- \
- nI-sf hn-Ik- n-¸n-¡p¶p.

Attack
F-´mWv French Paradox ?
lr-Z-b-¯n-\v \Ã-X-sÃ-¶v ]-d-bp-¶ ap-«, Nokv, amw-
kw ap-Xem-b rich food I-gn-¡p-sa-¦nepw {^-©p-Imc- copy
n lr-Z-bm-Lm-Xw hf-sc Ip-d-hm-sW-¶v Im-Wp¶p.
C-XmWv French Paradox. {^©p-Im-cp-sS Red wine
D-]-tbm-Khpw Portion controll F-¶ technique am-Wv
A-hcn lr-Z-bm-Lm-Xw Ip-d-bm-\p-ŠIm-c-W-am-bn
I-W-¡m-¡-s¸-Sp-¶Xv.

F-´mWv Portion controll ?

\½Ä-¡v C-ãs¸-« `-£-W-am-sW¦n hf-sc an-
Xam-b A-fhn am{Xw I-gn-¨v \n-dp-¯p-I F-¶
co-Xn-sb-bm-Wv Portion controll F-¶v ]-d-bp-¶Xv.
A-an-X-h®w, food carving ap-X-em-b-h C-Xph-gn \n-b-
{´n¡m³ I-gn-bpw.

F-´mWv Kerala Paradox ?

C´ybn life expectancy Nn-In-Õm ku-Ic - y§Ä,
in-ip-ac
- W
- \
- n-c¡v, am-Xr-Xza-cW- \nc-¡v ap-Xem-b
B-tcm-Ky kq-Nn-II - f
- n tIc-fw ap-¶n-em-sW-¦nepw
lr-Zb
- mLm-X \nc-¡v hf-sc Iq-Sp-Xe - mWv. C-Xn-t\-
bm-Wv Kerala Paradox F-¶p ]-db - p-¶X- v. Blm-c co-
XnIÄ, sh-fn-s¨-®, am-\k - n-Im-tcmKyw ap-Xe - m-bh- b
- m-
Wv Im-cW - §
- f - m-bn Nq-≠n-¡m-Wn-¡s - ¸-Sp-¶X
- v.

Alcohol lr-Z-b-tcm-K-s¯ F§-s\ _m-[n-

¡p-¶p ?
Red wine ap-X-em-b-h-bn-ep-Å antioxidents \Ã-Xm-
sW-¶v ]-d-b-s¸-Sp¶p. a-t\m-{]-iv-\-§fm-b kv-{S-Êv
B-Wv lr-Z-b-t»m-¡p-IÄ-¡v H-cp {][m-\ Im-
c-W-sa-¶n-cn-s¡ an-Xam-b D-]-tbm-Kw Kp-Ww
sN-¿m-sa-¦nepw lr-Z-b-tcm-K-hn-Z-Kv-²À H-cn-
¡epw *** D-]-tbm-Kw t{]m-Õm-ln-¸n-¡m-dnÃ.

74
75
 tUm. IpÂ-Zo-]v Ip-amÀ NpÅn-¸-d-¼nÂ
(ko-\n-bÀ ImÀ-Un-bm-Iv kÀ-P³ & h-Ip-¸v ta-[mhn)

tIm-gn-t¡m-Sv sa-Un-¡Â tIm-tf-Pn-se hn-ZKv-[ ]-cn-io-e-\-

¯n-\v ti-jw sN-ss¶- tI-{µ-am-bp-Å a-{Zm-kv sa-Un-¡Â an-
j³ B-ip-]-{Xn-bn tUm. sI.Fw. sN-dn-bm-sâ Io-gnepw
Cw-¥≠-­n-se eo-Uv-kv P-\-d C³-s^À-sadnbn ‘s^-tÃm’
Bbpw Xp-SÀ-¶v _mw-¥q-cn-se \m-cm-b-W lr-Z-bm-e-b-bn-se
I¬-kÂ-«âmbpw tUm. IpÂ-Zo-]v Ip-amÀ NpÅn-¸-d-¼nÂ
{]-hÀ-¯n-¨n-«p≠-­-­v.

sIm-¨n-bn-se lr-t{Zm-K hn-Z-Kv-[-cp-sS kw-L-S-\bmb ‘sIm-

¨n³ ImÀ-Un-bm-Iv A-tÊm-kn-tb-äv-kv’ F-¶ {]-Øm-\-¯n-
sâ Aac-¡m-c\pw ‘a-e-_mÀ lmÀ-«v ^u-t≠-­­-j³’ F-¶
k-¶-²-kw-L-S-\-bp-sS {]-kn-Uâp-amWv. Ct¸mÄ ko-\n-bÀ
ImÀ-Un-bm-Iv kÀP³, h-Ip-¸v ta-[m-hn F-¶o- ]Zhn-I-fnÂ
dnss\ sa-Un-kn-än- tlm-kv-]n-ä-en tk-h-\-a-\p-ãn-¡p-¶p.

t__n-tPm¬, hn.Fw. kp-[o-c³, sNÀ¡p-fw A-ÐpÅ XpS-

§n H-«-\h-[n {]-i-kv-X-hy-àn-I-fp-sS lr-Z-b-i-kv-{X-{In-bI
fn tUm-. IpÂ-Zo-]v Ip-amÀ Np-Ån-¸-d-¼n ]¦p-h-ln-¨n-«p
≠-­­
v. sNdn-b Ip-«n-I-fp-sS lr-Z-b-i-kv-{X-{In-b, lrZ-bw am-än-
sh-bv-¡Â ap-X-em-bh-bS-¡w 10,000þt¯mfw ss_-]m-Êv
i-kv-{X-{In-b-I-fp-sS A-\p-`-h-k-¼-¯p≠­v.

Contact: 99610 14446

Email: ckkkuldeep@yahoo.com
web: cochinbypasssurgery.com
www.cochincardiacsurgeons.com
www.malabarheartfoundation.com

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