Chronic Legendary Heart: Causes, Symptoms and Treatment. Chronic Legendary heart - classification, diagnostics, pathogenesis

A number of stanis will be brought together by the understandings of the "chronic Legend of the heart", with which the decisive fate will form a Legend. The Danish camp will often overtake the bagatoks of chronic bronchogenic diseases and can cause the sick to the point of incapacitation and lethal result.

Reasons, classification and mechanism of development

For all the reasons behind the development of the Legendary heart, there are three forms of this pathological camp:

• bronchopulmonary;
• thoracodiaphragmatic;
• vascular.

Cardiologists and pulmonologists see three groups of pathological conditions and sickness, which can lead to the development of a chronic heart disease:

• Group I: reduction of bronchogenic apparatus (chronic bronchitis, pneumoconiosis, bronchiectatic ailment, lenevic fibrosis with tuberculous lesions, hypoxemia, sarcoidosis, bronchial asthma, dermatitis systemic, mucositis, mucositis
• Group II: sickness, supravodzhuyutsya pathological damage to the collapse of the breast tissue (kyphoskolioz, visnazhennya, thoracoplasty, Pikvik's syndrome, obesity, pleural fibrosis, fever of the nerves.
• Group III: inferiority, to cause secondary lesions of the lesions of the lesions (lesions on the later lateral thrombosis, Legenevian hypertension, vasculitis, aneurysms due to the lesions of the lesions of the lesions, schistosomiasis, pulmonary disease)

With a stroke of a pathological camp, I see three stages. Pererahuєmo їkh:

According to the statistics of the WHO, most often chronically Legendary is provoked by such discomforts:

In 80% of patients, before the formation of the Legendary heart, they cause Legendary hypertension, so that they get caught up in the mental system. With thoracodiaphragmatic and bronchogenic forms of this pathology, the development of education is considered with good clothі microthrombi, Legendary arteriesі veins in areas of plump abo ignition processes... The vascular form of the Legendary heart is supervised by the damaged blood flow, provoked by the clogging of the Legenevus by the embolism and by the firing or plumpy inflammation of the vertebral column.

Such structural changes in the arteries and veins of the small cola produce blood circulation until the right side of the heart is re-entangled and supervised to increase the size of the mucous membrane of the vessels and the myocardium of the right snail. At the stage of decompensation in a sick person, dystrophic and necrotic processes in the myocardium are being repaired.

symptoms

At the stage of compensation, the chronic Legend's heart is overwhelmed with symptoms of the main illness and the first signs of hyperfunction and hypertrophy of the right heart.

At the stage of decompensation of the legendary heart, the sick have the following scars:

• zadishka, how to get overwhelmed when physically nurturing, inhaling a cold drink and trying to fall;
• cyanosis;
• If they are found on the basis of physical availability and cannot be stopped by taking nitroglycerin;
• a rise in tolerance reduction to physical prices;
• heaviness in the legs;
• , Will submit to the evening;
• swelling of the shin veins.

With the progress of the chronic, legendary heart, the patient develops a stage of decompensation, and there are abdominal changes:

• severe pain in the area of ​​the slunk and in the right side of the rib;
• flatulence;
• nudota;
• blues;
• formulation of ascites;
• Changes in the number of sections.

When lingering, percussion and palpation of the heart, start:

• deafness of tones;
• hypertrophy of the right slunk;
• dilatation of the right lug;
• the pulsation of malignancy from the sternum and into the epigastric period is swirled;
• accent II tone in the field of legendary art;
• diastolic noise of the second tone;
• pathological III tone;
• right ventricular IV tone.

In case of an important dichotomous deficiency in a sick person, there may be cerebral problems, which may manifest as a nervous nervousness In the case of deyakyh vipadki danі the ruin can be completed by the episodes of the court and unpredictability.

The important forms of the decompensated Legendary heart can be counteracted according to the collapsed version:

• tachycardia;
• zamorochennya;
• rіzke reduction arterial vise;
• cold pit.

diagnostics

If I am sick with adolescence on chronic Legenev's heart, please, take a consultation with a pulmonologist and a cardiologist and undergo such types of laboratory and instrumental diagnostics:

• clinical blood analysis;
• radiography;
• EXO cardiography;
• legeneva angiography;
• catheterization of the right heart;
• spirography;
• spirometry;
• test for diffuse lung health;
• pneumotachіgraphіya і ін.

lykuvannya

The main goals in the treatment of ailments with a chronic Legendary heart are straightened to the asylum of right-wing lunacies and inadequacy and Legendary hypertension. Also, active infusion appears on the basis of the bronchogenic system, which caused the development of this pathology.

For the correction of the legendary arterial hypoxemia, it will be stagnant:

• bronchodilator kosti (Berotek, Ventolin, Serevent, teopek);
• іngalyatsії kisnem;
• antibiotics.

The method of treatment for the reduction of hypercapacity, acidosis, arterial hypoxemia and reduction of the arterial vise.

For the better, the support of the Legendary judges and the reduction of the supply on the right side or the heart becomes stagnant:

• antagonism of calcium (Diltiazem, Nifedipine, Latsipil, Lomir);
• Ingibitori ACE (Captopril, Kvinapril, Enalapril, Raimpril);
• nitrate (Izosorbid dinitrate, Izosorbid-5-mononitrate, Monolong, Olikard);
• alpha 1 adrenergic blockers (Revokarin, Dalfaz, Fokusin, Zakson, root).

Stagnation of these preparations on the basis of the correction of the leg arterial hypoxemia is carried out under the continuous control of the functional stanchion, indications of the arterial grip, pulse and grip in the leg arteries.

Also, preparations for the correction of platelet aggregation and hemorrhagic lesions can be included in the complex of therapy for chronic heart disease:

• low molecular weight heparin (fraxiparin, Aksapain);
• peripheral vasodilators (Vazonit, Trental, Pentoxifylin-Acri).

In case of decompensated chronic legenic heart and right-sided lunar inadequacy, the patient may be recommended to take heart glucosides (Strofantin K, Digoxin, Korglikon), loop and calyzbergyuchikh disemuretics,

Forecast of the success of the chronic heart of the legendary heart in most cases to lie down at the level of gravity of the main ailment.
When the stage of decompensation is established, the patients need to know about the assignment of a group of ineffectiveness and rationalization. It is very important to suffer from ailments with repeated and primordial Legendary hypertension: with a decompensated Legendary heart, it is superfluous to suffer from an overgrowing right-handed lack of life, the triviality of a fateful life up to the age of 2.5.

Chronic Legendary heart is a pathological manifestation, as it develops in the right side of the heart against the background of bronchogenic ailments. Behind the degree of widening of the disease, there is a third place in the middle of the heart.

The chronic form develops on the side of the bagatech rock. In most cases Chronic obstructive ailments are the cause of ailments in the heart of the tea.

stages of becoming ill

The classification of the clinical manifestation of the legendary heart has been broken up by the Radiansk pulmonology. Surely, due to the characteristics of ailment, proponated by them, there are three main stages of overcoming ailments:

At the cob stage, the symptoms of the Legendary heart appear even weakly. The stench of turbulent liche in the period of zagostrennya. On the first stage of ailment, the heart of Legeneva is welcomed to love.

symptoms

Symptoms of the legacy heart are associated with the weakening of the function of the right louse, which cannot be wiped out, a bit of blood is needed, and it can be brought to the point of right-wing deficiency. At the same time, the symptoms are corrected.

In the world of development to the syndrome of the Legendary heart, the sick person can recover more symptoms of sickness. About the manifestation of the legendary heart of the signal

• zadishka on a lingering acid deficiency;
• tachycardia;
• lower arterial grip;
• ailments in the area of ​​the breast tissue, such as those that occur with angina pectoris;
• swelling of the veins;
• ailments shvidko stomlyuєatsya, splinters of the brain will not be removed from the proper amount of sour;
• ailment supravodzhutsya ridges in the legs: feet and homies, swelling grows up until evening, for nothing to go through the bunches;
• a sick person has a stove, the process of supervising great views in the area of ​​the right edge;
• cough;
• because of the incessant acid deficiency and an excess of carbon dioxide in the brain, pathological appearances appear, a moody swelling of the brain, people become overwhelmingly awake and aggressive, or, navpaki, we blame and baiduzhim.

An important step is to speed up the ships and the second certificate.

Classification

Symptoms of the heart syndrome can be manifested with a rapid increase in intensity and intensity. As far as the classification of ailment is concerned, I will show a sign of ailment on the basis of a quickness, ailment can develop in one of three forms:

1. Gostra form. Zvoryuvannya grows mittєvo, for some years. The reason is the overwhelming of the right slunk. triva gostra uniform not more than 6 types.
2. The subacute form can be trivial for days or days. Symptoms of ailments manifest themselves as such, as if there is a hostile interruption, if the stench does not occur like a rape, it doesn’t occur as a result of an hour of hospitality.
3. Chronic legendary heart. The ailing one will experience symptoms of illness by stretching out the bagatech rock_v. A collection of signs of heart failure is not spared. Sertseva's lack of development in steps.

The gostra form of the syndrome of the Legendary heart develops under the influence of thromboembolism of the Legendary artery, the diagnosis of which, in its own devil, provocation ischemic ailment heart, rheumatic fever in the myocardium, destruction of the larynx of the blood and of the disease heart-vascular system... Tsey version of the legendary heart є we will expand it.

A chronic legendary heart is seen as a trivial development. Most often, an ailment is to be repaired for shortcomings, as compensation for a hypertrophy problem. In the world of development, there is a decompensation in the development of illnesses, which will supervise the expansion of the right vision of the heart.

Symptoms in chronic variation are not clear. A sick person has a quickened heart rate, bad luck with physical nagging, heart pains, nigryaks. Proceedingly to see the build-up of bad luck. A lot of people are spared only when they are physical, with an accelerated ailment, the breath is brought back and calm in the country.

To serve as a part of bronchitis and pneumonia by post to the ear. Also, ailments can develop on aphids of tuberculosis of the lungs, bronchial asthma, and hypertension.

Vivchennya to the pathogenesis of becoming ill. The pathogenesis is accumulated by bagatma mechanisms, such as adding one to one.

Mechanics of getting rid of the disease:

Anatomical mechanism. In the course of the development of ailments, anatomical changes appear in Budov's heart, they grow in the size of the right little one, and the quick-feeling function is to drive. The pathology of an initiation has already developed at the first stage of the ailment.

Functional mechanisms. Functional changes are manifested by the following symptoms:

• development of hypoxemia - lack of blood sourness, as a result of which the hypoxemia is reduced;
• the Euler-Lilystrand reflex, which whirls around the sound of the capillaries in case of poor acidity and enlargement in case of renewed blood circulation;
• the growth of the internal chest grip, like a vine through a cough;
• as a result of hypoxia, the synthesis of histamine, lactic acid, serotonin, endothelin, thromboxane is improved;
• bronchogenic infections degrade the process of ventilation of the lungs, as a result, hypoxia and hypertension develop as a result.

Pathogenesis of dressing seizure different species the legendary heart. Khvoroba can cause nasty reasons:

• damage to the heart of the leg, which is spostering with vasculitis, thrombosis to produce a vascular version of the heart;
• bronchopulmonary form develops before the day chronic bronchitis, Tuberculosis, bronchial asthma;
• thoracodiaphragmatic variants to be repaired as a result of lack of ventilation of the legends, which suffer from fibrosis, kyphoscoliasis, Bekhturov's ailment, the cause of ailment in general, the destruction of the decay of the breast tissue.

Persh nіzh pohat lіkuvannya, it is important to vivify the pathogenesis of the Legendary heart, due to the reasons, which have infiltrated the development of the whole ailment. Until the end, the pathogenesis of the Legeny heart was not inoculated.

diagnostics

Diagnostics of the chronic heart of the legend to be repaired by looking at the sick and knowing about the scarg. Lykary needs information about the manifestation of ailment similar to the family in close relatives, the history of a disease of the present passes along the genetic line. First Look including advancing procedures:

• vimіryuvannya arterial vise;
• listening to the lungs;
• the appearance of the presence of heart noises.

A person who is sick needs to create the following analyzes:

• zagalny analysis of blood, schob according to SHOE due to the appearance of ignition processes, it is also possible to establish the cause of the ailment behind the warehouse of blood;
• biochemical analysis of blood is needed in order to calculate the amount of glucose, cholesterol, triglycerides, and it’s possible to help you know the disease was sick, but it’s important, the robot was destroyed, and the enemy’s judgment was destroyed;
• zagalny analysis of the slaughter;
• analysis of a gas storage facility for blood, schob prorahuvati spivvidnoshennya sour and carbon dioxide;
• a coagulogram to allow for a shelter on the throat;
• even more informative є EHC results They can be used to poke a classic picture of a legendary heart;
• Exercise the EchoKG to freeze the force of the right snorkel;
• roentgenography is also possible to reveal the manifestation of serious pathological processes;
• angiography of sudin is recognized when there is evidence of thrombi, in case of significant localization;
• method computer tomography to allow the appearance of the middle of the pathology;
• scintigraphy of the lungs to allow the development of ailments in pathogenesis, and it is also possible to know the cause of the disease;
• probing the right views of the heart;
• vimiryuvannya vise in the legendary artery.

V in particular the license signifies the procedure for vimiruvannya vise in the legendary artery. About the manifestation of hypertension, speak a vice, which is 25 mm Hg. Art. - in the camp of calm and ponad 35 mm Hg. Art. at navantazhennі.

The passage of all pererakhovanih vische procedures is not obov'yuvuyu mind. Warehouse license - an individual scheme of diagnostics for the urahuvannya of the peculiarities of the disease. Ale deyakі procedures will need to go through in general order.

In ailments with the diagnosis of "chronic heart disease", the symptoms manifest themselves visually. Their judgment on the cheeks expands, and an unhealthy blush appears. Cyanosis develops on the lips, nose, and vuha. Nigty phalanges change, the stench swells flat and widened shape, fingers become similar to drum sticks.

lykuvannya

Lіkuvannya chronic legeny heart in a specific skin type will be based on an individual scheme, especially respect for the pathogenesis of the disease. The course of therapy for the development of an elusive drug. A pulmonologist and a therapist will take care of the chronic, legendary heart, if the consultation of a cardiologist is required.

To become the basis of lіkuvannya drug therapy... complex drugs for the treatment of the Legendary heart includes the following preparations:

• antibiotics, with the presence of bacterial broncholegenic ailments;
• bronchodilating kosti, even if a patient has a varto diagnosis - bronchial asthma or bronchitis;
• antireagents, if thrombus formation;
• sechogіnnі preparations, such as ailment, superimposed on quilts;
• heart glucosides, antiarrhythmic drugs, if the patient is sick with arrhythmias;
• nitrate for improving blood circulation;
• іngіbіtorі APF, schob polіpshiti funktsіonalnі poznіlivosti of the heart;
• vіdharkuvalnі zoobi.

For the dermal stage of becoming ill, a special course of treatment is taken. Legenev's heart is rotten to drink. Only at the cob stage, you can quickly fit in with ill health.

The main meta lіkuvannya polyag in pouring on the cause of the ailment, spite of the heart є not the style of independent ailments, because of the inherited ailment.

The business plan includes three main officials:

1. Usunennya symptoms of the legendary illness, renewal of the function of the dichotomy.
2. The therapy is directed to the unbinding of the right snuggle.
3. Polishing the quality of blood.

Krim medicines for a sick person priznachayut massage, physical culture, likuvannya sour.

Lean heart syndrome is more effective, it is important to think about it. shkіdlivyh ringtone... Dotrimuvatisya regime of the day, properly harchuvatisya, lead a healthy way of life. Not a lesser important factor є correct feeding. The slid is seen from the overwhelmingly salty їzhі, including from the races of food fat. Korisna їzha, bagata kalієm, which I will paint the robot's heart. Kaliy can be found in curaz and bananas, as well as in wheat seedlings.

The ailment is guilty of unormuvati physical navantazhennya. It is not necessary to lead an unruly way of life, albeit overworldly physical reasons, the reason for the acceleration.

It is not possible to independently develop the correct drugs for the treatment of HLS, the therapy is guilty of taking care of Fakhivets.

Even though the conservative methods did not bring good results, then they are used until they are promptly involved. A sick person will re-play the legends. You can, if you need an operation on the heart.

People zasobi

lykuvannya folk methods you cannot fix it without rejoicing in the lycar. When there is a gossip of ailments, such a way to get rid of ailments does not come. If you do not have a diagnosis of “chronic heart legends”, you can use the following non-traditional recipes:

1. Prepare 8 tablespoons of calendula sheets and pour 500 ml of a bottle, infuse with a stretch of tea. If the infusion is ready, drink 30 drops each day for three months.
2. Zmіshati onset іngredієnti in the rural parts: quit and fruit to a child, dispute, tricolor violet, horsetail. Newly prepared new vidvar: 1 tbsp. pour 300 ml of sprinkle. Throughout the day, vipivayut tse zasib: 100 ml per dose.
3. Three heads for an hour-maker to make a drink and drink three lemon juice, then add one glass of honey. Such leaks are served on the same tables, in the evenings.

Before the methods of folk medicine, it goes with great care, it is important to support the body of the body in the process of treatment. When pogirshenny, I will turn more beautifully to the likar.

forecast

Legeneve's heart є to endure a widened pathology, with the skin fate of growing ailments of growth. On the whole, they pour in a lot of chinniks, the main ones are often chronic broncholegenic ailments.

Chronic Legendary Heart Syndrome Wono is a non-hostile forecast.

A high risik of lethal result. 45% of sick people can live in a decompensated stage of sickness only two rocks. The disease is in the fourth month after the number of deaths in the middle heart-and-heart disease... Navigate intensive therapy to improve the life of the patient for two additional years. On the prognosis of the disease injected and etiology of the disease.

Chim earlier rozpochato lіkuvannya, tim more beautiful forecast.

Legend's heart- pathological stan, characterizing the hypertrophy of the right slug, vicious hypertension of a small cola blood circulation, which develops with an impaired bronchial-lung apparatus, sudin legends, deformation of the chest cell and ruining the lung function.

Gostre lig heart-wedge symptom complex, wines in the legacy of thromboembolism of the legacy artery, and when the heart is sick and dichat systems. Ethiology:(gostre lig heart with heavy interruption)

1.Massive thromboembolism of the lung artery 2.embolism of gas, fat, puffiness 3.thrombosis of the lung artery, legenevian veins 4.pneumothorax. clinika: Gostre development with a stretch of decilkoh khviliin, years, on the smallest prosperity, with a frequent lethal result. Supravodzhuyutsya manifestations of the heart of decompensation. There is a shortness of time, cyanosis, pain in the chest cavity, damage. Thromboembolism is legally shy, by stretching decilkoh quilins until six months to produce a shock state and a lethal result. (Gostre Legeneve heart z pidgostream reboot): 1) thrombosis of hypertensive arteries 2) thrombosis of hypertensive arteries with recurrent interruptions 3) pulmonary infarction 4) ventilatory pneumotrax 5) advanced pneumonia 6) important interruption of bronchial asthma 7) arteries clinika: To develop in a stretch over a period of years up to several days and to grow up with a growing backwardness, cyanosis and a further development of a shock camp, a load of legends. During auscultation, there is a great number of dry wheezing and dry wheezing, there may be a pulsation in 2-3 mid-ribs, an accent over the Legendary artery. The nature of the swelling of the veins, progressively worsening of the liver, soreness on palpation. Often, there is a coronary deficiency in the gostra, which is accompanied by a pain syndrome, rhythm disturbances, and EKG signs of myocardial ischemia. The development of this syndrome is tied to the diagnosis of shock, the suppression of the veins, the expansion of the slurry, the development of the receptors of the legacy artery. The distance from the clinic to the lung infarction is characterized by the renewal of the enlargement of the bullets in the breast cells, the changes in the size of the breast, the cyanosis, ale mensha, in the case of the hospitable phase of the affliction. Dry cough, because of the appearance of small sputum, hemoptysis. Fever, tachycardia increases.

X-ray: one-way improvement of the root of the legacy, the advancement of the legibility. The high standing of the dome with diaphragms, the enlargement of the venous vessels, the improvement of the right views of the heart. Іnfrkt of the lung - darkening of the tricut form, rіdina in pleural emptying... EKG: (1-5 good) gliboki teeth Sv 1 іaVLіQv 3, V1-V2 negative T, flashing anterior. In the pre-state phase (1-3 weeks): negative T in 3, aVF, V1-2 in introductions. diagnosis: Clinical picture, EKG, X-ray, history of thrombophlebitis of lower symptoms. Legeneva angiography. lykuvannya: When developing a shock state - reanimation come in (intubation, heart massage, piece ventilation of legends). When reanіmatsії of Success shows termіnova operatsіya of metoyu vidalennya of thrombus Stovbur legenevoї arterії i Introduction trombolіtichnі preparatіv in legenevu arterіyu through zond.Terapevtіcheskі-kupіruvannya bolovogo syndrome (analgesics narkotocheskіe preparations neyroleptanalgezii) znizhennya vise in legenevіy arterії (eufіlіn at vіdsutnostі gіpotonіі- ganglioblokatori), treatment of heart failure. Early anticoagulant therapy - heparin internally with the transition to the internal laryngeal and secondary introduction under the control of the laryngeal blood. ? -10 days, instead of indirect anticoagulant. (Fibrolizin, streptokinase) Chronic lung heart- to develop in a row of rock and roll on the cob without heart failure, and then with decompensation according to the right-sided type. Ethiology: 1) anxiety in those who are primarily affected by ventilation and respiratory function of the lungs (infectious inflammation of the broncho-pulmonary apparatus-chronic bronchitis, chronic pneumonia, bronchiectatic ailment, tuberculosis with asthma. 2) zvoryuvannya, the primary enemy of the judgment of the lungs. (Legendary arteries, primary Legendary hypertension and thromboembolic processes in the system of small cola) pathogenesis: hypertension of a small cola in the form of obstructive and restrictive processes. Obstructive processes - impairment of bronchial passages - uneven alveolar ventilation, impaired diffusion of gases and decreases Po2 in the alveolar condition - arterial hypoxia. In the inheritance of the pivotal support, the dichotomy was led by an internal pectoral vise, so that hypoventilation was applied. Increased blood flow through the legene shunts, which can lead to alveolar hypoxia. Alveolus hypoxia to produce up to increased tone and vice in a small number and development of hypertrophy of the right slunk. Hypoxia wiklikє the increase in the number of erythrocytes, sp viscosity, increased blood flow and sp BCC. clinika: there is a twinge of slowness at physical navantazhenny, excessive stomachache, slenderness to tachycardia. In one way to press the beel behind the sternum, tied with a dilatation of the legendary artery, attack the confused, short-hour episodic loss of consciousness. When zagostrennі chronic іnfektsії dihat system in zv'yazku of pіdvischennyam vise in legenevіy arterії vіdbuvaєtsya posilennya Find our sertsevoї nedostatnostі іz zastoєm krovі of great cola (pravozheludochkovayanedostatnіst) - peripheric nabryaki, zbіlshennya pechіnki i tp.Prі obstezhennі appears Sertsevy poshtovhu abo pulsatsії in epіgastralnіy dіlyantsі, emphasis II over the legendary artery. If it means extended arteries, the noise of a dyastoli is audible (to indicate the lack of a lig stovbur valve) in 2 mid-ribs. It means acrocyanosis, enlargement of the jugular veins, showing signs of stagnation in the great coli. diagnostics: EKG: signs of hypertrophy and re-entanglement of the right chambers, shift Elos to the right, in assignment V1-2, the prong R increased, S small amplitude, T negative. X-ray: hypertrophy and dilatation of the right ventricle, signs of a legacy hypertension. EhoKG. lykuvannya: Nabryaki - sechogіnnі zasobi. Several post-life oxygen therapy with the help of acid balloons.

53. CLASSIFICATION OF INSUFFICIENCY ZOVNISHNOGO DIKHANNYA (FORMI, VIDI, STADIЇ ABO FUNCTSIONALNI CLASSI). NVD is a breakdown of the system of a legacy dichanium, as a result of a normal gas storage of arterial blood is not provided for the kit, in order to try to switch on copensatory mechanisms, to bring about a change in the functional capacities of the organism. Evidence and turnover of NVD is assessed by blood gases O2 and CO2 Changes in the basic constants with NVD: 1) hypercapnia Rart CO2> 46.6 2) hypocapnia Rart CO2< 35,8

Norm P О2 = 80-100 mm Hg 3) hypoxia Rart О2< 80 НВО2(%)<93% .Наиб чувствительный показатель – порциальное давление О2 по сравнению с НВО2 4) рН норм 7,35 – 7, 42 Classification:1.THE FORM 1) Gostra - to develop with a stretch of chilin, years, days 2) Subacute - to develop in the course of modernity 3) Chronic - developmental rock (non-negotiable 2. SEE NVD 1) impaired ventilation 2) impaired diffusion of the lungs (impaired diffusion of gases) 3) n blood flow in the legends 4) n regulation of the response

5) replacement of a gas storage facility for inhaled liquor 3. STADIS(Functional class) Functional class characterizes the standard of a complex of indicators, how to visualize the function of the entire AVD in case of deficiency 1) Рart О2 = 80-60 mm Нв О2 = 85-89% ) Rart О2 = 60-45 mm Нв О2 = 84-75%< 45HbO2< 75% Без сознания (кома)1st functional class(Compensation) Normal gas storage НВ О2 = 93-98% Р О2 = 80-100. according to CO "- normocapnia and hypocapnia in hyperventilation, Pa CO2 syndrome<35 2-ой Хроническая недостаточность Субкомпенсированная стадия: -нарушена вентиляционная функция - нарушение газового состава крови Ра О2<80 А)умеренная степень НВО2= 92-86% Б) значтельная НВО2=85-75% 3-я Декомпенсированная стадия -нарушение вентиляционной функции легких (любой степени) -нарушение газового состава крови:

A) hypoxemia НвО2<70% Б) нормо- или гиперкапния РаСО2 35-45 и >

54. HYPERTENSION Arterial Arterial hypertension (AH) - repeatedly fix the arterial vise. The early diagnosis of hypertension is shown, as the average value of the diastolic AT is 85 mm Hg, and of the systolic - 140 mm Hg, for this reason, the mean value is rejected as a result of the minimum amount of time calm situation, and ailment at all not taking the LZ, like moving, so reducing AT Classification For ethiology Essential arterial hypertension Symptomatic hypertension after the level of AT (18 years and older) in mm Hg. Normal AT> 130 /> 85 Upper normal range 130-140 / 85-90 Stage 1 AH (light) 140-160 / 90-100 Stage II AH (pomirna) 160-180 / 100-110 Stage III AH (important) 180- 210 / 110-120 IV stage (even more important)> 210 /> 120. Pathomorphology Hypertrophy of the livochka Іnstrophy ІМ nephroangiosclerosis Lack of blood circulation. key picture nonspecific and starts with different target organisms. Exercise of the central nervous system Main symptom head bill Often, when awakened, as a rule, in the provincial area, there is a loss of damage, damage to the brain, or the loss of cerebral blood flow, or an insult, bleeding into the bloodstream, or the swelling of the nipple of the healthy nerve. Signs of heart disease, pain in the chest, badness (due to the swelling of the heart in hypertension of the skin, another patient has heart symptoms) Exercise nirok: spraga, polyuria, nikturia, hematuria. Separation of peripheral arteries: cold spots, weight, so it is necessary to adjust the pulse on the interchange and steppe arteries in order to make the difference to the hour of the arrival of the pulse. Often, hypertension is asymptomatic, with the blame of important symptoms, or in cases of heart-and-vascular accidents. It is possible for them to appear in a deep empty space, as well as the appearance of judgmental noises, especially over the area of ​​nirok. laboratory methods Zagalny analiz blood and blood count Hb and ht Analysis of blood (protein, blood plasma, erythrocytes, leukocytes, cylindri) special methods X-ray dosage of organs in the breast cancer Angiography (incl. Coronary arteries) Excretory urography, ultrasound, MRI / CT, biopsies of nirok Signs of hypertrophy of the lіvnogo slung according to the data of EchoKG, EKG and radiography of the visual bottom: Hypertensive arteriosus - severe LIKUVANNYA non-medication, more medication with systolic AT more than 160 mm Hg. і / abo diastolic AT at 95 mm Hg. non-drug treatment Diet: salted salt (up to 6 g / dobu, with the ability to dry up with sodium and water -3 g per day), carbohydrates, fat (low weight in fat and non-saturated fat); reduction of the amount of living life up to 1.2-1.5 liters per day; Increase in food ratios, so as to replace calories and magnesium Vidmovs to alcohol and health Decreased excess weight Adequate physical activity: walking 30-45 hv not less than 3-4 p / wk more often than 100 crocs per minute), light big, rational psychotherapy. Lykarska therapy Lіkuvannya sid to repair with small doses wіth step-by-step іх adjustments In case of treatment with diuretics Angibitors of the ACE control the functional mill of nirok і zmіst elektrolіtіv. part principleI gag is indicated at stage I of the EAG: monotherapy with one drug in the vibor (diuretic drugs, B-adrenergic blockers, blockers of calcium channels, angibitorium ACE). The II gap is indicated at the II stage of the EAG and in the case of ineffectiveness of monotherapy, another drug is given to the vibor or one of the alternative drugs (for example, the addition of a diuretic and a B-adrenergic blocker or a diuretic and a-adrenergic drug). III gash is shown at III stage of the EAG and in terms of ineffectiveness, II gaps add a third one to replace another drug; it is allowed to combine drugs in a choice and alternative drugs. IV gap is indicated for non-effectiveness of the anterior stage, rapid progressing ailments or the development of malignant hypertensive syndrome: add the third quarter of the drug. Vibor preparations Thiazidi Hydrochlorothiazide 12.5-50 mg / day Cyclopentiazid (cyclomethiazid) 0.5 mg / day Chlortalidone (oxodolin) 12.5-50 mg / day IngibitoriaAPF Capoten (captopril) 25-150 mg / day Enalapril 2.5-20 mg / day / day Angiotensin II receptor blocker -lozartan 25-100 mg in 1 or 2 priyomy Calcium channel blockers nifedipin 30-120 mg / day in-blockers anaprilin 40-240 mg / day in 2 priyomy Viborchio (cardioselective) 25 100 mg 1-2 r / day, metoprolol 50-200 mg / day in 2-3 priyomi, acebutolol 200-800 mg / day, nadolol 40-240 mg / day, betaxolol 10-20 mg / day. 100 mg / day

55. SYMPTOMATIC HIPERTENSION Ethiology, pathogenesis, KLINIKA, DIAGNOSTICS, LIKUVANNYA PRINCIPLES. Arterial hypertension, which occurs as a result of early pathological processes, such as a symptom of an illness, are called secondary or symptomatic. With tsom arterial hypertension often it is the severity of the main problem. Classification Groups: 1. Hypertonia, viklicaniyu lesions of the central nervous system. There is a small number of stuns suffering from craniocerebral trauma, hypothalamic syndrome, dyencephalic hypertensive Page syndrome, lesions of the limbic system, vegetative-vascular dystonia due to hypertensive type, pyocephalitis. 2.Hypertension, obumovleni urazhennymi nirok: autoimmune debility, diffuse glomerulonephritis, amyloidosis, diabetic glomerulonephritis, vaginal nephropathy, pyelonephritis, anomalies of development of ni. 3. Decrease of the magistral vessels: coarctation of the aorta, atherosclerosis of the aorta, pananteritis, impaired blood circulation in the sleepy and spinal arteries. 4. Viklicania with impaired hemodynamics: lack of aortic valves, recurrent AV block, arteriovenous aneurysm, 5. detached with salts important metals, Trivial reception of lykarsky zasobiv (prototypal, glucocorticoid, meralocorticoid) pathogenesis.All nirkovy forms can be divided into: renaissance and volumetric dependence. Renin is an angiotensin-vasoconstrictor, which is realized through the change of sodium secretion and vidi. The order of the hyperfunctional PIVDNYA is determined by the bend of the main nirk apparatus - nephrons and a decrease in the nirk secret of physiological depressive speech. With hyperplasia of the cerebral ball of the supra-nirkoval zalosis, a rich adrenaline is seen, which increases the tone of the sympatadrenal system. Hvoroba Іtsenko-Cushinga increased secretion of 11-hydroxycorticosteroids. For systolic hypertension with thyrotoxicosis, the pathogenetic factor is the increase in the amount of blood in the heart and the mass of circulating blood. In case of aortic cavity in breastfeeding the adjustment of the grip is tied with the re-training of the upper half of the body, the adjustment of the shock and sinewy obsyagu. When cortical in the cranial cavity, the mechanism of dressing is due to changes in blood flow. Advancing the grip of the growing genesis of the development of the changes of the heart, the heart, the brain, the nirok, the destruction of the functional stanchion, which will cover the main ailment. Likuvannya. I am guilty of turning on the regime of pratsi and pobutu, dytu with interdependent reception of salt, normalization of the functional stan of the central nervous system, reduction of the activity of the sympatadrenal system.

Most effective є ethiological, in tch and operatively. The main groups of drug drugs: 1.neurotropy and psychotropic, sedative, tranquilizing and antidepressive actions 2.stimulants of the CENTRAL a-adrenergic blockers, sympatholytics 3.ganglioblokatory 4.peripheral vasodilatorenimatorialis ... in-adrenergic blockers 7. diuretic drugs.

56. INSUFFICIENCY of the mitral valve. Ethiology, hemodynamics, ETAPI COMPENSATION, KLINIKA, LIKUVANNYA PRINCIPLES. Add a defect of the heart, it is characterized by inappropriate movements of stools before the hour of systole. Ethiology: Organizational and functional walking.: In case of organ damage to the stools, valves and chords (atherosclerosis, rheumatism, etc.) in the event of a deterioration in the coordinated function of the muscular apparatus, which takes part in the mechanism of the closure of the rosette, open m'yaziv AV open, which is susceptible to myocarditis, cardiopathy, myocardial infarction, cardiosclerosis Ipr Pathoenesis Hemodynamic deterioration in the case of a large number of swollen blood flow in the hour of systole of the heart. It is possible, in conjunction with the obviousness of the swiveling gradient, the vice of m / y livim with a dimple and in front of the hearts the hour is fast.

With the turn of the metric inadequacy in in front of the heart From the slit, it is not more than 5-10 ml of blood flow, which does not affect the circulating hemodynamics. As soon as an hour reflux occurs, more than 20-30 ml of blood is thrown, with the skin it is necessary to increase the amount of blood, to produce tonogenic enlargement and hypertrophy of the front of the heart. Compensation of heart activity in viglyad hypertrophy can be saved by stretching out a lot of rock, starting to be able to do it in a forced myocardium l w. Ale l at the front of the heart, expanding, consumes the building of a general emptying. It is a congestion and an increase in the pressure in the front of the heart, and then in a small amount of blood circulation, which leads to the development of a congestive lack of blood circulation. Klinika. Stay at the level of lack. In case of severely abnormal valve deficiencies, additional compensation of heart activity can be obtained with a stretch of all life, to navigate with a physical robotics. Vyavlyayutsya vipadkovo. If there is a significant lack of skarga for bad luck, heart rate and interruptions in the robot's heart. When you look around (in the stage of compensation), there are no signs of shkiri, visible tears. In sick people with a swiveling lack of sufficiency, the growth of the lynx can reach the meaning of the world, as a result of which the top shipping increases the area and is replaced by the name of the middle key of the line. Percussion is the improvement of the common dullness of the heart up and down. A weakening of the tone over the top during auscultation (even to the point of general knowledge) Above the top, a loud systolic murmur is heard, varying in the position of a sick person on the other side. X-ray: in case of a turn of deficiency, the growth of the left atrium is increased, the heart is smoothed. EKG: in case of a turn of the deficiency - the output of the axis is left, the amplitude of the R wave is increased, the extension of the R wave is extended to the IIIIIstandard. lykuvannya... Excessive mildly inadequacies with a stretch of rock can be friendly. With frequent flare-ups of rheumatic heart disease due to a rotated lack of the mitral valve, there is an infusion of weakening of the fast-feeling healthiness of the left one, and sometimes the right half of the heart with characteristic signs of impaired blood circulation for a small amount, more for a great cola.

In case of rotational insufficiency of the mitral valve, it is possible to overcome the development of the heart decompensation.

57. STENOSIS Mіtralny MS-pathological ulceration of the anterior anteriocerebral orifice, an increase in the growth of the stools of the mitral valve (MC), and ulceration of the fibrous ring. Kf For the area of ​​the mitral opening (MO) of the 1st step - critical MS: area of ​​the MO - 1.0-1.6 cm II steps - bends of the MS: area of ​​the MO - 1.7-2.2 cm. - 2.3-2.9 cm. IV step - insignificant MS: the area of ​​the MO is more than 3.0 cm (the norm is 4-6 cm). Behind the stages of the I stage (the stage of the general compensation of blood circulation). Skarg does not reveal ailments, but it does not objectively reveal all the signs of MS. Stage II (stage of admitted lack of blood circulation). A zadishka at physical navantazhennі. Objectively - signs of stagnation and hypertension in a small amount of blood circulation. III stage ( pochatkova stage severe lack of blood circulation). By definition, the blood circulation in the small and great colas, the heart is growing in size, the venous grip of significant changes, the stove is improved. Stage IV (stage of severely abnormal lack of blood circulation with significant congestion in a great coli). The heart is significantly improved, the furnace of great growths, shchilna, a high venous grip, in some cases the bending of ascites and peripheral ridges. Until the whole stage, carry the sick with a flashy arrhythmia. Stage V (thermal, dystrophic). Significant improvement in the size of the heart, great liver, ascites, significant peripheral embryos, back in peace. Conservative treatment is not effective. Ethiology Rheumatic endocarditis (more than 90% of cases) probable pathology Pathophysiology A distal atrio-lingual gradient in the left venous girdle (first bar), the diastolic pressure of the left ventricle changes (In the norm less than 10 mm Hg) Gradient vice is transmitted through veins to lig. arterial hypertension in the right ventricle. Hypertrophy of PSh, on the substitute of such a deficiency, which is increased by a tricuspid deficiency, amalgamated by dilatation of the valve ring. key picture to lie in the form of a turn of stenosis and compensatory health of the LA. scarg The problem has been zoomed in to a shift in a small amount of blood circulation and there is a lack of compensatory health of the drug Sercebitty in case of physical replacement. Shvidka vtomlyuvanost, pumovanie vіdnіstyu adequate to the increase in wickedness ossyagu heart in as much as bar'єru. unobtrusiveness of hemoptysis, obscured by the sharp contractions of the grip in the lungs of the capillaries Hoarseness and vividness of the voice mіtralny rum'yanets Auscultation heart Guchny I tone (splash I tone) Accent of the II tone over the Legendary artery. Laboratory dosage- there may be signs of the activity of a rheumatic process. special doslіdzhennya X-ray of the heart in 3 projections. Direct projection: extension of the roots and the congested little ones of the leg. Vibukhaє 2 arc (tin Legendary artery). 3 arcs (tin LP) are smoothed, and the heart is smoothed. Tin heart is expanded to the right. X-ray of the heart: MK calcification. EKG Signs of LP hypertrophy (P- mitrale - high, wide, two-peaked P wave in I-II standard leads, two-phase P wave in V,) in different stages getting sick. Two-dimensional echocardiography of the dome-like diastolic vibrations of the anterior stool of the MK at the empty LSH Stage of the sweating and the incidence of calcification of the stools MK Stage of the shortening of the tendon chords LIKUVANNYA outpatient, dієta No. 10. Vinyatka of mint tea, kawi and іnshih zasobіv, which will make you hearty. tactics Permanently cautious Slides of uniqueness of physical agendas and emotional stress surgical treatment shows II, III and IV stages Zakrita mitral commissurotomy is indicated for ailments with isolovan stenosis with fibrous changes of the valve and stage I of th calcification. Vidkrita mitral commissurotomy in the minds of piece blood circulation Meta - the health of the drug from blood clots and changes in the size and looseness of the valve. If plastics are uncomfortable, carry out the piece valve implantation. For implantation of a prosthesis, we recommend that you take anticoagulants of an indirect type (phenylin and in.), Schob pidtrimuvati PTI at 60-65%. Lykarska therapy diuretic- the basis of therapy for ailments isolovanim MS. Indications of cIII-stage ailments Furosemide 0.04 g vseredin Ethacrinic acid 0.05 g vseredin 1-2 r / week Spironolactone 0.025-0.075 g 3-4 r / day Diacarb 0.25 g every other day or short (2-3 days ) courses - with a heart-lung deficiency, hypercapnia. Heart glucosides In ailments with sinus rhythm, it is not very effective Indications for migratory arrhythmias A combination of strophanthin (0.25-1 ml 0.05% solution) or corglikon (0.5-1 ml 0.06% solution) i / v drip 2 r / day Pislya to reach the effect - digoxin at 0.25 mg vseredin 2 r / dob (period of nasichennya), sometimes at 0.25-0.75 mg / day (additional dose). For cyclonic prophylaxis of aggravated rheumatism - bicilin-5, 1.5 million OD in / m 1 p / 4 tijn_v.

58. lack of aorta. valve Stenosis of the aortic throat is a heart defect in the vigalyad, ulceration of the aortic opening due to pathology of the aortic valve and near-valve structures. Genetic aspects. Defects of the gene to elastin, supravalvular stenosis of the aorta, legenevic arteries, peripheral arteries. riziku factor- rheumatic attack in history. Classification For the hikes of Nature (defect of development) Nabutia For the localization of the subvalve, Valve, Overvalve [For the stage of blood circulation loss Compensation of decompensations (critical) For the stage of rotation (as it appears to be behind the gradient of the flat opening of the systole) stenosis - with GDM<50 мм рт.ст., площадь >1 cm (norm 2.5-3.5 cm) Bending stenosis - with GDM 50-80 mm Hg. (Area 1-0.7 cm) Severe stenosis - with GDM> 80 mm Hg. Critical stenosis - with GDM up to 150 mm Hg. (Area 0.7-0.5 cm). Pathfiz At the first stage, the secondary systolic wikid is seen for the hypertrophy of LSh. Because of this dilatation, in case of weakness of the heart meat, there is an excess of blood, and there is a constant grip in the LSh. Through the front of the heart, the blood circulation of the myocardium in the cob stages is not transmitted to a small amount of blood circulation. Potіm vinikaє nevіdpovіdnіst mіzh require mіokarda i mozhlivostyami napovnennya coronary disease scho poyasnyuєtsya dekіlkoma reasons For rakhunok zvuzhennya the aorta nadhodit less then krovі Visoka shvidkіst Strumien krovі stvoryuє rozrіdzhennya in oblastі Girlikh coronary arterіy residual obsyag krovі obmezhuє dіastolu mіokarda i tim by uskladnyuє zapovnennya coronary arterіy gіpertrofovanogo mіokarda I need more sourness. cl picture Scargias: pain in the area of ​​the heart (angina pectoris), indolence and delusional symptoms of aortic stenosis are classic symptoms of aortic stenosis. The triviality of the life of the sick person is predicted for the first obscurity - 3 fate. Signs of heart failure. There may be signs of past ischemic disorders of cerebral blood circulation and strokes, vicious embolism of cerebral arteries. Look around the ailments: shkirni pokrivi blidi, mozhliviy heart hump. Percussion: Expansion between hearts Palpation: upper postal submissions downward and outward; in the jugular fossa, systolic tremors begin with GDM> 35 mm Hg. Auscultation A coarse systolic murmur of an audible tone over the aorta (above the heart on the right in the II mid-ribbed section), carried out in the sleep artery. Noise appears above the mitral valve, but it does not show the manifestation of mitral insufficiency. Klatsannya vignannya with the maximum sound in the lower sides of the heart from the sternum (it can be seen with a significant decrease in the heart wikid). High-frequency, random noise can be heard on the left edge of the sternum in the middle with combined porosity of the aortic valve (stenosis and lack). Muffled II tone of the sinus through the intercourse of loose stools of the stenotic aortic valve. Practically I will increase the loss of the aortic component of the II tone. To that, the hearing is only a legendary component of the II tone of the heart, in the norm it is even soft. Pulse і AT Normal in case of abnormal stenosis In case of abnormal stenosis, both systolic and pulsal squeeze changes. Bradycardia and t.v. maliy povilny pulse. special doslіdzhennya EKG In calmness: hypertrophy of the LSh (in one and the right), often in the middle depression of the S-T segment and in the inversion of the T wave, deterioration of the capacity, reduction in the front of the heart, lateral arrhythmias X-ray of the thoracic clitine The stage of compensation for the isolated stenosis of the aortic valve - between the heart and between the norms. early stages congestion develops hypertrophy of the myocardium, onset - cardiomegaly, signs of stagnation in the lesions, post-stenotic dilatation of the upper part of the aorta, seen in case of subclavian stenosis, and in vipads, the supravalvular region of heaving west Calcification of the stool of the aortic valve. Echocardiography іya ІХС. LIKUVANNYA dієta z low vmіstom kitchen salt. tactics All ailments incl. with insignificant aortic stenosis, since there are no clinical symptoms, Lykarska therapy Specific medication for daily use. Medication is directed to stabilization of hemodynamics behind the additional help of inotropic and ACE. Conductive korektsіyu pH torn down i dihalnoї nedostatnostі When aortic stenozі periferichnі vasodilators nіtrati blockers kaltsієvih kanalіv, B-blockers, dіuretichnі zasobi, sertsevі glіkozidi mozhut viklikati seryoznі uskladnennya, addition of їh zastosovuyut Especially oberezhnіstyu abo zastosovuvati zovsіm not shown profіlaktika іnfektsіynogo endokarditu. surgical treatment

to the value of valvulotomy. Radical treatment is aortic valve transplantation. Replacement of the aortic valve is indicated for all aortic patients with aortic stenosis, which is supervised by severe clinical symptoms. See the stenotic valve and replace it with a prosthesis.

59.stenosis of the aortic ostium Penetration of the passage from the LS to the aorta, stenosis with the aortic valve. Up to 30 rockets can be compensated. A clean porridge is not often, often due to aortic insufficiency. Ethiology and pathogenesis. Rheumatic endocarditis, and infectious, atherosclerosis, and congenital pathology. key picture... Compensation stages: systole elevation and LS hypertrophy. Residual blood loss in LSh, development of topogenic depolarization, increase in heart rate, hypertrophy of LSh, myocardial dystrophy. Disruption of diastolic function and systolic, increase of endometrial P in LSH 1) Zamorochennya, intolerance to specs 2) chronic lack livogo heart, zadishka, sivy. Asma, angina pectoris. (Hypertrophy of LSh, cyanosis, systole. Tremoty, in the aorta. Valves). hemodynamics: Systolic murmur, on the aorta, is performed on the sleep artery, on the key. To the right, low tone, supportive, to accept until the middle of the systole, when lying down, it becomes more beautiful, є systole. Tremtynnya. On the EKG there are signs of hypertrophy of the LSh, on the x-ray of the heart pidkreslena (type of seated rolling). Likuvannya.... The main respect is focused on the treatment and prevention of heart failure. It is necessary to usunennya physical overworking, unwelcoming callous minds, overwhelming infectious diseases. Prophylactic come in to prevent the aggravation of the disease, which is a common vice; Carrying out visits to the training of the functional myocardium. Ineffectiveness of conservative treatment in case of turn of the clinical picture of aortic stenosis in the form of surgical correction. In Danish hour to carry out aortic comissurotomy or piece valve implantation.

60. ENDOCARDIT Endocarditis is called the inflammation of the endocardium and the striking of the valves of the heart (ulceration). Pathogenesis: vicious with green streptococcus, enterococcus, bilim staphylococcus. Often, valves (microtrauma) occur in the wake of impaired hemodynamics and changes in the endocardium. clinika: Toxicity, stomachache, weakness, sluggishness, sub-fibrillation, potoodelllllllenie. Bleed shkira and sleazy (anemia). Bleeding (a symptom of trisk, cuffs) pytechial (increased brittleness of the sudin). Drum sticks and clock skeltsya. There is a functional noise on the paralyzed valve. For sub-acute interruption of the characteristic embolism through the thrombus on the valves of the heart in the nyrok, the spleen to the brain. Symptoms of septic blood loss. lykuvannya: antibiotic therapy in high doses.

61. MYOCARDIT- fiery hearty meat. The ailment is designed to be a yak in any kind of vice. During the interruption of the process, go to hospitality, food production and chronicle, for the broadening of the battle - to the fire and diffusion. Ethiology and pathogenesis. Ethiological factors, which lead to the development of myocarditis, bacterial and viral infections. Most often myocarditis is diagnosed with rheumatism, earlier - with sepsis, diphtheria, rickets, scarlet fever, in Russian infections that in. Myocarditis can be diagnosed with sensitization to the body, for example, to some drugs - so called allergic myocarditis. Microbial antigen, or a toxin, is injected into the heart's ointment, wicking into tissue antigens (autoantigens). In view of the awareness of autoantigens, autoantigens are being circulated, which can and will accumulate great changes in the myocardium. Klinichna picture. To develop from symptoms of lack of rapid function of the heart muscle and breakdown of the heart rhythm. weakness with physical symptoms, extreme weakness, heart rate, interruptions, dullness, low pain in the area of ​​the heart, such as with angina pectoris, hot stun, increased energy, bluishness of the skin In case of bends of the heart of the deficiency, they fill up the shiiny veins. The pulse is maliy, soft, in some arrhythmic, acceleration, and it can be more difficult and faster. When distributing the function of wakefulness and automatism, extrasystoles are detected, older blinking arrhythmia at the sight of paraxisms. Weakening of the flooded high-quality items, compensation in the left. Risko weakening I tone. With a significant weakened speed-sensing function of the myocardium, the rhythm of the gallop is audible. Above the top of the heart, there is often a systolic murmur, which is due to the failure of the mitral valve. Arterial grip of lowering, especially systolic, in which case the pulse grip changes. Naybilsch often on EKG means sinus tachycardia, sinus arrhythmia, extrasystole. Loss of performance is attributed to the type of non-identical abnormal atrioventricular blockade. With pre-adolescent blood it is possible to recover from neutrophilic leukocytes from destruction in liv, SHOE. Technical: friendly, often tedious. Inodi myocardial sclerosis. lykuvannya: postіlny regimen, antibiotics, SG, sechogіnnі. For polishhennya exchange in myocardium carboxylase, ATP, vitamins.

62.63.Ishemic ailment of the heart The IBS group is ill, amalgamated by the inappropriateness of myocardial demand in sour and iodine delivery. The morphological basis of IBS is known as atherosclerosis of the coronary arteries. Classification ІХС Raptor's coronary death Angina pectoris Angina pectoris Persevely stable Stable Progresuyucha (unstable) Angina pectoris calm (spontaneous) The form of angina pectoris is special (angina pectoris) Printsmetal)ІМ (div. Myocardial infarction) Postinfarction cardiosclerosis Sertseva lack of heart Rhythm. Causes of decreased myocardial perfusion Atherosclerotic plaques and calcification in the stems of the ventricular arteries. Zvuzhennya area of ​​education of the coronary artery by 75% is supervised by key signs of ischemia of the myocardium even with minor physical changes. INSHI reasons znizhennya perfuzії mіokarda mozhut poєdnuvatisya of coronary atherosclerosis abo vinikati pose zv'yazkom of them: i thrombosis embolії vіntsevih sudin (іnfektsіyny endokardit, eritremіya, migotliva aritmіya) koronarospazm Vrodzhenі anomalії vіntsevih sudin Sifіlіtichnі gumi koronaritom at difuzno hvorobah spoluchnoї tkanini Poshkodzhennya coronary arterіy at exchange therapy. pathogenesis In the course of progression to stenosis, the development of collateral vessels (during a three-hour hour to compensate for ischemia during physical activity). Decreased atherosclerosis (detection of platelet thrombus for malignant endothelium of the plaque, lesions, hemorrhage into the plaque, coronary spasm) increase the obstructive steps and reduce myocardial ischemia. Deficiency of internal cell metabolism and function of cell membranes Deficiency of ATP reserves and creatine phosphate decrease in the place of lactic acid and decrease in the concentration of ions in calories. Electrical instability of the ischemic myocardium is superimposed on important rhythm disturbances: polytopic extrasystole of Shlunochkov tachycardia Fibrillation of shlunochkov. The preclinical form of IXC is characterized by painless nima ischemia of the myocardium. Z Raptov's death in a large number of vyklican electrical instability of the myocardium, not having lost until the moment of fibrillation of shlunochki in high speed-sensitive health. Klinichna painting and lykuvannya- cm. Angina pectoris, myocardial infarction,special doslіdzhennya EKG - depression of the S-T segment, coronary T wave) for the inversion of the T wave Test with physical options - vvazhayut positive, as soon as an hour of no angina attack Scenti-graphy of myocardium from talin and one-hour coronary angina tests In one angiography, test the patient with an Echocardiography test. Differential diagnosis. Clinical signs of myocardial ischemia can be diagnosed in case of syndromes and discomforts, not related to lesions of coronary vessels First Legendary Hypertension Gostre and Chronic heart of legend Neurocyrculatory dystonia.

62. STENOCARDIA Angina pectoris is a short-term feeling of squeezing, squeezing for a sternum, or myocardial ischemia. One of the forms IXC. Classification Angina pectoris Forward angina pectoris - triviality up to 1 msec Stable angina pectoris naprugi - triviality more than 1 mіs I functional class - steps to be recognized only at higher functional levels - II III functional class - attack is detected when walking at a distance of more than 100-500 m, when one on top of the IV functional class - it is characteristic to recognize attacks in a calm Progressive angina pectoris. Ethiology Atherosclerosis of the coronary arteries Spasm of the coronary arteries Thrombosis Stenosis of the aortic throat Hypertrophic cardiomyopathy Primary Legeneva arterial hypertension Important arterial hypertension Lack of aortic valve. pathogenesis: in the basis of the persistent sounding of the coronary artery (fixed coronary obstruction), even in the calm artery, adequate perfusion of the myocardium, and ischemia are deprived of heat. Angina pectoris calm (emotion): dynamic coronary obstruction occurs temporal loss of local blood flow. key picture Health, in the presence of seriousness or pain (it is rarely obvious) behind the breastbone or (more) in half of the breastbone, which can be seen in the hand (partly in the left) or hurt the hands, the area of ​​the scapula, shuya., Attack will be recognized with physical problems, emotional excitement, with a cold weather. The triviality of the attack in the middle of 2 to 5 min. It will be more likely to change if the dose is taken out of nitroglycerin. Laboratory dosage Zagalny cholesterol - addicted HDL cholesterol - increase low cholesterol LDL cholesterol - addictive. These indicators are nonspecific and are often normal. Blocks of low heaths, Wolff-Parkin-Son-White syndrome LIKUVANNYA Mode - the patient is guilty of perebuvati pіd visual lіkar. Symptoms of unstable angina have appeared, hospitalization is indicated. Diet number 10s. Prickening kurinnya, a trace of uniqueness of stress.Preparations Vibor Aspirin (325 mg 1 r / dobu-all patients with angina pectoris during the daytime contraindications. B-adrenergic blockers: atenolol 25-100 mg 1 r / dobol at 25-100 mg 2 / dobu abo propranolol (anaprilin) ​​30-100 mg 2-3 r / dobu (doze individually, adjust the heart rate at rest at 50-60 minutes). impairment of peripheral blood circulation and obstructive ailments of legends, depression. prolonged activity (mononitraty abo nitrata percutaneous) should be interrupted by the age of 10-14 years, until the development of the ringing is possible. 1 r / dobu, dil tiazemu 90-360 mg 1 r / dob, ni-fedipina 30-120 mg 1 r / day Yak shunt vikoristoyut vein (pidshkirnu stegna vein) or the internal chest artery. prophylaxis Pipinennya kurinnya, for a low level of cholesterol and fat, regular presentation to a complex of special rights Hypolypidemic drugs.

63. INFARKT MYOKARDA IM - gosstro scho vinik seredkovy necrosis of the heart meat due to absolutely any lack of coronary blood flow. In 95% of cases, the IM is based on atherosclerosis of the coronary arteries, acceleration of thrombosis or spasm in the area of ​​atherosclerotic plaques. Causes Vintsevo artery thrombosis in the area of ​​atherosclerotic plaque is the most common cause of IM Coronary artery spasm developmental ethology(Including with implantation of cocaine) Vasculitis, which can fend off mid-caliber judgment, including coronary arthritis, - rheumatism, neoplastic periarthritis, Wegener's granulomatosis, VKV and rheumatoid arthritis; gas, important hypoxia Anemia, which has developed on aphids of coronary atherosclerosis pathogenesis... Main patofіzіologіchny mehanіzm ЇM - nevіdpovіdnіst mіzh require mіokarda in kisnі i mozhlivostyami coronary blood flow RPPOs aterosklerotichnoї plaque Aktivatsіya trombotsitіv, zapuskayutsya mehanіzmi zgortannya GOSTR oklyuzіya koronarnoї arterії Rozvitok necrosis aritmіy Rozmіri vognischa necrosis stale od rіvnya oklyuzії koronarnoї arterії i bagato in chomu viznachayut tyazhkіst perebіgu hvorobi i turnover of clinical manifestations. With the help of a slurry, 40% and more mass of the fast-feeling myocardium is inappropriate for life. blood 70% of the myocardium of the lilac duck Клінічні forms Anginous form (in 95% of ailments with the first onset of IM, with repeated IM - in 76%). Skargi on the unbearable squeeze pain behind the breastbone, for in half of the breastbone it is trivial for 30 minutes, not knowing the received nitroglycerin. More can come in my hand for offended hands, epigastric problems, back, lower slit or throat. Bil is often not tied to physical navanazhennyam, vinikє without apparent reason in the camp of calm. Significantly, the number of IMs is developing in the wake of the awakening. Characteristics of anxiety, anxiety and fear of death. IM can supravodzhuvati rіzka zadishka, blіdіst, ryasne sweaty, cough and wheezing. Deafness I tone, showing a trinomial rhythm during auscultation of the heart, the noise of rubbing the pericardium. Disruption of the heart rhythm (extrasystole, brady and tachyarrhythmias). Name arterial hypotension, protea in the first 20-30 minutes of pain syndrome, it is possible to increase the arterial grip. In some cases, supernatant nuisance, bloating, weakness, foulness, and the appearance of grubby toxicoinfections. Atypes of form IM gastralgic Asthmatic Cerebral Pain-free form of EKG Transmural IM - from the S-T segment in the cases, showing the localization of IM. Nadal, with the development of necrosis, the S-T segment decreases, there is a QS wave (the main EKG-sign of penetrating IM) і negative prong T. Echocardiography - zones of hypothesis of akinesia of heart stinoks in case of IM, assessment of the rapid function of the myocardium of a lingering scrub. X-ray of the organs of the thoracic clitine - swelling of legends, aneurysm of the lingering creeper, infarction pneumonia. Angiography Enzymatic diagnostics of LDH: the level of the enzyme grows for 24 years, and is taken at a high level of 6-8. SHOE will move in 12 years after the IM and may become a tall stretch of decilkoh tizhniv. LIKUVANNYA Hospitalization regimen in the intensive therapy ward. Post-bed regimen lasting for at least 24 years. Diet. Before stabilization - parenteral food, dal - a day with other food fats and salt, in a state and food-grade period - food No. 10a. ), with induced dichannya - naloxone. Renewal of coronary blood flow Streptokinase 1 million OD intravenously in drops for 1 year; alteplase- (tissue activator of plasminogen) 15 mg i.v. for a stretch of 2 minutes, for 0.75 mg / kg (not more than 50 mg) for a stretch of 30 minutes, for 0.5 mg / kg (not more than 35 mg) for a stretch of 60 minutes. It is important to fix the thrombolytic effects of the yakomog, before the ear of the ear, there was a great IM. Aspirin 325 mg is administered all at once for the establishment of diagnosis and at a dose of 325 mg / day. Extrina percutaneous VNUTRISHNOPROSVITNOGO angioplasty. Emergency aortocoronary shuntuvannya - the application of shunts in the form of an abnormality of the arteries of the coronary arteries. The yak of the shunt vicoristovuyut the pedicle vein is stegna or the inner thoracic artery. To spend 4 years for the development of IM. The zvyazu z zim method zasosovuyut is rare. Omezhennya razmіrіv necrosis Nіtroglіcerin in pershі 24-48 years - 0.01% solution with shvidkіstyu 5 mcg / hv i / v drip, increase the dose by 5 mcg / hv skin 5 minutes to reach the effect. Systolic AT is not lower than 80 mm Hg. With B-adrenergic blockers, Metoprolol 5 mg intravenously, every 50 mg every day in the middle of the skin for 6 years, repaired after 15 minutes for internal administration. Atenolol 5 mg intravenously for 5 minutes, repeat the dose after 10 minutes.

64. Sertseva lack tied with ↓ abbreviated. Building myocardium. With a whole venous rush to the heart and opir, it overcomes the myocardium; Reasons: 1) The disease is primarily an enemy of the myocardium with metabolic disorders during (infection. Vopalitis and toxic, people. Coronary. Blood circulation. Myocardium with pathology changes in the very heart abo cr. Streams (heart defects, P in a small number). clinika: zadishka cyanosis, cyanosis, bulges. Stagnant bronchitis may develop. Classification: Gostra Vinikak Raptovo, Chronicheskaya. Includes three stages 1) Pochatkova - only with fiz. Navantazhennі 2) Disturbance of hemodynamics 3) Kіntseva dіstrophic stage of lack. Vinnikayut nevorotnye snakes in the organs. lykuvannya: SG, sechogіnnі, blockers of aldosterone, blood letting, vitamіni.

65. KVOROBA VIRAZKOV SHUNK Classification Type I. There are a large number of paths to type I in the area of ​​the slunk, and in the area itself, called the place of the smallest support -those. the transition zone, roztaschana between the bottom of the slunk and the antral wedge. Type II. Creeper curves two-fingered intestines... Type III. Vyrazki pіlorichny canal. During his interruption and key manifestations the stench is more similar to the twisting of the two-fingered intestine, below the slunk. Type IV. Visoki slopes, which are located close to the stravohidno-slunk transition on a small curvature of the slunk. Unimportant to those who smell like a type I twist, they see a group around the world, so the stench stinks until little. key picture Bile in the epigastric area When the cardiac area and the back wall of the shlunks go up, it appears immediately behind the breastbone, it can be seen in the left shoulder. , boredom, stove, constipation Asthenovegetative syndrome Laboratory dosage Analysis of peripheral blood in case of persistent interruption without changes Gregersen. A positive reaction can serve as one of the indirect signs of a sharpening process. special doslіdzhennya When the slurry secretion is advanced, it is normo-abo hypochlorhydria, hyperchlorhydria is rarely meaningful. analysis shlunk juice additional help in differentiation of good and bad things. Basal secretion of hydrochloric acid for 1 year: less than 2 mEq is the norm, vyrazka of the slurry, cancer of the shlun 2-5 mEq is the norm, the vortex of the slurry is more than 5 mEq. ): 0 mEq - achlorhydria, atrophic gastritis, or cancer of the shlunk 1-20 mEq - the norm, shlunk, cancer of the shlunk 20-35 mEkv - prick of vyrazkovy ailment of two-fingered intestines 35-60 mEq - virazovy coli syndrome Zollinger-Ellison More than 60 mEq - syndrome Zollinger-Ellison. Rentgenoskopіya verhnіh vіddіlіv shlunkovo-kishkovogo path Endoskopіchne doslіdzhennya -Perevagi method: Pіdtverdzhuє chi vіdkidaє dіagnoz Viyavlyaє patologіyu slizovoї Ilya Obolonkov verhnіh vіddіlіv herb path, the method is not available for rentgenologіchnogo Mozhliva pritsіlna bіopsіya Mozhlivo mіstseve lіkuvannya virazkovogo defect control regeneratsії slizovoї Ilya Obolonkov abo formuvannya Scars LIKUVANNYA Diet: period of sharpening 1-2 days - day No. 1a 3-4 days - day number 16 period of remission - day No. 1. Dairy products, coffee and alcohol, chicken feed stimulating infusion into the secretion and against alcohol consumption. Try to inject on the acid-peptide factor Antagonism of histamine H2-receptors (cimetidine, wound-tidin, famotidine) to reduce acidity for a trivial hour and stimulate gastric reactivation and increase the frequency antigelicobacter therapy Consumer therapy de-nol 120 mg 4 r / dob for 28 days metronidazole 200 mg 4 r / dob for 10-14 days tetracycline 500 mg 4 r / dob for 10-14 days Antacid (alfogel). , inactivation of pepsin, elimination N.pylori, Do not alter the acidification rate). Sucralfate is an antacid, adsorbent and enveloping action. Misoprostol is an analogue of prostaglandin E2 - efficiently lіkuvannya virazkovoi ailments, allowed for the prevention of vyrazok slung at the bottom of the oil refinery. Carbenoxolone sodium - biogastron, 100 mg 3 r / dob in 1 day and 50 mg 3 r / day at the beginning of 6-8 days; spraying of peptide beetles.

66. CHRONIC GASTRIT The bile in the epigastric period is poorly rotated, it is not localized clearly, it does not flow into the foreign camp of the patients. swelling, nudity, bloating, impaired appetite Intestinal dyspepsia: abdominal swelling, gurgling, flatulence, stiffness of style Asthenovegetative syndrome: weakness, swelling, puffiness and mood swings. Chronic gastritis type A Hypo-abo achlorhydria Signs of pernicious anemia Suputny thyroiditis. Chronic gastritis of type B Bil in epigastric disease, changed to the right sidebar region. Postgastrectomy gastritis Disorder of viroblast of intravenous factor Up to Aslan(Lack of vitamins B12) Progression of changes to a rotated atrophy with the development of ahlorgidriya. Doslіdzhennya method Zagalny analіz krovі: pernicious anemіya at hronіchnomu gastritі type A Analіz feces: mozhliva nayavnіst prihovanoї krovі and takozh neperetravlenih zalishkіv їzhі at znizhenіy kislotnostі Bіohіmіchny analіz krovі: znizhennya vmіstu zagalnogo bіlka, zapalnі zmіni rіznogo stage virazhenostі (maksimalnі at phlegmonous gastritі) Doslіdzhennya shlunkovoї sekretsії : znizhennya abo pіdvischennya pH shlunkovogo juice natsche at zastosuvannі spetsifіchnih podraznikіv (kapustyany vіdvar, gіstamіn) viznachennya vmіstu pepsin FEGDS of pritsіlnoyu bіopsієyu: slizovoї Ilya Obolonkov (nabryak, oseredki Gіperemії, petehії, rozpushennya i poverhneve virazka, zbіlshennya folds at gіperhlorgіdrіі; blіdіst i atrophic in case of hypo- abo ahlorgidriya; there is no need for zhovchі in kuksu zholudі in case of reflux gastritis) necessary for differential diagnostics with diffuse cancer of the Viyavlennya shlunk Helicobacter pylori. lykuvannya Diet. Od fallow type sekretsії rozrіznyayut 2 varіanti lіkuvalnogo harchuvannya When gіpo- that ahlorgіdrії in gostrіy fazі priznachayut dієtu № 1a, Dali - dієta № 2 pіslya zakіnchennya rate lіkuvannya - povnotsіnne harchuvannya When gіperatsidnih mills - under study is dієta № 1. Korektsіya torn down shlunkovoї sekretsії When gіpo - that ahlorgidrii - polina's infusion, kulbaby root infusion, natural shlunkovy syk 1 tbsp. l. on pivsklyanki with small carpets for an hour; Polyenzyme preparations (festal, digestal, panzinorm-forte, mezim-forte) 1 tablet per hour; chloride and chloride-hydrocarbonate sodium mineral water enveloping you; blockers of histamine H2 receptors (only with high hydrochloric acid products and erosions). With gastritis, viclican Helicobacter pylori, - eradication (therapy course - 1-2 days) Consumer therapy de-nol 120 mg 4 r / dob for 28 days metronidazole 200 mg 4 r / dob for 10-14 days tetracycline 500 mg 4 r / dob for 10-14 days fellow sickness. In the period of remissia - sanatorium-resort lіkuvannya.

67. chronic enteritis and colitis Enteritis Ethiology and pathogenesis 1) Infections - typhoid fever, dysentery, salmonellosis and in.; 2) transfers of the hostry enteritis; 3) dysbacteriosis - destruction of microbial rivovagi in the intestine; 4) the alimentary factor - irregular eating, dry, chronically re-entangled intestines with difficult to digest; 5) radioactive detection; 6) alcohol malice; 7) allergic injections; 8) congenital enzymopathia - a shortage of enzymes, related to the wetness of life-long words (gluten, lactose deficiency); 9) endocrine infusion (carried in with thyrotoxicosis); 10) engulfment of other organs of etching - slunk, hepatobiliary system, subshlunk zone. key picture... Skargi for abdominal pain in the navel, flatulence. Styles of no decoration, shut up to swear by sneaks. Harchuvannya reductions, shkіrnі pokrivi blіdі. Signs of polyhypovitaminosis are obvious - dryness of the skin, lameness and growth of nigtiv. There is a lot of noise and turmoil in the right club area. At the stiles, mucus appears, with microscopic pre-sluggish feces - specks of neutral fat, oleaginous fibers. The characteristic radiological signs are hypotonia, the presence of gas and іvnіv in the small intestine, the uncleanness of the relfu or ribbed small intestine. Likuvannya. It is necessary to vrahovuvati steps of destructive intestinal etching, in the presence of acceleration, in the back of the patient. When the process is aggravated, the sign of sulfanilamide drugs, antibiotics is shown.

In case of hypermotorization of the small intestine, it is insufficiently digested that it adheres to the intestine, and that the mucous membrane is swollen and accelerates the development of microbial flora. Trivially іsnuvannya podushennyh to produce colitis to the development. The diagnosis of chronic colitis can be fixed with triviality. The mucous membrane of the intestine is functional, through which microbes and toxins, toxic products are seen, which circulate in the body when the speech is damaged. Tsi factor can become the reason for the diagnosis of chronic colitis in case of lack of function of nirok.

Nareshty, the cause of colitis can be autoinfectious, for example, an intestinal stick, as for singing minds, becomes pathogenic.

70. PANCREATITIS CHRONIC At the heart of the disease is the development of the ignition-sclerotic process, which leads to a progressive decrease in the functions of the internal and external secretions; there is a decrease in parenchyma of parenchyma (induration) as a result of the growth of tissue, if there are fibrous scars, pseudocysts and calcifications. Classification Chronic calcific pancreatitis Chronic obstructive pancreatitis Chronic fibro-induractive pancreatitis Chronic bones and pseudo-mucous membranes.

Ethiology Alcoholism Infection of gallbladders, shlunk and two-fingered intestines (fatty gallbladders, viral ailments, diverticulum of two-fingered intestines, chronic gastritis); Toxic injections - chemical words, including drugs. Blood circulation impairment. Allergic reactions. Spadkov’s mental strength. key pictureChronic pancreatitis at the early stages manifest themselves as attacks of gastric pancreatitis. Particularities of pain syndrome (with progressive functional deficiencies, the triviality and intensity will change in 30-40%) syndrome of impaired motility (in the event of the importance of hearing and bloating) Extension of pain syndrome (without clear localization). Through a few rockies dominate Steatorrhea Syndrome of malabsorption with further reductions in muscle mass Manifest diabetes Laboratory dosage Analіz krovі in perіod zagostrennya Leukocytosis іz zsuvom leykotsitarnoї of formulating vlіvo, aktivnostі amіlazi (krovі sechі i) i Hypoproteinemia disproteїnemіya for rakhunok pіdvischenogo vmіstu globulіnіv tolerantnostі torn down to glucose coprological doslіdzhennya - kreatoreya i steatorrhea scho svіdchit about znizhennya zovnіshnoї sekretsії pіdshlunkovoї zalozi Duodenal vmіst. A decrease in the activity of enzymes in the duodenal space before and after stimulation of the pancreatic zone with hydrochloric acid, secretin and pancreatic acid, in order to reduce the general secretory function in the general population special doslіdzhennya Radiologic dosage of organs in empty empty - in 30-40% of cases of pancreatic calcification. Ultrasonic examination of the calcification of the dermal zone or pseudoflux, CT scan and the contour of the dermal zone, the pukhlin or the cyst, the calcification of the Endoscopic retrograde cholangiopancreatography - deformity , covering of stones in the zagalny zhovchny prototype, stone of the pancreatic duct. LIKUVANNYA REFERENCE Tactics perіod zagostrennya neobhіdno strangled funktsії pіdshlunkovoї zalozi Goloduvannya, vzhivanie mіneralnoї Vod Іnfuzіyna terapіya Cholinolytics, spazmolіtiki, antigіstamіnnі preparations antibіotiki (for profіlaktiki vtorinnogo іnfіtsі-vannya kіst) іngіbіtori proteases cytostatics blockers gіstamіnovih H -retseptorіv (napriklad, cimetidine) abo en-4 tatsydi Pankreatichnі enzymes (pancreatin panzinorm, metіonіn, Festalum) - for lіkuvannya steatoreї i polegshennya bolyu Paranefralnіy novokaїnova blockade In perіod remіsії Dієta № 5a Pankreatichnі enzyme vіtamіnoterapіya lіkuvannya suputnoї patologії for spa lіkuvannya Borzhomі, Єsentuki, Zhelєznovodsk. Surgical treatment Indication Ineffectiveness of conservative therapy Napolegia pain syndrome: efficiency 60-80% The main part of the work on the papillary disease in case of primary chronic pancreatitis - resection and operation of the internal drainage

71. CHRONIC HEPATITIS Chronic hepatitis (CG) is a diffuse ignition process in the liver, not less than 6 m / s without polishing. Classification by ethology Autoіmunny hCG Vіrusny CH B (HBV-іnfektsіya) Vіrusny hCG D (HDV-іnfektsіya) Vіrusny chronic hepatitis C (HCV-іnfektsіya) Vіrusny hCG unspecified hCG NOT klasifіkuєtsya yak vіrusny abo autoіmunny Lіkarsky hCG hCG vnaslіdok Parvin bіlіarnogo tsiroz hCG vnaslіdok Parvin sclerosing holangіtu CG due to lack of antitrypsin. Classification by the level of activity to the process Evaluation of the index of histological activity of periportal necrosis of hepatocytes, including bridging 0-10 points of intralobular focal necrosis and dystrophy of hepatocytes 0-4 Inflammation in the portal tracts 0-4 Fibrosis - 0-4 Oxythological - 4-8 pomirny HG - 9-12 important HG-13-18. Classification by stages Portal fibrosis of periportal fibrosis Perihepatocellular fibrosis. Pathomorphology Dystrophy and necrosis of hepatocytes of small size and localization Lympho-macrophage inflammation Fibrosis of the liver. diagnostics Liver biopsy Other signs of ALT and ACT activity adjustment and results of special and biochemical dosages, tests of children, improvement of liver and spleens, asthenovegetative teleangelitis, palate tactics of lіkuvannya Suvora dіeta і interfering rukhovaya activity unimpaired.Unconditioned vimoga - outside of alcoholism ) Symptomatic therapy (for example, nudoti, antigist-minn, choleretic, cholekinetic cases) Laboratory Doslidzhennya. Bіohіmіchny analіz krovі: zbіlshennya Choe, gіperproteїnemіya, disproteїnemіya (pіdvischennya vmіstu y globulіnіv, zbіlshennya pokaznikіv timolovoї Samples znizhennya vmіstu albumіnіv krovі, zmenshennya pokaznikіv sublimate test), pіdvischennya aktivnostі ALT i ACT, zbіlshennya vmіstu zv'yazanogo (direct) bіlіrubіnu. serological data The identification of markers in CVH with the establishment of the activity of the replication of the virus (in the reactions of IFA, DNA hybridization, PLR). HBs-Ag (Australian) appears in the blood in 1.5 m / s after being informed special methods Ultrasound, Radioisotope detection of the liver, laparoscopy lykuvannya Ethiotropic: preparations for interferon (parenteral forms of natural and / or recombinant a- and B-interferons) - with a high level of activity of the infectious process (the appearance of markers in repetitive posture), as well as during changes Schemes of therapy with drugs for interferon In case of HBV infection Recombinant a-interferon (for example, Intron-A) at 2.5-5 million IU / m 2 a day or 3 r / day and / or in / m stretching 6 m / s Natural a-interferon 10 ME 3 times / day (children - up to 10 MO / m 2) stretching 12 hours. Addition of anti-layer drugs with a lower mechanism of diy (for example, ribavirin) With low activity of the HBV replication process - before taking prenizolone (for example, 30 mg / for a stretch of 3 days for 1 Interferon) In case of cholestasis, urzofalk is indicated.

72. HNN step-by-step development of irreversible deterioration of the function of nirok with a clear vivedennya of the organism of products of nitrogenous exchange and adjustment of water, electrolyte, osmotic and acid-puddle balance. Ethiology: stenosis of the nirkovo artery, embolism of the nirkovo artery, thrombosis of the lower empty vein, right ventricular failure, pathological reflux, chr. glomerulonephritis, chr. pyelonephritis, diabetic diabetes, amyloidosis, arterial hypertension, polycystosis of nirok, new conditions, trivial obstructions of every day. Pathomorphology. The morphological picture of nirka in case of chronic nirkovy deficiency lies in the main ailment, but most often it helps to substitute parenchymal tissue and wrinkles of nirka. key picture Nevrologіchnі symptoms (rozvivayutsya postupovo abo raptovo) Sonlivіst Splutanіst svіdomostі Pіdvischena nervovo-m'yazova zbudlivіst Sertsevy-sudinnі symptoms Arterіalna gіpertenzіya zastіyna Sertsevy nedostatnіst Pericarditis Shlunkovo-kishkovі rozladi Anoreksіya Nudota Blyuvota Metabolіchnі rozladi Find our Nespetsifіchnі (stomlyuvanіst, sverbіzh, torn down sleep) Reveal spetsifіchnih porazok (for example, pain in the cysts with secondary hyperparathyroidism). Laboratory dosage Oak Signs of normochromic normocytic anemia Lymphopenia Thrombocytopenia. Hour krovotechі zbіlsheno tank Azotemіya Pіdvischennya vmіstu kreatinіnu Zbіlshennya vmіstu sechovini, pіdvischennya kontsentratsії amіaku, Pіdvischennya zmіstu sechovoї acid Gіperlіpіdemіya (IVtіp) Znizhennya kontsentratsії aktivnoї FORMS vіtamіnaD Pіdvischennya kontsentratsії PTH Pіdvischennya vmіstu glucose i znizhennya chutlivostі peripheral character tkanin to іnsulіnu Gіperfosfatemіya hypokalemia (at polіurії) Gіperkalієmіya, hyponatrium, hypochloremia, hyper-magnesium (in the thermal stage) Hypocalcemia instead of sulfates Hypocalcemia Acidosis Analysis of the cell Proteinuria Cylindruria. special doslіdzhennya Glomerular filtration rate (GFR) The criterion for the need for conservative treatment of chronic nircovascular deficiencies - GFR below 50 ml / min. When there is a total in the blood plasma, it grows instead of creatine (more than 0.02 g / l) and the serum (more than 0.5 g / l) when the filtration is less than 10 ml / h, the thermal stage of HNN is infused, in which case it is necessary to increase for їх improvement with signs of polycystosis. It is possible to develop concrements, obstructions to the arteries of the duct, or to the internal opening of the secular canal with extended balls and cups. LIKUVANNYA Lіkuvannya main disease. Symptomatic therapy Antihypertensive drugs Antibacterial treatment for anemia Improvement of nirkovo osteodystrophy Sanatorium and health resort treatment. Nirkova replacement therapy (hemodialysis, peritoneal dialis, nirka transplantation) is indicated for GFR less than 10 ml / hv, as there is no need for correction of hypercalculation or acidosis and reversal of the BCC. Diet In the cob stage of the KhNN - school No. 7; in case of turnover of CHNI - food number 7a or 76. Principle of such a diet Adequate calorie intake for fat and carbohydrates consumption Reduction of dietary intake up to 0.6 g / kg (60% of dietary intake of foodstuffs) visvok, ribi, siru, etc.) intermixing of the line for the addition of sodium concentration in syrovatz at the intervals of 135-145 meq / l of edible salt up to 4 g / day kartoplya) Vitaminotherapy surgical treatment Operations, directing on the weakening of post-renal causes of CNS allotransplantation of nirka. Lykarska therapy In conjunction with this, when uremia is characterized by hypertriglyceridemia, hemifibrozil (600-1,200 mg / dob) is characteristic. It is not recommended to take clofibrate due to its potential toxicity. In case of hypochondriasis, viciklikanoi damages of tubular secretion, or with the use of diuretics, - preparations of kaliy. In connection with the breakdown of calcium metabolism and development of osteodystrophy, it is necessary to trivially consume calcium gluconate (0.5-1.5 g 3 r / dobu) and vitaminaD up to 100,000 IU / dobu, however, vitamin D in high doses of calcium To reduce the level of phosphates in the blood, use almagel for 1-2 tsp. 4 r / dobu (before the control instead of calcium and phosphorus in the blood). In case of acidosis in fallowness from the 1st stage - sodium hydrocarbonate (100-200 ml of 5% size) i / v. In case of decreased duresis - furosemide or bumetanide (bufenox) in doses that will prevent polyuria. For lowering the arterial vise - diuretic zasobi, for example furosemid 80-240 mg 2 r / dobu The treatment of anemia is more complex: testosterone propionate (for strengthening eritropoiesis), 1 ml of 5% oil rose in / і sodium, preparations of zaliza, folic acid, vitamin B 12 At W 25%, the lower is shown the transfusion of the erythrocytinous mass. Antibiotics in case of chronic nircovian deficiency, followed by stasosovuvati: dose of penicilin, ampicilin, methicilin, seporin and sulfanilamidiv change in 2-3

73. Acute diffusional glomerulonephritis. Ethiology, pathogenesis, KLINIKA, DIAGNOSTICS, PRINCIPLES OF LIKUVANNYA. Infectious-allergic neglect, in the res-ti kit. urazhayutsya nirkovі glomeruli. Ethiology -β-hemolytic streptococcus gr. A. Patagenesis - 3-type allergic. reactions: formation of immune complexes, deposition of cells on the membrane of cells of glomeruli → destruction of processes of filtration of blood, salts ... clinika - first signs of ch / z 1-3 types. for infectious diseases. extrarenal syndrome- weakness, headache, nudota, crosswise beats, chills, ↓ appetite, 0 body to high numbers, whiteness. Sichovy syndrome- embellishments on the face, oliguria, gematuria (colir of "meat pomii"), hypertension. diagnostics- 1). CLINICH. Dani 2). Analysis of the section - erythrocytes, blocks, cylinders, ↓ pets. Zimnitsky test- ↓ direzu, nikturia (check. At night). ↓ filtration nirok according to creatinin. General analysis of cr: leukocytosis, accelerated SHOE, anemia, saturating surplus nitrogen, sechovine, ↓ albumin. Coagulogram: hypercoagulation. Am to streptococcus (IgMіIgG), ↓ to complement. Biopsy with an electronic microscope. lykuvannya- 1). Strict post-treatment up to ↓ build up and AT. 2). Diet (↓ Na, block and water). 3). Antibiotics - penicilini. 3). Corticosteroids - prednisolone - with nephrotic syndrome. 4). Cytostatics. 5). Indirect anticoagulants - heparin. 6). Antiagreganti. 7). Refinery 8). Hypotensive zasobi - captopril, enal. nine). Sechogіnnі zasobi, wіtamіni. Dispensary lykuvannya - 5 rocks

74. CHRONIC GLOMERULONEPHRITIS. Ethiology, pathogenesis, KLINIKA, DIAGNOSTICS, PRINCIPLES OF LIKUVANNYA. getting sick with nirkovy glomeruli lesions. Ethiology - the result of OGN (β-hemolytic streptococcus), it develops in case of systemic cervonia, hepatitis, snake bites. pathogenesis - autoimmune mechanism: autoAt to vlsoy tissue nirka. clinika–hematuric form - hematuria, swelling on the face, arterial hypertension, signs of intoxication, snakes from the side of the heart, in the active phase - 0 t, accelerated SHOE, leukocytosis ... Nephrotic form- Proteinuria (NOT selective,> 3 g / L), hypo- and dysprotheinemia, hyperlippedemia, hypercholesterolemia, swelling (peripheral, empty to anasarca, puff). Change the form. Over the period - zagostrennya, remіsіya, unparalleled clientele. diagnostics- 1). CLINICH. Dani 2). Analysis of the section - erythrocytes, blocks, cylinders, ↓ pets. Zimnitsky test- ↓ direzu, nikturia (check. At night). ↓ filtration nirok according to creatinin. General analysis of cr: leukocytosis, accelerated SHOE, anemia, saturating surplus nitrogen, sechovine, ↓ albumin. Coagulogram: hypercoagulation. Am to streptococcus (IgMіIgG), ↓ to complement. Biopsy with an electronic microscope. lykuvannya- 1). Strict post-treatment up to ↓ build up and AT. 2). Diet (↓ Na, block and water). 3). Antibiotics - penicilini. 3). Corticosteroids - prednisolone - with nephrotic syndrome. 4). Cytostatics. 5). Indirect anticoagulants - heparin. 6). Antiagreganti. 7). Refinery 8). Hypotensive zasobi - captopril, enal. nine). Sechogіnnі zasobi, wіtamіni. ten). Hemodialis. Dispensary lykuvannya - 5 rocks

75. ANEMIA ZALIZODEFITSITNA Zalizodeficitna anemia (ZDA) - hypochromic microcytic hypergenerative anemia, which is caused by an absolute decrease in resources in the body Ethiology Chronic blood loss (for example, in case of intestinal abnormalities of uterine bleeding) zalosis (for example, in infants, in midlife, with vaginosis, with worm infections) NS: From the intestinal wall_Fe +3 plasma (in the set with transferin); In normi we have 1/3 transferrin. key picture Signs of the head (stomachache, weakness, urgency, apathy, thin skin curves and mucous membranes). Trouble, tachycardia, arterial hypotension, headache, zamorochennya, paresthesia are found in case of important forms specific symptoms: Angular stomatitis Koilonikhya Atrophic glosses Dysphagia Increasing appetite (addiction to credit, vapna, clay, vugily, tooth powder or ice). Laboratory dosageZ Farbuvannya aspirate of the cystic brain for viznachennya vst v_l_za A brilliant non-invasive method - viznennya reduction instead of feritin of blood serum. When a smear of peripheral blood is present, ailments develop hypochromic microcytic anemia, anisocytosis, and ailments. A smear may be normal and normal With a slight anemia or a gross loss of blood, the middle erythrocyte exaggeration and middle vmist Нb in erythrocytes may be normal laboratory signs Characteristic signs of hypochromia and microcytosis, bloody hypochromia of small growths (low middling hypochondria and middling hypochromia in blood cells) In dіtey vіdznachayut reticulocytosis (gіperregeneratornaya anemіya) Spetsifіchnі Find our ZDA: Nizke soderzhanіeFe 2 sirovattsі krovі Pіdvischennya TIBC Nizka kontsentratsіya ferritin sirovatki krovі (vіddzerkalennya nizkogo rіvnya zalіza, deponovanogo in kіstkovomu mozk) Pіdvischeny vmіst vіlnih protoporfіrinіv eritrotsitіv Vіdsutnіst zapasіv zalіza in kіstkovomu mozk Gіperplazіya Cervone kіstkovogo to the brain, the appearance of micro- and normoblasts, a change in the number of disintegrates (erythrocariocytes, where the granules of zaliza are replaced). TREATMENT Slіd obmezhiti implantation of milk up to 0.5 l / day (for grown-ups). Milk and dairy products should be added 2 years before the intake of mixed preparations. Lykarska therapy Zaliza of nitrous sulfate 300 mg 3 r / day in the middle between the galls of the gall (without preserving 180 mg of pure gall in the body); With adequate therapy, after 7 days in the blood, reticulocytosis is promoted; after 2 weeks of growth, Нb grows (add 0.7-1 g / day). The presence of a drug effect (or a weak effect) is indicative of trivial bleeding, an inferior infection, or a malignant neoplasm, a lack of a dose of the drug or (even worse) malabsorption of the disease. Zm_st Нb reach of normal indicators in a stretch of 2 msec. The drug should be taken for 6 m / s (ale not more) If you are intolerant to sulfate, it is possible to indicate either gluconate or fumarate (Ferrum Lek, Fercoven).

76. Have 12 deficiency anemia Pernicious anemia develops as a result of vitamin B 12 deficiency (dobova need 1-5 mcg). Most of the patients have a history of fundal gastritis and akhlorgidriya. Pernicious anemia - autoimmune disease from AT to partial cells of the slunk or to an internal factor Castle, prote іsnuty В | 2-deficiency anemia of alimentary genesis. Pernicious anemia can be inherently abnormal. Perevazhny vіk - older than 60 years. Ethiology Fundal gastritis (type A) AT to parietal cells of the slunk Castle)

Інші В | 2-deficiency anemia Vegetarian child without additional intake of vitamin B 12 Gastrectomy Syndrome bring loops Invasion of widespread malabsorption Syndrome of malabsorption Chronic pancreatitis Chronic alcoholism of LZ (biguanidi, phenylbutazone, aminosalicylic acid, oral contraceptives). Genetic aspects. A number of genetically developed forms of pernicious anemia Classical Pernicious anemia in adults with impaired vitamins B 12 Pernicious anemia in children with polyglandular autoimmune syndrome 2 і protein. When there is a megaloblastic anemia of the malformation of the sevid tract and the proteinuria of Vrodzhen Pernicious anemia in the presence of a daily gastric mucoprotein secretion with normal acidity of the slunk juice and morphology of the membrane. Pathomorphology Kіstkovy mozok - megaloblastichny type hematopoiesis, pіdvischeny vmіst zalіza, gіpersegmentіrovannie neytrofіli Shlunok - fundic gastritis, gіpertrofіya kelihopodіbnih klіtin, atrofіya parієtalnih klіtin, atrofіya bunt klіtin, characteristic klіtinny atipіzm spinal mozok - degeneratsіya mієlіnu zadnіh i bіchnih stovpіv, degenerativnі zmіni ganglіїv zadnіh korіntsіv (funіkulyarny myelosis) Degeneration of peripheral nerves. key picture to become deficient in vitamins B | 2 Signs of anemia (weakness, weakness, tachycardia, test, noise in the ears and in.) Rdmbergі finger test) Mental impairment (confusion of symptoms, depression, dementia) On the side of the intestinal tract - atrophic glositis (raspberry varnishes mova), hepatosplenomegaly, anorexia Shkira - hyperpigmentation, purpura, vitiligo. Laboratory dosage Pancytopenia (anemia, leukopenia, thrombocytopenia) Peripheral blood smear: macrocytosis (middle erythrocytic tissue> 115 microns 3), elliptocytosis, anizocytosis, a few; tiltsya Howella-Jollyі kіltsya Kebota, hypersegmented neutrophils, the number of reticulocytes is normal or reduced in blood plasma<100 пг/мл (в норме 160-950 пг/мл) Увеличение ферритина в сыворотке крови Ахлоргидрия Гипергастринемия При стимуляции пентагастрином рН желудочного сока >6 AT to internal factor Castle AT to parietal clitins Hyperbilirubinemia due to a direct fraction change in the place of haptoglobin Increase in LDH activity. special doslіdzhennya try shilinga - Changes to vitamins Puncture In 12 Puncture of the cystic brain. Differential diagnosis Folio-water deficiency anemia (it is necessary to be assigned instead of folic acid in the blood, as well as in the erythrocytes) mylodysplasia neurological damage Liver dysfunction Hypothyroidism Hemolytic or post-hemorrhagic anemia Toxic effects of LZ (methotrexate, trimethoprim, perimethamine, phenytoin).

LIKUVANNYA it is necessary to carry out the pre-treatment outpatient regimen. 2 Lykarska therapy. Vitamin V | 2 (cyanocobalamin) Zapobizhnі come in with the sign of cyanocobalamin. Before specifying the nature of macrocytic anemia, nicoli should not signify folic acid in the middle without vitamin B | 2, in addition, there are normal hematological indicators, less degeneration of the nerve tissue is triple.

77. LEUKEMIA GOSTRIY malignant disease of the blood-forming system; morphological substrate - blast cells. CF: development of lymphoblastic (children, grown-ups) and microblastic (myelomonoblastic, monoblastic, industrial, megacarioblastic) non-differentiable, non-classif. leukozy. stages: 1.Initial 2. Roshornutius period (persha attack) 3. Remisia (norm of ailing, no more than 5% blast cells in the myelogram, in the blood of leukocytes no less than 1.5 * 10 3, blast elements in the blood of dumb) ... remission 5 and more rocks 5.Recidiv 6. Thermal stage. pathogenesis accumulation of proliferation of chubby cells in the cyst and metastases in the organisms. The assumption of normal blood formation is related to two main factors. Klinkartina GOSTR leykozіv viznachaєtsya stage іnfіltratsії kіstkovogo mozk blast klіtinami i gnoblennya parostkіv Hematopoiesis Prignіchennya kіstkovomozkovogo Hematopoiesis anemіchny syndrome (mіeloftіznaya anemіya) Gemoragіchny dіatez (vnaslіdok trombotsitopenії vіdznachayut shkіrnі gemoragії - petehії, ekhіmozi; krovotechі іz mucous obolonok - nosovі krovotechі, vnutrіshnі krovotechі) Іnfektsії (torn down funktsії Leukocytes) lymphoproliferative syndrome Hepatosplenomegaly Deficiency of lymphatic nodes Hyperplastic syndrome Pain in the cysts Disorders of the cysts (leukemia), cerebral membranes (neuroleukemia) and internal organs diagnosis Gross leukemia is susceptible to blasts in the cystic marrow. For the identification of the type of leukemia, use the histological, immunological and cytogenetic methods of pretreatment. Laboratory diagnostics Anemia, reticulocytopenia, thrombocytopenia, SHOE, detected. blast forms, leukemic failure (vleyk. Formulas for the youngest and the growth of granulocytes) basophilic and eosinophilic. Mієlogram: blastnі clitini 20-90%, fast steam. lykuvannya complex; meta - reaching a new remission. Prolonged cytostatic hormonal therapy i / v hypoxia, prenizolone in the middle of the day, daunorubicin (rubomycin hydrochloride) and L-asparaginase for 1-2 msec without interruption i / v drip abo n / a skin 12 years for 6-7 days, daunorubicin (rubomycin hydrochloride) i / v lasting 3 days, one day in return from tioguanin. Bіlsh іntensivna postіnduktsіonnaya hіmіoterapіya, nischіvna zalishilisya leykoznі klіtini, zbіlshuє trivalіst remіsії Konsolіdatsіya remіsії: prodovzhennya sistemnoї hіmіoterapії that profіlaktika neuroleukemia at GLL (Endolyumbalno methotrexate in ALL in poєdnannі of promenevoyu terapієyu on the head mozok іz zahoplennyam segmentіv H 1-C 2 spinal mozk) Pіdtrimuyucha therapy: periodic courses of re-induction remission. Transplantation of the cystic marrow is a method of vibor in case of gostrich myloblastic leukemias and in case of relapses of gostrich leukemias. Zamisna therapy Transfusion of erythrocytic mass. Transfusion of fresh platelet mass (reduction of bleeding). Shown: zm_st platelets mensh 20x10 9 / l; hemorrhagic syndrome in case of thrombocyte intercourse less than 50x10 9 / l. Prevention of infectious diseases - the head of the brain for the treatment of patients with neutropenia; cleaning of disposable instruments, sterile treatment of medical personnel wide range diy: cephalosporins, aminoglycosides and napivsynthetic penicilins.

1960 0

Zgіdno of viznachennyam Komіtetu ekspertіv WHO, legeneve Serce - tse gіpertrofіya abo poєdnannya gіpertrofії of dilatatsієyu right shlunochka scho vinikayut on gruntі zahvoryuvan scho vrazhayut structure abo abo those funktsіyu legenіv Lots Other odnochasno th i s not pov'yazanih Pervin nedostatnіstyu lіvih vіddіlіv sericite, napriklad , with pridbanih abo vrodzhennyh vices of the heart.

Prior to the hypertrophy of the right slunk, with the onset of power supply, in the main legeneva hypertension (LH) and tied with her to build a court support.

Without legacy hypertension, it is not chronic legendary heart (HLS).

In conjunction with the European Union of Clinical Physiology, the Partnership of Clinical Physiology has included the presence of LH in the very meaning of HLS.

In addition, with a chronic Legendary heart, it’s too early to start getting busy before the process of livy shlunochk with the development of this dysfunction. The price is tied to hypoxemia, infectious-toxic infusions and mechanical factors (the pressure of a lingering slurry that was dilated by the paradoxical collapse of a lingering septum and a lingering child in an empty lining In connection with the cym, there is a tendency to include the dysfunction of both shlunochkіv in the designation of HLS.

In our country, the classification of the Legendary heart is widely recognized, which was proponated in 1964 by the name of a therapist and a clinical pharmacologist, Academician B.N. Votchalom (table).

The practitioner of the doctor most often perceives a chronic legendary heart. The causes of CHD in 80% є are the illnesses of the broncho-lene apparatus: chronic obstructive ailment legen (COPD), Fibrous alveoli, granulomatosis (sarcoidosis, dissemination of tuberculosis, legeny and in.), systemic scleroderma... On the other hand, in the context of the cause of the chronic legenous heart, there are striations of the thoracodiaphragmatic apparatus: deformity of the chest cell (kyfosi, scoliosi), obesity (Pikvik syndrome), great pleural movements, myasthenia.

Kilka is less significant because of the primary lesions of the Legeny Sudins: the primary Legenevian hypertension (Aerza's disease), vascular polyarteritis and the second systemic vasculature, recurrent thromboembolism in other diseases.

Table. Classification of the Legendary Heart (B.N. Votchal, 1964)

Legend's heart є inherited from three groups:

Bronchial infections and lesions are first infused into the passage of the alveoli. Qia group nalichuє approximately 69 ill. Є the reason for the development of the Legendary heart in 80% of vipadk_v.

• - chronic obstructive bronchitis;
• - pneumosclerosis of any ethology;
• - pneumoconioses;
• - tuberculosis, not by itself, yak Post-tuberculosis results;
• - BKV, Beck's sarcoidosis (Boeck), fibrous alveoli (endo exogenous);
• - ін.

Zagvoryuvannya, the primary enemy is the breast cage, the diaphragm of the intercourse and decay:

• - kifoskoliosi;
• - many ribs;
• - Pikvik's syndrome in obesity;
• - Bekhterev's ailment;
• - pleural suppuration of the transfer of pleurisy.

Engulfed in the first place to feud the legendary judges:

• - primary arterial hypertension (Ayerza's disease, disease Ayerza`s);
• - recurrent thromboembolism of the leg artery (BODY);
• - lesions of the leg artery from the veins (aneurysm, swelling, etc.).

Entrapment of other and third groups є the reason for the development of the Legendary heart in 20% of the population. The axis of what seems to be, in the fallowness ethiological factor Develop three forms of the Legendary heart:

• - bronchopulmonary;
• - thoracodiaphragmatic;
• - vascular.

The standards and values ​​that characterize the hemodynamics of a small amount of blood circulation.

The systolic grip in the legendary artery is less than the systolic grip in the great number of blood circulation approximately five times.

About the legacy hypertension, it seems like a systolic vise in the legenevian artery in a calm state more than 30 mm Hg, a diastolic vise more than 15, and an average vise more than 22 mm Hg.

pathogenesis... The basis of the pathogenesis of the heart of the leg is the legene hypertension. So as most of the heart grows more often in case of broncho-legeny ailments, then it’s more important. All sickness, and chronic obstructive bronchitis persh for all to produce dyshnoy (legendary) deficiency. Legeneva lack of - a tense camp when the normal gas storage of blood collapses.

Such a stun of an organism in any case does not take care of the admission of a normal gas storehouse of blood, or it can only be reached by an abnormal robotic apparatus of a callous dichotomy, which can lead to a decrease in the functional capacities of the organism.

There are 3 stages of legacy inadequacy.

Arterial hypoxemia is the basis of the pathogenesis; it is the basis for chronic heart disease, especially for chronic obstructive bronchitis.

All the tsі zhvoryuvannya to bring to a dizzy lack. Arterial hypoxemia is brought to alveolar hypoxia immediately after the development of pulmonary fibrosis, emphysemia of the lesions to move an intra-alveolar vice. In the minds of arterial hypoxemia, the nonrespiratory functions of the legends are destroyed - they repair the biological active speeches, which are not only bronchospastic, but a vasospastic effect. One hour at a time, the destruction of the court architecture of the lungs is seen - the part of the sudin gine, the part expands, etc. Arterial hypoxemia to produce tissue hypoxia.

Another stage of pathogenesis: arterial hypoxemia produced before the central hemodynamics is overwhelmed - the growth of circulating blood circulation, polycythemia, polyglobulus, increased blood viscosity. Alveolar hypoxia is reduced to hypoxemic vasoconstriction by a reflex path, after which an additional reflex is called the Euler-Liestrand reflex. Alveolar hypoxia called up to hypoxemic vasoconstriction, an increase in the intra-arterial vise, to produce a hydrostatic vise in the capillaries until the hypoxemic vasoconstriction. Disruption of nonrespiratory functions It is easy to produce serotonin, gistamina, prostaglandin, catecholamines, alveolar hypoxia in the minds of tissue and alveolar hypoxia of interstitial repair in the mind Lungs are the main organ develops as an enzyme. Win converting angiotensin 1 into angiotensin 2. Hypoxemic vasoconstriction, hypoxemic vasoconstriction in the minds of overwhelming central hemodynamics, it is not easy to create a clutch in the leg artery, ale up to the age of 30 mm.

As long as the processes are far away, if the main thing is not to get sick, then naturally there is a part of the Sudin in the system of the legacy artery, in the case of pneumosclerosis, and the grip of steadily moving in the legacy artery. Immediately, the secondary hypertension is due to the fact that before the shunts open up between the Legendary arteries and bronchialisalosis arteries and neoxygenated blood flows from the great number of blood circulation through the bronchial veins of the robot and so on.

Then, the third stage is the chain of Legenev hypertension, the development of venous shunts, which will help the robot with the right shlunochka. The right duck does not need to be forced on its own, as hypertrophy with the elements of dilation develops rapidly in a new way.

Quarter stage - hypertrophy or dilatation of the right lug. Dystrophy of the myocardium of the right flap with the same type of tissue hypoxia.

From the same time, arterial hypoxemia called up to the second legendary hypertension and hypertrophy of the right slunker, before its dilatation and development of the important right-sided lack of blood circulation.

The pathogenesis of the development of the heart in thoracodiaphragmatic form: with this form of conduction, hypoventilation of the lungs in cases of kifoscoliasis, pleural suppurations, deformity of the ridge, or obesity in case of a high fever. Hypoventilation of the lungs persh for all the result of a restrictive type of dichy deficiency on the form of an obstructive one, which occurs in a chronic heart disease. And far the mechanism is the same - a restrictive type of dichotomous deficiency in the case of arterial hypoxemia, alveolar hypoxemia, etc.

The pathogenesis of the development of the heart in the vascular form of the field is in the fact that, with thrombosis of the main hypertension of the lung arteries, the blood flow of the lung tissue changes sharply, as well as the order of the thrombosis of the main hypertension, and in the case of the spinal reflex. In addition, with a vascular form, zokrema in case of primary hypertensive hypertension, the development of a lung heart with a decrease in humoral malfunction, in addition to the addition of sertonectomy, prostaglandinitis, catarrh

The pathogenesis of the legeny heart is a chain of bagatoetapnia, abundant accessibility, in some cases, not to the point of being clear.