Treatment of comorbid COPD and CHF. Chronic obstructive ailment

read:

pathogenesis of chronic Legendary heart with chronic obstructive legends, folding and unreasonable dressing with dysfunctional rods. At the same time, the heart of the officials sees:

- alveolar hypoxia and arterial hypoxemia;

- Legenevu hypertension;

- hemorheological damage;

- neurohumoral roses;

- Infectious-toxic flooding;

- immune and autoimmune education;

- electrical changes;

- inlet lykarsky zasobiv, Vikoristovuvanih with ailments;

— ailments, І pershu chergu ІХС.

Reduced drainage function of bronchial tubes tricky adjustments bearing stream povіtrya generally produces up rozvitku nerіvnomіrnoї alveolyarnoї ventilyatsії, alveolyarnoї gіpoksії s away arterіalnoї hypoxemia scho Veda to generalized pіdvischennyu tonus legenevih arterіalnih sudin (reflex Eylera-Lіlestranda - spasm legenevih arterіol at zmenshennі CM 2 alveoli) to legenevoї gіpertenzії i torn down harchuvannya mіokarda. Increased tone in the arterial system of small cola blood circulation can be enhanced by neurogenic genesis, so that as a result of strengthening the function of sympathetic innervation. Slid pidkresliti, but in most ailments in chronic obstructive ailment, the legend of Legend's hypertension is beyond the reach of high numbers.

Hypoxemia is caused by a direct shock on the smooth interface of other arteries of the legends and in general on the myocardium. When there is a shortage of sour m'yazovyh fabrics Decrease the rate of utilization of glucose and clay of fatty acids. In the minds of hypoxia, glycoliz is the main source of ATP. Recovery of lactate from cells and accumulation of ions H +. as well as products of peroxide oxidation of lipids to produce acidosis and deterioration of the penetration of cell membranes. The destruction of the robotic enzymatic systems, the growth of the Na + / K + -ATPase system, Ca 2+ -ATP-ase of the keratin membranes is also very difficult. The accumulation of Na and Ca in the cytoplasm and the release of internal K + are recovered. The designated processes in chronic obstructive discomforts can lead to hypertension, electrical instability of the myocardium due to the formation of deteriorating heart rhythm.

An important way in the lance of the pathogenetic processes of the heart in chronic obstructive disease is the failure of the rheological power of the blood with the development of microcirculatory disorders in the increased energy hunger. Compensatory growth of circulating erythrocytes and a decrease in the amount of plasticity, swelling and degranulation of thrombocytes due to vasoactive rheumatoid arthritis to produce an increase in the viscosity of the blood, the aggregation of the syndrome

In the rest of the world, respect to the pre-ages, the role of the endothelium of the legeneviches, the renin-angiotensin-aldosterone system, cytokines in the formulated legacy hypertension and heart failure in chronic obstructive diseases It has been reported that, in the case of hypoxia, there is an increase in the production of endothelium of the vessel-sounding substances, the order of changes in the understanding of vasodilating speech, winter season, endothelial-pink factor. It was also established that the level of angiotensin-converting enzyme and components of the renin-angiotensin-aldosterone system and in ailments on chronic obstructive obstructive lesions of the growth of hypoxia was established. Some changes take the form of a legacy hypertension, stimulate the processes of fibrosis in the myocardium, disrupt the systolic and diastolic functions of both dysfunctions, leading to the development of lack of blood circulation.

The literature is increasingly aware of the active participation in the formulated chronic heart failure with dear ones a heart of pro-inflammatory cytokines (interleukin-1b, interleukin-6 and puffin necrosis factor-a). To get involved in the infusion of cytokines on the formation and progress of chronic heart failure, to be realized by the way of direct, on the cardiomyocyte and modulation of the activity of neurohumoral active systems, functional and endological

Negative inflow on the myocardium of ailments on chronic obstructive illnesses, diseases of the motherland and infectious toxic factors. The activity of the firing process in the bronchi and the rate of endogenous intoxication play at the same time the role of development in the development of both the breakdown of the rhythm of the heart, as well as in the decompensation of the heart. At the same time, medium-molecular-weight mass infuses direct toxic infusion onto fabrics, including on the myocardium, which are puffed up by the microcirculation.

Evidence of secondary immunological deficiencies in ailments, who suffer from chronic obstructive illnesses, are left behind. Deterioration of differentiation of highly organized fabrics, including immune system, In addition to tissue hypoxia in ailments broncho-obstructive syndrome It can lead to instability of anti-infectious immunity, as well as to breakthrough of immunological tolerance. There were data about a clear connection between the decrease in the speed of feeling health of the myocardium and the variation in autosensitization. With a sharpened ignition process in the lesions of ailments, sensitization to the heart antigen begins. In patients with a decrease in the speedy health of the myocardium, sensitization to the heart antigen appears during the period of remission of chronic obstructive diseases of the legends, so as to indicate the inclusion of autoimmune mechanisms in them. Autoimmune myocardial activity will inevitably change its bioelectric power, creating a breakdown of the rhythm in the robotic heart.

Carefulness, carried out by young people of the past, affect the possible fate of medicinal preparations, so that they can become vicious in cases of chronic obstructive diseases (euphilin, theophilin, sympathomimetics, formulations)

Especially respect for chronic obstructive illnesses of the legends, merit the nutrition of the pathogenesis of the defeat of all the hearts.

Prior to the main factors, how much the function of a lonely dumbbell in ailments on chronic obstructive illnesses is used, there are:

- the build-up of dilatation of the right slug from the increase of the yogh kintsevogo dyastolic vise and lug, which should be produced before the pressurization of the left slunk;

- paradoxically the collapse of the middle-sized partition, how to get sucked into the empty space of a lingering little one and an accelerated way;

- hypoxia, infectious-toxic and lykarskiy inflow, Activation of sympathoadrenal and renin-angiotensin-aldosterone systems in relation to certain rights and sometimes from heart to be found in the same minds.

The dissection of the myocardium in ailments on chronic obstructive incapacitation of the legends can be explained by the hypertensive ailment). It has been shown that the development of the IXC in the development of chronic obstructive illnesses of the legends, which is tied to the spilism of the Lankans and the pathogenesis. So, the form of the secondary legend arterial hypertension with chronic obstructive illnesses in front of the heart... Tim himself will burn out the coronary reservoir. Feel the ischemia of the myocardium both in the body until the progression of the coronary and the heart failure.

On the offensive stage of busyness of the weekend, it’s possible for students to spend time feeding and looking at a sick person with a chronic, legendary heart for any pathological condition. differential diagnostics with a chronic, legendary heart. Students under the control of vicladas take a part in questioning the sick, collecting scarg, giving anamnesis of sickness and life of the sick.

Legeneve heart with COPD. diagnostics

Tsim pathological term is called hypertrophy of the right duck... viclikana deranged in a small amount of blood circulation. COPD - itself common reason a legendary heart, ale іsnuє dumka, it’s very well to be developed, at least in the ruinous lands. Legenev's heart is diagnosed in vivo with the help of an MRI heart.

diagnosis call base on clinical assessment- an increase in homilessus loops and a clutch in the jugular vein in patients with post-hypoxemia of the order of EKG-signs of dilatation of the right diseases of the heart and lesions with a tooth P (p-pulmonale)

at COPD hypoxemia is the main factor in the development of a legendary heart, effective treatment... I would like not to regress to the point of regression of the important legacy hypertension, ale of progress.

Two randomized controls... held for more than 25 years, to show that patients with RaO2<7,3 кПа живут дольше, если получают в домашних условиях кислород. Эти изменения необязательно соотносятся с физиологическими улучшениями в малом круге кровообращения.

mussen It is more beautifully delivered by the acid concentrator from the visor of the face mask or the nasal cannulas (they are used to get rid of them). Patients have followed the situation in a clinically stable mill, which will confirm the manifestation of stiff hypoxemia, and the concentration of sourness is propagated to reach Pa02 in food of 8 kPa without the development of hypercapnia. The report on the explanation of the goals of oxygen therapy is of great importance. It is unlikely that the zadishka will change with the physical navantazhenny, and the patient's price for the nobility.

outpatient oxygen therapy to transfer for patients, building visits from the house, or to transfer the meaning of physical nurturing.

drug therapy here I will play a role. Diuretics and early use, to change the size, to which the ACE is widely recognized and, it seems, are effective, if every day there is a great class of advice, I want to confirm it.

sucking Other heart medications, for example, digoxin, are not recommended for patients with atrial fibrillation. Vasodilators of any type, including inhalation N0, significantly reduce gas exchange in case of chronic heart disease of COPD. It’s not even possible to show you how to use drugs to rob a friendly effect on natural plinth.

inclusion patient In the case of Patsinty, you can see it, find it like a placebo, see yourself more beautifully, you can’t touch it. Perekonannya people in need to meet the regime of likuvannya, ymovirno, є one of the most victorious methods of treatment. The manifestation of people with a turn of depression and triviality is of great importance, and the severity of the symptoms followed the course of the day.

vision hour on the explanation of the nature of the sickness of the patients, which means and what the addicts should be asked for, in order to give a realistic assessment of what it is possible to create for them, and if it is necessary to get out of the way, it is not necessary to do everything else. A retranslation is required, a changeover is necessary, a patient's visit to the English therapy, and it is necessary to repeat it. Special recommendations for storing an annex є obov'yazkovy.

Control of the spotting of the proponated lіkuvannya- the most important criterion for the value of a quiet person, who has great problems in the future, especially when taking less than 80% of all doses.

Chronic obstructive ailment

Main points:

signs

The very early symptom of COPD is cough. At the early stages of ailment, the disease is epizodic, but the turbulence gradually grows. The cough is superficial, with phlegm. Call me trochas, but in the stage of sharpening the number of visions grows. There may be sputum.

Another symptom of COPD is the trick. Won’t appear nicely, in some cases, you can navigate in 10 years after you get a cob of getting sick.

The guardian COPD is divided into two groups - "horny pikhtelshchikov" and "cyanosis Fatherland". "Rozhevi pikhtelshchikov" (emphіzematous type) are often thin, the main symptom of them is badness. Navigate a little bit physical navantazhennya Fir stench, blowing cheeks.

"Sinyushnist Otechnik" (Bronchitic type) may come to pass. COPD appears in them mainly with a strong cough with sputum. Their skin is cyanotic, their legs are swollen. Tse vіdbuvaєtsya through the legendary heart and stagnation of blood in the great number of blood circulation.

describe

For the tribute of the All-Union Organization for the Protection of Health (WHO), COPD suffers from 9 people out of 1000 and about 7 women out of 1000. Russia has close to 1 million people suffering from the disease. If I want to let you let it go, it’s better.

In 90% of HIV patients, the cause of COPD is the disease. and yak is more active, so і passive. Rashta 10% of COPD vapors are developed through:

• transfer of infectious diseases dikhalnyh nobles(Bronchitis);
• bronchial asthma;
• little vagi when people are people;
• recessionary schism;
• injecting professional shkidlivyh (drank, acid steam, lugs, SO2);
• atmospheric food, kitchen tea.

Possibility and development of COPD as a result of a combination of these factors.

There are 4 stages of COPD. on Stage I (Slight interruption) The sufferer may not be able to help, but this is not the case with him. Often, ailments manifest themselves only as a chronic cough, and organ damage is insignificant, so the correct diagnosis at the stage is even more difficult.

suffering COPD Stage II (Medium-heavy overdrive) often turns into a lick to the drive of the back-to-back for an hour of physical pressure, or at the point of acute illness and intense coughing.

on III stage (Heavy interruption) the currents in the spirited paths are not the same;

on IV stage (In the edge of an important break), the aggravation of COPD is not safe for life. The bronchi are markedly blocked (bronchial obstruction), developing in the heart. At the third stage, COPD is assigned an inconvenience.

The bronchi are an important part of the mental system. The very fact is that it turns out to be in the legend. The stench is a tube with a diameter of up to 18 mm, which is stored in cartilaginous rings or plates. Head bronchi, right and left, coming from the trachea. The right bronchus of the trochus is wider than the left one, so that the right bronchus is bigger than the left one. The head bronchi are divided into payovi (bronchi of the 1st order), zonal (bronchi of the 2nd order), subsegmental (bronchi of the 3rd order), segmental (bronchi of the 4th and 5th order), and the grade of the bronchi from the 6th up to the 15th order. Progressively gilkuchis, bronchi pass into bronchioles.

Bronchial enlightenment is covered with mucous membrane. When bronchoscopy won, seruvate colir. Epithelial cells of the mucus shell may be altered, as well as foreign inclusion. In addition, the cells produce mucus, which captures the bronchi from the inflow of third-party til and microorganisms.

Anxiety to fix because of the fact that tyutyunovy dim or іnshі toxic speech interacts with the receptors of the bloating nerve, as a result of which spasm of bronchial tubes is caused. In addition, due to other factors (anti-toxicity of tyutyunovym dim, gases, infections and inn.) As a result of the mucus, the mucus membrane of the bronchi is seen, not being called a natural path. In addition, through the injection of factors into the mucous membrane of the bronchial tubes, the cells repair the virus more slime, the schob is purged. At the tsіy stage, there is a chronic cough, but also a turbulent cough. Bagato kurtsіv on a whole stage of singing, but nothing serious can not be found, but coughing up the stench just through the palinnya.

However, after a dozen hour, chronic inflammation develops in the walls of the bronchi, due to the blockage of the bronchi. As a result of bronchial obstruction, the alveoli become over-tightened. The stretched alveoli hinder the other bronchioles, which is even more damaged by the deterioration of the winding paths.

On the cob of ailment, the obstruction is reversible, so it develops as a result of bronchial spasm and hypersecretion. Ale piznishhe, if the expiratory collapse of the bronchial tubes and bronchial tubes, fibrosis and emphysema develops. the blockage is also irreversible.

COPD is hostile to bronchi 2-17 order.

In the process of development of COPD, the reduction of the capillary bed of the small cola blood circulation takes place. However, the organism as well as the earlier need for a good amount of blood, wasted and sour. For a whole lot of wins, you can drain more blood through less blood circulation. But it has become mobile, it is necessary to tighten the grip in a small amount of blood circulation. At the same time, one should move on to the right lingo, which is weak, but not in the middle of the heart. The right slunk is growing, stretching - this is how the Legend's heart is shaped.

COPD can be fatal. According to the WHO, the infection of ailments on the 11th month for a number of deaths, protest, fakhivtsi allow, until after 10 the mortality rate of all ailments will increase by 30%, and you will leave in the first place. COPD is not safe by itself, it is not safe and fast - it’s a legendary heart, it’s a chronic dysfunctional deficiency. heart failure. secondary polycythemia (increased number of erythrocytes), spontaneous pneumothorax, pneumomediastinum.

diagnostics

The diagnosis of "chronic obstructive ailment of the disease" should be made by a pulmonologist. Diagnosis is based on anamnesis, clinical pictures and the results of a previous diagnosis.

The gold standard for diagnostics of COPD is the improvement of ventilation functions. Estimate the obsyag of a forced turn, which is seen in the first second (FEV1). People suffer for COPD because of reductions and changes in the world of progressing illnesses. It is also possible to control the pharmacological test, during which FEV1 is changed through 35-40 minutes of ingestion of the preparation, which expands the bronchial tubes and changes the appearance of mucus. In case of COPD, the incidence of a daily debilitation is minimal. With a breakdown, COPD is differentiated from bronchial asthma, and it is significant to improve with the use of the FEV drug.

It is also to curb the electrocardiography. on how to start the changes in the heart, echocardiography, for other reasons, start the manifestation of the legendary hypertension and the chronic legendary heart. In addition, to curb the clinical analysis of blood.

In case of a serious interruption, COPD will start a gas storage of blood.

If the therapy is ineffective, take sputum for bacteriological analysis.

lykuvannya

Chronic obstructive ailment legen However, adequate therapy can reduce the frequency of aggravated and meaningfully prolong the life of the patient. For the treatment of COPD, medications are used to expand the bronchial and mucolytic diseases, as well as the phlegm and the body.

For zyattya zapalennya priznachayut glucocorticoids. However, trivale їх stasosuvannya is not recommended through seryoznі side effects.

At the time of the aggravation of the disease, as well as the infectious nature is brought, antibiotics are recognized, or antibacterial, in the wilderness due to the sensitivity of microorganism.

Patients with mental disabilities should be treated with acid therapy.

Tim, who suffers from a legacy hypertension and COPD, when there is evidence of embryos, indicate diuretics, with arrhythmias, heart glucosides.

At the hospital, COPD is directed, as at the new one:

• the sign of an increase in symptoms;
• visibility of the effect from the designated treatment;
• the appearance of new symptoms;
• for the first time there was a breakdown of the heart rhythm;
• important adversity (diabetics. pneumonia. nirkova deficiency. pechinkova deficiency);
• the unhappiness of providing qualified medical aid in outpatient minds;
• difficult diagnostics.

In the case of intensive therapy, the patient is hospitalized, if he has:

• vzadishka, not to be stopped by drugs;
• damage to svidomostі, coma.

prophylaxis

The main prophylaxis of COPD is tse vidmova vid kurinnya. Likars recommend to maintain a healthy way of life, to properly harbor and improve immunity.

Likewise, it is so importantly and timely to catch the infectious diseases.

Pratsuyuchі on shkіdlivy virobnіstіvі blame strictly on the technique of safety, wear respirators.

It is a pity that great places do not have one of the factors in their rizik, the obstructed atmosphere.

COPD is more beautiful to fix lіkuvati in the early stages. For a quick diagnosis of a disease, it is necessary to undergo an hourly dispensary.

Chronic obstructive ailment is a legend or COPD can be attributed to chronic legeny illnesses, associated with a lack of energy. The development of bronchial infections with emphysema accelerated on aphids and extreme conditions and a very chronic progressive nature.

Cherguvannya period of the prikhovannaya interruption due to the sharpening of a special approach to the trip. Rizik the development of serious ones has to be completed with a high one, which is confirmed by statistical data... The deterioration of the dichotomy function becomes the cause of invalidity and a lethal result. Those patients with such a diagnosis need the nobility of COPD in order to get sick.

Zagalna characteristic

When infused into the dysfunctional system of different subtle words in people, who may be mentally ill to the point of burning legends, they repair the development of negative processes in the bronchi. To be sure, first for everything, distal viddili - roztashovani in an unprecedented proximity to the alveoli and legacy parenchyma.

On the basis of ignition reactions, the process of natural appearance of mucus collapses, and other bronchi become clogged. In case of admission of infectious diseases it is possible to expand on the balls and balls. As a result, remodeling of bronchial tubes with substitutions for additional fabrics is observed. Krym tsyogo, the Legend of the fabric on and the jumpers to run, until the development of the emphіzemi. With a change in elasticity of the legacy fabrics, hyperexistence will be promoted - almost literally blowing up the legacy.

Problems arise from the same vidihom, so as the bronchi can not be improved. Tse lead to the deterioration of gas exchange and change the gas exchange. The snake of the natural process of dikhannya manifests itself in ailments, like a bad thing in COPD, and meaningfully it can be used in case of new problems.

Potentially dyshal the lack of age is the cause of hypoxia - deficiency of acidity. From the sour hunger, all organisms are hungry. In case of trivial hypoxia, the judgment is heard more, and it can lead to hypertension. As a result, there are no worms of the heart - the right to see it, which becomes the cause of heart failure.

Why does COPD see the disease in the surrounding group?

Unfortunately, not only the patients, but the medical practitioners have little information about this term, as chronic obstructive ailment is a disease. Doctors diagnose emphysema or chronic bronchitis for zvichkoyu. To that the patient will not be happy, because of the banding with non-turning processes.

Indeed, in COPD, the nature of symptoms and treatment in the stage of remission is little understood as a sign of the methods of therapy for legene pathologies associated with mental deficiency. Well, that was the reason for the physicians to see COPD in the okremu group.

Medicine is the basis of such a disease - chronic obstruction. Alle the ringing of enlightenment in the ecstatic paths is perceived in the case of the protesters of the legendary ailments.

COPD, in the case of people with ailments, such as asthma, bronchitis, it is uncomfortable for them to become ill. Negative processes in the legends of non-gates.

So, in asthma, spirometry is used to show polypsychotics for the reason that bronchodilators are stagnant. Moreover, the indicators of PSV, FEV can increase by more than 15%. At that hour, the COPD did not give a hundred pollen.

Bronchitis and COPD are two different diseases. Ale chronic obstructive ailments can develop on aphids of bronchitis or against self-pathology, so both bronchitis itself cannot cause COPD to be provoked.

For bronchitis, a characteristic trivial cough with hypersecretion of phlegm and urezhennya spreads to the bronchi; Today, the appearance of sputum in COPD is not in all types of pimples, but it expands on the structural elements, I want bronchial wheezing to be heard auscultatory in both cases.

Why develop COPD?

Bronchies, inflamed legends of illnesses are not so little old and children. Why is it that chronic obstructive ailments can only develop in one person. Krim provocative bureaucrats on the ethology of ill-health are injected and produced. In order to develop COPD, you can think about how people appear who are sick to the legacy of pathologies.

The following factors can be included:

1. Spadkov is smart. A family history is not often observed, which is associated with a deficiency of singing enzymes. Such a camp is genetically similar, I will explain why mutations are not susceptible to mutations in an inveterate curt of the leg, and COPD in children develop without special reasons for those.
2. Vіk і become. It was a trivial hour that the pathology of the enemy was over 40. Along with the current number of women who can burn with experience, they are not less than the number of women. To that, the wideness of COPD is not less than the representatives of the excellent stati. Until then, they are awaiting women, vimusheni dikhati with cigarette dim. Passive kurnnya negatively infuses not only on the woman's, but on the child's organism.
3. Problems with the development of organs of dichannya. Moreover, it’s about negative influx on legends with intrauterine development, as well as the development of premature babies, in some of the legends they didn’t get up to develop again. In addition, in early childhood, physical development is negatively perceived on the stage of organisms.
4. Infectious disease. With frequent respiratory illnesses of infectious promenade, both in children and in older children, the development of HOL is increased.
5. Hyperreactivity of the lungs. A combination of such a person is the cause of bronchial asthma. But in the future, the involvement of COPD is not included.

Ale tse does not mean that all the children who have been treated to the group are inevitably guilty of COPD.

Obstructions develop when singing minds, which can be seen:

1. Kurinnya. Curtsy itself is the main patient with COPD diagnosis. For statistics, the category of ailments is 90%. That same kurinnya is called the main cause of COPD. The first professional іlaktika COZD is established, the first for everything, on the vidmovu from the house.
2. Shkіdlivі mind pratsі. People who are motivated by their kind of labor activity, inhale regularly drank a lot of food, drink, we have chemistry, we often get hungry for COPD. Robot in mines, Budovy, when collecting and processing bavovny, on metallurgical, cellulose, chemical food, in grain holdings, as well as at enterprises, where cement is used to blend, and the bodies wake up some problems with chicken pratsivnikiv.
3. Vdikhannya products zgoryannya. You can see about bioplasty: vugili, dereviny, pus, straw. Meshkans, who scorch the booths with such a scorching heat, and also people, who are in the presence of nature, inhale the products of burning, which are carcinogens, and pull the dicks.

In fact, be it a kind of inviting infusion on the legendary drastic character, it will provoke obstructive processes.

Main scarg and symptoms

The first signs of COPD are associated with a cough. Moreover, a cough, a big world, turbulent ailments in the afternoon. When there is a lot of phlegm, the wheezing may be visible. It is practically not a turbulence, the sputum comes in at the viglyadi mucus.

Sputum with obvious pus or harsh cough, provoking hemoptysis and wheezing, - if there is a greater stage.

Head COPD symptoms mingle with the apparent backwardness, the intensity of which occurs during the stage of illness:

• With easy zadishki dikhannya to force on tlі shvidkoy walking, as well as with pidyomas on the temporal area;
• About middling harshness, it is even necessary to adjust the pace of walking on a level surface through problems with dysfunctions;
• The important zadishka of the winery is when walking at a good pace or walking a distance of 100 m;
• For the backward step 4 is characterized by the appearance of problems for the environment before the hour of coming up, showing the simple steps, immediately after going to the street.

The diagnosis of such syndromes in COPD can be supervised not only by the stage of aggravation. Moreover, with the progress of becoming ill, the symptoms of COPD in viglyadі zadishki, coughing becomes strong. With auscultation, wheezing is audible.

Problems with dikhannya will inevitably provoke systemic changes in the body of people:

• M'yazi, scho take part in the process of dichannia, including mizhreberna, atrophy, scho wiklikak be in m'yaz, neuralgia.
• In the courts, there are spasms of whistling, atherosclerotic lesions. Improve mental strength before setting thrombus.
• Lyudin has heart problems with arterial hypertension, ischemic ailments and bring an infarction. For COPD, the nature of the heart changes of dressings with hypertrophy and dysfunction of the louse.
• Osteoporosis develops, spontaneous fractures of the tubular cysts, as well as the ridge, appear. Post_yna coarse bile, b_le in the cages will become the cause of a little-ruffled way of life.

Decrease and immunity, that be-like infections do not create support. Part of the common cold, when there is a fever, headache and signs of infectious disease are not a rare picture in COPD.

There are mental and emotional damage. Significantly decrease in prasezdatnitst, develop a depressed camp, unreasonable anxiety.

Koriguvati emotsіynі rozladi, scho have been found on aphids of COPD is problematic. Patients jump on apnea, stable sleeplessness.

At the newest stages, cognitive problems occur, which are manifested by problems with memory, misinterpretations, building and analysis of information.

Clinical forms of COPD

During the stages of development of COPD, as it is most often stagnated in the medical classification,

Vidіlyayut і forms of becoming ill according to the main manifestation:

1. Bronchial type. In sick people, coughs, wheezing from sputum infections are more common. At the same time, it’s hard to grow up, but the lack of heart to develop more rapidly. To that, the presence of symptoms in the viglyadi of swelling and cyanosis of the scruffy curves, which gave the name to the patients "blue Otechnik".
2. Emphysematous type. The cool pictures have the same bad luck. Evidence for cough and hardening - fertility. The development of hypoxemia and legacy hypertension is promoted only at different stages. At the patrons, the vaga is changing rapidly, and the shkirny twist the horny-gray vidtinka, which gave the name - "horny pikhtelshchikov".

However, it is unwise to talk about a clear pod, as in practice it is more common to develop COPD of a lesser type.

aggravation of COPD

You may not be able to get overwhelmed by indigestion for a variety of different factors, including new, dynamic, physiological and social factors. To bring a message to a welcome, in time, there can be a smell of breath. When there is a camp of people, they will go down violently. Have a cough, zadishka. Prolongation of acute basic therapy of COPD in such period does not give results. During the period of aggravation, it is necessary to correct not only the methods of eliminating COPD, but also to the dosage of stagnant diseases.

Zvvychay lіkuvannya be held in a hospital, de є the possibility of giving extra help to a sick person and to carry out the necessary maintenance. Yakshu zagostrennya COPD trapelling to finish often, zbіlshutsya risik development is accelerated.

Unavailable assistance

Sharpening with rapt attacks of scent and twisting backwardness, it is necessary to stop it inexplicably. Tom is on the first plan to come out with extra help.

More quickly, use a nebulizer or a spacer to prevent the surge of fresh food. In addition, people who are mentally ill before such attacks, inhalators are guilty of their mother when they are.

As soon as the persha can not help you do not give results and do not know the smell, you need to get help.

Video

Chronic obstructive ailment

Principles of lіkuvannya with sharpening

• Stagnation of short bronchodilators due to increased doses and frequency of intake.
• As soon as bronchodilators do not hamper the necessary action, the drugs Euphilin are injected internally.
• It can also be recognized in case of acute COPD treatment with beta-stimulants in combination with holinolytic drugs.
• Even in the sputum in the presence of the presence of antibiotics. Moreover, dozіlno vikoristovuvati antibiotics with a wide range of activities. Zastosovuvati vuzkopryamanі antibiotics can not be sensed without carrying out bacterial sowing.
• The eligible drug may have taken a decision about the sign of glucocorticoids. Moreover, Prednizolone and the other drugs can be prescribed in tablets, injections, or vikoristovuvatisya yak ingalyatsіynі glucocorticoids (IGCS).
• As the saturation is significantly reduced, oxygen therapy is indicated. Oxygen therapy is carried out with the help of a mask or nasal catheter, which will make sure that you have a good acidity.

Krym can use drugs for treating ailments that have been played on aphids of COPD.

basic lykuvannya

To prevent attacks and polishhennya zagalny camp of the patient, a complex of visits is carried out, in the middle of the loan, behavior and medication, dispensary caution.

The main drugs, which are stagnant on a whole stage, are bronchodilators and corticosteroid hormones. Moreover, there can be more bronchodilator symptoms of trivial diy.

Altogether, in order to get the best of it, it is necessary to give respect to the development of the legacy of vitality, for which it is vicious to develop dysfunctional gymnastics.

If you are afraid to eat, then the emphasis is to be on the merry-go-round of the wagy and the supply of the necessary vitamins.

Lіkuvannya COPD in young people, as well as in important children, are tied up with a number of difficulties through the manifestation of congenial ailments, acceleration and reduction of the immune zaistu. It’s not easy for these patients to look at them all the time. Oxygen therapy in such cases is victorious in the home mind and, for an hour, in the main way, we will direct it to increase hypoxia and those who are bound with it more quickly.

If the reduction of the legacy is necessary, it is necessary to cardinally go in for the resection of a part of the legion.

Prior to modern methods of cardinal treatment, radio frequency ablation (ablation) is considered. Robiti Mircha Mausens in case of poohlin detected, for whatever reasons, the operation is uncomfortable.

prophylaxis

The main methods of primary prevention are to lie in the middle of the ring and the way of life for people. Vidmova from kurinnya, zasosuvannya to an individual zakist in the times of reducing the development of obstruction of the lungs.

Secondary prophylaxis is aimed at increasing the risk of burning. This patient is strictly guilty of the recommendations of the physicians for treatment, as well as the inclusion of his life provocative factor.

Ale і vіlіkuvanі, the operated patients were not stolen again on the alert. This is relevant and third-rate prophylaxis. Regular medical examination allows you to get ahead of the disease and the appearance of snakes in the legends at the early stages.

Periodically lіkuvannya in professional sanatoriums is recommended as we are sick, right from the stage of COPD, as well as vilіkuvannyh patients. With such a diagnosis in the anamnesis, the voucher to the sanatorium is in the regime.

Relevance. As a result of COPD and CHF, the provincial causes of death are external factors of M. and pathogenetic mechanisms often differ, representing diagnostic and therapeutic difficult skin conditions as an independent predictor of mortality, vitality of the skin disease system. European Heart Journal (2013) 34, 2795-2803

The value of CHF COPD also breaks down the structure or the function of the heart, as a result of which the heart doesn’t need to be satisfied with consuming the body in sourness with a normal pressure on the heart, and it may be worthless to keep the heart out of the heart. parenchyma, form of emphysemia, impaired bronchial passage with development in general circulatory and non-vascular bronchial obstruction FEV 1 / FVC

3 ardiopulmonary continuum ІBSHSNS Death Factors of rhiziku Endothelial dysfunction Curinnya Hypodynamic disease MS SD Kurinnya Hypodynamia MS SD Chronic inflammation of COPD DN Ukena C, et al. The cardiopulmonary disease as lung continuum of soil of soil Int J Cardiol 2010 rock; 145: 172-176.

Older hypodynamics Faded legacy tissue Weakness of skeletal tissue, cachexia Cardiac failure ІХС, CHF, AG Disrupted metabolism of diabetes mellitus, MS, obesity Cystkovia damage: osteoporosis, et al. Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice. Respirology 2012; 17: 422-431

Velikі povіtronosnі Roads Ahead: broken-winded torn down MC klіrensu Remodelіrovanіe Zmіna stіnki bronchus Aktivatsіya FR Bronhіoli: broken-winded spasm gladkoї muscles Pіdvischena chutlivіst Remodelіrovanіe Perіbronhіalny fіbroz RPPOs elastichnoyu tkanini Znizhennya ploschі alveoli in COPD broken-winded Macrophages i monocytes Poshkodzhennya stіnki Vtrata atsinusіv Kolaps alveoli Povіtryanі pastki, bullies Znizhennya obmіnu gazіv CHF CHF: interstitial embryo Alveolar embryo Hydrothorax Bronchial obstruction Cardiomegaly (lung litter) Alveoli in CHF Lack of legeneous capillaries Reconstruction of the Alva - capillaries

Systolic i dіastolіchna disfunktsіya LS Klapannі vices Poshkodzhennya legenevih sudin Endotelіalna disfunktsіya Acidosis Pіdvischennya OPS legenevih sudin Dilation RV Nedostatnіst RV Legeneva AG Gіpoksіya vasoconstriction broken-winded Atherosclerosis legenevih arterіy Embolіya LA Pіdvischennya vise in LP Dilation LP Legeneva venous gіpertenzіya Pіdvischennya vise zaklinyuvannya in LA Pererivannya alveolar - kapіlyarnogo bar ru NM Hawkins, et al. European Heart Journal (2013) 34, 2795-2803

Genetic officials for the development of genetic frailty to COPD and CVD (AH, dislipidemies, IXC) A functional link was established between several factors of risk (LDL receptor). gene - a candidate for both phenotypes of COPD and CVD offense of multigenic disease, no interconnection was established Zeller T, et al. Genomewide association studies in cardiovascular disease-an update Clin Chem 2012; 58: 92-103. Todd JL, et al. The state of genome-wide association studies in pulmonary disease: a new perspective. Am J Respir Crit Care Med 2011 rock; 184: 873-880

Klіnіchne vivchennya poєdnannya COPD i CHF vzaєmodії mіzh sudinnoї i legenevoї nedostatnіstyu vivchaєtsya on pіdstavі regіstrіv, analіzu pіdgrup Absent prospective doslіdzhen of vivchennyam konkretnoї rolі legenevoї comorbidity in lіkuvannі that naslіdki Sertsevy - sudinnih zahvoryuvan retrospectively analіz zastosuvannya statinіv that / abo blokatorіv RAAS - polіpshennya perebіgu that forecast in case of COPD, reversals in case of common therapy, great randomized control is required for patients with COPD - with or without obvious heart-related diseases

Extent, prognosis of CHF COPD 1-3% of the out-of-the-world population, mortality in 5 7% of the median of survival in the period of hospitalization 2 diseases of the II stage of COPD 5-10% of the mortality of the prognosis is close to 3% of the prognosis of the hospital in the US until 2020 p NM Hawkins, et al. European Heart Journal (2013) 34, 2795-2803

Poshirenіst poєdnannya COPD i CHF varіyuyut within wide furrows fallow od vibіrki, vіku, dіagnostichnih kriterіїv patsієntіv 10-40% of CHF mayutsya odnochasno COPD doslіdzhennya Zi spіrometrії - COPD dіagnostovano in 36% (532 gospіtalіzovanih Khvorov CHF) 30% - prospectively for doslіdzhennya minds stabіlnostі CHF in COPD - the frequency of CHF is up to 20.9% of patients with reanimation of diseases 20.5 and 17% for the reason of stability of COPD (echocardiography in all ailments, systolic dysfunction at 13.8%) COPD is potentially masked in a significant part of patients with CHF Iversen KK, et al. Chronic obstructive pulmonary disease in patients admitted with heart failure. J Intern Med 2008; 264: 361-369. Boschetto P, et al. Occurrence and impact of chronic obstructive pulmonary disease in elderly patients with stable heart failure. Respirology 2013; 18: 125-130 Macchia A, et al. Unrecognized ventricular dysfunction in COPD. Eur Respir J 2012; 39: 51-58.

Prediction COPD prorokuє smertnіst at patsієntіv of CHF bronhoobstruktsіya asotsіyuєtsya of pogіrshennyam vizhivanostі Odne doslіdzhennya vivchilo prognostichnі naslіdki poєdnannya CHF i COPD (ehokardіografіya i doslіdzhennya FDD 83 of 405 patsієntіv Pokhil vіku of COPD has been viewed dіagnostovana CHF (20.5%). Patsієnti of CHF mayutsya podvіyny Risks of mortality in occasional conditions of CHF during the period of caution from average triviality 4.2 times) Rusinaru D, et al. Impact of chronic obstructive pulmonary disease on long-term outcome of patients hospitalized for heart failure. Am J Cardiol 2008; 101: 353-358.

The problem of the problem is the perception of the difficulty of the psyche, the observationally supervising the changes in the frequency, the rhythm and the rhythm The sub-active perception of the difficulty of the mental for the minds, with any earlier, there was no buzz)

"Mova zadishki" 1. Frequency 2. Vidih 3. Negliboke dikhannya 4. Robot 5. Suffocation 6. Marriage of a drunk 7. Stress 8. Severity 1. The turbulence is less frequent, I see the dick more often 2. I see it more importantly, I can’t see up to the end 3. I breathe in importantly, make a deep breath, over the top 4. Moihannya vimaga spurred 5. I see, I’m choking, I’m dizzy 6. I don’t feel good about it 7. My breasts are swollen 8. Simon PM, et al., 1990.

Scargi Anamnesis Oglyad "Legeneva" "Sertseviy" Suffocation, "whistling", cough with phlegm Bil, fear, weakness, dry cough, nichniy Kurennya, allergological, professional, infection of FR and type of atherosclerosis, osteoarthritis, osteoarthritis , cardiomegaly, pathological toni, noises, vologic wheezing ZADISHKA Pulse oximetry

Rentgenologіchnі Find our nabryaku legenіv Find our Kardіogenny nabryak Nekardіogenny nabryak Rozmіri sericite Normalnі abo zbіlshenі Zazvichay normalnі Sudinna Shade Normalnі abo zbіlshenі Normal Sudinne rozpodіl Rіvnomіrny abo "flip" Normal Rozpodіl nabryaku RavnomernoePyatnamі abo peripheral character Vipot pleural Mozhlivo not zavzhdi Perіbronhіalny vipіt PrіsutstvuetNe zavzhdi septal lіnії PrіsutstvuyutNe zavzhdi "povіtryana bronchogram "Do not wait.

Obezhennya. Otsіnka FDD Find our restriktsії in CHF - CHF vіdmіnna rice scho vіdobrazhaє kardіomegalіya, slabkіst dihalnoї muscle іnterstitsіalny fіbroz Zbіlshennya PL spriyaє pererivannyu vzaєmodії structuring i funktsії kapіlyarіv Pіdvischennya vise in legenevih kapіlyarah spriyaє aktivatsії faktorіv growth potovschennya alveolar - kapіlyarnogo bar'єru i modelyuvannya stіnki Sudin Change in the diffusion of gases through the tsei bar Legeneva hypertension - dyspraying of heart failure according to the pancreatic type Signs of obstruction - there may be types in case of accumulation of legends in the case of bronchial obstruction in the therapy of bronchial tissue obstruction;

Obezhennya. EXO KS Might be a bastard "UZ vikno" Evidence of the etiology of CHS .), lower in COPD (close to 30 mm Hg.)

Obezhennya. MNUP Pomilkovo positive test: To develop in PAH pancreatic insufficiency Lung impairment Reduced specificity for CHF Bozkanat E, et al. The significance of elevated brain natriuretic peptide levels in chronic obstructive pulmonary disease. J Int Med Res 2005; 33: 537-544. Rutten FH, et al. Comparison of B-type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary disease. Eur J Heart Fail 2007; 9: 651-659.

Butt. Cholovik 62 years old Kurets is close to 30 years, I will continue to fire close to packs a day 5 years ago, I have taken the first time, the preparations have taken only the first ryk, they didn’t have a turbulence, I’ve decided to take the preparation for the early days. ): diffuse cyanosis, amid acrocyanosis, with percussion box sound over the lungs, cardiomegaly (changing the cordon OST alone), with auscultation - weakening of the dichotomy, one dry wheezing with a forced type of other

"Kardіologіchnі preparation" COPD NOT povinnі Pogіrshuvati bronhіalnu prohіdnіst Viklikati hypokalemia (pogіrshuє funktsіyu dihalnoї muscle progresuvannya NAM) Zmenshuvati bcc Pіdvischuvati agregatsіyutrombotsitіv Stimulyuvati rozvitok cough Poslablyuvati efekta bazisnoї bronholіtichnu terapії Pіdvischuvati vice in legenevіy arterії Pogіrshuvati funktsіyu endotelіyu

Candesartan (Atakand) Indicated before delay: Arterial hypertension; Chronic heart deficiency;

Competitive and noncompetitive antagonism of the AT 1 receptor Due to the nature of the interaction with the receptor for angiotensin II, it is uncompetitive (losartan, prosartan) Uncompetitive (valsartan, irbesartan, candesartan, telmisartan) forget

Shlyakh vivedennya Pechinkova eliminatsiya (%) Nirkova ekskretsiya (%) Lozartan Valsartan Irbesartan Candesartanu cileksitil Telmisartan Eprosartan Nemaє need to adjust the dose of lungs

Candesartan (Atacand): farmakokіnetichny profіl Perіod napіvvivedennya (t 1/2) ~ 9 Godin Chi not kumulyuє at trivalomu zastosuvannі Priya їzhі not robit іstotnogo vplivu Vіdsutnіst klіnіchno znachuschih farmakokіnetichnih vzaєmodіy Absent neobhіdnostі koriguvati dose in patsієntіv s easy i pomіrnim torn down funktsії nirok i pechіnki Instructions on the use of the drug Atacand, Atakand Plus

Potential Beta AB and Beta - Agonizing Prototypical Pharmacological Effects? Bristow MR, et al. Beta 1 and beta 2-adrenergic-receptor subpopulations in nonfailing and failing human ventricular myocardium: coupling of both receptor subtypes to muscle contraction and selective beta 1 receptor down-regulation in heart failure. Circ Res 1986; 59: 297-309. Packer M. Pathophysiologicalmechanisms underlying the effects of beta-adrenergic agonists and antagonists on functional capacity and survival in chronic heart failure. Circulation 1990; 82: I77-188

Diuretics in CHF Indications in case of manifestation of the syndrome of obstruction of the birth: Correctness, obesity, weakness, appetite visceral pressure, pulsation of the jugular veins, wheezing, hepatomegaly, ascites, hypervolemia, cachexia to strong, from monotherapy to combination

Congestion of COPD and CHF Clinical manifest stagnation of birth and bronchial obstruction 11 Evidence of symptoms of massive re-entanglement (swelling, pulsation of the jugular veins, wheezing, hepatomegaly, ascites, hypertrophy) CHF increases the value for cinnamon STS 5.8 times Visoka predictive value of negative BNUP

Assessment of the degree of severity with stagnation (in scores) Indicator 0123 Orthopneal mildly moderately affected CVP (cm) Mensh Ponad 16 hepatomegalyanet edge Minor pulsation Increased abnormal swelling / 4 + MNUP Less pro-More significant change Т 6 МХ More than 400 m Mensh 100

Diuretics in AHF Furosemide intravenously mg Dose, as the minimum is equivalent to oral High doses (more than 200 mg) To impede the function of nirok Chi does not reduce the risk of hospitalization Immobilization of mortality

Chuchalin A.G.

In the current suspension (COPD) of the order of arterial hypertension, ischemic ailment of the heart and a sickly diabetes, to become a certain group of chronic ailments: in this part of the seizure there are 30% of the middle of all human forms. All-time organization of health protection (OOH) is to bring COPD to a group of illnesses in the high level of social havoc, since there is a wider expansion in the developed countries, so in the regions where they develop. The forecast, accumulated by the experts of the WHO until 2020 r, indicates that COPD is not only one of the most widespread forms of pathology of people, but is considered one of the leading causes of death, at that time, when it becomes clear that there is a decrease in deaths in the world. D.

The current concept of COPD, broken up by the WHO (GOLD, 2006), is based on the fact that ailments can be introduced to the number of quiet, development that can be easily achieved, successfully achieved; often the severity of interruption and the prognosis begin with extrapulmonary manifestations. I would like to get rid of ailments, take care of ailments, and take preventive programs in the meaning of the world to lie down in all the other ailments, on the smallest counterparts of the COPD. In clinical practice, it is necessary to eliminate those ailments, which manifested themselves during the natural excess of COPD. To such illnesses, you can bring the group heart-and-heart disease, Osteoporosis і інші. The most important scenario can be developed among ailments, as it takes a trivial hour to suffer from heart-and-judgmental illnesses, to those who have to break down the ventilation function of the legends according to the obstructive type. Often, the appearance of bad luck in the whole category of ailments is not tied to the style with manifestations of heart failure, but because of the weakness, for example, because of the decreased function of the lungs, as well as the heart. Before completing the developmental clinical picture of COPD and other illnesses, it is necessary to see those stages of the main ailment, when there are signs of systemic COPD defects. Abnormal in its nature, the fiery process can be localized in the spirited paths and the legacy parenchyma, and even at the singing stages of the ailment, this systemic efficacy manifests itself. Tyutyunopalinnya is considered to be a factor in the development and progress of COPD, and the development of a great group of supporters is also tied to it. With tyutyunopalinnyam to tie the appearance of pathological processes in the legends and development of systemic ignition reactions; systemic oxidative stress; dysfunction endothelium sudin; growth of activity of procoagulant officials; amplification of oncogenes and інші systemic effects.

Most frequent patients with COPD: cachexia, hypotrophy and atrophy of skeletal diseases, arterial hypertension, ischemic ailments of the heart, heart failure, vasculopathy of small colitis Forecast of the best unpleasantness in case of COPD infection with a group of heart-bladder ailments.

Ailments, who suffer from important forms of COPD, are reported to the group of high risk of rapid death. One of the reasons, which may lie at the basis of the development of raptor death, is the disruption of the rhythm of the heart very quickly. This is a key problem to be considered until the number of quiet ones, as it will require more detailed information, but it is presented in this hour.

Supraventricular and ventricular forms of impaired heart rhythm є to endure a frequent clinical problem in COPD ailments. However, the next step is the variation of the gifts presented in the literature. The values ​​of the collection of arrhythmias in COPD ailments are explained by the small population of ailments who take part in pre-illnesses; the development of the phase of illness and the stages of the development of clinical manifestations of COPD, as well as the methodical review and monitoring of the EHC. It’s insane, the great role of the development of the heart ischemic ailment and the manifestation of the weakness of the heart. In the case of COPD, an important reason for the diagnosis of arrhythmia episodes is associated with the reception of the singing lycars: theophilin, digoxin, agony? B-receptor. The whole spectrum of mental retardation is the diagnosis of arrhythmias in COPD ailments. However, in the rest of the rock, there has been a singing progress in її vivchenna.

Epidemiology of arrhythmias in COPD ailments and the deadly inheritance of Bula vivchen in pre-Danish scholars Copenhagen City Heart Study. In the whole unique epidemiological dosage it is shown that COPD is associated with a high frequency of a broken heart rhythm. Frequency of fibrillation in front of the heart is found as indicators of deterioration of ventilation functions. So, in patients with COPD, in those in the anamnesis there was no clue to the transfer of myocardial infarction, fibrillation at the front of the heart was twice as frequent with indicators of FEV1<60%. Контрольной группой служили больные ХОБЛ с показателями FEV1>60% .

Raptor death in ailments on COPD during the period of aggravation of ailments is observed very often. Fuso L., RA Incalzi., R Pistelli., R Muzzolon., S Valente., G Pigliari., F Gliozzi., Ciappi (Predicting mortality of patients for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 1995 Mar; 98 ( 3): 272-7) a group of 590 ailments was heard during the period of acute COPD and went to the university clinic. The result of the disease is estimated retrospectively. The mortality rate fell by 14%; logistic regression analysis having established a choice of independent factors: vik, alveoli - an arterial gradient perevischuvav 41 mm Hg, shlunochkova tachycardia, fibrillation in front of the heart. The author came to visnovka, where the development of the stages of myocardial dysfunction is a provincial reason in the powerful mechanism of the development of raptor death in ailments on COPD during the period of aggravation.

In the last years before the problem of arrhythmias in patients with COPD in the early stages of becoming ill, and from time to time, more and more respect is received. So, Kleiger, RE, RM, Senior (Long-term electrocardiographic monitoring of ambulatory patients with COPD. Chest 1974; 65: 483) were diagnosed that arrhythmias developed in 84% of the cases of ailments; , supraventricular tachycardia developed in 52%. The author also went on to show that the decrease in FEV1 indicators is a factor that influences the frequency of reestablished arrhythmic episodes.

Shih HT., CR Webb, WA Conway, E Peterson, B Tilley (Frequency and significance of cardiac arrhythmias in COPD. Chest 1 988 Jul; 94 (1): 44-8) showed that with swelling of hypoxemia in COPD ailments, the supraventricular tachycardia was rebuilt more low in 69%, more often it is possible to develop a dimpled form of impaired heart rhythm - 83%. In ailments, in those who have spontaneously embraced nig, hypercapnia and іnshі signs of a legendary heart, sluggish forms, the broken rhythm began to grow more often. This caution allowed the authors of the development of the heart against those that, when developing the heart of ailing in COPD, it is possible to predict the development of slime-like forms of disruption to the rhythm of the heart, as it can be the cause of the development of rapid death in patients.

However, there is a lack of nutritional symptoms in patients with COPD; To become too rich in non-virulent nutrition, zokrema, the role of secondary hypertension is practically not vivified. The role of drug preparations, which is recognized as a cardiac ailment by controlling the arterial grip, the rhythm of the heart, and b-blockers, is considered to be just as low in nutrition.

The pathogenesis of the development of arrhythmias in COPD ailments is multifactorial in nature. Sered chinnikіv scho provokuyut rozvitok aritmії, vidіlyayut lіkarskі zasobi, SSMSC priznachayutsya Khvorov COPD disfunktsіyu avtonomnoї provіdnikovoї sistemi sericite, іshemіchnu hvorobu sericite, arterіalnu gіpertonіyu, disfunktsіyu lіvogo i right shlunochka, pіdvischennya rіvnya kateholamіnіv in krovі at rozvitku gіpoksemії. A number of the other arrhythmogenic factors also have an impact on hypocalypse, hypomagnesemia, respiratory acidosis.

In the midst of a significant development of likars' problems, as historically we have become sick with COPD, most of the development of arrhythmogenic effects of theophilia and other derivatives. Signs of xanthine derivatives include arrhythmias, such as sinus tachycardia, anterior atrial speed, supraventricular tachycardia, atrial fibrillation, unifocal anterior multifocal Vinnennya yak of the anterior, as well as dimple arrhythmias are found in direct fallowness due to the concentration of theophilus in syrovatz blood. Therapeutically, theophylline is prone to accumulate in the boundaries of 10-15 mq / L. Toxic effects of theophilin can be consumed by theophilus, the intake of macrolides, antihistamines of the drug. Significant in the development of arrhythmogenic effects of theophilia gravic, such as sickness, such as ischemic ailment of the heart, sickness of the liver and deyakі іnshі. In the case of the presenter, Bittar G., HS Friedman (The arrhythmogenicity of theophylline. A multivariate analysis of clinical determinants. Chest 1991 Jun; 99 (6): 1415) During the period of aggravated discomfort, they made a call between the concentration of theophylline in the blood and development of the arrhythmias. Doslidzhennya bulo viconano for a group of ailments of 100 people. The diagnosed arrhythmias have a lot of factors, such as the concentration of digoxin ,? B-agonists, concentration of calories and a number of other parameters. The author came to visnovka, where arrhythmogenic effects were accumulated in Pershu Chergu by taking theophilin. Arrhythmias of the heart, deyakі from some boules carried up to life-threatening (for example, shlunochkova tachycardia, polytopna shlunochkova extrasystoles and іnshі forms), developed to focus on the therapeutic concentration of theophilia I especially respect the slaughter of COPD during the period of aggravated COPD, if the dysfunctional deficiency develops in important ailments, hypoxemia grows and in the drug programs include the internal sign of aminophylline. At the end of the period, the brain is used for the manifestation of the arrhythmogenic action of aminophylline. Fighting hypoxemia є an important storage part of the political program for COPD ailments, as it allows the sick person not only to go out of the stinging place, but also to avoid unnecessary side reactions from the side of a significant group of serious diseases.

An offensive group of lykarsky zasob_v, as it is widely stagnant in the drug programs of ailments on COPD, є agony? B-receptor. Salbutamol is widely used in the most common clinical practice. It is possible to inject salbutamol in a dose of 5 mg through a nebulizer, which can be injected internally in the eyes of the eye. It is not enough to take into account the fact that salbutamol is administered through a nebulizer to be administered in high doses (from 2.5 to 5 mg), and in especially important doses, the dose can be high. At the same doses, it appears that the activity of the sinus node changes: it changes the pace of the activity between the trivial activity of the university (an hour of short-circuits) and the hour of renewal of its activity. Salbutamol took more hours to deliver an impulse through the atrio-ventricular university, reducing the REFRACTIVE hour of the university's awkwardness, as well as myocardium. All pererakhovane allow to introduce salbutamol to drug use with a proarrhythmogenic effect. However, in a wide clinical practice, salbutamol does not tie the development of serious breakdowns to the rhythm of the heart. As soon as a meta-analysis was carried out for an hour, a meta-analysis of 33 randomized placebo-controlled patients was assigned to the signs of b-agony in chronic ob-structurally ailments of legends; Until the last effects, there is a decrease in the concentration of calories in the middle by 0.36 mmol / L and chlorine by 0.18-0.54 mmol / L. Beta-adrenergic agony is associated with irrelevant effects in the heart, in the main sinus tachycardia. Potentially, a group of drugs needs to be examined as lycars, as they occur with undesirable effects: to improve sinus tachycardia, myocardial ischemia, heart failure, heart arrhythmias. It is especially susceptible to admittance, as the disease of morbidity manifests itself especially in quiet ailments;

In the rest of the rock, uvaga is tied up to the side effects of the b-agony. Discussion of the Winnickle on the Discussion of the Rape Deaths in the African American Population for Salmeterol Intake. The current interpretation of the otrimani is based on the assessment of QT syndrome. With an increase in the QT interval of 0.45 ms, arrhythmogenic agonizing may occur. The change may be of an incongruous character, or it can be copied by people in the process of receiving a lykarsky zasob. Tsei klinicheskiy dosvіd lіg in the basis of the current klinіchny recommendations. If agonists are recognized, it is recommended to know the EKG and the triviality of the QT interval; in quiet cases, if the QT rate is 0.45 ms, it is not recommended to start agony for a trivial hour. In quiet people, if the ailments have become regularly reported by this group of drug users, it is recommended to write to the end of the month to follow the EKG support the triviality of the QT interval. As soon as it becomes a change of physiological parameters, meaning of food, then it is seen as a result of this? B-agonists.

Autonomic dysfunction of the heart is manifested in the increased QT interval. Syndrome of the podozhdenny QT interval is like a congenital, as well as nabutia character.

A lot of factors can be added to the increase in the QT interval. Among them, there are ailments with congenital damage in the provincial systems of autonomous heart activity: Jervell, Lange-Nielsen, Romano-Ward syndromes; I also see idiopathic symptoms of deterioration in performance. In the case of a prolonged QT interval, there is a great deal of metabolic changes (hypokalinemia, hypomagnesemia, hypocalcemia, hypothyroidism, anorexia). In some cases, there may be some drugs that can be added to the QT interval - hinidine, amiodarone, sotalol, disopiramide, as well as antimicrobial drugs - macrolide, pentamidine, fluorocholine, antihistamines of the disease

We are not very successful in developing є ligaments between respiratory deficiencies, which develop in ailments on COPD, from one side, and from the other - dysfunction of the lingual dumbbell and the diagnosis of sleep arrhythmias. In adolescent Incalzi RA, R Pistelli, A. Cocchi, MG Bonetti, A Giordano (Cardiac arrhythmias and left ventricular function in respiratory failure from chronic COPD. Chest 1 990 May; 97 (5); 1092-7) ligaments between the functions of the louse and heart arrhythmias. Shlunochkova arrhythmia has been monitored for 24 years, until it was repeated in the world as a result of the development of clinical manifestations of mental deficiency. Dysfunctional dysfunction of a lingual dumbbell is one of three factors, which helps to develop dysfunctional arrhythmias. The authors knew the direct accumulation of blood between the variability of manifestations of mental deficiencies and diastolic dysfunction of the louse, at that time, as indicators of gas in the blood, the key picture does not correlate with arrhythmic episodes. In klіnіchnіy praktitsі rekomenduєtsya provoditi bіlsh detail dіagnostichnu otsіnku vinikli epіzodami shlunochkovih aritmіy scho vinikli on tlі dіastolіchnoї disfunktsії lіvogo shlunochka so yak for tsimi Wink Mauger Buti prihovana іshemіya mіokarda, bezbolovoї FORMS stenokardії i perevantazhennya right shlunochka at formuvannі legenevogo sericite. It is necessary to admit that during the development of arrhythmia it is necessary to see and destroy the clinical manifestations of respiratory disabilities. Cheong TH, S Magder, S Shapiro, JG Martin, RD Levy (Cardiac arrhythmias during exercise in severe chronic obstructive pulmonary disease. Chest 1990 Apr; 97 (4): 793-7) were stopped when the maximum pressure was reached in patients with COPD. new arrhythmic episodes. It is a great pity, in the offensive of rock to the point of those who did not turn up the ages, the rhythm of the heart was broken very quickly, as they were diagnosed with COPD in ailments.

Especially in patients with arrhythmias, patients with COPD have multifocal atrial tachycardia. The main morphological signs of the formation of a breakdown in the rhythm of the heart are very fast є the discreteness of the "P" wave, at least in three forms, which is more beautifully restructuring in entries I, II, III; the number of hearts is very quickly more than 100 strokes per chilin, intervals R-R і R-R, R-R різні.

Multifocal atrial tachycardia associates in the meaning of the world with the development of dyshial deficiencies, moreover, due to the fact that it is necessary to knit functional snakes in the robots of the heart meat. The prognosis of overcoming COPD with the appearance of a type of heart arrhythmia is accepted as unpleasant.

Likuvalny programs of heart arrhythmias in patients with COPD may have a number of peculiarities. An important place in the dietary programs is to introduce the corrections of acid-puddle rivovagi, as well as hypocalypse, hypomagnesia, and acid therapy. The most important place is to take a medical visit, direct to the prevention of myocardial ischemia. It is necessary to switch on the sign of quiet lykarsk problems, as it can be added to the increase in the QT interval. Before such drugs are known: macrolides, anti-fungal drugs, antihistamines of drugs. It is recommended to recommend an increase in the value of the theophiline, as the EHC should be encouraged to increase the QT interval.

Specific antiarrhythmic therapy is significant, depending on the severity of clinical manifestations of COPD, concomitant illnesses and a wide range of individual reactions of a skin disease.

Ailments, in those who are restructuring with the knowledge of the EKG, asymptomatic ventricular arrhythmia, as a rule, does not require the recognition of special lykarsky problems (at least, it is necessary to start streaming tactics in the case of detection). With the development of clinical symptoms of hemodynamic collapse, ischemia of myocardium, hostile livoshlunochkovo deficiency, cardioversion is indicated. Naybils are often Vibor drugs є antiarrhythmic drugs of the IA class: hinidin, procainamid and disopyramid. In 2006, the American and European Association of Cardiologists made recommendations for fibrillation in front of the heart in ailments with obstructive lesions. In these recommendations, there is a great value in the fight against hypoxemia, acidemia; The overload is indicated by the signs of non-hydrohydropyridine groups and blockers of calcium channels (diltiazem, verapamil). The recommendations are for those that are uniquely assigned to theophilin, b-agonists, b-blockers, adenosine.

For supraventricular tachycardia, the use of calcium channel blockers, amiodarone, digitalis, flecainide is recommended. The greatest antiarrhythmic effect is reached with an internal introduction of verapamil. In case of multifocal atrial tachycardia, the sign of verapamil is important, and the sign of metoprolol is also recommended. The most effective b-blockers used metoprolol for the tone of smooth bronchial mucosa. Before the hour of discussing antiarrhythmic therapy in patients with COPD, it is necessary to take the role of verapamil, which is most often recognized in the category of ailments. An important point of the program is the submission of the minds to the protocol of its designation. Verapamil is administered intravenously in a dose of 1 mg. The effectiveness of the antiarrhythmic action is assessed after 1-2 minutes; in case of ineffectiveness, the dose can be increased to 4 mg, as it should be administered by pulling five quilins. If the antiarrhythmic effect is not instructed and on the day of the loss of the atrio-ventricular node, then a dose of 5 mg can be administered beforehand. The interval between the injections of verapamil is responsible for 10 quilins, with the need for a monitor EKG for caution. When an antiarrhythmic effect is reached, therapy should be continued by appointing verapamil per os at 80 mg. skin 6 years old. Prototypes are shown before the appointment of verapamil є AV blockade, in front of the appointment of b-blockers and other lykarsky diseases, which block the calcium channels. Verapamil, especially with internal signs, can be affected by hypotension. For a unique undesirable effect, it is recommended to combine it with internal signs of calcium gluconate, which should be kept before the signs of verapamil.

With the strongest b-blockers, as the food is already discussed, the transfer must be given metoprolol, which is prescribed in a dose of 50-100 mg two per dose. To accumulate data on the basis of the safety of consuming esmolu in ailments with obstructive impairment of the function of the dichotomy.

Additional arterial hypertension and chronic obstructive ailments can often be observed in clinical practice. Often ailments with multiple forms of ailments represent one and the same group. It is difficult for the current category of ailments to be tied to the first place, since antihypertensive patients can be able to press on the effect of bronchoconstriction, while they themselves have managed to overcome such bronchial asthma. General recommendations prompted on the boundary protection of b-blockers; In the minority of the world, recommendations are extended to the group of angiotensin converting enzyme (ACE). It is necessary to adapt the pathogenetic role of hypoxemia in the development of arterial hypertension. In recent literature, N.M. Mukharlyamov. In case of ailments from COPD and signs of dysfunctional deficiencies in the treatment of arterial hypertension, it is necessary to work with the ingestion of sour blood and to improve the ventilation indicators of the function of the callous dysfunction. English sisnem or is it more active in the respiratory tract, which is not invasive to ventilate the lesions, and is it also combined with the inhalation therapy? B-agonists and corticosteroids often bring positive results in the control of arterial hypertension.

In this day, a great deal of literature has been accumulated on nutrition about the effectiveness and safety of b-blockers in patients with bronchial asthma and COPD. If in ailments there are signs of reversible obstruction of dichal nobles, then in the highest degree of imovirnost b-blockers will show the effectiveness of bronchoconstriction and, moreover, develop resistance to the agonization of b-receptors. By such authorities, volodyut are b-blockers, which are indicative of glaucoma in people with glaucoma. Bula vivchena clinical effectiveness of selective b1-blockers. Salpeter S., T Ormiston, E Salpeter (Cardioselective beta - blocker use in patients with revesible airway disease. Cochrane Databese Syst Rev 2001; (2): CD002992) performed a meta-analysis; ... An analysis of the data was given on a single test of cardioselective b-blockers, which was injected onto a forced life in one second, and an assessment of the effectiveness of a short period of agonizing b-receptors. In such a rank, the analysis was given 19 days with a one-time reception of blockers and 10 days, if a group of drug users was assigned. The decrease in FEV1 was increased by 7.9%, and a good response to the intake of bronchodilators was 13%. In this meta-analysis, to avoid the problem: cardioselective b-blockers should not be used until the ventilation function is lost in broncho-obstructive syndromes. However, it was a little overwhelming, that the mova went about the ailments with a slight and medium degree of severity of obstruction. A whole group of drugs dozіlno sberіgati in the treatment of ailments for ischemic ailment of the heart, arterial hypertension. Trivial reception of b-blockers is not supervised over the destruction of the function of dichotomy in patients with COPD. The exact mechanism of the development of bronchoconstriction is due to the sign of b-blockers being too little for vivification. In the development of bronchospasm, the fate of the parasympathetic to the nervous system is transferred;

Angiotensin converting enzyme (ACE) inhibitors produce a dry, unproductive cough in 20% of cases, and in a small group of ailments they may develop a type of bronchial asthma. The whole group of lykarsky zasobiv cannot be seen as the therapy of the first line in the likeness of arterial hypertension in patients with COPD.

Alternative drugs are angiotensin receptor blockers. With a group of lykarsky zasobіv not to tie the development of a cough, there is no description of the type of iatrogenic bronchial asthma. For its efficiency and stench-free stench, it can be associated with calcium channel blockers.

Diuretics - is a group of lykarskih preoccupations, as it is widely used in arterial hypertension. However, it can be trivial to lead to such non-essential manifestations, such as hipokalimia, hipomagnesemia, which can be observed in case of persistent reception of agonists of b-receptors and glucocorticosteroids. The problem is that you can develop with signs of diuretics in COPD ailments, as well as negative influx into metabolic alkalosis. Decompensated form of metabolic alkalosis can be supressed by suppressing ventilation draveira, which can lead to an increase in the level of hypoxemia. It is recommended to take a different dose of hydrochlorothiazide (up to 25 mg) from the other advanced groups of drug addicts with a diuretic effect. Low dosages can be more effective, less fast, more not without their own side reactions to some groups of people with a diuretic effect.

The leading role in the treatment of arterial hypertension in patients with COPD is occupied by blockers of calcium channels. Widespread storage was known to have lost digidropyridin, such as nifedipin, nikardin. On the basis of the signs of the group of lykarsky zasobiv, as a rule, it is necessary to reach quickly to establish control over the arterial hypertension. There is also a sign of a positive effect on the regulation of the tone of smooth bronchial mucosa, an effect of the degranulation of large cells and the potential for dilatation effect of b-agony. Clinical recommendations for the treatment of arterial hypertension include the use of calcium channel blockers in monotherapy, for example, in combination with low doses of thiazide children.

The rest of the group of lykarsky zasobiv, which is guilty but it was agreed, should be considered the blockers with a sympathetic activity: the agony of a2-receptor clonidine, methyldopa guilty due to the preservation of arterial hypertension

Ischemic ailment of the heart (ІХС) chronic obstructive ailment legen (COPD) to end up often with є congenial illnesses. In a clinical practice hour, it is important to pay attention, as from the ailments of a given particular ailment in the context of a clinical situation and provocative. To confirm this, we advise Behar S., A. Panosh, H. Reicher - Reiss, M. Zion, Z. Schliezinger, U. Goldbourt (Prevalence and prognosis of COPD among 5839 consecutive patients with acute myocardial infarction. Sprint Study Group. Am J Med thousand nine hundred ninety-two Dec; 93 (6): 637-41). The main meta, yaka Bula, was placed in the whole pre-sluggish, felling in the fact that patients with ailments could carry myocardial infarction diagnostics of COPD. The authors stopped, that COPD appeared more low in 7% of cases and more often it was spared among quiet ailments, such as bully curts. In the same group of ailments with a single pathology, there was a greater mortality rate and a large heap of ailments with a development of a heart-healthy deficiency. At Russia L.I. Kozlovoy bulo vikonano continued for a group of ailments at the IXC, during a trivial hour they were using b-blockers. Warding over more than 300 ailments was built in a stretch of 10 years, and the actions were spared up to 15 years. With a hand over the entire period, except for cardiological programs, there is a dynamically up-to-date parameter in the function of the outgoing dichotomy. The author of the priests until Vysnovka, since at least one hour a great part of the ailments at the IXC became ailments with obstructive deterioration of the functions of the social environment. Often a provocative factor in the deterioration of the func- tion of the outgoing dichotomy was the portable hospitality of the devastating dichotomy. The main visnovka, which is a part of the doctoral dissertation L.I. Kozlovoy, polyagaє in that, the trivial use of b-blockers can become a factor in the development of obstructive impairments of the function of the external environment. Without a doubt, to lose sight of food, there are some changes in the ventilation function, and there are also some obvious changes in the mental system, since b-blockers are one of the factors in the risk of failure, and for systems without reason on IXC. In addition, it is necessary to state the fact that the most part of COPD will go to the IXC. N. Amposino vkazuє, ІХС of the ІХС of the risky degree of pivotism, it is practical to develop in the skin of another ailment on COPD. This is necessary in such situations, if the ailments from emphysema get ready for the operation to reduce the legacy fabric. If the assessment of the coronary reserve has not been carried out, then it is unlikely that there will be positive results in the form of prompt involvement. Sin D.D., S.F. Man (COPD as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorax Soc 2005; 2 (1): 8-11) came to the notice that COPD increases the risk factor for the fatal outcome in ICC patients by 50%. Due to the fact that the raptor arrhythmia is not safe for the raptor death, it is even more mature. To be afraid of a zagalny visnovok, a decrease in FEV1 by 10% increases the probability of a fatal result in a sick person with a single pathology by 14%. In preligens, yaks were conducted by P. Jousilahti, E. Vartianen, P. Puska (Symptoms of chronic ponchitis and the risk of coronary disease. Lancet one thousand nine hundred and ninety six Aug 31; 348 (9027): 567-72), analysis yielded 20 yew. A sick person, scho was spared by a stretch of 13 years. The main reason for this disease is that chronic bronchitis is the development of coronary ailments.

A great role is to introduce the development of hypoxemia, as it is often overwhelmed by the IXC. It is especially pernicious to reduce the saturation of acidity to 80% and the triviality of hypoxia more than 5 quills. Most of the ailments will not be safe for those who have hypoxia. In the dietary programs of the class of ailments, the sign of sourness is necessarily included. It has been repeatedly shown that trivial therapy is sour (an hour of ingestion is 15 years to do) signifies an increase in the vision of ailments. Suchasnі shown before the recognition of trivial sessions of kisne therapy:

arterial pressure acidic (PaO2) less than 55 mm Hg. or saturation acidity (SaO2) is less than 89%. Clinical signs: heart legeneva, decompensation of the right slunker, erythrocytosis (hematocrit> 56%);

PaO2> 60 mm Hg, saturation> 90% (ale ci indicators in ailments with clinical manifestations of IXC). It is necessary to speak on the need for a sign of depression, especially in a new year, if the respiratory function is deteriorating and the coronary reserve decreases.

Drug therapy in case of a single interruption of IXC and COPD is carried out to the number of the most relevant departments of internal medicine. In the given hour, the suvor is given a dose adequate to the choice of lykarsk assists in this category of ailments. In case of COPD, the most common use is salbutamol, salmeterol, formoterol, and a combination of glucocorticosteroids. The group of sympathomimetics significantly influences the metabolism of the myocardium: hypocalypse, hypomagnesemia, kisneva zaborgovanist. Due to the signs of these preparations, it is possible to tie the development of arrhythmias, which can also lead to the diagnosis of theophylline, which was mentioned above. perevaga see combined drugs Before the warehouse, which includes small doses of b-agonists and glucocorticosteroids, and for the sparing effect, the maximum inflow to the tone of the smooth muzzles of the sparing nobles can be reached. From the persistent bronchodilating drugs due to cardiotoxicity of the decrease in tiotropium bromide.

Beta-blockers, which are introduced to basic drugs in case of ІХС treatment, in this particular type of drop are considered to be of great protection, or to be considered as a result of the increase. Metoprolol should be administered before the preparation in the vibor, even if it is necessary in the prescribed b-blockers in the state standard specification. V key recommendations the priority is given to the signs of combined b-blockers (labetalol, carvedilol).

Chronic heart failure є a key problem, as a warning about the unpleasant prognosis of ailments on COPD. According to N. Amposino's tribute, the heart's lack of development is more low in 20% of cases, as a rule, it grows on a few ischemic ailments of the heart, arterial hypertension, red diabetes Type 2, osteoporosis. Diagnostics of heart failure is difficult, as in the meaning of the world it is masquerading as manifestations of hostile or chronic dysfunctional lack. The problem of central hemodynamic changes was already discussed, as well as during the period of acute COPD; for the whole camp of the characteristic development of dysfunctional dysfunction of the lone slut. By all appearances, if you show heart failure, dysfunction of your little one, you develop more often, you don't have to come to a sick person with COPD. Diagnostics is complicated by the fact that, in case of dysfunctional and heart failure, clinical manifestations may be even more similar. So, in the short run, the intensity of the growth in the case of physical replacement. Testimonials of the doctor who took the history of Volodya Mistress, maybe give him the power, vikoristovuyu tool move zadishki, because of the special features in the country key development... Prior to such a sign, the condition is orthopedic, a reaction to physical activity, In view of the marriage, because of the deyaki and the nuances. However, ailments will require that a critical problem is given to readily diagnose. Diagnostic algorithm includes heart rate monitoring, X-ray monitoring of organs breast cancer, EKG and EHKG. Biochemical markers of heart failure є the value of the level of cerebral sodium peptic hormone, which is highly specific for those with heart failure. The implementation of this diagnostic program is not academic in nature. The value of the heart failure and the decrease in the fraction of the wikidu can be seen in the capacity of an important prognostic sign, for which it is possible to predict the 5-fold vision. Triboulloy C., D. Rosinaru., H. Mahjoub., V. Souliere., F., Levy., M. Peltier., M., Slama., Z. Massy (Prognosis of heart failure with preserved ejection fraction: a 5 year prospective population - based study. Eur Heart J, 2007 Dec) We have seen the results of illnesses, who were admitted to the hospital with the first signs of heart defect. Spostering 799 ailments with a stretch of five years, the author was arrested, but the mortality rate in this category of ailments outweighed 55%. Especially high mortality rates were found in the middle of quiet patients; low indicators faction wikidu. When dyshally and heart failure prognosis of triviality of life of ailments of unpleasantness. One of the methods, which took away the development in the last rock in the likeness of the category of ailments, є the establishment of non-invasive ventilation of the legends and trivial therapy with the ingestion of sour. At the same time, this is a special therapy, which is indicated in case of heart failure, it is necessary to abruptly reduce the effect, take the closest prognosis for the emergence of a sick person from a sharp increase in hospitality, as if you do not carry out non-invasive ventilation.

For a quote: Akhmetzyanova E.Kh., Gainitdinova V.V., Sharafutdinova L.A. Conducting patients with chronic heart deficiency due to preservation of systolic function on the smallest severe overload of COPD in the acute phase // RMZ. 2014. No. 2. P. 138

In this hour, the goals of the treatment of heart failure (CH), according to the recommendations of the European Society of Cardiologists (EOK, 2012) for diagnostics and treatment of hospitality and chronic heart failure (CHF), for the change The strategy of treatment includes: lіkuvalny drugs Potentially indicated to all patients with symptomatic (FC II-IV NYNA) HF (ACE, β-blockers, APM), and drug preparations with less efficiency in patients with symptomatic (FC II-IV NYNA) HF (ARB, isosorbide dinitrate, omega-3-PUFA). The results of the previous SHIFT, conducted in 2010, showed that the heart rate was increased by a marker of the unpleasant result of CHF, and the concept of neurohormonal blockade in CHF could be supplemented by the effective decrease in heart rate with an if-channel blocker.

Tsikavim is a new therapeutic effect in the treatment of CHF, the heart rate is based on the effective control of the heart rate for the intake of an if-channel if-channel in ivabradin, recently included in the schemes of CHF treatment in patients with a decrease in the rate of 70% ./min., persistent symptoms (FC II-III NYNA) with intolerance to β-blockers.

In the pre-existing SHIFT, it was also demonstrated a decrease in the tolerance of risk from the primary combined result of cardiovascular death, or hospitalization from the drive of heart failure, improvement of the function of the patient and the health of life in case of loss of life.

In Russia, chronic obstructive ailment of legends (COPD) as the cause of the development of CHF, according to the data of the Association of Fakhivts in Heart Failure (OSSN, 2010), is 13% of the total. Diagnostics of heart failure in COPD is difficult, because K. Vaughn in the meaning of the world masquerades as manifestations of hospitality and chronic dysfunctional deficiency. Likuvannya COPD, the most recent global innovation GOLD 2011, 2013 years. , systemic corticosteroids (not recommended for trivial admission), іngіbіtorіv phosphodiesterazi IV (for GOLD III, GOLD IV). When aggravated, antibiotics, mucolytics, kisneva therapy are indicated.

Zgіdno of danimi naglyadovoї doslіdzhennya, y patsієntіv of CH SSMSC otrimuyut іngalyatsіynі β2-agonіsti, pіdvischeny rizik smertі i gospіtalіzatsії scho, ymovіrno, svіdchit about neobhіdnіst bіlsh retelnogo sposterezhennya for patsієntami of grave heart failure SSMSC otrimuyut іngalyatsіynі β2-agonіsti of drive COPD.

Calcium channel blockers in the category of ailments can alleviate a persistent heart failure and lead to the appearance of problems.

Therapy with selective β1-adrenergic blockers to inhibit the flow of fluid on the visibility of patients with heart failure, and the manifestation of COPD is due to a particular reason, for which the category of patients is not accepted by the general population.

Likuvannya of ailments with a single pathology is always difficult; in such a rank, try an active drug infusion on one ill-gotten tied with a real threat of iatrogenic aggravated suppurative pathology.

An injection of an If-canal injection into ivabradin was carried out for the clinical symptoms of CHF in ailments with COPD, an important transition to the acute phase.

materials and methods

In a pre-adolescent, 120 ailments were included with CHF syndrome in COPD, an important interruption in the aggravation phase. The diagnosis of COPD was established for the duration of the recommendations of GOLD 2010, the CHF syndrome was established immediately according to the EOC Recommendations for CHF (2012 r) on the basis of 4 criteria: typical symptoms, typical signs, normal EFL and structural and functional disorders ...

Inclusion criteria:

1. COPD (GOLD III, GOLD IV, 2010 r), acute phase.

2. sinus rhythm(HR is 70 beats / hv.).

3. Legeneva hypertension (viscera 20 mm Hg in a calm state).

4. Chronic Legendary heart.

6. Informed for the year of the ill for the fate of the preschool.

Vyklyuchennya criterion from loslidzhenya:

1. gostri form heart-sudinnikh zhvoryuvan (gostry coronary syndrome, Gostriy infarction of myocardium, state of cerebral blood circulation damage).

1. chronic form fibrillation in front of the heart.

2. Paroxysmal rhythm disturbance.

3. Diabetes mellitus.

We all get sick pochatkovo, after 1 and 3 months. conducted the EHC in a calm state, the heart rate began. EchoKG (at the same time) was carried out on the Fillips NNVVISERCHD apparatus - standard parameters of hemodynamics, the size of the louse in the day (KBRT LSh), the size of the lid of the lint in the systole , kintsevy systolic volume of the lingual shlunochka (KSO LSh), percussion volume (UO), the fraction of the vikidu livy shlunochka (FV LSh), liva in front of the heart (LP), right in front of the heart (PP), tovschina stinki of the right shlunochka , dystolic size of the right lug in diastolu (KBRT PZh), systolic grip in the legenevia artery (Ppa), presentation of items E / A LSh and PSh. In order to continue the function of the new life (FZD), a computer spirometry was carried out for the auxiliary device Master Screen Body (Jaeger); Conducted independent self-control of the arterial vise (SCAD) for the additional device Digital Automatic Blood Pressure Monitor M4 (Omron) with heart rate recording. Tolerance to physical testing was assessed according to the test of 6-grade blood test with a further assessment of the turnover rate according to Borg, assessment of the blood-test rate in CHF was carried out on the scale of blood pressure test, after 1. with the help of the hand-held pulse oximeter MD300C at the same time.

Statistical data processing was performed using the STATISTICA V.6.0 software package (StatsoftI nc, USA). The mean of statistics is trimmed: the mean is arithmetic with the mercy of the mean. Friedman ANOVA, Wilcoxon matchedpairs test, Spirman's nonparametric correlation analysis (r), two-factor dispersion analysis. The null hypothesis about the visibility of the group's visibility at p<0,05.

The results of that discussion

The pre-admission includes patients who were on the test in the intensive care and pulmonary clinic of the Republic of Belarus. G.G. Kuvatov (Ufa) with the drive of the poisoning of COPD. In all ailments, the history of COPD was 12.84 ± 0.53 in the middle triviality, and in the last 1-2 years, the progress of the death of the foreign body was slowed down, the backwardness grew, for the data of medical documentation, ... 12.5% ​​of the sick (in the middle 4.5 ± 1.21 k / d) underwent treatment in the period of early reanimation and intensive therapy. In the middle of the concomitant ailment in 24.1% of patients with boule IXC, stable angina pectoris in functional class II (FC), myocardial infarction (IM), in 17.5% - arterial hypertension (AH) stage I-I. Fibrobronchoscopy was performed on 109 (72.67%) patients.

The test with physical navantazhennyam (6-hilinna crocova test) is carried out in the 1-2nd add. if necessary to pulmonary diagnosis or transfer from intensive care. The clinical characteristics of the patients, included in the pre-adulthood, are presented in table 1.

The patients were tested for coughs for coughs because of the appearance of hard-to-separate mucous and mucous-nasty sputum, a restlessness. The backbone of the risky turn of the turn was spontaneous in all ailments: in 75% of the cases it appeared in the viglyad, in 12.5% ​​- in the vigil, in 95.8% - in the vigil with a low level of physicality at the viglyadi zadishki in calm. Nearly half of the sick (46.6%) experienced pain and discomfort in the area of ​​the heart. The accelerated heart rate, interruptions in the robot's heart meant a greater number of ailments - in 84.2% of cases. Likewise, the patients were guilty of weakness, increased obesity and the appearance of swellings in the lower cusps (Table 2).

In case of objectified obesity, acrocyanosis was diagnosed in 56.6% of patients with ailments, in 25% of patients with malaria there was a disease of diffuse cyanosis. Dry whistling wheezing is heard in all patients. The average frequency of dichromatic debris was 23.50 ± 1.26 in min., The reduction in blood oxygen saturation (SaO2) was reduced to 90.74 ± 0.69%.

The severity of the backside, assessed by the aid of the mMRC, was 3.09 ± 0.03 points in the middle. The increase in heart rate was observed in all ailments, storage in the middle 101.02 ± 0.81 beats. / Khv. The emphasis of the second tone on the legendary artery appeared during auscultation in patients in 75.8% of cases. In the middle systolic arterial vise (SAT) became 119.31 ± 1.41 mm Hg. Art., diastolic arterial vise (DAP) - 68.34 ± 0.77 mm Hg. Art. When assessing the clinical camp according to the SHOCK scale and the distance of the 6-phase blood test, the CHF syndrome appears in the III functional class (Table 3).

The increase in the size of the stove and the appearance of peripheral swellings was indicated in 25 (25.8%) ailments.

Echocardiographic indicators of the heart in pre-juvenile patients were characterized by an increase in the TPS of the pancreas, a decrease in the rate of E / A of the right slug, an increase in the indicator of a systolic pressure in the legenevia. The order of changes in the right views of the heart was indicated by pathological structural and functional changes in every type. There was a slight increase in the average size of the frontal atrium up to 35.12 ± 0.30 mm, which, bit by bit, indicate about the shifting grip of the lowering function of the frontal slit (LSH). The impaired systolic function of the LS (decrease in EF less than 50%) was not detected in one sparing drop, the mean value of EF of the LS approached the upper limit and reached 64.28 ± 0.43%. Dyastolic dysfunction of LH was restructed in 87.33% of patients, and there was a change in E / A spillover. An important type of Dysfunction of LH was relaxed. In 5 (3.3%) patients, there was an important interruption in the presence of pseudonormal type of LSh.

All ailments on COPD were treated with standard therapy (GOLD 2011, 2013): bronchodilators (thyrotropic bromide or a combination of β2-agonists of the trivial type), inhalation (IGCS) and systemic (SHCS) antibiotics, antiglucocorticoids. CHF treatment was carried out by antagonists to the receptors of minerlocorticoids (ARM) - spironolactone 50-75 mg / day, angiotensin-converting enzyme inhibitors (ACE) - enalapril in doses of 5-10 mg / day with inhibitors of angiotensin blockers. β-blockers are not recognized through a swollen broncho-obstructive component in acute ailments, associated with a severe illness and a phase of aggravation.

Patients were distributed into two groups: a group of 60 people and a group of 60 people. The groups were formed by the viper vibrating method, statistically significant (p> 0.05) did not develop according to the form, status, key characteristics, Vyhіdnoy heart rate, where standard therapy is carried out and that will be roznenі yak identity. In the skin group, the same number of ailments with a concomitant pathology on the side heart-vascular system... Groups are randomized according to the intake of ivabradine (with titrations up to maximum dose 7.5 mg 2 r. / Dobu) or the standard COPD treatment in the acute phase (GOLD 2011, 2013). Dynamically spared during 18 days.

In case of variable clinical and instrumental indicators in pre-juvenile groups, no statistically significant differences were observed in one drop (p> 0.05). More patients with low blood oxygenation levels. NPV in patients of both groups was 22.40 ± 1.08 і 23.62 ± 1.14 beats. / Khv. for sure. In both groups, sinus tachycardia was restored, heart rate was 99.46 ± 7.99 in the group і 102.53 ± 13.59 beats. / Khv. - in the group of lasts. Most of the patients have the results of the 6-step walk test of the III FC CHF (for NYHA).

With advanced hemodynamic indicators in the groups of early and advanced levels, the increase in the size of the right slit was observed 6.0 ± 0.35 mm and 6.03 ± 0.35 mm, for the average period legendary artery up to 38.0 ± 2.8 mm Hg. Art. i 39.15 ± 2.46 mm Hg. Art., the decrease in the peak performance of the E / A livogo shlunochka. The systolic function of the LS in all groups was spared, the mean value of the EF of the LS approached the upper limit and became 63.64 ± 1.02% and 62.35 ± 1.61% apparently. The tribute to our robots is based on the results of N.A. Caroli, R. Yilmaz, M. Gencer, E. Ceylan, R. W. Demirbag. Dysfunctional dysfunction of the louse was manifested in the vigil, the change in the lactose of the E / A LSh, it was found in 73.0% of all pre-juvenile ailments. The important type of diastolic dysfunction is LSh buv relaxation.

Diagram of the heart rate rise in pre-juvenile ailments (Fig. 1) directly shows how the most frequent heart rate was re-adjusted in the range from 90 to 100 beats. / Khv. With an important and an extremely important degree of severity of COPD, no symptoms in the heart rate were detected (p> 0.25).

Patients who were treated with ivabradin, because of the good tolerance of the drug. For the entire period of caution, no fatalities have been registered in the wake of the fall, none of the patients have been able to cough, hesitate, or have a mental discomfort.

Assessment of a clinical camp with CHF in ailments on COPD of both groups on the basis of a disease. Statistically significant indications of each group according to the results of the SHOKS scale, on tlі standard treatment as a result of a decrease in SHOCS indicators to 5.25 ± 0.18 points, on the basis of ivabradine - to 4.09 ± 0.18 points. Dodatkova, the recognition of ivabradina called for the completion of a clerical camp in ailments of CHF with acute COPD of an important and important interruption (p<0,05) (рис. 2).

Significantly, due to the records in the schoolchildren, the majority of the group's patients before the age of the year meant the sub''active training of the camp and the portability of physical adaptation. After 3 days. Likuvannya among the children increased tolerance to physical improvement, which manifested itself in a statistically significant improvement in performance and changes in performance on the Borg scale (p<0,05), по сравнению с данными группы сравнения (рис. 3).

On a standard course I have passed 6 min. increased by 14.49% (from 237.05 to 277.23 m), for those indicated for ivabradin - by 22.58% (from 236.25 to 305.48 m) (p<0,05) (рис. 4).

In all patients in the groups of children and in groups before the age of children (Fig. 5), a statistically significant decrease in heart rate (р< 0,05). Но снижение ЧСС до целевых величин (ЧСС < 70 уд./мин., ВНОК 2010 г.) было достигнуто только при назначении ивабрадина в дозе 15 мг/сут независимо от исходной ЧСС. При назначении ивабрадина в дозе 10 мг/сут снижение ЧСС наблюдалось на 4-5-й день приема препарата, целевого уровня ЧСС достичь не удалось. На фоне приема ивабрадина в дозе 15 мг/сут снижение ЧСС уже со 2-го дня приема препарата отмечалось у 92% больных, но статистически значимое снижение ЧСС наблюдалось через 2 нед. от начала лечения (p <0,001).

We carried out a multi-factorial dispersion analysis for an important and very important interruption with a chronic heart failure syndrome in patients with chronic obstructive pulmonary disease (CHF). Analysis including two factors: heart rate (two categories - less than 100 beats / hv., More than 100 beats / hv.) І treatment with ivabradine (two categories - before and after treatment). For a whole group of children, the maximum value of the breakdown heart rate was increased (Fig. 1), the value of the heart rate was increased by 2 subgroups: from the heart rate<100 уд./мин. и ЧСС >100 beats / Khv. (Fig. 6, 7). The results of the analysis showed the prevalence of depletion of the efficiency of the treatment of ivabradine as a result of the viral heart rate in pre-juvenile ailments.

When analyzing the factors for tolerance to physical adjustment, the indicator was determined to be multiplied by ivabradine, right from the abnormal heart rate (Fig. 6).

In such a rank, a two-factor analysis will indicate the significance of ivabradine injected on the results of a 6-phase blood test.

An analysis of two factors (heart rate and ivabradine injection) on the assessment of the clinical stance in CHF SHOKS in pre-juvenile patients also showed that a positive injection of ivabradine in sinus tachycardia (rice)

An analysis of two factors (heart rate and ivabradine injection) on the turn of the back of the Borg opiate previously showed that a positive injection of ivabradine to lodge in the wobble heart rate. In patients with a wake heart rate> 100 beats. / Khv. there was a great step in the improvement of the bad, assessed for the danim of the opytuvalnik (p<0,05).

In such a rank, the assessment of the clinical camp with CHF according to the SHOKS scale and the adjustment of tolerance to physical improvement in CHF patients with an important overload of COPD in the phase of acute illness in the absence of the disease. The efficiency of treatment with ivabradine is the same at a heart rate of 70 to 100 beats. / Khv., So and when tachycardia bends. The change in bad health for the Borg opiate on the lіkuvannya іvabradine in a larger world is indicated in ailments with a heart rate> 100 bpm. / Khv.

visnovka

1. In ailments with an important and extremely important stage of COPD, it is trivial to become ill for more than 10 years to rebuild CHF with the preservation of the systolic function of a lingual dumbbell.

2. Inclusion of ivabradine in the complex treatment of CHF ailments in case of acute severe overload of COPD to bring about the improvement of the clinical condition: a decrease in the symptoms of CHF, statistically significant improvement of health tolerance to the physical, maintenance The change in bad health for the Borg opiate on the basis of a large world is indicated in ailments with a heart rate of> 100 beats. / Khv.

3. Ivabradin at a dose of 15 mg / day can be recommended for the management of ailments of CHF with the preservation of systolic function in case of an important overload of COPD in the phase of aggravation.