Symptoms and symptoms of chronic heart failure. The codification of chronic heart failure in the ICD is in the power of a doctor

MKX code: 150

150.0 congestive heart failure

150.1 Left ventricular failure

150.9 Sertseva lack, unspecified.

Sertsev's lack of support is drawn to the state standard and chronicle, right- and livoshlunochkova. In the current hour, the term “heart failure” invites you to respect chronic heart failure, often left ventricular failure (Table 32).

Tsia klassifіkatsіya ob'єdnu accepted by vіtchiznyan classificatory classification lack of blood circulation behind the stages of illness N.D. Strazhesko and V.Kh. Vasilenko, and the classification of chronic heart failure for functional classes, was adopted in 1964 by the New York Cardiological Association (NYHA), which will establish the severity of clinical symptoms. Induced by the classifications.

Table 32.

(Edited by Yu.N. Bulunkov, V.Yu. Mareev, F.T.

Classification of lack of blood circulation N.D. Strazhesko and V.Kh. Vasilenko (1935)

Stage I. Pochatkova is accustomed to lack of blood circulation, it appears only when physically nailed, in the calmness of the manifestation, hemodynamics is not damaged.

Stage II. There was a trivial lack of blood circulation, impaired hemodynamics in small and great blood circulation in a calm state.

Period A. Signs of lack of blood circulation in a calm state of the world, impairment of hemodynamics in one of the formations of the heart-vascular system (in a great number of small number of blood circulation).

Period B. The end of a trivial stage, a turn of hemodynamic damage, in which the whole heart-vascular system is acquired (both great, and malium cola blood circulation).

Stage III. Kintseva dystrophic with important hemodynamic disorders, strong changes in the exchange of words and non-vascular changes in the structures of organs and tissues.

Classification of heart failure of the New York Cardiological Association (1964)

Functional class I - the visibility of the area physical activity The symptoms of heart failure are not healthy.

Functional class II - easier physical activity, in the calm self-esteem of normal patients, however, there are physical symptoms of heart failure.

Functional class III - apart from the interconnection of physical activity, in the calm self-esteem of the patients is normal, however, physical improvement is less, less sensitive, symptoms of heart failure.

Functional class IV - the lack of tolerance of physically nurturing without symptoms of heart failure, symptoms of being present in peace and being able to cope with any physical nurturing.

For a good assessment of the tolerance of a sick person to a physical one, take a test with a 6-hour walk (this is the name of the Canadian Classification). An easy heart failure is caused by the health of a sick person in 6 minutes to walk from 426 to 550 m, average - from 150 to 425 m, important - up to 150 m.

Fatal respect: in the bitter diagnosis of viciousness, the term “heart failure”, and not “lack of blood circulation”. Moreover, it is unacceptable to mention two stages of heart failure at once (like, for example, in the formula "PB-III stage").

Framingham Criterion of Heart Failure

Attack a no-nonsense dumbness

Cardiomegaly, which is used for X-ray dosage

Nabryak of legends

Gallop rhythm (III tone at the top of the heart)

Reduction of a central venous vise> 16 cm water stop

Hour of blood circulation> = 25 s Positive hepatojugular reflex

Nabreak legend, the blood of the organs is still bloodied or the cardiomegaly for the autopsy data

Decrease in mass tila? 4.5 kg for 5 days due to heart failure

little criteria

Double-sided embankments homilok

Nichny cough

Zadishlynaya navantazhennі zbіlšhennya stove plevralnyvipіt

Decrease in living space by one third of the maximum amount

Takhіkardіya (> = 120 blows in khilina).

Diagnosis is established when two great or one great and two small criteria appear at once. Small criteria can be vrahovani, because the stench is not a manifestation of the heart-and-heart disease.

Behind the character of the broken function of the lil 'slung can be seen:

Systolic heart failure

Dyastolic heart failure (table 33-34)

Combined systolic and diastolic deficiency.

The criterion of systolic deficiency is a decrease in the fraction of a wikidum and a heart wikidum of a louse. With systolic heart failure, the type appears:

Low heart disease (with a large heart disease, such as heart defects, hypertensive ailments, ischemic ailments of the heart, cardiomyopathies)

With a high heart wikid (with anemia, congenital and congenital arteriovenous fistulas, thyrotoxicosis, Paget's ailment, beriberi, multiple myeloma, eritremia, carcinoma syndromes, acromegaly).

Table 33.

Note: CH - heart failure, * - chest x-ray, level of B-natriuretic peptide, ** - start during heart catheterization or Doppler echocardiography.

With the manifestation of diastolic deficiencies with doppler chokhocardiography, there is a type: impaired relaxation, pseudonormal, restrictive.

Table 34.

Notes: * - to carry out the assessment after the data on the blood flow during the dopplerography of the transmitral diastolic and the leg venous blood flow; Ye / Ya - the delivery of the maximum fluidity to the flow through the mitral valve, DТ - the hour of control of the early flow, IVRT - the hour of the isovolumetric relaxation of the lithium slurry. Уs / Уd - the number of maximum rates of systolic sickness S and antegrade early diastolic sickness D, D t PVag - the triviality of the reversible UAH of the leg venous flow, D t mua - the triviality of the anterior heart.

Sertseva's lack of care for the accelerated heart. Code 150 should be included in the heading "accelerated" statistical picture of the patient's vibrating, as the heart failure is the reason for the hospitalization of the patient, apparently, big part vitrat on the pressure of medical services to be brought to the whole camp. If a hypertensive ailment is indicated in the diagnosis because of congestive heart deficiency, the vicorist code is 111.0.

Apply the formulation of the diagnosis in case of deyakykh rupture of the rhythm of the induction in the frontal parts.

Short description

Chronic systolic heart failure — key syndrome, So it is easier to move to a number of illnesses and is characterized by the obvious backwardness in case of physical activity (and at the same time, in calmness), swelling stomata, peripheral problems and objectival signs of serious

Code for the international classification MKH-10 ailment:

• I50 Sertseva lack

Statistical data. Chronic systolic heart failure of vinicum in 0.4-2% of the population. The growth rate is growing: for individuals older than 75 won, the growth rate is 10%.

cause

Ethiology... Sertseva lack of low heart disease .. Disorder of the myocardium: ... ІХС (postinfarction cardiosclerosis, chronic myocardial ischemia) ... Cardiomyopathy ... Myocarditis ... , amyloidosis) ... Endocrine discomfort ... Disorders of heart disease (deficiency in vitamin B1) .. Myocardial replacement ... Arterial hypertension ... Rheumatic heart disease ... Rheumatic heart disease. .. Supra and supine tachycardia ... Atrial fibrillation. Sertseva lack of high heart wikid .. Anemia .. Sepsis .. Arteriovenous fistula.

Riziku factories... Vidmova sick from pharmacotherapy. Appointing LZ with a negative effect, і uncontrolled їх reception. Thyrotoxicosis, the vagina of the disease, associated with the increased metabolic demands. Nadlishkova masa tila. Evidence of chronic pathology of the heart and Sudin ( arterial hypertension, ІХС, wadi sertsya ta ін.).

pathogenesis... The pumping function of the heart will break down, which will lead to a change in the heart wikid. As a result of a decrease in the heart wikidum, hypoperfusion of the organisms and tissues is hypoperfused. There is a decrease in the amount of oxygenation of the renin, when there is a lack of excessive metabolism of the product to angiotensin II, as it leads to vasoconstriction, the absorption of water (filling, spraga, improvement of the OCK) and a further increase in the improvement of the periphery of them before also hypoxia to produce swollen stomatomy.

KLASIFIKATSIS

Classification of the XII All-Union Union of Physicians in 1935 (M.D.Strazheska, V.Kh. Vasilenko).

Stage I (pochatkova) - a heart failure is present, it appears only when physically nailed (bad, tachycardia, swift stomachache).

Stage II (circulated) - trivial lack of blood circulation, impaired hemodynamics (congestion in great and small amount of blood circulation), impaired functions of organs and speech disorders in circulations and in calmness .. For only these parts .. Period B is the end of a trivial stage, characterized by severe hemodynamic impairments, before the process the entire CVS is started.

Stage III (kintseva, dystrophic) - severe damage to hemodynamics, changes in speech and function of all organs, non-collapse of tissue structures and organs.

Classification of the New York Cardiological Association(1964). I class - zvychana physical navantazhennya not vyklikoi stomluvanosti, zadishki abo sertsebittya. Class II - easier physical activity: more self-esteem in peace, ale, physical nontangency of wickedness, heartache, backwardness or pain. III class - the turn of the interconnection of physical activity: more self-esteem in calmness, and less self-esteem to produce before symptoms appear. IV class - the unkindness of being able to see something physical without losing one's self-esteem: symptoms of heart failure є to feel at ease and to accept it when there is something physical.

Classification of the Fakhivtsy Partnership for Heart Failure(OSNN, 2002) adopted at the All-Russian Congress of Cardiologists in July 2002 The importance of this classification in the fact that it is not only a visualization of the process, but of its dynamics. In diagnostics, it is necessary to represent both the stage of chronic heart failure, as well as the functional class. It is necessary to change, so that the stage and functional class are not completely clear - the functional class is displayed when there are fewer turns of manifestation, there is no need for a lack of stage for the development of the current

. Stages of chronic heart failure(You can pogirshuvatisya unaffectedly on lіkuvannya) .. Stage I - the cob stage of becoming ill (urazhennya) heart. Hemodynamics is not damaged. The heart's deficiency is prikhovannaya Asymptomatic dysfunction of the little louse .. II A stage - the stage of heart disease is clinically reversed. Damage of hemodynamics in one of the blood circulation cells, bends around the same. Adaptive remodeling of the heart and the heart. IIB stage - the importance of the stage of getting sick (fighting) of the heart. Variations of hemodynamic changes in both blood circulation. Maladaptive remodeling of the heart and the heart. Stage III - the endov stage of heart failure. Variations of hemodynamic changes and important (non-gate) structural changes of organs - targets (heart, legends, sudin, brain, nirok). The final stage of organ remodeling.

. Functional classes of chronic heart failure(You can change to one side or the other side) .. FC I - interchange of physical activity on the day: the physical activity is not supervised by a quick chill, the appearance of a heart of a good-natured person. Pіdvischene navantazhennya Khvorov bear, ale Won Mauger suprovodzhuvatisya zadishkoyu i / abo upovіlnenim vіdnovlennyam forces .. II FC - Neznachny obmezhennya fіzichnoї aktivnostі: in spokoї symptoms vіdsutnі, zvichna fіzichna aktivnіst suprovodzhuєtsya stomlyuvanіstyu, zadishkoyu abo sertsebittyam .. III FC - pomіtne obmezhennya fіzichnoї aktivnostі: in the calm the symptoms are on the day, the physical activity of the lesser intensity is caused by the occasional increase in the number of symptoms. symptoms of heart failure in the presence of peace and to accommodate with minimal physical activity.

Symptoms (signs)

Klinichny show

. skargi- zadishka, attack of breath, weakness, stomachache .. A backbone in the cob stage of heart failure in case of physical nascence, and in case of turn of heart failure - in peace. Vona appear as a result of an increased grip in the Legendary capillaries and veins. The price of a change in the tension of legends and for the robustness of dysfunctional mutilations. The loss of self-esteem in the position of the bed is poured into the deposits of the line in the legacy capillaries, which can lead to a hydrostatic grip. In addition, in the position of lying down, the diaphragm grows, so it’s easy to get into trouble. Chronic heart failure is characterized by a paroxysmal nichna backwardness (heart asthma), which is overwhelmed by the accusations of an interstitial build-up. At night, an hour of sleep develops an attack of a twisted backwardness, which leads to a cough and the appearance of wheezing in the legends. With progressive heart failure, there may be an alveolar swelling of legends. ascites) as a result of stagnation of blood in the liver and system of the portal vein .. On the side of the heart can be heard pathological III and IV tone of the heart. The legends begin to have wheezing. Characteristic hydrothorax, often right-handed, as a result of the reduction of the pleural capillary vise and transudation of the line in the pleural emptying.

. Klinichny show heart failure and really lie down at the її stage.. Stage I - signs (svidka stomlyuvanst, zadishka and heartbeat) are in case of acute physical imbalance, in calm manifestation of heart failure. Klinichny show to lie because of the fact that the heart was too much of a fever (right or wrong) ... Abnormalities and abnormal liver failure are not characteristic ... Right ventricular insufficiency is characterized by the formation of congestive manifestations according to the great count of blood circulation. Patient turbine bile and the importance of the right side, the change in dyuresis. Characteristically, a decrease in pechinki (the surface is smooth, the edge of the curves, palpation). Vidminnoy special Heart failure of the IIA stage, I will again compensate for the disease, so that the turnover of the manifestation of heart failure as a result of adequate treatment .. Stage IIB - severe damage to hemodynamics, the whole system is involved in the process. Zadishka winikє with the least physical navantazhennі. There is a bad feeling of being heavy in the right side of the area, weakness, sleep deprivation. Characteristic sluggishness, embryos, ascites (accumulation of clay in the liver veins and in the veins of the neoplasm - transudation, and accumulation in the middle of the drain), hygrothorax, hydropericardial disease - stage III As a rule, they become ill in the most important stage. The backbone is turned to look at the calm. Characteristics of massive embryos, purchase of ridges in empty spaces (ascites, hydrothorax, hydropericardium, embryos of statuary organs). At the ts_y stage of vinikak kakheksia.

diagnostics

instrumental data

. EHC... It is possible to detect signs of blockage of the left side of the right lower bundle of His, hypertrophy of shlunochki or the atrium, pathological Q waves (as a sign of a transferred IM), arrhythmias. A normal ECG allows for the diagnosis of chronic heart failure.

. EhoKG yes, the opportunity to establish the ethology of chronic heart failure and assessment of the function of the heart, the steps of their damage (zokrem, viznachiti FVLSh). Typical manifestations of heart flaws - the widening of the empty of the little louse (in the world of progress - the expansion of the second chambers of the heart), the improvement of the endless systolic and diastolic growth of the little louse,

. radiological dosage.. Mozhlivo viyavlennya venoznoї gіpertenzії in viglyadі pererozpodіlu blood flow to korist verhnіh vіddіlіv legen that zbіlshennya dіametra sudin .. When zastoї in legenyah viyavlyayut Find our іnterstitsіalnogo nabryaku (lіnії Kerlі in edge - dіafragmalnih sinuses) abo .. Find our nabryaku legenіv Viyavlyayut hydrothorax (chastіshe pravobіchny) .. cardiomegaly is diagnosed with an increase in the transverse size of the heart more than 15.5 cm in cholovik and more than 14.5 cm in females (even if the cardiothoracic index is more than 50%).

. Catheterization empty heart Allowing to wipe out the grip of the wedge of Legendary capillaries over 18 mm Hg.

Diagnostic Criteria - The Framingham Criteria for the Diagnosis of Chronic Heart Failure, which can develop on great and small. Great criteria: paroxysmal nichna zadishka (heart asthma) orthopedic, swollen veins, wheezing in lesions, cardiomegaly, swelling of legends, pathological III heart tone, increased positive CVP (more than 160 mm of water) "Hepatojugular reflux". Minor criteria: stiffness on the legs, low cough, sluggishness with navantazhenny, malnutrition, hydrothorax, tachycardia more than 120 per sickness, reduction of VC by 1/3 of the maximum. To confirm the diagnosis of chronic heart failure, it is necessary either 1 great or 2 small criteria. Amused signs of guilt but tied with heart ailments.

Differential diagnosis... Nephrotic syndrome - a history of embryos, proteinuria, nirkovo pathology. Liver cirrhosis. Occlusion of the veins with the advance development of the peripheral embryos.

Likuvannya. It is necessary in the first place to assess the possibility of pouring in on the cause of the deficiency. In a number of vascular diseases, the etiologic infusion is more effective (for example, surgical correction of heart defect, myocardial revascularization in ІХС), it is possible to change the frequency of manifestations of chronic heart failure. In cases of chronic heart failure, see non-drug and lykarsky methods therapy. Slide it means that the offense you see is guilty to add one more one.

non-drug treatment... obmezheniya vzhivannya kitchen salt up to 5-6 g / day, ridini (up to 1-1.5 l / add). Optimization of physical activity .. Some physical activity is possible and necessary (walking at least 20-30 minutes 3-5 r / week).

lykuvannya

Lykarska therapy... Kintseva meta of chronic heart failure - improving the quality of life and improvement and triviality.

Diuretics. When їh priznachennі neobhіdno vrahovuvati scho viniknennya nabryakіv at sertsevіy nedostatnostі pov'yazano dekіlkoma of reasons (zvuzhennyam nirkovih sudin, zbіlshennyam sekretsії aldosterone, pіdvischennyam venous vise. Lіkuvannya tіlki dіuretikami vvazhayut nedostatnіm. When hronіchnіy sertsevіy nedostatnostі zazvichay zastosovuyut petlovі (furosemіd) abo tіazidnі ( for example, hydrochlorothiazide) diuretics. in case of insufficient diuretic effect, a combination of loop diuretics and thiazidia. diuretics. . loop diuretics fix a few more days, the diuretic effect of their turns is stronger, less trivial, less in thiazidine diuretics. 40 100 mg / day

Angіbіtori APF vklikayut hemodynamic growth of myocardium in the case of enlargement of the swelling, decreasing the grip of the left and right slugs. The indications for the recognition of the ACE ingibitorіv vvazhayut key signs of heart failure, the decrease in the fraction of the wikid lіvogo shlunochka less than 40%. If an ACE is recognized, it is necessary to follow the recommendations of the European Association of Cardiologists (2001). deeds to those who are admitted .. It is necessary to control the function of the skin (reduction, loss of energy) and the concentration of electrolytes in the blood (in the amount of energy, sodium) in case of increased skin damage, 3-5 days it is possible to recognize only when hypocalypse) .. It is necessary to unify the one-hour storage of the refinery.

The first positive data on the splendid infusion of angiotensin II receptor blockers (zokrem, losartan) for the overcoming of chronic heart failure as an alternative to the ACE inhibitors in case of intolerance, for any reasons, are taken out.

Heart glucosides produce positive inotropic (increase and shorten systole), negative chronotropic (decrease in heart rate), negatively dromotropic (positive AB - provide) diu. The optimal dose of digoxin is infused with 0.25-0.375 mg / day (for young patients 0.125-0.25 mg / dob); therapeutic concentration of digoxin in syrovatz blood becomes 0.5-1.5 mg / l. Indicated for the recognition of heart glucosides є tachystolic form of fibrillation of the atrium, sinus tachycardia.

B - blockers .. Mehanіzm spriyatlivogo dії  - adrenoblokatorіv at hronіchnіy sertsevіy nedostatnostі obumovleny such factors ... right Zahist mіokarda od nespriyatlivogo vplivu kateholamіnіv ... Zahist od іndukovanoї catecholamines gіpokalієmії ... Polіpshennya blood flow in vіntsevih arterіyah vnaslіdok znizhennya HR i polіpshennya dіastolіchnogo weakening of the myocardium ... a change in the inflow of the vessel sound systems (for example, in the case of a decrease in the secretion of renin) ... adrenergic blockers for the treatment of chronic heart failure recommendations before the intake of carvedilol - b1 - і a1 - an adrenergic blocker with vasodilating powers. Pochatkova dose of carvedilol to become 3.125 mg 2 r / add with additional doses up to 6.25 mg, 12.5 mg or 25 mg ) and the largest negative manifestations of b - adrenergic blockers. It is also recommended metoprolol, repaired with a dose of 12.5 mg 2 r / dob, bisoprolol at 1.25 mg 1 r / add before the control of fractions of a dose of shlunochkiv, we will proceed to increase the dose in 1-2 hours.

Spironolactone. It has been established that the antagonist of aldosterone spironolactone in a dose of 25 mg 1-2 r / dob (with a daily counter-indication) has been shown to reduce the triviality of the life of the ailments to the heart's lack.

Peripheral vasodilators are recognized in case of chronic heart failure, in case of obvious contraindications, for example, in case of poor tolerance of the ACE ingibitors. In peripheral vasodilators, hydralazine at doses up to 300 mg / day, isosorbid dinitrate at doses up to 160 mg / day.

. Інші cardіotonіchnі zasobi... b - Adrenomimetics (dobutamin), іngіbіtory phosphodiesterazi are recognized to be prone to 1-2 days in the end of the stage of heart failure, for example, in the case of a severe malady.

Anticoagulants. Ailments with chronic heart deficiency of sickness to a high risk of thromboembolic acceleration. It is possible for the BODY to have venous thrombosis, as well as thromboembolism of the great cola blood circulation, the internal heart thrombus is enlarged, or fibrillation of the atrium. Appointment of indirect anticoagulants for chronic heart failure is recommended in the presence of atrial fibrillation and thrombosis in the anamnesis.

Antiarrhythmic drugs. If there is evidence of antiarrhythmic symptoms (fibrillation of the atrium, tachycardia), it is recommended to recommend vikoristovuvati amiodarone at a dose of 100-200 mg / day. The whole drug is minimally negative effect, at that time, the majority of the drugs in the class reduce the fraction of the wikid of the louse. In addition, antiarrhythmics themselves can provoke arrhythmias (pro-arrhythmic effect).

surgical treatment

Vibir of the optimal method of surgical treatment to lie for a reason, to lead to heart failure. So, with ІХС in bagatio, there is a healthy revascularization of the myocardium, with an idiopathic subaortic hypertrophic stenosis - septal myectomy, with valvular diseases - prosthetics, or reconstructive disorders, etc.

In the case of refractory heart failure before adequate therapy with the main surgical method lіkuvannya є heart transplantation.

Methods of mechanical blood circulation control (implantation of assists, single-piece slugs and biological pumps), earlier proponents of time-based options before transplantation, in this hour the status of self-mediated transplantation

To improve the progress of the dilatation of the heart, carry out the implantation of the annexes at the viglyade of the net, so that the overworldly enlargement of the heart is transformed.

With a tolerant to lіkuvannya to the legendary heart Most of the assistants are involved in the transplantation of the "heart-legends" complex.

Forecast. In total 3 - the risk of ailments on chronic systolic heart failure becomes 50%. The mortality rate due to chronic systolic heart failure is 19% per risk.

Factors, the appearance of which are the core of the nasty prognosis in the sick with the heart deficiency .. The decrease in the fraction of the wicker is less than 25%. l .. Decrease in concentration of ions in blood plasma less than 3 mmol / l .. Increase in blood instead of norepinephrine.

Rhizik of the raptus heart death of ailments due to heart deficiency in 5 times in food, not in the out-of-town population. There are a lot of people who are ill for chronic heart failure to go fast, regardless of whether they are getting rid of the little ones. Prophylactic antiarrhythmic events not preceded by this acceleration.

ICD-10. I50 Sertseva lack

Likarsky used medicinal preparations for treatment and / or prevention "Lack of heart chronic systolic".

Pharmacological group (s) of the drug.

Semeiniy likar. Therapist (volume 2). Chronic nirkov lack of ICD 10

Chronic nirkov deficiency

General information

Check the status of chronic nirkova lack(KhNN), the essence of whether they be built up to the development of a characteristic clinical-laboratory complex, as a result of progressive loss of all nirk functions.

Chronic nirkova deficiency (CNI)- tse vtrata homeostasis funktsіy nirok on tlі nirkovogo zahvoryuvannya protyagom bіlsh nіzh 3 months at: znizhennya klubochkovoї fіltratsії i vіdnosnoї schіlnostі (osmolyarnostі) pіdvischennya kontsentratsії kreatinіnu, sechovini, kalіyu, phosphorus, magnіyu i alyumіnіyu sirovatki krovі, znizhennya kaltsіyu krovі, torn down acid luzhnoї rіvnovagi (metabolic acidosis), development of anemia and arterial hypertension.

Epidemiology

The problem of HNN is being actively broken up for ten years, which has been zoomed in by the significant widening of the acceleration. So, according to the literature, the number of ailments with chronic lack of nirk in the lands of Europe, the United States and Japan rises from 157 to 443 per 1 million. Population. The breadth of the pathology in our land is 212 per 1 million. The population of the middle of the sick is older than 15 years. Among the causes of lethality of CHNN occur at the eleventh time.

Ethiology

HNN MAє in its basis is a single morphological equivalent - nephrosclerosis. There is no such form of pathology nirok, which could not potentially lead to development of nephrosclerosis, but, moreover, nirkovo deficiency. In such a rank, KhNN is the result of a chronic illness of nirok.

Primary incapacitation of nirok can lead to chronic nirk deficiency, as well as secondary inconsistencies in the result of an ongoing chronic malaise of organs and systems. Bezposredn ushkodzhennya parenchymi (first or second), which leads to CHN, cleverly go on getting sick with overweight lesions of the glomerular apparatus or the tubular system, or on the day. Among glomerular nephropathy, the most frequent is chronic glomerulonephritis, diabetic nephropathy, amyloidosis, vovchakovy nephritis. big for some reason ChNI with lesions of the glomerular apparatus є malaria, gout, lingering septic endocarditis, malaria ailment. Primary damage to the tubular system, most often, is more likely to be spontaneous in cases of high urologic diseases, supra-juvenile injuries due to the incidence of cuts, in the form of tubulopathies (nyclocytic canal dystocia), spadkovo get sick abo supravodzhu rіznі zhvoryuvannya), fringed with licks and toxic words. To the secondary ears, parenchymi nirok can bring Suddenly ill- the destruction of nirkovy arteries, esential hypertension (primary nephroangiosclerosis), malformations of nirk and secular paths (polycystosis, hypoplasia of nirok, neuromyazov dysplasia of the secular). The chronic isolation of any kind of nephron is actually a triggering mechanism for the development of CNN, however, in the clinical practice of the stage of CNN, it is characterized by the deterioration of the functions of the glomerular and tubular aparas.

pathogenesis

Independently of the ethiological factor, the mechanism of development of HNN based on a decrease in the number of active nephrons, a significant decrease in the fluidity of the glomerular filtration in some nephron and on the other indicators. Folding mechanisms of defense include a lot of factors (destruction of communication and biochemical processes, burning of blood, damage to the passage of slaughter, infection, anomalous immune processes), which are chronically due to modern In the development of chronic nirk deficiencies, the most important moment is, for all intents and purposes, the destruction of all nirk functions, about which ailments do not become suspicious. However, the modern methods of observance allow the development of the stage, so as the changes that appear in the body when the functional building is damaged, in this hour we are good. It is important to the important staff of the clinician, who allows him to carry out preventive and medical visits, direct to the advance of the early development of the thermal stage of nirkovo deficiency. Nirki may mean the values ​​of reserve capacity, just to reduce the saving and life of the body at the expense of 90% of nephrons. The process of adaptation is to try to improve the function of preserving nephrons and to wake up the whole body. With progressive bending of nephrons, the fluidity of the glomerular filtration decreases, the water-electrolyte balance breaks down, the absorption in the organisms of products of metabolism, organic acids, phenolic spoluks, certain peptides Thus, the impairment of the secretory and secretory functions of the development of pathological changes in the body, the severity of which lie due to the intensity of the nephron failure and the origin of the progressive deficiency. With chronic nircovian deficiency, one of the most important functions of nirok is destroyed - the adjustment of the water-salt balance. Vzhe on rannіh stadіyah HNN, Especially obumovlenoї zahvoryuvannyami of perevazhnim urazhennyam tubular aparata, sposterіgaєtsya torn down kontsentratsіynoї zdatnostі nirok scho proyavlyaєtsya polіurієyu, nіkturієyu, znizhennyam osmolyarnostі sechі to rіvnya osmotic kontsentratsії plasma krovі (izostenuriya) i at far zayshov urazhennі - gіpostenurієyu (osmolality kontsentratsіya sechі lower osmotic concentration of blood plasma). Polyuria, as it is of a persistent nature to navigate with an interconnected age, can be supplemented with an unprecedented decrease in the function of tubules, as well as a change in osmotic duresis. An important function of the regulation is to adjust the electrolyte balance, especially such ions, such as sodium, calcium, calcium, phosphorus and in. With chronic nircovian deficiency, the vision of sodium from the cross section can be increased and decreased. 99% of healthy people filter through the glomeruli with sodium to reabsorb in the tubules. To reduce the reabsorption of up to 80%, and, moreover, to increase the rate of reabsorption. Strengthening the vivedennya of sodium from the section does not lie in the introduction of it into the body, but it is especially not safe with the recommendation in similar situations to a person who is sick with salt. However, the improvement of glomeruli, reduction of the fluidity of glomerular filtration, especially with the preservation of the function of the tubules, can lead to the catching of sodium, which is pulling for itself the accumulated birth in the body, internal delay. Up to 95% of the calories introduced into the body are seen by nirkas, which can be reached by the secretion of them in the distal ducts. In case of chronic lack of regulation of the balance of calories in the body, it’s good to go to the intestines. So, with a decrease in GFR up to 5 ml / hv, close to 50% of the feasibility of the feces is necessary. The increase in calories in plasma can be promoted in the oligoanuric phase of CNI, as well as in case of aggravated main illness, with advanced catabolism. So as the main amount of calories in the body is located in the internal space (in plasma - close to 5 mmol / l, in the internal compartment - close to 150 mmol / l), in some situations (hot stomach). hyperkalієmіya, I will block the life of the sick. The state of hypocrisy in ailments with chronic nircum deficiency is more likely to increase and may be indicative of a deficiency of extracalcane in the body and rapid impaired secretory health distal view canal. Disruption of the functions of the glomerular and tubular apparatus, even at the early stages of chronic renal failure, can lead to hyperchloremic acidosis, hyperphosphatemia, altogether increased magnesium intake and transfusion.

Increase in blood concentration of sechovine, amino nitrogen, creatine, sechoic acid, methylguanidin, phosphates, etc. The growth of amino nitrogen can be used to cope with the catabolism of the bile as a result of the overwhelming overwhelming need, or of the sharp bump in case of hunger.

Sechovina is a kintsevym product of the metabolism of proteins, it is established in the oven with nitrogen of deaminated amino acids. In the minds of a nirk disadvantage, it is not only the complication of vision, ale, for unprecedented reasons, making the product more powerful.

Creatine is established in the meats of the body from its counterpart to creatine. Instead of creatine in the blood, the increase in creatinemia is parallel to the increase in the level of blood in the blood, as a rule, with a decrease in glomerular filtration up to 20-30% of the normal level.

Even more respect is attached to the excess production of parathyroid hormone as the main uremia toxin. Pidtverdzhennyam tsogo є the efficiency of the private parathyroid dectomy. There are more and more facts, such as to indicate the toxicity of speechless nature, the molecular weight of which is 100-2000, for which the stench is called "middle molecules". The very stench accumulates in the syrovatz blood of ailments with chronic nirk deficiency. However, it is becoming increasingly obvious that the syndrome of azotemia (uremia) does not accumulate in one form of toxins, but rather stays in all tissues and changes in transmembrane potential. The result is a deterioration in both the functions of both systems and systems that regulate their performance.

The reasons for blood loss, shortening of triviality of life of erythrocytes in case of deficiency of blood and tissue in the body, toxic infusion of products in nitrogen metabolism, hemolysis (deficiency of glucose-6-phosphate dehydrogenase) Growth of average molecules also induces eritropoiesis.

osteodystrophy

Osteodystrophy caused by impaired metabolism of calciferol. In nirkakhs, the establishment of an active metabolite of 1,25-dehydroxycalciferol is seen, so that it is added to the transport of calcium by the regulation of the synthesis of specific proteins. In case of chronic nircovian deficiency, the transfer of calciferol to the exchange-active form is blocked. The water-electrolyte balance was trivial to keep close to the physiological, right up to the thermal phase. In the minds of the deterioration of the ionic transport in the tubules, with tubular defects in the sodium intake of growth, and in case of lack of storage, it can lead to the syndrome of hyponatria. Hyperkalієmіya roztsіnyuєtsya yak different for the significance of the mark of the KhNN. It is not linked only to the growing catabolism, which is characteristic of nirkovy deficiency, altogether and to the malignant acidosis, but the smut - to the wistful growth of the caliber posture and in the middle of the clitin.

The change of the waste water treatment plant is seen at the link with the broken functions "vugilny acid - hydrocarbonate". In case of lower options, the deterioration of the functions of the nirok, which lies in the nature of the process, can be promoted by the same type of deterioration of the wastewater treatment plant. With glomerular, it is possible to be interconnected in the section of acidic valences, with tubular, it is possible to see the over-inclusion of ammonia-acidogenesis.

Arterial hypertension

The role of the imputation of the products of vasodilators (kinin) is irrelevant in the determination. Imbalance of vasoconstrictors and vasodilators with chronic insufficiency of obesity in the second level of health control in the body of sodium and volume of circulating blood. In the thermal phase of the HNN, the energy tension reaction can be adaptive, so that a filter grip is created. In cich vipadkah, the decrease in arterial grip can be fatal.

Zgіdno ICD-10, KhNN classify this rank:

N18 Chronic nirkova lack.

N18.0 - Thermal stage of battle nirok.

N18.8 - Chronic nirkovo deficiency.

N18.9 - Chronic nirkov deficiency has been clarified.

N19 - Chi not specified nirkova lack.

diagnostics

Diagnostics of CNI in case of a seeming nirk disease is awkward. The stage, and, moreover, the severity, is the increase in the concentration of creatine in the blood and the decrease in GFR. As a guilty one, it was smart from the early days, it is even more important to follow the camp of the electrolytic, acid-base exchange, to quickly restore the brokenness of the heart, legends.

Diagnostics of CNS is mainly laboratory. The first symptom is a decrease in the specificity of the cut to 1.004-1.011, directly in terms of the size of the dyuresis. The mother's need for respect, so the appearance of zukru and bile in the section can be adjusted to the efficiency of the section (leather 1% zukru - by 0.004 and 3 g / l - by 0.01).

Adding the electrolyte balance for the establishment of the level of decrease in the function of nirok is not very informative. The same can be said, both the steps of anemia, and, more so, the level of the arterial grip.

Even more important is an accurate assessment of the function of nirok, depending on the range of the other organs, the stages of degenerative processes in the body when feeding about the prospect of nirka transplantation.

In general therapeutic practice, it is possible to get lost in creatinemia without singing nirkovy obvoruvannya. Also to be spared with congestive heart failure. Let the creatininemia not change 0.6-0.8 mmol / l. More significant admissions can be promoted with a rapidly growing decompensation of the heart, for example, in patients with accelerated myocardial infarction. The specialty of such creatininemies is that it is uncommonly careful to achieve the high proficiency of the battle. Nirkova lack of vinikє with the rapid "nirk quota" of heart wikidu up to 7.8%. The reduction of normal hemodynamics will bind to the growth of the venous vise, and the reduction of the blood flow in the blood flow is reduced by the reduction of the glomerular filtration, so that the filtration fraction will lead to an increase. Failure of nirk hemodynamics is superfluous to overgrowth of nirk blood flow. Naybіlše hraddaє zvnіshnya part of the cork ball. The preservation of the increased power of the slaughter is tied to the trust of blood flow, especially in the cerebral speech.

In such a rank, "chronic" creatiniemia without the development of diffuse nephrosclerosis, which is not inevitable for extrarenal reasons, is not supervised for it, isostenuria, which is less diagnostic and prognostic for cardiology. Special treatment such a nirkova lack is not vimag. Another feature of the decrease in the function of nirok in case of congestive heart failure is the appearance and growth of protein. It is seen, as a rule, blood plasma blood cells, however, the tubular reabsorption of the blood cell is damaged. Histopathological picture of such congestive nirka shows enlarged veins. The glomeruli are larger in size, the loops of the capillaries are wide, and there are erythrocytes. The stroma of the nirka nabryakla, the canaliculi are often expanded, the epithelium is in the stage of dystrophy, and the canaliculi is abundant in the form of atrophy. Vognischevny interstitial fibrosis and arteriosclerosis.

CLINICAL CRITERIA

Main show:

- symptoms of endogenous intoxication;

- oliguria;

- nudota;

- macrohematuria or microhematuria;

- porushennya sechovipuskannya;

- sverbіzh shkіri;

- bleeding.

Already Pershe spіlkuvannya of ailments such danih z'yasuvannya i z anamnesis, yak trivalіst nefrologіchnogo zahvoryuvannya, nayavnіst abo vіdsutnіst hronіchnogo glomerulo- abo pієlonefritu, arterіalnoї gіpertenzії, trivalіst Tsikh zahvoryuvan frequency zagostren glomerulo- abo pієlonefritu, Quantity sechі scho vidіlyaєtsya for Dobou, as well as the detection of early symptoms of chronic renal failure, allowing the suspicion of a lack of deficiency and a plan of diagnostic and clinical visits.

A case in the anamnesis for the triviality of nephrological illness for more than 5-10 years is given, when it is perceived that there is a certain lack of evidence and that all diagnoses have been diagnosed, if it is confirmed anyway. An analysis of the past has shown that the total deterioration of the function of nirok and the development of the stage of HNN is possible with the victorious traditional methods of slaughter and blood.

Asthenic syndrome: weakness, drowsiness, drowsiness, loss of hearing, relish.

Dystrophic syndrome: dryness and a lot of itching of the skin, follow the scratching on the skin, thinning, you can help the cachexia, atrophy of the tongue.

Shlunkovo-intestinal syndrome: dryness, dryness and unacceptable metallicity in the mouth, apetite onset, severity and pain in the supracranial dysplasia; , stomatitis, parotitis, enterocolitis, pancreatitis, deterioration of the liver function.

Heart-vascular syndrome: backache, pain in the area of ​​the heart, arterial hypertension, hypertrophy of the myocardium of the louse, in important cases - attack of heart asthma, a set of legends; when CNN has gone far - dry abnormally exudative pericarditis, a bunch of legends.

Anemic-hemorrhagic syndrome: bleeding, nasal, intestinal, mucus bleeding, hemorrhage, anemia.

Cystkovo-angular syndrome: I have pain in the cysts, slopes, ridges (as a result of osteoporosis and hyperuricemia).

Disorder of the nervous system: uremic encephalopathy (headache, memory loss, psychosis with obsessive fears, hallucinations, convulsive attacks), polyneuropathy (paresthesias, reflexes, feeling of weakness in the hands and feet)

Sichovy syndrome: Isogipostenuria, proteinuria, cylindruria, microhematuria.

Early clinical signs of chronic disability- polyuria and nikturia, hypoplastic anemia; it is possible to come to gallant symptoms - weakness, drowsiness, dullness, apathy, myazova weakness. In the shallow, covered with nitrogenous slags, they win itchy skin(Inodi - large), nasal, shlunkovo-intestinal, uterine bleeding, Pidshkirni hemorrhage; may develop "uremic gout" with pain in the swellings, tofus. For uremia, the characteristic dyspeptic syndrome is nudota, blues, booze, loss of appetite, right up to vіdrazi to їzhі, carry. Shkirni pokrivi - a black-and-white colora Shkira - dry, with traces of scratching, blue on hands and feet; mova - dry, brown. With progression of CNI, symptoms of uremia increase. Sodium treatment should be brought to hypertension, often - with rice malignancy, retinopathy. Hypertension, anemia and electrolyte destructiveness viciously affects the heart. In the terminal stage, fibrinous abnormal pericarditis develops, which indicates an unpleasant prognosis. In the world of progression of uremia, outgrowths of neurological symptoms, there is a trial of humor, encephalopathy, right up to the development of uremic Komi, with strong gucky acidotic dichanny (Kussmaul's dichanna). Characterized by the strength of the ailments to infections; often associated with pneumonia.

laboratory criteria

Clinical analysis of the section- Proteinuria, hypoisostenuria, cylindruria, abacterial leukocyturia, hematuria.

Blood analysis:

classy- anemia, an increase in erythrocyte formation (SHOE), low leukocytosis, low leukocyte formulas, thrombocytopenia is possible;

biohimichny- increase in blood pressure, creatine, excess nitrogen in the blood, increase in blood glucose, blood pressure, hypertension, hypocoagulation, hypocoagulation, blood pressure

Laboratory diagnostics

- Analysis of the blood of the clinical, with the values ​​of platelets;

- analysis of blood biochemistry, based on values ​​of creatine, sechovine, cholesterol, proteinograms, electrolytes (calcium, calcium, phosphorus, sodium, chlorine);

- viznachennya dobovoy ekskretsії bіlka;

- viznachennya funktsіonalnogo stan nirok (shvidkіst glomerular filtration);

- acid-puddle mill;

- ALT, AST;

- roentgenologic dosage of nirok, kistok, legends.

Additional laboratory and instrumental information

- Ferritin;

- admission (%) of transferin weight;

- Viznachennya PTH;

- viznachennya ekskretsії kaltsіyu s cross-section;

- the value of blood amylase;

- bilkovo-siege samples;

- the value of products in the degradation of fibrin in the blood;

- radionuclide dosage (indirect renoangiography, dynamic and static reno-scintigraphy);

- biopsies of punctuation of nirka;

- functional support sectional mikhura;

- Echoencephalogram;

- echocardiography from the assessment of the functional stance of the heart, dopplerography of the judges.

Differential diagnosis

DIAGNOSIS OF CHNN in clinics who do not have special difficulties in the establishment of characteristic clinical pictures and laboratory changes in blood and slaughter. Alone, forgiven the need for memory: some of the classics can be summed up by the aggravated chronic nirkovy deficiencies as a result of the occlusive factor and the development of a severe ignition process in the upper or lower sečovyh shlyakh... If the mills are set, the reference stage of the HNN can be set only to update the passage of the sech and liquidation of the state-of-the-art ignition process. For nephrologists, it is important to diagnose early and before advanced stages of chronic renal failure, allowing the development of clinical tactics and ultimately the prognosis of nephrological illness.

The occurrence of CHN, as a rule, is carried out in parallel with the diagnosis of nephrological incapacitation and includes the history of impairment, cleverly show, Changes in the foreign analyzes of blood and slaughter, as well as specific dosages, are directed to the determination of the total function of various methods, so that they allow the assessment of morphological and functional parameters.

consultations fahivtsiv

- Oculist: camp of the full-time bottom;

- neuropathologist: the manifestation of uremic and hypertensive encephalopathy;

- gastroenterologist: the appearance of acceleration from the side shlunkovo-intestinal tract(Gastritis, hepatitis, colitis and in.);

- cardiologist: symptomatic arterial hypertension, hypertensive heart;

- cardiohirurg: uremic pericarditis (puncture);

- urologist: the appearance of calculi in the bowl-bowl form of nirok, sechovod and in.

tsіlі

Vyhodyach from the classification, the use of CNI is shown even from the level of glomerular filtration less than 60 ml / h, when the level of creatine is 140 micromol / l for people and 105 micromol / l - for women close to It is recommended to stabilize AT up to whole numbers< 130/80 мм рт.ст. а при протеинурии – < 125/75 мм рт.ст.

Diagnostics and the fight against acceleration.

rіven lіkuvannya

outpatient: therapist, family likar, Fakhіvets-cardiologist, gastroenterologist and іn.; stationary - reduction to stationary treatment.

Ailments with a chronic nircovy deficiency are given dispensary caution by a nephrologist-doctor, and in every single day - by a therapist-doctor at a time of living.

Dispensary for the prevention of the disease includes: the treatment of ailments with chronic deficiency of the first stage of the disease 3 times in the period, with the chronic deficiency of the II stage - 6 times for the period, and chronic deficiency of the acute deficiency of the III stage, drinking visits; Establishment and usunennya of bureaucrats, as a result of the progress of KhNN. When there is a problem with inter-competitive ailments, the situation is dodatkov. We are sick with chronic nircovy deficiency of stage IV. symptomatic therapy(If there is evidence, a contraindication for nirkovoi substitution therapy (PZT) for the month of living.

methods of treatment

Lykarska therapy basic(Based on international standards and hardened by the Ministry of Health of Ukraine by protocols: specifically pharmacological group of drugs, dose, rate of course) and dodatkov.

Hіrurgіchny lіkuvannya or іnshі vidіlіkuvannya (svіdchennya).

The main staff of the dieticheskiy lіkuvannya for chronic nirkovіy deficiencies є the change in the implantation of the bіlka from yizheyu is a low-protein diet (NBD); control over the living; Change in implantation of products, such as Na +, K +, Mg2 +, Cl-, phosphate.

Obmezhennya vzhivannya bіlka

Low-protein diet (NBD) in the process of galvanizing the progress of CNI: decrease in internal glomerular hypertension and hypertrophy of glomeruli, proteinuria, decrease in the frequency of development of secondary product hyperamentation

Correction of calcium-phosphate powder

The increase in phosphorus levels and development of secondary hyperparathyroidism (VHPT) is not only in the development of osteopathy, but in infusion on the progress of CNI. With GFR indicators of 40-50 ml / hv, the amount of phosphorus in the pre-dose rate is not guilty to change 800-1000 mg. With a GFR lower than 40 ml / hv, the limit of dietichesky phosphorus is up to 1 g / dob, phosphate-binding drugs (FSP) are used: phosphate binders.

Arterial vise control (AT) and proteinuria

Іngіbіtori APF (ІАПФ):

- enalapril - from 5 to 40 mg / dobu;

- perindopril - from 2 to 8 mg / dobu;

- kvinapril - from 5 to 20 mg / dob;

- moexipril - from 3.75 to 15 mg / dobu;

- ramipril - from 2.5 to 10 mg / dob;

- spirapril - from 3 to 6 mg / dob.

Angiotensin II receptor blockers (ARBAII):

- valsartan - from 80 to 160 mg / dobu;

- losartan - from 25 to 100 mg / dobu;

- candesartan - from 8 to 32 mg / dobu;

- irbesartan - from 150 to 300 mg / dobu;

- telmisartan - 40 to 80 mg / dobu;

- epprosartan - from 400 to 1200 mg / dob.

Calcium channel blockers:

- amlodipin - from 5 to 10 mg / add;

- lercanidipin - from 5 to 10 mg / dob;

- diltiazem - from 30 to 90 mg / add three;

- diltiazem retard - from 90 to 300 mg / add dvichі;

- verapamil - from 40 to 120 mg / dob from 2 to 3 times per dob;

- verapamil retard - from 240 to 480 mg / add.

Angiotensin ACE (ACE) and angiotensin II receptor blockers (ARBII)іstotnіshe, nіzh diuretics, antagonists of calcium and b-blockers, change protein and microalbuminuria.

Calcium channel blockers... but the group of nifedipin (dihydropyridinov), which effectively changes AT, however, does not infuse into the level of proteinuria and the progress of CHNN, but it is connected with the power of the power to rapidly change the tone of the afferent systemic artery Navpaki, non-hydrodynamic blockers of calcium channels (verapamil, diltiazem) practically do not infuse into the mechanism of non-automatic autoregulation, they take a change in proteineuria, and falsify glomerular fibrosis. Reaching the whole AT in case of chronic ailments of nirok is diagnosed in the presence of several drugs.

Korektsіya anemії

The intensity of the organism by the virus is controlled by the whole minimum indices of the concentration of eritropoietin in the syvate of 100 ng / ml and the level of transferin concentration is> 20%. If necessary, the preparation of zaliza should be prescribed in a dose of more than 200-300 mg of elementary zaliz for dobu. At the same time, stagnate the following preparations, which are generally viscous in the treatment of anemia:

- folic acid - from 5 to 15 mg / add;

- pyridoxine (Vitamin B6) - from 50 to 200 mg / add.

The main type of alternative therapy for eritropoietic deficiency anemia is the sign of eritropoietin:

- eprex - from 20 to 100 units / kg three per day;

- Recormon - from 20 to 100 OU / kg three per day.

Correction of hyperazotemia

I would like to change the level of azotemia, a toxic nascent uremia, to take medications that will help you to get rid of it.

Hypoazotemic phytopreparations:

- Hofitol - from 2 to 3 tablets three for doba for 15 min. up to 2 ampoules each for two vials for internal or internal production for 14-21 days;

- Lespenephril (Lespeflan) - from 3 to 6 teaspoons per dose or internally from a 1 ml / kg mass of sickness.

Enterosorbtion with the intake of interosorbents - 1.5-2 years before the release of the drug and medications:

- assets of a vugilla - up to 5 g of 3 to 4 times / dob;

- spherical carbonite - up to 5 g in 3 to 4 times / add;

- enterosgel - 1 tablespoon spoon (15.0 g) from 3 to 4 times / add;

- sorbigel - 1 tablespoon spoon (15.0 g) from 3 to 4 times / add;

- enterodesis - 5 ml per 1000 ml of water from 3 to 4 times / dob;

- polyphepan - 1 tablespoon spoon (15.0 g) from 2 to 4 times / dob or 0.5 g / kg masi / dobu.

intestinal dialis s injected into the intestine through a probe from 8 to 10 liters, which is to take revenge: sucrose - 90 g / l; glucose - 8 g / l, calcium chloride - 0.2 g / l, sodium bicarbonate - 1 g / l, sodium chloride -1 g / l.

CORRECTION OF DISLIPIDEMIA

Cylyovy level of LPNH cholesterol in older adults with chronic nirk's ills < 2,6 ммоль/л; уровень ХС ЛПВП >1 mmol / L (40 mg / dL); TG< 2,3 ммоль/л.

statini:

- lovastatin - from 10 to 80 mg / dobu;

- simvastatin - 10 to 40 mg / dobu;

- pravastatin - from 10 to 40 mg / dobu;

- atorvastatin - from 10 to 40 mg / dobu;

- fluvastatin - from 10 to 40 mg / add.

Statini block the key enzyme in the synthesis of cholesterol in the liver and may change the hypotension. Bazhaniy Rivn KhS LPNG -< 2,6 ммоль/л.

please:

- gemphibrozil - 600 mg dichі for doba;

- fenofibrat - 200 mg / dob.

Opt for TG> 5.7 mmol / l (500 mg / dl), with a dose according to the function of nirok. The combination of forms and statins is not a bastard, but a very high risk of development of rhabdomyolysis.

Shown before carrying out active methods of treatment of HNN:

- level of syrovatkovogo creatinine - 0.528 mmol / l (with diabetic nephropathy - 0.353 mmol / l), arteriovenous fistula is superimposed;

- pericarditis, neuropathy, encephalopathy, hypercalcemia, temporal hypertension, impaired CBS in ailments with chronic nircovy deficiency.

On the current year in Ukraine, there are such active methods for the treatment of chronic nircovascular deficiencies: chronic hemodialysis in conjunction with hemosorption and hemophilia, peritoneal dialysis and transplantation of certain types.

The prognosis of deviations, is made from the use of substitution therapy (RRT) and transplantation.

prophylaxis

The occasional appearance and treatment of nephrological ailments, which leads to the development of chronic nircum deficiencies, such as glomerulo- and polyonephritis, diabetic nephropathy.

Chronic heart failure. Viznachennya. Classification. Klinika. Diagnostics. Likuvannya.

Relevance of the problem

The broadening of clinically prevalent chronic heart failure (CHF) in the population is not less than 1.5-3.0%. Among individuals over 65 years of age, the incidence of CHF growth is up to 6-10%, and decompensation becomes the most frequent cause of hospitalization for illnesses. The number of ailments with asymptomatic dysfunctions of the lingering dumbbell is not less than 4 times less than the number of patients with clinically prevalent CHF. For 15 years, the number of hospitalizations with a diagnosis of CHF was consumed, and for 40 years, it increased 6 times. The five-fold visibility of ailments with CHF is still lower than 50%. rizik raptor death 5 times more, less in the population. In the United States, there are 2.5 million ailments from CHF, and nearly 200 yew are in the world. Patients, 5-year life expectancy after showing signs of CHF to become 50%.

Chronic heart failure (CHF) is a cardiac increase in the deterioration of (pumping) function with common symptoms, so that there is a lack of deficiency in the circulatory system and it is necessary for the organs and tissues to be delivered to the organs and tissues for normal blood function. Such a rank, the disproportion between blood circulation and the exchange of speech, as a growth in the increase in the activity of life processes; pathophysiological stance, when the function of the heart is impaired, it does not allow the blood circulation required for metabolism in tissues.

CHF can develop on the basis of a practical illness of the heart-vascular system, however, the main three are the onset of nosological forms:

- Ischemic ailment of the heart (ІХС)

- A rterial hypertension

- Heart vices.

IXC. From the classifications, especially often, the gostry of myocardial infarction (HIM) and ischemic cardiomyopathy (IKMP is a nosological unit, introduced into the clinical practice of ICD-10), to develop before the development of CHF. Mechanisms for the development of heart failure due to the reduction of the temperature by the change in geometry and local speed of the myocardium, called the term "remodeling of the lonely duck"

Arterial hypertension. Regardless of the ethology of hypertension, a structural overload of myocardium is observed, but I will give it a specific name - "hypertensive heart". Mechanism of CHF in this view of the development of diastolic dysfunction of LSh.

Heart of wadi. For Ukraine, until the present hour, the characteristic development of CHF is due to similar and uncorrected rheumatic defects.

For some reason, it is necessary to tell about dilatation and cardiomyopathy (DCMP), as about the cause of CHF. DKMP - get sick to the point of ridkisne, unspecified ethology, how to develop at all to a young personі quickly lead to heart decompensation.

The establishment of the cause of CHF is necessary for the choice of tactics for the treatment of a specific skin disease.

Pathogenetic aspects of heart failure

From the point of view happy theory The main role in the activation of compensatory mechanisms (tachycardia, Frank-Starling mechanism, constriction of peripheral vasculature) is the stage of hyperactivation of local abnormal neurohormones. In the main sympathetic-adrenal system (SAS) and efector - norepinephrine and adrenaline and renin-angiotensin-aldosterone system (RAAS) and efector - angiotensin II (A-II) and aldosterone uretic system The problem is that the “neglect” of the mechanism of hyperactivation of neurohormones is a nonvolatile physiological process. Later, the short-term compensatory activation of tissue neurohormonal systems passes into its prototype - chronic hyperactivity. It will remain supervised to develop and progress in systolic and diastolic dysfunction of the louse (remodeling).

With a single heart, the shock of the little one will change, and the endless volume and grip in the whole chamber of growth. Tse zbіlshu kіntsevo-diastolic stretching of the meat fibers, which can be brought to a large systolic shortening (Starling's law). Mechanism of Starling to help protect the heart's wikid. ale the resultant chronic pidyom of the diastolic grip will be transmitted to the front of the heart, or the blood circulation of the great cola. The capillary grip of supravodzhutsya transudation of the line with the development of embryos. A decrease in the heart rate, especially when there is a decrease in the arterial clutch, activates the SAS, stimulates the speed of the myocardium, the frequency of the heart rate, venous tone, and the decrease in perfusion is reduced to a decrease in the level of hydrochloric acidity, hyperemia.

Hypoxia of tissue in CHF is not only the resultant lank pathogenesis, but the th factor that can be used without a second provocation on the other provincial component - the decrease in the pumping health of the heart, before the start-up and after the load. Hypoxia є foldable multicomponent, easily accessible process. Direct primary hypoxia are direct on targets, localized on the very old regions: organismic, systemic, clinical and subclinical. On the subclinical level, hypoxia is the development of apoptosis.

The result of the described processes is the improvement of the peripheral vascular support and the volume of circulating blood from the general growth of the anterior and posterior vascularity.

Clinic of heart failure

Lack of heart is the primary development in most ailments. Naybіlsh is a frequent scargo є іnspіratorna zadishka, which is tied up with physical options and progresses to orthopedic, paroxysmal postural, to a tad in calm. Characteristic skargi for unproductive cough, nocturia. Ailments from CHF are indicative of weakness, stomachache, which is the result of decreased blood loss of skeletal mucosa and the central nervous system.

With right-sided lunar deficiencies, there is scarg in the right ridge through congestion in the liver, loss of appetite, nudity through the intestinal ridge or a decrease in gastrointestinal perfusion, peripheral ridge.

When looking around, it is possible to see that a part of the ailments, navit with a bend of CHF, in calm viglyadayut good, for those who have a bad time when they are too small or have minimal activity; ailments from trivial and important interruptions to see cachexic, cyanotic.

Some of the ailments have tachycardia, arterial hypotension, a drop in the pulse clutch, cold symptoms, pity (signs of activation of SAS).

When the heart is flattened, the heart will appear, the enlargement or the elevating top (dilatation or the hypertrophy of the shlunochkiv), the weakening of the I tone, the protodiastolic rhythm of the gallop.

With left ventricular failure, there is a lack of hearing, dry wheezing (congestive bronchitis), crepitus in the basal portions of the lungs, dullness in the basal portions (hydrothorax) may occur.

In case of right-handed SN, there is an increase in jarring veins, an increase in stoves; small onslaught on any possible swelling of the jugular veins - a positive hepato-jugular reflex. Ascites and anasarca are found in some of the ailments.

Diagnosis of heart failure

The residual clinical diagnosis of CH can be made only with the help of instrumental data, in the first place, EchoKG, as well as X-ray diffraction of the OGK, EKG, and other laboratory methods in advance.

For the additional help of the EchoKG assess: valve stance, the appearance of shunts, aneurysms, the pericardial stalk, the appearance of swelling abo, thrombi, and also - a quick function (diffuse changes and the onset of globular damage, - PV.

An important role in the diagnosis of heart failure is the level of roentgenologicheskie dosage of OGP: - assessment of heart size (cardiothoracic index); -revealedness and turnover of stagnation in the legends; Differential diagnostics due to incapacitation mental systems; -diagnostics and control of the effectiveness of treatment for the acceleration of heart failure (pneumonia, hydrothorax, BODY).

Inadvertent storage situation in case of heart failure syndrome - ECG, which allows for the development of hypertrophy, ischemia, symptoms, arrhythmias and blockages, and also to be used to control therapy with B-adrenoceptor blockers, dyramides.

For the assessment of the functional class (FC) in the patients, the test is performed with a 6-phase walk. This method is widely used in the last 4-5 years in the United States, including in the most recent years. Stan of patients, built for 6 chilins, from 426 to 550 m, from easy CHF; from 150 to 425 m - middle, and quiet, but not a building podolati and 150 m - important decompensation. In such a rank, the functional classification of CHF shows the health of the ailments before the appearance of the physical health and safety of the steps of the functional reserves of the body. It is especially significant when assessing the dynamism that I will become ill.

Laboratory maintenance for heart failure transmission of blood analysis (hemoglobin, erythrocytes, leukocytes, thrombocytes, hematocrit, SHOE), extracorporeal analysis of blood cells, biochemical blood tests (electrolysis -Kin +, Na + phosphatase, glucose).

Classification of CH

In Ukraine, the classification of the Ukrainian Association of Cardiologists in 2006 is recognized as a classification of the Ukrainian Association of Cardiologists in 2006;

New York Association of Heart Functional Classification Practices, which allow for allowing the vision of some functional classes to be good for those who need to endure physical training. Qia classification is recommended before the Victory Day of the WHO. The principle of laying the foundation is an assessment of the physical (functional) capabilities of the patient, which can be used as a doctor in case of a straightforward, retail and accurate collection of anamnesis, without the need for folding technology.

We saw a choice of functional class (FC) CHF.

I FC. Ailments do not see a lack of physical activity. Zvychayni navantazhennya does not provoke the diagnosis of weakness (nudoti), sercebitty, bad or anginal pains.

II FC. Pomezhennya fizichnykh navantazhen. Illness comfortably felt itself in the camp of calm, ale the visceral physical symptoms, weakness (nudity), heartache, or angina pain.

III FC. Virazhene obmezhennya physical navantazhen. Sickness seems to be comfortable only in a quiet camp, ale menshy, nizvichay, physical nurturing to develop weakness (boring), heartache, backslide or angina pains.

IV FC. Lack of viconuvati be-yaki navantazhennya without showing discomfort. Symptoms of heart failure or angina pectoris syndrome may appear in peace. With the appearance of a minimal build-up of growth, discomfort.

The very dynamism of FC in case of licuvanny allows for an active virality, for the correct and successful our therapeutic come. Carrying out the preliminaries brought about the fact that the value of FC by the singing world of the sound and possible forecast of the disease.

In clinical practice, it is of utmost importance for a differentiated approach to tactics to reduce myocardial dysfunction. Clinically and systolic and diastolic variations are manifested by the same type of symptoms - sluggishness, cough, wheezing, sluggishness. When vіdsutnostі danih EhoKG mozhna sprobuvati viznachiti varіant disfunktsії for dopomoga klіnіko-rentgenologіchnih danih of urahuvannyam etіologії CH auscultatory danih, viznachennya between sericite percussion i rentgenologіchno and takozh danih EHC (gіpertrofіya, dilatatsіya, rubtsevі zmіni їh lokalіzatsіya, nayavnіst Find our aneurysm sericite i іn .).

Likuvannya CHF.

With the goals of Lіkuvannya СН є:

· Usunennya abo mіnіmіzatsіya kіnіchnіy symptoms of CHF - pіdvishenoі stomlyuvanostі, sertsebittya, zadishki, nabryakіv;

Zachist organ_v-targets - sudin, heart, nirok, brain (for analogy with therapy of hypertension), as well as

· Increased development of hypotrophy of the cross-dark musculature;

Polishing the quality of life,

Zbіlshennya trivialosti life

· Change of number of hospitalizations.

Find non-drug and drug methods of treatment.

non-drug methods

Diet. The main principle is the interconnection of living with salt and in the menshy world - ridini. If there is a stage of CHF of ailments, it is guilty to take at least 750 ml of birth for doba. Obmezhennya schodo implantation of salt for ailments of CHF I FC - less than 3 g per dobu, for ailments II-III FC - 1.2-1.8 g per dobu, for IV FC - less than 1 g per dobu.

Physical rehabilitation. Options - walking or an exercise bike for 20-30 minutes a day up to five times per day due to self-control of self-respect, heart rate (it is effective to get involved in an exercise bike when reaching 75-80% of the maximum heart rate for the patient).

Medication for treatment of CH

The whole change of lykarsky zasobіv, scho stagnation for the treatment of CHF, subdivided into three groups: basic, additional, additional.

The main group of drugs in accordance with the criteria of "medicine of proof" and is recommended until the end of all countries of the world: ingibitori ACE, sechoginny zasobi, SG, ß-adrenoblokatory (dodatkovo) to.

Dodatkov group, the efficiency and safety of which has been brought by great preliminaries, however, the definition (meta-analysis): antagonism of aldosterone, antagonism of receptors to angiotensin I, BCK of the remaining generation.

Additional drugs, consumption of them are dictated by singing clinical situations. Prior to them, peripheral vasodilators, antiarrhythmics, antiaggreganti, direct anticoagulants, non-glucosidic positive inotropics, corticosteroids, statins are referred to.

Unimportant to the great vibe of lykarsky zasobiv, polypharmacy is unacceptable in the case of ailments (it is not true that a great number of drug groups is designated). At the same hour of the year in the polyclinic lanka, the main group of drugs for the treatment of CHF does not start from a given position, it is an hour that drugs from other and third groups are being tested.

Principles of common storage of the main resources for the treatment of CH.

1. Monotherapy in the treatment of CHF stagnates rarely, and at the same time, there may be vicoriasis and ACE at the cob stages of CHF.

2. Subway therapy of ACE + diuretic is optimal for patients with CHF II-III FC NYHA with sinus rhythm; Zasosuvannya scheme diuretic + glucoside, super-popular in the 50-60-і rock, in this hour it is not stagnant.

3. Use of therapy (ACE + diuretic + glucoside) - was the standard in the treatment of CHF in the 80s, and at the same time it was necessary to use the scheme in the treatment of CHF, however, for patients admitting with sinus rhythm it is recommended to use it.

4. The gold standard for the ear of the 90s by the present hour is a combination of chotir drugs - ACE + diuretic + glucoside + ß-blocker.

Gostra Sudinna Lack

With a term of choice, a gostrykh gostrich will damage the blood circulation, if you do not enter before the witness, neither the blood circulation nor the shock. The cordon with the rest of the floor is rottenly decorated, but often one term is used instead of the other.

Collapse is a cessation, with an infusion of peripheral blood circulation as a result of a gross deterioration in the volume of the vessel bed and a large amount of circulating blood.

For this purpose, they rely on respect for the destruction of the organism with non-schooled mechanisms for the protection. The result of the collapse is important to predict. You can lead to death, bend without inheritance, or go into shock.

Pathological physiology

The head manifestation of collapse is the fall of the arterial vise, as a rule, lower than 10.7 kPa (80 mm Hg. Art.) Abo 2/3 lower than the synovial blood pressure of the ailing peripheral pulse. The characteristic peculiarity of the hypotensive system is the rapid development of the organism in many cases. One of the factors in the appearance of shock, with any inclusion of these mechanisms, to bring about the development of the pathological standard syndrome to the hopeful development.

The visibility of the cycle of "zakisnoy reaction" is characteristic of such fabric systems:

Myocardium, the signs of bradycardia of the heart begin to arise from the hour to the collapse;

Peripheral blood circulation (bleed, cold, without cyanosis, marmur color of the skin);

Venous blood circulation (venous vice is low, the veins are not exactly like a jgut);

Cerebral blood circulation (often memory loss, damage and delirium, innocence and innocence);

Nirk blood circulation (in case of collapse of the head, oligo-abo anuria);

Neurovegetative system (pidvischene sweaty, blidist accusation, nudota).

Cause the collapse of the numbers. Win can be the result:

a) hospitable gipovolemy in cases of bleeding, post-occlusion fever (zokrema, with giponatriyemia);

b) a decrease in the heart wikid in connection with the broken rhythm of the heart in the direction of more frequent (shlunochkovatycardia, turning of the top of the heart) or a lesion (vuzlova or sinus bradycardia, atrioventricular block);

c) impaired blood circulation through a difficult emptying of the heart, for example, with tamponade of the heart;

d) a change in the peripheral support due to the secondary reaction of the vasovasal reflex in a labile patient with emotional stress;

e) hyperventilation, such as in case of piece ventilation in ailments, who suffer from a legendary lack of hypercapacity, as well as in case of stagnation of urinary dilatation.

The qi factor can be increased. The very same time to be spared during collapse, to appear in the cob stage of myocardial infarction (the first to develop into cardiogenic shock). As a result of barbiturates rejection in case of collapse, there is a possibility of buying a line in the splanchnic zone, and it is also typical for a new one to have galvanic drugs on the myocardium.

Shock stun is characterized by a syndrome, the main day of which manifests itself in diffuse diseases of the brain and secondary incapacity of tissue blood supply to the needs of the body. Vono alone to produce fatal results. However, the stage of non-turning is not clearly defined in people.

At the connection with the complexities of the classical value of the "shock stun", there will be proponents of the numerical values, for which the values ​​of Wilson are the most important. For yogo dany, for a sick person in a shock camp is characterized by the appearance of three and more signs:

The systolic grip of the door is less than 10.7 kPa (80 mm Hg);

Lack of blood circulation in tissues, which can be manifested by vologo, cold, cyanotic, marmurous blood pressure, or lower heart index lower than 2.5 l / min

Dyuresis less than 25 ml / year;

Acidosis with a volume of hydrocarbonates less than 21 mmol / l and lactacidemia more than 15 mg per 100 ml.

shock

Pidtrimka of adequate hemodynamics in the body is the result of rational interaction between three main factors: bcc, heart wikid and peripheral support of sudin. The change in one of these factors can lead to a "shock camp".

hypovolemic shock

Hypovolemic shock develops with a 20% decrease in the volume of the blood volume. Such a gostra vrata obsyazu can be the result of offensive officials:

Bigger-less significant final bleeding-

Internal bleeding, which occurs in the empty space (empty passage, grub canal) or in the tissue (hematoma). So, for example, a fracture stegnova tassels blood loss up to 1000 ml, fracture of the pelvic cysts - from 1500 to 2000 ml;

Plasma loss (opik, pancreatitis);

The waste of water (electricity, for example, sodium),

cardiogenic shock

Shock stun as a result of heart failure can be due to two reasons.

Through the lack of myocardial function and development as a result of a critical change in the heart wikidu. Decompensation infusion in case of lack of heart or breakdown of its rhythm (general or parts). Myocardial infarction, which occurs as a result of one of these mechanisms, is a fundamentally known cause of cardiogenic shock.

The transition to a fast, for a systolic wikid, is not enough for itself to be lacking in a way to go out of the way of the warehouse mechanism, which allows you to complete the grouping of unconnected causes, such as pericardial tamponade, intracranial thromboembolism.

Toxic-infectious shock

Toxic-infectious (bacterial) shock is, at least in the cob stage, to partly in its manifestation shock, wickedness to impaired peripheral blood circulation.

You can call it a shock of gram-negative microorganisms (enterobacteria and especially pseudomonas), ale septicemia, due to gram-positive microorganisms (actually staphylococcus), it can also be a cause of bacteria. The most frequent shock is the first familiar to the septic camp; In pathogenesis, which is mainly based on creatures, it means a change in the mechanisms of microcirculation. Slide behind the peripheral ulceration of the sudin followed by the stage of atony with the appearance of arteriole and blockage of the veins. It can lead to a significant stasis, which is overriding in the area of ​​the cranial zone, and from the same, up to hypovolemia, as a result of which there is a decrease in MOS. A whole decrease in MOS can be caused by direct damage to the myocardium by bacterial toxins. Bacterial endotoxins (exotoxins of staphylococcus) are used as a "triggering mechanism" of cych razladiv, such as vertebral infections, such as histamine, kinins and catecholamines.

Anaphylactic shock

Anaphylactic shock is the result of the interaction of circulating abnormal tissue antigens with antigens and develops after a similar mechanism of bacterial shock.

neurogenic shock

Pіd cim terminom ob'єdnanі destructions good time, Step behind the destruction of the central nervous system, or as a result of direct damage to the brain when speech is lost to the brain, or in case of pharmacological injection (ganglion blockators). The offense is a reason to lead to a decrease in VD and a secondary decrease in MOS with a further decrease in an arterial vice. Galmuvannya of the reflex ringing of the sudin does not allow coriguvati destructiveness.

Shocks are also encountered, mechanisms of such large folding ones. It is not susceptible to shocks, which are susceptible to massive withdrawal with barbiturates, since a neurogenic cause of shock is directly negative to the drug on the myocardium. Shock stun in people with polytrauma as a result of the appearance of two warehouse: hypovolemia and neurovegetative reactions. Shock with pancreatitis of hypovolemia, before which a toxic element comes, scho wiklikak, cyclomically, vasoplegia.

Ischemia of the brain is a type of cerebrovascular disease, the importance of pathology is expanded. Discikulatory encephalopathy is the name of a chronic ailment, as it stagnates in vіtchiznyany medicine. So tse take? Ischemia to the brain is a highly urgent neurological problem. This is a serious damage to the brain. In our days in the field of examiners, the diagnosis is made frequently. Dyscikulatory encephalopathy is hostile to close to 6% of the planet's population. A number of such ailments grow gradually.

Ethiology of dyscikulatory encephalopathy

Causes of ischemia. rіznі ailing to cause pathology. What is it also ischemic ailment to the brain?

The causative factors of circulatory encephalopathy are the following:

• atherosclerosis sudin;
• hypertension;
• fibrillation of the anterior;
• falling ill of blood-bearing judges;
• training of the endocrine system;
• ridge ailments;
• cervical pathology.

The blood in the tissues of the brain lays down from the level of erythrocytes. Wrong eating є cause of high cholesterol. Winik is the battle of the head. The great value is the great factor. In older people, it is not easy to develop ischemia in the brain. Young people suffer less ailment. Pohiliy vіk is a provocative factor.

Pathogenesis of dyscikulatory encephalopathy

The accumulation of cholesterol deposits in the blood vessels should lead to pathology. There are no gateways. The breakdown of cerebral blood circulation develops after the ischemic type. A vessel full of cholesterol plaque cannot visibly function. As soon as there is a blockage of the arteries, a sound to their education, a sour hunger develops. Clients of the brain who suffered from a deficiency living talk, Do not be updated. It is not easy for us to navigate a Sudan to a catastrophic legacy.

Classification of pathology

In ICD-10, ischemia of the brain is entered, which is a chronic type of cerebral pathology. Symptoms and treatment of dysculatory encephalopathy are in the competence of a neurologist. Likuvati ischemia foldably and dovgo. A multifocal or diffuse lesion occurs, an ischemic ailment in the brain develops. Cerebrovascular pathology is manifested by clinical, neurological, neuropsychological, mental disorders in the body.

Ischemia of the brain is diagnosed by a professional. Gostra form of cerebrovascular pathology є inherited from sour hunger. Rapt attack develop. The chronic form of pathology is formed step by step in the minds of the damaged blood circulation in the heads of the head.

key picture

Signs of ischemia to the brain are detected step by step or mittvo.

Dyscikulatory encephalopathy is manifested by offensive signs:

• pain syndrome;
• damaged parts;
• continuous noise in the head;
• the deed of the destruction of indicators of memory;
• low level of respect, decrease of prasezdatnosti;
• cognitive impairment.

At the early stage of cerebral ischemia, impairments of the functions of the nervous system are manifested. The shvidka appears to be swollen. The memory is heavily degraded. Tse to produce to a significant decrease in prasezdatnostі. However, beckon people at the stage not to show skarg. Most of the patients do not turn to a neurologist.

Dyscikulatory encephalopathy - damage to the brain of the 1st stage. The development of neurasthenic syndrome is observed. In general, the self-esteem of a sick person is normal, but a person can be lightly unconscious. For the early stage of pathology, characteristic chills, sudden changes in mood, gratitude, nerve zbudzhennya falling asleep. It’s not adequate to carry out the treatment, the camp of the ailing one will go to waste.

2 stages of ailment develop. There are gross neurological damage. Pathological reflexes are evident. Ailing turbine oniminnya, seeing the cold in the feet and lobes. Tse yaskraviy manifestation of pathology. Part of skargi on bastard self-respect... Break down the course. appear porosity... Patient sees after sleepiness. Zakvoryuvannya 2 steps to grow progressively lower memory. All signs of the 1st stage of cerebral insufficiency may occur at the same time, but if ailments are less likely to prevent defects. At the 2nd stage, transient ischemic attacks are indicated.

At the 3rd phase of ischemia tissue memory is lost, dementia develops. Social and labor adaptation of the patient will be destroyed. Such an ailment will require constant caution and a look. At 3 stages of ailment, there are even fewer scarg. Tse will explain to them that they will lower the critical position to their own will. At the stage of the headache it is painful to pass. Ale Stan is a human being. In sick people it is not uncommon for the importance of insult, dementia, parkinsonism.

diagnostic procedures

Yak can be put correct diagnosis? The neurologist assessed the ill symptoms and symptoms, if the patient's scarg is lingering. I would like 2 s characteristic symptoms to be manifested continuously by stretching out the last months, such scargs are to blame for the drive for the dead heart-vascular system.

When there is a sign of an ischemic ailment of the brain, the laboratory will be diagnosed with a blood test. The equipment of the dosage includes ultrasound, high-frequency ultrasound tomography, electroencephalography, dopplerogram of the brain, cardiography. The results of tsikh doslidzhen can show the localization of the battle.

Tactics of drug visits

Have symptoms of cerebral ischemia appeared? Yak vilykuvati sick? by ourselves effective method lіkuvannya є administration of special drugs, such as an individual drug. The head of the faculty is the treatment of forensic pathology. In case of ischemia of the brain, it is necessary to recover from the brain.

It is important to ease the symptoms of dyscikulatory encephalopathy, to improve the health of the sick. It is necessary to fend for blood internal wuh, Change the activity of the vestibular centers. Tse will help you to get out of trouble. I will look at the patient's camp, the neurologist signs Piracetam, Betagistim, Gingko biloba. Betagistim is the main drug, indications are up to date. vin normalizu electrical activity vestibular centers in the brain, peripheral receptors, I will reduce the blood circulation in the internal vuha.

Vestibo normal vestibular function. The whole drug is necessarily included in the therapeutic course for 2 or 3 stages of cerebral ischemia. Vestibo, Actovegin significantly reduce the noise in the ears, and the odds of aerobic metabolism will increase. Actovegin is a drug that will show a good result.

When vikorystannі cich preparationsіvіdbuvayut the processes of polishing the blood flow. Increase the energy resources of the clitin. Transport is becoming more active. Polysyuyatsya exchange processes. Shooting neurons in the brain to improve neuroprotection. Stagnant neuromodulatory drugs, vasoactive likarski zasobi, Neurotrophic cerebroprotectors, neuropeptides.

Such medications will help to neutralize the pathogenic factor, intercept and stop tissue tissue loss. Cinnarizine, Vinpocetine, Nimodipin are blockers of calcium channels. Such licks increase the cerebral blood flow, the odors of the stench expand the brain. The doctor recognizes Neuromedin, Pramipex, physiotherapy procedures, lykuvalny massage... Vykonutsya special vestibular gymnastics. Effectively sanatorium and health resort lykuvannya. When signs of ischemia to the brain are symptoms, treatment is the competence of the doctor.

What is the acceleration of getting sick? Dyscikulatory encephalopathy can lead to insult, infarction. Quite often the changes in the functions of the organisms, great activity. We are sick with the ischemia of the brain; treatment is necessary in a complex way. It is important to improve the dyscikulatory encephalopathy. Prophylaxis is being repaired earlier. It is necessary to all the uniqueness of stress, to control the vagu, to engage in physical culture. The prototype is shown to be victorian tyutyunu, drowned in alcoholic beverages. Ischemia of the brain is not safe.

In case of diagnoses of characteristic symptoms of ischemia, the patient should be referred to a neurologist. A bad step to show the fahivtsev. Early detection of pathology, treatment of ischemic ailments additionally helps to preserve old life.

The pathogenesis of AHF is developmental, the classification of a hostile heart failure on the basis of an early chronic interruption (CHF can be a lot of already present heart pathologies), or a host. Most often the disease is due to accelerated myocardial infarction. The diagnosis of the syndrome can be found in the young as well as in the young.

Reasons for the accusation and classification

The reasons for the development of a heartfelt deficiency in women, as well as in choloviks, are on the first and second, and more often cardiologists are stuck due to the wretched kind of ruin.

Before the primary causes of pathology in older adults and children, there may be:

1. Gastro ailments of infectious nature: hepatitis, INFLUENCE, scarlet fever in children, cyr, typhoid fever, rheumatism.
2. Fired with toxins, for example, foul gas, chlorine, oxide in carbon, methyl alcohol.
3. Harchovі іtruunnya for children and grown-ups.

As a result of the pathology of the disease, the heart is flushed or dystrophied. Harchuvannya and the need for speech to come in the smallest amount, the nerve regulation will collapse, and the heart of the heart grows girche.

Secondly, the reasons for getting sick are not to shy away from direct infusion on the myocardium, but rather to lead to overwhelming and unstable acidity. Prior to the date of delivery to be reported:

1. Attacks like breaking the rhythm.
2. Hypertensive crisis.
3. Stronger atherosclerotic lesions of coronary vasculature.

In case of hypertension, the heart grows up at the vase, the judgment is disgusting, the rapid health breaks down, which leads to the formation of an ailment. Atherosclerotic plaques change the mind and scarcity of blood, making up a sufficient supply of blood to the heart. Gosstra sertseva lack of - the phenomenon, with any cell of the myocardium vzagalit brother's fate in the process of blood circulation, causing the development of hypoxia.

Congenital anomalies in the development of the heart, myocarditis and hospitals of infections can often become the reason for the incidence of heart failure in children up to the age of three. More often, a child's heart failure syndrome develops through the infusion on the heart of strong spirits. Nebezpeka polyagaє in that, in children, symptoms appear only after an hour.

Yak rozp_znati zvoryuvannya

This is due to the fact that there is a heart of re-entanglement, the disease extends to the right ventricular and left ventricular type. Signs of that and the other type of hostile heart inadequacy to be self-conscious.

Show the pathology of the livy snuggle in the offensive fall:

1. Іnfarction of a livy little wench of the heart.
2. Hypertensive crisis.
3. Breaking the rhythm of the beat of the heart.
4. The filthy efficacy of the aortic valves.

Gostru left ventricular form of the disease is often called heart asthma. When a lot of sickness is involved, they try to attack (often at night), tied up with complications. Prior to the symptom type of pathology, consider:

• zadishka;
• unwillingness to accept lying position;
• the failure of the fortune, the unreality of the health of a deep breath;
• blіdіst;
• mayzhe blue lip color;
• cough with phlegm in viglyadi pini;
• dikhannya with wheezing;
• lowering the grip in the arteries;
• b_l behind the breast plate, it’s important to be docked;
• increasing blood circulation deterioration.

If I don’t give a sick person a chance to get medical help, the whole camp can be filled with legends, signs of how screaming vidikhs and vidikhs vvazhayutsya. The rhythm of the dichotomy continues to change, to the point of being pinned down. Nayvazhchiy signs of non-consistency of lіvnogo shlunochka - cardiogenic shock and collapse. Win trap, as soon as the raptus stops feeling close to half of the myocardium. Such a camp will clutter up the life.

Signs of a hostile right-wing disability are manifested with such camps:

1. Infarction of the right slunk.
2. Pericarditis (before the hour of that, I’m clutching at the heart, there’s a right-handed person).
3. Abrupt uncropped seizure in bronchial asthma.
4. Thromboembolism of the lung artery.

For an hour, the right ventricular type means onset symptoms:

• GOSTRI more views before we rule pidreber'yam (because of the fact that it’s in the heart of the blood).
• Swollen veins in the shia (good can be seen in children).
• The sign of the perevantazhennya right shlunochka (price can be seen on the EKG).

Gostra sertseva lack of - tse stan, with any additional help from the patient, it is possible only in the minds of the stationary.

Symptoms before death

The death of a patient with a severe form of pathology is often described as an unhappy symptom, a posture is seen with painful walls, and it can come from an overstrain (both physical and nervous). Half of the patients, not too well before the time of the lethal result, were caught before the death of the scarg to press the beat in the heart and in the face of fear.

For four children, death comes mittvo on a stable camp, for a couple of days before death, it means early catastrophes occur, so it’s like this:

1. More parts of the heart pain.
2. Inferior weakness.
3. Zadishka.
4. Adjusted in volume.
5. The inability to cope with physical options.
6. Arrhythmia.

The weakness and the anteropositic stump pass into the fibrillation of the heart and recession (asystole). After a couple of seconds, the blood circulation to the brain will creep up and the ailment will not be tolerated. Before death, with a heart failure, there are such symptoms as mimic rapid muscularity, galaslivi breaths, faintness and symptoms of children.

Even after 2 hours, the window expands to maximum sizes, And the good reflexes disappear. After 3 chilini, the dichanna will rise, incomparable processes will appear in the brain.

diagnostics

for recognition effective therapy it is necessary to establish the cause of the diagnosis. When looking at the car, it is typical to look at the patient's body, blue lips, veins on the shoulder. Listening to the heart gives an understanding about the broken rhythm, the manifestation of the tachycardia up to 120 and more blows for the sickness. Cardiologist vimiruy arterial vise, indicators of how to influence hypertension. There is also a rumor of the legends for the manifestation of a change in spirit, palpation of the liver.

Electrocardiograms are afraid and deciphered by the brigade at once in the machine of "shvidkoy help". Upon arrival of the patient in the medical mortgage, the diagnosis is carried out according to the offensive algorithm:

• Ultrasonic cleaning. With this help, not only the diagnosis is established, but it is the very beginning of the compensatory system and blood circulation.
• On the basis of blood analyzes, signs of pechinous and nirkovy ischemia emerge, it appears that the sour hunger is severely affected, and the products of the heart's mucus are ruined.
• X-ray directors can be made to enlarge the heart cordons, on lung tissue more ridini.

For all the results, the most effective way of treatment is possible: medication or surgical. Diagnostics of the disease is not a warehouse of special difficulties, but the axis I will not help you nadati a sick person is already more important. If the symptoms of ailment are present, it is necessary to be careful not to be infected with a cardiologist. Likarem is indicated for the therapy of hypertension and ischemia, control of the arterial vise, the level of sugar and cholesterol. Obov'yazkovo is regularly held and the EHC is updated for children to reduce the decline. Oh, I’m going to fix it during my hour prophylactic visits.

lykuvannya

The first help before the arrival of the patients includes the next steps:

• It is necessary to push the patient into a sitting position. At the same time, both the upper and lower ones are guilty of reloading in a lowered mill. Tse allow for the protection of blood from heart and mind.
• As soon as the attack was placed in a primitive state, it was necessary to see everything, as possible, by entering the room without any problems. zavazh dichny rucham Odyag znyati, rostebnuti.
• In a controllable grip, it is possible to proponate a human tablet "Nitroglycerin" along the tongue. Repeat qiu is allowed up to three times with an interruption of 5-10 khvili.
• Zapobigti a lot of legends you can make such diy. On the arms (in the area of ​​the shoulders) and the legs (zone of the stegon), jguty is applied, and it is as good as possible. Give a sick person a drink with alcohol, in which case you need to soak a piece of cotton wool in front of the front, and give it to nizdriv.
• As soon as the pulse is dumb and the energy is gone, I have to carry out the massage of the heart and the piece ventilation of the legends.

For the stage of conducting non-emergency pre-hospital visits, the sick term is delivered to the hospital. The hospital progresses to treat the syndrome of hostile heart failure. As soon as the person has been helped, the patient has to come back to normal, then it can be seen from the treatment in the walls of the clinic. But after 6 years, the brigade of "Shvidkoy" is guilty of viihati, so that they can control their sickness or transfer them to the clinic wiklik.

As soon as the attack was made among people with a chronic form of ailment, then the result of a glance and speed is a sign of earlier therapy.

The main ones come in, which are held in the stationary, poll at the victorian medicinal preparations:

Termynova will help the surgeons in any way they can in any situation. Relevant operatively in case of heart-vascular system diseases, which caused them to be attacked by myocardial deficiencies: enlargement and development of aortic aneurysms, valvular defects, aortic regurgitation, chronic cardiac disease

The surgical approach can include offensive operations:

• myocardial revascularization;
• prosthetics, reconstruction of valve stools;
• Correction of the same kind of heart wads;
• connection to the blood circulation system.

1. Polize metabolism in the heart and prevent it from eating asparagus likarska. In lykuvanna take the fate of all the elements of the growth. Oh, you need to do it, take 3 teaspoons of syruin, pour it with sprinkle and insist for 2 years in an airtight container. You can vikoristovuvati in the tsikh a thermos. Drink an infusion of treba through the skin for two years on a total of 1 tablespoon.
2. Against the good stuff, help the root of lovage. A good sechoginniy zasib is prepared for you. Taku taku alcohol infusion: take 100 g of dry roslin nude alcohol. Place the container in a dark place for 14 days. Let's drink on the tablespoons before the three for the day.
3. The natural hearts of the glucoside are to be found in the conval. The stench is necessary for the advancement of the heart. Ale zastosovuvati such words are not without a sign of a lykar. Nastia gotuyut like this: take a bottle of sprinkle for a teaspoon of fresh quotations. Brew pivgodini, process and take a tablespoon of three for a day.
4. With kind zaspok_ilivyy zasoby become real and v_dvari, prepared on the basis of poultry, meat, valerian, melisi, fennel, glode.

If you show you are ill guilty, you will serve as an incentive for the "shvidkoy" wikklik, to provide for and for the most part reasoning about the reasons for the attack. The prognosis in case of a serious heart failure is due to the fact that additional help will be given as quickly as possible, as the myocardium is severely damaged and out of the development of the non-slip camp. Outside of the statistical data, a large half of all cases will end with a fatal result. People who have been kidnapped and children are especially appreciated. It’s not a matter of insecurity, traces of a heart failure, in the presence of such pathologies: bronchopneumonia, nirkov or pechinkov’s deficiency, accumulation of legends, embolism, insult. Diagnosis "gostra sertseva lack" - tse privid in the edge of the world to be put to good health.

Beastly respect, that all information is disseminated on the site and bears a pre-existing character and

not intended for self-diagnostics and illicit diseases!

If the site is overhauled, it will not mean that it is active for the first time.

The Іnshi form of the guest ischemic ailments of the heart (I24)

victories:

• angina pectoris (I20.-)
• neonatal myocardial ischemia (P29.4)

Coronary (artery) (veni):

• embolism
• occlusion
• thromboembolism

do not lead to myocardial infarction

Exceptions: chronic coronary thrombosis, if it is tricky for more than 4 days (more than 28 days) per ear (I25.8)

coronary:

• lack of
• disunity

Excluded: ischemic ailment of the heart (chronic) NOS (I25.9)

The Russian International Classification of ailments of the 10th glance (ICD-10) has adopted a single normative document for the incidence of illness, the reasons for the infestation of the population to the medical establishments, the causes of death.

ICD-10 was introduced into the practice of protecting health in the entire territory of the Russian Federation in 1999 by the order of the Ministry of Health of Ukraine dated 27.05.97. No. 170

A new look (ICD-11) is planned by WHO in 2017 2018 roci.

From the changes and additions of the VOOZ rr.

Processing and transfer zmin © mkb-10.com

Anomalies of the gastric coronary syndrome (code for MKH 10)

It will remain an hour, all the more often in medical practice, to develop such a diagnosis, such as coronary syndrome, the code for the international classification of ailment (ICD 10) in which I20.0.

Such a patient's camp is only necessary for a prior diagnosis, which, as a rule, is given to a patient in the first few years of the hospitalization.

Based on the results of the electrocardiography and laboratory examination of the patient, the patient can put a residual diagnosis: myocardial infarction at the stage of development or angina is unstable. OKS є the basis of cich double diagnoses.

Who has special features

The syndrome appears to end up with a great change of sign, as it is used to develop a patient with myocardial infarction in the state development stage. Fakhivtsi means that such a camp will not be seen in a sick person, but only for a syndrome.

In some cases, there is a diagnosis of ischemic ailments of the heart and ACS. Ale tse is not so. In case of ІХС, there is a small decrease in the size of the mitral valve, as it is supervised by the manifestation of one abnormal symptom.

Todi yak with syndromes are practically all signs of ischemia or angina pectoris.

Signs that are manifested in a patient with an attack of a severe coronary syndrome, it is more important to influence the development of the IB heart, in the need for a term medical aid... In the end, it is a very deadly result. As the age falls on unstable angina pectoris, the sick person's camp is not so serious.

But it doesn’t mean at all that there’s no need for the construction of the people.

Nichto we can not be absolutely equal to the one who can end with ACS: IXC or angina pectoris. Tse means that at the most recent age, it will inadvertently turn to fakhivtsiv.

dear

Victory of the results of a comprehensive treatment is given for the establishment of the classification of any ailment or pathology. OK syndrome is not a blame.

For this classification, the results of electrocardiograms are taken as a basis, and it is also more accurate that the position of the ST-segment can be seen at that moment, if the right and left heart of the dumbbells are in the systole phase. At the present time, there are indications of this type of disease in the syndrome:

1. The ST segment is in the raised position. For this type, the development of occlusion in the coronary artery is characteristic.
2. Chi does not discourage the growth of the segment.

Dana klasifіkatsіya vvazhaєtsya to finish with an approximate. The reason for this is that it is not possible to read between ІХС and unstable angina pectoris.

Especially foldable zupinititsya on one zhvoryuvan on the cob stage. For this, it is necessary to decipher the data that is taken out by the electrocardiographers.

cause

You can talk about factors that can provoke the development of severe coronary syndrome, they can be combined into one group with factors of risk. Vyhodyachi z tsogo, a provocateur of the syndrome can be:

1. The development of atherosclerosis in the coronary arteries, such as the improvement of blood circulation in the heart, as well as the formation of cholesterol plaques, will destroy the blood circulation in the heart.
2. Trombuvannya arterіy. Such a process, as a rule, is the result of a thrombus. In general, ailments will require an inconspicuous hospitalization in order to avoid their death.
3. Spadkova smartness. Even though relatives on both sides have spared such problems, the development of OKS is growing rapidly.
4. Kurinnya. Moreover, vagitniy zhіntsі does not necessarily burn itself. To reach the term of vaginosity with a stretch, periodically perebuvati in one attachment with a chicken.
5. High level of cholesterol. Cholesterol є specific chemistry with two new species: ЛПНЩ і ЛПВЩ. As the number of cholesterol of the first type is higher, lower than the other, it is ideal for the development of atherosclerosis or thrombosis.
6. Great vaga tila.
7. The development of such a discomfort, like a diabetic diabetic, or an analogous ailment, associated with an increase in insulin.
8. Arterial vise adjustment.
9. Parts of the nerves are shaken or stress.
10. A sedentary image of life.
11. Pohiliy vik. As a rule, the power syndrome develops in people after 45 years. At the end of the day, chronic illnesses become stricken, and immunity falls to the body.

Yakshcho lyudin is sick to the point of pouring in one or more decilkoh factors, wine is consumed in the group for the development of a state-of-the-art COP.

diagnostics

For an accurate statement of the diagnosis, it is necessary to go through the following steps:

1. First history of the patient. At the end of the day, the doctor vislukhovu all the scars of the patient, to carry out yogo auscultation. It is an extremely important moment of the whole stage є knowing about the minds of the robot and the life of the patient, as well as about the manifestation of a childish family, getting sick from the closest relatives.
2. Laboratory coverage:

• zagalny blood analysis;
• analysis for the value of two types of cholesterol;
• biochemistry of blood;
• viznachennya rivnya zukru in blood;
• doslіdzhennya shvidkostі zgortannya blood;
• OA sech_.

1. Electrocardiogram. The tsey method is to be used as efficiently as possible. Especially in that case, as the result will be known before the hour of the attack and the message. Tse give the power to value, as the frequency of the fast heart changes, or the debts are empty in the minds.
2. Ultrasound monitoring of the heart. This kind of obsozhennya gives the possibility of the magnitude of the size and structure of heart disease, to determine the characteristics of the blood stream, assess the level of development of atherosclerosis of blood vessels and valves of the heart, to determine the rate of deterioration of the frequency.
3. Coronary angiography. Є One of the versions of the X-ray signaling of the heart, which additionally helps to correct the information about the localization and the stage of development of the sound of the Vintsev spacecraft.

Iakshcho winikne such a need, to get to the point of helping the faculty members of the university profile, or carrying out more folding methods.

lykuvannya

The vibe of the same method of development is based on such factors as the type of syndrome, the steps of its development, officials, who provoked the development process, the patient's camp.

For the treatment of severe coronary syndrome, the following basic methods of treatment are used:

1. Medication. At the same time, drugs of the following groups are recognized:

• anti-ischemic (beta-adrenergic blockers, nitrate, antagonism of calcium), which are directly related to lowering the consumption of heart's ointment in spite of sourness, lowering the arterial pressure, reducing the frequency and speed of the heart;
• disaggregation, as a result of the change in the thrombocytes gluing;
• antiaggreganti - lykarski zasobi, poklikanі change the thrombus;
• thrombolytics - are recognized when necessary, if there is a need to apply fibrin filaments;
• statini, which manifest itself in blocking the growth of atherosclerotic plaques;
• heavenly.

1. Hirurgic. One of the types of operative involvement, as vikoristovuyutsya for the treatment of corticosteroids - the whole of coronary revascularization. It is a kind of vruchannya to finish the young, but for their conduct it is necessary to have the obviousness to finish the expensive and rich possession. On top of that, the operation is very flexible. As a result of these clerks, the operation is practiced even more rarely.

In modern medical conditions, there are two areas of coronary revascularization: balloon and coronary artery bypass surgery. The skin of them has its own plus and minusi:

1. Balloon coronary angioplasty. The essence of the polyagus method is that a thin catheter is inserted through a small opening to the heart of the patient, on one end there is an expansion chamber. In order for the probe to reach the place where the thrombus has grown, the expanding balloon will open, and by the same time, the walls of the vessel will be expanded, by way of introducing a thin tube from the micro-organically safe material into the hole.
2. Coronary artery bypass surgery. The whole method is also a vidomy yak prosthetics of blood-bearing vessels. The essence of this pole is in the direction of another path, which is to pass through the mission of localization of the CS.

When we go to coronary syndrome, we also need to use phytotherapy and physical culture. But it is not possible to forget about those methods that are recognized as preventive or rehabilitative, but not in the quality of treatment.

/ LUTS cardiology

Gostriy CORONARY SYNDROME WITH PIDIOM OF ST SEGMENT.

I INFARCT OF MYOCARDIUM WITH PIDIOM OF SEGMENT ST.

Meta stage: Meta to improve the function of vital systems and organs, stable hemodynamics and advanced rapidity, and more and more rapid reperfusion for additional fibrinolytic therapy for abdominal angioplasty

Code (codi) according to ICD10

I21 gostry myocardial infarction

I21.0 Gostry transmural infarction of the myocardium of the anterior wall

I21.1 gostry transmural infarction of the myocardium of the lower stinka

I21.2 gostry transmural myocardial infarction and other specified localizations

I21.2 gostry transmural myocardial infarction, unspecified localization

I21.9 gostry transmural myocardial infarction, unspecified

Purpose: Myocardial infarction - ischemic necrosis of the heart, which develops as a result of lack of coronary blood circulation. Є The most widespread cause of death and disability of the population.

Classification: Transmission of th e rospodil by:

the size of the і glibinus of the heart meat: transmural IM - in the presence of necrosis it expands, either to the entirety of the heart meat, or to a larger part; non-transmural IM - in the presence of necrosis of rosette in the subendocardial or intramural viddils of the heart meat;

Diagnostic criteria: head with a classy acquaintanceІМ є angіnous bіl. Behind the power, there was a lot of variance, from the porteous lightness to the superstitiously strong, intolerant. Ailments characterize її yak squeeze, how to emboss, іdshe baking, cutting, tearing, dingzhalniy, wishing to locate behind the breastbone, growing in half of the thorax, in the middle of the breast, in front of the shoulder, in front An ear of rapta pain, the triviality is more than 30 minutes, it cannot be stopped by repeated intake of nitrates.

Strus zadishka, bliss, marmor, cyanosis of shkirny crooks, cold sticky pits, fear of death, awakening or driving a sick person. With an active obesity, there is a blizzard of cryptic curves and mucous, cold food, a deaf heart, an arterial grip will slightly decrease, overwhelmingly systolic, but sometimes it is possible to slightly break down. Zbіlshennya frequency and dikhannya, zadishka.

Electrocardiography is the main method for diagnosing damage to coronary blood circulation on pre-hospital stage... The EKG allows the development of the ST segment, a decrease in the amplitude, as much as an additional detection, the R wave, the manifestation of a pathological Q wave, a blockage of the left side of the gus bundle. On the ST segment without a pathological Q wave, there is a coronary syndrome with the ST segment onset. The appearance of a pathological Q wave on the EKG indicates the appearance of necrosis in the heart muscle.

Identification of markers in cardiomyocyte necrosis. It is very sensitive and specific є the value of the concentration of troponin T and I. Necrosis of cardiomyocytes of the supernatant grows at a relatively rapid and significant increase in the concentration of troponin. Rivn troponin T is used to start an additional express test.

Tactics of providing medical aid: By stretching 10 quills to the first contact medical doctor We are ailing, it is necessary to register and interpret the EHC. If it is uncomfortable to deliver the sick person to the hospital, which is to carry out percutaneous coronary arteries, with a stretch of 90 hilines from the first contact with medical personnel, thrombolytic therapy is indicated in the pre-hospital stage.

Nitrati tablets abo aerosol, if necessary, repeat

Antiplatelet therapy Acetylsalicylic acid - for planned primary PCI - mg. in the middle of ilimg i / v; s TLT mg vseredin or 250 mg i / v; without reperfusion therapy - mg in the middle.

Clopidogrel - in case of planned primary PCI - a nasal dose of 600 mg, at least 75 mg / day, with TLT - a nasal dose of 300 mg, at least 75 mg / day, Without reperfusion therapy - 75 mg / add. in the middle.

For the improvement of coronary blood circulation izosorbita dinitrate 10 mg. all the way in droplets by and large under the control of AT.

For the renewal of coronary blood flow - thrombolytic therapy. Recommended for 12 years for an ear of symptoms in patients without evidence, as it is unwise for a primary PCI to be passed out for 120 minutes for the first time in contact with medical personnel

Shown before TLT - when an hour on the ear of an anginous attack is 4-6 years old, take not more than 12 hours advances of the ST segment.

Prototype shown before TLT.

Before the transfer of hemorrhagic stroke or CMD of unattended walking;

An ischemic stroke of transfers lasting 6 months;

Recent major head injury / surgery - remaining 3 types;

Poshkojennya abo new solution of the central nervous system abo defect development;

Dose for aortic aneurysm;

F-K bleeding with a stretch of the last month

Evidence of bleeding or hemorrhagic disease (behind the vignette of menstruation);

The items in the month are not delayed for the last 24 years.

Transient ischemic stroke in 6 months ahead;

Oral anticoagulant therapy;

Waiting for a stretch of 1 stretch for canopy;

Refractory hypertension (SBP ≥180 mm Hg i / abo DAP ≥ 110 mm Hg);

Engulfing pechinki in a progressive stage;

Sharpening of the viral ailment or 12-palate intestine;

Traumatic abo trivial (> 10 min.)

streptokinase -(Not a fibrin-specific drug) administered intravenously in a dose of ME will be replaced in a small amount of physiological solution.

alteplase- administered intravenously following the bolus + infusion regimen. Dose 1 mg / kg mass, or not more than 100 mg. A bolus of 15 mg is administered with an additional infusion of 0.75 mg / kg mass for 30 quiline (not more than 50 mg), then 0.5 mg / kg (not more than 35 mg) for 60 quiline. The triviality of the infusion is 90 minutes.

Tenekteplaza- the dose is administered in 5-10 seconds with a bolus in the presence of sickness. 30mg with a mass less than 60 kg, 35 mg with a mass of kg, 40 mg with a mass of g, 45 mg with a mass of g, і 50 mg with a mass of more than 90 kg.

Hospitalization: Ailment with ACS or myocardial infarction with ST segment infarction or a new LBBB will be delivered to the closest clinic of the PCV with information about the patient's arrival hour. The patient must be transported without the aid of a catheterization style.

In installations without the possibility of carrying out PCI, ailments are transported in a cardio-reanimation, at the very least, as soon as possible.

Izosorbita dinitrate (Izoket) 10 mg 10.0 solution for intravenous administration

Nitroglycerin: tablets 0.0005, aerosol.

Acetylsalicylic acid 0.5 tablets

Clopidogrel 75 mg. pills

Morphin hydrochloride 1% - 1.0 amp

Metoprolol 50 mg. pills

streptokinase -ME

Alteplase 50 mg powder

Tenekteplazamg powder

Sodium chloride 0.9% - 500.0 solutions for infusions

Glucose 5% -500.0 solutions for infusions

Reopoliglyukin 400.0 solutions for efusion

Gostriy CORONARY SYNDROME WITHOUT PIDIOMU SEGMENT ST.

I INFARCT MYOCARDIUM WITHOUT PIDIOMU SEGMENT ST.

Meta stage: Meta to improve the function of vital systems and organs, stable hemodynamics.

Code (codi) according to ICD10

I20 angina pectoris (angina pectoris)

I20.0 unstable angina

I21 gostry myocardial infarction

I21.4 gostry subendocardial myocardial infarction

Viznachennya: Gostriy coronary syndrome - whether it is a group of key signs or symptoms, so they allow you to get a gostriy myocardial infarction or unstable angina pectoris. Myocardial infarction - ischemic necrosis of the heart meat, which develops as a result of lack of coronary blood circulation. Є The most widespread cause of death and disability of the population.

Classification: unstable angina pectoris:

the size and the glybin of the heart muscle damage: non-transmural IM - in the presence of the necrosis of the rosette in the subendocardial or intramural spaces of the heart meat;

For the nature of the perebіgu zahvoryuvannya: pervinniy, repeated, relapsing;

For localization: anterior septal (anterior septal), anterior apical, anterior, anterior basal (viscous anterior), widening anterior, posterior phrenic (lower), posterolateral, posterior basal, widening posterior;

For the stage of becoming ill: gostry, gostry, pidgostry, postinfarction period;

For the manifestation of acceleration: inability, acceleration.

Diagnostic criteria: head clinically familiar with unstable angina pectoris and ІМ є angina bile. Behind the power, there was a lot of variance, from the porteous lightness to the superstitiously strong, intolerant. Ailments characterize її yak squeeze, how to emboss, іdshe baking, cutting, tearing, dingzhalniy, wishing to localize behind the breastbone, growing in half of the thorax in the middle of the breast, in front of the shoulder, in front An ear of rapta pain, the triviality is more than 30 minutes, it cannot be stopped by repeated intake of nitrates. Some of the ailments may have such symptoms as a coward's scare, bliss, marmoriness, cyanosis of scum, cold sticky pits, fear of death, awakening or driving down a sick person. When there is an active obesity, there is a blaze of small crooked and slimy ones, cold food, a deaf heart, an arterial grip slightly decreases, overwhelmingly systolic, but sometimes it is possible to slightly break down. Zbіlshennya frequency and dikhannya, zadishka.

Forward angina pectoris: To be called so, that anginose attacks to the whole of a sick person. The triviality of the first angina pectoris occurs 4 times at the moment of the first angina attack. Anginous attacks from one and the same sick person, stretching out for a short period of time for an hour, are driven by their turn, gravity, triviality. Attack of angina pectoris can be caused by injecting physical pressure of low intensity. The stench doesn’t come across very importantly, I’ll be overwhelmed by sudden deaths, I’ll suddenly feel fearful, zadishka, tachycardia, bright cold, sticky pith, sharp weakness.

Progressive angina pectoris: In ailments, as it takes a trivial hour to suffer angina pectoris, the process is like bi stinging. Anginose attacks are often, become important and trivial, the zone of irradiation often changes. Progressive angina pectoris can be manifested in decilkokh klinic forms. In some cases, the number of angina attacks without a real change in character is very often. In some cases, the triviality and intensity of more attacks are increasing, and more zones and delays are expanding. Before attacks of angina pectoris, angina attacks can be brought in calm. I will go to see a lot of physical options. Nitroglycerin in different doses does not give a great effect. The development of stressful situations, physical overstrain, cramped arterial grip, unreasonable harchuvannya, disruption of the heart rhythm and unpleasant officials.

Spontaneous angina pectoris: The form of angina pectoris is manifested by low specific symptoms. Anginose attacks in case of niyayut rapt, without connection with physical navantazhennym, often cyclically, occurring in one or even an hour, often at night. More can be done in a specific localization, meaning more turns for strength and triviality, last for minutes and more. The morphological basis of spontaneous angina is a spasm of great, often subepicardial, arteries.

Switching of the main and additional diagnostic entries:

Electrocardiography is the main method for diagnosing coronary blood circulation disorders in the pre-hospital stage. The EKG allows the development of the ST segment change, the inversion of the T wave. Zsuv of the ST segment is lower than the isoelectric line more lower by 2 mm, the belt is smoothed, two-phase, negative prong T inform about myocardial ischemia. With intramural growth of ischemia or necrosis, changes in the T wave are more likely to occur.

Identification of markers in cardiomyocyte necrosis. Most sensitive and specific є the value of the concentration of troponin T and I. The necrosis of cardiomyocytes of the supernatant is usually a rapid and significant increase in the concentration of troponin. Rivn troponin T viznachaa for an additional express test. In case of unstable angina pectoris, troponin T does not develop, in case of myocardial infarction, it does not develop.

Tactics for providing medical assistance:

Physical and social spokiy

Nitrate tablets abo aerosol, if necessary, reapply the language nitroglycerin at 0.4 mg or isosorbid dinitrate at 1.25 mg (spray) (after taking care of systolic blood pressure)< 90 мм рт. ст.).

Oxygen therapy Kisen - supply 4-8 l / hv< 90%.

Antiplatelet therapy Acetylsalicylic acid is a sign of all patients, who do not have any contraindications, with the first dose of antiplatelet, which should become 150-300 mg.

Klopidogrel is a navantazhuvalny dose of 300 mg, with a dose of 75 mg - 75 mg.

Direct anticoagulants, if necessary, vibrate from the lower ones:

Enoksaparin - (1 mg / kg twice a day n / c) it is recommended that, if fondaparinux is not available, it is allowed to administer an intravenous bolus of 30 mg in patients with advanced risik, if the rate is less than 75

Non-refractionated heparin (UFH) - (with the presence of fondaparinux or enoxaparin), an intravenous bolus of ED / kg is shown (not more than 5000 OD).

Pain relief - triggered intravenous administration of opioids: morphine for trivial pain 4-8 mg intravenously with pre-given administrations 2 mg of skin 5-15 min. Before kupiruvannya pain, or if any side effects appear.

For the improvement of coronary blood circulation izosorbita dinitrate 10 mg. internally, drop by drop, by AT control.

When out of sight, the counter-indication of ß-adrenergic blockers is in the middle.

Hospitalization: Hvory with ACS or myocardial infarction without the ST segment is delivered to the specialization of the hospital in cardio-rehabilitation, as soon as possible.

Transfer of basic and additional medicines:

isosorbita dinitrate (isoket) 10 mg -10.0 solution for intravenous administration

Acetylsalicylic acid 0.5 tab.

Clopidogrel 75 mg. pills

Fondaparinux 2.5mg. / 0.5 ml for syringes for injections

Enoksaparin 100mg / 1.0 ml solutions for ін'єкцій

Non-fractionated heparin 5.0 vials

Bisoprolol 5 mg., 10 mg. pills

Metoprolol 50 mg. pills

Sodium chloride 0.9% - 500.0 solution for intravenous injection

Glucose 5% -500.0 solution for intravenous injection

Reopoliglyukin 400.0 solution for intravenous injection

Loss of heart rhythm.

I47 Paroxysmal tachycardia

I 47.0 Swivel arrhythmia

I47.1 Nadshlunochkova tachycardia

I47.2 Ventricular tachycardia

I47.9 Paroxysmal tachycardia, unspecified

I48 Fibrillation and tripping at the front of the heart

I49 Інші damage to the heart rhythm

I49.8 Inspection of heart rhythm disturbance

I49.9 Disorder of heart rhythm, unspecified

Viznachennya: Violations of the rhythm are called changes of normal physiological speed of heart as a result of the distribution of functions of automatism, wakefulness, provocation and speed. Cycling is a symptom of pathological conditions and ailments of the heart and associated systems. The plan for the reaction of the fauns to help them is classically significant is the breakdown of the heart rhythm, since the smell is the greatest step for those who are not safe and guilty of being guilty of being recognized at the time of the development of the transport.

Correct identification and treatment of arrhythmias in patients in critical countries can be passed over the heart. As a patient’s stance is not considered unstable, or we are hospitable, there are many options for treatment, including medication. If you are ineffective, you can telephone a special brigade.

Tachycardia with a wide QRS complex:

regular tachycardia with a wide QRS complex:

supraventricular tachycardia with blockade of the lower bundle

irregular tachycardia with a wide QRS complex:

fibrillation in front of the heart with blockade of the lower bundle of the gas,

fibrillation in front of the heart with early stimulation

shlunochkiv (WPW syndrome)

Tachycardia with a higher QRS complex:

regular tachycardia with a high QRS complex:

AV vuzlova takhіkardіya,

AV University tachycardia with Wolf-Parkinson White syndrome

Trypotinnya atrium with regular AV conduction (2: 1),

irregular tachycardia with a high QRS complex:

tripping in front of the heart with variable AV performance

The appearance or the visibility of the uncomfortable is a sign of dictating therapeutic tactics in case of large arrhythmias. The onset of unpleasant signs indicate instability in the camp, tied to an arrhythmia.

1. shock- blіdі cold shkіrnі pokrivi, loss of evidence, hypotension (systolic arterial vise< 90 мм рт. ст.).

2. Syncopal attacks.

3. Sertseva lack, Which appears OLZHN (nabryak legends) or OPZHN (pushing a grip in the jugular veins, swelling of the liver).

4. ischemia of myocardium To see if you see attacks of angina pectoris or if you see a painless ischemia - in the eyes of the EKG.

Yaksho patient is unstable.

If the patient is unstable and the patient will lose weight, simultaneously carry out a synchronized card version up to 3 times (the procedure is acceptable if HR is ≥ 150 beats in 1 hour). In the absence of an effect, amiodarone 300 mg is administered intravenously during the course of the day and is repeated using an electric cardioversion. With a navantazhuvalnoy dose, I repair the infusion of amiodarone 900 mg for 24 years.

Synchronized electrical cardioversion.

Synchronization with the R wave of the patient obovyazkov. Before the synchronized electrical cardioversion, the patients undergo premedication.

In case of tachycardia with a wide QRS complex and fibrillation in the anterior region, a monophasic discharge of 200 J or biphasic J should be stashed;

The anterior and paroxysmal overshoot tachycardia is converted by discharges with a cob energy of 100 J at a monophasic lidzha pulse with a biphasic pulse.

Yaksho patient is stable.

As a patient with a tachycardia, he is stable, he is victorious in drug therapy. At the same time assess the rhythm according to the EKG and the triviality of the QRS complex. If the QRS complex is more than 0.12 seconds, the tachycardia is classified as a wide complex. If the QRS complex is less than 0.12 seconds, the tachycardia is classified as a narrow complex. For viznachennya podalshoi tactics of treatment, it is necessary to start, which has a regular arrhythmia (that is, QRS complexes are regular). Vagus priyomy can be enough for the initial treatment of the supra-slurry tachycardia.

EKG-monitoring in case of instability,

EKG 12 a day,

pulse oximetry for measuring blood oxygen saturation

Switching of the main and additional ** diagnostic entries: monitoring and detecting the progressive death of the sick person by several parameters, for example for the "cutting and trigger" systems with one heart rate parameter< 35 и >140 in 1 xv; dichanna frequency<6 и >32 in 1 xv; i AT< 80 мм рт. ст. орбеспечивают наилучшую прогностическую оценку.

Tactics of providing medical assistance: Patients whose camp has become critical because there is a threat to their development, it is necessary to visit a team of special assistance - BIT or reanimation.

The first assessment of the diagnosis of patients with arrhythmias is due to the ABCDE algorithm. The key moments in the process include the assessment of unwelcoming signs, signifying a great flow the installation of venous access and improved monitoring (EKG, AT, SpO2). It is necessary to get rid of any electrical damage (cal, magnesium, calcium).

Meta lіkuvannya arrhythmias - converting to sinus rhythm But, take into account, the trust of the slurry type. The assessment and treatment of all arrhythmias are correlated to 2 factors: the patient's body (stable or unstable) and the nature of the arrhythmia. The range of antiarrhythmic drugs is developed more and more and is less important, less electric cardioversion, so it is recommended to use drugs in stable patients without uncomfortable signs. In unstable patients with unwelcoming signs, the electric cardioversion is a variant of the choice.)

Non-pharmacological treatment of vagal pain in case of regular tachycardia with a higher QRS complex

Fibrillation anterior to the blockade of the lower bundle-

lykuvati, yak arrhythmia with high QRS complexes.

Fibrillation in front of the heart with an early stimulation

Polymorphic shlunochkova tachycardia, for example, torsades de pointes- magnesium sulfate 10 min.

Shlunochkovatah_cardia - amiodarone 300 mg for 24 years.

Supraventricular tachycardia with blockade of the lower bundle of the gas adenosine (ATP) is also the case for tachycardia with narrow QRS complexes.

QRS- vagus, if necessary, adenosine 6 mg intravenously rapidly, dal at a daily efficacy 12 mg, more than 12 mg.

Regular tachycardia with the university complex QRS - the frequency of the heart is faster, for example, with beta-blockers.

Irregular tachycardia with the university complex QRS - imovirna blinking arrhythmia - control of heart rate with beta-blockers or diltiazem internally, far more possible to consume digoxin or amiodarone in case of heart failure. With a trivial attack of more than 48 years - anticoagulant therapy.

Shown before extra hospitalization

The breakdown of the rhythm has been revealed.

Tachycardia with non-effective drug therapy

Tachycardia with non-effective electrical cardioversion

Takhіkardії with the manifestation of unwelcoming signs, navіzanih.

When developing, antiarrhythmic therapy is accelerated.

Tachycardia with increased signs of heart failure.

Transfer of basic medicines

Amiodarone (cordarone) 300 mg 3 ml, amp

Magnesium sulfate 25% 5ml, amp

Adenosine (ATP) 1% 1 ml, amp

Propranolol (obzidan) 0.1% 10 ml, amp

Digoxin 0.25% 1 ml, amp

Transfer of supplementary medicines:

Fentanil 0.005% 2 ml, amp

Promedol 2% 1 ml, amp

Diazepam 0.5% 2 ml, amp

Heparin 5 ml vial, activity 5000 OD in 1 ml

Sodium chloride 0.9% 500 ml, fl

Diltiazem 180 mg tablet

To continue jumping, you need to take a picture.

Tsikavo! In all, there are majestic cats in the face of heart flaws, for example, in the United States, vitrati becomes 40 billion dollars a lot. There is a lot of sickness gradually growing, more often people are hospitalized for 65 years.

Chronic lack can be characterized by the following rank - the lack of ability of the heart-vascular system. Vaughn turn around in the ill-will of not having the necessary blood supply internal organs and myazovyh fabrics, which require a lot. The chronic form develops in the minds of the destruction of the heart functions, more precisely, the words of the myocardium. navigate at sliding grip you can't blow all the shelter out of the empty heart.

Causes of the pathological process and how to fail

The head cause is the defeat of the middle ball of the heart meat, the aorta, which is attacked directly from any of the valves. It can happen with the presence of ischemia, ignition processes in the heart, cardiomyopathy, as well as systemic damage with good fabrics organism. Mother's exercise can be toxic in nature. Tse vіdbuvaєtsya when otvennі toxic spews, otruts, medicinal preparations.

Bloody judges, great unpaired artery can be hostile with such ailments:

• atherosclerosis;
• stike pidvischennya vise;
• if there is a lack of sugar in the blood, there is a deficiency in the hormone insulin.

Chronic lack of heart to provoke and vices of the heart of a congenital or unsettled walk.

If the circulation of the blood is able to recover, it is better to fix the sour hunger of all the insides of the body. What is the urge to lay down from the number of living words and blood. One of the characteristic manifestations of a given camp is a backlash when navanazhennya and in a camp of calm. Ailments can be caused by not a mental sleep, tachycardia and stomatosis.

Symptoms, such as the power of the given camp, appear because the function of such a heart is difficult. In some cases, cyanosis is spontaneous, so as to add a twist to the fingers and lips of a blue-blue vidtinku. Tse inform about the shortage of sourness in all parts of the body. Nabreaki nіg andіnіh parts tіla wikklyayutsya time, so that in the venous channel the roof stagnates. If there is a re-placement of the liver veins, then there is more evidence in the area of ​​the right sidebar.

In the world of the development of a pathological process, the symptoms are overwhelmed by the symptoms.

Classification of disease

According to the ICD 10 code, a chronic shortage can be found in the following forms:

• serous heart failure (150);
• storage (150.0);
• livo shlunochkova (150.1);
• unspecified (150.9).

The protracted form of the sickly camp is characterized by the fact that the pathology is formed step by step. Її development can be reached by a number of tizhnіv, mіsyatsіv, rokіv.

For the classifications, chronic heart failure extends to IV functional classes:

1. navantazhennya not supravodzhutsya special stomlyuvanism, angina pectoris. The perceived heart rate, the slowness and the lack of activity are not implied;
2. overwhelmed in peace, ailments, seeming to yourself well, even if you see discomfort when you are nagging (in volume, difficulty in feeling, beating at the breasts);
3. there is a lot of physical activity;
4. Lyudin is not good at it. uncommon views... All the symptoms can be felt at peace, and when the stench is added, they will accept it.

Most often, if there is a chronic heart failure of the 1st step, the ailment may not be well enough to be found with it. It is imperative for the drug addict to drag on, which can lead to negative health benefits.

rigidity

Chronic heart failure of symptoms and treatment is tightly tied between oneself, even if it is not necessary to go to therapy, it is necessary to correctly diagnose. In the process, there is a critical manifestation of the history of ailments. You can't do without additional dosages, the stench comes from instrumental and laboratory. In the first one, there is an electrocardiogram, and in the other - a zagalny analysis of the blood, biochemical, and also the value of the blood in the place of hormones, which is seen as a thyroid gland in the roof.

What is the strength of a lykar?

For that, as a result, having put a diagnosis on the presentation of the results until the day, they will look around and the dialogue with the patient, they will start the seizure before starting the therapy. At the first place, it’s worth thinking, as it’s necessary to do it for a successful lіkuvannya. Really on uvazi correct value the main ailment, scho called to failure.

Lіkuvannya lacks polyag in the fact that ailments are to blame for a complex of singing preparations. For tsyo vikoristovuyutsya:

• sechogіnnі zasobi;
• Ingibitorium of angiotensin converting enzyme;
• antagonism to aldosterone;
• glucoside of the heart;
• β-adrenergic blockers and blockers of calcium channels;
• peripheral vasodilators.

The efficiency of the visceral forms of the Bula has been repeatedly brought to light.

Spostering for ill health, the drug is based on such criteria of quality, as a decrease in the appearance of symptoms, or an increase in the fraction of a bloody wikidum of a louse, in a lucid. An indicator of the effectiveness of therapy and improvement of the term in the hospital, improvement of the quality of life as a whole. Drug therapy will be based on two principles. Tse means, how to be able to stimulate the heart and improve the heart's activity.
More important is the meaning of ma dіeta. With CHF, the won is generally guilty of being high in calories, revenge for a minimum amount of salt, good for it. Chronic heart failure is not viral. It’s not easy to start thinking about it, follow the doctor’s recommendations, organize the correct way of life and lead a healthy way of life.

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