National Clinical Recommendations for Cardiology. CLINICAL RECOMMENDATIONS FOR SPECIALIZATION "CARDIOLOGY"

The stench includes a description of the diagnosis and treatment of the main cardiovascular pathologies And also vimogi before organizing a dynamic dispensary caution.

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The statistics and knowledge

arterial hypertension

Arterial hypertension is called the stike of the systolic vise in the eye of 140 mm Hg. і / abo diastolic vise of 90 mm Hg.

The given threshold indicators were based on the results of clinical tests, as they brought the cinnamon therapy, which was corrected to reduce the arterial pressure in patients with ailments. for hypertensive ailments"I" symptomatic arterial hypertension. Zahvoryuvannya be chronic in nature.

Sertseva's lack (gostra and chronic)

National Clinical Recommendations for Cardiology 2020 look at the CH stand, the association with the broken functions and structure of the heart meat, if you are satisfied with the consumption of myocardium in a sour age, you can drink the heart.

Gostra SN to become a threat to the life of a patient in case of a sharp increase in symptoms and development of a set of legends of a cardiogenic shock.

To this end, the country will need to survive non-emergency visits to the hospital for a sick person in a cardiological hospital.

Chronic HF is characterized by incremental increases in the intensity of symptoms right up to the development of decompensation.

Ischemic ailment of the heart

It can be organic (non-negotiable) and functional (past). The most common cause of IXC is stagnant atherosclerosis as a result of spasm, "gluing" of thrombocytes, and intravascular thrombosis.

Understanding ischemia of the heart includes both stable and unstable.

The main reason for the most severe manifestation of ischemic ailments of the heart, myocardial infarction;

Atherosclerosis is the enemy of the artery. Through the loss of elasticity, power is consumed to a sufficient expansion. Adding atherosclerotic plaques from the middle of the wiklik living talk... Critical changes take 50% of the diameter. When someone fixes it clinical symptoms hypoxia (unsatisfactory sourness) heart. Tse turn in the attacks of angina pectoris.

On the blockage of the coronary artery before the development of death (necrosis) with myocardial infarction. In all, the pathology of the disease is dominated by one of the main causes of mortality in older people.

Nowadays stenting of the heart allows the development of important and accelerated atherosclerosis.

So also "stentuvannya"?

The term "stenting" is an operation to install a stent in the middle of the artery, as a result of which a mechanical extension of the sound part and the restoration of normal blood flow to the organ is carried out. The operation is carried out before the endovascular (internal) surgical procedures. Conducted in the form of a vessel profile. Vimag is not only high quality surgery, but also technical equipment.

In surgery, the methods of improving are not only coronary stenting (heart disease), but also the installation of stents in the carotid artery to indicate the ischemia to the brain, in the stegnoyas - for the treatment of atherosclerotic symptoms of the heart, but in the uterine artery

Scho also "stent", dear

The stent is a lightweight tube, it’s a trickle hour to finish the artery. Stenti is available in metal alloys (often cobalt), depending on the highest technologies. Існує without lіch vidіv. The stench comes from the size, the structure of the grid, the nature of the painting.

You can see two groups of stents:

without pokrittya - vicarious during operations on arteries of the middle size;
cover with a special shell with a polymer, so you can see it by stretching out the rock lykarska rechovina, Scho pereshkojaє re-stenosis of the artery. The rate of such stents is much more expensive. The stench is recommended for installation in coronary vessels, in order to reduce blood clots.

How to undergo an operation?

For stenting Sudin Sertsya stegnova artery a catheter is inserted, a cryptic balloon is inserted at the end of the process with a new stent. Before the control of the X-ray apparatus, the catheter should be inserted into the coronal arteries and changed to the required amount of sound. Then the balloon is inflated to the required diameter. With a lot of atherosclerotic lesions, it is pressed into the wall. The stent, like a spring, expands and sits on the device for balloon inflation and visualization of the catheter. The result is a bloodstream of innovations.

The operation is carried out under the micro anesthesia. Three years from one to three years. Before the operation, the patient is injected with drugs to create a shelter for the prevention of thrombosis. If necessary, install a set of stents.

pislya surgical engagement ailments to spend at the hospital for up to seven days before a visual doctor. Youmu is recommended to ryasne pitta for vivedennya with a cross section of contrasting chants. Anticoagulant is used to prevent gluing platelets and setting blood clots.

Who is indicated for the operation?

Vidborom ailing s ischemic ailment The heart for the operative treatment is the consultant likar-cardiohirurg. At the polyclinic, at the place of residence, the patient undergoes the necessary minimum of maintenance, which includes all the requirements for blood analysis and blood analysis for the purpose of the function internal organs, Lipogram (gallant cholesterol of the first fraction), blood larynx. Electrocardiography allows you to clarify the length of the myocardium for infarction, the width and localization of the process. Ultrasound monitoring of the heart on the spot on signs showing the function of all views in front of the heart and slugs.

At the stationary office, it is necessary to conduct angiography. Qia procedure polyagaє in the intravascular injection of contrasting speech and serii X-ray signs, It will be carried out in the world of the protected vessel channel. There are the most problems of the sound, the localization and the steps of the sound.

internal vessel ultrasound dosage additional help to assess the mobility of the artery from the middle.

The security allows the angiohirurg to mount more precisely the place of the inserted stent;

Shown for the operation:

important part of the attack of angina pectoris, which is the beginning of a cardiologist as a peredinfarction stun;
pidtrimka of aortocoronary shunt (shuntuvannya - tse installation of a piece of blood flow in the bypass of the over-cut vessel), which may tend to sound ten times;
for life is shown with an important transmural infarction.

Prototype

The inconvenience of the stent insertion does not start until the hour of maintenance.

Expansion of the rate of all coronary arteries, through which every day is a specific place for stenting.
The diameter of the sound artery is less than three mm.
Decreased laryngeal blood.
Damage to the function of nirok, liver, dyhal lack.
Patient's allergic reaction to iodide preparations.

Perevaga stentuvannya before the first operations:

low trauma of the technique - there is no need to open the breast tissue;
short period of staying the patient in the stationary;
the parity is quite low;
The speed of renewal, turned to labor efficiency, is the appearance of the trivial innovation of the sick.

expedited operations

However, 1/10 part of the operated mali was accelerated or not required inheritance:

piercing the walls of the judge;
bleeding;
coverage of the purchased blood in the hematoma at the point of puncture of the stegovy artery;
stent thrombosis and the need for repeated stenting;
deterioration of the function of nirok.

Video, I will show you the essence of the operation:

renewal period

The postponed stenting of the heart allows the patient to feel more self-conscious, not atherosclerotic process, not to damage the fatty exchange. That sick person will be able to see the sign of the drug, the quest for the level of cholesterol and blood.

Get to the bottom of the diet of food and drink in carbohydrates. It is not recommended to live fatty pork, yalovitch, lamb, vershkov butter, lard, mayonnaise and hospitality spices, cowbass virobi, sir, ikru, macaroni from non-solid varieties of wheat, chocolate, malts and vipichku, tea, honey and beer, carbonated liquorice.

Dієta vimagа obov'yazkovo introduce vegetables and fruits in salads or fresh juices, poultry meat, riba, porridge, macaroni virobi from hard varieties, sir, fermented milk products, green tea.

It is necessary to gratify 5 - 6 times of eating, quilting after the vagoya. If necessary, carry out the removal of the drainage days.

Schodenna rankova gymnastics advances the exchange of words, changing the mood. It is not possible to immediately take on the importance of the right. It is recommended to walk, from small distances, because of increased distances. Walking on gatherings is popular. You can use the simulators. Obov'yazkovo paciєntam slid navchisya rahuvati at themselves pulse. Do not allow significant perevantazhennya with frequent hearts very quickly. For types of sports, it is recommended to ride a bike and bring it to the pool.

Lykarska therapy is produced beforehand, which reduces arterial pressure (in hypertensive patients), statins for normalization of cholesterol and drugs, and reduces thrombosis. we are sick for diabet follow the specific treatment of the endocrinologist.

More beautifully, as the rehabilitation of the stenting will be carried out in the sanatorium-resort minds, before the visual doctors.

The operation of stenting is carried out for nearly forty rockets. The methodology and technical suprovid are gradually completed. Svidchennya is expanding, there is no vikovy obmezhen. Recommended to all patients with ailments of the heart are not afraid of consulting a surgeon, so that they can continue to live more actively.

Signs of atherosclerosis of the head and head

Prevention of cerebral blood flow in the minimal step is found in arterial stovburiv, as aortic arteries. Atherosclerotic lesions of the shinnyh by a hundred bureaucrat in the pathogenesis of development chronic deficiencies cerebral blood circulation. With atherosclerosis of the region of somnolence and sleepy arteries, in humans, the growth of the disease appears to be severe, even to a lethal result.

Sudden atherosclerosis is systemic in nature, the main cause of which is atherosclerotic plaques. With an unfortunate diagnosis and diagnosis, such patients are given the risk of a diagnosis of an ischemic insult. Treatment of atherosclerosis of blood-bearing sudins shyny viddilu to be able to control the problems in the field of forensic surgery and neurology.

stan characteristics

Atherosclerosis of regional vascular disease is a local manifestation of systemic impairment of cholesterol metabolism. Increased concentration of cholesterol in systemic blood flow to form atheromatous plaques with further stenosis of the carotid arteries. A lot of blood-bearing vines є a nasty pipe, more often approved, more elastic for its consistency and a lot of smooth stinks.

vіkove pіdvischennya arterial vise in the vessels of the shia, as well as an increase in the concentration of cholesterol in the blood, to produce the previously formed atherosclerotic plaques. The cob stage of the ailment is characterized by the moment, if in the region of the vertebral column there is an accumulation of fatty elements, up to which in the rest of the tissue fibers and calcium particles are attached. The combination of these elements is called atherosclerotic plaques. The most important pathological statement is the main reason for the illumination of the blood-bearing judgment and the impairment of blood circulation in this region.

With the sound education of the vertebral body by 50% more, the patient has an adult development of serious damage, tied to the rotten perfused tissue of the brain. Trivial damage to perfusion leads to sour hunger and such a serious inheritance, like ischemic stroke of the brain. For the development of atherosclerosis of the blood vessels of the shia, the symptoms and diseases are dealt with by a neurologist and cardiologist.

cause

Atherosclerotic lesions are associated with blockage of small vessels in the body. This is the name of the occlusion of Sudin Vinica on the local purchase of fatty elements, which are calcium salts, cholesterol and fragments of red blood elements. The development of atherosclerotic lesions of the shinnyh vessels, take such unfriendly factors:

Trivale adjustment of glucose concentration in blood;
It is not rational to eat, as it is characterized by overworldly living of high-calorie, fat, greased and gostrich stravs;
Vzhivannya alcohol and tyutyunopalіnnya;
Nadlishkova masa tila;
Slightly cumbersome way of life (hypodynamia);
Addition of synthetic liver function, as a result of which a large number of endogenous cholesterol enter the systemic bloodstream;
Early postponed infectious disease.

A special risk for the formation of atherosclerotic lesions of the head and shia is that people are fed, on the organism of which they infuse a spike from overheated factors. When atheromatous plaques are formed in the area of magistral vessels and sleepy arteries, lyudin is automatically consumed in the group for the diagnosis of cerebrovascular damage and cerebral disasters.

symptoms

As a type of this disease, atherosclerosis of the arteries in the country is characterized by a trivial period during the day of the clinical picture. In case of progress of ailments, people will fix the turbulence of the minimum symptoms, as in the majority of cases they will recover. zagalne nezduzhannya, Pov'yane z vtovoy. If people have Vinnik, atherosclerosis has Sudin shih symptoms, such a viglyad may be:

Korotkochasnі epizodi zamorochennya;
Intense pains in the head and head area, which are most likely to disappear as they show vegetative-vascular dystonia and meteorological sensitivity;
Weakness і outside the house, how the wine is calm in the country, so і with physical nurturing;
Decrease of gosti zoru, as well as showing the so-called flies in front of the ochima;
Ruined sleep, right up to the form of sleeplessness.

In case of diagnoses of overwhelming symptoms, dermal people, it is recommended to turn to a medical problem for the passage of a complex system to the body. In order to develop pathological processes in the area of the disease, it is more intensive to manifest itself key picture given zhvoryuvannya.

Also, there is a change from the best key manifestations, Scho vkazuyut on the development of persistent cerebrovascular damage in the body. Before such manifestations can be brought:

Spontaneous loss of vision in one eye, but not tied with traumatic ears of the head area;
Seeing oniminnya and pokryuvannya in the area of upper or lower figures. As a rule, a subtle symptom is observed in the day-to-day ability to control and reduce the activity of the hands and nig;
There is no reason for the loss of testimony, as a supervisor is led by an increase in consumption and a blaze of wickedness;
The destruction of the mobile function, the unhappiness of the formulation of words and the circulation of thoughts;
A waste of joy in the open space.

In people with similar symptoms, severe cerebrovascular lesions appear, right up to cerebral catastrophe. Such people need extra medical aid, With a further hospitalization in neurological examination.

diagnostics

In the cob stages of diagnostics, medical care is taken to analyze the patient's scarg. Standard lykarsky experience in this category includes a collection of information about the manifestation of any chronic diseases of organs and systems, to the reception of small groups drugs, And also the manifestation of the decline in schism until the development of this ailment. Diagnostics of atherosclerotic lesions of blood-bearing vines, including the following:

Ultrasound diagnostics of the judgment with the Doppler function. It is a non-invasive diagnostic technique that allows the assessment of the progression of blood arteries in a given area, as well as the increase in blood flow. The level of stenosis for the education of the blood-bearing judgment is observed in the bones. It is possible to say, what is lower than the sum, is it the formation of non-reversible processes in the brain;
MRI angiography. The staff of the methodology can be assessed in detail the countries of the Sudan. Before the ear of a child, to the skin patient to introduce a special contrasting speech, to assess the passage of the sudin on the external image;
Computer tomographic angiography. This technique of non-invasive radiological monitoring allows for a precise visualization of the anatomical structures of the brain and blood vessels. Before the ear of the message, the patients introduce a special contrasting speech with the sign that was presented to the visitors. Withdrawal of knowledge is given information about the steps of sound arteries and exact localization of atheromatous plaques;
Angiographic dosage of the brain. This technique is considered to be minimally invasive methods of diagnostics of a given pathological camp. To discard information about the country of the Sudan, the patient is fitted with a special arterial catheter, through which a contrasting speech is supplied.

lykuvannya

The complex therapy of atherosclerotic lesions of the vertebral ridge does not include such important points:

dietotherapy;
Korekts_ya way of life;
Drug therapy.

In case of ineffectiveness of re-insurance methods in the correction, the patients should be given the operative methods of treatment.

Diet and correction to the way of life

Organization of the correct treatment for atherosclerosis of the disease. The key method of treatment is the intercourse of the implantation of food products, the increase in the reduction of cholesterol concentration in the systemic blood flow. pochatkova stage atherosclerosis of Sudin shia, transmission of such practical recommendations:

In the case of a natural race, it is recommended to feed the perevagu with fresh fruits, vegetables and fruit juices;
For a racion, it is necessary to include food products, rich food fats, smoked meats, greased food and fast food;
A special corista for the organisms of people, who suffer for atherosclerosis of Sudin Shi, Mayut sea riba and seafood. The production of food is to replace biologically active speech, to reduce the level of cholesterol in the blood and normalize the metabolic processes in the body.

In case of atherosclerosis of arteries of the shia, people are recommended in the best terms to be considered as implantation to alcohol and tyutyunopalinnya. With the presence of excess oil, people recommend not only a correction to the ratsion of Kharchuvannya physical navantazhennya... In case of an increase in arterial vise indicators, patients should be prescribed antihypertensive therapy. Children who have atherosclerosis of the main arteries of the shia have been diagnosed with atherosclerosis of the main arteries;

drug therapy

main meta drug therapy atherosclerosis sudin shi є prevention of cerebral catastrophe. The plan and the triviality of the solution is to be a medical worker in an individual order. On the vibration of the tactics of lykuvannya pouring in the steps of ringing the education of blood-bearing vessels, as well as the appearance of the formation of stiff ischemia of the cerebral tissue.

effective drug therapy It is possible only in the same way that the steps of the sounding of the blood-bearing vessels do not outweigh 50%. In addition, the use of medications should be in the same way as the patient will be able to carry out the operative involvement. In the feeding of atherosclerotic lesions of the shia, the following groups of pharmaceutical preparations:

Antihypertensive problems. In qiu great group lykarsky zasobiv enter іngіbіtori APF, Diuretics, calcium channel blockers and beta-blockers. With the infusion of a group of drugs in drugs, there is a regulation and control of indicators of arterial vise. Vikoristannya tsikh koshtіv was informed by the fact that the increase in blood pressure indicators is one of the main reasons for the formation of atherosclerosis;
Desagreganti. And the whole group of drugs includes Klopidogrel, Aspirin, Tiklopidin. The series of medications is aimed at preventing blood loss and development. It is especially important for people who suffer from atherosclerotic lesions of the shia, so as the thick blood passes importantly through the arterial enlightenment;
Statini. Dana group likarsky zasobіv will prevent a decrease in the concentration of cholesterol in systemic blood flow, and by preventing atheromatous plaques.

surgical treatment

Surgical methods of treatment are recommended for patients with a high and middle stage of stenosis of the shia. The main method of operational involvement is the prevention of such a dangerous acceleration, like an insult. In the course of the operative involvement, the appearance of atheromatous plaques and the expansion of the sclerosed judgment is increased.

In order to eliminate atherosclerosis of shinny vessels, the following operations will be stagnant:

Carotid stenting. The staff of the methodology є the ability to expand the education of the blood-bearing judge. Tse engaging in vikonutsya pіd angiographic control. By the cob stage of the operation є the introduction of a flexible catheter to the point of localization of the atheromatous plaque. At the same time, the patient will see the setting of an arterial stegovy catheter. Through the insertion of a catheter, another catheter is inserted into the vessel's lumen, which is to place a special balloon. From the start of the balloon, the enlargement of the vertebral education and the consolidation of atheromatous plaque will begin;
Carotid endarterectomy. In the course of this operative involvement, the atheromatous plaques are weakened. In the course of the operation, the medical facie of the viconus of the scruples in the area of the design of the sleepy artery, when I put on it a jam below the stenotic zone. The upcoming stage of the operation is the development of the artery, the cleansing of fatty deposits with the coming sutures;
Installation of shunts on the sleepy artery. The suttu is given to the procedure є the root of the alternative paths of judgment, for which there will be shelter to the brain. As a biological material for the stem anastomosis, the pediatric vein of the lower clinic is to be treated. As a result of the so-called commonplace way, people normalize a surge of blood to the tissues of the brain, which will reduce the risk of a cerebral catastrophe.

prophylaxis

We'll keep the ailments easier for us to get better, but not likuvati їkh. Prevention of a given pathological camp will be undamaged for the cause of the diagnosis. Zagalny plan preventive visits You can distribute on the following points:

Vidmova vjivannya alcohol and tyutyunopalinnya;
Rationalization of food and food products, rich in fats of foodstuff;
Improvement of mobility activity and prevention of hypo-dynamics;
Control of blood glucose levels;
In case of mental illness to the development of arterial hypertension, it is recommended to take a doctor's appointment with a cardiologist and a therapist, as well as to live with new drugs.

Vilikuvati signs of atherosclerosis folk zasob can only be done using conservative methods.

Thoracic aortic aneurysm (aortic heart): causes, symptoms, diagnosis, treatment, prognosis

The aorta is one of the great magistral vessels, as it enters without the middle from the heart and blood flow in the artery of a different diameter. They have an arterial shelter, sacking, yak, by entering the arteries, the reach of all the bodies of the people. The aorta should be repaired from the lithium of the heart at the viglyad of cybulin with a diameter of about 2.5-3 cm, then it should be advanced at the viglyad of the viscous viddle, the arch of the aorta and the lower viddil. The lower part of the aorta grows on the thoracic and cranial viddili.

Aneurysm is a locally weak spot in the vessel, like in the grip of blood in the vessel, to be called. Dane vipinnya can reach the growth of small, right up to giant aneurysms (more than 10 cm in diameter). Such aneurysms are not safe due to the fact that, due to the instability of the vertebral column, there can be a clogging of blood between the inner shells of the artery and its development. Some aneurysm can be associated with massive internal bleeding, which can lead to the death of a sick person. Aneurismatic mischief can be found in any aorta, ala, according to statistics, in the thoracic form of development, less in the cranial one (25% or 75% of the evidence). For the shape of the vipinnya, you can take a fusiform і saccular form.

Causes of aneurysms of the thoracic aortic appearance

Causal factors of aneurysms breastfeeding the aorta is often not given out to a particular patient. In general, we can talk about those who, prior to the development of aneurysms of the secondary aortic, are most advanced in children older than fifty years, to become and inject into the weakness of the vertebral column in the arteries, including in the aorta.

In addition, in a large number of cases, it is indicated that there is a ligament between the aneurysm and obvious atherosclerosis of the aorta. At the time of the disease, atherosclerosis is the cause of the largest cardiac ailments, in patients with heart attacks, strokes and ischemic ailment heart aneurysm thoracic aorta restructuring more often than not in individuals without any illnesses.

The children of the children are impressed by the innate specialties of Budovi heart-vascular system... Especially yaskravo stink manifests itself in particular with Marfan syndrome. Tse syndrome, which is characterized by "weakness" with good fabrics... So, as a result of the resulting tissue is found in the skin organ, the stems of the judgment can be stored from the tissue frame. In case of Marfan's syndrome, the synthesis of structural blemishes should be produced before the vertebral column gradually groans and is severe until the formation of aneurysms.

In some cases, aneurysm can be developed by stretching out decliners to eliminate trauma to the chest wall. The hour of aneurysm detection in all ages and becomes from one or two rocky up to 15-20 or more.

More severe causal illnesses can be attributed to the transfer of tuberculosis and syphilis to the affected portion of the upper part, the aortic arch or the lower part, and also Infectious diseases from the inflammation of the aortic wall - from aortitis.

Apart from the factors that lead to the development of the aortic wall, before the formation of the aorta, it can lead to the inflow from the middle, and at the same time, we need to go to the bottom of the high blood pressure. Tomato patients with arterial hypertension are included in the group for the development of aneurysms of the thoracic aortic.

Thoracic aortic aneurysm symptoms

With aneurysms of minor sizes (less than 2-3 cm in diameter), the symptoms can last a tricky hour in a day-to-day stretch and are deprived of time, if they have already become slower. It is disgusting for a sick person, so yak live without inappropriate symptoms They are not susceptible, but sometimes it may be possible to develop aneurysms, which may cause an unpleasant result.

If an aneurysm of the viscous appearance or the aortic arch is embossed on the organ of the middle in the chest cavity, the patient will have some symptoms. When an aneurysm of the aortic arch is reached, significant sizes are indicated, such as:

Attack a dry cough when trachea is pressed,
Seeing the scent when navantazhenny or in the camp of calm,
It’s difficult for an hour to prodolzovania,
Hoarseness of the voice, right up to the second afonia, when pressed rotary nerve, Innervating the larynx and voices,
Pain in the region of the heart, with the radial in the interregional region,
When the upper empty veins are slowed down, the patient is visibly swollen,
When the nerve bundles are depressed, unilateral ulceration of the brain and descent can be prevented upper vernacular, I’m going to meet with dry eyes and understand Horner's syndrome.

There is a clear picture of the accelerated aneurysms of the thoracic aorta against the tumultuous and growing burden of the sick person.

Diagnosis of unresolved aneurysms of the thoracic aortic cavity

Diagnosis of sickness can be made at the stage of the patient's experience. Anamnestic tributes, a medical history, which are sensible signs - a pulsation is seen when the jugular fossa above the sternum is visible in the aneurysm of the aortic arch, visible in the eye pulsating illumination of the pid sword-like sternum, more frequent heart rate, bland and cyanosis of the skin cover.

To confirm the diagnosis, the patient is shown additional methods of advancement:

Treatment of unresponsive aortic aneurysms

Unfortunately, the aortic aneurysm є will increase to irreversible anatomical statements, that without surgical treatment it is possible to develop more rapidly with a growing riser. Most often, severe aneurysms of the thoracic aorta, reaching a diameter of 5-6 cm and more. Zvyazu z zim surgical treatment for aneurysms of the same size, and aneurysms less than 5 cm can be used as a basis for clinical tactics and conservative politics the main zhvoryuvannya, which is pricey.

So, for example, individuals with small sizes of aneurysms of the thoracic aorta, without signs of compression of adjoining organs and with a minimal risk of enlargement, can be deprived of a dynamic warning from a cardiologist's view of skin inflammation of the heart. In case of atherosclerosis and hypertension of patient indications, post-use of drugs (hypolipidemic - statins, hypotensive, sechogenic and in).

In case of an increase in aneurysm growth, in case of rejection of data on MSCT, or Exo-KS, as the aorta stems are reduced to corysty, the patient is shown an operation. So, with an increase in the diameter of aneurysms, it is larger, lower by a centimeter per one centimeter, or by a centimeter in rik, є absolute indications for surgery. Allow the dynamics of the growth of aneurysms to become close to one millimeter per minute for the visual and low forms of the aorta.

The surgical method of treatment includes two types of operations. The first method of polyagi in the performed surgery on an open heart with a device for a piece of blood circulation and to visit for an additional rosette breastfeeding- thoracotomy. The operation is called resection of aortic aneurysms. When the access to the thoracic aorta is seen, the aneurysmal mouse hangs up, and a piece graft is applied to the rose of the aorta behind the additional sutures. Writing real, reticular anastomoses between the upper and lower arches, the arcuate and thoracic part of the lower aortic appearances, it will help to improve the wound suturing.

In the hour for endoprosthetics of the aorta, a graft will be stuck using the material called Dacron. The prosthesis can be installed in the be-like form of the thoracic aorta - in the upper one, in the arch or in the lower one. To shorten the engraftment of the transplant, cover it with collagen i antibacterial drugs... This allows the unification of the firing and pre-pelvic thrombosis in the aortic prosthesis.

Another technique for the use of aneurysms is that a probe is inserted through the arteries through the arteries until the aneurysm occurs, a probe is inserted with an endoprosthesis on the endoprosthesis, which fixes the aneurysm below the aneurysmal mouse. In such a rank, the aneurysm "vimitsitsya" from the bloodstream, so that the development of the aneurysm is accelerated.

At the moment, in this hour, endovascular techniques are only being repaired, but most often aneurysm resection is performed with access to a vicarious unit of piece blood circulation. Zrozumіlo, risik from the stasis of the whole apparatus is more serious, lower from endovascular involvement, so cardiohirurg can propose two methods in one patient.

Yakiy z methods of stasis for a particular patient, and if he is a doctor with a dynamic guard for ailments. To those patients with the previously emerging scargs, and also with the diagnosis of aneurysms of the thoracic aortic, they were often turned to a cardiologist and before a cardiac surgeon, and during the course of all the recommendations for all cases

What are the contraindications for the operation?

Thoracic aneurysm in the aorta є in the edge to poor people, Absolute counter-indications for carrying out the operation, especially carried out for life shows, not sleep. For example, it is possible to indicate a state of infection, a state of cardiological and neurological illness, as well as a focus on important chronic pathology. Besides, in the meantime, if the plan is transferred to the aorta, and it’s not enough for life through quick operations, it can be transferred to a more friendly period, if the patient is stable. A special group of risks includes the patients of the kidnapped Vika (over 70 years old), especially with severe chronic heart failure. In this regard, nutrition about the efficiency of the operation is strictly individualized.

Video: butt endoprosthetics of the thoracic aorta

Folding without lіkuvannya

Uninvolved on those who have surgery for resection of aneurysms of the thoracic aorta є bagatous and foldable, fight ї ї not varto, as long as a doctor is recommended promptly involved... For statistics, mortality on the operating table and in the early period of operation to become from 5 to 15%, according to the data of the previous authors. It is imperceptibly less, there is less mortality without death, so in the first five rocky when you have a scarg, an acute developmental aneurysm, for at the moment the diagnosis of aneurysms is established, guinea is up to 60-70% of patients. In connection with the cym, the operation is actually the only way to fix the aneurysm of the thoracic aorta from the side. Without affection, the patient will inevitably develop aneurysm growth and development, and the axis will no longer be able to transfer the license. At the junction of the cym aneurysm of the aorta, a bomb was fired.

Otzhe, accelerated this disease є aneurysm, opening up aneurysms and thromboembolic disease. All the stench manifests itself in an important staggering camp, pain syndrome in the chest and in the abdomen (with expanded aortic opening to the posterior viddil). It is also indicative of the bliss of the shkinny coat, the cold pit, the frontal waist, and the picture of shock. Without lіkuvannya, and often navіt at an extraordinary operation, patient guinea.

How can you speed up the operation?

The folding of operations does not occur very often (close to 2.7%), but still there is a new development. So, the most safe - bleeding from the aorta, gastric infarction, gastric stroke and parallel lower symptoms (in case of elimination of thoracoabdominal aneurysms - on the cordon of the thoracic and cranial veins). It is possible to reduce the risk of getting sick not only because of the impermissibility of the sutures on the aorta, or for blood clots in more other arteries, but to come as a cybulin and from the arches, like the head and the brain. It is not the reason for the emergence of an increase in the speed of the operation, but rather of the type of aneurysm caused by the appearance of thrombotic mass.

Is it possible to carry out resection of the aorta and yaka?

Surgery for resection of thoracic aortic prostheses can be used by the Viconan in the great federal centers. The operation can be carried out both for a quota and for a special case for a patient. Part of the involvement can be very varied in the occurrence of localization of aneurysms, in terms of the type of prosthesis and in the type of operation (from a criterion to an internal vessel). So, for example, in Moscow, resection of aneurysms is seen in lycaria. Sechenov, at the Institute of Surgery IM. Vishnevsky, in the lykarnі im. Botkina and in their clientele. The price is from 50,000 rubles to 150,000 rubles for food.

forecast

The prognosis for aneurysms of the thoracic aorta is based on localization, size of the aneurysmal mouse and dynamics of aneurysm growth. Krym tsyogo, the forecast will begin with a step in the development of growth and development. For example, one of the criteria for assessing the step of the risik is the size of the index of the aortic diameter. This indicator shows how the diameter of the aneurysm is measured in cm to the area of the patient in m ". Indicator less than 2.75 cm / m "to indicate those who have a forecast for a patient who are better off for everything, if he will be friendly, so as a risik I roast a warehouse, less than 4% in a ryk, an indicator of 2.75-4.25 to talk about a pompous risik (8%), and it is obvious that he is hospitable. forecasts, and an index greater than 4.25 is to blame for the alertness of the drug, so as a viscous risik rose (more than 25%), and the forecast seems to be unimportant. The patient himself is guilty of seeing the recommendations of the cardiac surgeon and waiting for the operation, as Dr. Napolyagay, so that he can promptly reduce the risk of fatal acceleration of aneurysms of the thoracic aortic.

Video: aortic aneurysm in the program "Life is healthy"

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Diagnosis of fibrillation at the front
In 20-30% of patients who underwent an ischemic stroke, atrial fibrillation (AF) was diagnosed (before, after or after an hour). In addition, there is great respect for people who come without symptoms (including self-termination) by means of FP.

Scheduled screening with the addition of FP detection of indications to patients over 65 years old (by way of monitoring the pulse or restoring the EKG calmly) (class of reporting IB).
Systematic screening with EKG control for detecting AF indications for all patients over 75 years old, or for individuals with with a high rizik insult (class IIaV).
Transferred the insult to TIA patients for the detection of FP, the restoration of the EHC is shown in calmness from the subordinate monitors of the EHC, yak minimum, stretching 72 years (class IB).
Patients who have undergone a stroke are shown before the trial of the EKG monitoring (including the implantation of the EKG loop reconstructors) for the emergence of a versatile asymptomatic AF (class IIaV).

In patients with implanted ECS, or with a defibrillator, the presence of the atrial electrode allows the control of the atrial rhythm. Including, there can be identification of patients with episodes of high frequency and atrial high rate episodes (AHRE). The occurrence of such episodes is associated with a significantly higher frequency of confirmed episodes of FP (5.56 times) and ischemic insult and systemic embolism (2.56 times). At the same time, the frequency of stroke in patients with AHRE is lower, lower in patients with confirmed AF; FP does not appear in all such patients. It has been shown that there is antithrombotic therapy for patients with AHRE - food that can be fed at a time within the framework of two clinical trials (ARTESiA and NOAH - AFNET 6). At this time, it is recommended to control the frequency of the robot in front of the heart in patients with implanted cardiac pacemakers, or a defibrillator, and in the development of high frequency of robots in front of the heart, before the situation is accelerated with the help of children.

Patients with implanted ECS or cardioverters should regularly assess the frequency of the robot at the heart. In the development of high frequency and high frequency robots, the in front of the heart needs additional provision (monitoring of the EHC) for verification of the FP and the designation of a specific treatment (class IV).

Malunok 1. Vedennya of patients with high-frequency episodes of robots in front of the heart, registered for the data of implanted attachments.

* - in some rare situations, anticoagulation can be used without verification of FP. Such a pidhid in the report of the report discussion with the patient and the retailer assessment of the quality of life

Assessment of Riziku bleeding
The editors' recommendation does not give an overwhelming scale for the stratification of hemorrhagic acceleration. A number of such scales have been assigned to breakdowns (it is important, on patients who took antagonism to vitamin K (AVK)): HAS-BLED, ORBIT, HEMORR2HAGES, ATRIA, ABC. Їх vikorystannya is guilty of helping to develop and, if possible, how quickly the factor of bleeding is modified (table 1).

In patients with FP, who are stasis of oral anticoagulants, for the development of potential modification of the factors in the risk of bleeding, following the special scales of stratification of the risk (class IIaV).

Table 1. Modification of non-modifiable factors of hemorrhagic disease in patients who receive anticoagulants (on the basis of scales for stratification of bleeding disorders)./ P>

* -In different scales

Vibir antithrombotic drugs
The principal aspects of this are:
- aspirin is not suitable for the prevention of thromboembolic acceleration in patients with AF
- patients with the index CHA2DS2-VASc 1 in men and 2 in women who have shown signs of anticoagulants (NOT aspirin)
- in patients with non-valvular AF, drugs of the first row є "new" oral anticoagulants
Malunok 2. Prevention of stroke in patients with AF.

Acceptance of anticoagulants with the method of prevention of thromboembolic acceleration of indications to patients with AF and index CHA2DS2-VASc2 or more for people, 3 or more for women (classIA).
At the cholovikiv with the value of the indexCHA2DS2-VASc1 for women with index valuesCHA2DS2-VASc 2 It is possible to identify anticoagulants from the assessment of the individual characteristics of the patient and the first person (class IIaB).
If anticoagulant therapy is first indicated for patients who can take NVAC (apixaban, dabigatran, rivaroxaban, edoxaban), їkh priyom more colorfully, nіzh AVK (class IA).
For the receiving AVK, the hour of overloading the INR in the whole range is subject to significant control, until it reaches its maximum values (class IA).
If the patient is still accepted by the AVK, it is possible to switch to the NVAC at the same time, if the hour of the transfer of the MPO in the whole range is not good, it is not good for good adherence to the therapy, but they are not used for the valve itself. IIbA).

Occlusion or isolation of the left front of the heart

Hirurgic isolation or occlusion of the front of the front of the heart can be a visonan before an hour or so on an open heart in a patient with FP (class IIbV).
Hirurgic isolation or occlusion of the front of the front of the heart can be used by the Viconan before the frequency of the thoracoscopy is connected with the drive of the FP (class IIbV).

If there is no difference in the isolation of the drug and the presence of excess blood flow, the risk of insult can be reduced, because:

For a patient with an FP and a high risk for an insult to continue with an anticoagulant (class IV).

Occlusion in the front of the heart with the help of prophylaxis and insult can be obtained from the patient with contraindications to trivial anticoagulant therapy (for example, in the anamnesis - life-threatening bleeding due to nonpercussion IIbB).

lykuvannya insult
Effectively, we will grasp it until it is frozen by the method of treatment of an ischemic insult є the introduction of a recombinant tissue plasminogen activator (rtPA) for 4.5 years after symptoms appear. Systemic thrombolisis of contraindications in patients who take oral anticoagulants for 48 years, however, can be used for vykonaniy, if that is taken by AVK patients with MNO less than 1.7, or if they have had more than a year between the norm of APT. Associativity of antidotes for antidotes to HVAC with further thrombolysis in the course of treatment within the framework of clinical trials. At patients with occlusion distal view internal sleepy artery abo middle brain artery You can take anticoagulants if thrombectomy is performed for 6 years after the symptoms are manifested.
Secondary prevention of insult
Ear of corn or renewal of anticoagulant therapy for ischemic insult or TIA
Chim more insult, thym vische rizik hemorrhagic acceleration in the form of early signs of anticoagulants. That expert recommend to fix anticoagulants from 1 to 12 additions in the fallow state in the size of the insult; in patients with great strokes, before the ear of anticoagulant therapy, repeat the tomography for the prevention of hemorrhagic transformation (Figure 3). The transfer of an insult or TIA is the most important factor in the risk of a second stroke, that is, such patients may have the maximum amount of acne due to the intake of anticoagulants. You can be vicorian as an antagonism to Vitamin K, as well as NVAK. The reception of the NVAK supervises the spine with short patches, which is tied, in the first place, with a smaller number of internal cranial hemorrhages. If a patient has suffered a TIA or an insult on anticoagulant therapy, the drug does not change.
Malunok 3. Ear of corn or renewal of anticoagulant therapy for ischemic insult or TIA.

(The recommendation of a good one was based on the Duma examiners, and not on the results of prospective reports)
Ear of anticoagulant therapy for intracranial hemorrhage
In a number of situations, anticoagulation can be detected after 4-8 types of intracranial hemorrhage (especially if the cause of the hemorrhage is suspected, for example, it may be uncontrolled.) Anticoagulant therapy in the whole situation reduces the risk of recurrent ischemic strokes and mortality. Yaksho take a decision about anticoagulant therapy, choose a more beautiful drug with the best safety profile. The decision about the renewal of anticoagulants can be taken collectively by a cardiologist / neurologist / neurosurgeon. On a small unit of 4 performances, the algorithm for the recognition of anticoagulants for intracranial hemorrhage, studies at the Duma examiners and retrospective reports.
Malunok 4. Ear of cob or renewal of anticoagulant therapy for intracranial hemorrhage.

In patients with AF, immediately on the basis of an ischemic insult, LMWH therapy or UFH is not recommended (class of recommendationsIIIRivn proofA).
Quiet patients who have undergone TIA or a stroke on anticoagulant therapy, during the assessment and optimize their aptitude before therapy (IIa C).
If anticoagulant therapy is recognized in patients who have undergone an equally important or important stroke, then they interrupt the treatment with anticoagulants for 3-12 days due to the results of an assessment of the risk of bleeding and repeated IIaC).
Before the ear or the renewal of anticoagulant therapy with the help of secondary prophylaxis, insult should indicate aspirin ( IIaB).
Systemic thrombolisis should not be carried out to patients with an INR greater than 1.7, as well as to patients on dabigatran, as the APHT is normal ( IIIC).
NVAC є with short preparations, lower AVK or aspirin, in patients who had suffered an earlier stroke ( IB).
For insult or TIA, it is not recommended to combine oral anticoagulant + antiplatelet therapy (IIIB).
Intracranial hemorrhage in patients with AF, oral anticoagulant therapy can be renewed after 4-8 months in case of failure of the cause of bleeding or correction factors ( IIbB).

Yak minimizuvati the number of bleeding in taking anticoagulants
The main way is the correction to be modified by the factors of the risk (div. Table 1). So, for example, the normalization of the GARDEN decreases the risk of bleeding.
Significant factors of risk are also early bleeding and anemia. The most frequent dzherel bleeding є shlunkovo-intestinal tract... In patients with warfarin, dabigatran 150 mg 2 times a day, rivaroxaban 20 mg and edoxaban 60 mg podvyschuyut rhizik slunkovo-intestinal bleeding. Dabigatran 110 mg was trimmed 2 times, and warfarin was trimmed 2 times for dobu and apixaban 5 mg 2 times, and warfarin was used for the supplement. Not long ago, the results of the glaring reports did not match the sorcerers, but apparently, it seemed to be a slight negative effect of the NVAC. In the case of an overgrowth, bleeding has been revealed as soon as possible, and anticoagulant therapy may be associated with an intracranial hemorrhage.
The amount of INR is also a factor in the risk of bleeding. Therapy with warfarin after the change on NVAC, when TTR (hour of overloading the INR in the whole range of 2.0-3.0) is less than 70%. Also, if necessary, adjust the dose of HVAC, which is applied to the patient, the nirkov function and mass.
Chronic alcoholism and chronic alcoholism - problems, which are guilty of being corrected in the possession of the UAC (risk of bleeding, varicose veins veins stravohodu, high risk of injuries, rottenness to lіkuvannya).
Part of the fall and dementia of the association with a poor prognosis in patients with AF without obvious evidence, as well as the prognosis of interfacing with advanced bleeding disorders. Anticoagulants should not be attributed only to children with even higher risk.
Genetic tests do not add much to the TTR and are safe for warfarin therapy, and are not recommended for routine testing.
At the time of the invasive therapy, there is a lot of cardiological procedures (PCI, implantation of the EKS) can be carried out without the need for anti-coagulants, but there are no anti-coagulants. skasuvati, therapy of the "bridge" should be given only to patients with mechanical prostheses of the valves of the heart. The hour of skasuvannya UAC is minimal for the prevention of insult.

Go to the treatment of patients with bleeding on the basis of anticoagulants
Malunok 5. Vedennya of patients with bleeding on aphids of anticoagulant therapy.

SZP - plasma is frozen; KKP is a concentrate for the prothrombin complex.

Standard coagulation tests do not give additional information to patients who receive NVAC (with a hint of ACHT from those who accept dabigatrans). Specific tests for the dilution of the thrombin hour (HEMOCLOT) for dabigatran and calibrations of the anti-Xa activity for the anti-Xa factor. However, pererakhovani testimonies most often appear inaccessible for routine vicariousness and most often do not seem to be significant in the liking of hostile bleeding.
The last dose of NVAK Bula was taken not long ago (2-4 years before bleeding). active vugillaі / for washing the slunk. For visualization of blood flow, dabigatran can be used for vicoristany dializ.
In the Danish hour, a specific antidote to dabigatran is available for the clinical victorian - the drug idarutsizumab.

Appointment of oral anticoagulants to patients who have suffered bleeding or are characterized by a high risk of bleeding
If anticoagulants are guilty but interrupted at the time of active bleeding, skasovuvati їх writing is necessary in order to achieve critical situations. If the patient suffered from bleeding on the background of some anticoagulant, then the drug changed. There is a great part of the reasons for great bleeding, such as hypertension is uncontrollable, Virazkov's ailment For the inner skull is micro-aneurysms, it can be weakened.
Recommendations for the tactics of treating patients with bleeding on the basis of anticoagulants and prophylaxis of hemorrhagic patients:

To treat anticoagulants to patients who need to be monitored arterial hypertension with a decrease in the risk of bleeding (class of recommendations IIARivne proof B).
Patients over 75 years old should receive a dose reduction of 110 mg 2 times a day to reduce the risk of bleeding ( IIbB).
In patients with high rhizic shlunkovo-intestinal bleeding dabigatran 150 mg 2 times a day, rivaroxaban 20 mg 1 time per day and enoxaban 60 mg per day until the release of AVK or NVAK ( IIAB).
Suggestions and solutions for preventing alcoholic treatments for patients who will be prescribed oral anticoagulants ( IIaB).
It is not recommended to carry out genetic tests (IIIB).
Repeated priznachennya antikoagulyantіv pіslya epіzodu krovotechі mozhlivo in bіlshostі patsієntіv pіslya otsіnki situatsії multidistsiplіnarnoї teams, of urahuvannyam vsіh mozhlivostey anticoagulant lіkuvannya i іnshih vtruchan for profіlaktiki іnsultu and takozh pіslya polіpshennya korektsії faktorіv riziku krovotech that іnsultu ( IIaB).
In case of severe active bleeding, it is recommended to interrupt the treatment with oral anticoagulants until the cause of the bleeding ( IC).

Combined therapy: oral anticoagulant and antiaggreganti
Nearly 15% of patients with AF had some history of IM; 5-15% of patients with AF may have PCI. The use of antithrombotic drugs is significant for great bleeding. The addition of HVAC to mono - or subordinate antiplatelet therapy increases the risk of great bleeding by 79-134%, apparently, it does not reduce the risk of ischemic acceleration. In addition, in the zagalny vipadu, it’s worthwhile to minimize the hour of unnecessary antithrombotic therapy (babies 6 and 7). I didn’t follow the NVAC in the framework of the combined therapy in doses lower than quiet, as they brought their effectiveness as a preventive measure to an insult. In the framework of the combined therapy, it is necessary to have a unique patient with a protozoan and ticagrelor, which can be used to treat a clopidogrel (in a quiet situation, if drugs are necessary to indicate, for example, in the case of stent thrombosis on a thrombosis of a thrombosis)
Malunok 6. Antithrombotic therapy for ACS in patients with AF who require anticoagulant therapy.

Malunok 7. Antithrombotic therapy for planned PCI in patients with AF who require anticoagulant therapy.

In some categories of patients, there may be a sub-line therapy for OAC + clopidogrel as a substitute for consumer therapy ( IIbC).

Anticoagulants for an hour and for catheter ablation with an AF drive
Ablation can be a viconan without a skasuvannya AVK (INR 2-3). A lot of money has been accumulated from highly qualified centers about the safe ablation carried out at the NVAK. For an hour of ablation, it is necessary to inject UFH during the period of an active hour for more than 300 seconds. For ablation, oral anticoagulants are guilty of being assigned a minimum of 8 months for all patients. Nadal anticoagulant therapy is indicated in the presence of a risk of an insult (there are some chances of a recurrence of AF, including asymptomatic).

Anticoagulant therapy in vaginal

Vaginal patients with AF and a high risk of insult are shown anti-coagulant therapy. For minimization of teratogenic effect and risk of bleeding from an hour to a low, in the first trimester of vaginosity and 2-4 months before the transfer of the term, after receiving heparin (in a dose adjusted by the weight of the patient). In the last hour, you can buy vicoristany yak heparin, as well as AVK ( IB).
NVAK does not mean to signify women who are planning to stay (III).

In the third trimester, more coagulogram control is required, and some patients often need more heparin doses or AVK to achieve adequate anticoagulation. Even vagіtnі with a mechanical valve prosthesis took the decision to interrupt the use of warfarin at 6-12 hours of vagіnosti, the stench in the general order was guilty of removing UFH or LMG with an adequate correction dose.

per materials :
P Kirchhof, S Benussi, D Kotecha, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal
doi: 10.1093 / eurheartj / ehw210

Material of preparation by an expert in laboratory of clinical problems of atherothrombosis in the context of angiology of the RKNPK im. A.L. Myasnikova, Ph.D. Shakhmatova O.O.