Online pharmacy without prescription – Diseases of cardiovascular system
Heart arrhythmias. Disturbances of frequency, rhythmicity and sequence of cuttings of departments of heart. Its causes – congenital anomalies or structural changes of conductive system of heart at various diseases, and also vegetative, hormonal or electrolytic disturbances at intoxications and actions of some medicines. In norm electrical impulse, been born in sinusovom the knot which has been had in the right auricle, goes on a muscle to an atrioventricular knot, and therefrom on a ventriculonector it is immediate to heart ventricles, causing their cutting. Changes can descend on any field of conductive system that causes manifold disturbances of a rhythm and conductivity. They happen at a neurocirculatory dystonia, myocardites, cardiomyopathies, endocarditises, heart diseases, an ischemic heart trouble. Arrhythmias are often a mors immediate cause. Main method of recognition – an electrocardiography, sometimes in a combination to the dosed load (veloergometrija, tredmil), with chrezpishchevodnoj stimulation of auricles; electrophysiological examination. The normal rhythm sinusovogo a knot at the majority of healthy adult people in rest compounds 60-75 ud. 1 minute. A sipusovaja tachycardia – a sinoatrial rate with frequency more than 90-100 ud. In a minute. At zdorovyhljudej it arises at an exercise stress and a contagious excitation. Often happens implication of a vegeto-vascular dystonia, in this case it zametns decreases at a breath holding. More proof sinusovaja a tachycardia happens at a fervescence, a thyrotoxicosis, myocardites, a heart failure, an anaemia, a thromboembolism of a pulmonary artery. Patients thus can feel palpitation. Treatment. First of all – the disease which have caused a tachycardia. Immediate therapy – sedatavnye drugs, beta adrenoblockers (anaprilin, Obsidanum), verapamil. Sinusovaja bradasardija – a sinoatrial rate with frequency less than 55 impacts in a minute. Quite often it becomes perceptible at healthy, especially at physically trained persons (in rest, in the sleep), can be implication of a neurocirculatory dystonia, and also arise at a myocardial infarction, a sick sinus syndrome, at intracranial pressure rising, a depression of function of a thyroid gland (hypothyrosis), at some virus diseases, under the influence of series of medicines (warm glycosides, beta adrenoblockers, verapamil, Reserpinum). The bradycardia is displayed by times as unpleasant sensations in the field of heart. Treatment is referred on a basic disease. Are sometimes effective Belloidum, alupent, an Euphyllinum. In hard cases (especially at a sick sinus syndrome) happens temporary or constant electrocardiostimulation (the artificial pacemaker) is shown. Extrasystoles – premature cuttings of heart at which electrical impulse radiates not from sinusovogo a knot. Can accompany any disease of heart, and in half of events are not bound to it in general, reflecting influence on heart of vegetative and psychoemotional disturbances, and also balance of electrolytes in an organism, medicinal treatment, alcohol and stimulants, smoking. Symptoms and flow. Patients either do not feel extrasystoles, or feel them as the reinforced jerk in the field of heart or its freezing behaviour. To it corresponds at examination of sphygmus attenuation or abaissement of the next pulse wave, at heart auscultation – premature warm tints. Value of extrasystoles variously. Happening occasionally at healthy heart normally are not essential, but their increase sometimes specifies in an exacerbation of available disease (an ischemic heart trouble, a myocarditis) or an overdosage of warm glycosides. Frequent atrial extrasystoles (impulse starts with an auricle, on not from sinusovogo a knot) quite often foretell an atrial fibrillation. Frequent manifold ventricular extrasystoles are especially unfavorable (impulse starts with right or a left ventricle) which can be ventricular fibrillation harbingers – see more low. Treatment first of all a basic disease. Rare extrasystoles of special treatment do not demand. As antiarrhytmic agents apply Belloidum (at a bradycardia), at nadzheludochkovyh extrasystoles – Obsidanum, verapamil, hipidip, at ventricular – lidocaine, novokainamid, difenin, an Ethmosinum, etatsizin. At all views it is possible to apply kordaron (Amiodaronum), Disopyramidum (Rhytmilenum, norpase). If extrasystoles have arisen against reception of warm glycosides them temporarily cancel, prescribe kalium drugs. A Bouveret’s disease – attacks of cardiopalmuses of the correct rhythm of 140-240 impacts in a minute with the subitaneous distinct beginning and the same subitaneous terminal. The causes and development mechanisms are similar to that at ekstrasistolii. Can be nadzheludochkovaja (the radiant of impulses is above atrioventricular bond) and ventricular (a radiant of impulses – in a muscle of ventricles). Symptoms and flow. The tachycardia paroxysm is felt as the reinforced palpitation with duration from several seconds about several days. The nadzheludochkovaja tachycardia is quite often accompanied by a sweating, an abundant emiction in the end of an attack, “rumble” in a gaste, a liquid chair, a small fervescence. Prolonged attacks can be accompanied by delicacy, the syncopes, unpleasant sensations in the field of heart at its diseases – a stenocardia, appearance or heart failure increase. The ventricular tachycardia is observed less often and is always connected to heart disease, can be a harbinger of blinking (fibrillation) of ventricles. Treatment. Rest, abandoning of exercise stresses; the paroxysm nadzheludochkovoj can be stopped tachycardias reflex methods: natuzhitsja to pinch a prelum abdominale, to hold the breath, press on eyeballs, to cause gaggings. At an inefficiency apply medicamental agents: propranolol (Obsidanum, anaprilin), verapamil, novokainamid, Rhytmilenum, sometimes digoxin. In hard cases make intraatrial or chrezpishchevodnuju superfrequent stimulation of auricles, a countershock. At a ventricular tachycardia introduce lidocaine, etatsizin, an Ethmosinum, also make a countershock. Blinking and an atrial flutter (ciliary arrhythmia) – chaotic cutting of separate bunches of muscular fibers at which auricles as a whole do not contract, and ventricles work spasmodically, normally with frequency from 100 to 150 impacts in a minute. The atrial fibrillation can be proof or paroxysmal. It is observed at mitral heart diseases, an ischemic heart trouble, a thyrotoxicosis, an alcoholism. Symptoms and treatment. The ciliary arrhythmia can not be felt as the patient or be felt as palpitation. Sphygmus wrong, sonority of cardiac sounds izmenchiva. The frequent rhythm of cutting of ventricles promotes appearance or heart failure increase. Predilection to education of thrombuses becomes perceptible. Treatment. In most cases the purpose – not restoration of the correct rhythm, and it urezhenie. For this purpose use digoxin (intravenously and inside). Basic disease treatment – a thyrotoxicosis, a myocarditis, operative elimination of heart diseases, the termination of reception of alcohol. To restoration of the correct rhythm apply Chinidinum, novokainamid, verapamil, Disopyramidum (Rhytmilenum, norpase). Make frequent vnutripredserechnuju or chrezpishchevodnuk) stimulation of auricles, a countershock. Blinking and flutter of ventricles (fibrillation of ventricles) can arise at any serious illness of heart (more often in an acute phase of a myocardial infarction), at a thromboembolism of a pulmonary artery, an overdosage of warm glycosides and antiarrhythmic agents, at an electrotrauma, a narcosis, intracardiac manipulations. Symptoms and flow. The subitaneous termination of a circulation, a pattern of clinical mors: lack of sphygmus, warm tints, consciousnesses, rhonchial agonal breath, sometimes cramps, dilating of pupils. Treatment is reduced to an immediate indirect cardiac massage, artificial breath (see” Subitaneous mors “). Lidocaine, kalium drugs without prescription, adrenaline, calcium gluconat vnutriserdechno is introduced, treatment by oxygen is made. Heart blocks – the disturbances of warm activity bound to retardation or the termination of carrying out of impulse on conductive system of heart. Distinguish blockages sinuatrial (at level of a muscular tissue of auricles), atrioventricular (at level of atrioventricular bond) and intraventricular. On expression happen – 1) blockage of 1 degree: each impulse is in a slowed-up way made to subjacent departments of conductive system, 2) blockage of II degree, incomplete: the part of impulses, 3) blockage of III degree, full is made only: impulses are not made. All blockages can be proof and transitory. Arise at myocardites, a cardiosclerosis, a myocardial infarction, under the influence of some medicines (warm glycosides, beta adrenoblockers, verapamil). Congenital full traversal blockage is very rare. Symptoms and flow. At incomplete traversal blockages abaissement of sphygmus and warm tints becomes perceptible. At the full traversal blockage the proof bradycardia (sphygmus less often 40 in a minute) is considerable. Depression krovenapolnenija organs and tissues is displayed by Morgani-Edemsa-stoke attacks (syncopes, cramps). There can be a stenocardia, a heart failure, subitaneous mors (especially at a sick sinus syndrome) happens temporary or constant electrocardiostimulation (the artificial pacemaker) is shown. Extrasystoles – premature cuttings of heart at which electrical impulse radiates not from sinusovogo a knot. Can accompany any disease of heart, and in half of events are not bound to it in general, reflecting influence on heart vegetative and psihoemotsiopalnyh disturbances, and also balance of electrolytes of an organism, medicinal treatment, alcohol and stimulants, smoking. Symptoms and flow. Patients either do not feel extrasystoles, or feel them as the reinforced jerk in the field of heart or its freezing behaviour. To it corresponds at examination of sphygmus attenuation or abaissement of the next pulse wave, at heart auscultation – premature warm tints. Value of extrasystoles variously. Happening occasionally at healthy heart normally are not essential, but their increase sometimes specifies in an exacerbation of available disease (an ischemic heart trouble, a myocarditis) or an overdosage of warm glycosides. Frequent atrial extrasystoles (impulse starts with an auricle, but not from sinusovogo a knot) quite often foretell an atrial fibrillation. Frequent manifold ventricular extrasystoles are especially unfavorable (impulse starts with right or a left ventricle) which can be ventricular fibrillation harbingers – see more low. Treatment first of all a basic disease. Rare extrasystoles of special treatment do not demand. As antiarrhytmic agents apply Belloidum (at a bradycardia), at nadzheludochkovyh extrasystoles – Obsidanum, verapamil, hinidip, at ventricular – lidocaine, novokainamid, difenin, an Ethmosinum, etatsizin. At all views it is possible to apply kordaron (Amiodaronum), Disopyramidum (Rhytmilenum, norpase). If extrasystoles have arisen against reception of warm glycosides them temporarily cancel, prescribe kalium drugs. A Bouveret’s disease – attacks of cardiopalmuses of the correct rhythm of 140-240 impacts in a minute with the subitaneous distinct beginning and the same subitaneous terminal. The causes and development mechanisms are similar to that at ekstrasistolii. Can be nadzheludochkovaja (the radiant of impulses is above atrioventricular bond) and ventricular (a radiant of impulses – in a muscle of ventricles). Symptoms and flow. The tachycardia paroxysm is felt as the reinforced palpitation with duration from several seconds about several days. The nadzheludochkovaja tachycardia is quite often accompanied by a sweating, an abundant emiction in the end of an attack, “rumble” in a gaste, a liquid chair, a small fervescence. Prolonged attacks can be accompanied by delicacy, the syncopes, unpleasant sensations in the field of heart at its diseases – a stenocardia, appearance or heart failure increase. The ventricular tachycardia is observed less often and is always connected to heart disease, can be a harbinger of blinking (fibrillation) of ventricles. Treatment. Rest, abandoning of exercise stresses; the paroxysm nadzheludochkovoj can be stopped tachycardias reflex methods: natuzhitsja to pinch a prelum abdominale, to hold the breath, press on eyeballs, to cause gaggings. At an inefficiency apply medicamental agents: propranolol (Obsidanum, anaprilin), verapamil, novokainamid, Rhytmilenum, sometimes digoxin. In hard cases make intraatrial or chrezpishchevodnuju superfrequent stimulation of auricles, a countershock. At a ventricular tachycardia introduce lidocaine, etatsizin, an Ethmosinum, also make a countershock. Blinking and an atrial flutter (ciliary arrhythmia) – chaotic cutting of separate bunches of muscular fibers at which auricles as a whole do not contract, and ventricles work spasmodically, normally with frequency from 100 to 150 impacts in a minute. The atrial fibrillation can be proof or paroxysmal. It is observed at mitral heart diseases, an ischemic heart trouble, a thyrotoxicosis, an alcoholism. Symptoms and treatment. The ciliary arrhythmia can not be felt as the patient or be felt as palpitation. Sphygmus wrong, sonority of cardiac sounds izmenchiva. The frequent rhythm of cutting of ventricles promotes appearance or heart failure increase. Predilection to education of thrombuses becomes perceptible. Treatment. In most cases the purpose – not restoration of the correct rhythm, and it urezhenie. For this purpose use digoxin (intravenously and inside). Basic disease treatment – a thyrotoxicosis, a myocarditis, operative elimination of heart diseases, the termination of reception of alcohol. To restoration of the correct rhythm apply Chinidinum, novokainamid, verapamil, Disopyramidum (Rhytmilenum, norpase). Make frequent intraprecardiac or chreznishchevodnuju stimulation of auricles, a countershock. Blinking and a flutter of ventricles (fibrillation of ventricles) can arise at any serious illness of heart (more often in an acute phase of a myocardial infarction), at a thromboembolism of a pulmonary artery, an overdosage of warm glycosides and antiarrhythmic agents, at an electrotrauma, a narcosis, intracardiac manipulations. Symptoms and flow. The subitaneous termination of a circulation, a pattern of clinical mors: Lack of sphygmus, warm tints, consciousnesses, rhonchial agonal breath, sometimes cramps, dilating of pupils. Treatment is reduced to an immediate indirect cardiac massage, artificial breath (see” Subitaneous mors “). Lidocaine, kalium drugs, adrenaline, calcium gluconat vnutriserdechno is introduced, treatment by oxygen is made. Heart blocks – the disturbances of warm activity bound to retardation or the termination of carrying out of impulse on conductive system of heart. Distinguish blockages sinuatrial (at level of a muscular tissue of auricles), atrioventricular (at level of atrioventricular bond) and intraventricular. On expression happen – 1) blockage of 1 degree: each impulse is in a slowed-up way made to subjacent departments of conductive system, 2) blockage of II degree, incomplete: the part of impulses, 3) blockage of III degree, full is made only: impulses are not made. All blockages can be proof and transitory. Arise at myocardites, a cardiosclerosis, a myocardial infarction, under the influence of some medicines (warm glycosides, begaadrenoblokatory, verapamil). Congenital full traversal blockage is very rare. Symptoms and flow. At incomplete traversal blockages abaissement of sphygmus and warm tints becomes perceptible. At the full traversal blockage the proof bradycardia (sphygmus less often 40 in a minute) is considerable. Depression krovenapolnenija organs and tissues is displayed by Morgani-Edemsa-stoke attacks (syncopes, cramps). There can be a stenocardia, a heart failure, subitaneous mors. Treatment. Treat a basic disease, eliminate the factors which have led to blockage. Temporarily – atropine, Isadrinum, alupent, an Euphyllinum. Full are traversale blockages are the indication to application of a temporary or constant ventricular electrical stimulation (the artificial pacemaker). An atherosclerosis. The widespread disease expressed in growth in wall of large and centre arteries of a copulative tissue (sclerosis) in a combination with futty by imbibition of their intrinsic shell (atero-). Because of thickenings walls of pots consolidate, their lumen is narrowed and thrombuses are quite often formed. Depending on in what region the amazed arteries range, blood supply of this or that organ or a field of a body with its possible necrosis (an infarct, a gangrene) suffers. The atherosclerosis meets most often at men at the age of 50-60 years and at women is more senior 60 years, but recently and than streets is much younger (30-40 years). Family predilection to an atherosclerosis becomes perceptible. To it also contribute: Arterial hypertonia, adiposity, smoking, diabetes, rising of level of lipids in a blood (disturbance of an exchange of Adeps and fatty acids). Development online pharmacy without prescription the variated pots is promoted by an inactive mode of life, an abudant emotional overstain, sometimes – personal features of the person (psychologic phylum of “leader”). Symptoms and flow. The illness pattern completely depends on a place and prevalence of an atherosclerotic lesion, but is always displayed by consequences of insufficiency of blood supply of a tissue or an organ. The aorta atherosclerosis affects an incremental arterial hypertonia, the hum auscultated over ascending and abdominal department of an aorta. The aorta atherosclerosis can become complicated a flaking aortic aneurysm with possible mors of the patient. At a sclerosis of branches of an aortic arch signs of insufficiency of blood supply of a brain (strokes, giddinesses, syncopes) or the upper extremities are observed. The atherosclerosis of mesenteric arteries, that is feeding an intestine, is displayed by two main states: first, a clottage of arterial branches with an infarct (necrosis) of wall of an intestine and a mesentery; secondly, an abdominal toad – an attack kolikopodobnyh the abdominal pains arising soon after meal, it is frequent with vomiting and an intestine inflation. The pain is facilitated by Nitroglycerinum, starvation stops attacks of an abdominal toad. The atherosclerosis of renal arteries breaks blood supply of nephroses, conducts to a rack which is badly giving in to treatment of an arterial hypertonia. Outcome of this process – a nephrosclerosis and chronic renal insufficiency. The atherosclerosis of arteries of the inferior extremities – see “the Alternating lameness”. The atherosclerosis of coronary (coronal) arteries of heart – see” Ischemic heart disease “. Recognition is made on the basis of a clinical pattern, examination of a spectrum of lipids of a blood. At roentgenography deposition of salts of calcium in walls of an aorta, other arteries sometimes becomes perceptible. Treatment first of all is referred on the factors promoting development of an atherosclerosis: an arterial hypertonia, a diabetes, depression of mass of a body at adiposity. Are necessary – physical activity, abandoning of smoking, a balanced diet (prevalence of Adepses of a phytogenesis, consumption of sea and oceanic fish, vitamin-rich low-calorie nutriment). It is necessary to track the regular bleeding of an intestine carefully. At the considerable and disproportionate rising of level lipidop bloods – reception of special drugs, its reducing (depending on a view of disturbance of an exchange of Adeps and fatty acids). At waist (stenosis) of the main arteries probably surgical treatment (excision by an intrinsic shell of arteries – eidarterektomija, applying of roundabout paths of blood supply – shunts, use of artificial prostheses of pots). The Raynaud’s disease. Paroxysmal disorders of arterial blood supply of brushes and (or) the stop, arising under the influence of a cold or agitation. Women are ill more often than men. As a rule the syndrome of Rejno is the secondary phenomenon educing at various diffuse diseases of a copulative tissue (first of all sclerodermas), a lesion of cervical department of a column, peripheric excitatory system (gangliopity), endocrine system (a hyperthyroidism, diencephalic disorders), manual arterites, arteriovenous aneurysms, extension cervical ribs, at a cryoglobulinemia. If otsutstvujutopredelennye the causes for development of a syndrome of Rejno speak also Raynaud’s diseases, its binding sign – symmetry of a lesion of extremities. Silttomy and flow. During an attack sensitivity of dactyls drops, they grow dumb, in ends there is a sensation of a pricking, the skin becomes mertvennoblednoj and cyanotic, paptsy – cold, and after an attack – morbidly hot and hydropic. 2-5 dactyls of brushes, stop are surprised preferentially, is more rare – other acting fields of a body (a nose, ears, a chin). Disorders of a food of a skin Gradually educe: uploshchenie or even vtjazhenie small pillows of finger-tips, the skin here loses the elasticity, it becomes dry, flakes off, pustules near the fingernails (paronychia), badly healing jazvochki later educe. Recognition on the basis of the clinical data. The investigation excluding or confirming diseases, Rejno accompanied by a syndrome is carried. Treatment. First of all – a basic disease. Take over the medicines enriching an aboriginal circulation: spazmolitiki (Nospanum, a papaverine), sympatholytics (Reserpinum, Methyldopa, guapetidip), the drugs containing kallikrein (andekalin, kallikrein-depot), antiagreganty (aspirin, Curantylum, a dextran), blockers of calcium channels (nifedipine, Corinfarum, kordipin, etc.) . Subitaneous mors. All states demanding actions of cardiopulmonary resuscitation, are united by concept “clinical mors” which is characterised by the breath and circulation termination. By it mean not only the full mechanical cardiac standstill, but also such view of warm activity which does not provide minimumly necessary level of a circulation. Such state can educe at various life-threatening disturbances of a warm rhythm: fibrillations of ventricles, the full traversal (atrioventricular) blockage accompanied by attacks of the Morganiedemsa-STOKE, paroksizmalnoj a ventricular tachycardia, etc. the Most frequent cardiogenic cause of the termination of a circulation the myocardial infarction is. Symptoms and flow. For a subitaneous cardiac standstill following signs are characteristic: Loss of consciousness, lack of sphygmus on large arteries (somnolent, femoral) and topov hearts, an apnoea or subitaneous appearance of breath of agonal phylum, dilating of pupils, a skin discoloration (grey with cyanotic shade). Presence of first three signs suffices For an establishment of the fact of a cardiac standstill (lack of consciousness, sphygmus on large arteries, warm activity). Time spent for searches of sphygmus on a large artery, should be underload. If sphygmus is not present, it is impossible to waste time on auscultation of cardiac sounds, measuring of arterial pressure, electrocardiogram putting off. It is necessary to remember that in most cases subitaneous mors of potentially healthy people centre duration of experience of the full termination of a circulation compounds about 5 minutes then there are irreciprocal changes in the central excitatory system. This time sharply contracts, if the circulation stopping was preceded by any serious diseases of heart, easy or other organs or systems. First aid at a cardiac standstill should be begun immediately, even before arrival of a brigade of the first help as important not only to reduce a circulation and breath of the patient, but also to restore it to life as the high-grade person. To the patient artificial ventilation of the lungs and the occluded cardiac massage is made. It stack on the rigid surface horizontally on a back, a head peakly throw back, a mandible peakly push forward and upwards. For this purpose trap a mandible two arms at its establishment; mandible dens should range ahead of dens of the upper jaw. For artificial ventilation it is better to use a method “from a mouth to a mouth”, thus nostrils of the patient should be clamped dactyls or are pressed by a cheek of the resuscitating. If the thorax of the patient extends, the inspiration means is carried out correctly. Intervals between separate respiratory cycles should compound 5 seconds (12 cycles for 1 minute). Carrying out of an indirect cardiac massage is anticipated the strong impact of a fist on a breast bone. The patient is in a horizontal standing on rigid, arms making resuscitation range on the inferior third of breast bone, is strict on centerline. Odnuladon put on another and make pressure on a breast bone, arms in elbows do not incurvate, pressure is manufactured only by wrists. Rate of massage – 60 massage movements in a minute. If resuscitation one person, makes a ventilation and massage interrelation – 2:12; if two this interrelation compounds 1:5 reanimate, that is on one insufflation 5 squeezings of a thorax are necessary. For continuation of an intensive care of the patient hospitalise in resuscitation unit. Congenital heart diseases. The diseases arising because of various disturbances of normal formation of heart and pots departing from it in the prenatal season or a stopping of its development after a birth. It is a question not of genetical inherited disease, and the anomalies which cause can be tolerated to time of pregnancy of a trauma, infection contaminations, a disadvantage of nutriment of vitamins, radial actions, hormonal disorders. Any of choronomic or internal actions does not cause any specific fault. All depends on a phase of development of heart during which time there was a foetus damage. All congenital heart diseases part on 2 bunches: faults with a primary cyanosis (”dark blue”) and faults without a primary cyanosis (”acyanotic” phylum). The isolated defect of an interventricular septum one of enough frequent heart diseases of “acyanotic” phylum at whom there is a report mezhdulevym and a right ventricle. It can be observed separately and in a combination to other heart diseases. Small defect of an interventricular septum (illness to the Tolochinova-physiognomy) – rather congenial congenital heart disease. Complaints normally are not present. To development of the child of floggings does not disturb, it can be found at casual survey. Heart of the normal dimensions. Loud, sharp hum along a breast bone left edge (III-IV mezhrebere) is auscultated and felt. As complication the bacteriemic (infectious) endocarditis with a lesion of edges of defect of an interventricular septum or a rheumatic endocarditis can educe. Defect recognition is helped by a cardiophonography, an echocardiography, in rare instances – a catheterization of cardial cavities, angiocardiography, kardiomanometrija. Highly had defect of an interventricular septum is accompanied by that the part of a blood from a left ventricle arrives not in an aorta, and is immediate in a pulmonary artery or from a right ventricle in an aorta. Only in certain cases long time proceeds asymptomatically. At thoracal children the strong dyspnea more often is observed, they badly suck and do not add in weight, a pneumonia is frequent. Their state promptly worsens and can conclude in the shortest term lethal outcome. Many children with major defect of an interventricular septum perish also flow of the first 2 years of life. If they endure a critical period, their state can be enriched considerably: the dyspnea disappears, appetite, physical development is normalised. However the motor performance gradually drops and to the puberty season the considerable disorders can educe. Complications of high defect of an interventricular septum – a bacteriemic endocarditis, a heart failure, it is rare – predserdpo-zheludoch digging blockage. nezarashchenne mezhdserdechnoj septums. One of frequent (10 %) congenital heart diseases from bunch of “acyanotic” phylum at which there is a report between right and left auricles. It is found not earlier than mature age (20-40 years), casually, it is observed in 4 times more often at women, than at men. Symptoms itechenie. bolnyezhalujutsja on a dyspnea, especially at an exercise stress, can become perceptible palpitation (ekstrasistolija, paroxysmal – paroksizmalnaja a ciliary arrhythmia). There is a predilection to syncopes. In rare instances – sonorous tussis with hoarseness of a voice. Sometimes there is a pneumorrhagia. Patients of routinely fragile constitution, with tender, semi-transparent and unusually acyanotic skin. Cyanosis at rest mostly does not happen. At crying, cry, laughter or tussis, natuzhivanii, an exercise stress or during pregnancy there can be a transitory cyanosis of a skin and mucosas. Often “the warm back hollow” – a protrusion of forward pieces of ribs over heart range is formed. The heart dimensions are enlarged, hum in second mezhrebere at the left is auscultated. Quite often defect of an interatrial septum becomes complicated a rheumatic lesion of heart, there are manifold disturbances of its rhythm and conductivity. A relapsing bronchitis and a pneumonia are possible. Predilection to education of thrombuses in lumens of the right auricle and a right ventricle, in the pulmonariest artery and its branches becomes perceptible. Centre lifetime of these patients without treatment averages 36 years. Recognition. The main thing is analysis of the data of angiocardiography, sounding of cardial cavities, an echocardiography, a heart X-ray inspection. Treatment. To confine exercise stresses. Symptomatic therapy (warm glycosides, diuretic, antiarrhytmic drugs without prescription). At the bad shipping of fault surgical treatment (defect plastic) is necessary. nezvrashchenie arterial (botallova) a duct – the congenital heart disease from bunch “acyanotic phylum”, at which ambassador of a birth does not grow and it is necessary to function the duct bridging an aorta with a pulmonary artery. One of the most widespread defects (10 %). At women meets more often, than at men. Symptoms and flow depend on magnitude of a duct and a load degree on heart. In uncomplicated events of complaints is not present or they are negligible. In such events of floggings it is found casually. At the considerable dilating of an arterial duct probably blanket growth inhibition and developments with considerably under physical working capacity. Patients, as a rule, thin, their mass below the normal. Naiboleechasty complaints to palpitation, a pulsing of pots on a neck and in a head, heavy feeling in breasts, tussis, a dyspnea at an exercise stress, promptly arising sense of weariness. There are giddinesses, predilection to syncopes. Cyanosis is not present. Loud long-term hum to the left of a breast bone (II-III mezhrebere) is auscultated. The Patent ductus arteriosus can become complicated a rheumatic and septic endocarditis, a heart failure. Centre lifetime is less, than at healthy faces. Recognition – the yielded cardiophonographies, catheterizations of cardial cavities, angiocardiographies. Treatment surgical – artificial closure of an arterial duct (a dressing, intersection). Conservative treatment is made only at complications. The aorta coarctation – a congenital stenosis (waist) of an isthmus of an aorta (from bunch of faults of “acyanotic” phylum) up to the full closure of a lumen of an aorta, compounds 6-7 % of all events of congenital heart diseases. At men, in comparison with women the interrelation 2:1 is more often becomes perceptible. Symptoms and flow. At a moderate coarctation of the complaint miss. Appearance of symptoms is caused by an arterial hypertonia and insufficient blood supply of the inferior extremities. Illness has an effect between 10-20 years of life. Naiboolee often patients complain of a ring in ears, rushes of blood, a burning sensation and fever of the person and arms, a pulsing of pots of a neck and a head, sense of gravity in it, a headache, giddiness, palpitation, a dyspnea. In more hard cases – attacks of a nausea, vomiting, predilection to syncopes. There can be nasal bleedings or a pneumorrhagia. Simultaneously with it troubles sense of a numbness, colds, delicacies in feet, cramps at an exercise stress, wounds on them heal badly. The alternating lameness happens seldom. Choronomicly sick can look normal. Sometimes at them muscles of a shoulder girdle and weakly podal are well educed. On a thorax and a gaste are visible pulsing arterii. Over heart range hum which is made on neck pots, to range between scapulas is auscultated. Very important sign – sphygmus different in force on top and bottom extremities, arterial pressure on arms is raised, and standing – is depressed. Various complications – hematencephalons, a heart failure, an early atherosclerosis of pots, aneurysms (dilatings) of pots, an infectious endocarditis, rheumatic process are possible. Centre lifetime without treatment does not exceed 35 years. Recognition is grounded on clinical signs, at the radiological is explored ii-expansion of an ascending part of an aorta and its arc, crucial importance has aorgografija. Treatment. A unique radical and effective method is surgical which is shown in all events of the taped coarctation of an aorta. Optimum age for operation of 8-14 years. Tetrada Fallo (the most frequent “dark blue” fault) is a combination of 4 signs: Stenosis (waist) of a pulmonary artery up to the full closure of a lumen, an aorta dextroposition (the aorta as though sits astride the right and left ventricles, that is it is reported with them both), defect of an interventricular septum and a hypertrophy (augmentation) of a right ventricle. It is accompanied since the early childhood by a proof cyanosis and it is compatible to rather long life. Symptoms and flow. The dyspnea occurs in the childhood, is normally bound even to a small exercise stress, sometimes has character of a dyspnea. Children frequently search for reliefs in a standing squatting, get used to sit, having enclosed under itself the crossed feet, and to sleep with the knees tightened to a gaste. They are ailing, chilly, at them syncopes and cramps are frequent. The state of health is influenced unfavorablely by changes of atmospheric conditions, excessive heat, a cold – strengthens a dyspnea, blanket delicacy, cyanosis. There can be nervous breakdowns. Children have alimentary system disturbances, at teenagers – palpitation, sense of gravity in the field of heart at a muscular exercise. Physical development and growth of the child, zapazdy saet mental and sexual is impeded. Reverses jaa itself attention incongruously long and the extremity, especially inferior is more thin. The important signs – cyanotic dactyls, utolshchennye in the form of drum-type rods. Over heart rasping hum is auscultated. Fault complications – comas, szjazakpye with depression of the content of oxygen in a blood, fibrinferments, a frequent pneumonia, infektsnoniyi an endocarditis, a heart failure. Centre lifetime of 12 years. Fault recognition is manufactured at sounding of cardial cavities, angiocardiography. Treatment surgical. The idiopathic hypertensia (an essential hypertonia) compounds to 90 % of all events of chronic rising of arterial pressure. In economically educed countries of 18-20 % of adult people suffer hypertopical illness, that is have repeated uprises of a BP to 160/95 mm hg and above. Are oriented on magnitudes of the so-called “casual” pressure measured after five-minute rest, in a standing sitting, triply successively (in calculation the lowest magnitudes) undertake, at the first survey of patients – it is binding on both arms, if necessary – and standing. At healthy people in 20-40 years “casual” the BP normally below 140/90 mm hg, in 41-60 years – below 145/90 mm hg, is more senior 60 years – not above 160/95 mm hg Symptoms and flow. The idiopathic hypertensia arises normally at the age of 30-60 years, proceeds chronically with the deterioration and enriching seasons. The stage 1 (easy) is characterised by uprises of a BP within 160-180/95-105 mm hg This level is nonresistant, during rest is gradually normalised. Trouble a pain and hum in a head, the bad sleep, depression of mental working capacity. Occasionally – giddiness, bleedings from a nose. A stage II (centre) – higher and stable level of a BP (180200/105-115 mm hg in rest). Headaches and in the field of heart, giddiness accrue. Hypertensive crises (subitaneous and considerable uprises of a BP) are possible. There are signs of a lesion of heart, the central excitatory system (transitory disturbances of a cerebral circulation, strokes), changes on an eyeground, blood flow depression in nephroses. Stage SH (serious) – more frequent occurrence of vascular accidents (strokes, infarcts). The BP reaches 200-230/115-130 mm hg, its self-maintained normalisation does not happen. Such load on pots causes irreciprocal changes in an action of the heart (a stenocardia, a myocardial infarction, a heart failure, arrhythmias), a brain (strokes, encephalopathies), an eyeground (a lesion of pots of a retina – retinopathies), nephroses (blood flow dropping in nephroses, depression of a glomerular filtration, chronic renal insufficiency). Recognition is made on the basis of the data of systematic definition of a BP, revealing of the characteristic changes on an eyeground, an electrocardiogram. The idiopathic hypertensia is necessary for distinguishing from the secondary arterial hypertonias (symptomatic) nephroses arising at diseases, renal pots, endocrine organs (illness of Itsepko-Kushinga, an acromegalia, primary aldosteropizm, a thyrotoxicosis), circulatory disturbances (an aorta atherosclerosis, insufficiency of valves of an aorta, the full atrioventricular blockage, an aorta coarctation). Treatment. Not medicinal: Depression of mass of a body, limitation of consumption of table salt, sanatorium treatment, physiotherapeutic procedures (baths, massage of collar region). medikamentoznoelechenie switches on beta adrenoblockers (Obsidanum, anaprilin, Viskenum, atenolol, spesikor, betalok, kordanum, etc.), diuretic (Hypothiazidum, Brinaldixum, Triampur compositum, etc.) Antagonists of calcium channels (verapamil, nifedipine), drugs of the central activity (clonidine, dopegit, Reserpinum), Prazozinum (adverzuten), captopril (kapoten), an apressine. Reception of complex drugs – Adelphanum, sinepresa, kristepina, brinerdina, trirezida is possible. Thus therapy selection should be made especially individually. A hypotension (a primary chronic hypotension, an essential hypotension). The disease bound to disturbance of functions of the excitatory system and a neurohormonal regulation of a tonus of pots, accompanied by depression of arterial pressure. An initial background of such state is the asthenia bound to psychoinjuring situations, persistent infections and intoxications (industrial harmfulnesses, abuse by alcohol), neurosises. Silttomy and flow. Patients are flaccid, apathetic, they are overcome by marginal delicacy and weariness in the mornings, do not feel vivacity even after the long-term sleep; Memory worsens, the person becomes dispersed, its attention nonresistant, working capacity is depressed, the sensation of shortage of air is constant, the potency and a sexual appetence at men and a menstrual cycle at women is broken. Emotional instability, irritability, hypersensitivity to bright light, loud speech prevails. The habitual headache is bound often to atmospheric pressure oscillations, abundant food intake, the long-term stay in an erect standing. Proceeding as a migraine, with a nausea and vomiting, decreases after walk in the open air or physical exercises, levigations of temporal ranges Acetum, applyings of ice or a cold towel for a head. There are giddinesses, poshatyvanie at hotbe, syncopes. A BP normally slightly or about 90/60-50 mm hg is moderately reduced Recognition is made on the basis of clinical signs and an exception of the diseases accompanied by the secondary arterial hypotension (illness of Addisona, insufficiency of a pituitary body, illness of Simmondsa, acute and persistent infections, a tuberculosis, a peptic ulcer, etc.) . Treatment. The correct regimen of work and rest. Apply sedative drugs and tranquilizers, adrenomimetiki: a phenylephine hydrochloride, ephedrine, Phethanolum; hormones of adrenals: korgin, DOXOES; the agents excitanting the central excitatory system: infusion zhen-shenja, Chinese limonnika, zamanihi, Pantocrinum, etc. probably physiotherapeutic (baths, massage), sanatorium treatment, physiotherapy exercises. A myocardial infarction. The disease of heart caused by insufficiency of its blood supply with the locus of a necrosis (necrosis) in a cardiac muscle (myocardium); the major shape of an ischemic heart trouble. To a myocardial infarction at the acute occlusion of a lumen of a coronary artery a thrombus, the turgent atherosclerotic plaque drives. Symptoms and flow. As the myocardial infarction beginning consider appearance intensive and long (more than 30 minug, quite often lasting many hours) a retrosternal pain (an anginous state), not stopped by repeated receptions of Nitroglycerinum; Sometimes in an attack pattern the dyspnea or a pain in an anticardium prevails. Bad attack complications: a cardiogenic shock, acute nedostatochntast a left ventricle up to a fluid lungs, serious arrhythmias with depression of arterial pressure, subitaneous mors. In the acute season of a myocardial infarction the arterial hypertonia disappearing after stihanija of pains, sphygmus increase, a fervescence (2-3 days) and numbers of leucocytes in a blood, replaced by rising soe, augmentation of activity of ferments kreatinfosfokinazy, aspartataminotrasferazy are observed, laktatdegidrogenazy, etc. Can arise epistenokarditichesky a pericarditis (the pain in the field of a breast bone, especially at breath, is quite often auscultated a pericardial rub). To complications of the acute season carry, except set forth above: The acute psychosis, infarct backset, acute a left ventricle aneurysm (its diverticulum istonchennoj nekrotizirovannoj parts), tearing up – a myocardium, an interventricular septum and papillary muscles, a heart failure, various disturbances of a rhythm and conductivity, a bleeding from acute stomach ulcers, etc. At the congenial flow in a cardiac muscle transfers process in a cicatrisation stage. The high-grade cicatrix in a myocardium is shaped to the extremity 6 months after its infarct. Recognition is made on the basis of analysis of a clinical pattern, the characteristic changes of an electrocardiogram at dynamic observation, level risings kardiospetsificheskih ferments. In doubtful events the echocardiography (revealing of the “immobile” regions of a myocardium) and radioisotope examination of heart (a myocardium scintigraphy) is made. Treatment. Urgent hospitalisation of the patient is necessary. Before first aid arrival it is necessary to yield the patient Nitroglycerinum (from one to several tablets with an interval of 5-6 minutes). Validol in these events is noneffective. In a hospital attempts of restoration of permeability of coronary pots (it is fused ie thrombuses by means of Streptokinasa, stretodekazy, alvezina, Fibrinolysinum, etc., heparin injection, an urgent surgical intervention – pressing aorto-coronary bridging) are possible. Anaesthetising drugs are binding (narcotic analyegiki, analginum and its drugs, is possible a narcosis nitrous oxide, etc., periduralnaja an anaesthesia – injection of anaesthetising materials under spinal cord shells), is applied Nitroglycerinum (intravenously and inside), antagonists of calcium channels (veraiamil, nifedipine, Sensitum), beta adrenoblockers (obzidap, anaprilin), antiagreganty (aspirin), make treatment of complications. Great value aftertreatment (has restoration of stable level of health and working capacity of the patient). Activity of the patient in bed – since the first day, prisazhivanie – with 2-4 days, a rising and walking – for 7-9-11 days. Terms and aftertreatment volume are selected strictly individually, after an extract of the patient from a hospital it is terminated in an out-patient department or sanatorium. An Ishemichssky heart trouble. The chronic illness caused by insufficiency of blood supply of a myocardium, in overwhelming majority of events (97-98 %) is a consequence of an atherosclerosis of coronary arteries of heart. Ground forms – a stenocardia, a myocardial infarction (see) An atherosclerotic cardiosclerosis. They meet at patients as separately, and in a combination, including their various complications and consequences (a heart failure, disturbances of a warm rhythm and conductivity, a thromboembolism). A stenocardia – an attack of a subitaneous stethalgia which always answers following signs: has accurately expressed time of occurrence and the termination, occurs under certain circumstances (at walking ordinary, after meal or with a serious burden, at a locomotion acceleration, uprise uphill, a sharp head wind, other physical effort); the pain starts to remit or is absolutely stopped under the influence of Nitroglycerinum (in 1-3 minutes after reception tabliki under tongue). The pain ranges behind a breast bone (most typically), sometimes – in the field of a neck, a mandible, dens, arms, a shoulder girdle, in the field of heart. Its character – pressing, compressing, is more rare stinging or is burdensome notable behind a breast bone. Simultaneously arterial pressure can raise, the skin turns pale, is coated with a perspiration, the pulse rate fluctuates, extrasystoles (Arrhythmias see) are possible. Recognition is made on the basis of inquiry of the patient. Changes on an electrocardiogram nespetsifichny, happen not always. Diagnosis improvement can be helped by assays with the dosed exercise stress (veloergometrija – “bicycle”, tredmil – “a running path”), chrezpishchevodnoj stimulation of auricles. To tap a degree and prevalence of an atherosclerotic lesion of coronary arteries, and also possibility of surgical treatment is allowed by a coronarography. Treatment. Cupping of an attack of a stenocardia: under tongue – Tabulettae Nitroglycerini, Corinfarum (kordafena, kordipina, foridona), korvatona (Sydnopharmum). If necessary reception of tablets can be retried. In mezhpristupnyj the season – the prolonged nitrodrugs (Nitrosorbidum, izodinit, Sustac, Nitrongum, sustonit, etc.) Beta adrenoblockers (Obsidanum, anaprilin, atenolol, spesikor, etc.) Antagonists of calcium (verapamil, nifedipine, Sensitum), korvaton (Sydnopharmum). At possibility surgical treatment – aorto-coronary bridging (applying of a path of blood supply of a myocardium bypassing reduced fields of coronary arteries) is made. Cardiomyopathies – primary noninflammatory lesions of a myocardium of the unknown cause which are not bound to defect of valves or congenital heart diseases, an ischemic heart trouble, an arterial or pulmonary hypertonia, general diseases. The mechanism of development of cardiomyopathies is obscure. Participation of genetic factors, disturbances of a hormonal regulation of an organism is possible. Possible action of a virus infection contamination and changes of immune system is not excluded. Symptoms and flow. Distinguish ground forms of cardiomyopathies: hypertrophic (obstructive and not obstructive), congestive (dilatatsionnuju) and restriktivnuju (meets seldom). Hypertrophic kardiomiochatija. For not obstructive (not causing difficulties for locomotion of a blood in heart) it is characteristic the augmentation of the dimensions of heart because of a thickening of walls of a left ventricle, is more rare only than a heart apex. Hum can be auscultated. At a hypertrophy of an interventricular septum with waist of outflow tracts of a blood from a left ventricle (the obstructive shape) there are pains behind a breast bone, attacks of giddiness with predilection to syncopal states, a paroxysmal night dyspnea, loud systolic hum. Arrhythmias and disturbances of intracardiac conductivity (blockage) are frequent. progressirovapie cardiomyopathies result ins to heart failure development. On an electrocardiogram signs of a hypertrophy of a left ventricle are taped, sometimes changes remind those at a myocardial infarction (”infarkgopodobnaja” an electrocardiogram). Congestive (dilatatsioichaja) the cardiomyopathy is displayed by sharp dilating of all cabinets of heart in a combination to their negligible hypertrophy and steadily progressing heart failure not giving in to treatment, development of clottages and thromboembolisms. The forecast at a progressing heart failure the unfavorable. At the expressed shapes events of subitaneous mors are observed. Recognition. Diagnosis improvement is helped by an echocardiography, a radioisotope ventriculography. It is necessary to distinguish a congestive cardiomyopathy and myocardites, a serious cardiosclerosis. Treatment. At a hypertrophic cardiopathy apply beta adrenoblockers (anaprilin, Obsidanum, Inderalum), at disturbance of outflow tracts of a blood from heart is possible a surgical method. At heart failure development confine fizicheskie loads, salt and fluid consumption, apply peripheric vazodilatatory (Sodium nitritums, kapoten, Prazozinum, apressii, Molsidominum), diuretics, antagonists of calcium (Isoptinum, verapamil). Warm glycosides are almost inefficient. At a congestive cardiopathy the heart transplantation is possible. A myocarditis. An inflammatory lesion of a cardiac muscle. Distinguish rheumatic, infectious (virus, bacteriemic, rickettsial, etc.) Allergic (medicinal, serumal, postvaccinal), at diffuse diseases of a copulative tissue, traumas, combustions, ionising radiation action. Evolve also idiopathic (that is the obscure nature) a myocarditis of Abramova-Fidlera. The vedushaja role in development of inflammatory process belongs to an allergy and immunodefence disturbance. Symptoms and flow. The myocarditis begins against an infection contamination or soon after it with a malaise, sometimes persistent heartaches, palpitation and faults in its job and a dyspnea, occasionally – morbidities in joints. A body temperature normal or slightly raised. The disease beginning can be imperceptible or hidden. The heart dimensions are early enlarged., but not constant signs disturbances serdechnoju a rhythm (a tachycardia – its increase, a bradycardia – it urezhenie, a ciliary arrhythmia, ekstrasistolija) and conductions (various blockages) are important. There can be acoustic symptoms – dullness of tints, a cantering rhythm, systolic hum. The myocarditis can become complicated heart failure development, appearance of thrombuses in cardial cavities which, in turn, carried by a current spray, cause a necrosis (infarcts) of other organs (thromboembolism). The Clinical course can be acute, subacute, chronic (recurring). Recognition. There are no strictly myocarditis specific characters. The diagnosis put on the basis of clinical signs, changes of an electrocardiogram, an echocardiography, presence of laboratory signs of an inflammation. Treatment. A confinement to bed. Early purpose of glucocorticoid hormones (Prednisolonum), nonsteroid resolvents (aspirin, Butadionum, Ibufrofenum, indometacin). Treatment of a heart failure, disturbances of a warm rhythm and conductivity is made. Apply the agents enriching regenerative processes of a metabolism in a muscle of heart: Retabolilum, nerabol, Riboxinum, bunch vitamins In and S.Pri a fixing clinical course – Delagilum, Plaquenilum. Neurocirculatory dpstonnja (NTSD, a vegeto-vascular dystonia). Has the functional nature, for it disorders of neuroendocrinal regulation of activity of cardiovascular system are characteristic. At teenagers and young men NTSD it is caused by a mismatch of physical development and a maturity degree of nervously-endokrinnogo apparatus more often. At other age to dystonia development can promote psychological attrition in outcome of acute and chronic infectious diseases and intoxications, nedosypanie, overfatigue, the wrong diets, sexual life, physical activity (reduced or too intensive). Symptoms and flow. Patients delicacy, fatigability trouble, sleep disorders, irritability. Depending on response of cardiovascular system evolve 3 phylums NTSD: cardial, hypotensive and hypertensive. Cardial phylum – complaints to palpitation, faults in heart range, sometimes sensation of shortage of air, can become perceptible changes of a warm rhythm (sinusovaja a tachycardia, the expressed respiratory arrhythmia, nadzheludochkovaja ekstrasistolija). On an electrocardiogram of changes is not present or sometimes changes of finger T.Gipotenzivnyj phylum – fatigability, muscular delicacy, a headache (it is quite often provoked by hunger), zjabkost brushes and stacks, predilection to syncopal states become perceptible. The skin routinely acyanotic, brushes of arms cold, palms damp, becomes perceptible depression of a systolic BP below 100 mm hg Hypertensive phylum – characteristicly transitory rising of arterial pressure which almost at half of patients is not combined with change of state of health and is found for the first time during medical inspection. On an eyeground unlike an idiopathic hypertensia of changes is not present. Complaints to a headache, palpitation, fatigability are In certain cases possible. Treatment. Preferentially not medicamental methods: normalisation of the mode of life, hardening procedures, employment by physical culture and some views of sports (floating, track and field athletics). The physiotherapy, balneoterapija, sanatornokurortnoe treatment is used. At irritability, sleep disorders – drugs of Valeriana, Leonurus, valocordin, sometimes tranquilizers. At hypotensive phylum – physiotherapy exercises, Belloidum, caffeine, Phethanolum. At hypertensive phylum – begaadrenoblokatory, Rauwolfia drugs. An alternating lameness. Arises at an obliterating atherosclerosis, an obliterating endarteritis. The basic sign – occurrence of pains in ikronozhnyh muscles at walking which disappear or decrease at a stopping. Appearance of an alternating lameness is promoted by the diabetes, the raised content of lipids in bloods, adiposity, smoking, elderly and senile age. Normally obliterating atherosclerosis is combined with a vasoconstriction of a brain, heart, nephroses. Symptoms and flow depend on gravity of disturbance of a circulation in extremities. 1 stage – depression and lack of sphygmus on pots of feet. 2 stage – naturally alternating lameness (in ikronozhnyh muscles and a rump at walking – the patient can transit a pain from 30 to 100), 3 stage – a pain in rest and at night accruing intensity, 4 stage – the considerable pain in rest, the exercise stress is almost impossible: the expressed disturbances of a food of soft tissues, a necrosis of tissues (necrosises) on dactyls and stop, a gangrenosis. Recognition: an angiography, dopplerografija pots of the inferior extremities. Treatment. The core – surgical, at its impossibility – conservative: spazmolitiki (Nospanum, a papaverine, Halidorum), anaesthetising, ganglioblokatory (Diprophenum, Dicolinum), antiagreganty (Trentalum, Curantylum, aspirin), the agents enriching processes of a food vtkanjah (vitamins, komplamin, solkoseril). Carry out physiotherapeutic procedures, hyperbaric oxygenation (treatment by oxygen in an altitude chamber), sanatorpo-resort treatment. A pericarditis. An acute or chronic inflammation of a pericardium (a pericardiac ascus, an outside shell of heart). Distinguish dry (slipchivyj, including konstriktivnyj – pinching) and vypotnoj (exudative) pericarditis. Infection contaminations (viruses, bacteria, tuberculosis micobacteria, mushrooms, the elementary, rikketsii), rheumatic disease, a pseudorheumatism, a system lupus erythematosus, a myocardial infarction, an uremia, a trauma (including it is operational “, radial), tumours, avitaminoses With and B1 can be the pericarditis causes. The mechanism of development of a pericarditis often allergic or autoimmuppyj. Symptoms and flow are spotted by a basic disease and harakteromzhidkosti in a pericardium, its quantity (dry or exudative) and rate of accumulation of fluid. In the beginning patients complain of a malaise, a fervescence, pains behind a breast bone or in the field of the heart, respirations quite often bound to phases (strengthen on an inspiration), sometimes pains remind a stenocardia, the pericardial rub more often is auscultated. Fluid appearance in a pericardium lumen is accompanied by extinction of pains and a pericardial rub, there is a dyspnea, cyanosis, cervical veins bulk up, there are various disturbances of a rhythm (blinking, an atrial flutter). At prompt increase of an exsudate the cardiac tamponade with the expressed cyanosis, sphygmus increase, excruciating attacks of a dyspnea, sometimes a loss of consciousness can educe. Circulation disturbance gradually accrues – there are edemas, an ascites, the liver is enlarged. At the long-term flow of a pericarditis deposition of salts of calcium (armored heart) can be observed. Recognition is helped by heart roentgenography, an echocardiography. Treatment. Apply nonsteroid resolvents (aspirin, Rheopyrinum, Ibufrofenum, indometacin, etc.) In hard cases – glucocorticoid hormones (Prednisolonum). At infectious pericardites – antibiotics. At tamponade threat manufacture a pericardiocentesis. Make heart failure treatment (diuretic, peripheric vazodilatatory, veroshpirop, exsanguinations). At konstriktivnom and purulent process probably surgical intervention. The got heart diseases. Lesions of the mitral valve (valves) which cusps appear incapable of the full disclosing (stenosis) of a valving foramen or to clamping (insufficiency of the valve) or to that and another (sochetannyj fault). The Most frequent cause of defect is the rheumatic disease, is more rare – a sepsis, an atherosclerosis, a trauma, a syphilis. The stenosis is formed owing to a cicatrical adnation, insufficiency of the valve arises because of fracture or damage of its cusps. Hardles in a path of transit of a blood cause an overload, a hypertrophy and dilating of structures lying above the valve. The impeded cardiac performance breaks a food of the hypertrophied myocardium and result ins a heart failure. A mitral fault – the lesion of the mitral valve accompanied by impeded transit of a blood from a small circle in major at level of the left atrioventricular foramen. At patients – a dyspnea, palpitation, tussis, edemas and a pain in right hypochondrium. It is available it is possible tsianotichesky a blush, arrhythmias (ciliary, extrasystoles ija) become perceptible. A mitral stenosis – waist of the left atrioventricular foramen. Specific acoustic signs – a rhythm has sung (”clapping” 1 top hearts, II tint and click of discovering of the mitral valve) and diastolic hum. At negligible waist of the left atrioventricular foramen the dyspnea occurs only at major exercise stresses. More considerable waists cause a dyspnea at moderated, and then and at an easy load, subsequently and in rest. During an attack of a dyspnea patients occupy the forced semisitting position facilitating breath. Recognition is made on the basis of an acoustic pattern, the data of a cardiophonography, an echocardiography. Treatment at a sharp and moderate stenosis – surgical (a mitral commissurotomy); at a heart failure – diuretic, peripheric vazodilatatory, antiarrhytmic drugs, if necessary – a countershock; treatment and preventive maintenance of the basic diseases, result ining to fault development. Insufficiency of the mitral valve. At negligible – complaints are not present, with insufficiency advance there can be palpitation, an undue fatigability, a moderate dyspnea, a fluid detention. There are edemas, the liver and the dimensions of heart at the expense of its left ventricle is enlarged. Systolic hum is auscultated. Stenosis and insufficiency combination name sochetannym mitral fault for which presence of signs and that and other lesion of the mitral valve is characteristic. Recognition – on the basis of analysis findings of an acoustic pattern, a cardiophonography, an echocardiography. Treatment conservative, at the expressed insufficiency of the mitral valve – its prosthetics. An aortal fault – symptoms and flow depend on the shape of fault and gravity of circulatory disturbances. The aortal stenosis happens rheumatic, atherosclerotic or congenital. Waist of initial department of an aorta impedes left ventricle bleeding, and incomplete exhaust of a blood in an aorta causes insufficiency cerebral and a coronary circulation. Patients complain of giddiness, blackout, pains behind a breast bone at an exercise stress. Fault advance result ins “mitralizatsii”, that is to appearance of signs of mitral insufficiency (a dyspnea, dyspnea attacks, a ciliary arrhythmia). Acoustic symptom of an aortal stenosis is specific rasping systolic hum which is auscultated over an aorta and is made on neck pots. Recognition on the basis of the data echocardiographic, fonokardiograficheskogo examinations. Treatment. At the considerable stenoses – surgical (a commissurotomy, the artificial aortal valve). Medicamental therapy includes Sodium nitritums, antagonists of calcium, blockers of beta adrenergic structures, diuretic. Insufficiency of the aortal valve. The cause more often rheumatic, and also an aorta lesion at a syphilis, a septic endocarditis, an atherosclerosis. Patients are troubleed by a dyspnea, there are attacks of a dyspnea and support a breast bone (stenocardia), palpitation, sensation of a pulsing in a head. The characteristic acoustic sign is “tender” diastolic hum. The heart dimensions are enlarged at the expense of dilating of a lumen of a left ventricle. Depression of a diastolic BP (below 60 mm hg) is typical . Promptly educes “mitralizatsija” fault (the aortal stenosis see). Recognition on the basis of the acoustic data, revealing of signs of an overload of a left ventricle, indications of a cardiophonography, an echocardiography. Treatment. Surgical correction of fault (implantation of the artificial valve) is possible. Conservative therapy includes application of Sodium nitritums, antagonists of calcium, peripheric vazodilatatorov, diuretic, warm glycosides. At a combination of defects on different valves tell about the combined heart disease (combined mitralyju-aortalnyj fault, etc.) . Symptoms and a clinical course depend on expression and an extent of injury of this or that valve. prolaps mntralnogo the valve. A protrusion, a diverticulum or even vyvorachipanie one or both cusps of the mitral valve in a lumen of the left auricle during left ventricle cutting. There is at persons of young age (15-30 years), at women at 9-10 time more often, than at men. Appearance prolapsa normally bind or to elongation of tendinous strands and disturbance of locomotion of cusps of the valve, or with damage of so-called papillary muscles, or with reduction of the dimension of a lumen of a left ventricle. Symptoms and flow. Complaints to painful sensations in the field of the heart, arising normally against the emotional experiences, not bound to an exercise stress and not taken out by Nitroglycerinum are possible. Pains it is frequent stationary values, are accompanied by the expressed alarm and palpitation. Sensations of faults in a cardiac performance are possible. At heart auscultation “click” in the middle of a systole (heart cutting) after which there is a hum is spotted on an apex. At 90 % of patients prolaps the mitral valve proceeds it is good-quality, without causing injury to their health and working capacity. Recognition is made on the basis of the cardiophonography and echocardiography data. Treatment at small prolapse the mitral valve and lack of disturbances of a rhythm of the active treatment is not required. At expressed prolapse, accompanied by pains, rhythm disturbances, apply beta adrenoblockers (anaprilin, Obsidanum). The rheumatic disease, a rheumatic carditis – see below partition “Rheumatic illnesses”. The Heart failure. A state caused by insufficiency of heart as the pompe, providing a necessary circulation. Is a consequence also implication of the diseases amazing a myocardium or impeding its job: nshemicheskoj a heart trouble and its faults, an arterial hypertonia, diffuse diseases of lungs, a myocarditis, cardiomyopathies. Symptoms and flow. Distinguish acute and hronichekuju a heart failure depending on rates of its development. Clinical implications neodinakovy at a preferential lesion of the right or left departments of heart. The left ventricular failure arises at a lesion and an overload of the left departments of heart. Developments of stagnation in lungs – a dyspnea, attacks of a warm asthma and a fluid lungs and their signs on a X-ray pattern, sphygmus increase educe at mitral heart diseases, serious shapes of an ischemic heart trouble, myocardites, cardiomyopathies. The exhaust left ventricular failure is displayed by cerebral circulation depression (giddiness, blackout, syncopes) and a coronary circulation (stenocardia), it is characteristic for aortal faults, an ischemic heart trouble, an arterial hypertonia, an obstructive cardiopathy. Both views of a left ventricular failure can be combined with each other. Pravozheludochkovaja insufficiency arises at an overload or a lesion of the right departments of heart. Congestive pravozheludochkovaja insufficiency (the swelling of cervical veins, a high venous pressure, cyanosis of dactyls, an end of a nose, ears, a chin, liver augmentation, appearance of small yellowness, edemas of a different degree of manifestation) normally joins a congestive left ventricular failure and is typical for faults of the mitral and three-cuspidate valve, konstriktivpogo a pericarditis, myocardites, a congestive cardiomyopathy, a serious ischemic heart trouble. Pravozheludochkovaja insufficiency of exhaust (its signs are taped in the core at a X-ray inspection and on an electrocardiogram) is characteristic for stenoses of a pulmonary artery of a pulmonary hypertonia. The dystrophic shape – a terminating stage pravozheludochkovoj failures, at which razvivaetssja a cachexia (attrition of all organism), dystrophic changes of a skin (a thinning, gloss, a drawing smoothness, flabbiness), edemas – propagated up to an anasarca (total cutaneous dropsies and perigastriums), protein level recession in a blood (albumins), disturbance of water-salt balance of an organism. Recognition and an assessment of severity level of a heart failure is made on the basis of the clinical data, are improved at additional examinations (roentgenography of lungs and heart, elektrokardioi an echocardiography). Treatment. Limitation of exercise stresses, a diet rich with squirrels and vitamins, kalium with limitation of salts of sodium (table salt). Medicinal treatment includes reception peripheric vazodilatatorov (Sodium nitritums, an apressine, Corinfarum, Prazozinum, kapoten), diuretic (Furosemidum, Hypothiazidum, Triampur compositum, Uregitum), veroshpirona, warm glycosides (a strophanthin, digoxin, Digitoxinum, Celanidum, etc.) . An endocarditis. The inflammation i an intrinsic shell of heart (endocardium) at rheumatic disease, is more rare at an infection contamination (a sepsis, mycotic affections), at diffuse diseases of a copulative tissue, intoxications (uremia). Subacute (lingering) septic endocarditis (an infectious endocarditis) – septic disease with a locating of the basic locus of an infection contamination on heart valves. More often disease-producing factors are streptococcuses, staphilococcuses, an is more rare-intestinal rod, si not purulent rod, protej, etc. is much more often the variated valves are surprised at the got and congenital heart diseases, valving prostheses. Symptoms and flow. Rise in temperature is characteristic, is frequent with a fever and then, with joint pains, pallor of a skin and mucosas. At a lesion of valves there are signs, characteristic for heart diseases. The inflammation of the muscle of heart is displayed by an arrhythmia, conductivity disturbances, heart failure signs. At involving in process of pots there are vasculites (a vascular wall inflammation), fibrinferments, aneurysms (pot dilating), hemorrhagic enanthesises (ecchymoses), infarcts of nephroses and a lien. Signs of a diffuse glomerulonephritis more often become perceptible, the liver, a lien, pojavletsja a small icterus is enlarged. Complications are possible: heart disease formation, tearing up of valves, heart failure advance, disturbance of function of nephroses, etc. In analysises of a blood haemoglobin reduction, moderate depression of leucocytes, ESR substantial growth. The acute septic endocarditis is complication of a blanket sepsis, on the implications does not differ from the subacute shape, is characterised only more by a rapid current. Recognition is helped by echocardiographic examination (taps a lesion of valves of heart and growth of bacterial clumps); at blood sowings it is possible to find the originator of an endocarditis and to spot its sensitivity to antibiotics. Treatment. Antibiotics it is long-term and in high doses, an immunotherapy (antistaphylococcal plasma, antistaphylococcal gamma globulin), immunomodulating factors (T-ACTIVIN, Thymalinum). Apply if necessary short courses gljukokorgikoidnyh hormones (prednizolop), a heparin, antiagreganty (aspirin, kuraltil, Trentalum), blood uv radiation, plazmaferez, a hemosorption. At an inefficiency antibakteralnoj therapies of an endocarditis, serious, nepoddajushchejsjalechepiju a heart failure the surgical method – excision of the amazed valve with its subsequent prosthetics is possible. 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