Additional methods of examination

ECG: hypertrophy of the left ventricle: the electrical axis is deviated to the left, the S-wave in the right chest leads are deep and the amplitude of the R-wave is higher in the left chest leads, relative coronary insufficiency: depressed of the ST-interval, inverted T-wave.

X-ray: protrusion of the left ventricle arch, heart apex rounding, marked heart waist, (heart configuration is duck-like), narrowing of the retrocardial space in the second position.

The phonocardiograph shows the specific changes in the heart sounds diminished amplitudes of the first sound at the heart apex and of the second sound over the aorta. Protodiastolic murmur over the aorta and at the Botkin-Erb's listening point is typical.

Echo-CG: dilated left ventricle, retrograde blood flow through the aortic valve into the left ventricle during diastole.

Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir . Publishers, 1990. - 647 p

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

Topic 5. The Main Syndromes and Symptoms of Arterial Hypertension. Hypertenic Crisis.

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation: Arterial hypertension (WHO/1999), essential hypertension, secondary hypertension. The risk main factors of arterial hypertension and mechanism of the development. Modern classification of arterial hypertension. The main complaints of the patients with arterial hypertension, external examination, palpation, percussion, auscultation of the patients with arterial hypertension. ECG-signs of the changes in myocardium in the patients with arterial hypertension. Secondary hypertension. Hypertonic crisis.

Syndrome of the arterial hypertension

Arterial hypertension is defined as elevation systolic blood pressure (SBP) to 140 mmHg and higher and diastolic blood pressure (DBP) to 90 mmHg and higher in case of stable elevation confirming on repeating measurement blood pressure (2-3 times in different days during 4 weeks).

Classification on etiology:

1. Secondary (symptomatic) hypertension.

2. Essential arterial hypertension.

Symptomatic arterial hypertension

Symptomatic arterial hypertension causally related to the diseases with dam­ages of some organs, participating in regulation of arterial pressure.

Causes of secondary hypertension

1. Renal diseases:

- parenchymal and interstitial diseases of kidneys (glomerulonephritis, chronic pyelonephritis, diabetic nephropathy, amyloidosis, hydronephrosis, postradiation nephrosclerosis):

- renovascular pathology (atherosclerosis of kidney artery, fibromuscular dysplasia, aortoartentis, vasculitis, endarteritis, thrombosis, embolism, aneurysm of kidney artery, stenosis and thrombosis of veins, trauma of kidney vessels);

- anomalies of kidney and urinary tract (polycystosis, hypoplasia, anomalies of urinary system);

- secondary damage of kidneys at tuberculosis, bacterial metastases and diffuse diseases of connective tissue (lupus, system sclerodermia).