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Module 2: Symptoms and syndromes in diseases of internal organs.doc
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Additional methods of examination

Clinical blood analysis: at the prolonged course of hypertension occur hypertensive polycytemia - increased hemoglobin and hematocrit are possible.

Biochemical blood analysis: at development of kidney failure there is increasing level of creatinine.

Clinical urine analyses: at development of nephroangiosclerosis and renal failure - proteinuria, microhematuria, hypo-, isostenuria in Zimnitsky's test.

ECG: the left ventricle hypertrophy, depressed ST-segment, inverted or two-phase T-wave in the 1st and 2nd standard, V5-V6 chest leads.

X-ray examination of heart. In the initial period of hypertrophy, rounding of apex of the left ventricle is find out. All chambers of heart are dilated in the late stages.

Echocardiography: hypertrophy of the interventricular septum and the back wail of the left ventricle, decrease of contractility of the myocardium, increase end systolic and diastolic dimensions of the left ventricle.

Ophthalmoscopy is revealed angioretinopathy.

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 6. Ischemic Heart Diseases, Main Symptoms and Syndromes at Angina pectoris and Myocardial infraction.

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: Determination of Ischemic Heart Diseases. Main pathogenesis mechanisms of Ischemic Heart Diseases, Basic risk factors of Ischemic Heart Diseases. Modern classification of Ischemic Heart Diseases. Determination and main symptoms of angina pectoris. Functional classes of angina pectoris. Objective diagnostic methods of angina pectoris (ECG, Monitor- controlling 24 hours –ECG, Exercise test, Scintigraphy of heart, Coranarigraphy). Unstable angina pectoris, definition of unstable angina pectoris and main clinical signs and symptoms of unstable angina pectoris. Determination of acute coronary symptoms. Determination of main clinical signs of acute myocardial infraction. Physical examination methods of patients with acute myocardial infraction. Stages of myocardial infraction. ECG-changes in different forms of myocardial infraction. Modern bio-markers of necrosis of myocardium.

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