- •Ministry of Public Health of Ukraine
- •Basic Symptoms and Syndromes in Diseases of Cardiovascular System.
- •Syndrome of cardiovascular failure
- •Etiology
- •Classification of heart failure
- •Classification of heart failure according n.D. Strazhesko and V.H. Vasilenko
- •Classification of heart failure according to New York Heart Association New York Heart Association Functional Classification (nyha)
- •Clinical features
- •Additional methods of examination
- •Acute heart failure Acute left ventricular failure
- •Cardiac asthma
- •Pulmonary edema
- •Additional methods of examination
- •Acute left atrial heart failure
- •Acute right ventricular heart failure
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Chronic heart failure Chronic left ventricular heart failure
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Chronic left atrial heart failure
- •Chronic right ventricular heart failure Etiology
- •Clinical features
- •Additional methods of examination
- •Syndrome of vascular failure
- •Syndrome of a syncope
- •Clinical features
- •Syndrome of collapse
- •Etiology
- •Clinical features
- •Syndrome of shock
- •Classification according to etiology
- •Clinical features
- •Additional methods of examination
- •Literature
- •Acute rheumatic fever
- •Etiology
- •Pathogenesis
- •Classification
- •The Jones Criteria for Rheumatic Fever, Updated 1992
- •Clinical features
- •Additional methods of examination
- •Literature
- •Contents heart valvular diseases
- •Mitral regurgitation
- •Etiology
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Mitral stenosis
- •Etiology
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Literature
- •Contents aortic stenosis
- •Etiology:
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Aortic regurgitation
- •Etiology
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Literature
- •Syndrome of the arterial hypertension
- •2. Endocrine hypertension:
- •3. Hemodynamic hypertension:
- •4. Neurogenic hypertension:
- •Clinical features
- •Essential hypertension
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Literature
- •Ischemic heart disease
- •Etiology and pathogenesis
- •Classification of ischemic heart disease (ihd)
- •Stable angina
- •Clinical features
- •Canadian Cardiovascular Society classification of stable angina
- •Additional methods of examination
- •Acute coronary syndrome
- •Clinical features
- •Additional methods of examination
- •Unstable angina
- •Braunwald classification system for unstable angina (ua)
- •Intensity of treatment
- •Myocardial infarction
- •Clinical features
- •Additional methods of examination
- •Optimal time for estimation of myocardial markers of necrosis
- •Dynamic of laboratory markers of myocardial infarction
- •Sudden cardiac death
- •Clinical features
- •Literature
- •Chronic obstructive pulmonary disease (copd)
- •Classification of Chronic Obstructive Pulmonary Disease by Severity
- •Clinical features
- •Additional methods of examination
- •Chronic bronchitis Chronic bronchitis is chronic inflammation of the bronchi and bronchioles. Etiology
- •Pathogenesis. On chronic bronchitis occurs development of classic pathogenetic triad:
- •Clinical features
- •Additional methods of examination
- •Bronchial asthma
- •Etiology
- •Classification
- •Clinical features
- •Additional methods of examination
- •Syndrome of bronchium obstruction (bronchospastic syndrome)
- •Additional methods of examination
- •Syndrome of increased airiness of the pulmonary tissue
- •Additional methods of examination
- •Bronchiectasis
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Literature
- •Pneumonia
- •Classification
- •Acute lobar pneumonia
- •Additional methods of examination
- •Bronchopneumonia (focal pneumonia)
- •Clinical features
- •Tumors of the lungs
- •Clinical features
- •Literature
- •Pleurisy
- •Dry pleurisy
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Pleurisy with effusion
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Syndrome of fluide accumulation in the pleural cavity
- •The main causes of pleural fluid accumulation
- •Classification
- •Clinical features
- •Additional methods of examination
- •Syndrome of air accumulation in the pleural cavity
- •Clinical features
- •Additional methods of examination
- •Respiratory insufficiency
- •Literature
- •Syndrom of functional dyspepsia
- •Classification
- •Clinical features
- •Chronic gastritis
- •Etiology
- •Classification
- •Clinical features
- •Additional methods of examination
- •Peptic ulcer disease (Gastric and Duodenal Ulcer)
- •Etiology
- •Pathogenesis
- •Cinical features
- •Additional methods of examination
- •Complications
- •Irritable bowel syndrome
- •Clinical features
- •Literature
- •Syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders)
- •Classification
- •Clinical features
- •Additional methods of examination
- •Chronic cholecystitis
- •Clinical features
- •Additional methods of examination
- •Cholangitis
- •Etiology
- •Pathogenesis
- •Classification
- •Clinical features
- •Additional methods of examination
- •Jaundice
- •Etiology
- •Pathogenesis
- •Additional methods of examination
- •Literature
- •Classification
- •II. Classification by grade or by stage:
- •Pathological anatomy
- •Clinical features
- •Additional methods of examination
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Syndrome of portal hypertension
- •Classification
- •Hepatic insufficiency
- •Literature
- •Glomerulonephritis
- •Classification
- •Etiology
- •Acute glomerulonephritis
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (nephritic form)
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (hypertensive form)
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (mixed form).
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (latent form)
- •Clinical features
- •Additional methods of examination
- •Pyelonephritis
- •Pathogenesis
- •Infectious agents may be transmitted by contact, hematogenous or lymphatic ways in obligatory presence of urodynamic abnormalities. Acute pyelonephritis
- •Clinical features
- •Additional methods of examination
- •Chronic pyelonephritis
- •Clinical features
- •Additional methods of examination
- •Syndrom of chronic renal failure
- •Etiology
- •Pathogenesis
- •Classification of chronic renal diseases (nkf, usa)
- •Clinical features
- •Additional methods of examination
- •Literature
- •Syndrome of anemia
- •Classification
- •Iron deficiency anemia
- •Etiology
- •Vitamin b12 deficiency anemia
- •Hemolytic anemia
- •Classification of hemolytic anemias
- •Additional methods of examination
- •Complete Blood Count (cbc)
- •Normal wbc count
- •Complete Blood Count (cbc)
- •Literature
- •The main methods of laboratory diagnostics of hemorrhagic syndromes
- •Tests for plasma factors involved in coagulation and fibrinolisis
- •Hemorrhagic syndrome
- •Etiology
- •Pathogenesis
- •Clinical feature
- •Additional methods of examination
- •Hemophilia b (Christinas' disease)
- •Clinical feature
- •Additional methods of examination
- •Additional methods of examination
- •Literature
- •Eucosis (Hemoblastosis)
- •Classification of hemoblastosis
- •Acute myeloblastic leukemia
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Chronic myelocytic leukemia
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Chronic lymphocytic leukemia
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Literature
- •Diabetes mellitus
- •Etiological classification of glycemia disorders
- •Classification according to clinical feature
- •Etiology and pathogenesis of insulin dependent diabetes mellitus
- •Etiology and pathogenesis of insulin nondependent diabetes mellitus
- •Clinical features
- •Comparative clinical features of iddm and niddm
- •Hypoglycemia
- •Clinical features
- •Diabetic ketoacidosis
- •Clinical feature
- •Objective examination
- •Additional methods of examination
- •Hyperosmolar non-ketotic coma
- •Clinical features
- •Additional methods of examination
- •Additional methods of examination dm
- •Hyperthyridism
- •Etiology
- •Pathogenesis
- •Clinical feature
- •Additional methods of examination
- •Hypothyroidism
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Literature
- •Contens
Acute coronary syndrome
Acute coronary syndrome (unstable coronary artery disease) includes both unstable angina and non-Q-wave myocardial infarction.
Clinical features
increased severity or frequency of the patient's pre-existing angina within the last month;
rapidly worsening chronic stable angina (crescendo angina);
new onset of angina pectoris;
angina at rest;
post-infarction angina (more than 24 hours after myocardial infarction);
non-Q-wave myocardial infarction.
Objective examination. During attack of chest pain the patient's condition is grave, forced sitting position, the face is pale with acrocyanosis. The border of relative cardiac dullness displaced outside.
In auscultation both heart sounds are decreased, S3 or S4 gallop may be detected during an episode of pain. Mitral regurgitation murmur appears. Arrhythmia is often observed. Blood pressure tends to have less level, than in period free of pain. The signs of congestion failure present: enlarged liver, pedal edema.
Additional methods of examination
Clinical blood analysis is without change, seldom may be slight leukocytosis.
Biochemical blood analysis: commonly there are the signs of disorders of lipid profile: increased level total cholesterol, triglycerides, low density lipoprotein cholesterol.
Small rises in the serum levels of biochemical markers of cardiac injury (creatine kinase, creatine kinase MB), troponin-T or troponin-I reflect the development of small foci of myocardial necrosis, minor creatine kinase, creatine kinase MB, which are usually accompanied by elevated troponin-T levels, indicate an increased risk of future events, despite stabilization of their clinical condition. Cardiac troponin-I is not detectable in the absence of cardiac injury. Because of the lag period before a rise becomes detectable, at least two samples, taken at an interval of 12-24 hours, should always be tested.
Elevated fibrinogen levels at the time of admission are associated with an increased risk of death, myocardial infarction or spontaneous ischemia in patients with unstable angina.
The acute-phase proteins C-reactive protein is sensitive, but non-specific, markers of inflammation. There is much evidence to suggest a role for inflammation in the etiology of unstable angina and myocardial infarction and level of this protein have been observed to be elevated in some patients with acute coronary syndrome. C-reactive protein levels 3 mg/1, as detected by means of sensitive radioimmunoassay, indicate an increased risk of subsequent cardiac events m patients with acute coronary syndrome.
Instrumental examination. ECG monitoring is regarded as an essential part of routine management. All patients with suspected acute coronary syndrome should be admitted to the coronary unit for 12-24 hours of ECG monitoring (Holter monitoring). Admission ECG finding in acute coronary syndrome: ST-segment depression, ST-segment elevation (transient), T-wave inversion, normal ECG.
A normal ECG recorded when the patient is pain free not exclude the diagnosis of acute coronary syndrome, although a normal ECG recorded during an episode of pain makes the diagnosis unlikely, and is associated with an excellent prognosis. Following abnormalities of ECG support a diagnosis of acute coronary syndrome: ST-segment depression >0,5 mm, ST-segment elevation >1mm, T-wave inversion. Transient elevation of the ST-segment which settles, either spontaneously or in response to nitrate treatment, is fully consistent with the diagnosis acute coronary syndrome. Isolated T-wave inversion on the initial ECG is a relative by benign sign, and is associated with a low risk of future myocardial infarction or death. A total of more than 60 minutes of ischemia during Holter monitoring is associated with a poor prognosis. However, T-wave inversion and change of ST-segment must be considered in the context of the whole clinical picture taking into account the patient's age, presence of other risk factors, levels of biochemical markers of cardiac injury. Exercise testing undertaken either before or shortly after hospital discharge, is a minimum requirement for patients. Once the patient has been pain-free for 24-48 hours and the ECG stable the risks associated with performing an exercise test are very low. Severe ischemia and low exercise tolerance in a patient who has had either unstable angina or non-Q-wave myocardial infarction is associated with a poor short-term prognosis.
Echocardiography should be performed in all patients in order to evaluate the left ventricular function.
Stress echocardiography can be performed either during or immediately after dynamic exercise or under pharmacological stress administration of dipyridamole or dobutamine. Patients who are unable to perform an exercise test can be usefully assessed by pharmacological induced stress echocardiography.
Myocardial perfusion scintigraphy (tallium or technetium scan) may be particularly valuable in patients who are unable to exercise. Such techniques can outline perfusion defects.