- •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
Hyperthyridism
Hyperthyroidism (hyperthyroid syndrome) - complex of symptoms, which results from hyperfunction of thyroid gland with increased secretion of thyroid hormones and expose them on the body tissues.
Etiology
In over 90% of patients with hyperthyroidism is due to Graves' disease. Other causes of excess production thyroid hormones are thyroiditis, multinodular goiter, iodide-induced after lingering taking some drugs (e.g. amiodarone). Extra thyroidal source of thyroid hormone excess is due struma ovary or excess secretion of TSH which may originate from pituitary in case of tumor - choriocarcinoma or hydatidiform mole.
The factors which provoke the development hyperthyroidism include:
inherited predisposition;
acute and chronic psychical traumas;
acute and chronic infections (flu, quinsy, measles, whooping-cough, tuberculosis, chronic tonsillitis, encephalitis, rheumatism);
immunological disturbances;
neuro-endocrine alteration in woman (pubertal period, pregnancy, lactation, climax);
chronic disease of liver and kidneys, attended with disorders of metabolism of thyroid hormones.
Pathogenesis
The development of hyperthyroidism is explained by immunological theory. The production of IgG antibodies directed against the TSH-receptor on the thyroid follicular cell stimulates thyroid hormone production.
In blood there are increased concentrations of thyroxin and triiodthyronin that lead to disorders of metabolism - proteins, lipids carbohydrates. Increased tone of sympathetic nervous system causes the development of hyperkinetic type of hemodynamic. Heart rate, cardiac contractility, stroke volume and cardiac output are increased and peripheral resistance is decreased. These alterations are explained by direct chronotropic and inotropic effects of thyroid hormones. The appearance of ophthalmopathy is caused by rise in retrobulbar pressure due to elevated interstitial fluid content and chronic inflammation, proliferation of fibroblasts. The eye is displaced forwards - exophthalmos.
Clinical feature
The main symptoms of the hyperthyroidism: excitability, anxiety, nervousness, inability; increased sweating, heat intolerancy; fatigue, muscular weakness; despite normal or increased appetite loss of weight; dyspnea on exertion; exacerbation of asthma; palpitation, pains in heart region; escaped beat; thirst, anorexia, vomiting, diarrhea; loss of libido, impotence.
Objective examination. The condition of patient is satisfactory. In case of hyperthyroid crises may be life-threatening condition. The consciousness is clear, posture is active. The patient is characterized by fast changing of mood, impossibility to be concentrated, motor, emotional and vocal lability. Patient looks younger his age.
The face has specific signs: lively with widened eye slits, exophtalmos, excessive lacrimation, corneal ulceration, hyperemia of conjunctiva.
There are specific eye signs in patients with hyperthyroidism:
upper lids are symmetrically retracted so that some sclera is visible;
Kraus' sign (abnormally sparkling eyes);
Ellinec' sign (pigmentation of eyelids related to adrenal insufficiency);
Rosenbach` sign (shallow tremor of the closed eyelids);
Greffe' sign (lid lag during fixing of slowly downward moving object);
Mebius' sign (weakness of convergence or loss of ability to fix a object at short distance);
Stelvag` sign (rare blinking, less than 6-8 times in a minute).
Dermopathy is characterized by moist, hyperemic skin with palmar erythema, spider naive, sometimes appearance pigmentation, vitiligo and giblet clubbing. The hair may become thin and fine in texture and alopecia can occur. The nail is soft and separated from the nail bed - onchyolysis. Perspiration is increased. In patient may be pretibial myxoedema in the form of pink coloured or purplish plagues on the anterior part of the leg, accompanied with itching. The muscles are atrophic, their force and tone are reduced.
Thyroid enlargement of some type is a common sign.
Classification of diffuse toxic goitre according to degree of enlargement of thyroid gland:
0 - there are no thyroid gland at palpation;
1 - at palpation enlarged isthmus of gland and slightly lateral lobes;
2 - thyroid gland is noticeable at swallowing, at palpation determined well;
3 – “thin neck” (enlarged thyroid gland is well noticeable at examination);
4 - the expressed goitre, sharply changing configuration of neck;
5 - degree is goitre of largeness.
The size and consistency varies according to the pathology caused hyperthyroidism. In Graves' disease the thyroid is twofold to fourfold enlarged slightly tender and the surface is usually smooth. The thyroid bruit or thrill related to increased thyroid blood flow are heard. Thyroiditis usually characterized by slight diffuse thyroid enlargement.
The affection of respiratory system in patient is uncommon. In severe hyperthyroidism may be pneumonia and abnormalities in respiratory function. Decreased vital capacity decreased pulmonary compliance, respiratory muscle weakness cause dyspnea, aggravation of bronchial asthma.
The Jeading signs of affection of cardiovascular system, which accompanied the hyperthyroidism at every stage are defined as thyroidtoxic heart. The apex beat displaced to the left, diffuse, high and strong. The main sign of hyperthyroidism is stable arrhythmic tachycardia more than 90 beats per minute. The heart sounds are loud. Functional systolic murmur can appear over all auscultative points. Pulse is high and fast (altus et celer). Functional murmur can be heard over a. carotis and v. jugularis. Systolic blood pressure is increased, diastolic blood pressure is decreased, pulse pressure is elevated. In case of constant longstanding atrial fibrillation in patients with hyperthyroidism may be complication in the form of heart failure with congestion in lesser and grater circulation.
Due to the increased motility of stomach and intestine appear the pain and hyperdefecation. Intestinal hypermotility lead to more rapid small and large intestinal transport, resulting in steatorrhea. Inactivation of thyroid hormones takes place in liver hence in condition of their excess circulation develop hepatic dysfunction with raised concentrations of enzymes. In severe course of disease the enlarged liver and jaundice are observed. Renal blood flow, glomerular filtration rate and secretory capacities are increased. The common sign are polydipsia and polyuria. Urine concentrating ability may be impaired due to the dehydratation. Neuromuscular signs of the hyperthyroidism: shallow symmetrical tremor of fingers when the hands are extended, but it may involve the arms, legs, tongue and head. The movements are rapid and low amplitude. Instability in the Romberg' posture, hyperreflexia, muscle weakness, proximal myophaty, increased reflexes of tendons are observed. Myopathy can also involve the respiratory and oropharyngeal musculature, causing difficulties in swallowing or hoarseness. After exercise may be the attacks of periodic paralysis. The signs of central nervous system dysfunction are anxiety, irritability, episodes of paranoia, impairment of cognitive function.
Disorders of endocrine system include gonadal dysfunction. In women menstrual cycles are normal, although some of them have oligomenorrhea or amenorrhea accompanied with infertility.
In men hyperthyroidism results in decreased potency and loss of libido. Gynecomastia may be observed.