- •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
Clinical features
The complaints are general weakness, tiredness, somnolence, cold intolerance, poor hearing, disorders of mental abilities, dyspnea, constipation, weight gain, impairment of sexual function, headache and dizziness. Subjective muscle dysfunction is the myalgia, muscle cramps and stiffness. The complaints of muscle weakness and fatigability are common. Hypothyroid patients may complain of arthralgia and joint stiffness.
Objective examination: the condition of the patient is satisfactory. In case of prolonged hypothyroidism and accompanying changes of organs the conditions becomes grave and even extremely grave if the coma occurs. The patient with hypothyroidism as a rule is adynamic. Patient has specific features of face, so called myxoedematous face (facies myxoedemica): periorbital pufliness narrowing of the eye slit, poor mimic, purplish lips, the hair is thinned or absent on the outward portions of the eyebrows. The patient looks older his real age.
The skin of patient is pale with icterus tint. Pallor develops due to vasoconstriclion and anemia. Yellow color is explained by carotinemia resulted from delayed turnover of carotin to vitamin A. The skin becomes rough, scaly and thickened. Trophic disorders of the skin and its derivates are characterized by such signs: dryness. Fragility and loss of hairs, nails are thin, brittle with transvered lines, grow slowly, infiltration of the skin with specific substances which content mucopolysaccharides leads to edema which does not pit with pressure. The edema is most marked in the skin of the hands, feet. The periorbital edema is observed. As a rule edema is nonpitting. If the edema is pitting, especially in the legs, should suspect the presence of complication as heart failure as a result of myxoedematous heart.
The skin is cold due to the both thickening and decreased blood flow, poor peripheral circulations. The patients are usually overweight.
Signs of muscular affection are dystrophy, muscle stiffness, mainly at the proximal part of extremities, muscular weakness and painful spasms, myotonia. Chronic hypothyroid myopathy occurs due to increased muscle mass (pseudohyperthrophy). Movements may be slow and clumsy. Some patients have synovial thickening and synovial effusions, usually of the knees.
Respiratory system. The signs related to the upper airways and respiratory system include chronic nasal congection, shortness of breath and sleep apnea. Complaints referable to the airways are explained by mutinous edema of the nasal mucosa and larynx. Shortness of breath may inducate on the presence of pleural effusion. The patient has low-pitched hoarse voice due to the edema of vocal cords. Simultaneously with enlarged tongue and lips therefore speech become very slowly with lingering intervals. The course of hypothyroidism is characterized by frequent attacks vasomotor rhinitis, pneumonia.
Disorders of the cardiovascular system are characterized so-called, myxoedematous heart due to the interstitial myocardial edema, dystrophy of its fibers. The apex beat is displaced to the left, diffuse and weak. In percussion the borders of relative cardiac dullness are displaced outside. In auscultation decreased loudness of both sounds over in all listening points are revealed. In case of pericardial effusion the loudness of cardiac sounds extremely decreased or even disappears. Constant and stable bradycardia less than 60 beats per minute is typical sign of hypothyroidism. Appearance of premature beat is possible. Blood pressure mainly systolic is decreased, pulse pressure diminished. Hypothyroidism promotes and accelerates the development of atherosclerosis with affection different vessels. These patients as usually have clinical features of ischemic heart disease.
Changes from the digestive system occur due lo the edema of gastrointestinal tract, which associated with motor and secretory dysfunction. These alterations appear as persistent constipation, flatulence, paresis of intestine. Decreased intestinal motility may cause abdominal distension and constipation, produce paralytic ileus or megacolon with the clinical feature of intestinal obstruction. Sometimes is observed the propensity to parodontosis. The liver usually is unaffected. Ascitis is uncommon sign of hypothyroidism.
Renal blood flow is reduced according to the decrease in cardiac output. The glomerular filtration rate is usually reduced and mild proteinuria is revealed. Due to the hypotension develops oliguria till anuria.
Neurological dysfunction manifested by carpal tunnel syndrome due to the edema of the flexor of the wrist. Patient has slow deep tendon reflexes with prolonged contraction and relaxation phases.
Cerebellar dysfunction includes such signs as ataxia, intention tremor and nystagmus. Disorders thermoregulation may present in a form of cold intolerance.
Hypothyroid patients have the signs of mental dysfunction due to chronic insufficiency of cerebral circulation, hypoxia and brain edema. The main features are somnolence, and even lethargy. The patient may sleep longer at night or may go to asleep frequently during the day.
The patient becomes physically and mentally slow: the speech is slow, memory loss, significant limitation of activity, adynamia, and apathy. In some patients may observe depression, indifference to surrounding or severe anxiety and agitation, maniac state. Lingering hypothyroidism leads to cognitive impairment and overt dementia. Outcomes of hypothyroidism may be disorders of pituitary gland. In men observe decreased sexual potential till impotence, deranged spermatogenesis. In women appears amenorrhea or menorrhagia, infertility. In patients of both gender groups occur diminished libido, no pubic and armpit hair. One of the dangerous complications of disease may be hypothyroid coma. The patient's condition is grave, unconsciousness, passive posture, declining body temperature till 23°C, deep and slow breating sinus bradycardia till 30 beats per minute, hypotension. Accumulation of fluid in pericardial cavity may cause the compression of the heart with acute heart failure. Constant and severe constipation resemble ileus.