Food for your heart

The heart is one of the most important organs in the human body. Our heart tirelessly house every day and gives us time to relive all those good things that await us in the miracle we call life. 

Today, tomorrow and the next day we can each do something beneficial for our health. Proper nutrition and physical activity are essential prerequisites for a healthy and long life.

For the health of the heart and blood vessels healthy diet is crucial. Abundant, greasy and spicy food can not be friends with your health. Water is your best friend. Day should drink at least a liter of water.

Oranges, cucumbers, plums, tomatoes, pineapple, grapes and olives are special guards your heart. The above foods are especially useful for people who have high blood pressure.

Green and black tea and curry positive impact on heart health. Vitamin E always been beneficial effect on the health of your heart. It is found in nuts, dairy products, wheat and olive oil.
Folic acid hundredth blood vessels. Can be found in green vegetables, egg yolk and beets.

Apples are especially healthy for the heart.
Eat apples tonight when you watch your favorite series. Lettuce, spinach and cabbage contain a number of antioxidants that protect your blood vessels from thrombosis.
Especially important impact on your health is magnesium. Magnesium is a mineral anti-stress which today can be found in rice, whole grains, almonds, bananas, pumpkin seeds and walnuts.

For optimal blood pressure important micronutrients such as selenium, iodine, and iron. Good sources of iron include onions, lentils, beans, peas, dried fruits, dates, figs, prunes and dried apples.
Do you think today the health of your heart. 

What can cause pain in your chest?

How many times have you scared because of pain in the chest? This symptom is very unpleasant and brings the fear of a heart attack. I must stress the fact that any kind of pain in the chest, particularly behind the breastbone, very serious symptom and requires a medical examination.

Chest pain may be associated with a whole range of causes, such as heart disease, digestive problems or lung disease. Pain in the chest may also be musculosceletal origin. Sometimes the chest pain of psychogenic nature.

There are extremely dangerous conditions that must be excluded in the diagnosis of chest pain. These are: myocardial infarction, angina pectoris, and aortic (cracking) of the aorta.

Angina pectoris is a common disease, especially in smokers of tobacco and obesity. It occurs due to changes in coronary blood vessels. These are the blood vessels that supply exclusively our hearts. It may be the result of small thrombosis in coronary blood vessels or pain occurs due to contraction (vasoconstriction) of blood vessels. Angina pectoris, especially variant that occurs at rest, it can cause a myocardial infarction, or heart attack. The pain of angina usually occurs in the form of tightness or pressure behind the breastbone. Sometimes spreads to the left arm and the chin. Anginal pain often accompanied by dizziness, sweating, nausea, high blood pressure. The people of angina pectoris often referred to as predinfarkt. Angina pectoris is diagnosed ergonomics. After the exercise test, the decision on coronary angiography.

There are several factors that may provoke angina pains. These are mental stress, physical exertion, cold weather, a large meal. The pain of angina usually stop at nitroglycerin and lasts up to 15 minutes.
People who know they have angina must bring your nitroglycerin.
If the pain does not stop at nitroglycerin, you should contact the emergency room!


Heart attack or myocardial infarction is caused by spasm or blockage of the coronary arteries, where stops the flow of blood and oxygen to the heart. Condition in which the heart does not have enough oxygen for their needs is called ischemia. If ischemia is caused long lasting changes, or lesions and necrosis of cardiac muscle. Heart attack accompanied severe pain behind the breastbone, which never ceases to nitroglycerin. It is sometimes accompanied by nausea and vomiting, especially when be said of the myocardial wall of the lower rate.
In our work, for fear of a specific patient's decision situations in which the patient is quiet, no panic on his back and complaining of severe pain behind the breastbone. Patients with myocardial infarction are usually silent and worried about his condition. First you need to test the ECG.
In most cases, the ECG shows changes in terms of myocardial infarction, but there are forms of stroke in whom there is no change in the ECG tape.
There is also a heart attack without pain or "silent heart attack", which usually occurs in patients with long-standing diabetes.
The pain of a heart attack is usually localized behind the sternum and has a classic pattern of spread. can go to the left arm, neck, stomach, jaw, and back. sometimes occurs and hiccups.
Pain comes with the feeling of breath, choking, fear, excitement, restlessness.
If it is a very extensive myocardial then there is hemodynamic instability, cold sweat, and blood pressure immeasurable.
A heart attack is fatal mainly due to malignant arrhythmias that accompany it.

Sometimes a heart attack discovered a few years later, when the ECG treadmill or ultrasound of the heart scar register and hypokinesis of the heart wall.

Valvular heart disease (mitral valve prolapse, aortic stenosis, mitral insufficiency) can also cause chest pain, but humanity changes usually follow choking, especially intense when lying on a flat surface.

Inflammation of the lining of the heart or pericarditis may also be the cause of chest pain. Intensifies during deep breathing, coughing, lying on his back. This pain is reduced when bending over and sitting.High risk for inflammation of the lining of the heart making the water around heart failure and pericardial effusion. A large amount of fluid in the pericardium, or pericardial tamponade napkin can cause death.

Particularly dangerous and extremely painful condition is aortic dissection. The aorta is the largest blood vessel arising from the heart. Aortic aneurysm is a pathological enlargement, and the weakening of the wall longitudinal aorte. Aorta often shoot in places aneurysm. This is a medical emergency, which quickly leads to tamponade and death if an emergency surgical procedure does not fix. The pain of dissection is tearing, extremely strong, spreading to the back, neck, arms, does not change when you change the position of the body. Very soon nastuopa cardiogenic shock, and death and it is time to help very shortly.


A common cause of chest pain are digestive problems, such as a hernia of the stomach (hiatus hernia), acid reflux from the stomach into the esophagus (GERD). This pain is usually associated with heavy meal, followed by heartburn and acid reflux. Taking medications that reduce the production of stomach acid, the pain is reduced. Previously, of course, necessary to exclude a heart attack. Hernia of the stomach may also cause disturbances in heart rhythm.

Inflammation of the esophagus or esophagitis may cause pain in the chest. It occurs frequently in alcoholics. Muscle spasm of the esophagus can also cause pain behind the breastbone.

Sometimes the cause of chest pain may be lung and pleura (the pleura). The most common diseases are cancer, metastasis, inflammation, adhesions (adhesions), thromboembolism or pulmonary infarction.The pain of pleurisy, or inflammation of the pleura increases in breathing and coughing, reduced lying on the affected side. Adhesions hurt the changing times. The pain of pleurisy is a sharp, piercing and character.


Diseases that are localized in the chest wall, may also be the cause of chest pain. These are osteoporosis, scoliosis, neuromuscular disease, fractures of the ribs, komresija nerves, forced standing, sitting, computer work, stretching the muscles in excessive physical exertion. The intensity of the pain varies in pressure.

Shingles can cause pain in one half of the chest.

In a previous article describes the most common causes of pain in the chest. The occurrence of pain in the chest, it is necessary to rule out serious conditions such as myocardial infarction and aortic dissection.
First search to make the EKG, cardiac necrosis markers and echocardiography.
After these  searches cardiologist decides about medications and additional diagnostic methods. 

What's good for your heart?

The heart is a marvelous organ, every day, ticking a better and happier days. Below are some tips on food that is healthy for your heart:

1 Flaxseed reduces levels of bad cholesterol, which is particularly important for the prevention of heart and blood vessels.

2 Parsley is a herb that strengthens the muscles of the heart, rich in Vitamin C reduces the risk of heart disease, stroke, and atherosclerosis.

3 Mistletoe in small quantities great value regulates blood pressure. It improves the blood circulation, heart function. It has beneficial effects on overall metabolism, especially in the endocrine glands.Mistletoe is a natural substance that helps with headaches, dizziness, anxiety, convulsions, heart problems, angina pectoris attacks, fatigue, fear, lack of will. Mistletoe is used in small amounts and must be PROFESSIONAL MADE. This plant has a beneficial effect on the blood and helps with noise in the ears.

4 Barley has a beneficial effect on blood lipids. helps in reducing bad cholesterol values. Drinking barley reduces morbidity from cardiovascular disease.

5 Hawthorn is a very effective natural remedy for the heart. Hawthorn contains substances that increase the force of heart contractions. Since ancient times used as a natural remedy for high blood pressure.  It also has favorable effects on thrombosis of blood vessels. HAWTHORN should not be used in larger quantities:

6 Nuts are expensive, but they are very healthy. Have a positive effect on the regulation of cholesterol and prevent the occurrence of thrombosis in the circulation.

7 Almonds are also healthy for the heart because they are rich in vitamin E, healthy fats, monosaccharides and polysaccharides. Almonds are great antioxidants, that affect the prevention of atherosclerosis.

8 Apples are great for controlling blood pressure and preventing the formation of clots in the circulation.

9 Garlic is an effective remedy for lowering high blood pressure, but do not overdo it!

10  Melissa and primula are also healthy circulation.

11t Olive oil, oatmeal, salmon, beans and avocado positive effect on heart health.

What to eat for a healthy heart?

Heart, magical, mysterious heart and the center of the strongest muscle in our body. A unique and remarkable organ that never runs her own will, and it never stops beating even when we sleep.
Every day strikes heart beats about 100 000.

The average human heart is the size of a closed fist men but as we grow, and it grows, especially if worthwhile exercise or do some sport.  Heart is one of the most important organs in the human body, which is why it is extremely important to maintain a healthy and strong heart.

The following are foods that are important for the health of your heart:

1 Fish - Fish is very beneficial for the body, because in addition to containing polyunsaturated fat, valuable for the prevention of cardiovascular diseases, anti-stress and improve concentration, it is also a rich source of important minerals. Saltwater fish is enriched with iodine, potassium, sodium and copper, while freshwater has less sodium and iodine. All types of fish contain vitamins from group B, valuable for the proper functioning of the nervous system. It is scientifically proven that the middle-aged and elderly who daily eat fish (especially oily fish, which is skimmed and enriched with omega-3 fatty acids) are less likely to develop diseases related to heart disease, diabetes and stroke. Therefore, in any case, good and desirable to include fish in a weekly meal plan, especially oily fish.

2 Fruit and Vegetables-frequent intake of fresh fruits and vegetables is very important to maintain the health of your heart. Apple is extremely rich in quercetin, which acts anti-inflammatory and prevents the formation of blood clots, and contains a lot of vitamins and fiber. There are also blueberries that are extremely healthy for the heart and circulatory system, avocados, which lowers the bad and raises the good cholesterol in the blood, contains healthy fats and helps in the absorption of beta-carotene and lycopene, which are essential for a healthy heart, tomato with rich vitamins and lycopene, and also lowers the risk of heart disease, along with other fruits and vegetables rich in vitamin C.

3 Tofu - Foods rich in protein is always especially important to health, especially if you are looking for food that is good for your heart health. Yosha if you want food without a lot of fat and calories, it's tofu right choice range for you. Tofu is a food Javanese origin derived clotting protein from soy milk, rich in calcium, potassium and magnesium, not to mention niacin and folate. For this reason, eating tofu examines the prevention of cardiovascular disease, high blood pressure and osteoporosis. Tofu has a mild flavor and is easily combined with other foods. Absorbs other flavors and odors and is therefore the possibility of using tofu in the daily diet is practically unlimited: from the preparation of a variety of spreads, dressings, salads and cold appetizers to main meals that include soups, cream soups, steaks, moussaka, stews and as well as a variety of desserts and sweets.
Tofu is also considered an adequate substitute for meat, milk and dairy products of animal origin.

4 Nuts - walnuts, almonds and other nuts contain healthy oils, vitamin E, and other substances that maintain healthy levels of cholesterol in the blood. Almonds are also a great source of protein and natural fiber, considered to be the healthiest foods. Nuts are a great and healthy snack that makes your heart will be grateful.

5 Brown rice - rice in general, energy food, containing protide rich in essential amino acids and low in fat, and the membrane that surrounds, high in fiber, contains potassium, magnesium, selenium and manganese, as well as fatty acids and vitamins such as biotin to - Cocktail of B vitamins and vitamin B1, is essential for the health of the nervous system. But for heart health is more important though brown rice that gently but deeply calming and focusing the work, for the life of the essential organs.

6 Cereals - Cereals are rich in vitamins and natural fibers that contribute to maintaining the health of your heart. It is also good to consume and wholemeal pasta, which is healthier than the ordinary.

7 Oatmeal - degradable fibers, in addition to heart disease, the good and for the prevention of diabetes.It has been scientifically proven that eating these fibers at an early age reduces the risk of chronic diseases such as cancer, diabetes and heart disease. Therefore, many cardiologists for heart health recommend oatmeal as it is rich in degradable fiber, which helps your heart, reducing the amount of bad LDL cholesterol.
However, it is not clarified how degradable fiber reduces LDL cholesterol in the blood, but it is speculated that this is a how to act like a sponge that absorbs cholesterol in the gut and then ejects it from the body together with the faeces. In addition to LDL cholesterol, biodegradable fibers can reduce the level of triglycerides, fats that are too dangerous for heart health.

8 Dark chocolate - it is scientifically proven that just a couple of squares of dark chocolate a day can reduce the risk of heart disease, and the secret probably lies in the high level of cocoa. The researchers also found that, in the group of smokers who consumed 40 grams per day of dark chocolate, in a very short period of time established by improved function of the arteries as a result of high levels of cocoa in dark chocolate containing 74% cocoa and is also rich in antioxidants that prevent damage to the heart.

9 Legumes - are very healthy for the heart, particularly beans, especially black beans. Since more difficult to digest provides a feeling of satiety, but not recommended for food more than three times a week. Since it contains a lot of medicinal ingredients, and is rich in folic acid, a beneficial effect in the prevention of heart disease. Statistics show that people with a lack of folic acid are dying as a result of heart problems and even in 69% of cases, more than the control group. To ensure the normal amount of homocysteine ​​in the blood, the recommended consumption of foods rich in folic acid. So be sure to incorporate beans into your weekly menu.

10th And as the icing always comes at the end, remember that red wine is healthy for your heart, but of course in moderation. Since ancient times, is a known fact that red wine is very good for the health of your heart. Alcohol and other ingredients of red wine may be beneficial in the prevention of cardiac disease in the way that alcohol, in moderation, proven increases levels of "good" HDL cholesterol levels, reduces the possibility of thrombosis and protect arteries from damage. Furthermore, the wine contains antioxidants and flavonoids, a substance called resveratrol, which has potential benefits for improving heart health. There is also a grape that contains antioxidants that act against free radicals and prevent cell damage. Also contains substances that protect blood vessels from damage, strengthen capillaries, prevent lipid oxidation and myocardial heart muscle. Some of the components of red grapes stabilized venous blood vessels and thus the risk of developing varicose veins and reduce the accumulation of fat in the blood vessel walls.

Nutrition for a healthy heart

Diseases of the heart and blood vessels are the leading cause of death in the modern world. Although women suffer later than men, this disease affects both sexes. The development of the disease depends on several factors. Certain factors such as age, sex and genetic causes can not be affected, but on the other hand, however, many can not.

Diet that keeps your heart

Diseases of the heart and blood vessels are the leading cause of death in the modern world. Although women suffer later than men, this disease affects both sexes. The development of the disease depends on several factors. Certain factors such as age, sex and genetic causes can not be affected, but on the other hand, however, many can not.

Why cholesterol increases?

One of the causes of cardiovascular risk is high LDL cholesterol. A diet rich in fat, excessive food intake, physical inactivity and smoking affect the growth of cholesterol. As for diet, a high intake of saturated fatty acids and trans fatty acids most affected by the increase in LDL cholesterol in the blood. Saturated fats are most abundant in red meat, butter, full-fat dairy products and palm oil as trans fatty acids formed during the hydrogenation of vegetable oil, and heating oil in the frying of the food industry as biscuits, snacks and deep fried foods are the major source of trans fatty acids .

It is known that in addition to the "bad" LDL cholesterol that we have is 'good'. HDL cholesterol is responsible for the removal of cholesterol from the blood to the liver and its izučivanje from the body, while LDL cholesterol has an inverse role. LDL cholesterol back into the blood stream where it builds up in the walls of blood vessels. Accumulation of plaque in the walls of blood vessels from high cholesterol, triglycerides, blood pressure and many other factors, their diameter is tapered and reduced elasticity.When you break off a piece of debris resulting clot can completely clog the narrow blood vessels and thereby stop the flow of blood to the tissues. The blood flow to the heart resulting in myocardial infarction, and interrupt the flow to the brain causing a stroke.

Fruits and vegetables keeps the heart

For a healthy heart is necessary to regularly introduce foods that are rich in dietary fiber. Fiber helps to reduce cholesterol levels and improve the ratio between LDL and HDL cholesterol. In the intestine, the fibers have the ability to bind bile acids that are rich in cholesterol absorption and instead, out of the body. Fiber-rich foods such as beans, and many fruits and vegetables.

In addition to fiber, fruits and vegetables provide antioxidants in our diet, especially beta-carotene from carrots and vitamin C from broccoli, which have a protective effect on the body.

And Folic acid is an important nutrient that preserves the health of the heart. The high amount of the amino acid homocysteine ​​in the blood indicate heart disease. Although the mechanism of action has not been clarified so far, it is believed that increased amounts of homocysteine ​​promotes the accumulation of plaque in the arteries.

Valuable omega

For good health, it is advisable to enter every day at least one food that is considered a good source of beneficial omega - 3 fatty acids. This means entering a serving of sardines, tuna, salmon or other fatty fish from cold seas or of vegetable origin rich in omega - 3 fatty acids (eg, nuts, flax seeds). While the impact of the amount of hlesterola modest, omega-3 fatty acids, especially eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids, and have a mild antihypertensive effect and decrease the rate of formation of atherosclerotic plaques.

Heart like a Mediterranean diet

The Mediterranean diet is a diet that is now considered the most justifiable health for an individual's health, particularly in the health of the heart and blood vessels. The Mediterranean diet is rich in whole grains and fresh, seasonal vegetables and fruits. Consumed and lean meats, fish and seafood, milk and skimmed milk products and is an important part of the make and nuts and legumes. Extra virgin olive oil is an essential part of the Mediterranean diet, and it is recommended and consuming wine in moderation to 2 day DL with a recommendation to be consumed with a meal.

Studies show that a healthy life style can halve the risk of heart attack in people with a genetic predisposition to heart disease, and to reduce chances of heart attacks the strongest positive effect with a proper diet is avoiding smoking and regular exercise, maintaining a healthy body weight and moderate consumption alcohol. 

Food for heart patients

The most important in this diet is to limit the intake of fat, especially saturated (fatty meat, fatty dairy products, fried foods), which increase cholesterol and risk of heart attack or stroke. It is recommended that 25 percent of daily calories from fat, less than seven percent of daily calories from saturated fat and no more than 200 milligrams of cholesterol per day (as there are in approximately 60 grams of cheese).

Less meat, more fish

Saturated fat in the diet can be reduced by limiting the amount of meat and fatty dairy products. Choose low-fat versions of these foods. Replace most animal fats with unsaturated fats, preferably monounsaturated oils such as olive, flax or peanut oil.

TLC diet includes a lot of carbohydrates, vegetables, fruits, low-calorie and fat-free dairy products, fish, turkey and chicken (without skin).

Authors TLC diets claim that adherence to such a diet for six weeks can lower the levels of bad (LDL) cholesterol by 8 to 10 percent. Also, this diet to lose one to two pounds per week, which is actually the healthiest weight loss methods.

TABLE FOOD

- Lean red meat, chicken, turkey, fish, legumes: not more than 150 grams per day

- Eggs: no more than two yolks per week

- Fat-free milk and dairy products: two to three times a day (a cup of milk or yogurt with low-fat, 30 g of fresh skim or low-fat cottage cheese, plain cheese)

- Fruits: two to four times a day (1 piece of fruit, apple, orange, banana, or half a cup of canned fruit, or one cup of berries, melon, or 3/4 cup juice)

- Vegetables: three to five times a day (one and a half cup of raw leafy green vegetables, 1 cup of cooked or fresh vegetables; 3/4 cup low-fat vegetable soup)

- Pumpernickel bread, cereals, pasta, rice: 6 - 9 times a day (1 thin slice of bread; 1/2 rolls or whole if small; 30 g cereals 1/2 cup of cooked pasta, rice or other grains; 1/2 cups of boiled potatoes)

- Fats and oils: 6 - 8 times per day (1 teaspoon of olive oil or peanut oil, 1 teaspoon of corn, soybean or sunflower oil), two tablespoons of nuts or seeds 1 tablespoon low-fat mayonnaise

- Sweets and Cakes: Only if you have less fat and sugar

Fresh spices

They are a healthy substitute for salt, and the salt contains 2,400 milligrams of sodium in one teaspoon kavenoj. The greater the amount of sodium than you should not enter into the body during the day, if you want to keep track of your blood pressure. So - it is clear why the fresh natural flavor much better option.

Fresh chopped garlic and rosemary goes well with potatoes, parsley goes well with soup or with eggs, sage goes well with meat, thyme can be added to the popcorn. These natural herbs are also rich in antioxidants, to further protect your heart from potential heart disease. If you can not deprive the salt, it is better to use sea salt, and you can also mix (and thus mitigate) with other spices.

Are recommended and macrobiotic condiments that are very tasty and add saltiness - soy and tamari.They can be put in salads, or added to cooked dishes at the end of cooking.

Low-calorie and low-fat yogurt

Many people prefer this foodstuff is consumed at breakfast or as a snack. It contains calcium and potassium - minerals that lower blood pressure.

Garlic

These vegetables some love it, some do not, but one thing is certain - Garlic has an important role in lowering bad cholesterol. To obtain the best effect, you need to eat a few slices a day.

Olive oil

This oil is rich in unsaturated fats, which can lower cholesterol when replacing saturated fat in your diet.It is important that any reduction in the intake of saturated fats (found in cheese, the butter and fatty meats). Good substitutes are foods with olive oil (salads and dishes that are fried in the oil), avocados, nuts and other sources of unsaturated fats, especially monounsaturated fat. Olive oil has other benefits - it contains polyphenols, which prevent the bad cholesterol that sticks to artery walls. Although this is more expensive than oil sunflower, it should be part of your kitchen. The health of people do not save.

Almonds

When adults eat about 30 grams of these koštunjavih fruit per day, the level of bad cholesterol, they are reduced by 13 to 20 percent. All nuts are healthy and nutritious, but almonds are especially good for the heart because they contain a lot of vitamin E. This antioxidant has a strong effect in the prevention of atherosclerosis. They are also a good source of calcium. If you do not like raw almonds, try a little browned in the oven, it will reduce the bitterness and the flavor.


Carrot

Researchers at Harvard found that very helpful to eat every day, half a cup of carrots. This amount reduces the risk of diabetes in women by as much as 27%. 

Tetralogy of Fallot

Tetralogia Fallot's pulmonary stenosis associated with highly placed septuni ventricular defect. In this way, the right ventricular empties into the aorta instead of into the pulmonary artery and is therefore highly unsaturated aortic blood oxygen. Early leads to cyanosis, and polioitemije batičastih fingers. Fatigue causes cyanosis. 

The clinical picture

A. The signs and symptoms in severe cases lagging growth. He is a frequent dyspnea, fatigue and facilitates čučanjemse dyspnea; occasionally, until syncope. Express the signs are cyanosis ibatičasti fingers, moderate protrusion desnogventrikla and absence of apical impulse, as ikratak, harsh noise sfstolni if ​​trirduž left edge of the sternum. The heart was not enlarged. In medium-sized openings hear a loud second sound, while jepocepan with pulmonary component of reduced amplitude.


B. Radiographic findings: sučista lung fields. Apex of the heart with a dull konkavnošću in a segment.pulmonary (heart shaped wooden shoes). Right aortic arch is set U25% cases.

C. ECG: umarena desnogventrikla hypertrophy is almost always present. Povremenose are expressed and P waves.

D. Special tests: diagnosis is based on kateterijzacije heart and from the right ventricle angiokardiografije. In this way, determined and morphological appearance. Aortography is recommended as a routine method In patients who are preparing for surgery. Time to show some unexpected aortic Granell associated defects.

Treatment

Tetralogia Fallot is treated surgically with the use of the machine for extracorporeal circulation.Operative mortality was moderately low. Patients with underdeveloped pulmonary arteries previously recommended Blalockov type of surgery. Propranolol (Inderal) is used in syncopal attacks which, in fact, caused by contraction of the infundibulum.

Forecast

In adults the most common tetralogia cainotic congenital heart defects, but children do not reach adulthood so often. The most common cause of death was pronounced hypoxemia. It is also common and vascular thrombosis caused by polycythemia. Strength syndrome is depending on the degree of stenosis and. pulmonary, if the stenosis is greater the higher the desnolevi shunt and pulmonary blood flow decreased. 

Ventricular septal defect

This congenital heart defect is in fact an opening in the upper part of the interventricular septum was due to nonunion of the aortic septum. In this way, the blood passes from the left ventricle where the high right ventricular pressure where pressure is low. In cases 1/4-1/3 shunt is not large enough to lead to strain rate. In the case of a large shunt leads to stress and the right and left ventricles. 

The clinical picture

A. Symptoms and signs: clinical presentation depends on the diameter of the defect and the presence or odsustvapovećane pulmonary vascular resistance. If the defect is small levodesni shunt is small, if the defect of resistance to the flow of blood between the two ventricles is small and the large levodesnišant, increased pulmonary shunt levodesni vaskularnarezistencija decreases and turns pansistolični noise sided šum.U 3ćem 4tom and intercostals space dužsternuma heard long, loud and coarse systolic murmur and a faucet tril. This may not be the only finding small defects. In the case of large shunts at the top of the faucet heart podizanjedesnog ventricular diastolic and mean hear "flow noise" and can be heard in the third tone.
B. Radiographic findings in large šantovadesni or left ventricular or both, as the left atrium and pulmonary arteries were enlarged, and the pulmonary flow increased.


C. ECG: may be normal or may dapokazuje hypertrophy of the right, left or obaventrikla.
D. Special tests: kateterizacijomsrca possible to diagnose even unajkomplikovanijiiin cases. The children sadekompenzacijom heart is necessary to establish a diagnosis and advise appropriate treatment.

Treatment

Ventricular septum defect can be asymptomatic with normal hemodynamics of the heart. However, the children can be a serious flaw that results in death due to cardiac decompensation. These patients should undergo surgery. Ideal case in surgery with the use of the machine for extracorporeal circulation is the one with the big levodesnim Santo, left ventricular hypertrophy, and only moderate pulmonary hypertension. When it comes expressed pulmonary hypertension (pulmonary artery pressure> 85 mm Hg), and levodesni shunt is small, then the risk of surgery is at least 50%. Surgical intervention is contraindicated if the shunt Reverse. However, if a surgical intervention is necessary in such case.cardiac decompensation caused by large levodesnim SANTO recommends placing a ring around the pulmonary artery, which will reduce shunt. Only the children of 5-6 years of age it is necessary to make a definitive correction. Based on the growing experience led to the conclusion that some defects closed spontaneously (perhaps 30 - 50%). Therefore, surgery should be delayed until late childhood, except in cases where the inability to live very strong or when it is concluded that pulmonary hypertension increases.

Forecast

Patients with typical forest can expect a normal life, except that you can always develop bacterial endocarditis in patients. With large shunts in early childhood caused congestive heart and they rarely survive 40 years of age. Reverse shunt encountered in about 25% of cases, leading to Eisenmengerovog syndrome. 

Ductus arteriosus persistens

It occurs when the ductus arteriosus development embriogenetskom not close and persisted as a shunt connecting the left branch. pulmonic and aortic usually near the left. subclaviae. The blood comes from the aorta through the ductus continuous systolic and diastolic, it is a form of fistula arterijovenskc how the work of the left ventricle increases. In some patients, obliterative changes in blood vessels in the lungs leading to pulmonary hypertension. In this case, the bi-directional shunt or desnolevi. 

The clinical picture

A. The signs and symptoms: no symptoms witness performances left ventricular decompensation. The heart is in the normal range or lakouvećano with strong action at the top. A wide pulse pressure, and diastolic pressure jenizak. To the left, on the edge of the sternum in the first intercostals space idrugom hear a continuous harsh noise "machine", accented ukasnoj systole. Trillo is common. If there is a significant increase in left ventricular present iparadoksalno splitting the second tone.
B. Radiographic findings: heart normalneveličine and contour, but there may enlarge the left atrium and left ventricle. A conspicuous bulge. pulmonary, aorta and left atrium.
C. ECG: normal findings or signs of left ventricular enlargement, which depends on the width of the duct.
D. Special tests: Cardiac catheterization can establish levodesni shunt. The catheter can pass from a.pulmonic through the duct and into the aorta through angiokardiografije possible to exclude the presence of other defects (such as. ruptured sinus Valsalvae right in the heart), which produces a similar sound as the ductus arteriosus perzistens.


Treatment

In the hands of an experienced operative mortality is low (<1%), therefore it is recommended closure duetusa both in children and in adults. Operative mortality was higher in elderly patients. Therefore, we should be cautious in advising surgical intervention, particularly if the patients are asymptomatic and left ventricular hypertrophy have. The greatest risk is subacute bacterial endocarditis.
In the event that there is an indication for pulmonary kipertenzija ligation or cutting duetusa are disputed, but the contemporary view in favor ligging in all cases, while the shunt still levodesni, while pulmonary flow increases, the pressure in a. pulmonic was <100 mm Hg.

Forecast

Floe in early childhood cause high mortality. Smaller shunts are compatible with long-life age. The most common complication was congestive decrease in heart function. You can come up and bacterial endocarditis. A small percentage of patients with pulmonary hypertension and shunt and rcverzni, so the lower extremities, especially the toes cijanotični the normal color of the fingers. In this condition the patient is in surgery. 

Atrial septal defect

The most common form of atrium septum defect lectual presence ostium secundum type defects in the middle of the septum, while less common ostium primum type (which is lower in the septum) and in these cases there are abnormalities in the mitral and tricuspid valves and.In both cases, normal oxygen saturated blood from the left atrium into the right atrium passes d thus increasing cardiac output and right ventricular pulmonary flow. The primum defect, mitral insufficiency causes left ventricular strain. 

The clinical picture

A. Symptoms and signs: the largest number of patients with moderate atrial septum defect is asymptomatic. In the event that there is a large shunt and leads to dyspnea prizamoru or cardiac decompensation. Visible sui palpable right ventricular pulsations. In II IIII intercostals space to the left of the sternum to hear a moderate systolic murmur that jerezultat increased flow through the pulmonary valve. Or at the top of the heart or in the area of ​​continuing ksifoidnog hear high diastolic mekšum, which is the result of increased flow kroztrikuspidalne valve, especially in the inspiration. Trillo is not common. The second tone is widely torn and does not change in relation to respiration.


B. Radiographic findings: large pulmonary arteries with strong pulsations, increased pulmonary vascular pattern, enlarged right atrium and iventrikl small aortic knob.

C. ECG: electrical axis deviation or right ventricular hypertrophy right in the case of the ostium secundum defekta.Inkompletan or a complete block of the right granese luck in most cases. Kodostium primum defect exists devijacijaelektrične axis to the left with a rotation in the frontal plane, the opposite of the movement kazaljkena clock.

D. Special tests: cardiac catheterization ze possible to calculate the amount of blood that šantira between the left and right atria, followed Intracardiac and pulmonary pressures and pulmonary vascular resistance. The catheter can pass through the defect into the left atrium. Angiokardiografijom can odkriti whether the ostium primum comes defect or mitral regurgitation.

Treatment

Male strijalne septum defects should not be treated surgically. Surgical treatment they require lump atrium septum defects Whose is levodesni shunt (2 or 3 times the systemic flow) with mild or no increase in pulmonary resistance. Operational risk is small so you need to operate on patients whose ratio between pulmonary and systemic flow 1.5:1.

Surgical intervention is indicated in cases of pulmonary hypertension and santa reverse because of the risk of acute cardiac decompensation.

Forecast

Patients with small SANTO can live a normal life, with a greater SANTO experience medieval age or later before it comes to the appearance of pulmonary hypertension or cardiac decompensation. Later usually lead to atrial fibrillation and pulmonary vascular resistance. Floe lead to physical disability in 40tim age. Increased pulmonary vascular resistance caused by pulmonary hypertension rarely encountered in childhood or mladićstva when it comes to the atrial septum defect type secundum, but is common in the case of the septum primum defect; 40tih after years of existence and the atrium septum defect lectual secundum type can be develop pulmonary hypertension.

Operative mortality with the use of the machine for extracorporeal circulation is low (<1%) in patients under 45 years of age, who are not and have decompensated pressure in a. pulmonic <60 mm Hg.Increases 6-10% in patients over 40 years of age, they also have heart decompensation and increased pressure in a. pulmonic> 60 mm Hg. The largest number of survivors show marked improvement. 

Bacterial endocarditis

The essence of diagnosis 

Subacute:

• A patient with rheumatic or congenital heart disease.
• Long-term fever, weight loss, joint pain and muscle pain, fatigue and anemia.
• heart murmur splenomegalia, petechiae, emboli phenomena.
• Blood culture was positive.

Acute:

• Patients with acute infection, a history that iliskorim jerađena surgery.
• High temperature, sudden changes or new noises, pojavaembolija, petechiae, splenomegalia itoksične phenomenon.

General assessment

Subacute bacterial endocarditis (SBE) is a bacterial infection of the endocardium flammable, and usually builds on rheumatic or valvular or caicifikovano changed to a congenital heart disease. The initial cause of bacteremia were respiratory infections, interventions to teeth or cystoscopy. But in most cases the source of infection is not known. Etiologic factors are usually nonhemolytic Streptococcus, Streptococcus viridans and especially S. faecalis, stapholococcus occasionally, but every other organism is viable.


Bacteria settle the endocardium valve (usually aortic and mitral) or more valves. Precipitated fibrin and platelet thrombi form so that the form of vegetation that are weathered and torn easily give emboli to the brain, peripheral artery or visceral organs. Embolični nephritis or glomerulonephritis true sometimes can lead to kidney failure. Dissemination of bacteria in the blood, but altered valve can lead to the development of mikotične aneurysm, which sometimes, however, rarely, it can rupture. May be present and active rheumatic carditis. SBE develop moderate to moderate systemic symptoms: cerebral, renal, splenic or mesenteric embolism, heart failure, or any combination of these that. After this may bacterioremia from one of the sources, and in the course of a few days or weeks.

Acute bacterial endocarditis (ABE) is a progressive infection of normal speed or variable valve and usually develops in severe bacteremia from acute infections, such as eg. pneumococcna pneumonia, postabortalna pelvic infection or abscess. It can also occur as a complication after surgery on the heart, transurethral postatecoomije, or after surgery on the infected tissue. The most common pathogens are challengers: Pneumococci, hemolytic staphvlococc, betahemolitični Streptococcus and gram negative coliform organisms.

Acute endocarditis creates great weathered forms of bacteria that lead to the occurrence of severe emboličnih with metastatic abscess, perforation fast, breaking and destruction of the changed valve chordae tendineae or rupture.

The clinical picture

A. Symptoms and signs: fever is present in all cases, although there may be afebrile period. Individually or as a whole may be present following symptoms: sweating at night, chills, malaise, fatigue, anoreksia, weight loss, vague muscle aches, artralgia, redness and swelling of joints, sudden changes in the eyes, aphasia, hemiplegia caused by cerebral embolism, abdominal pain, chest pain, changes on one side of the body caused by mesenteric, spleničnim, pulmonary embolism, renal, bleeding from the nose, bruises and symptoms of heart failure. The ABE is more turbulent flow and the patient was very intoxicated.

The SBE is usually a rheumatic or congenital heart disease. Available when the tahikardia, splenomegalia, petechiae on the skin and mucous membranes, and then finding the fundus, and bleeding under the nail more available; batičasti fingers and toes, pale or tan skin, neurologic findings following cerebral embolism, sensitive red nodules on fingers and legs. Heart murmurs can be considered irrelevant when it comes to infections trikuspidalnih valves and valvular pulmonary artery. However, with repeated pulmonary infarction due to pneumonia, heart murmurs can be very characteristic signs.In elderly patients clinical presentation is often atypical.

ABE is, in fact, a serious infection associated with fever, high fever, extreme iznemoglošću serious and multiple occurrences embolism. This can be down linked to previous causal infection (pneumonia, furunculosis, pelvic infection) or may occur suddenly after surgery. Heart murmurs can change rapidly, and heart failure expires earlier.

ABE may develop during prophylactic treatment with antibiotics and inadequate. In these cases, the changes are masked, and the first warning can occur suddenly embolism, then petechiae, unexpected heart failure, altered noises or fever.

B. Laboratory findings: if the suspected SBE is necessary to take two blood cultures daily for a period of 3-5 days. For 2-7 days of incubation, 85-95% of these cultures to isolate organisms and allow the selection of a special drug. The ABE is necessary to take 2-3 blood culture during the emergency treatment of patients, and then start with antibiotic therapy. In the case of repeated negative blood cultures (in uremic patients) is necessary to make the culture of bone marrow.

The effect of drugs on antimikorbnih positive blood cultures can be expected in 10 days.

Normochromic anemia, expressed sedimentation, leukocytosis, microscopic hematuria, proteinuria, and effusions are often found in the SBE and ABE. Especially in adult patients nitrogen retention may be the first sign. In 50 - 60% of cases there is rheumatoid factor when it comes to the SBE that has lasted for more than 6 weeks.

Complications

Complications in the presence of ABE and SBE may include peripheral arterial embolism (leading to hemiplegia or aphasia; bowel infarction, kidney or spleen, or acute arterial insufficiency of the hands or feet, congestive heart failure, renal failure, krvaljenje, anemia, and create metastatic abscesses ( especially when it comes to ABE). splenic abscess may adversely affect the effect of therapy, and even lead to the initial state.

Differential Diagnosis

SBE must be differentiated from patients with a variety of similar conditions. Hemiplegia, persistent heart failure, anemia, bleeding fondness or uremia may be caused by the SBE. If a patient has of any of these diseases in addition to temperature and even a heart murmur, it is necessary to take haemoculture.

Specific illnesses that require you to differentiate are: lymphoma, thrombocytopenic purpura, leukemia, acute rheumatic fever, diseminatni lupus erythematosus, polyarthritis nodosa, chronic meningococcemia, brucellosis, diseminantna or miliary tuberculosis, non-bacterial thrombotic endocarditis or chronic disease with weight loss.

ABE cover a severe systemic reaction to the apparent pre-existing infection. It can be recognized only if notice the rapid clinical deterioration, bacteriemia, the occurrence of sudden cardiac noise changes, heart failure and high embolične attacks, especially in the CNS, which give a picture of meningitis.

Preventive measures

Some cases of endocarditis can occur after surgery on the teeth, oropharynx, and genitourinary tract.Patients with known heart anomaly must be for the above-mentioned surgery to prepare the following:
(1) 600,000 units procaine penicillinasa 600,000 units of crystalline penicillin. They are administered one hour before surgery, and then procaine penicillin 600,000 units daily to them within two days.
(2) 500,000 units of penicillin G or oral Vper 4 or 5 times a day I danhirurške intervention and two days after the execution of the intervention.
(3) In the case of sensitivity to penicillin, iliu persons who received penicillin in the prophylaxis of rheumatic fever, it is necessary to prescribe erythromycin 250 mg orally four times daily on the day of surgery and two days after the procedure.
(4) When it comes to surgery on the genitourinary or gastrointestinal tract should be given streptomycin, 1-2 gm per day, apart from the point of therapy (1).

Treatment

A. Special measures: the value of understanding regarding the treatment of bacterial endocarditis is a bactericidal antibiotic concentrations in contact with infectious organisms, which is often localized in avascular tissue, or in a place where bacteria develop. By far the most effective drug in the treatment of bacterial endocarditis is penicillin because of its high degree of bactericidal activity against most of the bacteria that cause bacterial endocarditis and because of the small number of side reactions. When necessary, the synergistic effect of antibiotics proved to be useful. Several cases have been cured only by using bacteriostatic drugs.

Positive blood cultures do not have this value to confirm the diagnosis and to be a landmark in the treatment of sensitivity tests to different antibiotics or combination of antibiotics. Before you start the treatment you need to take two blood cultures daily for a period of 3-5 days, except in cases of very severe patients where antibiotic treatment administered immediately after the emergency treatment of patients, including blood cultures 2-3.

Note: control of the antimicrobial treatment.

Blood cultures were negative minimum initial requirements for the implementation of effective therapy.Since the start of treatment serum bactericidal activity test is the best indicator to support the selection of drug and dose. During treatment the serum of patients should be bactericidal under standard laboratory conditions. Serum diluiran 1:5 or 1:10 should be rapidly bactericidal.

First Penicillin is the drug of choice in most cases of bacterial endocarditis. At first it is necessary to prescribe parenteral all patients until an adequate serum bactericidal. Per oral administration of medication can be carried out in those cases where it is a particularly sensitive organism and it is possible to implement control per oral ingestion (5 times greater than parenteral) and you can keep an adequate level of serum.

Dosage of penicillin is depending on the sensitivity of the organism. Streptococcus viridans is sensitive to 0.1 units / ml penicillin (over 8096) can be treated bacterial endocarditis administration of penicillin G, 3-5 million units per day in 3-4 weeks. Given them 1.2 million units procaine penicillin 3 times a day.Streptococci are killed using 1.0 but not using 0.1 units / ml penicillin G, which requires (dissolved in water), 5-10 million units per day in 3-4 weeks. Antibiotic can prescribe them or iv streptococci and other organisms that die of penicillin in a concentration greater than 1.0 units / ml, requiring more than 10 million units of penicillin G, which is usually administered in the form of intravenous drip infusion (5% glucose or saline solution). You need to pay attention to the following complications: (a) Each million units of "potassium penicillin" contains about 1.7 milliequivalents potassium approaching the toxic dose, (b) at high concentrations of penicillin a lot of diffusion in the CNS and thus leads to the neurotoxic state, (c) the long-term intravenous antibiotic therapy, there is the possibility of superinfection, to avoid this it is necessary to change every 48 hours post injection and all work under strict aseptic conditions.

If bakteriemia and signs of bacterial endocarditis persistent active dose may be increased (and may provide 500 million units of penicillin G per day) until the serum is not the exam, and clinical signs do not become satisfactory. However, if a negative blood culture and serum testing has shown that it is necessary to prescribe the appropriate remedy. The signs and symptoms that occur may be caused by other factors and not only by infection.

Second The combined effect of penicillin and streptomycin or kanamvicina. - Appendix kanamvcina streptomycin or penicillin bactericidal activity increases in many of streptococcus, especially for enterococe (S. faecalis). Bacterial endocarditis With caused by the streptococcus viridans streptomvcinsulfat injected them 2-3 times a day, 10 days (penicillin is added as gorerečeno). The overall time of treatment can reduce the seovako 18-22 days (instead of the 3-4nedelje). In bacterial endocarditis caused enterococima given streptomycin 0.5 gm or 0.5 gm kanamvcin intervaluod in 8-12 hours, while penicillin G (10-60miliona units daily) or ampicillin (8-20gm per day) injected iv for 4 -5nedelja. This combined therapy has been shown capable of destroying enterococa when it comes to bacterial endocarditis, when injected negopenicillin I predstavljajedan of the most useful antibiotic synergism. And a combination of other drugs that are detected through laboratory analysis can bitiod used in the treatment of bacterial endocarditis caused by resistant microorganisms in particular, but all this must be uraditipod strict laboratory control.

3rd Cephalothin given dnevnointravenski 6-12 gm, and is used for bacterial endocarditis caused by staphylococcal infection streptococnomi zapenicillin as a substitute in allergic individuals.Hypersensitivity can occur and some other phenomena nacephalothin. Enterococci are usually resistant.

4th Methicillin given dnevnoi.v 6-24 gm. for a period of 4-6 weeks. Bacterial endocarditis-use your code caused penicillinazom created staphvlococca.Alternativni drugs are Nafcillin, 8-16 gm 4puta oxacillin and 8-16 gm four times a day Uist period. Vancomvoin GM4 is given 2-4 times daily for 2-4 weeks when it comes to bacterial endocarditis caused staphvlococcom.

5th Tetracvclin, erythromycin and other drugs that are mainly a bacteriostatic effect are the drugs of choice when it pitanjubakterijski endocarditis. If ordinirajubolesnicima having fever for unknown reasons, these drugs may temporarily potisnubakteriemiju and lead to symptomatic improvement.However, they did not care able to radically destroy the infection, but the disease progresses allow smetajuu and diagnosis. In bakterijskogendocarditisa caused by the Bacteroides species and other anaerobic bacteria or rickettsia, tetracycline may be the drug of choice. The dosage must be determined on the basis of serology and patient tolerance.

6th In bacterial endocarditis who jeizazvan gram negative bacteria flora gives the interior kanamvcin, 0.5 gm imsvakih 6-12 hours. Once combined and companion drugs to give baktericidnukombinaciju by laboratory tests. Cephalothin can be given alternatively 6-12 gm four times a day. Polymyxin B icolistin have not proven clinical bacterial endocarditis korisnimkod izazvanogPseuđomonas species of organism in spite naznačeneosetljivosti you wear. Only surgical removal of the holder of infection (a "patch" over the septal defect, prosthesis) in the cardiovascular system is able to incubate bacterial endocarditis caused pseudomonasom.Gentamicin sulfate, 3 mg / kg per day odefekta them in some cases caused by the bakterijskogendocarditisa rezistentnimgram negative bacteria. In upotrebiovih drugs need to be addressed in terms of the consequences naeventualne Nephrite, neuroili oto toxicity of their actions. If Upitanju decreased renal function dose SEMORE corrected.

7th In patients with a clinical picture typical for bacterial endocarditis but stalnonegativnom hemoculture empirically given penicillin G, 20-50 million units (daily iv plus streptomycin, 1 gm / day mode for 4 weeks). In this way a treatment of disease will show znatnapoboljšanja. If there is no improvement klničkog within 3-5 days, you should try it with other drugs (see 4, 5 and 6).

8th Monitoring results and the eventual return of the disease. At the end of a lečenjaposle 3-6 weeks, stop must be svomantimikrobnom therapy. 3 days after the blood culture is taken once daily for 4 danauzastopce, and then once a week for 4 weeks, during which time patients neophodnobrižljivo observirati. During this time may result in a greater number of Bacteriological to return, but some are still extended for nekolikomeseci. And embolism and temperature can be during and after successful treatment. alisame are not sufficient basis for re-treatment. Initially well postavljenaterapija bacteriologically proven bacterial endocarditis may prove successful even up to 90%. If the bacteriological status of refunds, the organism must be isolated and retested, and then you need to take more accurate treatment with certain drugs.

Despite the treatment of a large number of patients suffering from bacterial endocarditis progression to congestive heart failure and that within 5-10 years. This mechanical heart failure is partly due to the deformation of valves (valvular perforation, torn chordae) due to bacterial infection, and partly due to the healing process and scarring. Therefore, surgical correction of impaired cardiovascular dynamics as taking part in the management of patients.

B. General assessment: it must be taken and additional treatment as in any difficult infekciji.Ako it is difficult datitransfuziju anemia need blood or red blood cells. Anticoagulant therapy (heparin, bishydroxycoumarin) are not indicated in bacterial endocarditis nekomplikovanimslučajevima and can only contribute to complications such as short krvavijenje.

C. Treatment of complications:

First Infarction sistemnoj circulation in the body usually caused by emboli from levogsrca. Emboli from right heart leading to a heart attack the lungs. Treatment is symptomatic, and anticoagulant therapy sometimes helps. Embolektomija can be taken if odreditačna localization.
Second Heart failure - myocarditis, which is often accompanied by bacterial endocarditis and valvular deformity increases, heart failure can daubrza and requires digitization and salt restriction diet. Such patients is not advisable to prescribe fiziološkirastvor potassium or calcium. even during antibiotic therapy is necessary to think about the possibility of early valve replacement akopostoje signs of progressive and severe heart failure. Because of the poor prognosis and the development of renal progresivneaortne bakterijskogendocarditisa valve replacement can be done but only after 2-3 weeks of successful antimicrobial treatment.
3rd In many patients with endocarditis odbakterijskog the retention of nitrogen due to focal emboličnog nefritisaili glomerulonephritis. This requires ponovnukorekciju dose less frequently and occasionally lečenjeuremije until renal function is not popraviza during antimicrobial therapy.

Forecast

Bacterial endocarditis is generally fatal bacterial infection while not destroyed, but in some cases surgical solution A-V fistula or perzistensa ductus arteriosus may lead to a cure. Poor prognosis in patients with negative blood culture has and prolonged treatment, then those with very high resistance of the organism and that suffered an infection of the prosthesis. If the treatment is completed bacteriological forecast depends on adequate cardiovascular function only about 50% of patients feel good 5 years after cure of bacterial endocarditis. Among the diseased aortic valves have the gravest failure prediction and requires appropriate surgical intervention. What is the worst embolism embolism prognosis that affect the brain. Cerebral embolism and aneurysm rupture mikotične can occur even after treatment undertaken. Reduction in renal function is reversible and can be achieved by early adequate antimicrobial therapy.

Symptoms of heart disease

During the examination of patients can be obtained very important data on the etiology, nature and duration of heart disease. These include: Argyll Robertson pupil, splenomegalia, diffuse goiter, a kidney, congenital anomalies, abnormal venous pulsation in the neck or precordial, cyanosis, and edema  fingers. Careful palpation can detect and hypertrophy of the right or left ventricle, or diastolic movements tril. 

Edema

In the examination of patients in outpatient clinics can detect edema or lower limb joints as well as edema in the area of ​​the sacrum, glutel area and rear areas in inpatients.

The mere presence of edema is not sufficient for the diagnosis of patients suffering from heart failure, in addition to complaining more and dyspnea. Edema are often expressed in obese patients and in those with insufficient leg veins and thrombophlebitis after izlečenog. There are other non-cardiac causes of edema as wearing garters, stockings or elastic cuff deflation, followed by prolonged sitting or standing, fluid retention before menstruation, as well as idiopathic edema in women. Can lead to edema d nephrosis and nephritis terminal, cirrhosis with ascites, congenital and acquired lymphatic edema hypoproteinemia, expressed starvation and anemia, as well as obstruction of veins inferior coffee.


Cyanosis

Cyanosis may be central or peripheral. Central type of cyanosis caused by low arterial oxygen saturation caused by intracardiac desnolevim SANTO due to arteriovenous fistula in the pulmonary circulation, certain chronic lung disease, or due to pneumonia. And unlike peripheral cyanosis is expressed in the mucous membranes of warm-for instance. on the inside of the lips, the tongue and conjunctiva. Proves the determination of the partial pressure of oxygen (PO2) in arterial oxygen saturation and the system.Polycythemia vera can lead to the onset of cyanosis of central type despite normal oxygen saturation as a large number of red blood cells increases the amount of reduced hemoglobin. In order to differentiate cyanosis caused by a shunt in the heart or lungs than that caused by primary lung disease, it is useful to prescribe 100% oxygen. Oxygen has no effect on the cyanosis caused by Santa, but cyanosis will disappear if it is parenchymal lung disease.

And if saturaoija normal arterial oxygen may be a peripheral cyanosis. Appears in cold parts of the body such as the fingertips, nose, ears and cheeks. It is caused by slow circulation in the peripheral vascular system causing the capillary flow releases more oxygen than normal. And some diseases such as pulmonary stenosis Mitri stenosis or heart failure may lead to a reduced "cardiac output" and peripheral cyanosis. However, the most common causes of the tension of the nervous system that is associated with cold, cold hands and overall body exposure to cold.

Noises, sounds and popping sounds weak

Auscultation is possible to determine the presence of structural and functional abnormalities. This is achieved by noting changes in the first and second heart sounds, the presence of an extra heart sounds, ekstrakardijalnih sounds, noises and systolic pulmonary artery and high-pitched sound of the aorta in systole. It is also necessary to distinguish the sounds which have no known pathological features. These include: torn and normal tone, high systolic sound, III normal tone, and noise cardiorespiratory functional heart murmurs. In some cases it is very difficult to correctly interpret the appearance of noise, such as. pronounced in the case of heart failure with a very small "Cardiac Output" or in the case of pronounced ventricular tachycardia. Compensatory condition or reduction of ventricular tachycardia can cause low-intensity sounds clear. Thus, for example. you can hear the noises that they previously could not detect. Based on volume, the sound is divided by degrees of I-VI, where I denotes the number of noise at the lowest intensity, and VI of the strongest.

A. Systolic murmurs: short and soft systolic murmur may be functional, especially if there are no other changes, and if significant changes in respiration and changes in patient position. Fatigue and tachycardia increase the intensity of each forest. So called. functional systolic murmur meets the mitral and pulmonary mouth and he crescendodecrescendo guy who ends before systole and refers to the flow of blood from the right or left vcntrikla in pulmonary artery or aorta. Best heard in lean people. At full inspiration can be lost or reduced in intensity, while providing full expiration can significantly reinforce CATIA. Clear systolic murmur is probably essentially organic. Each systolic murmur, which was monitored and Trillo over a region of valvular disease in favor of valves, unless it comes to extreme anemia, Pansistolni noise that can be heard at the top of the heart, usually regurgitirajućeg character and result of changes in mitral valves. Propagates toward the left axilla or interscapular region and its character is organic. Systolic murmur over the aorta is transferred to the carotid artery or the upper interscapular region when it comes to organic changes in the aortic valves or aortic dilatation base. This noise is often heard well at the top of the heart.

B. Diastolic murmur: diastolic murmurs may be due to dilatation of the heart (acute myocarditis, severe anemia), dilation of aortic rings (pronounced hypertension), heart valves or deformation due to intracardiac shunts. In order to detect diastolic murmur attention needs to focus on dijastolu.

Of the authors:
Dr. Henry Brainerd, professor of medicine
Dr. Marcus A. Krupp, Professor of Medicine
Dr. Milton J. Chatton, Professor of Medicine
Dr. Sheldon Margen, professor of medicine

Article:
Dr. Maurice Sokolow
Dr. Ernest Jewetz 

How to recognize a heart problem?

Complete diagnosis of cardiovascular disease each consisting of (1) determining the etiology, (2) determining the structural changes, (3) determining the physiological abnormalities, (4) to estimate the remaining functional capacity of the heart. Treatment and prognosis are based on a clear understanding of these 4 factors. 

The etiology is determined on the basis of years of patient history, specific changes, laboratory tests, such as: antistreptolizinski 0 titer, serological test for syphilis determination, jodnproteinskog test or serum enzyme test. Abnormalities of cardiac structure and its functions can be determined through careful physical examination, which is necessary to add X-ray and ECG findings. Cardiac catheterization is needed to determine the size santa and to measure pressures in the heart chambers, the aorta and the pulmonary artery. Measurement of dye curves used in certain cases of unexplained desnolevog and levodesnog santa. Angiokardiografija in two directions cineangiografija used to show the anatomy of congenital and acquired anomalies, the extent of valve insufficiency, heart tumors, etc..

Nonspecific phenomenon

The most common symptoms of heart disease are: dyspnea, fatigue, chest pain and palpitations.However, as no matter which of the above symptoms can be found in diseases that are not related to the heart, the proper interpretation of symptoms depends on the systematic examination and diagnostic studies.


Dyspnea

Dyspnea caused by heart disease is usually associated with increased heart and other structural and physiological disorders.

The most common type of dyspnea caused by heart disease is dyspnea fatigue with shortness of breath that occurs even at moderate fatigue as you can break vacation.

Ortopnoa dyspnea in the supine position, which eliminates the sitting position. It exists only in an advanced stage of a heart failure.

Paroxysmal nocturnal dyspnea suddenly awakens patients from sleep and forced him to sit on the bed or stand up. This may be one of the first symptoms of left ventricular relaxation or very pronounced mitral stenosis.

Dyspnea fatigue luck in other circumstances not related to heart disease. Thus, for example, can occur in people with weak physical condition, in obesity, debility, in old age, chronic lung patients, anemia and obstruction of the airways. Ortopnea can occur in very obese patients with ascites, regardless of the cause, of gastrointestinal disorders that cause abdominal distension and in the third month of pregnancy. Paroxysmal nocturnal dyspnea may occur in adults in cases of first attack, bronchial asthma, and cases of obstruction of the airways caused by paratracheal tumors.

State anxiety and cardiac neurosis may also cause dyspnea. Such patients often report that they are unable to breathe well. Psychogenic dyspnea is associated with acute respiratory alkalosis which leads to mental disorders, paresthesias of the limbs or around the mouth, and then to tetany, tremors and fear.

Fatigue

Fatigue, which can be rectified rest is mostly caused by a decrease in heart function. This can be a major difficulty in congenital heart defects, cor pulmonale, or mitral stenosis in which are moreover more complicated and pulmonary hypertension. Asthenia, chronic fatigue and sleepiness that do not improve after rest are usually caused by mental changes as depression, cardiac neuroses and long-term care, or may be a component of "neurocirculatorne asthenia." Organic causes of fatigue include: chronic infections, anemia, endocrine and metabolic changes, chronic poisoning, the use of depressive and sedative drugs, malignancy, collagen disease, and all the debilitating disease.

Chest Pain

Chest pain occurs in sledeeih cardiovascular changes, angina pectoris (this pain is caused by intermittent myocardial ischemia), myocardial infarction; mioperikarditis, in the case of the presence of fluid in the pericardium with cardiac tamponade, aortic dissection or aneurysm of the aorta wall, pulmonary embolism or pulmonary infarction .

Chest pain is one of the most common disorders in which patients complain. It is necessary to carefully examine its quality, location, spread, duration, and factors that accelerate, worsen or odklanjaju pain. It is necessary to make several serial examination and laboratory tests. In addition to recommending and fatigue tests, therapeutic trials, and selective coronary sineangiografija.

However, some other diseases that are not related to the change of heart followed by chest pain and hard to distinguish from heart disease. These include: (1) disease or arthritis and discus in the upper or lower cervicalnim thoracic spine parties, (2) heart neurosis, (3) neurocirculatory asthenia and other emotional changes, (4) sliding hiatal hernia, acute or chronic cholecvstitis, Acute pancreatit, kardiospazam, peptic ulcus, esophageal pain, (5) changes that cause localized pain in the chest wall, pectoral strain or inflammation of the intercostal muscles and ligaments, postmiokardialnog infarction syndrome, (6) spontaneous pneumothorax, (7) pleurisy, diseases spinal hordes, mediastinal tumor, malignant changes in the ribs and vertebrae; (8) mediastinal emphysema.

Palpitations

The sudden loss of consciousness and irregular action of the heart are the most common complaints of cardiac patients. In most cases, palpitations arises because of fear or concern arises because of pre-existing heart disease or because of long-term emotional changes as eg. because neurocirculatory asthenia. Organic causes are anemia, thyrotoxicosis, debility and paroxysmal tachycardia.

Usually describes two types of palpitations: Sinus tachycardia, fast and hard hitting that can begin gradually or suddenly, but still slows down gradually appears on exertion or during arousal. Premature ventricular systole cause the heart to specific sensations such as eg. "Skipping shock" or "deadlock and strike again."

Patients with paroxysmal tachycardia describe the real feeling of rapid, regular palpitations or "flutter".This sensation begins suddenly, lasts a few minutes or hours, and stops suddenly. In younger patients, there are no other symptoms, except in cases when an attack is extended. In elderly patients, paroxysmal arrhythmias can lead to angina pectoris, congestive heart function, or syncope. Paroxysmal atrial fibrillation occurs as a rapid and irregular action that starts and stops abruptly. Patients usually do not complain about the occurrence of chronic atrial fibrillation and flutter on, except in cases when after efforts accelerated action and excitement of Commerce.

For the purpose of diagnosis it is necessary to take an ECG during episodes of palpitations. However, other clinical factors used in making the diagnosis. It is necessary to observe the clinical action of the heart, heart rate and rhythm, the effects of fatigue and pressure on the carotid artery. Add to this the age of the patient and possibly other diseases. If we take into account all of the above elements of the diagnosis can be set up without ECG.