Atherosclerosis

Arteries are muscular-walled vessels that carry blood from the heart to other parts of the body. If you are healthy, their inner walls with a smooth and flexible enough to adapt to changes in the final blood pressure, and blood passes through them freely. However, sometimes occur on the inner wall of the fatty streak, most likely due to pressure on places where the arteries branch or where the wall is slightly damaged. Fatty streak grows more and more damage artery walls and eventually can turn into a hard mass of adipose tissue, which damages the wall, reducing the elasticity of arteries, narrowing the vessel and obstructs blood circulation. Adipose tissue is known as atheroma, atheroma large masses called plates, and the name of the disorder is atherosclerosis, which literally means "hardening of the atheroma." Atherosclerosis is an important factor that contributes to the development of atherosclerosis.

Symptoms of atherosclerosis

Almost no symptoms until damage appears greater. When symptoms develop, usually after many years, this happens because the body is not circulation, and symptoms depend on which part is damaged. Thus, for example. You only have cramps in my legs after exercise, but you can infest and stroke, kidney failure, angina pectoris, or heart attack.

The incidence of atherosclerosis

Atherosclerosis is common in the West. There are many cases without symptoms and therefore do not have exact figures, but during the autopsy of people killed in traffic accidents revealed that the degree of the disorder is almost universal, especially among men. Atherosclerosis affects children. This is because atherosclerosis is associated with high fat and cholesterol in the bloodstream. Most people in the West eat a lot of fatty foods or foods rich in cholesterol, for example. meat, butter and eggs, which is probably the main cause of the incidence of atherosclerosis.

If you are a man of any age or women over 35 years, with much to eat fatty foods, more likely to get atherosclerosis, and if you smoke, if you have any kidney disease, diabetes or high blood pressure. Of course, atherosclerosis worsens with age.

The dangers of atherosclerosis

Severe atherosclerosis can exist without obvious bad consequences. Many parts of the body is not supplied with blood only a particular artery and its branches, but the lower branches of adjacent arteries: one need not be affected even though the main supply channel severely damaged. When the blood supply from the main artery runs dry, the other arteries can sometimes compensate for the shortfall, so to expand, and the total blood supply, and almost not at risk. And for some body tissues that rely on blood supply from an artery no bad consequences, even though the channel is significantly reduced, because the normal blood supply usually exceeds the actual need.

Therefore, damage from atherosclerosis may be small for years, but no. However, it is likely that the narrowing of arteries due to the occurrence of one part of the body panels, depending on the artery or one of its branches, will remain without a final blood. If this occurs in the coronary arteries that supply the heart, there is a risk of angina pectoris or heart attack. If you are affected by cerebral arteries (those supplying the brain) can lead to stroke. It is possible to damage the kidneys, causing kidney failure or dry gangrene in the hand or foot.

What to do?

Do not wait until symptoms develop. Symptoms are a sign of consequences and unpleasant consequences occur as the disease progressed for years. Suppose now that you and your children at risk and that risk may be higher if one of your neighbors' relatives have a heart disease or suffered a stroke. Now, should take measures of self-help which I have recommended below. They will help you to prevent or slow the development of atherosclerosis.

Scientific studies show that the fatty streak on the inner artery wall may seem to disappear, but nothing can be done when it has created the panel. After some time in the development of atherosclerosis is a thorough treatment can reduce the possibility of another attack, but the disorder can progress to the stage where nothing can prevent a heart attack. This does not mean you have to ask the doctor to immediately conduct a search to determine if you already have atherosclerosis. These results are complex and expensive, a self-help measures would have to satisfy almost everyone.

However, consult your doctor if you are in your family there is someone with the disorder of the heart or blood flow, if you know someone from your immediate family has a high content of fat in the blood or if you suffer from diabetes. If so, then it is justified to consider the possibility of diagnostic tests to determine drug therapy.

Doctors will tell you to perform a search of cholesterol in the blood (before the results may not eat for several hours). In addition you will obviously have to control blood pressure, may be required and other tests, eg.chest x-ray to determine heart size or detection of calcium deposits in places where it is suspected to atherosclerosis, then an electrocardiogram (EKG) and arteriogram.

Treatment of atherosclerosis

Self-help: Since the development of a severe form of arteriosclerosis associated with the content of cholesterol in the blood, reduce the intake of animal fats and other saturated (dairy) fat. Eat poultry and fish instead of pork, beef and lamb. Remove the fat from the meat and bake it rather than fry on the grill. Because your egg meets almost the entire daily amount of cholesterol, limit the amount of eggs to 3 per week. Avoid creams and sweets; use margarine, which has a high content of polyunsaturated fats instead of butter, eat more fruits and vegetables, cooking oil, use the label "high in polyunsaturated fat," for example. seed and sunflower oil, not oil labeled "vegetable oil" without further explanation.

There is no clear link between obesity and smoking and atherosclerosis. No. obese people and heavy smokers as they are known as particularly sensitive to disturbances that most of them caused by atherosclerosis. So be sensible. Stop smoking, even if it were not overweight because you are at the risk of lung cancer. If you have to do that even obese, dieting to lose weight that you use to get rid of excess fat.

Finally, regular physical activity. Moderate physical activity can prevent the development of atherosclerosis and reduce the possibility of its serious consequences. But do not overdo it. Consult your doctor if you think that you could harm the physical activity.

Professional help: the doctor will help you by controlling your blood pressure and healing you from hypertension, if necessary. If you have an abnormally high content of cholesterol in your blood, your doctor may prescribe a means to reduce it if you take it regularly (well, some of these assets cause side effects, for example. Slightly increased risk of gallbladder disease).

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Heart attack

Definition

Disorder in which damage occurs to the area of ​​heart muscle because of its insufficient supply of oxygen.

Causes, incidence, and risk factors

Causes of the clot or a spasm of the arteries that supply the heart muscle with blood (coronary arteries). This and other similar states are blocking the flow of oxygen to the heart area, causing damage or death of cells in the area. This is usually in a coronary artery that is narrowed due to changes caused by atherosclerosis. Damaged tissue forever lose the ability of the contraction of heart muscle.

Risk factors are: smoking, hypertension, hypotension, diabetes mellitus, foods high in fat, high cholesterol levels (LDL), obesity, people over 65 years of age and hereditary factors. At the same time, the disease affects more men of the population. Increase the risk of personal or family preference coronary artery disease, cerebrovascular disease, peripheral vessel disease, angina (especially unstable angina) or renal failure requiring hemodialysis. "Trigger" for me sometimes, though rarely, it can be an unexpected high stress. In the elderly may be a risk factor in defecation straining.

Acute MI annually affects about two out of 1000 people and is the most common cause of sudden death in adults.

Symptoms

The main symptom of MI is chest pain. However, in many cases it is mild, even nonexistent, especially in elderly and diabetic patients. Other symptoms such as weakness, shortness of breath, nausea and vomiting can be dominant.

chest pain below the sternum

backache

abdominal pains

pain in the chest, arms and shoulders (see the pain in the shoulder)

pain in the neck, jaw and teeth (see: toothache, sore face)

backache

duration of pain is prolonged, typically over 20 minutes

angina-like pain that never ceases to bed rest or by taking nitroglycerin

longer any pain in the chest, back or abdomen

Pain is:

as for "indigestion"

intense, strong, weak, there is

has the character of shrinkage or weight, belt-tightening around the chest

like "an elephant sitting on chest"

shortness of breath

cough

dizziness

loss of consciousness

nausea

vomit

sweating profusely, which can be (diaphoresis)

dry mouth

sense of "near death"

restlessness

Other symptoms that may be associated with disease are:

cramps

exhaustion

temporary cessation of breathing

shortness of breath, the need for laying

blood pressure (low, high, normal)

behavior (and unusually agitated)

Note: Number of cases most likely to deny having a heart attack. Symptoms may be absent ("silent attack").

Signs and tests

Scanning is usually establishes a rapid pulse. Blood pressure may be normal, high or low. Stethoscope (auscultation) may detect crackles in the lungs, heart murmur and other abnormal sounds.

ECG, single or repeated over 2-3 days is often reveals MI.

MI size and cardiac damage can be diagnosed by the following tests:

coronary angiography

ventriculography (MUGA or Rnv)

echocardiography

ergometry

Byproducts of heart damage and factors that indicate the MI determined by laboratory tests (LDH, LDH isoenzymes, CPK, CPK isoenzymes, etc.).

Treatment

Acute MI requiring immediate medical intervention

Usually need hospital treatment lasting 1-14 days. It is necessary to immediately begin monitoring the ECG for arrhythmias during the first few hours after acute MI can be fatal. The goal of treatment is to reduce cardiac workload in order to prevent possible complications and eliminate the current. At first, limit physical activity, and then gradually increase. In emergency drugs and infusion solutions are given intravenous catheter.Depending on the general condition can be applied to invasive diagnostic methods. To directly monitor the status of body fluids enter the urinary catheter. It is usually given oxygen, even if its level in normal blood, which ensures fast supply of tissues and reduce the burden on the heart.

Limit feeding is not inevitable, but if the food is indicated not contain much salt, caffeine should be free and low fat content.

Medicines

Morfijje analgesic that is generally given for pain management.

Nitratikao example. nitroglycerin, are given pain relief and reduction of cardiac oxygen consumption.

Beta-blockers (atenolol) reduce cardiac workload.

Digitalis improves heart function as a pump.

Channel blockers kalcijasmanjuju oxygen consumption in heart muscle. They can prescribe diuretics and antiarrhythmics.

Therapy with thrombolytics (anticoagulants) typically begins within 6 hours after the first chest pain. Initial therapy consists of intravenous infusion of anticoagulant (streptokinase or tissue plasminogen activator) and immediately after intravenous infusion of heparin. Heparin is given over 48-72 hours. In addition to giving oral aspirin and warfarin to prevent thrombus formation. Thrombolytics therapy is contraindicated in cases of minor surgery, organ biopsy or major trauma experienced back 6 weeks, then a recent neurosurgical procedure, head trauma back a month, history of GI (gastrointestinal) bleeding, intracranial tumors, stroke back 6 months or pregnancy.

Bleeding and hemorrhage are potential complications of therapy with thrombolytics.

Surgical Procedure

Some patients need to make an emergency surgery.

Forecasts

The outcome depends on the size and location of damaged tissue. Damage to the electroconductive system (impulses that control heart rate) worse prognosis. In one third of cases the outcome is fatal. If the patient survives 2 hours after the attack, the greater the possibility of his survival, but complications were not excluded.If not, complete recovery is possible. MI does not cause disability, and sufferers can gradually return to normal life and normal activities, including sex.

Complications

Arrhythmias like. ventricular tachycardia, ventricular fibrillation, heart block, congestive heart failure, cardiogenic shock, an extension of the affected heart tissue, pericarditis, a complication of treatment (eg, use of thrombolytics during treatment increases the risk of bleeding).

Contact your doctor

If you feel lancinating chest pain or any symptoms of acute MI, go to the doctor on duty or call an ambulance (telephone 94).

Prevention

Whenever you are able to control your risk factors. Control your blood pressure and total cholesterol, reduce or stop smoking, change diet (increase the intake of high-density lipoprotein and reduce your intake of low-density lipoprotein), if you need a test for diabetes if you are obese remove excess weight. Engage in exercise to improve cardiovascular status. (Prior to this, consult your doctor). After MI is important to be under constant medical control to reduce the risk of new MI. Many recommended rehabilitation program that promotes a gradual return to normal life. Follow the exercise program, diet and / or prescribed medication.

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Acute rheumatic myocarditis

Acute rheumatic myocarditis is a disease that occurs in a large percentage of patients with acute rheumatic fever with carditis. Can occur independently, rarely, or associated with acute rheumatic endocarditis, or pericarditis.According to some, in any acute rheumatic heart disease myocarditis is discrete or easily shaped. 

Symptoms and diagnosis

Clinical symptoms and diagnosis can be clearly expressed, under expressed or almost non-existent.

Start can be acute with fever, migratory poliarthritis, weakness, sweating, dyspnea at movement, abdominal pain, swelling around the ankles, palpitations. Physical examination may determine that the apex of the heart is moved laterally from medioclavicular lines, diffuse. There is tachycardia and during the day and during sleep of patients and occurs in more severe and is usually a bad prognostic sign.

Heart sounds are muffled. You can hear the rhythm of the gallop (gallop protodiastolic). Extrasystolic arrhythmias are common, especially during physical activity. Atrial fibrillation is rarely seen. Phlebography  jugular vein may show a pronounced wave of Berheimovog effect of the right ventricle, and pronounced v wave due to functional insufficiency trikuspidalnih valve when the heart is considerably enlarged.

About 5% of these patients will stagnans and heart failure. These are the most severe forms of acute rheumatic fever with carditis. More frequent in patients in whom acute rheumatic fever began gradually, with low temperatures and arthralgia for several weeks, but the children in which the disease started acutely with high fever and stiff joints.

The most common symptoms are: fatigue, sweating, loss of appetite, shortness of breath, coughing, chest pain, palpitation and epigastric pain. Physical signs vary and depend on the degree and duration of heart failure. The initial sign may be tachypnea. However, if it is a child, and if receiving salicylates, which can cause tachypnea, should be careful in assessing tachypnea as a sign of heart failure. In the lungs can be heard bronchogeny, wet litter in lung bases. Auscultation of the heart, in addition to tachycardia, hear the muffled tones and protodiastolic gallop.

The veins in the neck may be swollen, and there is tenderness in the right hypochondrium due to an enlarged liver that can tap under your upper abdomen. Sometimes there is a light facial fullness and swelling leg.

Radiological signs of

At radiological examination the heart is increased, more or less as a whole. Due to Brake heart failure is very pronounced hilus patterns. In pulmonary edema there confluent, inhomogeneous shadow in the upper and middle lung outside.

ECG signs of

The most common finding was prolonged PR interval, and occurs in about 25% of patients with acute rheumatic myocarditis. As the prolonged PR interval (or degree AV block) happiness in other pathological conditions, it should not be understood as a specific manifestation of rheumatic. Clinical symptoms and diagnosis of acute rheumatic fever, are in favor of acute rheumatic myocarditis.

Rarely are observed: Weckebachova periodicals, AV dissociation, complete AV block and nodal rhythm.

QT interval (electric systole) was extended, but it can not be taken as a sure indicator of acute carditis, or is in direct correlation with inflammatory changes in the myocardium.

Functional signs

Acute changes in diffuse inflammatory nature in the myocardium lead to less or more pronounced heart failure and delays. Cardiac output is reduced, there are signs of a halt to the lungs and in the field of large hollow veins.The patient was because of this and because of changes in the joints forced to lie in bed. If stagnans heart failure patients is more pronounced orthopnea and takes spolusjedeći iil sitting spoložaj.

If acute rheumatic myocarditis associated with endocarditis and pericarditis (pankarditis), signs of impaired hemodynamics are most pronounced.

Laboratory signs of

SE is accelerated. There is anemia, leukocytosis, increased alpha-2 globulin and fibrinogen in plasma. There is a C-reactive protein. In some patients leads to increased SGOT (AST) and SGPT (ALT) and lactic dehydrogenase increased (LDH), and alpha-1 glyco-iproteina.

Bacteriological and immunological findings

Group A beta-hemolytic streptococci are rarely isolated from throat swab culture. ASTO titer increased.Imunoelectroforesis shows is an increase of IgA globulin in about 70% of cases. The first days and weeks, and increased serum complement. Special techniques and methods of examination can be detected in the serum, circulating antibodies directed against heart tissue.

The minimal diagnostic program

Symptoms and diagnosis of acute rheumatic myocarditis is on the basis of data on the recent history of acute tonsillopharyngitis, acute migratory polyartritis interventions that mainly large joints, appears systolic functional character of forests at the top, tachycardia, gallop rhythm, tone muklih, rapidly, ASTO titer increases in serum , increase in alpha-2 globulin electrophoregram, extending PR and QT intervals, appears isorytmic dissociation or nodal rhythm on ECG and cardiac enlargement on X-ray shadow-in.

In some children the clinical picture is rarely seen. The child is usually pale, no appetite, cheerless, with arthralgia and myalgia, pronounced weakness, tachycardia, quiet heart sounds, gallop rhythm, functional sistolmm trees at the top, rapidly, anemia, leukocytosis, elevated ASTO titers, increased concentration of fibrinogen in plasma, and increased alpha-2 globulins in the electrophoregram. Rtg: cardiac shadow is enlarged, there is sometimes a delay in the hilum and the lung.

ECG: may be prolonged PR and QT interval, and the happiness and isorytmic dissociation and nodal rhythm.

Forecast

Acute rheumatic myocarditis leads to scars in the myocardium.

In some cases these changes are not so diffuse as to be in other cases. You, the easiest cases, clinical not show almost no signs of acute myocardial rheumatoid rniokarditisa. Sometimes it is just possible to see easily prolonged PR interval on ECG.

In other patients there is a diffuse change, enlargement of the heart and the occurrence of heart failure Brake. Aschoffovi nodules, which develop in the myocardium of patients and in 25% of these are clinically inactive cases, show signs of morphological evolution.  This suggests that certain patients may evolute that subclinical, and the prognosis is poor in them. These patients should be under the constant, regular, controlled by doctors.

The prognosis of patients with acute rheumatic myocarditis is even worse if the clinical manifestations of myocarditis are more pronounced and more difficult of the first attack of acute rheumatic fever with carditis.

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Aneurysms and aortic dissection

Aorta is the largest artery, which receives all the blood coming out of the left ventricle and distributes it throughout the body except the lungs. Like a great river, the aorta branches along its course in a small tributary of the left ventricle to the lower abdomen at the top of the iliac crest (pelvis). Problems with the aorta include weakness of some parts of the aortic wall because it picks up its bulge (aneurysm), and external rupture (perforation) and subsequent bleeding. Also, there may be separate layers of the aortic wall (dissection). Any of these conditions can be immediately fatal, but in most cases this condition can develop over years.

Aneurysms

• Introduction • • abdominal aortic aneurysms Aneurysms of thoracic aorta

Introduction

An aneurysm is a localized enlargement of an artery wall, usually the aorta.

Extension usually results in a weakened part of the wall. Although aneurysms can occur anywhere along the aorta, in three-quarters of all cases it occurs in the part that passes through the stomach. Aneurysms can be either rounded (saccular) or elongated (fusiform) were often fusiform.

Aortic aneurysms are primarily a result of atherosclerosis, which weakens the aortic wall to the extent that the pressure in the aorta, which is great, pressing the weakened portion of the wall and creates a bulge outward, like a balloon. The aneurysms often create a clot that can be spread along the inner wall. High blood pressure and cigarette smoking increase the risk of aneurysm. Other mitigating factors for the occurrence anurizme may include trauma, inflammatory disease of the aorta, hereditary disorders of connective tissue, for example.Marfan syndrome and syphilis. In Marfan syndrome, aneurysm affecting most of the ascending aorta (the part that fills with blood directly from the heart).

Aneurysm, except aorta, may occur in other arteries. Many of them are the result of congenital (congenital) or arteriosclerosis disorders. Some aneurysms are the result of trauma caused by stab or gunshot wound, or the artery wall due to infection by bacteria or fungi. The infection can start anywhere in the body, but usually starts at the heart valve flaps. Infected aneurysm of the arteries in the brain are especially dangerous and require immediate treatment. The most commonly treated surgically, which is very risky.

Abdominal aortic aneurysm

• Introduction • Symptoms • Diagnosis • Treatment

Introduction

Aneurysms that occur in the part of the aorta that passes through the stomach occur frequently in some families.In many cases, these aneurysms can occur in people with high blood pressure. Such aneurysms often become several times wider than the aorta, and may burst.

Symptoms

Patients with abdominal aortic aneurysm often have the feeling that something is pulsating in his belly.

An aneurysm can cause pain, usually deep, which is mainly spread in the back. The pain can be extremely strong and is usually permanent, but may be terminated by changing the body position.

The first sign of rupture (break or rupture) is usually very severe pain in the lower abdomen and back with painful sensitivity of the abdomen above the aneurysm. If there is internal bleeding, the patient quickly gets into shock. Rupture of abdominal aortic aneurysm is often fatal.

Diagnosis

Pain is a useful symptom for the diagnosis, but often occurs too late. However, many patients with aneurysms have no symptoms, a diagnosis is made incidentally during routine examination or radiograph performed for other reasons. The doctor can feel the pulse formation in the central abdominal line. Aneurysms that grow rapidly may quickly burst. They are often painful and sensitive to touch on clinical examination of the abdomen.In obese patients are difficult to detect even large aneurysms.

On diagnosis of aneurysm helps more laboratory tests. X-ray of the abdomen may show calcium deposits in the aortic wall. Ultrasound examination is usually clearly show the size of the aneurysm. CT of the abdomen, especially if performed after intravenous administration of contrast, is a safe method for determining the size and the edges of the aneurysm, but this method is expensive. MR is also a reliable method, but is more expensive than ultrasound and is rarely necessary.

Treatment

If no burst aneurysm, treatment depends on its size. Aneurysms of a width of less than 5 cm rarely burst, but if they are wider than 6.4 inches breast more often. This is why doctors usually recommend surgery to address an aneurysm wider than 5 cm, if the risk is too great for other accompanying medical conditions. During the surgery, put a synthetic implant (graft) in place of the aneurysm. The risk of death of such an operation is about 2%.

Rupture (burst) or threatening rupture of abdominal aneurysm requires emergency surgery. The risk of death from surgery in this state is about 50%. When the thoracic aortic aneurysm abdominal kidneys are in great danger because of the sudden interruption of blood supply or the shock that was created for the loss of blood. If kidney failure develops after surgery, patients chances of survival are very poor.

Aneurismal

• Introduction • Symptoms • Diagnosis • Treatment

Introduction

Aortic aneurysm in the fragment that passes through the thorax (chest, thorax) belong to one quarter of all aortic aneurysms. Thoracic aorta aneurysms occur most frequently in one form: the expansion of the aorta occurs at the point where the aorta leaves the heart, immediately after the aortic valve. This enlargement of the aorta may be the cause of malfunctioning aortic valve (valve located at the point where the aorta leaves the left ventricle), because the existence of such an aneurysm can lead to leakage (regurgitation) of blood back to the heart at the time the aortic valve is closed. About 50% of patients with this problem suffer from Marfan syndrome, this syndrome or similar variations. The other 50% of cases the cause is unknown, but many people in this group have high blood pressure.

Symptoms

Thoracic aneurysm (thoracic) aorta can become very large, and that do not cause symptoms. The symptoms are a result of the enlarged aortic pressure on other structures in the chest. Typical symptoms are pain (usually high in the back), coughing and wheezing in the lungs (wheezing) as well as in asthma. The patient may cough blood pressure due to an aneurysm of the windpipe (trachea) or the adjacent airways and mucosal damage. Pressure on the esophagus (the channel that connects the mouth to the stomach) can cause difficulty swallowing. Hoarseness may result from pressure on the throat (larynx). The patient may have multiple disorders simultaneously (Homer's syndrome), which consist of narrow pupil (miosis), sunken eyeballs, and sweating on one side of the face. X-ray shows a shift of the trachea (trachea). Abnormal pulsations of the chest wall can also be a sign of thoracic aortic aneurysms.

When it comes to burst (rupture) of thoracic aorta, there is very strong pain that usually begins high in the back and may spread down the back and abdomen, depending on where the rupture spreads. Pain can also be felt in the chest (chest) and hands and mimic a heart attack (myocardial infarction). The patient can quickly fall into a state of shock and die because of blood loss.

Diagnosis

The doctor can diagnose an aneurysm of thoracic aorta on the basis of symptoms or aneurysm can be detected during physical examination. Chest radiograph done for some other reason can detect an aneurysm. CT, MRI or transesophageal ultrasound is used to accurately determine the size of the aneurysm. Aortography (X-ray imaging of the aorta after injection of contrast into the aorta) is applied to accurately determine which surgical technique will be applied.

Treatment

If the thoracic aorta aneurysms larger than 7.6 cm, surgeons implanted a synthetic implant (graft). Knowing that the probability of rupture in Marfan syndrome, a large, doctors recommend surgery and when it comes to smaller aneurysms. The risk of death during surgery of aneurysm of thoracic aorta is about 10% -15%. Because patients with thoracic aortic aneurysm should be given beta blockers to slow down the speed of heart rate (heart rate) and lowered blood pressure and thus reduce the risk of rupture (rupture) of aneurysms.

DISECTIO AORTEAE

(Aortic dissection)

• Introduction • Symptoms • Diagnosis • Treatment • Forecast

Introduction

Aortic dissection (dissecting aneurysm, dissecting hematoma) is a very serious condition, often fatally, in which there is a cleft envelope inside the aortic wall (aortic endothelial cells), while the outer sheath remains intact.The blood enters the aortic wall through the gap, further splitting the middle envelope and creates a new channel in the wall of the aorta.

Damage to the aortic wall in most cases responsible for the formation of aortic dissection. The most common cause of such damage is high blood pressure, and was detected in more than two thirds of patients with aortic dissection occurs. Other causes are hereditary (hereditary) disorders of connective tissue, especially Marfan and EHLER-Dunlosov syndrome. Further causes are congenital defects of the heart and blood vessels, such as coarctation of the aorta, the ductus open arteriozus, aortic valve defects, arteriosclerosis and injury (trauma). In rare cases, dissection occurs accidentally, during catheterization when a doctor asks a catheter into an artery (aortography, angiography) or during surgery of the heart and blood vessels.

Symptoms

In principle, any person who experienced aortic dissection felt the pain that is typically sudden and lancinating.People often describe the pain as tearing or ripping chest. The pain occurs regularly in the back between the shoulder blades, and often spreads in the direction in which it spreads along the aortic dissection.

If the dissection progresses to close one or more arteries that leave the aorta. Depending upon which arteries are blocked effects may include: stroke, heart attack (myocardial infarction), sudden abdominal pain, and nerve damage can cause numbness or prevent movement of the arms or legs.

Diagnosis

The doctor diagnoses aortic dissection on the basis of characteristic symptoms. In two thirds of patients with aortic dissection can be found in the arteries pulse weakened arms and legs. Dissection that extends to the back, behind the heart, can cause noise that a doctor can hear using a stethoscope. Blood can accumulate in the chest.Also, due to dissection of the blood can flow from the heart and can accumulate in the pericardial sac (pericardium) around the heart and prevent the normal heart. It is a condition called cardiac tamponade, and endangers the life.

X-ray of the chest showed enlargement of the aorta in 90% of patients with aortic dissection. Ultrasound examination usually confirms the diagnosis even in cases where the aorta is enlarged.

The application of CT contrast is authoritative for the diagnosis, but it should be done quickly because it is very important in this emergency situation.

Treatment

Patients with aortic dissection should be admitted to the intensive care unit, where they closely monitor and measure vital signs (pulse, blood pressure and respiration rate). Lethality can occur several hours after the commencement of aortic dissection. That's why doctors as soon as possible give medicines to slow heart rate and lowering blood pressure to the lower value, and yet provide enough blood flow to the brain, heart and kidneys. Shortly after the initial therapeutic measures doctor should decide whether to take urgent surgery or treatment will continue only with medication.

Doctors almost always recommend surgery for dissections that affect the first few inches of the aorta immediately after its exit from the heart, dissection if complications are not so large that surgery is too great a risk. If the dissection farther from the heart usually continues to treat with drugs, except in the case of dissection leading to impending rupture (burst) aorta, or in case of dissection in the Marfan syndrome. In these cases require surgery.

During the surgery, the surgeon removes as much as possible of rascijepljenog (stratified or diseciranog) aortic wall, thus eliminating the possibility of entering the blood in the aortic false channel, and cut off part of the aorta is replaced by a synthetic graft (graft).

If there was leakage (regurgitation) aortic valve surgeon repaired or replaced.

Forecast

About 75% of patients with aortic dissection die within the first two weeks if left untreated. In contrast to this, 60% of patients who were treated and lived for the first two weeks can experience at least 5 years after aortic dissection, and 40% of them live at least 10 years. Out of people who die within the first two weeks approximately one-third die from complications of dissection, while the other two thirds to die of other diseases.

The risk of death from aortic dissection surgery in specialized centers is high today about 15% of dissections, which are close to the heart, a little more for those that are further away from the heart. All patients who survived aortic dissection, including those who underwent surgery, doctors make a long-term therapy to maintain low blood pressure, reducing the impact of blood flow to the aorta.

Doctors should also monitor patients for the possible development of late complications, such as the three most important: the emergence of a new dissection, the development of aneurysms in the aorta, and diminished gradually increasing leakage (regurgitation) aortic valve.

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Neurocirculatory dystonia

Dystonia neurocirculatoria (DNC)

Neurocirculatory dystonia (DNC.) is a dysregulation of the heart and / or peripheral vascular, psychogenic or subkortikalnog foundation, poslijedičnog no organic damage to the cardiovascular apparatus.

Special notes:

• it is a syndrome, a homogeneous group of psychosomatic disorders,

• Their nature has not been well studied,

• there is no unique positions in relation to DNC,

• it is a border area of ​​cardiology and neuropsychiatry,

• DNC in the concept of a partially coincides with the "functional disorders of the heart"

• syndrome is very common,

Symptoms and diagnosis of the DNC's. often misused in practice serves as the "labeling" unclear situation, or is misdiagnosed initial stage of organic heart damage (starting Pectoral angina, unfixed arterial hypertension, etc..).

Types of neurocirculatory dystonia

Based on the predominant aetiological factor (or dominant symptom) can be distinguished as special forms:

• neurocirculatory asthenia,

• iatrogenic DNC.,

• anxious DNC.,

• menopausal DNC.,

• supporting neurocirculatory dystonia.

In most cases, however, the main etiological factors are, presumably, conflict or other mental disorders, who "somatizuju" in the form of polymorphic clinical picture.

Symptoms and diagnosis

Symptoms are usually very numerous and varied: less often, the patient said a few symptoms (oligosymptomatic form). There may be following symptoms: dyspnea, precordial pain, palpitations, feeling of increased heart rate and feeling of heart failure, inability to lying on the left; fatigue; '. Door knocking Damar', typing in Lazic (unpleasant abdominal aortic pulsations); red spots the face, neck, chest, excessive sweating, sticky, cold hands; trvoglavica ("fainting"); headache insomnia; alteration affects; tremor; reputed sensitivity to weather, sub-febrile states.

Although each of the above symptoms for themselves nonspecific, if combined, they provide a lot of the typical clinical picture. It is characteristic and diagnostic of, almost pathognomonic importance, the manner in which the patient describes his illness: colorful expression, using optimal metaphors that it allows the level of education and the inventory of words and terms, the patient describes his symptoms such as experience, if it even allows the physician detail, zauzlmajući quasi-objective attitude towards the disease and during his speech.

The physical signs

There may be signs of the following: eretični tones, tachycardia, exceptionally, bradycardia, extrasystoles, hyperkinetic noise, variable blood pressure, often with high systolic pressure, positive dermografizam, paroxysmal tachycardia, paroxysmal arrhythmias absolute.

There are no signs of organic (anatomical) damage to the heart, with the exception of "supporting neurocirculatory dystonia."

Clinical features of special forms

Neurocirculatory asthenia (described as "military heart" in I and World War II)

It occurs in acute mental load or immediately after acute psychological trauma, although there may be all the listed symptoms, asthenia prevails, ie. effort intolerance due to abnormal heart adaptation to physical effort.The main sign of the tachycardia after a very light load.

Anxious DNC

Subscribe to anxiety neurosis, may be their main events. In the foreground are hypochondriac ideas, and behind them a rich symptomatology.

Iatrogenic DNC

Indicated a reckless statement or the use of so-called doctors. powerful to say, such as "heart murmur", "Enlargement of the aorta," "angina pectoris", "arrhythmia" to the patient, if susceptible to this kind of suggestions, and accepting yourself and upgrade processes.

Menopausal DNC

It occurs during and after menopause women (rarely men) in the foreground are vazoregulacioni disorders (heat waves), and affective instability.

Cover DNC

It occurs together with organic heart disease, coincidentally or poslijedično. Regardless of the somatic effects of organic heart disease, the mere knowledge of the patient's disease of his heart, that mystical body, can act as a mental trauma. In these cases there is a discrepancy between the organic findings (eg, compensatory vicijuma, infracted scar, etc..) And clinical symptoms of the DNC's. The DNC is a special form, sometimes insurmountable difficulties in the diagnosis and evaluation of functional and operational capabilities.

Radiological signs of

Quite often, the heart is a bit lively and pulsating.

ECG signs of

ECG is usually normal. Not infrequently, however, flattened T waves, which are normalized after the effort. On the other hand, the T waves may be high and pointed. There can be significant sinus arrhythmia, often

beats, as a rule, no postekstrasistolnog phenomenon. There may be genuine ST segment depression; down of the more common point of T. Sometimes there paroiksizmalna supraventricular tachycardia, rarely paroxysmal atrial fiibrilacija. Partly be seen and AV block, which can be corrected with atropine (diagnostic test).

Functional signs

There may be intolerance to effort, sometimes a very considerable degree, so the patient does not tolerate even small ergometric load. More often, however, the functional capability is preserved, although the effort, as a rule, there is a significant tachycardia.

Laboratory: no findings

The minimal diagnostic program

ECG with the load (double Master test or cirkloergometar). Rtg-incur the heart.

Pathophysiology

The matter is controversial not only in terms of definition and etiology, but (especially) in terms of pathophysiology. Simplistic interpretation of this is a change of "tone" of vegetative nervous system - hence the (outdated) the name of the syndrome - it is unsustainable. It is certain, however, by definition, and clearly, that these are disorders of the regulatory function of the heart and circulatory system, whose interpretation can be approached only by using modern knowledge of cybernetics.

Forecast

In most cases the prognosis quo ad function is good; quo ad sanationem is uncertain, and often depends on, whether the patient will be able to establish mental balance and satisfying relationships with their srijeđinom.Not infrequently, after many years, the symptoms gradually subside, and seeing the phenomenon of "psychosomatic refilling", ie. usually after a long period of neurocirculatory dystonia manifested in some other psychosomatic disease (eg colitis, hyperthyroidism, ulcers), then NCD symptoms are suppressed.

It should be noted that the DNC. may represent the first phase of development of a permanent dysregulation as hypertension or organic diseases, especially coronary heart disease.

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Ductus arteriosus persistens

This is the persistence of fetal defects between channels descendentnog of the aorta and pulmonary artery, which in fetal life necessary for the maintenance of fetal circulation, and in the postnatal period, his persistiranje an anomaly that allows direct communication between the systemic and pulmonary blood flow at the level of large blood vessels.

Types of diseases

The width and length, and may differ functionally:

• regular transient arterial channel

• with high pulmonary flow,

• with pulmonary hypertension.

Symptoms and diagnosis

• asymptomatic, discovered incidentally at the heart of a forest.

• It occurs early in heart failure, frequent respiratory infections.

• Cyanosis, dyspnea on exertion, frequent respiratory infections.

Clinical signs of

• A continuous thrill in mterkostalinom II (ir) area to the left, continuous noise also in part II ik left, top hiperdinamičan heart attack.

• With the above findings hear diastolic drip on top.

• Cyanosis, maljičasti fingers II of the pulmonary artery tone accent, noise is not continuous, systolic or diastolic dominant component.

Rtg

• The heart is normal size. Pulmonary vascular pattern is normal or slightly increased.

• The heart is increased at the expense of the left atrium and left ventricle. There are a plethora of lung and pulmonary artery pulsation at the same time, the left ventricle and aorta.

• The heart is a whole increased. There is an increase of right ventricle, left ventricle, left atrium. Pulmonic arch was bulging, full of the hilum, a peripheral light.

ECG

• In the normal limits.

• Left ventricular hypertrophy, left ventricular hypertrophy.

• Left ventricular hypertrophy, hypertrophy of both chambers with a predominance of the right ventricle with right bundle branch block, or without it.

Cardiac catheterization

In cases with typical auscultatory findings, catheterization is not required. It shows

left-right shunt at the level of large blood vessels, ie. oxygen saturation was higher in the pulmonary artery than in the right chamber.

In the hypertensive form of increased systolic pressure in the right ventricle and pulmonary artery.

The characteristic course of the catheter, which can pass from the pulmonary artery into the aorta through the channel.

Angiokardiografija

Angiokardiografijom retrograde passage receives the image contrast from the aorta into the pulmonary artery.

Functional characteristics of

Through transient arterial canal, a portion of blood from the aorta back into the pulmonary artery, pulmonary blood volume burdensome circulation, left atrium and left ventricle.

If the channel is larger blood volume, which burdens the pulmonary circulation can be a very early lead to left ventricular failure. If the channel is short and wide, there is a direct transfer of systemic (aortic) pressure in the pulmonary artery, ie. produces pulmonary hypertension, which prevents involution of fetal pulmonary arteries and the structure immediately after birth leads to the reversible pulmonary hypertension.

During his lifetime, as in ventricular septal defect, leads to lung damage intima of blood vessels and the formation of irreversible pulmonary hypertension.

Forecast

In today's level of development of medical prognosis in these patients is good. Today, every patient with transient arterial duct, which is complicated by irreversible pulmonary hypertension, surgically treated with success.

The most common complications include heart failure, pulmonary hypertension and subacute bacterial endocarditis.

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Arteriosclerosis

Arteriosclerosis is a degenerative disease of the artery wall. It belongs to the organic, structural phenomena. It is angioorganopatija occlusive nature. It is a typical disease of modern man and cililizovanog leads the list of morbidity and mortality rates of fatal complications, particularly in the level of coronary heart disease and cerebral arteries. While previously considered a disease of the elderly, is now a growing number of middle and younger age that are still in full working activity. 

Types of arteriosclerosis

When it comes to atherosclerosis refers to all forms of sclerosis of the artery wall, whether it is a predominantly Atherosclerosis, media sclerosis, diabetic atherosclerosis, or peripheral arteriosclerosis different genesis.

There are different classifications, but they all take account of the anatomical changes and clinical manifestations.

Media sclerosis

Senile hyperplastic,

Monckenbergova medioskleroza with calcifications.

Intimal sclerosis (Atheroscherosis).

Arteriolitic sclerosis (kidney and other visceral organs in hypertension).

Arteriosclerosis obliterans.

Etiopathogenesis

The emergence of atherosclerosis play an important role heredity, constitution, age, sspol, lifestyle and diet.

easily occurs in younger people, it is predominantly a disease of older persons. She favored the modern pace of life, mental stroke and extensive fat diet. It occurs frequently associated with hypertension, diabetes, gout, familial ksantomatozom, hypercholesterolemia, hypothyroidism and essential hyperlipemia miksedemom.

In the beginning of the process, which often occurs already in the second and 3 decade of life, in the deeper layers of the intima precipitated lipoidi, mainly cholesterol and leads to necrosis. In nekortičnim parts of the wall can be deposited and calcium salts, and if necrosis penetrating intimacy creates the atheromatous plates.

Symptoms and diagnosis

The clinical picture

So where is the field of arteriosclerosis develop stronger, we find a variety of symptoms and signs related to these organs. Frequently the arteriosclerotic process in a stronger degree of localization in the aorta, and

is primarily a question of Atherosclerosis of the aorta. It is often combined with coronary artery disease, although it can occur from the beginning as an isolated or predominant clinical picture. Also often associated with changes pomenutitn or herself may develop cerebral vascular syndrome as a reflection of atherosclerosis.

Symptoms

Subjective symptoms are different. Some patients have no symptoms for years. If the image is dominated ateromatoze aorta and coronary sclerosis, various problems occur behind the sternum and the heart area. At first it appears the pressure, then squeezing and burning, especially at work. There may be real aortalgije with burning feeling behind the breastbone that lasts for weeks and months to gain time for effort and frustration.

In the majority of coronary sclerosis leads to the appearance of stenocardia and pectoral angina with precordial pain and a feeling of fear of death. The pain often spreads to the left hand along the ulnar nerve in the neck and shoulder, although it may also have abdominal localization.

Arteriosclerosis of cerebral arteries initially causes a reduced ability of mental concentration and memory, then it may occur headache, vertigo, dizziness and fainting, especially when rapid changes in body position, ambient temperature and the stronger mental and physical effort.

If the changes are mainly in the lower extremities occurs occasionally limping - claudicatio intermittens of muscle ischemia, and if the process was developed in the abdomen can occur Dyspragia intermittens atherosclerotic abdominals.

The physical signs

Auscultation of the heart can be heard accent second the aortic tone, which may have a metallic sound. There may be a systolic murmur over the aorta. Pulse has the character of "pulsus celer," the artery is stiffer, the wall is thicker and can be easily moved. Artery may be elongated, tortuous and uneven due to calcification. Blood pressure can be increased, and in arteriosclerotic myocardiopathy and lowered. It can be changed skin color and skin temperature.

Radiological signs of

X-ray shows more distinct shadow of the aorta. It was expanded and elongirana. Aortic arch is moved upward to a height sternoklarikularnog joint, bulging is left in the form of more pronounced aortic button on whose periphery can see the lime deposits in the form of a thin scythe and the descending aorta is more noticeable.

Heart can be concentric hypertrophic. Aortography and arteriography can provide more visual information about the structure and change the lumen of the artery wall, particularly in cases of obstructive changes and collateral phenomena.

Oscillography pletismografski and signs

In cases with predominant obliteracionim changes, which developed peripheral circulatory insufficiency Oscillograms may show changes. But more important is the morphology of the oscillations of the curve, so we pletismogram gives more information about dikrotičnom wave and the speed of implementation; propagation time is extended, and the pulse wave is often modified, which causes the value inklinacionog time.

Functional signs

The function of the arteries may be affected to varying degrees. The arteries become more rigid, hard, lose their elasticity. Larger arteries are wider, less narrow, and can obliterisati. Sclerotic, elongirane medium caliber arteries become vulnerable to various stimuli and is very narrow and easy to stimuli that are normally wider (paradoxical reaction of the arteries), making it difficult to feed tissues.

Functional testing of the artery allows detection of early appearance of atherosclerosis. Change the color changing limb position (lifting legs upward), reactive hyperemia, which lag behind, or appears as a spot after 10 minutes of holding the elastic cuff deflation, the disappearance of the pulse in the construction of the limbs less than 45 ° indicate arteriosclerotic changes that lead to these functional characters.

Laboratory

There are no easy Typical laboratory analyzes that imply the presence of arteriosclerotic process, it is considered that hypercholesterolemia is one of the most common laboratory findings. It is important to pay attention to the total lipids and their relation to lipidogramu. As a rule, there is a higher index of lipoprotein that normally is beta / alpha to 3

Prognostic significance may have hiperprotrombinemija.

Radio isotopic technique offers fewer opportunities primarily for disorders and occlusion of blood flow through skeletal muscle.

Bacteriological, cytological and histological findings

Histological examination allows early detection of changes in the structure of the artery wall, but the need for these tests are not common.

The minimal diagnostic program

ECG with 12 derivations (3 standard, 3 and 6 unispolarne prekordijalnih at rest and after fatigue, if necessary).Oscilografija forearm and lower leg. Serum lipid levels, radiographs of the heart.

Treatment

First of all, an important prophylaxis. An appropriate pace of life and work with mandatory daily rest or break.Recommended physical activity, physical training and spending time outdoors at least 1-2 days a week. The diet insist on moderation and limit the fat content, especially with an abundance of saturated fatty acids.

The treatment must be used so. antisklerozantna resources: heparinoid ateroid, solvosterol, iodine, novocaine, vitamin A and E, vitamin B12, calcium panganicum, complamin other vazadilatatorna and opoterapijska assets (replacement therapy).

Forecast

It depends on age, degree of changes and complications.

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