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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Ischemic heart disease

It is a disease without specific clinical events, but with undoubted ECG signs of scarring after myocardial infarction or signs of ischemic cardiac muscle.

Common causes of disorders: 

• occlusion of coronary arteries - atherosclerosis, arteritis,

• narrowing the mouth of the coronary arteries - syphilitic aortitis,

• heart defects that reduce cardiac output - aortic stenosis, mitral stenosis, rarely,

• a sudden drop in blood pressure in the aorta - a state of shock, massive pulmonary embolism,

• reduction of O2 in the blood - anemia, hypoxia in pulmonary insufficiency.

Syphilitic aortitis may also lead to ischemic heart disease due to narrowed coronary mouth. Detection of aortic insufficiency and other signs of late syphilis indicate the correct diagnosis.

Polyarteritis nodosum, or narrowing of coronary arteries  obliteran smay create a clinical picture of ischemic heart disease. The varied symptomatology, and biopsies of skin and muscle can not solve the real nature of the disease.

The gradual narrowing of the coronary arteries leads to the formation of collateral circulation, which plays an important role in the further course of disease and the consequences.

CARDIOMYOPATHIA

• Introduction • Symptoms • Diagnosis and Forecast

Introduction

Under the name implies cardiomyopathy is a primary myocardial disease, which can monitor and endocardial disease, and to exclude secondary diseases: congenital heart defects, coronary insufficiency, arterial hypertension and rheumatic valvular defects or nonrheumatic nature.

Described under various synonyms, such as cardiomyopathy unspecified nature, congestive cardiomyopathy, constrictive cardiomyopathy, idiopathic cardiomyopathy, obstructive cardiomyopathy, endocardial fibrosis, familial hypertrophic cardiomyopathy, a hidden African cardiomyopathy (Becker type), etc..

Types of diseases

The variety of synonyms indicates the still insufficient knowledge and systematization of these diseases.

Recently, the disease in this group is trying to introduce the distinction:

• Symmetrical and

• Asymmetric cardiomyopathy

In that last allocated this local damage of the myocardium, in terms of hypertrophy, localized in the output of the aorta as described subaortic hypertrophic stenosis.

Symptoms and diagnosis

Symptoms appear between thirty and fifty years of age, although quite often occur in early adolescence.

The initial symptoms were mainly dyspnea on effort and the occurrence of heart failure.

Signs

Quiet tones, galopni rhythm, usually without a heart murmur. In some cases it can be heard at the top or mouth of the tricuspid systolic murmur of varying intensity.

The signs of venous stasis: the swollen veins in the neck, enlarged liver and edema.

In the subacute form of hypertrophic stenosis of the characteristic finding of the sharp systolic ejectional forest type, localized between the top of the heart and the sternum, followed by systolic fremissementom.

Rtg heart

Indicates an increase in whole heart.

ECG

It shows the different nature of the rhythm disorders: atrioventricular block, ectopic rhythms, atrial fibrillation and the like.

There are usually signs of left ventricular hypertrophy, with changes in T wave, which is flattened or negative.In addition, there is a bundle branch block, and often low QRS complex.

Cardiac catheterization

Cardiac catheterization showed a fixed low cardiac output, increased arteriovenous difference oxygenated blood, increasing end-diastolic and mean systolic pressure in the right chamber, increasing the value of the intermediate pressure in the pulmonary artery. The characteristic curve of the right ventricle, showing the sudden disappearance of the ejection phase and lowering postsistolic curves as in pericarditis.

Venous pressure is increased.

Angiocardiography

Angiocardiography shows an increase of cavities of the heart. It is not typical.

Biochemical analysis

Not characteristic. There may be changes in electrolytes and in other diseases with chronic heart failure.

Histopathological Findings

In order to confirm or exclusion, diagnosis is sometimes necessary to do a biopsy of the heart. Usually this is done via thoracotomy. Histopathological findings showed mostly hipetrophy and myocardial fibrosis.

Functional characteristics of

Because of diffuse myocardial damage myocardial effective propulsive force is reduced. There is a small output, causing a delay in the left, and consequently that in the right chamber, with an increase in venous pressure and delay in venous circulation - stagnans heart failure.

Forecast

The prognosis is bad.  The disease and leads to death. Treatment is symptomatic.

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Coarctation of the aorta (Coarctatio aortae)

Coarctation of the aorta (narrowing of the aortic isthmus) is a congenital heart defect, which is characterized by narrowing of the lumen of the aorta, usually at the site of attachment of the ligamentum arteriosum, which is enough to lead to systolic pressure gradient in front of and behind the constriction.

Types of diseases

The narrowing can be localized in any part of the thoracic or abdominal aorta,

Symptoms and diagnosis

Usually has no symptoms.

In older people headaches, dizziness, epistaxis, pain in the legs of type claudicatio intermittens.

Clinical signs of

A well-developed, athletic person. Systolic thrill in the pit supraclavicular, visible  intercostal artery intercostal artery pulsations, noise sistolic ejection ype II in k space left, lI accented tone of aorta, interscapular systolic murmur.

Increased blood pressure in the upper limbs, down to the bottom.

Carotid artery pulsation, and art. radialis stronger than the femoral artery, which was reduced and lags.

Rtg

Left ventricular hypertrophy. In the esophagus there are impressions that give the appearance of the letter E. On the lower edge of the ribs (Roeslerov sign).

ECG

In milder cases may be normal, usually shows left ventricular hypertrophy.

Cardiac catheterization

It is not necessary, does not provide diagnostic information.

Angiocardiography

Is needed in most cases to assess the localization of stenosis. Retrograde aortography showed narrowing of the aortic position and size of poststenotic dilatation.

Functional characteristics of

Place a narrowing obstructing blood flow to the lower part of the body. Therefore, pressure increases in the area before opstruction to the development of collateral arterial network in order to maintain blood flow in the part below the obstruction.

Maintenance of high blood pressure conditions before the obstruction burdens pressing the left ventricle leads to its failure.

Maintenance of high pressure in blood vessels before the obstruction, especially cerebral, it may lead to their rupture.

Forecast

Prognosis of these patients, if treated surgically at the time was favorable. In surgical patients untreathed prognosis is bad. Death is usually the fourth or fifth decade of life due to heart failure or cerebral apoplexy.


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Chronic pulmonary heart

Chronic pulmonary heart (HPS) is a clinical syndrome, characterized by right ventricular hypertrophy, right heart failure with or without it, that is the result of functional or anatomical damage to the lungs, but with the exclusion of lung lesions caused due to left heart disease or congenital heart disease (World Health Organization).

Classification

Anatomical

All the pathogens that cause HPS can be divided into three groups:

Diseases that damage the airways and alveoli of the lungs (chronic bronchitis with emphysema, tuberculosis, sarcoidosis, fibrosis, systemic connective tissue diseases, muskoviscedoza etc..)

diseases that hamper the movements of the chest wall (kyphoscoliosis, significant pleural adhesion, prolonged neuromuscular paralysis, excessive obesity),

diseases that primarily attack the pulmonary blood supply (multiple pulmonary embolism, primary pulmonary hypertension, arteritis, or pressure on the pulmonary blood vessels, as well as in different granulomas, carcinosis of the lungs, aortic aneurysm, sarcoidosis, etc..).

Functional (the predominant pathogenic cause):

• alvealna hypoventilation (chronic obstructive emphysema, neuromuscular disease, kyphoscoliosis, obesity - Peekwik syndrome);

• reduction of pulmonary blood vessels (alveolar-capillary block, recurrent pulmonary embolism and other causes that damage blood network).

Symptoms and diagnosis

In the compensatory stage of chronic pulmonary heart is still prevalent symptoms of primary pulmonary disease. There are frequent "cold" with cough and expectoration of small or large quantities purulent sputum, dyspnea on exertion or at rest. These symptoms last for 2-3 months, usually in winter, repeat for years.

There may be other pulmonary symptoms (eg haemoptysis.). If pulmonary hypertension is manifest at this stage can also aggravate symptoms: dyspnea even more pronounced in peace and in motion, sometimes anginal pain due to myocardial ischemia and anoxia. However, based on symptoms alone it is impossible to distinguish this stage of the more uncomplicated primary pulmonary disease.

In later, more late stage, joining the above symptoms and right heart failure symptoms: extreme fatigue, gastrointestinal disturbances due to delays and swelling feet.

The physical signs

Signs of primary pulmonary disease are:

• dyspnea, cyanosis and central type drumstick fingers, active auxiliary breathing muscles. The chest in the inspiratory position ("barrel"), expanding the "en bloc". Lung volume hipersonor, impaired breathing, vesicular, prolonged expiratory; bronchitic litter, they are usually high-pitched. It is significantly narrowed or disappeared silence heart, quiet heart sounds, and the liver is extremely lowered.

Signs of impaired heart function and blood flow

• Before the manifestation right heart failure, physical signs of chronic pulmonary heart are very scarce. Pulmonary hypertension may give salience pumonary second tone, right ventricular hypertrophy and visible pulsations epigastrium.

Difficult pulmonary emphysema may mask the signs, and even an early appearance Brake heart failure.

Clinical diagnosis of chronic pulmonary heart when it is easier to set up a fully developed signs of right heart failure: the swollen veins in the neck, significant increase in liver, edema of the legs and ascites. At heart, except for tachycardia, findings may be normal, but can be heard and right gallop and systolic murmur as a sign of relative tricuspid insufficiency.

Rtg

Characteristic radiological signs of chronic pulmonary heart does. Heart, even when something is increased due to larger chest may appear normal in size.

In advanced cases, we extended arc of the pulmonary artery, and lateral positions to see the enlarged right ventricle and right atrium. Besides the foregoing, x-ray may help to identify a type of lung disease.

ECG

easily in chronic pulmonary heart there is no pathognomonic ECG curve, changes in ECG were very valuable in diagnosing and proving the evolution of the disease. At first it may appear reversible changes, such as P-pulmonale, electrical axis deviation to the right, with a deep over the left heart, a negative T waves over the right precordial leads.

As it progresses, and compensatory and decompensated cor pulmonale found ECG signs of right ventricular hypertrophy, which are usually irreversible. There is often a tendency to low voltage. In a minority of cases there is a right bundle branch block.

For the purpose of uniform interpretation of electrocardiographic curve, the WHO expert committee has developed criteria for right ventricular hypertrophy, which can be applied in chronic pulmonary heart.

They are as follows:

• The existence of the wave QR intrinsic deflection greater than 0.03 seconds in the drain V1 or in leads V3R and V4R. This finding himself particularly for applications in a reliable sign of right ventricular hypertrophy.

• If there is no sign as described above, then the existence of two of the following criteria:

ratio R / S is less than 1 in lead V5,

dominant S wave in D1,

incomplete right bundle branch block.

Functional signs

Tests for lung function (spirography) and analysis of gases in arterial blood can indicate the type and degree of respiratory failure.

Cardiac catheterization can be defined as pulmonary hypertension has clinical signs of chronic pulmonary heart are manifested. In the compensated stage, the pressure in the pulmonary artery in peace can be normal

(25-30 mmHg), but the load can go up to 60 mmHg, and more.

In the decompensated phase of pressure is already elevated in peace (usually 40-60 mmHg), and the load reaches a much higher value. Pulmonary hypertension in an effort may be one of the earliest signs of chronic pulmonary heart.

The finding of elevated venous pressure (above 10-12 cm H2O) is an important diagnostic and differential

- A diagnostic sign of right heart failure.

Laboratory signs of

Arterial oxygen saturation is reduced, usually below 80%, while the partial pressure of CO2 in arterial blood above 60 mmHg.

In odmaklijim stages of lung disease in the compensated stage of chronic pulmonary heart there is a distinct hypervolaemia. In the decompensated stage of blood volume usually decreases, although there may be higher than normal. There polycythemia and increased hematocrit. SE has slowed.

The minimal diagnostic program

Symptoms and diagnosis of chronic pulmonary heart is based on:

• a history, physical and functional signs of primary pulmonary disease. To this end, in addition to detailed history and accurate physical examination, should make a radiograph and pulmonary functional tests (spirometry). In contentious cases are needed, and additional tests (arterial blood saturation with O2, CO2 partial pressure).

• electrocardiographic signs of right ventricular hypertrophy with signs of right heart failure, or without them.

• Careful clinical and other examinations, and possibly heart catheterization, in order to turn off left heart disease or congenital heart disease.

Pathophysiology

The occurrence of chronic pulmonary heart is the result of increased right ventricle, which occurs with increased resistance in the pulmonary blood vessels and the pulmonary hypertension.

The most important factors in the occurrence of these phenomena are:

• general alveolar hypoventilation,

• reduction of pulmonary sudovne network

• 'vascular intrapulmonary shunts, and

• myocardial factors.

Hypoxia due to alveolar hypoventilation leads to a number of disorders: increased output, polycythemia, pulmonary vasoconstriction of blood vessels which ultimately produce pulmonary hypertension.

This set of factors, certain are irreversible, and the second reversible. The latter often causes respiratory infections, and its removal can be partly repaired and hemodynamic disturbances.

Forecast

Forecast of chronic pulmonary heart depends mainly on the primary lung disease. As it is, generally, anatomically ireversible, it is possible to correct only the reversible functional disorders (prevention of infection, bronchospasm, respiratory dysfunction, normalization of metabolic disorders, etc..). The current available resources do not allow the correction of the functional integral. 

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Diagnostic methods in cardiology

Most diagnostic procedures on the heart is a small risk to patients, the risk increases with the complexity of the procedure and severity of existing heart disease. At the heart catheterization and angiography possibility of major complications (such as stroke, heart attack or death is 1 in 1000). Test load (ergometry) is the risk of heart attack (myocardial infarction) or death of 1 to 5000. In radionuclide tests virtually the only risk there is of low doses of radiation a person receives, and this radiation is less than X-rays where the patient is exposed to while performing the majority of radiological imaging.

ECG

EKG is a fast, simple and painless method in which the electrical impulses of the heart action and are recorded on paper tape. EKG allows doctors to analyze the source from which the heart rate begins each heartbeat, conducting electrical impulses through the nerve fiber conduction in the heart, the frequency (speed) and heart rate.

Most people suspected of having heart disease are recorded by ECG. This test helps doctors determine the number of heart problems, including heart rhythm disturbances, the insufficient supply of oxygen to the heart and blood, excessive thickening of the heart muscle (hypertrophy), which may be due to elevated cardiac pressures. EKG can also detect when the heart muscle is thin or when it does, it gets replaced with non muscular tissue. This condition may be due to a heart attack (myocardial infarction).

Ergometry (test load carrying)

Test of endurance during physical exercise can greatly doctor indicate the presence and severity of coronary artery disease and other cardiac disorders. Test load carrying (ergometry, stress test), during which the continuous monitoring ECG and blood pressure, can detect problems that are not visible in the standstill. If the coronary arteries are partially blocked, the heart may be getting enough blood at rest but not during physical exertion. Simultaneous examination of lung function can be distinguished limit physical exertion as a consequence of heart disease than those caused by lung diseases, and limit physical exertion that occurs due to the heart and lung disease combined.

During the test subjects were biking or walking on a mobile bar certain speed. Gradually, the load increases. At the same time controls the EKG and blood pressure is measured at certain intervals. In general, subjects performed the test load bearing until their heart rate reached 80% to 90% maximum for their age and gender. If symptoms as shortness of breath or chest pain, or become intolerable appear significant changes in ECG or blood pressure test is terminated earlier.

People who for whatever reason can not perform this test load may be subjected to stress electrocardiogram, which provides data similar to data obtained exercise test, but does not include physical activity. Instead, the injected drug with the aim of increasing the blood supply of normal heart tissue, but this drug reduces the supply of abnormal (diseased) tissue (eg, dipyridamole or adenosine) to mimic the effect of physical load.

Test load tolerance (ergometry) indicates coronary artery disease when

occurrence of certain abnormalities in the ECG when subjects developed angina pectoris or when lower blood pressure.

Neither test is perfect. Sometimes tests show disturbances in people without coronary heart disease (false-positive results), and sometimes the disorder is not found in people who have angina pectoris (false negative results). The people who have no symptoms, especially in younger people, the probability of coronary heart disease is low, despite an abnormal test result. However, the test load is used for screening (screening or search) in apparently healthy populations, for example. program of physical activity before or during the evaluation of life insurance. Many false-positive results can lead to great care and medical expenses. For this reason, many experts do not support the routine performance of ergonomics in people without symptoms.

Holter monitoring (continuous ECG moving)

A heart rhythm disorder, and inadequate blood flow to the heart muscle can occur only for a short or unpredictable. To detect such problems the doctor uses a long-term mobile ECG recorder. In this test subjects wearing a small device on the battery (Holter monitor) that records EKG for 24 hours. While wearing the monitor respondent recorded in calendar time and the type of individual symptoms. Later, the image is placed in a computer that analyzes the heart rate (speed) and rhythm, requires changes in electrical activity that may indicate inadequate blood flow to heart muscle and plays a recording of each heartbeat for 24 hours. Symptoms were recorded in the log are compared with changes in the ECG.

If necessary, the ECG can be sent by telephone to a computer located in a hospital or doctor's office for emergency reading ECG recording immediately after the onset of symptoms. Modern ambulances can be simultaneously recorded ECG and EEG (brain electrical activity measures) to those people who have episodes of fainting (syncope). Such images help to distinguish epileptic seizures from a heart rhythm abnormalities (arrhythmias).

Electrophysiological testing

Electrophysiological testing is used for the assessment of serious arrhythmias, and electrical conductivity. The hospital doctor introduces a small electrode through the veins and sometimes directly through the arteries in the heart chambers to record an ECG within the heart and to accurately determine the whereabouts of the electrical conductive paths.

Sometimes the doctor intentionally cause arrhythmia during testing to determine whether a particular drug can stop the disorder and to assist the operations. If necessary, a doctor will quickly return to normal heart rhythm by giving a brief electric shock (cardioversion). Although the invasive electrophysiological testing search and the patient should be anesthetized, testing is very safe: the risk of death is 1 to 5000.

RTG SEARCH

Anyone with heart disease will be recorded in front of the chest x-ray (posterior-anterior recording) and side (profile image). X-ray image shows the shape and size of the heart, and the outlines of the lungs and blood vessels of the chest. Abnormal shape or size of the heart and abnormalities, such as calcium deposits within the heart tissue, they are easily visible. Radiograph of the chest often reveal processes in the lungs, especially in the pulmonary veins and the presence of fluid around the lungs.

Heart failure or heart valve disorders lead to enlargement of the heart. But the size of the heart may be normal in patients with severe heart disease. In constrictive pericarditis, which surrounds the heart like armor connective (scar) tissue, the heart is not increased, although there is heart failure.

Showing pulmonary blood vessels is often more important than the diagnosis of heart show itself. For example.increase in pulmonary artery near the heart and constriction in their lung tissue, suggesting increased right ventricle.

HEART CT (computerized tomography)

Plain computerized tomography (CT) is often not applied in the diagnosis of heart disease. However, it can detect structural abnormalities of the heart, pericardium, great vessels, lungs and other structures of the chest.This test is used to get images that appear after the computer (computer) processing of X-ray data obtained by passing air through the entire chest wall (cross section), and in this way shows the exact position of the disorder.Newer high-speed computed tomography, called computerised tomography provides three-dimensional view of the heart in motion. This search is used to assess cardiac structure and movement disorders.

Fluoroscopy

Fluoroscopy is a continuous X-ray procedure that the screen displays your heart rate and breathing and releasing air from the lungs. No fluoroscopy, which includes a relatively high dose of radiation, mostly replaced by echo-cardiography and other tests.

Fuoroskopija is still used in heart catheterization and electrophysiologic testing. It may be helpful in the diagnosis of some heavy, for example. valvular heart disease and congenital heart defects.

ECHOCARDIOGRAPHY

Echocardiography is one of the most widely applied technique in the diagnosis of heart disease because it is noninvasive, does not use X-ray beam and provides a great view. Search is a harmless, painless, relatively inexpensive and particularly useful.

Echocardiography uses ultrasound waves emitted by high-frequency probe (transducer) and reflected by the structure of the heart and blood vessels and provide a moving picture. Imagery appears on the video screen and recorded to a VCR or on paper. By changing the position and angle sensors, the heart and large blood vessels can be viewed from different sides in order to obtain accurate images of cardiac structure and function assessed. In order to achieve greater clarity and structure analysis of the back of the heart, the doctor may conduct a probe through the patient's throat into the esophagus to record signals from the back side of the heart, to call transesophageal echocardiography.

Echocardiography can observe cardiac wall motion abnormalities, changes in blood volume displaced at each heart beat, and thickening of the membrane around the heart disease (the pericardium), and the accumulation of fluid between the pericardium and the heart muscle (pericardial effusion).

The main types of ultrasound scans are M-mode, two-dimensional, Doppler and color Doppler. In M-mode, the simplest technique is just one part of air directed at the heart under study. Two-dimensional ultrasound, the most widely used technique, creates a realistic two-dimensional display of the computer-created "lobes".Doppler ultrasound detects movements and turbulence of the blood and can provide color display. Color-Doppler and Doppler echocardiography to determine and display the direction and speed of blood flow in heart chambers and vessels. Picture helps the doctor to see if the heart valves open and close properly, and how much you miss when they are closed and the blood is flowing normally. I can see the abnormal connections between blood vessels or heart chambers and can be ordered structure and function of the vessels and chambers.

MRI (magnetic resonance)

Magnetic resonance imaging (MRI) is a diagnostic test that uses a strong magnetic field in order to make detailed view of the heart and chest. This is extremely expensive and modern imaging methods is still under development in the diagnosis of heart disease.

The subject is placed in a large electromagnet that causes vibrations of atomic nuclei in the body and gives characteristic signals, which are converted to two-and three-dimensional imaging of cardiac structures. Contrast media (radiologically visible assets) are not usually required. Sometimes, however, give intravenous paramagnetic contrast agents to help reveal areas of poor blood flow to the heart muscle.

The lack of MRI is that it is to create the imagery needed more time (search takes longer time) than with computed tomography (CT). For motion pictures of the heart obtained by MRI are less clear than those obtained by CT. In addition, some people get claustrophobic during the MRI recording because they have to lie quietly in a narrow space of a large machine.

Radionuclide EXPAND

In view radionuclide is the minimum amount of radioactively labeled substance (indicator) is injected into a vein, and the exposure to radiation during the execution of this search is less than most conventional x-ray examinations. The indicator can quickly spread through the blood throughout the body, and gets to the heart.Then using a gamma camera detects the presence of indicators. The image is displayed and stored on floppy or CD for subsequent analysis.

Different types of cameras to record the radiation can only display one image or can generate a series of computer-enhanced images (picture a cross-section), a technique that is known as computed tomography single photon emission (SPECT stands engl.). The computer can also create three-dimensional image.

Radionuclide imaging is useful in diagnosing partial to people who have chest pain of unknown origin. For those who have a narrowing of the coronary arteries is used to reveal a narrowing effect on the blood supply and heart function. Radionuclide display is also used to assess whether there are improvements in myocardial blood supply after the installation of bypass surgery (by-pass) or similar procedures, and to determine the prognosis after a heart attack (myocardial infarction).

The flow of blood through the heart muscle is usually examined thallium-201 injection into a vein and recording during the test load. The amount of thallium-201 is absorbed in the cells of the heart muscle depends on blood flow. At the highest load of the heart muscle with poor blood supply (ischemia) showed less radioactivity - and provides a weaker picture than the adjacent muscle tissue with normal supply. People who are unable to exercise may be given intravenous injections of the drug dipyridamole or adenosine to mimic the effect of physical stress on blood flow. These drugs are diverted from the bloodstream stricture (abnormal) in normal blood vessels.

Once a student breaks a few hours, this is another record. The doctor can then see in which areas of the heart there was a recovery of blood flow (reversibly reduced flow), which is usually the result of narrowing of the coronary arteries, and in which areas they have developed irreversible (irreversible) scars on the heart muscles, which are usually the result of previous heart attack .

If the suspicion of an acute heart attack (myocardial infarction) is used as an indicator of technetium 99-m instead of thallium-201. Unlike thallium, which accumulates primarily in normal tissues, technetium accumulates primarily in the damaged tissue. However, since technetium also accumulates in bones, the ribs in some degree obscure view of the heart.

Recording of technetium is used for the diagnosis of heart attack (myocardial infarction). Damaged area of ​​heart technetium is absorbed, so this test can detect heart attack within a week of starting 12 to 24 hours after onset.

PET (positron emission tomography)

With positron emission tomography (PET) nutritional ingredient that is essential for the functioning of the heart cells are marked with a substance that releases radioactive particles called positrons, and then injected into a vein. For several minutes, when selected nutritional ingredient reaches the heart of being tested, searches of the area and reveals the highest activity. Heart frequency is accelerating, and blood pressure is slightly lower.Rarely appear mild reactions such as nausea, vomiting and coughing. Serious reactions as shock, convulsions, kidney problems and heart failure (cardiac arrest) are very rare.

Allergic reactions ranging from skin rashes to rare and life-threatening condition called anaphylactic shock.Cardiac arrhythmia may occur when the catheter touches the heart wall. The team performing the procedure is equipped and trained for the emergency treatment of any adverse events.

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