Right ventricular hypertrophy

The diagnosis of right ventricular hypertrophy has a far greater importance in children, than it is in adults. We found out that the cause of the changes in the electrical axis of the standard leads, and then determining hypertrophy can be followed by clinical context, determine the type and location in the heart of pataološkog state.

When right ventricular hypertrophy have the right axle standard deviation leads (S1 R3) and unipolar leads ekstremitetni show R or R1 in the AVR high-more than 6 mm, unipolar chest leads.

• Certain indications DVH exist when precordial leads V1 RS-deflection of the V6 (which points to the predominance of the action potential of the right ventricle through the entire prekordija.

• Type RS R1 deflection in V1 and V2, indicating a probable right ventricular hypertrophy, if R is greater than 15 mm, especially if R is greater than 10 mm.

• High initial RV1-2, with or without Q waves with small R and undoubtedly indicates DVH.

• Intrisikoidna R wave deflection of 0.04 seconds. or more in leads V1 and V2, reliable data for the DVH.

• Intervertirani T waves in leads desnogrudnim accompanied by ST-segment depression in conjunction with other changes in the chest drains indicates serious DVH.

• Indirect data for the DVH is taken high and pointed P2 indicates that the right atrial hypertrophy

Atherogenic dyslipidemia

Hyperlipidemia is one of the means of dyslipidemia and increased cholesterol and / or triglycerides, low HDL (high density lipoprotein) in the blood plasma, which contributes to faster development of atherosclerosis.

Classification

Basic classification of dyslipidemia in the primary, secondary and is characterized by an increased cholesterol only (isolated hyperlipidemia), only triglyceride (isolated hypertriglyceridemia), or increase the value of both components (combined hyperlipidemia).

The cause of

The primary cause of single or multiple gene mutations that result in increased production and reduced breakdown of triglycerides and LDL (low density lipoproteins) cholesterol and increased production or breakdown of defective HDL (high density lipoproteins). Secondary causes contribute to the occurrence of dyslipidemia in the elderly. The most important reasons are lifestyle without exercise with excessive intake of saturated fats, cholesterol and semi-unsaturated fatty acids. Other common secondary causes are diabetes mellitus, excessive alcohol use, chronic renal failure, hypothyroidism, primary biliary cirrhosis and the consumption of certain drugs (thiazides, β-blockers, estrogen, glucocorticoids).

Symptoms

Hyperlipidemia itself is asymptomatic but can lead to symptomatic vascular diseases, including coronary and peripheral artery disease. High levels of triglycerides can cause acute pancreatitis. The increase in LDL causes the tendon xanthomas elbows, knees and metacarpophalangeal joints. Patients with high levels of triglycerides can have eruptive xanthomas on the trunk, back, knees, hands and feet.Extreme lipid levels can be set to give milk plasma.

Diagnosis

The diagnosis is made by measuring serum lipids. Background checks (lipid) includes total cholesterol, triglycerides, LDL and HDL. Considered elevated values> 6:28 for total cholesterol> 2.28 mmol / L and triglycerides of> 4:11 mmol / L for LDL cholesterol. Pathological values ​​are considered to be outside of HDL 1:03 to 1:55.

Treatment

Treatment is indicated in all patients with cardiovascular disease. The goal of therapy is to reduce the increased value triglicerdida, LDL and HDL normalization. The treatment involves changing modes of life including diet with reduced intake of saturated fats, cholesterol and maintaining ideal body weight.Lipostatini are the drugs of choice, their action is based on inhibition of hydroxymethylglutaryl CoA reductase.

Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is characterized by the presence of left ventricular hypertrophy (thickening of the heart muscle). It can be obstructive - with obstruction of the left ventricular outflow tract caused significant thickening of intraventricular septum subaortnog work, which contributes to the anterior mitral valve and nonobstructive - when there is an equal septal hypertrophy and left ventricular free wall. Contractile function of the left ventricle is preserved.

The cause of

The etiology of hypertrophic cardiomyopathy is not known. However, it seems that the genetic factor is very important. It is often found in close relatives and is inherited in an autosomal - dominant.

The clinical picture

The clinical picture varies from asymptomatic state to sudden cardiac death. In younger patients the disease can flow without symptoms, the chance discovery of systolic murmur, and additional methods to reveal the nature of the disease. The most common symptom was dyspnea (shortness of breath) on exertion, which is due to increased end-diastolic pressure in the left ventricle and the pulmonary veins, because the difficulty of left ventricular filling. Anginal pain occurs due to the disparity between supply and increased demand hypertrophic myocardium. The pain usually does not respond to nitroglycerin, which may be of diagnostic value. Syncope (transient loss of consciousness) or conditions near syncope, due to the low cardiac output and very frequent ventricular arrhythmias. Syncope usually occurs on exertion. Frequent and sudden cardiac death, especially younger people. In odmaklijem stage disease may develop congestive heart failure, which usually occurs after the onset of atrial fibrillation.

Diagnosis

It is based on history, clinical findings, objective examination, ECG, x-ray, ultrasound, cardiac catheterization and angiography.

Treatment

Treatment consists of a quart of physical effort and giving beta blockers. In about 60% of patients in whom beta-blockers are ineffective, verapamil leads to a subjective state of repair. In patients who have severe ventricular arrhythmias is necessary and efficacious application, most notably disopyramide and amiodarone. If there is chronic atrial fibrillation, and given oral and anticoagulant therapy. In patients with refractory symptoms may be applied dvokomorski pacemaker. If, despite these procedures in the treatment of persistent symptoms and the pressure gradient at rest of more than 50 mmHg, then it is a surgical septal myotomy or myomectomy.

Chronic venous insufficiency

Chronic venous insufficiency is a result of recurrent deep vein thrombosis and thrombophlebitis so called postflebitički syndrome. Given that the increased pressure in the venous system of the most important disturbance in this disease, some authors is called chronic venous hypertension.

The clinical picture

In chronic venous insufficiency, as a result of repeated deep thrombophlebitis, leads to irreversible changes in the veins in the form of obstruction and destruction of the valves (flaps). Stationary blood passes through the perforating veins in the superficial veins. Due to increased pressure, in time to rupture of small superficial veins and subcutaneous hemorrhage, which can eventually turn into pigmented surface. Later occurs skin atrophy, edema, fibrosis, and lymph paths otvraju the venous ulcers that do not heal easily. Patients complain of pain, swelling and heaviness in the legs. The scope of the extremities is increased, small injuries do not heal the skin and present trophic skin changes.

Diagnosis

It is based on history, clinical presentation, examination, Doppler, pletismografije, phlebography.

Treatment

Treatment consists of wearing elastic stockings, leg lifting when possible, skin care and more carefully, if necessary, dermatological care. In severe cases, surgical treatment is recommended. To relieve the symptoms apply to medicines and flebotomičnim vazoprotektivnim effect. If there is a venous ulceration apply antiseptic and antibiotic solutions and tools that encourage sanation of wounds.

Chronic pulmonary heart

Chronic pulmonary heart (HPS) involves hypertrophy (enlargement), and / or dilation (expansion) of the right ventricle as a result of structural and functional lung disease and pulmonary vascular network.

Frequency

It occurs on average at about 10% of all cases of heart disease. HPS is 5 times more common in men than in women.

The cause of

All causative diseases that cause HPS are divided into three groups:

• Diseases that primarily damage lung airways and alveoli - chronic bronchitis, bronchial asthma, emphysema, pulmonary fibrosis, pulmonary granulomatosis, lung resection, congenital cystic lung hypoxia due to high altitude

• Diseases that damage the movements of the chest - kyphoscoliosis, torakoplastika, pleural fibrosis, polio, Pickwickian syndrome

• Diseases that damage the vascular network of primary lung - the primary damage to the arterial wall, primary pulmonary thrombosis, sickle cell anemia, embolism, pressure mediastinal tumors, aneurysms (enlargement) or fibrosis pulmonary arteries and veins.

In the development of HPS play a major role and many aggravating factors of environment (exposure to dust, gases nadražajnih inhalation, and exposure to high atmospheric temperature fluctuations), frequent respiratory infections and poor economic conditions of life. In particular there is a great importance of constant irritant effects of cigarette smoke in smokers.

The clinical picture

The clinical picture of HPS is a combination of the clinical picture of primary lung and images hypertrophy and right heart failure. Frequently suffer middle aged men, farmers, laborers in the harshest conditions, and, smokers in poor social conditions. In the long history of stress cough from 5 to 10 years or longer, with mucous expectoration of sputum scarce and sometimes purulent sputum. How to develop right heart failure patients by state and fatigue and suffocation in severe physical exertion, and with the further course of the daily efforts. In patients noticed redness conjunctiva (conjunctiva), red, moist and warm skin, with podbulošću face and eyeball protrusion of the patient gives frog appearance. The chest was barrel-shaped, breathing easily and rapidly frequent signs and central cyanosis (blue discoloration of tongue) and maljičasti fingers. Jugular veins are swollen and right heart failure izaraženijoj see the islands on their feet and signs of ascites (presence of fluid in the abdomen).

Diagnosis

It is based on history, physical examination, x-ray, ECG's, ehokardigrafije (ultrasound) and cardiac catheterization. In patients with hypoxia is polycythemia (increased number of blood cells), high hematocrit, slow sedimentation and increased levels of bicarbonate.

Treatment

The basic principle of treatment HPS consists of improving the function of the right heart, and timely treatment to improve lung function, improve arterial hypoxia and reduction of pulmonary hypertension. In order to apply this: the period of acute deterioration of right heart to give less concentration of oxygen and aminophylline. The pronounced right heart failure should be given diuretics, almost always given digitalis and to repair weakened contractile force of the right ventricle.Favorably effect and vasodilators nifedipine and hydralazine-. In severe cases it can be done venipuncture.

Prevention

Implemented early and vigorous treatment of lung infections. Compulsory vaccination against influenza. No smoking.

Mitral insufficiency

Mitral insufficiency is a heart defect caused by inadequate closure of the mitral opening through the mitral valve, which in return leads to systolic - regurgitation of blood into the left atrium.

The cause of

The most common causes are mitral regurgitation Mitral valve prolapse and papillary muscle dysfunction in the ischemic heart disease. Possible etiological factors are rheumatic fever, heart disease, left ventricular dilatation, mitral annular kalcfikacija, hereditary connective tissue defects, congenital anomalies, and hordes of rupture of papillary muscle, and others.

The clinical picture

This defect is usually well tolerated for years, after which it exhibits fatigue and varying degrees of dyspnea (shortness of breath). When a significant reduction in cardiac output, there is a distinct weakness, fatigue and exhaustion. Mitral insufficiency in coronary disease is manifested and typical pain in the chest or the onset of acute heart attacks. Symptoms of Mitral valve prolapse are often in the form of palpitations, atypical boova in the chest, dyspnea, fatigue and anxiety.

Diagnosis

It is based on history, clinical findings, objective findings (holosistolni type regurgitation murmur), radiography of the lungs and heart, ECG, echocardiography, cardiac catheterization.

Treatment

Treatment is surgical - rekunstrukcioni on mitral valve surgery in which this is possible or installation of mechanical

Heart failure

Heart failure (HF) is a condition in which abnormal cardiac function is responsible for the inability of the heart to pump blood to the extent that they meet tissue metabolism, or it is achieved with the increased pressure load cardiac cavities.

The cause of

There are many possible causes for SI: myocardial diseases - coronary heart disease, cardiomyopathy, myocarditis, infiltrative myocardial disease, hypertension, aortic stenosis and pulmonary valve, aortic and mitral insufficiency, congenital heart defects, tireotoksokoza, anemia, pregnancy, beri-beri, then damage infarction drugs, ionizing radiation. As precipitating factors are: infection, anemia, pulmonary embolism, pregnancy, thyrotoxicosis, myocardial infarction, infective endocarditis, stress, increased salt intake.

Forms of heart failure

Most often encountered:

• SI with low and high volume minutnum

• Acute and chronic NE

• Failure of the left and right heart

• NE-type congestion and hypoperfusion

• Systolic and diastolic heart failure

The clinical picture

Dyspnea (breathing disorder) is definitely the first and foremost sign of SI, and occurs as a result of increased respiratory effort. In the initial phase occurs only during exercise, but later becomes present at rest.

Ortopnea - dyspnea in the supine position, caused by crossing the fluid from the abdomen and lower chest in ekstermiteta. Patients noted that in the course of the night, trying to sleep on a low pillow, with a feeling of being short of breath, coughing and shortness of breath.

Paroxysmal nocturnal dyspnea - short attacks of breathing and coughing that occur at night, be patient from sleep. While the sheer ortopnea lost when the patient sits down with his feet, in this case, coughing and wheezing persist in this position.

Acute pulmonary edema - a patient has severe dyspnea so that there is a sense of imminent threat to life and suffocation, anxious is abundant sweat, cough and sputum and blood-stained.The frothy sputum, and playing with audible rales in the chest.

Fatigue, weakness, reduced effort tolerance are common symptoms of SI. Also, there are anorexia, nausea, vomiting, dull pain in the liver. In elderly patients due to poor blood supply of the brain caused confusion, reduced concentration, memory, headache, insomnia. Contribute to insomnia and frequent nighttime urination.

Cardiac islands - around the ankles and lower legs, most pronounced in the evening, doughy, formed under the influence of gravity.

The liver is enlarged, painful, later becoming firmer, ascites (accumulation of fluid in the abdomen), jaundice caused by liver damage.

There may be other signs: pale, cold and damp ekstermiteti, decreased urination, low concentration of sodium in the urine, a positive albumin in the urine.

Diagnosis

It is based on history, physical examination, x-ray of the heart and lungs, ultrasound.

Treatment

The problem is the treatment of HF in the fact that a single rule for the treatment of these patients is not formulated because of varying etiology, hemodynamic images, clinical manifestations and severity of NE. The first measure is certainly decreased physical activity and reduce salt intake. If this is not enough, it begins drug therapy combination of diuretics, ACE inhibitors, and digitalis. The next step is a rigorous salt restriction and use of diuretics stronger. If no effect is applied the hospitalization, strict restrictions salts, intravenous vasodilators, positive inotropic agents, and others.