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.

Inflammatory diseases of the heart - myocarditis, pericarditis, endocarditis

Myocarditis 

The heart consists of three layers: the endocardium (inner), myocardium (middle, muscular) and epicardium (outer).

Myocarditis is inflammation of the myocardium (middle layer of the heart wall). When this happens, the pump function of the heart becomes weak, because of swelling and damage to muscle cells. This damage can be caused by viruses, toxins, or occurs as an autoimmune process (immune cells to destroy your own heart cells).During viral infection, destruction and adverse remodeling of the heart can lead to permanent dysfunction of Commerce and the so-called. dilated cardiomyopathy.

Clinical picture can be different from asympthomatic to severe heart failure requiring heart transplantation, so that if myocarditis in the asymptomatic form, is equivocal for the diagnosis and timely treatment. Disease has many causes, and sometimes it happens that in case of sudden death does not reveal the culprit.

4-14 days after viral infection results in the formation of cells of the immune response of the organism. These cells attacking viruses, destroying myocardial cells (myocytes) in which the viruses are. Inadequate immune response may lead to a further multiplication of the virus and chronic destruction of heart cells, leading to dilated cardiomyopathy and heart failure.

Discovered the presence of so-called. antimiozinska autoantibodies, long after viral infection, which continues to destroy the myocytes and their presence indicates a poorer clinical prognosis. Over time, areas of necrosis of creating connective tissue. If a large myocardial involvement, there is a remodeling of cardiac cavities and their increase, leading to heart failure.

Focal inflammation which affects the conduction system can cause fatal heart arrhythmias that cause sudden death.

Sometimes myocarditis can give a picture of a heart attack.

Often occurs with myocarditis and pericarditis.

WHAT ARE THE CAUSES Myocarditis?

Infectious agents:

· Viruses: enteroviruses (Coxackie B) in> 50% of cases, adenoviruses, parvovirus B19, human herpes virus 6, influenza virus, echovirus, herpes simplex virus, varicella-zoster virus, hepatitis, Epstein-Barr virus and cytomegalovirus

· Bekterije: bekterije diphtheria, streptococcus, staphylococcus, brucella, salmonella, bacteria, Lyme disease carried by ticks

· Parasites: trichina, toxoplasmosis

Toxic causes:

· Some drugs can cause a hypersensitive reaction: clozapine, penicillin, ampicillin, hydrochlorothiazide, methyldopa, and sulfonamides

· Other drugs can destroy the heart cells: lithium, doxorubicin, cocaine, catecholamines, acetaminophen

· Toxins: lead, arsenic, carbon monoxide

· Toxins of some spiders, scorpions, wasps

· Air Therapy

Immune diseases:

· Systemic lupus, reumatoid arthritis, dermatomyositis, scleroderma, sarcoidosis, giant cell arteritis.

WHAT ARE THE SYMPTOMS Myocarditis?

Most patients have nonspecific symptoms such as fatigue, shortness of breath easily, and muscle aches. If challenged Coxackie B virus usually occur first stomach problems (diarrhea and abdominal cramps). When adenoviruses can occur sore throat, aching muscles and joints.

· A small number of patients have rapid and malignant course of disease with symptoms of heart failure.

· In about 20% of cases present fever.

· Heart pounding and skipping are present due to cardiac arrhythmias. Syncope (fainting) can occur if there are more difficult forms of arrhythmia or atrioventricular block. They are dangerous because they are a sign of poor prognosis, ie. risk of sudden cardiac death.

· One third of patients have chest pain. They describe them as a sharp stabbing chest, because it is often present, and pericarditis (inflammation of the pericardial sac). Pain may also occur below the breastbone in the projection of the stomach, which can mimic the pain of a heart attack.

· Difficulty breathing in effort is often present.

· Choking in the supine position is present if there is heart failure. The patient may fall and cardiogenic shock.

· In some patients the disease becomes chronic, and manifest only later with the expansion of cardiac cavities and the development of dilated cardiomyopathy.

HOW Myocarditis is diagnosed?

· Laboratory tests: troponin (elevated in one third of cases), leukocytes (raised in a quarter of cases), sedimentation (may be high), tients antibodies are sometimes found in immune-mediated myocarditis.

· X-ray of the heart and lungs: usually a normal cardiac silhouette, except when there is pericarditis or delay in the lungs due to heart failure. Sometimes there is a pericardial effusion in a handkerchief.

· Echocardiography: reduction of systolic and diastolic left ventricular function, regional or diffuse reduction in wall motion of the heart, possibly the presence of fluid in the pericardial cavity and sometimes the presence of thrombus in the left ventricle.

· MRI: a visible inflammation of areas of tissue.

· ECG: can be found sinus tachycardia, changes in ST segment, QRS complex, arrhythmias (SVES, VES), heart blocks.

· Isolation of virus from the blood.

· Sometimes it is necessary to do cardiac catheterization and endomyocardial biopsy (a catheter is accessed through the veins to the heart and takes a sample of heart tissue that is sent to the histopathological laboratory).

Pericarditis

Pericarditis is an inflammatory process that involves swelling and irritation of the pericardium, heart tissues.Pericardium has two layers, unutašnji which is attached to the heart muscle that surrounds the outer roots of the major blood vessels of the heart and through the ligament (connection) attaches the heart to surrounding organs: spinal column, diaphragm and other neighboring parts of the body. Between these two layers of pericardium is about 50 ml of fluid, an ultrafiltrate of blood plasma, and facilitates the movement of the heart.This liquid is drained through the lymphatic vessel in his right lung tissue.

Pericardium has three functions. The first is a mechanical function, prevents sudden dilation (expansion) of the heart, maintain a normal extension of commerce, forming an enclosed space with subatmosferskim atrial pressure, which helps fill with blood. Second, it protects the heart from external friction and prevent the spread of infection and malignancy of the heart. Thirdly, through its relationship with surrounding organs, pericardium fixed heart.

What happens in the pericardium?

During inflammation of the pericardium leads to accumulation of leukocytes. Often occurs and accumulation of fluid between two layers of the pericardium, the so-called. perikardnoj bag, which puts pressure on the heart and hinders its function. It can lead to creation of adhesions between the pericardium and the adjacent organs.

Pericarditis can be acute (lasting about 3 weeks) or chronic (lasting 6 months or longer).

WHAT CAUSES Pericarditis?

viruses, especially coxackie B and echovirus, adenoviruses, herpes viruses, citomegalivirus, influenza virus

bacteria: streptococci, staphylococci, pneumococci, Proteus, Escherichia coli, Pseudomonas

causative agent of Lyme disease (transmitted by ticks)

tuberculosis

inflammatory disorders, the so-called systemic diseases (arthritis-reumatoid common pericardial effusion, systemic lupus erythematosus, scleroderma (also with pleural effusion or constrictive pericarditis), rheumatic fever, sarcoidosis, etc.).

metabolic disorders (renal failure, reduced thyroid function, cholesterol pericarditis due to the high-cholesterol), low albumin levels.

after a heart attack affecting the entire wall of the heart, pericarditis usually occurs the second or third day. Is due to irritation of the pericardium partially damaged heart muscle.

aortic dissection

thoracic injuries

surgical procedure

Tumors

drugs (penicillin, doxorubicin, cyclophosphymid, procainamide, methyldopa, hydralazine, reserpine. Pericarditis caused by hypersensitivity reactions to the drug.

Valika radiotherapy doses of over 4000.

RECURRENT (RETURN) Pericarditis

It is the repetition of acute pericarditis. It can occur with or without accumulation of fluid (effusion) in perikardnoj bag and sometimes is associated with accumulation of fluid in the pulmonary tissue or changes in lung tissue. The reason for repeating pericarditis is not entirely clear, but it is assumed that it generates an autoimmune process. Responds well to nonsteroidal anti-inflammatory drugs and kortikosteride.

What are the symptoms Pericarditis?

Chest pain is the main symptom.

It can be: sharp, dull, or burning in the form of pressure in the chest.

intensity varies from very mild to severe

Pain occurs in the chest, could be disseminated in the left shoulder and back, increases when lying down, coughing and breathing air, a decrease in the sitting and leaning the body forward.

shortness of breath is often associated with pericardial tamponade (rapid accumulation of fluid in the sac perikardnoj)

fever may be present

weakness, fatigue

Island leg or stomach pain

HOW Pericarditis is diagnosed?

LABORATORY FINDINGS: acute pericarditis often elevated leukocyte count, C-reactive pritein, check the level of creatinine to assess renal function, do the analysis of cardiac enzymes to differentiate myocardial infarction, viral batteries; proteins in the blood, then testing in suspected tuberculosis; antistreptolizinski titer, rheumatoid factor, antinuclear antibodies, assessment of thyroid function.

ECG

X-ray of the heart and lungs: it shows an enlarged cardiac silhouette, if you have accumulated a lot of fluid in the pericardium. If there is a small amount of effusion, X-ray was normal.

ECHOCARDIOGRAPHY: shows the movement of cardiac walls, the size of cardiac cavities and the amount of fluid in the pericardial cavity.

CT

MRI

Pericarditis How is it treated?

inaction

used drugs that reduce inflammation and swelling and pain: nonsteroidal antiinflammatory drugs (Brufen), and if you need some stronger medication for pain.

Corticosteroids can be given if the disease does not respond to anti-rheumatic drugs, or if repeated often.

if it is a bacterial infection treated with antibiotics, and sometimes we need to give:

pericardiocentesis: puncture of the pericardium and fluid evacuation. There is a pericardial catheter drainage bag is gradual fluid from it.

Sometimes the therapy is resection of the pericardium, cut part of the pericardium

pericardiectomy is a surgical procedure in which the outer layer resecira pericardium. Performed with pericarditis konstriktivnog disruptive normal heart work.

What are the complications Pericarditis?

Constrictive pericarditis - inflammation of the pericardium after long and repeated chronic disease, pericardial thickening occurs, it creates scar tissue that SKVRCE, it is often the turbidity settle down calcium and to put pressure on the heart. The heart is the "shield" that prevents the normal spreading and taking blood from the venous system. Because we have a weakness of the right ventricle, there are islands on the feet, liver and spleen enlargement, fluid in the abdominal cavity. Later there is a weakness of the liver, blood in the veins stop the door, poured in the pulmonary maramici.Vremenom occurs and the weakness of the left heart, stagnation of blood in the lungs, decreased blood flow to internal organs, coldness in hands and feet, loss of consciousness due to decreased blood to the brain, fatigue and fatigue.

CAUSES: In addition to chronic pericarditis, causes include: tuberculosis, radiation therapy, uremia (due to renal failure), tumors after surgical interventions on the heart, and may be of unknown cause called.idiopathic.

TREATMENT: pericardiectomy, or surgical removal of the pericardium.

Pericardial tamponade - occurs when fluid accumulates rapidly in perikardnoj bag and then put pressure on the heart, thus preventing it from filling with blood. This means that less blood is pumped from the heart. The amount of pericardial fluid that is needed to reduce the filling pressure depends on the speed of accumulation of fluid and the elasticity of the pericardium. If fluid accumulates rapidly, a small amount of liquid such as 150 ml can cause a sudden pressure port in the pericardial cavity and significantly reduce the amount of blood that is pumped from the heart, causing a dramatic drop in blood pressure. If left untreated, ends fatally. If fluid accumulates slowly, 1000 ml of fluid will not significantly affect the amount of blood that takes chamber during diastole (expansion). This is due to the gradual spread of the pericardium.

SYMPTOMS: labored and rapid breathing, rapid heartbeat, and some people can appear cold extremities due to decreased blood flow. Other symptoms depend on the reasons that caused the tamponade.

CAUSES:

· Systemic malignant disease (weakness, fatigue, weight loss)

· Pericarditis-viral, bacterial, tuberculous, fungal (chest pain)

· Heart attack (chest pain)

· Anticoagulant therapy

· Diseases of connective tissue (muscle, bones and joints)

· Renal failure

· Recent heart surgery or intervention in coronary vessels

· Chest injury

· Recent implantation of a pacemaker or central venous catheter

· Aortic dissection (separation of the walls of the aorta)

· HIV

· Thoracic radiation therapy for malignant disease of the lungs or esophagus

· Tuberculosis

TREATMENT: cardiac tamponade is a medical emergency in medicine. The patient is hospitalized and monitored in intensive care.

The patient receives oxygen

infusions to compensate for the volume of fluid in blood vessels

drugs that enhance the strength of cardiac contraction (spasm)

it is urgent pericardiocentesis to drain fluid in the pericardium

in patients who have recurrence perkiarditisa Makes a pericardial-pleural shunt, ie the link between cardiac and pulmonary tissues to fluid in the pericardial sac drainaging lung tissue.

sometimes it is resection of the pericardium, ie removal of bags to prevent cardiac tamponade pericardium.

Endocarditis

Endocarditis is an infection of the inner layer of the heart called. endocardium.

Endocarditis occurs when bacteria or other germs spreading through the bloodstream from one place in the body, such as. mouth, heart attack damaged parts. If left untreated, can damage or destroy heart valves and lead to life-threatening complications.

Endocarditis is rare in people with healthy hearts. In people who have damaged heart valves, artificial valves or other cardiac defects, there is an increased risk of developing endocarditis.

What are the symptoms Endocarditis?

Endocarditis may develop gradually or abruptly, depending on what is causing the infection and whether there is a heart defect.

The symptoms are:

fever

chills

fatigue

muscle and joint pain

night znojenjene

lack of air

cough

Islands of legs and abdomen

sudden weight loss

pain under left rib cage

Osler nodes-tiny red dots under the skin sore fingertips

petechiae-point bleeding under the skin, mucous membranes in the mouth and whites of the eye

embolism (parts of damaged tissue to detach and move through the bloodstream, and clog an artery of the) brain and neurological deficit occurs, the eye - vision loss, signs of systemic septic embolism (eg, pulmonary infection if endokaridits right in the heart)

Sometimes the appearance of blood in the urine.

Of these characters may appear only a few, perhaps only two.

WHAT ARE THE CAUSES Endocarditis?

Bacteria are the most common causes of endocarditis, but it may be a fungus and other microorganisms.

Sometimes the culprit is one of the many bacteria that live in your mouth, throat or other parts of the body. In other cases, bacteria can enter the body during tooth brushing, chewing food, especially if the teeth and gums are in poor condition. The causative agent can be spread from sites of infection, eg. wounds on the skin, inflammatory bowel disease, from entering the body through sexual contact etc.. It also increased the possibility of bacteria entering the body through a needle in drug users, tattooing, body-piersing a following by people who have a catheter in the bladder, in patients with implanted pacemaker. Some dental procedures can damage the gums allow bacteria to enter the bloodstream.

Your immune system destroys the bacteria that enter the bloodstream. Even if they reach the heart, must not cause an infection.

Most people who develop endocarditis have a damaged heart valves. Endocardium is rugged making it an ideal place for the establishment and growth of bacteria.

WHO HAS increased risk of Endocarditis?

People with artificial heart valves. The risk of endocarditis is increased in the first year after valve implantation.

People with congenital heart disease.

Individuals who have had endocarditis. Previous endocarditis damaged heart tissue or valves, and a suitable place for the redevelopment of endocarditis.

People with damaged heart valves, rheumatic fever or infection can damage heart valves to make them suitable terrain for the development of endocarditis.

Injecting drug users

People with heart transplant who have problems with heart valves.

How is it diagnosed

Work by biochemical analysis of blood

is the identification of pathogens from the blood in order to include the appropriate antibiotic to which the germ-sensitive

ECG

echocardiography

X-ray of the heart and lungs

heart catheterization

CT or MRI of the brain, lungs, abdomen and others. if there is suspected spread of infection to other organs.

What is the treatment Endocarditis?

· These patients are hospitalized and begins to empirical antibiotic therapy.

· Gives the oxygen

· Provide the drugs for heart failure

· When the situation improves, assesses the need for surgical treatment.

Endocarditis Prophylaxis

Is required for all persons with an increased risk before one of the following medical interventions:

dental procedures

medical interventions for which there is damage to the lining of the airways

procedures on infected skin and musculo-skeletal tissue

prophylaxis is not required for gynecological and urological procedures and interventions in the digestive tract.

Since antibiotics before dental procedures or interventions on airway mucosa taken:

Oral Amoxicillin 2 g, 30-60 min before procedure

Allergy to penicillin is taken: 2g Cephalexin or Clindamycin 600mg Azithromycin or Clarithromycin 500 mg or 500 mg 30-60 minutes before procedure

If people can not take oral medication is given: Ceftriaxon 1g of muscle or vein

Allergy to penicillin is given: Ceftriaxon 1g into a muscle or vein or Clindamycin 600 mg in a muscle or vein.

What are the complications Endocarditis?

Infarcts of other organs and tissues: heart, brain, spleen, intestine, kidney, extremities. They are formed by joining the masses of bacteria and cell fragments of the affected valve (the vegetation) and reach the bloodstream to other organs and tissues and deplete them

Infections of other parts of the body: abscesses caused the brain, heart, lung, kidney, spleen, liver, heart (arrhythmia occurs)

Pericarditis

Heart failure due to valvular damage functions

Kidney failure

If left untreated leads to death.

Prognosis

Increased mortality occurs in older individuals, then if the infection has affected the aortic valve, if there was a development of heart failure, complications of the brain, and if a person suffers from other serious diseases such as diabetes.

Mortality depends on the cause of endocarditis and appears to be greatest in Staphylococcus aureus.

Mortality was higher in patients with prosthetic heart valves. More than 50% of infection occurs within 2 months after valve surgery.

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