Cardiac arrest

Cardiac arrest means the absence of contraction or inappropriate contraction of heart chambers immediately lead to the cessation of circulation of blood.

The cause of

A large number of causes that lead to cardiac arrest, primarily to the ventricular fibrillation, bradyarrhythmia, asystole, ischemic heart disease, left ventricular hypertrophy, mikarditisi, insufincijencija heart, conduction system disease, and others.

The clinical picture

Cardiac arrest is characterized by sudden loss of consciousness due to cessation of cerebral circulation.Cessation of respiration always follows the cessation of circulation and are usually recorded several deep respirations before the cessation of breathing. There is cyanosis (pomodrelost) A deepening. Pulse can not be felt beyond the pupil and after 1 minute the part, and after 2 minutes fully dilated. Time of termination of the circulation to vital functions are preserved at the level of cells known as clinical death. After 4 to 6 minutes caused irreversible brain damage and biological death.

Diagnosis

The patient was pulseless over large blood vessels, no heartbeat and no pressure, skin color is pale or cijanotična, respiratory movements are absent. The mechanism of cardiac arrest (ventricular fibrillation, asystole or bradyarrhythmia, elektromehaniča dissociation) can not be distinguished without ECG registration. All patients who survived cardiac arrest should be careful clinical examination, which, in addition to medical history and physical examination, including a 24-hour ECG test, the test load may exertion, ultrasound and coronary angiography.

Treatment

Should immediately start cardiopulmonary resuscitation. CPR is performed by blowing air exhaled by the resuscitator mouth to mouth or mouth to nose. Lips patients are cleared of foreign content, they are placed over tissue or something like that. Reanimator is with the patient, one hand underline under the door (and slightly below), neck lifts patient's head spontaneously falls back below the vertex towards the back. Use your thumb and index finger close nostrils second hand, palm of the same hand pressure head and pushes her head down as much as possible and back to the chin take the top position. A deep breath, put a mouth to mouth, and the patient blows air making sure that the coverage of your lips lips covered volume of patients, because it avoids the loss of air. Then reanimator frees patients mouth to allow air to uduvani out spontaneously. The first ten blowing out quickly and repeatedly and then proceed to blow straight to the rhythm of normal breathing (12 - 14 min). Checking blowing performance is evaluated emergence of synchronous movement of the chest.

External heart massage should be started as soon as you stop or severely weakened heart. It is performed by a steady, strong pressure in the connection area of ​​the upper two thirds and lower third of the sternum (breastbone). The suppression of the sternum to the spine from 3.5 to 5 cm is transferred to the heart. The person who helps raise the patient's legs Reanimator to move more blood to the heart and brain. About 2 cm above the end of the breastbone to place the root of the palm of one hand over the other hand its roots. The arms are extended at the elbows and shoulders above the sternum, so as the body weight is transferred to the resuscitator of his hand, it would be more efficient compression of the heart. Fingers placed his hands are not touching the chest. Hands are not separate areas of the sternum following compressions. Rhythm is 80-100 compressions per minute, and after every fifth compression is done once blow air at which point the compression is not performed. If resuscitation performed by two people, with the same rhythm of heart compression performed two uzastpona blowing every 15 compressions. Checking the performance is done after one minute of CPR. Signs of success CPR: palpated the pulse of the arteries in the neck or legs, dilated pupils are maximum (extended), improves your skin color, muscle tone occurs, the chest spontaneously and rhythmically driven.

Pulmonary artery stenosis

Pulmonary artery stenosis is an obstruction at the level of the right ventricular outflow tract and is relatively common congenital cardiac malformations. Narrowing be localized on the biota subvalvulnom level, at the level of the pulmonary artery and valve supravalvulno, and may represent a more localized combinations. Valve disease pulmonary stenosis is the most common form of isolated outflow tract obstruction of the right ventricle.

The cause of

Congenital heart defects occur in a complex interaction of genetic factors and environmental factors. It is rare to find the cause of congenital cardiac malformations such as, for example, maternal rubella or chronically excessive abuse of alcohol in the mother during embryogenesis. Various factors such as hypoxia, ionizing radiation, certain drugs have teratogenic effects. The risk of congenital heart defects in children of parents with congenital heart malformation is low, 2-5%, and would not need to be an obstacle in the planning of the offspring.

The clinical picture

Symptoms depend on the degree of narrowing of the pulmonary artery valve. Patients with mild stenosis usually have no symptoms and the disease usually does not show significant progress in the course of life, and reveal the findings of the noise survey. More severe stenosis prevents a corresponding increase in cardiac output during physical exertion and coming soon to the expression of fatigue, dyspnea (shortness of breath) and may lead to the occurrence of syncope (transient loss of consciousness). There may be opening up communication between the right atrium and left atrium at the level of the foramen ovale, which is the only significant part of the population is functionally closed, but not anatomically obliterisan. With the transition neoksigenisane blood from the right to the left prekomoru, and then the systemic circulation and leads to cyanosis (bruised). Like all cyanogen heart defects, and this slows down growth and increased body weight and height of the child. Greater sensitivity to the boys showed cyanosis.

Diagnosis

It is based on clinical presentation, physical examination (systolic ejection murmur), ECG, x-ray, ultrasound, cardiac catheterization and angiography.

Treatment

Surgical treatment associated with relatively small risk. Recently, more and more valve stenosis, pulmonary artery resolved without surgical intervention, cardiac catheterization laboratories, using a balloon catheter and performing balloon - catheterization.

Subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space, which usually occurs due to rupture of the aneurysm.

The cause of

Aneurysms are localized enlargement of the arteries. They may be congenital or may develop on the basis of congenital defect intima and media of the vessel, and then the ball - globular or spindle - fusiform. They are often localized to Wilisovom hexagonal and often there are more in the same person.Acquired aneurysms, whether on the basis of arteriosclerosis, diffuse are.

SAH may arise from arteriovenous malformations. Usually it comes tuft enhanced arterial and venous vessels with arterial input and output, venous vessels. By SAH can lead to the rupture of blood vessels wall defect without aneurysm. Blood will flow in suarahnoidni space at different speeds, depending on the size of the vessel that was ruptured but once the blood stream can damage the brain tissue.

The clinical picture

History is typical - Sudden head pain (like a punch), usually in the back of the head with the expansion of the neck, and sometimes down the spinal column to the lumbar regions and the frontal part of the head.Due to the rapid increase in speed occurs nausea, vomiting and disturbance of consciousness up to coma.

Because stimulus meninges meningeal signs appear, but they can sometimes be poorly expressed or absent. In case of damage to brain tissue can be found focal signs (hemiparesis half-body paralysis, seizures).

A very important finding is bradycardia (slow heart rate), which can be 40-50 beats per minute, and can serve as an indirect indicator of the size of the intracranial pressure.

The presence of blood in the subarachnoid space usually leads to vasospasm, which began to develop 3 - 4 days after bleeding, and lasts about three weeks. This serious complication of SAH leads to further, often diffuse brain damage becomes apparent reduction in the level of consciousness, mutism, or focal signs.

Prognosis depends on the severity of bleeding, the development and severity of vasospasm. Better prognosis in the absence of SAH aneurysm or AV malformation or with negative angiographic findings.Mortality is high, and recurrences are common, especially in the first six months.

Diagnosis

It is based on clinical findings, lumbar puncture, fundus findings, angiography, CT (scan).

Treatment

Conservative treatment consists of rest in the strictest (the patient may not even get up for their physiological needs). By all means necessary to prevent unrest (neuroleptics, benzodiazepines) and seizures (phenobarbital sodium, diazepam, parenterally), since they can cause new bleeding. Blood pressure control is also very important measure of compensation and 2-3 liters of fluid per day. Since arrhythmias are very common and neurogenic pulmonary edema can occur very early cardiopulmonary monitoring is necessary. Sometimes it is useful careful lumbar puncture and hipervolemic hemodilution using dextran. Hyperosmolar solutions can reduce brain edema and reduce inrakranijalni pressure.

It is very important issue when it comes to surgical intervention, and in which patients. The general agreement is that it can intervene before the development of vasospasm, ie. the first three days, in patients who are not in a coma. The others should wait for the withdrawal of vasospasm before the start artériographie studies and planning intervention, which is usually about three weeks.

Mitral stenosis

Mitral stenosis is a narrowing of the mitral defect caused the hole (the opening between the left atrium and ventricular) which lead to difficulty in emptying the left atrium into the left ventricle.

The cause of

Rheumatic endocarditis is almost exclusive cause of mitral stenosis, mitral stenosis is extremely rare congenital malformation is the result of the mitral valve.

The clinical picture

Patients with moderate to tolerate any effort. Only the presence of precipitating factors (fever, greater effort, anemia, atrial fibrillation, pregnancy) leads to shortness of breath - dyspnea and cough. In moderate forms and less effort leads to these symptoms manifest themselves in severe and at rest. At an advanced stage dominated by fatigue, which increases due to right heart decompensation, with the advent of liver enlargement and edema prifernih - island. The emergence of palpitations - a racing heart caused by frequent atrial arrhythmias and atrial fibrillation later. Cause arrhythmias and emboli in the systemic circulation (brain, limbs, abdominal organs). Less commonly, symptoms appear in the form of angina pectoris, pulmonary embolism or hoarseness. When examining the dominant means of peripheral cyanosis (blue fingers, ears, nose) with cheeks flushed cheeks giving a typical picture-"facies mitralis". Jugular veins are swollen due to right heart decompensation.

Complications

Possible complications of acute pulmonary edema, atrial fibrillation, systemic embolism, bacterial endocarditis, lung damage.

Diagnosis

It is based on history, physical examination, physical findings (highlighted first tone, audible otvartanje mitral valve, noise), x-ray of the heart and lungs (configured mitral heart), ECG, fonokardiografije, ultrasound, cardiac catheterization.

Treatment

Medical treatment consists of prevention of rheumatic fever and infective endocarditis. In pulmonary congestion given diuretics, the restriction of salt intake. In the case of atrial fibrillation should be given digitalisne preparations, verapamil or beta blockers. The appearance of embolism requires anticoagulation. Medical treatment can reduce stenosis and surgical treatment is applied - different ways of expanding narrowed mitral opening or installing artificial valve.

Tetralogy of Fallot

Tetralogy of Fallot is the most common congenital heart defect cijanozna and represents 10% of all congenital anomalies. Means the combination of: 1) the defect međukomorske compartments, 2) riding aorta, which is an opening above the defect to receive blood from both chambers, 3) pulmonary stenosis (obstruction of the outflow tract of the right ventricle), and 4) right ventricular hypertrophy.

The clinical picture

Systemic hypoxemia (low oxygen levels) is the cause of most of the symptoms and signs in children and adults. Children lag behind in growth. During physical activity appear dyspnea (disturbed, shortness of breath), and dizziness, and relief appearances at zauuimanju characteristic position - squatting. Although there are forms of tetralogy acijanotični (pale Fallot), which can be found in adults, the majority of patients with this defect is characterized by cyanosis (blue discoloration) with maljičastim fingers and polycythemia (increased number of cells in the blood). Cyanosis can be of varying intensity. Attacks worsening cyanosis occur due to increased tone of excitement in the infundibulum (fear, crying) or taking drugs that increase myocardial contractility. Anoksemične crisis (crisis without oxygen) with sudden weakness, loss of consciousness, seizures, and even death, attributed to spasm - the deterioration of infundibular stenosis. Not seen in adults and in children are a sign of serious defects and indications for prompt surgical correction. Natural history of conservatively treated patients is poor.Frequent kompikacije such as heart attack and brain abscess, and the risk of infective endocarditis is great. Heart failure and arrhythmias are the most common causes of death in most patients until 30 appearances year.

Diagnosis

It is based on clinical presentation, examination, ECG, X-ray, ultrasound and cardiac catheterization.

Treatment

Cijanotički paroxysmal attacks is urgently treated by placing the child in the position with the knees to the chest, giving oxygen and opiates. With prolonged anoxic attacks should be included infusion and acidosis corrected bicarbonate. Once the required general anesthesia or giving beta blockers to stop the attack.

Surgical treatment is indicated in all patients. The ideal is a total correction of defects in the first years of life, which consists in closing the defect međukomorske barriers and reducing obstructions in the outlet of the right ventricle. Most operated almost normal lives, but some occur arrhythmias and sudden death.

Thrombophlebitis migrans

Migrans thrombophlebitis (phlebitis saltans) is a rare form of recurrent superficial thrombophlebitis, which can affect large and small veins throughout the body, and is often associated with other diseases.

The cause of

It is believed that this is allergy - hiperergijskoj vascular response to a variety of factors, eg. to local bacterial infection, tumor antigens, and the like. The disease is quite common in patients with cancer of the pancreas, lung and prostate cancer, leukemia, gout, lymphoma and trombangitis obliterans - a.

The clinical picture

Parts are usually thrombosed superficial veins in the legs, abdominal wall, thighs and arms, mostly in younger and middle godnina. Thrombosed veins and inflammatory part of the indurisan (hardened), and as a hardening and palpated as a pen or a rope, which is painful, and the skin over the vein edematous (swollen) and erythematous (red). With disease relapse and involvement of one hour, then the other veins, can last for months or years. The veins of the internal organs (spleen, mesentery) may also be affected, but it does not occur embolism.

Diagnosis

It is based on history, clinical, dermatological examination.

Treatment

Treatment is carried out Tylenol, the eventual systemic corticosteroids. Locally applied heparin and heparinoidni preparations. It is necessary to treat the local infection with antibiotics and stop smoking.

Raynaud's Syndrome

Raynaud's syndrome, intermittent episodic occurrence mutual pale and blue fingers, legs less often, because of occlusion (closing) digital arteries (arteries in the fingers) precipitated by cold or emotional stress, undergoing warming.

The cause of

It can be divided into primary or idiopathic, or secondary. Diseases related secondary Raynaud's syndrome are collagenosis (systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, Sjogren's anchor, diabetes mellitus), and other vascular disease, obstructive disease of the arteries (arteriosclerosis, thrombosis, Morbus Buerger), poisoning (ergotaminski alkaloids, vinyl chloride, cytotoxic drugs, heavy metals), neurological and neoplastic processes, and heating professional or injury (frostbite injuries, vibration syndrome).

The clinical picture

Raynaud's syndrome affects between 3 and 5 million people worldwide, mostly women. It is characterized by local paleness, cyanosis, pain, a burning sensation or loss of sensation to the skin, swelling, and in extreme cases can result in unpleasant ulcers (ulcers) in the skin.

Diagnosis

It is based on history, clinical examination and confirmed by capillary microscopy nail beds (see the loss, and tortuosity of capillaries and venules extension).

Treatment

General measures include advice to avoid the cold, tobacco, excitement, physical exertion.Symptomatic treatment includes the use of vasodilatory drugs. Surgical treatment can lead to transient blood flow to the fingers. Infected ulcers should be treated with antibiotics.