- •Ministry of Public Health of Ukraine
- •Basic Symptoms and Syndromes in Diseases of Cardiovascular System.
- •Syndrome of cardiovascular failure
- •Etiology
- •Classification of heart failure
- •Classification of heart failure according n.D. Strazhesko and V.H. Vasilenko
- •Classification of heart failure according to New York Heart Association New York Heart Association Functional Classification (nyha)
- •Clinical features
- •Additional methods of examination
- •Acute heart failure Acute left ventricular failure
- •Cardiac asthma
- •Pulmonary edema
- •Additional methods of examination
- •Acute left atrial heart failure
- •Acute right ventricular heart failure
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Chronic heart failure Chronic left ventricular heart failure
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Chronic left atrial heart failure
- •Chronic right ventricular heart failure Etiology
- •Clinical features
- •Additional methods of examination
- •Syndrome of vascular failure
- •Syndrome of a syncope
- •Clinical features
- •Syndrome of collapse
- •Etiology
- •Clinical features
- •Syndrome of shock
- •Classification according to etiology
- •Clinical features
- •Additional methods of examination
- •Literature
- •Acute rheumatic fever
- •Etiology
- •Pathogenesis
- •Classification
- •The Jones Criteria for Rheumatic Fever, Updated 1992
- •Clinical features
- •Additional methods of examination
- •Literature
- •Contents heart valvular diseases
- •Mitral regurgitation
- •Etiology
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Mitral stenosis
- •Etiology
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Literature
- •Contents aortic stenosis
- •Etiology:
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Aortic regurgitation
- •Etiology
- •Disorders of hemodynamics
- •Clinical features
- •Additional methods of examination
- •Literature
- •Syndrome of the arterial hypertension
- •2. Endocrine hypertension:
- •3. Hemodynamic hypertension:
- •4. Neurogenic hypertension:
- •Clinical features
- •Essential hypertension
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Literature
- •Ischemic heart disease
- •Etiology and pathogenesis
- •Classification of ischemic heart disease (ihd)
- •Stable angina
- •Clinical features
- •Canadian Cardiovascular Society classification of stable angina
- •Additional methods of examination
- •Acute coronary syndrome
- •Clinical features
- •Additional methods of examination
- •Unstable angina
- •Braunwald classification system for unstable angina (ua)
- •Intensity of treatment
- •Myocardial infarction
- •Clinical features
- •Additional methods of examination
- •Optimal time for estimation of myocardial markers of necrosis
- •Dynamic of laboratory markers of myocardial infarction
- •Sudden cardiac death
- •Clinical features
- •Literature
- •Chronic obstructive pulmonary disease (copd)
- •Classification of Chronic Obstructive Pulmonary Disease by Severity
- •Clinical features
- •Additional methods of examination
- •Chronic bronchitis Chronic bronchitis is chronic inflammation of the bronchi and bronchioles. Etiology
- •Pathogenesis. On chronic bronchitis occurs development of classic pathogenetic triad:
- •Clinical features
- •Additional methods of examination
- •Bronchial asthma
- •Etiology
- •Classification
- •Clinical features
- •Additional methods of examination
- •Syndrome of bronchium obstruction (bronchospastic syndrome)
- •Additional methods of examination
- •Syndrome of increased airiness of the pulmonary tissue
- •Additional methods of examination
- •Bronchiectasis
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Literature
- •Pneumonia
- •Classification
- •Acute lobar pneumonia
- •Additional methods of examination
- •Bronchopneumonia (focal pneumonia)
- •Clinical features
- •Tumors of the lungs
- •Clinical features
- •Literature
- •Pleurisy
- •Dry pleurisy
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Pleurisy with effusion
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Syndrome of fluide accumulation in the pleural cavity
- •The main causes of pleural fluid accumulation
- •Classification
- •Clinical features
- •Additional methods of examination
- •Syndrome of air accumulation in the pleural cavity
- •Clinical features
- •Additional methods of examination
- •Respiratory insufficiency
- •Literature
- •Syndrom of functional dyspepsia
- •Classification
- •Clinical features
- •Chronic gastritis
- •Etiology
- •Classification
- •Clinical features
- •Additional methods of examination
- •Peptic ulcer disease (Gastric and Duodenal Ulcer)
- •Etiology
- •Pathogenesis
- •Cinical features
- •Additional methods of examination
- •Complications
- •Irritable bowel syndrome
- •Clinical features
- •Literature
- •Syndrome of bile ducts dyskinesia (dysfunctional bile tract disorders)
- •Classification
- •Clinical features
- •Additional methods of examination
- •Chronic cholecystitis
- •Clinical features
- •Additional methods of examination
- •Cholangitis
- •Etiology
- •Pathogenesis
- •Classification
- •Clinical features
- •Additional methods of examination
- •Jaundice
- •Etiology
- •Pathogenesis
- •Additional methods of examination
- •Literature
- •Classification
- •II. Classification by grade or by stage:
- •Pathological anatomy
- •Clinical features
- •Additional methods of examination
- •Etiology
- •Clinical features
- •Additional methods of examination
- •Syndrome of portal hypertension
- •Classification
- •Hepatic insufficiency
- •Literature
- •Glomerulonephritis
- •Classification
- •Etiology
- •Acute glomerulonephritis
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (nephritic form)
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (hypertensive form)
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (mixed form).
- •Clinical features
- •Additional methods of examination
- •Chronic glomerulonephritis (latent form)
- •Clinical features
- •Additional methods of examination
- •Pyelonephritis
- •Pathogenesis
- •Infectious agents may be transmitted by contact, hematogenous or lymphatic ways in obligatory presence of urodynamic abnormalities. Acute pyelonephritis
- •Clinical features
- •Additional methods of examination
- •Chronic pyelonephritis
- •Clinical features
- •Additional methods of examination
- •Syndrom of chronic renal failure
- •Etiology
- •Pathogenesis
- •Classification of chronic renal diseases (nkf, usa)
- •Clinical features
- •Additional methods of examination
- •Literature
- •Syndrome of anemia
- •Classification
- •Iron deficiency anemia
- •Etiology
- •Vitamin b12 deficiency anemia
- •Hemolytic anemia
- •Classification of hemolytic anemias
- •Additional methods of examination
- •Complete Blood Count (cbc)
- •Normal wbc count
- •Complete Blood Count (cbc)
- •Literature
- •The main methods of laboratory diagnostics of hemorrhagic syndromes
- •Tests for plasma factors involved in coagulation and fibrinolisis
- •Hemorrhagic syndrome
- •Etiology
- •Pathogenesis
- •Clinical feature
- •Additional methods of examination
- •Hemophilia b (Christinas' disease)
- •Clinical feature
- •Additional methods of examination
- •Additional methods of examination
- •Literature
- •Eucosis (Hemoblastosis)
- •Classification of hemoblastosis
- •Acute myeloblastic leukemia
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Chronic myelocytic leukemia
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Chronic lymphocytic leukemia
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Literature
- •Diabetes mellitus
- •Etiological classification of glycemia disorders
- •Classification according to clinical feature
- •Etiology and pathogenesis of insulin dependent diabetes mellitus
- •Etiology and pathogenesis of insulin nondependent diabetes mellitus
- •Clinical features
- •Comparative clinical features of iddm and niddm
- •Hypoglycemia
- •Clinical features
- •Diabetic ketoacidosis
- •Clinical feature
- •Objective examination
- •Additional methods of examination
- •Hyperosmolar non-ketotic coma
- •Clinical features
- •Additional methods of examination
- •Additional methods of examination dm
- •Hyperthyridism
- •Etiology
- •Pathogenesis
- •Clinical feature
- •Additional methods of examination
- •Hypothyroidism
- •Etiology
- •Pathogenesis
- •Clinical features
- •Additional methods of examination
- •Literature
- •Contens
Basic Symptoms and Syndromes in Diseases of Cardiovascular System.
Concrete aims:
to combine the results of questioning, physical and instrumental examination of a patient with specific pathology of cardiovascular system and differentiate the basic symptoms and syndromes of their damage
to identify the basic syndromes in diseases of cardiovascular system and explain the mechanisms of their development
to choose the adequate methods of examination in specific diseases of cardiovascular system
to demonstrate the possessing of modern classifications of the diseases of cardiovascular system
Topic 1. The Main Syndromes of Heart Failure
Class lasts: 3 hours
Chronological class structure:
Control of initial standard of knowledges- 20 min.
Teacher′s demonstration of practical skills - 60 min.
Sudents′ independent work: - 30 min.
Control of ultimate standard of knowledges- 15 min.
Sum up of the class, homework- 10 min.
Questions for theoretical preparation: Heart failure. Etiology and pathophysiology of heart failure. Modern classification of heart failure (New York Heart Association functional class, stage of heart failure, haemodynamic forms of heart failure). Clinical manifestations of heart failure. Instrumental methods of examination. Acute vascular insufficiency (syncope, collapse, shock). Syncope.
Syndrome of cardiovascular failure
Heart failure is a pathological condition which characterized by decreased contractility of the myocardium, reduction of cardiac output in which the cardiovascular system fails to supply the necessary amount of blood to the organs and tissues for their adequate function.
This condition arises due to the affection of the heart or of the vessels, or it may be combined disorders of the cardiovascular system.
The syndrome of cardiovascular failure is divided into 2 groups:
heart failure: acute (acute left ventricular heart failure, acute left atrial heart failure, acute right ventricular heart failure) and chronic (chronic left ventricular heart failure, chronic left atrial heart failure, chronic right ventricular heart failure and total chronic heart failure);
vascular failure: syncope, collapse and shock.
Etiology
Heart failure may develop in case of overloading or overstrain of the myocardium by "pressure" (hypertension, aortic stenosis, stenosis of the pulmonary orifice), by "volume" (mitral or aortic regurgitation), and also owing to diseases affect primarily the myocardium and its metabolism. Affection of the myocardium may be due to infectious, inflammatory and toxic damage of the myocardium (myocarditis, cardiomyopathy, intoxication of the myocardium by alcohol, narcotic drugs, and other poisons), insufficient blood supply to the myocardium (disordered coronary circulation, anemia), metabolic disorders, and endocrine dysfunction.
Common causes of heart failure:
ischemic (coronary) heart disease;
arterial hypertension;
dilated cardiomyopathy;
heart valve diseases;
hypertrophic cardiomyopathy;
restrictive cardiomyopathy;
constrictive pericarditis;
high-output heart failure;
chronic anemia;
atrioventricular shunts;
thyrotoxicosis.
Pathogenesis. The clinical syndrome related to organ hypoperfusion and inadequate tissue oxygen delivery due to a low cardiac output and decreased cardiac reserve, as well as pulmonary and systemic venous congestion. Heart failure is associated with complex neurohormonal changes including activation of the renin-angiotensin-aldosterone and the sympathetic nervous systems. At first these changes may help to compensate cardiac function by altering the afterload or preload and by increasing myocardial contractility. Ultimately they become counterproductive and reduce cardiac output by causing an inappropriate and excessive increase in peripheral vascular resistance. A vicious cycle may be established because a fall in cardiac output will cause further neurohormonal activation and increasing peripheral vascular resistance. The onset of peripheral edema is due to salt and water retention caused by impaired renal perfusion and secondary aldosteronism.
Heart failure may develop as a result of impaired myocardial contraction due to decreasing of number functional activity of cardiomyocites - systolic dysfunction. Which may observe in patients with inflammation of myocardium, cardiosclerosis, hypertension, non-compensated regurgitation and dilated cardiomyopathy.
Heart failure may arise due to poor ventricular filling caused by disorder of active relaxation and increasing of rigidity of myocardium due to hypertrophy, fibrosis and infiltration - diastolic dysfunction, which may observe in patients with constrictive pericardities, hypertrophic cardiomyopathy.
Systolic and diastolic dysfunctions often coexist, particularly in patients with hypertension, ischemic (coronary) heart disease.
Compensatory mechanisms in heart failure: tachycardia, Frank-Starling's mechanism, myocardial hypertrophy, tonogenic dilation and slow blood flow.