Additional methods of examination

Clinical blood analysis: leucocytosis, shift in the leucocytic formula to the left, eosinophilia, mono- and lymphacytosis may further develop and accelerated ESR.

Biochemical analysis of blood. Special laboratory tests help diagnose rheumatism.

• Dysproteinaemia characteristic: the albumin content drops below 50 per cent, the γ-globulin increases, and the albumin-globulin factor decreases below unity. A proteinogram shows increased ²- and γ- globulin fractions;

• Fibrinogen content 0.6-1 per cent (normally it does not exceed 0.4 per cent).

• The C-reactive protein, which is absent in healthy individuals.

• The titres of antistreptolysine O, antistreptohyaluronidase, and antistreptokinase increase significantly.

• Increased levels of sialic acids, seromucoid, and gaptoglobin.

ECG: premature contraction, atrial fibrillation or flatter, decreasing of ECG voltage, depression of ST-segment, appearance of negative, asymmetrical T-wave is possible; elevation of ST-segment due to pericarditis or subepicardial damages of myocardium; different degrees of AV-blockade.

X-ray of heart and Echo-CG indicates enlargement of heart and its chambers.

Literature

1. Internal diseases an introductory course. - Vasilenko V., Grebenev A. - M.: Mir . Publishers, 1990. - 647 p

2. Propedeutics to internal medicine. Part 1.-Vinnytsya: NOVA KNYHA, 2006.- 424 p.

3. Propedeutics to internal medicine. Part 2.-Vinnytsya: NOVA KNYHA, 2007.- 264 p.

4. Introduction to the course of internal diseases. Book 1. Diagnosis: [Textbook/Zh.D. Semidotskaya, O.S. Bilchenko, et al.].-Kharkiv: KSMU, 2005. -312p.

5. Michael Swash Hutchison’s clinical methods / XIX edition. ELBS, 1989. -618p.

6. Mark H., Beers M.D., Robert Berkow The Merck Manual of diagnosis and therapy / XVII edition.- Published by Merk research laboratories, 1999.- 2833 p.

7. Harrison΄s principles off internal medicine / Fauci, Braunwald, Isselbacher and al.-XIV edition. - Vol. 1 and 2. - International edition, 1998.

Topic 3. Mitral Valvular Diseases of the Heart: the Main Syndromes and Symptoms on the Basis of Clinical and Instrumental Methods of Investigation.

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 Valvular Diseases. The main cause of acquired incompetence the mitral valve and mitral stenosis. Haemodynamics. Kitaev's reflex. The main complaints of the patients with incompetence of the mitral valve and mitral stenosis. External examination, palpation, percussion, auscultation of the patients with incompetence of the mitral valve and mitral stenosis. X-ray studies. Echocardiography. ECG. Phonocardiogram. Prolaps of the mitral valve.

Contents heart valvular diseases

Stable pathological changes in the structure of the heart that interfere with its normal function are called heart disease. Congenital and acquired diseases of the heart are distinguished. The incidence of acquired heart diseases is much higher.

Congenital diseases of the heart arise due to abnormal development of the heart and the great vessels during the intrauterine growth of the foetus with preservation of the intrauterine character of circulation after birth. Endocarditic, and especially rheumatic endocarditis, is the main cause of acquired heart defects. Less frequently heart disease is the result of sepsis, atherosclerosis, syphilis, injuries, etc. Inflammatory processes occurring in the valve cusps often end in their sclerosis: deformation and shortening. An affected valve does not close completely to cause valvular incompetence. The cusps of the valves may adhere to one another because of inflammation to narrow the orifice they close. This narrowing is called stenosis.