- •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
Additional methods of examination
Clinical blood analysis: leukocytosis, neutrophilia, shift of leukocyte formula to the left, accelerated ESR.
X-ray examination: - the signs of pleura affection, significant darkness with slanting upper border of the fluid and dislocation of mediastenum to the healthy side.
Pleural fluid analysis includes: assessment of macroscopic characteristics (character, transparency, color, consistency, odor, relative density); chemical study (protein, Rivalts's reaction); microscopic study (cellular composition); bacterioscopic study.
Syndrome of fluide accumulation in the pleural cavity
Hydrothorax - the grouping of the symptoms that develop due to the pleura affection or general electrolyte dysbalance in the organism.
Etiology
The main causes of pleural fluid accumulation
Charactpr of pleural fluid |
Main causes |
Less frequent causes |
Transudates |
Heart failure |
Nephritic syndrome Cirrhosis Myxidema Peritoneal dialysis |
Inflammatory exudates (infectious) |
Parapneumonic Tuberculosis |
Subdiaphragmatic abscess Viral infectious Fungus infectious |
Inflammatory exudates (noninfectious) |
Pulmonary artery thromboembolia |
Collagenosis Pancreatitis Reaction on drugs Dresler syndrome |
Tumor induced exudates |
Metastasis Lymphoma |
Mesothelioma Meigsa syndrome |
Hemothorax |
Trauma |
Spontaneous (impaired hemostasis) |
Chylothorax |
Lymphoma Carcinoma Trauma |
Lymphogranulomatosis |
Pathogenesis: in hydrothorax developing the primary affection belongs to inflammatory or reactive process in pleura that accompanied by fluid accumulation in the pleural cavity from several milliliters to 1 liter or more.
Classification
Depending on the etiology, character of excudates, duration and clinic-anatomic form there are the next forms of excudative pleurisy:
/. According to the etiology:
- infection;
- non-infection.
//. According to the character of exudates:
- serous;
- seropurulent;
- purulent;
- hemorrhagic;
- cholesterol;
- putrefactive.
ІІI. According to the duration:
- acute;
- subacute;
- chronic.
IV. According to the clinic-anatomic form:
- diffuse;
- local.
Besides exudates in pleural cavity may accumulate uninflammatory fluid (transudate) due to the impaired electrolyte exchange (increased hydrostatic pressure in the capillaries and decreased colloid and osmotic pressure in plasma).
As result pure of proteins plasma transits through unchanged capillary's wall and accumulates in the pleural cavity (heart failure, nephritic syndrome, liver cirrhosis, alimentary dystrophia, severe anemia, mediastenum tumor, myxedema, compression of vena cava superior).
Clinical features
Patients suffering from pleurisy with effusion usually complain of fever, pain or the feeling of heaviness in the side, and dyspnea (which develops due to respiratory insufficiency caused by compression of the lung) through is usually mild (or absent in some cases).
Objective examination. General patient's condition is from middle grave to extremely grave. Due to hypoxia, the inflammatory process and general intoxication may be observed the deranged consciousness.
The posture of the patients is frequently forced (lying on the affected side) in order to relieve the pain via limitation of the pleural layers movement and relieve dyspnea via decrease pressure of the fluid on mediastenum and therefore its displacement.
The color of the skin and visible mucous is characterized by diffuse cyanosis. In presence of effusion in mediastenum may be observed edematous face, swollen and pulsation of jugular veins, voice change and dysphagia.
Depending on the stage of pleural syndrome development there are the next particularities of objective examination:
/. In the initial stage of the hydrothorax there are more frequently observed the signs of dry pleurisy:
- poor movement of the affected side in respiration during dynamic inspection of the chest;
- in topographic percussion decreased of the lower lung's border respiratory mobility on the affected side;
- in auscultation of the lungs on the affected side over the region with pathologically decreased vesicular breathing is revealed pleural friction sound.
II. In stage of the fluid accumulation in pleural cavity there are observed the signs of effusive pleurisy:
- the chest is asymmetrical;
- affected half of the chest lags in the breathing act;
- vocal fremitus is badly transmitted or generally absent on the affected side (depending on pleural fluid volume);
- in comparative percussion of the lungs is determined the dull sound over the fluid. The minimum amount of the fluid that can be detected by percussion of the lungs is not less then 500 ml; determination of the dull sound from the IV rib is commensurable with 1.5L of fluid; from III rib – 2L; from II rib - more then 3L.
In presence of exudates. The upper border looks approximating a curve with apices along posterior subribs line (the line of Damuaso-Sokolsky) that characterized by unevenness of fluid accumulation due to the different lung tissue compliant. In body position change the border of the dullness isn't change via visceral and parietal pleura adhesion across the exudates upper border.
In occurrence of significant exudates amount in pleural cavity there are distinguish the next clinically and diagnostically zones:
- the zone of absolute dullness that accordant to exudates gathering and limited by Damuaso-Sokolsky line;
- the zone of dull sound that accordant to partial compressive atelectasis on the affected side (Garland triangle) and limit by spinal column, ascendant part of Damuaso-Sokolsky line and line drawing from top of Damuaso-Sokolsky line to spinal column;
- the zone of intermediate percussion sound on the health side accordantly to displaced mediastenum and joining of dull sound from exudates radiated on spinal-column (Rauxfux-Grokkus triangle);
- the zone of clear pulmonary sound that accordant to the lung free of fluid and placed over Garland triangle and Damuaso-Sokolsky line;
- the zone of bandbox percussion sound over the hyper inflated lung of emphysema on the health side.
Accordantly to distinguish zones the next auscultative records are observed:
- above the zone of absolute dullness - the breathing isn't detects or occurs pathologically decreased vesicular breathing;
- above the zone of dull sound (Garland triangle) - occurs pathologically bronchial breathing;
- above the zone of intermediate percussion sound (Rauxfux-Grokkus triangle) - vesicular breathing is absent via impaired sound transmition;
- over the zone of clear pulmonary sound and the zone of bandbox percussion sound (where the lungs are free of fluid) - occurs pathologically increased vesicular breathing.
In presence of transudates. The fluid's level is horizontal, more frequently bilateral and displaced throughout body's position change. The zone of dull sound (Garland triangle,) is absent.
Moreover, in patients observed the signs of main disease that leads to hydrothorax - heart failure, renal diseases, tumor of mediastenum.