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Early active detection of diseases of the cardiovascular system
IHD: primary stop of blood circulation. CHD: heart failure. IHD: arrhythmias and heart block. IHD: angina pectoris. Hypertensive heart disease (GB) and secondary arterial hypertension (VAG). Initial manifestations of circulatory failure of the brain (NPNKM). Risk groups of primary circulatory arrest and its recurrence: patients with ECG signs of threatening fibrillation (ventricular extrasystoles, especially frequent, polytopic, rhythmic; "early" ventricular extrasystoles; broadening of the ventricular complex ECG; increase in amplitude of the prong? ECG; bradycardia; late ventricular potentials) . Arrhythmia risk groups: males older than 40 years; women over 50; persons with risk factors for primary circulatory arrest; children who had at least once in their life "heart attack" (search for syndromes of pre-excitation of the ventricles).
The most significant risk groups for hypertension: men and women 40 years of age and older; patients with diabetes, ischemic heart disease; smokers with hypercholesterolemia; women in menopause and in menopause, with postmenopausal syndrome; women who have had preeclampsia.
Angina pectoris is significantly more common in men over 40, women over 50, in patients with arterial hypertension, obesity, gout, and “atypical” cardialgia.
When screening risk groups, it is necessary to measure blood pressure with identification of the non-randomness of its increase (not with psycho-emotional stress, not with hangover syndrome, not with “white coat syndrome”); verified by at least three medical appointments (two measurements each) for at least 3 weeks. up to 3 months high blood pressure (BP) above the figures 140/90 mm Hg. Art., proceeding with a lesion of target organs (brain, heart, kidneys). The diagnosis of GB is reliable after the exclusion of known secondary arterial hypertension (VAG).
According to the testimony to exclude VAG held:
- in case of suspected aortic coarctation, measurement of blood pressure in the arms and legs, chest radiographs (aorta enlarged and shifted to the right, rib fusion), aortography;
- in case of suspected pheochromocytoma ultrasound examination (ultrasound) of the adrenal glands, computed tomography (CT) of the adrenal glands;
- in case of suspicion of the Itsenko-Cushing's disease, radiographs of the Turkish saddle, ultrasound, adrenal CT;
- at suspicion on a renovascular arterial aortography;
- in case of suspicion of hypernephroma and hypernephroid cancer, ultrasound, CT of the kidneys, angiography of the kidneys;
- in case of suspicion of chronic diffuse glomerulonephritis, amyloidosis, renal biopsy;
- in case of suspicion of chronic bilateral pyelonephritis, urine culture on microflora and Mycobacterium tuberculosis, intravenous and retrograde pyelography;
- in case of suspicion of erythremia, a blood test with red blood cell count, leukocyte count, platelet count, sternal puncture.
For the purpose of early diagnosis of NPNCM, the underlying pathology of the heart, especially atrial fibrillation, diabetes mellitus, intermittent claudication, and burdened heredity (cerebral stroke, myocardial infarction, and hypertension from the parents) are taken into account. The questionnaires must include the following complaints: headache, dizziness, noise in the head, memory loss, poor performance, not caused by the consequences of traumatic brain injuries, neuroinfections.
• For early recognition of myocarditis, the PMSPN team should not let children and adults who have had viral and bacterial infections out of sight.
With complaints of shortness of breath, palpitations, interruptions, weakness, ECG control is required, the definition of “acute phase” tests.
• Early signs of hypertrophic cardiomyopathy: “accidentally” detected systolic murmur at the apex, in the Botkin zone, aggravated by abrupt rising and straining; brain syncope; cardialgia in combination with deep teeth Tv3-6.
• Early signs of dilated cardiomyopathy: “accidentally” revealed cardiomegaly in young people who are not suffering from ischemic, hypertensive disease, congenital and acquired heart defects, or heart failure unexplained by the indicated reasons. Additional examination volume: resting ECG, echo cardiography.
• Active detection of patients with acquired heart defects is performed by the PMSPN team during examinations of children, adolescents, pregnant women, men of working age. The leading screening method for level 1 is thorough auscultation of the heart. Level 2 screening is an additional examination of patients with systolic and (or) diastolic heart murmur to exclude its accidents or functional nature. ECG methods, radiography of the heart with esophageal contrast, phonocardiography, echocardiography are used.
• Congenital heart defects can be diagnosed in utero, in the third trimester of pregnancy, using an echocardiographic examination of the fetus. Risk group - women who have suffered rubella in the first months of pregnancy; women living in environmentally unfriendly areas, working in chemical plants; alcoholics, drug addicts.
• Infective endocarditis. High-risk groups: patients with aortic malformations, aortic coarctation, Marfan syndrome, mitral insufficiency, open arterial duct, septal defects. After tooth extraction, tonsillectomy, prostatectomy, it is advisable to prophylactically inject 1 million IU of penicillin or 80 mg of gentamicin before manipulation and twice more with an interval of 8 hours at the same dose after manipulation!
• Pulmonary embolism. Risk groups: women with varicose veins of the lower extremities, thrombophlebitis, trophic ulcers of the lower extremities; patients in the early postoperative period after operations on the abdominal organs, small pelvis, hip fracture; patients with heart failure, strokes; pregnant women. Screening Level 1: ECG; radiographs of the lungs; blood clotting, bleeding duration, platelets, prothrombin, fibrinogen.
To clarify the diagnosis of phlebothrombosis of deep veins of the legs, these clinics are taken into account (feeling of heaviness, pain, heat, pain in the calf muscles, cramps of the calf muscles at night, trophic disorders of the skin of the legs), instrumental methods, the most accessible of which is Doppler ultrasound.
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Early active detection of diseases of the cardiovascular system
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