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Early active detection of diseases of the cardiovascular system
CHD: primary circulatory arrest. CHD: heart failure. IHD: arrhythmias and heart block. CHD: angina pectoris. Hypertension (GB) and secondary arterial hypertension (VAG). Initial manifestations of circulatory failure of the brain (NPNKM). Risk groups for primary circulatory arrest and its relapse: patients with ECG signs of threatened fibrillation (ventricular extrasystoles, especially frequent, polytopic, rhythmic; “early” ventricular extrasystoles; broadening of the ventricular ECG complex; increase in tooth amplitude? ECG; bradycardia; late ventricular potentials) . Risk groups for arrhythmias: 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 a “heart attack” (search for ventricular pre-excitation syndromes).
The most significant risk groups for hypertension: men and women 40 years of age and older; patients with diabetes mellitus, coronary heart disease; smokers with hypercholesterolemia; women during menopause and menopause, with postmenopausal syndrome; women with preeclampsia.
Angina pectoris is significantly more common in men over 40 years old, women over 50 years old, in individuals with arterial hypertension, obesity, gout, and “atypical” cardialgia.
During a screening examination of risk groups, it is necessary to measure blood pressure with identification of the nonrandomness of its increase (not with psychoemotional stress, not with a hangover syndrome, not with a “white coat syndrome”); verified by at least three medical appointments (two measurements each) for a period of 3 weeks or more. up to 3 months increase in blood pressure (BP) above the numbers 140/90 mm RT. Art., proceeding with damage to target organs (brain, heart, kidneys). The diagnosis of GB is reliable after exclusion of known secondary arterial hypertension (VAG).
According to indications for the exclusion of VAG:
- if there is a suspicion of coarctation of the aorta, the measurement of blood pressure on the arms and legs, chest x-ray (expanded and shifted to the right of the aorta, ribs), aortography;
- if pheochromocytoma is suspected, an ultrasound examination (ultrasound) of the adrenal glands, computed tomography (CT) scan of the adrenal gland;
- if suspected of Itsenko-Cushing's disease, radiographs of the Turkish saddle, ultrasound, CT of the adrenal glands;
- with suspected renovascular hypertension aortography;
- with suspected hypernephroma and hypernephroid cancer, ultrasound, CT of the kidneys, renal angiography;
- with suspected chronic diffuse glomerulonephritis, amyloidosis, kidney biopsy;
- if there is a suspicion of chronic bilateral pyelonephritis, urine culture on microflora and Mycobacterium tuberculosis, intravenous and retrograde pyelography;
- if there is a suspicion of erythremia, a blood test with a count of red blood cells, white blood cells, platelets, sternal puncture.
For the purpose of early diagnosis of NSAIDs, background cardiac pathology is taken into account, especially atrial fibrillation, diabetes mellitus, intermittent claudication, aggravated heredity (cerebral stroke, myocardial infarction, arterial hypertension in parents). The following complaints must be included in the questionnaires: headache, dizziness, noise in the head, memory loss, poor performance, not caused by the effects of traumatic brain injuries, neuroinfections.
• For early recognition of myocarditis, the primary care team should not let children and adults who have had viral and bacterial infections out of sight.
For complaints of shortness of breath, palpitations, interruptions, weakness, ECG monitoring and determination of acute phase tests are mandatory.
• Early signs of hypertrophic cardiomyopathy: “accidentally” detected systolic murmur at the apex, in the Botkin area, amplified by a sharp rise and straining; cerebral syncopes; cardialgia in combination with deep Tv3-6 teeth.
• Early signs of dilated cardiomyopathy: “accidentally” detected cardiomegaly in young people who are not suffering from ischemic, hypertension, congenital and acquired heart defects, or heart failure unexplained by these causes. Additional examination: resting ECG, echo cardiography.
• Active identification of patients with acquired heart defects is carried out by the primary care team during examinations of children, adolescents, pregnant women, men of working age. The leading method of screening of the 1st level is thorough auscultation of the heart. Level 2 screening - additional examination of patients with systolic and (or) diastolic murmur of the heart to exclude its incidence or functional nature. ECG methods are used, radiography of the heart with contrast of the esophagus, phonocardiography, echocardiography.
• Congenital heart defects can be diagnosed in utero, in the third trimester of pregnancy, using an echocardiographic study of the fetus. Risk group - women who suffered measles rubella in the first months of pregnancy; women living in environmentally disadvantaged areas, working in chemical plants; alcoholics, drug addicts.
• Infectious endocarditis. High-risk groups: patients with aortic defects, aortic coarctation, Marfan syndrome, mitral regurgitation, open ductus arteriosus, septal defects. After tooth extraction, tonsillectomy, prostatectomy, it is advisable to prophylactically introduce 1 million units of penicillin or 80 mg of gentamicin before manipulation and twice more with an interval of 8 hours in 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 organs of the abdominal cavity, pelvis, hip fracture; patients with heart failure, strokes; pregnant. Level 1 screening: ECG; radiographs of the lungs; blood coagulation, duration of bleeding, platelets, prothrombin, fibrinogen.
To clarify the diagnosis of phlebothrombosis of the deep veins of the lower legs, the clinic data are taken into account (feeling of heaviness, fullness, heat, pain in the calf muscles, spasms of the calf muscles at night, trophic disturbances of the skin of the legs), instrumental methods, the most accessible of which is ultrasound dopplerography.
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Early active detection of diseases of the cardiovascular system
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