cardiovascular diseases dominate in the structure of
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• Cardiovascular diseases dominate in the structure of
practically all countries. According to the WHO data,
morbidity from cardiovascular diseases is about 17 million
people each year in the scale of the planet
• In 2008 in USA, heart disease was the third leading cause
of death for those aged 25-44 years, second for those aged
45-64 years, and first for those aged 65 years and older
• In Ukraine morbidity from cardio-vascular diseases in 2009
were 67% of all cases. 19.5-23% of men in our country that
are older 50-55 years have a chronic ischemic disease, and
with people getting older its frequency increases even more
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• Arterial hypertension
• High level of cholesterol and lipoprotein of low
density
• Obesity
• Smoking
• Diabetes mellitus
• lack of exercise
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Ischemic heart disease (IHD) or Coronary artery disease(CAD) is atherosclerosis of coronary arteries withdevelopment of myocardial ischemia due to the imbalancebetween delivery and myocardial oxygen demand
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• 1. Sudden death (primary cardiac arrest)
• 2. Angina
• 2.1. angina
• 2.1. One-onset angina (acute coronary insufficiency)
• 2.1.2 Stable angina (functional class from I to IV)
• 2.1.3 Progressive angina (angina preinfarction)
• 2.2 Spontaneous angina (intermediate syndrome)
• 3. Myocardial infarction
• 3.1 macrofocal (transmural) (ST-segment elevation MI)
• 3.2 microfocal (Non–ST-segment elevation MI)
• 4. Postinfarction cardiosclerosis
• 5. Cardiac arrhythmias
• 6. Heart failure
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-Crushing chest pain, diffuse nature, feeling of hot or discomfort in the chest- Chest pain radiating to the left arm, neck, mandible-Laboured respiration, feeling of the lack of oxygen (like fish
without water)- - Fear of death
Pain syndrome
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Chest pain appear
• after physical activity,
• after psycho-emotional stress,
• in overeating,
• due change environmental temperature from
hot to cold
Chest pain disappear
– in rest
–after taking nitrates
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Myocardial infarction is acute coronary syndrome,which occurs due to sudden cessation of the coronaryblood flow caused by the coronary vessel thrombosisand development of one or more nidi ischemicnecrosis in the cardiac muscle
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• Chest pain is similar to angina
pectoris, but:
• more severe (intolerable),
• do not remove by nitroglycerin,
• accompanied by signs of acute
cardiovascular failure (collapse,
pulmonary edema, or sudden
cardiac death), and arrhythmias
Symptoms of necrosis:
fever, leukocytosis,
increases of LDG and AAT-levels
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• S-T elevation (depressed)
• Inverted T wave
• Complex QRS-changes
• Pathologic deep Q
wave
Normal ECG
Patient with ischemia
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• Tachycardia
• Bradycardia
• Extrasystolia
(supraventricular
and ventricular)
• Atrial fibrillation
• Ventricular fibrillation
Arrhythmia is any heart rhythm that is not a regular sinusrhythm of normal frequency and conduction disturbancesof the electric impulse to various part of the conductionsystem of the heart
Normal heart rate: 60-80 in min
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• Palpitation – feeling of heart beaten
• Feeling a sinking heart, failing heart
• Disruptions in cardiac activity
• Dizziness, weakness
• Feeling of fear
• Transient loss of consciousness (Morgagni-
Edems-Stocks attaks)
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Heart failure
Acute heart failure is
• Cardiac asthma
• Pulmonary edema appear
Chronic heart failure manifestation by
• Tachycardia
• Acrocyanosis
• Inspirate dyspnoe
• Edema of low extremities
• Ascites
• Anasarca
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Cardiac asthma syndrome(paroxysmal dyspnea)
• Cardiac asthma is a condition, which manifests itself asan acute shortage of air, shortness of breath (inspiratorynature of breathlessness), possibly in the phenomenonof bubbling rales in the chest, cough with sputum of apink color (mixed with blood)
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Classification of
Chronic heart failure (by N.D. Strazhesko, V.Kh.Vasilenko)
Phase of CHF Clinical manifistation
The I stage –Starting, latent
The symptoms occur only at physical exertion,at rest hemodynamics are not impaired
The II A stage –moderately pronounced hemodynamic instability
Marked dysfunction of someone part of theheart (right or left ventricular failure)
The II B stage – profoundhemodynamic instability, impairment cvirculation
All cardiovascular system is involved in thedisease, severe hemodynamic instability inthe pulmonary circulation and systemiccirculation
The III stage – terminal, dystrophic
Persistent changes of metabolism and organfunctions, irreversible changes in the structureof organs and tissure, expressed dystrophicchanges, total disability
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New York Classification of
Chronic heart failure (1964)Functional
classClinical manifistation
I A patient does not experience limitation in his physical activity.Ordinary physical exertion does not result in origin of weakness,palpitation, dyspnea or anginal pain
II Moderate limitation of the physical activity. A patient feelscomfortable at rest, but the execution of ordinary physicalexertion causes fatigue, palpitation, dyspnea or anginal pain
III Marked limitation of the physical activity. A patient feelscomfortable only at rest, but smaller than usual, physical exertionleads to development of weakness, palpitation, dyspnea oranginal pain
IV Inability to comply with any load without the appearance ofdiscomfort. Symptoms of heart failure or angina attack may beobserved at rest. Patients are not capable to tolerate even theminimal physical loading without occurrence or aggravation ofdiscomfort
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Heart valvular diseases
Heart valvular diseases are complication after rheumaticheart disease or bacterial endocarditic that arecharacterased by defect of mitral or aortalvalvule/orifice, are manifistated by symptoms of heartfailure, specific systolic and diastolic murmurs,hypertrophy of different part of myocardium
• Mitral stenosis
• Mitral regurgitation
• Aortic stenosis
• Aortic regurgitation
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Congenital Heart Defects
• Ventricular septal defects
• Atrial septal defects
• Coarctation of the aorta
• Tetralogy of Fallot
Congenital heart defects are impairment of anatomical structure of heart in neonatal baby due to fetal disorders, that are manifested by signs of heart failure, special murmurs in cardiac region, and it lead to death without surgical intervention
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