• 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

• Arterial hypertension

• High level of cholesterol and lipoprotein of low

density

• Obesity

• Smoking

• Diabetes mellitus

• lack of exercise

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

• 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

-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

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

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

• 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

• S-T elevation (depressed)

• Inverted T wave

• Complex QRS-changes

• Pathologic deep Q

wave

Normal ECG

Patient with ischemia

• 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

• 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)

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

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)

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

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

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

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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