Illness of the human circulatory system. Diseases of the blood circulation organs

ARTERIAL HYPERTENSION (movement of AT) and ARTERIAL HYPERTENSION (movement of vessel tone). The concept is non-identical, although they often come up. Pomіrne vyschennya equal systolic AT (SBP) - a natural reaction to endogenous and ovnishnі diї. However, the progression of AT and the triviality of response to stressful injections can be inadequate and superficial. A similar direct reaction is typical for bugs in pubertal age (“hyperreactors”), for children and adults with vegetative dystonia (VSD), with primary arterial hypertension (PAH).

Secondary - symptomatic - arterial hypertension (AH) is associated with a stable increase in SBP and diastolic AT (DBP) in cerebral, cardiac, and especially in nirkovy and endocrine forms of hypertension. Secondary hypertension is based on organic (structural) udders due to congenital pathology (aortic stenosis on different ribs, stenosis of nirk vessels) or swollen rupture (trauma, neoplasm). Rizke increase in vessel tone (with SBP 200-250 mm Hg and DAPT 100-160-180 mm Hg) typically for hormonally active swellings of supra-nural folds (pheochromocytoma) in case of crisis overrun, Іtsenko-syndrome Kushin, primary aldosteronism, paraganglioma. Mensh sharp changes in the level of AT in adrenogenital syndrome, pubertal basophilism. Hypertoxicosis is characterized by moderate systolic hypertension with large fluctuations in CAT values ​​followed by a decrease in DAPT. In this way, the range of changes in the level of AT and in symptomatic hypertension should be wide, but small amounts of water can be used and functional neuroendocrine dysregulation.

In healthy children, the rhіven of the arterial pressure is kolivaetsya in wide ranges (90/50-130/80 mm Hg). physical features individual: yogo masi tila and growth, step and tempo of state maturation. In puberty, new neurohormonal relationships are formed. If the sympathoadrenal injections are overwhelmed by the supra-world illumination and the appearance in the circulation of presorptive amines, then a higher high level of AT is formed.

In a complex of factors of high risk, which is responsible for the development of primary arterial hypertension (PAH), there is no significant increase in the development of elevated AT in dynamics for a sprat of roki. PAH is a multifactorial disease. Spadkova sickness, "accumulation" of hypertensive disease (HA), ischemic heart disease (IXC), atherosclerosis and other illnesses of the cardiovascular system in families less often, lower in the population ) with an one-hour surge of exogenous factors of high risk: a social environment with a tribal psycho-emotional stress, negative environmental impacts, climatic (weather) contrasts. Psychological peculiarities of specificity, unsustainability of biorhythms in robotic organs and systems in case of a permanently disturbed day regimen and eating supplement the resemblance of endogenous factors, which eliminate the vinification of PAH. Posynannyi Qiich bіosotzіalnye Plivіv Calling to Neurotizatsiya Osshistosti, Lab_lnostі Ta Survival Regulatsії at Rіzni Lanka (on the Rivnі Central Republic, Vegetative Nervovo Systems, Endocrinny Organi, Clіtino Membranes) with Aktivatiyu Renіn-AngioTensiveness Systems, Secret Aldosterone, Prostatin. sodium retention, with manifestation of defects in membrane regulation of calcium, lack of depressant mechanisms and other.

PAH needs to be differentiated by vegetative vascular dystonia (VVD), if there is more low blood volume (MOV), upper and lower peripheral support, but there is no increased middle pressure. At the stage of PAH, the cardiac vein overflows over the passage of the precapillary bed. GARDEN moves transiently. In case of hyperkinetic type of hemodynamics, the syndrome of obsession is caused. The reaction of the vessels of the night bottom is daily. The further development of PAH (stage 1B) is characterized by hyperfunction of the left duct with more persistently damaged precapillary tone and increased cardiac vacuole. GARDEN is more advanced (up to 150 mm Hg and higher); tsya hypertension stiykish and do not know without likuvannya. Blame the inconstant progress that DAT. Sometimes there is a spasm of the vessels of the septum, on the ECG - an increase in the electrical activity of the myocardium of the left duct. Behind the blame of the main factors, the risk of adequate treatment can lead to the normalization of AT. In the PA stage of PAH, against the background of a steady increase in SBP and DA, symptoms characteristic of GB are most often manifested (angiopathy, hypertrophy of the left duct, cardialgia and cerebral scarring). Possible hypertensive crises with the appearance of a sharp headache, damage to the eyes (“flies” in front of the eyes, the appearance of the contours of the object thinly), tedium and vomiting with a sharp increase in SAD and DAT. However, the signs of cerebral angiopathies are more dynamic, lower in adults, and do not obliterate residual manifestations. Depending on the hemodynamic variant of all children and patients with PAH, it can be divided into 2 groups: 1) with increased IOC, normal or decreased peripheral support (PS; hyperkinetic type of blood circulation) and 2) with increased PS with normal or decreased typical IOC For clinical, biochemical and hemodynamic data, PAH is so heterogeneous, like GB in the case of a young age. There are more and more arguments that PAG is the first line of development of GB in adults.

Likuvannya. Spend some time in ordering your life, creating a fiery self-discipline in the victorious regime, organizing salaries. Even more important are sedatives, management of stressful situations, psychological training for the development of independent (autogenic) stress relief; promotion of the "reserve of mentality" and the quality of health in the way of systematic, privablivi physical training, adequate for training. Pre-colon coniferous, sour baths, electrophoresis of magnesium, bromine, calcium; electrosleep, electroaerosol therapy (with obzidan, dibazol).

Drug therapy is carried out only with drug caution. It is possible to vicorate dibazol, reserpine, beta-blocker anaprilin (with supra- mental sympathetic-adrenal activity) at minimal doses.

Be-yakі options for rehabіlіtаtsії during staged likuvannі vymagayut psychological comfort, spiritual equanimity, the need to be sensible, vimagayut warmth and tact from the side of the most grown-ups at home, at school, at the reception of a doctor and others. unhinged emotions."

ARTERIAL HYPOTENSION. Decreased AT. systolic and (or) diastolic, beyond the inter-century norm; in children of high school age, it is lower than 90/50 mm Hg. Art. A short-term decrease in arterial pressure in healthy children is associated with natural colitis in fallow in the position of the body, additional biorhythm (with the greatest decrease in early years); AT decreases after physical and mental exhaustion, overheating, perebuvannya in a suffocating host. In case of impairment of blood pressure, the activity of neuroendocrine systems of regulation is blamed on the increase in AT, which is more important than the decrease. Labile (non-stable) and especially stable (trivala) arterial hypotension (AHip) are accompanied by decreased vascular tone - vascular hypotension.

Pathogenesis. In the pathogenesis of AH, the leading factor is the lack of a sympathetic vegetative nervous system (ANS) with a deficiency in the synthesis of norepinephrine and yogo forwards, as well as a decrease in corticosteroid activity, which is between the ability to ensure the safety of stressful situations, In addition to cym, the depressive influx of kinin, prostaglandins A and E is stronger than the tone of the parasympathetic vein of the ANS. For children of types of suinary paroxysms with severe falls of AT with severe intoxication, exhaustion, collapse, massive blood loss. Insufficiency with sharp falls of AT is most often blamed on the puberty period, with severe dysfunctions in the systems of regulation and deficiency of the regional, especially cerebral, blood circulation. For orthostatic AHip, a typical loss of visibility in the vertical position of the body, as a result, there is no increased pulse rate (asymptomaticotonia), which is suspected in case of severe organ or systemic pathology (type II AHip). Type I AHip is the most common - a less severe manifestation of orthostatic hypotension. Tsei became vegetative dystonia (VSD) of a hypotonic type typical for manifestation of intoxication, especially on aphids of chronic infections.

Clinical picture. Symptomatology of damage in orthostasis is more likely due to getting up, it develops quickly - immediately due to a change in position; possible weakness, confusion due to the second evidence, VVD with a stable overshoot and persistent hypertension are affected by mild subjective symptoms. Characteristic rich-day head beat with a "lead" heaviness when the venous flow through the vessels of the brain is damaged. Typical unmotivated weakness, including at the early hour, even swedish stubbornness, arrogance, impossibility to become angry; watch out for disturbed sleep and sleep apnea and important awakenings. All individuals with persistent decrease in AT, especially in case of hypotonic ailment and VSD of the hypotonic type, are considered to be of the “owl” type (because of a favorable biorhythm), they have an increased rank reaction to ailments, they need a large lung susilla for high blood pressure. Children with AH are particularly difficult in autumn-winter gloomy days, as well as in the spring season, if asthenia is most pronounced. The large number of cerebral scars is due not only to the degree of decrease in arterial pressure, but also to the trivality of AH, which increases the deficit of cerebral blood flow, especially in the spinal arteries. Children with AHip type increase in age, rate of state maturation, insufficient body weight. However, during the period of pubertal transformations and the development of new neuroendocrine interrelations, it is possible to change and induce the development of subjective disorders (with VSD of the hypotonic type), especially in case of recurrent inflammation of chronic infection.

Prevention. It is necessary to arrange the way of life, organize clear mode day that I will take it with the improvement of the peculiarities of the additional biorhythms, as well as the correction of the factors of the risk of viniknennya AGip. For the advancement of AGіp, it is necessary to warm up from the increase in opirnosti to seasonal viral and bacterial infusions, to increase the physical strengths, adequate to the external possibilities, to increase the “relish” to coolness and other non-drug training infusions.

Likuvannya. Medicinal preparations and vicorist are less likely to be used in case of severe subjective disorders. With acute decrease in arterial pressure below 80/30 mm Hg. Art. prescribe fetanol intravenously at 2.5-5.0 mg, tobto Vi- 1 tablet 1-2-3 days a day chi pidshkirno 0.4 ml 1 % difference; mezaton - 0.3 ml each 1% in a variety of doses, either internally or internally, or internally, 0.1 ml each % 20-40 ml of 5-20% glucose; caffetamin - 1/2-1 tablet for headaches for a few days. In case of confusion, it is necessary to unify sharp hands when standing up, troubling to change to one position (standing), great breaks, to change at suffocating hosts.

CARDIOMIOPATHY (KMP). Ailments m'yazіv heart nevіmoї etіologii. There are various hypotheses about their progress, the protege of them did not take away the residual confirmation. In connection with this, that stinks are considered by different clinical manifestations, the basis of today's association in a single group under the single name "cardiomyopathy" has become more than a day of conflicting data about the causes of heart disease. There are three groups of CMP: hypertrophic, dilated (stagnant) and restrictive.

Hypertrophic cardiomyopathy (HCM) is characterized by hypertrophy of the myocardium of the left duodenum, which in some cases is accompanied by changes in the emptying of the emptying. With a symmetrical form of HCM, there is equal sweating of the left wall of the duct and the interductal septum (IVS). In case of asymmetric form of disease, which is most pronounced, it overcomes the hypertrophy of the IVS, however, the hypertrophy of the left wall of the duct is less pronounced or during the day. Hypertrophy of the myocardium and dilatation of the empty right ventricle are often observed in HCM.

Distinguish between obstructive and non-obstructive forms of HCM. In case of obstructive form of ill health, known in the literature under the name "idiopathic hypertrophic subaortic stenosis" (IGSS), a gradient between the left duct and the aorta under the hour of systole is indicated for non-obstructive HCM. The rest of the connection with hypertrophy of the IVS and anterior displacement of the stools of the mitral valve, which calls out the ringing of the visual tract of the left duct.

Clinical picture. Show GKMP Riznanіtnі і to seal Vіd Low Factor_v: Steps of G_Pertrophy Mіokard, reality of the values ​​of Gradієntta Tiscus, lack of dural valve, SHO often stroke at Khlunich, steps of smearing L_VOV Schulunochka, Tajazhkosti Associated by Dіstolіchnoi, and the pumping fun. Scars are often daily. Deyakі ailments mean shvidka stomlyuvanіst, butt in case of physical anxiety; possible headaches, confusion, pain in the heart, as well as syncope. Cordoni of the heart can be in the midst of norms and peacefully expanded. Severe cardiomegaly in HCM is rare. The sonority of the 1st tone is mostly preserved, and there are often weakenings of the 2nd tone over the legenian artery. There is a systolic murmur of different intensity and localization. IGCC is characterized by localization of the murmur at the top of the heart and at the third or fourth intercostal space of the levoruch in the sternum. The wine sounds rough, intense, often felt in a vertical position, weakly carried out on the judge's back. Diastolic noise is more likely to be heard. With non-obstructive form of HCM, systolic murmur is often maximally loud in another intercostal rib, often suggestive of functional murmur. Signs of hypertrophy of the left atrium and the left ventricle are registered on the ECG. Some ailments show signs of hypertrophy of the right atrium, as well as combined hypertrophy of the ventricles. Often a pathological tooth is identified Q, the leading rank in the introduction of HI, aVL and in left infants. Significant changes in the complex ST-T, with this, the G tooth in the left chest openings can be deep, negative, or high-amplitude from a pointed apex and a narrow base. Like in DKMP, with Holter monitoring, arrhythmias and heart blockade are often detected, as soon as the heart rhythm is disturbed, they are registered on the primary ECG. On FCG, the systolic murmur with IGSS may be rhomboid in shape, often III and GU heart sounds are recorded. On radiographs, the tone of the heart at the borders of the norm or more darkened. The aortic configuration of the thin heart is characteristic due to the presence of dilatation of the viscous aorta. However, the mitral configuration of the heart tone is often indicated. The main method of diagnosing HCM is EchoCG. When obstruktivnіy formі zahvoryuvannya of order of asymmetry indices gіpertrofієyu MSHP (tovschini representation MSHP to tovschini zadnoї stіnki lіvogo shlunochka bіlshe 1.3; y normі less then 1.3) vіdznachayutsya zmenshennya porozhnini lіvogo shlunochka, znizhennya dіastolіchnoї that nasosnoї funktsіy sericite Zi zbіlshennyam pokaznikіv Yogo skorotlivostі. Great significance is expected for such changes, such as anterior systolic rupture of the anterior stool of the mitral valve and midsystolic occlusion of the aortic valve, which are indirect signs of obstruction of the visual tract of the left duct. With a non-obstructive form of disease, the only manifestation may be less asymmetric hypertrophy of the IVS.

The prognosis for DCM is good, lower for DCM. The majority of lethality is 2-6%, moreover, although children of an early age die in refractory CHF, the death of children of an older age often occurs rapidly, which is associated with fluvial fibrillation.

Dilated cardiomyopathy (DCMP) is manifested by dilated empty heart due to the presence or presence of slightly pronounced hypertrophy of the myocardium of both ventricles. At the early stages, the development of DCMP is shown by dilatation of the left heart. The world is progressing, expanding that right side. As a result of the dilatation of the empty heart, there develops a visible insufficiency of the mitral, and then the tristicular valves. The expansion of the heart chambers is marked by a sharp decrease in the speed of the myocardium, as if it were accompanied, on the one hand, by a change in the cardiac vein, on the other hand, by an increase in the pressure in the empty spaces with a distant development of congestive manifestations in small and large amounts of blood circulation. DCMP often manifests itself in the lower stages, if it is blamed for scars and ob'ektivnі symptoms associated with the development of natural phenomena: back pain, pain in the heart, liver failure, swelling and other. That is why I called DKMP on the cob "stagnant cardiomyopathy".

Clinical picture. With DCMP, the expansion between the heart is left-handed and uphill, often right-handed. The tones are mostly muffled, the II tone over the legenian artery sound accents and splits. Quite often, a three-membered rhythm is indicated, which can be applied both from the additive III, and from the pathological IV tone. At the projection of the mitral valve, there is a systole murmur, the intensity of which lies in the presence and degree of mitral regurgitation. Often the fault is the cause of manifestations, which create problems of differential diagnosis with mitral valve insufficiency of organic origin. Systolic murmur over the area of ​​the tricuspid valve is less pronounced and less intense. On the ECG, signs of hypertrophy of the left atrium and the left ventricle are most often indicated, more often combined hypertrophy of the atrium and ductus. Often there are disturbances in the rhythm of the heart and conduction, especially with additional monitoring of the ECG. The data of the FKG show an aus-cultivative picture. On radiographs of the chest at the early stages, the development of DCM shows an increase in the left heart, and in the late stages, that of the right heart. The shadow of the heart is most often the mitral configuration, the more rounded form. The significance of EchoCG is great, in case of yakіy they signify the rіvennі dilatation of empties, the presence of concomitant hypertrophy of the myocardium of the lungs, the state of the function of the heart. In this case, the symptom of "ribbed rash" is often manifested, due to changes in the amplitude of the movement of the anterior stool of the mitral valve due to a change in blood flow through the left venous neck.

The prognosis for DKMP is more serious and slightly unacceptable. Primary lethality to become 10-20%, 5-fold survival is close to 50%. The main causes of death are refractory CHF, cardiac arrhythmias and thromboembolism, which are especially common in this form of cardiomyopathy.

Restrictive cardiomyopathy (RCMP) disease of the heart, which is characterized by a sharp sweating of the endocardium and changes in the myocardium due to the growth of fibrous tissue and the ignition process. Changes in hemodynamics are associated with a head rank due to significant damage to the diastolic function of the heart and changes in the lining of the ducts in the vein due to obliteration of the empty emptying. Whom they are afraid of as a livi, and a right person. Zustrichaєtsya the head rank of bagmen in tropical lands.

Prior to RCMP, endocardial fibrosis of Devisa and parietal fibroplastic eosinophilic endocarditis of Leffler, yakі in stay rocky are seen as stages of one and the same disease itself. The development of morphological changes in RCMP is of great importance to abnormal eosinophils, which cause toxic effect on cardiomyocytes. There are three stages of RCMP: stage I is necrotic, stage II is thrombotic, and stage III is fibrotic. A number of fibrous changes in the endomyocardium often show thrombotic masses in the empty hearts, inflamed inflammation and necrosis in the myocardium. There is an increase in the number of eosinophils in the blood; in RCMP, diffuse eosinophilic infiltration of the myocardium and internal organs is often observed.

The clinical picture of HCM is characterized by the severity of the clinical manifestations of CHF, which is an early indicator of its slow progress. Rosemary hearts sound small, a characteristic deep third tone, a non-intense systole murmur is heard. Possible disruption to the rhythm of the heart and conduction. Signs of hypertrophy of heart lesions are recorded on the ECG. Pathological tooth is often recorded Q, segment downgrade ST that tooth inversion T. Echographically, it is possible to establish endocardial sweating and a change in the empty duct, signs of insufficiency of the mitral or tricuspid valve, significant impairment of the diastolic function of the myocardium and the pumping function of the heart,

The prognosis for RCMP is most often unfavorable. Polypshennya is possible with recognition of the exuberance of early terms as on the cob of illness.

Likuvannya. The transfer of complex visits, directing to improve hemodynamics. In DCM, it is necessary to use medicinal preparations to reduce the increase in the speed of the myocardium and the decrease in the transmission of the signal. Heart glycosides, diuretics and peripheral vasodilators are prescribed as a method. For the presence of arrhythmias, which increase the severity of blood circulation disorders, antiarrhythmic symptoms are indicated. In case of F drug choice, as in non-rheumatic myocarditis, amiodarone (cordarone). For the prevention of thrombosis and embolism, anticoagulants should be used, which are indicated to overcome the manifestations of cardiac decompensation and hypercoagulability.

In HCM, a lot of space is taken by medical preparations to improve the diastolic function of the myocardium and change the degree of obstruction of the visible tract of the left duct. They include beta-blockers (anaprilin), calcium ion antagonists (finoptin and corinfar) and cordarone. The stench also relieves heart arrhythmia and changes the risk of rapt death. With the development of CHF, diuretics, vasodilators are contraindicated.

The triumph of the RKMP presents great difficulties and, most of all, less effective. Stopping glucocorticoid With that immunosuppressant, yakі allow for progression of disease progression only at the early stages of development. Vykoristovuyut also heart glycosides in small doses and diuretics. Surgical methods for the treatment of CMP are being developed, proteo stinks are still ineffective.

MYOCARDIODYSTROPHY(M). It is an injury to the mind of the heart, confused by the disruption of biochemical processes under the influx of various etiological factors. Before rozvitku M mozhut prizvesti rіznomanіtnі gostrі that hronіchnі іnfektsії that іntoksikatsії have to chislі lіkarskimi drugs avіtamіnozi, torn down harchuvannya (Especially bіlkovogo) vpliv fіzichnih agentіv (radіatsіya, nevagomіst, peregrіvannya) fіzichne perenapruga, torn down nervovo-vegetativnoї that endokrinnoї regulyatsії. іn The classic butt of M is tonsillocardial syndrome. The main symptoms of M are sedation, weakness, dyspnea with physical anxiety, weakened sonority of heart tones, presence of III tone and non-intense systole murmur at the top. Rosemary hearts are normal or a little more. Insufficiency of blood circulation begins to develop. Laboratory indicators are not changed. The main method of recognizing M є ECG, for which zsuv is indicated in the isolation of the segment ST that amplitude reduction or tooth inversion T, can disrupt the rhythm of the heart.

Likuvannya. Aimed at the use of the cause of M and the reduction of metabolic processes in the myocardium, for which there can be vikoristan riboxin, potassium orotate, polyvitamin and other.

MYOCARDITIS NEREUMATIC(MN). Injury of the m'yaza of the heart, with a development of non-specific changes in the ignition character. MN is most often blamed on children with severe viral infections. Coxsackie viruses, especially groups A and B, and ECHO, are expected to have the greatest significance. Other etiological factors include influenza viruses and parainfluenza, bark, mumps, cytomegalovirus and other. MNs can be caused by bacteria, rickettsiae, fungi and other infectious agents. We also see MN of non-infectious treatment, allergic and toxic myocarditis. In rich cases, the etiology of MN cannot be established.

Clinical picture. MNs in children are stunned at all times. The stinks are born (internal) and they are born. They are distinguished by polymorphism of clinical manifestations and varying severity of injury. In children, scars of a general character (weakness, malaise, stupor) and symptoms associated with the development of ZSP are more important. Cough, backache, dyspeptic manifestations caused by congestive manifestations in the system of the great stake of blood circulation, liver enlargement, swelling are seen until the last. More often, children experience heartbeat, interruptions, pain in the area of ​​the heart and in. tone), systolic murmur, disturbed by the rhythm of the heart and conduction. As a rule, there is a decrease in the speed of the myocardium, often damage to the diastolic and pumping function of the heart. On the ECG with MN, a series of disrupted rhythm and conduction (extrasystole, atrioventricular blockade I-II, and less than III stage and in.) characteristic changes in the segment ST in the appearance of a decrease in the isolation and amplitude of the tooth T, some kind of cohesion, two-phase chi negative. In case of roentgenological follow-up, accelerated pulsation and smoothness of the heart arcs, improvement of the third degree of expansion, more left beats are indicated. EchoCG shows dilatation of the left atrium and the left ventricle, often of the right heart. At whom myocardium is no more than normal. On the basis of EchoCG, the steps of the decrease in the short, diastolic and pumping functions of the myocardium are restored. Laboratory indicators in MN are mostly unchanged. The presence of humoral disorders, sound, associated with the main illnesses, and the anatomy of which myocarditis has developed.

In the fallow, in the severity of clinical manifestations, mild, moderately important forms of MN are seen. At light form subjective symptoms are often daily, and objective data are minimal. Between the hearts perebuvayut at the borders of the norms and trochs expanded. Tony troha muffled or overpowering sonority. Systolic murmur may be functional, vislukhovuetsya at the top of the heart or along the left edge of the sternum. The frequency of the rhythm is not changed, or it may be associated with tachycardia, more likely for bradycardia. The speed of the myocardium is slightly reduced, indicators of the pumping function of the heart can be in the range of normal or slightly reduced. There are no signs of natural manifestations in mild forms of MN. On the ECG, disturbances in the processes of repolarization of the ducts, possibly an increase in electrical systole, disturbances in the rhythm of the heart and conduction are recorded.

At moderate form MN ailments often sting for a swedish stump that ass, as it is often blamed for physical anxiety. When looking around, there is tachycardia, more frequent breathing, sometimes there are persistent rales in the legs, perhaps a small increase in the liver. The symptomatology was assigned to confirm the presence of symptoms of CHF at the stage. Per-kutornі between hearts zbіlsheі, more vlіvo. Tony in most ailments is muffled, with aus-cultivation and FCG, a three-membered heart rhythm is indicated. Systolic noise is more often heard at the top, and is weak or moderate in intensity. The murmur may be a myocardial pouch or due to the development of mitral valve insufficiency. On the ECG, the cream disruption of the processes of repolarization, it is possible to reduce the amplitude of the teeth in the complex QRS, different disruption to the rhythm of the heart and conduction and in. Behind the EchoCG data, there is a dilatation of the empty hearts not only of the left, but of the right hearts, as well as a greater deterioration in the pumping function of the left ventricle.

At severe form MN the camp of an ailment sounds heavy, or even more severe. The back is seen in the calm, in the act of breathing, additional muscles take part. Sharply pronounced clinical manifestations of impaired blood circulation, in their own lives, they are more important than the presence of a great number. Significantly, that sore liver on palpation is significantly relieved, pastosity of tissue and swelling are often noted. Also, in severe forms of MN, blood circulation damage occurs in stage IB. Percussion and radiologically, cardiomegaly is recognized as an increase in heart rate. The tones are muffled and deaf, the rhythm of the gallop is pronounced, in its own FKG it is often registered as III, and IV tone. The intensity of the systole murmur at the top is different, due to a number of factors; However, it does not depend on the stage of mitral re-gurgitation, which is responsible for the data of Doppler echocardiography. In some children, there is a systolic murmur over a sword-like child and in the fourth intercostal ribs, a levoruch in the sternum, due to an apneal insufficiency of the trispinal valve. Noise in case of visual insufficiency of the tricuspid valve is less pronounced and is often felt in the breath (River-Corvalho symptom). Often reduced arterial pressure. The pulse is often not only accelerations, but a weak tension.

To extreme options MN lie Abramov-Fiedler myocarditis, which is characterized by progressive overshoot, refractory heart failure and an even worse prognosis.

Leaks. Distinguish hostrі, pіdgostrі, protracted and chronic MN. To speak about the hot flow in that fluctuation, as if changing from the side of the heart, it is known for a stretch of 1 - 1.5 mіs. With their savings with a stretch of 2-3 minutes, it is noted that MN was overrun. About the protracted nature of MN, to note the symptoms of damage to the heart, which are saved for 4-5 months. For the presence of a clear accommodating dynamics of clinical symptoms for over 6 months, it was taken into account that MN having taken a chronic overtravel. Many clinicians consider chronic MN to dilated cardiomyopathy.

Differential diagnostics. Mild forms of myocarditis often differentiate into myocardial dystrophy, important forms - into dilated cardiomyopathy.

Likuvannya. Directed more importantly for strangulation of the ignition process and the elimination of symptoms of impaired blood flow. For this reason, I use the vicorist method for non-steroidal anti-seizure medications. These doses and trivality are the same as those for rheumatism. Glkzhokortikoidy zastosovuyut less with important forms of MN, if the effect of non-steroidal drugs is daily. For the expansion of metabolic processes, riboxin, potassium orotate, cocarboxylase and other can be used. The exultation of congestive heart failure follows a primal principle. It’s less important to take it to heart, but with myocarditis, sensitivity to cardiac glycosides is often increased. With arrhythmias, the heart beats for an hour! the need for finding antiarrhythmic diseases. Most of them can cause cardio-depressive symptoms. In conjunction with cym, it should be noted that amiodarone (cordarone), which has been shown to be effective in other antiarrhythmic drugs, does not have a significant negative effect on the inotropic function of the myocardium.

Forecast. With hospitable, subhospitable and protracted forms of MN, the majority of moodiness is amiable, with a splash of exuberance, it becomes more dressed. Illnesses with chronic MI die due to progressive heart failure, or death is more likely to occur as soon as the rhythm of the heart is disrupted or 1 rhomboembolism.

DAMAGE TO THE RHYTHM OF THE HEART AND PERFORMANCE.Є last change of function to automatism, alertness and conductivity. The main clinical manifestations are changes in the frequency of heart rates (HR), which go beyond the boundaries of normal beats, rhythm irregularity, changes in the localization of the rhythm and disruption of the conductivity of the impulse on different plots of the wire system. Three main groups of arrhythmias are seen in the fallow in the mechanism of blame: 1) arrhythmias, blamed for any manifestations of impaired illumination of the impulse; 2) arrhythmias, disturbances in impaired conduction; 3) arrhythmias associated with disruptions like conduction, and the process of making an impulse.

From a practical point of view, the greatest interest ps presenting the onset of arrhythmia and heart blockade: extrasystole, tachyarrhythmia (paroxysmal D1 non-paroxysmal tachycardia, Mi miya), weakness syndrome of the sinus node, povna atr» n< овентрикулярная блокада, трепетание и мерцанв ч* (фибрилляция) желудочков. Эти аритмии сопрововд- ю ются субъективными проявлениями, часто приводят! Ч нарушению гемодинамики, в связи с чем требуют ле- ci чения. П

Arrhythmia is fleeting, but merekhtinnya atrium, and disruption of the rhythm of the heart, which is characterized by chaotic shortness of the atrium with a frequency of 350-700 per whilina. On the ECG, the replacement of the teeth is registered with a slight atrial fibrillation (whirling) of a different amplitude and form, which is more common in cases II, HI, and VF and in the right thoracic cavity (Vi and V2). Tremtіnnya atrial fibrillation in the presence of a fleeting arrhythmias is accompanied by a lesser degree (up to 350 per whilina) and regular rapid atrial fibrillation. Tremtinnya atrial fibrillation on the ECG is manifested in the appearance of regular atrial flutters, in the distance one in one on a equal day. Interval between complexes QRS in case of merehti before the heart, there is a difference in trivality, in case of complex QRS do not expand, but change the shape and amplitude. In case of atrial fibrillation, the number of ventricular complexes is less than that of the atrial hiatus, which is associated with functional atrioventricular blockade, which may be 2:1, 3:1, etc.

Merekhtinnya and tripartite atrial fibrillation in children occurs in case of various diseases of the heart: congenital and swelling defects, myocarditis, cardio-myopathies and others. Due to the presence of organic pathology of the heart, it is rare to speak of idiopathic transient arrhythmia.

Likuvannya. When the heart is ill, the merekhtinnya and the tripartite atrium are accompanied by an increase in the severity of the blood circulation disorder. Antiarrhythmic symptoms that zastosovuyutsya, sound ineffective, vikoristovuvat їx not enough, more so, that stench, giving a negative inotropic effect, can lead to hemodynamic deterioration. Headache in such fluctuations helps to regulate to normal numbers the frequency of mucosal veins, which reaches the congestion of cardiac glycosides. The use of antiarrhythmic drugs (quinidine, amiodarone, or cordarone, etc.) is true only in idiopathic forms of fleeting arrhythmia and in a number of cases with myocarditis. Surgical methods are being successfully developed to treat the merexton and the trembling of the heart.

Povna atrioventricular blockade manifested by a new roz'dnanistyu diyalnosti atrial fibrillation and shlunochkiv. Clinically, it is characterized by bradycardia (sound less than 60 heart sounds soon for wheezing), as it can be accompanied by confusion or attacks of inattention (Morgan-Adams-Stokes attacks). As a result of bradycardia, arterial pressure develops, myocardial hypertrophy develops, dilatation of the empty heart occurs due to ventricular insufficiency of the mitral valve, or rather of the tristool valve. It is not often necessary to bring a mustache to the vindication of the ZSP. The more often the frequency of shlunochkovyh is sooner, the more often they blame the attacks on the loss of information and the important disorder of the blood circulation. On ECG teeth R postures are registered with the complex QRS, h higher frequency. At what complex QRS can be normal changes.

The treatment of new atrioventricular blockade is associated with the use of attacks and the use of evidence or their equivalents (zadrin pid tongue, atropine pidshkirno or internally). Heart glycosides, diuretics, peripheral vasodilators and other drugs are prescribed for the presence of CHF. With the appearance of attacks by Mor-Gagne-Adams-Stokes, or the development of CHF is caused by the implantation of a pacemaker.

Syndrome early damage slunochkіv pov'yazaniya z nayavnistyu dodatkovyh conductive paths, such as impulses are carried out in the atrium to slunotchkiv, bypassing the atrioventricular zadnannya. The most common variants of pre-arousal syndrome are Wolff-Parkinson-on-White (WPW) syndrome and shortened interval syndrome P-Q(R), also known as Clerk-Le-v-Cristesco syndrome (CLC). Criteria for Wolf-f-Parkinson-White syndrome є rapid interval P-Q(R), presence of additional quill (delta quill), expansion and slight deformation of the complex QRS, segment change ST i tooth T. Clerk-Levi-Christesco syndrome is characterized by a short interval PQ(R) less than 0.12 s for the daily change of the complex QRS. Wake-up syndrome can be installed only on the ECG base. Quite often wines are accompanied by attacks of paroxysmal tachycardia.

Syndrome sinus weakness vuzla (SSSU) causes a decrease in the function of the sinus node, which is manifested by depression and the formation and (or) conduction of an impulse. Razrіznyayut ugliness and nabuty SSSU. Vin can be true (organic) and functional, related to vagotonia. The main clinical manifestations of SSSU are sinus bradycardia, bradycardia-tachycardia syndrome, sinoauricular block, non-paroxysmal tachycardia and transient arrhythmia.

Jubilee of the SSSU before passing the entrances, directing them to the front and taking the attacks of Morgagne-Adams-Stokes. Prote zastosovuvani in their preparations (bellaspon, oxyphedrin, chi ildamen) give a sing effect only for SSSU, zumovlenny vagotonієyu. In SSSU, associated with organic lesions of the sinus node, the only effective is the implantation of a piece of water to the rhythm, which is due to the obviousness of the syncope and their equivalents.

Non-paroxysmal tachycardia (NT)(chronic ectopic tachycardia) in paroxysmal, more moderate heart rate (120-180 per quill), rape cob and end, more trivality, irregular rhythm (possible fluctuation of rhythm frequency at great boundaries), less effective antiarrhythmic drugs. Yak i PT, both supraventricular (atrial and atrioventricular) and shlunochkovy. Non-paroxysmal tachycardia can be fast and reverse, if the attacks of the accelerated hearts are quickly drawn out of the sinus twitching. Rest may be different trivality, which by a significant world signifies the particularity of the overrun of NT.

The treatment of NT is more effective in trivial (up to the establishment of sinus rhythm) oral administration of antiarrhythmic drugs, with amiodarone (cordarone) being the most effective. For the presence of symptoms of CHF, antiarrhythmic drugs should be taken with cardiac glycosides, if intravenous administration is prescribed at moderate doses.

Surgical treatment of tachyarrhythmia is carried out for the duration of the effect in medical therapy. Like in PT, so in NT, there are retinal appendages or destruction of the ectopic fossa.

Paroxysmal tachycardia(PT) is characterized by attacks of accelerated heart rates, yakі raptovo za'yavlyayutsya and raptovo pripinyayutsya. Come on often accompanied by blіdіsty skіrnіh crooked, drunkenness, pain in the abdomen and vomit, and other fluctuations in body temperature. Sickness to complain of heartbeat, pulsation in the cloaks, lack of repetition, confusion, darkening in the eyes. Sometimes stinks show fear. Distinguish the atrial, atrioventricular (vuzlov) and shlunochkovu form of PT. In atrial form of PT, the rhythm is correct, the heart rate fluctuates from 180 to 220 per quill, swollen veins pulsate from the pulse rate on the promeneutic artery. A tooth is registered on the ECG R, which sound is changed, interval PQ(R) normal chi submotion. Complex QRS often no change, yogo expansion of that deformation is indicated in Wolff-Parkinson-White syndrome in times of antegrade conduction of the impulse through the accessory pathways and functional blockade of one of the lower bundles of the Hisa (often for the right). Secondary segment changes are also registered ST that tooth inversion T.

With atrioventricular form of PT teeth R daily or are registered in front of the complex QRS or behind the new one, the stench is negative, their form is changed. Shlunochkovy complexes often do not change, but in a number of depressions the stench is widened and deformed. Often do not go to reveal a tooth R, in connection with which it becomes impossible to infuse the atrioventricular form of PT from the atrial. Therefore, in similar ways to talk about supraventricular (supraventricular) PT.

In the case of slunic form of PT, the frequency of slunotchkovyh soon fluctuates from 140 to 220 per whilin. The frequency of atrial fibrillation is within the norm, in connection with which there is a large difference in the frequency of pulsation of the cervical veins and the pulse over the promeneus artery. During auscultation, a strengthening of the 1st tone (“harmonic” tone) is periodically indicated, and splitting of the 1st and 2nd heart tones is also typical. Visible tooth on ECG R, extensions and deformations complex QRS, segment ST i prong T spread discordantly according to the distance to the main tooth of the complex QRS. Sometimes fixed teeth are registered R s frequency that matches the frequency of the rhythm of a healthy child. Shlunochkovy form of PT in children rarely develops.

Likuvannya PT is directed at the adoption of attacks. The lower back is blocked by the method of reflex injection on the tone of the bulging nerve: pressure on the eyes of the apple, root of the tongue, massage of the carotid sinus and other. Qi priyomi allow us to use more than an attack of supraventricular tachycardia, moreover, mainly in the early term of their vindication. One hour vikoristovuyut sedative zasobi (seduksen pіd yazyk). Antiarrhythmic drugs are prescribed for the effect: finoptin, anaprilin, etmo-zin, novocainamide and in. Їx to give internally one time at a perennial dosing. For the duration of the effect for 1 year, the attack was followed by parenteral injection of antiarrhythmic drugs. In the case of shlunochkovy form of PT, the most effective are novocaine and lidocaine. In patients with CHF, the attack should be initiated by intravenous administration of cardiac glycosides (strophanthin, isolanide, etc.). When attacks of PT, which are often repeated, with a prophylactic method, prescribe antiarrhythmic drugs and orally for a three-hour period. In cases of ineffectiveness of medical therapy, the attack of PT is used by the defibrillation method.

Extrasystole - post-cherish that early awakening of the heart. To the most disturbed rhythm of the heart activity, both functional and organic movement. Distinguish supraventricular (atrial and node) and ductal extrasystoles. On the ECG at atrial extrasystole order with forward registration of teeth R that complex QRS changes in the shape and polarity of the tooth are indicated R. interval PQ(R) can be normal, shorten or lower. Complex QRS no changes, only with a functional blockade of one of the lower bundle of His veins of deformities and expansions. When blocking atrial extrasystoles, an extra tooth is registered R, complex QRS daily.

Vuzlovі (atrioventricular) extrasystoles characterized by the fact that the tooth R negative, registered before the complex QRS otherwise, if something new, it is not uncommon for a day to get in touch with them, that they get angry with the rest. Complex QRSne changes, but a number of deviations may have expansions and deformations, which is associated with a functional blockade of one of the lower bundles of Hisa.

In case of supraventricular extrasystole, you will notice an irregular compensatory pause.

At duodenal extrasystole daily toothbrush R in front of the complex QRS, expansion and deformation, segment ST displacements discordantly in relation to the main tooth to the complex QRS, a compensatory pause is registered (with the presence of mucus complexes until the next extrasystole "comes to the subvariant interval R-R).

Extrasystole of a functional walk! zdebіlshoy not vmagaє lіkuvannya. Why is it due to the fact that extrasystoles do not accompany children! subjective manifestations do not indicate a hemodynamic disorder. Moreover, antiarrhythmic symptoms in the majority of fluctuations mean a decrease or elimination of extrasystole only during the period of lupus. After seeing their extrasystoles, they are inspired by the forward frequency. In case of extrasystole, which developed on aphids of organic pathology, the need to prescribe antiarrhythmic drugs is often blamed. It was mentioned that heart arrhythmias in depression often lead to an increase in the severity of blood circulation disorders.

Likuvannya. Antiarrhythmic drugs, which are vicorous in the treatment of arrhythmias of the heart, are combined in 4 groups:

1) membrane-stable, or quinine-non-similar (quinidine, novocainamide, etmozine, etacizine, aymalin, alapinine, disopyramide, or ritmodan, difenin, lidocaine),

2) beta-blockers (anaprilin, or obzidan, pindolol, or visken, that in),

3) calcium ion antagonism (verapamil, or finoptin, nifedipine, or corinfar, diltiazem and other),

4) amiodarone, or cordarone, and bretyl.

With extrasystoles, you can beat any drug. However, take care of their side effects, especially the negative inotropic effect and increase in conductivity. The circulatory system in children with CHF has been observed to overdo amiodarone (cordarone), which has little effect on the speed of the myocardium.

Average therapeutic doses of antiarrhythmic drugs for children are given in Table. 16.

INSUFFICIENCY OF BLOOD. Two main factors lead to the development of insufficiency of blood circulation: damage to the pumping function of the heart and the tone of the peripheral vessels. In connection with cym, the cardiac and vascular forms of circulatory insufficiency are distinguished. Quite often the stench is common, and the term "cardio-vascular insufficiency" is often used.

Heart failure. It develops under the influx of various officials, including the most frequent heart attacks, myocardial damage due to the ignition process and deep exchange injuries. Distinguish between energy-dynamic and hemodynamic, or congestive, forms of heart failure. Energy-dynamic heart failure (according to Hegglin) is manifested by shortened mechanical systole and is diagnosed by an early appearance of the II tone on FCG. It develops as a result of disruption of metabolic processes in the myocardium and is associated with severe infections, hypokalemia, diabetic coma and others. ).

Table 16

Doses of antiarrhythmic drugs for children

CHF is either left-sided or right-sided. However, the majority of depressions are characterized by both left-sided and right-sided (total) heart failure. In case of some ailments, the symptoms of left duct insufficiency are more important and earlier blamed, for others - signs of insufficiency of the right duct.

CHF, like a livoshlunochkova, so a right shlunochkova, both acute and chronic. Gostra heart failure develops rapidly, quickly recognizing after repeated therapeutic visits or causing the death of a sick person. Chronic heart failure is blamed step by step, a three-hour hour is saved, periodically increases and changes under the influx of glee.

Gostra levoshlunochkovy insufficiency is associated with a sharp decrease in the pumping function of the left septum and a slight increase in blood stasis in legenia. Sustrichaetsya in ailments with mitral and aortic heart defects, congenital vadas (aortic stenosis, coarctation of the aorta and other), myocardial ailments (myocarditis and cardiomyopathy) and other. Clinically, it is manifested by syndromes of cardiac asthma and congestion of the lungs.

Cardiac asthma priymaєtsya like a pochatkova stage of a swollen lung. With it, it is possible to seep out of the bloodstream from the vessel bed into the interstitial (mіzhnu) tissue, so that there may be an interstitial draft of the legends. When the lungs are tight, the rіdina from the interstitial space will pass into the alveoli. In connection with cym tsiu, the phase of acute levoslunochkovo insufficiency is called the alveolar stage.

Cardiac asthma is manifested by attacks of the venom, which often causes physical and emotional overstrain. In a sickly raptov, there is often a superficial dyhannia, a cough, dry on the back, then from the sight of serous sputum. The legens have dry and watery rales. Cardiac asthma does not always change into a flaming picture of the legends, especially if you come in your own time.

When developing out of the blue increase the glare of the skin and cyanosis, the breath becomes part and screeching. When coughing, one can see sputum sputum of a single color, possibly streaks of blood. In legenia, there is a mass of various-caliber wheezes, especially in the middle and upper ventricles.

Likuvannya. Directed us to change the vice in a small amount of blood circulation and the usunennia of hypoxia. The ailing man is put on a drunken camp, on the lower ends are put vein jguti. To reduce the pressure in a small amount of blood flow, change the volume of circulating blood and improve the pumping function of the heart, furosmide and euphylin should be administered internally. In case of congestion, the leg is blocked by glucocorticoids, thus reducing the penetration of the alveolar-capillary membranes and causing bronchospasmolytic disease. For the use of psychomotor arousal, seduxen, droperidol and fentanil are used. In the rest of the years, peripheral vasodilators (nitroglycerin and sodium nitropruside) become more and more stagnant, so they should be administered intravenously dropwise. In case of hypokinetic type of blood circulation, heart glycosides (strophanthin, digoxin and other) and sympathomimetic amines (dopamine and other) are used. In case of hyperkinetic type of blood circulation in the heart, glycosides are not indicated, ganglionic blockers (pentamin, benzohexon, etc.) are prescribed. To fight against pino-illumination, vicorist stumps (ethyl alcohol and antifomsilane). Perform immediate correction of dihalic acidosis and electrolyte balance.

Gostra right-sided insufficiencyє the result of a sharp pressure on the right heart. It is blamed for thromboembolism of the stovbur of the legenous artery and cilia, congenital heart defects (stenosis of the legenous artery, Ebstein's anomaly, etc.), severe attacks of bronchial asthma and other. It develops rapidly: mittevo z'yavlyayutsya almost breathless sharp weakness. The cyanosis is growing rapidly, the skin is creased in cold sweat, or the signs of the central venous pressure increase and stagnation in a great amount of blood circulation are increasing: the cervical veins swell, the liver becomes swollen, as if becoming sick. The pulse is weak, it means frequent. Arterial pressure is reduced.

Likuvannya. To carry out s urahuvannyam cause, scho priyaє development of a sharp ambition of the right shlunotochka. In case of bronchial asthma, broncho-spasmolytic diseases (eufilin, glucocorticoids, etc.) should be administered, oxygen therapy should be carried out. With CHD, heart glycosides in small doses and intravenous diuretics are used. Ill with thromboembolism of the legenous artery, heparin and fibrinolytic diseases are prescribed. Effectively, peripheral vasodilators (nitroglycerin and nitropruside intravenously and nitroglycerin intravenously), yak, adhering to the deposition of blood on the periphery, can improve the function of the right duct.

Chronic heart failure (CHF)є serious complication of heart disease and other organs, which obtyazhuє їх overbіg ta prognosis. The main clinical symptoms of levoshlunochkovy CHF are buttocks, tachycardia, cyanosis, persistent wheezing in the legs. Rozvivaєtsya at zahvoryuvannyah scho suprovodzhuyutsya urazhennyam abo perevantazhennyam lіvih vіddіlіv sericite, zokrema at mіokarditah, kardіomіopatіyah, mіtralnih that aortal sericite, hronіchnih bronholegenevih zahvoryuvannyah (mu-kovіstsidoz, fіbrozuyuchy alveolіt that іn.) Mnozhinnih tromboemterіyah in sistemі tromboembolії. most characteristic symptoms cyanosis, swelling of the neck veins, liver enlargement, diuresis change, swelling, ascites and other.

In our country, the severity of CHF is characterized by the clinical classification of Strazhesko and Vasilenko, which apparently distinguishes 3 stages of heart failure.

Stage I - latent; clinical manifestations of heart failure (buttocks and tachycardia) are blamed less for physical stress.

Stage II - buttocks and tachycardia are observed at rest, with an insignificant physical anxiety they are overcome. We see PA and PB stages of CHF. At the PA stage, the symptoms of impaired blood circulation are not sharply expressed: wheezing in the legs is often daily, the liver protrudes from the edge of the costal arch no more than 1-2 cm lower, the bumps do not show up, the pastosity of the tissues can be less. At the PB stage, a significant back is seen, which is often heard; stagnant wheezing in the legs, the liver protrudes from the edge of the costal arch by 4-5 cm and more, often there are signs of squeezing of the radii into the husband (ascites, hydropericardium and hydrothorax). The function of the internal organs - the liver, liver, etc. is often damaged.

Stage III - dystrophic, chi terminal. Severe manifestations of stasis, irreversible changes in the functions of internal organs and homeostasis.

Objective indicators of CHF stage II-III are a decrease in shock and low volume of the heart, an increase in blood flow, an increase in the mass of circulating blood, an increase in venous pressure and in.

Likuvannya. Depends on the nature of the underlying illness, severity and features of hemodynamic impairment. Likuvalni come to include the organization of the correct rukhovo regimen and eating, oxygen therapy and the establishment of medicinal products. Assign suvorium bedtime or lighter-lizhkovy regime. Suvoriy bed rest for indications for children with acute myocarditis. Diseases of the heart, cardiomyopathy and other ailments do not suffer from strict dehydration of rukhovo activity. In case of CHF N-III stage, it is necessary to take care of the ailment of the nodule. I am guilty of revenge, I will suffice for a quantity of vitamins and microelements, I will deplete the quantity of salt. Vykorivuyutsya easily acquired kharchovy products. With the improvement of diuresis, a small amount of native land is surrounded, which is drunk.

Pharmaceutical preparations, which are used in the treatment of CHF, are divided into two main groups. Prior to the first group, there are medications that increase the speed of the myocardium. The main heart glycosides (strophanthin, corglicon, digoxin, isolanide, digitoxin and others.) The other group is composed of pharmacological measures to treat the te-modinamichnogo razvantazhennya heart for the lowering of the front-I pіslyanavantazhennya (diuretics and peripheral vasodilators).

Heart glycosides on the cob are prescribed at the doses of the highest doses, then we switch to the last dose of the highest doses (Table 17). The most common vicarious method is the middle (2-3 days) and the most common method of degitalization, if the drug from the cob itself is stagnant, it is prescribed at a moderate dose.

Table 17

Doses of heart glucose for children

The criterion for the increase in the need for the transition to subtreated doses is the positive dynamics of CHF symptoms: a decrease in the heart rhythm, a change in the back and the expansion of the liver, an increase in diuresis and in. The process of liquation has an electrocardiographic control. Possible side effects, including the most common dyspeptic manifestations, arrhythmia of the heart, impaired conduction and others. For її viniknennі next change the dose of the drug chi timchasovo yogo kasuvati. In cases of serious violations of the heart rhythm, intravenously inject potassium preparations (potassium chloride, panangin), stop antiarrhythmic symptoms.

In the treatment of CHF, diuretics play a great role, the main signs of recognition of which are diabetic syndrome. Furo-semide (lasix), urethritis and hypothiazide are most frequently used, the average single dose of which is 1 mg/kg. Tsі diuretics vikoristovuyut to liquidation of bloating syndrome. You should often take potassium-sparing sechoginnimi preparations, to which veroshpiron, amiloride and triamterene are mentioned. Veroshpiron in the first 5-6 days is administered internally at an additional dose of 5-6 mg/kg, then the dose is reduced to 1-2 mg/kg.

In the rest of the years, a wide range of congestion in the treatment of CHF was taken away by vasodilators, a favorable hemodynamic effect of some indications for a decrease in the transmission of blood pressure (Table 18). Some vasodilators (phentolamine, hydralazine, nifedipine, captopril, or capoten, etc.) have an expansion of the arterial vessels, which leads to a decrease in the pressure. Other preparations (nitrates, molsidomin) increase the number of judges, causing a decrease in predilection. Active medicinal speech (prazosin, sodium nitro-prusid and іn) give vasodilatory effect both on arterial, and on vein vessels, and by the same token, they reduce the pre- and post-tension. Of particular interest is an angiotensin-converting enzyme inhibitor, the main representative of which is capoten (captopril). The drug can be vicoristovuvati trivaliy hour s minimal risk vindication of side effects. Vіn helps to reduce the severity of blood circulation disorders and improve the survival of patients with CHF. Vasodilators are not indicated in aortic stenosis and legenous artery, coarctation of the aorta, IGCC and low numbers of arterial pressure.

Table 18

Doses of peripheral vasodilators for children

When treating CHF, it is necessary to conduct periodic monitoring of the amount of electrolytes in the blood. In case of low potassium levels, panangin, potassium chloride and other drugs are prescribed.

In case of treatment of CHF, drugs are also used to improve the exchange processes in the heart (polyvitamin, riboxin, potassium orotate and other). It is important to come in, create for the adoption of the cause, which will cure the blame for heart failure. Thus, in case of myocarditis, protizapalnye zastozovuyut zabob, with arrhythmias - antiarrhythmic drugs, etc. Often stench plays a vital role in the elimination of circulatory insufficiency.

Judicial insufficiency. Distinguish between acute and chronic vascular insufficiency. Hospital insufficiency is clinically manifested in visual insomnia, collapse and shock.

Nepritomnіst - the easiest form of acute vascular insufficiency. Blame for a break, strong pain sensations, a sharp change in the position of the body and in. May be a manifestation of some important illness (myocarditis, infection, intoxication).

The clinical picture is associated with short-term ischemia of the brain: ailments are raptly pale, croaking in a cold sweat, boredom appears, darkening in the eyes, confusion. If it is necessary to guard against the loss of information, which is three times a few seconds up to 1-2 minutes. The pulse is weak, quick. Arterial pressure drops.

Likuvannya. The ailing person is laid in a horizontal position with his head down, sprinkled with cold water, and ammonia is inhaled. Introduce cordiamin, norepinephrine or mezaton subcutaneously. In more important moods, heart massage and SHVL are performed.

Collapse is an important form of acute vascular insufficiency, which accompanies greater manifestations and impaired functions of internal organs. It develops mainly at the height of any infectious disease or a toxic-septic state. I will become ill when I am accompanied by a sharp handicap. To turn respect, the blіdіst is pronounced, the sіruvaty chi sіruvato-earthly vіdtinok skіrnih pokrivіv. Figures are veiled, eyes are lit. The ailment is mlyavy, it reacts weakly to the present, the protection is saved. Dihannya is superficial, hastened. Tony's heart is muffled, the pulse is weak, partial. Arterial pressure drops.

Likuvannya. To carry out come in, direct to the fight against hypovolemia, movement of peripheral vessels and reduction of microcirculation. Introduce cordiamin, norepinephrine or mezaton subcutaneously. In severe depressions, glucocorticoids should be used: prednisolone up to 60-100 mg and more internally or internally. Carry out correction of the electrolyte balance and acid-base balance.

Shock is an important reaction of the body to an overpowered undertraining, which is characterized by a sharp deterioration in the functions of the life of important organs and systems. One of the cardinal symptoms of shock is damage to the circulatory system. The shock itself can be brought to severe vascular insufficiency.

Depending on the etiological factor, a small number of types of shock are distinguished: traumatic, opioid, anaphylactic, cardiogenic and other. Two stages are seen as a stretch of shock: arousal (erectile) and galvanization (torpidna). In the erectile stage of ailments, awakenings, restless. The truth is clear. Shkіrnі covers bіdі. Zіnitsі expansion. Acceleration pulse, arterial pressure of movement. At the torpid stage, adynamia, galmation (stupor) set in. Appearance of a mask-like, pale, open with a cold sweat. Cyanosis settles down, dermographism develops. Zіnitsі expanded, reduced all kinds of sensitivity. Tony's heart is sharply muffled. The pulse is threadlike, partial. Arterial pressure significantly decreases or does not show.

Likuvannya. First of all, come in and try to find out the reasons for the shock. The pain syndrome can be overcome by non-injection of analgesics: promedol, morphine, fentanyl and other. When bleeding, carry out the terms of blood transfusion. To improve the tone of the vessels, enter norepinephrine, mezaton, glucocorticoids. Indications for neuroleptics and sedatives. In case of cardiogenic shock, cardiac glycosides, sympathomimetic reactions (dopamine), and peripheral vasodilators are also congested. Zdiisnyuyut correction of the acid-base state, electrolyte balance. Ailing next to wake up, now they are covered with heating pads. In case of anuria, stimulate diuresis with additional diuretics (furosemide intravenously).

PERICARDITIS. Inflammation of the heart shirt (pericardium), due to various etiological factors. The stinks are infectious and non-infectious. Infectious pericarditis can be divided into bacterial, viral, tubercular, fungal, ricketsial and other. Allergic, promeneutic, uremic pericarditis can be classified as non-infectious. The stench is also sickened by blood poisoning, hemorrhagic diathesis, mourning, systemic disease of good tissue, evil newborns and others. Okremo see hostry benign, or idiopathic, pericarditis, the etiology of which cannot be established. Distinguish hospital and chronic pericarditis

Pericarditis hostri. There are a few clinical variants of acute pericarditis: dry (fibrinous), exudative, purulent and rotten.

At acute dry pericarditis inflammation of the pericardium is accompanied by fibrin deposits, due to which the surface of the leaf becomes short. It is not necessary to bring up the noise of the pericardial trench - the main clinical symptom of dry pericarditis. Crimsonly, dry pericarditis is often manifested by a rise in body temperature, pain in the heart, as if dull, to crush the character, do not know nitroglycerin and do not irradiate. Pain is often relieved with inhalation, in connection with which there is diarrhea in patients with dry pericarditis on the surface. The percussion between the hearts does not sound wider, the tone is weaker than the normal sonority. The noise of rubbing the pericardium is more often heard in the third-fourth intercostal space, but above the sternum, sometimes above the heart area, less often on the top. Wines are characterized by sluggishness, sluggishness, it is filthy carried out behind the borders of the heart; On the FCG, the noise rubbing the pericardium of representations with high-frequency components, in the distance to the I tone, is disturbed by the smallness of the amplitude and the trivality. On the ECG in the first days, a shift up the segment is registered 8T' standard vіdvedennyah, nadalі vіn go down to іzolіnії, with which the tooth is narrowed T, which nadali becomes negative. There are no radiological changes in dry pericarditis.

At Acute exudative (violent) pericarditis there is an accumulation of excess fluid in the empty pericardium, in view of the amount of such a significant world to lay a clinical picture. In normal empty pericardium, trochs are more than 30 ml of free fluid. The subjective manifestation is most often the same as in dry pericarditis. In the early stages, if a small amount of radiance accumulates, the only manifestations of exudative pericarditis can be felt at the heart and pericardial murmur. With each other, hearts often do not improve. In a world with more rіdini, cardialgia and pericardial murmur may occur, although these important symptoms are often taken away in case of significant pericardial effusion.

In the world of zbіlshennya, the volume of the hearts expands between the hearts, the tones become muffled or deaf, and the upper posts do not show up. With the accumulation of a large amount of rіdini in the empty pericardium, signs of cardiac tamponade appear: back, swelling of the cervical veins, liver enlargement, ascites, swelling and other. In these depressions, signs of damage to the functions of internal organs are often observed. The dysphagia appears after the destruction of the passage of the stravokhod after the squeezing. Nerіdkіsnі decrease in appetite, tedium and vomiting. Tracheal compression can be accompanied by a dry cough that “barks”, and the left rotary nerve can be accompanied by a hoarse voice or an aphonia. On the ECG, the succession of the segment is suspected ST burn out in isolation, with a large number of radii - a decrease in the amplitude of the teeth P i complex QRS. Alternation of ECG teeth is often recorded. With death and a great number of radii, there are also radiographic signs of exudative pericarditis. The shadow of the heart is swollen, tricot or trapezoidal in shape. There is a weakening of the pulsation of the contours of the heart with a clear pulsation of the aorta, a change in the shape of the tone of the heart with a change in the position of the body and in various phases of breathing (sounding in the breath and expansion in the vision), shortening of the vascular bundle and in.

The greatest value in the diagnosis of exudative pericarditis is hoped for by the method of EchoCG, for the help of which an echovial expanse is indicated behind the contours of the heart to induce for an insignificant amount of fever, which is not clinically manifested.

Likuvannya. I look back at the nature of the main illness. In case of infectious pericarditis, antibiotics and non-steroidal anti-inflammatory drugs should be used, in case of pericarditis of tubercular etiology, anti-tuberculosis drugs should be used. In case of idiopathic pericarditis, pericarditis in patients with diffuse diseases of healthy tissue, blood system and other. blame the need for glucocorticoid intake. Simultaneously conduct symptomatic therapy. To fight against tamponade of the heart, a salt-free diet is prescribed, diuretics in case of calcification of the amount of blood that is being used, up to 500-600 ml per doba. Pericardial puncture should be performed with increasing symptoms of cardiac tamponade, suspected purulent pericarditis and for establishing the etiology of the disease.

Pericarditis chronic. They trap closer, but are characterized by a more important break and the highest forecast. The stench is exudative and adhesive.

Chronic exudative pericarditis may be a recent acute pericarditis, which in the first stages is manifested by the symptoms described above. It is not uncommon to watch for step-by-step developments, in connection with which, signs are often seen. Only from savings great number Vipotu z'yavlyayutsya clinical symptoms of compression (tamponade) of the heart. When this is not characteristic of pain in the heart, there is rarely a murmur of rubbing the pericardium.

Chronic adhesive pericarditisє last development of the spike process between the leaves of the pericardium. Vіn pochinaєtsya for the type of acute dry or exudative pericarditis, or from the very cob proceeds with an important development of the productive process. Adhesions can cause damage to the function of the heart, in conjunction with which adhesive pericarditis and sometimes asymptomatic. In solitary depressions, there is a murmur rubbing the pericardium and pleuropericardial murmurs. On FCG, a manifestation of the spike process can be an additional tone, which is called “systolic pleuropericardial tone”. Between the sheets of the pericardium, they sometimes appear suddenly, more often, the leaves of the pericardium themselves are called. In such cases, to speak about the shell of the heart, as often accompanied by impaired blood flow.

In case of adhesive constrictive pericarditis, there is pressure on the heart by a sharp sweating of the pericardium due to the great process of sclerosis. The heart spends zdatnіst until complete relaxation, after which the stagnant appearances develop, more importantly in a great number. Leading clinical symptoms are ass, puffiness, swelling of the neck veins, enlarged liver, ascites. In this case, the cramps on the legs are not typical or insignificant. Cordoni of the heart in the middle of the norm, tones, as a rule, are sonorous, the noise is not heard, and a non-intense systolic murmur is pronounced. Weak pulse, arterial pressure drops. Tachycardia became characteristic. Before typical symptoms, there is a high venous pressure. On FKG, an additional tone is often recorded in the protodiastole, which is seen as a change in the III tone. On the ECG, an expansion and an increase in the amplitude of the tooth are registered R with reduced voltage of the teeth in the complex QRS. At X-ray follow-up, there is a change in the pulsation of the contours of the heart, which often shows an expansion of the upper empty vein. There may be a slight increase in the thinness of the heart, often there is a flattening of the waist, which gives the thinner heart of the mitral configuration.

Likuvannya. In chronic pericarditis, we must fight against the main illnesses. Oskіlki etiologiyu often not vstanovitsya, zdebіlshoy be brought between symptomatic therapy. In case of severe forms of chronic pericarditis, conservative therapy is ineffective, in connection with which, surgical treatment is carried out. The operation is aimed at the temporal part of the pericardium - pericardiectomy, directed to the elimination of heart pressure.

CONGENITAL HEART DEFECTS (PSV). The most common pathology in a child's head. In the average for 1000 newborns, 7-8 children are revealed with various anomalies in the development of the heart of those great ships. In infants, stench becomes close to 86% of all cases of disease of the cardiovascular system.

Fallow in the beginning of a small amount of blood circulation PSV will be reduced in the 3rd group: with greater, with less and with normal legenevy blood flow. They also see PSV of a pale and blue type. Razpodil Air Force on "blіdі" and "blue" є we will understand, shards of one and the same defects of the heart can protіkat with cyanosis and without cyanosis.

Interventional septal defect (VSD). By frequency, they borrow 10-25% of all PSV. The defect is rotting in the membranous, more in the m'yazovy part of the septum. Impaired hemodynamics due to blood flow from the left duct to the right one, obligatory and straight to lie in the size of the defect and the difference in small and large amounts of blood circulation. Defects of small diseases (Tolochinov-Roger's ailment) are accompanied by insignificant deficiencies, as if they do not indicate significant hemodynamic disturbances. Zagalny camp is sick, children develop normally. The expansion of the heart is not increased, but there is a small increase in the left sliver. The only manifestation of the defect can be a rough, scraping systolic murmur in the third or fourth intercostal space. In case of great defects due to significant blood loss, hypervolemia of a small amount of blood circulation is observed, which leads to legenous hypertension. The rest is the main factor that determines the severity of clinical manifestations of the defect, the overrun and the prognosis.

In patients with large septal defects, clinical signs of the defect are seen during the first months of life. There are signs of backache, tachycardia, persistent wheezing in the legs, enlargement of the liver, spleen and other. Children often get sick with pneumonia, hypotrophy develops. The heart hump appears early, the upper post has been strengthened. At the third-fourth intercostal ribs, the systolic trinity is marked. Cordoni heart zbіlsheі vіvo. An intense systolic murmur is heard in the third or fourth intercostal space, which is good to be carried out right-handed in the sternum. At the top, there may be a mesodiastolic murmur, as if it were an exudative stenosis of the left venous arm; II tone over the legenian artery is strengthened and split. The progression of legenous hypertension can lead to an increase in the right ventricular retraction, a sign of hypertrophy appears, as in severe depressions it can be overwhelmed. In the case of a high level of hypertension, there is a vice in the stools and bleeding.

On the ECG in case of moderate legenevity of hypertension, signs of hypertrophy of the left duct are registered, in case of the temporal duct - both ducts or the right duct. The X-ray picture also shows the degree of legenic hypertension. With mild legenous hypertension, the left ventricle was enlarged, the arc of the legenous artery vibrated and the arterial bed of the legenium was realigned. In case of significant legenous hypertension, the heart was enlarged beyond the ribs of both ventricles, the bulging of the legenous artery was pronounced, the aorta was hypoplastic. The strength of the legenous baby is associated with arterial hypertension and venous congestion.

Likuvannya. In case of CHF, heart failure, peripheral vasodilators are indicated, diuretics are prescribed if necessary. It is possible to spontaneously close the defect, as it is most common in patients up to 4 years old. Surgical treatment is carried out with progressive mild hypertension and persistent CHF.

Interventricular septal defect(DMPP). Zustrichaetsya in 8-16% of children, yakі were born from PSV. Distinguish between primary and secondary ASD. Primary defects and rotting low above the atrioventricular valves, secondary - in the area of ​​the oval vein. Hemodynamic damage to the blood flow from the left atrium to the right, the magnitude of which to lie in the size of the defect and difference in the atria. With small defects, there is no damage to the blood flow, and the defect is manifested pizno. In patients with great defects, blood clots can be caused to shift the right heart valves, increased blood flow in the legs and the development of legenous hypertension. In case of ASD, legenian hypertension develops appreciably rarely, especially sclerotic form.

Ailments from ASD often do not show scarg, physical development do not see, ZSP is blamed rarely. Between the hearts is enlarged to the right, at the other intercostal ribs, a systolic murmur is heard, often not intense, with a bordered zone of expansion; II tone over the legenian artery of splits, settlements behind the rachun of the legenian component. On the ECG, there are signs of hypertrophy of the right ventricle (or blockade of the right lower bundle of His, often incomplete), similar to that of the right atrium. On the radiographs, there is an increase in the right heart valves, a vibrating arc of the legenous artery, and a redeployment of the arterial bed of the leg.

Likuvannya. surgical; the operation is indicated for mild hypertension and the presence of a sign of CHF.

Coarctation of the aorta. Sounding of the aorta or obliteration on the obstruction of the dilatation of the area of ​​the arc, thoracic or celiac vіddіl. The sounding is most often localized in the area of ​​the transition of the aorta to the lower part (in the “typical” area). Distinguish "childish" and "grown-up" types of coarctation of the aorta. The first one looks like another manifestation of aortic malformation and aortic ringing on the great dilation of the arch. Impaired hemodynamics lie in the form of a rіvnya, the stage of aortic ringing and the development of collaterals, as well as in the type of coarctation. The most characteristic scars on the back, head bіl, zamorochennya, bіl in lithic m'yazah when walking. The difference in pulse rate and the magnitude of the systolic pressure on the upper and lower endings are considered to be valuable diagnostic signs. On the hands, there is a high rise to the pulse and an increase in the systolic vice, which reaches up to 200 mm Hg in a number of fluctuations. Art. and more. On the legs, the pulse is weak, the arterial pressure decreases, sometimes it does not show. In a number of depressions with coarctation of the aorta, an arterial pressure on the hands at the borders of the norm. The physical development of ailments is often not impaired, but the respect for the disproportion of the body: with a good shoulder girdle, the lower half of the body is noticeably underdeveloped.

The cordon of the heart is equally widened to the left. During auscultation, a systolic murmur is seen in the second or third intercostal space. The noise is greater than the turns at the interscapular expanse of the levoruch from the ridge. ECG shows hypertrophy of the left duct, in children of the early age, more often of the right duct. Radiologically, enlargement of the left duct, post-stenotic expansion of the aorta, in children of the older age - usuration of the lower edges of the ribs.

Likuvannya. Surgical, the optimal term for the operation is considered in 7-15 years. In early age, surgical correction of the defect is carried out for the presence of symptoms of CHF.

Vіdkrita ductus arteriosus (OAP). In intrauterine life, the hemorrhage of the fetus is ensured. Vin closes at the first day of the month after the people of the child. The func- tioning of the duct over the 2nd day of the afterlife is classified as PSV, the frequency of which becomes 10-30%.

Clinical picture. May be a sign of hemodynamics, disruption of what is connected with the blood flow through the duct from the aorta to the legenous artery. The amount of drop to lie down in the duct opening, cuta yogo inlet in the aorta and retail support in small and large amounts of blood flow. Vinikaє perepovnennia small stake krovoobіgu. Levi's slug wins the progress of the robot, develops his hypertrophy. With the development of high legenous hypertension, dilatation and hypertrophy of the right ventricle are blamed as a result of revantation.

Due to the severity of hemodynamic disturbances, PDA overflow is mostly asymptomatic. In ailments with significant blood loss, chronic hypertension develops early, in association with stench often ill with pneumonia, in physical development, with which the symptoms of CHF progress. Cordoni of the heart in case of PDA is expanded to the left, in case of high legenial hypertension - to the right. In another intercostal ribs, there is an uninterrupted systole-diastolic murmur, blood rumblings during systole and diastole in one straight line. In the first month of a child's life, with significant chronic hypertension, blood flow through the duct is less than an hour of systole, which means less systolic murmur; II tone over the legenian artery is strengthened and split. ECG shows signs of hypertrophy of the left duct, with mild hypertension - both ducts. Radiologically, there is an increase in the left duct, vibrating of the arch of the legenian artery, increased pulsation of the aorta and the legenian artery, and redeployment of the small stake behind the flare of the arterial bed. In case of high legenial hypertension, an increase in the right duct is indicated.

Likuvannya. Surgical, operation is indicated for mild hypertension and signs of CHF. It is possible to spontaneously close the ducts in the first month of life, especially in preterm infants, in whom for some reason the remaining fates to stop indomethacin (internally at a dose of 0.1 mg/kg 3-4 times a day in the first 2nd month of life). In case of CHF, heart glycosides and diuretics are used, acid therapy, blood transfusions are carried out.

Aortic stenosis. Vіd usіh PSV to become 2-7%. Buvaє valvular, podklepanim and supravalvular. The first one is the most sharpened. The degree of stenosis determines the severity of hemodynamic impairment and clinical manifestations of the defect. In case of severe stenosis, the symptoms of the defect develop in an early child: blistering of the skin, tachycardia, signs of CHF. With a small and moderate stenosis, the clinical manifestations gradually develop, the stench is most clearly manifested in children of school age. Up to them one can see the back, pain at the heart, confusion. In case of severe stenosis, it is possible to attack to spend the memory (syncope). Between the hearts expand to the left, ring out, insignificantly, often de stink bigger. There is a systolic tremton at the other interrib, right-handed at the jugular pit. During auscultation, a rough, scraping systolic murmur is heard in the tibia, which irradiates on the sudini shii. On FCG, the veins may have a rhomboid shape, the aortic component of the second tone is visible daily, or signifi- cantly decreases. ECG shows signs of hypertrophy of the left duct. On radiographs, an enlargement of the left duct and an enlargement of the viscous aorta are seen.

Likuvannya. Surgery: valvulotomy, balloon dilatation of valvular stenosis or prosthetics (in older children) of the aortic valve.

Stenosis of the legenous artery of isolation. become 0.9-6.7 % in the name of the main number of PSV. It grows like different anatomical variants, among which the first time in frequency is occupied by valvular stenosis. Impaired hemodynamics occur as a stage of stenosis, which induces the right ventricular pressure. With an insignificant stenosis of the scargum during the day, the compensation of the heart was saved, the defect is most often seen in the age of 10-15 years. With a sharp stenosis, clinical symptoms of the defect appear in an early child. Skargi is indicated on the back, pain at the heart, and tricuspid valve insufficiency develops with the onset of symptoms of right ventricular heart failure. Cordoni heart zbіlsheni right-handed. In another intercostal ribs, systolic trembling is manifested, systolic murmur is immediately heard, the intensity and trivality of which is directly proportional to the degree of stenosis; II tone over the legenian artery of the splits, the amplitude of the lung component is reduced. On FCG, the noise may be rhomboid in shape. ECG shows signs of hypertrophy of the right ventricle, often of the right atrium. Radiologically, an enlargement of the right duct, often the right atrium, post-stenotic expansion of the stovbur of the legeneval artery are indicated. Legeneviy baby is normal or ill.

Likuvannya. Surgery - valvulotomy or balloon valvuloplasty.

Zoshit Fallo. Folding vada, composed of 4 anomalies: stenosis of the ventral valve of the right duct, VSD, dextroposition of the aorta and hypertrophy of the right duct. Impaired hemodynamics are classified as the main rank of stenosis of the legenous artery and VSD. We see such clinical and anatomical variants of the defect: extreme, classic and pale form. In ailments with an extreme form of vadi, the ligament behind the atresia of the legenian artery of the blood in the legenia comes through the PDA or collaterals. In the classical form of blood from the right duct, the legenev artery and aorta are located near the legenev, in the case of the blіdіy form, the blood flows to the right, which explains the presence of cyanosis.

Clinical picture of the vice of different age periods may have its own characteristics. In the first month of a child's life, the defect is characterized by the absence of symptoms and is diagnosed on the basis of a coarse systole murmur in the third-fourth intercostal space of the breast. From 4-6 months, a “critical period” begins, which is three times up to 1.5-2 years. The child develops back pain, cyanosis, signs of physical development, symptoms of "drum sticks" and "annual age" are formed. In peripheral blood, the hemoglobin ratio and the number of erythrocytes increase. With a similar form of Fallot's disease, the back develops later - up to 5 years. The defect is often manifested by hypoxemic (zadishkovo-cyanotic) attacks, which are blamed raptly: the child becomes restless, the ass and cyanosis are sharply exacerbated, auscultatively indicate a change in the intensity of the noise; restlessness is possible. In a number of depressions, attacks are accompanied by a development of hemiparesis. Start with spasm of the in-fundibular duct of the right ventricle, stench is more often seen in ailments with anemia and suffered a lingual injury. After 3-5 years, the majority of depressions will begin to improve, which is explained by the maximum mobilization of compensatory mechanisms: polycythemia develops, collateral blood flow and other.

In the case of Fallot's disease, a rough systole murmur is heard in the third-fourth intercostal space, the second tone over the legenian artery of weakening. ECG shows signs of hypertrophy of the right ventricle. On the radiographs, the heart has the shape of a wooden cherevichka, small roses, the juvenile little ones are suffering. With a better shape of the wadi, the hearts will sound more, more for the rahunok of both shlunochkiv, the judge’s little one’s leg is strengthened.

The most important break is characterized by the extreme form of Fallot's disease, if cyanosis is sharply expressed, the children are significantly in physical development, the systolic murmur is often daily.

Likuvannya. Surgical. For the prevention of attacks, administer aprilin (obzidan) at a dose of 1 mg/kg per doba. In the method of stopping zadishkovo-cyanotic attacks, parenterally administer cordiamin, obzidan, transfuse glucose and erythrocyte mass (with anemia), with this heart glycosides are contraindicated.

TRANSPOSITION OF MAIN SUDIN POVNA. Zustrichaetsya head rank in children in the early century (12-20 % vіd usіh vad). Children die at the age of up to 1 year, at the link with which in the older age the vice grows much more slowly. In this case, the aorta enters the right duct, and the legenian artery - the left one. The heart valves and atrioventricular valves are formed correctly. The aorta is often distended in front of the trunk of the legenous artery. Non-oxygenated blood from the right duct should be found in the large circulatory system, resulting in hypoxemia. The legend of the left shunochka should have blood from moving instead of sour. Impaired hemodynamics after the people are compensated by the accompanying blood vessels of the heart: in the event of an oval vein, ASD, VSD and PDA, without such a life, the ailment is impossible. It is too early to blame the symptoms of ZSP, but they quickly progress. Children significantly develop in physical development, in a remarkably short term, polycythemia develops, symptoms of "drumsticks" and "annual age". Cordoni of the heart is normal or slightly expanded, but in the dynamics of the stench is more pronounced. During auscultation, murmurs are daily or audible systolic murmur, VSD murmurs or stenosis of the legenous artery. On the ECG, the signs of hypertrophy of the right one, more often than both, are most often seen. On radiographs, the shape of the heart looks like an egg that lies on the side; a handful of small growths, then cardiomegaly develops. Legenevy little ones can be normal, we can make them stronger.

Likuvannya. Surgical. At an early age, palliative operations are being carried out, the method of which is to change hypoxemia. In the older one (4-7 years), a radical correction of the defect is required.

FAILURES OF THE HEART OF NADBANI. Most often they speak at the high school vіtsі. The main cause of them is rheumatism, which is more commonly associated with infectious endocarditis, diffuse disease of healthy tissue, heart injury, syphilis and others.

Simple and combinable nabutі vadi hearts are divided. Forgive me - clean, isolated, wadi, in some of them there is more than a lack of stenosis. When combined vadas, one hour later, both insufficiency and stenosis are observed. When two are damaged and there are more valves, one can speak of a broken one, or a rich valve, or a heart. Aortic valve insufficiency. Occupies another place for the frequency of the midst of the vadus of the heart after mitral insufficiency. Impaired hemodynamics caused by inverse blood strum from the aorta in the left ventricle at the hour of mid-diastole. Perevantazhennia of the left flank, improved by the increase in the amount of blood, induced the development of yogo dilatation and hypertrophy. With a significant increase in venous insufficiency, mitral valve insufficiency (“mitralization” of aortic malformation) with a further dilatation of the left atrial fibrillation and stagnant manifestations in legenia is observed. In case of isolation of aortic valve insufficiency, blood circulation damage is rare. Clinical picture. In the early stage of aortic insufficiency, the only symptom is proto-diastolic murmur, which is heard in the other-third intercostal space. Appearance of a scarg to report about more manifestations of hemodynamic impairment. The most early and characteristic of them is shvidka stomlyuvanist, back, zamorochennya, more likely to be near the heart. When looking around, the glare of the skin’s curves, the pulsation of the carotid arteries (the “dance of the carotid”), the strength of the upper vein, are strengthened. Percussion between hearts expanded to the left. In the world of progression of insufficiency of the aortic valve, the intensity and trivality of the diastolic noise increase, and the timbre of the yogo is overfilled with a lot (m'yaky, sho llєtsya, dme or sizzling), carried out along the left edge of the sternum at the bik verkhіvki, de inod visluhov Iogo appearance explain scho, svorotny strum of blood from the aorta, removing the stool of the mitral valve, creating an external stenosis of the mitral opening. An important diagnostic value may be characteristic for aortic insufficiency of peripheral symptoms: rapid and high pulse, increased systolic and decreased diastolic arterial pressure, capillary and phalangeal pulse and in. On the FCG, the noise registers more slowly, lower vislukhovuetsya in the ear, starts without a middle for the I tone, may. On the ECG, signs of hypertrophy of the left ventricle are indicated, with "mitralization" of the defect - that of the left atrium. On radiographs, there is an increase in the left duct, expansion of the viscous aorta, and increased pulsation.

Likuvannya. Surgical. The operation is carried out for the presence of signs of severe aortic insufficiency and symptoms of CHF, refractory to drug therapy.

Mitral valve insufficiency. It is accompanied by a return of blood from the left duct in the left ventricle of the heart at the hour of the systole of the duct. As a result of the reversal, dilatation and hypertrophy of the left duct and left atrium are observed. The movement of the vice in the left veins of the heart is accompanied by the movement of the vice in the legenian veins, which suggests the development of the so-called passive legenic hypertension. Then, in the future, the increase in pressure in a small amount is blamed on dilatations and hypertrophy of the right ventricle and the right atrium. Nadal blaming the insufficiency of the tricuspid valve with a further development of symptoms of circulatory disorders in the great coli. The most common stages of mitral valve insufficiency are most common, if there is no sign of CHF or symptoms of left ventricular insufficiency.

Clinical picture. At the cob stages, the malady of malady is not presented by skarga, the heart is not healed. The only manifestation of this is only a soft murmur of systole at the top, which does not spread beyond the region of the heart. The progression of the defect is accompanied by an expansion between the heart to the left and uphill, an increase in the intensity of the systolic murmur, which becomes better, in the left inguinal region. There are scars and ob'ektivnі symptoms, po'yazanі s vyniknennyam ZSP (cyanosis, zadishka, enlargement of the liver, etc.).

On FCG, the amplitude of the 1st tone is changed, the 3rd tone is often recorded. The amplitude of the noise of systole is indicative of the severity of the defect, tobto. stage of mitral regurgitation. On the ECG at the early stage, there is no sign of myocardial hypertrophy, but there are signs of hypertrophy of the left atrium and the left duct. In times of decompensation, in a great number, signs of hypertrophy of the right heart are registered. On the radiographs of the first stages, the formation of the wadi does not change. In the late period, there is an increase in the left atrium and a left duct, the shadow of the heart is swelling in the mitral configuration, then there are signs of venous congestion in the legs and an increase in the right ventricles of the heart.

Likuvannya. Carry out the sign of CHF at the time. Stop cardiac glycosides, diuretics and peripheral vasodilators. Surgical treatment (prosthetics or anuloplasty) is carried out in case of refractory heart failure stage III-IV (after Bakulovich and Damir).

Insufficiency of the tristool valve. Buvaє prominence and organic. Vidnosna insufficiency poserigaetsya significantly more often for organic. Isolated insufficiency of the tricuspid valve in children is very rare. Vaughn, as a rule, goes along with the mitral or mitral-aortic heart veins. Therefore, the symptoms in ailments develop from manifestations of the main defect and insufficiency of the tricuspid valve. Return strum of blood from the right ventricle in the right atrium at the hour of systole of the ventricle in spriya їx dilatation and hypertrophy with a distant development of stagnation of blood in the system of the great stake of blood circulation.

Clinical picture. The camp of ailments with a lack of a tricuspid valve is most often severe: pronounced backside and cyanosis, enlarged liver, often there are swelling and ascites. Between the hearts are widened to the right, above the sword-like bud and in the fourth intercostal space, a systolic murmur is heard, which is more likely to be felt in the breath (Rivero-Corvallo symptom). On the ECG, signs of hypertrophy of the right ventricle and the right atrium are recorded. On radiographs, there is an increase in the right ventricles of the heart.

Likuvannya. Surgical. In order to correct the mitral or aortic veins, anuloplasty or prosthetics of the tristool valve is required.

Isolation of aortic stenosis and tricuspid valve stenosis in children practically does not improve.

Mitral stenosis(Stenosis of the left atrioventricular valve). The sounding of the left atrioventricular opening creates a passage for blood flow from the left atrium into the left ventricle. The internal anterior twitch moves, which is produced, from one side, until the retrograde twitch moves in the leg veins, that is, to venous hypertension, and on the other hand, to the reflex ringing of the arterioles in the legs (Kitaeva reflex). Spasm of the arteriole is accompanied by active legenous hypertension, so that more high numbers are reached on the venous surface. Legenev's hypertension caused the development of hypertrophy and dilatation of the right heart valves and ventricular insufficiency of the tricuspid valve. Through the war, decompensation is caused in a great amount of blood circulation.

Clinical picture. At the beginning, chi "auscultative", stage of mitral stenosis, there are no subjective symptoms, the heart is not enlarged. During auscultation, a typical complex of sound phenomena is revealed: diastolic noise with presystolic settlements on the top, splashing I tone, accent and splitting of the II tone over the legenev artery, which means "melody of mitral stenosis". Noise with mitral stenosis is rough, roaring, low timbre. At the top, there is also a “clattering” of the mitral valve, which, in addition to splashing I and II tones, creates a characteristic melody - “quail rhythm”.

In the world of progressing stenosis, there are scars on the back, shvidka stomlyuvanity, pain at the heart. Possibly attack chi equivalents to nabryak legends. Children have a lesser characteristic blush on the cheeks, for rare faults there are no pronounced lesions in a large amount of blood circulation. In more important stages of vice, there is an expansion between the heart of the mountain and the right hand. In the region of the upper part of the heart, a diastolic tremtinnya (“kotyache murkotinnya”) is appointed.

On the FCG, the instruction from the described sound phenomena is shown to be lower than the interval Q- I then Great significance is expected to be assigned to the interval II tone - “clattering” of the mitral valve (II- QS), a shortening of some kind of evidence about the progression of stenosis. On the ECG at the "auscultative" stage of mitral stenosis, there is no sign of myocardial hypertrophy. There are signs of hypertrophy of the left atrium, then of the right heart. On roentgenograms in the world of development, there are signs of an increase in the left atrium, which shows contrasting stravochida behind an arc with a radius of less than 6 cm, and of the right ventricle. Characterized by flattening of the waist of the heart behind the ribcage is the vibrating of the legenous artery and the eye of the left atrium. There are also signs of legenic hypertension: enlargement of the roots, clarity of their contours, rapt urvich of the enlarged veins of the legenous artery (symptom of "amputation" of the roots), malnature on the periphery, near the Kerley line.

The clinical picture in case of combined mitral valves of the heart lies in the presence of overdose of stenosis or insufficiency. In times of severe stenosis of the main stenosis, there are signs of stenosis of the left atrioventricular opening. In case of mitral valve disease with more important insufficiency in the first plan, symptoms appear that are characteristic of mitral insufficiency. It is not uncommon for insufficiency and stenosis to be found in the same world, even if we talk about mitral valve without a clear emphasis on stenosis or insufficiency.

Likuvannya. Mitral stenosis and combinations of mitral veins rejoice in the surgical path. With mitral stenosis, comisturotomy is necessary, with combined defects - prosthetics or anuloplasty of the mitral valve. The operation is indicated for stage III-IV of the defect (for Bakulov and Damir).

PROLAPSE OF THE MITRAL VALVE(PMK). Proginannaya one stool (often back) or both stools at the empty left atrium under the hour of systole. It is common to suck often - in 2-14% of the population, bowel stools are often accompanied by rozbіzhnistyu, after which mitral regurgitation is blamed. Causes of MVP are different: structural defect of the valvular apparatus of the heart, myxomatous degeneration of stools, vegetative damage and other. Distinguish the first and second PMK. Remaining sick with ailments from the Air Force, the ILC, heart arrhythmias and others.

Clinical picture. One can see the "aus-cultivating" and "nimu" forms of PMK. The main manifestations of the "auscultative" form are systolic "clattering" and systolic murmurs. The stench often droops on the top of the heart, closer to the other or the fourth intercostal ribs, in the vertical position, the intensity of growth increases. The systolic "clatter" on the FCG is indicated in the middle of the systole or in the other half. A systolic murmur is manifested by mitral regurgitation, venting right after the “clacking”. More often, a vociferous murmur is heard, which sounds to indicate more pronounced mitral regurgitation.

Illnesses at PMK are often not presented with scarg. Deyakі z them signify palpitations, periodic pain in the region of the heart, confusion and other. On the ECG with the "auscultative" form of MVP, damage to repolarization is often recorded: a decrease in the amplitude of the tooth T in III standard and lіvih thoracic insertions, which often go along with the displacement of the segment ST. Possible disruption to the rhythm of the heart and conduction. On radiographs, the heart of normal or altered (crippled heart) roses, often vibrates the arch of the legenous artery. With the manifestation of mitral regurgitation, there is an increase in the left atrium and the left ventricle, the tone of the heart may be mitral configuration. With “silent” MVP on the ECG, there are no changes on radiographs, the veins are only recognized with echocardiographic follow-up.

Likuvannya ailments from PMK will not require. In case of severe mitral regurgitation and manifest symptoms of CHF, prosthetic or anuloplasty of the valve is performed.

RHEUMOCARDITIS. The main clinical manifestation of rheumatism, which can be attributed to systemic disease of healthy tissue, in which the pathological process is localized more importantly in the heart. Rheumatism affects most children at the age of 7-15 years, more commonly it affects preschool children. The development of the disease is associated with r-hemolytic streptococcus group A, under the influence of which autoimmune disorders develop in the body. Rheumatism occurs in attacks (attacks), which sounds like it develops in 1.5-2 days after the transferred acute nasopharyngeal infection: tonsillitis, pharyngitis and other.

Clinical picture. The cob manifestations of illness are weakness, sickness, fever, drunkenness, chills and other. For obviousness, a sign of damage to all three membranes of the heart is to talk about pancarditis. Distinguish between primary and secondary rheumatic carditis. Remaining developing and the onset of repeated attacks of rheumatism, often due to the obvious formation of valvular heart vessels. Signs of myocarditis are expansion of the interheart, decreased sonority of tones, a gallop rhythm for the heartbeat, the appearance of an appendage III tone, systolic murmur at the top of the heart, disruption of the rhythm of the heart and conduction, decreased myocardial speed and pumping function of the heart. Myocarditis may be accompanied by circulatory disorders. Endocarditis occurs with lesions of the parietal, chordal and valvular endocardium. Prognostically unfavorable is valvular endocarditis (valvulitis), which in 8-12% of cases leads to heart failure. Endocarditis is manifested by rough, lower with myocarditis, systolic murmur, which sometimes may be musical. With endocarditis, diastolic murmurs are often heard: mesodiastolic murmurs in the projection of the mitral and protodiastolic - aortic valve. The most difficult for diagnosis is to establish pericarditis, which is more common in rheumatism, but is less common. The most characteristic yoga signs are pain in the heart space, pericardial rubbing murmur and changes on the ECG at the sight of a burn-out segment ST. With rheumatism, coronaritis and aortitis can occur.

In rheumatism, heart damage, in pathological processes, other organs of the system are often involved. Before the characteristic manifestations, there is a subclinical syndrome, which is accompanied by pains in the submerged areas (arthralgia) and swelling of the periarticular tissues. Shkira above them is hot on the dotik. Most often, the middle and large snowdrifts are affected, with which the lightness of the pain is characteristic and the total changeability. In 12-17% of ailments, there is damage to the nervous system, which is most often manifested in chorea. The main clinical symptoms are hyperkinesia, malignant hypotonia, coordination disorders, dystonia and psychopathological symptoms. . Visip is not carried over the surface of the shkіri and is not accompanied by sverbіny. Rarely, there are rheumatic bumps - painless sacs of the mouth of millet grain up to the pea, which grow on the surface of the loamy soil, in the area of ​​the tendon, spinous ridges and the potile part of the head. Significantly more common in rheumatism are legenia, liver, nirki, organ etching and other. In a number of disorders, an attack of rheumatism begins with the appearance of a sharp pain in the abdomen - the so-called abdominal syndrome.

Diagnosis. Grounded on the identified main and additional criteria. The main criteria include carditis, polyarthritis, chorea, anular visip and rheumatic nodules (Kisel-Jones absolute criteria). The diagnosis becomes more reliable with the addition of the main criteria with additional ones, to which febrile illness, arthralgia, rheumatism in anamnesis, or the presence of a formed valvular heart disease, changes in laboratory parameters: increased SOE, leukocytosis, a positive reaction to C-reactive protein, dysproteinemia, rise of immunoglobulin and other. It is necessary to protect yourself with the same data of ECG, FCG, EchoCG and X-ray follow-up. Great significance is hoped for by the data that confirm streptococcal infection: increased titres of streptococcal antibodies, the presence of group A streptococcus and a recent nasopharyngeal infection.

From the point of view of the severity and features of the disease, the tactics of success and the prognosis in rheumatism, it is necessary to specify the degree of activity of the ignition process and the severity of carditis, as well as the nature of the disease. Based on the improvement of the severity of clinical symptoms of heart damage, changes in laboratory tests and data on instrumental methods, the results show rheumatism with the maximum (III stage), mild (II stage) and minimal (I stage) activity of the process. The greatest manifestations of changes in the heart and humoral damage are observed at stage III, the least significant - at stage I of rheumatism activity, for which laboratory indications can be in the range of normal, and changes from the side of the heart are minimal.

Fallen due to the severity of the heart injury, there are weak expressions, a minimum of expressions and a clear expression of rheumatic heart disease. For the degree of severity of clinical symptoms on the cob of attack, those same dynamics in the process of healing differentiate between rheumatism with gostrim, subgostrim, protracted, recurrent and latent overshoot. Gostra leak is characterized by a rapt cob of illness, a high activity of the process and a pronounced clinical symptomatology, as it recognizes the convulsive dynamics with a duration of 1.5-2 min. In the case of an acute overrun, which is most pronounced, a greater development of clinical manifestations is indicated, the stench is less pronounced. At the same time, changes in laboratory indications, as well as clinical manifestations, are progressively normalized with a stretch of 2-3 minutes. For a protracted break, with some rheumatism on the back of the hand, it can be the mother of gostria or acute illness, the reverse dynamics of clinical and laboratory indications is characteristic, with a new normalization with a stretch of 4-5 months. In quiet depressions, if acute rheumatism is blamed for the presence of a sign of flowing rheumatic heart disease, we can talk about a recurrent flow. About the latent course of rheumatism to note the formation of valvular heart disease for the presence of other signs of rheumatic heart disease and changes in laboratory indications.

Likuvannya. It is necessary to improve the degree of activity of the process, the severity of heart damage and the degree of blood circulation disorder. The celebration is carried out in stages: start at the hospital, continue at the cardio-rheumatological sanatorium and then in the outpatient department. Likuval-prophylactic approaches include recognition of an adequate regimen of rotting activity and eating, stosuvanie of medicinal products, directing to fight against streptococcal infection and suppression of the activity of the ignition process. The regimen is prescribed depending on the severity of rheumatic heart disease and the stage of impaired blood flow: strict bedding, bedding, napіvlіzhkovy or tremulous. In the world, the disease becomes clinically ill, the activity of the process subsides, for the friendly dynamics of clinical signs of rheumatic heart disease and the change in the degree of blood circulation disorder, the regimen of the ailing step by step is expanded. At the same time, conduct mass and jubilant gymnastics.

Among the medicinal preparations in the treatment of rheumatism, the main place is occupied by non-steroidal anti-inflammatory drugs, of which acetylsalicylic acid, orthophene (Voltaren), indomethacin (methindol), brufen and in. ditini (zagalom 1.5-2.0 r) for doba. The average dose of Ortofen is 3 mg/kg, Brufen - 20-30 mg/kg. The dose of the drug is progressively reduced to a new level, the duration of the course of treatment was delayed depending on the dynamics of clinical symptoms and laboratory indications and the sound did not exceed 1.5-2.5 months. As an anti-seizure drug, vicorist is also a glucocorticoid. Indications of their zastosuvannia is the maximum activity of rheumatism and clear manifestations of carditis, especially pan-carditis. In severe, often refractory CHF in patients with valvular heart disease, it is also a sign of high activity in the process. Most often, prednisolone is used at a dose of 0.75-1.0 mg/kg per doba with further reductions. The validity of the course of treatment of Prednisolone is determined by the dynamics of clinical and laboratory indications and manifestations of impaired blood flow. In the middle, Prednisolone vicorate lasts 1-2 months.

In connection with the leading role of streptococcal infection in the development of rheumatism, the accumulation of antibiotics in the penicillin series is of great importance. Penicillin is prescribed for 10-12 days internally, 2 days a day. Fallow in the form of a child, the dose is administered in the form of 750,000 to 2,000,000 OD. If there are indications of intolerance to drugs in the penicillin series, or due to allergic reactions to them, it is possible to vicorate erythromycin or oleandomycin internally. After completion of the course of treatment with penicillin, switch to zastosuvannya with bicilin, which is administered internally. Bicilin-5 for children preschool age administer at a dose of 750,000 OD once every 10 days; The dose of bitsilin-1 for preschool children is 600,000 OD once for 10 days, for schoolchildren - 1,200,000 OD once for 3 days.

At the hospital, an active sanitation of chronic inflammations of the infection is carried out: the lower limbs of the tonsils, carious teeth, etc. Krym tsgogo, if necessary, prescribe polyvitamins, desensitizing agents, preparations to reduce the exchange processes in the myocardium, and so on.

The sanatorium stage of treatment of ailments for rheumatism transfers the differentiation of the treatment of the liquor regimen, the continuation of the treatment of non-steroidal antiseptic drugs, the rehabilitation of the cavities of chronic infections, and the selection of methods of physiotherapy. In the minds of the sanatorium, periodic monitoring of the state of the function of the heart-vascular system and the dynamics of laboratory tests is carried out. Ailments continue to take bicilin at the same doses as in hospitals.

After registration with the sanatorium, the bicillinoprophylaxis is carried out under the supervision of a cardio-rheumatologist for the place of residence. After the first attack of rheumatism, carry out maintenance for 3 years. When shaping the heart after the first attack and the inversion of rheumatic heart disease, bicillin with the method of secondary prevention of rheumatism is victorious for 5 years. Whether it is surgical intervention (tooth extraction, tonsillectomy, appendectomy, etc.) in patients with rheumatism, it is necessary to carry out penicillin for rheumatism, which should be administered internally 1-3 days before surgery and for 7-10 days after it. A cardiologist-matologist in the minds of a polyclinic makes a report on the examination of ailments for rheumatism at least once every 6 months, with which blood tests and ECG registration are performed.

The basis of the primary prevention of rheumatism is the early detection of ailments for acute streptococcal infection (tonsillitis, pharyngitis, scarlet fever) and their own treatment, as it is carried out with penicillin for 8-10 days. Of great importance is also the sanation of chronic secondary infections.

Forecast. In the rest, the rocks significantly painted. Predyaki complex Liskivo-trade attacks, shave on the Schih Thahh Etapah (Statsіonarny, Sanatorium, Polisc_nikhnaya) Socanswed, the frequency of the recurrent Latented passage of rheumatism was knowing, the R_Desha molded the valve on Vadi Sezia, that smeared the Kilkіt DiseTi. In zv'yazku z cym, the death rate for rheumatism has been significantly reduced.

Fibroelastosis of the endocardium (FE). Illness of the heart of a congenital (importantly in the early age) or full (in children of the older age) character, with which the diffuse sweating of the endocardium is due to supra-world proliferation of elastic and collagen fibers. With congenital FE, changes develop at 4-7 months of intrauterine development of the fetus. The reason is unknown, what is the reason for the heart damage of the ignition genesis.

Clinical picture. If you are ill, they will begin in the first days, today, or months after the people. The main ones are tachycardia, zadishka, persistent wheezing in the legs, enlarged liver, and sometimes rashes. Cordons of the heart are widened in the sides, more to the left. Tony muffled chi overly sonority. The third tone is often pronounced. At the top, there is a non-intense systole murmur; in a number of ailments, daily noise is heard. ECG shows signs of hypertrophy of the left ventricle, often of that left atrium. Characteristic disruption of repolarization processes: usunennia in the isolation segment ST that reduction, two-phase or tooth inversion T, especially in Vs and V views. There are signs of venous congestion in the legs.

Distinguish bliskavichni, gostrі, pіdgostrі and chronic forms of FE.

Forecast. Unfriendly: ailments sound to die at the first month and fates of life. FE often goes with different congenital heart waters, tightening their overshoot and prognosis.

Likuvannya. It is aimed at changing the severity of CHF, for which the heart glycosides, diuretics and drugs are used to reduce the exchange processes in the myocardium.

FUNCTIONAL NOISE. To functional noises, not related to organic lesions of the heart. The stench is blamed for the influx of various exogenous and endogenous factors. The most common causes are chronic intoxication, various illnesses, deformity of the chest and other. Їх sov'yazuyut zі zіzhennyam or podvishchennyam tonus sertsevoy m'yaza, zbіlshennyam shvidkostі blood flow in empty hearts and main vessels, constitutional features of the child, anatomical features of the chordal apparatus of the heart and іn. zustrіchayutsya and in healthy children.

Functional murmurs are heard during systole, more often they are localized in the other or third intercostal space, more often - on the top of the heart. The stench is characterized by lability: they succumb to vidikha, with physical stress and fever, weaken in the breath and in a vertical position. At FKG, functional noise is occupied Vi-% of systole, usually in the I tone, the amplitude is low; behind the shape there are rhombo-like, spindle-like and invisible.

Nourishment of the presence of functional diastolic noises in the wake.

Likuvannya ailments with functional noise will not require. Carried out less therapeutically come in the case of the main illness, and the natomist of such a stink of wine.

ENDOCARDITIS INFECTIOUS(TO HER). Illness of an infectious nature, through manifestations of some kind of bacteremia and endocardial injury. Changes are more often localized on valve stools, more likely on parietal endocardium. Virazkovo-necrotic changes and thrombotic vegetations, which develop with HE, lead to destruction of valve stools, rupture of chords of papillary ulcers, and sometimes to perforation of the IVS and the vindication of septic or mycotic aneurysms. Crim endocarditis, often show signs of myocardial damage, sometimes - symptoms of pericarditis (about 10%). In the pathological process, as a rule, other organ systems are involved.

Separate the first one and the second one. In quiet moods, if it develops in a sick person, in whom earlier there were daily signs of heart damage, the veins are seen as the first. Secondly, it comes to the anatomy of various heart defects (often congenital), cardiomyopathy, mitral valve prolapse and others. With the primary HE frequency, the left heart valves are affected, while with the secondary HE, the frequency of lesions of the left and right heart valves is approximately the same.

Clinical picture. From the uranium of the cob clinical manifestations and features of the distant yoga, we see hostria and podhostry HER.

Gostriy EY accompanied by clinical manifestations of sepsis. It develops rapidly: the body temperature rises, as it often accompanies drunkenness, chills or recognition. There are symptoms of intoxication. Changes from the side of the heart in the primary HE cobweb are minimally observed in the appearance of tachycardia, weakened sonority of tones and non-intense murmur of systole. Nadal, especially due to the effects of therapy, the stench increases, often there are signs of valve insufficiency, associated with their destruction. Most often, the mitral and aortic ones are affected, and more often, the tristool valves. With the advent of myocarditis or pericarditis, symptoms of CHF may appear.

A heart attack with secondary HE is clinically manifested by an increase in changes, as well as by the appearance of new symptoms, which are often associated with the destruction of the valvular apparatus. Often progresses to show impaired blood flow. Gostriy HER is accompanied by significant changes in laboratory tests. Characterized by leukocytosis (primarily leukopenia), increased COE, anemia, thrombocytopenia, dysproteinemia, increased levels of circulating immune complexes and immunoglobulins, a positive reaction to C-reactive protein, a positive HBT test and other.

Pidhostriy EY characterized by progressive development of clinical manifestations. Body temperature sounds subfebrile; Less pronounced symptoms of intoxication and drunkenness, chills are not alarmed. It is often important to catch the appearance of change from the side of the heart. In the case of acute HE, changes in laboratory indications are not pronounced, stench can be found at the borders of the norm.

The hostile perebіg is often more likely to be seen in ailments with the first one, the underdog - with the second one. Stertium, oligosymptomatic overflow of HE is especially often seen in children with congenital heart valves of the “blue” type.

Before post-heart manifestations, it can be seen damage to the skin and mucous membranes (hemorrhages, Dzheynuey's patches, Osler's bumps), the cystic-globular system (arthralgia, arthritis, periostitis), enlargement of the spleen. With HER, it is also possible to injure legenia (pneumonia), nirok (pyelonephritis, diffuse glomerulonephritis), liver (toxic hepatitis), eyes (petechia on the conjunctiva and sitkivtsі, microembolism of the vessels of the sitkivki), brain (meningitis, meningoencefa and .

Diagnosis. It is based on the presence of conductive (fever, heart disease and a positive result of bacteriological blood tests) and additional criteria. Great significance is hoped for by the changes of the EchoKG, until the presence of additional echo signals, which reflect the presence of vegetation on the valves.

Differential diagnosis is carried out with various infectious diseases, diffuse diseases of healthy tissue, diseases of the blood system (hostry leukemia, lymphogranulomatosis) and malignant neoplasms.

Forecast. To lie in the wake of the virulence of the health worker and I will become a deadly factor in the body of the ailing. Great is the significance of the early manifestation of ailment and the early rozpochat likuvannya. With ЇЇЇЇ, serious complications often develop, as a significant world signifies its overrun and result. Perebіg HER is often aggravated by refractory CHF, in the development of such, crim myocarditis and destruction of the valves, an important role can be played by opportunistic pericarditis, abscesses and myocardial infarction, disruption of the heart rhythm and in. Thromboses and embolisms, legenia, spleens, livers, nirok, intestines, etc. are seen to unsafe conditions. Not less severe complications are abscesses (lungs, nirok, brain, etc.), which are especially common in staphylococcal endocarditis. In a number of cases, HE can be accompanied by a development of bacterial shock, hemorrhage and bleeding.

Legality in case of HE occurs at the great boundaries - from 10% with streptococcal to 90% with gram-negative infection.

Likuvannya. More space is occupied by antibiotics, as they are prescribed for improving sensitivity to them. In streptococcal endocarditis, effective penicillin is more often used, in staphylococcal endocarditis - synthetic penicillin in combination with cephalosporins or aminoglycosides. In fungal endocarditis, amphotericin, nizoral and other antifungal drugs should be used. Antibiotics for ER are prescribed at maximum doses, the duration of treatment with them is not less than 1.5 min. Їх skasovuyt less after the elimination of clinical manifestations of HER and the new normalization of laboratory pokaznikiv, with an important intellectual and repeated negative results of bacteriological examination of blood.

For the presence of myocarditis, nephritis and polyarthritis, non-steroidal antiseptic drugs can be considered. In case of glucocorticoid stagnation with HE, it should be eliminated, it can be eliminated in small doses (no more than 10-15 mg per doba) in ailments with the so-called immunological phenomena (vasculitis, myocarditis, glomerulonephritis, etc.).

For staphylococcal endocarditis, administer anti-staphylococcal plasma and immunoglobulin. In a number of disorders with HE, effective hemosorption and ultraviolet blood transfusion. With anemia, transfusion of erythrocyte mass is indicated, with thrombocytopenia, which is accompanied by bleeding, platelet mass.

Surgical treatment is carried out for the duration of the effect of antibacterial therapy for 4-6 months, with refractory CHF and recurrent thromboembolism in patients with heart valve insufficiency. Zdijsnyuyut prosthetics of the damaged valve, the head rank, in children of school age.

Prevention. Polyagaє in the treatment of chronic inflammations of infection and adequate treatment of infectious diseases in children with heart ailments. For the prevention of HER in case of intercurrent illnesses, the stench of obov'yazkovo zastosuvannya antibiotics to wear. Usі hirurgichіchnі vtruchannya and іnvasіvnіі іinstrumentalіnі dolіdzhennya і іz іz khvorobіh sertsa іnіdіv іd prikrittami antibiotics.