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PostSubject: rheumatic heart   Fri Apr 06, 2007 5:07 pm

Clinical presentation. Characteristically extreme diversity of symptoms that result in a wrong diagnosis. Most are diagnosed with rheumatic heart defect and disease as a result of the similarity of complaints (pains in the heart and sternum), and the study (sistoliceski intense noise). In typical clinical picture are : 1) signs of atrophy ventricular myocardium (mainly left); 2) signs of a lack of diastolicescoy ventricular function; 3) evidence of obstruction output tract left chamber (not in all patients); 4) of the heart rhythm. In early, as well as in advanced stage of the disease may not be complaints. Sometimes people insist on the following complaints : 1) pain in the sternum neck difficulties encountered in the physical activity and disappearing at rest. Less pain there for the time being. Cause of pain, imbalance between demand increased tone in the attack krovosnabjenia and reduced in the bloodstream subendocardialnah myocardial segments as a result of ill-diastolic ventricular relaxation; 2) failure to physical activity, usually expressed mild, but sometimes severe; 3) dizziness, headaches, Grue to обморочным condition is the consequence of the sudden reduction in heart or release пароксизмов arrhythmias also reduce emissions of the left heart chamber, which lead to the temporary disruption of Cerebral Blood (frequent gamers предсердий, эктопических тахикардий). The symptoms noted in patients with gipertroficescoy expressed cardiomiopatiei. In nerezka exaggerated attack slight decrease diastolicescoy functions and the absence of obstruction termination of the left chamber of complaints may not be, and the disease is diagnosed accidentally. However, the patients with a pronounced change hearts symptoms are vague : pain in the hearts of note, sharp enough time. The human heart rhythm complaints are disruptions, dizziness, fainting condition, transient nausea. The disease can not be attributed symptoms of the poisoning, postponed infection, alcohol abuse, or any other pathogenic effects. The inspection fisichalnom most significant is the discovery of systolic noise pulse amended and removed verhusherngo heart. Auscultatory show the following features : 1) maximum performance systolic noise (noise removal) is defined in the Hungary at the top of the heart; 2) sistoliceski noise in most cases increased with a sharp vstavanii patient, as well as in the samples Valsalva; 3) II tone always retained; 4) noise no pressure on the neck. Pulse approximately 1 / 3 of patients higher early because of the lack of erosion on ways out of the left heart chamber at the beginning of Systolic but at the expense of powerful muscles a "functional" narrowing of the outflow, which results in premature decline VLP waves. Verhushechny boost in 34% of cases is a "dual" nature : first during palpation was hit by the reduction left atrium, then on the left of heart. These properties verhusherngo Push better detected in the patient lying on the left side. The importance of echocardiography : 1. asymmetric hypertrophy mejjeludockova walls, more pronounced in the upper third of its gipokinez; 2. sistolicescoe the front door Mitral Valve sent forward; 3. contact the front door mitral valve with mejjeludockova wall in diastolu.

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