With diseases of the cardiovascular system, edema
The most important common signs of violationblood circulation in diseases of the cardiovascular system are shortness of breath, pain, palpitation, cyanosis and swelling. They make up the content of the first complaints of the patient, they are also (first of all, dyspnea, cyanosis, edema) in the first cases and in objective research. In any case, if the patient himself does not indicate them, the presence or absence of these symptoms must be noted by the examining physician. In addition to these symptoms, which are evident for the patient, great importance is often not felt by patients changes in blood pressure. All these symptoms combined with each other and with other symptoms (fatigue, loss of efficiency, etc.), give a picture of circulatory insufficiency.
Shortness of breath in heart patients is one of theearly and most permanent symptoms. At the very onset of the development of heart failure, it appears only with more significant physical stresses, and with complete development of insufficiency, shortness of breath does not pass even at complete rest.
Causes of shortness of breath in the cardiovascularpatients are mainly: 1) stagnation of blood in the lungs and the worst of their aeration - mechanical dyspnea; 2) decreased excretion or increased formation of metabolic products, especially acidic ones, and carbon dioxide - toxic dyspnea. The accumulation of under-oxidized metabolic products during work and in a healthy person goes somewhat faster and in more quantity than the delivery of oxygen necessary for complete oxidation. The difference between the necessary and actual consumption of oxygen is called "oxygen debt". With heart failure of under-oxidized products, more oxygen accumulates, "oxygen debt" lasts longer; Increased breathing passes into shortness of breath. In severe heart failure, "oxygen debt" becomes permanent. In addition, a more or less significant role is played by: 3) increased excitability of the respiratory center on the basis of oxygen starvation; 4) accumulation of gases in the stomach and intestines, as well as fluid in the abdominal cavity, leading to a rise in the diaphragm.
Shortness of breath, as an indicator of heart failuremainly of the left heart, contains a subjective sensation and objective attributes, and in some cases, the subjective or the objective side can prevail.
The dyspnea of a cardiovascular patient cantake different forms. The most common are the following: 1) shortness of breath during physical exertion; 2) constant shortness of breath; 3.) inability to hold your breath; 4) rapid breathing without painful sensations; 5) dyspnea, appearing in the morning, as a result of a decrease in the tone of the cardiovascular system during sleep, but passing in the middle of the day: habitual labor often raises the dynamics of blood circulation; 6) dyspnea of the Cheyne-Stokes type; 7) dyspnea, appearing with a transition to the horizontal position, causing awakening after two to three hours of sleep; 8) the most painful form of dyspnea in a heart patient, coming in the form of suffocation occasionally, cardiac asthma (asthma cardiale).
Attacks of cardiac asthma develop usuallysuddenly as a sharp dyspnea, not associated with physical stress. On the contrary, asthma develops more often at night. Abundant food and drink at night contribute to the appearance of asthma. The patient wakes up with a feeling of extreme lack of air (suffocation), with a feeling of chest compression. Pain usually does not happen. The face is cyanotic, the skin is covered with a cold sweat. Frequent small pulse up to 140 beats per minute. Frequent violations of the heart rate. Breathing is increased to 30-40 per minute. When the seizure passes, a new attempt to lie down again causes its appearance. Percutally marked increased sonority throughout the light, auscultatory - often small wet rale, mainly in the lower lobes (stagnation). The mechanism of cardiac asthma is explained differently. The most common explanation is the following: in the supine position, due to partial absorption of swelling, the amount of circulating blood increases, often already increased with a heart failure. If the left heart is weaker than the right, then more blood enters the smaller circle than the left ventricle can pump; capillaries of a small circle are overfilled, and the sharply decreases both the respiratory surface and the mobility of the lung. In addition to the mechanical moment, the shifts in the autonomic nervous system in the direction of vagotonia seem to be of great importance. This is indicated by the suddenness of the onset, and often of the end of the attack, and often afterwards a copious separation of liquid urine with a specific gravity of about 1003-1000 (urina spastica). In addition to left ventricular muscular insufficiency (for example, with aortic valve defects), another obstacle to emptying the small circle may be a pronounced mitral stenosis. With it, asthma attacks are observed only in the presence of a strong right ventricle and an increased demand for the work of the heart. Under these conditions, the phenomenon of stagnation in the lungs sharply and sharply increases, and an attack sets in. As soon as the right ventricle begins to weaken, asthma attacks with stenosis pass. Thus, cardiac asthma is an indicator of the weakness of the left ventricle with the saved right power.
With a significant attack of asthma, wheyblood begins to sweat into the cavity of the alveoli, and acute swelling of the lung develops. Lung edema begins in the lower lobes, and the fluid, displacing air from the airways, gradually rises higher and higher. Depending on this there is a strong cough, sharply increased shortness of breath, when listening, a large number of very small, and then large, wet wheezes is detected, and foamy liquid sputum, usually pink in color, resembling cranberry mousse, is released in large quantities.
Pain is a frequent complaint of heart patients. When taking into account the significance of pain, two basic points must be remembered: 1) the individual sensitivity of the nervous system can change and pervert the external manifestations of subjective sensations; 2) the intensity of pain is not always proportional to the danger and especially the degree of anatomical changes.
With pain in the heart, it is necessary to excludediseases of the surrounding tissues of the heart and organs - ribs (fracture, tuberculosis gum), intercostal muscles (myositis), nerves (neuralgia, neuritis), pleura (pleurisy), etc. Pain, depending on heart damage,
1) diseases of the pericardium, most often with acute dry pericarditis:
2) acute stretching of the heart muscle;
4) diseases or functional disorders of the activity of the coronary vessels;
6) the pressure of the dilated parts of the heart and vessels on the nervous formations.
When analyzing heart pain, you need to pay attentionthe following features: 1) precise localization, 2) intensity, 3) nature, 4) connection with other phenomena, 5) duration, 6) the direction of recoil, 7) associated characteristic phenomena.
For differential diagnosis of pain can serve as the following characteristic features.
With pericardial pain is usually localizedIn the middle of the sternum or throughout the heart; their intensity varies to very severe pain; pain is a stabbing or shooting character. The pain intensifies when you move, cough, even when pressed with a stethoscope. Pain can last for several days continuously or appear as seizures; recoil is rarely seen - in the left shoulder. With adhesive pericarditis, pain may appear when the head is tilted back (tension of the adhesions).
Sharp stretching of the heart is always associated withpreceded by excessive physical stress - lifting of gravity, record running, etc. The pains do not represent the characteristic features. Their intensity is not very high. Soreness is caused by stretching both the muscle of the heart and the pericardium.
With myocarditis pain is not permanent, usually weak and deaf, often of a pressing character; appear in the presence of severe infection and in duration approximately correspond to it.
All these types of pain usually succeeds easilyExplain by analyzing the immediate past and present, thanks to a clear connection with the newly transferred or still tolerated infections or trauma. In addition, they are characterized by relative constancy during a certain period of time, unrepeatability and lack of recoil.
Significantly greater diagnostic interestrepresents a group of periodic painful manifestations associated with acute violation of the coronary circulation. This group of pain symptoms is combined in the angina pectoris syndrome.
Thoracic frog (angina pectoris). At the base of the angina pectoris is the acute onset of severe shortage of blood supply (ischemia) and impaired metabolism in a limited area of the heart muscle. The cause is a temporary disruption or complete stop of blood circulation in the trunk or in one of the branches of the coronary arteries, more often in the left.
Violation of blood flow or completeblockage of the artery (thrombosis), or spasm, which can occur in a healthy vessel, but more often in the presence of altered atherosclerosis or inflammation (syphilis) of the vascular wall. To anatomical changes, up to the development of ischemic or hemorrhagic infarction. can lead to spasm and a perfectly healthy vessel. The spasm reflex can come from a wide variety of organs: the skin, the stomach, the genitals, etc. The skin reflex is usually caused by a transition from a warm room to a damp (cold-moist) atmosphere with a strong counter, especially a cold wind, even in contact with cold linen sheets or, conversely, a transition to an unusual hot atmosphere. The reflex action on the coronary vessels is reinforced by the mechanical action of the often elevated arterial blood pressure observed under the same conditions. The reflex from the gastrointestinal tract is reinforced by the mechanical action of raising the diaphragm by the stomach, overcrowded with food and swallowed air, the chemical action of food, and the increase in blood flow. Walking after eating is especially indicated by the sick as a factor causing an attack of pain.
Generally, the attack can be mentalmoments (emotional trauma, mental fatigue), chemical (infection, tobacco) and mechanical (temperature, overload). Often seizures are observed at night: the most likely cause of this is the night predominance of the tone of the vagus nerve.