absolyutnaya i otnositelnaya sosudistaya nedostatochnost. ishemicheskaya bolezn serdtsa

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powerpoint presentation absolyutnaya i otnositelnaya sosudistaya nedostatochnost. ishemicheskaya bolezn serdtsa mansurova nuriniso 1. klinicheskie proyavleniya i diagnostika ibs 2. absolyutnaya i otnositelnaya sosudistaya nedostatochnost 3. ishemicheskaya bolezn serdtsa: patofiziologiya plan: lechenie ishemicheskoy bolezni serdtsa: xirurgicheskoe lechenie angioplastika koronarnix arteriy s implantatsiey stenta effektivna dlya lecheniya stenozov koronarnix arteriy diametrom ot 2 do 4 mm, snijaya risk razvitiya infarkta miokarda. aortokoronarnoe shuntirovanie (aksh) primenyaetsya bolee chem u 50% patsientov s ibs, nujdayushixsya v xirurgicheskom lechenii, obespechivaya vosstanovlenie krovotoka v porajennie koronarnie arterii. klassifikatsiya ishemicheskoy bolezni serdtsa po klassifikatsii who ibs podrazdelyaetsya na 4 osnovnix tipa, v zavisimosti ot preobladayushix klinicheskix proyavleniy: stenokardiya, infarkt miokarda, xronicheskaya serdechnaya nedostatochnost i vnezapnaya koronarnaya smert. v zavisimosti ot protyajennosti porajeniya koronarnix arteriy, ibs klassifitsiruetsya na odnososudistoe, dvuxsosudistoe i trexsosudistoe porajenie, chto vliyaet na stepen ishemii miokarda i vibor metoda revaskulyarizatsii. lechenie ishemicheskoy bolezni serdtsa: konservativnaya terapiya statini, v dozirovke, obespechivayushey snijenie urovnya lpnp na 50% …

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ardiya napryajeniya, pokoya), a takje dannie ekg s uchetom >50% stenoza koronarnix arteriy. laboratornaya diagnostika ishemicheskoy bolezni serdtsa ekg-izmeneniya, takie kak inversiya zubtsa t, depressiya segmenta st, ishemicheskie izmeneniya zubtsa q, ukazivayut na narushenie krovosnabjeniya miokarda, chto podtverjdaet diagnoz ibs. povishenie urovnya troponinov i i t v sivorotke krovi bolee chem v 5 raz vishe verxney granitsi normi svidetelstvuet o nedavnem povrejdenii miokarda, xarakternom dlya ibs. absolyutnaya i otnositelnaya sosudistaya nedostatochnost: opredelenie razlichie mejdu absolyutnoy i otnositelnoy nedostatochnostyu kritichno dlya vibora taktiki lecheniya: absolyutnaya trebuet nemedlennoy revaskulyarizatsii, otnositelnaya — konservativnoy terapii i modifikatsii faktorov riska. otnositelnaya sosudistaya nedostatochnost xarakterizuetsya snijeniem krovotoka na 20-69%, dostatochnim dlya obespecheniya metabolicheskix potrebnostey tkaney v sostoyanii pokoya, no nedostatochnim pri uvelichenii nagruzki. instrumentalnaya diagnostika ishemicheskoy bolezni serdtsa: exokg dopplerovskaya exokardiografiya, chast exokg, otsenivaet skorost i xarakter krovotoka v koronarnix arteriyax, pozvolyaya kosvenno sudit o stepeni stenoza i viyavit >70% sujenie prosveta sosuda. exokg pozvolyaet otsenit …

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tika ishemicheskoy bolezni serdtsa: ekg ekg mojet viyavlyat izmeneniya segmenta st, takie kak elevatsiya (bolee 1 mm v dvux smejnix otvedeniyax) ili depressiya (bolee 0,5 mm), ukazivayushie na ostriy koronarniy sindrom ili ishemiyu miokarda. analiz intervala qtc na ekg pomogaet otsenit dlitelnost repolyarizatsii jeludochkov i mojet bit kosvennim pokazatelem narusheniy elektrolitnogo balansa, vliyayushix na razvitie ishemii. diagnostika ishemicheskoy bolezni serdtsa: anamnez i fizikalnoe obsledovanie otsenka stepeni ishemii po klinicheskim dannim mojet bit dopolnena dannimi ekg, kotoraya fiksiruet izmeneniya segmenta st i volni t pri nagruzke ili spontanno. narushenie ritma serdtsa (bolee 20% patsientov) - vajniy simptom. fizikalnoe obsledovanie vklyuchaet auskultatsiyu serdtsa (viyavlenie shumov, tonov), izmerenie arterialnogo davleniya, otsenku pulsa (ritm, chastota, napolnenie), palpatsiyu i perkussiyu dlya opredeleniya granits serdtsa. oslojneniya ishemicheskoy bolezni serdtsa infarkt miokarda, naibolee seryoznoe oslojnenie ibs, ejegodno privodit k 7-10 mln smertelnix sluchaev vo vsem mire, znachitelno variruya po regionam. okolo 20% patsientov s ibs ispitivayut ostruyu …

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rovaniya revaskulyarizatsii. pomimo viyavleniya stenozov, koronarografiya mojet obnarujit anevrizmi, trombi i drugie anomalii koronarnix arteriy, rasshiryaya diagnosticheskie vozmojnosti do 95% tochnosti v opredelenii ibs. klinicheskaya kartina ishemicheskoy bolezni serdtsa okolo 20% bolnix s ibs vpervie proyavlyayutsya ostrim infarktom miokarda, klinicheski xarakterizuyushimsya rezkoy zagrudinnoy bolyu, poyavleniem simptomov serdechnoy nedostatochnosti i narusheniyami ritma. pristupi stenokardii voznikayut u 70-80% patsientov s ibs, xarakterizuyutsya zagrudinnoy bolyu, irradiiruyushey v levuyu ruku, sheyu, chelyust, i kupiruyutsya nitroglitserinom. profilaktika ishemicheskoy bolezni serdtsa otkaz ot kureniya, yavlyayushiysya odnim iz naibolee effektivnix sposobov profilaktiki, snijaet risk razvitiya ibs na 50% uje cherez god posle otkaza. kontrol urovnya xolesterina v krovi (ldl < 100 mg/dl) s pomoshyu dieti, bogatoy kletchatkoy i nenasishennimi jirami, a takje medikamentoznoy terapii, esli neobxodimo, yavlyaetsya klyuchevim faktorom profilaktiki. spasibo za vnimanie @taqdimot_robot image1.jpg image2.jpg image3.jpg image4.jpg image5.jpg image6.jpg image7.jpg image8.jpg image9.jpg image10.jpg image11.jpg image12.jpg image13.jpg image14.jpg image15.jpg

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powerpoint presentation absolyutnaya i otnositelnaya sosudistaya nedostatochnost. ishemicheskaya bolezn serdtsa mansurova nuriniso 1. klinicheskie proyavleniya i diagnostika ibs 2. absolyutnaya i otnositelnaya sosudistaya nedostatochnost 3. ishemicheskaya bolezn serdtsa: patofiziologiya plan: lechenie ishemicheskoy bolezni serdtsa: xirurgicheskoe lechenie angioplastika koronarnix arteriy s implantatsiey stenta effektivna dlya lecheniya stenozov koronarnix arteriy diametrom ot 2 do 4 mm, snijaya risk razvitiya infarkta miokarda. aortokoronarnoe shuntirovanie (aksh) primenyaetsya bolee chem u 50% patsientov s ibs, nujdayushixsya v xirurgicheskom lechenii, obespechivaya vosstanovlenie krovotoka v porajennie koronarnie arterii. klassifikatsiya ishemicheskoy bolezni serdtsa po klassifikatsii wh...

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