What is a disease of the cardiovascular system. Diseases of the cardiovascular system (CVD): overview, manifestations, principles of treatment. Weakness, fatigue

Cordially- vascular diseases have a lot of precursors and the most early symptoms, many of which can be easily confused with signs of other diseases. If you feel or notice at least one of the symptoms listed below, you do not need to panic, but you should not dismiss the warning signs either - it is important to see a doctor in time, because vascular diseases can really be prevented with the help of proper prevention.

Cough

Weakness and pallor

Functional disorders of the nervous system - absent-mindedness, increased fatigue, bad dream, anxiety, tremor of the limbs - frequent signs heart neurosis.

Pallor is usually observed with anemia, vasospasm, inflammatory heart disease in rheumatism, aortic valve insufficiency. At severe forms pulmonary heart disease changes the color of the lips, cheeks, nose, earlobes and limbs, which visually turn blue.

Temperature rise

Inflammatory processes (myocarditis, pericarditis, endocarditis) and myocardial infarction are accompanied by fever, sometimes even fever.

Pressure

40,000 die every year due to cerebral hemorrhage due to high blood pressure. At the same time, if you follow the rules for controlling pressure and not provoke its increase, then you can avoid not only feeling unwell, but also more serious problems.

Sustained rise blood pressure above 140/90 is a serious factor for concern and suspicion of the risk of cardiovascular disease.

Too rare (less than 50 beats per minute), frequent (more than 90-100 beats per minute) or irregular pulse should also alert, such deviations may indicate coronary disease, violation of the conduction system of the heart and regulation of cardiac activity.

Puffiness

Severe swelling, especially towards the end of the day, may occur due to the abundance salty food, kidney problems, including due to heart failure. This happens because the heart cannot cope with pumping blood, it accumulates in the lower extremities, causing swelling.

Dizziness and motion sickness

The first symptoms of an impending stroke may be frequent dizziness, but they are also a manifestation of a disease of the middle ear and visual analyzer.

Dyspnea

Feeling short of breath, severe shortness of breath are symptoms that may indicate angina and heart failure. Sometimes there is an asthmatic variant of myocardial infarction, accompanied by a feeling of suffocation. Only a specialist can distinguish lung disease from cardiac dyspnea.

Nausea and vomiting

Vascular complications are very easily confused with gastritis or an exacerbation of an ulcer, the symptoms of which are nausea and vomiting. The fact is that Bottom part The heart is located close to the stomach, so the symptoms can be misleading and even resemble food poisoning.

Pain resembling osteochondrosis

Pain between the shoulder blades, in the neck, left arm, shoulder, wrist, even in the jaw can be a sure sign of not only osteochondrosis or myositis, but also heart problems.

Chest pain

A feeling of burning and squeezing, obvious, dull, severe or periodic pain, spasm - all these sensations in the chest are the most certain. With spasm of the coronary vessels, the pain is burning and sharp, which is a sign of angina pectoris, which often occurs even at rest, for example at night. An attack of angina pectoris is a harbinger of myocardial infarction and coronary heart disease (CHD).

Severe prolonged pain behind the sternum, radiating to the left arm, neck and back, is characteristic of a developing myocardial infarction. Chest pain in myocardial infarction is extremely severe, up to loss of consciousness. By the way, one of the most common causes of a heart attack is atherosclerosis of the coronary vessels.

Chest pain that radiates to the back of the head, back, or groin is a symptom of an aneurysm or aortic dissection.

Dull and undulating pain in the region of the heart, which does not spread to other areas of the body, against the background of an increase in temperature, indicates the development of pericarditis.

However, acute chest pain may also indicate other diseases, for example, be a symptom of intercostal neuralgia, herpes zoster, sciatica in the neck or chest, spontaneous pneumothorax, or esophageal spasm.

Strong heartbeat

A strong heartbeat can occur with increased physical exertion, as a result of a person’s emotional arousal, or due to overeating. But a strong heartbeat is very often an early harbinger of diseases of the cardiovascular system.

A strong heartbeat manifests itself as a feeling of malfunctioning of the heart, it seems that the heart almost “pops out” of the chest or freezes. Seizures may be accompanied by weakness, unpleasant sensations in the region of the heart, fainting.

Such symptoms may indicate tachycardia, angina pectoris, heart failure, impaired blood supply to organs.

If you have at least one of these symptoms, it is important to consult a doctor without delay and undergo tests that will reveal true reason ailments. One of the most effective methods of treating any disease is its early diagnosis and timely prevention.

The causes of CVD are commonplace and known to everyone, but not every person takes into account the importance of these factors.

Many people spend their whole weekend on the couch watching some TV shows, not forgetting to refresh themselves with soda and sandwiches.

The worst thing that can happen is the development of diseases of the cardiovascular system. They occupy a leading position among diseases in terms of the number of deaths and prevalence.

Due to the changed way of life of people, the disease became widespread precisely at the end of the 20th - beginning of the 21st century.

Cardiovascular diseases

Only after studying the general characteristics can we talk about the causes of cardiovascular diseases. Among them, there are 5 different groups:

Arteries usually carry oxygenated blood. Therefore, their diseases lead to a lack of oxygen in the tissues; in advanced cases, ulcers and gangrene can develop. Veins carry blood from the tissues, saturated carbon dioxide.

Venous thrombosis of the extremities is common, leading to their numbness. Coronary vessels supply blood to the heart muscle. If they do not work properly, angina pectoris may occur.

Heart disease can be associated with a disorder of its muscles, blood vessels or valves. Since the life of a person directly depends on the work of the heart, failures in its work can quickly lead to death. Heart attack - tissue necrosis as a result of improper blood supply, lack of oxygen.

The human need for physical activity is explained very simply. The human body was formed as a result of centuries of evolution.

Ancient people moved a lot. They needed it to survive, so circulatory system developed in response to these pressures.

The activity level dropped so quickly that she didn't have time to adjust to it.

The heart is an organ made entirely of muscle tissue. Everyone knows that without proper physical activity, muscles become flabby. Due to decrepitude, it can no longer fully function.

Vessels are also dependent on physical activity. With insufficient activity, their tone decreases, this can lead to varicose veins.

Also, the blood flows more slowly, plaques grow on the walls, inhibiting its movement, hence atherosclerosis occurs.

Bad habits

Smoking and alcohol are the main causes of diseases of the cardiovascular system. These bad habits Negative influence on the whole body, but are especially dangerous for the circulatory system, as they can most quickly lead to death by acting on it. Everyone knows about it, without exception, but few people attach due importance to it.

When smoking, poisons such as hydrocyanic acid, carbon monoxide, nicotine, etc. enter the human body. Their amount from one smoked cigarette is very small, but many smoke a pack a day for decades.

As a result of smoking, the lumen of blood vessels narrows, which slows down the flow of blood and leads to a breakdown in their work. Their elasticity decreases, the content of cholesterol in the blood increases.

The risk of blood clots also increases due to the combination of blood cells (platelets, erythrocytes, leukocytes) with substances that come from smoking.

Alcohol is quickly absorbed into the blood, under its influence, the vessels first artificially expand, the pressure drops - and it does not enter the tissues enough oxygen. Then they sharply narrow, due to such frequent changes, their elasticity is lost.

Also ethanol, or ethanol, which is part of alcoholic beverages, destroys the membrane of red blood cells that carry oxygen on it, they stick together and can no longer perform their functions.

Emotional loads

The nervous system controls and interacts with all other organs and organ systems in the human body. Emotions often affect the circulatory system.

For example, from embarrassment or shame, a person blushes, as blood rushes to his face, blood vessels dilate. And during excitement and anxiety, the heartbeat quickens.

There is an opinion that stress negatively affects a person. It's not quite right this reaction needed to save life.

Another thing is that after it emotional unloading is required, rest, which modern man is sorely lacking.

Here again it is worth mentioning physical activity, which is the best rest after experienced stress.

In the modern world, commensurate with the decrease in physical loads, emotional loads increase. Media, the Internet, daily stresses lead to a breakdown of the nervous system.

As a result, hypertension and atherosclerosis can occur, with all the ensuing consequences.

Disruption of the endocrine system

The endocrine system affects the human body with the help of hormones that reach their target (the desired organ) with the bloodstream. Her disorder inevitably leads to the appearance of diseases of the heart and blood vessels.

Female hormones, estrogens, maintain normal blood cholesterol levels. With a decrease in their number below the norm, there is a risk of developing atherosclerosis.

Usually this problem affects women who have reached the menopause period.

Women taking hormonal contraceptives are at risk due to increased blood viscosity. Accordingly, the possibility of blood clots increases.

Adrenaline and noradrenaline act on the autonomic nervous system. The first hormone makes the heart beat faster, raises blood pressure. It is produced in stressful situations.

The second - on the contrary, reduces the heart rate and lowers blood pressure. Violation of the production of even one of these hormones can lead to serious problems.

How not to eat

Eating "forbidden" foods excess leads to obesity and high cholesterol. These two factors can be considered as separate causes of cardiovascular disease.

In overweight people, the heart works with additional load which leads to its gradual depletion. Fat is deposited not only on the sides, but also on the walls of blood vessels and even on the heart, making it difficult for them to contract.

Because of this, blood pressure rises - and hypertension, varicose veins, etc. appear.

An increased content of cholesterol leads to its deposition on the walls of blood vessels and a decrease in their elasticity, the formation of plaques.

As a result, blood cannot normally move through them, there is a lack of oxygen in the tissues and intoxication with carbon dioxide and other substances that are normally carried away by the blood.

As a rule, people whose diet is far from healthy do not receive the necessary vitamins and minerals.

They can be very important for the cardiovascular system.

For example, potassium strengthens the walls of blood vessels, vitamin C nourishes the heart muscle, and magnesium normalizes blood pressure.

Other factors in the development of cardiovascular diseases

There are many other reasons for the development of cardiovascular diseases. They are less common, but no less important.

Cardiovascular diseases are very dangerous and can be caused by everyday habits.

smoking, alcohol, unbalanced diet and disadvantage physical activity- the main causes of diseases of the vessels and heart.

If you want to prolong your life and stay healthy, keep in mind what diseases appear from. Try to minimize the impact of these factors. All in your hands.

The circulatory system is one of the integrating systems of the body. Normally, it optimally provides the needs of organs and tissues in the blood supply. Wherein the level of systemic circulation is determined by:

• activity of the heart;
• vascular tone;
• the state of the blood - the magnitude of its total and circulating mass, as well as rheological properties.

Violations of the function of the heart, vascular tone or changes in the blood system can lead to circulatory failure - a condition in which the circulatory system does not meet the needs of tissues and organs in the delivery of oxygen and metabolic substrates to them with blood, as well as the transport of carbon dioxide and metabolites from tissues.

The main causes of circulatory failure:

• pathology of the heart;
• violations of the tone of the walls of blood vessels;
• changes in the mass of circulating blood and / or its rheological properties.

According to the severity of development and the nature of the course, acute and chronic circulatory failure is distinguished.

Acute circulatory failure develops over hours or days. The most common reasons for it may be:

• acute myocardial infarction;
• some types of arrhythmias;
• acute blood loss.

Chronic circulatory failure develops over several months or years and its causes are:

• chronic inflammatory diseases of the heart;
• cardiosclerosis;
• heart defects;
• hyper- and hypotensive conditions;
• anemia.

According to the severity of signs of circulatory insufficiency, 3 stages are distinguished. In stage I, signs of circulatory failure (shortness of breath, palpitations, venous congestion) are absent at rest and are detected only during exercise. In stage II, these and other signs of circulatory insufficiency are found both at rest and especially during physical exertion. At Stage III there are significant disturbances of cardiac activity and hemodynamics at rest, as well as the development of pronounced dystrophic and structural changes in organs and tissues.

PATHOLOGY OF THE HEART

The bulk of various pathological processes that affect the heart, make up three groups of typical forms of pathology: coronary insufficiency, arrhythmias and heart failure .

1. coronary insufficiency characterized by an excess of myocardial demand for oxygen and metabolic substrates over their inflow through the coronary arteries.

Kinds coronary insufficiency:

• reversible (transient) disorders of coronary blood flow; these include angina, characterized by severe compressive pain in the sternum, resulting from myocardial ischemia;
• irreversible cessation of blood flow or a long-term significant decrease in blood flow through the coronary arteries, which usually ends with myocardial infarction.

Mechanisms of heart damage in coronary insufficiency.

Lack of oxygen and metabolic substrates in the myocardium in coronary insufficiency (angina pectoris, myocardial infarction) causes the development of a number of common, typical mechanisms of myocardial damage:

• disorder of the processes of energy supply of cardiomyocytes;
• damage to their membranes and enzymes;
• imbalance of ions and liquid;
• disorder of the mechanisms of regulation of cardiac activity.

The change in the main functions of the heart in coronary insufficiency consists primarily in violations of its contractile activity, an indicator of which is a decrease in stroke and cardiac output.

2. Arrhythmias - a pathological condition caused by a violation of the heart rhythm. They are characterized by a change in the frequency and periodicity of the generation of excitation impulses or the sequence of excitation of the atria and ventricles. Arrhythmias are a complication of many diseases of the cardiovascular system and main reason sudden death due to cardiac pathology.

Types of arrhythmias, their etiology and pathogenesis. Arrhythmias are the result of a violation of one, two or three basic properties of the heart muscle: automatism, conduction and excitability.

Arrhythmias as a result of a violation of automatism, i.e., the ability of the heart tissue to generate an action potential (“excitation impulse”). These arrhythmias are manifested by a change in the frequency and regularity of the generation of impulses by the heart, they can manifest themselves as tachycardia and bradycardia.

Arrhythmias as a result of a violation of the ability of heart cells to conduct an impulse of excitation.

There are the following types of conduction disorders:

• slowdown or blockade of conduction;
• acceleration of the implementation.

Arrhythmias as a result of disturbances in the excitability of the heart tissue.

Excitability- the ability of cells to perceive the action of an irritant and respond to it with an excitation reaction.

These arrhythmias include extrasystoles. paroxysmal tachycardia and fibrillation (flicker) of the atria or ventricles.

Extrasystole- an extraordinary, premature impulse, causing a contraction of the whole heart or its departments. In this case, the correct sequence of heartbeats is violated.

Paroxysmal tachycardia- paroxysmal, sudden increase in the frequency of impulses of the correct rhythm. In this case, the frequency of ectopic impulses is from 160 to 220 per minute.

Fibrillation (flickering) of the atria or ventricles is an irregular, erratic electrical activity of the atria and ventricles, accompanied by a cessation of the effective pumping function of the heart.

3. Heart failure - a syndrome that develops in many diseases that affect various organs and tissues. At the same time, the heart does not provide their need for a blood supply adequate to their function.

Etiology heart failure is mainly associated with two groups of causes: direct injury to the heart- trauma, inflammation of the membranes of the heart, prolonged ischemia, myocardial infarction, toxic damage to the heart muscle, etc., or functional overload of the heart as a result:

• an increase in the volume of blood flowing to the heart and increasing pressure in its ventricles with hypervolemia, polycythemia, heart defects;
• arising resistance to the expulsion of blood from the ventricles into the aorta and pulmonary artery what happens with arterial hypertension of any origin and some heart defects.

Types of heart failure (Scheme 3).

According to the predominantly affected part of the heart:

• left ventricular, which develops as a result of damage or overload of the myocardium of the left ventricle;
• right ventricular, which is usually the result of an overload of the myocardium of the right ventricle, for example, in chronic obstructive pulmonary diseases - bronchiectasis, bronchial asthma, emphysema, pneumosclerosis, etc.

Development speed:

• Acute (minutes, hours). It is the result of a heart injury, acute myocardial infarction, pulmonary embolism, hypertensive crisis, acute toxic myocarditis, etc.
• Chronic (months, years). It is a consequence of chronic arterial hypertension, chronic respiratory failure, prolonged anemia, chronic heart disease.

Violations of the function of the heart and central hemodynamics. A decrease in the strength and speed of contraction, as well as relaxation of the myocardium in heart failure, is manifested by a change in the indicators of heart function, central and peripheral hemodynamics.

The main ones include:

• a decrease in stroke and minute output of the heart, which develops as a result of depression of the contractile function of the myocardium;
• an increase in the residual systolic blood volume in the cavities of the ventricles of the heart, which is a consequence of incomplete systole;

DISEASES OF THE CARDIOVASCULAR SYSTEM.
Scheme 3

• increased end diastolic pressure in the ventricles of the heart. It is caused by an increase in the amount of blood accumulating in their cavities, a violation of myocardial relaxation, stretching of the heart cavities due to an increase in the final diastolic blood volume in them:
• increase in blood pressure in venous vessels and cardiac cavities, from where blood enters the affected parts of the heart. So, with left ventricular heart failure, the pressure in the left atrium, the pulmonary circulation and the right ventricle increases. With right ventricular heart failure, pressure increases in the right atrium and in the veins of the systemic circulation:
• decrease in the rate of systolic contraction and diastolic relaxation of the myocardium. It is manifested mainly by an increase in the duration of the period of isometric tension and systole of the heart as a whole.

DISEASES OF THE CARDIOVASCULAR SYSTEM

The group of diseases of the cardiovascular system consists of such common diseases as atherosclerosis, hypertension, coronary heart disease, inflammatory diseases of the heart and its defects, as well. as well as vascular disease. At the same time, atherosclerosis, hypertension and coronary heart disease (CHD) are characterized worldwide by the highest morbidity and mortality, although these are relatively “young” diseases and they acquired their significance only at the beginning of the 20th century. I. V. Davydovsky called them “diseases of civilization”, caused by the inability of a person to adapt to rapidly progressing urbanization and the associated changes in the way of life of people, constant stressful influences, environmental disturbances and other features of a “civilized society”.

in the etiology and pathogenesis of atherosclerosis and hypertension much in common. However, IBS which is now considered as an independent disease, is essentially a cardiac form of atherosclerosis and hypertension. However, due to the fact that the main mortality is associated precisely with myocardial infarction, which is the essence of IHD. according to the decision of WHO, it acquired the status of an independent nosological unit.

ATHEROSCLEROSIS

Atherosclerosis- a chronic disease of large and medium-sized arteries (elastic and muscular-elastic type), associated with a violation of mainly fat and protein metabolism.

This disease is extremely common throughout the world, since signs of atherosclerosis are found in all people over 30-35 years old, although they are expressed in varying degrees. Atherosclerosis is characterized by focal deposits in the walls of large arteries of lipids and proteins, around which connective tissue grows, resulting in the formation of an atherosclerotic plaque.

Etiology of atherosclerosis not fully disclosed, although it is generally recognized that this is a polyetiological disease caused by a combination of changes in fat-protein metabolism and damage to the endothelium of the intima of the arteries. The reasons metabolic disorders, as well as endothelial-damaging factors, can be different, but extensive epidemiological studies of atherosclerosis have made it possible to identify the most significant influences, which are called risk factors .

These include:

• age, since the increase in the frequency and severity of atherosclerosis with age is beyond doubt;
• floor- in men, the disease develops earlier than in women, and is more severe, complications occur more often;
• heredity- the existence of genetically determined forms of the disease has been proven;
• hyperlipidemia(hypercholesterolemia)- the leading risk factor due to the predominance of low-density lipoproteins in the blood over lipoproteins and high density, which is associated primarily with the characteristics of nutrition;
• arterial hypertension , which leads to an increase in the permeability of the vascular walls, including for lipoproteins, as well as damage to the endothelium of the intima;
• stressful situations - the most important risk factor, since they lead to psycho-emotional overstrain, which is the cause of violations of the neuroendocrine regulation of fat-protein metabolism and vasomotor disorders;
• smoking- atherosclerosis in smokers develops 2 times more intensively and occurs 2 times more often than in non-smokers;
• hormonal factors, since most hormones affect the disorders of fat-protein metabolism, which is especially evident in diabetes mellitus and hypothyroidism. Oral contraceptives are close to these risk factors, provided they have been used for more than 5 years;
• obesity and hypothermia contribute to the violation of fat-protein metabolism and the accumulation of low-density lipoproteins in the blood.

Patho- and morphogenesis atherosclerosis consists of several stages (Fig. 47).

Dolipid stage characterized by the appearance in the intima of the arteries of fat-protein complexes in such quantities that cannot yet be seen with the naked eye and at the same time there are no atherosclerotic plaques.

Stage of lipoidosis reflects the accumulation of fat-protein complexes in the intima of vessels, which become visible in the form of fatty spots and stripes yellow color. Under the microscope, structureless fat-protein masses are determined, around which macrophages, fibroblasts and lymphocytes are located.

Rice. 47. Atherosclerosis of the aorta, a - fatty spots and stripes (staining with Sudan III); b - fibrous plaques with ulceration; c - fibrous plaques; d - ulcerated fibrous plaques and calcification; e - fibrous plaques, ulceration, calcification, blood clots.

Stage of liposclerosis develops as a result of the growth of connective tissue around fat-protein masses and is formed fibrous plaque, which begins to rise above the surface of the intima. Above the plaque, the intima is sclerosed - it forms plaque cover, which can hyalinize. Fibrous plaques are the main form of atherosclerotic vascular disease. They are located in places of the greatest hemodynamic impact on the artery wall - in the area of ​​branching and bending of the vessels.

Stage of complicated lesions includes three processes: atheromatosis, ulceration and calcification.

Atheromatosis is characterized by the disintegration of fat-protein masses in the center of the plaque with the formation of amorphous mushy detritus containing remnants of collagen and elastic fibers of the vessel wall, cholesterol crystals, saponified fats, and coagulated proteins. The middle shell of the vessel under the plaque often atrophies.

Ulceration is often preceded by hemorrhage into the plaque. In this case, the plaque cover is torn and atheromatous masses fall into the lumen of the vessel. The plaque is an atheromatous ulcer, which is covered by thrombotic masses.

Calcinosis completes the morphogenesis of atherosclerotic

plaques and is characterized by precipitation of calcium salts in it. There is calcification, or petrification, of the plaque, which acquires a stony density.

The course of atherosclerosis wavy. When the disease is pressed, intimal lipoidosis increases, when the disease subsides around the plaques, the proliferation of connective tissue and the deposition of calcium salts in them increase.

Clinical and morphological forms of atherosclerosis. Manifestations of atherosclerosis depend on which arteries are large affected. For clinical practice most important is atherosclerotic lesions of the aorta, coronary arteries heart, arteries of the brain and arteries of the extremities, mostly low.

Atherosclerosis of the aorta- the most frequent localization of atherosclerotic changes, which are most pronounced here.

Usually plaques form in the region of origin from the aorta small vessels. More affected arc and abdominal region aorta, where large and small plaques are located. When plaques reach the stages of ulceration and atherocalcinosis, blood flow disturbances occur at their locations and parietal thrombi form. Coming off, they turn into thrombo-emboli, clog the arteries of the spleen, kidneys and other organs, causing heart attacks. Ulceration of an atherosclerotic plaque and, as a result, the destruction of the elastic fibers of the aortic wall can contribute to the formation aneurysms - sac-like protrusion of the vessel wall filled with blood and thrombotic masses. Rupture of an aneurysm leads to rapid massive blood loss and sudden death.

Atherosclerosis of the arteries of the brain, or cerebral form characteristic of elderly and old patients. With significant stenosis of the lumen of the arteries by atherosclerotic plaques, the brain constantly experiences oxygen starvation; and gradually atrophies. These patients develop atherosclerotic dementia. If the lumen of one of cerebral arteries completely closed by a thrombus, there is ischemic cerebral infarction in the form of foci of its gray softening. Affected by atherosclerosis, the cerebral arteries become fragile and may rupture. Hemorrhage occurs hemorrhagic stroke, in which the corresponding part of the brain tissue dies. The course of hemorrhagic stroke depends on its location and massiveness. If a hemorrhage occurred in the area of ​​the bottom of the IV ventricle or the outflow of blood broke into lateral ventricles brain, then rapid death occurs. With ischemic infarction, as well as with small hemorrhagic strokes that did not lead the patient to death, the dead brain tissue gradually resolves and a cavity containing fluid is formed in its place - brain cyst. Ischemic infarction and hemorrhagic stroke of the brain are accompanied by neurological disorders. Surviving patients develop paralysis, speech is often affected, and other disorders appear. When co-

With appropriate treatment, over time, it is possible to restore some of the lost functions of the central nervous system.

vascular atherosclerosis lower extremities also more common in the elderly. With a significant narrowing of the lumen of the arteries of the legs or feet by atherosclerotic plaques, the tissues of the lower extremities undergo ischemia. With an increase in the load on the muscles of the limbs, for example, when walking, pain appears in them, and patients are forced to stop. This symptom is called intermittent claudication . In addition, cooling and atrophy of the tissues of the extremities are noted. If the lumen of the stenotic arteries is completely closed by a plaque, thrombus or embolus, atherosclerotic gangrene develops in patients.

AT clinical picture Atherosclerosis may most clearly affect the renal and intestinal arteries, but these forms of the disease are less common.

HYPERTONIC DISEASE

Hypertonic disease- a chronic disease characterized by a prolonged and persistent increase in blood pressure (BP) - systolic above 140 mm Hg. Art. and diastolic - above 90 mm Hg. Art.

Men get sick a little more often than women. The disease usually begins at 35-45 years of age and progresses to 55-58 years of age, after which blood pressure often stabilizes at elevated values. Sometimes a persistent and rapidly increasing increase in blood pressure develops in young people.

Etiology.

Hypertension is based on a combination of 3 factors:

• chronic psycho-emotional overstrain;
• a hereditary defect in cell membranes, leading to a violation of the exchange of Ca 2+ and Na 2+ ions;
• genetically determined defect in the renal volumetric mechanism of blood pressure regulation.

Risk factors:

• genetic factors are not in doubt, since hypertension often runs in families;
• recurring emotional stress;
• a diet with a high intake of salt;
• hormonal factors - increased pressor effects of the hypothalamic-pituitary system, excessive release of catecholamines and activation of the renin-angiotensin system;
• renal factor;
• obesity;
• smoking;
• hypodynamia, sedentary image life.

Patho- and morphogenesis.

Hypertension is characterized by a staged development.

The transient, or preclinical, stage is characterized by periodic rises in blood pressure. They are caused by a spasm of arterioles, during which the wall of the vessel itself experiences oxygen starvation, causing it to dystrophic changes. As a result, the permeability of the walls of arterioles increases. They are impregnated with blood plasma (plasmorrhagia), which goes beyond the limits of the vessels, causing perivascular edema.

After normalization of the level of blood pressure and restoration of microcirculation, blood plasma from the walls of arterioles and perivascular spaces is removed into the lymphatic system, and blood proteins that have entered the walls of blood vessels, along with plasma, precipitate. Due to the repeated increase in the load on the heart, moderate compensatory hypertrophy of the left ventricle develops. If the conditions that cause psycho-emotional overstrain are eliminated in the transient stage and appropriate treatment is carried out, incipient hypertension can be cured, since there are still no irreversible morphological changes at this stage.

The vascular stage is clinically characterized by a persistent increase in blood pressure. This is due to deep dysregulation of the vascular system and its morphological changes. The transition of a transient increase in blood pressure to a stable one is associated with the action of several neuroendocrine mechanisms, among which the most important are reflex, renal, vascular, membrane and endocrine. Frequent rises in blood pressure lead to a decrease in the sensitivity of baroreceptors of the aortic arch, which normally provide a weakening of the activity of the sympathetic-adrenal system and a decrease in blood pressure. Strengthening the influence of this regulatory system and spasm of the arterioles of the kidneys stimulate the production of the enzyme renin. The latter leads to the formation of angiotensin in the blood plasma, which stabilizes blood pressure at a high level. In addition, angiotensin enhances the formation and release of mineralocorticoids from the adrenal cortex, which further increase blood pressure and also contribute to its stabilization at a high level.

Spasms of arterioles recurring with increasing frequency, increasing plasmorrhagia and an increasing amount of precipitated protein masses in their walls lead to hyalinosis, or parteriolosclerosis. The walls of arterioles thicken, lose their elasticity, their thickness increases significantly and, accordingly, the lumen of the vessels decreases.

Constantly high blood pressure significantly increases the load on the heart, resulting in its development compensatory hypertrophy (Fig. 48, b). At the same time, the mass of the heart reaches 600-800 g. Constant high blood pressure also increases the load on large arteries, as a result of which muscle cells atrophy and the elastic fibers of their walls lose their elasticity. Combined with changes biochemical composition blood, the accumulation of cholesterol and large molecular proteins in it creates the prerequisites for the development of atherosclerotic lesions of large arteries. Moreover, the severity of these changes is much greater than in atherosclerosis, not accompanied by an increase in blood pressure.

Stage of organ changes.

Changes in the organs are secondary. Their severity, as well as clinical manifestations, depend on the degree of damage to arterioles and arteries, as well as on the complications associated with these changes. At the core chronic changes organs are not disturbed by their blood circulation, increasing oxygen starvation and conditioned! them sclerosis of the organ with a decrease in function.

During hypertension essential It has hypertensive crisis , i.e., a sharp and prolonged increase in blood pressure due to spasm of arterioles. Hypertensive crisis has its own morphological expression: spasm of arterioles, plasmorrhagia and fibrinoid necrosis of their walls, perivascular diapedetic hemorrhages. These changes, which occur in such organs as the brain, heart, kidneys, often lead patients to death. A crisis can occur at any stage in the development of hypertension. Frequent crises characterize malignant course disease that usually occurs in young people.

Complications hypertension, manifested by spasm, thrombosis of arterioles and arteries, or their rupture, lead to heart attacks or hemorrhages in organs, which are usually the cause of death.

Clinical and morphological forms of hypertension.

Depending on the predominance of damage to bodies or other organs, cardiac, cerebral and renal clinical and morphological forms of hypertension are distinguished.

heart shape, like the cardiac form of atherosclerosis, is the essence of coronary heart disease and is considered as an independent disease.

Brain, or cerebral, form- one of the most common forms of hypertension.

Usually it is associated with rupture of a hyalinized vessel and the development of a massive cerebral hemorrhage (hemorrhagic stroke) in the form of a hematoma (Fig. 48, a). A breakthrough of blood into the ventricles of the brain always ends in the death of the patient. Ischemic cerebral infarctions can also occur with hypertension, although much less frequently than with atherosclerosis. Their development is associated with thrombosis or spasm of atherosclerotically altered middle cerebral arteries or arteries of the base of the brain.

Renal form. In the chronic course of hypertension, arteriolosclerotic nephrosclerosis develops, associated with hyalinosis of the afferent arterioles. A decrease in blood flow leads to atrophy and hyalinosis of the corresponding glomeruli. Their function is performed by preserved glomeruli, which undergo hypertrophy.

Rice. 48. Hypertension. a - hemorrhage in the left hemisphere of the brain; b - hypertrophy of the myocardium of the left ventricle of the heart; c - primary wrinkled kidney (arteriolosclerotic nephrosclerosis).

Rice. 49. Arteriolosclerotic nephrosclerosis. Hyalinized (GK) and atrophying (AK) glomeruli.

Therefore, the surface of the kidneys acquires a granular appearance: hyalinized glomeruli and atrophied, sclerosed, nephrons sink, and hypertrophied glomeruli protrude above the surface of the kidneys (Fig. 48, c, 49). Gradually, sclerotic processes begin to predominate and primary wrinkled kidneys develop. At the same time, chronic renal failure increases, which ends uremia.

Symptomatic hypertension (hypertension). Hypertension is called an increase in blood pressure of a secondary nature - a symptom in various diseases of the kidneys, glands internal secretion, vessels. If it is possible to eliminate the underlying disease, hypertension also disappears. So, after removal of a tumor of the adrenal gland - pheochromocytoma. accompanied by significant hypertension, normalizes blood pressure. Therefore, hypertension should be distinguished from symptomatic hypertension.

CORONARY HEART DISEASE (CHD)

Ischemic, or coronary, heart disease is a group of diseases caused by absolute or relative insufficiency coronary circulation, which is manifested by a mismatch between myocardial oxygen demand and its delivery to the heart muscle. In 95% of cases, coronary artery disease is caused by atherosclerosis of the coronary arteries. It is IHD that acts as the main cause of death in the population. Hidden (preclinical) CAD is found in 4-6% of people over 35 years of age. More than 5 million patients are registered annually in the world. And B C and more than 500 thousand of them die. men get sick before women However, after 70 years, men and women suffer from coronary artery disease equally often.

Forms of ischemic heart disease. There are 4 forms of the disease:

• sudden coronary death coming due to cardiac arrest in a person who had not complained about the heart 6 hours before;
• angina pectoris - a form of coronary artery disease, characterized by attacks of retrosternal pain with changes in the ECG, but without the appearance of characteristic enzymes in the blood;
• myocardial infarction - acute focal ischemic (circulatory) necrosis of the heart muscle, which develops due to sudden violation coronary circulation;
• cardiosclerosis - chronic ischemic heart disease (HIHD)- the outcome of angina pectoris or myocardial infarction; on the basis of cardiosclerosis, a chronic aneurysm of the heart can form.

The course of ischemic disease may be acute or chronic. Therefore, allocate acute ischemic heart disease(angina pectoris, sudden coronary death, myocardial infarction) and chronic ischemic heart disease(cardiosclerosis in all its manifestations).

Risk factors the same as in atherosclerosis and hypertension.

Etiology of IHD fundamentally the same as the etiology of atherosclerosis and hypertension. More than 90% of patients with IHD suffer from stenosing atherosclerosis of the coronary arteries with the degree of narrowing of at least one of them up to 75% or more. At the same time, a blood flow adequate to even a small physical load cannot be provided.

Pathogenesis of various forms of IHD

Development various kinds acute CAD is associated with acute violation coronary circulation, which leads to ischemic damage to the heart muscle.

The extent of these damages depends on the duration of ischemia.

1. Angina pectoris is characterized by reversible myocardial ischemia associated with stenosing coronary sclerosis and is a clinical form of all types of coronary artery disease. It is characterized by attacks of squeezing pains and a burning sensation in the left half of the chest with irradiation to the left arm, shoulder blade area, neck, lower jaw. Seizures occur during physical exertion, emotional stress etc. and are stopped by taking vasodilators. If death occurs during an angina attack lasting 3-5 or even 30 minutes, morphological changes in the myocardium can only be detected using special techniques, since the heart is not macroscopically changed.
2. Sudden coronary death is associated with acute ischemia in the myocardium already 5-10 minutes after the attack, archipogenic substances- Substances that cause electrical instability of the heart and create prerequisites for fibrillation of its ventricles. On autopsy of the deceased due to myocardial fibrillation, the heart is flabby, with an enlarged cavity of the left ventricle. Microscopically expressed fragmentation of muscle fibers.
3. Myocardial infarction.

Etiology acute myocardial infarction is associated with a sudden cessation of coronary blood flow, either due to obstruction of the coronary artery by a thrombus or embolus, or as a result of a prolonged spasm of an atherosclerotically altered coronary artery.

Pathogenesis myocardial infarction is largely determined by the fact. that the remaining lumens of the three coronary arteries in total account for only 34% of average norm, while the "critical sum" of these gaps should be at least 35%, because even in this case, the total blood flow in the coronary arteries falls to the minimum allowable level.

In the dynamics of myocardial infarction, 3 stages are distinguished, each of which is characterized by its morphological features.

ischemic stage, or stage of ischemic dystrophy, develops in the first 18-24 hours after blockage of the coronary artery by a thrombus. Macroscopic changes in the myocardium at this stage are not visible. At microscopic examination dystrophic changes in muscle fibers are observed in the form of their fragmentation, loss of transverse striation, myocardial stroma is edematous. Disorders of microcirculation are expressed in the form of stasis and sludge in capillaries and venules, there are diapedesmic hemorrhages. In areas of ischemia, glycogen and redox enzymes are absent. An electron microscopic examination of cardiomyocytes from the area of ​​myocardial ischemia reveals swelling and destruction of mitochondria, the disappearance of glycogen granules, edema of the sarcoplasm, and overcontraction of myofilaments (Fig. 50). These changes are associated with hypoxia, electrolyte imbalance and cessation of metabolism in areas of myocardial ischemia. In the myocardial regions not affected by ischemia, microcirculation disturbances and stromal edema develop during this period.

Death in the ischemic stage occurs from cardiogenic shock, ventricular fibrillation, or cardiac arrest (asystole).

Necrotic stage myocardial infarction develops at the end of the first day after an angina attack. At autopsy, fibrinous pericarditis is often observed in the infarction area. On the section of the heart muscle, yellowish, irregularly shaped foci of myocardial necrosis are clearly visible, surrounded by a red band of hyperemic vessels and hemorrhages - ischemic infarction with a hemorrhagic corolla (Fig. 51). Histological examination reveals foci of necrosis of muscle tissue, limited from the unaffected myocardium. demarcation(borderline) line, represented by a zone of leukocyte infiltration and hyperemic vessels (Fig. 52).

Outside the areas of infarction during this period, microcirculation disorders develop, pronounced dystrophic changes in cardiomyocytes, destruction of many mitochondria simultaneously with an increase in their number and volume.

Stage of organization of myocardial infarction begins immediately after the development of necrosis. Leukocytes and macrophages clear the field of inflammation from necrotic masses. Fibroblasts appear in the demarcation zone. producing collagen. The focus of necrosis is first replaced by granulation tissue, which matures into coarse fibrous connective tissue within about 4 weeks. Myocardial infarction is organized, and a scar remains in its place (see Fig. 30). Large-focal cardiosclerosis occurs. During this period, the myocardium around the scar and the myocardium of all other parts of the heart, especially the left ventricle, undergoes regenerative hypertrophy. This allows you to gradually normalize the function of the heart.

Thus, acute myocardial infarction lasts 4 weeks. If during this period the patient has a new myocardial infarction, then it is called recurrent . If a new myocardial infarction develops 4 weeks or more after the first heart attack, then it is called repeated .

Complications can occur already in the necrotic stage. So, the site of necrosis undergoes melting - myomalacia , resulting in a rupture of the myocardial wall in the infarction area, filling the pericardial cavity with blood - cardiac tamponade leading to sudden death.

Rice. 51. Myocardial infarction (cross sections of the heart). 1 - ischemic infarction with hemorrhagic corolla rear wall left ventricle; 2 - obstructive thrombus in the descending branch of the left coronary artery; 3 - rupture of the wall of the heart. In the diagrams (below): a - the infarction zone is shaded (the arrow shows the gap); b - slice levels are shaded.

Rice. 52. Myocardial infarction. The area of ​​muscle tissue necrosis is surrounded by a demarcation line (DL). made up of leukocytes.

Myomalacia can lead to bulging of the ventricular wall and the formation of an acute aneurysm of the heart. If an aneurysm ruptures, cardiac tamponade also occurs. If an acute aneurysm does not rupture, blood clots form in its cavity, which can become a source of thromboembolism of the vessels of the brain, spleen, kidneys, and the coronary arteries themselves. Gradually, in an acute aneurysm of the heart, blood clots are replaced connective tissue However, thrombotic masses persist or form again in the resulting aneurysm cavity. The aneurysm becomes chronic. The source of thromboembolism can be thrombotic overlays on the endocardium in the infarction area. Death in the necrotic stage can also occur from ventricular fibrillation.

Rice. 53. Chronic ischemic heart disease. a - post-infarction large-focal cardiosclerosis (shown by an arrow); b - disseminated focal cardiosclerosis (scars are shown by arrows).

Outcomes. Acute myocardial infarction can result in acute heart failure, often with the development of pulmonary edema and swelling of the brain substance. The outcome is also macrofocal cardiosclerosis and chronic ischemic heart disease.

4. Chronic ischemic heart disease

Morphological expression chronic ischemic heart disease are:

• pronounced atherosclerotic small-focal cardiosclerosis;
• postinfarction macrofocal cardiosclerosis;
• chronic aneurysm of the heart in combination with atherosclerosis of the coronary arteries (Fig. 53). It occurs when, after an extensive myocardial infarction, the resulting scar tissue begins to swell under blood pressure, becomes thinner and a saccular protrusion forms. Due to the swirl of blood in the aneurysm, blood clots appear, which can become a source of thromboembolism. Chronic aneurysm of the heart in most cases is the cause of increasing chronic heart failure.

All these changes are accompanied by moderately pronounced regenerative hypertrophy of the myocardium.

Clinically chronic ischemic heart disease is manifested by angina pectoris and the gradual development of chronic cardiovascular insufficiency, ending in the death of the patient. At any stage of chronic coronary artery disease, acute or recurrent myocardial infarction may occur.

Causes inflammation of the heart is various infections and intoxication. The inflammatory process can affect one of the membranes of the heart or its entire wall. inflammation of the endocardium endocarditis , inflammation of the myocardium - myocarditis, pericardium - pericarditis , and inflammation of all the membranes of the heart - pancarditis .

Endocarditis.

Inflammation of the endocardium usually extends only to a certain part of it, covering either the valves of the heart, or their chords, or the walls of the heart cavities. In endocarditis, there is a combination of processes characteristic of inflammation - alterations, exudations and proliferation. The most important in the clinic is valvular endocarditis . More often than others, the bicuspid valve is affected, somewhat less often - the aortic valve, quite rarely inflammation of the valves of the right half of the heart occurs. Either only the superficial layers of the valve undergo alterations, or it is affected entirely, to the full depth. Quite often alteration of the valve leads to its ulceration and even perforation. Thrombotic masses usually form in the area of ​​valve destruction ( thromboendocarditis) in the form of warts or polyps. Exudative changes consist in impregnation of the valve with blood plasma and its infiltration with exudate cells. In this case, the valve swells and becomes thicker. The productive phase of inflammation ends with sclerosis, thickening, deformation and fusion of the valve leaflets, which leads to heart disease.

Endocarditis sharply complicates the course of the disease in which it has developed, since the function of the heart is severely affected. In addition, thrombotic overlays on the valves can become a source of thromboembolism.

exodus valvular endocarditis are heart defects and heart failure.

Myocarditis.

Inflammation of the heart muscle usually complicates various diseases, not being independent disease. In the development of myocarditis, infectious damage to the heart muscle by viruses, rickettsiae, and bacteria that reach the myocardium with blood flow, i.e., by the hematogenous route, is important. Myocarditis occurs acutely or chronically. Depending on the predominance of one or another phase, myocardial inflammation can be alterative, exudative, productive (proliferative).

Acute exudative and productive myocarditis can cause acute heart failure. At chronic course they lead to diffuse cardiosclerosis, which in turn can lead to the development of chronic heart failure.

Pericarditis.

Inflammation of the outer shell of the heart occurs as a complication of other diseases and occurs either in the form of exudative or chronic adhesive pericarditis.

Exudative pericarditis depending on the nature of the exudate, it can be serous, fibrinous, purulent, hemorrhagic and mixed.

Serous pericarditis characterized by the accumulation of serous exudate in the pericardial cavity, which often resolves without any special consequences in the event of a favorable outcome of the underlying disease.

Fibrinous pericarditis develops more often with intoxication, for example, with uremia, as well as with myocardial infarction, rheumatism, tuberculosis and a number of other diseases. Fibrinous exudate accumulates in the pericardial cavity and fibrin convolutions in the form of hairs (“hairy heart”) appear on the surface of its sheets. When organizing fibrinous exudate dense adhesions are formed between the sheets of the pericardium.

Purulent pericarditis most often occurs as a complication of inflammatory processes in nearby organs - the lungs, pleura, mediastinum, mediastinal lymph nodes, from which the inflammation spreads to the pericardium.

Hemorrhagic pericarditis develops with metastases of cancer in the heart.

The outcome of acute exudative pericarditis may be cardiac arrest.

Chronic adhesive pericarditis characterized by exudative-productive inflammation, often develops with tuberculosis and rheumatism. With this type of pericarditis, the exudate does not resolve, but undergoes organization. As a result, adhesions are formed between the sheets of the pericardium, then the pericardial cavity is completely overgrown, sclerosed. squeezing the heart. Often, calcium salts are deposited in the scar tissue and a “armored heart” develops.

exodus such pericarditis is chronic heart failure.

HEART DEFECTS

Heart defects are frequent pathology usually requiring only surgical treatment. The essence of heart defects is to change the structure of its individual parts or those extending from the heart large vessels. This is accompanied by impaired cardiac function and general circulatory disorders. Heart defects can be congenital or acquired.

Congenital thresholds of the heart are the result of violations of embryonic development, associated either with genetic changes in embryogenesis, or with diseases suffered by the fetus during this period (Fig. 54). The most common among this group of heart defects are non-closure of the foramen ovale, ductus arteriosus, interventricular septum and Fallot's tetrad.

Rice. 54. Scheme of the main forms birth defects heart (according to Ya. L. Rapoport). A. Normal relationship of the heart and large vessels. Lp - left atrium; LV - left ventricle; Pp - right atrium; Pzh - right ventricle; A - aorta; La - pulmonary artery and its branches; Lv - pulmonary veins. B. Non-closure of the ductus arteriosus between the pulmonary arteries and the aorta (the direction of blood flow from the aorta to the pulmonary artery along the ductus arteriosus is indicated by arrows). B. Ventricular septal defect. Blood from the left ventricle partially passes into the right (indicated by the arrow). G. Tetralogy of Fallot. Defect of the upper part of the interventricular septum immediately below the origin of the aorta; narrowing of the pulmonary trunk at its exit from the heart; the aorta exits both ventricles in the region of the interventricular defect, receiving mixed arterial-venous blood (indicated by the arrow). Sharp hypertrophy of the right ventricle and general cyanosis (cyanosis).

Non-closure of the oval window. Through this hole in interatrial septum blood from the left atrium enters the right, then into the right ventricle and into the pulmonary circulation. At the same time, the right parts of the heart overflow with blood, and in order to bring it out of the right ventricle into the pulmonary trunk, a constant increase in the work of the myocardium is necessary. This leads to hypertrophy of the right ventricle, which allows the heart to cope with circulatory disorders in it for some time. However, if the foramen ovale is not closed surgically, decompensation of the myocardium of the right heart will develop. If the defect in the atrial septum is very large, then venous blood from the right atrium, bypassing the pulmonary circulation, can enter the left atrium and mix with arterial blood here. As a result of this, mixed blood, poor in oxygen, circulates in the systemic circulation. The patient develops hypoxia and cyanosis.

Non-closure of the arterial (botallova) duct (Fig. 54, A, B). In the fetus, the lungs do not function, and therefore the blood from the pulmonary trunk enters the aorta directly from the pulmonary trunk through the ductus arteriosus, bypassing the pulmonary circulation. Normally, the arterial duct overgrows 15-20 days after the birth of the child. If this does not happen, then the blood from the aorta, in which high blood pressure, through the botallian duct enters the pulmonary trunk. The amount of blood and blood pressure in it increase, in the pulmonary circulation, the amount of blood that enters the left side of the heart increases. The load on the myocardium increases and hypertrophy of the left ventricle and left atrium develops. Gradually, sclerotic changes develop in the lungs, contributing to an increase in pressure in the pulmonary circulation. This causes the right ventricle to work more intensively, as a result of which its hypertrophy develops. With far-reaching changes in the pulmonary circulation in the pulmonary trunk, the pressure may become higher than in the aorta, and in this case, venous blood from the pulmonary trunk partially passes through the ductus arteriosus into the aorta. Mixed blood enters the systemic circulation, the patient develops hypoxia and cyanosis.

Ventricular septal defect. With this defect, blood from the left ventricle enters the right one, causing its overload and hypertrophy (Fig. 54, C, D). Sometimes the interventricular septum may be completely absent (three-chambered heart). Such a defect is incompatible with life, although for some time newborns with a three-chambered heart can live.

Tetrad FALLO - defect of the interventricular septum, which is combined with other anomalies in the development of the heart: narrowing of the pulmonary trunk, aortic discharge from the left and right ventricles simultaneously and with hypertrophy of the right ventricle. This defect occurs in 40-50% of all heart defects in newborns. With a defect such as the tetralogy of Fallot, blood flows from the right side of the heart to the left. At the same time, less blood than necessary enters the pulmonary circulation, and mixed blood enters the systemic circulation. The patient develops hypoxia and cyanosis.

Acquired heart defects in the vast majority of cases, they are the result of inflammatory diseases of the heart and its valves. Most common cause acquired heart defects is rheumatism, sometimes they are associated with endocarditis of a different etiology.

Pathogenesis.

As a result of inflammatory changes and sclerosis of the leaflets, the valves become deformed, become dense, lose their elasticity and cannot completely close the atrioventricular orifices or the orifice of the aorta and pulmonary trunk. In this case, a heart defect is formed, which can have various options.

Valve insufficiency develops with incomplete closure of the atrioventricular orifice. With insufficiency of the bicuspid or tricuspid valves, blood during systole flows not only into the aorta or pulmonary trunk, but also back into the atria. If there is insufficiency of the valves of the aorta or pulmonary artery, then during diastole, blood partially flows back into the ventricles of the heart.

Stenosis, or hole narrowing, between the atrium and the ventricles develops not only with inflammation and sclerosis of the heart valves, but also with partial fusion of their valves. In this case, the atrioventricular orifice or the orifice of the pulmonary artery or the orifice of the aortic cone becomes smaller.

Combination vice heart occurs when a combination of stenosis of the atrioventricular orifice and valve insufficiency. This is the most common type of acquired heart disease. With a combined defect of the bicuspid or tricuspid valve, the increased volume of blood during diastole cannot enter the ventricle without additional effort from the atrial myocardium, and during systole, blood partially returns from the ventricle to the atrium, which overflows with blood. In order to prevent overstretching of the atrial cavity, and also to ensure the supply of the required volume of blood into the vascular bed, the force of contraction of the atrial and ventricular myocardium increases compensatory, resulting in its hypertrophy. However, the constant overflow of blood, for example, the left atrium with stenosis of the atrioventricular orifice and insufficiency of the bicuspid valve leads to the fact that blood from the pulmonary veins cannot completely enter the left atrium. There is stagnation of blood in the pulmonary circulation, and this makes it difficult for the flow of venous blood from the right ventricle to the pulmonary artery. To overcome the increased blood pressure in the pulmonary circulation, the contraction force of the right ventricular myocardium increases and the heart muscle also hypertrophies. Developing compensatory(working) cardiac hypertrophy.

exodus acquired heart defects, if the valve defect is not eliminated surgically, is chronic heart failure and decompensation of the heart, which develops after a certain time, usually calculated in years or decades.

VASCULAR DISEASES

Vascular diseases can be congenital or acquired.

CONGENITAL VASCULAR DISEASES

Congenital vascular diseases are in the nature of malformations, among which congenital aneurysms, coarctation of the aorta, hypoplasia of the arteries and atresia of the veins are of the greatest importance.

Congenital aneurysms- focal protrusions of the vascular wall caused by a defect in its structure and hemodynamic load.

Aneurysms look like small saccular formations, sometimes multiple, up to 1.5 cm in size. Among them, aneurysms of the intracerebral arteries are especially dangerous, since their rupture leads to subarachnoid or intracerebral hemorrhage. The causes of aneurysms are the congenital absence of smooth muscle cells in the vessel wall and a defect in elastic membranes. Arterial hypertension contributes to the formation of aneurysms.

Coarctation of the aorta - congenital narrowing of the aorta, usually in the region of transition of the arch into the descending part. Vice manifests itself sharp rise blood pressure in the upper extremities and its decrease in the lower extremities with a weakening of the pulsation there. At the same time, hypertrophy of the left half of the heart and collateral circulation through the systems of the internal thoracic and intercostal arteries develop.

Hypoplasia of the arteries characterized by underdevelopment of these vessels, including the aorta, while hypoplasia of the coronary arteries may underlie sudden cardiac death.

venous atresia - a rare malformation, consisting in the congenital absence of certain veins. The most important is atresia of the hepatic veins, which is manifested by severe violations of the structure and function of the liver (Budd-Chiari syndrome).

Acquired vascular disease are very common, especially in atherosclerosis and hypertension. Obliterating endarteritis, acquired aneurysms, and vasculitis are also of clinical importance.

Obliterating endarteritis - a disease of the arteries, mainly of the lower extremities, characterized by thickening of the intima with a narrowing of the lumen of the vessels up to its obliteration. This condition is manifested by severe, progressive tissue hypoxia with an outcome in gangrene. The cause of the disease has not been established, but smoking and hypertension are the most important risk factors. In the pathogenesis of suffering, an increase in the activity of the sympathetic-adrenal system and autoimmune processes play a certain role.

ACQUIRED ANEURYSM

Acquired aneurysms - local extension lumen of blood vessels due to pathological changes in the vascular wall. They can be bag-shaped or cylindrical. The causes of these aneurysms may be damage to the vascular wall of an atherosclerotic, syphilitic or traumatic nature. More often aneurysms occur in the aorta, less often in other arteries.

atherosclerotic aneurysms, as a rule, develop in the aorta damaged by the atherosclerotic process with a predominance of complicated changes, usually after 65-75 years, more often in men. The reason is the destruction of the muscular-elastic frame of the cardiac membrane of the aorta by atheromatous plaques. Typical localization is the abdominal aorta. Thrombotic masses form in the aneurysm, serving as a source of thromboembolism.

Complications- rupture of the aneurysm with the development of fatal bleeding, as well as thromboembolism of the arteries of the lower extremities, followed by gangrene.

Syphilitic aneurysms- a consequence of syphilitic mesaortitis, characterized by the destruction of the muscular-elastic skeleton middle shell wall of the aorta, usually in the area ascending department arc and its thoracic part.

More often these aneurysms are observed in men, they can reach 15-20 cm in diameter. With prolonged existence, the aneurysm puts pressure on the adjacent vertebral bodies and ribs, causing their atrophy. Clinical symptoms are associated with compression of adjacent organs and are manifested respiratory failure, dysphagia due to compression of the esophagus, persistent cough due to compression of the recurrent nerve, pain syndrome, decompensation of cardiac activity.

Vasculitis- a large and heterogeneous group of inflammatory vascular diseases.

Vasculitis is characterized by the formation of an infiltrate in the vessel wall and in the perivascular tissue, damage and desquamation of the endothelium, loss of vascular tone and hyperemia in the acute period, wall sclerosis and often obliteration of the lumen in the chronic course.

Vasculitis is divided into systemic, or primary, and secondary. Primary vasculitis is a large group of diseases, are common and have independent significance. Secondary vasculitis develops in many diseases and will be described in the relevant chapters.

Diseases of the veins are mainly represented by phlebitis - inflammation of the veins, thrombophlebitis - phlebitis complicated by thrombosis, phlebothrombosis - thrombosis of veins without their previous inflammation, and varicose veins.

Phlebitis, thrombophlebitis and phlebothrombosis.

Phlebitis is usually the result of infection of the venous wall, it can complicate acute infectious diseases. Sometimes phlebitis develops due to trauma to the vein or its chemical damage. When a vein becomes inflamed, the endothelium is usually damaged, which leads to the loss of its fibrinolytic function and the formation of a thrombus in this area. Arises thrombophlebitis. It manifests itself pain symptom, tissue edema distal to the occlusion, cyanosis and redness of the skin. In the acute period, thrombophlebitis may be complicated by thromboembolism. With a long chronic course, thrombotic masses undergo organization, however, thrombophlebitis and phlebothrombosis of the main veins can cause the development trophic ulcers, usually the lower extremities.

Phlebeurysm- abnormal expansion, tortuosity and lengthening of the veins that occurs in conditions of increased intravenous pressure.

A predisposing factor is congenital or acquired inferiority of the venous wall and its thinning. At the same time, foci of hypertrophy of smooth muscle cells and sclerosis appear next to each other. The veins of the lower extremities, hemorrhoidal veins and veins are most often affected. lower section esophagus with blockade of venous outflow in them. Areas of varicose veins may have a nodular, aneurysm-like, fusiform shape. Often, varicose veins are combined with vein thrombosis.

Varicose veins- the most common form of venous pathology. It occurs mainly in women over 50 years of age.

An increase in intravenous pressure may be associated with professional activities and lifestyle (pregnancy, standing, carrying heavy loads, etc.). Superficial veins are predominantly affected, clinically the disease is manifested by edema of the extremities, trophic skin disorders with the development of dermatitis and ulcers.

Varicose hemorrhoidal veins- also a common form of pathology. Predisposing factors are constipation, pregnancy, sometimes portal hypertension.

Varicose veins develop in the lower hemorrhoidal plexus with the formation of external nodes or in the upper plexus with the formation of internal nodes. The nodes usually thrombose, bulge into the intestinal lumen, are injured, inflamed and ulcerated with the development of bleeding.

Varicose veins of the esophagus develops with portal hypertension, usually associated with cirrhosis of the liver, or with tumor compression of the portal tract. This is due to the fact that the veins of the esophagus shunt blood from the portal system to the caval system. In varicose veins, wall thinning, inflammation and erosion occur. Rupture of the wall of the esophageal varicose vein leads to severe, often fatal, bleeding.

Diseases of the heart and blood vessels are considered one of the most common causes of premature death in people. The main symptom that indicates possible development pathological processes, manifested in the form pain syndrome in chest area giving to the left. Also, the patient may be disturbed by swelling or shortness of breath. When manifested the slightest sign indicating a possible dysfunction of the system, you should consult a doctor. The doctor will conduct appropriate studies, the results of which will either confirm or exclude the pathology. About the list of common heart diseases, their symptoms, treatment and causes of development - later in this article.

Ischemic heart disease is a common disease characterized by myocardial damage. Occurs as a result of a violation of the blood supply to the heart muscle and takes first place in the list dangerous pathologies. It manifests itself in both acute and chronic forms. The progression of the disease often leads to the development of atherosclerotic cardiosclerosis.

Among the main causes and risk factors for coronary artery disease are thromboembolism, atherosclerosis of the coronary arteries, hyperlipidemia, overweight problems (obesity), bad habits (smoking, alcohol), and hypertension. It should also be taken into account that the disease is more common in males. Also, hereditary predisposition contributes to its development.

Common signs of ischemia include pain paroxysmal nature in the thoracic region, palpitations, dizziness, nausea, vomiting, fainting, puffiness.

One form of ischemia is unstable angina. According to the Braunwald classification table, the risk of developing a heart attack depends on the classes of the disease:

• First grade. It is characterized by the usual angina pectoris. Pain occurs against the background of stress. At rest, seizures are absent for two months.
• Second class. Stable angina at rest. It can also occur from two to sixty days.
• Third class. acute form occurring within the last 48 hours.

Treatment depends on the clinical form of ischemia, but is always aimed at preventing complications and consequences. Applies drug therapy as well as lifestyle interventions: proper nutrition, elimination bad habits. In the course of treatment, surgery may be necessary - coronary artery bypass grafting or coronary angioplasty.

Chronic heart failure

Heart failure is a common heart disease caused by poor blood supply to vital organs. Violations occur regardless of human activity (both at rest and during exercise). As the pathology progresses, the heart gradually loses its ability to fill and empty. The main symptoms of heart disease:

• Edema of a peripheral nature. Initially, it occurs in the feet and lower legs, and then spreads to the hips and lower back.
• general weakness, fast fatiguability.
• Dry cough. As the disease progresses, the patient begins to produce sputum, and then blood impurities.

Pathology forces the patient to take a prone position, with his head raised. Otherwise, coughing and shortness of breath will only get worse. The list of the main factors contributing to the development of the disease is quite large:

• Ischemia.
• Heart attack.
• Hypertension.
• Diseases in which the endocrine system is affected (the presence of diabetes mellitus, problems with thyroid gland, adrenals).
• Improper nutrition, which leads to the development of cachexia or obesity.

Among other factors that are the causes of the development of cardiovascular insufficiency, there are congenital and acquired heart defects, sarcaidosis, pericarditis, HIV infection. To minimize the likelihood of illness, the patient is advised to exclude from his life the use of alcoholic beverages, caffeine in high doses, smoking, follow a healthy diet.

Treatment should be comprehensive and timely, otherwise the development of pathology can lead to irreversible consequences - this is a fatal outcome, heart enlargement, rhythm disturbance, blood clots. To avoid possible complications, doctors prescribe patients a special therapeutic diet, optimal physical activity. Drug therapy is based on the intake of inhibitors, adenoblockers, diuretics, anticoagulants. You may also need an implant. artificial drivers rhythm.

Valvular heart disease

A group of serious diseases affecting the heart valves. They lead to a violation of the main functions of the body - blood circulation and sealing of the chambers. The most common pathology is stenosis. It is caused by narrowing of the aortic orifice, which creates serious obstacles to blood outflow from the left ventricle.

The acquired form most often occurs due to rheumatic valve disease. As the disease progresses, the valves are subject to severe deformation, which leads to their fusion and, accordingly, a decrease in the ring. The onset of the disease is also facilitated by the development of infective endocarditis, renal failure and rheumatoid arthritis.

Often, the congenital form can be diagnosed even at a young age (up to thirty years) and even in adolescence. Therefore, one should also take into account the fact that rapid development pathology contributes to the use of alcoholic beverages, nicotine, a systematic increase in blood pressure.

For a long time (with compensation of stenosis), a person may experience practically no symptoms. There is no external clinical picture of the disease. The first signs are manifested in the form of shortness of breath during physical exertion, palpitations, feelings of malaise, general weakness, loss of strength.

Fainting, dizziness, angina and swelling respiratory tract often manifest in the stage of coronary insufficiency. Shortness of breath can disturb the patient even at night, when the body is not subject to any stress and is at rest.

Patients with heart disease (including those who are asymptomatic) should be seen by a cardiologist and tested. So, in particular, every six months, patients undergo echocardiography. Medicines are prescribed to relieve the disease and prevent possible complications. For preventive purposes, it is necessary to take antibiotics.

At the same time, the main method of treatment is to replace the affected area aortic valve artificial. After surgery, patients must take anticoagulants for the rest of their lives.

birth defects

Pathology is often diagnosed even in the early stages in infants (immediately after birth, the child is subject to a thorough examination). Formed at the stage of intrauterine development. The main signs of heart disease:

• Color change skin. They become pale, often acquire a bluish tint.
• There is respiratory and cardiac failure.
• Heart murmurs are observed.
• The child may lag behind in physical development.

In most cases, the main method of treatment is surgery. Often it is not possible to completely eliminate the defect or it is not possible. Under such circumstances, a heart transplant should be performed. Drug therapy is aimed at eliminating symptoms, preventing the development chronic insufficiency, arrhythmias.

According to statistics, in 70% of cases the first year of life ends fatally for the child. The prognosis improves significantly if the disease is detected early. The main prevention lies in the careful planning of pregnancy, which implies compliance with right image life, elimination of risk factors, regular monitoring and implementation of all recommendations of the attending physician.

Arrhythmia and cardiomyopathy

Cardiomyopathy is a myocardial disease that is not associated with ischemic or inflammatory origin. Clinical manifestations depend on the form of the pathological process. Common symptoms include shortness of breath that occurs during physical exertion, pain in the chest area, dizziness, fatigue, pronounced swelling. The use of diuretics, anticoagulants, antiarrhythmic drugs is mainly indicated. A surgical intervention may be required.

Arrhythmia is characterized by any rhythm disturbance. To this species Pathologies include tachycardia, bradycardia, atrial fibrillation. One of the forms is also considered extrasystole. In most cases, it is asymptomatic, but as the disease progresses, there is a rapid or slow heartbeat, periodic fading. Accompanied by headache, dizziness, pain in the chest area. In the process of treatment, both drug therapy and surgical methods are used.

Inflammatory diseases

Clinical manifestations of inflammation of the heart depend on which tissue structure was involved during the progression of the pathology:

Common symptoms include pain, irregular heartbeat, and shortness of breath. If you were involved infectious process, patients have fever body.

Not all heart diseases are listed. The list of titles can go on. So, for example, often mental (against the background of the prevalence of the vagus nerve) or physical overstrain can lead to neurosis, vegetovascular dystonia, mitral valve prolapse (primary and secondary form) or a disorder of a different nature.

Modern diagnostic methods make it possible to quickly establish the presence of pathology and take all necessary measures. Most heart diseases cannot be completely cured, but they can be stopped, alleviated general state patient, minimize risks or prevent possible disability.

The risk group includes both men and women, but most ailments can only be diagnosed at an older, often elderly age. The main problem with treatment is untimely appeal for qualified help, which in the future can strongly bind and limit the possibilities of modern medicine.

It is important to follow all the recommendations of the doctor, take prescribed medications and lead an appropriate lifestyle. If a we are talking about folk methods and remedies, then before using them, you need to consult with a specialist.

At the present time, diseases of the cardiovascular system are a very common problem among people of all ages. It should be noted that the death rate from these diseases is increasing every year. A huge role in this is played by factors affecting violations in the work of organs.

What criteria are used to classify such pathologies, what symptoms accompany them? How are these diseases treated?

What are they?

All pathologies of the cardiovascular system are grouped depending on their location and nature of the course. Therefore, diseases are divided into the following types:

• Heart disease (muscles and valves);
• Diseases of the blood vessels(peripheral and other arteries and veins);
• General pathologies of the whole system.

There is also a classification of cardiovascular diseases according to etiology:

In addition, these pathological conditions are congenital, and can be hereditary and acquired.

Diseases of the vessels and heart differ in symptoms and severity.

List of diseases of the heart muscle and heart valves:

In addition, cardiac diseases include rhythm disturbances: arrhythmia (tachycardia, bradycardia), heart block.

Vascular pathologies include:

Common diseases of the cardiovascular system that affect the activity of these organs in general are:

• hypertonic disease;
• stroke;
• atherosclerosis;
• cardiosclerosis.

The above diseases are very life-threatening and therefore require timely treatment. To avoid such pathologies, it is necessary to follow the rules for the prevention of diseases of the heart and blood vessels.

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General characteristics and therapy

Common symptoms of cardiovascular pathologies are:

It is important to note that the treatment of cardiovascular diseases is carried out with integrated approach. It includes medication, folk remedies, physiotherapeutic procedures, physiotherapy exercises.

Applies also breathing exercises. Scientists have proven that sobbing breath cures cardiovascular diseases.

Ischemic disease

This disease usually occurs in older people. This disease is also called coronary disease due to the fact that the myocardium is affected due to impaired blood circulation in the coronary arteries. Often occurs without any symptoms.

Symptoms occur during physical exertion, the same as with angina pectoris:

• feeling of lack of air;
• pain in the middle of the chest;
• frequent pulse;
• increased sweating.

To improve the condition and prevent various complications are assigned:

AT severe cases Maybe surgical intervention– coronary artery bypass grafting, stenting. Recommended special diet, exercise therapy, physiotherapy.

angina pectoris

People call it angina pectoris. It is a consequence of atherosclerosis of the coronary vessels. With angina pectoris, there is pain behind the sternum of a compressive nature, radiating to the scapula and upper limb From the left side. Also, during attacks, shortness of breath, heaviness in the chest area occurs.

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The attack is removed with the help of nitroglycerin and its analogues. Beta-blockers are used for treatment (Prinorm, Aten, Azectol, Hipres, Atenolol), isosorbitol dinitrate (Izolong, Ditrat, Sorbidin, Cardiket, Etidiniz).

The patient is prescribed drugs that block calcium channels, as well as drugs that improve metabolic processes in the myocardium.

Myocarditis

With myocarditis, the myocardium becomes inflamed. This is facilitated bacterial infections, allergies, weakened immune system. This disease is characterized by acute pain in the chest region, weakness, shortness of breath, disturbed heart rhythm, hyperthermia. The conducted studies testify to the increased size of the organ.

If myocarditis is infectious, then antibiotic therapy is used. Other medicines prescribed by a specialist depending on the severity of the disease.

myocardial infarction

The disease is characterized by the death of myocardial muscle tissue. This condition is especially dangerous for human life.

The main symptoms are pain behind the sternum, pallor of the skin, loss of consciousness, darkening in the eyes. But if after taking nitroglycerin, the pain with angina pectoris disappears, then with a heart attack, it can bother even for several hours.

With signs of pathology, it is recommended to ensure the patient's rest, for this he is laid on a flat surface. AT urgently hospitalization of the patient is necessary. Therefore, without delay, you need to call an ambulance. It is recommended to take Corvalol (thirty drops).

The risk of death is dangerous in the first hours pathological condition, so the patient is placed in intensive care. Treatment includes the use of drugs to lower venous pressure, normalize cardiac activity and relieve pain.

Rehabilitation activities last up to six months.

Heart disease

Heart disease - deformation of the heart muscle and valves. There are such types of this pathology:

• congenital;
• Acquired.

Heart disease Tetralogy of Fallot

Congenital ones appear due to the fact that the heart of the fetus was not properly formed in the womb. Acquired lesions are a complication of atherosclerosis, rheumatism, syphilis. The symptoms of the disease are varied, and depend on the location of the defects:

Cardiac defects also include such types of pathologies: mitral stenosis, aortic disease, mitral valve insufficiency, tricuspid insufficiency, stenosis of the aortic orifice.

With such diseases, maintenance therapy is prescribed. One of the effective methods of treatment is a surgical method - in case of stenosis, a commissurotomy is performed, in case of valve insufficiency, prosthetics. With combined defects, the valve is completely changed to an artificial one.

Aneurysm

An aneurysm is a disease of the walls of blood vessels, when a certain part of them expands significantly. Most often this occurs in the vessels of the brain, aorta, heart vessels. If the aneurysm of the veins and arteries of the heart ruptures, death occurs instantly.

Symptoms depend on the location of the vasodilatation - the most common is an aneurysm of the cerebral vessels. The disease is mostly asymptomatic. But when the affected area reaches a large size or is on the verge of rupture, then such a pathology is indicated by a severe headache that does not go away within a few days. Therefore, it is important to consult a doctor in time to avoid disastrous consequences.

Completely get rid of the aneurysm, you can only with the help of surgical intervention.

Atherosclerosis

In this condition, the arteries that are in the organs are affected. The characteristic of the disease is the deposition of cholesterol on the walls of blood vessels, which leads to the fact that their lumen narrows, so the blood supply is disturbed. Atherosclerotic plaques can detach from blood vessels. This phenomenon can be fatal.

Used to treat statins, which lower cholesterol, as well as drugs that improve blood circulation.

Hypertonic disease

general characteristics hypertension - an increase in systolic and diastolic blood pressure. Main symptoms:

Treatment is aimed at lowering blood pressure and eliminating the causes of this process. Therefore, antihypertensive drugs are prescribed, for example, beta-blockers (Atenolol, Sotalol, Bisprololol).

In addition, diuretics are used to remove chlorine and sodium (Chlorthalidone, Indapamide, Furosemide), and potassium antagonists to prevent disorders in the vessels of the brain (Amplodipine, Nimodipine, Verapamil).

Also, with hypertension, a special diet is prescribed.

Stroke - serious condition as a result of impaired blood circulation in the brain. Due to malnutrition, the brain tissue begins to be damaged, and the vessels become clogged or ruptured. In medicine, these types of strokes are distinguished:

• Hemorrhagic(rupture of the vessel);
• Ischemic (blockage).

Stroke symptoms:

• acute headache;
• convulsions;
• lethargy;
• drowsiness;
• loss of consciousness;
• nausea and vomiting.

If such signs are observed, the patient needs urgent hospitalization. To provide first aid, he needs to ensure a lying position, air flow and release from clothing.

Treatment depends on the type of pathology. For the treatment of hemorrhagic stroke, methods are used to reduce pressure and stop hemorrhages in the brain or skull. With ischemic - it is necessary to restore blood circulation in the brain.

In addition, drugs are prescribed to stimulate metabolic processes. Oxygen therapy plays an important role. It is important to note that post-stroke rehabilitation is a long process.

Varicose veins

Varicose veins are a disease that is accompanied by impaired functioning of the venous blood flow and vascular valves. Most often, pathology spreads to the veins of the lower extremities.

The symptoms of varicose veins are as follows:

• puffiness;
• change in the shade of the skin near the site of the lesion;
• muscle cramps (especially at night);
• pain syndrome;
• feeling of heaviness in the limbs.

Recommended to ease the wearing condition compression stockings and exercise. Drug treatment includes the use of venotonic agents, drugs that improve venous blood flow, anticoagulants. In severe cases, surgical intervention is used.

Diseases of the heart and blood vessels require timely treatment. To avoid complications, therapy should be comprehensive and systematic.

To prevent pathological processes, proper nutrition, physiotherapy exercises are necessary. Breathing exercises are effective in this regard, because it has been established that sobbing breathing cures cardiovascular diseases.

Cardiovascular disease and hereditary predisposition

Among the main causes of pathologies of diseases of the heart and blood vessels is a hereditary factor. These diseases include:

Hereditary pathologies make up a large percentage of the list of diseases of the cardiovascular system.

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