Department of propedeutics of internal diseases

 

 

METHODICAL ELABORATIONS

ON PROPEDEUTICS OF INTERNAL MEDICINE

(Module 2: Symptoms and syndromes in diseases of internal organs).

 

(for the third-year students of the medical faculty and teachers)

 

Zaporozhye, 2012

UDK 616.1 / 4-07(075.8)

Authors: Doctor of medical science, professor - Sivolap V.V.; assistant c.m.s. Avramenko N.F.; assistant c.m.s. Likhasenko I.V.

“Methodical Recommendations on propedeutics of internal disease”: Book 2: Symptoms and syndromes in diseases of internal organs. Chapter 1: Basic Symptoms and Syndromes in Diseases of Cardiovascular System. Zaporozhye. 2012.

Reviewers:

Sivolap V.D. - the Head of department of internal diseases № 1 ZSMU,

Doctor of medical science, professor

Tokarenko A.I. - the Head of department of therapy, physiotherapy and kurortology ZMAPS

Doctor of medical science, professor

The methodical recommendations focuses on syndromes and diseases of cardiovascular system.

 

 

The methodical recommendations are intended for medical students, intern-doctors.

 

The structure of studying discipline

Names of modules, thematic modules and topics	Amount of hours
Full-time studying
Total	including
L.	Pr.	Lab.	Ind.w.
MODULE 2.
The Contents of Module 6. Basic Symptoms and Syndromes in Diseases of Cardiovascular System.
Topic 1. The Main Syndromesof Heart Failure	5,5				0,5
Topic 2. Rheumatism					-
Topic 3. Mitral Valvular Diseases of the Heart: the Main Syndromes and Symptoms on the Basis of Clinical and Instrumental Methods of Investigation.	3,5	-			0,5
Topic 4. Aortal Valvular Diseases of the Heart: the Main Syndromes and Symptoms on the Basis of Clinical and Instrumental Methods of Investigation.	3,5	-			0,5
Topic 5. The Main Syndromes and Symptoms of Arterial Hypertension. Hypertenic Crisis.	5,5			-	0,5
Topic 6. Ischemic Heart Disease. The Main Syndromes and Symptoms of Angina Pectoris and Myocardial Infarction.	5,5			-	0,5
The Contents of Module 7. Basic Symptoms and Syndromes of the Diseases of Respiratory System.
Topic 7. The Basic Clinical Symptoms of Chronic Bronchitis and Bronchial Asthma. Chronic Obstructive Pulmonary Diseas.	5,5			-	0,5
Topic 8. Pneumonias: Symptoms and Syndromes on the Basis of Clinical - Instrumental and Laboratory Methods of Examination. Pneumosclerosis. Tumors of the Lungs.				-
Topic 9. The Basic Symptoms and Syndromes in Dry Pleurisy and Pleural Effusion. Syndrome of Respiratory Failure in the Pathology of Broncho-Pulmonary System. Curation of the patients		-			-
The Contents of Module 8. Basic Symptoms and Syndroms in Diseases of the Digestive System and Urinary System.
Topic10. Clinical, Instrumental and Laboratory Examination of the Patients with Chronic Gastritis, Gastric and Duodenal Ulcer and Diseases of the Intestine.	5,5			-	0,5
Topic 11. Basic Symptoms and Syndroms in Biliary Diseases: Chronic Cholecystitis, Cholangitis, Cholelithiasis.	3,5	-		-	0,5
Topic 12. Basic Clinical and Laboratory Features in Chronic Hepatitis and Hepatic Cirrhosis.	5,5			-	0,5
Topic 13. The main symptoms and syndromes in renal disease-acute and chronic glomerulonephritis and pyelonephritis.	5,5			-	0,5
The Contents of Module 9. Endocrine Diseases, Blood System Pathology and the Interpretation of Laboratory Methods of Examination Results.
Topic 14. The main symptoms and syndromes in anemia. General clinical blood tests.			-	-
Topic 15. Hemorrhagic syndromes and the pathology of blood coagulation system. The syndrome of disseminated intravascular blood micro coagulation		-	-	-
Topic 16. The main syndromes in leucosis. Chronic lympholeucosis and myeloleucosis.		-	-	-
Topic 17. The main symptoms and syndromes in diabetes mellitus. The main clinical manifestations of thyroid gland diseases.		-	-	-
Topic 18. Final module control.		-
All the hours of Module2				-

MODULE 2. BASIC SYMPTOMS AND SYNDROMES IN DISEASE OF INTERNAL ORGANS

 

The Contents of Module 6. Basic Symptoms and Syndromes in Diseases of Cardiovascular System.

Basic Symptoms and Syndromes in Diseases of Cardiovascular System.

 

Concrete aims:

· to combine the results of questioning, physical and instrumental examination of a patient with specific pathology of cardiovascular system and differentiate the basic symptoms and syndromes of their damage

· to identify the basic syndromes in diseases of cardiovascular system and explain the mechanisms of their development

· to choose the adequate methods of examination in specific diseases of cardiovascular system

· to demonstrate the possessing of modern classifications of the diseases of cardiovascular system

Topic 1. The Main Syndromesof Heart Failure

Class lasts: 3 hours

Chronological class structure:

Control of initial standard of knowledges- 20 min.

Teacher′s demonstration of practical skills - 60 min.

Sudents′ independent work: - 30 min.

Control of ultimate standard of knowledges- 15 min.

Sum up of the class, homework- 10 min.

Questions for theoretical preparation: Heart failure. Etiology and pathophysiology of heart failure. Modern classification of heart failure (New York Heart Association functional class, stage of heart failure, haemodynamic forms of heart failure). Clinical manifestations of heart failure. Instrumental methods of examination.Acute vascular insufficiency (syncope, collapse, shock). Syncope.

SYNDROME OF CARDIOVASCULAR FAILURE

Heart failure is a pathological condition which characterized by decreased contractility of the myocardium, reduction of cardiac output in which the cardiovascular system fails to supply the necessary amount of blood to the organs and tissues for their adequate function.

This condition arises due to the affection of the heart or of the vessels, or it may be combined disorders of the cardiovascular system.

The syndrome of cardiovascular failure is divided into 2 groups:

- heart failure: acute (acute left ventricular heart failure, acute left atrial heart failure, acute right ventricular heart failure) and chronic (chronic left ventricular heart failure, chronic left atrial heart failure, chronic right ventricular heart failure and total chronic heart failure);

- vascular failure: syncope, collapse and shock.

Etiology

Heart failure may develop in case of overloading or overstrain of the myocardium by "pressure" (hypertension, aortic stenosis, stenosis of the pulmonary orifice), by "volume" (mitral or aortic regurgitation), and also owing to diseases affect primarily the myocardium and its metabolism. Affection of the myocardium may be due to infectious, inflammatory and toxic damage of the myocardium (myocarditis, cardiomyopathy, intoxication of the myocardium by alcohol, narcotic drugs, and other poisons), insufficient blood supply to the myocardium (disordered coronary circulation, anemia), metabolic disorders, and endocrine dysfunction.

Common causes of heart failure:

· ischemic (coronary) heart disease;

· arterial hypertension;

· dilated cardiomyopathy;

· heart valve diseases;

· hypertrophic cardiomyopathy;

· restrictive cardiomyopathy;

· constrictive pericarditis;

· high-output heart failure;

· chronic anemia;

· atrioventricular shunts;

· thyrotoxicosis.

Pathogenesis. The clinical syndrome related to organ hypoperfusion and inadequate tissue oxygen delivery due to a low cardiac output and decreased cardiac reserve, as well as pulmonary and systemic venous congestion. Heart failure is associated with complex neurohormonal changes including activation of the renin-angiotensin-aldosterone and the sympathetic nervous systems. At first these changes may help to compensate cardiac function by altering the afterload or preload and by increasing myocardial contractility. Ultimately they become counterproductive and reduce cardiac output bycausing an inappropriate and excessive increase in peripheral vascular resistance. A vicious cycle may be established because a fall in cardiac output will cause further neurohormonal activation and increasing peripheral vascular resistance. The onset of peripheral edema is due to salt and water retention caused by impaired renal perfusion and secondary aldosteronism.

Heart failure may develop as a result of impaired myocardial contraction due to decreasing of number functional activity of cardiomyocites - systolic dysfunction. Which may observe in patients with inflammation of myocardium, cardiosclerosis, hypertension, non-compensated regurgitation and dilated cardiomyopathy.

Heart failure may arise due to poor ventricular filling caused by disorder of active relaxation and increasing of rigidity of myocardium due to hypertrophy, fibrosis and infiltration - diastolic dysfunction, which may observe in patients with constrictive pericardities, hypertrophic cardiomyopathy.

Systolic and diastolic dysfunctions often coexist, particularly in patients with hypertension, ischemic (coronary) heart disease.

Compensatory mechanisms in heart failure: tachycardia, Frank-Starling's mechanism, myocardial hypertrophy, tonogenic dilation and slow blood flow.