Diseases of the circulatory system. Methods for preventing circulatory diseases

Diseases of the circulatory system occupy one of the leading places. Damage to the circulatory system often leads to complete loss of ability to work. The causes of circulatory diseases are very diverse. A variety of parts of the heart are affected, as well as blood vessels: myocardium, endocardium, pericardium, coronary arteries of the heart, aorta, large main arteries and arteries of smaller caliber. The outcome of many heart diseases is circulatory failure.

Diseases of the circulatory system are observed in people of different ages and genders, but some diseases are more common in men, while others are more common in women. The increase in morbidity of the circulatory system in recent decades, combined with severe outcomes of the disease, indicates the great social significance of this pathology.

Main symptoms With diseases of the circulatory system, patients present a variety of complaints that are not characteristic of any specific disease. All these complaints in varying combinations and varying degrees of severity can occur in a wide variety of diseases. At the same time, in the initial stages of some diseases, patients may not present any complaints and the disease itself in these cases is detected by chance (during medical examination, when visiting a doctor for a completely different reason, for example, when visiting about an acute respiratory disease). However, knowledge of the main symptoms helps to recognize the pathology of the circulatory system, since if the patient makes certain complaints, then during further examination Special attention

will be aimed at identifying changes in the circulatory system. On the other hand, if the diagnosis is already known, these complaints may appear or intensify as the condition worsens, and the nurse can promptly detect a change in the course of the disease and inform the doctor about it.

In diseases of the circulatory system, a number of characteristic symptoms are observed: interruptions, pain in the heart, shortness of breath, suffocation, swelling, cyanosis, etc. As you know, a healthy person does not feel his heartbeat at rest and during moderate physical activity. However, even a person with a healthy heart feels palpitations during significant physical activity (for example, after an intense run); with strong excitement, along with a rapid heartbeat, strong heartbeats are felt; finally, at high temperature

the body can feel the heartbeat. In patients with heart disease, palpitations can occur (and be felt) even with minor physical activity and even at rest. The slightest excitement or eating can also lead to palpitations. The cause of palpitations in heart disease is a decrease in the contractile function of the heart, when the heart pumps a smaller amount of blood into the aorta in one contraction than normal. To prevent the blood supply to organs and tissues from suffering, the heart is “forced” to contract more often, therefore, the heartbeat is essentially a compensatory (adaptive) mechanism. However, working in this mode is unfavorable for the heart, since when the heart beats, the relaxation phase of the heart (diastole) is shortened, during which favorable biochemical processes occur in the heart muscle aimed at restoring the performance of the heart muscle. A rapid heartbeat is called tachycardia. Interruptions. A feeling of irregular heartbeat (arrhythmia) in the form of a feeling of fading, stopping, short strong blow etc. are called interruptions. Outages can be isolated or longer (even permanent). Most often, interruptions are combined with rapid heartbeat - tachycardia, but can often be observed against the background of a rare heart rhythm. The reason for the interruptions is various disorders heart rate: extrasystoles (extraordinary contractions of the heart), atrial fibrillation (irrhythmic work of the entire heart due to the fact that the atria lose the ability to contract rhythmically),

different kinds dysfunction of the conduction system and in the heart muscle. Pain in the heart area. This symptom occurs very often in diseases of the circulatory system, but its meaning is very different: in some diseases (for example,

Pain in coronary heart disease (CHD) is of greatest importance. The cause of such pain is due to the development of a lack of blood supply to the heart muscle (myocardial ischemia). Pains of ischemic origin have a clear characteristic: they are of a compressive nature, short-term (up to 3-5 minutes), occur in paroxysms, most often during physical activity (walking, climbing stairs), when going outside during a period of low ambient temperature. The pain is most often localized behind the sternum (less often in the heart area), and is relieved after stopping movement and taking nitroglycerin. This attack of pain is called exertional angina. Similar pain may occur at night during sleep; usually the patient, after waking up, sits down and the pain gradually goes away (often even without taking nitroglycerin). This attack is called resting angina. The considered attacks of pain can also occur with some heart defects(most often aortic).

In other diseases, pain does not have such characteristic symptoms. As a rule, they are aching in nature, their duration varies (from several minutes to several hours), the intensity is low, and there is no clear relief effect from taking certain medications. Pain of this nature occurs in many heart diseases: heart defects, myocarditis, pericarditis, increased blood pressure etc. Pain in the heart area can also be observed in diseases that have nothing to do with the cardiovascular system. Thus, pain in the heart area is observed with left-sided pneumonia (with the involvement of the pleura in the pathological process), with osteochondrosis cervicothoracic region spinal column, diseases of the esophagus, ribs and costal cartilages, intercostal neuralgia, myositis, etc.

Dyspnea. A common symptom of heart disease is shortness of breath. The causes of shortness of breath are a decrease in the contractile function of the heart and the resulting stagnation of blood in the vessels of the pulmonary circulation. Therefore, shortness of breath is one of the first signs of heart failure. With a slight weakening of the heart muscle, shortness of breath occurs only during physical exertion, climbing stairs, and over time - with any movement, even the most insignificant. In severe cases, shortness of breath is observed in patients, even while lying in bed. heart muscle can cause sudden shortness of breath in the form of attacks of suffocation, which are called cardiac asthma attacks. If an attack of suffocation is not stopped in a timely manner with the help of various therapeutic measures, then pulmonary edema may develop: suffocation is accompanied by a cough with the release of foamy pink (bloody) sputum (for more details, see “Acute heart failure”).

These attacks are very dangerous; during such attacks, patients can die. Edema. This is a characteristic sign of heart failure, and more precisely, right ventricular failure. A decrease in the contractile function of the right ventricle leads to stagnation of blood in its cavity and increased blood pressure. Gradually, blood stagnation occurs throughout the entire system. As a result of stagnation of blood, the liquid part of it sweats through the walls of blood vessels into the surrounding tissues, and edema occurs. Edema in heart failure has a number of characteristic features : appear on lower limbs

(ankles, feet, legs), i.e. V greatest distance

from the heart. If the patient lies down, swelling first appears on the sacrum and lower back. With further weakening of the heart, fluid accumulates in the cavities (pleural, abdominal). Before the appearance of peripheral edema, blood stagnation primarily develops in the liver, which swells, increases in size, which causes a feeling of heaviness, and then dull pain in the right hypochondrium.

Cyanosis.

A bluish discoloration of the lips, tip of the nose, fingers and toes is called cyanosis. Typically, cyanosis appears somewhat earlier than edema and is also caused by heart failure. The bluish coloration is explained by the transillumination of blood containing a large amount of reduced hemoglobin through the skin. The amount of restored hemoglobin increases due to the fact that tissues remove oxygen from hemoglobin to a greater extent than normal; body. The transfer of heat, generated mainly in the muscles and liver, to other organs and skin also occurs through the blood.

The circulatory system includes: the heart and arteries, through which blood moves from the heart to the capillaries; capillaries in which the exchange of substances between blood and tissues occurs; and veins that carry blood back to the heart. The continuous movement of blood through the vessels is ensured by rhythmic contractions of the heart muscles - systole, alternating with its relaxation - diastole. During systole, blood from the left ventricle of the heart enters the aorta, arteries and capillaries throughout the body, and from the right ventricle into the pulmonary arteries and capillaries. During diastole, blood flows from the atria to the ventricles. The right atrium is filled from the superior and inferior vena cava, which collect blood from the capillaries of the whole body, the left atrium - from the pulmonary veins. Thus, blood is pumped into the systemic circulation by the left ventricle of the heart, and collected from it into the right heart (right atrium and ventricle). Blood is pumped into the pulmonary circulation by the right ventricle and collected from it into the left heart.

The number of vessels and their length in the systemic circulation are greater than in the small circle, and accordingly the muscle of the left ventricle of the heart stronger muscles right ventricle.

Each systole of the left ventricle of the heart throws 60–80 ml of blood into the aorta. The number of systoles in 1 minute and the systolic volume determine the minute volume - the amount of blood ejected by the heart into the systemic circulation in 1 minute. The minute volume averages 5.5–6.5 liters of blood.

Not all the blood circulates through the vessels; part of it (1–2 liters) is in the blood reserve (depot): in the vessels of the spleen, liver, skin and gastrointestinal tract.

The blood pressure in the vessels is different: the further a given section of the vessel is from the heart, the lower the pressure in it. Thus, in the aorta it is equal to 115–130 mmHg, blood enters the capillaries under a pressure of 20–40 ml, into small veins - 8–15 mm, and in large veins the pressure is 2–6 mmHg below atmospheric pressure. Due to the negative pressure in the large veins, the return of blood to the heart (especially from the lower half of the body) becomes possible due to muscle contractions, as if squeezing the blood towards the heart. The reverse movement of blood is blocked by the semilunar valves in the veins. In addition, the movement of blood towards the heart through the veins is facilitated by the suction effect of the negative pressure of the chest.

Supreme regulator of cardio-vascular system, bringing blood circulation into line with the needs of the body and conditions external environment, is the central nervous system. Regulation is carried out through nerves containing sympathetic and parasympathetic fibers.

Sympathetic nerves speed up the rhythm of heart contractions, increasing the excitability and conductivity of the heart muscle. In addition, sympathetic nerves, increasing metabolism and nutrition of the heart muscle, increase the strength of heart contractions. The vagus (parasympathetic) nerve slows down the rhythm of heart contractions, reduces the excitability and conductivity of the heart muscle and reduces the force of heart contractions.

Due to the presence of its own, autonomous conduction system, the heart muscle has the ability to contract rhythmically.

Blood circulation depends not only on the work of the heart, but also on vascular tone, changes in which are associated with changes in the width of the lumen of blood vessels, blood pressure and its distribution among organs.

Regulation of vascular tone occurs reflexively through vasoconstrictor (sympathetic) and vasodilator (parasympathetic) nerve fibers. The exception is heart, brain and renal vessels, narrowing of which occurs through the vagus, and expansion through the sympathetic nerve.

There are receptors in the walls of blood vessels, through which reflex regulation of blood circulation occurs. Pressoreceptors respond to changes in blood pressure and cause its normalization. Chemoreceptors react to the composition arterial blood, the amount of carbon dioxide, oxygen and other substances in it. In response to chemoreceptor signals, the functioning of the corresponding organs changes, and the normal composition of the blood is restored.

Changes in blood circulation also occur in connection with changes in other organs. For example, muscle contractions cause increased blood circulation, irritation of peritoneal receptors (a blow to the abdomen) inhibits cardiac activity, etc.

Changes in blood circulation also occur in a conditioned reflex way: to increase blood circulation, a word is enough - a signal about the upcoming work.

Blood circulation also increases with significant physical stress: the number of heart contractions and the strength of each of them increases, systolic and minute volumes increase by 5–6 times, and in athletes - by 10 times, the amount of circulating blood increases due to its release from the depot. The number of simultaneously open capillaries in working organs increases, and tissue metabolism improves accordingly.

Physical work, sports training require prolonged hard work of the heart, which leads to thickening of the heart muscle, an increase in each of its fibers - hypertrophy. Simultaneously with the hypertrophy of the heart muscle, the capacity of the ventricles also increases - a compensatory expansion of the heart occurs.

For various heart diseases, as well as for high blood pressure and other painful conditions the heart is subject to increased demands, and it responds to them in the same way as to prolonged physical stress - with muscle hypertrophy and compensatory expansion of the cavities. In the future, if the heart muscle gets tired from constant hard work, it weakens and cannot expel all the blood entering the heart cavity, then congestive expansion of the heart and other signs of heart failure develop.

DISEASES OF THE CARDIOVASCULAR SYSTEM

These diseases are the most common pathology of internal organs and rank first among all causes of mortality. The incidence of hypertension, coronary heart disease and other diseases of the cardiovascular system is growing, often leading to premature disability, and the patient population is becoming “younger”.

Recent years have been characterized by an increase in technical capabilities for diagnosing diseases of the cardiovascular system. Along with conventional electrocardiography (a method of graphically recording electrical potentials that arise when the heart is excited), microprocessor electrocardiographs with automated functions for managing and analyzing electrocardiogram (ECG) data, and daily monitoring using stationary and portable sensors have been introduced into the practice of cardiology departments. These methods make it possible to record heart rhythm disturbances that occur during the day and are not detected during normal ECG recording. Special work diagnostic centers providing advisory assistance medical workers in deciphering ECG using telemetric control. Various are used in the diagnosis of diseases. X-ray methods research. Fluoroscopy and chest radiography are considered traditional. TO special methods– X-ray kymography (provides an image of the movement of the contours of the shadow of the heart during its contraction); coronary angiography (detects changes in the coronary arteries by introducing a contrast agent into the bloodstream); phonocardiography (records sound phenomena that occur during heart contraction); polycardiography (synchronous recording of ECG, phonocardiogram and fluctuations in blood filling of the carotid arteries); ultrasound examination, or echolocation (makes it possible to determine the thickness of the myocardial wall, the condition of the valves and the volume of the cavities of the heart and large vessels); probing of the heart cavities, etc.

Relatively simple research methods also retain their importance (determining the pulse by palpating radial artery, blood pressure measurement, etc.). In many cases they provide valuable information about the state of the cardiovascular system.

HEART FAILURE. In chronic heart failure, systolic and minute volumes decrease, but the amount of circulating blood increases. A weakened heart, even having increased the rhythm of contractions, is not able to pump all the blood flowing to it through the veins into the arteries. The veins become congested, the blood pressure in them increases, various organs venous congestion is formed.

In chronic heart failure, blood oxygen saturation in the lungs is reduced, and oxygen absorption by tissues is increased. Therefore, in the blood of such patients there is little oxygenated (oxidized) hemoglobin, which has a scarlet color, and a lot of reduced hemoglobin, which has a red-blue color. Subcutaneous capillaries and small veins overflowing with such blood give the skin a bluish coloration (cyanosis), especially in places where the vascular network is visible (mucous membranes, nails).

Shortness of breath in heart failure occurs various shapes and to varying degrees. Its causes are: impaired lung function due to stagnation of blood in them, irritation respiratory center carbon dioxide, the content of which is increased in the blood, reflex irritation of the respiratory center.

Dyspnea is felt by the patient as a lack of air and difficulty breathing, and is manifested by rapid breathing, initially only during physical exertion, and then at rest, according to the stage of heart failure.

With severe cardiac dyspnea, a semi-sitting position alleviates the patient's condition, while in a horizontal position, the work of the respiratory muscles and heart is difficult due to an increase in the amount of circulating blood.

The occurrence of an attack of cardiac asthma is associated with rapid developing stagnation blood in the lungs due to acute weakness of the left ventricle of the heart. The attack occurs at night: the patient is suffocating, he is forced to sit, his face is cyanotic, the skin is covered with cold sweat, the pulse is frequent, weak filling, breathing is rapid up to 39–40 per minute, sometimes a cough appears with the release of pink foamy sputum.

One of the main manifestations of heart failure is edema. An increase in pressure in the veins and capillaries, a slowdown in blood flow in them and an increase in capillary permeability cause an increase in the flow of fluid from the blood into the tissues. Retention of sodium and water by the kidneys, as well as a decrease in protein levels in the blood due to impaired renal and liver function, contribute to the development of edema.

At first, the accumulation of edema may occur hidden. So, upon examination, a retention of 6 liters of fluid in the body may not be noticed. The accumulation of edema during this period is judged by weight gain, decreased diuresis (formation and excretion of urine), the predominance of nighttime diuresis over daytime (nocturia), an increase in the rate of absorption of intradermally administered saline solution in an amount of 0.1 ml.

Later, swelling in the legs appears in the evening and disappears by morning. Then night rest becomes insufficient, swelling accumulates in the subcutaneous fatty tissue of the legs, thighs, buttocks, abdomen, chest and easily moves to the underlying part of the body. If the patient sits, the legs swell; if he lies on his back, the swelling accumulates in the area of ​​the sacrum, buttocks and lower thighs. With a predominant position on one side, the swelling moves accordingly.

In heart failure, the swelling is usually mild - finger pressure (especially if the subcutaneous fatty tissue lies on the bone) leaves a hole. Long-term swelling is somewhat denser.

The skin over the swelling becomes smooth, shiny and its temperature decreases. Skin sensitivity decreases, and careless use of a heating pad can easily cause a burn. Bedsores also occur easily. The nutrition of swollen skin is insufficient, resistance to infection is reduced, so burns and bedsores are difficult to treat and easily suppurate. Medicines should not be injected into swollen subcutaneous fatty tissue, as they are poorly absorbed, and through a puncture of the skin with an injection needle, edematous fluid will ooze and infection may occur.

In addition to subcutaneous fatty tissue, edema can develop in internal organs (liver, lungs, stomach, etc.), disrupting their function. Edematous fluid accumulates in the abdominal cavity (ascites), chest cavity (hydrothorax), and in the cavity of the cardiac membrane (hydropericardium).

CARE FOR PATIENTS WITH HEART FAILURE

Since rest is a necessary condition for the treatment of patients with heart disease, the bed of such a patient should be as comfortable as possible. It is desirable that it have devices that provide an elevated position for the upper half of the body and the ability to lower the legs. If there is no such bed, you need to put a headrest on the mesh of a regular bed and make a foot rest.

Careful skin care and prevention of bedsores are necessary.

The state of rest should not be long. From the very first days of illness, the patient’s position in bed should be frequently changed (if there are no contraindications) not only to prevent bedsores, but also to prevent thrombosis (blood clotting inside a vessel, leading to its blockage), which often forms in the deep veins of the legs. A stationary position and prolonged congestion in the lungs contribute to the development of pneumonia.

Has a beneficial effect in heart failure inhalation administration oxygen. You should also ensure that the air in the room is constantly fresh, with normal humidity and temperature.

The patient's diet should be low in calories (2500–2800 cal), with limited protein (65–70 g), liquid and salts (table No. 10) and a high content of vitamins A, C and group B. For the first 3–7 days the patient receives food mashed 7 times, and then 6 times a day. It is prepared without salt; as prescribed by the doctor, the patient is given 3–5 g of salt.

Food should include foods containing a lot of potassium salts (potatoes, cabbage, dried apricots, figs, rose hips) and calcium, which have a diuretic effect.

When caring for a patient with heart failure, the responsibilities nurse includes monitoring diuresis and the amount of fluid consumed by the patient. Systematic daily recording of diuresis and fluid intake in combination with daily weighing (if the patient’s condition allows) makes it possible to navigate the accumulation of edema or its reduction under the influence of treatment.

It should be borne in mind that when the body burns 100 g of fat, 100 ml of water is formed, 100 g of protein - 40 ml, 100 g of carbohydrates - 60 ml of water. On average, 1000 ml of water is formed from food in the body as a result of metabolism, and about 1500 ml enters the body in the form of liquid. A person loses on average 500 ml through the skin, 400 ml through the lungs, 100 ml through feces, and 1500 ml through urine. 3/4 of diuresis occurs during the daytime.

On average, the amount of fluid consumed should be equal to the amount of urine excreted. If the daily diuresis is less than 80% of the amount of fluid drunk per day, we can assume the accumulation of edema; if it is more, the edema decreases.

The nurse or patient can keep a record of the amount of liquid drunk during the day, including liquid dishes: soup, jelly, compote, kefir, etc. The amount of urine collected per day in an individual container is measured, or each portion of urine is measured separately and summed up. The nurse enters information about the amount of fluid consumed and urine excreted per day into the medical history every day.

To identify hidden edema by the presence of nocturia, water balance is determined. Under normal conditions, the patient receives strictly 1 liter of fluid per day. Two portions of urine are collected: daytime - from 8 am to 8 pm and night - from 8 pm to 8 am the next day. Normally, the amount of daytime urine is greater than nighttime; in the presence of hidden edema, the relationship is the opposite.

A nurse caring for a patient with heart failure must be able to apply leeches to the liver area, do bloodletting, treat with oxygen, etc. Due to congestive dysfunction of the gastrointestinal tract, it is necessary to monitor the patient’s appetite, know how much he eats, to inform the doctor about this. You should also ensure that the patient does not violate the diet prescribed to him in terms of limiting salt and liquid, and check the transfers he receives.

You need to monitor your bowel movements.

HEARTACHE

With various diseases, heart pain differs in nature, strength, duration, place of origin and spread.

With cardiac neurosis, the pain is stabbing in nature and is felt in the area of ​​the apex of the heart. These pains are long-lasting and appear with excitement.

With angina pectoris (angina pectoris), the pain is squeezing, pressing, burning. The pain is short-term and is felt behind the sternum, less often in the epigastric region. The pain most often spreads in left hand, shoulder blade, shoulder, left half of the neck and lower jaw. Pain occurs during physical exertion (angina of movement) and excitement, and in severe cases during sleep (angina at rest), accompanied by a feeling of melancholy and fear of death.

The causes of these pains are different, the treatment and consequences are different. With neuroses of the heart, pain is a consequence of a general increased and perverted sensitivity, but the heart is healthy; with angina pectoris, pain occurs in the heart muscle from insufficient blood supply due to spasm of the coronary arteries.

If the spasm is prolonged, or in coronary artery If a blood clot has formed, the pain, the same as with angina pectoris, becomes prolonged (more than an hour), and necrosis occurs in the bloodless area of ​​the heart - myocardial infarction.

Determining the cause of pain in each individual case is often difficult, especially at the beginning of the disease. Diagnostic difficulties are also explained by the fact that a patient suffering from cardiac neurosis may develop angina pectoris, and prolonged spasm coronary vessels due to associated thrombosis, it can lead to myocardial infarction.

Despite the difficulties of diagnosis, treatment and care for a patient with heart pain must be correct, since the slightest negligence and underestimation of the patient’s condition can lead to death from cardiac arrest. Cases where the cause of pain is unclear, as well as prolonged attacks of angina pectoris should be considered as a suspicion of myocardial infarction.

Before the doctor arrives, the patient must be put to bed. You can give vasodilators (1-2 drops of 1% nitroglycerin solution on a piece of sugar and put under the tongue), take a validol tablet under the tongue.

Mustard plasters applied to the heart area, heat in the form of a heating pad to the left shoulder blade and arm, or hot baths for the left arm relieve pain. Good action provides oxygen inhalation.

When providing assistance to a patient, you should observe his behavior, since not all patients with myocardial infarction experience fear, some underestimate the severity of their condition and sometimes, even in very severe cases, fall into an unreasonable joyful mood; it can be difficult to keep them in bed.

Before the doctor arrives, it is not recommended to lavage the stomach if the patient complains of pain in the epigastric region, nausea and even vomiting, since all these phenomena can be associated with infarction of the posterior myocardial wall, and bothering the patient with the lavage procedure in such cases is not only useless, but also harmful.

The question of the possibility of transporting a patient with myocardial infarction is decided by the doctor. When transporting a patient from home to the hospital, you should not dress him, you just need to wrap him in a blanket and carefully place him on a stretcher. Sanitary treatment of a patient with myocardial infarction is carried out according to the doctor’s decision, but it is better not to carry it out, or limit it to wiping. Linen must be changed very carefully, without disturbing the patient and without giving him a reason for self-care.

VASCULAR INSUFFICIENCY

The cause of circulatory disorders can be not only cardiac, but also vascular insufficiency. Acute vascular insufficiency - collapse, shock and fainting - occurs when the amount of circulating blood decreases, either as a result of blood loss or dehydration, or as a result of an acute increase in the capacity of the vascular bed due to a drop in vascular tone (crisis with infectious diseases). A particularly large amount of blood accumulates in the dilated vessels of the abdominal cavity. A decrease in circulating blood mass leads to a decrease in venous flow to the heart, as a result of which systolic volume decreases and arterial and venous pressure sharply decreases. At the same time, nutrition of vital organs, primarily the central nervous system, turns out to be insufficient.

Signs of acute vascular insufficiency: pale skin with slight cyanosis, weakness, decreased body temperature (cold extremities), cold sweat, pulse of weak filling and tension (“thready”), decreased arterial and venous pressure. In shock, consciousness is preserved, but all functions of the central nervous system are inhibited. With collapse there may be a blackout, and with fainting there may be a short-term loss of consciousness.

Treatment of such patients depends on the cause acute failure and the severity of the condition. To bring a patient out of a state of fainting, sometimes it is enough to give him horizontal position and, raising the lower half of the body and limbs, thereby increasing the blood flow to the brain or, for a reflex effect on the brain vessels, allow the patient to inhale ammonia.

If a collapse occurs, these measures are not enough. Drugs that increase vascular tone, subcutaneous and intravenous infusions are used.

When caring for a patient, it is important not to miss the first signs of incipient collapse, so that by reporting them to the doctor, you can provide assistance to the patient.

PULSE EXAMINATION

The pulse is the periodic oscillation of the walls of blood vessels associated with changes in their blood supply and pressure dynamics during one cardiac cycle. Depending on the blood vessel in which pulse waves are determined, arterial, venous and capillary pulses are distinguished. Arterial can be central (on the aorta, carotid arteries) or peripheral (on the radial artery, dorsal artery of the foot). For diagnostic purposes, the pulse is determined in various arteries: carotid - carefully, due to the danger of a sharp reflex slowdown of the heart rate, temporal, femoral, subclavian, brachial, popliteal, posterior tibial, etc. Most often, the pulse is examined in the radial artery, which is located superficially and can be easily felt between the styloid process of the radius and the tendon of the internal radial muscle.

When examining the pulse on the radial artery, the hand is placed just above the wrist joint so that the first finger is on the dorsum of the forearm, and the rest are above the radial artery. Having felt the artery, they press it to the radius and begin to analyze the various properties of the pulse.

First of all, by simultaneously feeling the pulse on the right and left radial arteries, compare the magnitude of the pulse waves on both arms, which normally should be the same. Different sizes of pulse waves on the right and left radial arteries occur with developmental anomalies, narrowing or compression of the corresponding radial, brachial or subclavian arteries.

If the pulse on the right and left radial arteries is different, its other properties are determined by examining the radial artery where the pulse waves are better expressed.

Pulse rhythm is assessed by the regularity of successive pulse waves. If pulse waves appear at regular intervals, then they speak of the correct rhythm (rhythmic pulse). With different intervals between pulse waves, the pulse rhythm will be incorrect. If the number of pulse waves becomes significantly less than the heart rate (for example, with atrial fibrillation), it is customary to talk about the presence of a pulse deficiency.

The number of pulse waves per minute is called the pulse rate. When determining it, count the number of pulse waves in 30 seconds and then multiply the result by 2. If the rhythm is incorrect, the pulse rate is counted for a whole minute.

U healthy people The pulse rate ranges from 60 to 80 beats per minute. When the heart rate increases above 80 (tachycardia), which is observed in various physiological and pathological conditions (emotional and physiological stress, fever), the pulse frequency also increases accordingly, which in these cases is also called rapid. When the heart rate decreases to less than 60 beats per minute (bradycardia), the pulse becomes rare (bradysphygmia).

Tachycardia is observed during infectious fever, and the increased heart rate corresponds to the fever: an increase in temperature by 1° increases the heart rate by 8-10 beats per minute. A lag in the pulse rate from an increase in temperature is typical for typhoid fever, inflammation of the meninges, and influenza.

Tachycardia is constant sign function enhancement thyroid gland, one of the first signs of heart failure.

Bradycardia is characteristic of jaundice, decreased thyroid function, concussion and some other diseases.

The cause of tachycardia is most often irritation of the sympathetic nerve, while bradycardia is most often caused by irritation of the vagus nerve.

The filling of the pulse is determined by the volume of blood in the artery. When there is enough blood in the artery, it is said to be well filled, or a full pulse. When the volume of circulating blood decreases (for example, due to blood loss) and the filling is weak, the pulse is called empty.

The force that must be applied to completely compress a pulsating artery is characterized by the concept of pulse tension.

The degree of pulse tension depends on the level of blood pressure: when blood pressure increases, the pulse becomes tense, or hard, and when it decreases, it becomes soft.

The height of the pulse and its magnitude depend on the amplitude of oscillations of the artery wall. With a large amplitude of oscillations (due to an increase in stroke volume of blood and a decrease in the tone of the vascular wall), the pulse becomes high or large. When the amplitude of oscillations of the artery wall decreases, a low and small pulse appears. In some conditions accompanied by a fall cardiac output and a decrease in blood supply to the arteries (with shock, collapse), the magnitude of the pulse waves decreases so much that the pulse can barely be felt (thread-like pulse).

The speed, or shape, of the pulse is characterized by the speed of change in the volume of the palpable artery. With rapid stretching of the artery wall and the same rapid decline, it is customary to speak of a fast, or fast, pulse (not to be confused with a rapid pulse), which is observed, for example, with one of the heart defects - aortic valve insufficiency. With a slow rise and a slow decline pulse wave a slow pulse appears.

To get an idea of ​​the state of the artery wall during pulse examination, you should close the lumen of the artery by squeezing it with the first finger of the examining hand, and palpate the artery with the second and third fingers, which no longer feel the pulsation, trying to get an idea of ​​​​the elasticity or density of its walls.

Correct assessment of certain properties of the pulse is of great diagnostic importance. The results of determining the pulse rate are entered daily into the temperature sheet.

The resulting points are connected to each other with a red pencil, forming a graphical representation of the heart rate curve.

A graphic recording of pulse oscillations of the vascular wall with its subsequent analysis (sphygmogram) can also be obtained using a special device - a sphygmograph.

In diagnostic practice, the study of pulse fluctuations in blood filling of various arteries is also used.

ARTERIAL PRESSURE

Arterial pressure is the pressure that is formed in the arterial system of the body during heart contractions. Its level is influenced by the magnitude and speed of cardiac output, the frequency and rhythm of heart contractions, and the peripheral resistance of the arterial walls.

The blood pressure that occurs in the arteries at the moment of maximum rise of the pulse wave after ventricular systole is called systolic. The pressure that is maintained in the arterial vessels in diastole due to their tone is called diastolic. The difference between systolic and diastolic pressure forms pulse pressure.

Blood pressure can be measured directly by inserting the pressure gauge sensor directly into the bloodstream. Thus, with the help of catheterization in cardiology, pressure is determined in the cavities of the heart and large vessels.

In practice, blood pressure is most often measured by the indirect sound method, proposed in 1905 by the Russian surgeon N. S. Korotkov, using sphygmomanometer (tonometer) devices. A sphygmomanometer consists of a mercury or spring manometer connected to a cuff and a rubber bulb. The flow of air into the cuff is regulated using a valve that allows you to maintain and smoothly reduce the pressure in the cuff.

Typically, blood pressure is measured in the brachial artery, where it is fairly close to the pressure in the aorta (if necessary, blood pressure can be determined in the femoral, popliteal and other peripheral arteries).

The procedure for measuring pressure is as follows. Before measuring blood pressure, the patient should rest for 10–15 minutes; the room should be warm and quiet. His hand should be freed from clothing if the sleeve is narrow. Place the hand on the table or on the edge of the bed approximately at the level of the heart, in an extended position, palm up, its muscles should be relaxed. The device should be placed at the same level as your hand.

A cuff is placed on the shoulder of the patient or the person being examined (the patient can sit or lie down at this moment) (its edge with the exit point of the rubber tube should be located below) so that only one finger passes between it and the skin. A phonendoscope is installed in the cubital fossa above the brachial artery, which is found by determining its pulsation. By pressing the bulb with the valve closed, they begin to pump air into the cuff, focusing on the readings of the pressure gauge, until the pressure in the cuff is approximately 30–40 mm Hg. Art. exceed the pressure level at which pulsation of the brachial artery disappears. The valve is then opened slightly, allowing air to escape from the cuff and a gradual decrease in pressure in the cuff. Using a phonendoscope, listening to the brachial artery in the elbow bend, note the moment of the appearance of sounds (on the tonometer scale, this will correspond to systolic pressure) and their disappearance (this will correspond to diastolic pressure).

Record the pressure as a fraction: the numerator is systolic pressure, the denominator is diastolic pressure.

Errors in measurements can be caused by a malfunction of the device and violations of the methodology. To avoid errors, devices are subject to periodic inspection. Errors in measurement may also be associated with changes in sound phenomena heard in the compressed artery. For example, sometimes tones appearing at the level systolic pressure, disappear, then reappear and disappear again at the level of diastolic pressure. In these cases, if the mercury column is not first raised to the required height, the tones that appear after the sound dip can be mistaken for systolic pressure. To prevent this from happening, in doubtful cases (when the pulse is tense and the systolic pressure is normal), you should feel the pulse to check. When measuring blood pressure, almost simultaneously with listening to the first sound, the pulse begins to be felt.

Another deviation in sound phenomena is expressed in the fact that the tones do not disappear until the end of the scale. In these cases, diastolic pressure is conventionally considered equal to zero. This phenomenon is often observed with aortic valve insufficiency, but sometimes occurs in other disease states.

In some tonometers, using a microphone installed in them, objectification of the moment of appearance and disappearance of sound phenomena is achieved. In such devices, microphone signals are transmitted to a light indicator of the scale.

In clinical practice, blood pressure is also measured using the oscillographic method using special oscilloscopes, which, in addition to blood pressure, also allow one to determine the tone and elasticity of the vascular wall.

Normal systolic blood pressure ranges from 100–120 mmHg. Art., diastolic – 60–80 mm Hg. Art. To a certain extent, blood pressure indicators depend on the person’s age. Thus, in older people, the maximum permissible systolic pressure is 150 mmHg. Art., and diastolic – 90 mm Hg. Art. Short-term increase blood pressure (mainly systolic) is observed during emotional stress and physical stress.

An increase in blood pressure is called arterial hypertension (hypertension), and a decrease (less than 100/60 mm Hg) is called arterial hypotension (hypotension).

Hypertension developing as a result of disorders complex mechanisms regulation of blood pressure, occurs in hypertension, some diseases of the kidneys, blood vessels, diseases endocrine system. A prolonged increase in blood pressure is accompanied by serious changes in various organs and systems of the body (cardiovascular system, kidneys, central nervous system, etc.) and requires systematic drug treatment. When monitoring and caring for patients suffering from arterial hypertension, great attention it is necessary to pay attention to compliance with the requirements and rules of the medical and protective regime, since various neuropsychic factors, negative emotions, and insufficient sleep have an adverse effect on the course of the disease.

The blood pressure figures obtained from daily measurements (in some cases, blood pressure is determined several times a day) are entered into the temperature sheet.

In the diet of patients with arterial hypertension, it is advisable to limit the content of table salt to 1.5–2 g, which in itself in some cases already helps to normalize blood pressure. IN initial stages diseases widely use various physiotherapeutic procedures and physical therapy.

A sharp increase in blood pressure, accompanied by severe headache, dizziness, nausea, and vomiting, is called a hypertensive crisis. Sometimes a prolonged hypertensive crisis can lead to the development of disorders cerebral circulation, deterioration of coronary circulation up to the occurrence of myocardial infarction. In case of hypertensive crisis, patients are prescribed strict bed rest; they can have mustard plasters placed on the back of their heads or given a hot foot bath. If chest pain occurs, you should definitely take nitroglycerin. Parenterally (intramuscularly and intravenously) administered antihypertensive drugs(8-10 ml of 0.5% dibazole solution, 10 ml of 10% magnesium sulfate solution, 0.5–1 ml of 0.01% clonidine solution, 0.5–1 ml of 5% pentamine solution) and diuretics (40– 80 mg Lasix IV).

Intravenous administration of antihypertensive drugs is carried out very slowly, under constant monitoring of blood pressure. After this, patients must remain in bed for 2–2.5 hours, since a sharp drop in blood pressure (orthostatic collapse) may occur when trying to get up.

Arterial hypotension sometimes occurs in completely healthy people, especially in thin subjects (the so-called asthenic constitution), but it can also be a symptom of serious diseases, occurring, for example, with bleeding, myocardial infarction and some other conditions.

ANGINA

In typical cases, attacks of angina pectoris (angina pectoris) are characterized by the appearance of chest pain of a pressing or squeezing nature. Pain spreads to the left shoulder, shoulder blade, left half of the neck; accompanied by sweating and a feeling of fear, lasting several minutes and quickly disappearing after taking nitroglycerin. Depending on the conditions under which angina attacks occur (during physical activity, at night during sleep, etc.), it is customary to distinguish angina pectoris and angina at rest. Sometimes the equivalent of angina pectoris can be attacks of suffocation or interruptions in the functioning of the heart.

An attack of angina requires emergency therapy, since if it lasts for a long time, transition to myocardial infarction is possible. During an attack of angina, the patient must be provided with complete rest, given nitroglycerin (tablet or 1-3 drops alcohol solution on a piece of sugar under the tongue), which quickly eliminates spasm of the coronary arteries. Placing mustard plasters on the left half of the chest can also have a good effect.

MYOCARDIAL INFARCTION

Myocardial infarction is extremely serious illness, often life-threatening patient, while foci of ischemic necrosis occur in the heart muscle. A typical painful variant of myocardial infarction is characterized by the fact that the previous anginal pain turns out to be much more intense, and most importantly, longer lasting, lasting for several hours. The pain is accompanied by severe general weakness and fear of death. There may also be variants of myocardial infarction, which manifest as suffocation, severe pain in the epigastric region, heart rhythm disorders, cerebrovascular accidents.

Patients with myocardial infarction require urgent hospitalization in the first hours of the disease. It is advisable to transport the patient by specialized ambulance teams that have the necessary equipment to combat complications of myocardial infarction. Upon admission to the hospital, patients are immediately sent to the department without taking hygienic bath and without changing into hospital gowns.

Special departments (wards) have been created for the treatment of patients with acute myocardial infarction intensive care. These departments are equipped with the necessary equipment for constant monitoring of cardiovascular and respiratory systems– breathing and pulse rate, heart rate, blood pressure level, etc., defibrillators to eliminate severe rhythm disturbances, pacemakers for resuscitation measures in case of cardiac arrest, devices for artificial ventilation lungs, etc. These departments are connected to an express laboratory, which makes it possible to conduct round-the-clock necessary research, are provided with the necessary medications and transfusion solutions.

After stabilization of the course of acute myocardial infarction (elimination of pain through the administration of narcotic drugs, reduction of blood clotting through the administration of heparin and fibrinolysin, normalization of heart rate and blood pressure levels), patients are usually transferred to a general therapeutic or cardiology department after 5–7 days. During the first 2–3 weeks, patients with myocardial infarction are on strict bed rest. In the first days they are not even allowed to turn over in bed. During this period, it is of great importance to carry out all necessary care measures: monitoring the condition of the bed, timely change of underwear and bed linen, feeding patients, skin care, supply of a bedpan and urinal, careful monitoring of the functions of the respiratory and circulatory system.