DISEASE OF BODIES OF BLOOD CIRCULATION : HYPERTENSION (MORBUS HYPERTONICUS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Кровеносная система, сердце, сосуды, кровь
Unlike symptomatic hypertension syndrome (hypertension), which is the private symptom of other diseases (nephritis, various endocrinopathy, urological suffering, diseases of the brain and other), hypertension (hypertension) is a disease in which blood pressure (increased vascular tone) is the main, leading the manifestation of the pathological process.
Etiology. Long functional voltage (excitement) of the cerebral cortex and subcortical vehicles (affects, emotions), and sometimes organic brain damage, disruption of metabolism and toxicity, poor muscle activity in the famous combinations can often be recognized as a cause of hypertension, Hypertensive heart disease war time (in particular, the Leningrad blockade hypertension) had its own peculiarities: along with long-term psycho-neural injuries were severe protein deficiency (starvation), physical stress, frequent perniosis. It is established that a massive outbreak of hypertension occurred on the background of the former hypotension at the moment when the blockade was partly broken, and the power of the population increased, i.e. when the reactivity of machines, regulating blood pressure, increased significantly.
Pathogenesis. Cerebral mechanism. Anoxia brain caused by compression of his plastic capsule or irritation of different departments of the interstitial brain, where is the higher centres of the autonomic nervous system, may in the experiment to cause long-term increase of arterial blood pressure. A person disorders emotional activity, the collision processes irritation and braking may occur neurosis vasomotor center dominated vasoconstrictor effect that leads to hypertension (lang). In the experiment with the use of the conditioned reflex method "SHIPKA" of excitation and inhibition in the cerebral cortex leads to prolonged hypertension.
Disorder depression a p p a R a t o century When transection depressors, and when husking on both sides of the Sino-carotid nodes (put in place dividing the total of the trunk of the carotid artery on the inside and outside branches), as well as with concussion (butchers), you can experiment to cause prolonged hypertension.
Hypertension often develops in women in menopause. About participation of the adrenal glands in the regulation of blood pressure in people says paroxysmal hypertension resulting from paroxysmal entering the blood stream of a large number of adrenaline (in feohromotsytome, i.e. tumors of the adrenal gland, usually the right).
Renal mechanism. In experimental renal ischemia (overlaying of a clip into the renal artery) is produced in large quantities special substance - renin (enzyme), which, combined with a-globulin, blood forms a polypeptide (hypertension, hypertension), which causes spasm of arterioles and increase of arterial blood pressure. It is assumed that the person ischemia kidneys can cause arteriospasm by violations of psycho-neural mechanisms.
If to take into account the intimate relationship neuro-vegetative mechanisms with hormonal system, you can prevent friendly role of all the above factors under the Supreme leadership of the cerebral cortex in creating long arteriospasm, the final step in the pathogenesis of hypertension.
Headache is the main, sometimes the only and very often an early symptom. Often found increased (sometimes substantial) arterial blood pressure in the complete well-being and health of the patient. Thus, hypertension can no apparent in relation to the well-being of the patient. Frequent are cases when accidentally discovered high blood pressure causes the trauma to the patient and creates a number of painful subjective oshushenie (palpitations, sleep disorder, unpleasant feelings in the heart area and others). Headache, or relatively little worried sick, or, conversely, is a source of great suffering and significantly limits the ability to work. Sometimes one of the early symptoms of disease is violation of view. Objectively this is found (in the early stages of the disease) narrowing arteriol fundus of the eye that is easily installed ophthalmoscopically. In the future picture of the fundus of the eye becomes more severe (swelling nipple, bleeding in the retina and other phenomena, bearing the General name hypertensive retinopathy, followed by bleeding in the retina). In the initial stages of the disease has considerable volatility all subjective sensations and objective data from the fundus of the eye, and the elevation of arterial blood pressure; the latter may fall even to a normal limits (not more than 140/90 mm Hg). These fluctuations allow to speak about transient (transitory) hypertension. This is the first stage of the disease. Later, when, in particular, blood pressure reaches significant, but are still hesitant, although not falling to the norm digits (for example, 160/100-180/110 mm Hg;we can talk about labile phase without sclerotic changes in the arteries. At this time detected the increase of the heart left due to hypertrophy of the left ventricle, the appearance of a significant focus of the second tone of the aorta and the left type of electrocardiogram. Renal function is not usually impaired. Pain in the heart stenokardicheskie character, as a rule, are absent. Dizziness and noise in the ears in this period is rarely disturbed patients. Of other phenomena are marked pain in skeletal muscles, paresthesias (numbness, crawling) in the fingers or toes, so-called phenomenon of "dead fingers" (transient blanching and numbness, especially after wet cooling); this group of symptoms sometimes occurs in the stage transient hypertension. Renal function is saved. Similar situation was characteristic for the second (Unstable) hypertension. The third (stable) stage include symptoms that indicate the development of arteriosclerosis (in particular, arteriosclerosis of the kidneys) with a stable (kept at a higher figures, not falling to the norm) arterial blood pressure. Subjective sensations (headache, noise in the ears) are becoming more persistent and severe. In this stage usually clearly outlines the type of hypertension: a) brainstorming, b) a heart, kidney. More common mixed type. Although advanced evolution of hypertension with impaired renal function and uremia is characteristic for the final (fourth) stage, still kidneys already in the third stage are to some extent affected (urine protein appears, hyaline cylinders and microhematuria; concentration ability of the kidneys is broken, samples Rehberg and especially hinolinovy or digestiva give pathological deviations). In this stage renal humoral factor in the pathogenesis manifests itself with the greatest regularity. Heart type
is manifested in the growing hypertrophy of the left ventricle of the heart and the occurrence of coronary heart disease (angina and change the electrocardiogram in the form of lower S-T interval in all derivations and two phase of the T wave left type of electrocardiogram). Can sometimes occur (in physical or mental strain) the attacks of acute failure of the left ventricle (see the Heart failure acute). Brain type appears in headaches, dizziness, noise in the head, and especially in the so-called brain crises of hypertensive patients. When this blood (sometimes venous) blood pressure suddenly reaches high numbers (240/140 mm Hg or higher), and in connection with spasm and cerebral vessels come phenomenon, reminiscent of a stroke; sometimes develops a true stroke; after the attack severe headaches or dizziness may occur, loss of consciousness, hemiparesis, speech disorder, and similar symptoms of cerebral circulation, which, however, quickly wane and disappear if it is only a spasm of the blood vessels. The manifestation of a more clearly expressed heart failure (myocardial infarction, cardiac asthma, and later the failure of both ventricles of the heart), severe malnutrition cerebral circulation (repeated strokes and kidney failure (azotemia, uremia) belong to the fourth stage of hypertension, stage of outcomes. The division into stages conditionally: part terrible symptoms of the fourth stage can in attenuated form to appear in the third. The main objective symptom of hypertension - hypertension - may at the fourth stage absent, especially after cerebral stroke and myocardial infarction.
Malignant form of hypertension is when it appears in a relatively early (previously 40 years), and sometimes in adolescence, and immediately acquires galloping (rapidly deteriorating) for some peculiar features of the clinical picture: the suddenness of onset (often with cerebral hypertensive crisis); further jerky for; early manifestation of eye symptoms; extremely high numbers of blood (especially diastolic) pressure (above 140 mm Hg) and in connection with this extremely severe left ventricular hypertrophy; preemptive, but not exclusive, evolution towards of nephrosclerosis (arteriosclerosis) with symptoms azotemii (uremia).
The diagnosis is presumably based on a number of subjective sensations (headache, dizziness, parestesia, impaired vision). Objective research detecting increased blood maximum and minimum pressure at repeated measurement, accenta the second tone of the aorta, left ventricular hypertrophy, narrowing of the arteries of the eyes and other, clarifies and strengthens the diagnosis. Based on the above clinical features with a certain degree of approximation to install and period of evolution of hypertension. When the differential recognition of the need to have in mind the so-called systolic hypertension, which increased only maximum (systolic) pressure (atherosclerosis of the aorta,graves ' disease, failure of the valves, the aorta)and diastolic hypertension (after cerebral stroke and myocardial infarction in hypertensive patients), and symptomatic hypertension or hypertension (at illnesses of urinogenital system, endocrinopathy and others).
The prediction depends on the period of illness, the tempo of its development, timely start of treatment, and rational organization of conditions of work and life. As regards, in particular, the pace of development, at a gallop over the characteristic of malignant form of hypertensive disease when a patient dies sometimes for 1 1/2 or 1-2 years of onset, often at a young age. In the ordinary form of hypertension, life expectancy is usually measured in decades. Capacity for work is determined partly subjective sensations in the relatively early (in the third or even second) stage of the disease (severe headache, dizziness, visual disturbances), most of those heavy disorders of the most important organs and systems (brain, heart, kidneys), which are characteristic of the fourth stage, the stage of outcomes. At this stage patients disabled (II group of disability), sometimes not capable of self (I group of disability). In the first and second stage patients, as a rule, tradespeople. Restrictedly (group III disability or limitation of working hours without the award of the disability group) patients in the third stage of the disease. Assessment of disability must be based on the totality of subjective and objective symptoms characterizing the state of the organism with the obligatory account of the conditions of work and life.
Stay patient in a hospital in conditions of physical and mental rest provides a significant improvement, not only subjective (decrease headache and others)and objective (a drop in blood pressure on 30-40 mm Hg or more). Of therapeutic measures in the first place put psychotherapy (in all its forms), accompanied by the soothing medicines. The treatment is long-term sleep (using Andreev and other modifications) aimed at consolidating the soothing effect, subnarcotic therapy, based on the healing effect of sleep as a protective inhibition (Pavlov). In the first and second stage, when the psycho-neural effects are leading, and sometimes determinative pathogenetic aspects, of the above activities provide satisfactory results.
Apply coniferous or fresh bath temperature 35-36 degrees according 10-15 minutes with the subsequent pouring and a light massage. Well tolerated well as damp wrapping duration 40-45 minutes (temperature of water for wetting the sheets 20-25 degrees) with the subsequent temperature 35-36 degrees. Also useful circular and radial souls low pressure temperature 35-e (2-3 minutes). Carbon dioxide, hydrogen sulfide baths do not always give favorable results (they are appointed only with cardiovascular insufficiency of the 1st degree).
The high-frequency currents, d'arsonval currents and General diathermy often reduce blood pressure and improve the health of patients. Great act (especially for headaches and dizziness) hot foot bath on Hauffe, as well as galvanic collar on Shcherbakov, with a gradual increase of force of a current, magnesium-iontophoresis, and diathermy cervical nodes, carotid sinus and area of the aorta. Apply also intensely small doses carotid sinus, hypothalamic region (intermediate brain), diathermy and intensely renal region.
Physiotherapy certainly shown as very careful procedures: the combination of the so-called developing gymnastic exercises, breathing exercises while gradually increasing the load. Therapeutic exercise is particularly useful to people leading a sedentary lifestyle and full-bodied. Spa treatment can give a good result only in case, if established, the maximum peace of mind with light training procedures. Most need to avoid a large number of various eventually tiring patient treatment measures (polypragmasia). We have to reckon with individual reactions and habits of patients: some people feel better on the shore of the southern sea, others on the Riga coast or on the lake in summer (July, August); many withstand Kislovodsk and Tskaltubo. You should avoid mountain resorts, as the patients in the period of acclimatization are passing through a phase of hypoxemia, usually accompanied by the increase of arterial blood pressure. A patient with hypertension are best treated in a comfortable sanatoriums of General type with established psychotherapy and not to leave the familiar climate. Sharp calorie restriction (starvation, especially protein), usually leading to hypotension (and eventually to elementarnoi dystrophy), reduces arterial blood pressure and improves health in hypertensive patients, but it is, for obvious reasons, cannot be prolonged. On the contrary, long floridna (rice, fruit, dairy and vegetable) power sometimes even in severe cases of the disease produces good results. Very significantly to keep pace supply: not to starve and do not overeat because in that and in other case disrupted normal tone of vegetative nervous system. In the third stage, when gradually develops atheromatous cardiac and cerebral vessels and arteriosclerosis kidney diet becomes more important (off of foods rich in cholesterol: eggs, fats, liver, brain, and other; salt-free meals).
Relatively low efficiency of some given therapeutic services in outpatient conditions makes more likely to be hospitalized bolnyh and to resort to the means that are feasible in the hospital.