Stable angina of effort

MINISTRY OF PUBLIC HEALTH OF THE REPUBLIC OF KAZAKHSTAN
EDUCATIONAL-METHODICAL SECTION

OF KAZAKH STATE MEDICAL ACADEMY

ON SPECIALITIES OF HIGHER AND POST GRADUATE EDUCATION
KARAGANDA STATE MEDICAL ACADEMY





Taijanova D.J., Kotlyarova O.A., Yevseenko L.V.,
Toleuova A.S.




special lectURES of cardiology


Educational manual






karaganda 2007




UDK 616.12
BBK 54.10?7

Taijanova D.J.,Kotlyarova O.A.,Yevseenko L.V., Toleuova A.S. the
educational manual " Special lectures of cardiology". Karaganda, 2007.
Reviewers:
Umbetalina N.S. - d.m.s., professor, the head of department of internal
diseases EIF and SPE.
Molotov - Luchanskiy V. B. - c.m.s., assistant professor, the head
of department for the
assistant professors' course of nursing management at KSMA
Seisenbekov T.Z.- professor of the internal disease department of
FPDME of Kazak Medical Aakdemy,
Professor


Brief performance characteristic: In this educational methodical manual,
are presented the contemporary concepts about etiology, classification and
pathogenesis of frequently meeting diseases of cardiology, the contemporary
diagnostics methods, the criteria of diagnostics and differential
diagnostics of diseases, contemporary approaches to the treatments.
Educational methodical manual is intended for the foreign students of High
Medical School - Institute of Higher Education and interns.


Confirmed and recommended for edition of Academic Council of KSMA
Protocol N 29____ of _03. 2007 ?.










Intoduction

Atherosclerosis, the underlying cause of heart attacks, strokes, and
peripheral vascular disease, is one of the major killers in the world. The
disease develops slowly over many years in the innermost layer of large and
medium-sized arteries. It does not usually become manifest before the
fourth or fifth decade, but then often strikes with devastating suddenness.
Fifty per cent of individuals still die (25 per cent immediately) from
their first heart attack; and morbidity from coronary heart disease is
significant. The disease has a profound impact on health-care services and
on industrial economies.
Progress has been made in identifying the risk factors that predispose to
atherosclerosis, its medical and surgical treatment, and the consequences
of the disease once it has developed. Cellular and molecular biology have
allowed an understanding how risk factors contribute to the process of
atherogenesis and are providing the rationale for the development of new
and effective treatments; as a consequence the prevalence and mortality
from atherosclerosis are decreasing.
Epidemiological examinations, performed in 23 cities of CNS, showed that
23% of males aged 35-39 and 22% of female of the same age suffer from AH
and more often with the age ( 25,4% are cases in groups of 55-59 years
old). AH is the main factor resulting in mortality in cases with insult and
infarction and IHD. Among all the cases with AH 90-95% of patients suffer
from hypertensive diseases (HD).
In the USA in 70-th years 60 million of people with high pressure were
fixed and only one/fourth (¼) part of adult population had "ideal"
pressure. Coming of these data annually 1250000 of infarctions were
registered as well as 650000 coronarogennic deaths and 500000 insults and
one third ( 1/3 ) of them were mortal.
All above mentioned determines the importance of HB investigations and
increases practical importance of clinical examination of cases with HD.
This is of great importance in proving individualized treatment and in
prophylaxis.
Hypertensive disease (essential hypertension or primary arterial
hypertension) is a widespread disease of not enough studied etiology; the
main manifestations of it are: increased arterial pressure combining with
regional, mainly cerebral, disorders of vascular tonus, stages in the
development of the disease, expressed the dependence of the course on
functional condition of nervous mechanism of AP regulation with the absence
of the evident cause of connection with the primary organic disorder of any
organs or systems.
In the regulation of the level of arterial BP takes part central nervous
system (CNS) and first of all the sympathetic nervous system,
reninangiotensinaldosterone system, cardiovascular system mostly it
resistant and major vessels and kidneys which are responsible for the
maintenance of intra vascular liquids volume take part. Disorders of these
systems lead to the high blood pressure.









List of abreviation

LDL - lipoproteids of low density
HDL - lipoproteids of high density
IHD - ischemic heart disease
CAD - coronary aretry diseases
ECG - electrocardiogramm
BP - blood pressure
AH - arterial hypertension
MI - myocardial infarction
CHD - coronary heart diseases
AV - atrio-ventricular
RBBB - right bundle branch block
LBBB - left bundle branch block
LAH - left anterior hemiblock
HD - hypertensive disease
CNS - central nerv system
CHF - chronic heart failure
RV - right ventricle
LV - left ventricle

Atherosclerosis. Ischemic heart disease

Atherosclerosis

Introduction
Atherosclerosis, the underlying cause of heart attacks, strokes, and
peripheral vascular disease, is one of the major killers in the world. The
disease develops slowly over many years in the innermost layer of large and
medium-sized arteries. It does not usually become manifest before the
fourth or fifth decade, but then often strikes with devastating suddenness.
Fifty per cent of individuals still die (25 per cent immediately) from
their first heart attack; and morbidity from coronary heart disease is
significant. The disease has a profound impact on health-care services and
on industrial economies.
Progress has been made in identifying the risk factors that predispose to
atherosclerosis, its medical and surgical treatment, and the consequences
of the disease once it has developed. Cellular and molecular biology have
allowed an understanding how risk factors contribute to the process of
atherogenesis and are providing the rationale for the development of new
and effective treatments; as a consequence the prevalence and mortality
from atherosclerosis are decreasing.

Epidemiology
The demonstration of coronary heart disease in an individual is taken as a
reliable index of the presence of more general atherosclerosis. The highest
death rates from coronary heart disease are found in Britain, northern
Europe, the United States, Australia, and New Zealand. Death from coronary
disease in industrialized countries rose dramatically after the end of the
First World War. Rates peaked in the late 1960s in the United States and
have since declined rapidly, with a reduction of 45 per cent for all
persons. In Britain and the rest of Europe this peak and decline lagged
behind the United States by some 10 years, but is now evident. Changes in
diet, exercise, smoking, and affluence account for much of this decline.
Better medical and surgical intervention has also been important. By
contrast, the countries of eastern Europe and the former Soviet Union are
showing a marked. increase in the prevalence of coronary heart disease and
are now equal to our own . This can be attributed to the influence of the
risk factors that have, until recently, operated in the industrialized
West.
Substantially lower death rates are found in southern Europe, Latin
America, and Japan, but the largest differences exist between the
industrialized nations and less-developed countries such as China. The most
obvious difference between these groups of individuals is in lifestyle-diet
and physical activity-and this must account for much of the differences in
risk. This is best examplified by migrants from Japan to Hawaii and in turn
to the United States, who adopt the North American lifestyle and then have
the same risk of coronary heart disease as those of their host nation.

Etiology
Most important in pathology is atherosclerosis of the coronary
arteries in 90% of cases. It is supposed that atherosclerosis is a chronic
viral disease and clinical picture is conditioned by the generalization of
the virus of herpes simplex, often in the background of microbe- viral
coalition. Structural and functional changes of vessel walls are one of the
preclinical stage of the development of atherosclerosis, the result of
combined action of virus on walls of the vessels and on the system of
cholesterol production.
Mechanism of athersclerotic mass formation: in the special sights of
vessels endothelium penetrates albumin, fibrinogen and lipoprotein of low
density (LDL), in sub endothelium cumulates swiftly as compare to the other
sights. Penetration of monocytes here (by the action of chemotactic
substances, formed of lipoprotein of low density) converts into macrophage.
Macrophages engulf oxidized LDL and converts in to foamy cells with high
concentration of ethers of cholesterol. These foamy cells damage and thin
the endothelium cells. This occurs formation of fat strips with foamy
cells, fibrils of collagen and elastin of proteoglycanes.
In subendothelial space proliferate smooth muscle cells under the
action of thrombocytes factors of generation. This proliferation is
accompanied by the synthesis of elements of connective tis