Survival percentage. What does five-year cancer survival mean?

Pulmonary embolism is the overlap of the lumen of the arterial vessels of the lungs by blood clots that have come off the venous walls.

Within the first hour after a blood clot comes off, the death rate of patients is up to 10 percent. If the main branches of the pulmonary arteries become clogged, up to 30% of patients die.

The "route" of the clot

In 90% of cases, detached blood clots enter the lungs from the deep veins of the lower leg. It may seem strange: why does a blood clot from the legs suddenly end up in the lungs? To understand the situation, you need to think about how this can happen.

The human circulatory system consists of two circles of blood circulation: large and small. The small circle is designed to saturate the venous blood with oxygen. The superior and inferior vena cava, which collect venous blood from the entire body, flow into the right half of the heart.

Blood clots that have come off the veins of the lower extremities enter the right atrium through the inferior vena cava, and from there into the lungs.

Floating blood clots (blood clots that are attached to the vein wall with their head, and the body and tail move freely in the lumen) break off most often. The composition of these blood clots is loose, so any muscle tension can provoke a part of it to come off.

Pulmonary embolism is not an independent disease, but only a consequence of venous thrombosis. Given this fact, the factors of the Virchow triad, which provoke the development of phlebothrombosis, are among the predisposing factors for the occurrence of PE:

A thrombus can be detached from injury or sudden movements. As a result, a thrombus that has come off enters the pulmonary artery, causing the lumen to overlap.

The right ventricle of the heart fills with blood, resulting in right ventricular failure.

The volume of blood entering the left ventricle from the lungs decreases, which causes a significant decrease in blood pressure. A collapse occurs, which can be fatal.

Depending on the size of the detached thrombus, arteries of various diameters are clogged. With a small size of blood clots, a pronounced clinical picture is not observed. When a large thrombus is torn off, acute right ventricular failure may occur. Extensive thromboembolism of the pulmonary arteries occurs less frequently than "small" ones, which tend to recur.

Causes and clinical picture of pulmonary embolism

The most common causes of PE are:

The factors provoking the development of pulmonary embolism include:

In addition, up to 20% of cases of pulmonary embolism are hereditary.

Symptoms that occur from the moment a blood clot came off (which was the cause of the blockage of the human pulmonary vessels) depend on:

With this pathology, a number of pathological changes occur in the respiratory and cardiovascular systems of a person:

• increased resistance in the pulmonary circulation;
• violation of gas exchange as a result of loss of functions of segments or lobes of the lungs;
• an increase in airway resistance due to reflex spasm;
• decreased elasticity of the lungs due to hemorrhage in them.

PE can manifest itself in different ways. It depends on the size of the blood clots that have come off and clogged the pulmonary arteries, as well as on how many vessels are affected in a person. Often, PE is asymptomatic, and it is detected only posthumously.

The clinical picture of PE is nonspecific and is characterized by a wide variety of symptoms.

Pulmonary embolism can manifest in one of three clinical variants:

Embolism of large branches of the pulmonary artery is accompanied by a serious condition of the patient, which can be fatal.

Danger of PE: emergency conditions and prognosis

Pulmonary embolism provokes the occurrence of pathological changes, which subsequently become the cause of the patient's disability or death.

Frequently diagnosed consequences of PE include:

How much time doctors have from the moment a blood clot came off, clogging the pulmonary arteries, it is impossible to say. It depends on the extent of the embolism:

• with small foci, it is possible to dissolve blood clots and restore blood flow even without treatment;
• with extensive foci, it is very possible to develop a pulmonary infarction, which without treatment in a short time can lead to death.

As a result of the development of acute respiratory failure, a condition occurs in which the lungs cannot saturate the blood with oxygen and remove carbon dioxide from it. As a result, hypoxemia (oxygen deficiency) and hypercapnia (excess carbon dioxide) occur.

The consequences of such a state are deadly, since there is a violation of the acid-base balance in the blood, poisoning of the body tissues with carbon dioxide occurs, with damage to the enzymatic and energy systems of the body.

Intensive therapy is indicated for such patients. For this purpose, patients with severe acute respiratory failure in pulmonary embolism are connected to a mechanical ventilation apparatus (IVL). IVL provides artificial restoration of gas exchange in the lungs. It is used in extreme cases:

After the restoration of the acid-base balance of the blood in the presence of spontaneous breathing, the patient can be disconnected from the ventilator. After transferring the patient to spontaneous breathing, blood gas indicators are monitored without fail. The prognosis for such patients is quite favorable.

The prognosis for life and health after suffering thromboembolism depends on:

In general, the prognosis for thromboembolism of small pulmonary arterioles is quite favorable, provided that adequate treatment and competent prevention of recurrent thromboembolism are carried out. Prevention of repeated cases of pulmonary embolism consists in:

• regular courses of medication;
• treatment of diseases provoking the onset of pulmonary embolism;
• if necessary - carrying out planned surgical treatment.

The prognosis for patients who have undergone extensive PE is not very favorable.

The survival rate of patients within 4 years is only 20%.

Every fourth patient with pulmonary embolism dies within the first year after an attack.

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Russia ranks 127th in terms of the health of the population, 130th in the integral indicator of the effectiveness of the health care system. However, the reason for such dramatic statistics is not only underfunding, but also in insufficiently effective management and organization of medical care.

Organ statistics

In mid-February, the head of the Ministry of Health, Tatyana Golikova, reported on how the state was coping with the implementation of demographic policy. It turned out that the natural population decline is decreasing every year. Indeed, in 2010 it decreased in comparison with 2006 by 2.8 times - to 1.7 per 1,000 population in 2010 (241.3 thousand people), and the overall mortality rate decreased by 5.9%. However, the minister did not mention in her report that for the first time since 2003 last year the downward trend in the number of deaths was not confirmed: in 2010, 20 thousand more people died than in 2009, including 3.7 thousand more due to diseases of the circulatory system. And the reduction in the natural decline in the population as a whole was due to the increase in the number of births.

Even if, according to Rosstat data for 2008, the absolute champion among diseases is respiratory diseases (23%) and only 14% of registered diseases are diseases of the circulatory system, then it is the latter that are the main cause of death: more than half of them die from them (57% ) population.

In Russia, people die from cardiovascular diseases seven times more often than in France (the country is the best in the WHO rating in terms of health care), four and a half times more often than in the United States.

At a speech in the State Duma at the end of February, the chief cardiologist of the Ministry of Health Yevgeny Chazov complained that the number of heart attacks among young and working-age people is increasing every year, and preventive work, including with patients who have already suffered a heart attack, is at a very low level. ... People who have had a heart attack continue to be treated with medicines that are morally outdated, and such an advanced method as angioplasty (restoration of narrowed arteries and veins) is used in our country once.

According to the World Health Organization, Russia ranks 127th in terms of population health, 130th in terms of an integral indicator of the effectiveness of the health care system. Almost 10% of officially recorded cases of inadequate quality care in Russia, 13% - hospitalization without medical indications, 11% - the diagnosis was made incorrectly, etc.

The data cited by the academician of the Russian Academy of Medical Sciences, Alexander Chuchalin, is more than impressive: in Russia, "one third of incorrect diagnoses".

According to a professor at the Moscow Medical Academy. I. Sechenov Natalia Kravchenko, one of the most important criteria for the quality of medical care is life expectancy, and this indicator in Russia is lower than in Europe.

Bed relapse

The latest report of Rosstat "Modern problems of medical care for patients with cardiac diseases" testifies to how things are in the regions with the treatment of cardiac patients. The department's specialists scrupulously studied the statistics of the Ministry of Health of Tatarstan, Saratov, Chelyabinsk, Vologda, Omsk regions and the Klinsky district of the Moscow region for 2008. And in 2009 more than 200 cardiologists were interviewed. The first thing that catches your eye: there is not only a catastrophic lack of cardiologists in rural areas - in half of the surveyed territories they simply do not exist, and the mortality rate from cardiac diseases in the countryside is almost twice as high as in the city.

Among the main conclusions of the report: assistance is provided not to all patients and not completely. Only 75% of cardiologists say that all patients receive all treatment in full in a hospital for free. “Thus, even patients with acute myocardial infarction in some cases remain without the necessary treatment, which not only does not contribute to recovery and prevent complications, but also leads to premature death,” the authors of the report conclude. One of the important components of treatment - the provision of medicines - is also missing. For example, in none of the regions, patients with acute myocardial infarction receive medication for six months after discharge, as it should be.

Only every third patient (34%) with pathology of the circulatory system was under dispensary supervision.

The highest indicators of technological equipment were noted in Tatarstan.

21% of surveyed cardiologists admitted that they often have to make a diagnosis without the necessary data. Even in the conditions of cardiological units, some of the mandatory examinations are not provided either in an emergency or in a planned manner, since doctors have nothing to do with them. The patient is not able to do artificial ventilation of the lungs, echocardiography, and daily ECG monitoring everywhere.

Delivery of a patient to a hospital is a separate problematic topic - for example, 10% of doctors indicated that they do not hospitalize a patient because of a long queue. Rosstat recorded: in the first three hours from the onset of a painful attack, patients are "rarely" taken to hospitals, and within four to six hours, 75% of patients taken to the hospital have not yet started the necessary therapy. In the overwhelming majority of cases (up to 90% or more), patients with cardiac diseases died at home.

Up to 50% of patients die in their own bed only because they cannot call an ambulance or it does not arrive on time.

Hope does not die

One of the main reasons for the poor quality of healthcare, which doctors and officials constantly talk about, is the underfunding of the industry. Russia spends 3.7% of GDP on healthcare, while in European countries these costs amount to 7-8% of GDP and more. Government spending on health care in Russia is even less than in countries that have a significantly lower or similar level of GDP per capita to Russia, for example, Costa Rica, Cuba, Latvia, Lithuania, Turkey, Chile. The government of the Russian Federation, however, promises to increase spending to 5.25% of GDP, only this will not happen before 2020 - by this time it is assumed that Russia will spend on medicine at the level of 10% of GDP of developed countries when comparing the purchasing power of currencies.

Meanwhile, WHO experts have already proven the direct proportional dependence of population health on investment in health care. So, if the state spends an average of $ 10 per citizen per year, then the biological capabilities of a citizen are realized by no more than 50%, and if about $ 1,000, then the citizens of such a country can count on 75% implementation. According to the Ministry of Health, today in Russia a third of hospitals and clinics are in disrepair, and more than half of the equipment has been in operation for more than ten years. The further into the outback, the more depressing the picture.

“The patient is afraid to go to the doctor because of the fear of the high cost of drugs,” says Larisa Popovich, director of the Institute for Health Economics.

In Russia, the patient will continue to buy drugs at his own expense until at least 2014, being content with outdated, but affordable drugs. The topic of "payment for" medical services, which arose in the 1990s, deserves a separate discussion. According to the Independent Institute for Social Policy, more than 8% of the population has to bear catastrophic health care costs, and the burden of these costs is much heavier for the poor than for the rich.

However, the point is not only underfunding, but also in insufficiently effective health care management, experts unanimously agree. There are low-income regions and countries where the quality of medical services is nevertheless at a decent level.

Globally, WHO has calculated that 20% to 40% of health care funds are wasted. In Russia, these estimates reach 90%. Among the obvious shortcomings of Russian health care are the lack of an adequate outpatient-polyclinic link (ineffectiveness of outpatient treatment leads to hospitalization in 17% of cases), unreasonably long periods of hospital stay, lack of preventive work, lack of specialists, etc. For example, cardiovascular centers lack qualified personnel who could work on modern cardiological equipment. In Khakassia, the only cardiovascular center in the entire republic is still inactive. However, the point is not only in the low qualifications of doctors, but also in their lack of motivation and responsibility.

Against this background, it is regrettable that the Concept of Healthcare Development until 2020, which has been discussed since 2008, has not yet been adopted. "The main sin of Russian healthcare is the lack of consistency in the organization of ensuring the timeliness, availability and quality of medical care. New standards cannot solve the problems of medicine. In such conditions, it is very difficult for a Russian patient to survive," sums up Natalya Kravchenko.

Daria Nikolaeva

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A pulmonary thrombus damages both the lung tissue and the normal functioning of all body systems, with the development of thromboembolic changes in the pulmonary artery. Blood clots or emboli are blood clots that block vascular tissue, blocking the path of blood. Extensive blood clots with untimely treatment will lead to death.

Carrying out diagnostic measures for pulmonary artery thrombosis is problematic, since the symptoms of pathology are similar to other diseases and are not detected immediately. Therefore, the death of the patient is possible within a couple of hours after the diagnosis.

What leads to blood clots

Medical scientists recognize that blood clots cause pulmonary thrombosis. They are formed at the moment when the flow of blood through the arterial vessels is slow, it coagulates at the moment it moves through the body. This often happens with a prolonged absence of human motor activity. With the resumption of movements, the embolus may come off, then the consequences for the patient will be serious, up to death.

It is difficult to determine what causes the emboli. But there are circumstances that predispose to the formation of pulmonary thrombi. Thrombus formation occurs due to:

• Past surgical procedures.
• Too long immobility (with bed rest, long flights).
• Overweight.
• Bone fractures.
• Taking drugs that enhance blood coagulation.
• Various other reasons.

Other circumstances are considered important conditions for the formation of a blood clot in the lungs, forming the symptoms of the disease:

• damaged vascular network of the lungs;
• suspended or severely slowed down blood flow through the body;
• high blood coagulability.

About symptoms

Emboli are often secretive and difficult to diagnose. In a condition where a blood clot has come off in the lungs, the lethal outcome, as a rule, is unexpected, it is no longer possible to help the patient.

But there are symptoms of pathology, in the presence of which a person is obliged to receive medical advice and assistance in the next 2 hours, the sooner the better.

These are symptoms that characterize acute cardiopulmonary failure, which are manifested in the patient by the following symptoms:

• shortness of breath, which has never been shown before;
• soreness of the patient's chest;
• weakness, sharp dizziness, fainting state of the patient;
• hypotension;
• a failure of the patient's heart rate in the form of a painful rapid heartbeat, which has not been observed before;
• swelling of the neck veins;
• cough;
• hemoptysis;
• pale skin of the patient;
• cyanotic skin of the upper body of the patient;
• hyperthermia.

Such symptoms were observed in 50 patients with this disease. In other patients, the pathology was invisible and did not cause any discomfort. Therefore, it is important to fix each symptom, since the clogged small arterial vessels will show mild symptoms, which is no less dangerous for the patient.

How to help

You need to know that when an embolus breaks off in the lung tissue, the development of symptoms will be lightning fast, the patient may die. If symptoms of the disease are found, the patient should be in a calm environment, the patient needs urgent hospitalization.

The urgent measures are as follows:

• the area of ​​the central vein is urgently catheterized, the introduction of Reopolyglucin, or a mixture of glucose and novocaine, is performed;
• intravenous administration of Heparin, Enoxaparin, Dalteparin;
• Elimination of pain with drugs (Promedol, Fentanyl, Morin, Leksir, Droperidol);
• oxygen therapy;
• the introduction of thrombolytic drugs (Urokinase, Streptokinase);
• introduction for arrhythmias of Magnesium sulfate, Digoxin, Ramipril, Panangin, ATP;
• prevention of shock by introducing Prednisolone or Hydrocortisone and antispasmodics (No-shpy, Euphyllina, Papaverine).

How to treat

Resuscitation measures will restore the blood supply to the patient's lung tissue, prevent septic reactions from developing, and prevent pulmonary hypertension.

But after emergency care has been provided, the patient requires further treatment. Relapses of the pathology should be prevented so that the emboli that did not come off would dissolve. In treatment, thrombolytic therapy and surgery are used.

The patient is treated with thrombolytics:

• Heparin.
• Streptokinase
• Fraxiparine.
• Tissue plasminogen activator.
• Urokinase.

With the help of these means, the emboli will dissolve, the formation of new blood clots will stop.

Intravenous administration of Heparin should be from 7 to 10 days. It is required to monitor the blood coagulation parameter. 3 or 7 days before the end of the treatment measures, the patient is prescribed the following pills:

• Warfarin.
• Thrombostop.
• Cardiomagnet.
• Thrombotic ACC.

They continue to control blood coagulation. After a previous illness, the tablets are taken for about 12 months.

Thrombolytics are prohibited during operations. Also, do not use them at risk of blood loss (stomach ulcer).

Surgical operation is indicated in the case of an embolus affecting a large area. It is required to eliminate the embolus localized in the lungs, after which the blood flow is normalized. The operation is performed if there is an embolus blockage of the arterial trunk or a large branch.

How is diagnosed

In case of pulmonary embolism, it is mandatory to carry out:

• Electrocardiographic examination, which allows you to see the neglect of the pathological process. When combined with a patient's history with an ECG, the likelihood of confirming the diagnosis is high.
• X-ray examination is of little informative, but distinguishes this disease from others with the same symptoms.
• Echocardiographic examination will reveal the exact location of the embolus, its parameters of size, volume and shape.
• A pulmonary scintigraphic examination will show how much the vessels of the lungs are affected, areas where blood circulation is impaired. It is possible to diagnose the disease with this method only if large vessels are damaged.
• Ultrasound examination of the venous vessels of the lower extremities.

About prevention

Primary preventive measures are carried out before the appearance of a thrombus in the lungs of those patients who are prone to thrombosis. It is carried out for people who are on long bed rest, as well as those who are prone to flights, patients with high body weight.

Primary prevention measures include the following:

• it is necessary to bandage the patient's lower extremities with elastic bandages, especially with thrombophlebitis;
• lead an active lifestyle, it is necessary to restore physical activity to patients who have undergone surgery or myocardial infarction, and further reduce their bed rest;
• exercise therapy should be carried out;
• with strong blood coagulation, a doctor prescribes blood thinners under strict medical supervision;
• surgical intervention to eliminate existing blood clots so that they cannot come off and block blood flow;
• a specific Hawa filter is installed to prevent the formation of a new embolus in the lung tissue. It is used in the presence of pathological processes on the legs in order to prevent their further formation. This device does not allow emboli to pass through, but there are no barriers to the movement of blood;
• use the pneumocompression method for the lower extremities in order to reduce edema with varicose changes in the venous vessels. At the same time, the patient's condition should improve, thrombus formation will gradually dissolve, the likelihood of relapse will decrease;
• you should completely abandon alcoholic beverages, drugs, do not smoke, which affects the formation of new emboli.

Secondary preventive measures are necessary in the case when the patient has suffered pulmonary embolism, and health workers are fighting to prevent relapse.

The main methods for this option are:

• install a kava filter to trap blood clots;
• the patient is prescribed anticoagulants to prevent rapid blood coagulation.

You should completely abandon destructive habits, eat balanced foods that have the necessary norm for a person of macro- and microelements. Repeated relapses are difficult to tolerate, and can lead to the death of the patient.

What are the possible complications

A blood clot in the lungs causes many different problems, among which are:

• unexpected death of the patient;
• infarction changes in lung tissue;
• inflammation of the pleura;
• oxygen starvation of the body;
• relapses of the disease.

About forecasts

The chance to save a patient with a torn embolus depends on how extensive the thromboembolism is. Small focal areas are able to dissolve on their own, the blood supply will also be restored.

If the foci are multiple, then the pulmonary infarction poses a threat to the patient's life.

If respiratory failure is observed, then the blood does not saturate the lungs with oxygen, the excess carbon dioxide is not eliminated. Hypoxemic and hypercapnic changes appear. In this case, a violation of the acid and alkaline balance of the blood occurs, tissue structures are damaged by carbon dioxide. In this state, the patient's chance of survival is minimal. Urgent artificial pulmonary ventilation is required.

If emboli are formed on small arteries, adequate treatment is performed, then the outcome is favorable.

Statistics claim that every fifth patient who has suffered from this disease dies within the first 12 months after the symptoms appear. Only about 20% of patients live for the next 4 years.

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In most ART cycles, superovulation is stimulated to ripen a large number of eggs, therefore, as a rule, there are also a large number of embryos. Since usually no more than three embryos are transferred into the uterine cavity, many patients leave behind "extra" embryos after the transfer.

These "extra" embryos can be cryopreserved (frozen) and stored for a long time in liquid nitrogen at -196 ° C. Subsequently, they can be thawed and used for the same patient if pregnancy does not occur during the IVF cycle, or if she wants to have more children after the birth of the child. Thus, she can go through the embryo transfer cycle again without being subjected to stimulation of superovulation and ovarian puncture.

Cryopreservation of embryos is one of the well-established methods of assisted reproductive technologies. The first child after the transfer of a thawed embryo was born in 1984. Most IVF clinics practice cryopreservation of embryos remaining after an IVF cycle for subsequent transfer to the uterus.

The chances of pregnancy after a thawed embryo transfer are lower than with a fresh embryo transfer. However, reproductive specialists strongly advise all their patients who have "extra" embryos to carry out their cryopreservation. The cycle of cryopreservation and transfer of thawed embryos is much cheaper than a new IVF cycle, and the presence of frozen embryos is a kind of "insurance" for patients in case a pregnancy does not occur. However, since it only makes sense to freeze good quality embryos, cryopreservation is a "bonus" that only about 50% of IVF patients get.

Approximately half of good quality embryos survive the freeze-thaw cycle. The risk of developing congenital fetal abnormalities does not increase with cryopreservation of embryos.

Benefits of embryo cryopreservation

• Allows you to maximize the chances of pregnancy after IVF and prevent the death of normal viable embryos remaining after the IVF cycle. This is the most important benefit of cryopreservation. About 50% of patients may have additional embryos for cryopreservation. The effectiveness of the transfer of thawed embryos is constantly growing, approaching the effectiveness of "fresh" IVF cycles.
• Cryopreservation of all embryos for future transfer into the uterus can be recommended for women who have an increased risk of developing severe ovarian hyperstimulation syndrome after induction of superstimulation in the IVF cycle.
• IVF cryopreservation of embryos is recommended in cases where the likelihood of embryo implantation is reduced, for example, in the presence of an endometrial polyp, insufficient thickness of the endometrium at the time of embryo transfer, dysfunctional bleeding during this period or illness.
• In case of difficulties with the transfer of embryos in the IVF cycle, for example, stenosis of the cervical canal (inability to pass through the cervical canal due to narrowing of the canal, the presence of scars in it, etc.).
• Freezing of embryos with IVF can be included in the egg donation cycle if, for some reason, it is difficult to synchronize the menstrual cycles of the donor and recipient. In addition, in some countries, cryopreservation of all embryos obtained from donor eggs is mandatory and their quarantine for six months until the donor's repeated negative test results for HIV, syphilis, hepatitis B and C.
• After the IVF cycle, which ended with the birth of a child, and if the spouses do not want to have any more children, the frozen embryos can be donated to another infertile couple.
• Before chemotherapy or radiation therapy for cancer.

How is the freezing and thawing of embryos going?

Embryos can be frozen at any stage (pronuclei, cleavage embryo, blastocyst) as long as they are of good enough quality to survive the freeze-thaw cycle. The embryos are stored one at a time or in groups of several embryos, depending on how many embryos are subsequently planned to be transferred to the uterus.

Embryos are mixed with cryoprotectant (a special environment that protects them from damage during freezing). They are then placed in a plastic straw and cooled to a very low temperature using a special software freezer or by ultra-fast freezing (vitrification). Embryos are stored in liquid nitrogen at -196 ° C.

During defrosting, embryos are removed from liquid nitrogen, thawed at room temperature, the cryoprotectant is removed and the embryos are placed in a special environment.

If the embryos have been frozen at the cleavage or blastocyst stage, they can be thawed and transferred to the uterus on the same day. However, if they were frozen at the stage of two pronuclei, then they are thawed one day before transfer, cultured for 24 hours to assess their cleavage, and transferred to the uterus at stage 2-4 of the cell embryo.

How long can frozen embryos be stored?

Frozen embryos can be stored as long as required - even several decades. When they are stored in liquid nitrogen at -196 ° C, all metabolic activity of cells at such a low temperature stops.

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What is the survival rate of embryos after freezing and thawing?

Not all embryos tolerate the freezing and thawing process well. In a clinic with a well-established cryopreservation program, the percentage of embryo survival is 75-80%. Damage to embryos occurs as a result of cryopreservation, but not during the storage period of the embryos, but during their freezing and thawing. Therefore, it may be necessary to thaw several embryos in order to obtain two to three good quality embryos for transfer to the uterus.

The most important indicator of human health is blood pressure. Pressure parameters are purely individual, and can change under the influence of many circumstances.

However, there is a specific set rate. In this regard, if a person has deviations from the norm up or down, this will allow the doctor to assume a failure in the functioning of the body.

It is necessary to find out what pressure is considered the norm in an adult. And also, find out what symptoms indicate that the pressure is high?

Blood pressure is the pressure of blood in a person's large arteries. Arteries are the main blood vessels, but veins and small capillaries, which penetrate most of the internal tissues, perform an equally important function.

The pressure of the blood flow in the vessels occurs due to the pumping function of the heart muscle. In addition, the pressure parameters are interconnected with the state of the vessels, their elasticity. The pressure level directly depends on the rhythm and frequency of the heartbeat.

Pressure readings are always presented as two digits, for example 140/90. How important are these numbers?

• The first number denotes the systolic (upper) pressure, that is, the level of pressure that is fixed at the time of the limiting frequency of contractions of the heart muscle.
• The second number is the diastolic (lower) pressure, that is, the level of pressure that is recorded during the maximum relaxation of the heart.

Blood pressure is measured in millimeters of mercury. Also, there is such a thing as pulse pressure, it shows the difference between systolic and diastolic pressure.

The ideal pressure should be 120/70. If the indicators on the tonometer are greatly exceeded, it means that the human body signals about the ongoing pathological processes.

When a patient has persistent high blood pressure, the likelihood of stroke increases 7 times, 5 times the risk of developing heart failure, 3.9 times of heart attack, and 2.9 times of peripheral vascular disease.

The pressure is subject to changes not only in the arms, but also in the ankles. In a healthy person, on the arms and legs, the parameters of blood pressure, with full patency of the arteries of the legs, should not differ by more than 20 mm Hg.

When the readings exceed the numbers 20-30, it is believed that this may indicate a narrowing of the aorta.

It is necessary to measure pressure in an adult only in a calm state, because any load (emotional or physical) can affect the indicators.

The human body independently controls the level of blood pressure, and if there is a moderate load, then its indicators can rise by 20 mm.

This situation is due to the fact that the muscles and internal organs that are involved in the work require increased blood circulation.

It should be noted that the parameters of blood pressure depend on the age of the person, the individual characteristics of the organism. Pressure table for men by age:

1. 20 years old - 122/79.
2. 30 years old - 125/79.
3. 40 years old - 128/81.
4. 50 years - 134/83.
5. 60 years old - 141/85.
6. 70 years - 144/82.

The data shown is correct. If there is a slight deviation in the range of 5-10 mm, then this is quite natural. Perhaps the slight rise was provoked by a stressful situation, or fatigue. Pressure table for women:

• 20 years - 116/72.
• 30 years old - 120/75.
• 40 years old - 127/80.
• 50 years - 137/84.
• 60 years old - 144/85.
• 70 years old - 159/85.

In men aged 80 years, blood pressure should be 147/82, and at the age of 90 years - 145/78. In women aged 80 years, it is considered to be the norm of blood pressure - 157/83, and at 90 years old - 150/79.

If we take the average indicators, then the normal pressure for men 30-40 years old is 120-130 / 70-80. For women 30-40 years old should be the same values.

It is important to note that with each passing year, irreversible processes occur in the human body, leading to an increase in pressure throughout life. The older a person gets, the higher his blood pressure rises (upper and lower).

Based on statistical data, it is believed that hypertension can affect every person, regardless of age, whether a person is 70 years old or 20-40.

Another important indicator of the general condition of a person is the pulse.

The normal pulse in an adult ranges from 60 to 80 beats per minute. The more intensively the metabolism is carried out, the higher the pulse will be.

Pulse, like blood pressure, also has its own established norms for people of different age groups:

1. 4-7 years old - 95.
2. 8-14 years old - 80.
3. 30-40 years old - 65.
4. During the period of illness, the pulse rises to 120 beats per minute.
5. Shortly before death - 160 beats per minute.

If you know your normal heart rate and learn how to measure it correctly, you can recognize an impending problem in advance. For example, if the pulse increases sharply 2-3 hours after eating, the body may be signaling poisoning.

An intense pulse, the blows of which are felt by the patient very clearly, may indicate that blood pressure has risen sharply.

As a rule, magnetic storms and changes in weather affect blood pressure readings, they decrease. The body reacts in response to the decrease and increases the heart rate to maintain normal blood pressure.

Pressure increase symptoms

Severe stress, a sedentary lifestyle, addictions and excess weight - all this leads to the development of hypertension in people. Often, hypertension occurs due to nervous stress at work.

What pressure a healthy person should have was found out. Now it's worth figuring out what symptoms of an increase indicate a change in blood pressure:

• Unreasonable tiredness.
• Headache.
• Painful sensations in the region of the heart.
• "Flies" before the eyes, tinnitus.
• General weakness.

All the symptoms of an increase do not have to be present, a few are enough. For example, most often it is fatigue, pain in the heart and migraine.

Overwork at high pressure resembles in its sensations the onset of a cold, which is accompanied by irritability, drowsiness / insomnia, redness of the eyeballs.

Such signs should not be ignored, especially in cases where the indicators of an adult in a calm state reach 140/90. Such parameters indicate a previous hypertension.

Scientific research indicates that the highest incidence rate is observed in men over 40 years of age. The reasons for high blood pressure made it possible to form a risk group:

1. Smoking people.
2. Patients with diabetes mellitus.
3. Patients who are overweight.

All men who fall under these points must constantly monitor their blood pressure, and in case of its slightest deviations, consult a doctor. The first symptoms of hypertension are headaches:

• Typically, the pain is aching or shingles in nature.
• Some patients, when telling the doctor about their symptoms, say that they have sensations of a tight band around their head, which is constantly squeezed.
• When examining such patients, pathological transformations in the fundus are diagnosed, less often retinal atrophy.
• These symptoms signal a disturbance in blood circulation in the brain, which increases the risk of blindness and stroke.

In situations where the pressure is higher than 160/100, it is necessary to urgently visit a doctor to prescribe adequate treatment with medications.

The symptoms of high blood pressure are numerous. But, the most serious concern is chest pain. She can give to her left hand.

Similar symptoms indicate that pathological changes occur in the coronary vessels, heart muscle. All these transformations provoke high blood pressure.

Deviations from the norm: possible causes

The reasons that provoke an increase in blood pressure are quite large. And the doctor does not always manage to establish the exact causes of such a pathology. The most common are the following:

1. The heart cannot cope with the load, and cannot function in a full-fledged mode.
2. Changes in the quality indicators of blood. With each passing year of a person, the blood becomes more viscous, therefore, the thicker it is, the harder it is for it to move through the vessels. The causes of thick blood can be autoimmune disorders and diabetes mellitus.
3. Reduced elasticity of blood vessels. Poor nutrition, some medications, serious physical exertion on the body can lead to this condition.
4. The formation of cholesterol plaques on the walls of blood vessels when the amount of cholesterol in the blood is exceeded.
5. Hormonal changes in the body, which provoked a narrowing of the vascular lumen.

Also, a deviation from the norm may be due to endocrine disorders. In addition, the causes of this pathological condition are the abuse of alcoholic beverages, an improper lifestyle, the consumption of large amounts of table salt, and so on.

After assessing the blood pressure indicators, the doctor relies on the accepted averaged values. You should pay attention to the same rate when measuring the pressure at home.

It is with such indicators that the human body can work normally, there is no harmful effect on internal organs, the likelihood of developing cardiovascular pathologies decreases. The video in this article will tell you what to do with high blood pressure.

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All about myocardial infarction: causes, symptoms and ECG

Myocardial infarction is a necrosis (necrosis) of a part of the heart muscle, arising as a result of circulatory disorders, which ultimately leads to a lack of oxygen supply to the heart muscle. Myocardial infarction is today one of the leading causes of death and disability in people around the world.

Since this article will focus on the electrocardiogram, first it is worth understanding the definition of this term. So, an electrocardiogram (ECG) is a record of the electrical activity of the heart. The ECG measures the rhythm and conduction of the heart, helps assess the blood supply to the heart muscle at rest, and also detects an increase in the atria and ventricles. Transformations on the ECG in myocardial infarction depend on the form of the infarction, its location and stage.

Signs of illness

If you find the following symptoms, you should worry and contact a cardiologist for an examination. Depending on the symptoms, several variations of myocardial infarction are distinguished:

1. Anginal is the most popular option. It is expressed by unbearable pressing or squeezing pain behind the sternum, which does not stop even after taking drugs (nitroglycerin). These sensations can be given to the chest on the left side, as well as to the left arm, jaw and back. The patient may experience weakness, lethargy, anxiety, fear of death, increased sweating.
2. Asthmatic - an option in which there is shortness of breath or choking, intense heartbeat. Pain is often absent, although it is a precursor to shortness of breath. This variant of the formation of the disease is inherent in older age groups and people who have already suffered a myocardial infarction.
3. Gastralgic - characterized by a special localization of pain, manifested in the upper abdomen. It can spread to the shoulder blades and back. This option is accompanied by hiccups, belching, nausea, and even vomiting. Bloating in the abdomen is likely due to intestinal obstruction.
4. Cerebrovascular - the symptoms are combined and, one way or another, have a connection with cerebral ischemia. The patient feels dizziness, loss of consciousness, nausea, vomiting, deterioration of orientation in space is possible. Due to the appearance of neurological symptoms, it becomes difficult for a doctor to diagnose, therefore, in this case, the diagnosis can only be made with the help of an ECG for myocardial infarction.
5. Arrhythmic - the main symptom in this case is palpitations: a feeling of cardiac arrest and periodic interruptions in its work. There is no pain or they appear slightly. Weakness, shortness of breath, fainting, or other symptoms are likely to result in a drop in blood pressure.
6. Low-symptom - with this option, the detection of a previously transferred myocardial infarction is possible only after taking an electrocardiogram. But a heart attack may be preceded by symptoms that are mild, for example, causeless weakness, shortness of breath, heart failure.

For each variant of myocardial infarction, an ECG must be done for accurate diagnosis. Thanks to the electrocardiogram, there is a possibility of early detection of deterioration in the work of the heart, which will prevent the occurrence of myocardial infarction.

Reasons for development

The main cause of myocardial infarction is impaired blood flow through the coronary arteries. The main factors in the formation of this deviation are:

• coronary thrombosis (acute blockage of the lumen of the artery), which often leads to macrofocal (transmural) necrosis of the walls of the heart;
• coronary stenosis (severe narrowing of the arterial opening by an atherosclerotic plaque, thrombus), which often leads to large-focal myocardial infarction;
• stenosing coronary sclerosis (acute narrowing of the lumen of some coronary arteries), which causes small focal subendocardial myocardial infarction.

In many cases, the disease develops against the background of atherosclerosis, arterial hypertension and diabetes mellitus. Often, smoking, a sedentary lifestyle, overweight and subsequently obesity play the main role in the formation of myocardial infarction.

Conditions that increase myocardial oxygen demand can provoke myocardial infarction:

• depression and nervous tension;
• excessive physical activity;
• stress and anxiety;
• changes in atmospheric pressure;
• surgical intervention (less often).

Hypothermia can serve as an impetus for the formation of pathologies, therefore seasonality in the occurrence of myocardial infarction also takes an important place. A high incidence rate is observed in winter with low temperatures, while in the summer months the disease occurs much less frequently. But it is worth noting that excessive heat also contributes to the development of this disease. The number of cases also increases after the flu epidemic.

It is very important to diagnose myocardial infarction on time, because 50% of cases of the disease are fatal in the first hours. However, only in the first 6 hours is it likely to limit the site of cardiac death and reduce the risk of complications.

How to distinguish a heart attack from other pathologies on an ECG?

Doctors define an ailment on two main grounds:

The characteristic dynamics of the electrocardiogram. If on the ecg, over time, there are transformations typical of a heart attack, the shape, size and location of teeth and segments, then in this case it is possible to declare with great confidence about myocardial infarction. In infarction departments of hospitals, electrocardiograms are done every day. To make it easy to assess the dynamics of the heart attack on the ECG, it is advisable to mark the areas of application of the chest electrodes so that further hospital ECGs are recorded in the chest leads identically.

From this, an important conclusion can be drawn: if pathologies were found in the patient on past cardiograms, then in such cases it is strongly recommended to have a "control" ECG copy at home. It is necessary so that the ambulance doctor can quickly compare the fresh electrocardiogram with the old one and draw a conclusion about the age of the detected changes. If the patient has previously suffered a myocardial infarction, then the provided recommendation and continuous diagnosis become the main rule.

If the symptoms that are characteristic of a heart attack were not observed in the patient for the first time, but are also observed on cardiograms made one to two months ago, one should think about the presence of chronic post-infarction changes. In doubtful situations, as well as with changes that border on the norm, the diagnosis is re-assigned after at least eight hours.

When an acute myocardial infarction is detected, transformations on the cardiogram will increase. It is also worth noting that in some cases, in the first hours, there may be no changes at all, they will appear later, therefore, with typical clinical signs, it should be assumed that the patient has a myocardial infarction.

Electrocardiographic stages of the course of the disease

According to the electrocardiogram of myocardial infarction, there are four main stages in the course of a heart attack:

1. The most acute stage. Covers the period from the beginning to the formation of cardiac muscle necrosis. It lasts from several tens of minutes to two or three hours. Expressed ECG with a heart attack, ischemic syndromes and injuries.
2. Acute stage. Covers the time from the formation of necrosis to absolute stabilization, reduction of the ischemic zone and damage. This stage lasts from two to three days to three weeks. On the electrocardiogram, two syndromes can be combined - necrosis and damage. As a rule, there is a pathological Q wave (QS), ST above the isoline with an arc up (in reciprocal leads below the isoline with an arc down). By the end of this stage, the ST approaches the isoline, there is a delimitation of the zone of damage and ischemia, and the first signs of the development of a coronary tooth appear.
3. Subacute stage. Reparative processes take place, the zone of necrosis is delimited, damage decreases, and a scar begins to form. A pathological Q wave remains on the electrocardiogram, but QS can be replaced by Qr or QR complexes. ST on the isoline. The ischemic zone is delimited and deep negative isosceles (coronary) teeth are formed.
4. Cicatricial stage (in other words, the stage of cardiosclerosis). Lasts no more than eight months. There remains a pathological Q, ST wave on the isoline and a coronary T wave, although by the end of this time it begins to decrease in amplitude and becomes non-isosceles.

Traces of a transferred heart attack can be observed for a long time, sometimes a pathological Q wave can remain for decades. Little by little, and it can decrease in amplitude, but in duration it exceeds the norm. In some patients, after a few years (1-3 years), all traces of a previous myocardial infarction may completely disappear. In conclusion, it should be said that a pathologically altered electrocardiogram does not in all cases indicate an organic lesion of the heart. A normal electrocardiogram also does not always indicate the absence of damage to this organ.

After suffering myocardial infarction, patients can be advised to use the method of long-term recording of the electrical activity of the heart in the conditions of their daily habitual life. This method is called daily (Holter) ECG monitoring. A conventional electrocardiogram gives the attending physician detailed information about the work of the heart, or rather, about the frequency of contractions, their rhythm, about the work of the cardiac conduction system, about the presence of insufficient blood supply. However, if pain attacks or arrhythmias appear in a patient only during exertion or up to twice a day, a conventional electrocardiogram, taken without an attack of pain, will be completely normal.

Holter monitoring allows you to record an ECG over a long period (usually within 24 hours), moreover, the ECG is not performed in a calm state of the patient, but in the circumstances of his usual activity. With the help of this technique, it is possible to assess the activity of the patient's heart in conditions of habitual activity, to check the reaction of the heart to both physical and emotional stress. In addition, monitoring helps to assess the state of the heart during the patient's rest period, the rhythm and conductivity of the heart within 24 hours.

With the help of this method, it is possible to clarify the main cause of fainting or light-headedness of the patient. To identify and analyze all types of arrhythmias, as well as to detect episodes of painful and painless myocardial ischemia, their number, duration, threshold level of load and pulse, along with which ischemia develops.

Another effective method is to conduct an electrocardiographic study during the patient's physical activity on a special simulator, which is called a bicycle ergometer. There is another version of this technique using a treadmill (treadmill). Bicycle ergometry is used in order to identify the form and stage of coronary heart disease, as well as to determine the individual's tolerance to physical activity.

It is also important that ECG with exercise makes it possible to quantitatively express the degree of insufficiency of coronary blood flow and to reveal the adaptive capabilities of the patient's body along with dosed physical activity. This method will help to track the recovery time of the heart and blood pressure after the load is stopped. Consequently, it becomes possible to objectively and competently assess the dynamics of the formation of the disease and the correctness of its treatment.

In conclusion, it should be mentioned that upon discharge from the hospital, each patient who has had a myocardial infarction, the doctor must give a control electrocardiogram. Subsequently, the patient should always and everywhere carry the resulting ECG with him, since the doctor may need it in case of a recurrence of the disease or complaints.