tabloul clinic – ivs pt prezentat
TRANSCRIPT
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TABLOU CLINIC IC
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dispneepolipneetusea de decubithemoptiziaastenia / fatigabilitateanicturia,oliguriasimptome cerebrale :ameteli,
verij,confuzie, tulb. ritm nictemeralrespiratia Cheyne- stokes
TABLOUL CLINIC – IVS- simptomatologia -
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DISPNEEAsimptom cardinal al IVS= expresia congestiei pulmonarede efort, ortopnee, proxistica nocturnasenzatie de ‘sete de aer’ in conditiile unui travaliu
respirator excesiv pe un plaman rigiddg. dif. cu :• Fatigabilitatea• Dispneea de cauza pulmonara
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Crestere presiune
veno-capilara in circulatia pulmonara moderata
Staza interstitiala
Dispnee +
tahipnee
Crestere rapida a presiunii capilare
pulmonare peste
30mmHg
EPA
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Clasificarea NYHADefinitie Dizabilitate Prognostic
Clasa I Fara limitare a activitatii fizice
Fara simptome la activitati obisnuite
poor
Clasa II Limitare usoara a activitatii fizice
Simptome la activitati obisnuite
bad
Clasa III Limitare marcata a activitatii fizice
Simptomele apar la activitati cotidiene
awful
Clasa IV Disconfort la orice tip de activitate fizica
Simptome la repaus terminal
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TUSEA
• Coexista cu dispneea• Seaca, iritativa, apare la efort
• Daca nu se amelioreaza sub diuretic trebuie ≠ de:– Tusea din contextul IARCS– Tusea indusa de IEC
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ASTENIA / FATIGABILITATEA
• Senzatie de slabiciune
• Expresie a ↓DC periferic (hipoxiei)
• Spre deosebire de dispnee ↑ in :– Hipovolemie– Tratament diuretic– hNa– Β-blocant
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NICTURIA
apare precoce in evolutia IC
OLIGURIA
apare tardiv, in IC terminala -expresie a prabusirii DC si a debitului renal
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SIMPTOME CEREBRALE
• Anxietate • Confuzie• Cefalee• Tulburari de memorie
• Respiratie Cheyne-Stokes ( expresie a ischemiei centrului respirator )
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Respiratia Cheyne-Stokes
• = hipoxia centrului respirator = alternanta de perioade de apnee cu accese de tahipnee.
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TABLOUL CLINIC – IVS- obiectiv -
1. general• paloare cutanata / cianoza periferica• extremitati reci• transpiratii profuze• falsa crestere ponderala ( retentie hidrosalina )• malnutritie / casexie cardiaca ( in stadiile terminale )
2. pulmonar• raluri de staza (crepitante) &/ EPA• revarsat pleural ( unilateral de obicei, pe dr)• dispnee pana la ortopnee
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TABLOUL CLINIC – IVS- obiectiv -
3. cardiac• cardiomegalia • tahicardia / tahiaritmiile ( cvasiconstante daca pacientul nu
prezinta tulburari de conducere / fara tratament β-blocant, digitala)
• galop protodiastoic stang• suflu sistolic apexian ( IMI. functionala )• puls slab / puls alternant• TAs ↓& TAd ↑ ( mai ales in decompensarile acute )
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SEMNE ŞI SIMPTOME CARACTERISTICE IC STÂNGI
Simptome Semne
IC stanga
Dispnee de efort, de repaus, ortopnee, dispnee paroxistica nocturna;
Tuse, hemoptizii;
Respiratie Cheyne-Stokes;
Astenie, fatigabilitate;
Paloare/ cianoza, transpiratii;Raluri pulmonare de staza;Tahicardie;Deplasare laterala soc apexian;Crestere arie matitate cardiaca;Galop protodiastolic de VS (Zg 3);Suflu sistolic apical (regurgitare mitrala secundara);
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TABLOUL CLINIC – ICD (1)- simptomatologia -
• Staza sistemica – are expresie subiectiva preponderent la nivel digestiv
• Hepatalgie – de efort / repaus
• Meteorism abdominal, greata, anorexie, constipatie
• Astenie, oligurie
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TABLOU CLINIC – ICD (2)
• astenie si fatigabilitate• hepatalgia de efort/ repaus – expresia stazei
hepatice• sindrom dispeptic nespecific – staza in
teritoriul splahnic• ENTEROPATIA PROTEIPRIVA- DA CASEXIE
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TABLOUL CLINIC – ICD- obiectiv -
• Sistemic – semne de staza retrograda periferica:- cianoza extremitati- icter/ subicter- edeme periferice → anasarca- jugulare turgescente / reflux
hepatojugular- hepatomegalie de staza +/- splenomegalie
- +/- ciroza cardiaca
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TABLOUL CLINIC – ICD- obiectiv -
Cardiac :
– cardiomegalie ( dr. )– Hartzer (+)– galop protodiastolic drept– IT functionala ( pulsatii jugulare / hepatice sistolice
)– Zgomot 2 accentuat la focarul pulmonarei– Suflu de insuficienta pulmonara– PVC ↑
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SEMNE ŞI SIMPTOME CARACTERISTICE IC DREPTE
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EDEME + STAZA VENOASA = INSUFICIENTA CARDIACA CONGESTIVA
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