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Subject 7 - Myocarditis and cardiopathy (4 hours) Place Educational room, dpt. of Cardiology Purpose Students must know: • Classification noncoronary heart disease. • Etiology and pathogenesis of myocarditis , primary and secondary ( specific ) cardiomyopathies . • Clinical manifestations of non-rheumatic myocarditis , menopausal , dilated and hypertrophic cardiopathy . • Methods of diagnostic criteria for the diagnosis and differential diagnosis ( exclusion criteria ) . • Principles of treatment and prevention, especially the treatment of various clinical variants . To Able: Based on the examination of the patient with non-rheumatic myocarditis formulate the final clinical diagnosis and treatment. • Put a preliminary diagnosis and determine whether treatment for climacteric , hypertrophic cardiomyopathy and dilated . to formulate a clinical diagnosis • to the differential diagnosis • identify and evaluate tactical test results • prescribe treatment • identify and forecast performance • recommend preventive measures Professional orientation of students Non-rheumatic myocarditis may occur in young patients after previous infection or syndrome as in other diseases , timely diagnosis and appropriate treatment can significantly improve the prognosis , secondary cardiomyopathy were widespread , their knowledge is necessary for the differential diagnosis with other cardiac disease , prevention of coronary heart disease and iatrogenic giperdiagnostitsi Purpose and effective therapy. Lately, more often diagnosed primary cardiomyopathy . For their diagnosis requires knowledge of modern methods of examination , and the heavy forecast to be significantly improved by the application of modern methods of treatment. Base level of knowledges and abilities № Discipline To know 1. Anatomy anatomical structure of the heart 2. Histology Structure and function of the myocardium and cardiac conduction system 3. Biochemistry myocardial metabolism and cardiac muscle contraction 4. Pathophysiology Mechanisms pathophysiology of myocardial hypertrophy and dilatation . Mechanisms of myocardial metabolism disorders in secondary cardiomyopathy 5. Propedevtik diseases of To able internal Semiotics of cardiac rhythm and to assess the clinical, conduction , circulatory failure instrumental and laboratory tests Plan of practical employment № Elements of practical employments 1. Verification of present's students 5 2. Entrance control and his analysis 15 Time(minutes) 3. * Distributing patients for Supervision ( card or clinical tasks ) 10 4. * Review patients or study of educational hospital chart 40 5. Discussion of findings, formulation of previous diagnosis, determination of methods of additional inspection of patient, interpretation of their results, formulation of final diagnosis and plan of treatment 50 6. Exercises with clinical formulations for solving clinical situation tasks 20 7. Output control of knowledge and its evaluation 15 8. Results and final assessment of knowledge and skills of students and tasks to self- preparation for the next lesson 5 Note: * - in the case of patients absence in clinical, practice can be made in the form of preparation and decision of situational tasks. List of theoretical questions addressed in class 1. Idea of Noncoronary heart disease and their classification. 2. The most common options myocardial damage ( dystrophy, inflammation , primary cardiomyopathy ) . 3 . Etiology and pathogenesis of myocardial lesions of different options , the concept of cardiomyopathy as a nosological entity and how pathophysiological form. 4 . Myocarditis : classification and diagnostic criteria . Principles of treatment . 5 . Clinical manifestations and additional methods for specific surveys ( menopause , alcohol and thyrotoxic ) cardiomyopathies . 6. Basic principles of treatment of specific cardiopathy . 7. The treatment regimen of patients with climacteric cardiomyopathy . 8. Clinic hypertrophic cardiomyopathy and dilated . 9. Additional methods of research in dilated cardiomyopathy and hypertrophic . 10 . Treatment of hypertrophic and dilated cardiopathy . Method of leadthrough of practical employment * On the first employment teacher hold instructing from accident (if there are such terms) which registers in the magazine of teacher's signature of student prevention. * Students answer in writing on the tests of base knowledges entrance control. Then a teacher distributes students for kuration patients and determines them a task. № Task 1. Spend curation of patient During an inspection diagnosed with dilated discover: cardiomyopathy 1. Signs of heart failure Teasher's students pointing to Teacher's note for students to Pay special attention to the absence of a reason for hypertrophy and dilatation of the heart cavities 2 . Increase in heart size 3 . Possible arrhythmias 4 . Characteristic changes in DCM for ECG , X-ray , echocardiography A teacher works in obedience to the plan of organization of employment, in the end - initial control of knowledges. Before completion of employment teacher announce his results with the estimation of every student and declares the theme of next employment. Forms and methods of self-control Tests 1. 32 years old patient complained of disruption of the heart , dizziness, shortness of breath on exertion . Still sick. Objectively : Ps - 74/hv . , rhythmic. AT 130/80 mmHg Auscultation : first normal tone sonority , systolic murmur over the aorta. ECG showed left ventricular hypertrophy, signs of repolarization in V5, V 6 leads. Echocardiography : interventricular peretenka 2 see what is the most likely diagnosis ? A. * Hypertrophic Cardiomyopathy B. hypertonic disease C. myocardial infarction D. aortarctia E. Aortic stenosis 2 . Female 37 years old complains of choking, squeezing chest pain . week ago suffered flu. OBJECTIVE: akrotsianoz , HR - 98/hv . , BP - 90/75 mm Hg. Art. , BH - 26 / Min. Heart borders zmischeni i left right 3 cm Heart sounds muffled , over the top protodiastolichny gallop , systolic murmur . Hb - 130 g / L ESR - 25 mm / hour. which Early diagnosis can be ? A. Acute myocarditis B. Dilyatatsiyna kardiomiopatiya C. pericardial effusion D. metabolic cardiomyopathy E. CHD : angina 3 . Patient 49 years old, complains of pain in the heart, fatigue, confusion. Pain occurred three years ago and involves a violation of the menstrual cycle , the emergence of " hot flashes ." Objectively : the limits of the heart is not enlarged, muted tones . AO 155/90 mmHg ECG T-wave flatness in V5 - V6. On repeated ECG - without dynamics. What is the most likely diagnosis ? A. * Dishormonal cardiomyopathy B. hypertonic disease C. CHD : angina D. myocarditic kardiosklerosis E. cardiopsychoneurosis Situational tasks 1. When prophylactic tuberculin testing in men 35 years showed an increase in heart size . No complaints. OBJECTIVE: Heart sounds moderately weakened. On ECG - signs of left ventricular hypertrophy . In an.krovi unchanged. Further examination revealed that either causes enlargement of the heart . What is the most likely diagnosis ? What additional research needs to appoint ? Your tactics of treatment of the patient ? 2 . Patient 35 years old, complains noyuchy pain in the heart , yadihu , increasing t to 37,3 C. Sick 3 days . 15 days ago suffered " flu ." OBJECTIVE: HR = PS = 98 in 1 min. BH = 22 at 1 min. AT-120/80 mmHg Heart borders + 2 cm left, muted tones , in systole soft noise is heard . In an. Blood Lake . - 10,6 September 10 / l, ESR -32 mm / hour. What is the most likely diagnosis ? What additional research needs to appoint ? Your tactics of treatment of the patient ? Ilustrative material 1. Tables and slide classifications noncoronary heart disease , myocarditis , cardiomyopathy . 2 . Audiocassettes rhythm disorders . 3 . Videotape with ehokardiografichnimi studies of the heart in noncoronary heart disease . 4 . Set ECG . 5 . Set of benchmark tests and situational problems with standards answers. sources of information Sources of information (literature) Basic: Therapy. Course of lectures. Simferopol. -2003.- 444p. Additional: 1. Harrison's Principles of Internal Medicine 18th edition. .org) 2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines) The program of preparation students to the theme To learn: • Presentation of Noncoronary heart disease and their classification. • The most common options myocardial damage ( dystrophy, inflammation , primary cardiomyopathy ) . • Etiology and pathogenesis of myocardial lesions of different options , the concept of cardiomyopathy as a nosological entity and how pathophysiological form. • Myocarditis : classification and diagnostic criteria . Principles of treatment . • Clinical manifestations and additional methods for specific surveys ( menopause , alcohol and thyrotoxic ) cardiomyopathies . • Basic principles of treatment of specific cardiopathy . • The treatment of patients with climacteric cardiomyopathy . • Clinic and dilated hypertrophic cardiomyopathy . • Additional methods of research in dilated cardiomyopathy and hypertrophic . • Treatment of hypertrophic and dilated cardiopathy . draw: • echocardiographic picture in primary cardiomyopathy . To Able: • Establish a definitive diagnosis of myocarditis , assign the necessary examination and treatment. • Establish a preliminary diagnosis of climacteric , dilated and hypertrophic cardiomyopathy, assign the necessary examination and determine whether treatment for these diseases . Note the use of modern methods of instrumental examination at Noncoronary myocardial pathology .