E ffekty lipid-lowering therapy 2

In the concept of a multifactor approach, the most important is the correction of lipid metabolism disorders, which, as already mentioned, makes the most important contribution to the risk of complications. By impaired lipid metabolism, we mean an increase in the level of total cholesterol (cholesterol), cholesterol cholesterol of low-density lipoproteins (LDL), triglycerides (TG), and a decrease in cholesterol cholesterol of high-density lipoproteins (HDL). In large epidemiological studies, a direct relationship was found between cholesterol level and mortality from coronary heart disease [71,72], and also that a decrease in the level of LDL cholesterol leads, in turn, to a decrease in the risk of developing coronary heart disease [73,74]. Today, the most effective and safest drug-based lipid-lowering therapy is statins. They reduce LDL cholesterol by 20–60%, TG – by 10–40%, and HDL cholesterol increases by 5–15% . Prolonged use of statins leads to a significant reduction in the risk of cardio and cerebrovascular complications [76]. At the same time, the effectiveness of statins has been proven not only in patients with coronary artery disease, but also without coronary artery disease. The ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm) study proved the effectiveness of statins for the prevention of cardiovascular complications in patients with hypertension and moderate hypercholesterolemia [77]. This fact is reflected in the recommendations of GFCF for the diagnosis and treatment of atherosclerosis, where statin administration is recommended not only for treating patients with various clinical manifestations of atherosclerosis, but also for treating patients without clinical manifestations of atherosclerosis and with a high risk of CVD death according to the SCORE scale. Thus, indications for lipid-lowering therapy are greatly expanded, as a means of not only secondary, but also primary prophylaxis.

At the same time, statins have a number of additional pleiotropic effects, which include the ability to improve endothelial function, reduce blood viscosity, and also have an anti-inflammatory, hypotensive effect. One of the most important effects of statins is an improvement in endothelial function [78,79]. It is with the improvement of endothelial function in the application of statins that their hypotension effect has been identified, which has been identified in a number of studies in recent years [80,81]. In this regard, the data of our own double-blind, randomized, placebo-controlled clinical study are of interest, the purpose of which was to study the hypotensive effect of pravastatin in patients with mild hypertension and HCS. The 12-week study included 52 male patients aged 35–60 years,who were randomly assigned to 3 groups. Group I received a placebo – 16 people, Group II – Pravastatin – 40 mg per day – 18 people and Group III – prolonged non-dihydropyridine calcium antagonist – diltiazem (altiazem PP ® ) – 180 mg per day – 18 people.

The treatment with pravastatin showed a significant decrease in the average daily GAD by 6.2 mm Hg. (p <0.001), the average daily dad – 5.4 mm Hg. Art. (p <0.001). At the same time, against the background of receiving a placebo, there was no change in the average daily GARDEN (total –0.1 mm Hg, p> 0.05), nor the average daily DBP (total –0.3 mm Hg. Art. , p> 0.05). At the same time, pravastatin provided a significant reduction in the average daily GARDEN and DBP compared with placebo. At the same time, it was slightly inferior in its hypotensive effect.

As for the hypolipidemic effect of pravastatin, the decrease in total cholesterol was 29.2 ± 3.3% of the initial level (p <0.001), LDL cholesterol – 37.7 ± 4.4% of the initial level (p <0.001) , increase in HDL cholesterol levels – 30.1 ± 5.7% from the initial level (p <0.001).

Interestingly, the degree of decline in cholesterol levels did not correlate with the degree of decline in either GARDEN or DBP. Thus, the hypotensive effect of pravastatin was not dependent on its hypolipidemic action.

Pravastatin’s hypotensive effect made an additional contribution to reducing the total coronary risk, calculated on the basis of the computerized model of the West German study PROCAM STUDY [82]. The main components of this formula are: age, CAD, level of total cholesterol or LDL cholesterol, HDL cholesterol, TG, smoking status, type 2 diabetes, history of coronary artery disease, myocardial infarction, history of coronary artery disease.

Taking into account only the hypolipidemic effect, the total risk was significantly reduced (–69%) and amounted to 7.2%, while taking into account the hypotensive effect, it reached 6.3%. Thus, the antihypertensive effect of pravastatin makes an additional contribution to the reduction in total coronary risk .

Perhaps the additional antihypertensive effect of pravastatin, which is a consequence of the improvement in endothelial function, can be attributed to the WOSCOPS (West of Scotland Coronary Prevention Study) study on primary ischemic heart disease prevention, where the efficacy of pravastatin in the treatment of 6550 people with lipid metabolism disorders was evaluated [83] . The reduction in coronary risk (combined endpoints – nephatal MI, coronary artery disease, coronary angioplasty, CABG) was significantly higher (by 12%) than expected, calculated on the basis of the Framingham model, which takes into account the level of total cholesterol.

With long-term statin therapy, it is necessary to take into account not only their hypopidemic effect, but also the hypotensive effect, which makes an additional contribution to the reduction in total coronary risk.

Since endothelial dysfunction is the cause of the disruption of the structure and normal functioning of the vessels of the microvasculature [84], it would be logical to assume that statins have a favorable effect on the microcirculation system, which is the basis for adequate organ and tissue perfusion. There are only a few data from foreign studies on the effect of statins on microcirculation. . No studies on this topic have been conducted in Russia. We have undertaken a study to study the effect of a new statin called Rosuvastatin (Crestor, AstraZeneca, UK) on the microcirculatory bed in patients with dyslipidemia and mild and moderate hypertension. The study involved 25 patients with cholesterol levels above 5.0 mmol / l and LDL cholesterol above 3.0 mmol / l and the level of the GARDEN 140–179 mm Hg. and dad 90–109 mm Hg For 12 weeks, patients took 10 mg of rosuvastatin without dose adjustment. The state of the microcirculatory bed was studied using laser Doppler flowmetry.

In general, the favorable effect of rosuvastatin on the microcirculatory bed has been established. At the same time, positive shifts were observed in various pathological types of microcirculation – in spastic and hyperemic. In the case of the spastic type of microcirculation, when the microcirculatory bed is depleted in blood, an increase in blood flow occurs during the treatment with Krestor, as evidenced by the increase in the microcirculation index. The same is evidenced by the decrease in the reserve of capillary blood flow (RSC), which is a consequence of the increase in the number of functioning capillaries. In the hyperemic type of microcirculation, when there is an overflow of the vascular bed, there is a decrease in blood flow, as evidenced by a decrease in the microcirculation index. In these patients, an increase in RCC is observed, which plays a positive role, since it facilitates unloading of the overfilled precapillary link.

At the same time, in both groups, a decrease in peripheral vascular resistance was observed, as evidenced by a significant increase in myospheric amplitudes. As a result, blood flow to the capillaries increases and organ and tissue perfusion improves.

Thus, in general, during the treatment with Crestor, patients with DLP and mild and moderate hypertension have seen favorable changes in the microcirculation system.

Another positive effect of rosuvastatin on the vessels was also revealed – a significant decrease in the SBP – by 8 mm Hg. Art., DBP – at 6 mm Hg. Art.

The study confirmed the pronounced hypolipidemic effect of Crestor.

Thus, the new hypolipidemic drug rosuvastatin has not only a pronounced hypolipidemic effect, but also a positive effect on the vessels, contributing to microcirculation and a decrease in blood pressure in patients with dyslipidemia and mild and moderate arterial hypertension . Of course, the indicated vascular effects of Crestor can positively affect the effectiveness of the prevention of CCO during long-term therapy with this statin.

Questions t riverzhennosti

As already noted, the problem of control of blood pressure and the correction of concomitant risk factors in the case of patients without clinical manifestations of atherosclerosis is that patients are not motivated for drug treatment (“risk factors do not hurt”), not to mention the motivation for non-pharmacological methods for the correction of concomitant risk factors. In this regard, one should note the successful experience of holding educational schools (in Ivanovo, Khabarovsk), which indicate that achieving better control not only of blood pressure, but also of correcting risk factors is quite possible .

Of particular note is the relevance of the development and implementation of motivational technologies in clinical practice. One of them can be the electronic version of SCORE (Systematic Coronary Risk Evaluation – Systematic (regular) coronary risk assessment) – a new system for assessing the risk of fatal outcomes of CVD for 10 years, developed by experts of the European Society of Cardiology together with specialists of the Federal Research Center The Ministry of Health and Social Development of Russia based on data from prospective studies conducted in European populations, including Russian (in total, more than 200,000 people). This The interactive system allows you to visually demonstrate to the patient the risk of a fatal outcome from CVD within 10 years and its positive dynamics in reducing the risk as a result of the intervention. Such a visual computer demonstration is designed to increase the motivation and commitment of patients to the drug and non-drug correction of risk factors and, ultimately, lead to a significant decrease in MDR. Currently, the Russian version of HeartScore has appeared on the Internet, which can be used by practical doctors.

The SCORE system includes the following risk factors: gender, age, smoking, systolic blood pressure (MAP), total cholesterol level. The high-risk criterion was defined as a risk of 5% and higher, in contrast to the previous figure of 20% and higher.

The status of smoking is determined when the patient is asked if he answers “yes” or “no”. A patient is considered to be a smoker if he smokes more than seven cigarettes a week.

The risk is considered very high if, when the patient data is projected onto the SCORE card, it is higher than 10%; high – if it is in the range from 5 to 10% medium – from 2 to 4% and low – less than or equal to 1%.

In case of high and very high risk, the patient needs to take active preventive and therapeutic measures aimed at eliminating and correcting risk factors.

Compared to the risk table, the advantages of using HeartScore for clinicians and patients are in their speed and ease of use, individual adaptation to the patient. The program offers:

.                                      graphic demonstration of absolute cardiovascular risk,

.                                      assessment of the relative role of corrected risk factors,

.                                      recommendations of intervention that contributes to a change in the behavior of treatment tolerance, i.e. patient adherence to treatment. HeartScore ® is a primary prevention tool for CVD, for assessing the risk of those who are not yet sick. But patients with existing symptoms of diseases associated with atherosclerosis require intensive treatment to prevent complications, so in such cases there is no need to resort to such a risk assessment, because these patients are already at high risk. HeartScore ®helps to assess the risk, and does not pretend to the absolute accuracy of the forecast. In HeartScore task ®
 
 
 
 
 It does not include an influence on the decision of the doctor regarding the tactics of treatment of patients and the starting point of treatment (from what level of risk to start treatment). These questions undoubtedly remain in the competence of the doctor.

In accordance with the European recommendations for the prevention of CVD, treatment should begin if the risk of death from CVD within 10 years exceeds 5%. For young patients, it is necessary to focus on the relative risk table. We have conducted a multicenter large-scale study on the effectiveness of integration into the clinical practice of the electronic version of SCORE.
 . The study involved 350 therapists from 47 cities of Russia. Each therapist included 3 high-risk patients with hypertension in the study (risk on the SCORE scale> 5%). A total of 1050 patients were included in the program. For the first time in the practice of research, not only in Europe, but also in Russia, the electronic version of SCORE was used to study the effect of its use in order to increase adherence to medical treatment of hypertension and effective control of associated risk factors. For this purpose, a subsample of 128 patients with AH was formed. In these patients, the risk was assessed using the electronic version of SCORE. Patients (n = 481 people) matched for age, sex, systolic blood pressure, frequency of smokers, body mass index were selected as the control group.In the control group, patients were shown a risk assessment according to the usual SCORE table. All patients were prescribed combination antihypertensive therapy as a starting therapy. The study lasted 1 year. By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. And / or decrease in DBP not less than 10 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.All patients were prescribed combination antihypertensive therapy as a starting therapy. The study lasted 1 year. By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.All patients were prescribed combination antihypertensive therapy as a starting therapy. The study lasted 1 year. By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.By the end of the study, in the main group, a significantly larger number of patients reached the target level of blood pressure or responded to treatment (decrease in the GARDEN not less than 20 mm. Mercury. with a group of patients whose total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.compared with the group of patients in whom the total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.compared with the group of patients in whom the total risk was assessed according to the tables (without using the electronic version of SCORE), which corresponded to 90% to 82% of patients in the main and control group (p <0.005), Fig. 13. Thus, a more pronounced decrease in total cardiovascular risk was achieved in those patients whose risk was assessed using the electronic version of SCORE.

These data indicate the feasibility of introducing into clinical practice the management of patients without clinical manifestations of atherosclerosis of the electronic version of SCORE, not only as a tool for assessing the overall risk, but also as a motivational technology to improve adherence to drug and non-drug risk control methods. Ultimately, this should lead to a more effective reduction in total cardiovascular risk.

Algorithm for the treatment of acute heart failure

  1. Hypotension is diagnosed if systolic blood pressure does not exceed 90 mm Hg. Art.
  2. Shock is a clinical syndrome characterized by, in addition to hypotension, signs of reduced perfusion of peripheral tissues (cold skin, oligoanuria, lethargy and lethargy).
  3. Breathing with 100% oxygen through a mask with a non-reversible valve and a bag-tank at an oxygen supply rate of 5–6 l / min).
  4. To correct the pumping function of the left ventricle, blood pressure should be initially normalized. In case of arterial hypotension / cardiogenic shock, it is initially necessary to make sure that the ventricles of the heart are sufficiently filled with pressure (no absolute or relative hypovolemia). In an emergency in the absence of pulmonary edema, it is advisable to quickly inject 250 to 500 ml of fluid intravenously, possibly repeatedly (by controlling the degree of stagnation in the lungs and, if possible, at least central venous pressure). If a sufficient increase in blood pressure is not achieved, infusion of a pressor agent should be initiated, the choice of which depends on the level of blood pressure. In the presence of hypovolemia, it is important to identify and, if possible, eliminate its cause. In cases where pulmonary edema is combined with increased blood pressure, it is necessary to reduce it by infusion of nitroglycerin or sodium nitroprusside.To correct myocardial contractility, other existing disorders should also be eliminated (hypoxia, hypoglycemia, drug overdose). In addition, rapid restoration of normal myocardial blood supply (thrombolytic therapy or invasive methods of myocardial revascularization during occlusion of a large epicardial coronary artery), as well as surgical correction of existing intracardiac hemodynamics, may be required.as well as surgical correction of existing intracardiac hemodynamic disorders.as well as surgical correction of existing intracardiac hemodynamic disorders.
  5. The norepinephrine infusion rate is 0.5–30 mcg / kg / min, the dopmin infusion rate is 2.5–20 mcg / kg / min.
  6. Simultaneous (but not isolated infusion of dobutamine) is possible. Dobutamine is the drug of choice for myocardial infarction of the right ventricle (it is also important to administer intravenous fluids, not using vasodilators and diuretics).
  7. Dobutamine infusion rate 2–20 mcg / kg / min.
  8. Perhaps the use of intra-aortic balloon contraception (considered as a temporary measure before conducting invasive interventions – myocardial revascularization using angioplasty procedure, coronary artery bypass surgery, surgical correction of intracardiac hemodynamics, heart transplantation).
  9. For the correction of high blood pressure in the acute phase of myocardial infarction, nitroglycerin is preferable, and in the absence of myocardial ischemia, sodium nitroprusside is preferable.
  10. First-line interventions, in addition to intravenous administration of morphine and a diuretic (furosemide), also include giving the patient a half-sitting position with his legs down and ensuring breathing with 100% oxygen. With systolic blood pressure above 100 mm Hg. Art. you should start taking nitroglycerin (1 tablet every 5 to 10 minutes) or isosorbiddinitrate as an aerosol until it is possible to administer intravenous infusion of nitroglycerin. If there is no response to the first dose of furosemide, a double dose should be administered within 20 minutes. A ventilator should be started when the arterial blood oxygen saturation drops to 90%, the oxygen tension in the arterial blood reaches 60 mm Hg. Art. when breathing 100% oxygen, as well as clinical manifestations of brain hypoxia (drowsiness, lethargy), a progressive increase in the voltage of carbon dioxide in the blood or an increase in acidosis.In milder cases, it is possible to evaluate the effectiveness of creating a positive pressure at the end of exhalation or breathing under constant positive pressure.
  11. Intravenous nitroglycerin is assigned to second-line drugs due to the time lag before the start of treatment. The administration of positive inotropic agents (dobutamine in the absence of arterial hypotension and dopmine in its presence) is assigned to the same group of interventions.
  12. Amrinone as a positive inotropic agent and a vasodilator is administered at a loading dose of 0.75 mg / kg for 2–3 minutes followed by an infusion of 5–15 µg / kg / min. Euphyllinum is administered with severe bronchospasm at a loading dose of 5 mg / kg in 20-30 minutes, followed by an infusion of 0.5-0.7 mg / kg / h. Its use should be avoided with supraventricular tachyarrhythmias. Intra-aortic balloon contraception is considered as a temporary measure before invasive interventions (myocardial revascularization using an angioplasty procedure, coronary artery bypass surgery, surgical correction of intracardiac hemodynamics, heart transplant).

Atherosclerosis – the silent killer

Atherosclerosis, a chronic disease of the arteries that is accompanied by cholesterol deposition, is the gray cardinal of death, a silent killer that people, alas, underestimate. At the age of 30, 40% of Russians already have atherosclerotic lesions. At the age of 40, 50% already have pronounced atherosclerotic lesions. In 60 years, 70% of people have pronounced manifestations of atherosclerosis.

But in most cases, the course of atherosclerosis is asymptomatic. As long as the 70% plaque does not overlap the vessel, there will be no complaints. This is the case when “suddenly”, against the background of complete health, a person enters the hospital with an infocalct or stroke. But this is not “all of a sudden”, but because all people’s reserve capacities are very large and the vessels can carry the load for a long time.

“The main thing is the state of the vascular wall,” explains Alexey Chudinov. – From the outside, the vessel is smooth, like plastic. And if pure cholesterol is passed through this vessel, then cholesterol is not deposited there. Therefore, the discovery made was so important: even if the cholesterol is high, but the vascular wall is in a normal state – cholesterol plaques will not form there. But if microdamages appear on the vascular wall, then vascular plaques begin to form on these microcracks even with normal cholesterol.

What damages the vessels

The main aggravating factors that cause vascular damage are hypertension, diabetes, smoking, alcohol, obesity, a sedentary lifestyle, and taking various medications, often uncontrolled.

“Also, microdefects of blood vessels cause free radicals, saturated fatty acids, aggressive environmental factors, various additives and toxic components that are found in our food today,” Alexey Chudinov continues. – For example, in meat – in fat beef and pork – there are two main unhealthy fats – cholesterol and saturated fatty acids. When saturated fatty acids are subjected to heat treatment, they turn into aggressive factors that cause damage to the endothelium of the vessel. Not immediately, but the more meat there is, the higher the risk of damage to the blood vessels. With age, the vessel becomes rough and atherosclerotic plaques begin to deposit on it.

Headache – a sign of atherosclerosis?

“Atherosclerosis has been modified,” says Alexei Chudinov. – Even 25-30 years ago, we found plaques in large vessels – in the carotid artery, in the aorta, and so on. But now plaques affect even small capillaries, including the brain. Those people who suffer from headaches, dizziness, memory loss, should know that this is primarily a sign that the small vessels are no longer working, that is, they are amazed. After all, intracerebral vessels have a thinner endothelium.

All our organs and tissues, primarily the heart, liver, brain – have a phospholipid membrane, a membrane that protects our cells from damage. When a person constantly uses saturated fatty acids, this saturated fat has the same ability as a dishwashing detergent that destroys fat on a plate. It destroys the phospholipid membrane of brain cells, cardiac cells, liver cells. Two clinical studies of the Institute of Nutrition of the Russian Academy of Medical Sciences proved that excluding saturated fatty acids from food reduces the risk of death by 22%, and the incidence of heart attacks and strokes by 18%. The same studies proved that if a person had a heart attack or stroke, then most likely this condition will recur within 5 years. But if a person switches to a healthy lifestyle, the risk of their recurrence is reduced by 80%.

IMPORTANT

5 principles of a healthy lifestyle (according to the latest scientific data)

1. Proper nutrition – the elimination of cholesterol and saturated fatty acids.

That is, try to eat less or completely abandon the fried meat, especially red and fatty – lamb, marbled beef. Less baking with margarine. Do not fry anything in butter. Try to switch to lighter dairy products (for example, reject cream, hard varieties of cheese).

Try to prepare food in a good mood, do not sort things out in the kitchen, otherwise the kitchen will automatically be perceived as an unpleasant place, and the absorption of food will be worse.

2. Active lifestyle, which raises good cholesterol.

Good cholesterol rises only in one case – if the person is actively moving. Nothing else raises good cholesterol – neither drugs, nor food. After all, the body, in addition to external influence, synthesizes its own cholesterol.

Therefore, vegetarians are not always the right level of cholesterol in the blood. For example, in India, people practically do not eat meat, but still suffer from cardiovascular diseases, atherosclerosis. Our body produces its own endogenous cholesterol, and we have the so-called cholesterol metabolism receptors. As soon as cholesterol levels fall below normal, endogenous cholesterol synthesis increasya And even without eating meat, vegetarians can have quite high cholesterol due to endogenous internal cholesterol.

In order to compensate for this, there is one single way – an active lifestyle, that is, at least a person must move and walk a lot. But not to do grueling physical exertion – they also lead to an increase in cholesterol levels.

3. Freedom from stress and tension.

In addition to food containing saturated fatty acids, damage to the vascular endothelium causes stress. Stress is not what happens to us, but our reaction to situations. Only by remaining calm can we solve problems and difficulties. And only in this case our vessels will remain undamaged by stress.

4. Full sleep.

During a long (at least 8 hours) sleep, cholesterol levels are reduced. Vascular endothelium is restored. Alas, 45% of people today have trouble sleeping. The reason follows from the previous one – anxiety during the day.

5. Acceptance of omega-3 fatty acids.

These substances help the cells of the blood vessels to recover, stay elastic longer. They are contained in nuts, unrefined vegetable oils, wheat sprouts, oily fish.

EGGS AND CHOLESTEROL – GOOD AND HARM

Eggs can be found in any kitchen of the world. The Chinese use them to prepare the well-known egg noodles, Australians – in all sorts of desserts and baking. Finns add a hard-boiled and finely chopped egg to nettle soup, and Chileans add it to their favorite empanadas meat dish.

Eggs can be found in any kitchen of the world. The Chinese use them to prepare the well-known egg noodles, Australians – in all sorts of desserts and baking. Finns add a hard-boiled and finely chopped egg to nettle soup, and Chileans add it to their favorite empanadas meat dish.

Boiled and fried eggs are one of the most popular breakfast items in our country. Eggs contain eight essential amino acids, protein and vitamins. However, despite such a rich composition, their usefulness is often questioned.

This is due to the high concentration of cholesterol contained in them. It is certainly impossible to deny, but to understand how great such harm is, it is necessary to sort out this issue in more detail. Few know what cholesterol is. However, ignorance does not prevent the majority from considering it as an extremely harmful and dangerous for health substance. In fact, cholesterol is very important for our body. It is part of the cell membranes, ensuring their density and thereby protecting intracellular structures from the effects of free radicals; participates in the process of digestion, without it the full functioning of the liver, the formation of bile is not possible; involved in the synthesis of male and female sex hormones (testosterone, estrogen, progesterone); helps the adrenal glands produce cortisol; ensures the normal functioning of the brain’s serotonin receptors. Violations of cholesterol concentration in the blood lead to a weakening of the immune system.

Mostly cholesterol is produced by the body independently (about 75-80%), the remaining 20-25% comes from food, and therefore the level of cholesterol can deviate to one side or the other, depending on the diet. Conventionally, “bad” (in conjunction with lipoproteinaminase density) and “good” (combined with high-density lipoproteins) cholesterol are isolated, but in fact it has a single composition and a single structure, and its properties are determined by the transport protein to which it will join.

With an increased concentration of low-density lipoproteins, there is a danger of cholesterol precipitating on the walls of blood vessels and the formation of so-called plaques covering the lumen of a blood vessel, increasing the risk of developing associated diseases. High-density lipoproteins clear the walls of blood vessels from “bad” cholesterol and send it for processing to the liver.

It should be noted that individual genetic characteristics, lifestyle and food ration significantly affect the “behavior” of the body and it begins to adjust the synthesis of cholesterol, depending on how much it comes from the outside.

Nutrition plays, though not a key role in the mechanism of the dynamics of cholesterol in the blood, but it still has a significant effect on it. What type of lipoprotein it goes into can be said depending on the parallel-eaten foods and metabolic peculiarities.

So, for example, a product in itself rich in cholesterol (egg, shrimp), eaten with fatty foods (mayonnaise, sausages, etc.) is more likely to cause an increase in LDL levels. The same effect will be if a person inherits a defective gene, in the presence of which the same result will occur, even if along the way nothing fat was used.

Thus, cholesterol in itself does not cause serious concern, until it accumulates in the body in high concentrations, eating foods that contain a lot of cholesterol automatically reduces the production of its own to compensate for the incoming.

Despite the presence in the yolk of significant amounts of cholesterol, eggs contain a lot of protein (about 5.5 g in one egg), the high nutritional value of eggs is due to the presence of amino acids necessary for various biological processes, which play an important role in maintaining the normal functioning of the body, and provitamin A, vitamins B2, B5; B12, E, D, folic acid, phosphorus, lecithin, choline, lutein, iodine, biotin, iron, selenium makes them truly useful.

So, taking into account all the pros and cons of this product, it is not recommended to include more than 1 egg per day in the diet. If the level of cholesterol in the body is elevated, it is better to limit yourself to 2-3 eggs per week or to avoid consuming yolks.

Do not forget about the dangerous conditions that can occur when excessive or improper use of chicken eggs:

Salmonella infection (when eating raw eggs and when the technology of cooking dishes from them is not followed);

excessive cholesterol in the blood (excessive consumption of eggs, especially without taking into account the initial level of cholesterol in the blood); the development of an allergic reaction, especially in children (the use of eggs without taking into account the individual sensitivity of the body).

And remember, a balanced diet combined with adequate physical activity is a guarantee of health and longevity.

TWO DIMENSIONAL ECHOCARDIOGRAPHY

Ultrasound is reflected from boundaries tissue deforms piezoelectric crystal and generates electric sky pulse which transformed at the point on the screen .

Brightness and position points depends on from of character and depths investigated structures .

For create two-dimensional Images ultrasonic Ray skipped through region interest . Ultrasound is transmitted along several (90-120) lines scanner of by wide ( about 90 ° ) arc up to20-30 times at second.

Summation reflected ultrasound waves form beats picture on the screen . Fast generation after respectable of images creates ” Living “ picture movable structures . Any frameliving Images can be “Frozen”, analyzed on the screen or printed out on thermal paper .

Two-dimensional Echocardiography allows to study anatomy hearts and relationship different structures .

With two-dimensional cardiography possibly revealing intracardiac formations and pathologies pericardium , visualized motion walls ventricles and leaflets valves .

Also spend measurement thickness walls wish daughters and sizes cameras, computed shock volume fraction emission and cordial overshoot .

Two-dimensional picture use at quality orientation shooting gallery at research at M – mode , and also at doppler – echocardiography for installations control volume .

The clinical significance of diastolic dysfunction of the left ventricle 


Clinical manifestations chronic heart not sufficiency can to arise on normal background or almost normal systolic LV function by according to Echocardiography . A common cause of chronic heart failure is LV diastolic dysfunction .

Diastolic dysfunction is detected at a whole range of cardio – vascular diseases . She is more sensitive at comparing with systolic cal function to natural aging processes . Violations of diastolic function can be iso Rowan , combined with systolic dysfunction or precede a clear violation of systole . Violations of diastole is dominated by about at thirdspatients with chronic heart failure . Required evaluate as systolic , so and diastolic function of the left ventricle , so as the causes of their violations and , that more importantly , their correction methods are different . Simplified times division on systolic and diastolic dysfunction is often unjustified . Systole and diastole – Inter – liyayuschie phase of the cardiac cycle . With minor systolic dysfunction some segments with on ruined local contractility can keep shrinking at diastole , resulting in to decrease in time for ventricular fillingand diastolic dysfunction . On the contrary , a stubborn LV , unable to adequately fill at diastole , provides low stroke volume at systole and leads to systolic dysfunction . High peak BUT It corresponds to the fourth auskultativ Nome tone of the heart , then as high peak E – the third auscultatory tone

Possible errors in identifying dysfunction of the right ventricle.

Echocardiographic assessment of the pancreas is difficult at svya communication with significant trabecular , complex geometry cal form and interaction with other chambers of the heart . More than that the prostate is located directly behind the breastbone which hinders its visualization . Evaluation The pancreas is especially difficult with increased airiness of the lung tissue ( emphysema ), pneumosclerosis and torus kotomii at history . For unfortunately , namely with of these states estimation function of the pancreas is the largest zna chenie . RV function depends not only from myocardial contractility , but and on the conditions of load , contractility of the left ventricle , excursions IVS and pressure atpericardium . With analysis of pancreas function should be considered everything these factors . Even an experienced researcher is able to conduct a full study of the pancreas less than in 50% of patients .

The clinical significance of right ventricular dysfunction

Identification of dysfunction of the pancreas is a principled nym with a number of congenital and acquired diseases of the heart for the choice of tactics of treatment , planning the timing of surgical intervention , determine the prognosis .

With congenital defects , such as defect MZhP , defect MPP or tetralogy of Fallot , evaluation function of the pancreas to and after surgery treatment allows define prognosis of the disease .

In a similar manner as possible surgical vmesha ments with defects of the heart , such as mitral ste ERA , stenosis of the mouth of the pulmonary artery or tricuspid regurgitation ( TR ) depends on the availability or lack of dysfunction of the pancreas . Patient long-term prognosis with chronic diseases of the lung ( chronic obstructive disease of the lungs , interstitial for bolevaniya light ) depends on the function of the pancreas . Dilatation of the pancreas , pulmonary hypertension and pulmonary heart are predictors of negative prognosis .

With myocardial infarction pancreas dysfunction observed at following situations :

.       lower myocardial infarction with involvement of the pancreas ;

.       anterior myocardial infarction with acute defect MZhP .

Tactics treatment pancreatic infarction is different from leche of LV infarction . Dysfunction of the pancreas due postin farktnogo defect IVS is an important cause of death ( see . Chapter ” Coronary disease of the heart ” ). Diastolic kollabirovanie pancreas is an important echocardiographic sign of tamponade of the heart ( see . Chapter ” Diseases of the pericardium ” ).

Possible errors in the detection of diastolic dysfunction of the left ventricle.

Indicators transmitral blood flow depends on many factors , and not only on tensile properties and LV relaxation . Therefore , when assessing diastolic function of the left ventricle to rely only on E / A ratio is incorrect .

On The transmitral bloodstream is affected by the following factors :

.       load capacity ( preload and afterload );

.       frequency of heart contractions ;

.       systolic function of the LP ;

.       respiratory phase .

Overload volume due to mitral or Aortic insufficiency reduces peak A , so as atrial contraction not at able to effectively push blood at already maximally stretched the desire of daughters . With tachycardia peak amplitude BUT increases at connections with shortening of diastole ( greater contribution of atrial systole ). On the contrary , if bradycardia peakBUT Decrease the creases due to the elongation phase of diastolic filling ( smaller contribution contraction of the atria ). So manner , high peak BUT It has a greater value onbackground bradycardia .

Ratio E / A incorrectly when atrial Arita mission , complete transverse blockade and lengthening the PR interval . Have elderly patients dominated by peak A. Ratios e E / A > 1 or E = A at combined with the shortening of time for slowing reflects the increase in course – diastolic pressure at LV . This type of diastolic dysfunction was the name pseudonormal .

Parasternal position along the long axis

2D echocardiography not It allows you to directly Rate Vat diastolic function of the left ventricle , however, may reveal associated with It LVH , violations of local by kratimosti , infiltrative diseases myocardium or thickening of the leaves of the pericardium . Alongside with diastolic dysfunction can be detected violation sistoliche tion function of the left ventricle . Special features Diastolic the blood flow ka of LP at LV can be studied with using pulse doppler – echocardiography . For of this control volume is set on level of the cusps of the mitral valve at apical four- position . This study allows to obtain a spectrum of good quality transmitral blood flow .

AT Normally transmitral bloodstream has the following characteristics ( Fig . 6.6, A).

.       Peak passive early diastolic Napoli nenie LV .

.       Peak BUT – active later diastolic Napoli nenie LV .

.       Ratio E / A— > 1.

With LV relaxation disorder at connections gipertro fiey or myocardial ischemia an increase in peak BUT and reduction peak E . With In this respect, the E / A ratio becomes less than 1 ( Fig . 6.6, B). Time deceleration of peak E is lengthened (> 220 ms ).

Have patients older than 50 years for confirmation dia stolicheskoy dysfunction required reduction ratio E / A of less than 0.5 in connections with normal increase am plitudy peakBUT with of this age . This type diastema netocrystalline dysfunction received the title of ” slow relaxation ” and reflects reduced LV compliance . With This is marked by an increase in the pre- rhythm systole contribution . at filling the ventricle .

With tackle extensibility infarction due infiltrative disorders or constrictive pericarditis peak E becomes very high , and the peak BUT low . Time deceleration peak E ukorachi INDICATES (<150 ms ). These violations diastole include to restrictive type and reflect an increase in diastolic pressure of course at LV . Filling of the ventricle occurs quickly. atearly diastole , when this contraction schenie atrial unable longer stretch of LV .

DIASTOLIC DYSFUNCTION OF THE LEFT VENTRICLE

For An adequate assessment of LV diastolic function is necessary to know the physiology of the diastolic phase of the cardiac cycle .

AT diastole there are four periods :

.       phase relaxation : on closing of the aortic valve stem Pan to the opening of the mitral valve ( phase 1);

.       early rapid filling phase : from the opening of the mitral valve to the end of filling ( fa for 2);

.       phase of diastasis — equilibrium ( phase 3);

.       phase systole predserdiy- active cut of auricles ( phase 4).

The first two phases correspond to the relaxation of the ventricular myocardium ( energy-intensive process ). Tre tya and The fourth phase reflects the passive extension of the myocardium , depending on its rigidity . So way , allocate two major type dia stolicheskoy dysfunction :

slow relaxation ;

restrictive type .

Diastolic dysfunction occurs at connections with by Vyshen stiff LV , which leads to disruption of diastolic blood flow of LP at LV .

Scanning in the M-mode at the level of the mitral valve

AT normal movement PSMK at diastole has character hydrochloric M – shaped form ( with waves E and A ) With diastema netocrystalline dysfunction LV tour PSMK reduced , wave BUT becomes higher , than the wave E , that leads to reducing the E / A ratio . These changes OCU by previously increased rigidity LV and subsequent increase in pressureat LP . Indicated signs not are highly sensitive or specific for identify diastolic dysfunction .