Author/Editor		Štajer, Dušan
Title		Prepoznava nujnega stanja pri bolniku s srčnim popuščanjem
Translated title		Diagnosing of emergency state in patient with heart failure
Type		članek
Source		Zdrav Vars
Vol. and No.		Letnik 40, št. 3-6
Publication year		2001
Volume		str. 139-43
Language		slo
Abstract		Patients with chronic heart failure have a shortened life span due to heart disease. On the average, some years pass between the diagnosis of heart failure and death, and the survival is shorter in men than in women. Patients with chronic heart failure can be acutely threatened either by the deterioration of underlying heart disease, or by some other diseases which are more problematic owing to diminished cardiac reserve; treatment complications can also be threatening. In treating the patient with heart failure outside hospital, patient history, physical examination, electrocardiogram and some examinations must be performed. Auto- and heteroanamnesis can be used for defining the cause of patient's health state deterioration. Symptoms of acute coronary syndrome (chest pain), infection (elevated temperature, fever dysuria, cough with purulent expectoration), arrhythmias (palpitations, syncopes) and hemorrhages (melena, hematemesis) have to be looked for. It is necessary to determine the patient's underlying heart disease, his physical capacity before the present deterioration and his present medication. Hemodynamic status of the patient is assessed by physical examination. Besides the anamnestic information regarding the degree of dyspnea (deterioration), blood pressure, frequency of heart rate, cardiac rhythm, breathing frequency, skin changes (cutis marmorata, cold, clammy skin), cyanosis and heart and lung auscultation are also important for the assessment. The signs of infection are also looked for. When there is suspicion of stroke, a simplified neurologic examination has to be performed. Results of the examination are than compared with the patient's previous results to find out which pathologic diagnoses have appeared anew. (Abstract truncated at 2000 characters)
Summary		Bolniki s kroničnim srčnim popuščanjem imajo na račun srčne bolezni skrajšano življenjsko dobo. Med ugotovitvijo srčnega popuščanja in smrtjo mine v povprečju nekaj let, preživetje pa je krajše pri moških kot pri ženskah. Bolnike s kroničnim srčnim popuščanjem lahko akutno ogroža bodisi poslabšanje osnovne srčne bolezni, bodisi druge bolezni, ki jih zaradi zmanjšane srčne rezerve težje prebolevajo; ogrožajo jih lahko tudi zapleti zdravljenja. Pri obravnavi bolnika s srčnim popuščanjem zunaj bolnišnice si pomagamo lahko z anamnezo, fizikalno preiskavo, elektrokardiogramom in nekaterimi preiskavami. Z avto- ali heteroanamnezo skušamo ugotovlti vzrok poslabšanja bolnikovega stanja: sprašujemo po simptomih akutnega koronarnega sindroma (bolečina v prsih), okužbe (povišana temperatura, mrzlica, dizurija, kašelj z gnojnim izmečkom), motenj srčnega ritma (palpitacije, sinkope) in krvavitve (melena, hematemeza). Izvedeti moramo, kakšna je bolnikova osnovna srčna bolezen, kakšna je bila njegova fizična zmogljivost pred sedanjim poslabšanjem in katera zdravila prejema. S fizikalno preiskavo skušamo oceniti hemodinamsko stanje bolnika. Za oceno so poleg anamnestičnega podatka o stopnji (poslabšanja) dispneje pomembni še krvni tlak, frekvenca srčnega utripa, srčni ritem, frekvenca dihanja, spremembe na koži (marmorirana koža, hladna, potna koža), cianoza ter izvid avskultacije srca in pljuč. Iščemo tudi znake okužbe. Če sumimo na možgansko kap, opravimo poenostavljen nevrološki pregled. lzsledke pregleda primerjamo z bolnikovimi prejšnjimi izvidi, da ugotovimo, kateri patološki izvidi so se pojavili na novo. Elektrokardiogram je nepogrešljiv pri diagnostiki akutnega koronarnega sindroma in motenj srčnega ritma. (Izvleček skrajšan pri 2000 znakih)
Descriptors		HEART FAILURE, CONGESTIVE EMERGENCIES SHOCK, CARDIOGENIC DYSPNEA, PAROXYSMAL CORONARY DISEASE ATRIAL FIBRILLATION