cardio-vascular an vi
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BOLILE
APARATULUI
CARDIO-VASCULAR
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A.Obstrucia fuxuluisangvin cerebral
Ateroscleroz; embolii; neoplzii; tromboz;tr!mtisme
B.CardiopulmonareB"#Aritmii cr$iceB#%#Ostr!c&ii
Br$iritmii' bloc!ri cr$ice;Sin$rom br$icr$ie-tr(icr$ie;
Sincop )sopresore;*ipersensibilitte sin!s!l!i croti$in;
T(iritmii' t(icr$ie s!pr)entric!lr;Sin$rom t(icr$ie-br(icr$ie;
T(icr$ie )entric!lr;Stenoz ortic s! p!lmonr;
*ipertro+e simetric;Tmpon$ cr$ic, nomlii conenitle $ecor$ c! .!nt $rept-st/n
C.Presiunea sangvinC#"#Sc$ere $ebit!l!icr$icC#%#Sc$ererezisten&ei peri0erice
C#"#"#Sc$ere 0rec)en&ei cr$iceC#"#%#Sc$ere )ol!m!l!i btie 1sc$ere contrctilit&ii b1sc$ere )ol!m!l!i circ!lnt'
(ipo)olemie;(emorie; .oc; sincop t!sien;(ipotensi!ne post!rl;me$icmente )so$iltoreC#%#"#Vsc!lr' (iper)entil&ie
C#%#%#Sc$ere stim!lrii simptice' en&ibtblocn&i $renerici; *ipotensi!ne
post!rl; Sincop )so$epresore etc#D.Metabolice D#"#Sc$ere presi!nii C!ze cr$iop!lmonre
Etiologia sincopei2$!p Ettiner, "334 cit# $e BR5SLA6U, %77"1
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emiologie Elemente de diagnostic
Examen general Obosel
Curba respiratorie Dispnee, t(ipnee, cinoz, ortopnee!oc precordial Cre.tere 0rec)en&ei
Ascultaie cardiac Diro+lrioz' s!8! $!bl!, $i+cil $e $esci0rt 20ono1Stenoz' s!8! sistolic $e stenoz p!lmonr 2proiec&interior s!b triceps .i intrre /n piept1
Ascultaie pulmonar 9omote s!pr$!te, comple:e .i )rite pe prc!rs!le)ol!&iei
"adiogra#e lateral Diro+lrioz' $imin!re importnt l!minii bron.ice,bron(opne!monie obstr!cti)Stenoz' (iperclritte p!lmonr
Electrocardiogram T(icr$ie, P cresc!t .i sci&it, c!rb RS s! RS, ST /nlt
s! s!b$ecltEc$ilibru acido%ba&ic Aci$oz, poi lcloz respirtorie mortl
'epatomegalie -l
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emiologie uspiciune de ,CD uspiciune de ,cD asociatcu ,cs
Examen general r elemente speci+ce OboselCurba respiratorie orml Pert!rbt $e- l!n!l !nei Ics
!oc precordial
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emiologie uspiciune mic uspiciune mare Diagnostic decertitudine
/ 4 7 8Examen general Obosel proresi) l
e0ortT!se c(intos,emetiznt noct!rn +
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:ipul e(u&iunii Etiologia Elemente caracteristice
S/ne "#T!morile bzei cor$!l!i%#Alte neoplzii2metsttice1G#R!pt!r tri!l!i st/nF#Tr!mtisme4#Tr!me itroene
De obicei l rse brc(ice0le,peste )/rst $e H ni, s/neneco!ltDe obicei l msc!li $in rsemici, peste H niP!nc&ie s! cteterism cr$ic
Trnss!$t "#Ins!+cien& cr$icconesti)%#*ipoproteinemieG#Sec!n$r, (erni$i0rmticperitoneopericr$ice
E0!zi!ne rreori $etectbil le:men +zic s! r$ioloic
E:s!$t "#En0!zi!ne pericr$ic
i$ioptic benin%#Pericr$it septic
Lic(i$ sero-sn)inolent, c!lore
)i.nie, neco!lbilE:s!$t seros /n bol Crre .ileptospiroz; sn)inolent /nt!berc!loz s! socit c!ple!rit .i cocci$ioi$omicoz
Diagnosticul di(erenial -n e(u&iunile pericradice la c-ine2$!p Ettiner .i S!tter, "3>7 cit# De M*ERMARIU, "3341
i i di( i l i i - $i # i dil i di l i i
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peci#care Cardiomiopatia'ipertro#e Dilataie
imptome-$ispnee;-tromboembolie;
-ptie;-0rec)en& cr$ic cresc!t;-zomote cr$ice intense;-e$em p!lmonr 2lic(i$ /nc)itte ple!rl1;
-$ispnee;-tromboembolie;
-ptie r);-0rec)en& cr$ic cresc!t;-zomote cr$ice $imin!te-lic(i$ /n c)itte ple!rl;
E;< -t!lb!rri $e con$!cere;-ritmii;
-ritmii
Ecocardiogra#e
-cre.tere )ol!m!l!i peretel!icr$ic;-perete inter)entric!lr cresc!t;-sept cresc!t;-c)itte )entric!l!l!i st/neste mrit
-$ilt&ie;-perete inter)entric!lr s!b⁢
Modi#cri
mor(opatologice
-(ipertro+ m!.c(ilor
)entric!l!l!i st/n;-)ol!m!l tri!l!i st/n cresc!t;-tromboembolie rteril;
-$ilt&i triilor .i )entric!lilor;
-tromboembolie rteril;
:"A:AME=: -Propnol ' 7,4-",7 m=N m#c#,per os;-!rosemi$ ' 7,4-%,% m=Nm#c#, i#)#;-C to ril ' 7 4-" m N m#c#
-Propnolol ' 7,4-",7 m=N m#c#, per os-!rosemi$ ' 7,4-%,% m=N m#c#,per os, i#)#;-Cptopril ' 7,4-" m=N m#c#, per os;-Dio:in ' $oz ini&il ' 7,77F m=N m#c#, peros2$i)izt /n $o! pr&i1-$oz $e /ntre&inere ' 7,77Gm N m#c# er os $i)izt /n $o! r i
Diagnostic di(erenial >i terapie -n $ipertro#a >i dilataia cardiac la pisic2$!p ?$!s ?elin$ .i col#, "33G, prel!crt $e ?O@, %771
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ufuri cardiace emnevascular
e
emnepulmon
are
Diagnostic
topogra#c
Diagnosticde boal
:imp deapariie
,ntensitate
:imbru oc depercepi
e
Propagare
/ 4 7 8 ? 6 2 1 0
Sufuldiastolic
?e$ie
?e$ie
D!lce
D!lce
ocr!lortic
ocr!lp!lmonr
Pecroti$
-
P!ls
rterilsltre&
-
-
D
Ins!+cien& orticIns!+cien
&p!lmonr
S!8!ri
en$ocr$iceornice '
en$ocr$ite2cronice1 .i
)icii)l)!lre $elt nt!r
Suful
presistolo
c
Slb
Slb
D!r
D!r
ocr!ltric!spi$
ocr!lmitrl
Spre )/r0
Spre )/r0
lebectzie;P#)#
neti)e:ert
P##nemo$i+
-
D
Stenoztric!spi$i
n
Stenozmitrl
S!8!rien$ocr$ice0!nc&ionle '
$ilt&iecr$ic,
r!pt!ri s!(ipotonie cor$elor
ne e cr er e agnos c n va vu opa e cron ce2$!p BR95 .i col#, "3H"1
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/ 4 7 8 ? 6 2 1 0
Sulul
sistolic
?e$ie
?e$ie
?re
?e$ie
D!lce
D!lce
D!r
D!r
ocr!ltric!spi$ocr!lmitrl
ocr!lortic
ocr!lp!lmonrei
Spre )/r0
Spre )/r0
Pe croti$
-
P#)# poziti) '
8ebectzie
P## mo$i+cts! mic
P## $!r, mic,lent
-
-
D
-
D
Ins!+cien&tric!psi$
Ins!+cien&mitrlStenozortic
Stenozp!lmonr
S!8!rien$ocr$ice0!nc&ionle '
$ilt&iecr$ic,
r!pt!ri s!(ipotonie
cor$elor s!m!.c(ilor
ppilri cre+:ez )l)ele
Sulul
sistolic
orteslb
D!lce
n 0r0ocrelormobile,
intermitente
- - - -
S!8!ri/n.eltore '
nemie,c.e:ie, stri0ebrile, $!pe0ort!ri mri
etc#
Sulul
sistolic
Di0erit D!lcen 0r
0ocrelor,mi
0rec)entspre bz
cor$!l!i
- - - -
S!8!ri $in
nomliicr$iceconenitle 'persisten&cnl!l!irteril,
!rii Botllo, ori+ci!l!i
inter)entric!lretc#
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e&iunea "A " A Aort MPA Circ. P C Alte caracteristici/ 4 7 8 ? 6 2 1 0 /5 //
,nsu#cie
namitralei
Pote + sec!n$r
cr$ioptiei, en$ocr$itelors! .!nt!l!i $rept-st/n
teno&aaortic
?e$istin lrit-0rec)ent/nt/lnit
,nsu#cienaortic
C!zt $e en$ocr$it s!bol conenitl
,nsu#cientricuspidian
Pote + sec!n$rcr$iomioptiei, in0#Przitre c! se$i! cr$ic,stenozei p!lmonre
teno&apulmonar
De)iere pe:!l!i, similrc! LV*
:etralogia allot
Pozi&i ortei este crnil.i pote lri me$istin!l
De(ectseptalatrial
Menerlizrecr$iomeliei $c esteprezent VSD
Diro#lario&
Artere p!lmonre lri,in+ltrte p!lmonre
Aspecte radiogra#ce tipice -n bolile cardiace)$!p QirN .i col#, "337; elson .i Co!to, "333 cit# $e ?O@, %77+
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/ 4 7 8 ? 6 2 1 0 /5 //Persistenacanaluluiarterial
E$em!l p!lmonr este0rec)ent /nt/lnit
De(ectseptalventricular)D+
Aspectele)riz#Pote +consecin& $e0ect!l!ien$ocr$il 2l pisic1
Cardiomiopatie$ipertro#c
Ape: $e)it, e$emp!lmonr, colec&ieple!rl
Cardiomiopatiecongestiv)dilataie+
Colec&ie ple!rl,e$em p!lmonr0rec)ent /nt/lnit
E
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ubstaa =ume despecialitate
,ndicaii Posologie
/ 4 7 8Amiodaron Cr$rone ibril&ie !ric!lr "-",4 m=N=zi, $e F ori, per
osAprindin iborn T!lb!rri $e ritm )entric!lr G-4 m=N=zi, /n % prize, per
osAtenolol Tenomine T!lb!rri $e ritm
s!pr)entric!lrCr$iomioptie (ipertro+c*ipertiroi$ie
7,4 m=N=zi
Benzilthiouracil Bs$ene *ipertiroi$ie2pisic1 "47 m=zi 2" spt#1, poi,"77 m=zi, /n G prize, per os
Bepridil Cor$i!m estbilite estbilitCaptopril Lopril Ins!+cien& cr$ic "-4 m=N=zi, /n G prize, per
osCarbimazol eomerczole *ipertiroi$ie2pisic1 "4 m=zi 2" spt#1, poi "7
m=zi, /n G prize, per os
Cibenzolin Ciprln T!lb!rri $e ritm rezistente llte me$icmente
4 m=N=zi, /n G prize, per os
Digitalin Diitline nti)elle Ins!+cien& cr$iccomptibil c!(ipocontrctilitte
7,74-7," m=N, /n % prize,per os
Digoxin Dio:ine coro:ine Ins!+cien& cr$icT!lb!rri $e ritm
s!pr)entric!lrCr$iomioptie
7,7"-7," m=N=zi, /n % prize2pisic1
7,7"> m=N=zi, /n % prize,per os 2c/ine1
,ndex terapeutic -n cardiopatiile carnivorelor)$!p M(erri!, "334 cit# $e ?O@, %77+
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/ 4 7 8Dobutamin Dob!tre: 6oc cr$ioen
P!se! c!t $e ins!+cien&cr$ic conesti)
4-"4 !=N=min#, i#)#, $il!t /nsol# l!cozt, izotonic
Enalapril Renitine Ins!+cien& cr$ic 7,4 m=N=zi, per osFlecainid lecine T!lb!rri $e ritm rezistente l
lte me$icmente4 m=N=zi, /n % prize, per os
Flunarizin Sibeli!m Tromboembolie 2pisic1 " m=N=zi, /n % prize, per osFurosemid Lsili: Is!+cien& cr$ic 2$i!retic1 F m=N=zi, /n % prize, poi %
m=N=zi, /n % prize, tot l %zile, per os 2pisic1H m=N=zi, /n % prize, poi Fm=N=zi /n % prize 2c/ine1
Heparin r:iperine Tromboembolie 2pisic1 "77 UI=N=zi, s#c#, se re/noiexiletin ?e:itil T!lb!rri $e ritm )entric!lr " m=N=zi, /n G prize, per osilrinon Inocor 6oc cr$ioen 7,4 m=N=zi, i#)#, % inec&ii!icardipin Lo:en estbilite estbilit!iedipin A$lte Cr$iomioptie (ipertro+c "m=N=zi, /n % prize, per os"uabain !bine Diitlizre $e !ren& 7,7" m=N, i#)##rocainamid Pronestl T!lb!rri $e ritm )entric!lr H-%7 m=N=zi, /n G prize, per
os
#ropaenon Rt(mol T!lb!rri $e ritm rezistente llte me$icmente
4 m=N=zi, /n G prize, per os
#ropanolol A)locr$l Cr$iomioptie (ipertro+cT!lb!rri $e ritms!pr)entric!lr*ipertiroi$ie
7,-G m=N=zi, /n G prize, peros
$rinitine Lenitrl
perc!tne
Ins!+cien& cr$ic
2)so$ilttor1
G ori=zi, l bz !rec(ii
%erapamil Isoptine ibril&ie !ric!lr "-",%H m=N=zi, /n F prize, per
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Medicamenteantiaritmice
Pre&entare Productor
/ 4 7
CAA , )blocanteale canalelor desodiu+Li$ocin
Uz )eterinr-%7 m=ml 2% 1, sol# in#Uz !mn-%7 m=ml 2% 1, sol# in# Di0erite 0ormeilocin 2Astr, estboro!(,?A1
Procinmi$ %47, G>4 .i 477 m, tblete .i cps!le"77 .i 477 m=ml, sol# in#
Pronestl 2Bristol ?res S!ibb,Princeton, W1
Procinmi$ 2retr$1 %47, 477, >47 .i "777 m, tblete Pronestl 2Bristol ?res S!ibb,
Princeton, W1S!l0t $e !ini$in2stn$rt1
%77 .i G77 m, tblete Di0erite 0orme
S!l0t $e !ini$in 2retr$1 G77 m, tblete !ini$e: E:tentbs 2A#*#Robins, Ricmon$, VA1
Ml!cont $e !ini$in2retr$1
G%F m, tbleteH7 m=ml, sol# in#
!inl!te D!r-Tbs 2Berle:Lbortories, ne, W1
!inlnLnnet, P(il$elp(i, PA 2EliLill, In$inopolis, I1
Polilct!ront $e!ini$in
%>4 m, tblete 2ec(i)lent %77 m$e s!l0t $e !ini$in1
Cr$io!in 2P!r$!e re$ericN,orXlN, CT1
Tocini$ F77 .i 77 m, tblete Tonocr$ 2?ercN, est Point, PA1?i:elitin "47, %77 .i %47 m, cps!le ?e:itil 2Boe(riner Iei(eim
P(rmce!ticls, Ri$e+el$, CT1enitoin 47 m=ml, sol#in# Dilntin 2PrNe-D)is, ?orris
e ca e an ar m c)$!p ELSO .i COUTO, "333+
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/ 4 7
CAA a ,,%a )blocantebeta%adrenergice+Proprnolol
"7, %7, F7, 7, H7, 37 m,tblete" m=ml, sol#in#F, H .i H7 m=ml, sol#orl,
cps!le
In$erl 2et(-AerstLbortoires, P(il$elp(i, PA12Ro:ne Lbortoires, Col!mb!s,O*1
In$erl LA 2et(-AerstLbortoires1Atenolol %4, 47 .i "77 m, tblete
4 m="7 ml, sol#in#Tenormin 29enec, ilminton,DE1
Esmolol "7 m=ml .i %47 m=ml, sol#in# Bre)ibloc 2D!Pont ?ercN,ilminton, DE1
CAA a ,,,%a )blocante
ale canalelor de potasiu+Bretli!m
47 m=ml, sol#in# Bretlol 2D!Pont Criticl Cre,
ilminton, DE1
Amio$rone %77 m, tblete47 m=ml, sol#in#
Cr$rone 2et(-AerstLbortoires, P(il$elp(i, PA1
Sotlol H7, "7 .i %F7 m, tblete Betpce 2Berle:, ne, W1
CAA a ,%a )blocante
ale canalelor de calciu+Verpmil
F7, H7 .i "%7 m, tblete
4m=% ml, sol#in#
Cln 2Serle, C(ico, IL1
Isoptin 2Qnoll P(rmce!ticl,(ippn, W1
Diltizem G7, 7, 37 .i "%7 m, tblete4m=ml, sol#in#
Cr$izem-CD 2?rion ?errelDoX, Qnss Cit, ?O1
Diltizem "%7, "H7, %F7 .i G77 m,cps!le"%7, "H7 .i %F7 m, cps!le
Cr$izem-CD 2?rion ?errelDoX1Dilcor R 2R(one-Po!lencRorer, Collee)ille, PA1
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A=:,CO,=E"
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=ume generic Denumire comercial Do&a )interval+
Benzopril Lotensin 7,%4 m>N, per os, %F ore 2c/ine1
Cptopril Cptopril 7,4-% m=N, per os, H-"% oreEnlpril Encr$ 7,%4-7,>4 m=N, per os, "%-%F ore
Lisinopril Prini)il 7,F-" m=N, per os, "%-%F ore 2c/ine1
Rmipril Altce 7,4 m=N, per os, "%-%F ore 2c/ine1
Atenolol Tenormin ,%4-"%,4 m, per os, "%#%F ore 2pisic1"-% m=N, per os, "%-%F ore 2c/ine1
Proprnolol In$erl 4-"7 m=N, per os, H-"% ore 2pisic14-H7 m=N, per os, H-"% ore 2c/ine1
Przosin 2blocrereceptor!l!il0$reneric1
?inipress 7,%4-" m=N, per os, H-"% ore 2pisic17,%4-" m=N, per os, H-"% ore 2c/ine1
Amlo$ipine or)sc 7,%4 m, per os, %F ore 2pisic1
Diltizem Cr$izem >,4-"4 m, per os, H-"% ore 2pisic17,%4-% m=N, per os, H-"% ore 2c/ine1
Verpmil Isoptin " m=N, per os, H-"% ore 2pisic1
Diltizem Cr$izem DC "7 m=N, per os, %F ore 2pisic1
*i$roclortrizi$ *$roD!ril %-F m=N, per os, "% ore
!rosemi$ Lsi: "-F m=N, per os, H-"% ore
Spironolcton Al$ctone %-F m=N, per os, %F ore
edicamente (olosite -n terapia anti$ipertensiv la c-ine >i pisic)$!p P*ILIP, "333+