Vasoactive test for pulmonary hypertension. Vasoactive test for erectile dysfunction What to do if the vasoactive test is negative

Because there are many causes of impotence, your healthcare provider may use several different tests to diagnose the disorder and prescribe treatment. Effective treatment can be prescribed only after establishing the cause of impotence.

Before sending you for any tests, the doctor should review your medical record and conduct a thorough physical examination. The doctor may also ask you questions about your personal and sexual life. Some of these questions may seem too intimate and even indecent to you. However, it is important that you answer them honestly. Such questions may include the following:

What medications are you currently taking? This includes prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements (dietary supplements), and illegal drugs or alcohol.

Have you encountered any psychological problems such as stress, fear, or depression?

When did you first notice the symptoms of impotence?

What is the frequency, quality and duration of your erections?

Under what circumstances did you first experience impotence?

Do you / have you experienced nocturnal or morning spontaneous erections?

What sexual techniques do you use?

Are there problems in your current relationship with your partner?

Do you have relationships with multiple sexual partners?

If you have more than one sexual partner, do you experience impotence with both of them?

The doctor may also want to talk to your sexual partner, as the latter may be guessing about the cause of your erectile dysfunction.

After your medical examination and interview, your healthcare provider may refer you to the following tests:

Clinical blood test (complete blood count): This is a comprehensive blood test, which, among other things, can reveal anemia in a person. Anemia is caused by low levels of red blood cells in the blood and can contribute to fatigue, which in turn causes impotence.

Liver and kidney function tests: These blood tests can determine if impotence is due to impaired liver or kidney function.

Fat blood test: This blood test measures the level of lipids (fats) such as cholesterol. High lipid levels may indicate atherosclerosis (hardening of the arteries), which can interfere with blood flow to the penis.

Functional diagnostics of the thyroid gland: The function of one of the thyroid hormones is to regulate the production of sex hormones, the deficiency of which leads to the development of impotence.

Blood test for hormones: The level of testosterone and / or prolactin in the blood can be measured to detect abnormalities in the concentration of any of these hormones.

Analysis of urine: A lot of information can be obtained from urinalysis, such as protein, sugar and testosterone levels. If the blood levels of these substances are abnormal, it could be due to diabetes, kidney disease, or low testosterone levels. All this can lead to impotence.

Duplex scanning: This test is one of the most effective for detecting impotence. In ultrasound, high-frequency waves are used to obtain a visual assessment of body tissues. For patients suffering from impotence, duplex scanning can be used to assess the state of blood flow and detect signs of venous leakage and atherosclerosis, as well as to assess the condition of the vascular walls. This test is done twice: the first time when the penis is erect (often after an injection of an erection-stimulating drug) and the second time when it is relaxed.

Bulbocavernosus reflex: This test checks the sensitivity of the nerve endings in the penis. To do this, the doctor will squeeze the head of your penis, which should cause the anal sphincter muscles to contract. If the function of the nerve endings is impaired, the response will be slowed down, or muscle contraction will not occur.

Night erection test: This study tests male erectile function during his sleep. Usually, during sleep, a man experiences 5-6 episodes of erection. Lack of spontaneous erections may indicate a problem with nervous function or the blood supply to the penis. For this study, two methods are used: the method for measuring the circumference of the penis and the method for measuring its rigidity. For the first method, three plastic loops of varying degrees of tension are attached around the penis. Erectile function is determined depending on which of the loops is torn. For the second method, the gauge loops are tightened around the circumference of the penis at the root and apex. If an erection occurs at night, the loops will tighten and the electronic device will register the changes.

Penis biothesiometry: This test uses electromagnetic vibration to assess the sensitivity of the penis and its innervation. Reduced sensitivity to these vibrations may indicate nerve damage.

Injection of a vasoactive drug: During the test, an erection will be induced by an injection of a special solution that expands (enlarges) the blood vessels and the access of blood to the penis.

Dynamic infusion cavernosometry: This test is given to men with impotence who are suspected of having a venous leak. During this procedure, a special dye is injected into the vessels of the penis under a certain pressure. By measuring the physiological pressure with which fluid must be supplied to the penis to maintain a stable erection, the doctor can determine the extent of venous leakage.

Cavernosography: Used in conjunction with dynamic infusion cavernosometry. This test involves injecting a radiopaque contrast agent into the penis. An x-ray of the erect penis is then taken to check for venous leakage.

Arteriography: This test is indicated for patients preparing for vascular reconstructive surgery. A radiopaque contrast agent is injected into an artery that is considered damaged and the artery is X-rayed.

PSA test: PSA is the main marker of prostate cancer. Abnormalities in this test may indicate an enlarged prostate or an infection, which can complicate the case of impotence.

Before referring you to these tests, your doctor will explain to you what they are. If you have any questions, feel free to ask them.

Reviewed by physicians at the Glickman Institute of Urology at the Cleveland Clinic.

I am sure that you will be surprised by the fact that a normal man has 5-6 erections during sleep. Every 90 minutes! And they last up to 30 minutes. The absence of such erections most often indicates a neurological or vascular pathology. Identifying an erection during sleep helps to prove the psychogenic nature of the disorder. How it's done? Very simple. You receive a small electric instrument with a writing mechanism. It is attached to a cuff that fits over the penis. If an erection occurs during a night's sleep, impulses are transmitted to the writing mechanism, which draws a curve.

According to this curve, the specialist determines the quantity and quality of erections. On the medical English language this test is called Nocturnal Penile Tumescence (NPT)... The method, of course, is not very accurate, but to some extent useful, because detecting an erection in itself is already comforting ... There is a simpler and more "pleasant test" practiced in some special clinics. I call him " porn test". The patient is placed in a cozy darkened room and shown video films of erotic content. After watching, he must tell the doctor not the content of the film, but how he and his penis reacted to it. The meaning of this test is the same as the first. It is clear that and he is not very objective, because his results are influenced by many factors. I know men who such films cause not an erection, but disgust. Some just fall asleep during the "session".

Scientists have not been able to standardize such tests and it is not known when it is best to use them for maximum reliability. Biothesiometry is a test that uses vibration to determine sensitivity to vibration. Lack of sensitivity can mean damage to the nerves in the pelvic region, which also leads to impotence. Personally, I did not have to be present at this check. Determination of blood circulation in the penis. Exist different ways determination of blood flow to the penis. The most common- Doppler ultrasound (ultrasound or ultrasound).

Injection of vasoactive drugs... The introduction of solutions that dilate blood vessels into the corpora cavernosa can cause an erection. This procedure is currently performed in most clinics and is designed to determine the adequacy of blood flow to the penis for the production of an erection. This test is sometimes supplemented with various measurements and x-rays with contrast agents. To this day, many doctors teach their patients to self-administer vasoactive drugs into the penis before the intended sexual intercourse. With the advent of Viagra, there was a revolution not only in medicine. But, naturally, we will devote a separate category to this. Today Viagra is used for testing in parallel with the vasoactive drugs mentioned above. It should be noted that there are many other tests, but none of them are of practical importance.

Examination of a man when identifying problems with his potency includes a number of diagnostic measures. One of the most informative tests is the vasoactive test. It involves the use of drugs of certain pharmaceutical groups. Due to their properties, it is possible to determine the ability of the patient's penis to erect. This allows you to plan the amount of upcoming therapeutic interventions.

How is it done, what the results say

The peculiarity of the vasoactive test is that the drug is injected directly into the corpora cavernosa. Diagnostic course:

1. The man sits on the couch.

2. The specialist treats the skin of the patient's penis with an antiseptic solution.

3. The doctor injects the drug into the cavernous bodies of the man's penis. Substances of the drug cause the expansion of the lumen of the blood vessels. Papaverine, Fentalamin are used more often.

4. For a better distribution of the injected solution over the tissues, the urologist performs a massage of the genital organ. The action helps to improve blood flow.

5. Then they expect the onset of an erection and record the main indicators of the results of the procedure. In the normal state of the reproductive system, arousal occurs after 5-15 minutes.

Based on the results of the manipulation, the volume of erection, the speed of its onset and the duration of preservation are determined. The normal reaction to an injected substance is a condition of the penis in which it cannot be bent. The lethargy of the penis after the injection of the specified drug is an indication for hardware diagnostics. Through research, the doctor determines what caused the patient's potency problems. All causes are divided into psychological, inflammatory and vascular factors (associated with blood vessel failure).

Contraindications

There are some contraindications for a vasoactive test:

recent alcohol use;
the interval between injections is less than 2 days;
an allergic reaction of the patient's body to the drugs due to which the test is carried out.

The procedure is performed only with disposable syringes - even if it is necessary to re-inject the drug into the same area. The use of a thin needle tightly screwed to the barrel of the syringe eliminates the likelihood of damage to the corpora cavernosa.

Testing and high-quality treatment in our clinic by competent doctors allows you to quickly and reliably diagnose the state of the reproductive system. observe the rules of asepsis, carry out the manipulation in the treatment room, where the sterility regime is maintained. This makes all the actions of doctors safe, since there is no risk of complications. Each patient is treated confidentially in our clinic.

The vasoactive test is one of the most informative tests for erectile dysfunction. During it, an erection is stimulated with the help drugs... Which ones - the doctor selects depending on general condition health of a man. In "Es Class Clinic Stavropol", only proven medicines are used. Before the test with vasoactive substances, the patient in our clinic undergoes a number of additional examinations to make sure that the procedure is actually indicated for him and that it will in no way harm him.

How is the vasoactive test for erectile dysfunction performed?

For the vasoactive test, the patient is given an injection special drug directly into the genitals. The injection causes minor painful sensations, but the vast majority of men tolerate it easily. The dosage of the active substance is calculated based on the weight, age and general health of the patient.

After the injection has been delivered, the urologist massages the penis. After 10-15 minutes, a drug erection occurs. It is very important that at this moment the man is calm, otherwise the results of the study may be inaccurate.

What the results say

The patient should also help the doctor assess the onset of an erection. It must be compared with the usual one: how different is the speed of its onset, volume, intensity. If, as a result of the test, a full-fledged erection occurs, which the patient cannot achieve under normal conditions, then the problems with potency that led him to the doctor are psychological. It can be stress, depression, incompatibility with a partner.

If an erection is insufficient for any criterion, then we are talking, most likely, of neurological or vascular diseases. In this case, more detailed examinations are prescribed, including those that identify common diseases, such as diabetes, vascular insufficiency and others.

The vasoactive test is contraindicated in people with:

hyperplasia of the prostate;
severe heart disease, ischemia;
kidney failure;
glaucoma.

What to expect after your procedure

When testing with vasoactive substances, the dose of the drug is calculated so that the erection goes away after 1 hour. During this time, it is recommended to stay in the clinic (this is done solely for the comfort of the subject). If the patient has gone home, and the erection has not disappeared after 6 hours or more, then he is recommended to return to the hospital. It is also necessary to see a doctor for any other discomfort that occurs in the genitals after the tension subsides.

In "Es Klass Clinic Stavropol" you can address any, even the most delicate problem. Here they treat each patient with understanding, all examinations are carried out by experienced urologists who know their business.

Portal hypertension is defined by increased pressure in the portal (portal) vein. Violation of blood flow is possible either in the vessel itself or in the overlying venous formations. Portal hypertension syndrome necessarily includes clinical manifestations:

enlargement of the spleen (splenomegaly);
expansion of the venous network of the esophagus and stomach (bleeding);
ascites (big belly);
varying degrees of liver failure from mild to advanced encephalopathy with irreversible brain damage.

Portal hypertension in the International Statistical Classification (ICD-10) is included in the digestive system diseases with the code K76.6.

A bit of anatomy

The portal vein (Latin name v. Portae) collects blood from abdominal cavity from the stomach, spleen, large and small intestines, pancreas. It is considered the largest vein associated with internal organs... The tributaries are:

inferior and superior mesenteric veins;
splenic;
cystic;
left and right gastric.

The beginning of the portal vein is located behind the head of the pancreas. Its length up to the hepatic hilum is 40-50, and its diameter is from 15 to 20 mm. The vein bed is located inside the dense hepatoduodenal ligament. The bile duct and the internal hepatic artery also pass here.

In the liver, the portal vein divides into left and right branches, each of which distributes blood flow to eight segmental veins. Further division proceeds according to the interlobular principle into septal (septal) and capillaries. Between the liver cells, capillaries, also called sinusoids, converge radially towards the center.

Blood already purified from toxins gets here. The central wreaths, merging, form the hepatic vein, which flows into the inferior vena cava. This circulation prevents poisonous substances from entering the heart.

Hypertension is considered to be an increase in pressure in the portal vein system above 12 mm Hg. This causes collateral varicose veins.

If in the hepatic vein with portal hypertension the pressure exceeds the threshold, then auxiliary vessels (collaterals or varicose veins) open, along which part of the blood flow is directed, bypassing the liver, into the esophageal venous network, gastric, into the umbilical vein (under the skin around the navel), into the rectum ...

The mechanism of development of hypertension in the portal vein

For the onset of portal hypertension syndrome, there must be a violation of blood flow along the course of the portal vessels and above (hepatic lobules, hepatic and inferior vena cava).

Arterial blood enters the liver under high pressure, but in a small volume, while venous blood in the portal vein has a lower pressure, but a greater amount. Sinusoids equalize the vibrations. Cirrhosis increases the connection of these systems through arterioportal shunts. Compensatory expansion of the hepatic artery occurs, blood flow increases to support the functioning of the capillaries.

The release of internal vasodilators is activated, which include:

glucagon,
vasoactive peptide,
nitrogen oxide.

This leads to the expansion of the venous network in the abdominal cavity and heart, increases the amount of cardiac output and blood flow in the tissues.

Discharge of blood into collateral vessels does not eliminate the mechanical compression factor. Over time, the resistance of the auxiliary network becomes so strong that the possibility of stress relief from the portal vein disappears. At the same time, the resistance inside the lobular veins increases by 20-30%.

Myeloproliferative diseases (subleukemic leukemia) cause hyperfunction and enlargement of the spleen, followed by fibrosis. The pressure rises at the level of the splenic vein and is transmitted to the portal vein.

This video will help you to finally understand the mechanism of development of portal hypertension:

Relationship between the classification of portal hypertension and the causes

Depending on the localization of the mechanical obstruction to the outflow of blood, forms of hypertension are distinguished in the portal vein system. Each species has common causes. The names correspond to the block level.

Suprahepatic hypertension develops when:

thrombosis of the hepatic veins ( malignant tumor, Budd-Chiari syndrome);
mechanical effect on the inferior vena cava (due to tumor or metastases);
decompensation of the work of the heart in cases of adhesive pericarditis, reverse flow of blood through the tricuspid valve with insufficient closure.

Intrahepatic portal hypertension is formed with three types of capillary lesions: before sinusoids (pre-), inside and after them.

There is a rare variant of non-cirrhotic (idiopathic) portal hypertension.

The sinusoidal shape is caused by:

in all cases of cirrhosis;
with acute alcoholic hepatitis;
if viral hepatitis is severe;
poisoning with vitamin A;
cytotoxic drugs;
hepatic purpura;
systemic mastocytosis.

Post-sinusoidal hypertension is possible with veno-occlusive disease, alcoholic hyaline sclerosis.

The subhepatic form occurs when:

thrombosis in the bed of the portal or splenic veins;
the formation of an arteriovenous fistula;
an idiopathic form of tropical splenomegaly.

The mixed nature of the lesion is more common and found.

When does extrahepatic hypertension occur?

Extrahepatic portal hypertension occurs much less frequently than intrahepatic hypertension. It is more common in children because it is associated with congenital causes (vascular anomalies).

In 80% of cases, it contributes to childhood splenomegaly caused by thrombophlebitis after an infectious disease. Among the reasons:

pustular skin lesions;
inflammation of the umbilical ring;
umbilical sepsis;
erysipelas;
mastoiditis;
osteomyelitis;
chronic tonsillitis;
carious teeth;
pancreatitis;
intestinal infections;
scarlet fever.

The examination reveals the characteristic absence of any liver dysfunction. The changes concern only the connection of the splenic and portal veins.

Clinical manifestations

Symptoms of portal hypertension are identified by typical complications:

bleeding from dilated veins of the esophagus and stomach;
enlarged liver and spleen;
ascites.

Early manifestations can be:

bloating;
loss of appetite;
nausea;
feeling full after eating a small amount of food;
vague pain throughout the abdomen or heaviness in the area of the right hypochondrium;
amyotrophy;
loss of subcutaneous fat, dry skin.

The increase in ascites is characterized by:

an increase in the abdomen;
a picture of an enlarged venous ring around the navel with a spread in the form of rays to the sides (the symptom resembles the "head of a jellyfish");
swelling in the feet and legs.

Bleeding from the esophageal, gastric and hemorrhoidal veins is manifested with vomiting, loose stools. Nosebleeds are possible.

The enlargement of the liver is determined by palpation of the abdomen: the edge of the liver is dense, sharp, the surface is hard, with tubercles. You can feel the tumor or growing nodes.

The growth of the spleen is also determined by palpation of the left hypochondrium.

The defeat of the stomach leads to portal hypertensive gastropathy, which is manifested by erosions and ulceration of the gastric mucosa. Such changes may accompany the sclerotherapy used to treat bleeding.

Chronic pathology leads to symptoms of portal encephalopathy:

headaches;
memory impairment;
sleeplessness at night with daytime sleepiness;
dizziness.

Perhaps a mental disorder with inappropriate patient behavior, delirium, hallucinations.

Signs of portal hypertension depend on the form of the disease: ascites is more typical for the suprahepatic development of pathology, dyspepsia is for intrahepatic.

With suprahepatic localization, the following are more common:

early ascites, which is poorly treated with diuretics;
significant enlargement of the liver with a relatively small growth of the spleen;
severe pain syndrome.

The subhepatic form is characterized by the following features:

developed splenomegaly;
lack of simultaneous enlargement of the liver;
slow progressive development with multiple varicose bleeding.

Intrahepatic hypertension is different:

early and persistent dyspeptic syndrome with bloating, loss of appetite, weight loss, recurrent diarrhea;
at a later stage, a clinic of varicose veins with bleeding appears, ascites, the spleen is significantly enlarged;
abdominal pains are localized in the epigastric region and in the area of the left hypochondrium (hepatolienal type).

How does portal hypertension develop in childhood?

Portal hypertension in children, as well as in adults, has supra-, intra- and subhepatic causes of development.

Intrahepatic changes are most often caused by hepatitis, fibrosis, cirrhosis. It is based on a pronounced oxygen deficiency of hepatocytes.

Various vascular anomalies lead to extrahepatic changes. Most often they are caused by thrombosis in the portal vein, thrombophlebitis.

A more rare pathology is cavernomatosis. The essence of the disease: early thrombosis, followed by an incompletely restored lumen, the portal vein itself turns into an enlarged angioma or a network of small vessels. Characterized by early severe complications in the form of bleeding, intestinal infarction, the development of hepatic coma. The prognosis of the disease is unfavorable, children live with the formation of portal hypertension for no more than 9 years.

Symptoms of portal hypertension in children do not differ from adults.

Stages of development of hypertension

The stages of portal vein hypertension are determined by the severity of clinical manifestations:

in the initial (preclinical) stage - the patient's general well-being is satisfactory, a slight heaviness in the right hypochondrium, weakness, bloating and rumbling is possible;
in the second stage - clinical manifestations are clearly defined by dyspepsia, enlargement of the liver and spleen;
the third stage is characterized by the presence of pronounced ascites, but the absence of bleeding;
the fourth is considered a stage of severe complications.

How is portal hypertension detected?

Of great importance in the diagnosis is the establishment of the cause of hypertension in the portal vein. Since the most likely disease is cirrhosis of the liver, they find out the connection with the transferred viral hepatitis, alcoholism, hereditary diseases, pathology of the abdominal organs.

Predisposing factors may be blood clotting disorders, hormonal medications. The patient must be asked information about:

episodes of gastrointestinal bleeding, their frequency and severity;
transferred sepsis;
diseases of the spleen;
previous endoscopic examination.

The most reliable information for diagnosis is based on measuring the pressure in the portal vein. But it is very difficult to conduct such a study due to the deep location, little available localization. The opportunity appears only during surgery with an open abdominal cavity.

Depending on the pressure level in the portal vein system, 3 degrees of increase are distinguished:

degree I - 250-400;
degree II - 400-600;
grade III - more than 600 mm of water. Art.

For practical purposes, the increase in pressure in the portal vein is judged by varicose veins of the esophagus. The method allows you to assess tension, daily fluctuations, control bleeding and prevent recurrence. The criteria are approved for endoscopic examinations and allow you to accurately navigate the clinic.

Laboratory Methods

Laboratory tests make it possible to diagnose the diseases that caused the hypertensive syndrome, the degree of functional disorders of the liver and spleen. To do this, carry out:

general clinical blood test;
biochemical tests;
coagulogram;
immunological detection of antibodies to known hepatitis.

According to the analysis of urine, the parameters of the filtration of the kidneys are determined:

erythrocytes,
protein,
specific gravity,
uric acid level.

A biopsy test can help identify a specific liver disorder.

Instrumental diagnostics

Esophagoduodenoscopy allows you to study and visually determine abnormalities of the gastric mucosa (gastropathy), to see the enlarged nodes and veins in the esophagus and stomach. In diagnosis, there are 2 types of lesions:

hepatolienal - stagnant veins are localized along the greater curvature of the stomach, in the high parts of the esophagus and in the spleen;
intestinal mesenteric - dilated veins in the esophagus are poorly expressed. If at the same time laparoscopy is carried out (examination of the peritoneum through a puncture), then the predominant location of stagnation is determined in the zone of the diaphragm, intestines, hepatic ligament.

Ultrasound diagnostics (ultrasound) determines not only the size of the liver and spleen, but also the structure of organs, reveals a small amount of fluid in the peritoneal cavity, the diameter of the hepatic and portal veins, their patency and places of compression.

The method of Doppler ultrasonography of the veins of the hepatic zone provides information about collaterals, arteriovenous fistulas, the state of the inferior vena cava, and determines the blood flow rate at each site.

Computer and magnetic resonance imaging examines the liver parenchyma, reveals nodules, tumors, anastomoses between the hepatic and splenic veins.

Hepatoscintigraphy is based on the absorption capacity and the release of a special drug from the venous blood. It is used to determine the degree of fibrous cell replacement.

Transhepatic venography may be necessary to determine the patency of the veins, to assess the results of the operation performed.

Problems of treatment and prevention of complications

Treatment of portal hypertension involves the main tasks:

therapy of the underlying disease that caused impaired blood flow in the portal vein system;
prevention of bleeding;
treatment of acute bleeding.

The use of individual methods and means has been studied sufficiently. Problems should be considered from the standpoint of the prevalence of benefits over harm:

drugs with vasoconstrictor action (Vasopressin, Terlipressin) exhibit the most pronounced effect of reducing portal venous blood flow and pressure in the portal vein, but they are characterized by an increase in total vascular resistance, which is unacceptable for debilitated patients, in old age (cause myocardial ischemia, hypertension, arrhythmias) ;
vasodilators (Isosorbide 5-mononitrate) have a favorable result, but their effect is too weak, a high dosage is needed, and many patients do not tolerate it well;
it is possible to cure hypertension with the help of a surgical creation of an artificial bypass for increased blood discharge to other veins with the most optimal success, but contraindications and the stage of the disease should be taken into account, the technique can deepen encephalopathy;
endoscopic techniques are promising in eliminating acute complications and consequences, but do not affect the progression of hypertension.

Feature Videos surgical treatment portal hypertension:

All therapeutic measures are divided into stages, each of which has its own tasks.

Stage 1 - it is necessary to stabilize hemodynamic parameters, carry out esophagoduodenoscopy and assess the degree of damage:

fresh frozen plasma, vitamin K is poured through a catheter in the subclavian vein;
antibiotics are introduced to prevent the addition of infection (Norfloxacin, Ciprofloxacin have proven themselves better);
a nasogastric tube is inserted and the stomach is washed out before examination.

Stage 2 - stopping bleeding and preventing recurrence:

when a source is identified in the dilated veins of the esophagus, a temporary stop of bleeding with an inserted inflated balloon (for 24 hours) is shown, followed by ligation of the veins using endoscopic techniques or sclerotherapy;
if the source is gastropathy or bleeding from the veins of the stomach, such methods are not applicable, the use of both combinations is shown pharmacological preparations vasoconstrictor and vasodilator action (Octreotide + nitrates).

In case of ineffectiveness, surgical shunting is used between the portal and hepatic veins, the portal and the inferior cavity, and the issue of liver transplantation is being considered.

What is the prognosis for portal hypertension?

The forecast depends on:

the presence and frequency of recurrence of bleeding;
the degree of damage to liver functions.

The following factors, detected during esophagogastroscopy, affect the likelihood of bleeding:

large size of varicose veins in diameter;
superficial location of veins in the area of the esophageal-gastric junction;
late stages of the disease;
identification of red nodes (cherry color) with thinning in the form of bubbles;
transformation of veins into telangiectase.

The use of sclerotherapy and β-blockers prevents such an outcome in 42% of patients.

To prevent gastric bleeding, the most effective method is the introduction of N-butyl cyanoacrylate, isobutyl-2-cyanoacrylate, thrombin into the nodes using an endoscope. It is possible to achieve the absence of recurrent bleeding within a year in 94.5% of patients, within 5 years - in 82.9%.

What are the complications of portal hypertension?

The most famous complications are:

bleeding;
ascites;
bacterial peritonitis;
hepatic encephalopathy;
hepatorenal syndrome.

Many international associations are involved in the management of portal hypertension. The accumulated experience is summarized and published annually. The benefits of each method are studied and verified in detail.

A significant role is assigned to the primary prevention of liver diseases with the help of adequate nutrition, adherence to the dietary regimen according to indications, and vaccinations against hepatitis, starting from childhood.

The rate of blood pressure in humans

Blood pressure is a concept that determines the force with which blood presses against the walls of blood vessels. Blood pressure directly depends on the speed, strength of contraction of the human heart and the volume of blood that the organ can pump in 60 seconds.

During the heartbeat, blood is pumped under pressure into the large arteries. This pressure is called systolic. The BP that is observed during relaxation is called diastolic.

This indicator is minimal and completely depends on the resistance of the vessels. When diastolic blood pressure is subtracted from the systolic indicator, you can find out the pulse pressure.

Causes of high blood pressure

The complaint that blood pressure rises is very common. At high pressure, if it is not reduced quickly, the patient complains of headaches, bad feeling, dizziness. With increased pressure, the patient very often suffers from bouts of nausea, anxiety. Therefore, it is imperative to reduce pressure, especially when a person is at home alone.

When only the lower pressure increases, the causes may be associated with kidney pathologies. First of all, the doctor will suspect:

atherosclerosis;
stenosis;
abnormalities in the development of renal vessels;
glomerulonephritis.

If the diastolic pressure rises to the level of 105 mm, it lasts for more than 2 years in a row, the likelihood of developing cerebral accidents increases immediately by 10 times, and myocardial infarction by 5.

Systolic blood pressure usually rises rapidly in elderly patients with thyroid disease, anemia, and heart defects. If the pulse rises, it also increases the likelihood of a stroke, heart attack.

The reasons for low blood pressure are associated with hypotension and weak heart function, features of autonomic tone. In some diseases, blood pressure is constantly lowered:

vegetative-vascular dystonia;
prolonged fasting, underweight;
myocardiopathy;
hypothyroidism;
diseases of the hypothalamic-pituitary system;
insufficiency of the adrenal cortex.

With mild hypotension, people can live normal, fulfilling lives. But when the upper pressure drops quickly and significantly, for example, in shock, this can cause multiple organ failure, centralization of blood circulation, and the development of disseminated intra-articular blood coagulation. Therefore, it is better to lower blood pressure smoothly, it is extremely important to eliminate the causes of violations, to try to keep the pressure within the normal range.

With high pressure, if it is not reduced, very dangerous irreversible changes in the body can begin.

Everyone has their own physiological characteristics, and the level of blood pressure is no exception. For adults, there is no clear age norm for blood pressure, but in any case:

the pressure should not be higher than 140/90 mm. rt. Art .;
130/80 is considered to be normal averages;
the optimal pressure will be 120,125 / 70.

As for the upper pressure limit, after which the patient is diagnosed with arterial hypertension, it is often 140/90 mm. rt. Art. At higher numbers, the body should be diagnosed to identify the cause of this condition. table blood pressure will show all changes.

Initially, the doctor will recommend revising habits, lifestyle, quitting smoking, doing feasible physical exercise... When a person's blood pressure rises rapidly to 160/90, they are shown drug treatment... It happens that the patient manages to lower the tonometer readings without drugs, sometimes it helps to just lie down for a while and take a sedative.

It is possible that a hypertensive patient has concomitant pathologies, for example, diabetes mellitus of the first and second types, coronary heart disease. In this case, medications are taken at lower numbers.

If a person is sick arterial hypertension, for him the norm is 140.135 / 65.90 mm. rt. Art. With severe vascular atherosclerosis, blood pressure should be reduced gradually and smoothly. Very sharp drops in blood pressure will cause:

myocardial infarction;
stroke.

When there is a history of renal failure, diabetes mellitus, and the patient is less than 60 years old, his optimal blood pressure is 120,130 / 85.

Absolutely healthy person the lower pressure limits are within 110/65 mm. rt. Art. With even lower numbers, general well-being deteriorates, organs and tissues do not receive a sufficient amount of oxygen. First of all, the brain suffers, especially sensitive to oxygen starvation.

It is noteworthy that some people live quite normally with a pressure of 90/60 and do not have health problems. Constant very low blood pressure occurs in former athletes with hypertrophied heart muscle.

For an elderly person, too low blood pressure is undesirable, since it carries the threat of brain catastrophes. Therefore, it is very important for such people to have drugs at home to help lower blood pressure. The drug Nitroglycerin perfectly lowers blood pressure.

Diastolic blood pressure in people over 50 years old should be between 85 and 89 mm. rt. Art. Measurements are carried out immediately on both hands with an interval of 1-3 minutes. It is normal if the difference between the received data is no more than 5 mm. In right-handers, the musculature of the working limb is more developed, for this reason, the blood pressure on it is usually slightly higher, and in left-handers, vice versa.

With a difference of 10 mm or more, the doctor will assume atherosclerosis, if the excess is 15-20 mm, this means that there is stenosis of large vessels, their abnormal development.

Heart rate

The normal heart rate is 35 mm. rt. Art. It happens that a healthy person has a pulse 10 mm higher or lower:

up to 35 years old, normal heart rate is from 25 to 40;
after 35 years - up to 50 mm. rt. Art.

Immediately after birth, the pulse of a child is 140; in a middle-aged person, it is 65; in case of illness, it is 130; the pulse before death is 160 mm.

A drop in the contractile ability of the heart can lower the pulse rate, in particular: tamponade, heart attack, atrial fibrillation, paroxysmal tachycardia. It is possible that sharp jumps in vascular resistance are due to a state of shock.

A high pulse (over 60) occurs with atherosclerotic changes in the arteries, heart failure. There is a similar problem with anemia, pregnancy, endocarditis, intracardiac blockages.

Doctors do not use a simple subtraction of diastolic pressure from systolic pressure. The greatest diagnostic value will have heart rate variability, which should be within 10%.

The rate of blood pressure changes depending on the age of the person. Moreover, normal blood pressure in young women with low body weight is always slightly lower. After age 60, the likelihood of vascular catastrophes among men and women is compared.

under 20 years old - 123 / 75.76;
up to 30 years old - 126/79;
30-40 years old - 126/81;
40-50 years old - 135/83;
50-60 years 142/85;

up to 20 years old - 116/72;
up to 30 years old - 120/75;
30-40 years old - 130/80;
40-50 years old - 137/84;
50-60 years 144/85;
over 70 years old - 142/80 mm. rt. Art.

Normally, blood pressure is a parameter that changes depending on physical activity... For example, with emotional stress and activity, the pressure will increase, and if you stand up suddenly, this can lower your blood pressure.

For this reason, to obtain the most accurate data possible, blood pressure is measured in the morning without getting out of bed. When measuring blood pressure, the tonometer is always placed in line with the patient's heart. The arm with the cuff should be at the same level.

The phenomenon of "white coat hypertension" is widely known, when a person taking antihypertensive drugs, in the presence of a doctor, produces high blood pressure. It happens that the pressure rises:

after a quick climb up the stairs;
with tension of the muscles of the thigh, lower leg during measurement.

Such pressure can be lowered without pills, for example, if you lie at home for a while with closed eyes... Classical music relieves blood pressure very well.

When blood pressure has risen much above normal, it must be quickly reduced. The drug Clonidine helps very well, and you can even take it at home.

BP in children, adolescents, during pregnancy

Normal pressure for a newborn baby is 80/50. And what is the norm for older children, the table will show:

from birth to 12 days - 60.96 / 40.50;
3-4 weeks - 80.112 / 40.74;
from 2 to 12 months - 90.112 / 50.74;
2-3 years - 100.112 / 60.74;
3-5 years - 110.117 / 60.76;
6-10 years old - 110,122 / 60,78 mm. rt. Art.

Adolescence begins when a child turns 11. During this period, the body not only grows rapidly, but also hormonal changes occur, which affect the cardiovascular system.

IN adolescence normal upper blood pressure is constantly in the range from 110 to 126 mm. rt. Art., the lower ranges from 77 to 82. When a child is from 13-15 years old, the pressure approaches the norm of an adult, and soon equalizes with him, amounting to 110.125, 130 / 70.85.

With an increase in blood pressure in a child, you should definitely look for reasons, take a harmless remedy that can reduce pressure quickly and without consequences.

Since hormonal changes are typical for pregnant women, their blood pressure rates may also vary. If before 6 months of pregnancy the level of blood pressure does not change, then after this period there may be a slight increase. Knowing what are the symptoms of high blood pressure in women is extremely important for timely treatment.

How to lower blood pressure at home?

When the pressure has risen, and the person is alone at home, first of all he needs not to be nervous and sit in bed, but rather to lie. Sometimes it helps to avoid the use of medications.

With increased pressure, which is not associated with a chronic illness, doctors recommend taking a decoction medicinal plants, which will quickly help lower blood pressure. You need to turn off the TV at home and just listen to soothing music.

If high blood pressure is frequent, and its causes are associated with serious illnesses, it helps to quickly reduce it:

Nifedipine;
Anaprilin;
Verapamil;
Clonidine;
magnesium sulfate.

These funds are prescribed for treatment at home or in a hospital. To lower the pressure, it is necessary to take treatment constantly, and not when blood pressure rises, this is important when asking how to bring down the pressure at home.

When pressure is present, sedatives such as valerian extract can help reduce anxiety. You can use diuretics to lower blood pressure at home. If this does not help, then you need to call an ambulance. The video in this article will help you figure out how to measure pressure and prevent its surges.

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Causes of congenital heart defects, prognosis and treatment

In some people, at birth, pathologies of the development of the heart, which were formed in utero, may be noted. This problem is called congenital heart disease. They lead to disturbances in normal hemodynamics, which affects the entire body, in some cases, the defects are incompatible with life. In general, heart disease is a series of pathologies that anatomically change an organ or certain parts of it.

Causes of pathology

There are a number of reasons for congenital heart disease:

Chromosomal breakdowns.
Gene mutations.
Other factors (excessive alcohol consumption during pregnancy, drug addiction, complex infectious diseases transferred in the 1st trimester, taking antibiotics and other drugs).
The main cause of the pathology is hereditary predisposition. For this reason, children most often have a congenital defect.

If chromosomal aberrations occur, the formation of various organ systems is impaired. As a rule, with serious breakdowns, the fetus dies, but if the distortions are compatible with life, then a person is born with certain congenital defects.

Important! With trisomy of 21 pairs of chromosomes (the appearance of the third chromosome in the set), Down syndrome develops, often accompanied by heart defects.

Symptoms

The symptoms of congenital heart disease vary depending on the type of heart disease. In medicine, the following types of pathology are distinguished:

"Blue" vices.
"White" vices.
With an obstruction to blood flow.

"Blue" defects are determined by a change in the location of the arteries. In patients with such a pathology, the skin on the fingers, toes, feet, nose, lips begins to turn blue; with complications, cyanosis appears throughout the body. In patients, the oxygen content in the blood decreases, shortness of breath appears, convulsions are possible, with loss of consciousness, and a strong heartbeat. The child may be lagging behind in development and is often sick.

Manifestations of "blue" heart defects are visible within a few hours after childbirth. If the location of the mitral arteries changes (transposition), then the child is not viable with this form of pathology. Pathology leads to almost instant death after birth. A three-chambered heart, when a child has two atria and one ventricle, or vice versa, belongs to the "blue" type of defects. This pathology has an unfavorable prognosis. Blue vices are characterized by a high mortality rate. If the baby manages to survive during the first day, then without surgery, by the age of 2 years, death still occurs.

If a person has "white" defects, then cyanosis does not develop. Their signs do not appear immediately, but closer to the age of 18. The signs will be as follows:

Pale skin.
Development and growth delays.
Exposure to colds.
Shortness of breath, fast heartbeat at rest and after exertion.

"white" defects include defects of the septum of the heart, patent ductus arteriosus, etc.

If a person has a defect with an obstacle to blood flow (stenosis, narrowing), then the person has the following symptoms:

A strong and frequent heartbeat appears.
Possible chest pain.
Decreases endurance.
Swelling of the limbs or parts of the body appears.
Development lag is noted.

Such defects include coarctation of the aorta, stenosis of collapans, branches of the pulmonary artery. Other types of pathologies are also distinguished: congenital cardiomyopathies, congenital rhythm disturbances, coronary artery defects, etc.

Knowing the etiology of congenital heart defects, it is worth learning more about the consequences, methods of diagnosis and treatment, what is the prognosis and how long children and adults live with heart disease.

Important! Many are interested in the question of whether they are being taken into the army from the UPU? With such pathologies, a person should not be called upon, especially if he has complications.

Diagnostics

Often, the disease is diagnosed at the time of the development of the child in the womb, using ultrasound. If the doctor was able to identify a similar problem, then the pregnant woman is offered to refuse to bear the fetus, but she may refuse to decide on childbirth. If it is decided to give birth, then immediately measures are taken to save the child's life. Childbirth is often taken directly at the department of the cardiac surgery center.

It is not always possible to make a diagnosis before the birth of a child, sometimes it turns out to be done only after that. For example, when passing an EchoCG, auscultation of the heart.

Echocardiography is used to establish an accurate diagnosis; this method is the most informative for detecting diseases. Additionally, he can use ECG, radiography. If the case is very difficult or requires surgery, then ventriculography, angiography are prescribed.

Diagnostics in case of failures of the small circle of blood circulation

In more detail it is necessary to dwell on an ultrasound scan for defects. During the procedure, congenital defects are revealed, which are characterized by the phylogenesis of the pulmonary circulation:

Atrial septal defect.
Ventricular septal defect.
Botalov duct - visible on echocardiography, in the form of constant blood flow in the aorta and pulmonary artery.
Coarctation of the aorta - shows the part where the lumen of the aorta narrows.

An ultrasound scan shows the location of the defect, the presence of a shunt, dilatation of the heart chambers, and the degree of pulmonary hypertension.

Defects with a decrease in blood circulation in the pulmonary circulation:

Fallot's tetrad.
Pulmonary artery stenosis.
Ebstein's anomaly.
Tricuspid valve atresia.

CHD with a decrease in the amount of circulating blood in a large circle:

Coarctation of the aorta.
Isolated stenosis of the pulmonary artery.

There are phylogenetically determined defects, when a person's heart is located in a mirror position, in other words, it is on the right. In this case, there are no violations of geodynamics. Such a phylogenetically determined defect is called dextrocardia. The problem is very rare, and no changes are visible on the ultrasound.

After the diagnosis of congenital heart defects has been carried out and an accurate diagnosis has been made, the doctor will prescribe correct treatment depending on the severity of the case.

Treatment

Important! Complete treatment of almost any congenital heart disease is performed using surgical methods.

The operation is performed as soon as possible after birth. In some cases, it is possible to postpone the intervention, but then the operation is required in the first year of life. If the patient has an open arterial defect or septal defects, and there is no threat to life, the tactics can be expectant.

Surgical treatment of congenital heart defects is carried out on an open heart, when the chest is dissected, but in some pathologies the endovascular method is used, when a probe is inserted into the vessels, which penetrates into the heart itself. The closed method can be used to correct VSD, ASD.

In addition to surgical intervention, the patient may be prescribed medication treatment. How to treat in this case, only a doctor can tell. Often, these funds are used to normalize and improve the function of contraction of the heart, and to relieve the small circle. ACE inhibitors, diuretics and B-blockers are prescribed.

Lifestyle

You can live with a congenital heart defect, while after a successful operation, people are no different from others, but it is recommended to follow certain rules regarding lifestyle:

To follow the rules healthy eating... Exclude from the diet junk food, alcohol.
More is in the air, get enough sleep.
Exclude professional sports, loads should be dosed.
Regularly be examined by a cardiologist to prevent complications.
Congenital heart disease in adults of the "blue" type prohibits pregnancy, but if it is corrected surgically, carrying a child is allowed with the permission of a doctor.

For the prevention of congenital heart defects, pregnant women should adhere to the correct lifestyle.