ECG: diseases — симптомы, диагностика и лечение

Arterial hypertension is a persistent increase in blood pressure from 140/90 mmHg. Art. and higher. It is the most common chronic disease in the world and a leading cause of strokes, heart attacks and kidney failure. The insidiousness of hypertension is that for many years it does not give any sensations: a person feels normal with a pressure of 160/100 and learns about the disease after a vascular accident. That is why it is called the “silent killer”, and the only way to detect it is to regularly measure your blood pressure, and not wait for symptoms.

Myocardial infarction is the death of a section of the heart muscle due to cessation of blood flow through the coronary artery. As with a stroke, time is of the essence here: the sooner blood flow is restored, the less muscle will die and the better the person will live in the future. The main reason for lost time is not transport or queues, but the patient himself: they endure the pain, take antispasmodics, wait for the morning. Half of deaths from heart attacks occur in the first hour, before any medical assistance, and almost always this is a consequence of delay.

Atrial fibrillation is the most common stable heart rhythm disorder, in which the atria stop contracting correctly and “flutter”, and the pulse becomes chaotic. The main danger of this arrhythmia is not the interruptions themselves: blood stagnates in the motionless atria and blood clots form, which travel with the blood flow to the brain. Atrial fibrillation increases the risk of stroke by about five times, and that is why the main thing in its treatment is not to “even out the pulse,” but to prevent a stroke.

Myocarditis is an inflammation of the heart muscle, most often caused by a common viral infection. This is its main feature: the disease begins not as a heart disease, but as a cold, and a person associates weakness and shortness of breath with a recent virus, and not with the heart. Most cases are mild and end with complete recovery; no one will ever know about them. But there is another side: it is myocarditis that remains one of the leading causes of sudden cardiac death in young people and athletes, and almost always due to physical activity to which the person returned too early. Therefore, this disease has one rule that is worth knowing before any diagnosis: after any infection with a fever, you cannot immediately return to heavy training, and if after the virus you develop chest pain, shortness of breath or a feeling of interruptions in the heart, this is a reason to be examined and not wait it out.

Pericarditis is an inflammation of the outer lining of the heart, a thin two-layer sac within which the heart beats freely. Normally, there is very little liquid between its leaves, and they slide over each other silently. When inflamed, the leaves become rough and rub with each contraction - hence the pain and the characteristic noise that the doctor hears when listening. This disease has a feature that is rare in cardiology: the diagnosis is largely suggested by the patient himself, if he accurately describes how the pain behaves. It intensifies in a lying position and with a deep breath, but when you sit down and lean forward, it noticeably weakens. This does not happen either with a heart attack or with angina, and it is this detail that most often directs the diagnosis in the right direction. The second thing you need to know: in some patients, fluid accumulates in the pericardial cavity, and if there is a lot of it, it compresses the heart - a condition requiring emergency care.

Extrasystoles are extraordinary contractions of the heart that occur earlier than the next normal beat. A person feels them in different ways: as a push, somersault, freezing or failure, after which the heart seems to “catch up” with a strong blow. The feeling is frightening, and it is fear, and not the arrhythmia itself, that usually brings the patient to the doctor. Therefore, you need to start with the main thing: extrasystoles are recorded in almost all people if you record a cardiogram during the day, and in a person with a healthy heart they are almost always safe and do not shorten life. What matters is not the fact of their presence or even their quantity, but the state of the heart in which they arise. That is why examination during interruptions is not aimed at “removing extrasystoles”, but at answering one question: is the heart healthy. If the answer is yes, treatment is often not required at all.

Pressure below 90/60 is considered low, but this figure in itself is not a diagnosis. The purpose of blood pressure is to supply blood to the brain, heart and kidneys, and if a person with indicators of 95 to 60 is alert, productive and does not experience dizziness, his blood pressure is doing its job, which means there is nothing to treat. Moreover, persistently low blood pressure in young, thin people is associated with a lower risk of cardiovascular disease in the future. Another distinction is fundamentally important - between pressure that has always been low and pressure that has recently decreased. The first is almost always harmless. The second is a symptom, which could be due to blood loss, a side effect of medications, adrenal or thyroid dysfunction, infection, or a heart problem. A separate and most practically significant situation is a drop in pressure when standing up in older people, because it leads to falls and fractures.

Tachycardia is a heart rate greater than 100 beats per minute at rest. In itself, increased heart rate is not a disease: the heart must speed up under stress, excitement, temperature, and dehydration. The question is always whether the acceleration of the situation is adequate. Paroxysmal tachycardia deserves special attention - an attack that begins and ends suddenly, “like a switch,” with a frequency of 150–220 per minute. Such an attack has a specific electrical cause and in many cases is cured radically.