Radu Ana Maria

8/17/2019 Radu Ana Maria

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MINISTERUL EDUCATIEI NATIONALE SI CERCETARll STllNTIFICE

SCOALA POSTLICEALA SANITARA ,,CHRISTIANA" TIRGOVISTE

DOMENIUL SANATATE SI ASISTENTA PEDAGOGICA

CALIFICAREA PROFESIONALA ASISTENT MEDICAL GENERALIST

PROIECT DE CERTIFICARE ACALIFICARll PROFESIONALE

INDRUMATOR

M.I. TOGAN MIHAELA

ABSOLVENT

RADU F. ANA- MARIA

TIRGOVISTE

2016


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INGRIJIRI ACORDATE PACIENTULUIcu

HIPERTENSIUNE ARTERIALA


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CU PRINS

ARGUMENT pag.1

CAPITOLUL I - ANATOMIA SI FIZIOLOGIA INIMll

1.1. Anatomia inimii pag.2

1.1.1.Topograi! pag.2

1.1.2.Str"#t"ra g!n!rala pag.2

1.1.$.Conig"ratia !%t!rna pag.$

1.1.&.Raport"ri pag.$

1.1.'.Conig"ratia int!rna pag.&

1.1.(.)al*"l!l! #ar+ia#! pag.(

1.1.,.Str "#t"ra inimii pag.(

1.1..)a#"lar i/atia i in!r*atia inimii. pag.

1.2.P!r i#ar+"l. pag.0

1.$. Fi/iologia inimii pag.0

1.$.1.Ci#l"l #ar+ia# a" r!*ol"tia #ar+ia#a pag.1

1.$.1.1.Mani!tari a#"ti#! pag.11

1.$.1.2.Mani!tari m!#ani#! pag.111.$.1.$.Mani!tar i !l!#tri#! pag.11

CAPITOLUL II - IPERTENSIUNEA ARTERIALA

2.1. O!initi!. Claii#ar!. Sta+iali/ar ! pag.1&

2.1.1. O!initi! pag.1&

2.1.2. Claii#ar! pag.1&

2.1.$. Sta+iali/ar! pag.1'

2.2.Epi+!miologi! pag.1'

2.$.Etiologi! pag.1(

2.&.E*al"ar! #lini#a a 3olna*"l"i #" TA pag.1,2.'.E*al"ar! para#lini#a a 3olna*"l"i #" T A. pag.1,

2.(.E*ol"ti!. Compli#atii pag.10

2.(.1. Compli#atiil! *a#"lar! pag.10

2.(.2. Compli#atiil! #ar +ia#! pag.10

2.(.$. Compli#atiil! r!nal! pag.2

2.(.&. Compli#atiil! #!r!3ro*a#"lar! pag.2

2.,.Tratam!nt. pag.2

2. , .1.Tr atam!nt"l non arma#ologi# pag.2

2.,.2. Tratam!nt"l arma#ologi# pag.21

2.,.2.1. 4i"r!ti#!l! pag.21

2.,.2.2. ln5i3itor ii a+r!n!rgi#i6 pag.212.,.2.$. )ao+ilatatoar! +ir !#t! m"#"lotrop! pag.22

2.,.2.&. ln5i3itorii !n/im!i +! #on*!ri! pag.22

2.,.2.'. ln5i3itorii r!#!ptor ilor p!ntr" angiot!nina pag.22

2.,.2.(. 7lo#ant! +! #al#i" pag.22

2.,.2.,. ln5i3itorii r !#!ptor ilor !rotonini#i pag.22

2.,.2.. A#ti*atorii #anal!lor +! potai" pag.22

2.,.$. Ta#ti#a tratam!nt"l"i anti5ip!rt!ni* pag.22

CAPITOLUL Ill - CAZURI CLINICE pag.2&

CONCLUZll pag. '0

AN E8E pag.(

7I7LIOGRAFIE


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1

ARGUMENT

ip!rt!ni"n!a art!r iala 9T A: r !pr !/inta a !#ti"n!a #ar+io-*a#"lara #!a mai

rapan+ita in pop"latia glo3"l"i i "na +intr! pro3l!m!l! !!ntial! +! anatat! in tar il!

in+"triali/at!.

ln#i+!nta TA #"noat! o #ontin"a a#!ni"n! moti*ata +! #r!t!r!a pop"lati!i

#" ri! 5ip!rt!ni* 9 mai al! a pop"lati!i *ar tni#!:; +ar i +! mo+ii#ar!a #rit!riilor

+! +iagnoti# in a#!ata a!#ti"n!.

Co3orar !a pr ogr!i*a a *alor ilor t!nional! #oni+!rat! normal!; !t!


5/79

CAPITOLUL I

ANATOMIA SI FIZIOLOGIA INIMll

1.1. An!#$ $n$#$$

Apar at"l #ar +io*a#"lar !t! ormat +in inima i it!m"l +! *a! pr in #ar !

#ir #"la ang!l! i lima. Sit!m"l #ir #"lator ang"in !t! ormat +in inima; art!r !;

#apilar ! i *!n!. El tr anporta prin art!r! ang! in#ar #at #" o%ig!n i "3tant!

n!#!ar! m!ta3olim"l"i #!l"lar ; #ar ! a


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lnima +r !apta !t! or mata +in atr i"l i *!ntr i#"l"l +r!pt; !t! inima *!noaa

+!oar!#! prin atri" pr im!t! ang!l! *!no +in #ir#"latia mar! i prin *!ntri#"l ii tr imit!

in #ir #"latia p"lmonar a. lnima tanga !t! or mata +in atr i"l i *!ntr i#"l"l tang; !t!

inima art!r iala; #ar! pr in atr i"; prim!t! ang!l! art!rial +in #ir#"latia p"lmonara i pr in

*!ntr i#"l ii trimit! in mar!a #ir#"lati!. Capa#itat!a totala a inimii !t! in m!+i! +! '-

( #m3, iar gr!"tat!a +! apro%imati* $ g.

1.1.$. Con ig "ratia !%t!rn a

lnima ar ! orma "n"i #on t"rtit; #" a%"l longit"+inal +ip" o3li# in tora#! . 0

!%tr!mitat! a a%"l"i #or!p"n+! *ar"l"i inimii i pr i*!t! ant!rior ; la tanga i in


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int!r #otal tang; p"tin m!+ial +! linia m!+io#la*i#"lara.

1.1.+. C"n($&u'!$$n!)'n

lnima +r !apta !t! al#at"ita +in atri"l i *!ntr i#"l"l +r!pt; +o"a #a*itati #" p!r !ti

in!gali #a gr oim!. 4atorita ar#inilor #ontr a#til! +i!rit! p!r !t!l! atrial !t! m"lt mai

"3tir ! +!#at !!l *!ntr i#"lar. C!l! +o"a #a*itati #om"ni#a intr ! !l! pr in orii#i"l 9oti"l:

atrio*!ntri#"lar +r!pt pr !*a/"t #" *al*a atrio*!ntri#"lara +r !apta a" tri#"pi+a. 4in

*!ntr i#"l"l +r!pt pl!a#a tr"n#5i"l p"lmonar pr !*a/"t #" *al*"l!l! !mil"nar !.

Atri"l +r !pt; +!i or m!a/a o #a*itat! "ni#a !t! "3ampartit p! 3a/a +!/*oltarii

ontog!n!ti#! i a tr"#t"r ii p!r !t!l"i in 6 in""l *!no i atr i"l pr opi"-/i; #ar ! tr imit!

pr!l"ngir!a n"mita "r !#5i"a a" a"r i#"l"l +r!pt. Sin""l *!no !t! part!a atri"l"i

+r !pt #"prina intr! or ii#iil! +! *arar! a *!n!i #a*! "p!rioar ! i *!n!i #a*! in !rioar !

i ar! p!r !tii n!t!/i. El !t! +!partit +! atr i"l pr opi"-/i prin ant"l t!rminal la "pr aata

#ar "ia ii #or!p"n+! la int!r ior #r!ata t!rminala +! p! p!r!t!l! ant!r ior al a#!t"ia

9an!%a $:. Atr i"l propr i"-/i ar ! p!r!tii mai groi +!#at in""l *!no i pr!/inta p!

ata int!rioara; tra3!#"l! m"#"lar! p!rp!n+i#"lar ! p! #r!ata t!r minala; ormat! +!

m"#5ii p!#tinati. P! !pt"l int!ratr ial; it"at pot!r ior +!oar!#! atr i"l +r!pt !t! ant!r ior

ata +! !!l tang in r !gi"n!a ot!i ga"r i o*al! 97ot5aA: ! ala oa o*ala marginita

+! lim3"l o!i o*al!. Orii#i"l +! +!#5i+!r ! a *!n!i #a*! in!r ioar ! In antr i" !t!

pr !*a/"t #" o mi#a *al*"la; +!n"mita *al*"la *!n!i #a*! in!r ioar!. P! langa #!l! +o"a

*!n! #a*!; in antr i"l +r !pt ! +!#5i+! in""l #oronar ; #ar! a+"#! ang!l! *!no +in

p!r!tii inimii. Or ii#i"l a" !t! pr!*a/"t #" *al*"la in""l"i #oronar 9T5!3!i":.

M!+ial +! a#!t orii#i" "3 !n+o#ar + ! ga!t! no+"l"l atrio*!ntr i#"lar 9 A#5o-

TaBara:; iar la ni*!l"l ant"l"i t!r minal; in apropi!r!a *ar arii *!n!i #a*!; "p!rioar! in

antri"; "3 !pi#ar+ ! ala no+"l"l inoatr ial 9!it5-Fla#D:.

)!ntri#"l"l +r !pt !t! !t! al#at"it +in #a*itat!a *!ntri#"l"i pr opi"-/i i #on"l

art!r ial; pr ima r!pr!/!ntan+ part!a +! r!#!pti! a ang!l"i iar #on"l ant!rial part!a +!

!*a#"ar!. P!r !t!l! *!ntri#"l"l"i pr opi"-/i !t! m"lt mai gro +!#at al atri"l"i i pr !/inta

p! "praata a int!rna n"m!roa! r!li!"ri r i+i#at! +! mio#ar + orman+ aa n"mit!l!

tra3!#"l! #arnoa! i m"#5ii papilar i. Pr !/!nta tra3!#"l!lor a*ori/!a/a o mai 3"na

golir ! in timp"l itol!i. Tr a3!#"la !ptomar ginala l!aga !pt"l int!r*!ntri#"lar +!

p!r!t!l! ant!r ior i m"#5i"l papilar ant!r ior . M"#5ii papilar i 9ant!r ior ; pot!rior i

!ptaA +"pa n"m!l! p!r !tilor :; a" 3a/a i%ata In p!r!t!; iar #!alalta !%tr !mitat! ! l!aga;

prin #or +a

Can"l art!rial al *!ntr i#"l"l"i +r!pt r!pr!/inta lo#"l +! or igin! a tr "n#5i"l"i

art!r !i p"lmonar !. El !t! +!partit +! #a*itat!a *!ntri#"l"l"i propi"-/i printr -o

#r !ata


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m"#"lara groaa +!n"mita #r !ta "pra*!ntri#"lara. P!r !tii #on"l"i art!r ial "nt n!t!/i

ar a tra3!#"l!. Tr"n#5i"l p"lmonar !t! pr!*a/"t la origin! #" tr!i *al*"l! !mil"nar !

9ant!r ioara; +r!apta i tanga: #ar! impi!+i#a r!intoa#!r!a ang!l" i in *!ntri#"l in

timp"l +iatol!i *!ntr i#"lar !. El! a" or ma "n"i #"i3 +! ran+"ni#a #" #on#a*itat!a in "

i p! margin!a lor li3!ra ! ala #at! "n mi# no+"l 6 no+"lii *al*"l!lor !mil"nar!

9Morgagni:.

Orii#i"l a" oti"l atr io*!ntri#"lar +r!pt !t! pr !*a/"t #" *al*a atr io*!ntr i#"lara

+r !apta a" *al*a tri#"pi+a. A#!ata !t! ormata +in tr!i *al*"l! a"

#"pi+! 9ant!r ioar a; pot!rioar a i !ptala : #ar! pr in 3a/a lor ; ! pr in+ p! in!l"l i3r!

+! p! #ir#"m !rinta oti"l"i i prin #or +a

ang!l! lo*!t! ata pari!tala a #"pi+!lor ; #ar ! apropiin+"-! in#5i+ oti"l

atrio*!ntri#"lar . In timp"l itol!i; #"pi+!l! n" pot i impin! in atri"; +!oar!#! #or+a

t!n+inoa! ! l!aga +! m"#5ii papilar i. Oti"l atr io*!nti#"lar iin+ in#5i; ang!l! n"

poat! l"a +!#at ing"ra #al! poi3ila; a#!!a pr! #on"l art!rial i tr"n#5i"l p"lmonar

pr in +!#5i+!r!a *al*!lor art!rial! a" !mil"nar !.

lnima tanga !t! al#at"ita +in atri"l i *!ntr i#"l"l tang #ar! #om"ni#a intr! !l!

pr in oti"l atio*!ntr i#"lar tang. A#!t orii#i"; !t! pr!*a/"t #" *al*a atr io*!ntri#"lara

tanga a" 3i#"pi+a. 4in *!ntri#"l"l tang pl!a#a art!ra aorta #ar! pr!/inta la or igin!

*al*"l!l! !mil"nar!. Atr i"l tang ar! p!r!t!l! +! groim! apr o%imati* !gala #" a#!!a a

p!r!t!l"i atr i"l"i +r!pt. In !l ! +!#5i+ #!l! & *!n! p"lmonar! 92 *!n! p"lmonar !

+r !pt! i 2 tangi: #ar! a+"# +! la plamani ang! in#ar #at #" o%ig!n 9art!rial:.

S"praata int!rna a p!r!t!l"i atr ial !t! n!t!+a; #" !%#!ptia pr!l"ngirii al!; +!n"mita

"r!#5i"a a" a"ri#"l tang; a #ar !i "pr aata pr!/inta r !li!"ri m"#"lar! ormat! +!

m"#5ii p!#tinati. A"r i#"l"l tang in#on #"pi+!l! *al*!i atr io*!ntri#"lar! tangi. Con"l art!r ial apartin! p!r!t!l"i ant!rior al

*!ntr i#"l"l"i tang; ar! "pr aata n!t!+a; !t! mai #"rt; #a !!l +r!pt i ! #ontin"a #"

art!ra aorta.

'


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,

M io#ar+"l a" m"#5i"l #ar +ia# orm!a/a tr at"l !!l mai gro al p!r !t!l"i inimii.

Str"#t"r a a mi#r o#opi#a !t! #ompar ata #" "n in#iti"; iin+ or mata +in #!l"l!

!parat!. La ni*!l"l atr iilor a#i#"l!l! +! i3r! mio#ar +i#! "nt +ip"! #ir #"lar i

orm!a/a "n tr at mai "3tir! #ar ! n" ! #ontin"a #" m"#"lat"ra *!ntr i#"l!lor . In

*!ntr i#"l! a#i#"l!l! m"#"lar !; a" o +ipo/iti! parti#"lara; #" +ir!#ti! o3li# - piralata;

orman+ pr! *ar ; *art!


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a *!ntr i#"l"l"i tang. Fi3r !l! r !t!l!i patr "n+ in mio#ar + pr intr ! i3r!l! m"#"lar !.

1.1.. Vcul'$!$ $ $n)'/!$ $n$#$$

lnima !t! "n organ 3ogat *a#"lar i/at; ap!#t #on+itionat +! a#ti*itat!a ritmi#a;

n!intr!r "pta; a mio#ar+"l"i; #ar ! intr-o ora pomp!a/a in #ir#"lati! & litr i ang!; iar in

+!#"r +! o /i 1. litr i ang!. A#ti*itat!a m!ta3oli#a #r!#"ta a mio#ar +"l"i n!#!ita

+!#i "n mar! aport +! ang!; #ar! ! r !ali/!a/a prin art!r !l! #or onar ! tanga i

+r!apta.

Art!ra #or onar a tanga ia nat!r! +in aorta la ni*!l"l in""l"i )ala*a tang i;

+"pa "n #"rt trai!#t a


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9

3atail! inimii i pro+"#! *ao#ontri#tia #or onar !lor. Fi3r!l! !n/iti*!; #!l! mai m"lt!

impati#!; "nt n"m!roa! In !pi#ar + i !n+o#ar+.

1.*. P)'$c'0ul

P!ri#ar +"l !t! "n a# i3ro!ro #ar! a+apot!t! inima. P!ri#ar +"l i3r o

9t"ni#a i3roaa: or m!a/a tr at"l !%t!rn al p!ri#ar+"l"i; #ar ! ! i%!a/a #" 3a/a p!

#!ntr "l t!n+ino al m"#5i"l"i +iaragm; iar *ar"l ! #ontin"a #" t!"t"l #on


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t!"t"l"i no+al +! a tranmit! "n+a +! !%#itati! g!n!rata la ni*!l"l no+"l"l"i inoatr ial.

4! la no+"l"l inoatr ial "n+a +! +!polar i/ar! ! pr opaga in mio#ar +"l atr iilor ; g!n!ran+

itola atr iala; apoi a

2 )4c$!3$l$!!), !t! propri!tat!a mio#ar +"l"i +! a rap"n+! pr intr-

o #ontr a#ti! la tim"li a+!#*ati 9tim"li #" int!nitat! prag:.

2 c"n!'c!$l$!!), !t! propr i!tat!a mio#ar +"l"i +! a ! #ontra#ta #a

"rmar! a "n+!i +! +!polari/ar! +!#ar #at! ritmi# +in no+"l"l inoatrial. Forta +!

#ontra#ti! a inimii +!pin+!; pana la o an"mita limita; +! l"ngim!a initiala a i3r !i

mio#ar +i#!.

2 !"n$c$!!), !t! o pro3l!ma #ontro*!rata +!oar!#! noti"n!a +! ton";

+!in!t! tar !a +! #ontr a#ti! "tin"ta prin #ar! "n m"#5i ! op"n! "n!i intin+!r i

"plim!ntar! .

1..1. C$clulc'0$c-u ')/lu!$ c'0$c

A#ti*itat!a #ar+ia#a !t! #ara#t!ri/ata printr-"n n"mar +! apro%imati* , #i#l"ri

p! min"t? pr in #i#l" a" r!*ol"ti! #ar +ia#a +!inin+"-! o #ontra#ti! 9itola: i o

r!la%ar ! 9+iatola:. Sitola i +iatola ! +! aoara im"ltan la ni*!l"l #!lor +o"a inimi;

+ar #ontra "nor gr a+i!nt! pr!ional! +i!r it!.

Ci#l"l #ar+ia# ! #omp"n! +in6

itola atr iala - +"r !a/a ; 1 O !# i in#!p! la ni*!l"l no+"l"l"i

inoatrial +! "n+! ! tranmit! pr! orii#i"l atr io*!ntr i#"lar i pro+"#! +!#5i+!r !a

*al*"l!lor atr io*!ntri#"lar ! #" paaart!ra p"lmonara. Ca "rmar! a !%p"l/i!i #r !t! pr!i"n!a in art!r! 912' mmg in aorta

i 2 mmg in art!ra p"lmonara:.

+iatola *!ntr i#"lara ...-. +"r !a/a ;'$ !#? #a+!r!a pr!i"nii

intr a*!ntr i#"lar! "3 #!a +in art!r ! +!t!rmina in#5i+!r!a *al*"l!lor !mil"nar ! i

*!ntr i#"lii +!*in iar #a*itati in#5i!.


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S#a+!r !a pr !i"nii intr a*!ntr i#"lar ! #ontin"a i ! +!#5i+ *al*"l!l! atrio*!ntr i#"lar !.

+iatola g!n!r ala --+ +"r!a/a ;& !#; !t! #om"na atr iilor i

*!ntri#"l!lor ? in timp"l !i ang!l! ! #"rg! pai* +in atr ii in *!ntr i#"l!.

Mani !tar il! #ar ! inot!# #i#l"l #ar+ia# "nt6 a#"ti#!; m!#ani#!; !l!#tri#!.

1..1.1. Mn$( )-!'$ cu-!$c)

A#ti*itat!a m!#ani#a a #or+"l"i +!t!rmina /gomot! #ar ! pot i a"/it! +a#a !

apli#a "r !#5!a a" "n t!to#op in /ona pr!#or +iala i pot inr!gitrat! grai# +a#a

"nt #"l!! +! "n mi#r oon i tr anmi! printr -"n it!m amplii#ator "n"i o#ilogra

9ono#ar+iograma:.

In mo+ o3in"it ! a"+ +o"a /gomot! #ar+ia#!6

/gomot"l I --+ !t! pr!l"ng; #" tonalitat!


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3ipolar ... #" 2 !l!#tro/i !%plorator i.

4!r i*atiil! "nipolar ! al! m!m3r!lor ! o3tin #on!#tan+ pol"l po/iti* al

gal*anom!tr"l"i #" "n !l!#tro+ a!/at p! ran+ p! i!#ar! +in #!l! tr!i m!m3r! 9!l!#tro+

!%plor ator :; pol"l n!gati* iin+ #on!#tat #" "n !l!#tro+ a!/at #at mai +!part! +! inima

i n"mit !l!#tro+ in+i !r!nt6

a)R - +!r i*atia "nipolar a a 3rat"l"i +r !pt

a)L - +!r i*atia "nipolara a 3r at"l"i tang

a)F ... +!r i*atia "nipolara a pi#ior"l"i tang.

Un+! a im3oli/!a/a #on+"#!r!a amplii#ata; ) !t! "n im3ol #ar! +!!mn!a/a

+!ri*atiil! "nipolar ! al! m!m3r!lor ; iar lit!r !l! R 9r ig5t = +r!apta:; L 9l!t = tanga: i F

9oot = pi#ior : r !pr!/inta pr!#"rtaril! "nor #"*int! +! origin! !ngl!/a; #ar! ar ata lo#"l

"n+! ! apli#a !l!#tr o+"l !%plorator .

4!ri*atiil! pr!#or+ial! "nt +!r i*atii "nipolar! #ar! inr!gitr !a/a +i!r !nt!l! +!

pot!ntial +in r!gi"nil! mio#ar+i#! it"at! "3 !l!#tro+"l !%plorator .

Amplit"+ in!a +! l!%i"nilor !t! mai mar ! +!#at in +!r i*atiil! m!m3r !lor ;

+!oar !#! !l!#tro+"l !%plor ator !t! a!/at mai apr oap! +! inima.

P"n#t!l! +! !%plorar! "nt in n"mar +! a!; iar +!ri*atiil! pr im!# ca im3ol

lit!ra )6

)1 - !%tr!mitat!a int!rna a #!l"i +! al I)-l!a pati" int!r #otal +r!pt

)2 - !%tr !mitat!a int!rna a #!l"i +! al I)-l!a pati" int!r#otal tang

)3 - la


16/79

T!mp!rat"r a #am!r!i a i! +! #!a 2C. T!g"m!nt!l! *or i +!gr !at! #" al#ool; iar

!l!#tro/ii p"i in #onta#t #" m!m3r !l! p! r!gi"ni n!paroa!; pr in int!rm!+i"l "nor aii

+! pan/a "+at! #" ol"ti! alina 9#lor"ra a" 3i#ar3onat +! o+i":. Aparat"l ! p"n! in

#onta#t #" "r a +! #"r !nt; ! #ontrol!a/a "n#tionar !a; ! i%!a/a !l!#tro/ii i !

pro#!+!a/a la inr !gitrar!. 4"pa !%am!n ! r!tr ag !l!#tro/ii i ! #"r ata. P!ntr"

i!#ar! 3olna* ! not!a/a n"m!l!; *arta; pro !ia; +iagnoti#"l #lini#; +a#a a l"at

m!+i#am!nt! #ar ! pot inl"!nta ECG 9+igitala; #5ini+ina:.

El!#tr o#ar+iograma normala pr !/inta o !ri! +! +!l!%i"ni 9"n+!:; !gm!nt! i

int!r*al! 9an!%a &:. 4!l!%i"nil! ! n"m!# P; JRS i T. S!gm!nt!l! "nt porti"ni +!

tr a!" #"prin! intr! "n+!6 PJ i ST; iar int!r*al!l! "nt porti"ni +! tr a!" #ar! #"prin+

"n+! i !gm!nt! PJ i JT.

Un+a P r !pr!/inta pro#!"l +! +!polari/ar! atr iala. Ar! o orma rot"n


17/79

CAPITOLUL II

HIPERTENSIUNEA ARTERIALA

*.1. D)($n$!$). Cl-$($c'). S!0$l$')

*.1.1. D)($n$!$)

In !n i/iologi# n" ! poat! *or3i +! 5ip!rt!ni"n! art!riala #i +! t!ni"n!a

art!riala a i!#ar"i in+i*i+? ina +in p"n#t +! *!+!r! m!+i#al t!rm!n"l +! in!t!

#r!t!r!a *alorilor t!nional! +in#olo +! #ar ! #r!t! ri#"l apariti!i "nor #ompli#atii in

;;organ!l! tinta 9rini#5i; #or+; #r !i!r :.

St"+ii !pi+!miologi#! !%t!ni*! a*an+ #a #op ta3ilir !a limit!i intr! *aloril!

normal! i patologi#! al! t!ni"nii art!r ial!; pr i*ita prin pr ima r i#"l"i #ar+io*a#"lar a"

ot !!#t"at! +! OMS i +! Koint National Commit!! 9 KNC:. At!l +"pa "ltim"l raport

p"3li#at +! KNC ! #oni+!ra #a *alori normal! t!nional!; *aloril! it"at! intr! 11-

1$=('-' mmg? #onorm a#!t"i raport TA !t! +!inita #a o #r!t!r! p!rit!nta a

*alorilor t!nional! p!t! 1&=0 mm g 9a#!t! *alori "nt #or!lat! #" *arta

pa#i!nt"l"i:.

*.1.*. Cl-$($c' )

ip!rt!ni"n!a art!r iala ! #laii#a p! 3a/a a +o"a #r it!rii ma


18/79

15

---. #ir#"mtant!6 pa#i!nt"l n" a #on"mat #a!a in ora pr !#!+!nta; n" a

"mat #" 1' min in "r ma; #a3in!t m!+i#al #al+; linitit; p!ntr" a limita ;;! !#t"l +! 3l"/a

al3a

!#5ipam!nt6 groim!a man!t!i a n" +!pa!a#a 2=$ +in l"ngim!a 3rat"l"i;

manom!tr" *!rii#at la ( l"ni t!5ni#a6 +o"a +!t!rminar i la i!#ar ! *i/ita; patiat! la #at!*a min"t! i tr !i

!t"ri +! +!t!r minari la !!l p"tin o aptamana int!r*al. La pa#i!nt"l no" pr!/!ntat !

a# +!t!rminar i la am3!l! 3r at! i ! ia in #oni+!rati! #!a mai mar ! *aloar ! gaita.

La *alori t!nional! ri+i#at!; in p!#ial la pa#i!ntii "3 $ ani; ! a# +!t!rminari

i la m!m3r!l! in !r ioar!

#or!#tit"+in!a +!t!rminarii6 ! "m la r api+ man!ta pana la *aloar! #"

2 mmg mai mar! #a T AS i ! +!"mla #" $mm=!#"n+a.

+a#a la pr ima *i/ita *alor il! t!nional! gait! "nt oart! mar i; 3olna*"l *a i

#oni+!r at 5ip!rt!ni*

*.1.. S!0$l$')

OMS prop"n! in 100$ "rmatoar!a ta+iali/ar !; #ar ! n" tin! #ont +! *aloril!

t!nional! #i +! l!/i"nil! organi#! pr o*o#at! +! 5ip!rt!ni"n! art!riala in organ!l! tinta6

2 !0$ul I - ara !mn! +! a!#tar! a or gan!lor tinta

2 !0$ul II - pr!"p"n! 5ip!rtroi! *!ntri#"lar a tanga +!montrata

!#ograi#; !l!#tro#ar+iograi# i ra+iologi#; !%am!n"l "n+"l"i +! o#5i #" mo+ii#ari +!

gra+"l I a" II; prot!in"ri! minima i=a" #r !t!r ! "oara a #r!atinin!i

2 !0$ul Ill - pr!"p"n! in"i#i!nta *!ntri#"lar a tanga a" in"i#i!nta

#ar+ia#a glo3ala; !%am!n"l "n+"l"i +! o#5i #" mo+ii#ar i +! gr a+"l Ill; a!#tar!

#!r!3ra la #" 5!moragi! intr a#!r!3rala; #!r!3!loaa a" +! tr "n#5i #!r!3r al;

!n#!alopati! 5ip!rt!ni*a i a!#tar ! r!nala #" pr ot!in"ri!; mi#ro5!mat"ri! i=a"

in"i#i!nta r!nala.

T A maligna a" a##!l!r ata; #a orma parti#"lara #" "rmatoar !l! #rit!rii +!

+!inir!6 *alor i al! TA4 mai mari a" !gal! #" 1$ mmg; in"i#i!nta

#ar+ia#a; !%am!n"l "n+"l"i +! o#5i #" mo+ii#ari gra+"l Ill a" I); in"i#i!nta r !nala

progr !i*a; a##i+!nt #!r!3ro*a#"lar a" !n#!alopati! 5ip!rt!ni*a i r !/it!nta

r !lati*a la tratam!nt.

*.*. E%$0)#$"l"&$)

ln#i+!nta T A #"noat! o #ontin"a a#!ni"n! moti*ata +! #r !t!r !a pop"lati!i

#" ri! 5ip!rt!ni* 9mai al! a pop"lati!i *artni#!:; +ar i +! mo+ii#ar !a #rit!r iilor

+! +iagnoti# in a#!ata a!#ti"n!.


19/79

Co3orar!a progr !i*a a *alorilor t!nional! #oni+!r at! nor mal!; !t! +in p!roan!l! p!t! & ani i &> +in p!roan!l! p!t! (&ani.

Fr !#*!nta !t! r!lati* !gala p! !%!? +"pa *ar ta +! ( ani in#i+!nta !t! mai

mar! la !%"l !minin. Rapan+ir !a g!ogr ai#a !t! in!gala; *ar iatiil! iin+ in raport #"

#on+itiil! o#io-!#onomi#!; g!ograi#!; ol; apa.2.3. E!$"l"&)$

In a3!nta "n!i !tiologii #!rt!; in pro+"#!r !a 5ip!rt!ni"nii art!rial! !!ntial!;

! a#or+a at!nti! "r matorilor a#tor i6 !r !+itat!; *ar ta; !%; raa; a#tor i +! m!+i";

o3!/itat!; al#ool; #a!a; ao#i!r ! #" alt! tari mor3i+!

Er!+itat!a - ri#"l amilial al 5ip!rt!ni"nii art!r ial! !t! apr !#iat la $-(>. N"

! #"noat! tr anmit!r!a g!n!ti#a +! tip m!n+!lian; +ar "nt r!#"no#"t! +i!rit!

anomalii #!l"lar! tranmi! g!n!ti#; anomalii #" r i! #r!#"t in patog!nia 5ip!rt!ni"niiart!r ial!.

)ar ta - in#i+!nta ma%ima ! it"!a/a +"pa ( ani; ina #r!t!r!a *alorilor

t!nional! #" '-1 mmg=an n" mai !t! #oni+!rata "n pro#! i/iologi#.

S!%"l - n" !t! #oni+!rat a#tor +!t!r minant? TA !t! mai p"tin r!#*!nta i

!*!ra la !m!i pana la m!nopa"/a.

Raa - 3oala !t! mai r!#*!nta la raa n!agra; pro3a3il prin r!t!nti! +! o+i";

#a m!#anim a+aptati* la #on+itiil! +! #lima.

Aport"l +! o+i" - r!latia intr ! aport"l alim!ntar +! o+i" i TA !t! #lar

+!montrata; ina; #on"m"l #r!#"t +! o+i" !t! a#tor +! ri!; +a#a ! ao#ia/a

"nor anomalii pri*in tr anport"l tram!m3ranar al o+i"l"i.

Aport"l +! #al#i"; potai" i man!/i"- +i!ta #ar !ntata in ao!ti ioni

a*or i/!a/a apar itia 5ip!rt!ni"nii art!r ial!.

O3!/itat!a - !t! #or !lata +ir!#t #" in#i+!nta 5ip!rt!ni"nii art!r ial! mai al!

#an+ "r*in! la #opii i a+ol!#!nti.

Con"m"l +! al#ool - a*ori/!a/a pro+"o!r!a 5ip!rt!ni"nii art!rial!; #5iar i in

+o/! mi#i.


20/79

17

F"mat"l H #r !t! *alor il! t!nional! pr in +!#ar #ar ! +! nor a+r!nalina? in timp

#ompli#a 5ip!rt!ni"n!a art!riala.

Con"m"l +! #a !a H #r !t! a#"t *alor il! t!nional!? in timp ! intal!a/a

tol!r anta.

S!+!ntar im"l H #r!t! r i#"l intalar ii 5ip!rt!ni"nii art!rial!; ao#iat #"

o3!/itat!a.

Fa#torii pi5o!motionali 9tr !: H #r !# ri#"l 5ip!rt!ni"nii art!rial! in ao#i!r!

#" #!ilalti a#tor i.

Ao#i!r ! #" alt! tari mor3i+! H +ia3!t"l /a5ar at; 5ip!r"ri#!mia; at!ro#l!ro/a i

poli#it!mia *!ra #r !# +! 2-$ or i ri#"l 5ip!rt!ni"nii art!r ial!.

*.5. E/lu' ) cl$n$c 3"ln/ulu$ cu HTA

E*al"ar!a #lini#a a 3olna*"l"i #" 5ip!rt!ni"n! art!riala par #"r g! "rmatoar!l!

!tap!6 itor i# ! *a a*!a in *!+!r ! *arta +! +!3"U+!#op!rir ! a 3olii; *ar iatiil!

pontan! i "3 tratam!nt al! *alorilor t!nional!; t"l3"rar il! "n#tional! atr i3"it! 3olii;

!mn!l! i imptom!l! +! a!#tar! a organ!lor tinta 9angina p!#torala; t"l3"rar i +! r itm;

+ipn!!; *!rti


21/79

E%plor ar!a initiala *a #"pr in+!6

!%am!n "mar +! "rina6 o pr ot!in"r i! minima ! poat! intalni atat in T A

!!ntiala n!tratata #at i in TA +! #a"/a r!nala? !+im!nt"l "r inar ; +!nitat!a i

omolaritat!a "rinara ori!nt!a/a +iagnoti#"l.

5!mato#rit"l6 !t! !%am!n o3ligatori" la 5ip!rt!ni*ii pl!tori#i i poat!

i !mnii#ati* #r!#"t in poli#it!mia *!ra.

#r!atinin!mia i=a" "r!!a ang"ina6 "rni/!a/a inormatii a"pra gra+"l"i +!

a!#tar! r!nala

pota!mia6 pro3a in+ip!na3ila p!ntr " 5ip!rt!ni"n!a !n+o#rina pr in

5ip!ral+ot!ronim !t! "tila i in #on+"ita t!r ap!"ti#a

gli#!mia; #ol!t!r ol!mia; trigli#!ri+!mia i a#i+"l "ri#; a+"# +at! "til!

in ta3ilir !a a#torilor +! r i! m!ta3oli#.

!%am!n"l "n+"l"i +! o#5i ! !#t"at la or i#! 5ip!rt!ni*; a+"#! inormati i

a"pra !*!ritatii i +"rat!i 5ip!rt!ni"nii art!rial!. Mo+ii#ar il! *a!lor r !tini!n!

r !l!#ta in 3"na part! mo+ii#aril! *a!lor #!r!3ral! i pot i #laii#at! in & ta+ii6

-- ta+i"l I6 art!r iol! #" l"m!n r !+"; pati#!; in"oa!; in;; ir +! #"pr";

*!n"l! piralat!

-- ta+i"l II 6 art!r ! #l!r oa! ; #" #ali3r" n!r!g"lat; *!n! +ilatat! 9pr!/!nta

!mn"l"i in#r "#iar ii art!r io-*!noa! +!#r i +! Sall"- G"nn:

-- ta+i"l Ill6 la !l!mnt!l! ta+i"l"i II ! a+a"ga !+!m r !tinian; 5!moragii

r!tini!n! .. in la#ar a p!r i*a#"lar ! i !%"+at! +!t!rminat! +! r "pt"ra *a!lor mi#i.

-- ta+i"l I)6 art!r ! iliorm!; *!n! oart! +!tin!; 5!moragii ;;in pan/a i

!%"+at! intin!; !+!m ma#"lar ; papilar i p!r ipapilar.Mo+ii#ar il! +in a#!t ta+i" "nt

p!#ii#! T A !*!ra #" !*ol"ti! maligna.S! imp"n! pr!#i/ar!a; #a ni#i "na +in a#!t!

mo+ii#ari n" "nt patognomoni#! 5ip!rt!ni"nii art!rial!.

ra+iogr aia tora#i#a poat! r!l!*a al"ngir!

a i=a" 3om3ar!a ar #"l"i in !rior tang; #ar+om!gali!

!#ograi! #ar+ia#a tin+! a +!*ina !%am!n o3ligatori" +atorita mar ii al!

!ni3ilitati i p!#ii#itati in +!pitar !a 5ip!rtr oi!i *!ntr i#"lar ! tangi

!l!#tro#ar+iograma; +!i mai p"tin !ni3ila #a !#o#ar+iogr ama; p"n! in

!*i+!nta !mn! +! 5ip!rtr oi! *!ntr i#"lara tanga; 5ip!rtroi! atr iala tanga;

mo+ii#ari i#5!mi#! !#"n+ar !.

C!l mai "tili/at #r it!r i" !t! in+i#!l! +! *olta< SoDoloB-L@on. Foart! oloit !t!it!m"l imaginat +! Rom5ilt i Et!; #ar! apr !#ia/a 5ip!rtroia *!ntri#"lara tanga

p!


22/79

3a/a "n"i #or #! ia in #oni+!rati! atat #rit!riil! +! *olta< #at i mo+ii#ar il! !gm!nt"l"i

ST i al! "n+! P.

!%plorari para#lini#! #ompl!m!ntar!6 "nt n!#!ar! la "n gr"p limitat

+! 5ip!rt!ni*i; #ar! n!#!ita o !*al"ar! p!#iala p!ntr " +iagnoti#"l T A

!#"n+ar !.

*.6. E/"lu!$). C"#%l$c!$$

P!ntr " T A pr!#o#! +!pitata i #or!#t tr atata itor ia nat"r ala !t! !mnii#ati*

#5im3ata; in !n"l r!+"#!rii mor 3i+itatii i mortalitatii. T A !!ntiala ar ! +! r !g"la o

!*ol"ti! l"nga; p! /!#i +! ani pana la ta+i"l #ompli#atiilor !*!r !. E*ol"tia 3olii poat! i

mo+ii#ata prin tratam!nt in !n"l intar/i!rii apariti!i #ompli#atiilor a" #5iar a r !gr !i!i

lor . 7oala n" ar! ina in*aria3il o !*ol"ti! progr !i*a? t"+ii !pi+!miologi#! !%tin!

ar ata #a "3 tr atam!nt !i#i!nt apro%imati* 1> +in 3olna*i +!*in normot!ni*i p! timp

n!limitat. In !*ol"tia T A pot a apara #ompli#atii in +!o!3i la ni*!l"l organ!lor ;;tinta6

#or +; rini#5i; o#5i; #r!i!r.

*.6.1. C"#%l$c!$$l) /cul') apar r!lati* pr!#o#! i r!#*!nt ; a!#tan+

art!r!l! mari; art!r !l! mi#i i art!riol!l!6

at!ro#l!ro/a a##!l!rata r!pr!/inta "n pro#! +i "/ lo#ali/at la ni*!l"l t"ni#ii

m!+ii i r!pona3il +! +ilatar !a i r igi+i/ar!a art!r!lor mari

r !mo+!lar!a *a#"lara 5ip!rt!ni*a ! pro+"#! la ni*!l"l art!r !lor +! #ali3r"

m!+i" i a art!r iol!lor i #"pr in+! 5ip!rtroia art!r iala 95ip!rtr oia i3r !lor m"#"lar !

n!t!+!:; art!rio#l!ro/a 5ialina 9+!po/it "3!n+ot!lial +! gli#opr ot!in!; i3rina; lipi+!

i #olag!n:; 5ip!rpla/ia intimala pron"ntata i n!#ro/a i3rinoi+a 9in TA maligna:

*.6.*. C"#%l$c!$$l) c'0$c) "nt #"no#"t! "3 n"m!l! +!

#ar+iopati! 5ip!rt!ni*a i ! r!!ra la 5ip!rtroia *!ntr i#"lara tanga i la

#on!#int!l! al!. T!rm!n"l +! #ar +iopati! 5ip!rt!ni*a r!"n!t! a#tor "l

mio#ar +i# 95ip!rtroia *!ntri#"lara tanga: i !!l #or onar ian6

5ip!rtroia *!ntr i#"lar a tanga poat! i #on#!ntri#a 9n!inotita +! +ilatar !

#a*itara:; !%#!ntr i#a 9+ilatati*a: i aim!tr i#a +! !pt 9ingr oar ! i/olata a !pt"l"i

int!r*!ntri#"lar :.

alt!r ar !a #ir#"lati!i #oronar i!n! ! a#! i! pr in p!rt"r3ar !a *aomotr i#itatii;

i! prin l!/i"nil! tr"#t"ral! +! tip art!riopati! 5ip!rt!ni*a.

Car+iopatia 5ip!rt!ni*a !*ol"!a/a #atr! tr!i tip"ri +! mani!tari6

in"i#i!nta #ar +ia#a +! #a"/a 5ip!rt!ni*a- !t! r !lati* r!#*!nta i !

pro+"#! atat prin 5ip!rtroi! i +ilatati! *!ntr i#"lara #at i prin a!#tar ! #oronar iana

aritmiil! -+ r!#*!nt *!ntr i#"lar!.

i#5!mia mio#ar+i#a -+ mani!tata #a angina p!#torala a" inar#t.


23/79

*.6.. C"#%l$c!$$l) ' )nl) "nt +!p!n+!nt! +! ni*!l"l i +"rata T A; pr !#"m

i +! parti#"lar itatil! #ir #"lati!i r!nal!. El! "nt6

art!rio#l!r o/a 5ip!rt!ni*a - a!#t!a/a art!r!l! int!rlo3"lar ! i art!riol!l!

a!r !nt! i r !ali/!a/a n!roangio#l!r o/a 5ip!rt!ni*a

at!ro#l!ro/a +! art!r a r !nala - poat! ti "ni a" 3ilat!rala i prin i#5!mia

#on!#"ti*a agra*!a/a !*ol"tia 3olii

alt!r ari t"3"lar ! --+ "nt atroii t"3"lar ! progr !i*!

mo+ii#ari int!r titial!- pr in inlamati! i #l!ro/a

*.6.5. C"#%l$c!$$l) c)')3'"/-cul') "nt intalnit! #" o rata +! & or i mai

mar ! +!#at la normot!ni*i i "nt r!pr !/!ntat! +!6

!n#!alopatia 5ip!rt!ni*a - r !lati* r ara? !t! #ompli#atia tipi#a a TA

malign!

5!moragiil! intra#!r !3r al! - r !pr !/inta 2> +in total"l a##i+!nt!lor

#!r !3ro*a#"lar ! i r!#"no# +r !pt prin#ipal a#tor T A.

inar#t!l! #!r!3ral!

ata#"r il! i#5!mi#! tran/itorii - +!init! #a t"l3"r ari "n#tional! r !*!r i3il! in

2& or !; "nt r !#*!nt! la 5ip!rt!ni*i

in ar#t!l! la#"nar ! -- "nt mani!tari n!"rologi#! aproap! p!#ii#

5ip!rt!ni*!.

2. 7. T'!#)n!

Program! +! tratam!nt larg a##!ptat! +! OMS pr!#i/!a/a "rmatoar !l! o3i!#ti*!

t!r ap!"ti#!6

r !+"#!r!a *alor ilor t!nional! #atr! limit! normal!

r!+"#!r !a mor 3i+itatii i mortalitatii ao#iat! T A

#ontrol"l altor a#tori +! r i! #ar+io*a#"lari mo+ii#a3ili.

A#!t! o3i!#ti*! pot ti atin! prin mi


24/79

*a#"lar! p!r i !ri#!? r!+"#!r !a aport"l"i +! ar ! "3 2g=/i pro+"#! #a+!r ! *ol!mi#a;

+ar !t! gr !" a##!ptata +! 3olna*i

r!+"#r !a gr!"tatii #orpor al! prin r !gim 5ipo#alori# i !%!r #itii i/i#! r !g"lat!

!t! ma"r a t!r ap!"ti#a !!ntiala; a#tionan+ po/iti* a"pra a#torilor +! ri!

#ar +io*a#"lari

"plim!ntar!a potai"l"i i #al#i"l"i in #on+itiil! r!+"#!rii aport"l"i o+at;

+imin"a *alor il! t!nional!

alim!ntatia #" #ontin"t #a/"t lipi+i# !t! in+ip!na3ila la p!r oan!l!

5ip!rt!ni*! #" +ilipi+!mi!

r!tr i#tia +! al#ool ar! ! !#t 5ipot!nor #!rt mai al! ao#iata #" r !gim

5ipo#alor i# i 5ipoo+at

in#!tar !a "mat"l"i i a #on"m"l"i +! #a!a #ontr i3"i! la r !+"#!r !a

*alorilor t!nional! prin #a+!r!a ton""l"i impati#

!%!r#itiil! i/i#! /ilni#! +inami#! i mo+!r at! #a int!nitat! a" ! !#t

5ipot!nor ? "nt #ontrain+i#at! in T A !*!r a

t!5ni#il! +! r !la%ar! 3a/at! p! a"to"g!ti!; in#r !+!r !a in t!r ap!"t i

!%!r #itiil! r !pir atorii r!+"# *aloril! t!nional! in p!#ial la in+i*i/ii #" tr !

m!ntal #r !#"t.

2.7.2. T'!#)n!ul ('#cl&$c ar ! in+i#ati! a3ol"ta in or m!l! mo+!rat!

i

!*!r! +! TA. 4ip"n!m ata/i +! "n n"mar mar ! +! m!+i#am!nt! anti5ip!rt!ni*!

gr "pat!; in "n#ti! +! m!#anim"l +! a#ti"n! in #la!6

2.7.2.1. D$u' )!$c)l) a" at pr im!l! m!+i#am!nt! "tili/at! in tr atam!nt"l T A i

#"p rin+6

#al#i"

+i"r !ti#! tia/i+i#! - N!ri%

+i"r!ti#! +! ana - F"ro!mi+ 9 Lai%; F"r antril:

- A#i+ !ta#rini# 9E+!#rin:

-Tor!mi+

ln+apami+a 9T!rt!ni:6 +i"r!ti# i *ao+ilatator pr in in5i3ar!a #anal!lor +!

+i"r !ti#! #ar! !#onomi!# potai"6 Spir onola#tona; Triamt!r !n; Amilor i+

E!#t!l! !#"n+ar ! al! +i"r !ti#!lor tia/i+i#! 95ip!r gli#!mi!; 5ip!r"r i#!mi!;

5ip!r #at#!mi!; +ilipi+!mii al#alo/a m!ta3oli#a; 5ipo*ol!mi!; 5iponatr!mi!;

in"i#i!nta r!nala i 5ipopota!mi!: l! r !+"# "tili/ar!a +! +"rata.

2.7.2.2. ln8$3$!'$$ 0')n)'&$c$9

p!r i!ri#i - G"an!ti+ina

21


25/79

#!ntrali - Alam!til+opa 9 Al+om!t ; 4op!g@t:; Cloni+ina 9Catapr!an;

a!miton:; G"ana3!n/; G"ana#ina.

#!ntrali i p!ri !r i#i - R!/!r pina 9ipo!r pil:

al a3lo#ant! !l!#ti*! - Pra/oin 9Minipr !:; 4o%a/oin 9Car +"r a:;

T!r a/oin 9@tr in:

3!ta3lo#ant! n!!l!#ti*! - Propr anolol; Na+olol; Sotalol

3!ta3lo#ant! !l!#ti*! - M!topr olol; At!nolol; 7!ta%olol

ala-3!ta3lo#ant! - La3!tolol

#" a#ti"n! mi%ta - Urapi+il

*.7.*.. V-"0$l!!"' ) +ir!#t! m"#"lotrop! - 4i5i+rala/ina; 4ia/o%i+;

Nitopr"iat +! o+i"

*.7.*.5. ln8$3$!"'$$ )n$#)$ 0) cn/)'$) - Captopril; Enalapril;

Li/inopril; Ramipril; P!r in+opril; J"inapril; 7!na/!pril; Tr an+olapr il; Zo!nopril; Foinopril.

*.7.*.+. ln8$3$!"'$$ ')c)%!"' $l"' p!ntr " angiot!nina - )alartan;

T!lmiartan; Loartan; lr 3!artan; Can+!artan #il!%!til; Olm!artan; Epr oartan

m!@lat.

*.7.*.6. Blcn!) 0) clc$u - )!r apamil; 4iltia/!m; Ni !+ipina; F!lo+ipina

9Pl!n+il:; Amlo+ipina; L!r#ani+ipina; Ni!+ipina.

$*.7.*.7. ln8$3$!"'$$ ' )c)%!"'$l"' -)'"!"n$n$c - !tan!rina

*.7.*.. Ac!$/!"'$$ cnl)l"' 0) %!$u - Ni#or an+il

*.7.. Tc!$c !' !#)n!ulu$ n!$8$%)'!)n-$/

R!+am in an!%a "n algoritm rational r!#!nt !la3orat i a##!ptat "nanim in

tr atam!nt"l 5ip!rt!ni"nii art!rial!. In tratam!nt"l m!+i#am!nto al TA r !p!#t!r!a

"nor prin#ipii ar ma#ologi#! !t! o3ligator i!? +intr ! a#!t!a mai important! "nt6

oloir!a +o/!lor minim! !i#i!nt!

#r!t!r !a progr!i*a a +o/!lor ! *a a#! +"pa #! a tr !#"t "i#i!nt timp

p!ntr " a ! +o*!+i !!#t"l m!+i#am!nt"l"i

! !#t!lor

ao#i!r !a m!+i#am!nt!lor anti5ip!rt!ni*! ! *a a#! in #op"l pot!ntar ii

! !*ita ao#i!ril! +! m!+i#am!nt! #" m!#anim! +! a#ti"n! a!manatoar!

i #" !!#t! !#"n+ar ! imilar !

ta3ilir !a +o/!lor optim! ! a#! in minim"m #at!*a l"ni

a+minitr ar ! o +ata a" +! +o"a ori p! /i p!ntr " a #r !t! #omplianta

pa# i!nt"l"i.

In T A "oara a" mo+!r ata al! #ar !i *alor i raman p!t! 1&-10 mm g

+"pa o p!rio+a +! minim tr !i l"ni +! o3!r*ar ! i apli#ar ! a ma"rilor

non arma#ologi#! !


26/79

22


27/79

in#!p! tratam!nt"l #" "n"l +in "rmatoar !l! m!+i#am!nt!6 +i"r!ti#; p-3lo#ant; IEC;

3lo#ant +! #al#i". Poi3ilitat!a apariti!i t"l3"r ar ilor m!ta3li#! a+*!r !; pr!#"m i

#omplianta r !lati* r !+"a "nt #a"/! #ar ! limit!a/a oloir!a +i"r !ti#!lor 9!! l p"tin

tia/i+i#!: #a pr im +r og in T A.

Utili/ar !a P-3lo#ant!lor imp"n! +o/! r!lati* mar i i !!#t! a+*!r! nota3il!.

E%ita t!n+inta a#t"ala +! a oloi #a alt!rnati*a la +i"r !ti#! a" P-3lo#ant! "n

IEC +ar mai al! "n pr !parat +in #laa artanilor ; n" n"mai p!ntr" !i#i!nta +ar i

p!ntr" oart! 3"na tol!ranta.

4"pa 1-2 l"ni +! monot!r api!; in lipa "n"i rap"n a+!#*at; ! r !#oman+a

inlo#"ir!a +rog"l"i #" "n"l +in alta #laa a" a+a"gar!a "n"i no" m!+i#am!nt +in alta

#laa. 4a#a +i"r!ti#"l n" a ot pr im"l m!+i#am!nt; !l !t! +! o3i#!i al 2- l!a

m!+i#am!nt +in ao#i!r!. In TA !*!ra ! in#!p! +! o3i#!i #" o ao#iati! +! 2

m!+i#am!nt! a" !*!nt"al $ m!+i#am!nt! +in #la! +i!r it!.

C!l! mai !#*!nt! ao#i!ri "nt6

IEC 9artan: +i"r !ti#

a -3lo#anti +i"r!ti#

IEC 9artan: 3lo#ant +! #al#i" +i"r!ti#

a -3lo#anti p -3lo#anti +i"r!ti#

IEC 9artan: +i"r !ti# in5i3itor i a+r!n!r gi#i #!ntrali

Foloir!a a#!tor ao#i!ri +! anti5ip!rt!ni*! in +o/! a+!#*at! #ontrol!a/a

*aloril! t!nional! la p!t! > +in pa#i!nti? la *alor i t!nional! normali/at! +o/!l! !

pot r !+"#! a" ! poat! tr !#! la monot!r api!.

23


28/79

242

SPITALUL JUDETEAN DE URGENTA TIRGOVISTE

SECTIA CARDIOLOGIE

DOSAR DE INGRIJIRE

DATE DE IDENTIFICARE

DATE DESPRE SPITALIZARE

1.4ata int!mar ii6 an"l21( l"na I /i"a , or a .

2.4ata !%t!rnar ii6 an"l21( l"na I /i"a 1& ora 126$

$.Moti*!l! int!rnar ii6 tar! g!n!rala mo+!r at alt!r ata; mo+!rata +ipn!! apar"ta in

#on+itii +! !ort; palpitatii; #!al!! pr!+ominant o##ipitala; a#"!n!; o!n!; *!rti <

la #5im3ar!a po/iti!i; at!ni!; o3o!ala.

&.4iagnoti#"l la int!rnar !6 1. TA !!ntiala 2. O3!/itat! 3. 4ilipi+!mi!

SITUATIA MATERIALA SI SOCIALA

Sit"atia amiliala6 - Nr . #opii6 $Sit"atia

Con+itii

o#iala6

+! lo#"it6

-mo+!t!

Pro !ia6 p!nionar

PERSOANE CU CARE SE IA LEGATURA

N"m!6 G.C. 9oti!: A+r!a6 Targo*it! T!l!on

N"m!6 G.P. 9 rat!: A+r !a6 Targo*it! T!l!on

ANTECEDENTE

1.!r !+o-#olat!ral!6 ara importanta; n!aga l"!"l; 5!patita; SI4A; T.7.C.i

3olil! p"lmonar ! #r oni#! in amili!

P!ronal! i/iologi#!6 ara importanta

P!ronal! patologi#!6 5ip!rt!ni"n! art!riala +iagnoti#ata in 2& i tr atata

int!rmit!nt

2.Fa#tori +! ri! l!gati +! mo+"l +! *iata6 "mator ; #on"ma al#ool; #on"ma

#a !a; +"#! r!gim +!/!#5ili3rat +! *iata

E:TRAS DIN E:AMENUL MEDICAL LA INTERNARE7olna* +! !% ma#"lin in *arta +! 64 ani; #" tar! g!n!rala "or mo+ii#ata;

tar ! +! #onti!nta patr ata; T$(;C; G 79 g; I 1, #mS! int!rn!a/a in !#tia +! Car+iologi! a Spital"l" i


29/79

S"3 a#!t tratam!nt imptomatologia ! a##!nt"!a/a; apar ! +ipn!!; !mn

#! alarm!a/a 3olna*"l; #ar! ! pr !/inta la m!+i#"l +! amili! #ar! ii r!#oman+a

int!rnar !a

PRESCRIPTll MEDICALE

1 . T ratam!nt6

•l.iinopril E 1 O mg .E 1 #p I /i; +imin!ata

• T!rt!ni SR; 1;' mg; 1 #p I /i• Pr !+"#tal MR; $'mg; 1 #p I /i• Zo#or ; 1 O mg; 1 #p I /i; !araE F!no3ar3ital 1 mg ; 1 #p I /i !ara la #"l#ar!

2.E%aminar i6 5!mol!"#ograma; !%am!n "mar +! "rina; #al#!mi!; gli#!mi!;

pr ot!in!mi!; #ol!t!rol; 4L #ol!t!rol; trigli#!r i+!; lipi+!; "r!!; a#i+ "r i#; #r !atinina;

i+!r!mi!; TGP; TGO; )S; i3rinog!n; I4R la PP4; R%. p"lmonar ; EG.

$.R!gim6 r !gim 5ipo#alori#; ara graimi animal!; ara o"a; ara +"l#i"ri #on#!ntr at!;

3oat in *!!tal! i i3r ! *!!tat!. 5ipoo+at.

O7SER)ARE INITIALA

Sit"atia la int!rnar !6lnaltim!6 1, #m

Gr!"tat!6 ,0 Dg

T.A.6 10 =1 mm g

P"l &=min

T!mp!r at"r a6 $(. C

R!pirati!6 2=min

)a/6 nor mal

A"/6 normal

E:AMEN FIZIC LA INTERNARE

7olna* +! !% ma#"lin in *arta +! 64 ani; #" tar ! g!n!rala "or mo+ii#ata;tar ! +! #onti!nta patrata; T$(; C; I 1, #m; G ,0 g; ! int!rn!a/a in

!#tia +! Car+iologi! a Spital"l"i


30/79

Aparat +ig!ti*6 ap!tit +imin"at; #a*itat! 3"#ala normal #onormata; #ar ii

+!ntar! m"ltipl!; a3+om!n mar it +! *ol"m prin +!po/it! +! gr aim!; mo3il #"

mi#aril! r !piratorii; i#at #" limita "p!rioara in pati"l ) i.!. +r . i limita in!r ioara

la r!3or +;plina n!paloa3lla; #a"n +! ap!#t normal.

Apar at "ro-g!nital 6 mi#ti"ni i/iologi#!; lo


31/79

27

INTERPRETAREA DATELOR

4in #!l! 1& n!*oi "n+am!ntal!; 1 "nt n!*oi +! +!p!n+!nta i & "nt n!*oi +!

in+! !n+!nta

POSIBILIT ATI DE EVOLUTIE

1.)in+!#ar!6

2. Sta3ili/ar!; am!liorar!6 1. 4 A 2. 4 A$. 4A

$. Agra*ar!6&.4!#!6

OBIECTIVE DE INGRIJIRE

1.3i!#ti*! glo3al! E#5ipa +! ingr i

E a-i aig"r !!#t"ar!a igi!n!i #or por at!E a-i aig"r ! !#t"ar !a in*!tigatiilor para#lini#! pr !#r i! a-i !!#t"!/ r !#oltar!a pro+"!lor 3iologi#! p!ntr " !%am!n!l! para#lini#!• a-i a+minitr !/ #or !#t tratam!nt"l pr!#r iE a-i monitori/!/ "n#tiil! *ital! i al! #on!mn!/ in oaia +! o3!r*ati!E a ! !#t"!/ !+"#ati! anitara pri*in+ a#tor ii +! r i! in im3olna*iril! #ar+ia#!

COMPORTAMENT ASTEPTAT, IN CE INTERVAL

I In apro%imati* , /il! pa#i!nt"l a i! !%t!rnat #" tar ! g!n!r ala 3"na; am!liorat.

lnt!rnar !a in pitalR!#oltar !a anali/!lor

E%t!rnar !a +in pital

EPICRIZA, RECOMANDARI LA E:TERNARE

7olna* +! !% ma#"lin; in *arta +! (& ani ! int!rn!a/a p! +ata +!,.1.21( ora . in S!#tia +! Car+iologi! a Spital"l"i K"+!t!an +! Urg!ntaTirgo*it! p!ntr"6 tar ! g!n!r ala mo+!rat alt!r ata; mo+!r ata +ipn!! apar"ta in#on+itii +! !ort; palpitatii; #! al!! pr!+ominant o##ipitala; a#"!n!; o!n! ; *!rti<la #5im3ar !a po/iti!i; at!ni!; o3o!ala.

4in airmatiil! 3olna*"l"i r!/"lta #a prim!l! !mn! a" apar"t in "rma #"apr o%imati* o aptamana; #an+ 3olna*"l a a#"/at tar! g!n!rala mo+!rat alt!r ata;#!al!!; a#" !n!; o !n!; *!rtii.i at!ni!.

li a+minitr !a/a +in pr oor i! initiati*a tr atam!nt #" Enalaoril i Pr opranolol

S"3 a#!t tr atam!nt imptomatologia ! a##!nt"!a/a; apar! +ipn!!; !mn#! alarm!a/a 3olna*"l? ! pr!/inta la m!+i#"l +! amili! #ar! ii r!#oman+a int!rnar !a

4in !%am!n"l #lini# p! apar at! i it!m! r!tin!m

6 T!"t #!l"lar "3#"tanat 6 r!pr!/!ntat in !%#!.

Aparat #ar+io-*a#"lar 6 aria pr!#or+iala +! ap!#t nor mal; ar ia matitatii#ar+ia#! in limit! i/iologi#!; o# ap!%ian in pati"l ) i.!. tang p! liniam!+io#la*i#"lar a; /gomot! #ar +ia#! r itmi#! A) & =min? n" ! p!r#!p " l"r i; p"l & =min. TA 10=1 mmg


32/79

Aparat +ig!ti*6 ap!tit +imin"at; #a*itat! 3"#ala normal #onormata; #ar ii +!ntar!

m"ltipl!; a3+om!n mar it +! *ol"m prin +!po/it! +! gr aim!; mo3il #" mi#aril!

r !pir atorii; i#at #" limita "p!r ioar a in pati"l ) i.!. +r . i limita in !rioara la

r !3or+;plina n!palpa3ila; #a"n +! ap!#t normal.

S! !!#t"!a/a "rmatoar!l! in*!tigatii6

• !mogr ama i orm"la l!"#o#itara6 3 1&;0 g>; t $0>;• L '.0 =mm3, N &>; M 2&> ; limo#it! 2(> ; E 2>

• Cal#!mi! 0;2$ mg>; Gli#!mi! mg>; Prot!in!mi! (;mg>;• )S 12=1 mm;• Fi3rinog!n 22 mg>;• Col!t!r ol $0 mo>; 4L #ol!t!rol & mo>;Trioli#!r i+! $' mo>;• t.loi+! ,2 mo> Ur !! 2' mg>;• A#i+ "r i# 2; 1 mg>;• Cr!atinina , mg>;• TGP 1 "i;• TGO 1,"i.• E%am!n "mar +! "rina *ol"m "rinar 1 ml; ap!#t limp!+!; +!nitat!

1$; p a#i+; l"#o/a a3!nt; al3"mina a3!nt; !+im!nt "r inar in limit!normal!

• I4R la PP4 n!gati*;• Ra+iograi! tora#o - p"lmonara? imagin! p"lmonar a in limit! nor mal! ; #or +

+! +im!ni"ni "or mar it!; #" ar#"l in !rior ting 3om3at.

EG ritm in"al; r !g"lat; ta5i#ar +i#; A) & 3at=min; a% !l!#tri# +!*iat latanga; "nt pr!/!nt! !mn! +! 5ip!rtroi! *!ntri#"lara tanoa; n" ! +itin

t"l3"rari +! r !polari/ar !.

S! !!#t"!a/a tratam!nt #"6• Liinopril ; 1 mg. ; 1 #p I /i; +imin!ataE T!rt!ni SR; 1;' mg; 1 #p I /i

Pr!+"#tal MR; $'mg; 1 #o I /i• Zo#or ; 1 mg; 1 cc I /i; !ar a• F!no3ar 3ital 1 mo ; 1 #o I /i !ara la #"l#ar !

E*ol"tia !t! a*ora3ila; ! !%t!rn!a/a 1; 2; $; am!lior at; #" r!#oman+aril!6

E tratam!nt #onorm RP.;• alim!ntati! +i*!rii#ata; #" +i!ta 5ipo#alor i#a; 5ipoo+ata; 3ogata in

alim!nt! #! #ontin i!r i *itamin!;

• int!r/i#!r!a "mat"l"iE int!r/i#!r!a #on"m"l"i +! al#ool.• int!r/i#!r!a #on"m"l"i +! #a !a• r!gim !#5ili3r at +! *iata; #" r!p!#tar !a or !lor +! o+i5na• !*itar !a !+!ntarim"l"i• #ontrol i tratam!nt tomatologi#• +ip!nari/ar ! prin #a3in!t"l m!+i#"l"i +! amili!• ! inman!a/a #rioar!a m!+i#ala #atr! m!+i#"l +! amili!

MOD DE E:TERNAREMo+ +! !%t!rnar!6 ing"r #" amilia +a alt"lMi


33/79

29

EVALUARE

ELEGATE

;7.;1. Star ! g!n!rala Sa-i aig"r #onort"l A


34/79

303

;,. ;1. Star! g!n!r ala Sa-i aig"r r!gim"l Com"ni# #" pa#i!nt"l A+minitr !/ Star ! g!n!rala mo+!rat alt!rata;*;16 alim!ntar pr !#r i i in#!r# a ii a; M 2&> ;

i l! #on!mn!/ in limo#it! 2(> ; E 2>

ia. Cal#!mi! 0;2$ mg>;gli#!mi! mg>;prot!in!mi! (;mg>;

)S 12=1 mm=5;i3rinog!n 22 mg>;I4R la PP4 n!gati*;#ol!t!r ol $ mg>;4L #ol!t!rol & mg>Lipi+! ,2 mg>trigli#!r i+! $' mg"r!! 2' mg>;

at!ni!; p!ntr" r!#oltar !a #" l!a r!Sa-i maor "n#tiil! pro+"!lor 3iologi#!

o3o!ala; *ital! i a l! p!nrtr " !%am!n!l! +! R!#olt!/ pro+"!l!


35/79

313

a#i+ "r i# 2;1 mg>;


36/79

31

#r !atinina , mg>;

TGP 1 "i;

TGO 1,"i.

!%am!n "mar +! "r ina *ol"m "rinar

1 ml; ap!#t Aimp!+!; +!nitat!1$; p a#i+; gl"#o/a a3!nt;al3"mina a3!nt; !+im!nt "rinar inlimit! nor mal!;

EG ritm in"al; r !g"lat; ta5i#ar+i#; A) & 3at=min; a% !l!#tri# +!*iat latanga; "nt pr!/!nt! !mn! +!

5ip!rtr oi! *!ntri#"lar a tanga.


37/79

1.;1. Star ! Sa-i aig"r m!ntin!r!a A


38/79

E/lu!$ )!) (/"' 3$l, ) )4!)'n) l 15.;1. *;16, 1, *, 3, = #)l$"'!, cu ')c"#n0'$)l9

tratam!nt #onorm Rp.; alim!ntati! +i*!r ii#ata; #" +i!ta 5ipo#alori#a; 5ipoo+ata; 3ogata in alim!nt! #! #ontin ti!r i *itamin!;• int!r/i#!r!a "mat"l"i int!r /i#!r!a #on"m"l"i +! al#ool. int!r /i#!r!a #on"m"l"i +! #a !a r !gim !#5ili3rat +! *iata; #" r !p!#tar!a or!lor +! o+i5na• !*itar!a !+!ntar im"l"i #ontr ol i tr atam!nt tomatologi#E +ip!nar i/ar ! prin #a3in!t"l m!+i#"l"i +! amili!

E ! inman!a/a #rioar !a m!+i#ala #atr! m!+i#"l +! amili!FOAIE DE EM!ERA"RA AD"#$I&'(.!r(n&'(An&l 2016 #&na 01 r. )*ii ( *(ra/i( 617 r.al*n 4 r.a 4

Daa 15.01 16.01 . 24.01

il( *ala 1 2 - 10R( .A. !&l T D D D D D D D D D D D

35 300 160 41

30 250 140 40

25 200 120 39

I 20 150 100 38


39/79

15 100 80 37

10 50 60 36

#ici in:(ra( 25 ** 25 OO 1700Di a 2200 2400 1600ca& Di(a


40/79

34

MASURAREA PULSULUI

Sc%

!*al"ar!a "n#ti!i #ar+io*a#"lar!

El)#)n!) 0) %')c$!

r itmi#itat!

r !#*!nta

#!l!r itat!

amplit"+in!

Lcul0) #u'')

ori#ar! art!ra a##!i3ila palparii i #ar! poat! i #omprimata p! "n

plan oo6 art!ra ra+iala; !m"r ala; 5"m!r ala; #aroti+a; t!mpor ala "p!ri#iala;

p!+ioaa M!)'$l) n)c)')

#!a #" !#"n+ar

#r!ion ro" a" pi% #" mina roi!

ln!)'/)n!$$l)-$-!)n!)$

pr!gatir !a pi5i#a a pa#i!nt"l"i

aig"rar!a r !pa""l"i i/i# i pi5i# 1-1' min

palar!a p! maini

r !p!rar!a art!r !i

i%ar !a +!g!t!lor palpatoar! p! trai!#t"l art!r!i

!%!r#itar!a "n!i pr !i"ni a"pr a p!r!t!l"i art!rial #" *ar "l +!g!t!lor

n"mar ar!a p"latiilor timp +! 1 min

#on!mnar!a *alor ii o3tin"t! printr -"n p"n#t p! oaia +! t!mp!rat"ra;

tinan+ #ont #a i!#ar! lini! ori/ontala a oii r !pr!/inta & p"latii

"nir!a *alorii pr!/!nt! #" #!a ant!r ioar a #" o lini!; p!ntr" o3tin!r !a

#"r3!i #on!mnar!a in alt! +o#"m!nt! m!+i#at! a *alor ii o3tin"t! i a

#ara#t!riti#ilor p"l"l"i.


41/79

SPITALUL JUDETEAN DE URGENTA

TIRGOVISTE SECTIA CARDIOLOGIE

DOSAR DE INGRIJIRE



1.4ata int!rnarii6 an"l21( l"na I /i"a 1$ ora.

2.4ata !%t!rnarii6 an"l21( l"na I /i"a 10 ora12

6$$.Moti*!l! int!rnar ii6 tar ! g!n!rala mo+ii#ata; mo+!rata +ipn!! +! !ort; t"!

#" !%p!#torati! m"#oaa; r !#*!nt matinala; #! al!! pr!+ominant o##ipitala;a#" !n!; o !n!; *!rti< n!it!mati/at; at!ni!; o3o!ala.&.4iagnoti#"l la int!rnar!6 T A !!ntiala ta+i"l II; 4ilipi+!mi!; 7ronita#roni#a

SITUATIA MATERIALA SI SOCIALASit"atia amiliala6 #aator it Nr. #opii6

Sit"atia o#iala6Con+itii +! lo#"it6

-mo+!t!

Pro!ia6 agri#"ltor


N"m!6 U.C. 9rat!: A+r !a6 Ra#i" T!l!on

N"m!6 U.P. 9r at!: A+r !a6 Ra#i" T!l!on

ANTECEDENTE

1.!r !+o-#olat!r al!6 n!aga l"!"l; 5!patita; SI4A; T.7.C.i 3olil! p"lmonar!#roni#! in amili!

2. P!ronal! i/iologi#!6 ara importanta

$. P!ronal! patologi#!6 T A +iagnoti#ata in "rma #" 3 ani p!ntr" #ar!a#! tr atam!nt int!rmit!nt i n" r!p!#ta r !gim"l igi!no+i!t!ti#

&.Fa#tor i +! r i! l!gati +! mo+"l +! *iata6 "mator a p!t! 2 tigar!t! /ilni#;#on"ma al#ool in #antitat! mar !; +"#! r !gim +!/!#5ili3r at +! *iata; #on"magraimi animal! in #antitat! mar !; #on"ma alim!nt! #on!r*at! pr in ar ar !.

E:TRAS DIN E:AMENUL MEDICAL LA INTERNARE

7olna* +! !% ma#"lin in *ar ta +! '0 ani; #" tar! g!n!rala "or mo+ii#ata;tar ! +! #onti!nta patr ata; T$(;0C; G ( g; I 1( #m

S! int!rn!a/a in !#tia +! Car+iologi! a Spital"l"i


42/79

alim!nt! #on!r*at! pr in arar!.

In #"r "l /il!i +! i!ri imptomatologia ! a##!nt"!a/a; apar! +ipn!!a; t"!a

! a##!nt"!a/a; !mn! #! alar m!a/a 3olna*"l; #ar ! ! pr!/inta la m!+i#"l +!

amili! i i ! r!#oman+a int!rnar !a


1 . T ratam!nt6 Enap 1 mg; 1 c*.


43/79

37

m!+io#la*i#"lar!; /gomot! #ar+ia#! ritmi#! A) = I min ? n" ! p!r #!p "l"r i; p"l= =min. TA 2=11 rnrnl-t

Aparat +ig!ti* 6 ap!tit +imin"at; #a*itat! 3"#ala normal #onormata; #ar ii

+!ntar! m"ltipl!; a3+om!n marit +! *!l"m prin +!po/it! +! gr aim!; mo3il #"

mi#aril! r !pirator ii; i#at #" limita "p!r ioara in pati"l ) i.!. +r!pt i limita in!r ioara

la limita r !3or+"l"i #otal tan; plina n!palpa3ila; #a"n +! ap!#t nor mal.

Apar at "ro-g!nital 6 mi#ti"ni i/iologi#!; lo


44/79


I 4in #!l! 1& n!*oi "n+am!ntal!; 11 "nt +! +!p!n+!nta i $ +! in+!p!n+!nta

POSIBILITATI DE EVOLUTIE

1.)in+!#ar!6

2.Sta3ili/ar !; am!liorar !6 1. 4a 2. 4A $. 4A

. A#ra*ar!6&.4!#!6

OBIECTIVE DE INGRIJIRE1.3i!#ti*! glo3al! E#5ipa +! ingr i


45/79

T!rt!ni 1;' mo; 1 #p.= /i

Cr!tor 1 O mo. 1 #p.= /i

Pr!+"#tal MR $' mg; $ #p I /i

ACC (mg; 1 #p I /i

S! !!#t"!a/a "rmatoar!l! in*!tigatii6

!moHr ama i orm"la l!"#o#itara6 3 1$;( g>; t $,>;

L '.' =mm . N &(>; M 2(> ; limo#it! 2(> ; E 2>

• Cal#!mi! 0;$ mg>;• gli#!mi! ' mg>; prot!in!mi! ( ;0mg>;

)S 1=1& mm;

i3rinog!n 2( mg>;

• I4R la PP4 n!gati*• #ol!t!rol 2 mg>;• 4L #ol!t!rol 0, mo>

tr io

li#!ri+! $( mo>;

• lioi+! ,0 mo>• "r!! 2& mg>;• a#i+ "ri# &;1 mg>;• #r!atinina ,2 mg>;• TGP 1& "i;• TGO 2,"i.• !%am!n "mar +! "rina *ol"m "r inar 1, ml; ap!#t limp!+!; +!nitat!

12; p a#i+; l"#o/a a3!nt; al3"mina a3!nt; !+im!nt "rinar in limit! normal!;

• Ra+iograi! tor a#o - p"lmonara? imagin! p"lmonar a in limit! normal! ; #or++! +im!ni"ni "or mar it!; #" ar #"l in!r ior ting 3om3at.

• EG r itm in"al; r!g"lat; ta5i#ar+i#; A) 3at=min; a% !l!#tri# +!*iat latana; "nt pr!/!nt! !mn! +! 5ip!rtroi! *!ntr i#"lar a tana.

• E%am!n "n+ o#5i6 "n+ o#5i gr . IllE*ol"tia !t! a*or a3ila; ! !%t!rn!a/a 1; 2;$; am!liorat; #" r!#oman+aril!6

tratam!nt #onorm Ro.;E alim!ntati! +i*!rii#ata; #" +i!ta 5ipo#alor i#a; 5ipoo+ataE int!r /i#!r!a "mat"l"iE int!r /i#!r!a #on"m"l"i +! al#ool.• tr atam!nt tomatologi#

• r!gim !#5ili3r at +! *iata; #" r!p!#tar!a or !lor +! o+i5na• +ip!nari/ar! prin #a3in!t"l m!+i#"l"i +! amili!

• ! inman!a/a #rioar!a m!+i#ala #atr ! m!+i#"l +! amili!

MOD DE E:TERNARE

Mo+ +! !%t!rnar!6 in"r +a #" amilia alt"l

Miilo# +! tr anport6 al*ar !

$0


46/79

40

EVALUARE

1.; S!') &)n)'l S-$ $&u' cn('!ulA

A


47/79

1&. 1. Star! g!n!r ala Sa-i aig"r r !gim"l Com"ni# #" pa#i!nt"l A+minitr !/ Star! g!n!rala mo+ii#ata;21( alim!ntar pr !#ri i in#!r# a ii a ;

Pr!gat!# pa#i!nt"l p!ntr" !%am!n"l EGprot!in!mi! (;0mg>;

o3o!ala. p!ntr" !%am!n"l)S 1=1& mm;

EGi3rinog!n 2( mg>;I4R la PP4 n!gati*;

Maar "n#tiil! *ital! #ol!t!r ol 2 mg>;

i l! #on!mn!/ in4L #ol!t!rol 0,mg>

ia. trigli#!r i+! $( mg>;lipi+! ,0 mg>"r!! 2& mg>;a#i+ "ri# &; 1 mg>;

•

a#" !n!; *ital! i a l! 1 #p I /i#on!mn!/ in oaia +! Pr!gat!# pa#i!nt"l

o !n!; o3!r*ati!. p!ntr " r !#oltar!a R!#olt!/ pr o+"!l!

=


48/79

#r !atinina ,2 mg>;TGP 1& "i;

TGO 2,"i.E%am!n "mar +! "rina

*!l"m "r inar 1, ml; ap!#t

imp!+!; +!nitat! 12; p a#i+; gl"#o/aa3!nt; al3"mina a3!nt; !+im!nt

"r inar in limit! normal!

EG ritm in"al; r!g"lat; ta5i#ar +i#; A) 3at=min; a% !l!#tr i# +!*iat la

tanga; "nt pr !/!nt! !mn! +!

5ip!rtroi! *!ntr i#"lar a tanga; in+i#!SoDoloB- Lion &,mm.

E%am!n "n+ o#5i6"n+ o#5i gr . Ill


49/79

43

1. 1. Star ! Sa-i aig"r m!ntin!r !a Com"ni# #" pa#i!nt"l A+minitr!/ Star ! g!n!rala 3"na; a!3ril21( "n!i 3"n! r !pir atii i in#!r # a ii a


50/79

E*ol"tia !t! a*or a3ila; ! !%t!rn!a/a la 10.1.21(; 1; 2; $; = am!liorat; #" r !#oman+ar il!6E tratam!nt #onorm Ro.;• alim!ntati! +i*!r ii#ata; #" +i!ta 5ipo#alori#a; 5iooo+ata• int!r/i#!r!a "mat"l"i int!r/i#!r!a #on"m"l"i +! al#ool.• tratam!nt tomatologi#• r !gim !#5ili3r at +! *iata; #" r !p!#tar !a or!lor +! o+i5na

• +ip!nar i/ar ! prin #a3in!t"l m!+i#"l"i +! amili!

• ! inman!a/a #r ioar !a m!+i#ala #atr! m!+i#"l +! amili!


51/79

FOAIE DE TEMPERA TURA ADULTl

N "m! "pr !n"m! p A n" 21( L"na 1 N r . 01.1. + !

o3!r*atr!

92 N r .a on 4 N r .pa 2

4ata 13.01 14.01 18.01

il! +! 3oala 1 2 6

R!o T.A. P"l r 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

35 300 160 41·

30 250 140 40·

25 200 120 39'

20 150 100 3s·

15 100 80 $, Ir-

10 50 60 35•

i#5i+! ina!r at! 1600 1500 - ,. .; 1600i"r!/a 1800 1700 H 1500

#a"n!4i!ta

.

;;


52/79

45

ADMINISTRAREA MEDICAMENTELOR PE CALE ORALA

D)($n$!$)

Gal!a orala !t! #al!a nat"rala +! a+minitrar ! a m!+i#am!nt!lor ; a#!t!a

p"tan+"-! r!or3i la ni*!l"l m"#oa!i 3"#al! i a int!tin"l"i "3tir! a" gro.

Sc%

S#op"l a+minitrarii !t! o3tin!r !a !!#t!lor lo#al! a" g!n!ral! al!

m!+i#am!nt!lor.

E( )c!) l"cl)9

a*ori/!a/a #i#atri/ar!a "l#!ratiilor m"#oa!i +ig!ti*!

prot!

aparat! 9anti3ioti#!; *ao+ilatatoar!; #ar+iotoni#!; !+ati*!:.

C"n!'$n0$c $$!

m!+i#am!nt"l !t! ina#ti*at +! !#r !tiil! +ig!ti*!

m!+i#am!nt"l pr!/inta pr opr i!tati ir itant! a"pra m"#oa!i gatri#!

pa#i!nt"l r !"/a m!+i#am!nt!l!

m!+i#am!nt"l n" ! r!oar3! p! #al! +ig!ti*a

F'#) 0) %'))n!') #0$c#)n!)l"'

Li#5i+!6

ol"tii; mi%t"ri; in "/ii; tin#t"ri; !%tr a#t!; "l!i"r i; !m"lii

Soti+!6 p"l3!r i; ta3l!t!; +ra

T)8n$c 0#$n$-!''$$

Pa#i!nt"l !t! inormal a"pra !!#t!lor "r marit! pr in a+minitrar!a

m!+i#am!nt"l"i r!p!#ti* i a !*!nt"al!lor !!#t! !#"n+ar!.

A*!m n!*oi! +! "rmatoar !l! mat!rial!6 ling"ra=ling"rita=pip!ta= ti#la pi#"r atoar !=

pa5ar g rad aU #!a#a= i apa=#!ai=lapt!.

Li#5i+!l! "nt6 irop"ri; "l!i"ri; ap! min!r al!; !m"lii.

! ma#ara +o/a "ni#a #" pa5ar"l a" #!a#a +! #a!a


53/79

mi%t"ril!; ol"tiil!; !m"liil! ! maoar a #" ling"ra a" ling"rita

tin#t"ril!; !%tra#t!l! ! +o/!a/a #" pip!ta a" ti#la pi#"ratoar !

M!+i#am!nt!l! li#5i+! ! pot +il"a #" #!ai; apa a" ! a+minitr!a/a #a atar!;

apoi pa#i!nt"l 3!a apa; #!ai.

Soli+!l!6

ta3l!t!l!; +r a

an"m! nitrogli#!rina; ! aa/a "3 lim3a

p"l3!ril! in #ap"l! #!rat! ! inmoai! inaint! #ap"la in apa i !

aa/a p! lim3a p!ntr" a i ing5itita

gran"l!l! ! ma#ara #" ling"r ita

"n!l! p"l3!ri ! +i/ol*a in apa; #!ai; i apoi ! a+minitr!a/a

"3 orma +! ol"tii

Contin"t"l "nor intr"m!nt! #" #ar ! ! a+minitr !a/a m!+i#am!nt!l! oli+!6

1 pa5ar #" apa 2 ml ol"ti! apoaa.

1 ling"r ita = ' ml ol"ti! apoaa ? = &;' ml "l!ioaa? (;' ml irop

1 ling"ra $ ling"r it! apa

2 pi#at"r i 1 g ol"ti! apoaa.

( pi#at"r i 1 g ol"ti! al#ooli#a

&-&' pi#at"r i N 1 g ol"ti! "l!ioaa

1 ling"rita r aa 1;' - 2;' g

1 ling"r ita #" *ar 2;' - ' g

1 *ar +! #"tit ;' -1 g

La pa#i!nti in#onti!nti #" t"l3"r ar i +! +!gl"trti! m!+i#am!nt!l! ! intr o+"# #"

a


54/79

SPITALUL JUDETEAN DE URGENTA TIRGOVISTE

SECTIA CARDIOLOGIE

DOSAR DE INGRIJIRE



1.4ata int!rnar ii6 an"l21( l"na I /i"a 2 ora .

2.4ata i!irii6 an"l21( l"na I /i"a 2, ora 126$

$.Moti*!l! int!rnarii6 tar! g!n!rala mo+!r at alt!rata; +"r!r! pr!#or+iala #"

#ara#t!r #ontri#ti* #" ir a+i!r ! in "mar"l ting i p! ata #"3itala a m!m3r"l"i"p!rior tinJ apar "ta in #on+itii +! !ort; oatottat5; +ipn!!; #!al!!; a#"!n!;

*!rtii.

&.4iaJnoti#"l la int!rnar!6 1. TA ta+i"l II 2. Anina o!#tor ala $. O3!/itat!

SITUATIA MATERIALA SI SOCIALA

Sit"atia amiliala6 #aator it Nr . #opii6 2

Sit"atia

Con+itii

o#iala6

+! lo#"it6

3"n a

3"n!

Pro !ia6 l"#rator #om!r#ial


N"m!6 O.C.; oti!;

N"m!6 O.P.; rat!;

A+r!a6

A+r!a6

Targo*it!

Targo*it!

T!l!on

T!l!on

ANTECEDENTE

1. !r!+o-#olat!r al!6 n!aga l"!"l; 5!patita; SI4A; T.7.C.i 3olil! p"lmonar!

#r oni#! in amili!

2. P!ronal! i/iologi#!6 ar a irnoortanta

3. P!r onal! patologi#!6 T A +iagnoti#ata in "rma #" & ani p!ntr " #ar ! a#!tratam!nt int!rmit!nt i n" r!p!#ta r !gim"l igi!no+i!t!ti#

4. Fa#tor i +! r i! l!gati +! mo+"l +! *iata6 "mator a p!t! 1' tigar !t! /ilni#;#on"ma al#ool in #antitat! mar!; +"#! r !gim +!/!#5ili3rat +! *iata; #" t"r! +!noapt!; #on"ma r aimi animal! in #antitat! mar !.

E:TRAS DIN E:AMENUL MEDICAL LA INTERNARE

7olna* +! !% ma#"lin in *ar ta +! ', ani; #" tar! g!n!rala "or mo+ii#ata ;

tar ! +! #onti!nta patrata; T$(;,C; G 0 g; I 1,1 #m

S! int!rn!a/a in !#tia +! Car+iologi! a Spital"l"i


55/79

N" ! a+r !!a/a m!+i#"l"i +! amili!; #ontin"a a "m!/!; #on"ma al#ool in

#antitat! mar!; #on"ma #a!a.

In #"r"l /il!i +! i!r i imptomatologia ! a##!nt"!a/a; apar ! +"r !r!

pr !#or+iala #" #ara#t!r #ontr i#ti* #" ira+i!r ! in "mar"l ting i p! ata #"3itala a

m!m3r"l"i "p!rior ting apar "ta in #on+itii +! !ort; !mn #! alarm!a/a 3olna*"l i

! pr!/inta la m!+i#"l +! amili! #ar! ii r !#oman+a int!rnar!a


1.Tr atam!nt6

Nitrogli#!rina ;' mg 1 t3 "3ling"al; la n!*oi!

Pr !tar i"m 1 mg; 1 #p.= /i

T!rt!ni 1;' mJ; 1 co.t /i• Sorti 1 mg; 1 #p.= /iE Ma@#or r!tar+ 2 mg; > #p. % 2 I /i M!toprolol 'mg; 1#p % 2 1 /i• Trom3!% ,'mg; 1 #p.=/i

2.E%aminar i6 5!mol!"#ograma; !%am!n "mar +! "r ina; #al#!mi!; gli#!mi!;

pr ot!in!mi!; #ol!t!rol; 4L #ol!t!r ol; lipi+!; tr igli#!r i+!; "r !!; a#i+ "r i#;

#r!atinina; i+!r!mi!; TGP; TGO; )S; i3rinog!n; I4R la PP4; R%. p"lmonar ; EG;

!%am!n "n+ +! o#5i.

$.R!gim6 r!gim 5ipo#alori#; 5ipoo+at.

OBSERVARE INITIALA

Sit"atia la int!rnar !6

lnaltim!6 1,1 #mE Gr!"tat!6 0 Dg

E T. A.6 21 =1 mm g• P"l =min T!rnp!rat"ra6 $(., C R!pir ati!6 2,=min )a/6 normal A"/6 normal

E:AMEN FIZIC LA INTERNARE

7olna* +! !% ma#"lin in *ar ta +! ', ani; #" tar ! g!n!rala "!r mo+ii#ata;

tar! +! #onti!nta patr ata; T$(;, C; I 1,1 #m; G 0 g; ! int!rn!a/a in

!#tia +! Car+iologi! a Spital"l"i


56/79

49

m!+io#la*i#"lar!; /gomot! #ar +ia#! r itmi#! A) I min? n" ! p!r#!p "l"ri; p"t

=min. T A 21=1 mmg. In #"r "l /il!i +! i!ri a pr !/!ntat +"r !r ! pr!#or+iala

#" #ara#t!r #ontr i#ti* #" ira+i!r! in "mar"l ting i p! ata #"3itala a m!m3r"l"i

"p!rior ting aoar"ta in #on+itii +! !ort; +"r!r! #ar! a #!+at la itar !a ! ort"l"i.

Aparat +ig!ti* 6 ap!tit +imin"at; #a*itat! 3"#ala normal #onormata; a3+om!nmarit +! *!l"m pr in +!po/it! +! graim!; mo3il #" mi#ar il! r!pirator ii; i#at #" limita

"p!rioar a in pati"l ) i.!. +r . i limita in!r ioara la r !3or+;plina n!palpa3ila; #a"n+! ap!#t nor mal.

Aparat "ro-g!nital 6 mi#ti"ni i/iologi#!; lo


57/79


I 4in #!l! 1& n!*oi "n+am!ntal!; 1 "nt n!*oi +! +!p!n+!nta i 4 +! in+!p!n+!nta

POSIBILITATI DE EVOLUTIE

1.)in+!#ar!6

2.Sta3ili/ar!; am!liorar!6 1. 4a 2. 4A $. 4A

$. AJra*ar!6

&.4!#!6

OBIECTIVE DE INGRIJIRE

1.3i!#ti*! glo3al! E#5ipa +! ingr i


58/79

'1

• !mograma i or m"la l!"#o#itar a6 3 1$;( g>; t $,>;L '.' =rnm. N &(>; M 2(> ; limo#it! = 2(> ; E 2>

E Cal#!mi! 0;$ mg>;• gli#!mi! ' mg>;• prot!in!mi! = (;0mJ>;• )S 1=1& mm;

• i3rinog!n 2( mg>;• I4R la PP4 = n!gati*;E #ol!t!rol = $& mg>;• 4L #ol!t!r ol = mg>E Lipi+! = (0 mg>• triti#!r l+! = $ m>;• "r!! = 2& mg>;E a#i+ "r i# &; 1 mg>;• #r!atinina = ,2 mg>;• TGP = 1& "i;

• TGO 2,"i.• !%am!n "mar +! "rina *ol"m "r inar 1, ml; ap!#t Aimp!+!; +!nitat!

12; p a#i+; gl"#o/a a3!nt; al3"mina a3!nt; !+im!nt "r inar in limit! normal!.

• Ra+iogr ai! tor a#o - p"lmonar a? imagin! p"lmonar a in limit! nor mal! ; #or ++! +im!ni"ni "or marit!; #" ar #"l in !r ior tin 3om3at.

• EG r itm in"al; r !g"lat; ta5i#ar+i#; A) 88 3at=min; a% !l!#tr i# +!*iat latanga; "nt pr!/!nt! !mn! +! 5ip!rtr oi! *!ntri#"lara tanga i t"l3"rar i +!r!polari/ar ! *!ntri#"lara.

E*ol"tia !t! a*ora3ila; ! !%t!rn!a/a 1; 2; $ = am!liorat; #" r!#oman+aril!6

E tratam!nt #onorm Rp.;

E alim!ntati! +i*!r ii#ata; #" +i!ta 5ipo#alor i#a; 5ipoo+ata• int!r/i#!r!a "mat"l"i int!r/i#!r!a #on"m"l"i +! al#ool.• r !gim !#5ili3rat +! *iata; #" r!p!#tar !a or !lor +! o+i5na• +ip!nar i/ar ! pr in #a3in!t"l m!+i#"l"i +! amili!

• ! inman!a/a #rioar !a m!+i#ala #atr ! m!+i#"l +! amili!

MOD DE E:TERNARE

Mo+ +! !%t!rnar!6 ing"r #" amilia +a alt"l

Mi


59/79

52

E)ALUARE

4ELEGATE

2.1.21(

Star ! g!n!r ala Sa-i aig"r #onort"lpi5i# i i/i# i a a


60/79

• A) ( 3at=minting i p! ata Pr !gat!# pa#i!nt"l Sorti 1 mg; • TA1=0mmgSa-i ! !#t"!/ !%am!n! p!ntr" r!#oltar!a 1 #p.= /i R!p = 2' I min

#"3itala a para#lini#! pro+"!lor 3iologi#!m!m3r"l"i p!ntr" !%am!n!l! +! Ma@#or r !tar + 2 mg;

• Aport 5i+r i# = 1, mlSa-i maor "n#tiil! la3orator > #p. % 2 I /i.• 4i"r !/a 1 ml"p!r ior ting *ital! i l! #on!mn!/

apar"ta in oaia +! o3!r*ati!. Maor "n#tiil! *ital! M!toprolol 'mg; • S#a"n 1; normal

i l! #on!mn!/ in 1 #p. % 2 I /i. •)ar at"ra O

in #on+itii +! !ort; ia. !mogr ama i or m"la l!"#o#itara6 3

+ipn!!; #!al!!; 1 #p.= /i = 1$;( g>; t $,>;

L '.' =mm3, N &(>; M 2(> ;

a#"!n!; *!rti;

!%am!n!l! +! la3oratorgli#!mi! ' mg>;prot!in!mi! (;0mg>;)S 1=1& mm;

i3rinog!n 2( mg>;I4R la PP4 n!gati*;#ol!t!rol $& mg>;4L #ol!t!rol = mg>trigli#!ri+! = $ mg>;lipi+! (0mJ>

21. 1. Star ! g!n!rala Sa-i aig"r r!gim"l Com"ni# #" pa#i!nt"l A+minitr!/ Star! g!n!rala mo+!rat alt!rata;21( alim!ntar pr !#ri i in#!r# a ii a


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"r !! 2& mg>;a#i+ "r i# &;1 mg>;

#r !atinina ,2 mg>;TGP 1& "i;TGO 2,"i.!%am!n "mar +! "rina *ol"m "rinar = 1, ml; ap!#t limp!+!; +!nitat!12; p a#i+; gl"#o/a a3!nt;

al3"mina a3!nt; !+im!nt "r inar in

limit! nor mal!.


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2(. 1. Star ! g!n!rala Sa-i aig"r m!ntin!r!a Com"ni# #" pa#i!nt"l A+minitr!/ Star! g!n!rala 3"na; a !3r il21(

3"na;

"n!i 3"n! r !piratii i in#!r # a ii a


63/79

E*ol"tia !t! a*ora3ila; ! !%t!rn!a/a la 2,.1. 21(; 1; 2; $ am!lior at; #" r!#oman+ar il!6

tr atam!nt #onorm Rp.; alim!ntati! +i*!rii#ata; #" +i!ta 5ipo#alor i#a; 5ipoo+ata int!r/i#!r!a "mat"l"iE int!r/i#!r!a #on"m"l"i +! al#ool.E r !gim !#5ili3rat +! *iata; #" r !p!#tar !a or !lor +! o+i5na +ip!nar i/ar ! prin #a3in!t"l m!+i#"l"i +! amili! ! inman!a/a #rioar !a m!+i#ala #atr ! m!+i#"l +! amili!


64/79

FOAIE DE EM!ERA"RA AD"#$I &'(!r(n&'(An&l 2016 #&na 01 r. )*ii ( *(ra/i( 617 r.al*n 4 r.a 4

Data 15.01 16.01 .^NNS 24.01

Zile boala 1 2"-

10

Resp T.A. Pls T D S D S D S D S D S D S D S D S D S D S D S

!5 !00 160 41

# !0 250 140 40

25 200 120 !$

% 20 150 100 !&

15 100 &0 !'

10 50 60 !6

(ic)i i*+e,ate 25 oo 25 1'00 Di a 2200 2400 1600

Sca s


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Dieta


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57

MASURAREA TENSIUNll ARTERIALE

Sc%

!*al"ar !a "n#ti!i #ar+io*a#"lar ! 9orta +! #ontra#ti! a inimii;

r!/it!nta *a#"lara i #ali3r" *a!lor :

El)#)n!) 0) )/lu!

t!ni"n!a art!riala itoli#a 9ma%ima:

t!ni"n!a art!riala +iatoli#a 9minima:

M!)'$l) n)c)')

aparat p!ntr" ma"rar!a t!ni"nii art!r ial! 9#" m!r#"r Ri*a

Ro##i; #" manom!tr "; o#ilom!tr" Pa#5on:

t!to#op 3ia"r i#"lar

tampon +! *ata

al#ool

#r!ion ro" a" pi% #" mina roi!.

M)!0) 0) 0)!)'#$n' )

palpator i!

a"#"ltatori!.

ln!)'/)n!$$)l-$-!)n!)$

p!ntr" m!to+a a"#"ltator i!

- pr!gatir!a pi5i#a a pa#i!nt"l"i

- aig"rar!a r!pa""l"i i/i# i pi5i# timp +! 1' min"t!

- palar!a p! maini

- ! apli#a man!ta pn!"mati#a p! 3rat"l pa#i!nt"l"i; pri


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58

- ! r!tin! *aloar!a in+i#ata +! #oloana +! m!r #"r a" a#"l

manom!tr"l"i p!ntr" a i #on!mnata

p"t!rni#!

--+ ! #ontin"a +!#oprimar!a; /gomot!l! art!r ial! +!*!nin+ tot mai

- ! r!tin! *aloar!a in+i#ata +! #oloana +! m!r#"r a" a#"l

manom!tr"l"i; in mom!nt"l in #ar! /gomot!l! +ipar ; a#!ata r!pr !/intan+ *aloar!a

t!ni"nii art!rial! minim!

--+ ! not!a/a p! oaia +! t!mp!rat"r a *aloril! o3tin"t! #" o lini!

ori/ontala +! #"loar ! roi!; o#otin+"-! p!ntr" i!#ar! lini! a oii o "nitat! #oloana +!

m!r#"r

- in alt! +o#"m!nt! m!+i#al! ! inr!gitr!a/a #itri#

9 E%!mpl"6 T.A. ma% 1' mmg; T. A. min ,' mm g:

--+ ! +!/in!#t!a/a oli*!l! t!to#op"l"i i m!m3rana #" al#ool

p!ntr" m!to+a palpatori!

--+ +!t!rminar!a ! a#! pr in palpar!a art!r!i ra+ial!

--+ n" ! olo!t! t!to#op"l 3ia"ri#"lar

-- !tap!l! "nt i+!nti#!

-- ar! +!/a*anta


69/79

CONCLUZll

E%ita "n n"mar !mnii#ati* +! p!roan! 5ip!rt!ni*! #ar! n" ti" #a "!ra +!

a#!ata 3oala.

S"nt n!#!ar! ma"r i a+r!at! intr!gii pop"latii p!ntr" a r!+"#! #on!#int!l!

5ip!rt!ni"nii art!rial! i a minimi/a n!#!ar"l +! tratam!nt! m!+i#am!ntoa!

anti5ip!rt!ni*!.

lnaint! +! in#!p!r !a "n"i tr atam!nt m!+i#am!nto; ! r !#oman+a mo+ii#ar!a

til"l"i +! *iata #" #op"l +! a #a+!a t!ni"n!a art!riala.

In an"l 2004, So#i!tat!a 7r itani#a +! ip!rt!ni"n! a prop" "r matoar !l!

mo+ii#ari al! til"l"i +! *iata; in #onormitat! #" in+i#atiil! p!#ii#at! in an"l 2002 in

#a+r"l Program"l"i National Am!ri#an +! E+"#ati! a"pra ip!rt!ni"nii p!ntr "

pr!*!nir!a pr imara a 5ip!rt!ni"nii6

m!ntin!r !a "n!i gr!"tati #orpor al! nor mal! 9"n in+i#! +! maa #orporala +! 20-

25 Dg=m2>.

r !+"#!r!a #on"m"l"i +! o+i" +in alim!ntati! la Q1 mmol=/i 9Q( g +! ar! +!

3"#atari! a" Q2;& g +! o+i" p! /i:.

pra#ti#ar !a #" r!g"laritat! a "n!i a#ti*itati a!ro3i#! #"m !t! m!r "l al!rt

9H$ min p! /i; in ma


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AN!:A 1.

? ?

INIM A - I Ut-UGt-Q At-lt

oU


71/79

ANt:XA 2.

INIMA - l?UNt-1;


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AN!:A @.

)!na #a*!

"p!r ioara

)al*a aorti#a

)!na p"lmonar a

+r !apta

Atri" +r!pt

Aorta

Art!ra p"lmonar a

Atri" tang

)!na p"lmonara.---j--tanga

I

)al*a tri#"pi+a----ii

)!na #a*a in!r ioara

)al*a mitrala

)!ntr i#"l

tang

)!ntri#"l +r!pt

INIMA- l?UNHlt


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ANt:X.A 5.

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ANt.8.A ti.

Cat!gori!

T A normala

TAS 9mm g:

o

TA4 9mm g:

8C3

TA ;; 5ig5 normal 130-139 85-89

TA ta+i"l I 9"oara: 140-159 90-99

T A ta+i"l II 9mo+!rata: 160-179 100-109

TA ta+i"l Ill 9!*!ra: 180-209 110-119

TA ta+i"l I) 9oart! !*!ra:

CLAHlt-lC At6.A ll-t I tNHIUNll A 1 l66.IALt LA AUUL I IN I-UN9? I It Ut66

)ALORILE TENSION ALE

94"pa KNC:

**


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ANt68A ,.

Cat!gori!

Normot!ni"n!

TAS 9mm g:

TA "oar a 1&-1 i=a" 0-1'

S"3gr"p6 +! gr anita 140-160 i=a" 0-0'

TA mo+!rata i !*!ra

TA itoli#a i/olata !gala a" 140 3i Q0

S"3gr"p6 +! gr anita

CLAHlt-lCAt6A Vl66 I t66NHIUNll A 1 l66IALI66

94"pa So#i!tat!a lnt!rnationala +! ip!rt!ni"n!:


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ANE8A

Rap"nina+!#*at

Ma"ri n!anna#ologi#! pl" raa'(n anna#ologi# #" "n ing"r m!+i#am!nt +i"r!ti# a" 3!ta3lo#ant ( pot oloi6 IEC; 3lo#anti +! #al#i";

3lo#anti +! ala.Hiori; ala3!ta3lo#anti.

/Rap"nina+!#*at

l

Cr!t!+o/ainiiala

Rap"nina+!#*at

A+a"gar!a "n"i altm!+i#am!nt +intr-o alta #laa

A+a"gar !a #!l"i +!-al 2-l!a a" al $-l!a; i=a" +i"r!ti# +a#a n" a at pr !#r iant!rior

I AC 1 ICA TRAT AMENTULUI ANTIIPERTENSI)

67


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BIBLIOGRAFIE

1. B'un0)l C. -Man"al +! M!+i#ina int!rna p!ntr " #a+r! m!+ii;

E+it"r a Si# All; 7"#"r!ti; 2

*. G8)' $# L. -M!+i#ina lnt!rna;

E+it"ra M!+i#ala; 7"#"r!ti; 21

. G8)'$# L. -A#t"alitati in #ar +iologi!;

E+it"ra T!ora.; 7"#"r!ti; 2&

5. H''$n -Pr in#ipiil! m!+i#in!i int!rn!;

E+it"ra T!or a; 7"#"r !ti; 2

+. M) C. -T!5ni#a ingri

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