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Keywords: a case history, faculty therapy, therapy, internal, diseases, a case history on the therapy, combined mitral fault, a ciliary arrhythmia, an ischemic disease, a hypertonic disease, an idiopathic hypertensia, an arrhythmia, mitral fault, ischemic disease, a hypertonia
the CASE HISTORY
******** ********* ********
the Clinical diagnosis:
-1) the Basic disease - ischemic disease of heart, a stable stenocardia of a strain, III functional class; a ciliary arrhythmia; chronic heart failure IIÁ of a stage, IV functional class.
-2) Complication of a basic disease - the transferred ischemic insult (1989 year); a chronic discirculate encephalopathy
-3) Background diseases - an idiopathic hypertensia of III stage, 4 group of risk; the inactive rheumatic disease, combined mitral fault with predominance of failure.
-4) Concomitant diseases - a bronchial asthma, a cholelithiasis, a urolithiasis, HOBL, a diffuse nodal struma.
NAMEPLATE DATA
- the Surname, a name, a patronymic - ******** ********* ********.
- Age - 74 flying (year of a birth 1928).
- the Sex - female.
- the Nationality - Russian.
- Formation - average.
- the Place of work, a trade - the pensioner about 55 flying, worked as the technologist earlier.
- the Home address: street *********** d. 136, sq. 142.
- Date of entering in clinic: on October, 4 2002 years.
- the Diagnosis at entering - rheumatic disease, an inactive phase. Combined mitral fault. A cardiosclerosis. A paroxysm ciliary arrhythmia. An idiopathic hypertensia of III stage, 4 group of risk. Heart failure IIÀ on levozheludochkovomu to phylum. A chronic discirculate encephalopathy.
COMPLAINTS AT ENTERING
The patient complains of a short wind, is especial in a horizontal position, on the expressed delicacy, razlituju a headache, discomfort in range of heart, fault in a cardiac performance, on periodic, paroxysmal, not intensive choping pains in the ranges of heart arising in a quiet condition, irradiating in the left brachium. The short wind is facilitated in a position "sitting". At walking the short wind strengthens, pains in range of heart arise more often.
THE HISTORY OF THE PRESENT DISEASE
Counts itself the patient about 1946 years when to it was 18 flying. After an angina the rheumatic disease which showed megalgias in large joints, a tumescence, sharp difficulty of locomotions has developed. It was treated in 3-rd municipal hospital, received Acidum salicylicum. In 1946 year the diagnosis is put: failure of the mitral valve of 1-st degree. In 1950 year, in the age of 22 flying - repeated rheumatic attack after the transferred angina. Rheumatic attack was accompanied by a sharp articulate pain, infringement of function of joints, a tumescence of the struck joints (ulnar, coxofemoral). In 1954 year has transferred a tonsilectomy. About 1972 years (age 44 years) the patient marks regular risings arterial pressures (blood pressure) up to 180/100 mm Hg, from time to time up to 210/120 mm Hg. In 1989 year - an insult. Accepted hypotensive preparations, including in 1989-2000 Clophelinum. About 1973 years suffers a chronic pneumonia; about 1988 years - a bronchial asthma; the allergy on odours has developed. With 1992 the diagnosis a cholelithiasis is put, operation has refused. In the last 3 years of the complaint to a short wind. 4 days prior to hospitalization the short wind has amplified.
THE HISTORY OF LIFE OF THE PATIENT
Was born in the Voronezh range in family of collective farmers. Conditions of a life in the childhood were serious. Grew and educed in conformity with the years. Worked all over again as the teacher of initial classes, then the technologist, all over again in. Bobrove, then in Khabarovsk edge, then in Voronezh. Work has been connected to ammonia. The psychologic atmosphere in collective was easygoing, conflicts arose seldom.
Does not smoke, the use of alcohol - moderate, the use of narcotics denies. During 11 flying (1989-2000) on a regular basis accepted Clophelinum in connection with an idiopathic hypertensia.
In the childhood frequently was sick of catarrhal diseases and anginas. In the age of 18 flying - rheumatic disease with a defeat of the mitral valve of heart. About 1972 years (age 44) - an idiopathic hypertensia, about 1973 years - a chronic pneumonia, about 1978 years - a bronchial asthma, about 1988 years - an allergy on odours. 1989 year - has transferred an insult. With 1953 on 1990 year marked choping pains in range of heart. 1992 year - a cholelithiasis. About 1994 years - the invalid of II group. 1996 year - a ciliary arrhythmia. In last two years marks downstroke of mass of a body on 10 kg. In 1997 year the urolithiasis, cysts in kidneys is diagnosed, marked pains in both kidneys, irradiating in both legs. In 2000 year the nodal struma is found. Accepted Mercazolilum, a potassium Iodidum, a L-thyroxine. Has stopped treatment as marked deterioration from spent therapy.
The tuberculosis, an infectious disease, venereal diseases at itself and denies relatives. An allergy on antibiotics. Mother has died in the age of 51 years (from words of the patient, probably, the insult), father has died in 73 years, suffered an idiopathic hypertensia.
Is married about 22 flying. A menses have begun in 15 flying, regular. Pregnancies - 7, labors - 2, artificial abortions - 5. Pregnancies proceeded quietly, threat of an abortion was not. A menopause about 48 flying. Marks augmentation of frequency and a degree of rise of arterial pressure after a menopause.
THE PRESENT CONDITION OF THE PATIENT
the General inspection.
A condition of the average patient. Consciousness clear. A position of the patient awake, but it marks, that in a horizontal position and at walking the short wind strengthens, therefore the most part of time carries out in a position "sitting". The look quiet, however, is marked a "mitral" cyanosis of labiums. Phylum of a body build normosthenic, the patient of a moderate feed, however, it marks, that for last two years has grown thin for 10 kg. In a youth and in mature age had superfluous mass of a body. Body height - 168 sm, weight - 62 kg. An index of mass of a body - 22.
Colour of integuments acyanotic, with a yellowish shade. The turgor of a skin is reduced, there is an excess of a skin that testifies to downstroke of mass of a body. A skin rugosity, it is especial on brushes. The coat is advanced moderately, amplified body height of a hair on a labrum.
Not strongly expressed edemas of legs, constants are marked, decrease after method of Furosemidum. On a dextral leg there is badly healing wound received as a result of a household trauma.
Submandibular lymph nodes, moderately dense, painless, in size with a pea, mobile, not commissured among themselves and with environmental tissues are palpated. The skin above them is not changed. Other peripheric lymph nodes are not palpated.
The muscle system is advanced in conformity with the years, the general oligotrophy of muscles is marked, force and a tonus of muscles are reduced. Morbidities and tremors of muscles it is not revealed. The head and extremities of the usual form, a backbone is deformed, appreciable asymmetry of clavicles. Joints are mobile, painless at a palpation, integuments in range of joints are not changed.
A body temperature - 36,5 ° Ñ.
SYSTEM OF ORGANS OF THE CIRCULATION
The chest in range of heart is protruding (" a cardiac back hollow "). The apical beat is palpated in the fifth intercostal space on the left papillary line, the diastolic tremor is determined. The cardiac impulse is not palpated. Musset sign - negative.
A percussion of heart: borders of relative dullness of heart - dextral - by a right edge of a breast bone, top - in the third intercostal space, left - on a mammilar line. Width of a vascular bundle - 5 sm in the second intercostal space. Dlinnik hearts - 14 sm, a diameter of heart - 13 see
An auscultation of heart. Cardiac sounds it are weakened, sharply weakened I tint. The accent of II tint above an aorta is determined. Systolic hum in all points of an auscultation is audible. In the best way systolic hum is auscultated on an apex. Frequency of cardiac reductions (heart rate) - 82 ud/minutes. A pulse rate (Ps) - 76 ud/minutes. Deficiency of pulse (pulsus defficiens) - 6. Pulse spasmodic, complete, satisfactory filling. ÀÄ=150/85 mm Hg on a dextral arm, ÀÄ=140/80 on the left arm.
SYSTEM OF THE RESPIRATORY ORGANS
A nose of a regular form, a palpation of additional sinuses it is painless. A larynx at a palpation painless. The form of a chest normal, symmetric is present an insignificant diverticulum in range of heart. Phylum of respiration - thoracal. Frequency of respiratory locomotions (CHDD) - 24 in one minute. Respiration rhythmical, superficial. The expressed short wind intensifyed in a horizontal position and at walking. The chest resistant, integrity of ribs is not broken. Morbidities at a palpation are not present. Intercostal spaces are not amplate. A voice tremor usileno.
At a percussion the dullness in the inferior departments mild is determined: on a scapular line at a level of IX rib at the left and at a level of VII rib on the right. In other plots mild - a clear pulmonary note. The data of a topographical percussion: the inferior border dextral mild on a mammilar line - 6 rib, on an average axillary line - 8 rib, on a scapular line - 10 rib; the inferior border left mild on a mammilar line - 6 intercostal space, on an average axillary line - 8 rib, on a scapular line - 10 rib (obtusion). Width of fields Kreniga - 5 see
At an auscultation it is auscultated bronhovezikuljarnoe respiration, microvesicular rhonchuses are audible, in the inferior departments dextral mild respiration is weakened.
SYSTEM OF ORGANS OF DIGESTION
A mucosa of an oral cavity and a pharynx pink, clean. Tongue wet with a light raid, gustatory papillas are well-marked. The dentition is not kept, many tooths are absent. Labiums tsianotichny, angles of labiums without cracks. The forward abdominal wall is symmetric, participates in the act of respiration. The form of a belly: the "frog" belly that testifies to presence of a free liquid in an abdominal cavity. At a percussion of lateral departments of a belly the insignificant dullness is taped. The seen peristalsis of an intestine, hernial diverticulums and expansions of saphenas of a belly are not determined. At a palpation of intensity and morbidity of muscles is not present, the prelum abdominale is advanced moderately, the divarication of recti is absent, the umbilical ring is not enlarged, the sign of a fluctuation is absent. Sign SHCHetkina-Bljumberga negative.
The inferior edge of a liver painless, acts on 4 sm from under a rib arch. The dimensions of a liver on Kurlovu 13ñì, 11 sm, 9 see. The lien palpatorno is not determined. Morbidity in a point of a projection of a gall bladder - positive sign Zaharjina. Signs Georgievskogo-Mjussi, Ortnera-Grekova, Murphy - negative.
SYSTEM MOCHEOTDELENIJA
At inspection of lumbar range of a tumescence, a protrusion it is not revealed. Kidneys are not palpated. Sign Pasternatskogo negative from both sides. Sexual system - without features.
ENDOCRINE SYSTEM
The thyroid gland is not visualized. Palpatorno the isthmus of 5-7 mm is determined and the augmentation of both lobes of Ferri lactas is marked. In the left lobe of a thyroid gland units are palpated. The form of palpebral fissures usual, pucheglazija is not present. Presence of amplified body height of a hair on a labrum.
NERVOUS SYSTEM AND SENSE BODYS
Consciousness clear. Memory on the present events is reduced. Dream superficial, frequently wakes up at night because of intensifying a short wind in a horizontal position. Alalias are not present. Coordination of locomotions normal, gait free. Reflexes are kept, cramps and paralysises are not found. Vision - the left eye: the cataract, vision is absent; a dextral eye: a myopia of an average degree, vision it is reduced. The ear is reduced. A dermographism - white, evanescent.
THE PRELIMINARY DIAGNOSIS
Ischemic disease of heart, arrhythmic variant. A ciliary arrhythmia. A stenocardia of a strain II FK, chronic heart failure IIÁ of a stage, IV functional class. An idiopathic hypertensia of III degree, 4 group of risk, inactive rheumatic disease, a stenosis and failure of the mitral valve.
THE PLAN OF INSPECTION
The general analysis of a blood, a biochemical analysis of a blood, the general analysis of urine, an electrocardiogram, Echo - kg, the analysis of urine on Nechiporenko, a cardiophonography, holterovskoe a monitoring, research TTG of a blood, inspection of the oculist.
THE TREATMENT PLANNING
It is recommended to appoint the following preparations: Korglykonum, Nitrosorbidum, Furosemidum, Riboxinum, enalapril, a potassium Sodium chloridum.
LABORATORY AND TOOL METHODS OF RESEARCH
the General analysis of a blood (7.10.02):
the Haemoglobin (Hb) - 116 g/l (N=120-150)
Erythrocytes - 3,6*1012/ë (N=3,7-4,7)
Leucocytes - 6,2*109/ë (N=5-8):
eosinocytes - 3 % (N=0,5-5)
relating to stab neutrophile neutrophils - 5 % (N=1-6)
segmentojadernye neutrophils - 66 % (N=47-72)
lymphocytes - 21 % (N=19-37)
monocytes - 5 % (N=3-11)
SOE - 8 mm / ch (N=3-15.)
the Biochemical analysis of a blood (7.10.02):
the Glucose - 4,5 mmol/l (N=3,3-5,5)
the Urea - 6,3 mmol/l (N=3,3-6,6)
the Amylase - 4,0 (N=2,2-7)
AlAT - 55 nmol/l (N=27,8-125)
AsAT - 31 nmol/l (N=27,8-189)
the Bilirubin free - 9 (N=5-20,5)
the General analysis of urine (7.10.02):
Urine cloudy, colour - yellow, relative density - 1017, reaction - acidic, protein - 1 g/l. It is not enough epithelium, leucocytes - 1-2 in sight, erythrocytes - 1-2 in sight, it is a lot of bacteria.
the Electrocardiogram (electrocardiogram) (5.10.02):
PQ=0,20 ", QRS=0,14 ", QT=0,16 ", RR=0,75 ". The deflection of an electrical axis of heart - is sharp to the left (Ða =-45 °), attributes of complete blockage of the left leg of a ventriculonector, attributes of a hypertrophy of a left ventricle, attributes of a ciliary arrhythmia.
the Echocardiography (August 2002):
the Aorta condensed, an aortal aperture - 3,1; the left auricle - 4,2; final diastolic volume - 5,8 sm3; a final systolic volume - 5,06 sm3. The fraction of outlier is sharply reduced - 30 %. Depth of an interventricular septum - 1 sm, depth of a back wall of a left ventricle - 0,8 see. The aortic valve condensed, the mitral valve condensed, a calcification of cusps. The conclusion: a dilatation of the left auricle and a left ventricle, appreciable downstroke of constriction ability of a left ventricle. A mitral stenosis of 1-st degree, failure of the mitral valve - 2-3 degrees, failure of the trivalve valve of 1-st degree. Inspissation of an aorta and a calcification of the aortal ring.
THE DEVELOPED CLINICAL DIAGNOSIS
A basic disease - ischemic disease of heart, a stable stenocardia of a strain, III functional class; a ciliary arrhythmia; chronic heart failure IIÁ of a stage, IV functional class.
Complication of a basic disease - the transferred ischemic insult (1989 year); a chronic discirculate encephalopathy
Background diseases - an idiopathic hypertensia of III stage, 4 group of risk; the inactive rheumatic disease, combined mitral fault with predominance of failure.
Concomitant diseases - a bronchial asthma, a cholelithiasis, a urolithiasis, HOBL, a diffuse nodal struma.
THE SUBSTANTIATION OF THE CLINICAL DIAGNOSIS
One of forms of an ischemic disease is the stenocardia of a strain. Stable stenocardias of a strain III FK - on the establishment of complaints to the compressive retrosternal pains irradiating in the left arm, arising at a small exercise stress (walking less than 100 m, rise on a ladder). Pains are accompanied by a short wind, last less than 15 minutes, pass independently or are stoped by Nitroglycerinum. The ciliary arrhythmia is put according to an electrocardiogram and on the establishment of complaints to a short wind, palpitation, pains behind a breast bone, fatigability and deficiency of pulse - 6-10.
For the benefit of a chronic heart failure the following signs testify: a short wind, general delicacy, rising of fatigability, an intolerance of an exercise stress on a background of an ischemic disease and failure of the mitral valve. IIÁ stage HSN is put on the establishment of the expressed changes of a hemodynamics in both circles of the circulation, showing by delicacy, a short wind, palpitation; a hepatomegalia, owing to overflow of a liver by a blood; edemas on legs and presence of a liquid in an abdominal cavity; microvesicular rhonchuses in mild; a Crocq's disease. IV functional class HSN - on the establishment of impossibility to perform any physical work without a short wind, discomfort in range of heart. Signs of a heart failure are present at dormancy and strengthen at the minimal physical activity. On Echo - kg - downstrokes of a fraction of outlier to 30 %. As indirect attributes blockage of the left leg of a ventriculonector, attributes of a hypertrophy of a left ventricle and a ciliary arrhythmia, revealed on an electrocardiogram serve. The factor complicating a heart failure, the anemia is normohromnaja.
The diagnosis of an idiopathic hypertensia is put on the establishment of presence in an anamnesis of constantly increased arterial pressure, about 1973 years ÀÄ=160/100 mm Hg, from time to time a blood pressure raised up to 210/120 mm Hg. On an electrocardiogram there is a hypertrophy of a left ventricle, on Echo - kg of a hypertrophy is not present, that, most likely, is connected to a replacement of tissue of a myocardium a connective tissue. III stage - there are associated clinical conditions: on the part of a brain - the transferred insult, a chronic discirculate encephalopathy, on the part of heart - a stable stenocardia of a strain, a chronic heart failure.
Combined mitral fault with predominance of failure is confirmed at an echocardiography; in an anamnesis rheumatic disease. At an auscultation of heart - attributes of mitral failure: sharp weakening I of tint, accent of II tint above an aorta, the expressed systolic hum.
Concomitant diseases - on the establishment of the data of an anamnesis. Objectively: the thyroid gland is palpated, there are units that testifies to a diffuse nodal struma. Positive sign Zaharjina indirectly specifies a cholelithiasis. The dullness in the inferior departments dextral mild can specify on HOBL.
THE DIFFERENTIAL DIAGNOSIS
The stenocardia of a strain is differentiated with an acute myocardial infarction on the establishment of that pains proceed less than 15 minutes, pass independently or are stoped by Nitroglycerinum. The stenocardia of a strain is differentiated with a defeat of a thoracal department of a backbone, a diaphragmatic hernia, a round ulcer, a cholecystitis on the establishment of an anamnesis and a typical clinical picture.
THE LEAF OF MEDICAL PURPOSES
Preparations:
Sol. Glucosi 5 % - 400 ml
Sol. Insulini 10 ED
Tab. Enalprili 0,005. On 1 tablet once a day.
Sol. Corglyconi 0,06 % - 1 ml. On 1 ml in a vein.
Sol. Furosemidi 1 % - 2 ml. On 2 ml in a vein.
Tab. Nitrosorbidi 0,1. On 1 tablet 2 times day.
Sol. Riboxini 0,2 % - 10 ml. On 10 ml.
Asparcam solutio pro injectionibus 5 ml. Intravenously kapelno.
THE DIARY OF THE PATIENT
on October, 7.Complaints to a strong short wind in a dormant state, intensifyed in a horizontal position and at the minimal exercise stress. The general condition - average. Integuments acyanotic, dry, cool. Cardiac sounds at an auscultation deaf persons, systolic hum, I tint is absent, accent of II tint above an aorta. There are edemas of anticnemions, autopodiums. The patient leads intravenous drop infusions of the appointed preparations. ÀÄ=130/80 mm Hg. Ps=90 of ud/mines, ×ÑÑ=82 ud/minutes. ÄÏ=8. ×Ä=26-28 in one minute. t=36,7°C.
on October, 8.an average Condition. Has woken up in the morning at 4 o'clock, marks, that the small pulse was. Has accepted 1 tablet of Nitrosorbidum, the condition has improved. Complaints to choping pains in range of heart, on a short wind in a dormant state and at the minimal exercise stress. Cardiac sounds deaf persons. ÀÄ=140/90 mm Hg. Ps=82 of ud/mines, ×ÑÑ=80 ud/minutes. ÄÏ=2. ×Ä=24-26 in one minute. t=36,6°C. The patient leads intravenous drop infusions of the appointed preparations.
on October, 9.Complaints to a strong short wind in a dormant state, intensifyed in a horizontal position and at the minimal exercise stress. The general condition - average. Integuments acyanotic, dry, cool. Cardiac sounds at an auscultation deaf persons, systolic hum, I tint is absent, accent of II tint above an aorta. There are edemas of anticnemions, autopodiums. ÀÄ=130/80 mm Hg. Ps=80 of ud/mines, ×ÑÑ=74 ud/minutes. ÄÏ=6. ×Ä=22-24 in one minute. t=36,5°C. The patient leads intravenous drop infusions of the appointed preparations.
on October, 10.Complaints to a strong short wind in a dormant state, intensifyed in a horizontal position and at the minimal exercise stress. The general condition - average. Integuments acyanotic, dry, cool. Cardiac sounds at an auscultation deaf persons, systolic hum, I tint is absent, accent of II tint above an aorta. Are available pastoznost anticnemions, autopodiums. ÀÄ=140/80 mm Hg. Ps=82 of ud/mines, ×ÑÑ=76 ud/minutes. ÄÏ=6. ×Ä=24 in one minute. t=36,7°C. The patient leads intravenous drop infusions of the appointed preparations.
THE EPICRISIS
- the Surname, a name, a patronymic of the patient - ******** ********* ********.
- Age - 74 years (1928 year of a birth).
- the Pensioner. Worked as the technologist earlier.
- there Are in a hospital since October, 4 2002 years.
- the Basic complaints at entering - on a short wind, it is especial in a horizontal position, on the expressed delicacy, razlituju a headache, discomfort in range of heart, fault in a cardiac performance, on periodic, paroxysmal, not intensive choping pains in the ranges of heart arising in a quiet condition, irradiating in the left brachium.
- From an anamnesis it is known, that in the age of 18 flying (1946 year) after an angina the rheumatic disease with a defeat of the mitral valve of heart has developed. In 1950 year - repeated rheumatic attack. About 1972 years rising a blood pressure up to 160/100 mm Hg, from time to time up to 210/120 mm Hg is marked. In the last 3 years the patient marks a respiratory embarrassment.
- Objectively: the cyanosis of labiums, puffiness of legs is marked, " the cardiac back hollow " is taped. At an auscultation of heart - weakening I of tint, accent of II tint in 2 and 3 points of an auscultation; deficiency ïóëüñà=6. Frequency of respiratory locomotions - 24 in one minute; in mild microvesicular rhonchuses are audible. The specific form of a belly - reminds "frog". At a percussion of a liver the hepatomegalia is marked, the liver on 4 sm acts from under a rib arch. Positive sign Zaharjina is marked. The thyroid gland enlarged, units are palpated.
- the Data of laboratory and tool methods of research. A moderate anemia. A proteinuria, a pyuria. The deflection of an electrical axis of heart - is sharp to the left (Ða =-45 °), attributes of complete blockage of the left leg of a ventriculonector, attributes of a hypertrophy of a left ventricle, attributes of a ciliary arrhythmia. On Echo - kg: the Fraction of outlier is sharply reduced - 30 %. A dilatation of the left auricle and a left ventricle, appreciable downstroke of constriction ability of a left ventricle. A mitral stenosis of 1-st degree, failure of the mitral valve - 2-3 degrees, failure of the trivalve valve of 1-st degree. Inspissation of an aorta and a calcification of the aortal ring.
- the Developed clinical diagnosis: the Basic disease - ischemic disease of heart, a stenocardia of a strain, III functional class; a ciliary arrhythmia; chronic heart failure IIÁ of a stage, IV functional class. Complication of a basic disease - the transferred ischemic insult (1989 year); a discirculate encephalopathy Background diseases - an idiopathic hypertensia of III stage, 4 group of risk; rheumatic combined mitral fault with predominance of failure. Concomitant diseases - a bronchial asthma, a cholelithiasis, a urolithiasis, a chronic pneumonia, inactive rheumatic disease, a diffuse nodal struma.
- the Appointed treatment. Sol. Glucosi 5 % - 400 ml. Sol. Insulini 10 UNITS Tab. Enalprili 0,005. On 1 tablet once a day. Sol. Corglyconi 0,06 % - 1 ml. On 1 ml in a vein. Sol. Furosemidi 1 % - 2 ml. On 2 ml in a vein. Tab. Nitrosorbidi 0,1. On 1 tablet 2 times day. Sol. Riboxini 0,2 % - 10 ml. On 10 ml. Asparcam solutio pro injectionibus 5 ml. Intravenously kapelno.
- Dynamics of disease during a presence in hospital. During stay in a hospital downstroke of a pulse rate, a heart rate and frequencies of respiratory locomotions is marked, subjectively the patient marks improvement.
- the Evaluation of efficacyy of treatment. On a background of treatment improvement of a condition of the patient is observed: the short wind in a dormant state and in a horizontal position thereof dream has become deeper has decreased, the patient wakes up at night less often, edemas on legs have decreased, disturb pains in range of heart less often.
THE LITERATURE
- Internal diseases: the textbook. Under edition Martynova, Mukhin, Moiseyev - GEOTAR-HONEY, 2002. Ò.1.
- Internal diseases: the textbook. Under F.I.Komarova's edition - M.: Medicine, 1991 - 688 with.
- Materials of 3-rd national conference on a cardiology (classification of a heart failure) // SPb, 2002.
- the International management on a heart failure. 2 edition. Under the general red. S.Dzh. Ball, R. V.F.Kempbella, G.S.Frensisa. M.: 1998.
- the Nosography. Diagnosis and therapy. Ò.1.: Translation from English / Under red. R.Berkou, E.Fletcher. - M.: the World, 1997. xxxiv + 1045 with.
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Keywords: a case history, faculty therapy, therapy, internal, diseases, a case history on the therapy, combined mitral fault, a ciliary arrhythmia, an ischemic disease, a hypertonic disease, an idiopathic hypertensia, an arrhythmia, mitral fault, ischemic disease, a hypertonia
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