Differential diagnosis and treatment edema. Tactics gp

Causes of edema syndrome
Chronic heart failure
Heart failure - a pathological condition in which the cardiac output does not match the needs of the body by reducing the pumping function of the heart.Symptoms of heart failure:Causes of Heart Failure:The cause may be an overload of the heart increased blood volume and (or) pressure (heart diseases, hypertension, pulmonary heart, etc.), as well as reducing myocardial contractility decreases its mass (myocardial infarction, myocardial infarction, cardiac aneurysm, etc. ), degenerative changes (in amyloidosis, hemochromatosis, etc.), myocarditis, cardiomyopathy, myocardial dystrophy of different etiologies.Cardiac edema a manifestation of heart failureIn patients with chronic heart failure are identified heart disease (heart, atherosclerotic infarction, myocardial infarction, cardiac aneurysm, congestive cardiomyopathy, etc.). Determined by expanding the boundaries of the heart to some degree, hepatomegaly. Often marked arrhythmias, particularly atrial fibrillation. Characteristic position orthopnea, oliguria, nocturia, congestion in the lungs, swelling of the neck veins. The development of edema, usually preceded by shortness of breath. Swelling grows slowly, usually extend from the bottom up. They are symmetrical, little shifting. Considered severe swelling dependence on the position of the body: the appearance on his feet and walking to the back in bedridden patients. Edema is usually stronger in the evening. They are characterized testovatoy consistency, with pressure remaining debt does not disappear fossa. The skin over the area of ​​swelling is cold, cyanotic. With long-term existence of edema occur trophic skin changes, cracks, dermatitis. In severe cases (anasarca) external swelling combined with ascites, hydrothorax, most - right, at least - with hydropericarditis.In chronic heart failure, swelling associated with an increase in R Guide and increased permeability of the vessel wall due to circulatory hypoxia. Since the growth was due to lower R Guide contractile activity of the right ventricle, and hypertension are already hollow vein leads to increased pressure in the capillaries and venules microvasculature. Peripheral edema due to isolated right heart failure or a combination with left ventricular. In addition to hemodynamic reasons should be indicated on the development of secondary hyperaldosteronism with sodium and water retention in heart failure, a factor that independently cause or exacerbate swelling.Since the genesis of edema plays a major role hydrostatic components, they are observed in parts of the body, in which the position P Guide higher (lower limbs). Swelling of the feet have a tendency to decrease in the supine position, with the enhanced swelling of face and upper extremities. Usually swelling decreases with loop diuretic therapy. Anasarca may develop, as well as abdominal and parenchymal edema, often associated peripheral edema. Edema in heart failure is always accompanied by other symptoms of it in the form of general weakness, shortness of breath, malaise. In history, there is usually a chronic cardiac pathology (hypertension, ischemic heart disease, cardiomyopathy, congenital or acquired heart disease, etc.). Shortness of breath when walking increases and decreases in the rest. When echocardioscopy detect signs of systolic left ventricular dysfunction in the form of reduced ejection fraction, increased end-systolic and diastolic volumes, reduction in stroke volume. The study of blood is observed hypoalbuminemia, and the study of urine - proteinuria, eliminating nephrotic syndrome or protein deficiency as causes of edema syndrome. However, the known phenomenon of congestive kidney develops in chronic heart failure, and shows little oc-inuriey with decreased renal function, which has a wave-like nature, and increases or decreases with the growth or relieve symptoms of heart failure decompensation. This pathological condition is not always easy to differentiate with glomerulonephritis against heart failure. In congestive kidney (renal disease secondary to the presence of chronic heart failure) is not nephrotic syndrome is extremely rare hematuria, and an explanation of its appearance often lies in the plane of iatrogenic disease (drug interstitial nephritis). The latter also must be differentiated from congestive kidney. Presence of isolated red blood cell, the lack of amplification of edema, the presence of the causative drug or combination (NSAIDs, analgesics, aminoglycosides), and restoration of renal function after discontinuation of these drugs can produce a differential diagnosis.Not all pathological conditions accompanied by the development of edema, but their appearance in the background of chronic heart failure accounts for their combination with edema.Moreover, in some cases, the genesis of the edema and bladder syndromes due to a single disease. For example, in patients with infective endocarditis, valvular heart disease is formed with the development of severe heart failure and as a result, swelling and urinary syndrome (congestive kidney), renal damage occurs by the type of glomerulonephritis caused by immune mechanisms that lead to the formation of urinary symptoms and making contribution to the development of edema. In this case, holding needle nefrobiopsii is not always possible to make a differential diagnosis, and by the severity of the condition and the presence of contraindications for biopsy last seems unlikely.