Differential diagnosis and treatment edema. Tactics gp

Classification by HNK ND Strazhesko and VH VasilenkoPhase
I Hidden CH manifested dyspnea, palpitations, fatigue during exercise only. At rest, hemodynamics is not broken.
A Phase II HF symptoms alone expressed moderately, exercise tolerance is reduced, there are violations in a large or small circle of blood, asthma, radiographic, in some cases, ECG signs of secondary pulmonary hypertension, peripheral edema, and observed a moderate increase in liver size.
Stage II B Severe symptoms of CHF at rest, severe hemodynamic disturbances in the large and in the pulmonary circulation.Phase
III-A terminal with little movement or even at rest severe hemodynamic, metabolic, irreversible degenerative changes in organs and tissues.
Classification of chronic heart failure of New York Heart Association (NYHA)
I-class patients with heart disease, but without the limitations of physical activity. Asymptomatic left ventricular dysfunction.
II-class patients with diseases of the heart, causing a slight limitation of physical activity. Mild heart failure.
III-class patients with heart disease, causing significant limitation of physical activity. Heart failure of moderate severity.Class
IV-Patients with heart disease who have even minimal performance exercise causes discomfort. Severe heart failure.
Edema associated with kidney disease
Gipoonkoticheskie edema can occur when hypoproteinemia (less than 50 g / l). With particular importance is the shortage of albumin (less than 25 g / l), which have a much greater osmotic activity than globulins.Edema in the nephrotic syndrome appear primarily in places where the loose subcutaneous tissue on the face (especially in the century), the anterior abdominal wall, in the genital area. Breathlessness is not typical. There is no dependence on the position of the body edema. Gradually swelling may extend to the point of anasarca. Often they are accompanied by ascites, at least - hydrothorax. Oliguria is optional. Characterized by high proteinuria (daily - more than 3 g), hypoproteinemia, disproteinemia, hyperlipidemia, often - abundance in urine cylinders (granular, fatty, waxy) and zhiropererozhdennogo renal epithelium. At obscure reason nephrotic syndrome kidney biopsy.Nephritic edema often observed in acute or chronic glomerulonephritis (without nephrotic syndrome), arise in connection with the reduction of filtration charge of sodium and increased permeability of the capillary wall. Characterized by rapid development of edema (a few days). However, they can sometimes appear earlier than the changes in the urine. Swelling moderate, localized in the places where the loose fiber (eyelids, face), more - in the morning, quite soft and mobile. The skin over the area of ​​swelling warm, pale. Trophic changes are not typical. Often combined with edema oliguria, hypertension. Almost always there is urinary syndrome (mild proteinuria, hematuria, cylindruria). Laboratory signs of nephrotic syndrome otsutstvuyut.Nefrotichesky syndromeGenesis of edema in the nephrotic syndrome is associated with decreased plasma oncotic pressure by reducing the concentration of albumin. This swelling is called protein-free. Are characteristic of their symmetry, as well as localization of the lower extremities. Last seen in patients, most of the time staying in the standing or sitting with legs hanging down. Edematous tissue tend to form in those areas of the body, venous blood pressure in which position improved. Edema can migrate position, ie depending on the position of the patient may swell hands, face and neck and body. At long lying edema of the lower extremities are reduced, there is swelling of the upper limbs and face. Often the intensity of edema is asymmetrical. At long lying on his side more swollen limbs lateral side. Must-edema in the nephrotic syndrome are high proteinuria and hypoalbuminemia. Failure of any of these signs of questions the nephrotic syndrome.