L UCRARE DE D IPLOMA

CUPRINS
I. MOTIVATIA LUCRARE
II. ANATOMIA SI FIZIOLOGIA APARATULUI
CARDIOVASCULAR
A. INIMA -Asezare
-Forma si dimensini -
Con!i"ra#ia e$#erna a inimii -
S#r%#ra inimii -
Vas%&ariza#ia inimii
-Iner'a#ia inimii
-Pro(rie#a#i&e ms%)&i
%ardia% -A%#i'i#a#ea me%ani%a
a inimii
*. AR*ORELE CIRCULATOR
+. Ar#ere&e
,. Vene&e
-.Vase&e &im!a#i%e
-CIRCULATIA SANGVINA
SISTEMATICA -CIRCULATIA
PULMONARA -CIRCULATIA
LIMFATICA
C. REGLAREA ACTIVITATE CARDIOVASCULARE
+. Prin me%anisme in#rinse%i
,. Prin me%anisme e$#rinse%i
IV. .EPERTENSIUNE ARTERIALA
+ .De!ini#ie si %&asi!i%are
,.E#io(a#o"enie
-.Fizio(a#o&o"ia )i(er#ensinii ar#eria&e
/.Ana#omia (a#o&o"i%a
0.Dia"nos#i%& .TA si e'a&are
1.Forme %&ini%e si semi(a#o&o"i%e
2.E'o&#ie si %om(&i%a#ii
3. Pro"nos#i%&
4.Tra#amen#& .TA5a.Tra#amen# i"ieno-die#e#i%
6.Tra#amen# medi%amen#os
%.
Tra#amen#& r"en#e&
or
)i(er#ensi'e
+7.Pro!i&a$ia )i(er#ensinii ar#eria&e
V. PREZENTAREA CAZURILOR STUDIATE
VI. CONCLUZII
VII. *I*LIOGRAFIE




MOTIVATIA LUCRARII
'Invatam pentru
viata, nu pentru
scoala'
8 SENECA 9
In#r-o &me in %are e$is#en#a %o#idiana a in#ra# in#r-n ri#m
ame#i#or si so&i%i#an# #re6ie sa in'a#am %m sa ne (as#ram sana#a#ea: dar mai
a&es %m sa rea%#ionam in %az de im6o&na'ire.
C)iar da%a ne %ond%em in 'ia#a d(a n mo##o %a
a%es#a5
E preferabil sa te epuizezi decat sa ruginesti
8 DAVID ;. SC.A<ARTZ - P#erea ma"i%a a
"and&i 9: #re6ie sa s#im si %e ris%ri im(ne a6ordarea ni as#!e& s#i& de
'ia#a.
Am a&es a%es# s6ie%# (en#r %a 6o&i&e %ardio-'as%&are o%(a
ne&e din#re (rime&e &o%ri (rin#re %aze&e de mor#a&i#a#e din #ara noas#ra.
Es#e s#i# %a )i(er#ensi'ii re(rezin#a +7= din (o(&a#ia "enera&a. In (o(&a#ia
de (es#e /7 de ani: a%es#ia %(rind /7=: iar in (o(&a#ia de 00-17 de ani
nmar& &or %res#e &a 07-17=.
Cm s#res& es#e n !a%#or !a'orizan# a& ins#a&arii .TA: iar as#azi
es#e !oar#e %res%# (en#r in#rea"a (o(&a#ie: am 'r# %a a6ordand a%es# s6ie%#
sa in'a# %a# mai m&#e des(re a%eas#a a!e%#ine si des(re im(or#an#a nei 'ie#i
e%)i&i6ra#e> mai a&es sa &e (o# #ransmi#e si
%e&or&a&#i a%es#e in!orma#ii: in s(e%ia& %e&or
(redis(si sa !a%a .TA.













Anatomia S i fiziologia
aparatului
cardiovacular


Sis#em& %ir%&a#or es#e !orma# din inima: 'ase san"ine si
&im!a#i%e: %are a&%a#ies% o ni#a#e !n%#iona&a %oordona#a si (ermanen#
ada(#a#a ne'oi&or or"anim&i . Desi a(ara#& %ardio-'as%&ar re(rezin#a
n #o# ni#ar: e& (oa#e !i im(ar#i# in 5
o sis#em& san"in
re(rezen#a# (rin5
-inima
-'ase san"ine
o sis#em& &im!a#i%
re(rezen#a# de5
-'ase&e &im!a#i%e
-"an"&ioni &im!a#i%i
A9. INIMA
Inima es#e %onsidera#a %a or"an %en#ra& a& a(ara#&i %ardio-
'as%&ar: a %ari !n%#ionare asi"ra %ir%&a#ia san"e&i in#ers#i#ia&.
? Asezare 5 Inima se "ases#e aseza#a in %#ia #ora%i%a : in
(ar#ea in!erioara a medias#in&i an#erior. Cea mai mare (ar#e a
ei es#e in (ar#ea s#an"a a medias#in&i si o%(a (a#& inimii
de (e !a#a medias#ina&a a (&aman&i s#an".
?Forma si dimensini 5 Are !orma a(ro$ima#i'a a ni
%on #r#i#
an#ero-(os#erior: marimea (mn&i
ni ad&# si %an#ares#e a(ro$ima#i' -77
".

? Con!i"ra#ia e$#erna a inimii 5 Inima (rezin#a 5 o !a#a
an#erioara: o
!a#a in!erioara a mar"ini: n 'ar!
si o 6aza.
? S#r%#ra inimii 5
Inima es#e n or"an %a'i#ar si ms%&ar: % o
s#r%#ra %ara%#eris#i%a: (o#ri'i#a !n%#ii&or (e %are &e inde(&ines#e. in
s#r%#ra ei: 'om s#dia 5 %a'i#a#i&e inimii si (ere&e inimii. Un (ere#e
&on"i#dina& des(ar#e inima in doa (ar#i5 inima drea(#a si inima s#an"a: iar
n (ere#e #ran'ersa& nmi# si se(#& an#rio-'en#ri%&ar: im(ar#e !ie%are din
%e&e doa (ar#i in doa %a'i#a#i 5 o %a'i#a#e %a#re 6aza inimii: nmi#a a#ri si
o %a'i#a#e %a#re 'ar!& inimii nmi#a 'en#ri%&.
Pere#e&e &on"i#dina& %e des(ar#e a#rii&e se nmes#e
se(# in#era#ria&: iar %e& %e des(ar#e 'en#ri%&e&e se(# in#er'en#ri%&ar.
Fie%are a#ri %omni%a % 'en#ri%&& res(e%#i' (rin
ori!i%ii&e a#rio-'en#ri%&are (re'az#e % 'a&'e: %are se des%)id doar in#r-
n anmi# sens: s(re 'en#ri%&e&e 5 -s#an" 86i%s(ida9
-si dre(# 8#ri%s(ida9.
.is#o&o"i% inima es#e a&%a#i#a din #rei s#ra#ri
%on%en#ri%e 5
-(eri%ard>
-mio%ard>
-endo%ard.
Peri%ard& sa s#ra#& e$#ern es#e %ons#i#i# din#r-o
!orma#ine mem6ranoasa: %are in'e&es#e si 6aza 'ase&or mari %are
(ornes% din inima. Es#e a&%a#i# din doa !oi#e 5 'is%era&a si (arie#a&a.
in#re a%es#ea se "ases#e %a'i#a#ea (eri%ardi%a % o &ama s6#ire de &i%)id:
%are !a'orizeaza a&ne%area in #im(& a%#i'i#a#ii %ardi%e.
Mio%ard& - ms%)i& inimii - es#e mai "ros in 'en#ri%&e 8mai
a&es in %e& s#an"9 de%a# in a#rii si es#e %ons#i#i# din !as%i%&e de !i6re
ms%&are %ardia%e: orien#a#e %ir%&ar in (ere#e&e a#rii&or: si din !i6re
o6&i%-s(ira&a#e in 'en#ri%&e. Mio%ard& a#rio-'en#ri%&ar es#e se(ara# de %e&
'en#ri%&ar (rin ine&e !i6roase a#rio-'en#ri%&are. Mio%ard& a#ria& es#e ne#ed
(e !a#a in#erna: iar %e& 'en#ri%&ar (rezin#a ms%)i (a(i&ari @ #ra6e%&e
%arnoase de %are se (rind: (rin %ondaAi: 'a&'e a#rio-'en#ri%&are. in (ere#e&e
inimii: in a!ara %e&&e&or mio%ardi%e: mai e$is#a %e&&e s(e%ia&iza#e in
"enerarea si %ond%erea im(&sri&or de %on#ra%#ii - a%es#ea %ons#i#ie
sis#em& e$%i#o-%ond%#or noda& %e %(rinde 5 nod&i sinoa#ria&: nod&i
a#rio'en#ri%&ar: !as%i%&& .ISS %are se #ermina (rinre#eaa PURBIN;E in
!i6re&e mio%ard&i 'en#ri%&ar.
Endo%ard& - es#e %ons#i#i# din#r-n endo#e&i si#a# (e o
mem6rana 6aza&a %e se %on#ina % s#ra#& s6endo#e&ia& !orma# din !i6re
%o&a"ene: !i6re de re#i%&ina: !i6re e&as#i%e: rare %e&&e %onAn%#i'e si
nmeroase #ermina#ii ner'oase senzi#i'e.
?Vas%&ariza#ia inimii
Iri"area inimii % san"e es#e asi"ra#a: %a (en#r ori%are
a&# or"an: (rin ar#ere si 'ene.
Ar#ere&e inimii se nmes% si ar#ere %oronare: res(e%#i' ar#era
%oronara s#an"a si ar#era %oronara drea(#a.
Ar#era %oronara s#an"a se 6i!r%a in ar#era in#er'en#ri%&ara
an#erioara si ar#era %ir%m!&e$a.
Vene&e inimii sn# 5
-'ene&e %oronare %are sn# re(rezen#a#e (rin 5 marea 'ena %oronara : 'ena
in#er'en#ri%&ara(os#erioara si mi%a 'ena %ororia&a>
-'ene %ardia%e a%%esori: sn# %a#e'a 'ene mi%i: %are se des%)id dire%# in
a#ri& dre(#.
Vas%&ariza#ia inimii es#e %om(&e#a#a (rin nmeroase 'ase
&im!a#i%e si "an"&ioni &im!a#i%i.
? Iner'a#ia inimii
Inima are o iner'a#ie e$#rinse%a si o iner'a#ie in#rinse%a. Iner'
a#ia e$#rinse%a a inimii es#e rea&iza#a (rin !i6re 'e"e#a#i'e sim(a#i%e si
(arasim(a#i%e !ormand (&e'& %ardia%. Fi6re&e
sim(a#i%e (romi din "an"&ionii (ara 'er#e6ra&i %er'i%a&i si e$er%i#a e!e%#e
s#im&a#oare as(ramio%ard&i si 'asodi&i#a#oare %oronariene. Fi6re&e
(arasim(a#i%e (ro'in din ner'ii 'a"i: merzeaza (redominan# mod&i
sinoa#ria& si a#rio'en#ri%&ar si a %a e!e%# diminarea a%#i'i#a#i&or %ord&i.
In#er'en#ia in#rinse%a a inimii es#e re(rezen#a#a de
sis#em& e$%i#o%ond%#or.
? Pro(rie#a#i&e ms%)i&i %ardia%
Mio%ard& %are din (n%# de 'edere s#r%#ra& es#e n ms%)i s#ria#:
are (ro(rie#a#i %omne % ms%)i s#ria#i: dar si o serie de
(ro(rie#a#i %ara%#eris#i%e.
-Ri#mi%i#a#ea 8a#oma#ism&9 es#e (ro(rie#a#ea %ord&i de a se
%on#ra%#i' s%%esi': %a rmare a im(&sri&or %on#ra%#i&e de nod&i
sinoa#ria&.
-Cond%#i6i&i#a#ea es#e (ro(rie#a#ea mio%ard&i: in s(e%ia& a
#es#&i noda&: de a %ond%e nde de a %on#ra%#ia de &a ni'e&& nod&&i
sinoa#ria& in in#re" %ord&.
-E$%i#a6i&i#a#ea es#e (ro(rie#a#ea mio%ard&i de a ras(nde (rin#-o
%on#ra%#ie &a s#im&ii ade%'a#i.
-Con#ra%#i&i#a#ea es#e (ro(rie#a#ea mio%ard&i de a se %on#ra%#a a#n%i
%and es#e s#im&a# ade%'a#. Con#ra%#ii&e mio%ard&i se nmes% sis#o&e: iar
re&a$ari&e - dias#o&e.

? A%#i'i#a#ea me%ani%a a inimii
Inima es#e n or"an ms%&os: !a(# (en#r %are a%#i'i#a#ea ei
es#e %ara%#eriza#a (rin %on#ra%#ii si re&a$ari: %are se s%%ed % re"&ari#a#e.
Con#ra%#ia inimii se nmes#e sis#o&a: iar re&a$area: dias#o&a. O sis#o&a:
im(rena % dias#o&a %are ii rmeaza !ormeaza o re'o&#ia %ardia%a sa n
%i%& %ardia%.
Re'o&#ia %ardia%a in%e(e % sis#o&a a#ria&a: %are dreaza
7:+ se%nde: #im( in %are san"e&e es#e im(ins in 'en#ri%&e. D(a #erminarea
sis#o&ei a#ria&e: a#rii&e in#ra in dias#o&a: dias#o&a a#ria&a: %are dreaza (ana &a
sis#o&a a#ria&a rma#oare: adi%a 7:2 se%nde. In #im(& dias#o&ei a#ria&e:
(resinea in a#rii s%ade !oar#e m&# si san"e&e #re%e din 'ene in a#rii:
m(&and-&e din no.
In momen#& in %are in%e(e dias#o&a a#ria&a: in%e(e si
%on#ra%#ia 'en#ri%&e&or: adi%a sis#o&a 'en#ri%&ara: %are dreaza 7:-
se%nde> sis#o&a 'en#ri%&ara dreaza de%i mai m&# de%a# %ea a#ria&a. In
#im(& sis#o&ei 'en#ri%&are: dis#in"em o !aza in %are (resinea san"e&i
din 'en#ri%&e %res#e
(ana e"a&eaza (resinea din ar#ere> in a doa !aza se des%)id 'a&'&e&e
si"moide si san"e&e es#e im(ins in ar#ere. Cand in%e(e sis#o&a 'en#ri%&ara:
'a&'&e&e a#rio-'en#ri%&are se in%)id as#!e& %a san"e&e n se (oa#e in#oar%e
in a#rii. D(a %e se #ermina sis#o&a 'en#ri%&ara: in%e(e dias#o&a 'en#ri%&ara:
%are dreaza 7:0 se%nde.
Da%a rmarim re'o&#ia %ardia%a: %ons#a#am %a din 7:3 se%nde:
%a# dreaza : inima: in #o#a&i#a#e: se "ases#e in sis#o&a 7:/ se%nde si in
dias#o&a 7:/ se%nde. A%es# re"im in %are a%#i'eaza inima ne e$(&i%a de %e
a%es#a (oa#e !n%#iona #oa#a 'ia#a !ara sa o6oseas%a.
!" AR!ORELE CIRCULATOR
Ar6ore&e %ir%&a#or es#e %ons#i#i# din 'ase&e san"ine. A%es#ea
sn# #6ri&e in %are es#e in%)is si (rin %are %ir%&a san"e&e. in !n%#ie de
s#r%#ra si !n%#ii&e (e %are &e a: sn# #rei !e&ri de 'ase san"ine5 ar#ere:
%a(i&are si 'ene.
#" ARTERELE
Ar#ere&e sn# 'ase san"ine (rin %are san"e&e %ir%&a de &a inima &a
or"ane. E&e (ornes% din 'en#ri%&e si rami!i%and-se: se ras(andes% &a #oa#e
or"ane&e: nde se %a(i&arizeaza. D(a dimensini: ar#ere&e se im(ar# in #rei
%a#e"orii5 mari: miA&o%ii si mi%i> %e&e mai mi%i ar#ere: %are se %on#ina %
%a(i&are: se nmes% ar#eria&e. Ar#ere&e sn# 'ase % asezare 'aria6i&a.
Ar#ere&e mari sn# aseza#e: in "enera&: (ro!nd (e %and ar#ere&e mai mi%i
sn# s(er!i%ia&e. In drm& ei: ar#era!ormeaza ramri: %are (oar#a
denmirea de %o&a#era&e iar &a %a(a# !ormeaza ramri #ermina&e. Di!eri#e&e
ar#ere (o# %omni%a in#re e&e (rin ramri: %are se nes% si !ormeaza
anas#omoze.
STRUCTURA ARTERELOR
Pere#e&e nei ar#ere es#e a&%a#i# din #rei (a#ri nmi#e #ni%i.
a9 Tni%a in#erna sa in#ima es#e !orma#a din#r-n s#ra# s6#ire de
%e&&e
#r#i#e: nmi# endo#e&in.
S6 endo#e&in se a!&a s#ra#& s6endo#e&ia&: a&%a#i# din#r-o re#ea de
!i6re e&as#i%e: %o&a"ene si de re#i%&ina: iar s6 a%eas#a se a!&a o mem6rana
"roasa si e&as#i%a %are (oar#a denmirea de &imi#a e&as#i%a in#erna. Ea
(ermi#e #re%erea (&asmei san"ine si a "&o6&e&or a&6e s(re #es#ri.
69 Tni%a miA&o%ie sa media es#e a&%a#i#a din !i6re e&as#i%e si
!i6re
ms%&are ne#ede dis(se %ir%&ar. Pro(or#ia a%es#or doa #es#ri de(inde
de
marimea ar#erei: de%i de de(ar#area de inima. S#ra#& de #es# e&as#i% se
s6#iaza
(e masra %e ne de(&asam de inima: iar s#ra#& ms%&ar se in"roasa %
%a# ne
de(ar#am de inima. La (eri!eria #ni%ii medii se a!&a o mem6ra e&as#i%a:
%are o se(ara de #ni%a e$#erna: &imi#an#a e&as#i%a e$#erna.
%9 Tni%a e$#erna sa ad'en#i%ea es#e a&%a#i#a din #es# %onAn%#i'
e&as#i%
si %a#e'a e&emen#e ms%&are. In #ni%a e$#erna a 'ase&or mari si miA&o%ii
se "ases% a#rio&e si %a(i&are san"ine %are a ro&& se )raneas%a (ere#e&e
ar#erei.
In #ni%a miA&o%ie si #ni%a e$#erna se "ases#e si n mare nmar de
#ermina#ii ner'oase 'e"e#a#i'e. La ni'e&& %a(i&are&or: #ni%a miA&o%ie si
%ea e$#erna a dis(ar#.
$"VE%ELE
Vene&e sn# 'ase san"ine %are se !ormeaza (rin
%on!&en#a %a(i&are&or san"ine si %are se #ermina &a inima: in a#rii. Prin e&e
san"e&e %ir%&a de &a (eri!erie s(re inima.
Vene&e sn# mai nmeroase de%a# ar#ere&e: ra(or#& nmeri%
din#re e&e !iind de a(ro$ima#i' ,5+. In !n%#ie de dis(ozi#ia &or in or"anism:
'ene&e sn#5 (ro!nde si s(er!i%ia&e. O a&#a %ara%#eris#i%a o !ormeaza
mare&e nmar de anas#omoze: &e"a#ri (rin ramri %o&a#era&e. In !n%#ie de
"rosimea &or: 'ene&e se im(ar# in #rei %a#e"orii5 mari: miA&o%ii si mi%i. Ce&e
mai s6#iri ramri a&e 'ene&or se nmes% 'en&e si se !ormeaza (rin nirea
%a(i&are&or.
SRUCTURA VE%ELOR
Din (n%# de 'edere s#r%#ra&: 'ene&e a (ere#e&e mai s6#ire si
mai (#in rezis#en# de%a# ar#ere&e si: din a%es# mo#i': in se%#inea #ras'ersa&a:
%on#r& 'ene&or es#e o'a&: #r#i#:in #im( %e ar#ere&e a n %on#r %ir%&ar:
re"&a#.
Pere#e&e nei 'ene es#e !orma# din #rei #ni%i5
a9 Tni%a in#erna sa endo'ena es#e !orma#a din#r-n endo#e&in:
%are %a(#ses#e &men& 'enei si are a%eiasi s#r%#ra %a si endo#e&i&
%a(i&are&or: si din#r-n s#ra# %onAn%#i' e&as#i%: aseza# in Ar& endo#e&i&i:
%are %on#ine !i6re e&as#i%e: dis(se in !orma de re#ea.
Tni%a in#erna !ormeaza in in#erior& nor 'ene nis#e (&iri
semi&nare: nmi#e 'a&'&e 'enoase. Va&'&e&e 'enoase se "ases% nmai in
'ene&e in %are san"e&e %ir%&a de Aos in ss. Si se nmes% 'ene
'a&'&are.Vene&e %are n a 'a&'&e (oar#a denmirea de 'ene a'a&'&are.
69 Tni%a miA&o%ie sa mezo'ena es#e mai s6#ire de%a# #ni%a
miA&o%ie a ar#ere&or si are o s#r%#ra 'aria#a.Ea es#e !orma#a din #es#
%onAn%#i': in %are sn# %(rinse si !i6re ms%&are.Tes#& %onAn%#i'
%on#ine !i6re %onAn%#i'e si !i6re e&as#i%e: % dis(ozi#ie si (ro(or#ii !oar#e
'aria#e.
%9 Tni%a e$#erna sa (eri'ena es#e mai "roasa de%a# #ni%a
miA&o%ie si es#e %ons#i#i#a #o# din #es#& %onAn%#i' &a$: in %are se "ases%:
(e &an"a !i6re %onAn%#i'e si e&as#i%e: si e&emen#e ms%&are> de o6i%ei :
#es#& %onAn%#i' a& mezo'enei se "ases#e in %on#inarea #es#&i
%onAn%#i' a& (eri'enei: !ara o &imi#a dis#in%#a.
S#r%#ra (ere#e&i si in s(e%ia& s#r%#ra #ni%ii miA&o%ii 'ariaza
% di!eri#e&e #i(ri de 'ene 5 -'ene !i6roase: !i6roe&as#i%e si 'ene ms%&oase.
Vene&e ms%&oase sn# 'ene mi%i: aseza#e de(ar#e de inima: %m
sn# 'ene&e mem6re&or.
&" VASELE LIM'ATICE
Vase&e &im!a#i%e se !ormeaza (rin %on!&en#a %a(i&are&or dand
nos#in 'ase&or &im!a#i%e mi%i:%are: (rin %on!&en#a: !ormeaza 'ase &im!a#i%e
mari: iar a%eas#a da nas#ere: &a rand& &or: &a #rn%)iri &im!a#i%e: %are
%omni%a % sis#em& 'as%&ar san"in.
S#r%#ra&:'ase&e &im!a#i%e sn# asema#oare % 'ene&e: doar %a in
"enera& sn# mai s6#iri de%a# 'ene&e.
? CIRCULATIA SA%(UI%A
SISTEMATICA
Cir%&a#ia sis#ema#i%a asi"ra #rans(or#& san"e&i de &a inima
s(re or"ane si #ese#ri (rin sis#em& ar#eria& si %a(i&ar: iar rein#oa#%erea &a
inima: (rin sis#em& 'enos.
Cir%&a#ia sis#ema#i%a in%e(e in 'en#ri%&& s#an": de nde
(&ea%a ar#era: aor#a: din %are se des(rind a(oi #oa#e ar#ere&e mari -Car#ere-
Car#erio&e-C %a(i&are a(oi (rin 'ene&e-C'ene-C'ene&e-Ca#ri& dre(#.
? CIRCULATIA PULMONARA
Cir%&a#ia (&monara es#e %(&a#a in serie % %ea
sis#ema#i%a:san"e&e din 'en#ri%&& dre(# !iind (ro(&sa# (rin ar#era
(&monara s(re (&amani: nde are &o% s%)im6& de "aze: d(a %are re'ine
(rin 'ene&e (&monare in a#ri& s#an".
? CIRCULATIA LIMFATICA
Cir%&a#ia &im!a#i%a es#e o %a&e deri'a#a a marii %ir%&a#ii: (rin %are
rein#ra in 'ene o (ar#e din &i%)ide&e in#ers#i#ia&e. Simi&ar %ir%&a#iei
san"'ine: %ir%&a#ia &im!a#i%a are &o% in %adr& ni sis#em 'as%&ar in%)is:
%are in%e(e din #es#ri: (rin %a(i&are in%)ise: se %o&e%#eaza a(oi in 'ase din
%e in %e mai mari: si: in !ina&:
!ormeaza doa %o&e%#oare &im!a#i%e mari: %are se desa%)id in 'e
ne&e s6%&a'i%&are.

C"RE(LAREA ACTIVITATII
CARDIOVASCULARE
Re"&area a%#i'i#a#ii inimii se !a%e (rin me%anisme in#rinse%i si
e$#rinse%i. 1 Re!larea prin mecanisme intrinseci
O re"&are a a%#i'i#a#ii %ardia%e se o6ser'a si &a inima s%oasa
din or"anism: &i(si#a de%i de in!&en#e ner'oase si imora&e.
"Re!larea prin me%anisme e$#rinse%i
Re"&area a%#i'i#a#ii %ardia%e se !a%e in s(e%ia& (e %a&e re!&e$a si
mora&a5
a9 Re"&area re!&e$a
Se s#ie %a inima es#e iner'a#a de !i6re&e sim(a#i%e si
!i6re (arasim(a#i%e.Fi6re&e sim(a#i%e sn# (os#"an"&ionare si (ro'in din
(&e$& %ardia%.Fi6re&e (arasim(a#i%e (ro'in din ner'& 'a" si sn# !i6re
(remer"a#oare.
A%es#i ner'i a a%#ine a#o"onis#a as(ra inimii.Sim(a#i%&
a%%e&ereaza %on#ra%#ii&e %ardia%e si mares#e in#ensi#a#ea: (e %and
(arasim(a#i%&8'a"&9 in%e#ines#e ri#m& %on#ra%#ii&or %ardia%e si s%ade
in#ensi#a#ea &or.
A%#i'i#a#ea %ardia%a es#e in!&en#a#a si de a%#i'i#a#ea
s%oar#ei %ere6ra&e. Es#e s#i# %a s#ari&e emo#iona&e (o# (ro'o%a modi!i%area
a%#i'i#a#ii %ardia%e 5 !ri%a: mania: 6%ria e#%. (o# de#ermina o a%%e&erare a
%on#ra%#ii&or %ardia%e.
69 Re"&area mora&a
A%#i'i#a#ea inimii es#e %oordona#a si (e %a&ea mora&a: adi%a
(rin a%#inea nor s6s#an#e (e %are &e (rod% di!eri#e or"ane si (e %are
san"e&e &e ad%e &a inima.Din#re a%es#e s6s#an#e: %e&e mai im(or#an#e sn#
)ormonii.De e$em(& adrena&ina:)ormon& med&os(rarena&ei: (ro'oa%a o
in#ensi!i%are si o a%%e&erare a %on#ra%#ii&or %ardia%e 8o6isni# %an#i#a#ea de
adrena&ina din san"e es#e redsa9. A%eeasi a%#ine o are si #iro$ina: de
a%eea in )i(er#eroidism se (rod%e o a%%e&erare a ri#m&i %ardia%.
A%e#i&%o&ina: (rods a& sis#em&i ner'os (arasim(a#i%: are o a%#ine
in'ersa adrena&inei. Si di!eri#e&e sarri %are in#ra in %om(ozi#ia (&asmei a
a%#ine as(ra a%#i'i#a#ii %ardia%e. Im(or#an#e din a%es# (n%# de 'edere sn#
sarri&e de %a&%i: %are a%%e&ereaza ri#m& %ardi%: si arri&e de (o#asi: %are
in%e#ines% ri#m& %ardi%. Da#ori#a re"&arii re!&e$e si re"&arii mora&e se
(rod%e o ada(#are !ina a #ra'a&i&i %ardia% &a ne'oi&e or"anism&i.
)IPERTE%SIU%EA ARTERIALA
Definitie : )i(er#ensinea ar#eria&a es#e n sindrom %ara%#eriza#
(rin %res#erea (resinii sis#o&i%e si a %e&ei dias#o&i%e (es#e 'a&ori&e norma&e.
D(a OMS se %onsidera 'a&ori norma&e (en#r (resinea ma$ima +/7-
+17 mm.": in#er(re#a#e in ra(or# % 'ars#a: se$& si "re#a#ea: iar (en#r
minima 47-40 mm.".
Clasificare : in !n%#ie de e#o&o"ie se deose6es%
a9 .TA esen#ia&a in %are n se (oa#e e'iden#ia o %aza or"ani%a
69 .TA se%ndara sa sim(#oma#i%a in %are es#e do'edi#a %aza
se
deose6es% )i(er#ensini se%ndare 5 rena&e: endo%rine: nero"ene
si
%ardio'as%&are.
.TA es#e na din#re %e&e mai ras(andi#e 6o&i.Presinea ar#eria&a
(oa#e %res#e !ie (rin marirea de6i#&i: !ie (rin %res#erea rezis#en#ei.Ce&e mai
m&#e )i(er#ensini a &a 6aza %res#erea rezis#en#ei (eri!eri%e 8)i(er#ensinea
esen#ia&a: reno&.9.
Ini#ia&:(ro%es& es#e !n%#iona&-'aso%ons#r%#ie-a(oi &ezini
or"ani%e %are (ermanen#izeaza )i(er#ensinea ar#eria&a. in %eea %e (ri'es#e
!a%#orii %are rea&izeaza 'aso%ons#r%#ia ar#eria&a: se a%orda n ro& im(or#an#
sis#em&i ner'os %en#ra&: sis#em&i )i(o!izo-s(rarena& si )i(er rea%#i'i#a#ii
'as%&are.in e'o&#ia )i(er#ensinii ar#eria&e:d(a mai m&#i ani de e'o&#ie
a(oi &ezini or"ani%e de a#eros%&eroza: %are a"ra'eaza #&6rari&e.
a9.TA esen#ia&a 5 (rin %are se in#e&e"e ori%e sindrom %&ini%
)i(er#ensi': in %are 'a&ori&e (resinii ar#eria&e sn# %res%#e: in
a6sen#a nei %aze or"ani%e. Se mai nmes#e si 6oa&a )i(er#ensi'a.Es#e
%ea mai !re%'en#a: re(rezen#and 37-47 = din #o#a&& )i(er#ensini&or: si
a(are de o6i%ei d(a -7 de ani: % n ma$imm de !re%'en#a in#re /7 si 07
de ani. In%iden#a es#e mai mare &a !emeie: dar !orme&e mai "ra'e a(ar &a
6ar6ar#i. Meno(aza si o6ezi#a#ea sn# !a%#ori !a'orizan#i: &a !e& 'ia#a
in%orda#a: s#resan#a si eredi#a#ea. Eredi#a#ea ar A%a n ro& !oar#e im(or#an#:
a!e%#inea in#a&nind-se in (ro(or#ie de ,7-37= 8d(a di!eri#e s#a#is#i%i9 in
an#e%eden#e&e !ami&ia&e a&e 6on&a'i&or. Ceea %e se #ransmi#e ar %ons#a in#r-o
#&6rare a me#a6o&ism&i %a#e%o&amine&or 8adrena&ina si noadre&ina9:
%are ar s#a &a 6aza 'aso%ons#r%#iei ar#eria&e. Se (are %a si a&imen#a#ia
6o"a#a ar A%a n ro&.
69.TA sim(#oma#i%e5
o de %aza rena&a. Din a%es#e "r(e !a%
(ar#e5
-)i(er#ensini&e reno-'as%&are 8anoma&ii %on"eni#a&e a&e 'ase&or rena&e
-s#enoze: ane'risme- #rom6oze : em6o&ii 9: )i(e.
-)i(er#ensini&e din 6o&i&e (aren%)im&i rena& 8"&amern&ane!i#a a%#a
si %roni%a: &ezini rena&e din dia6e#: (ie&one!i#e&e e#%9.
In a(ari#ia )i(er#ensinii rena&e: ro&& (rin%i(a& es#e de#in# de o
enzima %are ia nas#ere in rini%)i& is%)emi% 8% %ir%&a#ie ins!i%ien#a 9
si %are se nmes#e renina. A%eas#a se #rans!orma in san"e in#r-o s6s#an#a
)i(er#ensi'a nmi#a an"io#ensi'a. E im(or#an#a (re%izarea e#io&o"iei rena&e
deoare%e ne&e !orme sn# ss(e%#i6i&e de in#er'en#ie %)irr"i%a&a
8)i(er#ensinea reno-'as%&ara: ne&e (ie&one!i#e9>
-#ra#amen#& se adreseaza a#a# 6o&ii de 6aza: %a# si )i(er#ensinii
ar#eria&e.
o de %aza endo%rina . Din a%e&asi "r( !a% (ar#e 5
- !eo%roma%i#om& - o #moare &o%a&iza#a in med&ara "&andei
s(rarena&e:
%ara%#eriza#a (rin %rize (aro$is#i%e de )i(er#ensini da#ora#e
des%ar%arii in
%ir%&a#ie de %a#e%o&amine8 adre&ina si noradre&ina9> #ra#amen#& es#e
%)irr"i%a&>
- )i(era&dos#eronism& (rimar 8 adenom %or#i%os(rarena& % se%re#ie
e$esi'a de
a&dos#eron9>
- sindrom Cs)in": da#ora# nei #mori %or#i%os(rarena&e sa )i(o!izare
%are se
%ara%#erizeaza (rin )i(er#ensine: o6ezi#a#e: 'er"e#ri: )irs#ism si
%res#erea
e&iminarii rmare a +2- %e#os#eroizi&or > #ra#amen#& es#e %)irr"i%a&.
- )i(er#ensini endo%rine: mai a(ar in )i(er#i%ordism: in %rs& sar%inii> in
%rs&
(rimei sar%ini (oa#e a(area o )i(er#ensine re'ersi6i&a: re%idi'and
e'en#a& %
!ie%are noa sar%ina : a&#eori : "ra'idi#a#ea a"ra'eaza o )i(er#ensine
ar#eria&a
(ree$is#en#a: de a&#a na#ra.
de %aza nero"ena
in 6o&i #rama#i%e: #mora&e sa in!&ama#orii a&e %reier&i %are
d% &a o %res#ere a (resinii in#ra%raniene sa in %az de &ezini a&e %en#ri&or
'asomo#ori se o6ser'a: neori si %res#erea #ensinii ar#eri&e.
o de %aza %ardio'as%&ara5
*o&i&e inso#i#e de )i(er#ensine ar#eria&a
sn#5
- %oar#a%#ia aor#i%a
- 6&o%& %om(&e#
- ins!i%ien#a aor#i%a
- a#eros%&eroza.
Etiopatogenie: MaAori#a#ea a#ori&or a%%e(#a as#azi
%on%e(#ia ner'is#a: (o#ri'i# %areia (redis(ozi#ia eredi#ara es#e de na#ra
nero"ena : &e"a#a de o anmi#a s#r%#ra a (ersona&i#a#ii si de o anmi#a
moda&i#a#e de ras(ns &a si#a#ii&e de s#ress 5 drere: !ri%a: s(arare.*oa&a ar
!i esen#ia& ner'oasa: (rodsa de o #&6rare in a%#i'i#a#ea %en#ri&or ner'osi
s(eriori. Di!eri#i e$%i#an#i din s!era (si)oemo#iona&a8 ne%azri: "riAi :
nesi"ran#a 9: a%#ionand (e !ond& nei (redis(ozi#ii eredi#are: d% &a
a(ari#ia nor !o%are de e$%i#a#ie (ermanen#a &a ni'e&& s%oar#ei %ere6ra&e:
de#erminand se%ndar o 'as%&a#ie ar#eria&a. In &an#&
(a#o"eni% a& )i(er#ensinii mai in#er'in #o# (rin in#ermedi& s%oar#ei -
sis#em& endo%rin si rini%)i&.
Modi!i%ari&e !ndamen#a&e &o%a&e %are s#a &a 6aza )i(er#ensinii
sn# 'aso%ons#r%#ia ar#eria&a si %res#erea %on#in#&i (ere#e&i ar#eria& in
a(a si sare.Mai #arzi a(ar &ezini or"ani%e si a#ers&eza: %are "ra6es%
e'o&#ia si in#ne%a (ro"nos#i%& (rin %om(&i%a#ii.

Fiziopatologia hipertensiunii arteriale
Pen#r (ra%#i%a %&ini%a si (a#o&o"i%a: im(or#an#a es#e n a#a#
'a&oarea %i!ri%a a %res#erii #ensiona&e %a# %onse%in#a 'as%&ara si
)emodinami%a a a%es#ia.
Re&a#ia din#re )i(er#ensine si (a#o&o"ia 'as%&ara es#e
6ine%nos%#a: im6ra%and in mare rma#oare&e as(e%#e 5
- )i(er#ensinea ar#eria&a : in a!ara !a(#&i %a es#e n !a%#or de ris%
(en#r
a#erosderoza: (oa#e (re%i(i#a si a"ra'a e'o&#ia a%es#eia >
- )i(er#ensinea ar#eria&a in%&de modi!i%ari modi!i%ari ar#erio&are
s(e%i!i%e -
ar#erido(a#ia )i(er#ensi'a.
U&#im& as(e%# re#ine a#en#ia in mod deose6i# a#a# (rin me%anisme&e
sa&e de (rod%ere %a# si (rin %onse%in#e&e as(ra e'o&#iei )i(er#ensinii
ar#eria&e. E$is#a doa !orme dis#in%#e de ar#erido(a#ii )i(er#ensi'e5
ar#eri&os%&eroza si ne%roza !i6rinoida a mediei ar#erio&are .
Ar#erio&os%re&oza %ons#a in in"rosarea si : &#erior : in )ia&inizarea
ar#erio&e&or : !enomen& (arand sa de6#eze s6endo#e&ia&: % (rindere
(ro"resi'a a mediei. In (a#o&o"eneza )ia&in&i sn# im(&i%a#e
)i(er(rod%#ia de %o&a"en ar#eriar: de"enerarea mem6re&or
6aza&e: e$sda#ia (&asma#i%a % de(nere de !i6rina si de"eneres%en#a
ms%&a#rii ne#ede.Lezini&e de ar#erio&os%re&oza sn# (ar%e&are>
in#ereseaza % (re%adere rini%)i& si %ons#i#ie s6s#ra#& asanmi#ei
ne!roan"ios%re&ozei 6eni"ne: de in'a&ire in .TA esen#ia&a. Sommers#
%ons#a#a %a &ezini&e de ar#erio&os%re&oza e'o&eaza in mai m&#e s#adii5
s(asm a& %e&&e&or ms%&are din media ar#erio&ei a!eren#e: in"rosare a
(ere#e&i 'as%&ar da#ori#a edem&i: )i(er#ro!ie a %e&&e&or ms%&are:
de"eneres%en#a nia&nia a (ere#e&i ar#erio&ar % in"s#area &men&i
'as%&ar. Ne%roza !i6rinoida ar#erio&ara %ons#i#ie Dmar%aD mor!o&o"i%a a
.TA ma&i"ne. Se %ara%#erizeaza (rin r(#ri a&e !i6re&or ms%&are ne#ede
din media ar#erio&ara: e$da#ia (&asma#i%a enorma in (ere#e&e 'as%&ar:
rea%#ie in!&ama#orie e$da#i'a si (&ori!era#i'a in ad'en#i%e % o6&i#erare sa
s#enozare %onse%#i'a a nmen&i ar#erio&ar. Ar#erio&a %a(a#a n as(e%#
6izar: moni&o!orm: a'and zone di&a#a#e %are a&#erneaza % a&#e&e
s#ram#ora#e. Lezini&e a!e%#eaza in masra di!eri#a rini%)i&: (an%reas&:
s(rarena&e&e: in#es#in&: %reier&: %ord& si !i%a#&. La ni'e&& rini%)i&i:
&ezini&e ar#eria&e se sis#ema#izeaza: !iind re(rezen#a#e de endor#eri#a
(ro&i!era#i'a: ar#erio&i#a ne%rozan#a "&omer&i#a ne%rozan#a.
Pa#o"enia &ezini&or ar#eria&e es#e %om(&e$a si doar (ar#ia& %nos%#a:
mai a&es in %eea %e(ri'es#e se%'en#ia&i#a#ea e'enimen#e&or mo6ide.
In#er'en#ia me%anism&i renina-an"io#ensi'a: )i(erse%re#ia de
minera&%or#i%orzi si %a#e%o&amide: e$%es& de Na
E
:
%ons#i#ie e&emen#e&e (a#o"eni%e (rin%i(a&e %are s#a &a 6aza
'as%&ozei (&asma#i%e: a de(nerii de !i6rinoid in media ar#erio&ara si a
ne%roze&or ar#erio&are.
A%ATOMIA PATOLO(ICA
.TA en#i#a#e noso&o"i%a indi'ida&iza#a (e %ri#erii !izio&o"i%e: n
are n e%)i'a&en# ana#omi%. In %rs& e'o&#iei sa&e a(ar m&#i(&e
as(e%#e mor!o&o"i%e: in !n%#ie de s#adi& 6o&ii: de ra(idi#a#ea ins#a&arii ei:
de in#ensi#a#ea #&6rari&or !n%#iona&e si de "rad& de in#eresare a di!eri#e&or
or"ane in (ro%es& (a#o&o"i%.
Tendin#a 'e%)e de a iden#i!i%a )i(er#ensinea %
modi!i%ari&e s#r%#ra&e a !a%# di!i%i&a %noas#erea ro&&i A%a# de
ar#erio&e 'as%&are or"ani%e in is#oria na#ra&a a 6o&ii. In#r-ade'ar .TA si
de"radari&e mor!o&o"i%e n sn# nea(ara# doa as(e%#e di!eri#e a&enia si
a%e&iasi (ro%es. Marimea #ensinii si "rad& ar#erios%re&ozei n sn#
&e"a#e in#re e&e (rin &e"a#ri ma#ema#i%e: de %aza &a e!e%#. In#re
im(or#an#a &ezini&or si "ra'i#a#ea mani!es#ari&or &or %)imi%e: de
asemenea: n e$is#a o (ro(or#iona&i#a#e s#ri%#a. M&#e din#re as(e%#e&e
&eziona&e %ons#a#a#e n a nimi% %ara%#eris#i% in#re e&e si: mai m&# %)iar:
%ea mai mare (ar#e din#re %om(&i%a#ii&e 6o&ii (o# !i %ore&a#e mai de "ra6a %
(ro%ese&e ar#eros%re&o#i%e a%%en#a#e de )i(er#ensine: de%a# % inssi
.TA. M&#e a&#e &ezini: de asemenea: n se deose6es% de
de"enerari&e ar#eria&e &e"a#e de (ro%es& de senes%en#a: indi!eren# de %i!re&e
#ensiona&e. In "enera&: &i(ses% s#dii de mare an'er"ra: 6aza#e (e
%ri#erii ni#are: 6ine (re%iza#e: %are sa %a#e sa s#a6i&eas%a o %ore&a#ie
s#ri%#a : %om(ara#i'a: in#re #i(& si "rad& nor anmi#e &ezini: (e de o
(ar#e: si "r(a de 'ars#a: se$&: %i!ra #ensiona&a: 'e%)imea si 'i#eza e'o&#iei
6o&ii: (e de a&#a.
De a%eea sn#em mai m&# sa mai (#in si&i#i sa ne &imi#am &a
o e$(nera %a#a"ra!i%a a #i(ri&or de &ezini in#a&ni#e in a%eas#a 6oa&a si sa
!a%em nmai (res(neri %are din#re modi!i%ari&e de"enera#i'e %e
a&%a#ies% Dar#erios%re&ozaD sn# &e"a#e de o #ensine mare.
Termen& ana#omi% "eneri% de Dar#erios%re&ozaD: %(rinzand
#o#a&i#a#ea &ezini&or de"enera#i'e a&e ar#ere&or: n inseamna nimi% mai
m&# de%a# Dindra#ie a ar#ere&orD. S6 a%es# #ermen se %(rind #rei "r(e de
&ezini5
+. Medio%a&%oza -(ro%es de"enera#i' %are in#ereseaza media
ar#ere&or miA&o%ii: in#eresan# din (n%# de
'edere ana#omi%: dar &i(si# de %onse%in#e
!n%#iona&e si %)imi%e semni!i%a#i'e.
,.A#eros%re&oza -(ro%es 'as%&ar
o6s#r%#i': da#ori#a %ons#i#irii (&a%i&or de
ar#erom in inima ar#ere&or ms%&oe&as#i%e
de marime miA&o%ie: % ne%roze:
)emora"ii:!i6roza si %a&%i!i%are.
-. Ar#erio&os%re&oza-%ara%#eriza#a (rin )i(er(&azie
endo#e&ia&a: %
in"rosare si )ia&inizare a in#imei
si )i(er#ro!ia ms%&ara a ar#erio&e&or.
Prime&e doa #i(ri &eziona&e a!e%#eaza ar#ere&e mari: ar#ere % n
s#ra# miA&o%i 6o"a# in #es# e&as#i%. A& #rei&ea #i( &ezionar %(rinde ar#ere&e
mi%i si ar#erio&e&e: e&emen#e 6o"a#e in #es# ms%&ar: % !n%#ii&e esen#ia&e in
%on#ro&area rezis#en#ei.
Pro%ese&e (a#o&o"i%e: %are d% &a de"enerarea !i6re&or
(eri!eri%e e&as#i%e din media aor#ei si din media ar#ere&or mari: %res%
(resinea (&s&i si d% &a o )i(er#ensine e$%&si' sis#o&i%a. In (ar#e:
a%es#e (ro%ese sn# in !n%#ie de 'ars#a.
Ridi%ari&e a#a# a&e (resinii sis#o&i%e: %a# si %e&ei dias#o&i%e sn# &e"a#e in
(rim& rand de modi!i%ari&e: !n%#iona&e sa s#r%#ra&e: din ar#ere&e
mi%i: ms%&are.
DIA(%OSTICUL )TA SI EVALUARE
.TA !iind o 6oa&a de !re%'en#a %res%#a in (o(&a#ia
"enera&a: ade'ara#e&e (ro6&eme (e %are &e (ne sn# %e&e a&e de(is#arii sa&e
in masa si n %e&e a&e s#a6i&irii dia"nos#i%&i &a ni'e& indi'ida&. De a%eea
(o(&a#ia #re6ie sa !ie a'iza#a si sa s(riAine e!or#& medi%o-sani#ar de
de(is#are a%#i'a a 6o&ii. S(riAin& %e& mai dire%# es#e ma#eria&iza# (rin
(rezen#area &a a%#ini&e dede(is#are a .TA (e de o (ar#e: iar (e de a&#a
(ar#e: (rin e!e%#area %ons#iin%ioasa a e$aminarii medi%a&e im(se %
di'erse (ri&eAri 8an"aAari in mn%a: admi#ere in in'a#aman#& s(erior:
e$amene (en#r (ermis de %ond%ere a#o: e.#.%9. In !ond: (ro6&ema
%en#ra&a a dia"nos#i%&i indi'ida& a& .TA es#e &e"a#a de 'a&oarea %i!rei
#ensiona&e.
In !e&& a%es#a masrarea TA de'ine miA&o%& esen#ia& de dia"nos#i%.
Asis#en#ei medi%a&e: si in s(e%ia& %e&ei %are &%reaza in
%omni#a#i: ii re'ine n ro& insemna# in de(is#area )i(er#ensi'i&or (rin
(risma !a(#&i %a ea es#e %ea %are masoara TA: dar mai a&es (rin na#ra
mn%ii sa&e %are-i (ermi#e sa %&ea"a mai m&#e in!orma#ii des(re (a%ien#
si medi& sa. Sa n i#am %a neori 'a&ori&e %res%#e: (es#e &imi#a: a&e TA
n indi%a nea(ara# o )i(er#ensine ar#eria&a %i se (o# da#ora nor !a%#ori de
medi. De a%eea %on#e$#& in %are se inre"is#reaza a%es#e 'a&ori es#e !oar#e
in(or#an#. De asemenea AM #r6ie sa s#a(aneas%a !oar#e 6ine #e)ni%a
masrarii #ensinii ar#eria&e s#i# !iind !a(#& %a masrarea in%ore%#a d%e &a
'a&ori erona#e.
Ce #re6ie sa !a%a (a%ien#& %aria &a o e$aminare medi%a&a i s-a
"asi# %res%#a TAF Ras(ns& 'a #re6i sa #ina seama de %i!ra TA si 'ars#a
(ersoanei in %aza. As#!e&: (en#r ad&#i: indi!eren# de 'ars#a: des%o(erirea
nei TAd e"a&a sa mai mare de +77 mmG." #re6ie sa !ie rma#a de
(rezen#area &a medi% (en#r in'es#i"a#ii&e de r#ina si (res%rierea
#ra#amen#&i.
D(a des%o(erirea si %on!irmarea )i(er#ensinii ar#eria&e es#e
ne%esar sa se e!e%#eze (en#r !ie%are 6o&na' n 6i&an# %&ini%o-6io&o"i% in
s%o(& indi'ida&izarii dia"nos#i%&i si e'en#a& a& "asirii nei
e#io&o"ii a )i(er#ensinii. E!or#& dia"nos#i% 'a !i &imi#a# &a n minim
%on%&den# de da#e: in asa !e& in%a# sa se (oa#a e'iden#ia5
-se'eri#a#ea 6o&ii
-"rad& de a!e%#are %ardio'as%&ara
-%oe$is#en#a a&#or !a%#ori de ris% (en#r a#eros%re&oza
-n (osi6i& !a%#or e#io&o"i%
-e&emen#e orien#a#i'e (en#r (ro"nos#i% si #ra#amen#
.i(er#ensi'& es#e (rin e$%e&en#a n 6o&na' am6&a#or: in#ernarea
sa in s(i#a& ne!iind indi%a#a de%a# in %a#e'a si#a#ii si anme5
H Persoane&e #inere 8s6 /7 de ani9 % .TA modera#a sa se'era>
H Persoane&e % TAs mai mare sa e"a&a % ,/7 mmG." siGsa TAd
mai
mare sa e"a&a % +,7 mmG.">
H *o&na'ii &a %are se ss(i%ioneaza %&ini% o !orma de .TA
se%ndara>
H Indi'izii % .TA rezis#en#a &a #ra#amen#>
H .i(er#ensi'ii a %aror .TA D6ana&aD isi modi!i%a 6rs% %rs&
e'o&#i'
8e!e%#e ad'erse maAore a&e medi%a#iei a#i)i(er#ensi'e: ins#a&area
rezis#en#ei
&a #ra#amen#: a(ari#ia nor %om(&i%a#ii: e.#.%9>
H *o&na'ii &a %are .TA se aso%iaza % a&#e a!e%#ini %roni%e
8me#a6o&i%e:
%ardio'as%&are: (&monare: e.#.%.9 %are a!e%#eaza (ro"nos#i%&
si
#ra#amen#&.
A6ordarea ni 6o&na' )i(er#ensi' 'a in%e(e in mod o6&i"a#or %
o anamneza a#en#a: n e$amen %&ini% %om(&e# si o in'es#i"a#ie
(ara%&ini%a de r#ina: s#ri%# ne%esara.
a9 ANAMNEZA
Asis#en#a medi%a&a !iind (rima %are in#ra in %on#a%# % (a%ien#&
8de %e&e mai m&#e ori9 #re6ie sa %ond%a dis%#ia as#!e& in%a# sa (oa#a
(ro%ra rma#oare&e da#e5 de6re#& a(ro$ima#i' sa si"r a& .TA:
sim(#ome&e de de6# sa %e&e (en#r %are se adreseaza medi%&i: sa
orien#eze si sa ierar)izeze in'es#i"a#ii&e (ara%&ini%e (en#r s#a6i&irea
e#io&o"i%a a .TA si a %ara%#er&i sa e'o&#i': sa e!e%#eze n 6i&an#
orien#a#i' (ri'ind ris%& %ardio'as%&ar: 6o&i&easo%ia#e si e'e#a&e&e %ondi#ii
de medi !a'orizan#e (en#r %res#erea 'a&ori&or TA. Anomneza 6o&na'&i
% .TA es#e e#a(a ini#ia&a si indis(ensa6i&a s#a6i&irii de6#&i
)i(er#ensinii.
In#ero"a#ori& (re%izeaza ne&e #&6rari !n%#iona&e %omne
##ror !orme&or de .TA si anme5
-%e!a&ee -semna&a#a indeose6i diminea#a inain#e de s%&are> are sedi&
%er'i%o-o%%i(i#a& sa se (rezin#a %a o )emi%ranie (redominan# (reor6i#ara:
a&#eori es#e (&sa#i&a: inso#i#a sa (re%eda#a de #&6rari 'iza&e sa
di"es#i'e> 6o&na'ii re&a#eaza %a %e!a&eea es#e !a'oriza#a de in"es#ia de
a&%oo& si de s(raso&i%i#are in#e&e%#a&a>
-'er#iA de dra#a 'aria6i&a: aso%ia# sa n s%)im6ari&or de
(ozi#ie :
-#&6rari de 'edere :
-'aAaie&i in re%)i :
-o6osea&a !izi%a si in#e&e%#a&a:
-(ares#ezii: (areze: disar#rii #re%a#oare:
-(a&(i#a#ii: (re%ordia&"ii: dis(nee de e!or#:
-an$ie#a#e: insomnii: iri#a6i&i#a#e:
-(rezen#a in an#e%eden#e&e (a#o&o"i%e (ersona&e a nor a!e%#ini ne!ro&o"i%e
sa
ro&o"i%e 8a&6minrie sa )ema#rii (asa"ere: in!e%#ii rinare: %o&i%i
ne!re#i%e:
a!e%#ini rena&e dia"nos#i%a#e: e.#.%.9 #rama#isme &om6are: .TA (e #im(&
nei
sar%ini:
-e$is#en#a an#e%eden#e&or )eredo%o&a#era&e de .TA: de a#eros%re&oza si
!orme&e
%&ini%e de mani!es#are a a%es#ora:
-ne&e o6i%eiri a&imen#are indi'ida&e si !ami&ia&e 8%onsm de sare: de
d&%iri9:
!ma#& si %onsm& de a&%oo&:
-(ro!i&& (ro!esiona&: "rad& de so&i%i#are (ro!esiona&a
D%om(e#i#i'i#a#ea si
e!i%a%i#a#eaD so%ia&a a 6o&na'&i:
-e$is#en#a nor sim(#ome %are (o# s"era o .TA se%ndara 8%rize
sdora&e
inso#i#e de (a&(i#a#ii: an$ie#a#e si (a&oare: as#enie ms%&ara: (ares#ezii:
mia&"ii:
(ara&izii in#ermi#en#e: (o&irie: e.#.%.9:
-(rezen#a nor sim(#ome %e s"ereaza e$is#en#a nor %om(&i%a#ii
'as%&are
8e%&i(se %ere6ra&e: %&adi%a#ie in#ermi#en#a: %rize de an"ina (e%#ora&a9 e.#.%.
69 PREGATIREA SI ASISTAREA EIAMINARILOR CLINICE
Co&a6orarea &a e$aminarea %&ini%a a 6o&na'&i es#e na din
sar%ini&e im(or#an#e a&e asis#en#ei. AA#or& a%rda# medi%&i si 6o&na'&i
in %rs& e$aminarii %&ini%e de"re'eaza (e a%eas#a din rma de e!or#ri
!izi%e: ii (re'ine o serie de s!erin#e in#i&e: %on#ri6ie &a %rearea ni
%&ima# !a'ora6i& in#re 6o&na' si medi%: !a%e a%%esi6i&a medi%&i e$(&orarea
##ror re"nine&or or"anism&i: ser'ind-+ % ins#men#ar& ne%esar: #oa#e
a%es#ea in#er'enind (en#r s%r#area#im(&i e$(nerii 6o&na'&i in s#are
"ra'a &a e$aminari&e %&ini%e es#e indis(ensa6i& in %az& 6o&na'i&or in s#are
"ra'a5 as#eni%i: adinami%i: somno&en#i: in%ons#ien#i: imo6i&iza#i: e.#.%. si
!oar#e #i&a in %az& ##ror 6o&na'i&or
Sar%ini&e asis#en#ei in (re"a#irea si asis#area ni e$amen
%&ini% me%i%a& sn# rma#oare&e5
-(re"a#irea (si)i%a a 6o&na'&i:
-adnarea: 'eri!i%area si (re"a#irea ins#rmen#&i ne%esar:
-dez6ra%area si in6ra%area 6o&na'&i:
-ad%erea 6o&na'&i in (ozi#ii&e ade%'a#e e$amina#ori&or:
-asi"rarea i&mina#iei ne%esare &a e$aminari&e %a'i#a#i&or
na#ra&e:
-deser'irea medi%&i % ins#rmen#e:
-!erirea 6o&na'&i de #rama#isme si ra%ea&a:
-asezarea 6o&na'&i in (a# d(a e$aminare si !a%erea
(a#&i.
? Pre"a#irea (si)i%a a 6o&na'&i se in%adreaza in mn%a de
ed%a#ie si de &inis#ire (e %are asis#en#a o d%e % 6o&na'& din momen#&
(rimirii &i in se%#ie. A#i#dinea ei !a#a de 6o&na' #re6ie sa re!&e%#e dorin#a
(ermanen#a de a-+ aA#a> %rearea %&ima#&i !a'ora6i&: a#i#dine
(rie#eneas%a: %ons#i#ie !a%#orii im(or#an#i ai nei 6ne (re"a#iri (si)i%e.
In (reaAma e$aminari&or de ori%e na#ra: asis#en#a #re6ie sa &amreas%a
6o&na'& as(ra %ara%#er&i ino!ensi' a&
e$aminari&or: %a#and sa se red%a &a minimm dreri&e %are e'en#a& 'or
!i (ro'o%a#e (rin ne&e mano(ere sim(&e: %a5 e$aminarea nei ar#i%&a#ii
in!&ama#e: (a&(area ni a6domen dreros: e.#.%. *o&na'& n #re6ie
ni%ioda#a inds in eroare %a%i as#!e& 'a (ierde in%rederea in noi.
Da%a insa %noas#e esen#a si im(or#an#a e$aminari&or: (rin in%rederea (e
%are i-am ins!&a#-o: 'a s(or#a m&# mai sor s!erin#e&e %aza#e de di'erse
e$(&orari: o6#inand %oo(erarea &i a%#i'a in resi#a si o(era#i'i#a#ea
e$aminari&or.
Tinand seama de sim#& (dorii: asis#en#a 'a izo&a (a#&
6o&na'&i 8in s(e%ia& &a (rima e$aminare9: des(ar#ind-& % n (ara'an de
%e&e&a&#e (a#ri: %eea %e &inis#es#e (e m&#i 6o&na'i.
E*AME%UL CLI%IC
De#erminarea (resinii ar#eria&e se !a%e %ore%# (rin me#oda
as%&#a#i'a sa %ea e&e%#roni%a: masrand TA &a am6e&e 6ra#e: in %&inos#a#ism
si or#os#a#ism: da%a es#e (osi6i& diminea#a: d(a re(as !izi% si in#e&e%#a&.
E$amen& %&ini% in%ear%a sa de%e&eze %aze&e sa &ezini&e
"enera#oare de .TA: (re%m si s#adi& e'o&#i' si rasne#& as(ra
in#re"&i or"anism. S%aderea in(or#an#a a (&s&i &a ar#ere&e !emra&e
sa a6o&irea sa e'o%a o s#enoza a sis#em&i aor#i% %are se %on!irma &a
(a&(area ar#ere&or in#er%os#a&e (e #ora%e&e (os#erior: (rin as%&#a#ia inimii
8s!& sis#o&i% (ara'er#e6ra& s#an"9 si de radio"ra!ia #ora%e&i 8erozini
%os#a&e9. S#enoza nei ar#ere rena&e (oa#e de#ermina neori n s!&
(er%e(#i6i& (araom6i&i%a& si in re"inea &om6ara. Pa&(area &oAe&or rena&e
(oa#e e'iden#ia o #moare rena&a sa ne!rome"a&ie 6i&a#era&a: s"erand
(o&i%)is#oza rena&a. Tse& re%#a& &a 6ar6a# si %e& 'a"ina& &a !emeie sn#
asemenea ne%esare. E$amen& %&ini% "enera& (oa#e (ne in e'iden#a si
semne&e nei a!e%#ini endo%rine sa me#a6o&i%e: ss%e(#i6i&e de a
(rod%e .TA se%ndara 8)i(er#iroidism: 6oa&a Cs)in": a%rome"a&ie:
mani!es#ari %#ana#e a&e nei dia#eze "#oase sa dis&i(o(re#einemii9.
A(re%ierea rasne#&i 'is%era& a& .TA5 %and 6o&na'&
semna&eaza dis(nee &a e!or#ri 6ine #o&era#e an#erior: iar e$amen&
o6ie%#i' de%e&eaza n s!& sis#o&i% si %ardiome"a&ie 8%on!irma#a
radio&o"ie: EBG: e%o"ra!ie9: se %on#reaza s(raso&i%i#area %ord&i>
semna&area nei (o&irii no%#rne: re%en#e: !ara disrie: o6&i"a &a
ss(i%ionarea rena&izarii .TA. Deasemenea: s%aderea %a(a%i#a#ii de &%r:
e%&i(se %ere6ra&e: n e$amen de !nd de o%)i modi!i%a# 8"rad& II-III9
ss#in !a(#& %a .TA a (rods a!e%#area 'ase&or %ere6ra&e.
%9 RECOLTAREA PRODUSELOR *IOLOGICE SI PATOLOGICE
PENTRU EIAMENELE PARACLINICE
In"riAirea 6o&na'i&or im(&i%a s#a6i&irea dia"nos#i%&i (re%is in#r-
n #im( %a# mai s%r# (osi6i&: (en#r a se (#ea a%orda in"riAiri&e si
#ra#amen#& ade%'a#. Un aA#or (re#ios -de m&#e ori indis(ensa6i&- in
a%eas#a mn%a-+ %ons#i#ie (ro6e&e de &a6ora#or: %are e$(rima in mod
o6ie%#i' modi!i%ari&e
sr'eni#e in mor!o&o"ia: !n%#inea si 6io%)imia or"anism&i si
e'iden#iaza a"en#ii a"resi'i: !a%#orii e#io&o"i%i ai im6o&na'iri&or.
U#i&i#a#ea rez&#a#e&or de &a6ora#or de(ind de %ei doi !a%#ori de
6aza5 re%o&#area %ore%#a a (rodse&or s(se ana&ize&or si e!e%#area
ana&ize&or (ro(ri zise. E!e%#area ana&ize&or %ade a(roa(e e$%&si' in
sar%ina (ersona&&i de &a6ora#or: maAori#a#ea re%o&#ari&or insa: !a% (ar#e din
sar%ini&e (ersona&&i %are &%reaza nemiA&o%i# &a (a#& 6o&na'&i: din a%es#
mo#i': asis#en#a #re6ie sa ai6a %nos#in#e (re%ise si mana&i#a#e
%ores(nza#oare.
Im(or#an#a e$aminari&or de &a6ora#or se %on%re#izeaza in
rma#oare&e5 -im6o"a#es% sim(#oma#o&o"ia 6o&i&or % nmeroase e&emen#e
o6ie%#i'e: -%on!irma sa in!irma dia"nos#i%& %&ini%:
-%&ari!i%a dia"nos#i%& di!eren#ia& !a#a de #a6&ori %&ini%e simi&are si
di!eren#iaza !orme&e %&ini%e a&e a%e&easi im6o&na'iri: -s#a6i&es#e !a%#or&
e#io&o"i% in nmeroase %azri:
-in!ormeaza as(ra "ra'i#a#ii %az&i : re!&e%#a o6ie%#i' e'o&#ia e'o&#ia
6o&ii si aA#a &a s#a6i&irea (ro"nos#i%&i: -%on#ri6ie &a a(re%ierea
e!i%a%i#a#ii#ra#amen#&i: -(re'es#es#e ins#a&area nor %om(&i%a#ii: -%on!irma
'inde%area %&ini%a si e#io&o"i%a a 6o&na'&i:
-%on#ri6ie &a (ro!i&area 6o&i&or in!e%#o-%on#a"ioase: (rin de(is#are
(re%o%e a srse&or de in!e%#ie: 6o&na'ii si (r#a#orii de "ermeni.
E*AME%E PARACLI%ICE
In !n%#ie de %az: e$amene&e %om(&emen#are sn#
indis(ensa6i&e (en#r a a(re%ia rasne#& 'is%era& a& .TA si a des%o(eri
e#io&o"ia.
In (ra%#i%a zi&ni%a: ni 6o&na' )i(er#ensi' i se e!e%#eaza
rma#oare&e e$amene5
-dozarea (o#asi&i san"in si rinar:
-dozarea reei si %rea#ininei san"ine:
-e$amen %i#o6a%#erio&o"i% rinar:
-"r( san"in:
-#es#& Addis-.am6r"er sa ro%&#ra %an#i#a#i'a:
-(ro#einrie (e ,/ de ore 8(es#e 7:+ O" ara#a a!e%#are
rena&a9:
-dozarea "&i%emiei &a , ore (os# (randia&:
-dozarea %o&es#ero&&i: #ri"&i%eride&or:
-dozarea a%id&i 'ani&mande&i% si %a#e'o&amide&or:
-radio"ra!ia rena&a (e "o& siGsa ro"ra!ia LV.:
-radio"ra!ia %ardio(&monara:
-e$amen smar de rina:
-ro%&#ra:
-EBG
-e$amen& !nd&i de o%)i
-.LG: VS.:
Cand in'es#i"a#ii&e de D(rima &inieD n a resi# n 6i&an# sa#is!a%a#or: se
re%r"e &a aA#or& ser'i%ii&or s(e%ia&iza#e (en#r ar#erio"ra!ie rena&a:
dozarea a%#i'i#a#ii (&asma#i%e renina-an"io#ensi'a: dozarea a&dos#eron&i:
#es#& .oJard: s%in#i"rama rena&a: (n%#ia rena&a.





'ORME CLI%ICE SI
SIMPTOMATOLO(IE
C&asi% se deose6es%5
. S#adi& (re)i(er#emsi' n (oa#e !i %onsidera# %a n s#adi #im(ri a&
.TA
esen#ia&e> se (o#: #o#si: a!irma %a s6ie%#ii (redis(si: indeose6i
#inerii %
'a&ori in#ermediare a&e TA 8+/7G47-+17G409 si &a %are n #es# (resor &a
re%e
8%are es#e (ozi#i' %and: in#rod%and mana in a(a &a /K: 'a&ori&e TA
%res% %
(es#e /7mm."9 s-a ara#a# in sens (ozi#i': rmari#i in #im(: a #re%# in
!aza
de )i(er#ensine (ermanen#a.
Sn# %(rinsi in a%es# s#adi s6ie%#i % 'a&ori o%aziona&
%res%#e a&e TA: norma&iza#e &#erior !ara o medi%a#ie deose6i#a: (re%m si
s6ie%#ii %onsidera#i )i(er#ensi'i: dar a&e %aror 'a&ori s-a norma&iza# d(a
,-- zi&e de s(i#a&izare. La a%es#i 6o&na'i: de o6i%ei asim(#oma#i%i:
e$amen& %&ini% es#e ne"a#i'. O (ar#e din ei (o# a'ea #&6rari nero-
'e"e#a#i'e: do'ada nei &a6i&i#a#i ner'oase % #endin#a &a
)i(ersim(a#i%o#onie.
. S#adi& I de .TA izo&a#a si (ra. Pes#e 47= din s6ie%#ii )i(er#ensi'i
sn#
de(is#a#i in a%es# s#adi: in %are sn# (rezen#e 'aria#ii #ensiona&e: %
'a&ori
!re%'en# (es#e +17G40mm.". A%es# s#adi (oa#e dra +7-+0 ani:
(erioada in
%are: &a %res#eri&e #ensiona&e: se aso%iaza &ezini 'as%&are minore #radse
(rin
a&#erari de "rad& I a&e F.O.
A%es# s#adi %ores(nde !ormei 6eni"ne: %are e'o&eaza
(ro"resi' si se %ara%#erizeaza (rin5
-semne %are a(ar &a e$amen& ar#ere&or: ar#ere sinoase si ri"ide: (&s 6ine
6a##> -semne de !ra"i&i#a#e %a(i&ara> di'erse mani!es#ari )emora"i%e
8e(is#a$is: me#rora"ii: neori )ema#emeze: )emora"ii re#iniene e#%9>
-semne %ere6ra&e5 %e!a&ee o%%i(i#a&a: de o6i%ei diminea#a: &a #rezire:
ame#e&i: o6osea&a: as#enie: insomnie: #&6rari de memorie si %on%en#rare:
modi!i%are de %ara%#er: !re%'en# #&6rari de 'edere si #&6rari #re%a#oare
de %ons#ien#a si de &im6aA sn# %e&e mai !re%'en#e #&6rari !n%#iona&e:
%omne ##ror !orme&or de )i(er#ensine>
-!rni%a#ri &a ni'e&& e$#remi#a#i&or: ame#e&i: senza#ia de Dde"e# mor#D>
-e$amen& inimii re&e'a s6ie%#i' (a&(i#a#ii: dreri (re%ordia&e: di!eri#e
"rade de dis(nee: iar o6ie%#i': semne de marire a inimii s#an"i 8)i(er#ro!ie
si di"i#a#ie9>
-radio&o"ia: e&e%#ro%ardio"ra!ia: !nd& de o%)i si (ro6e&e !n%#iona&e
rena&e a(re%iaza "rad& de e'o&#i'i#a#e a& .TA.
. S#adi& II de )i(er#ro!ie 'en#ri%&ara s#an"a 8.VS9 es#e %onse%in#a
so&i%i#ari&or
me%ani%e e$er%i#a#e de %res#erea 'a&ori&or TA as(ra (a#&i
'as%&ar si
as(ra (om(ei %ardia%e. Va&ori&e TA sn# ins(re ,77G+,7mm.".
E$amen& %&ini% re&e'a .VS: so%& a(e$ian es#e mai
(#erni%: z"omo#& II es#e in#ari# &a aor#a. E$amen& radio&o"ie e'iden#iaza
%ord de 'o&m norma& sa semne in%i(ien#e de .VS: % ar% in!erior
s#an" a&n"i#5 in OAS
'en#ri%& s#an" (roie%#a# sor (e %o&oana. E$amen& EBG o6ie%#i'eaza
senine de
.VS.
.i(er#ro!ia 'as%&ara sis#ema#i%a se remar%a (rin ar#ere % %a&i6r
mari#: sinoase: indra#e: iar radio&o"ie aor#a a(are: &ar"i#a: der&a#a:
6#on&
aor#i% (roeminen#. Modi!i%ari&e FO sn# a'ansa#e 8"rd. II9. Fn%#ia
rena&a se
men#ine m&# #im( nea&#era#a.
. S#adi& III de .TA %om(&i%a#a. In a%es# s#adi sn# (rezen#e (e &an"a
a%ze&e (erioade&or an#erioare si semne si sim(#ome noi: %a rmare a
'is%era&izarii )i(er#ensinii si a a!e%#arii or"ane&or #in#a.
Com(&i%a#ii&e .TA a !os# im(ar#i#e ar6i#rar in %om(&i%a#ii nes(e%i!i%e
si %om(&i%a#ii s(e%i!i%e.
Complicatiile nespecifice sn#: de !a(#: %onse%in#a (ro%es&i
ar#eros%re&o#i% %e se in#er%ondi#ioneaza % .TA> a(ar s#enozari aor
#i%e:
%oronariene: %ere6ra&e: (eri!eri%e nein!&en#a#e semni!i%a#i' de #ra#ame
n#&
)i(o#ensor.
Complicatiile specifice, % (redi&e%#ie (en#r )i(er#ensi'ii #ineri:
s6 00 de ani. E&e (o# !i s#a6i&iza#e s6 #era(ia
)i(o#ensoare e!i%a%e.
Com(&i%a#ii&e s(e%i!i%e sn#5 .VS % ins!i%ien#a 'en#ri%&ara s#
an"a
%onse%#i'a: re#ino(a#ia )i(er#ensi'a 8FO "rd. III: IV9: )emora"a %ere6ra&a
sa
%ere6romenin"iana: ins!i%ien#a rena&a (rin ne!ro-an"ios%re&oza.
. S#adi& IV de .TA ma&i"na . Es#e !orma % e'o&#ie a%%e&era#a si
mor#a&i#a#e ridi%a#a. In %on#rarea %adr&i %&ini%: %ri#eri& e'o&#i'
es#e %e& mai im(or#an#. Da%a &a e$aminari s%%esi'e: 6o&na'& % .TA
se'era aso%iaza edem (a(i&ar si a&#erarea ra(ida a !n%#iei rena&e: %e
de&imi#eaza !orma ma&i"na a .TA. .TA ma&i"na es#e 6oa&a ad&#&i
#anar: mai a&es 6ar6a#. Dia"nos#i%& se s#a6i&es#e (e %ri#erii %&ini%e:
6io&o"i%e: )is#o&o"i%e.
Criterii clinice: TA dias#o&i%a (es#e +,7mm.": en%e!a&o(a#ie:
re#ino(a#ie: semne de de%om(ensare %ardia%a ra(ida: e'en#a& edem
(&monar
a%#: drere a6domina&a sim&and o %o&e%is#o-dodeni#a a%#a.
Criterii biologice: %res#erea reei si %rea#ininei: (ro#einrie:
)ema#rie mi%ros%o(i%a: %i&indrie: anemie )emo&i#i%a mi%roan"io(a
#i%a:
a&dos#eron san"in si rinar %res%#: %res#erea a%#i'i#a#ii reninei (&asma#i%e.
Criterii histologice: ar#erio&i#a ne%rozan#a 8(or#inea dis#a&a a
ar#ere&or in#er&o6&are (rezin#a ne%roza !i6rinoida9:
UR(E%TE )IPERTE%SIVE
Cores(nd nor si#a#ii %and %res#erea ra(ida: a%#a: a TA
amenin#a 'ia#a da%a n es#e san%#iona#a r"en# #era(e#i%. Criza
)i(er#ensi'a (oa#e a(area in - im(reArari5 en%e!a&o(a#ia )i(er#ensi'a> .TA
ma&i"na> (seri #ensiona&e % e$%es de %a#e%o&amine 8!eo%romo%i#om:
o(rire 6rs%a a nei #era(ii % %&onidina9.
-en%e!a&o(a#ia )i(er#ensi'a are %a sim(#om %ara%#eris#i% a&#erarea
%ons#ien#ei: aAn"and in %a#e'a ore &a %oma. Se in#a&nes#e &a5 !emeia
insar%ina#a % #o$emie
"a'idi%a5 %o(ii si #ineri % "&omer&one!i#a a%#a5 in %rs& ori%arei
!orme de
.TA (rimi#i'a sa se%ndara. *o&na'& se adreseaza medi%&i (en#r
%e!a&ee
'io&en#a: "re#ri: #&6rari de 'edere: 'aria#e semne nero&o"i%e. TA a#in"e
'a&ori
!oar#e mari.
-.TA ma&i"na sa a%%e&era#a.
-Pseri&e )i(er#ensi'e % e$%es de %a#e%o&amine.
? !eo%romo%i#om5 (aro$isme&e #ensiona&e sn# inso#i#e de %e!a&ee
a%%en#a#a:
#rans(ira#ii a6nden#e: (a&(i#a#ii: #&6rari de "&i%ore"&are de%e&a6i&e
(rin
#es#e (ara%&ini%e. Con!irmarea 6o&ii se !a%e (e dozarea rinara a
a%id&i
'ani&mande&i%: me#a6o&i# a& %a#e%o&amine&or.
? adminis#rarea nor a&imen#e 6o"a#e in #iramida sa a
mine
sim(a#i%omime#i%e &a n 6o&na' #ra#a#.
? o(rirea 6rs%a a ni #ra#amen# % %&onidina: in doze !oar#e
mari
8&:,m"Gzi9.
To# %a r"en#a #re6ie %onsidera#a .TA %om(&i%a#a.
EVOLUTIE SI COMPLICATII
In !orma 6eni"na: %ea mai o6isni#a: 6oa&a dreaza ani sa
%)iar ze%i de ani. S6 in!&en#a ni #ra#amen# %ore%# si (re%o%e (o# a(area
remisini im(or#an#e. In !orma ma&i"na: e'o&#ia es#e !oar#e ra(ida: e#a(e&e
6o&ii !iind (ar%rse in +-- ani.
Indi!eren# de e#io&o"ie: !ie%are !orma de .TA in ra(or# %
%ara%#er& sa e'o&#i': (oa#e !i 6eni"na sa ma&i"na si (ar%r"e: in
e'o&#ia sa: %e&e - s#adii din %&asi!i%area (ro(sa de OMS.
In s#adi& a& III-&ea a(ar %om(&i%a#ii5 &a ni'e&&
a(ara#&i %ardio'as%&ar 8ins!i%ien#a 'en#ri%&ara s#an"a a%#a si
ins!i%ien#a %ardia%a "&o6a&a: in!ar%# mio%ardi%: ane'rism dise%an#9> &a
ni'e&& %ir%&a#iei %ere6ra&e 8en%e!a&o(a#ie )i(er#ensi'a: #rom6oze si
)emora"ii %ere6ra&e9> &a ni'e&& rini%)i&i 8#&6rari 'aria#e: de &a
a&#erari !n%#iona&e: (ana &a s%re&oza % ins!ien#a rena&a9.
Com(&i%a#ii&e de(ind de !orma %&ini%a 6eni"na sa ma&i"na.
As#!e&: in )i(er#ensinea 6eni"na %om(&i%a#ii&e se da#oreaza a#eros%re&ozei:
%e&e mai !re%'en#e !iind #rom6oza %ere6ra&a si in!ar%#& mio%ardi%. Ai%i se
in#a&nes% !re%'en# en%e!a&o(a#ia )i(er#ensi'a: )emora"ia %ere6ra&a:
ins!i%ien#a %ardia%a si ins!i%ien#a rena&a.
A. Complicatii cere#rale ale $TA
A%es#e %om(&i%a#ii (o# !i a%%iden#e 'as%&are minore sa
maAore. Ce&e minore sn# %onse%in#a a#eros%re&ozei %ere6ra&e si im(n n
%on#o& ri"ros a& TA. A%iden#e&e maAore se mani!es#a %&asi% (rin )emora"ie
%ere6ra&a: %are se (oa#e (rezen#a s6 doa as(e%#e5 )emora"ia %ere6ra&a
(rimi#i'a 8%ea mai !re%'en#a !orma %&ini%a: #radsa (rin de!i%i#
nero&o"i%: %e!a&ee: 'arsa#ri: #&6rari de %ons#ien#a9 si )emora"ia
menin"iana sa menin"o-%ere6ra&a: asemana#oare %&ini% % (re%eden#a %
mai (#ine e'iden#e semne nero&o"i%e: darada"and-se %on#ra%#ra
menin"iana.
% Complicatii car&iace ale $TA
*o&na'& % .TA es#e amenin#a# de ins!ien#a %ardia%a si
de ris%ri&e ins!i%ien#ei %oronariene. E$is#a o %ore&a#ie dire%#a in#re "rad&
.TA si ra(idi#a#ea: in#ensi#a#ea dez'o&#arii %ardio(a#iei. Ris%& %res%#
de in!ar%# mio%ardi% a& )i(er#ensi'i&or es#e %ore&a# % TA dias#o&i%a &a
#ineri si % TA sis#o&i%a &a 'ars#ni%i.
Se %onsidera %a in%e(# a& %ardio(a#iei momen#& %and se
s%)i#eaza )i(er#ro!ia 'en#ri%&i s#an". E$amen& radio&o"ie ara#a o
)i(er#ro!ie soara si e&e%#i'a a %ord&i s#an": mai 6ine o6ser'a#a in OAS.
Mai %ons#an#e de%a# semne&e radio&o"i%e sn# modi!i%ari&e
EBG %are e'iden#iaza )i(er#ro!ia 'en#ri%&i s#an". De asemenea: se mai
(o# remar%a di'erse "rade si !orme de !orme de 6&o% de ramra sa AV.
Semne&e %&ini%e %are (re%ed ins#a&area ins!i%ien#ei %ardia%e
sn#5 #a)i%ardia: (&s a&#ern: %&an"or aor#i%: "a&o( mezo-sa #e&edias#o&i%:
#&6rari de ri#m 8e$#rasis#o&e: !i6&a#ie ar#eria&a9.
Semne&e ins!i%ien#ei %ardia%e sn# %nos%#e si n insis#am
de%a# as(ra nor amann#e5
-s%ena (oa#e !i des%)isa de o ins!ien#a 'en#ri%&ara s#an"a:
ins#a&a#a 6rs%>
-n )i(er#ensi' a(aren# %om(ensa# (oa#e de%eda &a
(rima %riza de edem(&monar a%#>
-mani!es#ari&e dis(nei%e (aro$is#i%e 8as#m %ardia%: edem
(&monar a%#9 ann#ade%&ansarea ins!i%ien#ei %ardia%e %on"es#i'e.
In a%eas#a (erioada a(ar s!&ri nede%e&a#e an#erior5 de
ins!i%ien#a mi#ra&a !n%#iona&a: mai rar de ins!i%ien#a aor#i%a. Va&ori&e
#ensiona&e ridi%a#e: adeseori: 'or s%adea d(a ins#a&area ins!i%ien#ei
'en#ri%&are s#an"i.
E$amen& radio&o"ie ara#a )i(er#ro!ia %ord&i 8'en#ri%&
s#an": a#ri dre(# si a#ri s#an": in !ina& 'en#ri%& dre(#9: (re%m si semne
de s#aza (&monara.
In e'o&#ie: n (ro%en# a(re%ia6i& de )i(er#ensi'i 'or
de'eni an"inosi sa 'or !a%e in!ar%# de mio%ard.
C. Complicatiile renale ale $TA
A(re%ierea !n%#iei rena&e (res(ne e!e%#area nor e$amene
de r#ina5 (ro#einria (e ,/ de ore: #es#& Addis sa S#ans!e&d-<e66:
dozarea reei si %)iar %&earen%e-& s6 /7m&Gmin. ara#a de!i%i# !n%#iona&
rena&: (ro6a de %on%en#rare Vo&)ard: e&iminarea rena&a a !eno&s&!on!#a&einei
8norma& +0= &a +0 min. 00-27= &a 27 min.9. Com(&i%a#ia rena&a a .TA es#e
ins!i%ien#a rena&a (rin ne!roan"ios%re&oza.
.TA de %aza rena&a re(rezin#a +0= din #o#a&&
)i(er#ensi'i&or si sn# se%ndare. .TA reno(aren%)ima#oasa a(are &a
17= din 6o&na'ii % (ie&one!ri#a %roni%a. Se (rezin#a %&ini% % semne&e
%&asi%e a&e (ie&one!ri#ei5 (irie: (o&irie: sindrom %is#i#i%: sindrom 6io&o"i%
de in!e%#ie rinara 8&e%o%i#rie: %i&indrii &e%o%i#ari: ro%&#ri (ozi#i'e9:
sindrom de #6 dis#a& 8s%aderea%a(a%i#a#ii de %on%en#rare a rinei: !i&#rarea
ramane norma&a9. Tardi': a(ar semne de ins!ien#a rena&a.
*oa&a (o&i%)is#i%a rena&a es#e o a!e%#ine 6i&a#era&a: %
%ara%#er !ami&ia&: (rezen#a &a #ineri. E$amen& %&ini% de%e&eaza5
ne!rome"a&ie 6i&a#era&a 8rini%)i 6o6e&a#i9: )ema#rie: dreri &om6are.
Uro"ra!ia %on!irma dia"nos#i%&5 rini%)i mari: %o&i%e a&n"i#e % as(e%# de
(anza de (aianAen. G&omer&one!ri#a %roni%a (rezin#a .TA aso%ia#a %
semne rena&e 8a&6minrie: )ema#rie: s%aderea im(or#an#a a !i&#ra#&i
"&omer&ar9.
.TA reno-'as%&ara se 6anies#e &a n 6o&na' s6 /7 de ani:
% .TA !ara %aza a(aren#a: % (osi6i& de6# d(a #rama#ism &om6ar5>
(rezin#a n s!& a6domina&: e(i"as#ri% sa in &oAa rena&a. Se de%e&eaza
di'erse anoma&ii ro"ra!i%e a&e ne!ro"ramei izo#o(i%e: s%in#i"ramei rena&e:
ar#erio"ra!iei rena&e.
A&#e %aze (osi6i&e a&e .TA rena&e (o# !i #6er%&oza
rena&a: a(&azii&e si a#ro!ii&e rena&e ni&a#era&e %on"eni#a&e.In'es#i"a#ii de
s(e%ia&i#a#e (re%izeaza dia"nos#i%&.
PROGNOSTICUL
-de(inde de !orna %&ini%a 6eni"na sa ma&i"na: de eredi#a#e: de ni'&&
#ensinii dias#o&i%e si 6aza&e: de 'ars#a 8#inerii !a% !orme mai "ra'e9: de
res(e%#area #ra#amen#&i: de mod& de 'ia#a re%omanda# si: in s!arsi#: de
a(ari#iia %om(&i%a#ii&or.
Pro"nos#i%& es#e !a'ora6i& in (rim& s#adi de 6oa&a: !iind
mai rezer'a# in s#adi& a& doi&ea si mai a&es in a& #rei&ea. Moar#ea se
da#oreaza indeose6i %om(&i%a#ii&or %ardia%e: %ere6ra&e si rena&e. S6
in!&en#a #ra#amen#&i a%#a&: (ro"nos#i%& s-a im6na#a#i#.
TRATAM'NTUL $TA
. Cine #re6ie sa 6ene!i%ieze de #ra#amen# an#i)i(er#ensi'F
Teore#i% ras(ns& es#e sor de da#. To#i %ei %are a
%i!re #ensiona&e (es#e +17G40mm." &a mai m&#e e$aminari medi%a&e es#e
ne%esar sa !ie in%adra#i in (ro"ram& #era(e#i% an#i)i(er#ensi'.
Pra%#i% (ro6&ema es#e mai di!i%i&a: deoare%e nr.
)i(er#ensi'i&or 8s#a6i&i#i d(a a%es#e &imi#e re%omanda#e de OMS9 es#e mare.
In (&s: maAori#a#ea a%es#or 6o&na'i sn# asim(#oma#i%i si: %a rmare:
%om(&ian#a &or &a #ra#amen# es#e mi%a: de asemenea: adminis#rarea inde!ini#a
a nor dro"ri an#i)i(er#ensi'e are e!e%#e se%ndare nedori#e: "re a%%e(#a#e
de (a%ien#i.
C #oa#e a%es#ea %ei mai m&#i din#re a#ori sn# nanimi in a
re%omanda #ra#amen# ##ror )i(er#ensi'i&or !ie s6 !orma re"im&i
i"ieno-die#e#i% !ie a %e&i medi%amen#os. Ar"men#e&e in !a'oarea (n%#&i
de 'edere res(e%#i' sn# !rniza#e: (e de o (ar#e: de so%ie#a#i&e de
asi"rari a&e %aror s#a#is#i%i ara#a %a .TA es#e o %aza maAora de %res#ere
a mor6idi#a#ii si de s%adere a &on"e'i#a#ii: iar (e de a&#a (ar#e: de rez&#a#e&e
nor s#dii #era(e#i%e%on#ro&a#e %are demons#reaza %a s%aderea s6
#ra#amen# a TA mi%soreaza mor6idi#a#ea si mor#a&i#a#ea &a )i(er#ensi'i.
Ra(or#and in#re6area (sa &a in%e(#: se (oa#e s(ne %a: indi!eren# de
in%adrarea in#r-o %&asi!i%are sa a&#a: #o#i )i(er#ensi'ii #re6ie #ra#a#i.
Da%a a#i#dinea #era(e#i%a !a#a de 6o&na'& )i(er#ensi'
% TAC+17G40mm." es#e re&a#i' %&ara: n a%e&asi &%r se in#am(&a %
)i(er#ensi'ii
&a &imi#a 8D6order&ine )L(er#ensionD TA
S
+/7-+04: TA
d
47-
4/mm."9. Orien#area m&#or a#ori as(ra #ra#amen#&i .TA &a &imi#a
es#e e%&e%#i%a: %ri#erii&e de &are in #ra#amen# !iind ar6i#rare si 'aria6i&e.
Un &%r reiese % (re"nan#a din s#dii&e (ri'ind &on"e'i#a#ea si anme
%a s(eran#a de 'ia#a aa%es#or (a%ien#i es#e mai mi%a de%a# a
normo#ensi'i&or.
Consideram %a si a%eas#a %a#e"orie de 6o&na'i #re6ie in%adra#a
in#r-n (ro"ram #era(e#i%. O(or#ni#a#ea &i 'a !i a(re%ia#a n nmai d(a
%i!ra #ensiona&a: %i si in !n%#ie de a&#i !a%#ori5 ris%& "ene#i%: 'ars#a: ne&e
o6isnin#e a&imen#are: s#ress& (si)o-so%ia&: e'en#a&e&e aso%ia#ii mor6ide
8dis&i(idemii: )i(erri%emie: o6ezi#a#e: dia6e#: ne!ro(a#ie: di'erse e#%9.
Consm& de an#i%on%e(#iona&e ora&e: zona de resedin#a 8(re'a&en#a .TA
es#e mai mare in ne&e re"ini de%a# in a&#e&e9: e#%.
Un indi'id #anar: )i(er(ondera&: %e (ro'ine din#r-o !ami&ie de
)i(er#ensi'i: s(s ni s#ress (si)oso%ia& in#ens: %are e'n#a& %onsma si
sare m&#a sa es#e dis&i(idemi%: are #oa#e sanse&e %a in rma#orii ani din
Dmi% )i(er#ensi'D sa de'ina n Dmare )i(er#ensi'D. De a%eea es#e in#e&e(#
%a #ra#amen#& sa in%ea(e in a%es# s#adi a& 6o&ii: in %are si e!i%ien#a
(oa#e !i ma$ima. Tra#amen#& .TA &a &imi#a n #re6ie sa !ie nmaide%a#
medi%amen#os. Adeseori %ore%#area o6ezi#a#ii: re"im& sara% in sodi si
6o"a# in (o#asi sa
(ra%#i%area s(or#&i de a"remen# sn# s!i%ien#e (en#r a rea&iza re'enirea
&a norma& a TA.
Tra#amen#& .TA #re6ie sa 'izeze anmi#e o6ie%#i'e si in
(rim&r rand norma&izarea 'a&ori&or #ensiona&e. E& #re6ie sa #ina seama de
anmi#e (rin%i(ii si orien#ari5
-e$(&orarea #re6ie 6ine !a%#a deoare%e sn# )i(er#ensini %are
6ene!i%iaza de #ra#amen# %)irr"i%a& 8)i(er#ensini&e reno-'as%&are9> -
#ra#amen#& #re6ie sa !ie %om(&e$ i"ieni%o-die#e#i%: medi%amen#os e#%> -
#ra#amen#& #re6ie indi'ida&iza# si s#a6i&i# in %ondi#ii de am6&a#or: n
des(i#a&>
-dro"ri&e )i(o#ensi'e 'or !i adminis#ra#e &a in%e(# in %an#i#a#i mai mi%i
si mari#e a(oi (ro"resi': (ana &a norma&izarea TA. Es#e 6ine %a
dro"ri&e )i(o#ensi'e sa !ie aso%ia#e si &a in%e(#& #ra#amen#&i aso%ierea
sa %(rinda n )i(o#ensi' % n dire#i% #iazidi%>
-#re6ie #in# seama de a#eros%re&oza aso%ia#a: de ai%i 8mai a&es &a
'ars#ni%i9 de%r"and (rden#a: (en#r a n (re%i(i#a a%%iden#e&e
'as%&are %ere6ra&e: %oronoriene si (eri!eri%e 8ni%ioda#a n se 'a in%e(e %
doze mari: 6r#a&e9> -deoare%e m&#e )i(er#ensini sn# %onse%in#a sa sn#
aso%ia#e a#eros%re&ozei: re"im& si #ra#amen#& 'or !i ada(#a#e a%es#eia
din rma. Se 'or %om6a#eo6ezi#a#ea: "#a dia6e#& za)ara#:
)i(er&i(o(ro#einemii&e e#%> -re(as& n #re6ie sa !ie a6so&#. E$er%i#ii&e
!izi%e: mers& (e Aos si
"imnas#i%a medi%a&a: !a% (ar#e din #ra#amen#. E!or#& !izi% 'a !i do
za# si ada(#a# (osi6i&i#a#i&or 6o&na'&i>
-seda#i'e&e si #ran%)i&izan#e&e sn# de m&#e ori ne%esare>
-die#a 'a !i sara%a in %o&es#ero& si "rasimi sa#ra#e>
-es#e 6ine %a #ra#amen#& sa !ie si 'asodi&a#a#or %ronarian: deoare%e aso%ia#ia
%ardio(a#ie is%)emi%a
-.TA es#e !oar#e !re%'en#a>
-n ori%e .TA rmeaza sa (rimeas%a #ra#amen# )i(o#ensi'.
As#!e& in !orme&e &a6i&e de "rd. I: es#e s!i%ien# re"im& die#e#i%: e'en#a&
#ran%)i&izan#e si seda#i'e.
A" TRATAME%TUL I(IE%O+DIETETIC
Tra#amen#& i"ieni%o-die#e#i% rmares#e s#a6i&irea
re"im&i a&imen#ar 8die#a si re"&emen#area a%#i'i#a#ii !izi%e si
in#e&e%#a&e9. Im(or#an#a a%es#i #ra#amen# rez&#a si din !a(#& %a m&#e
6o&i se (o# 'inde%a nmai (rin die#a si re(as 8ne&e en#ero%o&i#e a%#e:
ne&e ne!ri#e e#%9: a&#e&e (#and-se men#ine in s#are de %om(ensare
8a!e%#ini %ardia%e: )e(a#i%e: rena&e9.
Die#e#i%a sa a&imen#a#ia %ra#i'a se o%(a % a&imen#a#ia
om&i 6o&na'. A%eas#a #i&iza#a %ore%#: &imi#eaza in#re6in#area
medi%amen#e&or: e'i#and as#!e& o6isnin#a or"anism&i % medi%amen#e&e.
Dar: die#e#i%a Aoa%a n ro& im(or#an# si in (ro!i&a$ia
e(isoade&or a%#e: a %om(&i%a#ii&or si a de%om(ensari&or 8ins!i%ien#a
%ardia%a: .TA: dia6e# za)ara#: %o&e%is#i#e: 6oa&a &%eroasa e#%9. Re"im&
die#e#i% #re6ie in#o#deana
indi'ida&iza#: ada(#a# !azei de e'o&#ie a 6o&ii si %a# mai 'aria#: (en#r a
n (ro'o%a re(&sie: de%i ne%oo(erarea 6o&na'&i.
La s#a6i&irea ni re"im #re6ie (re%iza#e a&imen#e&e (ermise: %an#i#a#ea si
%a&i#a#ea &or: orar& si re(ar#izarea mese&or: dra#a a(&i%arii. Se re%omanda:
neori !oi de re"im. Periodi%: 6o&na'&#re6ie %an#ari#: (en#r a a(re%ia
s%%es& sa ine!i%ien#a me#odei.
Rolul asis#en#ei medi%a&e in a(&i%area #ra#amen#&i i"ieno-
die#e#i% es#e !oar#e im(or#an#: ea %on#ri6ind &a #oa#e !orme&e si !aze&e
a%es#i #ra#amen#: rmarind res(e%#area a%es#ia: a(re%iind rez&#a#e&e
!a'ora6i&e sa de(is#and #&6rari&e se%ndare.
Re!imul alimentar in $TA
ALIMENTE PERMISE5
-s(e5 de zarza'a# sim(&e sa % adaos !ainos: 6ors de zarza'a# sa %
%ar#o!i:
s(e de &e"me: s(e de rosii: #oa#e !ara sare>
-!ainoase5 in %an#i#a#e &imi#a#a: "ris: orez: !&"i de o'az: !idea: #oa#e !ier#e
!ara
sare
-oa in%an#i#a#e redsa 8+-, (e sa(#amana9: !ara "a&6ens>
-%arne in %an#i#a#e redsa: de- ori (e sa(#amana: de 'i#a: 'i#ei: "aina: (i:
s&a6a:
!iar#a %a raso&: !ri(#a: % (a#rnAe&: %ar#o!i: mor%o'i: orez: (erisoare !ier#e in
a6ri
sa a(a: #oa#e !ara sare: (es#e s&a6 8&in: sa&a: s#i%a: %ra(: (as#ra'9 !ier#:
raso&:
!ri(# sa %o(# in (er"amen# 8in zi&e&e % %arne n se da (es#e si in'ers9>
-"rasimi %rde: 'e"e#a&e: &ei de (orm6: !&oarea soare&i: mar"arina
nesara#a.
To#& se da %rd &a sa&a#e: %am 07"Gzi.
-(aine5 a&6a sa in#ermediara: !ara sare: 'e%)e de o zi sa (raAi#a>
-&e"me si zarza'a#ri5 %rde sa !ier#e: #re%#e (rin si#a: (ireri:
s#re%ra#e:
%)i!#e&#e de zarza'a#: %ar#o!i %o(#i: mor%o'i: do'&e%ei: !aso&e 'erde:
mazare
'erde: s!e%&a: sa&a#a 'erde: rosii: 'ine#e: ardei "rasi: 'arza %rda si mra#a:
!ara
sare: #o#e rase marn# si adminis#ra#e %a sa&a#e: sa !ier#e %a so#eri sa
6din%i
de &e"me>
-&a(#e si 6ranze#ri5 &a(#e d&%e: iar#: &a(#e 6a##: 6ranza de 'a%i: %as:
rda
nesara#a: &a(#e % %a!ea>
-!r%#e s6 ori%e !orma5 %rde: %oa(#e: (ireri: %om(o#ri>
-d&%iri5 (re(ara#e !ara 6i%ar6ona# si sare: din a&a# !ier#: s%a#: %
6ranza de
'a%i: % !r%#e sa "e&a#ina de !r%#e: % &a(#e: iar#: (e&#ea: sa&a#a de
!r%#e: %
miere si !ris%a: marme&ada: (a#eri: d&%ea#a: za)ar>
-6a#ri5 &a(#e sim(& de"resa#: &a(#e 6a## sa iar#: s%ri de !r%#e
sa
zarza'a#ri: %eairi de (&an#e>
-%ondimen#e5 sos de rosii: sosri die#e#i%e 8!ara "rasime (raAi#a9 % !aina
rmeni#a
(e s%a#: % zeama de zarza'a# 8seara in %an#i#a#e redsa9: 'erde#ri
#o%a#e
8(a#rnAe&: marar: #e&ina: &es#ean: %im6r9: zeama de &amaie si sare &imi#a#a.
ALIM'NT' INT'R(IS')
-&a(#e in#e"ra&: 6ranze#ri sara#e si "rase>
-%arne "rasa: 'is%ere: 'ana#: (es#e "ras sa sara#: %onser'e de (es#e sa
%arne:
a!ma#ri>
-oa in %an#i#a#e %res%#a 8mai a&es "a&6ensri9: oa #ari: om&e#a:
Amari:
maioneza>
-"rasimi anima&e in %an#i#a#e %res%#a
8n#: n#ra: !ris%a: sman#ana: se:
s&anina9: "rasimi (raAi#e>
-(aine % sare si (aine nea"ra>
-!ainoase (re(ara#e % sare si in %an#i#a#e mare>
-6ranze#ri5 "rase: sara#e: !ermen#a#e>
-sosri5 % "rasimi (raAi#e: % zeama de %arne: % ms#ar sa maioneza>
-&e"me si zarza'a#ri %are %on#in m&# sodi 8#e&ina: s(ana%: 'arza
a%ra:
mra#ri9>
-d&%iri (re(ara#e % 6i%ar6ona#: % n# si "a&6ens de o: % %io%o&a#a
sa
%a%ao5
-6a#ri a&%oo&i%e: %a!ea: %eai #are: &i%)ide in e$%es>
-%ondimen#e5 sare mai m&# de%a# es#e (res%ris: (i(er: ardei i#e: 6oia de
ardei:
)rean: ms#ar: %ea(a: s#roi.
R'COMAN*AM)
-'ia#a ordona#a: !ara e!or#ri: !ara !ma#: !ara s#ress: !ara a&%oo&>
-mese mi%i si !ra%#iona#e: &a ore re"&a#e. U&#ima masa % , ore
inain#e de
%&%are>
-in#o#deana se 'a %om6a#e o6ezi#a#ea 8%and e$is#a9.
R'+IMUL *' ,IATA
Cons#a in &imi#area e!or#ri&or !izi%e: % &%r de 1-3 oreGzi: d(a
%az: % res(e%#area ore&or de somn si a ore&or de masa. A o mare
im(or#an#a miA&oa%e&e (si)o#era(i%e: %om6a#erea an$ie#a#ii si e'i#area
si#a#ii&or %on!iden#ia&e din medi& de 'ia#a sa de mn%a. Vor !i %a#a#e si
In%raAa#e e&emen#e&e de sa#is!a%#ie din (ro!esinea 6o&na'&i: 'or !i
%&#i'a#e (reo%(ari&e %are (rod% re&a$area 8(&im6ari: &e%#ra: mzi%a:
#ea#r9.
!" TRATAME%TUL MEDICAME%TOS
Prin%i(ii "enera&e a&e #ra#amen#&i medi%amen#os
Tra#amen#& .TA 'a !i (ermanen#: %)iar a#n%i %and %i!re&e
#ensiona&e s-a norma&iza#. In a%eas#a si#a#ie se 'a s#a6i&i (rin #a#onare
doza minima e!i%ien#a: % %are se 'a %on#ina a(oi #ra#amen#&. Es#e
o6&i"a#ori %a a#a# re"im& i"ieno-die#e#i%: %a# si medi%a#ia
an#i)i(er#ensi'a sa !ie adminis#ra#e in mod %on#in. Renn#area &a n
#ra#amen#: oda#a % norma&izarea TA: d%e &a
%res#erea %i!re&or TA (ana &a 'a&ori&e (re#era(e#i%e 8in %a#e'a &ni9 &a (es#e
27= din %azri. N se 'a renn#a &a n medi%amen# sa &a o s%)ema
#era(e#i%a de%a# d(a %e a%es#ea a !os# adminis#ra#e s!i%ien# #im(:
(en#r a-si !a%e (ro6a e!i%a%i#a#ii sa ine!i%a%i#a#ii &or. De o6i%ei: #im(&
medi de a(re%iere a e!i%a%i#a#ii nei s%)eme #era(e#i%e es#e de /-1
sa(#amani 8% %ondi#ia %a medi%amen#e&e sa !ie adminis#ra#e in doze
e!i%ien#e9.
In %az& a(ari#iei e!e%#e&or ad'erse &a n medi%amen#: se 'a
mi%sora doza sa a%es#a 'a !i in&o%i#: d(a %az: % n a&# medi%amen#:
dar ne se 'a renn#a &a %on#ini#a#ea #ra#amen#&i. N se re%omanda
adminis#rarea dis%on#ina a ni medi%amen# an#i)i(er#ensi' in#r%a# es#e
ie!i%ien#a. )i %adr& %on#ini#a#ii #ra#amen#&i in !n%#ie de e'o&#ia 6o&ii:
se 'a a'ea in 'ederea(&i%area &i #re(#a#a: e!i%ien#a #ra#amen#e&or
an#erioare si e'en#a&e&e e!e%#e ad'erse a&e nor s%)eme #era(e#i%e.
In #ra#amen#& .TA se 'or in#re6in#a %a# mai (#ine
medi%amen#e. La maAori#a#ea 6o&na'i&or: .TA es#e %on#ro&a#a % +-,
medi%amen#e %e se a&e" in !n%#ie de (ro!i&& !izio(a#o&o"i% a& 6o&ii:
(ar#i%&ari#a#i&e %&ini%o-e'o&#i'e: e$(erien#a (ersona&a a medi%&i si
dis(oni6i&i#a#ea de medi%amen#e. A(roa(e in #oa#a &mea se (re!era azi
dire#i%e&e #iazidi%e si (-6&o%an#e&e: sin"re sa in aso%ia#ie. In%a de &ar"a
#i&izare sn# rezer(ini%e&e si )idra&azina. Fo&osirea aso%ia#ii&or de --/ sa
mai m&#e an#i)i(er#ensi'e %ons#i#ie o e$%e(#ie si es#e a(&i%a6i&a &a n
nmar res#rans de 6o&na'i.
Poso&o"ia 'a !i res(e%#a#a (en#r !ie%are medi%amen#.
*o&na'ii 'or !i a'iza#i de &a in%e(# as(ra e!e%#e&or se%ndare
a&e medi%a#iei an#i)i(er#ensi'e s#a6i&i#e: iar (e (ar%rs& o6ser'a#iei
medi%a&e 'or !i %)es#iona#i in a%es# sens. Pe %a# (osi6i& se 'a !a%e
(ro!i&a$ia &or 8de e$. a(or# e$o"en de (o#asi in %az& sa&re#i%e&or9: iar
oda#a a(ar#e 'or !i %ore%#a#e imedia#. Uneori e!e%#e se%ndare minore
8o6s#r%#ia naza&a d(a rezer(ini%e: somno&en#a: s%a%inea
m%oase&orMd(a %&onidina> as#enia !izi%a soara d(asa&re#i%e9
deranAeaza m&# (e 6o&na'i: de#erminand-i adesea: da%a n sn# a'iza#i si
(re"a#i#i (si)o&o"i% de medi% 8asis#en#a medi%a&a9: sa
a6andoneze #ra#amen#&: %)iar %and a%es#a era e!i%ien#. La 6ar6a#i se 'a e'i#a
adminis#rarea in (erioada a%#i'i#a#ii "eni#a&e de dro"ri an#i)i(er#ensi'e %are
a %a e!e%# se%ndar #&6rari de dinami%a se$a&a: (en#r %a in mod
si"r a%es#ia isi 'or a#oin#re(rinde #ra#amen#&.
CON*UITA T'RAP'UTICA IN FUNCTI' *' TIPUL
$TA
$TA usoara es#e ni%a !orma nde a(are in#re6area o(or#ni#a#ii
nei #era(ii a%#i'e. Unii a#ori re%omanda s(ra'e")erea si (res%rierea
seda#i'e&or.
A&#ii re%omanda mono#era(ia % n dire#i% sa P-6&o%an#.
$TA sistolica La #ineri es#e de#ermina#a de )i(er#onia
sim(a#i%a: re%omandad-se de%i n P-6&o%an#. La 'ars#ni%i se
da#oreaza red%erii
%om(&ian#ei ar#eria&e si se re%omanda dro"ri % a%#ine dire%#a as(ra
(ere#e&i ar#eria&.
.IDRALAZINA-P.O.GI.V. > NICERGOLINA
$TA mo&erata . Se re%omanda 8--
6&o%an#e&e 8.IDRALAZINA (.oGi.'.9 Edire#i% 8NICERGOLINA9: iar in
%az de ese%: se aso%iaza si )idra&azina sa me#i&do(a. Sa se adminis#reaza
aso%ierea5 CLONIDINA (.o.E ALFAMETTLDOPA (.o.E DIURETIC.
$TA severa : de!ini#a (rin#r-o dias#o&i%a (es#e
+,7mm.": 6ene!i%iaza de )i(o#ensoare maAore: sa&re#i%e:
s(irono&a%#ona: #i&iza#a sis#ema#i%. Da%a n e$is#a ne&e %om(&i%a#ii:
#era(ia .TA es#e mai nan#a#a.
In $TA cu insu-icienta car&iaca se aso%iaza #oni%ardia%e. Sn#
de e'i#a# P-6&o%an#e&e. Se !o&oses% sa&re#i%e 8Ne!ri$ (.o.: Frosemid (.o.G
i.'.: A%id e#a%rini%9 in aso%iere % S(irono&a%#ona (.o. % 'asodi&a#a#oare. Se
re%omanda .idra&azina 07-+77m"Gzi aso%ia#a % deri'a#i ni#ri#i % a%#ine
(re&n"i#a 8IsoNe#9 ,7-/7m" $ -Gzi seara sa % Prazosim (.o. &-,m" $ -Gzi
%res%and (ro"resi' (ana &a +7-,7m" $ -Gzi: !ie Ena&a(ri& (.o. in doza ni%a.
In $TA cu insu-icienta coronariana siGsa ateroscrelo.a
cere#rala se re%omanda sa&re#i%e in doze modera#e: (-6&o%an#e: o%-
me#i&do(a: an#i%a&%i%e 8Ado&a#9: ni#ri#i % a%#ine (re&n"i#a 8IsoNe#9 si in
an"or& de de%6i#: no%#rn: %a#a(&asma % #rini#rina -"e& +0--7m": a(&i%a#
(e #ora%e seara &a %&%are. La %ei % s!erin#a %ere6ra&a 'as%&ara se
re%omanda a se aso%ia Sadamin: Ian#ino&: Pra$i&en: Tren#a&: Pen#o$i!i&ina:
Cosa&don. De e'i#a# s%aderea 6rs%a a TA
In $ta cu insu-icienta renala sn# de (re!era# dro"ri %are n
s%ad !&$& san"in rena&5 .idra&azina: a-me#i&do(a: C&onidina: Ca(#o(ri&.
Se aso%iaza % dire#i%5 Frosemid: a%id E#a%rini%. Ca #a%#i%a #era(e#i%a: se
re%omanda men#inerea %on#ro&&i #era(e#i% a& .TA %)iar da%a a(are o
de#eriorare a !n%#iei rena&e: (osi6i&a &a in%e(#& #ra#amen#&i: dar
(asa"era. In !orme&e se'ere sn# de #i&iza# in)i6i#orii sis#em&i renino-
an"io#ensi'a.
$TA mali!na Ca #ra#amen# de a#a% se !o&oses#e Diazo$id
i.'. 0m"GB" %or(: aso%ia# % Frosemid i.'. 37m". Ras(ns& a(are in
,-- ore. Ca#era(ie de in#re#inere se re%omanda na din aso%ieri&e5
-.idra&azina E Pro(ano&o& G(.o. -.idra&azina E Pro(ano&o& E Dire#i% G(.o.
-C&oridina E Me#i&do(a E Dire#i% G(.o. -Mino$idi& G(.o. -Pro(ano&o& E
Dire#i% G(.o. -Ca(#o(ri& E Frosemid G(.o.
A'and in 'edere ris%& %ardia% si s!erin#a rena&a: s-a
(ro(s #ra#amen#e mai a"resi'e5 )emodia&iza (eriodi%a: ne!re%#omie
6i&a#era&a: sim(a#e%#omie s(ra- si s6dia!ra"ma#i%a: s(rarena&e%#omie
(ar#ia&a sa s6#o#a&a.
$TA la !ravi&e U#er& "ra'id (are sa (rod%a renina
e$(&i%and )i(er#ensinea 8'a&ori (es#e +/7G47mm."9 &a ne&e !emei
"ra'ide. Se re%omanda5 s(i#a&izarea: re(as &a (a#: %#-me#i&do(a: .idrozina:
(-6&o%an#e.
$TA la varstnici ras(nde !a'ora6i& &a5 Dire#i% E
#riam#eren: e'en#a& aso%ia# % Me#i&do(a sa C&onidina.
TRATAM'NTUL UR+'NT'LOR $IP'RT'NSI,'
Crize&e )i(er#ensi'e sr'in %a o %res#ere 6r#a&a a 'a&ori&or TA &a
n 6o&na' % .TA (ermanen#a: %nos%# si #ra#a# sa i"nora# (ana &a (rima
%riza.
E&e re(rezin#a o r"en#a #era(e#i%a: (nand in (eri%o& !n%#ii
'i#a&e 8%ardia%a: %ere6ra&a: (rin %om(&i%a#ii&e imedia# %e a(ar5 ins!i%ien#a
'en#ri%&ara s#an"a: en%e!a&o(a#ie )i(er#ensi'a> !n%#ia rena&a -(rin
%om(&i%a#ii&e #ardi'e5 ne!roan"ios%re&oza9. S(i#a&izarea es#e o6&i"a#orie.
Ca (rin%i(i "enera&: se im(ne red%erea r"en#a a 'a&ori&or TA si
&#erior %er%e#area %azei (osi6i&e a (aro$ism&i. Medi%a#ia se
adminis#reaza (aren#era&: i.m. sa i.'.: (en#r a o6#ine o %o6orare %a#
mai ra(ida a 'a&ori&or TA. Se !o&oses% rma#oare&e s6s#an#e5
-FUROSEMID 8LASII9 !io&e ,7m" i.'.: re(e#a#e &a ne'oie &a 3 ore>
-REZERPINA 8RAUNERVIL9 !io&e de ,:0m": se adminis#reaza im sa
i.'.: re(e#a#e &a 1-3 ore>
-DIZOIID: i.'.: 8ra(id-6o&s9: +07--77m" re(e#a#e &a 3-+, ore>
-NITROPRUSIAT DE SODIU in (er!zie %on#ina &-,"G N"G min#e:
6o&na'& #re6ie moni#oriza#>
-DI.IDRALAZINA i.'. &en#: a%#ioneaza in +0--7 de min#e>
-CLONIDINA 8CATAPRESAN9 i.m. in !io&e de 7:+07m" are a%#ine
(re&n"i#a -LA*ETALOL are o #o&eran#a e$%e&en#a: n (rod%e #a&%ardie
re!&e$a: (rod%e o s%adere #re(#a#a a TA: n red%e semni!i%a#i' de6i#&
%ardia%. Doza es#e de &:0m"G N" %or( in (er!zii s%r#e: se (oa#e %on#ina %
adminis#rarea (er os. Es#e #era(ia s(e%i!i%a a (seri&or )i(er#ensi'e din
!eo%romo%i#om>
-CAPTOPRIL: ENALAPRIL adminis#ra#e (er os: a%#ioneaza in +0-
,7min#e. In %az de ese% se (oa#e aso%ia n dire#i%: o6#inand-se s%aderea
#re(#a#a a 'a&ori&or #ensiona&e>
-NIFEDIPES!A: NICARDIPINA s6&in"a& (rod% o 6na si ra(ida
'asodi&a#a#ie % s%aderea TA. Se (o# #i&iza in %rize&e )i(er#ensi'e de ori%e
e#io&o"ie> -se re%omanda #ra#amen#& an#i%on'&si'an# % s&!a# de
M" ,7= i.'. 8Feno6ar6i#a&9: in %az de edem %ere6ra&.
In r"en#e&e )i(er#ensi'e se in%e(e % n dire#i% (#erni%
adminis#ra# i.'. 8Frosenid5 /7-37m"9: %are (rod%e o ra(ida des)idra#are:
% diminarea edem&i (&monar si %ere6ra&. In !n%#ie de %aza: se
aso%iaza (re(ara#& de e&e%#ie5
-da%a e$is#a ins!i%ien#a (&monara s#an"a se aso%iaza n
'asodi&a#a#or #i(
Ni#ro(rsia#& de sodi: Prazosin>
-da%a e$is#a o dise%#ie de aor#a: aso%iem a-6&o%an#e (en#r a dimina
'i#eza de
eAe%#ie>
-da%a e$is#a )emora"ie %ere6ra&a 'om e'i#a dro"ri&e %e (rod% o
di&a#a#ie
ar#erio&ara 8Diazo$id: .idra&azina9.
Indi%a#ii&e si &imi#e&e (osi6i&i#a#i&or %)irr"i%a&e in #era(ia
.TA In#er'en#ii&e %)irr"i%a&e isi "ases% a(&i%a6i&i#a#e in
!orme&e de .TA
se%ndara. Ma&!orma#ii&e aor#i%e (rezin#a n (ro%en# de 2,= de
norma&izare a
TA (os#o(era#or. Tmori&e s(rarena&e %e de#ermina sindrom& Cs)
in":
!eo%romo%i#om sa sindrom& Conn sn# mai di!i%i& de a6orda#
%)irr"i%a&:
(ro%en#& de nomina&izare a TA !iind mai s%az#. Lezini&e rena&e %e
(o#
6ene!i%ia de in#er'en#ie %)irr"i%a&a sn#5 a(&azii-a#ro!ii rena&e
ni&a#era&e:
#6er%&oza rena&a: %an%er& rena&: rmari&e nei (&a"i rena&e sa in!ar%#
rena&:
s#enoze&e ar#ere&or rena&e. inain#ea in#er'en#iei o(era#orii #re6ie !a%#
6i&an#&
!n%#iona& &a rini%)i& indemn.
ORIENTARI5
-Dire#i%e&e sn# #i&iza#e in maAori#a#ea )i(er#ensini&or ar#eria&e:
indi!eren# de
s#adi& si se'eri#a#ea 6o&ii.
-O-6&o%an#e&e 8Pro(ano&o&&9 sn# )i(o#ensoare de 6aza.
-P-me#i&do(a si C&onidina sn# )i(o#ensoare %are n in!&en#eaza
ne"a#i'
%ir%&a#ia rena&a. Sn# #i&iza#e in mod o6isni#.
-.idra&azina a rede'eni# n )i(o#ensor de 6aza: da#ori#a aso%ia#iei
% O -
6&o%an#e&e: a%es#ea din rma %ore%#and-i e!e%#e&e se%ndare.
-In 07= din#re %azri: dire#i%e&e ori O -6&o%an#e&e norma&izeaza
'a&ori&e
#ensiona&e. In %e&e&a&#e 07= din#re %azri a%#ioneaza aso%ieri&e de
)i(o#ensoare %
dire#i%e. Cea mai e!i%a%e si 6ine #o&era#a aso%iere es#e %ea din#e n
dire#i%
#iazidi%: n O -6&o%an# si n 'asodi&a#a#or 8.idra&azina e.#.%9: &a %are se
(oa#e ada"a n sim(a#i%o&i#i%o %en#ra& 8P -me#i&do(a sa C&oridina9.
-N se aso%iaza doa sim(a#i%o&i#i%e %en#ra&e sa n sim(a#i%o&i#i% %
n Q--
6&o%an#.
-.idra&azina n se adminis#reaza de%a# aso%ia#a % n (-6&o%an#:
iar
sim(a#i%o&i#i%e&e !ara n dire#i%.
PRO'ILA*IA )IPERTE%SIU%II ARTERIALE
Pro!i&a$ia )i(er#ensinii ar#eria&e rmares#e ed%area in 'ederea
ni %om(or#amen# ade%'a# de 'ia#a: %)iar orien#area (ro!esiona&a a
des%enden#i&or din (arin#i )i(er#ensi'i: a 6o&na'i&or in s#adi& (re)i(er#ensi':
de%i a (ersoane&or ss%e(#i6i&e de a !a%e 6oa&a. Foar#e im(or#an# es#e si
(ro!i&a$ia %om(&i%a#ii&or: rea&iza6i&a (rin asi"rarea %oo(erarii 6o&na'&i
si (rin re%omandari !erme si Adi%ioase. Asis#en#a medi%a&a #re6ie sa
%ons#ien#izeze (ersoane&e (redis(se &a )i(er#ensine ar#eria&a de ro&& (e
%are-+ a ei insasi in (re'enirea 6o&ii: dar maia&es (re'enirea %om(&i%a#ii&or5
+. Es#e (osi6i&a (ro!i&a$ia )i(er#ensinii ar#eria&eF
.i(er#ensinea ar#eria&a es#e %onsidera#a %a o D6oa&a de re"&areD
in (a#o"enia %areia sn# im(&i%a#i !a%#orii "ene#i%i si de medi. Ponderea
!ie%aria din#re ei di!era de &a n #i( e#io&o"i% &a a&#&: de &a n
)i(er#ensi' &a a&# )i(er#ensi'. Fa(#& %a in e#io&o"ia 6o&ii sn# im(&i%a#i
!a%#orii "ene#i%i: n #re6ie (ri'i# %a o !a#a&i#a#e. Com6a#erea nor
%om(onen#e e#io(a#o"eni%e din medi&e$#ern 8%onsm& e$%esi' de NaC&:
s#res& (si)oso%ia&: %onsm& %roni% de medi%amen#e (ro)i(er#ensi'e
e.#.%.9 (oa#e (re'eni im6o&na'irea sa a#ena "ra'i#a#ea 6o&ii &a n nmar
%onsidera6i& de oameni: in%&si' &a %ei Dmar%a#iD "ene#i%. Asadar: (ro!i&a$ia
)i(er#ensinii ar#eria&e n mai %ons#i#ie as#azi o )imera: %i o (osi6i&i#a#e
%on%re#a: rea&iza6i&a %are n ne%esi#a %)e&#ie&i deose6i#e. Ea #re6ie sa
!ie m&#i !a%#oria&a: din %aza (o&ie#io&o"iei 6o&ii. Pro!i&a$ia se 'a !a%e &a
ni'e& so%ia&: %omni#ar si nmai in si#a#ii %on%re#e: s(e%ia&e: &a ni'e&
indi'ida&. A%#inea (ro!i&a%#i%a #re6ie sa !ie (ermanen#a si sa in%ea(a
inain#e de nas#ere 8s!a# "ene#i%9 sa %a# mai de #im(ri (osi6i&:
in %o(i&arie. Da%a ad&#& normo#ensi' are !a%#ori de ris% (en#r
im6o&na'ire:(ro!i&a$ia i se 'a a(&i%a in #inere#e.
Asis#en#a medi%a&a %omni#ara !iind (rima %are in#ra in %on#a%#
% a%es#e (ersoane 'a #re6i sa e$(&i%e si mai a&es sa im(&emen#eze
a%#ini&e (ro!i&a%#i%e.In so%ie#a#ea moderna: (ro!i&a$ia )i(er#ensinii
ar#eria&e n nmai %a es#e (osi6i&a: dar %ons#i#ie %)iar o ne%esi#a#e. Ve%)i&
a!orism Des#e mai sor sa (re'ii de%a# sa #ra#eziD isi "ases#e a(&i%a6i&i#a#ea
(er!e%#a ai%i.
,.Ci i se adreseaza (ro!i&a$iaF
Teore#i%: masri&e de (ro!i&a$ie a 6o&ii ar #re6i sa (oa#a !i
a(&i%a#e in#re"ii (o(&a#ii: &%r im(osi6i& de rea&iza# insa si in#i& (en#r
%a n #o#i oamenii !a% )i(er#ensine ar#eria&a.
Pra%#i%: masri&e de (ro!i&a$ie #re6ie sa se adreseze a%e&or
"r(e (o(&a#iona&e % ris% %res%# de )i(er#ensine ar#eria&a: !ie da#ori#a
#are&or eredi#are: !ie %a rmare a a%m&arii mai m&#or !a%#ori de medi5
%onsm e$%esi' de sodi: e$is#en#a s#ressan#a: seden#arism: e.#.%.
o Ce&or % in%ar%are eredi#ara
o Populatiei active, in general si tinerilor in special
o Ado&es%en#i&or si #ineri&or %are: desi norma#ensi'i: a in mod
%ons#an#
'a&ori a&e TA &a &imi#a s(erioara a norma&&i
o Ce&or %are a a'# )i(er#ensine ar#eria&a e(isodi%a
o S(ra(ondera&i&or
o Ce&or % #&6rari de "&i%ore"&are
o Seden#ari&or
o Mari&or %onsma#ori de NaC& 8(es#e &O"Gzi9
o Indi'izi&or % s#ress (ro!esiona& im(or#an# 8%on#ro&ori de #ra!i%
aerian:
(ersona& din #rans(or#ri: !rna&is#i: %ei e$(si %roni% &a #rame
sonore:
e.#.%.9
o Ce&or % !a%#orii de ris% (en#r a#eros%re&oza 8!ma#ori:
dis&i(idemi%i:
)i(erri%emi%i: e.#.%.9
Asis#en#a medi%a&a din %omni#a#e: %nos%and mod& de 'ia#a
a& maAori#a#ii (ersoane&or din %omni#a#ea res(e%#i'a (oa#e re%noas#e n
(o#en#ia& )i(er#ensi' si (oa#e in%e(e %a# mai de'reme (ro!i&a$ia.
-. Cm se rea&izeaza (ro!i&a$ia )i(er#ensinii ar#eria&eF
.i(er#ensinea ar#eria&a a'and o (re'a&en#a ridi%a#a in
(o(&a#ia "enera&a: (ro!i&a$ia #re6ie %on%e(#a &a ni'e& %omni#ar: %a
(ar#e in#e"ra#a a (ro"ram&i %om(&e$ de %om6a#ere si (re'enire a
6o&i&or %roni%e si de"enera#i'e.
S(e%ia&is#ii in sana#a#e (6&i%a: e(idemio&o"ii: in#ernis#ii:
radio&o"ii o%(a &o%& %en#ra& in %oordonarea si a(&i%area masri&or de
(ro!i&a$ie ini#ia&e. Un &o% % #o#& (ar#i%&ar: in %adr& (ro"ram&i de
(re'enire a& .TA: #e6ie sa-+ o%(e asis#en#a medi%a&a %omni#are a&a#ri
de medi%& de medi%ina "enera&a. Prin na#ra (reo%(ari&or sa&e %ra#i'e si
(ro!i&a%#i%e: asis#en#a medi%a&a 'ine in %on#a%# dire%# % (o(&a#ia
sana#oasa sa 6o&na'a: %noas#e %a nimeni a&#a%ondi#ii&e medi%o-so%ia&e
a&e a%es#eia: (#and as#!e& sa des!asoare o mn%a de (ro!i&a$ie ade%'a#a si
e!i%ien#a. Asis#en#a medi%a&a de medi%ina "enera&a din %o&e%#i'i#a#i 8arma#a:
s%o&i: in#re(rinderi inds#ria&e: e.#.%.9 dis(ne de %adr& or"aniza#ori%
(ro(i%e (en#r rea&izarea (ro!i&a$iei 6o&ii: (#and a(&i%a a#a# masri&e
(ro!i&a%#i%e "enera&e: %a# si (e %e&e (ar#i%&are: &o%a&e: &e"a#e
demi%ro%&ima#& so%ia&: !izi% sa (ro!esiona& din %o&e%#i'i#a#ea da#a.
Pro!i&a$ia 6o&ii in%e(e % de(is#area in san& (o(&a#iei "enera&e
a (ersoane&or % ris% %res%# de a !a%e 6oa&a:&%r %are se rea&izeaza (rin
e$amen& de s%reenin" medi%a& in%iden#a&. Masri&e (ro!i&a%#i%e (ri'es%
re"im& de 'ia#a: orien#area si i"iena (ro!esiona&a: e.#.%.
a/Re!imul &e viata)
Via#a a%#i'a: %are im6ina a%#i'i#a#ea in#e&e%#a&a % %ea
!izi%a: (ra%#i%area ed%a#iei !izi%e si a s(or#&i: a #rism&i si a a&#or
miA&oa%e de des#indere in aer &i6er sn# de(rinderi %are #re6ie in'a#a#e si
a(&i%a#e in%a din %o(i&arie. A&imen#a#ia 'a !i ra#iona&a: e%)i&i6ra#a
%a&i#a#i' si %an#i#a#i'. Se 'a
%om6a#e % #ena%i#a#e o6i%ei& de a %onsma sare in e$%es. Fma#& 'a
!i %om6a## in%a din s%oa&a.
#/Orientarea pro-esionala si pre!atirea psi0olo!ica pentru
com#aterea
eventualului 0an&icap psi0osocial
Pe %a# (osi6i&: (ersosne&e % ris% %res%# de a !a%e
)i(er#ensine ar#eria&a 'or !i s!a#i#e sa n-si a&ea"a (ro!esini % s#ress
(ro!esiona& mare. Vor e'i#a: de asemenea: (ro!esini&e %are (redis(n &a
seden#arism si o6ezi#a#e. Deoare%e a%es# &%r ar (#ea de#ermina ne&e
%om(&e$e de in!eriori#a#e: mai a&es &a ado&es%en#ii si #inerii: (re"a#irea
(si)o&o"i%a (en#r %om6a#erea ni e'en#a& )andi%a( (si)oso%ia& 'a !i
!a%#a % m&#a a6i&i#a#e. An#renamen#& (si)o&o"i% are n d6& s%o(5
-A'izeaza om& sana#os as(ra e'en#a&e 6o&i &a %are es#e (redis(s: !a(#
%are n #re6ie (ri'i# %a o !a#a&i#a#e. A(&i%and % seriozi#a#e masri&e
(ro!i&a%#i%e indi'id& (oa#e e'i#aGa#ena 6oa&a.
-I& (re"a#es#e #o#oda#a: !ara a-i ind%e (si)o&o"ia de in!irm: sa &imi#eze %a#
mai m&# (osi6i& 8(rin ed%a#ie9 e!e%#& dana#or as(ra sana#a#ii a&
s#ress&i (si)oso%ia& &a %are in mod ine'i#a6i& es#e s(s om& in
so%ie#a#ea %on#em(orana.
c/ S-atul !enetic
A%eas#a %ons#i#ie n a&# e&emen# %are in%e(e sa de'ina n
miA&o% e!i%a%e de (ro!i&a$ie (en#r m&#e 6o&i % %om(onen#a
e#io(a#o"eni%a eredi#ara: a%e&asi &%r se as#ea(#a in (rezen# si (en#r
)i(er#ensinea ar#eria&a: oda#a % e&%idarea (onderii !a%#or&i "ene#i% in
(rod%erea sa.
&/ Suprave!0erea me&icala activa
Prin sis#em& de dis(ensarizare 8'a&a6i& mai a&es in %o&e%#i'i#a#i9 a ##ror
%e&or s(si (ro!i&a$iei es#e si ea o a%#ine %e #re6ie des!asra#a %
seriozi#a#e si %om(e#en#a.
Cnoas#erea mai %om(&e#a a e(idemio&o"iei 6o&ii:
a(ro!ndarea e#io(a#o"eniei si "ene#i%ii )i(er#ensinii ar#eria&e 'a
%ond%e &a %on#ina ame&iorare a masri&or (ro!i&a%#i%e.
PRE,E%TAREA CA,URILOR STUDIATE
CA(UL 1
NUME SI PRENUME5 I.F. SEI5 FEMININ
DATA NASTERII5 +4/0: 7--7/ 803 de ani9
DATA INTRARII5 ,771-7+: 3
-0
DATA EITERNARII5 ,771-77+-,-
DIAGNOSTIC LA INTRARE 5 .TA ST. II: C.I.C.: ANGOR DE EFFORT.
MOTIVELE INTERNARII5
Pa%ien#a se in#erneaza (en#r %e!a&ee !ron#o-o%%i(i#a&a % %ara%#er
(&sa#i&: a(ar#a in inie +444: inso#i#a de ame#e&i: #ini#s: dreri
o%&are:"re#ri: 'arsa#ri si TA ma$ ,,7G+ &Omm.". Uneori se inso#es#e si de
(a&(i#a#ii a(ar#e 6rs%: % ri#m nere"&a#: %are dis(ar (ro"resi': insa de %e&e
mai m&#e ori a(ar !ara %ore&a#ii % %e!a&eea si o #rezes% noa(#ea din somn.
Ce!a&eea s-a in#ensi!i%a# in &#ime&e doa sa(#amani: !a(# %are a ne%esi#a#
in#ernarea &a S(i#a&& de Ur"en#a % TA R ,77G&OOmm.": nde a rma#
#ra#amen#& % Ca(#o(& 8,07 m"9 /%(Gzi: Di&#iazem S %(Gzi.
Pa%ien#a es#e %nos%#a de mai m&#i ani % C.I.C.D.8dia"nos#i%a#a in
+4419: rmand #ra#amen#& in#ermi#en# % As(irina: Ni#ro(e%#or:
Pro(rano&o&8/7m"9.
ANTECEDENTE MEDICALE SI C.IRURGICALE 5
- Menar)a +/ ani: Meno(aza 07 de ani> NR-: AR1:
- S(ondi&oza %er'i%a&a:
- Co&e%is#e%#omie +44,:
- A(endi%e%#omie:
- Dia6e# za)ara# e%)i&i6ra# (rin re"im a&imen#ar in +43/.
ISTORICUL *OLII5
Pa%ien#a in 'ars#a de 03 de ani: %nos%#a de mai m&#i ani % *.C.I.:
An"or de e!or# 8in #ra#amen# % As(irina: Ni#ro(e%#or: Pro(rano&o& /7m"9 si
.TA 8'a&. Ma$ ,,7G++7 mm."9 #ra#a#a % Ca(#o(ri& 8+77 m"9: Ni!edi(in
8-7 m"9: se in#erneaza (en#r %e!a&ee o%%i(i#a&a si !ron#a&a (&sa#i&a: ame#e&i.
O6ie%#i': se %ons#a#a (a%ien#a % s#are "enera&a 6na: a!e6ri&a> TAR
,77G++7 mm.": AVR 37 6a#aiGmin.: re"&a#: %ra%mere &a mo6i&izarea
ar#i%&a#ii&or mari. In res# e$amen o6ie%#i' norma&.
INVESTIGATII SI ANALIZE DE LA*ORATOR
CONFORM PRESCRIPTIE I
MEDICULUI
*IOC.IMIE +--74-,770 Va&ori
Norma&e
20-++7m"Gd&
+4-/- m"Gd&
7:3-+:0 m"Gd&
+-2-+/0mmo&G&
43-+72mmo&G&
-:0-0mmo&G&
+17-,/7 m"Gd&
27-+20m"Gd&
-:0-3:0 m"Gd&
+2-04 UGL
,+-2, UGL
-+--1+3 UGL
00-+27 UGL
7-+- UGL
-2-+,0 UGL
3-23 UGL
7:,-+:- m"Gd&
7-+:+ m"Gd&
7-7:/ m"Gd&
/4-+3+ T"Gd&
- G&%oza +70m"Gd&

- Ureea /2:1 m"Gd&
- Crea#inina 7:2 m"Gd&
-Na
E
+/3mmo&G&
1C&E
+7,mmo&G&
-B
E
-:4mmo&G&
- Co&es#ero& ,,+ m"Gd&
- Tri"&i%eride +/0m"Gd&
- A%id ri% 0:-m"Gd&
-AST ,7UGL
-ALT -+UGL
-LD. /+1 UGL
-CB /0 UGL
-CB-M* , UGL
- Fos!a#aza a&%a&ina 17 UGL
-GGT -/ UGL
- *i&ir6ina #o#. 7:1 m"Gd&
- 6i&ir6ina ne%. 7:+ m"Gd&
- *i&ir6ina dir. 7:0 m"Gd&
-Fier +/, T"Gd&
-VS. +3G/7
-<*C 1:4$&7
-
TGL
-R*C /:,0$&7
1
TGL
-.S +,:4 "Gd&
-.CT /+:0=
-PLT -,7$&7
-
TGL
ELECTROFOREZA

UROCULTURA +/-74-,770
- rare e(i#e&ii: re&a#i' !re%'en#e &e%o%i#e> !re%'en# o$a&a# de Ca
- En#ero%o% C +77.777Gm&
ANTI*IOGRAMA
Amo$i%i&in AM
-S
Amo$i%i&inGC&a'&ani% AM
-S Ci(ro!&e$a%in
Co#rimazo&
Gen#ami%in
Imi(enem
Peni%i&in
Van%omo%in
EIAMEN URINA +/-74-,770
-(. 0
- Le%o%i#e +77G+
- G&%ide norma&
- Uro6i&ino"en norma&
- Pro#eine ne"&iAa6i&
RI.PULMONAR+/-74-,770
Trans(aren#a (&monara norma&a.
Cord % diame#r& &on"i#dina& %res%#.
*om6area ar%&i miA&o%i.
ECO-CORD +/-74-,770
Con#ra%#ii norma&e VS> 'a&'e de as(e%# norma&> AS R -:0 %m> VD R -:, %m>
SIV 7:3>VS R /:2 %m> PP R 7:3.
ECO-A*DOMINAL +/-74-,770
Fi%a# LSR 1 %m> LD R +/ %m.
Vena (or#a in &im. + %m> CP* R 7:2 %m.
Pan%reas omo"en 6ine de&imi#a# de dimensini
norma&e. S(&ina: rini%)i de dimensini si e%os#r%#ra
norma&e.
CONSULT PSI.IATRIC +0-74-,770
T&6rare an$ioasa medie % am"ora!o6ie.
CONSULT ORL ,--74-,770
Do( %ermen 6i&a#era&. .
,
O
,
- re'ine
(en#r s(a&a#ra si andio"rama.
PLA% DE I%(RI-IRE AL
!OL%AVULUI CU )"T"A" .#/
NEVOIA PRO*LEMA
SURSE DE
O*IECTIVE INTERVENTIILE
ASISTENTEI
EVALUARE
FUNDAMENTAL
A
DIFICULTATE
PROPRII DELEGA
TE
+.Ne'oia de a
res(ira si a a'ea o
6na %ir%&a#ie
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a(ar#e 6rs%:
% ri#m
nere"&a#
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#ensine
,77G&OOmm."
-.TA s#adi& II
-C.I.C.
Pa%ien#a sa
(rezin#e %ai
res(ira#orii
(ermea6i&e> o
res(ira#ie si o
%ir%&a#ie
ade%'a#e
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n medi
am6ian#
6ine aerisi# si
da%a es#e
%az&:
'a mezi
aer& din
in%a(ere.
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eaza
medi%a#ia
(res%risa5
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re:
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o
s#are 6na
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min
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a&imen#a#ie
6o"a#a in
!r%#e:
zarza'a#ri>
-red%a
"rasimi&e si
NaC& din
a&imen#a#ie.
Urmares#e
e!e%#&
medi%amen#e
&or:
Masoara si
no#eaza in
!oaia
de o6ser'a#ie
TA: (&s& si
res(ira#ii&e.
e.#.%. +27G-7mm.
"
,. DE A SE
.IDRATA SI A
SE
ALIMENTA
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ai6a o s#are
de 6ine: #ara
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!ie e%)i&i6ra#a
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&i#i% si
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(a%ien#a in
#im(&
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si o
in%raAeaza>
-Aseaza
(a%ien#a in
(ozi#ie
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semisezanda
sa in
A(&i%a
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% %an#i#a#i
mi%i de
&i%)ide
re%i: o!eri#e
% &in"ri#a>
-
Cons#ien#ize
aza (a%ien#a
as(ra
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re"im&i
a&imen#ar
minera&e
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MISCA
SI A AVEA 7
*UNA POSTURA
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e!e%#area
mis%ari&or
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mari a&e
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ai6a o (ozi#ie
ade%'a#a.
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es#e
(ozi#ia
ade%'a#a si
%m sa
e!e%#eze
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ms%&are
a%#i'e.
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nod&i
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)a&s
'a&"s s#an".
/.DE ADORMI
SI
A SE ODI.NI
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6ene!i%ieze de
n nr. de ore
de somn
%ores(nza#or
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(a%ien#a sa
(ra%#i%e
#e)ni%i de
re&a$are:
e$er%i#ii
res(ira#orii
min#e:
inain#e
de %&%are.
Iden#i!i%a
ni'e&&
si %aza
an$ie#a#ii &a
(a%ien#ii
% insomnie.
Adminis#re
aza
#ra#amen#
&
medi%ame
n#os
(res%ris
Pa%ien#a are
n
somn &inis#i#.
In%a
mai (rezin#a
o
s#are de
an$ie#a#e.
0.DE A
MENTINETEMPERAT
URACORPULUI LIMIT
ELE NORMALE
Pa%ien#a
sa(as#reze
#em(era#ra%or(
&i in &imi#e
norma&e.
In'a#a (a%ien#a sa-
sior"anizeze
a%#i'i#a#ea:re"im&
a&imen#ar:"ardero6a: s
a: in !n%#ie de
#em(era#ra
medi&iam6ian#.
Pa%ien#a es#e a!e6ri&aTR-1:0KC
1.DEAFICURAT:DEA
-SI
PROTE;ATEGUMENT
ELE SIMUCOASELE
Pa%ien#a sa-si
(oa#a men#ine
#e"men#e&e
si m%oase&e%r
a#e si mede.
7 in'a#a masri&e
dei"iena
%or(ora&a%ores(nza#
oare: % m&# #a%# si
di(&oma#ie.
Pa%ien#a (rezin#a #e"men#e si
2 DE A EVITA
PERICOLELE
Pa%ien#a
sa6ene!i%ieze
de n medi
si"r: !ara
(eri%o&
dea%%iden#e.
S(ra'e")eaza da%a
sn# res(e%#a#e
norme&e de i"iena:
sa&6ri#a#e:
dezin!e%#ie:
dezinse%#ie:dera#izare
si
%ir%i#e&e!n%#iona&e.
N a &o%a%%iden#e.
3.DE A
COMUNICA
-
soara)i
(oa%zie
-do( %ermen
6i&a#era&
Pa%ien#a sa
!o&oseas%amiA&
oa%e&e
de%omni%are
ade%'a#e
s#arii sa&e.
Da (osi6i&i#a#ea
(a%ien#ei sa-si
e$(rime ne'oi&e:
sen#imen#e&e: idei&e si
dorin#e&e sa&e. -'a
inso#i (a%ien#a &a
%a6ine#& ORL (en#r
s(a&a#ra ari%&ara:
-'a e'i#a sa 'or6eas%a
in soa(#a si se 'a
asi"ra %a (a%ien#a a
in#e&es %e I s-
a%omni%a#.
Admi
nis#re
aza
medi
%a#iar
e%om
anda#
a5
.
,
O
,
Pa%ien#a si-are%a(a#a# (e
4 IDE A
ACTIONACONFORMP
ROPRIILOR CONV
INGERI SIVALORI
Pa%ien#a sa-
si re%a(e#ein%re
derea insine si
sa ai6e o s#are
de 6ine !izi% si
(si)i%.
De#ermina (a%ien#a
sa-si e$(rime
(ro(rii&e %on'in"eri si
'a&ori. P&ani!i%a
im(rena %(a%ien#a
a%#i'i#a#ire&i"ioase.
Pa%ien#aa%#ioneaza%on!orm
+7.DE A
SE RECREA

Pa%ien#a sa
ai6e o s#are
6na
dedis(ozi#ie.
E$(&oreaza
"s#ri&e(a%ien#ei
(en#r
a%#i'i#a#i re%rea#i'e si
asi"ra %ondi#ii&e
ne%esare.
Pa%ien#ae!e%#eazaa%#i'i#a#i
++.DEA
INVATACUM SA-
SIPASTREZE
SANATATEA.
Pa%ien#a
saa%m&ezes!i
%ien#e%nos#in#e
&e"a#e de mod&
de a-si (as#ra
sana#a#ea.
Ss#ine mo#i'area
(a%ien#ei !a#a de
%nos#i#e&e %are
rmeaza sa &e
do6indes%a.
Prezin#ama#eri&e
s6ie%#ein#eresan#e
:a##ra%#i'e
:% miA&oa%e si
(ro%edee ade%'a#e
ni'e&&i de %&#ra si
"rad&i de in#e&e"ere
a (a%ien#ei
Pa%ien#a es#e!oar#e in#eresa#a
sa-si(as#rezesana#a#ea.
CA(UL II
NUME SI PRENUME5 M.I.
SEI5 FEMININ
DATA NASTERII5 +4,,.7,.++
DOMICILIU5 *UCURESTI:S#r. *A*A NOVAC: nT. 1: 6&.T
,
: se D: e#
/: a(. 37.
OCUPATIA5 PENSIONARA
DATA INTERNARII5 ,771.7+.7+5,+
/7
DATA EITERNARII5,771.7+.++
DIAGNOSTIC LA INTERNARE5 .TA Pse ,77G++7 mm."> E(is#a$is
#am(ona# s#an"> T&6rare de(resi'a mi$#a.
MOTIVELE INTERNARII5 E(is#a$is
ANTECEDENTE PERSONALE5 -Menar)a ++ ani: Meno(aza 17 ani> SR,:NR, -
Co&e%is#e%#omie +42/
ISTORICUL *OLII5 *o&na'a )i(er#ensi'a de a(ro$ima#i' , ani 8'a&. Ma$. ,,7G47
mm."9 (rezin#a e(is#a$isri re(e#a#e: &#im& (e da#a de 7+.+7.+444 (en#r
%are se (rezin#a &a %&ini%a ORLCo&#ea. Pe da#a de ,/.74.,77, (a%ien#a
(rezin#a 6rs% ame#e&i: (ares#ezii &a ni'e&& 6ze&or: (ares#ezii
si im(o#en#a !n%#iona&a &a ni'e&& mem6r&i in!erior s#an": sim(#ome %are se
remi# d(a a(ro$ima#i' &). A rma# #ra#amen# % STUGERON - %( G zi.
O6ie%#i' se %ans#a#a (a%ien#a % s#are "enera&a re&a#i' 6na: a!e6ri&a> TAR +/7G37
mm.": AVR23Gmin. Ri#mi%> #ora%e % diame#r an#ero(os#erior %res%#:
)i(ersensi6i&.
I%VESTI(ATII SI A%ALI,E DE LA!ORATOR
CO%'ORM PRESCRIPTIE I MEDICULUI
*IOC.IMIE 7/.+7.,770 VALORI NORMALE


20-++7m"Gd&
+4-/- m"Gd&
7:3-+:0 m"Gd&
+-2-+/0mmo&G&
43-+72mmo&G&
-:0-0mmo&G&
+17-,/7 m"Gd&
27-+20m"Gd&
-:0-3:0 m"Gd&
+2-04 UGL
,+-2, UGL
-+--1+3 UGL
00-+27 UGL
7-+- UGL
3-23 UGL
7:,-+:- m"Gd&
7-+:+ m"Gd&
7-7:/ m"Gd&
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.EMOGRAMA 7/.+7.,770
Le%o%i#e 2:2:$&O
-
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-
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SUMAR DE URINA 0.+7.,770
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- Uro6i&ino"en norma&
- Eri#ro%i#e ne"&iAa6i&
RI. PULMONAR -.+7.,770
Trans(aren#a (&monara norma&a.
Cord % diame#r& &on"i#dina& %res%#.
EIAMEN NEUROLOGIC 0.+7.,770
C&ini% norma&.
ECO-CORD 0.+7.,770
AO &a ine& R -: % des%)idere +:0 %m !ara "radien# sis#o&i% semni!i%a#i'.
As R -:0 %m
V
D
R -:-CM
Si' R +:,
V
s
R /:2 CM
Con#ra%#ii norma&e V
s
.
PLA% DE I%(R-IRE A !OL%AVULUI CU )"T"A" .$/
NEVOIA PRO*LEMA SURSE DE INTERVENTIILE ASISTENTEI
EVALUARE
FUNDAMENTALA DIFICULTATE O*IECTIVE PROPRII DELEGATE
Va asi"r n
medi
am6ian# 6ine
aerisi# si
da%a es#e %az&: 'a
mezi
aer& din in%a(ere.
+.NEVOIA DE A RESPIRA SI -(se de -6oa&a Pa%ien#a sa In'a#a (a%ien#a5 sa
ai6a
Adminis#reaza
Pa%ien#a % s#are
A AVEA O *UNA #ensine )i(er#ensi'a (rezin#e %ai a&imen#a#ie 6o"a#a
in
medi%a#ia
"enera&a 6na.
*UNA CCIRCULATIECIRCULATI
E
,77G+ &Omm." res(ira#orii !r%#e:
zarza'a#ri> sa
(res%risa5
AVR37Gmin
CIRCULATIE (ermea6i&e> o red%a "rasimi&e si
NaC&
#oni%ardia%e:
TAR++7G37-
res(ira#ie si o din a&imen#a#ie. dire#i%e: +27G47mm."
%ir%&a#ie Urmares#e e!e%#& an#iari#mi%e:
ade%'a#e. medi%amen#e&or. )i(o#ensoare
Masoara si
no#eaza in
e#%.
!oaia de o6ser'a#ie
TA:
(&s& si
res(ira#ii&e
Ca&%&eaza
%an#i#a#ea de
&i%)ide in"era#e si
(er!za#e si (e %ea
e&imina#a.
,.De A E&imina E(is#a$is Pse
)i(er#ensi'
Pa%ien#a sa Core%#eaza
deze%)i&i6r&
Pa%ien#a
,77G+
&Omm."
(rezin#e )idri%: (rin
)idra#area sa
(rezin#a mi%#ini
mi%#ini red%erea
a(or#&i de
!izio&o"i%e si
!izio&o"i%e si n &i%)ide si
e&e%#ro&i#i.
#ranzi# in#es#ina&
#ranzi# Aseaza (a%ien#a in norma&.
in#es#ina& de%6r# dorsa& si o N mai (rezin#a
norma&. s!a#ies#e sa
%om(rime
e(is#a$is.
nara (e nde s-a
(rods
san"erarea #im( de
S min
-.DE ADORMI SI -ne&inis#e:
soara
T&6rare Pa%ien#a sa Va in%er%a sa-i
ins!&e
Adminis#reaza
Pa%ien#a es#e
A SE ODI.NI a"i#a#ie. de(resi'a
mi$#a.
6ene!i%ieze de in%rederea in
e%)i(a
#ra#amen#
mai in%reza#oare
n nr. de ore medi%a&a %e o
in"riAes#e:
medi%amen#os
si mai &inis#i#a.
de somn Ii 'a e$(&i%a %
#a%# si
(res%ris.
Somn& es#e
%ores(nza#or in#e&e"ere ori%e
!izio&o"i%.
CA( III
NUME SI PRENUME5 R.S.
SEI5 FEMININ
DATA NASTERII5 ,0.70.+4/0
VARSTA5 03 de ani
DATA INTERNARII5 -7.7-.,771
DATA EITERNARII5 +7. 7/. ,771
DIAGNOSTIC LA .TA Pse +47G+77 mm
INTERNARE5
MOTIVELE - %e!a&ee o%%i(i#a&a:
INTERNARII5 - ame#e&i
- (a&(i#a#ii
ISTORICUL *OLII5
Pa%ien#a in 'ars#a de 03 de ani se %noas#e % .TA de a(ro$ima#i'
0 ani:dia"nos#i%a#a % o%azia nei in#er'en#ii %)irr"i%a&e (en#r o r(#ra de
(erine. A rma# #ra#amen# % *rLnerdine 8n (re%izeaza %a#9 si 'a&ori&e
TA a !os# men#in#e (erioade &n"i in &imi#e norma&e. In rma %
a(ro$ima#i' + &na % o%azia nei in!e%#ii de %ai aeriene s(erioare (a%ien#a
a%za %e!a&ee: ame#e&i: (a&(i#a#ii> mo#i' (en#r %are a %)ema# sa&'area.
Medi%& de (e am6&an#a i-a re%omanda# Ena&a(ri& +7 m"Gzi si Frosemid +
%(. La ,-- zi&e. Pa%ien#a a rma# % in#ermi#en#e a%es# #ra#amen#. De
men#iona# %a in &#ima &na (a%ien#a a!irma %a a s%az# in "re#a#e
a(ro$ima#i' +7 N". To# de a(ro$ima#i' + &na (a%ien#a re&a#eaza des(re
a(ari#ia nor dreri (re%ordia&e % dra#a de mai m&#e ore inso#i#e
de (ares#ezii in mem6r& in!erior s#an": drerea a'and %ara%#er de a(arare si
a(arand si &a e!or# %a# si &a re(as. In rma % a(ro$ima#i' o sa(#amana
so&i%i#a %on#ro& &a medi%& de !ami&ie (en#r a%eeasi sim(#oma#o&o"ie %are
re%omanda %on#inarea #ra#amen#&i si %ons&# de s(e%ia&i#a#e. Tra#amen#&
indi%a# in am6&a#or5 Ena&a(ri& +7 m"Gzi> As(irina S %(.Gzi.
ANTECEDENTE PERSONALE PATOLOGICE
- r(#ra de (erine o(era#a in rma % 0 ani>
- !ra%#ra "&ezna in rma % ,7 ani>
- a&er"ie &a Am(i%i&ina.
ANTECEDENTE PERSONALE FIZIOLOGICE
- menar)a +, ani> SR/> AVR7
- meno(aza /4 ani
'2AM'N' PARACLINIC'
*IOC.IMIE -7.7-.,770
G&%oza 42m"Gd&
Ureea /,:4 m"Gd&
Crea#inina &:&m"Gd&
Na
E
+07mmo&G&
C&E
+72mmo&G&
B
E
/:,mmo&G&
Co&es#ero& ,2+ m"Gd&
Tri"&i%eride +7,m"Gd&
A%id ri% 0:4m"Gd&
AST ,-UGL
ALT ,/UGL
LD. /70 UGL
*i&ir6ina #o#. 7:4 m"Gd&
6i&ir6inane%. 7:2 m"Gd&
*i&ir6ina dir. 7:, m"Gd&
.EMOGRAMA -7.7-.,77
<*C 2:,$&O
;
R*C /:74
.6 +,:2
.CT -4:1=
PLT ,-2
VS. -7G1,
SUMAR DE URINA -+.7-.
,770
Densi#a#ea +774
P) a%id
A&6mina: "&%oza a6sen#e
Uro6i&ino"en norma&
VALORI NORMALE 20-++7m"Gd& +4-/- m"Gd& 7:3-+:0 m"Gd& +-2-
+/0mmo&G& 43-+72mmo&G& -:0-0mmo&G& +17-,/7 m"Gd& 27-+20m"Gd& -:0-
3:0 m"Gd&
+2-04 UGL
,+-2, UGL
-+--1+3 UGL 7:,-+:- m"Gd&
7-+:+ m"Gd&
7-7:/ m"Gd&
PLAN DE INGRUIRE A *OLNAVULUI CU ..T.A. 8-9
NEVOIA
FUNDAM-
ENTALA
PRO*LEMA SURSE DE
DIFICULTA-
TE
O*IECTIVE INTERVENTIILE AUTONOME EVALUARE
Pro(rii Delegate
Ide a res(ira
Si a a'ea
o a
*na
Cir%&a#ie:
Pse de .TA
+47-
Loomm)"
*oa&a
.i(er#ensi'a
Pa%ien#a sa
(rezin#e
Cai res(ira#orii
Permea6i&e: o
6na
Res(ira#ie si
O%ir%&a#ie
ade%'a#a.
In'a#a (a%ien#a5
-sa ai6a a&imen#a#ie
*o"a#a in !r%#e:
Zarza'a#ri:
-sa red%a "rasimi&e
si
Na%& din
a&imen#a#ie.
Adminis#reaz
a
Medi%a#ia
Pres%risa.
Va&ori&e #a se
In%adreaza in &imi##
Norma&e.
+/7G+,7-37mm)"
,. De a se
A&imen#a si
a se
a&imen#a
Pa%ien#a sa !ie
E%)i&i6ra#a
.idroe&e%#ro&i#i% si
N#ri#iona&.
Cons#ien#izeaza
(a%ien#a
As(ra im(or#an#ei
Re"im&i
a&imen#ar in
Re%as#i"area
sana#a#ii.
Pa%ien#a es#e
E%)i&i6ra#a
.idroe&e%#ro&i#i% si
N#ri#iona&.
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e&imina
Pa%ien#a sa
(rezin#e
Mi%#ini
!izio&o"i%e
Si #ranzi# in#es#ina&
Norma&.
S!a#ies#e (a%ien#a
sa
Des!asoare
a%#i'i#a#e
Fizi%a a#i# %i# ii
(ermi#e
S#area sa.
Pa%ien#a are #ranzi
In#es#ina& norma&.
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mis%a
Si a a'ea o
*na (os#ra
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O%%i(i#a&a:
-ame#e&i:
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Mem6r&i
S(erior s#an"
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Pa%ien#a sa ai6a
Tons& ms%&ar
Ade%'a# a%#i'i#a#ii
De(se si sa ai6a o
Pos#ra ade%'a#a.
P&ani!i%a n
(ro"ram de
E$er%i#ii si de mers:
in
Fn%#ie de
%a(a%i#a#ea
Pa%ien#ei. Fo&oses#e
U#i&aAe&e a$i&iare si
de
Con!or#: (en#r
Men#inerea (ozi#iei
Ana#omi%e.
Adminis#reaza
Medi%a#ia
Pres%risa.
Pa%ien#a n mai
Prezin#a sim(#ome
Des%rise ini#ia&.
CO%CLU,II
C)iar da%a .TA es#e in ma&Aori#a#ea %azri&or o a!e%#ine
%roni%a n #re6ie (ri'i#a %a n )andi%a(.
*o&na'ii de .TA #re6ie sa in#e&ea"a %a 'ia#a &e mai (oa#e
o!eri m&#e &%rri !rmoase: (o# d%e o 'ia#a a(ro$ima#i' norma&a
a&a#ri % %ei dra"i: #re6ie doar sa rmeze #ra#amen#& medi%amen#os
(res%ris si in s(e%ia& %e& i"ieni%o-die#e#i%. S(riAin& !ami&iei si a& asis#en#ei
%omni#are sn# !oar#e im(or#an#e mai a&es in %eea %e (ri'es#e a%%e(#area
de %a#re (a%ien# a a!e%#inii sa&e si de a-+ !a%e sa %ons#ien#izeze de dorin#a
&i de a in'in"e 6oa&a sa de(inde %e& mai m&# resi#a #ra#amen#&i.
Un domn s(nea in#r-o %ar#e5
'Mi-am plans de mila pentru ca purtam niste pantofi vechi si
rupti pana mi-a iesit in cale un om fara picioare'
8DAVED ;. SC.<ARTZ5 DP#ere a ma"i%a a "and&iD9
Sa n %onsideram .TA 8mai a&es !orme&e %roni%e9 %a (e o
!a#a&i#a#e. Poa#e des#in& ne-a s%os in %a&e a%es# o6s#a%o& (en#r a in'a#a sa
a(re%iem mai 6ine 'a&oare a 'ie#ii.
Asis#en#ei medi%a&e ii re'ine a%es# ro&5 de a reda
s(eran#a oameni&or in 'ia#a.
!I!LIO(RA'IE
+.DMEDICINA GENERELAD
-SU* REDACTIA LUI MARIN VOICULESCU-VOLUMUL I-
, DTRATAMENTUL .IPERTENSIUNII ARTERIALED
-EUGEN TURCU. CEZAR MACARCE. DAN DOMINIC
IONESCU-
- DMEDICINA INTERNA PENTRU CADRE MEDIID-CORNELIU
*ORUNDEL-
/ DTE.NICA INRI;IRII *OLNAVULUID -CAROL MOZES-
0 DG.ID DE NURSINGD -LUCRETIA TITIRCA-
1 DPRINCIPII FUNDAMANTALE ALE VIRGINIEI .ENDERSOND
2 DANATOMIA SI FIZIOLOGIA OMULUID-I. C. VOICULESCU.> I
C PETRICU-
3 DCE TRE*UIE SA STIE *OLNAVUL .IPERTENSIVFD-C.
MACARIE-
4 D.IPERTENSIUNEA ARTERIALAD -G.. GALEA-
+7 TRATAMENTUL *OLILOR CARDIOVASCULARED-T.
TEODORESCU-