Article
FEATURES OF MANAGEMENT OF PATIENTS WITH LATE DIAGNOSTED CONGENITAL HEART DISEASE
| About the author: | Shevchenko T.I., Shaposhnyk O.A., Sorokina S.I., Kudrya I. P., Efremenko V.M. |
| Heading | CLINICAL MEDICINE |
| Type of article | Scentific article |
| Annotation | Congenital heart disease (CHD) is pathological condition associated with the presence of structural defects in the myocardium or blood vessels that arise intrauterine. The symptoms become apparent and can occur immediately after birth, in early childhood, but sometimes the congenital heart disease has an asymptomatic course until adulthood or, rather infrequently, is found in adulthood. The variety of congenital heart disease manifestations complicates their timely diagnosis. The clinical picture of the CHD in the older patients depends not only on the type of heart disease and the possible consequences of previous operative corrective interventions, probable late complications, but also on the presence of comorbid conditions, the development of acquired cardiovascular disease, with age-related changes, polyorganic manifestations of the aging process. Understanding the principles of development, peculiarities of the CHD hemodynamics, the probable consequences of surgical treatment in childhood, and late primary diagnosis require a sufficiently high level of qualifications for primary care physicians. The aim of the study is to update the problem of congenital heart disease diagnosing in adults, to identify specific tasks for physicians of the general practice for the timely detection of patients with this pathology. According to our clinical observation, there is a patient O., 68 y.o., who was urgently hospitalized to the cardiology department of the Poltava Regional Clinical Hospital named after M.V. Sklifosovsky (PRCH) with complaints of severe mixed character dyspnea, a feeling of air lack with insignificant physical activity, burning, sometimes prickly-like pain in the area of the heart without irradiation, general weakness. According to the patient, the murmur in the heart was heard from childhood. Carefully was not examined, was not treated. During the period of patient's observation in the cardiological department, general-clinical, laboratory and instrumental examinations (ECG on the devices "Yukard-100", "Yukard-200", echocardioscopy on the device "Acuson X300" "Siemens" company, daily ECG-monitoring using the Holter's system "LABTECH Ltd ", software version V4.04.RC14). Assumption of the congenital heart disease presence was revealed by doctors during the examinations since childhood. However, due to the absence of any complaints, clear clinical manifestations, the CHD was not diagnosed timely, special clinical monitoring, examination and, moreover, treatment was not offered. Previous medical records are lost. According to existing medical records, an outpatient card, the first assumption of the congenital heart defect in the patient was recorded during the examination and treatment in the cardiology department in September-October of 2014 at the age of 65 years. On the basis of physical examination, the results of general clinics, special and instrumental methods the clinical diagnosis was substantiated. CHD: atrial septal defect in the area of venous sinus, tricuspid valve relative insufficiency of the III st. Relapsing pulmonary embolism (26.09.14, 08.02.17), moderate-low risk. Subacute pulmonary heart in the stage of subcompensation. Severe pulmonary hypertension. IHD: diffuse cardiosclerosis. HFof IIA st., III FC with preserved LV ejection fraction. Secondary arterial hypertension stage II, grade 2, very high risk. COPD: group B, stage of non-infectious exacerbation, moderate severity, RF II st. The variety of manifestations of congenital heart defects complicates their timely diagnosis. But, despite this, understanding the principles of pathology development in patients of the older age group, the professional awareness of doctors, including the information obtained in acquaintance with the materials of the given clinical case, will allow to form modern approaches to differentiated treatment using conservative and surgical methods, will affect positively the quality of patients' life, should optimize the prognosis. |
| Tags | сongenital heart disease, late diagnostics, treatment methods, prognosis optimization |
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| Publication of the article | «World of Medicine and Biology» №1(67), 2019 year, 111-116 pages, index UDK 616.12-007.2-071 |
| DOI | 10.26724/2079-8334-2019-1-67-111 |