Skrb za bolesnika sa zatajivanjem srca u obiteljskoj medicini

master's thesis

• Title (english): Care for patient with heart failure in family medicine
• Author: Ivan Palatinuš
• Mentor: Venija Cerovečki Nekić (mentor)
• Committee member: Miroslav Hanževački (predsjednik povjerenstva)
• Committee member: Zlata Ožvačić Adžić (član povjerenstva)
• Committee member: Venija Cerovečki Nekić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Family Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Family Medicine

Abstract

Zatajivanje srca je klinički sindrom koji nastaje uslijed privremene ili trajne nesposobnosti srčanog mišića da omogući dostatnu perfuziju tkiva i organa. Karakterizirano je tipičnim simptomima poput zaduhe, oticanja gležnjeva i umora, te može biti popraćeno
znakovima kao što su povišeni jugularni venski pritisak, plućni hropci i perifernim edem, te je uzrokovano poremećajima srčane strukture ili funkcije, što rezultira smanjenim srčanim učinkom i/ili povišenim intrakardijalnim tlakom u mirovanju ili tijekom stresa.
Uzročni čimbenici zatajivanja srca su bolesti miokarda, valvularne bolesti, bolesti perikarda, endomiokardne bolesti, urođene i nasljedne srčane bolesti te aritmije i bolesti električnog provođenja u srcu. Vodeći etiološki čimbenik je infarkt miokarda, potom slijedi arterijska hipertenzija te dilatacijska kardiomiopatija. Za procjenu stupnja zatajivanja srca danas se najčešće rabe NYHA i ACC/AHA klasifikacija koje se temelje na lakoći podnošenja napora odnosno na težini simptoma i dokazanoj strukturnoj bolesti srca. Liječenje zatajivanja srca provodi se nefarmakološki gdje je cilj promijeniti odnosno prilagoditi način života stupnju razvijene bolesti, što prvenstveno uključuje kontrolu prehrane i tjelesne težine, te redovitu fizičku aktivnost. Temelj farmakološkog liječenja čine ACE-inhibitori, blokatori angiotenzinskih receptora (ARB), diuretici, antagonisti aldosterona te inotropi. Liječnik obiteljske medicine primarnom prevencijom djeluje na čimbenike rizika za razvoj zatajivanja srca, a to su arterijska hipertenzija, dislipidemija, pretilost, šećerna bolest, tjelesna neaktivnost, nikotinizam te koronarna bolest srca i infarkt miokarda. Kod već razvijene bolesti, sekundarnom prevencijom uvodi se farmakoterapija dok je tercijarna prevencija, odnosno
završna faza zatajivanja srca u domeni specijalista kardiologa.

Abstract (english)

Heart failure is a condition which is caused either by temporary or permanent inability of the cardiac muscle to ensure adequate tissue and organ perfusion. This condition is characterized by typical signs and symptoms such as dyspnea, perimalleolar edema, fatigue, increase in jugular venous pressure, pulmonary crackles as well as peripheral edema. Decrease of cardiac output, with or without, increased intracardiac pressure is manly caused by changes in cardiac structure or function. There are many factors that contribute to heart failure, some of them include myocardial, valvular, pericardial, endomyocardial diseases, hereditary or congenital heart conditions as well as conductive abnormalities and disorders of cardiac rhythm. Leading, and most contributing factor is myocardial infraction followed by arterial hypertension and dilatative cardiomyopathy. In order to assess the severity of the heart failure NYHA and ACC/AHA classifications are most often used. They are based around the patient’s ability to tolerate normal or increased physical activity, or on the presence of symptoms and structural abnormalities of the heart. Treatment of heart failure can be pharmacological or
nonpharmacological. Nonpharmacological treatment consists of life style changes such as change in diet, decrease of
body weight and regular physical activity. Furthermore, several medications can be prescribed, these include angiotensin converting enzyme inhibitors, aldosterone receptor antagonists and inotropic agents. Family medicine specialists, through primary prevention, address factors that contribute to the onset of heart failure. These include arterial hypertension, dyslipidemia, obesity, lack of physical activity, diabetes, nicotine addiction and coronary artery disease. Secondary
prevention consists of medication prescription whereas tertiary prevention (end stage heart failure) is referred to and treated by the cardiologists.

• Keywords: zatajivanje srca; liječnik obiteljske medicine; skrb
• Keywords (english): heart failure; family medicine physician; patient care
• Language: croatian
• URN:NBN: urn:nbn:hr:105:761789
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-01 09:03:27