Blood - what tests to take? Necessary tests for a cardiologist's appointment What kind of blood test is needed for a cardiologist.

What are analyses? Analyzes are a confirmation or exclusion of a particular disease, which has an opinion after a clinical examination of the patient. With their help, the doctor will find out what exactly prevents your body from living and working normally, what is the state of its individual organs and systems.

So, what do these same tests say if there are pains in the region of the heart? Important in the diagnosis of diseases associated with myocardial damage is the determination of enzymes contained inside the cells. And depending on which and how many cells die, their values ​​will also change.

Indicators of a biochemical blood test:

ALT (alanine aminotransferase): up to 68E / l, when assessing the level of this enzyme, it should be taken into account that it is contained not only in the myocardium, but to a greater extent in the liver, therefore, AST and ALT are always determined together, which helps in distinguishing damage to the heart and liver. The timing of the increase in ALT is similar to AST.

AST (aspartate aminotransferase): up to 45E / l, this enzyme is found in large quantities in the myocardium, and its increase, in most cases, indicates damage to cardiomyocytes - muscle cells of the heart; an increase in serum AST is observed in myocardial infarction (95-98%) cases already after 6-12 hours from the onset of the disease. The maximum increase is observed on days 2-4, and on days 5-7 the enzyme level returns to normal. There is a clear relationship between the AST numbers and the size of the focus of necrosis of the heart muscle. Therefore, with a necrosis value of less than 5 mm in diameter, it is possible to maintain the level of this enzyme within the normal range, which should also be taken into account.

LDH (lactate dehydrogenase) and the fractions that make up this indicator: up to 250 U / l, is considered a specific marker for AMI, an increase in the activity of the isoenzyme LDH1 and LDH2, even with normal indicators of total LDH activity, indicates the presence of small necrosis in the heart muscle. With AMI, its level increases rapidly on days 2-4, and normalizes only at 2-3 weeks. The level of LDH provides valuable information about MI throughout the course of the disease. Other fractions LDH3 and LDH4 are enzymes of the lung tissue, LDH5 - liver.

CPK (creatine phosphokinase) and the fractions that make up this enzyme: up to 190 U / l, creatine phosphokinase - is considered a specific marker (especially an increase of more than 10 times) in acute myocardial infarction. It increases in the acute period (in the first 4-8 hours from the onset of the disease), far ahead of the activity of the above enzymes and is a marker for the early diagnosis of AMI, especially the CPK-MB isoenzyme. After 8-14 hours, the CPK value can reach its maximum value, and normalization can occur after 3-4 days. Also, the value of CPK may increase with myocarditis;

Troponin test: up to 0.4 µg/l. Troponin is a specific contractile protein that is part of the structure of the heart muscle and skeletal muscles. This test is a diagnostic marker for suspected acute damage to myocardial cells, is one of the key results in the diagnosis of "acute myocardial infarction";

Myoglobin: 12-92 mcg/l. A protein in muscle tissue that is involved in the process of cell respiration. If it appears in the blood, it is regarded as a product of the breakdown of the muscle tissue of the heart or skeleton, with an appropriate clinic, it may indicate necrosis (necrosis) of the focus of the muscle tissue of the heart, therefore it is also considered a specific marker of this pathology.

ALT, AST, CK, CK-MB, LDH, myoglobin, and troponin test values ​​closely correlate with the size of the necrosis focus in the heart muscle, and therefore have not only diagnostic, but also prognostic value.

Acid phosphatase: 67-167 nmol / (s l), increases in activity in patients with severe, complicated by MI, mainly transmural;

C-reactive protein (CRP): up to 0.5 mg / l, its detection indicates the presence of a pathological process in the body, in particular, an inflammatory or necrotic one. It belongs to the so-called "acute phase" proteins. A sharply positive reaction to CRP indicates the severity of the inflammatory process.

Sialic acids: 2.0-2.36 mmol / l, the content of sialic acids may increase with endocarditis, MI;

Electrolytes, mainly represented by K + ions (norm 3.6 - 5.2 mmol / l), Na + (norm 135 - 145 mmol / l), Cl- (norm 100 - 106 mmol / l), Ca2 + (norm 2.15 -2.5 mmol/l). An increased amount of potassium in the serum may be accompanied clinically by a violation of the rhythm of cardiac activity, which is confirmed by an ECG. Atrioventricular blockade of the conduction system of the heart may develop, premature ventricular excitation syndrome, ventricular fibrillation, and such a formidable disorder as cardiac arrest may develop. Therefore, patients with heart rhythm disturbances need to control the content of K + ions in the body. On the other hand, a decrease in potassium in the blood can also lead to adverse consequences in these patients - myocardial hyporeflexia. A decrease in the level of sodium ions may be accompanied by the development of insufficiency of the cardiovascular system, since the ratio of K + and Na + ions, as regulators of cell processes, is in constant interaction and a decrease in one leads to an increase in another ion. Hyperchloremia is observed in patients with kidney disease, and may also lead to the development of cardiovascular insufficiency;

Lipid spectrum, is associated in a simple person with the word "cholesterol". In this case, substances are determined (lipoproteins of various densities, triglycerides) that are involved in the metabolism of cholesterol (Cholesterol) (the norm in the blood is 3.1 - 5.2 mmol / l). In addition to the value of total cholesterol, an important indicator is the atherogenic coefficient (normal up to 4), which shows the ratio of "good" and bad lipids involved in the metabolism of fats and cholesterol, and the threat of development or progression of atherosclerosis and all the ensuing consequences. An increase in fractions of lipoproteins and triglycerides can be both a physiological state (alimentary nature) and a pathological state. An increase in lipids is characteristic of widespread atherosclerosis, obesity accompanying and causing arterial hypertension. Or rather, it would be more correct to say that this disruption of the functioning of internal organs and intermediate links in the metabolism of lipids and triglycerides, expressed in an increase in the atherogenic index, causes the deposition of cholesterol in vessels of various diameters, the deposition of "reserve fat", which leads to the above diseases. Therefore, with widespread atherosclerosis, in this blood test, you can see elevated values ​​of ß-lipoproteins and total cholesterol. However, a decrease in the concentration of phospholipids can be seen. But even so, it is necessary to take into account the fact that there are age-related fluctuations in blood fat.

Coagulogram- an analysis by which you can see the "viscosity" of the blood, or in other words, is there a threat of blood clots, which can lead to the formation of blood clots with different localization, which in turn can be complicated by pulmonary embolism, in which instant death is noted. Or, on the contrary, to see how high the probability of bleeding is and whether it can stop on its own after surgery, for example, for prosthetic heart valves.

Any analysis or studies provide the doctor with additional information that helps to make a more accurate diagnosis, determine the stage of the disease, and prescribe treatment. Tests also help to control the course of the disease, the effectiveness of the prescribed treatment, and also ensure the safety of therapy. But sometimes additional studies are required to confirm or supplement the results of past analyzes.

Fedorova Lyubov Alekseevna, doctor of the first category, therapist, cardiologist

26.01.2017 10:11:01

Diseases of the cardiovascular system in medical practice are the most complex and dangerous, which most often lead a person to death, regardless of the age of the patient.

Over the past quarter century in Ukraine, mortality due to these diseases has doubled, which cannot but cause serious concern.

That is why it is necessary to keep the state of your cardiovascular system under constant control, undergo preventive examinations with a cardiologist, especially if there are certain prerequisites for the occurrence of pathologies, for example, heredity, overwork, heavy physical exertion, etc.

One of the main symptoms of heart disease is the appearance of pain in the region of the heart, which can have different strength and direction depending on the heart disease and its severity.

The second characteristic sign of heart disease is shortness of breath, which occurs from circulatory failure.

The third sign of problems in the work of the heart is a rapid heartbeat, as well as interruptions in the work of the heart.

All of the above symptoms are signals of an appeal to a cardiologist, who, in order to make an accurate diagnosis, will send the patient for an additional examination, which includes passing certain tests.

What tests are done for heart disease?

It is also worth considering that many pathological processes in the cardiovascular system are asymptomatic. Therefore, even if you are not worried about pain in the heart, shortness of breath, heart palpitations or arrhythmia, a periodic visit to a cardiologist should be included in the list of mandatory preventive measures that will help maintain your health for many years.

As with any diseases of various organs and systems, timely diagnosis and well-prescribed effective treatment of heart diseases will help not only to cure certain diseases, but also prevent serious complications, improve the quality of life, prolong it and even save it.

In diseases of the heart and blood vessels, a comprehensive analysis is prescribed - a cardiological profile.

Cardiology profile: why is it needed?

Cardiology profile is a set of special blood tests that allows you to:

Assess risk factors for developing heart and vascular diseases;

Reveal early and latent lesions of the cardiovascular system;

To identify the risk of developing atherosclerosis, coronary heart disease and heart failure;

Assess the risk of myocardial infarction.

Cardiology profile: indications

Indications for the appointment of a complex of analyzes of a cardiological profile are:

Atherosclerosis of vessels;

Cardiac ischemia;

High blood pressure;

Heart rhythm disturbances, including:

Stroke;

Arrhythmia;

heart attack;

Tachycardia.

What tests are included in the cardiology profile?

- Troponin quantitative;

Potassium (K);

Lipidogram;

Coagulogram;

AST (AST, aspartate aminotransferase);

Creatine kinase (creatine phosphokinase, CK, CPK);

Lactate dehydrogenase (LDH).

What do cardiac profile indicators mean?

• Troponin can diagnose myocardial infarction. Troponin- this is a special protein that is contained only inside the cells of the heart muscle (cardiomyocytes), it is practically not determined in the blood under normal conditions. However, if cardiomyocytes begin to die and collapse, and most often this happens due to a developed myocardial infarction, then troponin begins to penetrate into the general bloodstream, as a result of which its concentration in the blood increases hundreds, and sometimes thousands of times. This feature has become a key factor in making early or late diagnosis of myocardial infarction.

• NT-proBNP- brain natriuretic hormone - a protein produced in the left ventricle of the heart. Plays an important role in the diagnosis of heart failure. Blood analysis to D-dimer indispensable when examining patients for various thrombotic disorders. D-dimer is a small protein fragment that is formed as a result of the breakdown of fibrin (fibrin is a blood plasma protein. Fibrin serves as the structural basis of a blood clot - ed.). Elevated levels of D-dimer in the blood indicate the tendency of the human body to form blood clots or other problems with blood clotting.

• Potassium(K) is an essential trace element in the human body. He takes part in the act of muscle contraction, the normal activity of the heart, the conduction of an impulse along nerve fibers, metabolism and enzyme activity. Potassium deficiency leads to disruption of the cardiovascular system, can cause muscle weakness. Prolonged potassium deficiency can cause cardiac arrest. Large doses of potassium cause heart failure.

• INR- this indicator is purely for assessing the effectiveness and correctness of treatment with anticoagulants ( drugs that reduce the activity of the blood coagulation system and prevent excessive formation of blood clots - ed.). Patients who are forced to constantly take drugs to thin the blood are required to control its coagulation abilities. This is necessary not only to assess the effectiveness of treatment, but also allows you to choose an adequate dose of funds. In the same way, a person can be saved from an overdose of anticoagulants, preventing the development of appropriate complications against this background. One of the modern methods of such control is the INR (international normalized ratio).

• Lipidogram(lipid profile) helps diagnose atherosclerosis and coronary heart disease.

• With help coagulograms the level of blood viscosity is determined. An increased value of blood viscosity indicates an increased risk of developing complications of hypertension, coronary heart disease, heart attack or stroke.

• Increase ASAT values, an intracellular enzyme involved in the metabolism of amino acids in the tissues of the liver, heart muscle and other organs, indicates an increased risk of developing a heart attack.

• This is also indicated by the enzyme creatine kinase, which is a catalyst for the rate of ATP conversion. An increase in the activity of CPK-MB, an enzyme found in heart muscle cells, indicates an increased risk of myocardial infarction.

• Most active LDH(lactate dehydrogenase), a zinc-containing enzyme, is observed in the cells of the heart muscle, liver, and kidneys. LDH activity also increases sharply in acute myocardial infarction.

How should one prepare for a cardiology profile?

A cardiological profile is a comprehensive blood test for the content of certain enzymes. Blood for a cardiological profile is taken in the morning, on an empty stomach.

The day before blood sampling, it is necessary to exclude the use of alcohol, as well as psycho-emotional and physical activity.

Cardiovascular diseases are widespread among our population, regardless of gender and age. In addition, they very often cause premature death. You can protect yourself by regularly passing the simplest tests. In this article, we will consider what kind of examination you need to undergo in a particular case.

Symptoms of diseases of the heart and blood vessels

Very often, people do not pay attention to the presence of the following symptoms, attributing their appearance to fatigue and other ailments. Of course, you should not rush headlong to a cardiologist, having found one of the symptoms described. But to consult a doctor if these manifestations are observed over a long period of time and do not go away, it will not be superfluous.

Paleness and weakness

Anxiety, fatigue, poor sleep can be symptoms of cardiac neurosis. The pallor of the skin indicates anemia and vasospasm, and the blueness of the limbs, nose, cheeks, and ears indicates the presence of cardiopulmonary insufficiency.

Edema

Kidney problems, which people sin in case of regular swelling by the end of the day, are not the only reason for the increase in the lower extremities. The reason for this is a large amount of salty foods, because of which both the kidneys and the heart suffer. It becomes unable to pump blood, which subsequently accumulates in the legs and causes heart failure.

Dizziness, nausea, headache

The frequent appearance of these symptoms may be the first "bell" of an impending stroke, and also indicates an increase in blood pressure.

Dyspnea

One of the signs of heart failure and angina may be shortness of breath and feeling short of breath.

Cardiopalmus

If you did not exercise and did not experience an emotional upsurge, and your heart “jumps out of your chest”, this symptom may indicate a malfunction of the heart: impaired blood supply, heart failure, tachycardia, angina pectoris.

chest pain

This is one of the surest signs of heart problems. Acute chest pain that occurs even at rest may be a sign of angina pectoris, which, in turn, is a precursor to coronary heart disease and myocardial infarction.

What tests are taken to detect diseases of the heart and blood vessels?

Oddly enough, but to diagnose the state of the cardiovascular system, the doctor prescribes the most common laboratory tests: general and biochemical blood tests. Based on their results, one can judge the main processes occurring in the body.

Complete blood count (CBC): interpretation of the results

It gives an idea of ​​the level of hemoglobin, the number of leukocytes, erythrocytes, platelets, erythrocyte indices, erythrocyte sedimentation rate (ESR) and other indicators. Deciphering the results of this seemingly simple analysis, the doctor can detect several disorders in the body at once:

• low hemoglobin level(norm for men - 130-160 g / l, for women - 120-140 g / l) indicates kidney problems, anemia, internal bleeding may indicate;
• an increase in the number of leukocytes(the norm is from 4 to 9 x109 cells per liter) suggests the development of an inflammatory process;
• decrease in red blood cells(the norm for men is 4.4-5.0 x1012 / l, for women - from 3.8 to 4.5 x1012 / l) - a sign of chronic inflammatory processes and oncological diseases, and their increase indicates dehydration of the body;
• lack of platelets(for men, the norm is 200-400 thousand U / μl, for women - 180-320 thousand U / μl.) leads to problems with blood clotting, and too much - to the formation of blood clots;
• big erythrocyte sedimentation rate(ESR) is a clear sign of the inflammatory process. The norm of ESR for men is 1-10 mm / h, for women - 2-15 mm / h.

Biochemical blood test: what do deviations from the norm indicate?

Thanks to it, the doctor receives additional information about the work of the heart and blood vessels, since it provides results for a larger number of enzymes.

ALT (alanine aminotransferase) And AST (aspartate aminotransferase) are always tested in pairs so that the doctor can see and separate heart and liver lesions. Their increase, in most cases, indicates problems with the muscle cells of the heart, the occurrence of myocardial infarction. Norma ALT in women - up to 31 U / l, in men - up to 41 U / l. The norm of AST in women is also up to 31 U / l), and in men - up to 35-41 U / l.

• LDH - lactate dehydrogenase(for women, the norm is 125-210 U / l, for men - 125-225 U / l) and CPK-creatine phosphokinase and especially its MB-fraction (MB-CK) increase in acute myocardial infarction. The laboratory norm of CPK is 10-110 IU, and the isoenzymes of CPK-MB are 4-6% of the total CPK.
• myoglobin increases in the blood as a result of the breakdown of the muscle tissue of the heart or skeleton. The norm for men is 19 - 92 mcg / l (average - 49 ± 17 mcg / l), for women - 12 - 76 mcg / l (average - 35 ± 14 mcg / l).
• Electrolytes (K+, Na+, Cl-, Ca2+ ions) they also tell a lot: an increase in the content of potassium in the blood serum (the norm is 3.6 - 5.2 mmol / l) entails a violation of the heart rhythm, the possible development of excitation and ventricular fibrillation; a low level of K + can cause a decrease in myocardial reflexes; insufficient content of Na + ions (norm 135 - 145 mmol / l) and an increase in chlorides (norm 100 - 106 mmol / l) are fraught with the development of cardiovascular insufficiency.
• Cholesterol, contained in the blood in large quantities, is a risk of atherosclerosis and coronary heart disease. On average, the norm for total cholesterol is considered to be from 3.61 to 5.21 mmol / liter, the level of "bad" cholesterol (LDL) should be in the range from 2.250 to 4.820 mmol / liter, and high-density cholesterol (HDL) - from 0.71 to 1.71 mmol/liter.
• C-reactive protein appears in the body during an inflammatory process or tissue necrosis that has already occurred, since it is contained in the blood serum of a healthy person in minimal values. The norm for children and adults is the same - less than 5 mg / l.

Coagulogram

The results of this analysis, which is sometimes prescribed in addition to the main ones, give the doctor an idea of ​​the process of blood clotting, its viscosity, the possibility of blood clots or, conversely, bleeding. The table below shows the main indicators of this analysis.

Note that during pregnancy, the results of the coagulogram differ from the norms presented above.

A referral for a UAC, a biochemical blood test and a coagulogram is prescribed by the attending physician, and the results of the study can be obtained within 1-2 days, depending on the equipment of the laboratory.

How to protect yourself from diseases of the heart and blood vessels?

Getting rid of excess weight, which significantly increases the risk of developing diseases of the cardiovascular system, is in the first place. For normal blood circulation, to exclude the formation of blood clots, it is necessary to expose your body to physical activity every day. This doesn't mean hitting the gym every day, walking will suffice initially, increasing the distance every few days.

Compliance with the diet reduces the level of cholesterol in the blood and thus has a positive effect on the condition of the vessels. Fresh vegetables, berries and fruits, which contain antioxidants useful for our body, cleanse and strengthen the walls of blood vessels. Vessel thrombosis, for example, is fought by acids contained in fatty fish, walnuts and almonds.

Refusal to use alcohol and tobacco, of course, will be useful not only for the heart and blood vessels, but also will have a beneficial effect on the healing of all body systems.

Tests for diseases of the heart and blood vessels: what to take, why and where?

Editorial opinion

Approximately 40 - 60% of all people in the world die from diseases of the heart and blood vessels. Against this background, it is simply impossible to dispute the importance of cardiology as a field of practical medicine.

Who is a cardiologist?

Many have heard that in Greek, "cardio" means heart. The importance of this organ for a person was understood by people in ancient times. Now the field of knowledge of a cardiologist is wider - it is not only the heart, but also the blood vessels.

Cardiovascular disease is a huge human problem. Problems of this kind can be the consequences of diabetes, obesity or be congenital. And if earlier the heart usually began to "naughty" in people of retirement and / or advanced age, now many diagnoses have become "younger". And now from a heart attack sometimes die quite young.

Modern cardiology allows you to cure or at least alleviate a lot of diseases of the cardiovascular system. Still, the rate of sudden or imminent death from cardiac arrest remains high. The reason is people's inattention to their health.

When to contact a cardiologist

The obvious answer is when the heart hurts. However, cardiovascular disease does not always cause pain. Human can:

• have difficulty climbing stairs, overcoming even relatively short distances;
• excessive and unreasonable sweat;
• feel dizzy, suddenly nauseous, lose balance;
• feel your heart enlarged, beating too fast.

The initial stage of many diseases of the heart and blood vessels is asymptomatic. That is why therapists recommend annually, even if there are no complaints.

Other risk groups are people with high blood pressure (hypertension), diabetes, rheumatoid diseases. And if real chest pains have begun, albeit mild ones, you should contact a cardiologist as soon as possible.

How to prepare for an appointment

The most important thing is to collect specific complaints. It is best to remember exactly when any warning signs appeared, in what situation (for example, during physical or emotional stress). It is also important to tell when and how the relief came: did you have to lie down or did it all go away on its own?

Perhaps there are any additional medical documents? For example, it became ill on a business trip, and the specialists of the local ambulance did a cardiogram? The results of such and similar surveys can be very useful.

It is also desirable to know if any of the closest relatives have or had cardiovascular diseases. Hereditary factors are very strong here.

How is the reception, consultation, examination, with a doctor.

The cardiologist receives the first opinion about the patient's condition from the simplest studies: measuring the pulse, pressure, listening. In this way, the doctor finds out what to look for. Then various examinations are prescribed: cardiograms, ultrasound, radiography of the heart, blood tests.

Such studies usually allow you to determine the diagnosis. Sometimes the doctor writes out additional directions, for example, for vascular catheterization. This method is invasive, that is, penetrating.

• using a simple tonometer, monitor your blood pressure (measure every day and record the readings of the device);
• do not let yourself sit in one place, be sure to move, and in the fresh air;
• combine in your diet fish, meat, cereals, vegetables and fruits, whole grain bread, limit simple fats and sweets;
• do not smoke, avoid alcohol as much as possible or completely;
• from time to time donate blood for analysis and check the levels of sugar and cholesterol.

Chronic heart failure

Chronic heart failure (CHF) is a disease in which the heart is unable to pump enough blood to supply the body with oxygen. It can occur as a result of many diseases of the cardiovascular system, among which coronary heart disease, hypertension, rheumatoid heart disease, and endocarditis are the most common. A weakened heart muscle is unable to pump blood, throwing less and less of it into the vessels.

Heart failure develops slowly and in the initial stages manifests itself only with physical exertion. Characteristic symptoms at rest indicate a severe stage of the disease. Progressing, CHF significantly worsens the patient's condition, leads to a decrease in performance and disability. The result of it can be chronic liver and kidney failure, blood clots, strokes.

Timely diagnosis and treatment can slow down the development of the disease and prevent dangerous complications. An important role in stabilizing the condition is given to the right lifestyle: weight loss, low-salt diet, limiting physical and emotional stress.

Russian synonyms

Congestive heart failure, heart failure.

Heart failure, congestive heart failure.

Clinical manifestations of heart failure depend on its duration and severity and are quite diverse. The development of the disease is slow and takes several years. If left untreated, the patient's condition may worsen.

The main symptoms of chronic heart failure include:

• shortness of breath during physical exertion, when moving to a horizontal position, and then at rest;
• dizziness, fatigue and weakness;
• lack of appetite and nausea;
• swelling of the legs;
• accumulation of fluid in the abdominal cavity (ascites);
• weight gain against the background of edema;
• fast or irregular heartbeat;
• dry cough with pinkish sputum;
• decreased attention and intelligence.

General information about the disease

By contracting, the heart provides continuous circulation of blood through the vessels. Together with the blood, oxygen and nutrients enter all organs and tissues, and the end products of metabolism, including fluid, are removed. This is achieved by alternating two phases: the contraction of the heart muscle (called systole) and its relaxation (diastole). Depending on which of the phases of cardiac activity disrupts its work, they speak of systolic or diastolic heart failure.

• Systolic heart failure is the result of weakness of the heart muscle and is characterized by insufficient ejection of blood from the chambers of the heart. Its most common causes are ischemic heart disease and dilated myocardiopathy. More commonly seen in men.
• Diastolic heart failure develops when the heart muscle loses its ability to stretch. As a result, a much smaller volume of blood enters the atria. The most common causes are arterial hypertension, hypertrophic myocardiopathy and stenosing pericarditis.

The human heart can be conditionally divided into right and left halves. Pumping blood to the lungs and saturating it with oxygen is ensured by the work of the right parts of the heart, and the left parts are responsible for delivering blood to the tissues. Depending on which departments do not cope with their task, they speak of right ventricular or left ventricular heart failure. With impaired work of the left departments, shortness of breath and cough come to the fore. Right-sided insufficiency is manifested by systemic edema.

To select the necessary drugs, it is very important to determine the mechanism of occurrence of heart failure and its type.

Who is at risk?

The presence of at least one of the following risk factors is sufficient for the development of chronic heart failure. The combination of two or more factors greatly increases the likelihood of the disease.

The risk group includes patients with:

• high blood pressure;
• ischemic heart disease;
• myocardial infarction in the past;
• heart rhythm disturbances;
• diabetes mellitus;
• congenital heart disease;
• frequent viral diseases throughout life;
• chronic renal failure;
• alcohol addiction.

The diagnosis of "chronic heart failure" is made on the basis of a history of the disease, characteristic symptoms, and the results of laboratory and other studies.

Laboratory research

• In the general blood test, most often there are no changes. In some cases, moderately severe anemia can be determined.
• The erythrocyte sedimentation rate (ESR) may be elevated, especially when heart failure is the result of rheumatic heart disease or infective endocarditis.
• Urinalysis is important in order to diagnose renal complications and rule out renal origin of edema. One of the possible manifestations of chronic heart failure is a high level of protein in the urine.
• Total protein and protein fractions in the blood may be reduced due to their redistribution into the edematous fluid.
• Glucose in the blood. It is important to exclude diabetes mellitus as one of the risk factors for heart failure.
• Cholesterol. high and low density lipoproteins. There is a clear relationship between elevated cholesterol levels and the development of atherosclerosis, coronary heart disease, and hypertension. High cholesterol and lipoprotein levels in heart failure may indicate a more severe course of the disease.
• Sodium and potassium in the blood. In chronic heart failure, their level in the blood serum can change significantly due to edema. Blood composition control is especially important when prescribing diuretic drugs.
• brain sodium

Cardiac examination

Often, a person who first feels any complaints from the cardiovascular system, during the initial visit at the outpatient stage, immediately receives treatment, bypassing a full-fledged cardiological and related examinations, which should include both instrumental and laboratory diagnostic methods.

Depending on the predominance of clinical symptoms, three main groups of patients can be conditionally distinguished:

1. Patients with complaints of pain in the heart area

2. Patients with high blood pressure

3. Patients with rhythm disturbances, interruptions in the work of the heart

Various combinations of clinical symptoms are also possible (rhythm disturbances and pain in the heart against the background of high blood pressure).

The minimum examination should include:

• Examination by a cardiologist with a detailed collection of complaints and physical examination (auscultation, percussion)

• ECG (12-lead ECG, long tape ECG, cardiotopography, EKTG-60, isometric exercise ECG)

• Ultrasound (ultrasound) of the heart, vascular dopplegraphy, transesophageal ultrasound (often necessary for rhythm disturbances to exclude the presence of blood clots in the heart cavities), ultrasound of the kidneys, adrenal glands, thyroid gland

• Daily monitoring of blood pressure and ECG (Holter monitoring)

• Load tests (velergometric, treadmill test, informational and pharmacological tests)

• Consultations of related specialists (endocrinologist, gynecologist, ophthalmologist, gastroenterologist, neurologist, nephrologist, etc.)

• Laboratory studies: biochemical blood test (glucose, electrolytes, lipid spectrum, cholesterol and other cardiac enzymes), determination of the level of certain hormones (thyroid gland, brain natriuretic peptide).

Heartache

The most common reasons:

• Ischemic heart disease (CHD)
• Valvular heart disease
• Neurocirculatory dystonia (NCD)

A special role should be assigned to the differential diagnosis of pain in diseases of the spine (osteochondrosis).

An important role in the examination is given to ECG changes, including during exercise tests and daily monitoring, as well as changes in the biochemical blood test (lipoproteins, triglycerides). If necessary, coronary angiography is performed to establish the final diagnosis and determine further treatment tactics. Treatment can be conservative (medication), endovascular (angioplasty and placement of a stent in the coronary arteries through the brachial or femoral artery), surgical (coronary bypass grafting with cardiopulmonary bypass or on a beating heart).

If osteochondrosis of the spine is suspected, a consultation with a neurologist is required, which determines the amount of necessary studies (CT, MRI, etc.)

High blood pressure

First of all, it is necessary to exclude the symptomatic nature of arterial hypertension (hypertension caused by diseases of specific organs). Such hypertension includes hypertension against the background of diseases of the kidneys and their vessels, tumors of the kidneys and adrenal glands, brain tumors, vascular disease (coarctation of the aorta, other vascular pathology.) Endocrine causes of increased blood pressure deserve special attention, especially in women after 45 years.

If the cause of hypertension cannot be found (and this happens in about 95% of cases), such hypertension is considered idiopathic, or essential (it is an independent disease), and requires treatment with special drugs. It is very important to understand that this disease requires systematic, often lifelong treatment. A very common mistake is the practice of taking antihypertensive drugs only to reduce high blood pressure, and not taking them constantly and regularly. (See Guidelines for Lowering Blood Pressure.)

Rhythm disturbances, interruptions in the work of the heart

A key role in the diagnosis belongs to the data of the electrocardiogram (ECG). To find out the causes of arrhythmia, it is necessary to exclude organic causes (lesion of the valvular apparatus of the heart) - for this, ultrasound of the heart is performed - and coronary heart disease. Some arrhythmias may be congenital. A frequent cause of arrhythmia may be a dysfunction of the thyroid gland, which requires a full endocrinological examination (consultation of an endocrinologist, determination of the level of hormones in the blood). When establishing the cause and determining the nature of the rhythm disturbance, an electrophysiological study (EPS) of the heart may be necessary.

What do the results of a clinical blood test say?

It is hardly possible to find a person who has not done a clinical (or general) blood test at least once in his life. This is one of the most frequently used tests for diagnosing various diseases; such a professionally performed study can tell a doctor a lot about the patient's health status.

Most often, people, independently receiving the results of a clinical blood test in the laboratory or listening to their interpretation from a doctor, do not understand what this or that indicator means and how they are related to their condition. Of course, the patient should not “replace” the doctor and try to make a diagnosis based on the results obtained, etc. The purpose of this article is to familiarize a wide range of readers with the main indicators of a complete blood count, so that the terminology used by doctors when communicating with patients is not a "secret with seven seals", and the doctor and patient would better understand each other.

For a general blood test, blood is taken from a finger (or from a vein) in the morning on an empty stomach. The night before, it is recommended to refrain from fatty foods, as this can affect the number of leukocytes. Stress can also distort the blood picture - even a quarrel with someone on the way to the clinic.

For taking the analysis, disposable sterile instruments are used. The laboratory assistant performing blood sampling must work either in disposable gloves or in rubber gloves, which are disinfected with disinfectant solutions after each blood sampling, and which he changes as necessary.

Traditionally, blood is taken from the fourth finger of the left hand, which is carefully wiped with cotton wool and alcohol, after which an injection is made with a special needle into the flesh of the finger to a depth of 2-3 mm. The first drop of blood is removed with cotton wool soaked in ether. First, blood is taken to determine hemoglobin and ESR, then to determine the number of erythrocytes and leukocytes, after which blood smears are made using glasses and the cell structure is studied under a microscope.

In addition, you need to take into account that each laboratory has its own “norms” for a general (clinical) blood test, so it’s better to ask the doctor all the questions.

A general blood test helps a doctor of any specialty. Based on the results of a blood test (hemogram), the doctor can competently assess the state of the body, make a preliminary diagnosis and prescribe appropriate treatment in a timely manner.

So, general (clinical) blood test shows:

• number of erythrocytes
• erythrocyte sedimentation rate (ESR),
• hemoglobin content,
• the number of leukocytes
• leukocyte formula
• and other indicators, each of which we will dwell on in detail.

red blood cells also known as red blood cells. In humans, 1 mm³ of blood contains 4.5-5 million red blood cells. Red blood cells contain hemoglobin, carry oxygen and carbon dioxide. An increase in the number of red blood cells is a sign of diseases such as leukemia, chronic lung disease, congenital heart disease. Anemia (decrease in the number of red blood cells) can be caused by stress, increased physical activity, starvation. If it is not possible to immediately determine the cause of the decrease in the number of red blood cells, then it is better to go to a hematologist and undergo an additional examination.

A significant increase in the content of red blood cells may indicate erythremia (one of the blood diseases). In addition, an increase in the number of red blood cells (erythocytosis, polycythemia) is observed in acute poisoning, when, due to severe vomiting and diarrhea, there is a large fluid deficit in the body; with acidosis (due to metabolic disorders during exacerbation of certain diseases); with loss of fluid for various reasons (heat, illness, great physical exertion); with prolonged cardiovascular or pulmonary diseases, when the body is not sufficiently supplied with oxygen and increases the number of red blood cells in an attempt to still deliver oxygen to the tissues; or when a person is in the highlands, when he ceases to have enough oxygen.

color indicator- its normal value in people of any age is 0.85-1.15. The color index of blood is an indicator of the degree of saturation of red blood cells with hemoglobin and reflects the ratio between the number of red blood cells and hemoglobin in the blood. When its values ​​\u200b\u200bare different from the norm, then this basically indicates the presence of anemia. In this case, anemia is divided into:

- hypochromic - color index less than 0.85;

- hyperchromic - the color index is more than 1.15.

However, anemia can also be normochromic - when the color index remains within the normal range.

Reticulocytes are young forms of erythrocytes. Children have more of them, adults have less, because the formation and growth of the body has already been completed. An increase in the number of reticulocytes can be observed with anemia or malaria. A decrease in the number of reticulocytes or their absence is an unfavorable sign in anemia, showing that the bone marrow has lost the ability to produce red blood cells.

Erythrocyte sedimentation rate (ESR) determines how quickly erythrocytes settle in a test tube, separating from blood plasma. In women, the ESR rate is slightly higher than in men; during pregnancy, the ESR increases. Normally, the ESR value in men does not exceed 10 mm / hour, and in women - 15 mm / hour. The ESR indicator may vary depending on various factors, including due to various diseases.

An increase in ESR in a blood test is one of the indicators that makes a doctor assume that a patient has an acute or chronic inflammatory process (pneumonia, osteomyelitis, tuberculosis, syphilis), as well as an increase in ESR is characteristic of poisoning, myocardial infarction, injuries, bone fractures, anemia, kidney disease, cancer. It is observed after operations, and as a result of taking certain medications. A decrease in ESR occurs during fasting, with a decrease in muscle mass, while taking corticosteroids.

Hemoglobin- a complex iron-containing protein contained in red blood cells - erythrocytes - of animals and humans, capable of reversibly binding with oxygen, ensuring its transfer to tissues. The normal content of hemoglobin in human blood is considered to be: in men 130-170 g/l, in women 120-150 g/l; in children - 120-140 g / l. Blood hemoglobin is involved in the transport of oxygen and carbon dioxide, maintains pH balance. Therefore, the determination of hemoglobin is one of the most important tasks of a general blood test.

Low hemoglobin (anemia) can be the result of a large blood loss, a decrease in hemoglobin occurs when there is a lack of iron, the necessary material for the construction of hemoglobin. Also, low hemoglobin (anemia) is a consequence of blood diseases and many chronic diseases that are not associated with them.

Higher than normal hemoglobin levels can be an indicator of many blood disorders, while a complete blood count will also show an increase in red blood cells. Elevated hemoglobin is typical for people with congenital heart defects, pulmonary heart failure. An increase in hemoglobin can be caused by physiological reasons - in pilots after flights, climbers, after significant physical exertion, the hemoglobin level is higher than normal.

Leukocytes- These are the defenders of our body from foreign components. In the blood of an adult, leukocytes contain an average of 4-9x10 9 / l. White blood cells fight viruses and bacteria and cleanse the blood of dying cells. There are several types of leukocytes (monocytes, lymphocytes, etc.). The leukocyte formula allows you to calculate the content of these forms of leukocytes in the blood.

If leukocytes are found in an increased number in a blood test, this may mean the presence of viral, fungal or bacterial infections (pneumonia, tonsillitis, sepsis, meningitis, appendicitis, abscess, polyarthritis, pyelonephritis, peritonitis), and also be a sign of body poisoning (gout ). Past burns and injuries, bleeding, postoperative condition of the body, myocardial infarction, lung, kidney or spleen infarction, acute and chronic anemia, malignant tumors, all these “troubles” are accompanied by an increase in the number of blood leukocytes.

In women, a slight increase in leukocytes in the blood is also observed in the period before menstruation, in the second half of pregnancy and during childbirth.

A decrease in the number of leukocytes, which a blood test can show, may be evidence of viral and bacterial infections (flu, typhoid fever, viral hepatitis, sepsis, measles, malaria, rubella, mumps, AIDS), rheumatoid arthritis, kidney failure, radiation sickness, some forms of leukemia, diseases of the bone marrow, anaphylactic shock, exhaustion, anemia. A decrease in the number of leukocytes can also be observed while taking certain medications (analgesics, anti-inflammatory drugs).

platelets These cells are also called platelets. They are the smallest blood cells. The main role of platelets is participation in the processes of blood coagulation. In blood vessels, platelets can be located at the walls and in the bloodstream. At rest, platelets are disc-shaped. If necessary, they become like a sphere and form special outgrowths (pseudopodia). With their help, platelets can stick together or stick to a damaged vascular wall.

A decrease in the number of platelets is observed in women during menstruation and during a normal pregnancy, and an increase occurs after exercise. Also, the number of platelets in the blood has seasonal and daily fluctuations. Usually, platelet control is prescribed when taking certain medications, when the capillaries burst for no reason, nosebleeds are frequent, or when being examined for various diseases.

An increase in the number of platelets in the blood (the so-called thrombocytosis) occurs when:

- inflammatory processes (acute rheumatism, tuberculosis, ulcerative colitis);

- acute blood loss;

- hemolytic anemia (when red blood cells are destroyed);

- conditions after removal of the spleen;

noted during treatment with corticosteroids;

- some rarer diseases.

A decrease in the number of platelets (thrombocytopenia) is observed in a number of hereditary diseases, but appears much more often in acquired diseases. The number of platelets decreases with:

- severe iron deficiency anemia;

- some bacterial and viral infections;

- liver diseases;

- diseases of the thyroid gland;

- the use of a number of drugs (vinblastine, chloramphenicol, sulfonamides, etc.);

- systemic lupus erythematosus.

Hematocrit- this is the proportion (in percent) of the total blood volume, which is erythrocytes. Normally, this figure is 40-48% for men and 36-42% for women.

The volume of erythrocytes in comparison with plasma increases with:

- dehydration (dehydration), which happens with toxicosis, diarrhea, vomiting;

- congenital heart defects, accompanied by insufficient oxygen supply to the tissues;

- finding a person in high mountains;

- insufficiency of the adrenal cortex.

The volume of red blood cells in relation to plasma decreases with blood thinning (hydremia) or with anemia.

Hydremia can be physiological if a person immediately drank a lot of liquid. After significant blood loss, compensatory hydremia occurs when blood volume is restored. Pathological hydremia develops in violation of water-salt metabolism and occurs with glomerulonephritis, acute and chronic renal failure, with heart failure during the period of convergence of edema.

Blood Formula. The study of the leukocyte formula is of great diagnostic value, showing characteristic changes in a number of diseases. But these data should always be evaluated together with other indicators of the blood system and the general condition of the patient.

For various diseases, a combination of the following signs is looked at: the total number of leukocytes; the presence of a nuclear shift of neutrophils (the so-called "shift according to the formula to the left", that is, the appearance in the blood of young, immature forms of neutrophils); the percentage of individual leukocytes; the presence or absence of degenerative changes in cells.