Hospital therapy. Treatment and prevention of hypertrophic cardiomyopathy (HCM) (most important)

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Hospital therapy. Treatment and prevention of hypertrophic cardiomyopathy (HCM) (most important)

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13. Treatment and prevention of hypertrophic cardiomyopathy (HCM)

Treatment. The basis of drug treatment of HCM is drugs that improve the blood supply to the ventricles of the heart in diastole. These drugs are a group of b-blockers (anaprilin, atenolol, metoprolol and propranolol, 160-320 mg / day, etc.) and a group of calcium ion antagonists (verapamil, but with caution). Novokinamide disopyramide also reduces heart rate and has an antiarrhythmic effect. At the very beginning of treatment, small doses of these drugs are used, then there is a gradual increase in dosage to the maximum tolerated by the patient.

β-blockers are used with caution in diabetes mellitus, bronchial asthma and some other diseases. When treating with these drugs, constant monitoring of blood pressure and pulse rate is necessary. A decrease in pressure below 90/60 mm Hg is dangerous. Art. and heart rate below 55 per minute. If a patient has dangerous rhythm disturbances that cannot be treated with b-blockers or calcium ion antagonists, then other antiarrhythmic drugs are additionally used in the treatment of such patients.

The appointment of anticoagulants is recommended for paroxysmal arrhythmias and atrial fibrillation, as well as in the presence of blood clots in the heart chambers (warfarin, etc.). During the period of treatment with these drugs, it is necessary to regularly monitor a number of indicators of the blood coagulation system. With a significant overdose of anticoagulants, external (nasal, uterine, etc.) and internal bleeding (hematomas, etc.) are possible.

Surgical treatment is performed in patients with obstructive HCM when medical treatment is not effective or when the gradient between the left ventricle and aorta is more than 30 mm Hg. Art. (the operation of myotomy or myectomy is performed - excision or removal of a part of the hypertrophied myocardium of the left ventricle). Mitral valve replacement and non-surgical IVS ablation are also performed.

Prevention. All patients with HCM, especially those with an obstructive form, are contraindicated in sports in which a pronounced increase in physical activity is possible in a short period of time (athletics, football, hockey). Prevention of the disease consists in early diagnosis, which makes it possible to begin early treatment of the disease and prevent the development of severe myocardial hypertrophy. An echocardiogram should be performed in the genetic relatives of the patient. Screening ECG and EchoCG, which are carried out during the annual medical examination, are also important for diagnosis. In patients with obstructive HCM, prophylaxis of infective endocarditis (antibiotic prophylaxis, etc.) should be carried out, since the presence of obstruction creates the conditions for the development of this life-threatening condition.

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The hotel will be served by robots 12.02.2015

First, in banks, and now in hotels in the Land of the Rising Sun, it is planned to partially replace the staff with robotic mechanisms that can serve customers no worse than their biological counterparts. A new techno hotel Henn-na will open in the Japanese prefecture of Nagasaki. The staff of a small hotel will include 10 robots, three of which will have an extremely human-like appearance.

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