Case history 54541, 32 years, body height 176, weight 102 The dear doctor. Here mo...

[Nikolay]

Case history 54541, 32 years, body height 176, weight 102
The dear doctor. Here my signs:
Electrocardiogram: sinusovaja a tachyarrhythmia 79 140 ud. Mines, a hypertrophy l..;
Objectively: the dyspnea or short wind at fast (only at fast) walking, a hyperhidrosis of diabetic type at the slightest load (Diabetum is not revealed, a glucose 4, 4 prothrombin of 114 % on toshchak), faults with pressure at walking, especially with a load in the left arm or hand (180 on 135), quickly decreases up to 140 on 90 or below. In rest skips, from 130 up to 158. A diastole almost always 89 91. Pulse in a load 135 140, longly does not decrease, yesterday measured, in 6 hours after walking on 2 km-pulse 102.
At measurement of pressure on legs or foots a diastole 120 135 in rest, the systole is peer or on 5 10 items or points above, than on arms or hand, bad pulse on stops, especially on left. The diagnosis in an out-patient department cannot establish or install. I suspect, what is it a heart disease, congenital and late shown, probably prolaps the mitral valve, t. To. To me very hardly to wear the left arm or hand even 5 6 kg of a load, the dyspnea or short wind amplifies, the palmar erythema becomes krovavo-red (in rest she too is), also periodically zatekanija the left arm or hand at position on left to a side and the left leg or foot at sitting on a rigid sofa or a chair). Heart in rest does not hurt, in a load what that gravity and the pulling not expressed pain.
Your opinion and references.

[Zholudev A.A.]

It is not enough information. It is necessary to pass or take place inspection at vracha-the cardiologist - analyses of a blood (lipids, including), an echocardiography, daily monitoring of a BP and an electrocardiogram, assay with fiz. A load. Consultations of experts - the neuropathologist, the oculist. Then it will be possible to speak about therapy.
Measures which advantage or benefit is proved
1. Refusal of smoking. Refusal of smoking is one of the most significant changes of a way of life by way of prevention as serdechno-vascular, and diseases of other organs.
2. Depression of superfluous mass of a body. It is recommended especially to faces with an abdominal obesity. Depression of mass of a body renders beneficial effect on assotsiirovannye risk factors, including insulinorenzistentnost, Diabetum, a lipidemia, a hypertrophy of a left ventricle. Depression of a level of pressure at depression of mass of a body can be usilenno due to simultaneous augmentation of an exercise stress, decrease of consumption of alcohol, table salt. Loss of superfluous 5 kg reduces a systolic BP on 5, 4 mm Hg, and diastolic on 2, 4 mm Hg
3. Restriction of consumption of sodium up to 2 g/day, t. e. Up to 5 gram of table salt a day. Patients with superfluous mass of a body and older persons are most sensitive to decrease of consumption of table salt. Selective controllable researches have shown, that depression of the use of salt with 10 g up to 4, 5 g/day the level of systolic pressure on 4 6 mm Hg At older persons reduces depression the use salt up to 2 g in day it is not accompanied by the undesirable phenomena and leads to essential decrease of need or requirement for medicamental treatment, raises or increases efficiency of inhibitors APF and diuretics. In a teaspoon contains 5 g table salt. Faces with AG usually consume more salts (owing to depression of gustatory sensitivity to her). At definition of quantity or amount of salt in products it is recommended to use special tables, instead of to be limited to the general or common references (type do not add some salt to nutrition ). It is not enough table salt in products of a phytogenesis (fruit, vegetables, groats or croups), milk, cottage cheese, svezhezamorozhennoj a fish, meat. In its or her ready gastronomic products it is much more (in sausage in 10 15 times more, than in fresh meat), as well as in bread of a standard batch. Not enough table salt is contained with special dietary products. Are more sensitive to restriction of salt in nutrition of the face with solchuvstvitelnoj AG. To these faces to recommend not only restriction of consumption of table salt, but also a liquid up to 1, 2 1, 5 litres. Use of Sanasolum on 1, 5 3 g in day is possible or probable.
4. Decrease of the use of alcohol. There is a linear dependence between the use of alcohol, a level of a BP and prevalence AG in a population. Besides alcohol weakens or easies effect of antihypertensive agents. To patients with AG to recommend decrease of the use of alcohol up to 23 30 g pure or clean ethanol in day for men (corresponds or meets 50 60 ml vodka, 200 250 ml dry wine, 500 600 ml beer) and 10 20 g in day for women. In a week, in recalculation on pure or clean alcohol, men can use up to 168 ml, to women up to 112 ml.
5. Augmentation of an isotonic exercise stress. The aerobic exercise stress on open air in not less than 30 60 minutes 3 4 times a week Is recommended. For example, walking on foot, navigation. More intensive exercise stress (run) possesses less expressed antihypertensive action. Isometric loads (a raising of gravities) can cause or call rising of a BP.
6. Complex updating a diet. Augmentation of the use of the protected carbohydrates, depression not protected and Adepses. As a whole references are similar to " gold rules diets at an atherosclerosis. It is necessary to lower the general or common caloric content of a ration (up to 1200 kkal/sut). It is desirable to accept nutrition not less often 3 4 times a day, 6 times day, last reception of peep not later than 2 3 hours up to a dream, and an interval between a breakfast and a supper no more than 10 hours are optimum.