CARDIOLOGY (grech, kardia heart + logos the doctrine) — the section of internal diseases studying function morphology is normal also pathology of cardiovascular system, and also separate diseases of the blood circulatory system, their etiology, a pathogeny, clinical manifestations, diagnosis, prevention and treatment.
Allocation To. in the independent section treats the beginning of 20 century and it is connected with emergence of the special methods of a research of cardiovascular system which allowed to establish a number of earlier not recognizable diseases. Development To. it is closely connected with achievements in various areas a wedge, medicine — pediatrics, surgery, physical therapy, geriatrics, etc. In the theoretical direction K. develops on the basis of studying of morphology and physiology of the blood circulatory system, achievements of biochemistry, immunology, biophysics, genetics, pharmacology. It led to formation along with clinical as well theoretical To., in a cut the greatest development was gained by two of its departments — traditional experimental To. and molecular To., arisen in 60 — the 70th. Theoretical To. it is connected with problems of exchange of energy and substances at the cellular and subcellular levels, complex hydrodynamic systems, regulation of vegetative functions, etc.
Fight against cardiovascular diseases became the state problem and in the field of health care is a problem of paramount importance.
It is explained by growth of incidence and cardiovascular diseases mortality, considerable disability and big labor losses. E.g., in the USA in 1973 diseases of the blood circulatory system were available almost for 25% of adult population. In the USSR increase in mortality from cardiovascular diseases is noted. So, e.g., if in 1939 11% of all cases of death fell to their share, then in 1959 this indicator reached 36%, and in 1971 — 1972 — 48,3%. If in 1973 — 1974 rate of mortality of the population from cardiovascular diseases made 423,9, then in 1976 — 472,7 on 100 000 population. Especially mortality from diseases of the blood circulatory system among persons of working-age increased. If in 1975 (in comparison with 1965) cardiovascular diseases mortality among persons is more senior than 65 years increased by 111,2%, in an age group of 30 — 34 years this indicator made 126,7%. In 30% of cases disability is connected with cardiovascular diseases. On growth rates heart troubles mortality and vessels much more advances mortality from malignant new growths.
Importance of researches in the area K. it is connected also with the fact that diseases of the blood circulatory system are widespread not only among adult population. Many heart diseases and vessels develop at youthful and even children's age. So, at inspection of 10 000 school students of Moscow at 6,7% arterial hypertension was revealed.
To. has centuries-old accumulation of knowledge of the blood circulatory system in the basis.
Instructions on feature of a condition of cardiovascular system are available in Hippocrates and Ibn-Sina's works. In Ibn-Sina's «Canons» value of studying of pulse is for the first time rather in detail lit. The first separate data on a structure of cardiovascular system can be found in the most ancient sources. The scheme of blood circulation was offered by K. Galen in 2 century. It showed that the right heart and veins are filled with dark blood, and a left heart and arteries — scarlet. According to K. Galen's views, blood on arteries and veins thanks to oscillating motions * their walls comes to bodies where there is its consumption. At the same time K. Galen mistakenly considered that blood from the right departments of heart directly passes into the left departments. The ban on anatomic researches imposed by church led to the fact that through many centuries wrong views of K. Galen remained a certain dogma. Works had special value And. Vezaliya (1543) who described arterial and venous systems of the person, Fabrition (H. Fabricius, 1533 — 1619) who described valves in veins, Ibn-An-Nafisa (13 century) which indicated that all blood from a right ventricle passes in left only through vessels of lungs. In 1628 the English scientist U. Garvey opened cardinal laws of blood circulation and described a big and small circle of blood circulation. U. Garvey's works were a logical conclusion of the whole series of anatomic researches as a result of which the circulatory system was described. M. Malpigi's opening (1661) systems of capillaries completed the description of all blood circulatory system.
Quantum leap in studying of problems K. occurred at the end of 19 — the beginning of 20 century in connection with implementation of new methods of a research. The Czech physiologist and the anatomist Ya. Purkinye (1839) investigated a cellular texture of a myocardium and the carrying-out system of heart, to-ruyu further in detail studied it. scientist V. Gis (1893). Works it is mute. pathologist L. Ashoff and Japanese anatomist Tavara (S. Tawara, 1873 — 1952), British Pussycat and Fleka (A. Keith, 1866 — 1955; M of W. Flack, 1882 — 1931), the Russian physiologist A. F. Samoylov allowed to present mechanisms of automatic equipment of heart and transfer of excitement to various departments of a myocardium. Opening of nervous control of action of the heart and maintenance of level of arterial pressure also belongs to this period (K. Bernard, 1850 — 1858; I. F. Tsion and K. Ludvig, 1866; I. P. Pavlov). To development To. in the second half of 19 century researches of physiology of capillaries (A. Krog), Poiseuille's work promoted (J. M of Poiseuille, 1799 — 1869), K. Ludvig, I. M. Sechenov, J. Haldane on studying of transfer of gases blood, relationship of a hemodynamics and gas exchange. Especially broad development was gained by the researches devoted to studying of interrelation between nervous and cardiovascular systems (I. M. Sechenov, I. P. Pavlov, K. M. Bykov, V. Ya. Danilevsky, L. A. Orbeli, V. N. Chernigovsky). Researches of the English physiologist E. Starlinga allowed to find out a number of essentially important mechanisms of cardiac performance.
Wedge. To. in Russia much attention was paid by founders of domestic therapy M. Ya. Mudroye and G. A. Zakharyin. For the first time scientific approaches to diagnosis of heart diseases and vessels were developed and implemented by S. P. Botkin. He not only gave the brilliant description a wedge, pictures of a number of heart troubles, pointed to value of the anamnesis, percussion and auscultation in establishment of the diagnosis, but also implementation was promoted by a wedge, physiology in cardiology.
Great value in development and formation To. at the beginning of 20 century had implementation in clinic of new methods of a research and the description of the diseases of the blood circulatory system which were earlier not distinguished.
In 1905 N. S. Korotkov offered the auskultativny way of measurement of arterial pressure which laid the foundation for studying of arterial hypertension. In 1909 P. Obraztsov and N. D. Strazhesko described a wedge, a picture of coronary thrombosis and myocardial infarction, and opened a goal. the scientist V. Eyntkhoven in 1903 a technique electrocardiography (see) made diagnosis of a myocardial infarction in the subsequent available to a wide range of doctors. Development of an electrocardiography allowed to select the whole section in To., connected with studying and diagnosis of disturbances of a rhythm and conductivity of heart.
In 1904 F. Marchand offered the term «atherosclerosis of arteries». The doctrine about atherosclerosis of H. „Anichkov (1912) and his schools brought N to wide experimental and a wedge, to studying of this widespread patol, process.
To development wedge. To. at the beginning of 20 century works of a number of foreign researchers promoted: in England — J. Mackenzie, Lewis (Th. Lewis, 1881 — 1945), D. Pikkeringa, U. Osler; in France — Yushara Dzh. (Huchard, 1844 — 1910); in the USA — P. Whyte.
Decision pound. theoretical problems in modern To. includes studying of the general patterns of regulation of activity of cardiovascular system in normal and patol, conditions. First of all the principles of the hierarchical organization of regulation of blood circulation, its nervous and endocrine mechanisms are studied. The nature of automatic action of the heart, mechanisms, the providing vascular tone, biophysics and biochemistry of cordial activity is investigated.
One of the major directions K. — studying of a problem of the general patterns microcirculation (see), specific patterns of microcirculation in vitals, specification of a role of physiologically active agents in regulation of regional blood circulation and microcirculation.
Important problem K. studying of the main patterns of adaptation and compensation in the blood circulatory system is. Researches can help with this area not only to the decision pound. problems K., but also to promote development of methods of the prevention of the damaging action of some factors on an organism, including on cardiovascular system.
One of the main directions K. studying of questions of an etiology, pathogeny, epidemiology, clinic, diagnosis, prevention, conservative and operational treatment of cardiovascular diseases is. In this direction representatives of many medical specialties, both theorists, and clinical physicians work. Special attention is paid to studying of such widespread diseases as atherosclerosis (see), idiopathic hypertensia (see), myocardial infarction (see). The studying of atherosclerosis and coronary insufficiency begun in Russia by pathologists of H. N. Anichkov and S. S. Halatov, and also clinical physicians N. D. Strazhesko and V.P. Obraztsov, gained further development in the USSR thanks to works of scientists of school of A. L. Myasnikov (3. M. Volynsky, E. N. Gerasimov, E. I. Chazov, 3. I. Janusz-kevichus, I. K. Shkhvatsabaya, H. N. Kipshidze, etc.), to V. F. Zelenin, D. D. Pletnev, P.E. Lukomsky's works, etc.
The concept of H was the basis for researches of atherosclerosis long time. N. Anichkova about primary role of disturbances of cholesteric exchange in development of atherosclerosis. As a result of long-term researches the difficult pathogeny of this disease was studied, in development to-rogo the complex neurohumoral, immunol, factors and environmental factors plays a role. Researches of scientists of a number of the countries are devoted to a pathogeny of atherosclerosis (the USA, Sweden, Germany).
Carrying on traditions of the Russian therapeutic school, the Soviet cardiologists made a lot of things for clarification of mechanisms of development of a myocardial infarction, its diagnosis, clinic and treatment (And. JI. Butchers, V. of X. Vasilenkou P. E. Lukomsky, Etc.). For development of a diagnostic method and treatment of a myocardial infarction in 1969 awards of the USSR V. N. Vinogradov, P.E. Lukomsky, E. I. Chazov, 3 were conferred State. I. Yanushkevichus and B. P. Kushelevsky. The methods offered by the Soviet cardiologists combined achievements of science in development of new diagnostic methods and treatments by new forms of the organization of the medical aid by this patient including creation of specialized ambulance crews and early hospitalization.
The Soviet cardiologists put forward original concepts of an idiopathic hypertensia and mechanisms of increase in arterial pressure. G.F. Lang who put forward and developed the neurogenic theory of an idiopathic hypertensia was conferred the State award USSR. This theory which gained development and deepening in works of A. L. Myasnikov, E. M. Tareev and other researchers gained wide recognition abroad. She along with implementation of new diagnostic methods played an important role differentiations of different types of arterial hypertension with allocation of the symptomatic forms demanding specific methods of treatment including and surgical.
Domestic pathologists (A. I. S I rub k, V. T. Talalayev) and clinical physicians (M. P. Konchalovsky, M. V. Chernorutsky, N. D. Strazhesko, etc.) a long time intensively developed a problem acquired, generally rheumatic, heart diseases (see. acquired ). System of prevention of rheumatism in the USSR (A. I. Nesterov with sotr., etc.) allowed to reduce quantity of the acquired heart diseases considerably.
The problem is actively studied heart failure (see). In 1935 at the XII All-Union congress of therapists the classification of a circulatory unefficiency offered N. D. Strazhesko and V. of X was accepted. Vasilenko, edges was based on researches of the general patterns of change of cardiovascular system at development of heart failure. Modern To. opened a number of important links in a pathogeny of a circulatory unefficiency; researches are conducted at the cellular and molecular levels. A number of mechanisms of development of heart failure, mechanisms of transition of the compensated changes of a myocardium to dekompensirovanny is found out, methods of early diagnosis, the most rational and effective methods of treatment are developed. In researches
questions of disturbance of a rhythm and conductivity of heart figure prominently (see. Arrhythmias of heart , Heart block ). They allowed to find out a variety of reasons and origins of these disturbances, promoted implementation of new diagnostic methods, in particular use of monitor systems; led to development of effective methods of therapy (antiarrhytmic drugs, a countershock, electrostimulation). This problem was traditionally actively developed by the Russian and Soviet theorists and clinical physicians (A. F. Samoylov, I. A. Chernogorov, M. A. Aryev, A. M. Segal, M. G. Udelnov, 3. I. Yanushkevichus, L. I. Fogelson, B. M. Fedorov, V. M. Bogolyubov, etc.). Scientific bases of a countershock are developed. For its implementation and development in 1970 A. To A. Vishnevsky, N. L. Gurvich, B. To A. Negovsky, B. M. Zuckerman, A. I. Lukoshevichuta, A. I. Smaylis was awarded the State award. Countershock (see) much increased efficiency of resuscitation actions. Its use allowed to achieve to lay down. effect at many patients with the disturbances of a cordial rhythm steady against action of medicamentous means. Therapeutic opportunities of doctors extended with implementation in a wedge, practice of a method of electric cardiac activation in various modifications (see. Cardiostimulation ).
New tasks in To. arose with development of a heart surgery. In 1967 for the first time in the history of medicine Barnard (Page N. Barnard) with sotr. made operation of heart transplantation from the person to the person, in 1974 he for the first time implanted the second heart from the person to the person at preservation of own heart of the patient. However the problem of allotransplantation (homotransplantation) of heart is still far from the decision in connection with emergence in most cases of bystry reaction of rejection of the replaced heart. The solution is connected substantially with researches immunol, compatibility of fabrics and bodies. The uniform point of view and on ethical aspects of this problem is not developed. Therefore researchers, hl. obr. Soviet and American, actively develop a problem artificial heart (see). In work of cardiosurgeons reconstructive operations on coronal vessels at coronary heart disease figure prominently, including and at a myocardial infarction. The heart surgery actively develops in many countries of the world.
The Soviet heart surgery achieved considerable success. Implementation of an artificial and artificial circulatory support, development of anesthesiology made available to the surgeon all areas of cardiovascular system. For short term the Soviet heart surgery did a big way from the first acquired heart diseases operations (generally at a mitral stenosis) before difficult surgeries in connection with the inborn heart diseases combined by mitral and aortal defects, aneurism of heart, aorta, Lerish's syndrome, defeats of coronal vessels etc. For development of operations on heart cardiosurgeons A. N. Bakulev, B. V. Petrovsky, P. A. Kupriyanov, A. A. Vishnevsky, E. N. Meshalkin are conferred Lenin awards. For development of surgical methods of treatment of inborn heart diseases State awards of the USSR are conferred V. I. Burakovsky, Ya. V. Volkolakov, B. A. Konstantinov and V. I. Frantsev.
Researches in the field of molecular To. allowed to find out fine structure of a cell of a muscle of heart, value of cellular membranes, mitochondrions, myofibrils as a muscle of heart, thin mechanisms of education and transfer of energy in heart. These researches allowed to find out biochemical essence of a systole and diastole, stood on active hind legs of the last.
Value of a sarcoplasmic reticulum and the related calcium in reduction of a myocardium is found out, and also some mechanisms of synthesis and functioning of sokratitelny proteins of a myocardium, feature of plastic providing a hypertrophy of a cardiac muscle are studied. Cellular and molecular researches open new perspectives in studying of atherosclerosis. Electronic microscopic examinations of vessels in the conditions of the developing atherosclerosis, studying immunol, aspects of its pathogeny, relationship of a lipometabolism and content of hormones etc. are especially important. Researches in the field of molecular To. allowed to specify mechanisms of effect of cardiac glycosides, to find out the nature of influence of anabolic hormones on a cardiac muscle, features of effect of some drugs on power processes in a muscle of heart. In the USSR in the field of molecular To. S.E. Severin, A. M. Chernukh, T work. 3. Meerson, E. I. Chazov, etc. Questions molecular To. are widely developed in a number of the countries.
Development To. substantially depends on development and deployment of methods of a research of cardiovascular system. In 50 — the 60th 20 century began to use widely elektrofiziol, by methods of a research, to apply various ways of quantitative assessment of the central hemodynamics, a regional blood-groove, sokratitelny function of heart, methods of a research of a tone of arteries and veins; techniques of catheterization of cardial cavities were developed and implemented (see. Catheterization of heart ) and contrast angiocardiography (see). Use of these techniques allowed to expand opportunities funkts, diagnoses, to diagnose the inborn and acquired heart diseases, anomalies of development of vessels, their occlusal defeats more precisely (in connection with atherosclerosis or thrombosis), aneurisms of heart and vessels. A method of a contrast research of vessels of heart (see. Coronary angiography ) occupied one of the leading places in objective assessment of their state. Catheterization of cavities hearts angiocardiography were the most important premises of wide use of surgical methods of treatment of cardiovascular diseases.
Achievements of physics, electronics, optics, chemistry and other sciences expand opportunities To. By means of tracer techniques of a research the hemodynamics is studied, the scanning of a muscle of heart allowing to judge a condition of blood circulation at all levels of a coronary blood-groove and a condition of a myocardium in general is carried out. Implementation of electron-optical converters expanded possibilities of contrast x-ray methods of a research; use of ultrasound led to creation and implementation of a method echocardiography (see) — ultrasonic localization of heart, his cavities, valves, walls of ventricles and auricles. Progress in development biochemical, methods of a research allowed to implement a number of diagnostic tests for identification of necroses of a myocardium and their differentiation with necroses of other bodies (studying of activity of serumal aminotransferases, isoenzymes of a lactate dehydrogenase, kreatinfosfokinaza etc.). With the research and diagnostic purposes in To. are more and more widely used immunol, methods, especially during the studying of a myocardial infarction and atherosclerosis.
To formation modern To. the organization in 1950 promoted. International cardiological about-va. The first World congress of cardiologists took place in 1950 in Paris. P. Whyte and the Mexican cardiologist I. Chavetz played in the organization International cardiological about-va a big role. The second International congress of cardiologists took place in 1954 in Washington.
Since this congress the Soviet cardiologists actively participated in work of all subsequent international and European congresses which are carried out each four years.
Four regional departments organized by the geographical principle are a part International cardiological about-va: European, Asian, Pacific and Inter-American about-va cardiologists.
All-Union cardiological about-in it is officially accepted in structure International and European about-in cardiologists on the V congress which took place in 1966 in New Delhi (India).
The first (constituent) All-Union cardiological conference took place in 1963 in Leningrad and was devoted to a problem of a myocardial infarction and the organization All-Union cardiological about-va. The conference was organized on an initiative And. JI. Myasnikov and P.E. Lukomsky. About-va P.E. Lukomsky was elected the first chairman of the board. From the moment of the organization All-Union cardiological about-va two congresses are held. The first congress (1966) was devoted to a problem of hypertensia of a big and small circle of blood circulation. At the second congress (1973) problems of coronary heart disease were discussed. Kardiol. about-va are organized in all republics of the Soviet Union and in many large regional centers.
Problems K. are developed in a number of research in-t and departments of higher education institutions. The main coordinating body is the Scientific council on cardiovascular diseases of the USSR Academy of Medical Sciences combining work of four problem commissions: «Physiology and pathology of cardiovascular system» (leading research institute — Ying t of the general pathology and pathological physiology of the USSR Academy of Medical Sciences), «An arterial hypertension, atherosclerosis, coronary heart disease», «Heart diseases and a circulatory unefficiency» (leading research institute — Ying t of cardiology of the USSR Academy of Medical Sciences of A. L. Myasnikov), «Surgical treatment of cardiovascular diseases» (leading research institute — Ying t of cardiovascular surgery of the academician A. N. Bakulev).
Scientific research in the area K. are carried out in a number of the republican centers — in Georgia (scientific research institute of clinical and experimental cardiology of the academician M. D. Tsinamdzgvrishvili and scientific research institute of experimental and clinical therapy), in Armenia (scientific research institute of cardiology and cordial surgery), in Ukraine (The Kiev scientific research institute of clinical medicine of the academician N. D. Strazhesko), in Siberia (Ying t of clinical and experimental medicine of the Siberian branch USSR Academy of Medical Sciences and the Novosibirsk scientific research institute of pathology of blood circulation M3 of RSFSR). More than 200 departments of various higher education institutions of the country are engaged in scientific research. Surgical methods of treatment of cardiovascular diseases, in addition to Ying-that cardiovascular surgery of the academician A. N. Bakulev, are developed in All-Union scientific research institute of clinical and experimental surgery M3 of the USSR, in Ying-those surgeries of A. V. Vishnevsky by the USSR Academy of Medical Sciences, in Army medical college of S. M. Kirov in Leningrad.
In Moscow on the funds raised during the Lenin community work day in 1971 the new building of All-Union cardiological scientific center of the USSR Academy of Medical Sciences is under construction. In this center researches on theoretical are concentrated To., clinical To., on studying of a role sots. - a gigabyte. factors in development of cardiovascular diseases and development in this regard preventive actions, and also concerning surgical methods of treatment of heart diseases and vessels.
Problems K. are widely covered in magazines «Clinical Medicine», «Therapeutic Archive», since 1961 — in the Kardiologiya magazine, but also, in a number of magazines of a theoretical profile («The bulletin of experimental biology and medicine», «Pathological physiology and experimental therapy», «Archive of pathology», «the Bulletin of the USSR Academy of Medical Sciences», etc.), in the magazines which are taking up practical questions of diagnosis, prevention and treatment («The Soviet medicine», «Medical business», etc.), in magazines of a surgical profile («Chest surgery», «Surgery», «Anesthesia and resuscitation»), etc.
Since 1959 in Prague the international magazine «Cor et vasa» with participation of cardiologists of the socialist countries is issued. In many countries of the world the magazines which are specially devoted to questions of cardiology are issued. In the USA — «American Journal of Cardiology» (official body American about-va), «College of Cardiology», «Circulation» (official body of the American association of heart), «American Heart Journal», «Circulation Research», etc.; in England — «British Heart Journal»; in Italy — «Minerva cardioangiologica», «Giornale italiano di cardiologia»; in Japan — «Japanese Heart Journal»; in Poland — «Kardiologia Polska»; in GDR — «Archiv fur Kreislaufforschung».
Experimental cardiology, using fiziol., patofiziol., biochemical, methods and morfol, researches, are studied on animals by a condition of cardiovascular system normal and at influence of various environmental factors. One of the main objectives is modeling patol, states, development of methods of their diagnosis, the prevention and treatment. A crucial role in development experimental To. plays the improvement of methods of a research reflecting achievements of science and technology. From the first rough descriptive methods allowing to open only some general patterns, experimental To. passed to studying of function and a condition of cardiovascular system in hron, experience by means of implanted electrodes, to studying of a hemodynamics and cardiac performance with use of radioactive materials; to a research of microcirculation on the basis of these latest optical devices etc. Reproduction of various cardiovascular diseases in the conditions which are brought closer to real became possible. So, e.g., great value for specification of a role of c. N of page in emergence idiopathic hypertensia (see) had the works which showed pattern of increase in arterial pressure at monkeys and other experimental animals at direct irritation of various departments of c. N of page. A certain place in modeling of cardiovascular diseases is taken by researches of coronary circulation with reproduction of necroses of a myocardium. From experiments in which necroses of a myocardium received by bandaging of coronal arteries of heart researchers passed to studying of the models allowing to reproduce patol, mechanisms of a myocardial infarction at the person. Among them there is a model of electrolytic and steroid cardiopathies of G. Selye, necroses of a myocardium with thrombosis of coronal vessels caused in rats and monkeys by the special diet including a large amount of cholesterol or introduction animal with an experimental lipoidosis of coronal vessels of vasoconstrictors and coagulants. Generalizing results of experimental modeling of necroses of a myocardium, A. L. Butchers with sotr. allocated depending on origins the so-called koronarogenny, connected with disturbance of coronary circulation necroses of a myocardium, and nekoronarogenny which emergence is connected with disturbance of metabolism in a myocardium (see. Myocardial infarction ). In pilot studies
the works on studying of heart diseases and mechanisms of development of a hypertrophy of a myocardium which allowed to develop methods of surgical treatment and proved some approaches to treatment of heart failure figure prominently.
A subject of studying experimental To. questions of regulation of a vascular tone and arterial pressure, in particular value of baroreceptors and reflexogenic zones of heart, questions of studying of sokratitelny function of a myocardium, questions of reproduction of various forms of disturbances of a rhythm and mechanisms of development of atherosclerosis are.
Results of researches allowed to prove a number of diagnostic methods, preventions and treatments of cardiovascular diseases. These are methods of electrocardiographic diagnosis of a myocardial infarction which studying was begun by Smith (F. M.! Smith, 1918) is also continued by J. Parkinson, F. N. Wilson, Ja. G. Oettinger, I. A. Chernogorov, etc.; methods biochemical, diagnoses of a myocardial infarction; methods of the prevention of atherosclerosis; methods of controlling with cardiogenic shock; treatment of disturbances of a rhythm; use of fibrinolitic enzymes and anticoagulants; methods of surgical treatment of heart diseases, aneurisms of heart, coronary insufficiency etc.
Special value in experimental To. have pharmakol, the researches directed to studying of mechanisms and points of application of vasodilating action of a number of means, mechanisms of hypotensive effect of various drugs including the central mechanisms of regulation of a vascular tone, a state gangliyev, hemodynamic indicators, change of content of the hormones regulating a vascular tone, etc. These researches exerted a great influence on studying of the drugs influencing metabolism of a myocardium and its sokratitelny ability.
Organization of the cardiological help
Organization of the cardiological help in the USSR. Help to patients with cardiovascular diseases is given both in usual hospitals and policlinics, and in specialized institutions kardiol. profile. Primary diagnosis of heart diseases and vessels is carried out by generally district doctors (therapists, pediatricians) who make also dispensary observation for the revealed patients (see. Medical examination ). Use of a dispensary method allows to reduce considerably the frequency of aggravations hron, heart diseases and vessels, to reduce disability and mortality. Preventive therapy allows to improve considerably the course of cardiovascular diseases, to sharply reduce number of hypertensive crises, number of heart attacks and repeated myocardial infarctions.
For the specialized help to patients with cardiovascular diseases are created kardiorevmatol. centers, clinics, kardiorevmatol. the offices at policlinics performing scientific and methodical management on diagnosis, prevention and treatment of heart troubles and vessels. In 1975 in the country functioned And kardiorevmatol. clinics, 127 city, regional and republican centers, 127 specialized kardiorevmatol. departments, St. 1600 kardiorevmatol. offices in policlinics for adults.
In 1973 in the USSR only in the cities there were about 4500 cardiologists, and specialized bed fund for patients kardiorevmatol. a profile made 26 835 beds.
M3 of the USSR further development specialized kardiol is planned. help. In 1973 in the cities with the population of 300 thousand people are organized above specialized kardiol. the departments having not less than 40 beds with chambers of an intensive care. In the cities with the population less than 300 thousand people will be organized chambers of an intensive care for patients with cardiovascular diseases in an acute state at kardiol., all-therapeutic hospitals or as a part of intensive care units and anesthesiology.
In 1958 in the USSR the system of specialized ambulance for patients kardiol was for the first time created. a profile (see. Fast and acute management ), generally sick with a myocardial infarction. It includes the organization at stations of emergency medical service of the crews of an intensive care equipped with specialized cars, the necessary equipment for diagnosis of acute states and an arsenal of pharmaceuticals for treatment of these patients. Work of these crews is based on the principles: 1) the doctor armed with modern diagnostic methods and treatments shall give as soon as possible help to the patient in full; 2) highly skilled medical assistance shall be on site given; 3) the patient accompanied by the doctor shall be hospitalized as soon as possible, with continuation of necessary treatment during the transportation.
Soviet system of assistance kardiol. the patient it is recognized as World Health Organization of the most advanced and perfect.
In the USSR organizational bases of development of the specialized cardiac help are created. So, in 1972 the All-Union center of a heart surgery is organized, the Crimea is Ying t of cardiovascular surgery of A. N. Bakulev the USSR Academy of Medical Sciences, and not only surgical treatment of patients with cardiovascular diseases, but also the scientific and methodical management is organized in all republics of 35 cardiac surgery departments which are carrying out. Besides, since 1971 in the USSR 55 departments of vascular surgery are organized and the All-Union center of vascular surgery on base Ying-that clinical and experimental surgery of M3 of the USSR is created.
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E. I. Chazov.