From Big Medical Encyclopedia

CORDIAL AND VASCULAR SYSTEM — the system of a human body and animals, the main function a cut is supply of bodies and fabrics with oxygen, nutrients, and also removal of waste products from them.

S.'s part - villages of the village are heart, blood vessels (circulatory system) and lymphatic system (see). The central body of S. - the village of the village is heart (see). Arteries (see), on the Crimea flows blood (see), in process of removal from heart become more small, passing into the arterioles, precapillary arterioles and capillaries (see) forming in bodies of network. From networks of capillaries post-capillary venules begin, to-rye, merging, create larger venules, and then veins (see), bearing blood to heart. In bodies to a dress e circulatory capillaries form networks limf, capillaries, from to-rykh begin absorbent vessels (see). From textures small limf, vessels form larger, taking away lymph (see) from bodies to regional lymph nodes (see). Having passed through limf, nodes, a lymph comes in limf, trunks, and then to the chest canal (see) and right limf, a channel, falling into veins in conjunctions of internal jugular and subclavial veins on the right and at the left. All way blood circulations (see) it is subdivided into two circles: the big, or corporal, providing inflow of blood to bodies and from them back in heart, and small, or pulmonary, on Krom blood from heart goes in lungs (see) where there is a gas exchange between blood and the air filling alveoluses and then is returned to the left auricle.

At backboneless animals (except for annlides) the vascular system which is not closed. At vertebrate animals it becomes closed and its main component is endothelium (see). In the course of phylogenetic development of vascular system there is a differentiation of special muscular body — hearts (see), reductions to-rogo provide fluid movement on vessels, at the same time rhythmic reductions of vessels fade into the background. In the course of evolution the structure of heart becomes complicated and it gains the increasing value in function C. - the village of the village. Fishes have an allocation limf, the system presented at them limf, bags and slozhnorazvetvlen-ny tubes, the peripheral ends to-rykh are closed, and central open in veins.

The person has a heart and vessels develop from an average germinal leaf — mesoderms (see). At early stages of development laying of heart is differentiated irrespective of laying of the peripheral vessels appearing at the end of the 2nd week of development in an extraembryonic mesoderm. Later communication of heart with the forming blood vessels is formed (see). In the course of S.'s ontogenesis - the village of the village undergoes a number of essential changes in connection with passing of different stages of development (vitelline, placental blood circulation) and establishment of continuous blood circulation (see) from the moment of the birth of the child. In this regard S. - the village of the village of the newborn (see) has the morfofunktsionalny features. After the birth growth of heart happens unevenly. Most quicker it grows in length therefore there is a change of its proportions. For the first 7 months after the birth the weight (weight) of heart increases approximately in two, by 2 — 3 years in three, by 6 years five times, by 12 — 13 years in 10, and by 20 years approximately by 15 times in comparison with heart of the newborn. According to it also its functionality changes.

The most intensive transformations of a microstructure of a vascular wall are noted at the age of 1 — 3 years and 8 — 12 years. During from 16 to 20 years there occurs stabilization of structural transformations. Dominance of elastic fibers in walls of blood vessels at children provides big distensibility of vessels of the growing bodies. With age in walls of vessels the amount of collagenic, reticular fibers and muscular elements increases. The microcirculator bed in ontogenesis undergoes development from more or less indifferent forms to specialized organospetsifichesky structures.

Functions of all links of S. - the village of the village are strictly coordinated thanks to perfect neuroreflex regulation that provides adaptation of an organism to diverse changes of the environment and maintenance homeostasis (see). Nervous control of size of a gleam of vessels thanks to activity of the chemoceptors perceiving change of chemical composition of blood, and the baroreceptors perceiving change of pressure provides balance of capacity of system, speed of a blood-groove (see) and heights blood pressure (see). Products of fabric exchange, hormones — adrenaline (see), vasopressin (see), etc., and also histamine (see) and acetylcholine (see) can influence a wall of vessels in the neuroreflex way or locally. In redistribution of blood and a lymph in bodies vessels of a microcirculator bed have huge value, to-rye along with transport function participate in ensuring transcapillary exchange (see. Microcirculation , Mikrotsirkulyation ).

Function C. - the village of the village is in the closest communication with work of all organism in general, with activity of respiratory system (see), eliminative organs, etc. Its functional state can be characterized a number of hemodynamic indicators, the most important of to-rykh the systolic and minute volume of heart, the ABP, pulse rate, a tone of vessels, volume of the circulating blood, speed of a circulation of blood, size of venous pressure, speed of a blood-groove, a blood stream in capillaries, etc. are.

S.'s pathology - the village of the village includes so-called primary heart diseases (e.g., nek-ry forms of myocarditis, a cardiomyopathy, a tumor of heart, etc.); damages of heart at infectious, infectious and allergic, dizmetabolichesky and general diseases (tuberculosis, syphilis, rheumatism, atherosclerosis, collagenoses, etc.) and diseases of other bodies (a diffusion toxic craw, hron. pulmonary diseases, etc.); generalized diseases of vascular system; diseases, the main manifestation to-rykh is system structural change or functions of vessels (widespread atherosclerosis, an idiopathic hypertensia, vasculites), and, at last, focal lesions of vessels (aneurisms, thrombophlebitis, etc.).

In this article only common problems of pathology of S. - the village of the village — classification, statistics, epidemiology are described. Private pathology — see. Heart and articles devoted to individual diseases, e.g. Idiopathic hypertensia , Coronary heart disease , Myocarditis etc.

Actually heart diseases meet rather seldom, and the most part of diseases of this body is closely connected with various forms of pathology of vessels. In this regard in the International classification of diseases, injuries and causes of death of the IX review (MKB) operating in the USSR accepted in 1975, a heart disease and vessels are united in the uniform class under the name «Diseases of the Blood Circulatory System» divided into the following groups. 1. The rheumatism (see) in an active phase including both active rheumatism without damage of heart and an active rheumatic pericardis (see), an endocarditis (see), myocarditis (see) and various combinations of defeats of a pericardium, a myocardium and an endocardium of a rheumatic etiology (see. Pancarditis ). 2. Chronic rheumatic heart troubles, to-rykh are a part rheumatic defeats of a pericardium (an adhesive pericarditis, hron. the mediastinopericarditis, mioperikardit also a pericardis), and also rheumatic defeats of valves of heart (see the Heart diseases acquired). 3. Idiopathic hypertensia (see). 4. The coronary heart disease (see) including various forms of acute myocardial infarction (see), intermediate forms of coronary heart disease and different forms stenocardias (see), and also an atherosclerotic cardiosclerosis (see) and the aneurism of heart (see) which developed owing to a myocardial infarction. 5. Other forms of heart troubles. This group most of a polimorfn also includes diseases of a different origin and nek-ry patol. states. Enter it an acute not rheumatic pericardis, hron. not rheumatic diseases pericardium (see), acute and subacute not rheumatic myocarditis, hron. not rheumatic diseases of an endocardium, cardiomyopathy (see), heart troubles of a pulmonary origin, including Ayersa's disease (see. Ayersa syndrome ), a pulmonary heart (see) and the kifoskoliotichesky heart, diseases connected with atherosclerosis of pulmonary arteries and primary pulmonary hypertensia (see Hypertensia of a small circle of blood circulation), and also the following patol. states: insufficiency of heart of congestive character (see. Heart failure), insufficiency of a left ventricle of heart (see the Fluid lungs, Cardiac asthma), disturbances of a heart rhythm and endocardiac conductivity (see. Arrhythmias of heart , Heart block , Wolff — Parkinson — Whyte a syndrome , Ciliary arrhythmia , Bouveret's disease , Premature ventricular contraction ). 6. The vascular damages of a brain combining subarachnoidal hemorrhages (see. the Subshell hemorrhages ), hematencephalons, thrombosis and an embolism of brain arteries (see the Stroke), passing disturbances of cerebral circulation (see), and also generalized defeats of vessels of a brain. 7. Diseases of arteries, arterioles and capillaries. The group includes atherosclerosis (see) with the indication of localization patol. process, arteriosclerosis (see), not syphilitic aortic aneurysm (see), diseases of peripheral vessels (see. Obliterating defeats of vessels of extremities, Reynaud a disease, the Thromboangitis obliterating, Eritromelalgiya), an embolism (see) and thrombosis of an aorta and arteries (see. Thrombosis ), the gangrene connected with vascular defeats (see Gangrene), a nodular periarteritis (see Pe-puapmepuum nodular), an allergic angiitis (see Vasku of litas) where Gudpascher's syndrome, Wegener's granulomatosis (see Wegener a granulomatosis), giant-cell arteritis of craniocereberal vessels (see Arteritis giant-cell is carried), a thrombocytopenic mikroangiopatiya (see a Werlhof's disease), other arteritis, e.g. Takayasu a syndrome (see), and also all other diseases of arteries, arterioles and capillaries. The same section included diseases of veins: a varicosity (see), phlebitis (see) and thrombophlebitis (see), embolisms the trombotichesky masses which is formed in veins (e.g., an embolism and a heart attack of a lung), thrombosis of a portal vein (see), and also diseases of lymphatic system, napr, limfangiit (see) and arterial hypotension (see Hypotension arterial).

Such division of a class into groups answered the ideas of an etiology and a pathogeny of diseases of S. which developed by 1975 - the village of the village. From this point of view given klassi-fikatspya, undoubtedly, is a step forward in comparison with the classifications existing earlier. At the same time the etiopatogenetichesky principle is carried out in it insufficiently consistently that is connected first of all with lack of accurate data on an etiology and a pathogeny of a number of diseases. In recent years thanks to researches in the field of molecular and cellular cardiology new materials are received. In this regard need of entering into classification of a number of specifications was designated. It is necessary to consider, in particular, that genesis of coronary heart disease cannot be reduced to purely mechanical factors (a stenosis of coronary arteries of heart); ischemia of a myocardium can be a net result of a row patol. the processes proceeding both in coronary arteries, and in cells of a myocardium. The so-called stenocardia of Printsmetal (see Stenocardia) which is a consequence of a spasm of the coronary arteries not always affected with atherosclerosis is not reflected in classification, in particular. Therefore a number of researchers suggest to designate the forms of coronary heart disease connected with atherosclerosis of coronary arteries, the term «coronary disease of heart». In a subheading «The idiopathic hypertensia with damage of kidneys» appears hron. glomerulonephritis. However at this disease arterial hypertension is secondary, i.e. cannot be considered as result of an idiopathic hypertensia. At the same time other diseases (e.g., hron. pyelonephritis, a stenosis of renal arteries, hormonal and active tumors of adrenal glands) are not mentioned in this section. Apparently, it would be reasonable to allocate symptomatic arterial hypertension in a separate heading or to exclude hron. a glomerulonephritis from the heading «Idiopathic hypertensia». Hypertensive crises are not mentioned in classification. It is probably connected with the fact that foreign scientists do not use this term, and distinguish short-term increase in the ABP and hypertensive encephalopathy. The section «Diseases of the Blood Circulatory System» did not include congenital anomalies of development of S. - the village of the village (see Heart diseases inborn). Their inclusion in other sections in connection with their inborn character or owing to genetic conditionality very diskussionno since the section «Diseases of the Blood Circulatory System» is grouped by the principle of localization of defeat (sustained, however, not everywhere). From the point of view of an etiology and a pathogeny the group of diseases and patol is represented especially polymorphic. the states combined by the heading «Other Forms of Heart Troubles». So, the subheading of «Cardiomyopathy» combines heart diseases, absolutely diverse on an etiology and a pathogeny, including and genetically caused (see the Cardiomyopathy). The only principle which is been the basis for formation of this subheading — absence enough clear ideas of an etiology and a pathogeny of the diseases entering it. Quite often refer to the same group also dystrophic damages of a myocardium at noncardiac diseases (see the Myocardial dystrophy) though according to classification they. treat other subheading if their etiology is not established, and to other classes (e.g., alcoholism, a diffusion toxic craw, etc.) if it is known. Under observation of cardiologists get, though it is rare, patients with tumoral damages of heart (metastasises of tumors of other bodies, germination in heart of tumors of lungs and bodies of a mediastinum and a tumor, coming from tissues of the heart). As casuistry helminthoses of heart (an ascaridosis, trichinosis) proceeding with symptomatology of myocarditis, coronary insufficiency (see) or focal damages of a myocardium meet.

A cause of infringement of a heart rhythm and endocardiac conductivity, apparently, are generally these or those diseases of a myocardium, and in some cases noncardiac pathology (see Arrhythmias of heart, the Heart block, Wolff — Parkinson — Whyte a syndrome, the Ciliary arrhythmia, the Bouveret's disease, Ekstr an asystolia). Therefore the subheading of «Disturbance of a heart rhythm» includes only those cases, at to-rykh it is not possible to find out the reason of arrhythmia or disturbance of conductivity; these uniforms of arrhythmias are worn the name of idiopaticherky. It is undoubted that with improvement of our knowledge and creation of new methods of a research the group of idiopathic arrhythmias will decrease.

It is it is unlikely lawful to carry to diseases of vessels a nodular periarteritis, to-ry, according to most of domestic and many foreign researchers, is a general disease of connecting fabric. The same treats also a hemorrhagic capillary toxicosis (see), at Krom capillaries serve only as a point of application patol. the processes which are made at other levels and also to some other the diseases included in the heading «Diseases of Arteries, Arterioles and Capillaries».

Despite all noted contentious clauses, MKB generally conforms to requirements of practical health care though in process of emergence of new data on an etiology and a pathogeny of diseases of S. - the village of the village need of its review steadily increases.

S.'s diseases - the village of the village, and first of all coronary heart disease and a hypertension with its complications, generally with disturbances of cerebral circulation, are the main causes of death and invalidism of residents of economically developed countries. Mortality from these diseases in 1977 made in Hungary 637,7, in Sweden 567,7, in England and Wales 595,7 on 100 thousand population. According to TsSU USSR, this indicator in 1979 was equal in our country to 527,9. The share of cardiovascular diseases in the general structure of mortality till 1980 steadily increased; in the USSR it increased from 11% in 1939 up to 52,5% in 1981. Only since 1981 — 1982 in a number of the countries there is a tendency to stabilization, and in the certain states, including in the USSR, and to nek-rum to decrease in this indicator. Growth of rate of mortality from S.'s diseases - the village of the village is substantially connected with reduction of child mortality, and also mortality from inf. diseases. In a smaller measure growth of this indicator was influenced by improvement of diagnosis of cardiovascular diseases. There is an opinion that not only relative, but also absolute measures of prevalence of cardiovascular diseases and mortality from them increase. In dynamics of these indicators it is possible to note three main tendencies: increase in incidence and mortality among persons of young age, among inhabitants of rural areas and among the population of those regions where growth of these diseases was not noted earlier. - the village of the village with good reason it is possible to call S.'s pathology a disease of the 20th century.

Data on prevalence of cardiovascular diseases and incidence are based by them (see Incidence) on data of negotiability of the population on medical aid. (According to negotiability) understand number of cases of cardiovascular diseases on each 1000 people of the serviced population registered within a year as prevalence; under incidence — number for the first time the registered cases on 1000 inhabitants. The indicators of incidence of cardiovascular diseases established on the basis of data of negotiability in various regions of the USSR fluctuate in very wide limits and depend on quality of diagnosis, accuracy of the statistical account, level of the general and a dignity. cultures of the population. At clarification of the reasons of distinctions it is also necessary to consider age composition of the population, a quantitative ratio of men and women, structure of the studied contingents by the nature of occupations.

The medical statistics studies also mortality (see) from cardiovascular diseases, an invalidism of the population (number of the persons for the first time recognized as disabled people from cardiovascular diseases in a year on 10 000 population) and incidence with temporary disability (number of cases of temporary disability owing to cardiovascular diseases in a year on each 100 working). Statistical data on mortality of the population of the USSR from diseases of the blood circulatory system from I960 for 1981 are presented in the table. Similar dynamics of mortality from cardiovascular diseases is noted also in some other industrialized countries. Continuous increase of mortality happens hl. obr. at the expense of coronary heart disease and vascular damages of a brain. The share of these groups of diseases in the general mortality from diseases of cardiovascular system made in the USSR in 1960 68,7%, and in 1980 — 86,3%.

So significant increase in 20 years of mortality from coronary heart disease and from vascular damages of a brain cannot be explained only with improvement of quality of diagnosis and increase in number of openings though these factors and played a certain role in these changes.

For a number of reasons (lack of uniform criteria of diagnosis, exact accounting of incidence, etc.) the clearest idea of prevalence of individual diseases of S. - villages of the village among the population allow to gain selective scientific research. They help to find out influence of specific factors on prevalence of diseases and to estimate efficiency of these or those preventive actions. For the last three decades adequate methodical approaches to carrying out the similar researches which received the name of epidemiological are developed; wide recognition was gained also by the term «epidemiology of noninfectious diseases».

Epidemiol. researches depending on their purposes divide into the observation and preventive. The first are directed to studying of certain indicators (prevalence of diseases of S. - the village of the village, temporary and permanent disability and mortality from them), at the same time is excluded any impact of the persons conducting a research, on the natural course studied epidemiol. processes. Comparison of the received indicators to various factors — external (a way of life, character of food, smoking, etc.) and internal (lipidic composition of blood, the ABP level, etc.) — allows to reveal the so-called risk factors promoting development of certain cardiovascular diseases. The observation researches can be single-step and prospective (long). Prospective researches allow to establish influence of various factors on the frequency of emergence of new cases, on a lethality (see) in the observed contingent of patients and the frequency of development of complications at them. Task preventive epidemiol. researches comes down to studying of opportunities of decrease in frequency of a certain disease of S. - the village of the village by impact on risk factors (primary prevention) or frequencies of failures and complications at this disease — secondary prevention (see Prevention primary).

Epidemiol. researches of cardiovascular diseases are based on selective researches, and the number of inspected shall be rather big (representative). The most important conditions of obtaining reliable results are an equilibration of the compared contingents, under the Crimea understand compliance of representatives of the compared contingents on perhaps bigger number of signs (ideally — full compliance), except for studied (e.g., smoking and non-smoking) and standardization of methods of a research.

Standardization of methods of a research allows to compare the studied indicators in dynamics at one contingent,' and also at various contingents. However even during the use of the standardized methods during preparation of a research a number of organizational actions, such as training of the medical staff participating in a research and the instructing of the population providing its acquaintance with research problems and conditions of carrying out is necessary. Standardization of diagnostic criteria is extremely important. So, in the majority modern epidemiol. researches coronary heart disease comes to light on the basis of the analysis of an ECG (see Elektrokardiografiya), results to-rogo are processed of the uniform scheme (The Minnesota code). For identification of an angina of exertion use a special (uniform) questionnaire. Nevertheless various researchers not always rely on identical criteria of diagnosis of coronary heart disease. The most accurate and comparable data manage to be obtained about the frequency and outcomes of a myocardial infarction. It is promoted by the analysis of the so-called registers of a myocardial infarction fixing all cases and its outcomes.

In epidemiology of cardiovascular diseases the following indicators are used: prevalence, frequency of new cases, mortality and lethality. Understand number of the revealed patients on 1000 inspected as prevalence. Frequency of new cases is expressed by number of these cases on 1000 of prospective observation inspected, at to-rykh this disease was not revealed at the first inspection. Rate of mortality from the studied disease reflects number of the dead from it among all inspected on 1000 prospective observation. At last, understand number of the dead from all reasons as a lethality of patients with cardiovascular diseases (including the studied disease) among persons with this (specific) disease for 100 cheloveko-years of observation.

The greatest number carried out in the world epidemiol. researches of cardiovascular diseases it was devoted to studying of prevalence and the course of coronary heart disease that is connected with its big frequency and high rates of temporary disability, an invalidism and mortality caused by it.

By data epidemiol. researches, prevalence of separate forms of coronary heart disease worldwide and even in the different cities of one country fluctuates in quite wide limits. So, it is established that in 1960 — 1969 prevalence of an angina of exertion among men of 50 — 54 years made in Hisayam (Japan) 1,1%, in the Gothenburg and the Malm (Sweden) respectively 2,1 and 2,5%, in Moscow 7,4%, in Riga 7,7%, in Prague 9,6%. Frequency of new cases of coronary heart disease on 1000 of observation among men at the age of 40 — 59 years was equal in England 9,45, in Italy 5,9 and 7,7 (different provinces), in the Western Finland 6,4, in East Finland 13,6.

According to the register of a myocardial infarction, its frequency on 1000 people of the population made among men at the age of 45 — 49 years from 2,1 (Gothenburg) to 5,0 (Dublin), at the age of 50 — 54 years — from 3,8 (Gothenburg) to 9,5 (London). In the USSR this indicator for the population is aged more senior than 40 years in the different cities (Kiev, Kaunas, Arkhangelsk, Krasnoyarsk, Ufa, Frunze and Kharkiv) fluctuated from 2,5 to 3,9 at men and from 0,8 to 1,2 at women.

Results epidemiol. researches demonstrate that as major factors of risk of development of coronary heart disease serve arterial hypertension, smoking, excess weight of a body, iyek-ry disturbances of lipidic exchange, decrease in tolerance to carbohydrates and insufficient physical activity. Preventive epidemiol. researches are based on programs of fight against these risk factors (the so-called program of multifactorial prevention of coronary heart disease). Influence of a number of risk factors can be korrigirovat or to exclude completely. It belongs first of all to smoking, arterial hypertension, excess weight of a body and low physical activity. It is possible to influence disturbance of lipidic exchange only with the help of a special diet so far; the pharmaceuticals offered for this purpose (Atheromidum, etc.) did not equal the hopes laid on them. There are no accurate data and on preventive value of the medicinal or dietary interventions directed to fight against disturbances of carbohydrate metabolism yet.

In the USSR since 1976 the cooperative program for multifactorial prevention of coronary heart disease is carried out. By 1982 researchers of Moscow, Kaunas, Minsk, Tashkent, Frunze and Kharkiv participated in carrying out the program. The program pursues two aims: to study a possibility of decrease in incidence of coronary heart disease and mortality from it by means of measures of primary and secondary prevention; to develop model of multifactorial prevention of coronary heart disease for practical health care. Due to the slow progressing of the majority of forms of coronary heart disease it will be possible to estimate influence of primary prevention on incidence and mortality only in several years. Similar programs are carried out also in some other countries. Epidemiol. researches of other cardiovascular diseases are complicated by a number of circumstances. E.g., at epidemiol. researches of an idiopathic hypertensia all cases of arterial hypertension, edge, according to modern data are registered, in 20 — 30% of cases has symptomatic character. In epidemiol. researches symptomatic arterial hypertension comes to light much less often (approximately in 5% of cases). According to national bureau of statistics of the USA, arterial hypertension is registered approximately at 20% of the population, i.e. at every fifth resident of this country. Epidemiol. the research conducted in Moscow by All-Union cardiological scientific center of the USSR Academy of Medical Sciences revealed arterial hypertension at 26,9% inspected at the age of 40 — 59 years, at the same time accurate increase in its prevalence was noted with age. Comparison of these various researchers is at a loss use by them during the studying of arterial hypertension of different diagnostic criteria, despite existence of the unified criteria developed and recommended to WHO.

Mass epidemiol. researches, despite their great informative value, carry out in connection with methodical difficulties and limitation of personnel on rather small selections of the population. Therefore the statistics of cardiovascular diseases remains a basis of planning of cardiological service. Analyzing prevalence and structure of cardiovascular pathology, governing bodies of health care define the evidence-based need for different types of the specialized cardiological help to the population — the ambulance, polyclinic, including and dispensary, hospital, rehabilitation, specialized sanatorium (see Cardiology, the organization of the cardiological help). Data on negotiability of the population in these or those to lay down. - prof. of establishment allow to reveal shortcomings of system of cardiological service and to optimum distribute flows of the cardiovascular diseases asking for the help with an occasion. Comparison of statistical data on negotiability with data epidemiol. researches of the same contingent gives the chance to estimate quality of diagnosis of cardiovascular diseases in institutions of practical health care and to plan actions for its improvement.

S.'s diseases - the village of the village cause the huge damage to economy of the developed countries caused by reduction of a manpower owing to mortality, an invalidism and temporary disability. In the USA, e.g., due to disability of patients with cardiovascular diseases about half a million cheloveko-years of productive work, and due to their mortality — more than a quarter of one million cheloveko-years are annually lost. Society incurs considerable expenses for different types to lay down. - prof. of the help to patients with cardiovascular diseases. Expenses and on provision of pensions of the persons which became disabled people are big. Big losses are connected also with decrease in operability of the persons having cardiovascular diseases, but continuing to work.

Table. DYNAMICS of MORTALITY of the POPULATION of the USSR FROM DISEASES of the BLOOD CIRCULATORY SYSTEM from 1960 to 1981 (&nanbsp; 100 000 population)

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