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Question: Yesterday, an ambulance took away her husband's 40 th hospital (reg VDNH). were taken from strokes, and today he reonimatsii with a suspected heart attack. My favorite in February was only 40 years old. I am also 40 years old and I am in "inteoesnom" position on the age of 32 weeks. But about anyone and anything (may God forgive me) I think not Mugu. Favorite and edinstvennyymuzh always the first place. Our daughter will soon turn 17 years old, and mother's milk is absorbed, that if it were not for dad, then it would not. We have a friendly happy family. Therefore, hospitalization husband put me in a state of shock. What to do? Where to find the best doctors? "Where is the course of rehabilitation and how to go on living?

Answer: First of all, calm down. If the patient able to take to the hospital and put in the more intensive surveillance, the chances of an adverse outcome is low. Suspicion (not the explicit wording of diagnosis) usually indicate that the infarction is not extensive. Question about treatment alternatives addressed in the first 2-3 hours, and further management of patients performed a standardized and more expensive or scarce drugs are not needed. Moscow rehabilitation patients after myocardial sereeznogo held in well-defined cardiac sanatoriums. Attempts to solve the remaining issues are premature.

Question: In the month of August, was hospitalized with strokes. During the week passed a course of treatment and was sent to a sanatorium in the cardiology department. I live in Slavyansk, Don. region. After a course of rehabilitation in the sanatorium began to emerge in the heart of pain, walking or loads. Smoke. Sometimes in the process of motion arising pain gradually pass, ie, as a load-balancing effect occurs. Local Aesculapius in one voice to offer coronarography. There are doubts about the appropriateness of such intervention. What'll show? In May, planning to go to her parents in St. Petersburg. Maybe there and make coronarography? If you have addresses of clinics'll show please. Yours Alexander

Answer: 49 years. This stable angina. The effect of surgical treatment (the only question about this and solved by coronary angiography) is equivalent to the life prediction effect _optimalnogo_ medicinal and regime of treatment. For individuals, small following treatment with low self-discipline, preferred the first option. Coronary angiography should be undertaken where possible and surgical treatment.

Question: Dear Doctor! My friend (67 years) five weeks ago there was an extensive transmural infarction. We formed aneurysm. Can he have sex now, and what are the limitations? In this respect he has always been a very active person and said that abstinence does him more harm than the possible physical burden.

Answer: (20. 04. 07) Sex helpful in all respects (http://doktor. ru / qa / heart / article. html? id = 48529), but in such a situation, it must be evaluated and in terms of physical activity, and is under force to the patient. Note that up to 8 weeks stretches subacute infarction period – yet to happen, speaking in medical terms, complete replacement of necrotic masses of granulation tissue and the completion of the initial process of forming scar. Inadequate, excessive fiznagruzki may further provoke the formation of an aneurysm of the heart. And if the patient is not taking prescribed medications, the increased risk of arrhythmia.

Question: doctor! The following excerpt from one of your answers made me very interested: "I think (in the U.S. at least) that patients with uncomplicated myocardial infarction and maximal functional capacity 8 yr (unit of energy equal to the oxygen consumption at rest) and above, are not complaining and with good exercise tolerance on these special tests, medical rehabilitation is not needed. "Tell me, please, and how and where to measure these meta, for me this is important – feel the power and want to increase the load after not too strong (uncomplicated) infarta. Sorry for the inconvenience. Sincerely, Boris Leonidovich, Baku

Answer: The difference between the work of the car at idle (A) and a man at rest (q) as follows. I. A: consumption of gasoline and oxygen (O2) air for the reaction, which occurs as a result of the release of energy as heat, C: the cost of domestic reserves and O2 for the reaction of energy to maintain metabolic H weighing 70 kg to produce heat with an intensity of 1. 0-1. 2 kcal / min. II. A: fuel consumption is determined by design features varies widely; H: fuel consumption alone has roughly the same parameters in people of different age and sex, but depends on the build. III. A: O2 goes without restrictions, so the cost is estimated at up gasoline; H: O2 enters a state of rest and without limitation, its consumption in the rest of the build, it is about 3. 5 ml O2/min/kg body weight. IV. A: Physics called the power intensity of work done per unit of time, depending on the scope of the power can be measured in watts (watt = one joule of energy per second) or, say, the horsepower (1 liter. Pp. = 0,736 kilowatts); H: medicine uses a different unit of power, called the subject of, or with us, ME (metabolic unit). 1 MW is equal to the average adult resting energy expenditure Charles V. A: while driving efficiency of the engine is not limited to receipt of O2; B: during physical stress transfer of O2 as oxidizing agents determined by the state (1) The functions of respiration, and (2) heart (3) the regulation of peripheral circulation and (4) metabolism in muscle. When the possibility of delivery of O2 to the muscles are exhausted, reached Sc. Anaerobic threshold: a further increase in power long endure supports the metabolism without the involvement of O2 (anaerobic metabolism), but only at the cost of development of lactic acidosis and oxygen starvation. VI. A: Work well-regulated engine does not depend on the length of service; B: age-state function changes, in particular, reduced the upper limit of heart rate, its maximum value in healthy people related to age as follows: heart rate = 210 – [0. 65 x age (years)]. VII. A: when the owner is not satisfied with his work, it carries out a consistent test sites, their replacement and adjustment; B: In order to determine what limits or restricts a physical capacity – respiratory or cardio-vascular system and other programs, research with the implementation of submaximal exercise in TREDMIL tests for Bruce protocol. Ability to perform work depends on the state of physical efficiency Rights trenirovannosti, so accepted and the abbreviation of efficiency: PWC (Physical working capacity), or in Russian Fed. Information obtained by exercise testing of patients should be interpreted not in isolation but always in light of the overall clinical picture. Repeated studies in the dynamics, of course, more useful than a single measurement. IT – ANSWER TO YOUR QUESTION. Power in Metakhim defined as a multiple of metabolic query O2 alone. The annexes to the article "A little about the benefits of physical culture» – http://doktor. ru / articles / article. html? id = 48557 are examples of moderate physical activity. It corresponds to the power in the range of 3. 0 to 6. 0 MET, or 3. 5 to 7 calories per minute. This category has three degrees. For example, do not ride a bicycle at a speed of 8, 11 and 14 km / h or energetic walk at a speed of 4. 5, 6 and 7 kilometers per hour. In a special table, to explain that there are no opportunities are listed and gradations lists of physical activity to conventional categories of people weighing about 70 kg – men aged 30 to 50 years and women aged 20-40 years. To achieve the recommended "healthy" daily energy expenditure is usually required – depending on the degree – 25-50 minute sessions of moderate intensity. The rationale power (does not apply to details such as selection and rotation exercises – a special operating time). How to calculate approximately (ie, assume that met = 1 kcal / min) consumption of energy necessary to you? For example, you want to know how much time to deal with varying load in order to "burn" 150 calories for obesity. Pressures estimated at Metakhim. For example, if the load has a capacity of 3 meta, then divide 150 by three and get 50 minutes. This is, so to speak, a scientific approach. Important. Almost every occupation requires some connection of all degrees of exercises, depending on the immediate tasks. To choose the levels of activity for himself, ask yourself: how many minutes each day I spend on the types of actions, described as mild, moderate, or large (aggressive)? At other tables, you can also determine which energy consumption is actually available for life. Where to study and, most importantly, get a qualified assessment of the results, an adequate set of uprazheniey etc. in Baku – say, of course, can not.

Question: Men 47 years, before he suffered a massive heart attack the front wall, led an active sex life. Сейчас считает, что с сексом нужно полностью " завязать". What advice would you give? Thank you.

Answer: (08. 02. 07) is wrong. 'Sex – is coaching. Or you know a pleasant exercise for the heart and circulatory system? " (Http://doktor. Ru / qa / heart / article. Html? Id = 48529). After a heart attack often and naturally develop a neurosis or depression – they even reduce sexual desire and, consequently, activity. ФИЗИЧЕСКАЯ АКТИВНОСТЬ ПОСЛЕ ПЕРЕНЕСЕННОГО ИНФАРКТА. As the healing of heart attack patients recommend to encourage in 3-4-week term BACK TO DAILY LIFE, without exposing the myocardium loads exceeding the maximum tolerable (threshold). It is advisable to use such loads, which increases the rate of heart rate to 110-120 per minute, which allows to restore the physical form and return to active life. It is believed (in the U.S. at least) that patients with uncomplicated myocardial infarction and maximal functional capacity 8 yr (unit of energy equal to the oxygen consumption at rest) and above, are not complaining, and with good exercise tolerance on these special tests, medical Rehabilitation not need. The patient is at high risk should undergo rehabilitation under intensive medical supervision. 3-4-th week of the Q-myocardial (ie, transmural) are virtually safe period for the tests of physical endurance (samples with measured physical load). The positive effect of exercise on parameters of tissue respiration, blood clotting, blood lipid spectrum, observed increase in the intensity of blood flow, and most importantly – change for the better psychological condition of patients. P. S. Physical work capacity from 3 to 6 metov (or 3. 5 to 7 calories per minute) is called a moderate. In turn, this category is subdivided for ease of loading on the three degrees. For example, riding a bicycle at a speed of 8, 11 and 14 km / h or energetic walk at a speed of 4. 5, 6 and 7 kilometers per hour. To achieve the recommended "normal" daily energy expenditure is usually required – depending on the level – 25-50 minutes of moderate-intensity training, examples of which see the article "A little bit about the benefits of physical education, and the usual treatment» – http://doktor. ru / articles / article. html? id = 48557.

Question: <br> about 16 years I have tachycardia, with no health problems I experienced. In June 2008, the first time, increased blood pressure (160/110). Been appointed riboksin, Magnesia, Nebilet, thrombo-ACC. Approximately 3-4 days after the state returned to normal. <br> In March 2009, the newly risen blood pressure – 160/100. Provedeno ECG monitor system were recorded: single atrial ekstrosistoliya with predektopicheskim interval 898 msec – only 5 (during the day – 4 night-1), tolerance to the load average. Prescribe Concor. <br> After receiving the improvements did not happen, but instead appeared stabbing pains in the heart, any interruptions in the work of the heart (it seems that the heart stops), shortness of breath, numbness of fingers and chin. <br> In April 2009, while examining all of the tests are normal, blood pressure 140/100, pulse about 90. Osteochondrosis of the cervical and thoracic spine, scoliosis, right, chronic gastritis, exacerbation bulb. Was hospitalized. They put kapilnitsy: glucose, insulin, reboksin, megneziya. Also given tablets Concor, Noliprel forte, Grandoksin. Pressure returned to normal. However, the condition has not improved, the weakness in the body, but also appeared ventricular arrythmia. We spent <br> ergometers, with a load extrasystoles disappeared, detained a high tolerance. However, the feeling is not improving. Be re-monitor system ECG were recorded: single Supraventricular extrasystole with predektopicheskim interval from 390 to 515 msec. Total 3. Single ventricular, including sutural, extrasystole with predektopicheskim interval from 296 to 734 msec. Total 4519 (an average of 203 per hour). Happy 2989, night 1530. During exercise – 73. Group ventricular beats with heart rate of 94 strokes / min. Total – 1. Arrhythmic syndrome presented single nadzheludochkovyh extrasystoles; single ventricular, including interpolated extrasystole in pathological quantities; Group ventricular premature beats (Lown class 4A). Tolerance to the load is high. This study was conducted while taking Concor. <br> Can the occurrence of extrasystoles be related to Concor, osteochondrosis, gastrointestinal disease? Or is it still is connected with the heart. Beats – this is dangerous? Please, suggest what to do, how to get rid of extrasystoles?

Answer: Hi Joe! <br> extrasystole in the absence of organic pathology of the heart is not dangerous. Consulting cardiologist (internal) can help to optimize the way of life, elimination of trigger factors, etc., but drug therapy is likely to need would not arise. Ask your therapist, functional extrasystole, including emotion, occurs frequently. Treat osteochondrosis.

Question: Women 79 years. Myocardial infarction has borne through-defeat, does not work 20% of the heart. The remaining tests all normal. The hospital dripped glucose and calcium. And for some reason valerian. Five years ago, suffered a stroke. At the hospital, the woman getting the flu. Headaches. Discharged home. What?

Answer: Hello, In this situation, I can advise only one thing – call a doctor at home.

Question: Dear Doctor, hello! I was diagnosed in 1989, the All-Union Scientific Center of Surgery, AMS USSR: Dilated cardiomyopathy dysrhythmia type atrial fibrillation NK-IZheludochkovaya extrasystole. Cholelithiasis. Nephrolithiasis. Interruptions in the heart area since 1986. Pray sobschit where do I go for surgery.

Answer: Dear Valery Petrovich! It is not clear what kind of operation you are talking about. If surgery for cholelithiasis, then go to any surgical hospital, is now doing endoscopic surgery to remove stones from the gallbladder / duct. If over nephrolithiasis, the question must be addressed urologist. If you're referring to surgery, your heart disease, a heart surgeon decides the issue. He must evaluate the condition of your heart at the moment, and not 20 years ago.

Question: My father came Infark infarction with stroke at a time. The hospital is on 29 June. He edema. Doctors told his paralyzing the right side. In the mind, only his eyes moving. . . I want to know whether he will survive? What is the probability that it will be disabled? Please answer Chesney, and clear. Thanks in advance for your response.

Answer: These questions need to ask doctor. Reply absentia, without seeing the patient, not knowing its associated diseases, is impossible. One thing I can say – the prognosis of these combined lesions is very serious.

Question: My mother went to hospital with a double fracture of the leg, said that he needed surgery. But when did a cardiogram revealed that 4 months ago she had a heart attack. What is the probability that during the operation fails the heart, and can generally do the operation? She was 40 years.

Answer: Hello! The situation is serious enough. This question should be asked physician or anesthesiologist, the hospital where you are going to the operation. If the risk of surgery is high, it will not hold.