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Differential diagnostic criteria to distinguish coronary insufficiency of a syphilitic nature from coronary heart disease can serve as appropriatentgenological signs of Cialis of the ascending aorta, the possible presence of clinical manifestations of visceral syphilis and serological studies.

The nature of the disease becomes clear with the appearance of aortic valve insufficiency. Coronary angiography reveals the true origin of the disease at the first sign of coronary insufficiency, since syphilitic aortitis leads to a narrowing of the lumen of the coronary arteries at the site of their departure from the aorta, leaving the coronary arteries themselves completely intact. However, a sharp narrowing of the lumen of the coronary arteries extending from the aorta does not allow the use of the most advanced research method - selective coronary angiography; it is necessary to carry out thoracic aortography, which makes it possible to detect not only the narrowing of the lumen of the orifices of the coronary arteries, but also the initial degree of cialis pills expansion of the ascending aorta long before the appearance of distinct clinical signs of aortic valve insufficiency.

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Much more often, the coronary variant of syphilitic aortitis proceeds differently. With a slow rate of narrowing of the coronary arteries and a good development of collateral blood supply to the myocardium, angina pectoris is absent; the only sign of the disease is slowly progressive heart failure, sometimes accompanied by heart rhythm disturbances. The clinical picture is dominated by shortness of breath.

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In the future, attacks of cardiac asthma appear. Despite the severity of the clinical picture, electrocardiographic changes may be absent or insignificant and can be detected only during a dynamic study. Of the rhythm disorders, atrial or ventricular extrasystole appears more often than others. Atrial fibrillation is a rare manifestation of Generic Cialis aortitis. Disorders of atrioventricular and intraventricular conduction up to the development of the Morgani-Adams-Stokes syndrome have been described.

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The second variant of syphilitic aortitis occurs with a predominance of symptoms of aortic valve insufficiency and occurs in a third or half of tadalafil. It appears more often at the age of 40-50 years, is combined with coronary insufficiency and relatively quickly leads to heart failure. This variant is characterized by the presence, in addition to diastolic, and systolic murmur. The latter is due not to stenosis of the aortic orifice, but to the expansion of the initial part of the ascending aorta.

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In the third variant, the higher part of the ascending aorta and its arch are involved in the process.

The disease is usually asymptomatic. Only after a thorough questioning of patients, it is possible to reveal the presence of a kind of pain syndrome - aortalgia.

This syndrome seems to be based on significant morphological changes in the adventitia of the aorta with involvement of the paraortal nerve plexuses in the process.

Aortalgia is difficult to differentiate from angina pectoris, since the nature of pain, localization and their irradiation are quite similar.

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At the same time, aortalgic pains are more prolonged, less clearly associated with physical activity, rarely radiate to the left hand, and are not amenable to the action of tadalafil. Aortalgia does not exhaust the consequences of syphilitic neuritis of the cardio-aortic plexus.

They also result in symptoms such as bouts of whooping cough and suffocation, which cannot be explained by the state of the heart muscle. Carefully analyzing the clinical symptoms of syphilitic aortitis, some authors especially emphasize the constant shortness of breath and tachycardia inherent in these patients, not eliminated by digitalis, which is noted long before the onset of Cialis of heart failure, the first manifestations of a cut in most patients are caused by an already developed aortic aneurysm. With syphilis of the aortic arch, a sharp narrowing of the mouth of one or more arteries extending from it may develop; there are signs of cerebral ischemia, visual impairment, syndrome of increased reactivity of the carotid glomus.

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Early diagnosis of syphilitic aortitis is difficult, therefore, studies of patients should be carried out carefully and repeatedly. In the early stages of aortitis, the size of the aorta and heart is not changed, so percussion and conventional X-ray examination do not help to clarify the diagnosis.

Under these conditions, auscultation acquires exceptional importance, which allows more than half of the patients to catch a slight systolic murmur above the aorta at an early stage of the disease, caused by its slight expansion.

The systolic murmur caused by a syphilitic lesion of the ascending aorta is often better heard in the center of the sternum and above the xiphoid process.

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In some patients, systolic murmur may occur only when the arms are raised up (symptom of Sirotinin - Kukoverov). Above the aorta, an accent of the II tone is heard, acquiring a metallic timbre over time. Of great importance is the phonocardiographic study of persons who are suspected of having syphilitic aortitis.

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Particular attention should be paid to determining the diameter of the ascending aorta. The size of the ascending aorta is determined by teleroentgenography and X-ray tomography, but the most accurate data arenye gives aortography.

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An important, albeit late, radiological sign of the syphilitic process is calcification of the ascending aorta.

Modern cialis tadalafil equipment (electronic-optical converters, X-ray cinematography) can significantly increase the percentage of detection of aortic calcification in syphilis. It is necessary to resort to aortography for the diagnosis of occlusive lesions of the branches of the aorta, especially if drug therapy does not eliminate the stenosis and when, due to the severity of the clinical picture, surgical intervention is inevitable. We are talking about the syndrome of cerebral ischemia in the defeat of the places of discharge of the brachiocephalic trunk and the left carotid artery.

Syphilitic aortitis of the descending, thoracic and abdominal aorta is characterized by a complex and peculiar symptom complex. The development of posterior aortitis (periaortitis - mediastinitis) and the involvement of the intercostal nerves in the inflammatory process cause excruciating pain in the spine and paravertebral region in some patients. When the lower part of the thoracic aorta is affected, pain in the epigastric region is often noted - epigastralgia, simulating the gastralgic equivalent of angina pectoris.

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The clinical picture of lesions of the abdominal aorta is characterized by attacks of abdominal toad and transient disorders of the mesenteric circulation up to the development of ileus and gastrointestinal bleeding. Stenosis of the renal arteries is accompanied by the development of arterial hypertension.

Diagnosis of occlusive lesions of the branches of the abdominal aorta is possible only with the use of abdominal aortography.

Syphilis, especially in the first years of the course, is accompanied by cialis pills rises in temperature. The temperature curve differs in syphilis by extreme inconstancy.

Recognition of the syphilitic nature of aortitis is greatly aided by serological tests. However, with active visceral syphilis, they are negative in a certain number of patients. Bacterial endaortitis manifests itself differently depending on its form.

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Bacterial endocarditis is a consequence of tadalafil pills to the aorta of bacterial endocarditis from the aortic valve. After surgical interventions on the aorta, bacterial endoortitis may develop at the site of the aortotomy.

In subacute septic endocarditis, the causative agent of the disease is most often green streptococcus, in postoperative endocarditis - staphylococcus aureus. The clinical picture corresponds to subacute septic endocarditis; with postoperative endaortitis, there are no signs of damage to the valvular apparatus of the heart. Complications - thromboembolism, bacterial embolism, aortic rupture.

Step 2:

The diagnosis is based on the clinical symptoms of sepsis, positive blood cultures, and the effect of antibiotic therapy. Bacterial thrombaortitis occurs due to infection of blood clots present in the aorta, usually by various cocci, proteus and salmonella. Blood clots serve as a breeding ground for bacteria and can become a breeding ground for them. Purulent inflammation develops in the aorta up to the formation of small abscesses in its wall.

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Since the development of most thrombi is associated with ulcerative atherosclerosis, bacterial thrombaortitis usually develops in the abdominal aorta. Parietal thrombi of the ascending aorta affected by a rheumatic process can also become infected.