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4.A#a&o!a pa&o)og!(a
0.D!ag#os&!($) /TA s! e*a)$are
1.Fore ()!#!(e s! se!pa&o)og!(e
2.E*o)$&!e s! (op)!(a&!!
. Prog#os&!($)
.Tra&ae#&$) /TA5a.Tra&ae#& !g!e#o-"!e&e&!(
6.Tra&ae#& e"!(ae#&os
(. Tra&ae#&$) $rge#&e)or
+!per&e#s!*e
7.Pro%!)a'!a +!per&e#s!$#!! ar&er!a)e
V. PREZENTAREA CAZURILOR STUDIATE
VI. CONCLUZII
VII. ,I,LIOGRAFIE
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OTIVATIA LUCRAR II
'Invatam pentru viata, nu pentru
scoala'
8 SENECA 9
I#&r-o )$e !# (are e'!s&e#&a (o&!"!a#a a !#&ra& !#&r-$# r!& ae&!&or s! so)!(!&a#&
&re6$!e sa !#*a&a ($ sa #e pas&ra sa#a&a&ea: "ar a! a)es ($ sa rea(&!o#a !# (az "e
!6o)#a*!re.
C+!ar "a(a #e (o#"$(e !# *!a&a "$pa $# o&&o (a a(es&a5
E preferabil sa te epuizezi decat sa ruginesti
8 DAVID ;. SC/A
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Anatomia
S
f iziologia
aparatului cardiovascular
S!s&e$) (!r($)a&or es&e %ora& "!# !#!a: *ase sa#g$!#e s! )!%a&!(e: (are
a)(a&$!es( o $#!&a&e %$#(&!o#a)a (oor"o#a&a s! pera#e#& a"ap&a&a #e*o!)or orga#!$)$! .
Des! apara&$) (ar"!o-*as($)ar reprez!#&a $# &o& $#!&ar: e) poa&e %!!par&!& !# 5
o s!s&e$) sa#g$!# repreze#&a& pr!#5
-!#!a
-*ase sa#g$!#e
o s!s&e$) )!%a&!( repreze#&a& "e5
-*ase)e )!%a&!(e
-ga#g)!o#! )!%a&!(!
A9. INIMA
I#!a es&e (o#s!"era&a (a orga# (e#&ra) a) apara&$)$! (ar"!o-*as($)ar: a (ar$!
%$#(&!o#are as!g$ra (!r($)a&!a sa#ge)$! !#&ers&!&!a).
? Asezare 5 I#!a se gases&e aseza&a !# ($&!a &ora(!(a : !#
par&ea!#%er!oara a e"!as&!#$)$! a#&er!or. Cea a! are par&e a e! es&e !#
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par&ea s&a#ga a
e"!as&!#$)$! s!
o($pa pa&$) !#!!! "e pe
%a&a e"!as&!#a)a a
p)aa#$)$! s&a#g.
?Fora s! "!e#s!$#! 5
Are %ora apro'!a&!*a
a $#$! (o# &$r&!&
a#&ero-pos&er!or: ar!ea p$#$)$! $#$! a"$)& s!
(a#&ares&e apro'!a&!* 377 g.
? Co#%!g$ra&!a e'&er#a a !#!!! 5 I#!a prez!#&a 5 o %a&a a#&er!oara: o
%a&a !#%er!oara a arg!#!: $# *ar% s! o 6aza.
? S&r$(&$ra !#!!!5
I#!a es&e $# orga# (a*!&ar s! $s($)ar: ($ o s&r$(&$ra (ara(&er!s&!(a:
po&r!*!&a %$#(&!!)or pe (are )e !#"ep)!#es&e. !# s&r$(&$ra e!: *o s&$"!a 5 (a*!&a&!)e !#!!! s!pere)e !#!!!. U# pere&e )o#g!&$"!#a) "espar&e !#!a !# "o$a par&!5 !#!a "reap&a s! !#!a
s&a#ga: !ar $# pere&e &ra#*ersa) #$!& s! sep&$) a#&r!o-*e#&r!($)ar: !par&e %!e(are "!# (e)e
"o$a par&! !# "o$a (a*!&a&! 5 o (a*!&a&e (a&re 6aza !#!!!: #$!&a a&r!$ s! o (a*!&a&e (a&re
*ar%$) !#!!! #$!&a *e#&r!($).
Pere&e)e )o#g!&$"!#a) (e "espar&e a&r!!)e se #$es&e sep& !#&era&r!a): !ar
(e) (e "espar&e *e#&r!($)e)e sep& !#&er*e#&r!($)ar.
F!e(are a&r!$ (o$#!(a ($ *e#&r!($)$) respe(&!* pr!# or!%!(!!)e a&r!o-
*e#&r!($)are pre*az$&e ($ *a)*e: (are se "es(+!" "oar !#&r-$# a#$!& se#s: spre
*e#&r!($)e)e 5 -s&a#g 86!($sp!"a9
-s! "rep& 8&r!($sp!"a9.
/!s&o)og!( !#!a es&e a)(a&$!&a "!# &re! s&ra&$r! (o#(e#&r!(e 5
-per!(ar">
-!o(ar">
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-e#"o(ar".
Per!(ar"$) sa$ s&ra&$) e'&er# es&e (o#s&!&$!& "!#&r-o %ora&!$#e e6ra#oasa:
(are !#*e)es&e s! 6aza *ase)or ar! (are por#es( "!# !#!a. Es&e a)(a&$!& "!# "o$a
%o!&e 5 *!s(era)a s! par!e&a)a. !#&re a(es&ea se gases&e (a*!&a&ea per!(ar"!(a ($ o )aa
s$6&!re "e )!(+!": (are %a*or!zeaza a)$#e(area !# &!p$) a(&!*!&a&!! (ar"!(e.
M!o(ar"$) - $s(+!$) !#!!! - es&e a! gros !# *e#&r!($)e 8a! a)es !# (e)
s&a#g9 "e(a& !# a&r!! s! es&e (o#s&!&$!& "!# %as(!($)e "e %!6re $s($)are (ar"!a(e: or!e#&a&e
(!r($)ar !# pere&e)e a&r!!)or: s! "!# %!6re o6)!(-sp!ra)a&e !# *e#&r!($)e. M!o(ar"$) a&r!o-
*e#&r!($)ar es&e separa& "e (e) *e#&r!($)ar pr!# !#e)e %!6roase a&r!o-*e#&r!($)are. M!o(ar"$)
a&r!a) es&e #e&e" pe %a&a !#&er#a: !ar (e) *e#&r!($)ar prez!#&a $s(+! pap!)ar! @ &ra6e($)e
(ar#oase "e (are se pr!#": pr!# (o#"a!: *a)*e a&r!o-*e#&r!($)are. !# pere&e)e !#!!!: !# a%ara
(e)$)e)or !o(ar"!(e: a! e'!s&a (e)$)e spe(!a)!za&e !# ge#erarea s! (o#"$(erea
!p$)s$r!)or "e (o#&ra(&!! - a(es&ea (o#s&!&$!e s!s&e$) e'(!&o-(o#"$(&or #o"a) (e($pr!#"e5 #o"$)$! s!#oa&r!a): #o"$)$! a&r!o*e#&r!($)ar: %as(!($)$) /ISS (are se &er!#a
pr!#re&ea$a PURBIN;E !# %!6re)e !o(ar"$)$! *e#&r!($)ar.
E#"o(ar"$) - es&e (o#s&!&$!& "!#&r-$# e#"o&e)!$ s!&$a& pe o e6ra#a
6aza)a (e se (o#&!#$a ($ s&ra&$) s$6e#"o&e)!a) %ora& "!# %!6re (o)age#e: %!6re "e
re&!($)!#a: %!6re e)as&!(e: rare (e)$)e (o#$#(&!*e s! #$eroase &er!#a&!! #er*oase se#z!&!*e.
?Vas($)ar!za&!a !#!!!
Ir!garea !#!!! ($ sa#ge es&e as!g$ra&a: (a pe#&r$ or!(are a)& orga#: pr!# ar&ere
s! *e#e.
Ar&ere)e !#!!! se #$es( s! ar&ere (oro#are: respe(&!* ar&era (oro#ara s&a#ga s!
ar&era (oro#ara "reap&a.
Ar&era (oro#ara s&a#ga se 6!%$r(a !# ar&era !#&er*e#&r!($)ara a#&er!oara s! ar&era
(!r($%)e'a.
Ve#e)e !#!!! s$#& 5
-*e#e)e (oro#are (are s$#& repreze#&a&e pr!# 5 area *e#a (oro#ara : *e#a
!#&er*e#&r!($)arapos&er!oara s! !(a *e#a (oror!a)a>
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-*e#e (ar"!a(e a((esor!: s$#& (a&e*a *e#e !(!: (are se "es(+!" "!re(& !# a&r!$) "rep&.
Vas($)ar!za&!a !#!!! es&e (op)e&a&a pr!# #$eroase *ase )!%a&!(e s!
ga#g)!o#! )!%a&!(!.
? I#er*a&!a !#!!!
I#!a are o !#er*a&!e e'&r!#se(a s! o !#er*a&!e !#&r!#se(a.I#er*a&!a e'&r!#se(a
a !#!!! es&e rea)!za&a pr!# %!6re *ege&a&!*e s!pa&!(e s! paras!pa&!(e %ora#" p)e*$)
(ar"!a(. F!6re)e s!pa&!(e pro! "!# ga#g)!o#!! para *er&e6ra)! (er*!(a)! s! e'er(!&a
e%e(&e s&!$)a&oare as$pra!o(ar"$)$! s! *aso"!)!&a&oare (oro#ar!e#e. F!6re)e
paras!pa&!(e pro*!# "!# #er*!! *ag!: erzeaza pre"o!#a#& o"$)$! s!#oa&r!a) s!
a&r!o*e#&r!($)ar s! a$ (a e%e(& "!!#$area a(&!*!&a&!)or (or"$)$!.
I#&er*e#&!a !#&r!#se(a a !#!!! es&e repreze#&a&a "e
s!s&e$) e'(!&o(o#"$(&or.
? Propr!e&a&!)e $s(+!$)$! (ar"!a(
M!o(ar"$) (are "!# p$#(& "e *e"ere s&r$(&$ra) es&e $# $s(+! s&r!a&: are propr!e&a&!
(o$#e ($ $s(+! s&r!a&!: "ar s! o ser!e "e propr!e&a&! (ara(&er!s&!(e.
-R!&!(!&a&ea 8a$&oa&!s$)9 es&e propr!e&a&ea (or"$)$! "e a se
(o#&ra(&!* s$((es!*: (a $rare a !p$)s$r!)or (o#&ra(&!)e "e #o"$)$! s!#oa&r!a).
-Co#"$(&!6!)!&a&ea es&e propr!e&a&ea !o(ar"$)$!: !# spe(!a) a &es$&$)$! #o"a): "e a
(o#"$(e $#"e "e a (o#&ra(&!a "e )a #!*e)$) #o"$)$)$! s!#oa&r!a) !# !#® (or"$).
-E'(!&a6!)!&a&ea es&e propr!e&a&ea !o(ar"$)$! "e a rasp$#"e pr!#&-o (o#&ra(&!e
)a s&!$)!! a"e(*a&!.
-Co#&ra(&!)!&a&ea es&e propr!e&a&ea !o(ar"$)$! "e a se (o#&ra(&a a&$#(! (a#"
es&e s&!$)a& a"e(*a&. Co#&ra(&!!)e !o(ar"$)$! se #$es( s!s&o)e: !ar re)a'ar!)e
- "!as&o)e.
? A(&!*!&a&ea e(a#!(a a !#!!!
I#!a es&e $# orga# $s($)os: %ap& pe#&r$ (are a(&!*!&a&ea e!
es&e (ara(&er!za&a pr!# (o#&ra(&!! s! re)a'ar!: (are se s$((e" ($ reg$)ar!&a&e. Co#&ra(&!a !#!!!
se #$es&e s!s&o)a: !ar re)a'area: "!as&o)a. O s!s&o)a: !pre$#a ($ "!as&o)a (are !! $reaza
%oreaza o re*o)$&!a (ar"!a(a sa$ $# (!()$ (ar"!a(.
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Re*o)$&!a (ar"!a(a !#(epe ($ s!s&o)a a&r!a)a: (are "$reaza 7: se($#"e:
&!p !# (are sa#ge)e es&e !p!#s !# *e#&r!($)e. D$pa &er!#area s!s&o)e! a&r!a)e: a&r!!)e !#&ra
!# "!as&o)a: "!as&o)a a&r!a)a: (are "$reaza pa#a )a s!s&o)a a&r!a)a $ra&oare: a"!(a 7:2
se($#"e. I# &!p$) "!as&o)e! a&r!a)e: pres!$#ea !# a&r!! s(a"e %oar&e $)& s! sa#ge)e &re(e "!#
*e#e !# a&r!!: $p)a#"$-)e "!# #o$.I# oe#&$) !# (are !#(epe "!as&o)a a&r!a)a: !#(epe s! (o#&ra(&!a *e#&r!($)e)or:
a"!(a s!s&o)a *e#&r!($)ara: (are "$reaza 7:3 se($#"e> s!s&o)a *e#&r!($)ara "$reaza "e(!
a! $)& "e(a& (ea a&r!a)a. I# &!p$) s!s&o)e! *e#&r!($)are: "!s&!#ge o %aza !# (are
pres!$#ea sa#ge)$! "!# *e#&r!($)e (res&e
pa#a ega)eaza pres!$#ea "!# ar&ere> !# a "o$a %aza se "es(+!" *a)*$)e)e s!go!"e s! sa#ge)e
es&e !p!#s !# ar&ere. Ca#" !#(epe s!s&o)a *e#&r!($)ara: *a)*$)e)e a&r!o-*e#&r!($)are se
!#(+!" as&%e) (a sa#ge)e #$ se poa&e !#&oar(e !# a&r!!. D$pa (e se &er!#a s!s&o)a
*e#&r!($)ara: !#(epe "!as&o)a *e#&r!($)ara: (are "$reaza 7:0 se($#"e.
Da(a $rar! re*o)$&!a (ar"!a(a: (o#s&a&a (a "!# 7: se($#"e: (a& "$reaza :
!#!a: !# &o&a)!&a&e: se gases&e !# s!s&o)a 7:4 se($#"e s! !# "!as&o)a 7:4 se($#"e. A(es&
reg! !# (are a(&!*eaza !#!a #e e'p)!(a "e (e a(es&a poa&e %$#(&!o#a &oa&a *!a&a %ara sa
o6oseas(a.
B. ARBORL CIRCULATOR
Ar6ore)e (!r($)a&or es&e (o#s&!&$!& "!# *ase)e sa#g$!#e. A(es&ea s$#& &$6$r!)e !#
(are es&e !#(+!s s! pr!# (are (!r($)a sa#ge)e. !# %$#(&!e "e s&r$(&$ra s! %$#(&!!)e pe (are )e a$:s$#& &re! %e)$r! "e *ase sa#g$!#e5 ar&ere: (ap!)are s! *e#e.
!. ARTRL
Ar&ere)e s$#& *ase sa#g$!#e pr!# (are sa#ge)e (!r($)a "e )a !#!a )a orga#e. E)e por#es(
"!# *e#&r!($)e s! ra!%!(a#"$-se: se raspa#"es( )a &oa&e orga#e)e: $#"e se (ap!)ar!zeaza.
D$pa "!e#s!$#!: ar&ere)e se !par& !# &re! (a&egor!!5 ar!: !)o(!! s! !(!> (e)e a! !(!
ar&ere: (are se (o#&!#$a ($ (ap!)are: se #$es( ar&er!a)e. Ar&ere)e s$#& *ase ($ asezare
*ar!a6!)a. Ar&ere)e ar! s$#& aseza&e: !# ge#era): pro%$#" pe (a#" ar&ere)e a! !(! s$#&
s$per%!(!a)e. I# "r$$) e!: ar&era%oreaza ra$r!: (are poar&a "e#$!rea "e (o)a&era)e !ar)a (apa& %oreaza ra$r! &er!#a)e. D!%er!&e)e ar&ere po& (o$#!(a !#&re e)e pr!# ra$r!:
(are se $#es( s! %oreaza a#as&ooze.
STRUCTURA ARTRLOR
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Pere&e)e $#e! ar&ere es&e a)(a&$!& "!# &re! pa&$r! #$!&e &$#!(!.
a9 T$#!(a !#&er#a sa$ !#&!a es&e %ora&a "!#&r-$# s&ra& s$6&!re "e (e)$)e
&$r&!&e: #$!& e#"o&e)!#.
S$6 e#"o&e)!# se a%)a s&ra&$) s$6e#"o&e)!a): a)(a&$!& "!#&r-o re&ea "e %!6re e)as&!(e:
(o)age#e s! "e re&!($)!#a: !ar s$6 a(eas&a se a%)a o e6ra#a groasa s! e)as&!(a (are poar&a
"e#$!rea "e )!!&a e)as&!(a !#&er#a. Ea per!&e &re(erea p)ase! sa#g$!#e s! a g)o6$)e)or
a)6e spre &es$&$r!.
69 T$#!(a !)o(!e sa$ e"!a es&e a)(a&$!&a "!# %!6re e)as&!(e s! %!6re
$s($)are #e&e"e "!sp$se (!r($)ar. Propor&!a a(es&or "o$a &es$&$r! "ep!#"e "e
ar!ea ar&ere!: "e(! "e "epar&area "e !#!a. S&ra&$) "e &es$& e)as&!( se s$6&!aza
pe as$ra (e #e "ep)asa "e !#!a: !ar s&ra&$) $s($)ar se !#groasa ($ (a& #e
"epar&a "e !#!a. La per!%er!a &$#!(!! e"!! se a%)a o e6ra e)as&!(a: (are o separa "e
&$#!(a e'&er#a: )!!&a#&a e)as&!(a e'&er#a.
(9 T$#!(a e'&er#a sa$ a"*e#&!(ea es&e a)(a&$!&a "!# &es$& (o#$#(&!* e)as&!(
s! (a&e*a e)ee#&e $s($)are. I# &$#!(a e'&er#a a *ase)or ar! s! !)o(!! se gases(
a&r!o)e s! (ap!)are sa#g$!#e (are a$ ro)$) se +ra#eas(a pere&e)e ar&ere!.
I# &$#!(a !)o(!e s! &$#!(a e'&er#a se gases&e s! $# are #$ar "e &er!#a&!! #er*oase
*ege&a&!*e. La #!*e)$) (ap!)are)or: &$#!(a !)o(!e s! (ea e'&er#a a$ "!spar$&.
".V#L
Ve#e)e s$#& *ase sa#g$!#e (are se %oreaza pr!# (o#%)$e#&a (ap!)are)or
sa#g$!#e s! (are se &er!#a )a !#!a: !# a&r!!. Pr!# e)e sa#ge)e (!r($)a "e )a per!%er!e spre!#!a.
Ve#e)e s$#& a! #$eroase "e(a& ar&ere)e: rapor&$) #$er!( "!#&re e)e %!!#" "e
apro'!a&!* 5. I# %$#(&!e "e "!spoz!&!a )or !# orga#!s: *e#e)e s$#&5 pro%$#"e s!s$per%!(!a)e. O a)&a (ara(&er!s&!(a o %oreaza are)e #$ar "e a#as&ooze: )ega&$r! pr!#
ra$r! (o)a&era)e.I# %$#(&!e "e gros!ea )or: *e#e)e se !par& !# &re! (a&egor!!5
ar!: !)o(!! s! !(!. Ce)e a! s$6&!r! ra$r! a)e *e#e)or se #$es( *e#$)e s!
se %oreaza pr!# $#!rea (ap!)are)or.
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SRUCTURA V#LOR
D!# p$#(& "e *e"ere s&r$(&$ra): *e#e)e a$ pere&e)e a! s$6&!re s! a! p$&!#
rez!s&e#& "e(a& ar&ere)e s!: "!# a(es& o&!*: !# se(&!$#ea &ras*ersa)a: (o#&$r$) *e#e)or es&e
o*a): &$r&!&:!# &!p (e ar&ere)e a$ $# (o#&$r (!r($)ar: reg$)a&.
Pere&e)e $#e! *e#e es&e %ora& "!# &re! &$#!(!5
a9 T$#!(a !#&er#a sa$ e#"o*e#a es&e %ora&a "!#&r-$# e#"o&e)!#: (are (ap&$ses&e
)$e#$) *e#e! s! are a(e!as! s&r$(&$ra (a s! e#"o&e)!$) (ap!)are)or: s! "!#&r-$# s&ra&
(o#$#(&!* e)as&!(: aseza& !# $r$) e#"o&e)!$)$!: (are (o#&!#e %!6re e)as&!(e: "!sp$se !#
%ora "e re&ea.T$#!(a !#&er#a %oreaza !# !#&er!or$) $#or *e#e #!s&e p)!$r! se!)$#are: #$!&e
*a)*$)e *e#oase. Va)*$)e)e *e#oase se gases( #$a! !# *e#e)e !# (are sa#ge)e (!r($)a "eos !# s$s. S! se #$es( *e#e *a)*$)are.Ve#e)e (are #$ a$ *a)*$)e poar&a "e#$!rea "e
*e#e a*a)*$)are.
69 T$#!(a !)o(!e sa$ ezo*e#a es&e a! s$6&!re "e(a& &$#!(a !)o(!e a ar&ere)or
s! are o s&r$(&$ra *ar!a&a.Ea es&e %ora&a "!# &es$& (o#$#(&!*: !# (are s$#& ($pr!#se s!
%!6re $s($)are.Tes$&$) (o#$#(&!* (o#&!#e %!6re (o#$#(&!*e s! %!6re e)as&!(e: ($ "!spoz!&!e
s! propor&!! %oar&e *ar!a&e.
(9 T$#!(a e'&er#a sa$ per!*e#a es&e a! groasa "e(a& &$#!(a !)o(!e s! es&e
(o#s&!&$!&a &o& "!# &es$&$) (o#$#(&!* )a': !# (are se gases(: pe )a#ga %!6re (o#$#(&!*e s!e)as&!(e: s! e)ee#&e $s($)are> "e o6!(e! : &es$&$) (o#$#(&!* a) ezo*e#e! se gases&e !#
(o#&!#$area &es$&$)$! (o#$#(&!* a) per!*e#e!: %ara o )!!&a "!s&!#(&a.
S&r$(&$ra pere&e)$! s! !# spe(!a) s&r$(&$ra &$#!(!! !)o(!! *ar!aza ($ "!%er!&e)e
&!p$r! "e *e#e 5 -*e#e %!6roase: %!6roe)as&!(e s! *e#e $s($)oase.
Ve#e)e $s($)oase s$#& *e#e !(!: aseza&e "epar&e "e !#!a: ($ s$#& *e#e)e
e6re)or.
$. VASL LI %ATIC
Vase)e )!%a&!(e se %oreaza pr!# (o#%)$e#&a (ap!)are)or "a#" #os&!# *ase)or
)!%a&!(e !(!:(are: pr!# (o#%)$e#&a: %oreaza *ase )!%a&!(e ar!: !ar a(eas&a "a$ #as&ere:
)a ra#"$) )or: )a &r$#(+!$r! )!%a&!(e: (are (o$#!(a ($ s!s&e$) *as($)ar sa#g$!#.
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S&r$(&$ra):*ase)e )!%a&!(e s$#& asea&oare ($ *e#e)e: "oar (a !# ge#era) s$#& a!
s$6&!r! "e(a& *e#e)e.
?CIRCULATIA SA#&UI#A SIST ATICA
C!r($)a&!a s!s&ea&!(a as!g$ra &ra#spor&$) sa#ge)$! "e )a !#!a spre orga#e s!
&ese&$r! pr!# s!s&e$) ar&er!a) s! (ap!)ar: !ar re!#&oa&(erea )a !#!a: pr!# s!s&e$) *e#os.
C!r($)a&!a s!s&ea&!(a !#(epe !# *e#&r!($)$) s&a#g: "e $#"e p)ea(a ar&era:
aor&a: "!# (are se "espr!#" apo! &oa&e ar&ere)e ar! -ar&ere-ar&er!o)e- (ap!)are apo! pr!#
*e#e)e-*e#e-*e#e)e-a&r!$) "rep&.
? CIRCULATIA PULMONARA
C!r($)a&!a p$)o#ara es&e ($p)a&a !# ser!e ($ (ea s!s&ea&!(a:sa#ge)e "!#*e#&r!($)$) "rep& %!!#" prop$)sa& pr!# ar&era p$)o#ara spre p)aa#!: $#"e are )o( s(+!6$)
"e gaze: "$pa (are re*!#e pr!# *e#e)e p$)o#are !# a&r!$) s&a#g.
? CIRCULATIA LIMFATICA
C!r($)a&!a )!%a&!(a es&e o (a)e "er!*a&a a ar!! (!r($)a&!!: pr!# (are re!#&ra !# *e#e o
par&e "!# )!(+!"e)e !#&ers&!&!a)e. S!!)ar (!r($)a&!e! sa#g*!#e: (!r($)a&!a )!%a&!(a are )o( !#(a"r$) $#$! s!s&e *as($)ar !#(+!s: (are !#(epe "!# &es$&$r!: pr!# (ap!)are !#(+!se: se
(o)e(&eaza apo! !# *ase "!# (e !# (e a! ar!: s!: !# %!#a):
%oreaza "o$a (o)e(&oare )!%a&!(e ar!: (are se "esa(+!" !# *e#e)e s$6()a*!(
$)are.
C.R&LARA ACTIVITATII
CAR'IOVASCULAR
Reg)area a(&!*!&a&!! !#!!! se %a(e pr!# e(a#!se !#&r!#se(! s! e'&r!#se(!. 1
Re!larea prin mecanisme intrinseci
O reg)are a a(&!*!&a&!! (ar"!a(e se o6ser*a s! )a !#!a s(oasa "!# orga#!s: )!ps!&a
"e(! "e !#%)$e#&e #er*oase s! !ora)e.
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"Re!larea prin e(a#!se e'&r!#se(!
Reg)area a(&!*!&a&!! (ar"!a(e se %a(e !# spe(!a) pe (a)e re%)e'a s! $ora)a5
a9 Reg)area re%)e'a
Se s&!e (a !#!a es&e !#er*a&a "e %!6re)e s!pa&!(e s!
%!6re paras!pa&!(e.F!6re)e s!pa&!(e s$#& pos&ga#g)!o#are s! pro*!# "!#
p)e'$) (ar"!a(.F!6re)e paras!pa&!(e pro*!# "!# #er*$) *ag s! s$#& %!6re preerga&oare.
A(es&! #er*! a$ a(&!$#e a$&ogo#!s&a as$pra !#!!!.S!pa&!($)
a((e)ereaza (o#&ra(&!!)e (ar"!a(e s! ares&e !#&e#s!&a&ea: pe (a#"
paras!pa&!($)8*ag$)9 !#(e&!#es&e r!&$) (o#&ra(&!!)or (ar"!a(e s! s(a"e !#&e#s!&a&ea )or.
A(&!*!&a&ea (ar"!a(a es&e !#%)$e#&a&a s! "e a(&!*!&a&ea s(oar&e! (ere6ra)e.
Es&e s&!$& (a s&ar!)e eo&!o#a)e po& pro*o(a o"!%!(area a(&!*!&a&!! (ar"!a(e 5 %r!(a: a#!a:6$($r!a e&(. po& "e&er!#a o a((e)erare a (o#&ra(&!!)or (ar"!a(e.
69 Reg)area $ora)a
A(&!*!&a&ea !#!!! es&e (oor"o#a&a s! pe (a)ea $ora)a: a"!(a pr!# a(&!$#ea
$#or s$6s&a#&e pe (are )e pro"$( "!%er!&e orga#e s! pe (are sa#ge)e )e a"$(e )a
!#!a.D!#&re a(es&e s$6s&a#&e: (e)e a! !por&a#&e s$#& +oro#!!.De e'ep)$
a"re#a)!#a:+oro#$) e"$)os$prare#a)e!: pro*oa(a o !#&e#s!%!(are s! o a((e)erare a
(o#&ra(&!!)or (ar"!a(e 8o6!s#$!& (a#&!&a&ea "e a"re#a)!#a "!# sa#ge es&e re"$sa9. A(eeas!
a(&!$#e o are s! &!ro'!#a: "e a(eea !# +!per&ero!"!s se pro"$(e o a((e)erare a r!&$)$!(ar"!a(. A(e&!)(o)!#a: pro"$s a) s!s&e$)$!#er*os paras!pa&!(: are o a(&!$#e !#*ersa
a"re#a)!#e!. S! "!%er!&e)e sar$r! (are !#&ra !# (opoz!&!a p)ase! a$ a(&!$#e as$pra
a(&!*!&a&!! (ar"!a(e. Ipor&a#&e "!# a(es& p$#(& "e *e"ere s$#& sar$r!)e "e (a)(!$: (are
a((e)ereaza r!&$) (ar"!(: s! ar$r!)e "e po&as!$: (are !#(e&!#es( r!&$) (ar"!(. Da&or!&a
reg)ar!! re%)e'e s! reg)ar!! $ora)e se pro"$(e o a"ap&are %!#a a &ra*a)!$)$! (ar"!a( )a
#e*o!)e orga#!s$)$!.
(I)RT#SIU#A ARTRIALA
Definitie: +!per&e#s!$#ea ar&er!a)a es&e $# s!#"ro (ara(&er!za& pr!# (res&erea
pres!$#!! s!s&o)!(e s! a (e)e! "!as&o)!(e pes&e *a)or!)e #ora)e. D$pa OMS se (o#s!"era
*a)or! #ora)e pe#&r$ pres!$#ea a'!a 47-17 /g: !#&erpre&a&e !# rapor& ($
*ars&a: se'$) s! gre$&a&ea: !ar pe#&r$ !#!a 7-0 /g.
Clasificare: !# %$#(&!e "e e&o)og!e se "eose6es(
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a9 /TA ese#&!a)a !# (are #$ se poa&e e*!"e#&!a o (a$za orga#!(a
69 /TA se($#"ara sa$ s!p&oa&!(a !# (are es&e "o*e"!&a (a$za se
"eose6es( +!per&e#s!$#! se($#"are 5 re#a)e: e#"o(r!#e: #e$roge#e s!
(ar"!o*as($)are.
/TA es&e $#a "!#&re (e)e a! raspa#"!&e 6o)!.Pres!$#ea ar&er!a)a poa&e (res&e %!e
pr!# ar!rea "e6!&$)$!: %!e pr!# (res&erea rez!s&e#&e!.Ce)e a! $)&e +!per&e#s!$#! a$ )a 6aza
(res&erea rez!s&e#&e! per!%er!(e 8+!per&e#s!$#ea ese#&!a)a: re#o).9.
I#!&!a):pro(es$) es&e %$#(&!o#a)-*aso(o#s&r$(&!e-apo! )ez!$#! orga#!(e (are
pera#e#&!zeaza +!per&e#s!$#ea ar&er!a)a. !# (eea (e pr!*es&e %a(&or!! (are rea)!zeaza
*aso(o#s&r$(&!a ar&er!a)a: se a(or"a $# ro) !por&a#& s!s&e$)$! #er*os (e#&ra): s!s&e$)$!
+!po%!zo-s$prare#a) s! +!per rea(&!*!&a&!! *as($)are.!# e*o)$&!a +!per&e#s!$#!! ar&er!a)e:"$pa
a! $)&! a#! "e e*o)$&!e apo! )ez!$#! orga#!(e "e a&eros()eroza: (are agra*eaza &$)6$rar!)e.
a9/TA ese#&!a)a 5 pr!# (are se !#&e)ege or!(e s!#"ro ()!#!( +!per&e#s!*: !# (are
*a)or!)e pres!$#!! ar&er!a)e s$#& (res($&e: !# a6se#&a $#e! (a$ze orga#!(e. Se a!
#$es&e s! 6oa)a +!per&e#s!*a.Es&e (ea a! %re(*e#&a: repreze#&a#" 7-7 = "!# &o&a)$)
+!per&e#s!$#!)or: s! apare "e o6!(e! "$pa 37 "e a#!: ($ $# a'!$ "e %re(*e#&a !#&re 47 s!
07 "e a#!. I#(!"e#&a es&e a! are )a %ee!e: "ar %ore)e a! gra*e apar )a 6ar6ar&!.
Me#opa$za s! o6ez!&a&ea s$#& %a(&or! %a*or!za#&!: )a %e) *!a&a !#(or"a&a: s&resa#&a s!
ere"!&a&ea. Ere"!&a&ea ar $(a $# ro) %oar&e !por&a#&: a%e(&!$#ea !#&a)#!#"$-se !# propor&!e
"e 7-7= 8"$pa "!%er!&e s&a&!s&!(!9 !# a#&e(e"e#&e)e %a!)!a)e a)e 6o#)a*!)or. Ceea (e se&ra#s!&e ar (o#s&a !#&r-o &$)6$rare a e&a6o)!s$)$! (a&e(o)a!#e)or 8a"re#a)!#a
s! #oa"re)!#a9: (are ar s&a )a 6aza *aso(o#s&r$(&!e! ar&er!a)e. Se pare (a s!a)!e#&a&!a
6oga&a ar $(a $# ro).
69/TA s!p&oa&!(e5
o "e (a$za re#a)a. D!# a(es&e gr$pe %a( par&e5
-+!per&e#s!$#!)e re#o-*as($)are 8a#oa)!! (o#ge#!&a)e a)e *ase)or re#a)e
-s&e#oze: a#e*r!se- &ro6oze : e6o)!! 9: +!pe.
-+!per&e#s!$#!)e "!# 6o)!)e pare#(+!$)$! re#a) 8g)aer#)a#e%!&a a($&a s! (ro#!(a:
)ez!$#! re#a)e "!# "!a6e&: p!e)o#e%!&e)e e&(9.
I# apar!&!a +!per&e#s!$#!! re#a)e: ro)$) pr!#(!pa) es&e "e&!#$& "e o e#z!a (are !a
#as&ere !# r!#!(+!$) !s(+e!( 8($ (!r($)a&!e !#s$%!(!e#&a 9 s! (are se #$es&e re#!#a.
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A(eas&a se &ra#s%ora !# sa#ge !#&r-o s$6s&a#&a +!per&e#s!*a #$!&a a#g!o&e#s!*a. E
!por&a#&a pre(!zarea e&!o)og!e! re#a)e "eoare(e $#e)e %ore s$#& s$spe(&!6!)e "e
!#&er*e#&!e (+!r$rg!(a)a 8+!per&e#s!$#ea re#o-*as($)ara: $#e)e p!e)o#e%!&e9>
-&ra&ae#&$) se a"reseaza a&a& 6o)!! "e 6aza: (a& s! +!per&e#s!$#!! ar&er!a)e.
o "e (a$za e#"o(r!#a . D!# a(e)as! gr$p %a( par&e 5
- %eo(roa(!&o$) - o &$oare )o(a)!za&a !# e"$)ara g)a#"e! s$prare#a)e:
(ara(&er!za&a pr!# (r!ze paro'!s&!(e "e +!per&e#s!$#! "a&ora&e "es(ar(ar!! !#
(!r($)a&!e "e (a&e(o)a!#e8 a"re)!#a s! #ora"re)!#a9> &ra&ae#&$) es&e (+!r$rg!(a)>
- +!pera)"os&ero#!s$) pr!ar 8 a"e#o (or&!(os$prare#a) ($ se(re&!e e'es!*a "e
a)"os&ero#9>
- s!#"ro C$s+!#g: "a&ora& $#e! &$or! (or&!(os$prare#a)e sa$ +!po%!zare (are se
(ara(&er!zeaza pr!# +!per&e#s!$#e: o6ez!&a&e: *erge&$r!: +!rs$&!s s! (res&erea
e)!!#ar!! $rare a 2- (e&os&ero!z!)or > &ra&ae#&$) es&e (+!r$rg!(a).
- +!per&e#s!$#! e#"o(r!#e: a! apar !# +!per&!(or"!s: !# ($rs$) sar(!#!!> !# ($rs$)
pr!e! sar(!#! poa&e aparea o +!per&e#s!$#e re*ers!6!)a: re(!"!*a#" e*e#&$a) ($
%!e(are #o$a sar(!#a : a)&eor! : gra*!"!&a&ea agra*eaza o +!per&e#s!$#e ar&er!a)a
pree'!s&e#&a: "e a)&a #a&$ra.
"e (a$za #e$roge#a
!# 6o)! &ra$a&!(e: &$ora)e sa$ !#%)aa&or!! a)e (re!er$)$! (are "$( )a o (res&ere
a pres!$#!! !#&ra(ra#!e#e sa$ !# (az "e )ez!$#! a)e (e#&r!)or *asoo&or! se o6ser*a: $#eor!
s! (res&erea &e#s!$#!! ar&er!)e.
o "e (a$za (ar"!o*as($)ara5
,o)!)e !#so&!&e "e +!per&e#s!$#e ar&er!a)a s$#&5
- (oar&a(&!a aor&!(a
-6)o($) (op)e&
- !#s$%!(!e#&a aor&!(a
- a&eros()eroza.
Etiopatogenie:Maor!&a&ea a$&or!)or a((ep&a as&az! (o#(ep&!a #er*!s&a:
po&r!*!& (are!a pre"!spoz!&!a ere"!&ara es&e "e #a&$ra #e$roge#a : )ega&a "e o a#$!&a
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s&r$(&$ra a perso#a)!&a&!! s! "e o a#$!&a o"a)!&a&e "e rasp$#s )a s!&$a&!!)e "e s&ress 5
"$rere: %r!(a: s$parare.,oa)a ar %! ese#&!a) #er*oasa: pro"$sa "e o &$)6$rare !# a(&!*!&a&ea
(e#&r!)or #er*os! s$per!or!. D!%er!&! e'(!&a#&! "!# s%era ps!+oeo&!o#a)a8 #e(az$r!: gr!! :
#es!g$ra#&a 9: a(&!o#a#" pe %o#"$) $#e! pre"!spoz!&!! ere"!&are: "$( )a apar!&!a $#or %o(are
"e e'(!&a&!e pera#e#&a )a #!*e)$) s(oar&e! (ere6ra)e: "e&er!#a#" se($#"ar o *as($)a&!ear&er!a)a. I# )a#&$)
pa&oge#!( a) +!per&e#s!$#!! a! !#&er*!# &o& pr!# !#&ere"!$) s(oar&e! - s!s&e$) e#"o(r!# s!
r!#!(+!$).
Mo"!%!(ar!)e %$#"ae#&a)e )o(a)e (are s&a$ )a 6aza +!per&e#s!$#!!
s$#& *aso(o#s&r$(&!a ar&er!a)a s! (res&erea (o#&!#$&$)$! pere&e)$! ar&er!a) !# apa
s! sare.Ma! &arz!$ apar )ez!$#! orga#!(e s! a&ers)eza: (are gra6es( e*o)$&!a s! !#&$#e(a
prog#os&!($) pr!# (op)!(a&!!.
Fiziopatologia hipertensiunii arteriale
Pe#&r$ pra(&!(a ()!#!(a s! pa&o)og!(a: !por&a#&a es&e #$ a&a& *a)oarea (!%r!(a a
(res&er!! &e#s!o#a)e (a& (o#se(!#&a *as($)ara s! +eo"!#a!(a a a(es&!a.
Re)a&!a "!#&re +!per&e#s!$#e s! pa&o)og!a *as($)ara es&e 6!#e($#os($&a: !6ra(a#"
!# are $ra&oare)e aspe(&e 5
- +!per&e#s!$#ea ar&er!a)a : !# a%ara %ap&$)$! (a es&e $# %a(&or "e r!s( pe#&r$a&eros"eroza: poa&e pre(!p!&a s! agra*a e*o)$&!a a(es&e!a >
- +!per&e#s!$#ea ar&er!a)a !#()$"e o"!%!(ar! o"!%!(ar! ar&er!o)are spe(!%!(e -
ar&er!"opa&!a +!per&e#s!*a.
U)&!$) aspe(& re&!#e a&e#&!a !# o" "eose6!& a&a& pr!# e(a#!se)e sa)e "e
pro"$(ere (a& s! pr!# (o#se(!#&e)e as$pra e*o)$&!e! +!per&e#s!$#!! ar&er!a)e. E'!s&a "o$a
%ore "!s&!#(&e "e ar&er!"opa&!! +!per&e#s!*e5 ar&er!)os()eroza s! #e(roza %!6r!#o!"a a
e"!e! ar&er!o)are .
Ar&er!o)os(re)oza (o#s&a !# !#grosarea s! : $)&er!or : !# +!a)!#!zarea ar&er!o)e)or :%e#oe#$) para#" sa "e6$&eze s$6e#"o&e)!a): ($ pr!#"ere progres!*a a e"!e!. I#
pa&o)oge#eza +!a)!#$)$! s$#& !p)!(a&e +!perpro"$(&!a "e (o)age# ar&er!ar: "ege#erarea
e6re)or 6aza)e:e's$"a&!a p)asa&!(a ($ "ep$#ere "e %!6r!#a s! "ege#eres(e#&a
$s($)a&$r!! #e&e"e.Lez!$#!)e "e ar&er!o)os(re)oza s$#& par(e)are> !#&ereseaza ($
pre(a"ere r!#!(+!$) s! (o#s&!&$!e s$6s&ra&$) asa#$!&e! #e%roa#g!os(re)oze! 6e#!g#e:
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"e !#*a)$!re !# /TA ese#&!a)a. Soers& (o#s&a&a (a )ez!$#!)e "e ar&er!o)os(re)oza
e*o)$eaza !# a! $)&e s&a"!!5 spas a) (e)$)e)or $s($)are "!# e"!a ar&er!o)e! a%ere#&e:
!#grosare a pere&e)$! *as($)ar "a&or!&a e"e$)$!: +!per&ro%!e a (e)$)e)or $s($)are:
"ege#eres(e#&a #!a)#!a a pere&e)$! ar&er!o)ar ($ !#g$s&area )$e#$)$! *as($)ar. Ne(roza
%!6r!#o!"a ar&er!o)ara (o#s&!&$!e ar(a or%o)og!(a a /TA a)!g#e. Se (ara(&er!zeaza pr!#r$p&$r! a)e %!6re)or $s($)are #e&e"e "!# e"!a ar&er!o)ara: e'$"a&!a p)asa&!(a e#ora !#
pere&e)e *as($)ar: rea(&!e !#%)aa&or!e e'$"a&!*a s! p)or!%era&!*a !# a"*e#&!(e ($ o6)!&erare
sa$ s&e#ozare (o#se($&!*a a #$e#$)$! ar&er!o)ar. Ar&er!o)a (apa&a $# aspe(& 6!zar:
o#!)o%or: a*a#" zo#e "!)a&a&e (are a)&er#eaza ($ a)&e)e s&ra&ora&e. Lez!$#!)e
a%e(&eaza !# as$ra"!%er!&a r!#!(+!$): pa#(reas$): s$prare#a)e)e: !#&es&!#$): (re!er$): (or"$)
s! %!(a&$). La #!*e)$) r!#!(+!$)$!: )ez!$#!)e ar&er!a)e se s!s&ea&!zeaza: %!!#" repreze#&a&e
"e e#"or&er!&a pro)!%era&!*a: ar&er!o)!&a #e(roza#&a g)oer$)!&a #e(roza#&a.
Pa&oge#!a )ez!$#!)or ar&er!a)e es&e (op)e'a s! "oar par&!a) ($#os($&a: a! a)es !#
(eea (epr!*es&e se(*e#&!a)!&a&ea e*e#!e#&e)or o6!"e. I#&er*e#&!a e(a#!s$)$! re#!#a-
a#g!o&e#s!*a: +!perse(re&!a "e !#era)(or&!(orz! s! (a&e(o)a!"e: e'(es$) "e Na:
(o#s&!&$!e e)ee#&e)e pa&oge#!(e pr!#(!pa)e (are s&a$ )a 6aza *as($)oze! p)asa&!(e: a
"ep$#er!! "e %!6r!#o!" !# e"!a ar&er!o)ara s! a #e(roze)or ar&er!o)are.
A#ATO IA )ATOLO&ICA
/TA e#&!&a&e #oso)og!(a !#"!*!"$a)!za&a pe (r!&er!! %!z!o)og!(e: #$ are $#
e(+!*a)e#& a#a&o!(. I# ($rs$) e*o)$&!e! sa)e apar $)&!p)e aspe(&e or%o)og!(e: !#%$#(&!e "e s&a"!$) 6o)!!: "e rap!"!&a&ea !#s&a)ar!! e!: "e !#&e#s!&a&ea &$)6$rar!)or %$#(&!o#a)e s!
"e gra"$) "e !#&eresare a "!%er!&e)or orga#e !# pro(es$) pa&o)og!(.
Te#"!#&a *e(+e "e a !"e#&!%!(a +!per&e#s!$#ea ($ o"!%!(ar!)e s&r$(&$ra)e a
%a($& "!%!(!)a ($#oas&erea ro)$)$! $(a& "e ar&er!o)e *as($)are orga#!(e !# !s&or!a
#a&$ra)a a 6o)!!. I#&r-a"e*ar /TA s! "egra"ar!)e or%o)og!(e #$ s$#& #eapara& "o$a
aspe(&e "!%er!&e a)e$#$!a s! a(e)$!as! pro(es. Mar!ea &e#s!$#!! s! gra"$)
ar&er!os(re)oze! #$ s$#& )ega&e !#&re e)e pr!# )ega&$r! a&ea&!(e: "e (a$za )a e%e(&.
I#&re !por&a#&a )ez!$#!)or s! gra*!&a&ea a#!%es&ar!)or )or (+!!(e: "e asee#ea: #$e'!s&a o propor&!o#a)!&a&e s&r!(&a. M$)&e "!#&re aspe(&e)e )ez!o#a)e (o#s&a&a&e #$ a$ #!!(
(ara(&er!s&!( !#&re e)e s!: a! $)& (+!ar: (ea a! are par&e "!#&re (op)!(a&!!)e 6o)!! po&
%! (ore)a&e a! "e gra6a ($ pro(ese)e ar&eros(re)o&!(e a((e#&$a&e "e +!per&e#s!$#e: "e(a&
($ !#s$s! /TA. M$)&e a)&e )ez!$#!: "e asee#ea: #$ se "eose6es( "e "ege#erar!)e ar&er!a)e
)ega&e "e pro(es$) "e se#es(e#&a: !#"!%ere#& "e (!%re)e &e#s!o#a)e. I#ge#era): )!pses(
s&$"!! "e are a#*erg$ra: 6aza&e pe (r!&er!! $#!&are: 6!#e pre(!za&e: (are sa (a$&e sa
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s&a6!)eas(a o (ore)a&!e s&r!(&a : (opara&!*a: !#&re &!p$) s! gra"$) $#or a#$!&e )ez!$#!: pe
"e o par&e: s! gr$pa "e *ars&a: se'$): (!%ra &e#s!o#a)a: *e(+!ea s! *!&eza e*o)$&!e! 6o)!!: pe
"e a)&a.
De a(eea s$#&e a! $)& sa$ a! p$&!# s!)!&! sa #e )!!&a )a o e'p$#era
(a&agra%!(a a &!p$r!)or "e )ez!$#! !#&a)#!&e !# a(eas&a 6oa)a s! sa %a(e #$a! pres$p$#er!(are "!#&re o"!%!(ar!)e "ege#era&!*e (e a)(a&$!es( ar&er!os(re)oza s$#& )ega&e "e o
&e#s!$#e are.
Tere#$) a#a&o!( ge#er!( "e ar&er!os(re)oza: ($pr!#za#" &o&a)!&a&ea )ez!$#!)or
"ege#era&!*e a)e ar&ere)or: #$ !#sea#a #!!( a! $)& "e(a& !#"$ra&!e a ar&ere)or.
S$6 a(es& &ere# se ($pr!#" &re! gr$pe "e )ez!$#!5
. Me"!o(a)(oza -pro(es "ege#era&!* (are !#&ereseaza e"!a ar&ere)or !)o(!!:
!#&eresa#& "!# p$#(& "e *e"ere a#a&o!(: "ar )!ps!& "e
(o#se(!#&e %$#(&!o#a)e s! (+!!(e se#!%!(a&!*e.
.A&eros(re)oza -pro(es *as($)ar o6s&r$(&!*: "a&or!&a (o#s&!&$!r!! p)a(!)or
"e ar&ero !# !#!a ar&ere)or$s($)oe)as&!(e "e ar!e
!)o(!e: ($ #e(roze: +eorag!!:%!6roza s! (a)(!%!(are.
3. Ar&er!o)os(re)oza -(ara(&er!za&a pr!# +!perp)az!e e#"o&e)!a)a: ($
!#grosare s! +!a)!#!zare a !#&!e! s! +!per&ro%!a $s($)araa ar&er!o)e)or.
Pr!e)e "o$a &!p$r! )ez!o#a)e a%e(&eaza ar&ere)e ar!: ar&ere ($ $# s&ra& !)o(!$
6oga& !# &es$& e)as&!(. A) &re!)ea &!p )ez!o#ar ($pr!#"e ar&ere)e !(! s! ar&er!o)e)e: e)ee#&e
6oga&e !# &es$& $s($)ar: ($ %$#(&!!)e ese#&!a)e !# (o#&ro)area rez!s&e#&e!.
Pro(ese)e pa&o)og!(e: (are "$( )a "ege#erarea %!6re)or per!%er!(e e)as&!(e "!#
e"!a aor&e! s! "!# e"!a ar&ere)or ar!: (res( pres!$#ea p$)s$)$! s! "$( )a o +!per&e#s!$#e
e'()$s!* s!s&o)!(a. I# par&e: a(es&e pro(ese s$#& !# %$#(&!e "e *ars&a.
R!"!(ar!)e a&a& a)e pres!$#!! s!s&o)!(e: (a& s! (e)e! "!as&o)!(e s$#& )ega&e !# pr!$) ra#" "e
o"!%!(ar!)e: %$#(&!o#a)e sa$ s&r$(&$ra)e: "!# ar&ere)e !(!: $s($)are.
'IAOSTICUL (TA SI VALUAR
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/TA %!!#" o 6oa)a "e %re(*e#&a (res($&a !# pop$)a&!a ge#era)a: a"e*ara&e)e
pro6)ee pe (are )e p$#e s$#& (e)e a)e "ep!s&ar!! sa)e !# asa s! #$ (e)e a)e s&a6!)!r!!
"!ag#os&!($)$! )a #!*e) !#"!*!"$a). De a(eea pop$)a&!a &re6$!e sa %!e a*!za&a s! sa spr!!#e
e%or&$) e"!(o-sa#!&ar "e "ep!s&are a(&!*a a 6o)!!. Spr!!#$) (e) a! "!re(& es&e
a&er!a)!za& pr!# preze#&area )a a(&!$#!)e "e "ep!s&are a /TA pe "e o par&e: !ar pe "e a)&apar&e: pr!# e%e(&$area (o#s&!!#(!oasa a e'a!#ar!! e"!(a)e !p$se ($ "!*erse pr!)e$r!
8a#gaar! !# $#(a: a"!&ere !# !#*a&aa#&$) s$per!or: e'ae#e pe#&r$ per!s "e
(o#"$(ere a$&o: e.&.(9. I# %o#": pro6)ea (e#&ra)a a "!ag#os&!($)$! !#"!*!"$a) a) /TA
es&e )ega&a "e *a)oarea (!%re! &e#s!o#a)e.
I# %e)$) a(es&a as$rarea TA "e*!#e !)o($) ese#&!a) "e "!ag#os&!(.
As!s&e#&e! e"!(a)e: s! !# spe(!a) (e)e! (are )$(reaza !# (o$#!&a&!: !! re*!#e $#
ro) !#se#a& !# "ep!s&area +!per&e#s!*!)or pr!# pr!sa %ap&$)$! (a ea es&e (ea (areasoara TA: "ar a! a)es pr!# #a&$ra $#(!! sa)e (are-! per!&e sa ($)eaga a! $)&e
!#%ora&!! "espre pa(!e#& s! e"!$) sa$. Sa #$ $!&a (a $#eor! *a)or!)e (res($&e: pes&e
)!!&a: a)e TA #$ !#"!(a #eapara& o +!per&e#s!$#e ar&er!a)a (! se po& "a&ora $#or %a(&or! "e
e"!$. De a(eea (o#&e'&$) !# (are se !#reg!s&reaza a(es&e *a)or! es&e %oar&e !#por&a#&. De
asee#ea AM &r6$!e sa s&apa#eas(a %oar&e 6!#e &e+#!(a as$rar!! &e#s!$#!! ar&er!a)e s&!$&
%!!#" %ap&$) (a as$rarea !#(ore(&a "$(e )a *a)or! ero#a&e.
Ce &re6$!e sa %a(a pa(!e#&$) (ar$!a )a o e'a!#are e"!(a)a ! s-a gas!& (res($&a
TA Rasp$#s$) *a &re6$! sa &!#a seaa "e (!%ra TA s! *ars&a persoa#e! !# (a$za. As&%e):pe#&r$ a"$)&!: !#"!%ere#& "e *ars&a: "es(oper!rea $#e! TA" ega)a sa$ a! are "e 77
/g &re6$!e sa %!e $ra&a "e preze#&area )a e"!( pe#&r$ !#*es&!ga&!!)e "e r$&!#a s!
pres(r!erea &ra&ae#&$)$!.
D$pa "es(oper!rea s! (o#%!rarea +!per&e#s!$#!! ar&er!a)e es&e #e(esar sa se
e%e(&$eze pe#&r$ %!e(are 6o)#a* $# 6!)a#& ()!#!(o-6!o)og!( !# s(op$) !#"!*!"$a)!zar!!
"!ag#os&!($)$! s! e*e#&$a) a) gas!r!! $#e! e&!o)og!! a +!per&e#s!$#!!. E%or&$) "!ag#os&!(
*a %! )!!&a& )a $# !#! (o#()$"e#& "e "a&e: !# asa %e) !#(a& sa se poa&a e*!"e#&!a5
-se*er!&a&ea 6o)!!
-gra"$) "e a%e(&are (ar"!o*as($)ara
-(oe'!s&e#&a a)&or %a(&or! "e r!s( pe#&r$ a&eros(re)oza
-$# pos!6!) %a(&or e&!o)og!(
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-e)ee#&e or!e#&a&!*e pe#&r$ prog#os&!( s! &ra&ae#&
/!per&e#s!*$) es&e pr!# e'(e)e#&a $# 6o)#a* a6$)a&or: !#&er#area sa !# sp!&a)
#e%!!#" !#"!(a&a "e(a& !# (a&e*a s!&$a&!! s! a#$e5
H Persoa#e)e &!#ere 8s$6 47 "e a#!9 ($ /TA o"era&a sa$ se*era>
H Persoa#e)e ($ TAs a! are sa$ ega)a ($ 47 /g s!sa$ TA" a!
are sa$ ega)a ($ 7 /g>
H ,o)#a*!! )a (are se s$sp!(!o#eaza ()!#!( o %ora "e /TA se($#"ara>
H I#"!*!z!! ($ /TA rez!s&e#&a )a &ra&ae#&>
H /!per&e#s!*!! a (aror /TA 6a#a)a !s! o"!%!(a 6r$s( ($rs$) e*o)$&!*
8e%e(&e a"*erse aore a)e e"!(a&!e! a$&!+!per&e#s!*e: !#s&a)area rez!s&e#&e!
)a &ra&ae#&: apar!&!a $#or (op)!(a&!!: e.&.(9>
H ,o)#a*!! )a (are /TA se aso(!aza ($ a)&e a%e(&!$#! (ro#!(e 8e&a6o)!(e:
(ar"!o*as($)are: p$)o#are: e.&.(.9 (are a%e(&eaza prog#os&!($) s!
&ra&ae#&$).
A6or"area $#$! 6o)#a* +!per&e#s!* *a !#(epe !# o" o6)!ga&or ($ o a#a#eza
a&e#&a: $# e'ae# ()!#!( (op)e& s! o !#*es&!ga&!e para()!#!(a "e r$&!#a: s&r!(& #e(esara.
a9 ANAMNEZA
As!s&e#&a e"!(a)a %!!#" pr!a (are !#&ra !# (o#&a(& ($ pa(!e#&$) 8"e (e)e a!
$)&e or!9 &re6$!e sa (o#"$(a "!s($&!a as&%e) !#(a& sa poa&a pro($ra $ra&oare)e "a&e5
"e6re&$) apro'!a&!* sa$ s!g$r a) /TA: s!p&oe)e "e "e6$& sa$ (e)e pe#&r$ (are se
a"reseaza e"!($)$!: sa or!e#&eze s! sa !erar+!zeze !#*es&!ga&!!)e para()!#!(e pe#&r$
s&a6!)!rea e&!o)og!(a a /TA s! a (ara(&er$)$! sa$ e*o)$&!*: sa e%e(&$eze $# 6!)a#& or!e#&a&!*
pr!*!#" r!s($) (ar"!o*as($)ar: 6o)!)easo(!a&e s! e*e&$a)e)e (o#"!&!! "e e"!$ %a*or!za#&e
pe#&r$ (res&erea *a)or!)or TA. A#o#eza 6o)#a*$)$! ($ /TA es&e e&apa !#!&!a)a s!
!#"!spe#sa6!)a s&a6!)!r!! "e6$&$)$! +!per&e#s!$#!!.I#&eroga&or!$) pre(!zeaza $#e)e &$)6$rar! %$#(&!o#a)e (o$#e &$&$ror %ore)or "e
/TA s! a#$e5
-(e%a)ee -se#a)a&a !#"eose6! "!!#ea&a !#a!#&e "e s($)are> are se"!$) (er*!(o-o((!p!&a)
sa$ se prez!#&a (a o +e!(ra#!e pre"o!#a#& preor6!&ara: a)&eor! es&e p$)sa&!)a: !#so&!&a sa$
pre(e"a&a "e &$)6$rar! *!z$a)e sa$ "!ges&!*e> 6o)#a*!! re)a&eaza (a (e%a)eea es&e
%a*or!za&a "e !#ges&!a "e a)(oo) s! "e s$praso)!(!&are !#&e)e(&$a)a>
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-*er&! "e "$ra&a *ar!a6!)a: aso(!a& sa$ #$ s(+!6ar!)or "e poz!&!e :
-&$)6$rar! "e *e"ere :
-*aa!e)! !# $re(+! :
-o6osea)a %!z!(a s! !#&e)e(&$a)a:
-pares&ez!!: pareze: "!sar&r!! &re(a&oare:-pa)p!&a&!!: pre(or"!a)g!!: "!sp#ee "e e%or&:
-a#'!e&a&e: !#so#!!: !r!&a6!)!&a&e:
-preze#&a !# a#&e(e"e#&e)e pa&o)og!(e perso#a)e a $#or a%e(&!$#! #e%ro)og!(e sa$
$ro)og!(e 8a)6$!#$r!e sa$ +ea&$r!! pasagere: !#%e(&!! $r!#are: (o)!(! #e%re&!(e:
a%e(&!$#! re#a)e "!ag#os&!(a&e: e.&.(.9 &ra$a&!se )o6are: /TA pe &!p$) $#e!
sar(!#!:
-e'!s&e#&a a#&e(e"e#&e)or +ere"o(o)a&era)e "e /TA: "e a&eros(re)oza s! %ore)e
()!#!(e "e a#!%es&are a a(es&ora:
-$#e)e o6!(e!$r! a)!e#&are !#"!*!"$a)e s! %a!)!a)e 8(o#s$ "e sare: "e "$)(!$r!9:
%$a&$) s! (o#s$$) "e a)(oo):
-pro%!)$) pro%es!o#a): gra"$) "e so)!(!&are pro%es!o#a)a (ope&!&!*!&a&ea s!
e%!(a(!&a&ea so(!a)a a 6o)#a*$)$!:
-e'!s&e#&a $#or s!p&oe (are po& s$gera o /TA se($#"ara 8(r!ze s$"ora)e
!#so&!&e "e pa)p!&a&!!: a#'!e&a&e s! pa)oare: as&e#!e $s($)ara: pares&ez!!: !a)g!!:
para)!z!! !#&er!&e#&e: po)!$r!e: e.&.(.9:
-preze#&a $#or s!p&oe (e s$gereaza e'!s&e#&a $#or (op)!(a&!! *as($)are
8e()!pse (ere6ra)e: ()a$"!(a&!e !#&er!&e#&a: (r!ze "e a#g!#a pe(&ora)a9 e.&.(.
69 PREGATIREA SI ASISTAREA EAMINARILOR CLINICE
Co)a6orarea )a e'a!#area ()!#!(a a 6o)#a*$)$! es&e $#a "!# sar(!#!)e !por&a#&e
a)e as!s&e#&e!. A$&or$) a($r"a& e"!($)$! s! 6o)#a*$)$! !# ($rs$) e'a!#ar!! ()!#!(e
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"egre*eaza pe a(eas&a "!# $ra "e e%or&$r! %!z!(e: !! pre*!#e o ser!e "e s$%er!#&e !#$&!)e:
(o#&r!6$!e )a (rearea $#$! ()!a& %a*ora6!) !#&re 6o)#a* s! e"!(: %a(e a((es!6!)a e"!($)$!
e'p)orarea &$&$ror reg#!#e)or orga#!s$)$!: ser*!#"$- ($ !#s&$e#&ar$) #e(esar: &oa&e
a(es&ea !#&er*e#!#" pe#&r$ s($r&area&!p$)$! e'p$#er!! 6o)#a*$)$! !# s&are gra*a )a
e'a!#ar!)e ()!#!(e es&e !#"!spe#sa6!) !# (az$) 6o)#a*!)or !# s&are gra*a5 as&e#!(!:a"!#a!(!: so#o)e#&!: !#(o#s&!e#&!: !o6!)!za&!: e.&.(. s! %oar&e $&!)a !# (az$) &$&$ror
6o)#a*!)or
Sar(!#!)e as!s&e#&e! !# prega&!rea s! as!s&area $#$! e'ae# ()!#!( e(!(a)
s$#& $ra&oare)e5
-prega&!rea ps!+!(a a 6o)#a*$)$!:
-a"$#area: *er!%!(area s! prega&!rea !#s&r$e#&$)$! #e(esar:
-"ez6ra(area s! !#6ra(area 6o)#a*$)$!:-a"$(erea 6o)#a*$)$! !# poz!&!!)e a"e(*a&e e'a!#a&or!)or:
-as!g$rarea !)$!#a&!e! #e(esare )a e'a!#ar!)e (a*!&a&!)or #a&$ra)e:
-"eser*!rea e"!($)$! ($ !#s&r$e#&e:
-%er!rea 6o)#a*$)$! "e &ra$a&!se s! ra(ea)a:
-asezarea 6o)#a*$)$! !# pa& "$pa e'a!#are s! %a(erea pa&$)$!.
? Prega&!rea ps!+!(a a 6o)#a*$)$! se !#(a"reaza !# $#(a "e e"$(a&!e s! "e
)!#!s&!re pe (are as!s&e#&a o "$(e ($ 6o)#a*$) "!# oe#&$) pr!!r!! )$! !# se(&!e.
A&!&$"!#ea e! %a&a "e 6o)#a* &re6$!e sa re%)e(&e "or!#&a pera#e#&a "e a- a$&a> (rearea
()!a&$)$! %a*ora6!): a&!&$"!#e pr!e&e#eas(a: (o#s&!&$!e %a(&or!! !por&a#&! a! $#e! 6$#eprega&!r! ps!+!(e. I# preaa e'a!#ar!)or "e or!(e #a&$ra: as!s&e#&a &re6$!e sa
)a$reas(a 6o)#a*$) as$pra (ara(&er$)$! !#o%e#s!* a)
e'a!#ar!)or: (a$&a#" sa se re"$(a )a !#!$ "$rer!)e (are e*e#&$a) *or %! pro*o(a&e
pr!# $#e)e a#opere s!p)e: (a5 e'a!#area $#e! ar&!($)a&!! !#%)aa&e: pa)parea $#$!
a6"oe# "$reros: e.&.(. ,o)#a*$) #$ &re6$!e #!(!o"a&a !#"$s !# eroare (a(! as&%e) *a
p!er"e !#(re"erea !# #o!.
Da(a !#sa ($#oas&e ese#&a s! !por&a#&a e'a!#ar!)or: pr!# !#(re"erea pe (are !-a
!#s$%)a&-o: *a s$por&a $)& a! $sor s$%er!#&e)e (a$za&e "e "!*erse e'p)orar!: o6&!#a#"(ooperarea )$! a(&!*a !# re$s!&a s! opera&!*!&a&ea e'a!#ar!)or.
T!#a#" seaa "e s!&$) p$"or!!: as!s&e#&a *a !zo)a pa&$) 6o)#a*$)$! 8!# spe(!a) )a
pr!a e'a!#are9: "espar&!#"-$) ($ $# para*a# "e (e)e)a)&e pa&$r!: (eea (e )!#!s&es&e pe
$)&! 6o)#a*!.
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*A #UL CLI#IC
De&er!#area pres!$#!! ar&er!a)e se %a(e (ore(& pr!# e&o"a as($)&a&!*a sa$ (ea
e)e(&ro#!(a: as$ra#" TA )a a6e)e 6ra&e: !# ()!#os&a&!s s! or&os&a&!s: "a(a es&e pos!6!)
"!!#ea&a: "$pa repa$s %!z!( s! !#&e)e(&$a).
E'ae#$) ()!#!( !#(ear(a sa "e(e)eze (a$ze)e sa$ )ez!$#!)e ge#era&oare "e /TA:pre($ s! s&a"!$) e*o)$&!* s! ras$#e&$) as$pra !#®$)$! orga#!s. S(a"erea !#por&a#&a a
p$)s$)$! )a ar&ere)e %e$ra)e sa$ a6o)!rea sa e*o(a o s&e#oza a s!s&e$)$! aor&!( (are se
(o#%!ra )a pa)parea ar&ere)or !#&er(os&a)e pe &ora(e)e pos&er!or: pr!# a$s($)&a&!a !#!!!
8s$%)$ s!s&o)!( para*er&e6ra) s&a#g9 s! "e ra"!ogra%!a &ora(e)$! 8eroz!$#! (os&a)e9. S&e#oza
$#e! ar&ere re#a)e poa&e "e&er!#a $#eor! $# s$%)$ per(ep&!6!) parao6!)!(a) s! !#
reg!$#ea )o6ara. Pa)parea )oe)or re#a)e poa&e e*!"e#&!a o &$oare re#a)a sa$
#e%roega)!e 6!)a&era)a: s$gera#" po)!(+!s&oza re#a)a. T$se$) re(&a) )a 6ar6a& s! (e) *ag!#a)
)a %ee!e s$#& asee#ea #e(esare. E'ae#$) ()!#!( ge#era) poa&e p$#e !# e*!"e#&a s!
se#e)e $#e! a%e(&!$#! e#"o(r!#e sa$ e&a6o)!(e: s$s(ep&!6!)e "e a pro"$(e /TAse($#"ara 8+!per&!ro!"!s: 6oa)a C$s+!#g: a(roega)!e: a#!%es&ar! ($&a#a&e a)e $#e!
"!a&eze g$&oase sa$ "!s)!popre&e!#e!!9.
Apre(!erea ras$#e&$)$! *!s(era) a) /TA5 (a#" 6o)#a*$) se#a)eaza "!sp#ee )a
e%or&$r! 6!#e &o)era&e a#&er!or: !ar e'ae#$) o6!e(&!* "e(e)eaza $# s$%)$ s!s&o)!( s!
(ar"!oega)!e 8(o#%!ra&a ra"!o)og!e: EBG: e(ogra%!e9: se (o#&$reaza s$praso)!(!&area
(or"$)$!> se#a)area $#e! po)!$r!! #o(&$r#e: re(e#&e: %ara "!s$r!e: o6)!ga )a s$sp!(!o#area
re#a)!zar!! /TA. Deasee#ea: s(a"erea (apa(!&a&!! "e )$(r$: e()!pse (ere6ra)e: $# e'ae#
"e %$#" "e o(+! o"!%!(a& 8gra"$) II-III9 s$s&!# %ap&$) (a /TA a pro"$s a%e(&area *ase)or
(ere6ra)e.
(9 RECOLTAREA PRODUSELOR ,IOLOGICE SI PATOLOGICE
PENTRU EAMENELE PARACLINICE
I#gr!!rea 6o)#a*!)or !p)!(a s&a6!)!rea "!ag#os&!($)$! pre(!s !#&r-$# &!p (a&
a! s($r& pos!6!): pe#&r$ a se p$&ea a(or"a !#gr!!r!)e s! &ra&ae#&$) a"e(*a&. U# a$&or
pre&!os -"e $)&e or! !#"!spe#sa6!)- !# a(eas&a $#(a- (o#s&!&$!e pro6e)e "e
)a6ora&or: (are e'pr!a !# o" o6!e(&!* o"!%!(ar!)e
s$r*e#!&e !# or%o)og!a: %$#(&!$#ea s! 6!o(+!!a orga#!s$)$! s! e*!"e#&!aza age#&!!
agres!*!: %a(&or!! e&!o)og!(! a! !6o)#a*!r!)or.
U&!)!&a&ea rez$)&a&e)or "e )a6ora&or "ep!#" "e (e! "o! %a(&or! "e 6aza5 re(o)&area
(ore(&a a pro"$se)or s$p$se a#a)!ze)or s! e%e(&$area a#a)!ze)or propr!$ z!se. E%e(&$area
a#a)!ze)or (a"e aproape e'()$s!* !# sar(!#a perso#a)$)$! "e )a6ora&or: aor!&a&ea
re(o)&ar!)or !#sa: %a( par&e "!# sar(!#!)e perso#a)$)$! (are )$(reaza #e!)o(!& )a pa&$)
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6o)#a*$)$!: "!# a(es& o&!*: as!s&e#&a &re6$!e sa a!6a ($#os&!#&e pre(!se s! a#$a)!&a&e
(oresp$#za&oare.
Ipor&a#&a e'a!#ar!)or "e )a6ora&or se (o#(re&!zeaza !# $ra&oare)e5 -
!6oga&es( s!p&oa&o)og!a 6o)!)or ($ #$eroase e)ee#&e o6!e(&!*e: -(o#%!ra sa$
!#%!ra "!ag#os&!($) ()!#!(:
-()ar!%!(a "!ag#os&!($) "!%ere#&!a) %a&a "e &a6)o$r! ()!#!(e s!!)are s! "!%ere#&!aza %ore)e
()!#!(e a)e a(e)eas! !6o)#a*!r!: -s&a6!)es&e %a(&or$) e&!o)og!( !# #$eroase (az$r!:
-!#%oreaza as$pra gra*!&a&!! (az$)$! : re%)e(&a o6!e(&!* e*o)$&!a e*o)$&!a 6o)!! s! a$&a )a
s&a6!)!rea prog#os&!($)$!: -(o#&r!6$!e )a apre(!erea e%!(a(!&a&!!&ra&ae#&$)$!: -pre*es&es&e
!#s&a)area $#or (op)!(a&!!: -(o#%!ra *!#"e(area ()!#!(a s! e&!o)og!(a a 6o)#a*$)$!:
-(o#&r!6$!e )a pro%!)area 6o)!)or !#%e(&o-(o#&ag!oase: pr!# "ep!s&are pre(o(e a s$rse)or"e !#%e(&!e: 6o)#a*!! s! p$r&a&or!! "e gere#!.
*A # )ARACLI#IC
I# %$#(&!e "e (az: e'ae#e)e (op)ee#&are s$#& !#"!spe#sa6!)e pe#&r$ a
apre(!a ras$#e&$) *!s(era) a) /TA s! a "es(oper! e&!o)og!a.
I# pra(&!(a z!)#!(a: $#$! 6o)#a* +!per&e#s!* ! se e%e(&$eaza $ra&oare)e e'ae#e5
-"ozarea po&as!$)$! sa#g$!# s! $r!#ar:
-"ozarea $ree! s! (rea&!#!#e! sa#g$!#e:
-e'ae# (!&o6a(&er!o)og!( $r!#ar:-gr$p sa#g$!#:
-&es&$) A""!s-/a6$rger sa$ $ro($)&$ra (a#&!&a&!*a:
-pro&e!#$r!e pe 4 "e ore 8pes&e 7: Og ara&a a%e(&are re#a)a9:
-"ozarea g)!(e!e! )a ore pos& pra#"!a):
-"ozarea (o)es&ero)$)$!: &r!g)!(er!"e)or:
-"ozarea a(!"$)$! *a#!)a#"e)!( s! (a&e*o)a!"e)or:
-ra"!ogra%!a re#a)a pe go) s!sa$ $rogra%!a LV.:
-ra"!ogra%!a (ar"!op$)o#ara:
-e'ae# s$ar "e $r!#a:
-$ro($)&$ra:
-EBG
-e'ae#$) %$#"$)$! "e o(+!
-/LG: VS/: +ea&o(r!&.
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Ca#" !#*es&!ga&!!)e "e pr!a )!#!e #$ a$ re$s!& $# 6!)a#& sa&!s%a(a&or: se re($rge
)a a$&or$) ser*!(!!)or spe(!a)!za&e pe#&r$ ar&er!ogra%!e re#a)a: "ozarea a(&!*!&a&!! p)asa&!(e
re#!#a-a#g!o&e#s!*a: "ozarea a)"os&ero#$)$!: &es&$) /oJar": s(!#&!graa re#a)a: p$#(&!a
re#a)a.
%OR CLI#IC SI SI )TO ATOLO&I
C)as!( se "eose6es(5
S&a"!$) pre+!per&es!* #$ poa&e %! (o#s!"era& (a $# s&a"!$ &!p$r!$ a) /TA
ese#&!a)e> se po&: &o&$s!: a%!ra (a s$6!e(&!! pre"!sp$s!: !#"eose6! &!#er!! ($
*a)or! !#&ere"!are a)e TA 8477-1709 s! )a (are $# &es& presor )a re(e
8(are es&e poz!&!* (a#": !#&ro"$(a#" a#a !# apa )a 4K: *a)or!)e TA (res( ($
pes&e 47/g9 s-a ara&a& !# se#s poz!&!*: $rar!&! !# &!p: a$ &re($& !# %aza
"e +!per&e#s!$#e pera#e#&a.
S$#& ($pr!#s! !# a(es& s&a"!$ s$6!e(&! ($ *a)or! o(az!o#a) (res($&e a)e TA:
#ora)!za&e $)&er!or %ara o e"!(a&!e "eose6!&a: pre($ s! s$6!e(&!! (o#s!"era&!
+!per&e#s!*!: "ar a)e (aror *a)or! s-a$ #ora)!za& "$pa -3 z!)e "e sp!&a)!zare. La a(es&!
6o)#a*!: "e o6!(e! as!p&oa&!(!: e'ae#$) ()!#!( es&e #ega&!*. O par&e "!# e! po& a*ea
&$)6$rar! #e$ro-*ege&a&!*e: "o*a"a $#e! )a6!)!&a&! #er*oase ($ &e#"!#&a )a
+!pers!pa&!(o&o#!e.
S&a"!$) I "e /TA !zo)a&a s! p$ra. Pes&e 7= "!# s$6!e(&!! +!per&e#s!*! s$#&
"ep!s&a&! !# a(es& s&a"!$: !# (are s$#& preze#&e *ar!a&!! &e#s!o#a)e: ($ *a)or!
%re(*e#& pes&e 170/g. A(es& s&a"!$ poa&e "$ra 7-0 a#!: per!oa"a !#
(are: )a (res&er!)e &e#s!o#a)e: se aso(!aza )ez!$#! *as($)are !#ore &ra"$se pr!#
a)&erar! "e gra"$) I a)e F.O.
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A(es& s&a"!$ (oresp$#"e %ore! 6e#!g#e: (are e*o)$eaza progres!* s! se
(ara(&er!zeaza pr!#5
-se#e (are apar )a e'ae#$) ar&ere)or: ar&ere s!#$oase s! r!g!"e: p$)s 6!#e 6a&$&> -se#e
"e %rag!)!&a&e (ap!)ara> "!*erse a#!%es&ar! +eorag!(e 8ep!s&a'!s: e&rorag!!: $#eor!
+ea&eeze: +eorag!! re&!#!e#e e&(9>-se#e (ere6ra)e5 (e%a)ee o((!p!&a)a: "e o6!(e! "!!#ea&a: )a &rez!re: ae&e)!: o6osea)a:
as&e#!e: !#so#!e: &$)6$rar! "e eor!e s! (o#(e#&rare: o"!%!(are "e (ara(&er: %re(*e#&
&$)6$rar! "e *e"ere s! &$)6$rar! &re(a&oare "e (o#s&!e#&a s! "e )!6a s$#& (e)e a!
%re(*e#&e &$)6$rar! %$#(&!o#a)e: (o$#e &$&$ror %ore)or "e +!per&e#s!$#e>
-%$r#!(a&$r! )a #!*e)$) e'&re!&a&!)or: ae&e)!: se#za&!a "e "ege& or&>
-e'ae#$) !#!!! re)e*a s$6!e(&!* pa)p!&a&!!: "$rer! pre(or"!a)e: "!%er!&e gra"e "e "!sp#ee:
!ar o6!e(&!*: se#e "e ar!re a !#!!! s&a#g! 8+!per&ro%!e s! "!g!&a&!e9>
-ra"!o)og!a: e)e(&ro(ar"!ogra%!a: %$#"$) "e o(+! s! pro6e)e %$#(&!o#a)e re#a)e apre(!aza
gra"$) "e e*o)$&!*!&a&e a) /TA.
. S&a"!$) II "e +!per&ro%!e *e#&r!($)ara s&a#ga 8/VS9 es&e (o#se(!#&a so)!(!&ar!)or
e(a#!(e e'er(!&a&e "e (res&erea *a)or!)or TA as$pra pa&$)$! *as($)ar s!
as$pra pope! (ar"!a(e. Va)or!)e TA s$#& !#spre 777/g.
E'ae#$) ()!#!( re)e*a /VS: so($) ape'!a# es&e a!
p$&er#!(: zgoo&$) II es&e !#&ar!& )a aor&a. E'ae#$) ra"!o)og!e e*!"e#&!aza (or" "e
*o)$ #ora) sa$ se#e !#(!p!e#&e "e /VS: ($ ar( !#%er!or s&a#g a)$#g!&5 !# OAS
*e#&r!($) s&a#g pro!e(&a& $sor pe (o)oa#a. E'ae#$) EBG o6!e(&!*eaza se#!#e "e
/VS.
/!per&ro%!a *as($)ara s!s&ea&!(a se rear(a pr!# ar&ere ($ (a)!6r$
ar!&: s!#$oase: !#"$ra&e: !ar ra"!o)og!e aor&a apare: )arg!&a: "er$)a&a: 6$&o#$)
aor&!( proe!#e#&. Mo"!%!(ar!)e FO s$#& a*a#sa&e 8gr". II9. F$#(&!a re#a)a se
e#&!#e $)& &!p #ea)&era&a.
. S&a"!$) III "e /TA (op)!(a&a. I# a(es& s&a"!$ s$#& preze#&e pe )a#ga a($ze)e per!oa"e)or
a#&er!oare s! se#e s! s!p&oe #o!: (a $rare a *!s(era)!zar!! +!per&e#s!$#!! s! a
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a%e(&ar!! orga#e)or &!#&a. Cop)!(a&!!)e /TA a$ %os& !par&!&e ar6!&rar !# (op)!(a&!!
#espe(!%!(e s! (op)!(a&!! spe(!%!(e.
Complicatiile nespecifice s$#&: "e %ap&: (o#se(!#&a pro(es$)$!
ar&eros(re)o&!( (e se !#&er(o#"!&!o#eaza ($ /TA> apar s&e#ozar! aor&!(e:
(oro#ar!e#e: (ere6ra)e: per!%er!(e #e!#%)$e#&a&e se#!%!(a&!* "e &ra&ae#&$)
+!po&e#sor.
Complicatiile specifice, ($ pre"!)e(&!e pe#&r$ +!per&e#s!*!! &!#er!:
s$6 00 "e a#!. E)e po& %! s&a6!)!za&e s$6 &erap!a +!po&e#soare e%!(a(e.
Cop)!(a&!!)e spe(!%!(e s$#&5 /VS ($ !#s$%!(!e#&a *e#&r!($)ara s&a#ga
(o#se($&!*a: re&!#opa&!a +!per&e#s!*a 8FO gr". III: IV9: +eoraga (ere6ra)a sa$
(ere6roe#!#g!a#a: !#s$%!(!e#&a re#a)a pr!# #e%ro-a#g!os(re)oza.
. S&a"!$) IV "e /TA a)!g#a . Es&e %ora ($ e*o)$&!e a((e)era&a s! or&a)!&a&e r!"!(a&a. I#
(o#&$rarea (a"r$)$! ()!#!(: (r!&er!$) e*o)$&!* es&e (e) a! !por&a#&. Da(a )a
e'a!#ar! s$((es!*e: 6o)#a*$) ($ /TA se*era aso(!aza e"e pap!)ar s! a)&erarea
rap!"a a %$#(&!e! re#a)e: (e "e)!!&eaza %ora a)!g#a a /TA. /TA a)!g#a es&e6oa)a a"$)&$)$! &a#ar: a! a)es 6ar6a&. D!ag#os&!($) se s&a6!)es&e pe (r!&er!! ()!#!(e:
6!o)og!(e: +!s&o)og!(e.
Criterii clinice: TA "!as&o)!(a pes&e 7/g: e#(e%a)opa&!e:
re&!#opa&!e: se#e "e "e(ope#sare (ar"!a(a rap!"a: e*e#&$a) e"e p$)o#ar
a($&: "$rere a6"o!#a)a s!$)a#" o (o)e(!s&o-"$o"e#!&a a($&a.
Criterii biologice: (res&erea $ree! s! (rea&!#!#e!: pro&e!#$r!e:
+ea&$r!e !(ros(op!(a: (!)!#"$r!e: a#e!e +eo)!&!(a !(roa#g!opa&!(a:
a)"os&ero# sa#g$!# s! $r!#ar (res($&: (res&erea a(&!*!&a&!! re#!#e! p)asa&!(e.
Criterii histologice: ar&er!o)!&a #e(roza#&a 8por&!$#ea "!s&a)a a
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ar&ere)or !#&er)o6$)are prez!#&a #e(roza %!6r!#o!"a9:
URT (I)RT#SIV
Coresp$#" $#or s!&$a&!! (a#" (res&erea rap!"a: a($&a: a TA ae#!#&a *!a&a "a(a
#$ es&e sa#(&!o#a&a $rge#& &erape$&!(. Cr!za +!per&e#s!*a poa&e aparea !# 3 !pre$rar!5e#(e%a)opa&!a +!per&e#s!*a> /TA a)!g#a> p$se$r! &e#s!o#a)e ($ e'(es "e (a&e(o)a!#e
8%eo(roo(!&o: opr!re 6r$s(a a $#e! &erap!! ($ ()o#!"!#a9.
-e#(e%a)opa&!a +!per&e#s!*a are (a s!p&o (ara(&er!s&!( a)&erarea (o#s&!e#&e!: a$#ga#"
!# (a&e*a ore )a (oa. Se !#&a)#es&e )a5 %ee!a !#sar(!#a&a ($ &o'e!e
ga*!"!(a5 (op!! s! &!#er! ($ g)oer$)o#e%!&a a($&a5 !# ($rs$) or!(are! %ore "e
/TA pr!!&!*a sa$ se($#"ara. ,o)#a*$) se a"reseaza e"!($)$! pe#&r$ (e%a)ee
*!o)e#&a: gre&$r!: &$)6$rar! "e *e"ere: *ar!a&e se#e #e$ro)og!(e. TA a&!#ge *a)or!
%oar&e ar!.
-/TA a)!g#a sa$ a((e)era&a.
-P$se$r!)e +!per&e#s!*e ($ e'(es "e (a&e(o)a!#e.
? %eo(roo(!&o5 paro'!se)e &e#s!o#a)e s$#& !#so&!&e "e (e%a)ee a((e#&$a&a:
&ra#sp!ra&!! a6$#"e#&e: pa)p!&a&!!: &$)6$rar! "e g)!(oreg)are "e(e)a6!)e pr!#
&es&e para()!#!(e. Co#%!rarea 6o)!! se %a(e pe "ozarea $r!#ara a a(!"$)$!
*a#!)a#"e)!(: e&a6o)!& a) (a&e(o)a!#e)or.
? a"!#!s&rarea $#or a)!e#&e 6oga&e !# &!ra!"a sa$ a!#e
s!pa&!(o!e&!(e )a $# 6o)#a* &ra&a&.
? opr!rea 6r$s(a a $#$! &ra&ae#& ($ ()o#!"!#a: !# "oze %oar&e ar!
8):gz!9.
To& (a $rge#&a &re6$!e (o#s!"era&a /TA (op)!(a&a.
VOLUTI SI CO )LICATII
I# %ora 6e#!g#a: (ea a! o6!s#$!&a: 6oa)a "$reaza a#! sa$ (+!ar ze(! "e
a#!. S$6 !#%)$e#&a $#$! &ra&ae#& (ore(& s! pre(o(e po& aparea re!s!$#! !por&a#&e. I#
%ora a)!g#a: e*o)$&!a es&e %oar&e rap!"a: e&ape)e 6o)!! %!!#" par($rse !# -3 a#!.
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I#"!%ere#& "e e&!o)og!e: %!e(are %ora "e /TA !# rapor& ($ (ara(&er$) sa$
e*o)$&!*: poa&e %! 6e#!g#a sa$ a)!g#a s! par($rge: !# e*o)$&!a sa: (e)e 3 s&a"!! "!#
()as!%!(area prop$sa "e OMS.
I# s&a"!$) a) III-)ea apar (op)!(a&!!5 )a #!*e)$) apara&$)$! (ar"!o*as($)ar8!#s$%!(!e#&a *e#&r!($)ara s&a#ga a($&a s! !#s$%!(!e#&a (ar"!a(a g)o6a)a: !#%ar(& !o(ar"!(:
a#e*r!s "!se(a#&9> )a #!*e)$) (!r($)a&!e! (ere6ra)e 8e#(e%a)opa&!e +!per&e#s!*a: &ro6ozes! +eorag!! (ere6ra)e9> )a #!*e)$) r!#!(+!$)$! 8&$)6$rar! *ar!a&e: "e )a a)&erar!
%$#(&!o#a)e: pa#a )a s(re)oza ($ !#s$%!e#&a re#a)a9.
Cop)!(a&!!)e "ep!#" "e %ora ()!#!(a 6e#!g#a sa$ a)!g#a. As&%e): !#
+!per&e#s!$#ea 6e#!g#a (op)!(a&!!)e se "a&oreaza a&eros(re)oze!: (e)e a! %re(*e#&e %!!#"
&ro6oza (ere6ra)a s! !#%ar(&$) !o(ar"!(. A!(! se !#&a)#es( %re(*e#& e#(e%a)opa&!a
+!per&e#s!*a: +eorag!a (ere6ra)a: !#s$%!(!e#&a (ar"!a(a s! !#s$%!(!e#&a re#a)a.
A. Complicatii cere#rale ale $TA
A(es&e (op)!(a&!! po& %! a((!"e#&e *as($)are !#ore sa$ aore. Ce)e
!#ore s$#& (o#se(!#&a a&eros(re)oze! (ere6ra)e s! !p$# $# (o#&o) r!g$ros a) TA.
A(!"e#&e)e aore se a#!%es&a ()as!( pr!# +eorag!e (ere6ra)a: (are se poa&e preze#&as$6 "o$a aspe(&e5 +eorag!a (ere6ra)a pr!!&!*a 8(ea a! %re(*e#&a %ora ()!#!(a:
&ra"$sa pr!# "e%!(!& #e$ro)og!(: (e%a)ee: *arsa&$r!: &$)6$rar! "e (o#s&!e#&a9 s! +eorag!a
e#!#g!a#a sa$ e#!#go-(ere6ra)a: asea#a&oare ()!#!( ($ pre(e"e#&a ($ a! p$&!#e
e*!"e#&e se#e #e$ro)og!(e: "ara"a$ga#"$-se (o#&ra(&$ra e#!#g!a#a.
% Complicatii car&iace ale $TA
,o)#a*$) ($ /TA es&e ae#!#&a& "e !#s$%!e#&a (ar"!a(a s! "e r!s($r!)e
!#s$%!(!e#&e! (oro#ar!e#e. E'!s&a o (ore)a&!e "!re(&a !#&re gra"$) /TA s! rap!"!&a&ea:
!#&e#s!&a&ea "ez*o)&ar!! (ar"!opa&!e!. R!s($) (res($& "e !#%ar(& !o(ar"!( a)
+!per&e#s!*!)or es&e (ore)a& ($ TA "!as&o)!(a )a &!#er! s! ($ TA s!s&o)!(a )a *ars!(!.
Se (o#s!"era (a !#(ep$& a) (ar"!opa&!e! oe#&$) (a#" se
s(+!&eaza +!per&ro%!a *e#&r!($)$! s&a#g. E'ae#$) ra"!o)og!e ara&a o +!per&ro%!e $soaras! e)e(&!*a a (or"$)$! s&a#g: a! 6!#e o6ser*a&a !# OAS.
Ma! (o#s&a#&e "e(a& se#e)e ra"!o)og!(e s$#& o"!%!(ar!)e EBG (are
e*!"e#&!aza +!per&ro%!a *e#&r!($)$! s&a#g. De asee#ea: se a! po& rear(a "!*erse gra"e
s! %ore "e %ore "e 6)o( "e ra$ra sa$ AV.
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Se#e)e ()!#!(e (are pre(e" !#s&a)area !#s$%!(!e#&e! (ar"!a(e
s$#&5 &a+!(ar"!a: p$)s a)&er#: ()a#gor aor&!(: ga)op ezo-sa$ &e)e"!as&o)!(: &$)6$rar!
"e r!& 8e'&ras!s&o)e: %!6$)a&!e ar&er!a)a9.
Se#e)e !#s$%!(!e#&e! (ar"!a(e s$#& ($#os($&e s! #$ !#s!s&a "e(a& as$pra
$#or aa#$#&e5
-s(e#a poa&e %! "es(+!sa "e o !#s$%!e#&a *e#&r!($)ara s&a#ga: !#s&a)a&a 6r$s(>
-$# +!per&e#s!* apare#& (ope#sa& poa&e "e(e"a )a pr!a (r!za "e
e"ep$)o#ar a($&>
-a#!%es&ar!)e "!sp#e!(e paro'!s&!(e 8as& (ar"!a(: e"e p$)o#ar a($&9
a#$#&a"e()a#sarea !#s$%!(!e#&e! (ar"!a(e (o#ges&!*e.
I# a(eas&a per!oa"a apar s$%)$r! #e"e(e)a&e a#&er!or5 "e !#s$%!(!e#&a !&ra)a
%$#(&!o#a)a: a! rar "e !#s$%!(!e#&a aor&!(a. Va)or!)e &e#s!o#a)e r!"!(a&e: a"eseor!: *or
s(a"ea "$pa !#s&a)area !#s$%!(!e#&e! *e#&r!($)are s&a#g!.
E'ae#$) ra"!o)og!e ara&a +!per&ro%!a (or"$)$! 8*e#&r!($) s&a#g: a&r!$ "rep&
s! a&r!$ s&a#g: !# %!#a) *e#&r!($) "rep&9: pre($ s! se#e "e s&aza p$)o#ara.
I# e*o)$&!e: $# pro(e#& apre(!a6!) "e +!per&e#s!*! *or "e*e#! a#g!#os! sa$
*or %a(e !#%ar(& "e !o(ar".
C. Complicatiile renale ale $TA
Apre(!erea %$#(&!e! re#a)e pres$p$#e e%e(&$area $#or e'ae#e "e r$&!#a5
pro&e!#$r!a pe 4 "e ore: &es&$) A""!s sa$ S&a#s%e)"-
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($ aspe(& "e pa#za "e pa!a#e#. G)oer$)o#e%r!&a (ro#!(a prez!#&a /TA aso(!a&a ($
se#e re#a)e 8a)6$!#$r!e: +ea&$r!e: s(a"erea !por&a#&a a %!)&ra&$)$! g)oer$)ar9.
/TA re#o-*as($)ara se 6a#$!es&e )a $# 6o)#a* s$6 47 "e a#!: ($ /TA %ara
(a$za apare#&a: ($ pos!6!) "e6$& "$pa &ra$a&!s )o6ar5> prez!#&a $# s$%)$ a6"o!#a):
ep!gas&r!( sa$ !# )oa re#a)a. Se "e(e)eaza "!*erse a#oa)!! $rogra%!(e a)e #e%rograe!
!zo&op!(e: s(!#&!grae! re#a)e: ar&er!ogra%!e! re#a)e.
A)&e (a$ze pos!6!)e a)e /TA re#a)e po& %! &$6er($)oza re#a)a: ap)az!!)e s!
a&ro%!!)e re#a)e $#!)a&era)e (o#ge#!&a)e.I#*es&!ga&!! "e spe(!a)!&a&e pre(!zeaza "!ag#os&!($).
PROGNOSTICUL
-"ep!#"e "e %or#a ()!#!(a 6e#!g#a sa$ a)!g#a: "e ere"!&a&e: "e #!*)$) &e#s!$#!! "!as&o)!(e
s! 6aza)e: "e *ars&a 8&!#er!! %a( %ore a! gra*e9: "e respe(&area &ra&ae#&$)$!: "e o"$)"e *!a&a re(oa#"a& s!: !# s%ars!&: "e apar!&!!a (op)!(a&!!)or.
Prog#os&!($) es&e %a*ora6!) !# pr!$) s&a"!$ "e 6oa)a: %!!#" a! rezer*a& !#
s&a"!$) a) "o!)ea s! a! a)es !# a) &re!)ea. Moar&ea se "a&oreaza !#"eose6! (op)!(a&!!)or
(ar"!a(e: (ere6ra)e s! re#a)e. S$6 !#%)$e#&a &ra&ae#&$)$! a(&$a): prog#os&!($) s-a
!6$#a&a&!&.
TRATAMNTUL $TA
C!#e &re6$!e sa 6e#e%!(!eze "e &ra&ae#& a#&!+!per&e#s!*
Teore&!( rasp$#s$) es&e $sor "e "a&. To&! (e! (are a$ (!%re &e#s!o#a)e
pes&e 170/g )a a! $)&e e'a!#ar! e"!(a)e es&e #e(esar sa %!e !#(a"ra&! !#
progra$) &erape$&!( a#&!+!per&e#s!*.
Pra(&!( pro6)ea es&e a! "!%!(!)a: "eoare(e #r. +!per&e#s!*!)or 8s&a6!)!&!
"$pa a(es&e )!!&e re(oa#"a&e "e OMS9 es&e are. I# p)$s: aor!&a&ea a(es&or 6o)#a*!
s$#& as!p&oa&!(! s!: (a $rare: (op)!a#&a )or )a &ra&ae#& es&e !(a: "e asee#ea:
a"!#!s&rarea !#"e%!#!&a a $#or "rog$r! a#&!+!per&e#s!*e are e%e(&e se($#"are #e"or!&e: gre$a((ep&a&e "e pa(!e#&!.
C$ &oa&e a(es&ea (e! a! $)&! "!#&re a$&or! s$#& $#a#!! !# a re(oa#"a
&ra&ae#& &$&$ror +!per&e#s!*!)or %!e s$6 %ora reg!$)$! !g!e#o-"!e&e&!( %!e a (e)$!
e"!(ae#&os. Arg$e#&e)e !# %a*oarea p$#(&$)$! "e *e"ere respe(&!* s$#& %$r#!za&e: pe
"e o par&e: "e so(!e&a&!)e "e as!g$rar! a)e (aror s&a&!s&!(! ara&a (a /TA es&e o (a$za
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aora "e (res&ere a or6!"!&a&!! s! "e s(a"ere a )o#ge*!&a&!!: !ar pe "e a)&a par&e: "e
rez$)&a&e)e $#or s&$"!! &erape$&!(e(o#&ro)a&e (are "eo#s&reaza (a s(a"erea s$6 &ra&ae#&
a TA !(soreaza or6!"!&a&ea s! or&a)!&a&ea )a +!per&e#s!*!. Rapor&a#" !#&re6area
p$sa )a !#(ep$&: se poa&e sp$#e (a: !#"!%ere#& "e !#(a"rarea !#&r-o ()as!%!(are sa$ a)&a:
&o&! +!per&e#s!*!! &re6$!e &ra&a&!.
Da(a a&!&$"!#ea &erape$&!(a %a&a "e 6o)#a*$) +!per&e#s!* ($ TA170/g
es&e re)a&!* ()ara: #$ a(e)as! )$(r$ se !#&ap)a ($ +!per&e#s!*!!
)a )!!&a 86or"er)!#e +per&e#s!o# TAS47-0: TA"7-4/g9. Or!e#&area
$)&or a$&or! as$pra &ra&ae#&$)$! /TA )a )!!&a es&e e()e(&!(a: (r!&er!!)e "e )$are !#
&ra&ae#& %!!#" ar6!&rare s! *ar!a6!)e.
U# )$(r$ re!ese ($ preg#a#&a "!# s&$"!!)e pr!*!#" )o#ge*!&a&ea s! a#$e (a spera#&a "e
*!a&a aa(es&or pa(!e#&! es&e a! !(a "e(a& a #oro&e#s!*!)or.
Co#s!"era (a s! a(eas&a (a&egor!e "e 6o)#a*! &re6$!e !#(a"ra&a !#&r-$#progra &erape$&!(. Opor&$#!&a&ea )$! *a %! apre(!a&a #$ #$a! "$pa (!%ra &e#s!o#a)a: (! s!
!# %$#(&!e "e a)&! %a(&or!5 r!s($) ge#e&!(: *ars&a: $#e)e o6!s#$!#&e a)!e#&are: s&ress$) ps!+o-
so(!a): e*e#&$a)e)e aso(!a&!! or6!"e 8"!s)!p!"e!!: +!per$r!(e!e: o6ez!&a&e: "!a6e&:
#e%ropa&!e: "!*erse e&(9. Co#s$$) "e a#&!(o#(ep&!o#a)e ora)e: zo#a "e rese"!#&a
8pre*a)e#&a /TA es&e a! are !#$#e)e reg!$#! "e(a& !# a)&e)e9: e&(.
U# !#"!*!" &a#ar: +!perpo#"era): (e pro*!#e "!#&r-o %a!)!e "e +!per&e#s!*!:
s$p$s $#$! s&ress ps!+oso(!a) !#&e#s: (are e*#&$a) (o#s$a s! sare $)&a sa$ es&e
"!s)!p!"e!(: are &oa&e sa#se)e (a !# $ra&or!! a#! "!# !( +!per&e#s!* sa "e*!#a $#
are +!per&e#s!*. De a(eea es&e !#&e)ep& (a &ra&ae#&$) sa !#(eape !# a(es& s&a"!$ a)
6o)!!: !# (are s! e%!(!e#&a poa&e %!a'!a. Tra&ae#&$) /TA )a )!!&a #$ &re6$!e sa %!e
#$a!"e(a& e"!(ae#&os. A"eseor! (ore(&area o6ez!&a&!!: reg!$) sara( !# so"!$ s!
6oga& !# po&as!$ sa$
pra(&!(area spor&$)$! "e agree#& s$#& s$%!(!e#&e pe#&r$ a rea)!za re*e#!rea )a #ora) a
TA.
Tra&ae#&$) /TA &re6$!e sa *!zeze a#$!&e o6!e(&!*e s! !# pr!$)r ra#"
#ora)!zarea *a)or!)or &e#s!o#a)e. E) &re6$!e sa &!#a seaa "e a#$!&e pr!#(!p!! s!
or!e#&ar!5
-e'p)orarea &re6$!e 6!#e %a($&a "eoare(e s$#& +!per&e#s!$#! (are 6e#e%!(!aza "e &ra&ae#&
(+!r$rg!(a) 8+!per&e#s!$#!)e re#o-*as($)are9> -&ra&ae#&$) &re6$!e sa %!e (op)e' !g!e#!(o-
"!e&e&!(: e"!(ae#&os e&(> -&ra&ae#&$) &re6$!e !#"!*!"$a)!za& s! s&a6!)!& !# (o#"!&!! "e
a6$)a&or: #$ "esp!&a)>
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-"rog$r!)e +!po&e#s!*e *or %! a"!#!s&ra&e )a !#(ep$& !# (a#&!&a&! a! !(! s! ar!&e
apo! progres!*: pa#a )a #ora)!zarea TA. Es&e 6!#e (a "rog$r!)e +!po&e#s!*e sa %!e
aso(!a&e s! )a !#(ep$&$) &ra&ae#&$)$! aso(!erea sa ($pr!#"a $# +!po&e#s!* ($ $# "!$re&!(
&!az!"!(>
-&re6$!e &!#$& seaa "e a&eros(re)oza aso(!a&a: "e a!(! 8a! a)es )a
*ars!(!9 "e($rga#" pr$"e#&a: pe#&r$ a #$ pre(!p!&a a((!"e#&e)e *as($)are
(ere6ra)e: (oro#or!e#e s! per!%er!(e 8#!(!o"a&a #$ se *a !#(epe ($ "oze ar!: 6r$&a)e9> -
"eoare(e $)&e +!per&e#s!$#! s$#& (o#se(!#&a sa$ s$#& aso(!a&e a&eros(re)oze!: reg!$) s!
&ra&ae#&$) *or %! a"ap&a&e a(es&e!a "!# $ra. Se *or (o6a&e o6ez!&a&ea: g$&a
"!a6e&$) za+ara&: +!per)!popro&e!#e!!)e e&(> -repa$s$) #$ &re6$!e sa %!e a6so)$&. E'er(!&!!)e
%!z!(e: ers$) pe os s!
g!#as&!(a e"!(a)a: %a( par&e "!# &ra&ae#&. E%or&$) %!z!( *a %! "oza& s! a"ap&a
& pos!6!)!&a&!)or 6o)#a*$)$!>
-se"a&!*e)e s! &ra#(+!)!za#&e)e s$#& "e $)&e or! #e(esare>
-"!e&a *a %! sara(a !# (o)es&ero) s! gras!! sa&$ra&e>
-es&e 6!#e (a &ra&ae#&$) sa %!e s! *aso"!)a&a&or (ro#ar!a#: "eoare(e aso(!a&!a (ar"!opa&!e
!s(+e!(a
-/TA es&e %oar&e %re(*e#&a>
-#$ or!(e /TA $reaza sa pr!eas(a &ra&ae#& +!po&e#s!*.
As&%e) !# %ore)e )a6!)e "e gr". I: es&e s$%!(!e#& reg!$) "!e&e&!(: e*e#&$a) &ra#(+!)!za#&e s!
se"a&!*e.
A. TRATAM#TUL I&I#O+'ITTIC
Tra&ae#&$) !g!e#!(o-"!e&e&!( $rares&e s&a6!)!rea reg!$)$! a)!e#&ar
8"!e&a s! reg)ee#&area a(&!*!&a&!! %!z!(e s! !#&e)e(&$a)e9. Ipor&a#&a a(es&$! &ra&ae#&
rez$)&a s! "!# %ap&$) (a $)&e 6o)! se po& *!#"e(a #$a! pr!# "!e&a s! repa$s 8$#e)e
e#&ero(o)!&e a($&e: $#e)e #e%r!&e e&(9: a)&e)e p$&a#"$-se e#&!#e !# s&are "e (ope#sare
8a%e(&!$#! (ar"!a(e: +epa&!(e: re#a)e9.
D!e&e&!(a sa$ a)!e#&a&!a ($ra&!*a se o($pa ($ a)!e#&a&!a o$)$! 6o)#a*.
A(eas&a $&!)!za&a (ore(&: )!!&eaza !#&re6$!#&area e"!(ae#&e)or: e*!&a#" as&%e)
o6!s#$!#&a orga#!s$)$! ($ e"!(ae#&e)e.Dar: "!e&e&!(a oa(a $# ro) !por&a#& s! !# pro%!)a'!a ep!soa"e)or a($&e: a
(op)!(a&!!)or s! a "e(ope#sar!)or 8!#s$%!(!e#&a (ar"!a(a: /TA: "!a6e& za+ara&:
(o)e(!s&!&e: 6oa)a $)(eroasa e&(9. Reg!$) "!e&e&!( &re6$!e !#&o&"ea$#a
!#"!*!"$a)!za&: a"ap&a& %aze! "e e*o)$&!e a 6o)!! s! (a& a! *ar!a&: pe#&r$ a #$ pro*o(a
rep$)s!e: "e(! #e(ooperarea 6o)#a*$)$!.
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La s&a6!)!rea $#$! reg! &re6$!e pre(!za&e a)!e#&e)e per!se: (a#&!&a&ea s! (a)!&a&ea )or:
orar$) s! repar&!zarea ese)or: "$ra&a ap)!(ar!!. Se re(oa#"a: $#eor! %o! "e reg!.
Per!o"!(: 6o)#a*$)&re6$!e (a#&ar!&: pe#&r$ a apre(!a s$((es$) sa$ !#e%!(!e#&a e&o"e!.
Rolul as!s&e#&e! e"!(a)e !# ap)!(area &ra&ae#&$)$! !g!e#o-"!e&e&!( es&e %oar&e
!por&a#&: ea (o#&r!6$!#" )a &oa&e %ore)e s! %aze)e a(es&$! &ra&ae#&: $rar!#" respe(&area
a(es&$!a: apre(!!#" rez$)&a&e)e %a*ora6!)e sa$ "ep!s&a#" &$)6$rar!)e se($#"are.
Re!imul alimentar in $TA
ALIMENTE PERMISE5
-s$pe5 "e zarza*a& s!p)e sa$ ($ a"aos %a!#os: 6ors "e zarza*a& sa$ ($ (ar&o%!:
s$pe "e )eg$e: s$pe "e ros!!: &oa&e %ara sare>
-%a!#oase5 !# (a#&!&a&e )!!&a&a: gr!s: orez: %$)g! "e o*az: %!"ea: &oa&e %!er&e %ara
sare
-o$a !#(a#&!&a&e re"$sa 8- pe sap&aa#a9: %ara ga)6e#$s>
-(ar#e !# (a#&!&a&e re"$sa: "e3 or! pe sap&aa#a: "e *!&a: *!&e!: ga!#a: p$!: s)a6a:
%!ar&a (a raso): %r!p&a: ($ pa&r$#e): (ar&o%!: or(o*!: orez: per!soare %!er&e !# a6$r!
sa$ apa: &oa&e %ara sare: pes&e s)a6 8)!#: sa)a$: s&!$(a: (rap: pas&ra*9 %!er&: raso):
%r!p& sa$ (op& !# pergae#& 8!# z!)e)e ($ (ar#e #$ se "a pes&e s! !#*ers9>
-gras!! (r$"e: *ege&a)e: $)e! "e por$6: %)oarea soare)$!: argar!#a #esara&a.
To&$) se "a (r$" )a sa)a&e: (a 07gz!.
-pa!#e5 a)6a sa$ !#&ere"!ara: %ara sare: *e(+e "e o z! sa$ pra!&a>
-)eg$e s! zarza*a&$r!5 (r$"e sa$ %!er&e: &re($&e pr!# s!&a: p!$re$r!: s&re($ra&e:
(+!%&e)$&e "e zarza*a&: (ar&o%! (op&!: or(o*!: "o*)e(e!: %aso)e *er"e: azare
*er"e: s%e()a: sa)a&a *er"e: ros!!: *!#e&e: ar"e! gras!: *arza (r$"a s! $ra&a: %ara
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sare: &o&e rase ar$#& s! a"!#!s&ra&e (a sa)a&e: sa$ %!er&e (a so&e$r! sa$ 6$"!#(!
"e )eg$e>
-)ap&e s! 6ra#ze&$r!5 )ap&e "$)(e: !a$r&: )ap&e 6a&$&: 6ra#za "e *a(!: (as: $r"a
#esara&a: )ap&e ($ (a%ea>
-%r$(&e s$6 or!(e %ora5 (r$"e: (oap&e: p!$re$r!: (opo&$r!>
-"$)(!$r!5 prepara&e %ara 6!(ar6o#a& s! sare: "!# a)$a& %!er&: $s(a&: ($ 6ra#za "e
*a(!: ($ %r$(&e sa$ ge)a&!#a "e %r$(&e: ($ )ap&e: !a$r&: pe)&ea: sa)a&a "e %r$(&e: ($
!ere s! %r!s(a: are)a"a: pa&e$r!: "$)(ea&a: za+ar>
-6a$&$r!5 )ap&e s!p)$ "egresa&: )ap&e 6a&$& sa$ !a$r&: s$($r! "e %r$(&e sa$
zarza*a&$r!: (ea!$r! "e p)a#&e>
-(o#"!e#&e5 sos "e ros!!: sos$r! "!e&e&!(e 8%ara gras!e pra!&a9 ($ %a!#a r$e#!&a
pe $s(a&: ($ zeaa "e zarza*a& 8seara !# (a#&!&a&e re"$sa9: *er"e&$r! &o(a&e
8pa&r$#e): arar: &e)!#a: )e$s&ea#: (!6r$9: zeaa "e )aa!e s! sare )!!&a&a.
ALIMNT INTR(IS)
-)ap&e !#&egra): 6ra#ze&$r! sara&e s! grase>
-(ar#e grasa: *!s(ere: *a#a&: pes&e gras sa$ sara&: (o#ser*e "e pes&e sa$ (ar#e:
a%$a&$r!>
-o$a !# (a#&!&a&e (res($&a 8a! a)es ga)6e#$s$r!9: o$a &ar!: o)e&a: $ar!:
a!o#eza>
-gras!! a#!a)e !# (a#&!&a&e (res($&a 8$#&: $#&$ra: %r!s(a: sa#&a#a: se$:
s)a#!#a9: gras!! pra!&e>
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-pa!#e ($ sare s! pa!#e #eagra>
-%a!#oase prepara&e ($ sare s! !# (a#&!&a&e are>
-6ra#ze&$r!5 grase: sara&e: %ere#&a&e>
-sos$r!5 ($ gras!! pra!&e: ($ zeaa "e (ar#e: ($ $s&ar sa$ a!o#eza>
-)eg$e s! zarza*a&$r! (are (o#&!# $)& so"!$ 8&e)!#a: spa#a(: *arza a(ra:
$ra&$r!9>
-"$)(!$r! prepara&e ($ 6!(ar6o#a&: ($ $#& s! ga)6e#$s "e o$: ($ (!o(o)a&a sa$
(a(ao5
-6a$&$r! a)(oo)!(e: (a%ea: (ea! &are: )!(+!"e !# e'(es>
-(o#"!e#&e5 sare a! $)& "e(a& es&e pres(r!s: p!per: ar"e! !$&e: 6o!a "e ar"e!:
+rea#: $s&ar: (eapa: $s&$ro!.
RCOMAN*AM)
-*!a&a or"o#a&a: %ara e%or&$r!: %ara %$a&: %ara s&ress: %ara a)(oo)>
-ese !(! s! %ra(&!o#a&e: )a ore reg$)a&e. U)&!a asa ($ ore !#a!#&e "e
($)(are>
-!#&o&"ea$#a se *a (o6a&e o6ez!&a&ea 8(a#" e'!s&a9.
R+IMUL * IATA
Co#s&a !# )!!&area e%or&$r!)or %!z!(e: ($ )$(r$ "e 1- orez!: "$pa (az: ($respe(&area ore)or "e so# s! a ore)or "e asa. A$ o are !por&a#&a !)oa(e)e
ps!+o&erap!(e: (o6a&erea a#'!e&a&!! s! e*!&area s!&$a&!!)or (o#%!"e#&!a)e "!# e"!$)
"e *!a&a sa$ "e $#(a. Vor %! (a$&a&e s! I#($raa&e e)ee#&e)e "e sa&!s%a(&!e "!# pro%es!$#ea
6o)#a*$)$!: *or %! ($)&!*a&e preo($par!)e (are pro"$( re)a'area 8p)!6ar!: )e(&$ra: $z!(a:
&ea&r$9.
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B. TRATAM#TUL M'ICAM#TOS
Pr!#(!p!! ge#era)e a)e &ra&ae#&$)$! e"!(ae#&os
Tra&ae#&$) /TA *a %! pera#e#&: (+!ar a&$#(! (a#" (!%re)e &e#s!o#a)e s-a$
#ora)!za&. I# a(eas&a s!&$a&!e se *a s&a6!)! pr!# &a&o#are "oza !#!a e%!(!e#&a: ($ (arese *a (o#&!#$a apo! &ra&ae#&$). Es&e o6)!ga&or!$ (a a&a& reg!$) !g!e#o-"!e&e&!(: (a& s!
e"!(a&!a a#&!+!per&e#s!*a sa %!e a"!#!s&ra&e !# o" (o#&!#$$. Re#$#&area )a $#
&ra&ae#&: o"a&a ($ #ora)!zarea TA: "$(e )a
(res&erea (!%re)or TA pa#a )a *a)or!)e pre&erape$&!(e 8!# (a&e*a )$#!9 )a pes&e 27= "!#
(az$r!. N$ se *a re#$#&a )a $# e"!(ae#& sa$ )a o s(+ea &erape$&!(a "e(a& "$pa (e
a(es&ea a$ %os& a"!#!s&ra&e s$%!(!e#& &!p: pe#&r$ a-s! %a(e pro6a e%!(a(!&a&!! sa$
!#e%!(a(!&a&!! )or. De o6!(e!: &!p$) e"!$ "e apre(!ere a e%!(a(!&a&!! $#e! s(+ee
&erape$&!(e es&e "e 4-1 sap&aa#! 8($ (o#"!&!a (a e"!(ae#&e)e sa %!e a"!#!s&ra&e !#
"oze e%!(!e#&e9.
I# (az$) apar!&!e! e%e(&e)or a"*erse )a $# e"!(ae#&: se *a !(sora "oza sa$
a(es&a *a %! !#)o($!&: "$pa (az: ($ $# a)& e"!(ae#&: "ar #e se *a re#$#&a )a
(o#&!#$!&a&ea &ra&ae#&$)$!. N$ se re(oa#"a a"!#!s&rarea "!s(o#&!#$a a $#$!
e"!(ae#& a#&!+!per&e#s!* !#&r$(a& es&e !e%!(!e#&a. +! (a"r$) (o#&!#$!&a&!! &ra&ae#&$)$! !#
%$#(&!e "e e*o)$&!a 6o)!!: se *a a*ea !# *e"ere ap)!(area )$! &rep&a&a: e%!(!e#&a
&ra&ae#&e)or a#&er!oare s! e*e#&$a)e)e e%e(&e a"*erse a)e $#or s(+ee &erape$&!(e.
I# &ra&ae#&$) /TA se *or !#&re6$!#&a (a& a! p$&!#e e"!(ae#&e. La
aor!&a&ea 6o)#a*!)or: /TA es&e (o#&ro)a&a ($ - e"!(ae#&e (e se a)eg !# %$#(&!e "epro%!)$) %!z!opa&o)og!( a) 6o)!!: par&!($)ar!&a&!)e ()!#!(o-e*o)$&!*e: e'per!e#&a perso#a)a a
e"!($)$! s! "!spo#!6!)!&a&ea "e e"!(ae#&e. Aproape !# &oa&a )$ea se pre%era az!
"!$re&!(e)e &!az!"!(e s! p-6)o(a#&e)e: s!#g$re sa$ !# aso(!a&!e. I#(a "e )arga $&!)!zare s$#&
rezerp!#!(e)e s! +!"ra)az!#a. Fo)os!rea aso(!a&!!)or "e 3-4 sa$ a! $)&e a#&!+!per&e#s!*e
(o#s&!&$!e o e'(ep&!e s! es&e ap)!(a6!)a )a $# #$ar res&ra#s "e 6o)#a*!.
Poso)og!a *a %! respe(&a&a pe#&r$ %!e(are e"!(ae#&.
,o)#a*!! *or %! a*!za&! "e )a !#(ep$& as$pra e%e(&e)or se($#"are a)e e"!(a&!e!a#&!+!per&e#s!*e s&a6!)!&e: !ar pe par($rs$) o6ser*a&!e! e"!(a)e *or %! (+es&!o#a&! !# a(es&
se#s. Pe (a& pos!6!) se *a %a(e pro%!)a'!a )or 8"e e'. apor& e'oge# "e po&as!$ !# (az$)
sa)$re&!(e)or9: !ar o"a&a apar$&e *or %! (ore(&a&e !e"!a&. U#eor! e%e(&e se($#"are !#ore
8o6s&r$(&!a #aza)a "$pa rezerp!#!(e: so#o)e#&a: $s(a(!$#ea $(oase)or"$pa ()o#!"!#a>
as&e#!a %!z!(a $soara "$pasa)$re&!(e9 "era#eaza $)& pe 6o)#a*!: "e&er!#a#"$-! a"esea:
"a(a #$ s$#& a*!za&! s! prega&!&! ps!+o)og!( "e e"!( 8as!s&e#&a e"!(a)a9: sa
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a6a#"o#eze &ra&ae#&$): (+!ar (a#" a(es&a era e%!(!e#&. La 6ar6a&! se *a e*!&a a"!#!s&rarea
!# per!oa"a a(&!*!&a&!! ge#!&a)e "e "rog$r! a#&!+!per&e#s!*e (are a$ (a e%e(&
se($#"ar &$)6$rar! "e "!#a!(a se'$a)a: pe#&r$ (a !# o" s!g$r a(es&!a !s!
*or a$&o!#&repr!#"e &ra&ae#&$).
CON*UITA TRAPUTICA IN FUNCTI * TIPUL $TA
$TA usoara es&e $#!(a %ora $#"e apare !#&re6area opor&$#!&a&!! $#e! &erap!!
a(&!*e. U#!! a$&or! re(oa#"a s$pra*eg+erea s! pres(r!erea se"a&!*e)or.
A)&!! re(oa#"a o#o&erap!a ($ $# "!$re&!( sa$ P-6)o(a#&.
$TA sistolica La &!#er! es&e "e&er!#a&a "e +!per&o#!a
s!pa&!(a: re(oa#"a"$-se "e(! $# P-6)o(a#&. La *ars!(! se "a&oreaza re"$(er!!
(op)!a#&e! ar&er!a)e s! se re(oa#"a "rog$r! ($ a(&!$#e "!re(&a as$pra pere&e)$! ar&er!a).
/IDRALAZINA-P.O.I.V. > NICERGOLINA
$TA mo&erata . Se re(oa#"a 83-6)o(a#&e)e 8/IDRALAZINA p.o!.*.9
"!$re&!( 8NICERGOLINA9: !ar !# (az "e ese(: se aso(!aza s! +!"ra)az!#a sa$ e&!)"opa.
Sa$ se a"!#!s&reaza aso(!erea5 CLONIDINA p.o. ALFAMETTLDOPA p.o.
DIURETIC.
$TA severa : "e%!#!&a pr!#&r-o "!as&o)!(a pes&e 7/g: 6e#e%!(!aza
"e +!po&e#soare aore: sa)$re&!(e: sp!ro#o)a(&o#a: $&!)!za&a s!s&ea&!(. Da(a #$ e'!s&a
$#e)e (op)!(a&!!: &erap!a /TA es&e a! #$a#&a&a.
I# $TA cu insu-icienta car&iaca se aso(!aza &o#!(ar"!a(e. S$#& "e e*!&a& P-
6)o(a#&e)e. Se %o)oses( sa)$re&!(e 8Ne%r!' p.o.: F$rose!" p.o. !.*.: A(!" e&a(r!#!(9 !#
aso(!ere ($ Sp!ro#o)a(&o#a p.o. ($ *aso"!)a&a&oare. Se re(oa#"a /!"ra)az!#a 07-
77gz! aso(!a&a ($ "er!*a&! #!&r!&! ($ a(&!$#e pre)$#g!&a 8Isoe&9 7-47g ' 3z! seara sa$
($ Prazos! p.o. )-g ' 3z! (res(a#" progres!* pa#a )a 7-7g ' 3z!: %!e E#a)apr!)
p.o. !# "oza $#!(a.
I# $TA cu insu-icienta coronariana s!sa$ ateroscrelo.a cere#rala se
re(oa#"a sa)$re&!(e !# "oze o"era&e: p-6)o(a#&e: o(-e&!)"opa: a#&!(a)(!(e 8A"o)a&9:
#!&r!&! ($ a(&!$#e pre)$#g!&a 8Isoe&9 s! !# a#gor$) "e "e($6!&: #o(&$r#: (a&ap)asa ($
&r!#!&r!#a -ge) 0-37g: ap)!(a& pe &ora(e seara )a ($)(are. La (e! ($ s$%er!#&a (ere6ra)a
*as($)ara se re(oa#"a a se aso(!a Sa"a!#: a#&!#o): Pra'!)e#: Tre#&a): Pe#&o'!%!)!#a:
Cosa)"o#. De e*!&a& s(a"erea 6r$s(a a TA
I# $ta cu insu-icienta renala s$#& "e pre%era& "rog$r! (are #$ s(a" %)$'$)
sa#g$!# re#a)5 /!"ra)az!#a: a-e&!)"opa: C)o#!"!#a: Cap&opr!). Se aso(!aza ($ "!$re&!(5
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F$rose!": a(!" E&a(r!#!(. Ca &a(&!(a &erape$&!(a: se re(oa#"a e#&!#erea (o#&ro)$)$!
&erape$&!( a) /TA (+!ar "a(a apare o "e&er!orare a %$#(&!e! re#a)e: pos!6!)a )a !#(ep$&$)
&ra&ae#&$)$!: "ar pasagera. I# %ore)e se*ere s$#& "e $&!)!za& !#+!6!&or!! s!s&e$)$!
re#!#o-a#g!o&e#s!*a.
$TA mali!na Ca &ra&ae#& "e a&a( se %o)oses&e D!azo'!" !.*. 0gBg
(orp: aso(!a& ($ F$rose!" !.*. 7g. Rasp$#s$) apare !# -3 ore. Ca&erap!e "e
!#&re&!#ere se re(oa#"a $#a "!# aso(!er!)e5 -/!"ra)az!#a Propa#o)o) p.o. -/!"ra)az!#a
Propa#o)o) D!$re&!( p.o. -C)or!"!#a Me&!)"opa D!$re&!( p.o. -M!#o'!"!) p.o. -
Propa#o)o) D!$re&!( p.o. -Cap&opr!) F$rose!" p.o.
A*a#" !# *e"ere r!s($) (ar"!a( s! s$%er!#&a re#a)a: s-a$ prop$s &ra&ae#&e
a! agres!*e5 +eo"!a)!za per!o"!(a: #e%re(&o!e 6!)a&era)a: s!pa&e(&o!e s$pra- s!
s$6"!a%raga&!(a: s$prare#a)e(&o!e par&!a)a sa$ s$6&o&a)a.
$TA la !ravi&e U&er$) gra*!" pare sa pro"$(a re#!#a
e'p)!(a#" +!per&e#s!$#ea 8*a)or! pes&e 477/g9 )a $#e)e %ee! gra*!"e.
Se re(oa#"a5 sp!&a)!zarea: repa$s )a pa&: (&-e&!)"opa: /!"roz!#a: p-6)o(a#&e.
$TA la varstnici rasp$#"e %a*ora6!) )a5 D!$re&!( &r!a&ere#: e*e#&$a)
aso(!a& ($ Me&!)"opa sa$ C)o#!"!#a.
TRATAMNTUL UR+NTLOR $IPRTNSI
Cr!ze)e +!per&e#s!*e s$r*!# (a o (res&ere 6r$&a)a a *a)or!)or TA )a $# 6o)#a* ($
/TA pera#e#&a: ($#os($& s! &ra&a& sa$ !g#ora&am