Chronic cerebral ischemia

The meaning of “chronic cerebral ischemia” is ending up being familiar to a broader circle of individuals, since the variety of medical diagnoses of this illness has actually increased noticeably. This is due not just to a decline in the basic level of public health, however likewise to the advancement of medication. After all, a variety of signs of this illness are too comparable to the indications of other conditions.

Most frequently, the symptom of ischemia was identified as Parkinson’s illness, ataxia, Alzheimer’s illness. With the advancement of medication and pharmacology, it has actually ended up being possible not just to make a precise medical diagnosis, however likewise to get rid of the repercussions of this illness and bring back the normal method of human life.

Chronic cerebral ischemia is a breakdown of the brain that happens due to oxygen shortage in brain cells, which results in harm to brain tissue. Oxygen hunger happens usually due to the development of embolism and atherosclerotic plaques or constricting of the vessels of the brain.

Chronic ischemia has 3 degrees. Each phase is defined by a problem of the illness and a stress of its signs.

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1st phase

It is likewise called the compensated phase, that is, its repercussions are not important and can be entirely reversible.

Symptoms of chronic cerebral ischemia of the 1st degree can be unnoticeable to an individual and he will not even discover a factor for going to the physician, associating all the signs to common tiredness. The preliminary phase of ischemia does not interfere with a regular way of life and carry out a labor function.

During the preliminary phase 1, the illness manifests itself in the kind of the following signs:

  • cognitive problems:
    • reduced attention;
    • memory problems;
    • hindered understanding.
  • sleepiness
  • loss of tone and reduced activity;
  • regular headaches;
  • basic weak point of the body;
  • quick fatiguability ;
  • irritation;
  • sped up breathing;
  • sound in ears.

In most cases, these signs are not adequately pronounced to identify the medical diagnosis, however nonetheless, the detection of ischemia in the very first phase is a warranty of the repair of typical brain function.

2st phase

2 degree (subcompensated) is the development of the illness and the stress of its signs. Syndromes of the illness are currently more noticable, appear more frequently and might currently make complex the efficiency of some regular actions.

The following issues are included:

  1. impaired coordination, which can be seen in an abnormal gait and issues with preserving balance;
  2. impaired vision, hearing, odor;
  3. mental illness – state of mind swings and hostility;
  4. conditions of the nerve system – uncontrolled motions;
  5. queasiness and throwing up;
  6. feelings of cold in the limbs;
  7. offense of motor functions.

If no treatment procedures are carried out, the illness advances to the next phase.

3st phase

The 3rd degree (decompensated) of chronic ischemia mentions lots of afflicted locations of the brain, which suggests that brain activity has actually ended up being a lot more restricted.

Patients with a 3rd degree of cerebral ischemia are handicapped, frequently not able to service themselves. Symptoms of the illness are intensified, the client’s condition worsens. The 3rd phase is incurable entirely. The just thing that is possible is to extend the client’s life and reduce the signs of the illness.

Signs of a 3rd phase illness:

  1. parkinsonism (trembling, sluggish movement, reduced total activity);
  2. absence of coordination approximately falls;
  3. trouble swallowing;
  4. regular syncope;
  5. cognitive dysfunctions;
  6. urinary incontinence;
  7. mental illness;
  8. fuzzy speech, confusion of words;
  9. feeling numb of the limbs and even paralysis of the body;
  10. short-lived loss of vision;
  11. dementia

All phases of the illness are accompanied by mental issues that are not managed by people:

  • lethargy throughout the preliminary phase of the course of the illness;
  • anxiety after its stress;
  • social disorientation throughout the last phase of ischemia.

With the advancement of the illness, an individual loses the capability to self-discipline and self-criticism. For example, a client might not know that he has incoherent speech or might forget his address. Such a client remains in immediate requirement of care and care.

The rate of development of the illness from the very first phase to the 3rd might differ in various clients and depends mainly on the vulnerability to the illness, lifestyle and making use of treatment approaches.

Most frequently, physicians call such terms for the advancement of the illness from the preliminary to the last phase:

  1. sluggish rate: more than 5 years;
  2. typical rate: from 2 to 5 years;
  3. fast lane: approximately 2 years.

A complicated treatment of cerebral ischemia is carried out by a vascular cosmetic surgeon, an eye doctor, a psychotherapist, and a neurologist. Treatment of cerebral ischemia can be medication and surgical.

Medication is focused on reperfusion, that is, repair of typical blood flow in brain tissue and neuroprotection, to put it simply, security of brain tissue from damage.

Objectives of drug treatment:

  1. Expansion of capillary.
  2. Prevention of embolism.
  3. Improving blood flow in the vessels of the brain.
  4. Stimulating brain activity.
  5. Improving brain tissue metabolic process.

Groups of substance abuse in the treatment of:

  1. Vasodilator drugs – add to the relaxation of smooth muscle tissue, and as an outcome, a boost in vascular periods.
  2. Antiplatelet representatives – hinder the adhesion of platelets and the look of embolism.
  3. Angioprotectors – enhance microcirculation and decrease vascular permeability.
  4. Nootropic drugs – trigger cognitive activity of the brain.

Treatment of ischemia in the 3rd phase is difficult without surgical intervention. The usage of surgical intervention avoids the event of strokes in clients with this illness.

Tasks of the surgical intervention:

  1. Removal of an embolism or atherosclerotic plaque.
  2. Expansion of the walls of capillary.
  3. Restoring typical blood flow to the brain.

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Unfortunately, surgical treatment is not safe for some clients.

The threat throughout operations are:

  • comprehensive growths;
  • hypertension;
  • cardiac arrest;
  • unsteady angina.

The security of the operation is examined utilizing:

  • brain tomography;
  • angiography (inspecting the practical state of capillary);
  • duplex ultrasound scanning of the brain (monitoring physiological modifications in capillary).

For the treatment of chronic cerebral ischemia, the following surgeries are usually utilized:

  1. Carotid endarterectomy – elimination of the inner wall of the carotid artery impacted by atherosclerotic plaque.
  2. Stenting of the carotid arteries – growth of the walls of the carotid arteries.

Mandatory treatment conditions are:

  • incorporated nutrition;
  • eliminating excess weight, bad practices for the body;
  • physiotherapy;
  • execution of all suggestions of the participating in doctor.

Lack of treatment can cause:

  • necrosis of brain cells;
  • paresthesia;
  • speech loss;
  • brain sclerosis;
  • a stroke;
  • asphyxia of the brain.

The portion of impairment and death from chronic cerebral ischemia is extremely high.

With appropriate prompt treatment, picking an efficient course of treatment, you can stop the advancement of the illness. After effective treatment, the client requires rehab, in some cases a yearly course of drug avoidance of the illness. Most notably, the treatment of chronic ischemia of 1 and 2 degrees provides favorable lead to many cases.

The causes of a pathological violation of microcirculation in the vessels of the brain tissue are usually divided into two types – primary and secondary.

Key factors

The main factors affecting insufficient blood supply and the occurrence of the disease include:

  1. Hypertensive diseases associated with impaired functioning of the cardiovascular apparatus.
  2. Atherosclerosis, in which arteries are affected as a result of the accumulation of cholesterol.
  3. Vascular inflammation (vasculitis) due to allergic or infectious processes.
  4. Blood disease.
  5. Vinivarter-Burger disease associated with damage to the small and medium arteries.
  6. Intracranial injuries of varying severity.
  7. Low blood pressure (hypotension).
  8. Aneurysm, pathology of the vascular bed of the brain.
  9. Disruption of the endocrine system (AIT of the thyroid gland, diabetes mellitus).

The secondary causes leading to hypoxia of brain neurons include:

  • inflammatory processes and diffuse changes in the spine that impede the blood flow of the vertebral arteries (osteochondrosis, disc herniation);
  • tachycardia;
  • anemia;
  • elderly age.

Improper nutrition, alcohol and smoking can provoke chronic ischemia. Alcohol, like nicotine, inhibits the walls of blood vessels, making blood flow difficult.

Chronic cerebral ischemia: treatment, stages, symptoms and causes

What is cerebral ischemia of the brain – this is a pathological condition caused by a decrease in blood supply to nerve tissue. Ischemia leads to oxygen starvation of cells and metabolic disorders, which leads to damage and necrosis of neurons.

The concept of ischemia is not identical with hypoxia. The latter is oxygen starvation due to impaired transport or perception of gases. Ischemia is a broader concept, including tissue hypoxia and reduced nutrient delivery.

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Ischemic blockade is a reversible dynamic process. When vascular patency is restored, blood again flows to starving tissues and nerve cells continue to function.

Prolonged ischemia leads to acute disorders, for example, to ischemic stroke or heart attack and softening of brain tissue. Also, chronic ischemia leads to cerebrovascular insufficiency.

Types of disease

Vascular ischemia is of several types:

  1. Transient ischemic attack of blood vessels. This is an acute and reversible process, characterized by a sudden violation of the blood circulation of the brain. The condition does not reach the level of stroke, therefore, stands out in a separate subspecies. As a rule, the duration of a transient ischemic attack does not exceed 60-90 minutes. Mostly affected are patients with cerebral arteriosclerosis and compression of the main arteries (carotid, vertebral).
  2. Chronic vascular ischemia. This type of cerebral pathology is characterized by a slow progressive violation of the delivery of blood to the brain, which leads to a gradual increase in neurological disorders. Previously, this disease was called “discirculatory encephalopathy.” Chronic cerebral ischemia appears in people suffering from atherosclerosis, blood clots and diseases, which are accompanied by a violation of the properties of blood, such as viscosity. With a prolonged course, small, and then large foci of gliosis are formed in the brain first. This is mainly found in the area of ​​the basal ganglia.

Causes

By nature of origin, coronary artery disease occurs:

  • Compression. This means that an artery in some place is compressed by a volumetric process, for example, a tumor or a hygroma.
  • Obstructive. Partially or completely overlaps the lumen of the vessel, which causes obstruction. Blood clots, emboli, atherosclerosis and inflammation of the walls of the arteries are the most common causes of obstructive ischemia.
  • Angiospastic. This type of ischemia is functional in nature: due to an internal (pain) or external (life-threatening object) stimulus, the artery narrows. Because of this, the minute volume of blood in the vessel decreases, which leads to ischemia.

There are factors that increase the likelihood of developing ischemia:

  1. overweight;
  2. smoking;
  3. passive lifestyle;
  4. age after 60 years;
  5. frequent stress;
  6. existing diseases of the kidneys, heart, metabolism, blood;
  7. hereditary defects of arteries.

Symptoms

Symptoms of cerebral ischemia are determined by its shape.

Acute form

The clinical picture of acute transient ischemic attack.

If the vessel is blocked in the spinal cord, the person has the following symptoms:

  • dizziness, headaches, nausea, and indomitable vomiting;
  • autonomic disorders: severe sweating, increased blood pressure, cooling of the fingers and toes;
  • visual impairment, double vision;
  • elementary visual hallucinations, for example, short-term flashes in front of the eyes;
  • loss of consciousness;
  • drop-attack – a person falls without losing consciousness;
  • disorientation in time and space, short-term memory loss.

If blood circulation is disturbed in the carotid artery:

  1. paresis (weakening of muscle strength) of one limb, paresis of half the body on the side of ischemia;
  2. in the same place where muscle strength is lost, sensitivity decreases;
  3. motor aphasia: the patient can not pronounce the sounds articulate, it turns out “porridge” in the mouth;
  4. visual impairment: its acuity decreases and side fields fall out.

Chronic form

Signs of chronic ischemia:

  • mental disorders: memory impairment, impaired concentration, slowing the pace of thinking; emotional lability, mood swings;
  • dementia – a steady and almost irreversible decline in cognitive activity;

Chronic ischemia proceeds in three stages:

  1. General deterioration in well-being and a decrease in cognitive processes are combined with small-focal neurological symptoms, due to the formation of gliosis in places of chronic ischemia. The plasticity of the brain is disturbed. All intellectual processes are rapidly declining. Despite the clinical picture of the first stage, patients continue to live at the same pace.
  2. The second stage is characterized by the formation of a leading focal neurological syndrome. For example, if the blood supply is disturbed in the frontal cortex, motor disturbances, convulsive seizures and a violation of the patient’s behavior come first. The general adaptation of man to society is worsening. Professional skills are forgotten.
  3. In the clinical picture, leading syndromes are distinguished. The ability to self-service is lost. Often there is spontaneous urinary incontinence. Lost criticism of his condition. The emotional sphere is upset: patients become quick-tempered, explosive. Dementia develops. Usually patients at this stage are disabled and often cannot answer for their actions.

For the diagnosis of ischemia in the first place, clinical examinations and instrumental research methods are important. The patient is offered to pass a general and biochemical blood test, where they pay attention to the level of glucose and lipids.

Among instrumental methods, the most important are:

  • Electrocardiography
  • Electroencephalography.
  • Fundus study.
  • Neurosonography
  • Angiography of the vessels of the brain.

According to the clinical picture, ischemia resembles neurodegenerative diseases, in which cognitive decline is in the first place. For this, the patient should be examined by a medical psychologist and psychiatrist.

The treatment of cerebral ischemia has the following goals:

  1. Stop the progression of intellectual disorders.
  2. Restore normal blood flow to the brain.
  3. Prevent vessel blockage and ischemia.
  4. Restore neurological function.

Therefore, therapy is aimed at normalizing blood circulation and restoring normal biochemical blood counts. For this, among drugs prescribed hypotensive, hypolipidemic, antiplatelet and combination drugs.

Surgical treatment is used in acute conditions when the artery was compressed by a volumetric process.

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Treatment with folk remedies loses before traditional medicine in all aspects. It is ineffective and has no evidence base. When treating with folk remedies, there is no control over the dynamics of the disease, so people who decide on such therapy run the risk of complications and consequences in the form of dementia, ischemic stroke, cerebral infarction and death.

The diet for ischemia consists of the following fundamental points:

  • Calorie content should be consistent with human energy expenditures. You can’t eat a lot if you sit at the computer all day.
  • Fat reduction. Limit the amount of skim milk, sour cream or cheese. Also exclude fatty meat.
  • Increase the amount of any vegetables and fruits.
  • Limit sugar to at least two.
  • Include porridge, especially buckwheat in the diet.
  • Once a week, it is recommended to add seafood to dinner: shrimp, fish, mussels.

Brain ischemia is a dangerous damage to brain structures that occurs against the background of insufficient blood supply to one or another part of the brain.

When this condition develops due to a sharp blockage of the main arteries, a loss of function of the brain area or even the death of all cells can occur.

The longer the brain is left without blood, the more destructive are the consequences of ischemia.

Chronic cerebral ischemia has long-term consequences, since it does not completely block the arterial bed. Long-term relative insufficiency of blood flow in the brain tissue leads to this form of ischemia. In the process of such a disease, a gradual loss of the functions of higher nervous activity occurs.

Cerebral ischemia can be localized and extensive. In the first case, a lack of blood flow is detected only in certain areas of the organ, so there is a loss of specific functions. Extensive ischemia is much more difficult and manifests itself in almost everything.

Various parts of the brain control all processes in the body: from the ability to see, hear and think to maintain a heartbeat and breathing. Lack of blood flow can hit any functional part of the brain, and the consequences will always differ in the degree of life threat.

Damaged nerve cells are not replaced by new ones and are not restored. An ischemic attack on any part of the brain will lead to regular dysfunction. Chronic ischemia is quite insidious in that the cells do not die immediately. A person with this disease may not feel anything for months and years, although his brain will gradually collapse.

Patients with chronic cerebral ischemia suffer from a wide range of symptoms. Symptoms may vary slightly from patient to patient. The prevalence of ischemic lesion plays a role, since a localized violation of the blood supply to the brain will manifest itself with specific symptoms associated with the functions of the affected area.

The most common symptoms include impaired coordination of movement, insecure gait, numbness of body parts. Clarity of thinking may be disturbed, and short-term and even long-term memory may be lost. Almost all patients experience headaches and dizziness.

Lack of concentration

  • visual impairment: bifurcation, blur, loss of visual field, sudden blindness
  • hearing loss
  • sensation of fog in the head
  • involuntary urination during sleep
  • non-digestive nausea and vomiting
  • fast fatiguability
  • loss of attention
  • tardiness
  • mental disorders
  • loss of work skills and social adaptation

Symptoms and degrees of pathology

Initial changes associated with cerebrovascular insufficiency manifest themselves as a mild violation of the musculoskeletal system, short-term disorientation. Memory impairment is noted, which entails the inability to perceive new information.

The more cognitive functions of the brain are suppressed, the more distinctly the disease affects the emotional state. A person becomes withdrawn, prone to depression. The reverse progression is observed: the longer the pathology is not detected, the less complaints will come from the patient. Therefore, to make a diagnosis, it is necessary to take into account that there is no connection between the subjective manifestation in the form of a complaint and the severity of the disease.

Knowing these signs will help in time to pay attention to the presence of ischemia and stop its progression in the future. Symptoms that cause seeking medical help:

  • periodic headaches with frequent dizziness;
  • uncertainty in movements, unsteady gait;
  • memory impairment, it is difficult to concentrate on one subject;
  • emotional instability, a sharp change in mood;
  • insomnia or lethargy and a constant desire to sleep.

These clinical manifestations are inherent in a number of different diseases, but, nevertheless, will help a specialist to determine the degree of chronic brain ischemia in each individual case. The longer the vessels were narrowed, the stronger the focal lesion, which can trigger the development of a microstroke.

The first degree is the initial one, HGM (chronic cerebral ischemia), characterized by a stable general condition, normal health. Only occasionally are cases of chills and slight dizziness. After physical exertion, slight pain in the muscles of the hands is possible. The gait changes in the direction of decreasing the stride length.

The second degree – subcompensation – reflects the dynamics of symptoms: headaches progressing with bouts of nausea. The patient hardly meets the requirements of society. Partially lost professional and domestic skills. Inadequate behavior is noticeable not only to the close environment. The sequence of actions is not coordinated and is chaotic. There is no critical self-esteem, perception of one’s own behavior is biased. Without conscious assistance, the patient will not be able to see a doctor.

The third degree – decompensation of the disease – occurs if treatment has not been carried out for the two previous stages. This form of the disease is characterized by disorders associated with neurology. The motor functions of the arms and legs are upset, the inability to be in balance appears, which deprives the patient of the ability to move.

Methods of diagnosis

The first stage of diagnosis involves a detailed study of the anamnesis and the presence of neurological abnormalities. A patient’s medical record is examined for past illnesses. Based on the data, it is concluded whether a person is at risk or not. Diagnosis measures are carried out comprehensively and include:

  1. Laboratory blood tests for cholesterol and sugar.
  2. Cardiography, using the method, the state of the heart and blood vessels is investigated, violations in the organs are detected and their severity is assessed.
  3. Ultrasound tomography reveals the pathology of intracranial arteries, a change in cerebral perfusion.
  4. Electroencephalography captures the electrical activity of the brain.
  5. The physical examination method consists in examining the patient with a doctor using his senses (palpation, percussion, auscultation).
  6. Doppler imaging makes it possible to observe the volumetric picture of blood vessels in real time, is used to detect abnormal abnormalities.

A diagnostic complex is assigned individually for each case, and after a detailed study of the disease, a diagnosis is made.

Medical events

head5 - Chronic cerebral ischemia

After a diagnosis of chronic cerebral ischemia is diagnosed, treatment of any degree of cerebrovascular insufficiency is aimed at eliminating existing disorders and preventing further transient ischemic attacks and microstrokes.

When prescribing therapy to stop the pathology, it is necessary to take into account the level of blood pressure. Sharp jumps will affect the clinical course of the disease, since with ischemia, a disorder in the autoregulation of blood flow in the brain is noted.

Discirculatory encephalopathy, if it has not reached the third degree, is not an indicator for hospitalization. But only if the disease was not complicated by the presence of a stroke or somatic pathology in severe form. A patient’s change of habitual environment to a stationary stay, in the presence of cognitive impairment, can only worsen his condition.

Treatment of chronic insufficiency of blood supply to brain tissue is carried out comprehensively and is aimed at:

  • prevention of atherosclerotic changes and exclusion of cramps;
  • improving blood flow to enrich the neurons with oxygen and improve metabolic processes in them;
  • prevention of stroke and ischemic attack and restoration of collateral circulation function.

If the patient, along with chronic ischemia, has diabetes, hypertension or osteochondrosis, then these diseases must be controlled.

Antiplatelet therapy is aimed at the use of drugs that normalize vascular patency and prevent platelet adhesion. “Clopidogrel” and “Dipyridamole” are widely used in this direction.

Hypolipidemic therapy involves the use of Atorvastatin, Simvastatin and Rosuvastatin. This group of statins prevents cholesterol and has an antioxidant effect.

Combination therapy is used to normalize blood, improve venous outflow and restore microcirculation. Drugs have a neurotrophic effect. These include:

  1. “Ginkgo biloba leaf extract”;
  2. “Vinpocetine”;
  3. “Cinnarizine”;
  4. “Pentoxifylline.”

This group of drugs is prescribed twice a year for up to three months, depending on the clinical picture of cerebral ischemia.

To improve the metabolism inside the cell and the ability to function with insufficient oxygen, neuroprotectors help: Actovegin, Piracetam and Encephabol.

Widely used “Cytoflavin” it consists of succinic acid, biboxin, nicotinamide and riboflavin. Due to its multicomponent nature, the medication helps the cell to receive energy by acting on different links. The drug is used not only for stroke, but also during the rehabilitation period.

Surgical intervention is indicated to the patient if treatment with conservative methods did not give the desired result. The cause may be an acute clinical course or if chronic ischemia has reached the third stage. But the main indicator for the operation is an occlusive-stenotic lesion of the main arteries of the head.

For surgical intervention, craniotomy is not used, surgical operations are carried out in the following way:

  • stenting, when a stent is placed in the lumen of the carotid artery, if the use of this design is not possible, then a peripheral blood flow is formed;
  • apply the method of carotid endarterectomy – removal of the inner wall of an artery affected by atherosclerosis;
  • thrombectomy is performed to remove blood clots from the bed of arteries.

The operation of chronic cerebral ischemia is complex. The recovery period is quite long. The patient is prescribed medication for better tissue regeneration. The prognosis here is ambiguous: there is no guarantee that such an approach to the treatment of cerebrovascular insufficiency will exclude the occurrence of relapses.

preventive measures

In order for therapeutic measures for the treatment of chronic cerebral ischemia to bring outcomes and in order to avoid surgical intervention in the future, it is necessary to observe several simple rules.

Compliance with diet

Diets for ischemia are primarily aimed at preventing the formation of blood cholesterol plaques and increasing sugar levels. The diet is selected by the nutritionist individually for each patient, taking into account the biological characteristics of the body and the accompanying ischemia of the illness.

It is recommended that fat-containing foods be excluded from eating. The proportion of fat in the daily diet should not exceed one fourth of all foods. Animal fats, pork are completely excluded. It is also necessary to limit the use of salt, so marinades, pickles, smoked foods are minimized. To prevent a rise in sugar level, it is necessary to completely abandon confectionery products, muffins and those products that contain sugar.

To replenish carbohydrates in the body, unlimited vegetables and fruits are included in the diet. Beef, poultry and turkey meat can completely replace pork. If possible, diet rabbit meat should be added to the menu. Coffee and energy drinks will have to be abandoned in favor of juices and fermented milk products.

Doctors and nutritionists recommend dividing the daily intake of foods into five to six doses. A large volume in one sitting with chronic ischemia is not recommended.

It is very important to lead an active lifestyle, which involves sports, hiking. Being in the fresh air will contribute to better oxygen enrichment of brain neurons. The time allotted for sleep should not be less than eight hours. Significant physical exertion should be avoided, especially for the elderly. Negative emotional stress in the form of stress is also contraindicated.

It is better to abandon bad habits: alcohol and smoking adversely affect the walls of blood vessels. If there are illness of diabetes mellitus or hypertension, their treatment needs to be strictly under the supervision of a doctor, so as not to provoke self-medication of the appearance of chronic cerebral ischemia.

Subject to the rules of prevention and timely contact a neurologist to prescribe adequate treatment, the prognosis for recovery is rather beneficial.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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