What is left atrial hypertrophy and how to recognize it on an ECG

DlyaSerdca → Heart Diseases → Other Diseases → Left Atrial Enlargement: Causes, Symptoms, Diagnosis and Treatment

Hypertrophy (increase) of the left atrium is not an independent disease, but is an alarming symptom of a number of other pathological processes.

Most often, hypertrophic changes in this part of the heart are formed almost simultaneously with similar changes in the right ventricle.

The cause of hypertrophic changes in this part of the heart may be one of the diseases listed below, or their combination.

  • Congenital malformations of the cardiovascular system:

  • coarctation of the aorta;
    Coarctation of the aorta
  • hypoplasia of the left ventricle;
  • mitral valve defects;
  • malformations of the aortic valve;
  • combined heart defects.

Acquired heart defects:

  • mitral valve defects;
  • malformations of the aortic valve;
    Aortic valve defects
  • combined heart defects.
  • Hypertrophic cardiomyopathy.
  • Hypertension with the formation of a hypertensive heart.
  • Myocarditis of various etiologies.
  • Based on the above list of possible causes, we can conclude that left ventricular hypertrophy often has a hereditary character.

    In addition, there are a number of non-cardiac factors that can lead to the fact that the left atrium experiences increased functional load and hypertrophies. Most often it is:

    • pulmonary diseases, especially protracted, chronic;
    • frequent and / or severe stress;
    • overweight.

    Hypertrophy or an increase in the left atrium only sounds like a disease, but in fact, this is an alarming signal about problems in the functioning of the cardiovascular system.

    An increase in cells in the heart tissue often occurs precisely on the left side of the heart muscle.

    To avoid the dangerous development of the disease, you need to see a doctor in a timely manner, but not everyone knows how to determine the pathology, what it means, and for what reason it appears, although you probably have heard of such an ailment.

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    Causes

    Why the left atrium is increasing is still not known exactly, but there are many reasons for this pathology. Despite the fact that heart diseases are more common among older people, trends change every year, and diseases become younger.

    The most common causes of hypertrophy include heredity, high blood pressure and excess weight. The problem of obesity is not news in the modern world, therefore, atrial enlargement is no longer a rare symptom, and this symptom is often found in young people and even children.

    If you consider the reasons better, you can understand why there is such a pathology and how to deal with it.

    Hypertension

    Most often, hypertrophy occurs in hypertensive patients, high blood pressure increases the load on the heart and disrupts blood flow. In a chronic form, even with treatment, blood pressure is far from normal, and a constant load on the muscle leads to its swelling and hypertrophy.

    The enlargement of the left atrium occurs as a result of the narrowing of the opening, which regulates the blood flow between the left side and the ventricle. In this case, the load on the heart muscle increases, the blood is retained in the left atrium more than it should be, and it accordingly stretches, and also increases in size.

    Despite the remoteness of this department from the atrium with pathology in the zones between the ventricle and the aorta, blood circulation is disturbed, and there are known violations of the left atrium.

    Not only the narrowing leads to pathology, the functioning of these valves affects the blood supply.

    If one of the valves does not close tightly or the frequency of contractions does not correspond to the rhythm, then the outflow of blood occurs in the opposite direction, which inevitably leads to the inflammatory process of the heart cavity and left atrium. As a result of these disorders and the inflammatory process, hypertrophy develops.

    Myocardial inflammation has a negative effect on the contractile function of the heart muscle.

    Disorders of the left atrium can also be caused by diseases of the respiratory system, lack of oxygen, heart rhythm disturbance lead to hypertrophic changes.

    The process is a lengthy one, so an ordinary cold cannot lead to such consequences. The cause can only be neglected and chronic diseases that methodically disrupt the functioning of the heart.

    Hypertrophy of the left atrium is caused by a gene mutation of chromosomes, which results in hypertrophic cardiomyopathy. Pathological compaction of the walls of the ventricle leads to a load of the lower parts of the heart, and increased blood flow increases the cavity of the organ.

    Disorders of the nervous system

    Not the least among the causes of atrial enlargement is stress and nervous tension. They are the culprits of high blood pressure, which leads to hypertrophic changes.

    Symptoms

    The process of changing the left atrium is slow, and symptoms do not occur immediately. It all starts with chest pain, which is not perceived as a serious sign of impairment. Over time, fatigue appears, at first during physical exertion, later at rest. Well-being worsens as the disease progresses.

    The symptomatology of the manifestation of an increase largely depends on the causes of the development of the pathology. If the problem arose against the background of mitral valve stenosis, in addition to pain, severe edema of the lower extremities, a strong cough with hemoptysis are observed.

    With mitral or aortic valve insufficiency, a person complains of the following symptoms:

    • cardiopalmus;
    • heart rhythm disturbances;
    • dyspnea;
    • general weakness;
    • excessive fatigue;
    • pain during physical exertion.

    If there are several reasons, then symptoms gradually arise in different order. A large influence on the symptoms is exerted by external factors. Lifestyle, bad habits, hard physical work and individual characteristics can change symptoms and manifest in different ways.

    Diagnostics

    A slow lesion and an increase in the left atrium does not allow pathology to be diagnosed based on symptoms, but there are methods by which hypertrophy can be detected at the initial stage.

    Auscultation is referred to the first method for diagnosing disorders in the work of the heart muscle and increasing atria. He does not need special equipment, but just a stethoscope and a doctor’s professionalism.

    Such a study is based on listening and evaluating sounds during the work of the heart. The appearance of noises and short harsh sounds indicates pathology of the valves, which allows for atrial hypertrophy.

    Evaluate the performance of the valves and detect violations in their operation using ultrasound diagnostics. Echocardiography and ultrasound allows you to examine the tissue of the heart muscle, to evaluate the size and thickness of the walls of the heart. Monitoring blood flow in the heart muscle allows you to detect pathological changes before hypertrophy is visible.

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    X-ray examination is less informative, but is an indispensable diagnostic method for congenital disorders. In an X-ray, in addition to the state of the heart muscle, the potential of the lungs and their work are also evaluated.

    Since violations of contractions are observed with hypertrophy quite often, an electrocardiogram is one of the methods for examining the heart. One method may not be a way to accurately diagnose. To establish the causes and degree of neglect of the disease, the whole complex of the examination is carried out.

    Therapies

    Since atrial enlargement is not a separate disease, and symptom treatment is based on eliminating the causes that led to hypertrophy and therapy of the underlying disease. The effectiveness of treatment depends on identifying the exact causes of atrial hypertrophy. Mistakes are unacceptable here and can be fraught with serious consequences.

    If the enlargement of the left atrium occurred due to an infectious lesion, antiviral or antibacterial therapy is prescribed. Supportive therapy is prescribed to support the heart and restore normal atrial sizes.

    With hypertension and high blood pressure to normalize the unpleasant consequences, an important part of therapy is the normalization of pressure and keeping it within normal limits. Antihypertensive drugs are used for treatment.

    In addition, drug treatment and surgical intervention for a speedy recovery are recommended to reconsider the lifestyle, keep a diet for some time and abandon bad habits, first for the duration of treatment, and then forever.

    How effective the treatment will be depends on how quickly the pathology was detected, in what state the cardiovascular system and the body as a whole are, and how badly the heart and left atrium were affected. Timely diagnosis and the right treatment allow you to get rid of a dangerous symptom and return to your usual life without fear for your health.

    It is important to remember that the causes that led to hypertrophy could cause damage not only to the atrium, but also to the vessels, aorta, or ventricle. During examination and therapy, these points must be taken into account.

    Hypertrophy of the left atrium is a dangerous symptom, which, in addition to serious consequences, can cause life-threatening complications.

    Missed moment, ineffective treatment, incorrectly established reasons can lead to disability or death.

    But timely diagnosis and proper treatment, even with congenital malformations, gives good forecasts for recovery. After medical treatment and surgical intervention, a person can return to his usual life without limiting himself due to illness.

    The prognosis for recovery is favorable, most importantly, do not delay the call to the doctor. When the first signs appear, you need to immediately go to the clinic. Slight malaise and barely perceptible pain can not be an accident, this body gives a signal about the occurrence of problems in the cardiovascular system. The sooner they are identified, the faster recovery will be.

    Left ventricular hypertrophy – how it manifests itself, is detected and treated

    A common disease is left ventricular hypertrophy, and it manifests itself in people of different ages equally. Statistics show 4% of deaths that occur as a result of left ventricular hypertrophy or LVH. Such a designation will be used further on the topic.

    Today we have to consider the reasons that provoke the development of pathology, symptoms indicating the presence of a problem, diagnostic methods and treatment options, possible complications that may arise as a result of the lack of treatment.

    What it is?

    Before all planned issues will be considered, it is necessary to find out what hypertrophy of the left ventricle of the heart means. Having delved into the essence of the pathology, it will be easier to get acquainted with its features, causes, methods of treatment and diagnosis.

    The essence of this pathology is to increase the thickness of the muscle layer in the left ventricle. Normal values ​​do not go beyond 11 mm. With a muscle layer thickness of more than 12 mm. there is already a moderate hypertrophy of the left ventricle. The disease is equally found in people of different ages. It is quite common.

    A complete cure is possible only through surgical intervention. But it is prescribed not to all patients with such a diagnosis, but only to those people who have a life threat. In most cases, conservative treatment is prescribed, which can reduce the pathological manifestation or keep it at a constant level.

    Causes of the disease

    There are a large number of factors that can provoke the development of LVH. The development of pathology is based on factors due to which the left ventricle contracts in an intensive mode. Under such circumstances, muscle wall growth occurs. Various pathologies or a high load on the heart can act as such factors.

    Hypertrophy, which spreads to the left ventricle, is often diagnosed in professional athletes. Throughout their sports careers, they regularly subject their bodies to excessive aerobic exercise.

    With this lifestyle, the muscle wall is forced to inflate and thicken. Another reason is overweight.

    In such people, the heart is constantly experiencing a high load, which makes it work in an enhanced mode.

    Now consider the diseases that often become causes of left ventricular hypertrophy of the heart:

    • hypertrophy, which has grown into a chronic condition, in which the pressure indicators are above the mark of 145 per 100;
    • narrow aortic valve;
    • atherosclerosis of the aorta.

    The disease is not always acquired, there are also congenital pathologies.

    Pathology is divided into types. Separation is based on various factors. For example, according to severity, three varieties are distinguished:

    • the moderate form is characterized by an increase in the muscle layer up to a maximum of 2 cm, treatment is easy, but there is no threat to life, for the most part characteristic of athletes;
    • the middle form is characterized by an increase in left ventricular tissue up to 2,5 cm;
    • a pronounced degree is diagnosed in cases where the thickness of the muscle layer exceeds 2,5 cm.

    Another classification is based on the location of the thickening:

    1. Concentric hypertrophy of the left ventricle is characterized by expansion of the myocardium and a decrease in the cavities of the heart muscle. The left ventricle usually expands. This form of the disease affects people after 35 years.
    2. Eccentric left ventricular hypertrophy has opposite characteristics (cavities enlarge and walls expand). At risk are people after 30 years, mostly men. The cavity of the left ventricle is very large. People with this pathology complain of severe heart pain. As the load decreases, the process of increasing the muscle layer decreases.
    3. An obstructive or mixed form is also called cardiomyopathy. The shape of the ventricle with this form of the disease resembles an hourglass. The thickening affects the walls of the cavities and myocardium. Such a disease manifests itself in young people who have not reached the age of 35.

    The symptomatology of this disease is heterogeneous, which makes its identification problematic.

    For some people, the pathology of the heart does not manifest itself in any way, and they live quietly, not realizing its presence.

    There are also cases where the symptoms of left ventricular hypertrophy have a significant effect on the well-being of a person. The most common signs of the disease include the following:

    • angina pectoris develops against the background of compression of the vessels that are responsible for nourishing the heart, this sign of left ventricular hypertrophy is displayed on the ECG and is felt even without examination;
    • atrial fibrillation;
    • loss of consciousness occurs as a result of a sinking heart for a few seconds;
    • atrial fibrillation;
    • myocardial starvation;
    • dyspnea;
    • increase or violation of blood pressure, instability of indicators;
    • headaches and poor sleep;
    • weakness, fatigue, decreased well-being;
    • chest pain.

    Any of these conditions should be an impetus for visiting a doctor. You can not wait until the symptoms go away on their own. She always has a reason that can lead to irreparable consequences.

    Diagnostics

    In the vast majority of cases, LVH or left ventricular hypertrophy is detected during a routine examination. This is exactly what happens with athletes who undergo an in-depth medical examination every year.

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    The disease manifests itself on echocardiography when a cardiac chamber is examined. This procedure is prescribed for people with hypertension, in the presence of shortness of breath, dizziness, general weakness and pain in the chest.

    If thickening is detected on the walls of the left ventricle, additional diagnostic methods are prescribed that allow you to determine the nature of the disease and identify the causes of its development. These diagnostic methods are the following procedures:

    • determination of heart rate and blood pressure;
    • ECG;
    • examination of the aorta using ultrasound;
    • Doppler echocardiography.

    Based on the data obtained as a result of such a comprehensive diagnosis, treatment is prescribed. Only in this case will it be effective.

    If not treated

    In itself, a moderate disease is not dangerous and does not pose a threat to human life. But against its background, a number of diseases can develop, each of which has a serious impact on health and well-being. Therefore, it is necessary to deal with the treatment of LVH, despite the absence of symptoms and changes in well-being.

    In the absence of treatment with a high degree of probability, various kinds of heart ailments can develop, among which the following diseases are most dangerous:

    With any of these ailments, an attack can cause heart failure and death. The danger of left ventricular hypertrophy is known to you, and now no one will doubt the danger of this ailment, which means that we can proceed to consider treatment methods.

    Therapies

    Only a cardiologist can tell how to cure left ventricular hypertrophy. He must have in his hands the data obtained as a result of a full diagnosis. The choice of treatment is influenced by the nature of the ailment, the causes of occurrence, developmental features and associated pathologies.

    In the process of treatment, various drugs can be prescribed, each of which has a different effect on the body and allows you to achieve the corresponding effect.

    1. Reception “Verampil” with beta-blockers will remove unpleasant and painful symptoms, improve overall health.
    2. Drugs that allow you to normalize blood pressure and reduce the heart rate.
    3. ACE inhibitors block the development of hypertrophy. Taking these drugs over time can reduce symptoms and prevent the development of the disease.
    4. Antihypertensive drugs improve myocardial nutrition and help normalize heart rate.

    operations

    Only surgery can completely relieve a person of LVH. If the disease arose against a background of heart disease, then surgery cannot be avoided; moreover, it must be done without delay. Three types of surgical treatment are practiced:

    1. Prosthetics on the aortic valve must be performed against the background of its narrowing. The operation is vital. According to statistics, without surgery, 95% of patients live no more than 5 years with such a diagnosis.
    2. Aortic stenting is performed when diagnosing aortic atherosclerosis. The operation is prescribed for narrowing the vessel with an atherosclerotic plaque by more than 50%. At lower rates of narrowing of the artery, the treatment is of a medicinal nature.
    3. With a strong severity of hypertrophy, they resort to excision of excess muscle tissue.

    Lifestyle & Diet

    Regardless of the form of the disease, its degree and compliance with therapeutic tactics, it is necessary to change your lifestyle and adhere to a special diet. Such actions will increase the effectiveness of treatment and increase the ability of the heart to resist the disease.

    When diagnosing LVH, it is necessary to change the lifestyle in accordance with the following recommendations:

    • complete rejection of all bad habits;
    • normalization of the weight indicator;
    • regular exercise physiotherapy, especially for people with a sedentary / sedentary lifestyle;
    • reduction of stress factors;
    • decrease in physical activity.

    The diet also has to be adjusted:

    • fractional nutrition (6 times a day in small portions);
    • a decrease in the amount of salt;
    • refusal of smoked meats, fatty and fried foods;
    • inclusion in the daily diet of dairy and dairy products;
    • seafood and lean meat;
    • fruits and vegetables should be included in the daily diet;
    • sweets to exclude or minimize.

    Folk remedies

    Treatment with folk remedies for left ventricular hypertrophy is rarely used. The most common are plants that have an antioxidant and calming effect on the body.

    It is also recommended to take decoctions from plants that strengthen blood vessels and free the body from plaques.

    You can take vitamin complexes and dietary supplements, which contain potassium and calcium, omega, magnesium and selenium.

    1. We make a collection of 3 tablespoons of motherwort, 2 tablespoons of cinnamon and rosemary, tablespoons of kidney tea. One tablespoon of this collection is filled with 1,5 cups of warm water. Bring to a boil and keep on fire for 5 minutes. We infuse the broth for 4 hours. Filter and take three times a day before meals in a warm form.
    2. Rub fresh cranberries with sugar. Take it in this form three times a day after eating a teaspoon.
    3. To prepare a decoction of young shoots from blueberry bushes, you need to take a tablespoon of crushed sprouts and boil them in a glass of water for 10 minutes. Chilled and filtered broth is taken three times a day for a tablespoon.

    Left atrial hypertrophy: development, signs and diagnosis, how to treat, prognosis

    Sazykina Oksana Yuryevna, cardiologist

    In order for the heart to perform its pumping function and pump blood through the arteries of the whole body unhindered, all heart structures must work smoothly and smoothly. But even this important organ is not immune from diseases, and if pathological processes arise in it, it seeks to compensate for the arising violations.

    One of such compensatory (adaptive) reactions is a thickening of the heart muscle due to an increase in the number and mass of cells with the inability of any calving of the heart to carry out its activities. Such processes in the heart muscle are called hypertrophic.

    In other words, hypertrophy means an increase and thickening of something, in this context – the myocardium.

    Thickening of the heart muscle (myocardium) can occur in any chamber of the heart – in the right or left atria, as well as in the right or left ventricle. Each of these species has its own causes and consequences. Possible causes of left atrial hypertrophy (HFR) will be discussed below.

    hypertrophy of all parts of the heart

    So, an increase in the left atrium in most cases accompanies any of the cardiological diseases. If the patient showed signs of ECG hypertrophy, for example, he must be further examined, because left atrial hypertrophy is not a normal option.

    An exception is people who have been involved in sports for a long time and professionally, but they develop physiological uniform hypertrophy of all parts of the heart or only the left ventricle (the so-called “athlete’s heart”).

    The isolated thickening of the left atrium is more characteristic of cardiac pathology.

    1. Heart defects

    Violation of the architectonics of the heart muscle greatly affects its work. With defects, compensatory hypertrophy of the heart chambers develops, and subsequently heart failure increases. An increase in the left atrium develops with such types of defects as:

    • Congenital heart defects, for example, a bicuspid aortic valve.
    • Acquired defects of the mitral valve, which serves as a kind of “door” between the cavities of the atrium and ventricle on the left. During the expulsion of blood from the atrial cavity, the valve cusps open, passing the blood stream, and during the expulsion of blood further, from the ventricle to the aorta, the cusps are tightly closed to avoid the reverse flow of blood. Mitral defects develop due to autoimmune or bacterial inflammation in its valves – after acute rheumatic fever (previously called rheumatism), after scarlet fever, as a result of chronic tonsillitis or with infectious endocarditis. Due to scarring of the valves, a narrowing of the valve ring (a defect is called stenosis) or insufficiency of the left atrioventricular opening (a defect is called insufficiency) develop.
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    With stenotic narrowing of the aortic valve, the muscle of the left atrium is very difficult to push blood through a narrow hole, it is natural that after a while the wall of the atrium thickens to contract with more force.

    But sooner or later decompensation sets in, the atrium cannot work under conditions of constantly high load, and chronic heart failure develops.

    The rate of development of the process varies in different patients, ranging from several months to decades.

    left atrial hypertrophy in combination with right ventricular hypertrophy with mitral valve insufficiency

    With mitral valve insufficiency, the mechanism of hypertrophy is slightly different. So, due to the fact that the valve flaps are not tightly closed, there is a reverse flow of blood from the cavity of the left ventricle to the cavity of the left atrium (regurgitation, which should not be normal. The walls of the atrium are always overstretched.

    On the basis of the Frank-Starling law (which states that the stronger the muscle is stretched, the more it will contract), the more regurgitation, the stronger the left atrial muscle works. As a result, compensatory hypertrophy develops, which also leads to heart failure.

    With vasospasm accompanying high blood pressure, increased afterload on the heart, since the myocardium should make a lot of effort to push the blood flow into the arterial bed. As a result, left ventricular hypertrophy develops, and then a thickening of the wall of the left atrium.

    3. Cardiomyopathies

    Cardiomyopathy, characterized by a change in the configuration of the heart due to past illnesses, may be the cause of HFID. Often develops in parallel with cardiosclerosis (proliferation of connective, scar tissue) after inflammation (myocarditis) or heart attacks.

    ILC can be hypertrophic (with a thickening of the walls of the heart), dilatation (with the expansion of the heart chambers and with an increase in the volume of blood in them) and restrictive (with a violation of the ability of the myocardium to relax during diastole of the heart).

    The mechanism of development of enlargement of the left atrium in patients with IMS involving the left ventricle differs slightly – with hypertrophic and restrictive atria, it is difficult to push blood, because it requires more effort, and with a dilated ventricle, it is so full and outgrowed with blood that the atrium has to work with a very high load.

    There are no strictly specific clinical manifestations of directly hypertrophy of the left atrium. However, in any patient, those signs that are most characteristic of the causative disease that caused hypertrophy will be noted.

    So, mitral stenosis is characterized by hemoptysis, attacks of dry obsessive cough and shortness of breath with exercise, aggravated when lying down.

    As chronic heart failure progresses, shortness of breath is noted even at rest and with minimal household activity, and swelling of the legs and feet is increasing.

    A slight increase in the left atrium caused by arterial hypertension is accompanied by frequent deterioration with very high numbers. Blood pressure (180-200 mm Hg and above), with frequent crises, poorly responding to antihypertensive drugs.

    If there are any complaints from the cardiovascular system, a cardiologist or therapist should be consulted for further examination, and the diagnosis of an enlarged left atrium is established based on the results.

    A doctor may expose a suspicion of heart hypertrophy or a disease that can lead to it during an examination and examination of the patient.

    During the survey, the nature of complaints and the conditions under which they arise (state of rest or physical activity, wakefulness or night time, etc.) are taken into account.

    characteristic blush for hypertrophy due to mitral stenosis

    During the examination, special attention is paid to the skin.

    With mitral stenosis, the so-called “mitral” blush on the cheeks may be violet-pink, and in case of insufficiency, pallor and friability of the skin with a bluish color of the nails, tip of the nose, and ears can be observed.

    This is due to a decrease in the oxygen content in the blood in chronic heart failure. The severity and localization of edema is also evaluated (in severe stages, swelling from the legs and feet spreads higher, capturing the external genitalia, hips, abdomen).

    Clarification of the diagnosis is possible with auscultation (listening) of the heart and lungs. In severe stages of heart failure in the lungs, dry or wet rales in the lower sections are heard.

    With hypertension, the patient can hear the accent of the second tone at the point of listening to the aorta (in the second intercostal space to the right of the sternum), and with mitral stenosis, a rough noise is heard in the projection of the mitral valve (under the left nipple in the fifth intercostal space).

    With mitral valve insufficiency, systolic murmur can be heard at the same point.

    Any patient with cardiac complaints must have an ECG. On the cardiogram, it is easy to see signs of left ventricular hypertrophy.

    Due to the fact that conduction in the atria is reflected by the P wave (the ascending part characterizes the excitation of the right atrium, and the descending part of the left), then with hypertrophy of the left atrium on the ECG, the descending part of the P wave increases and lengthens in duration. The tooth acquires an M-shape and is called P-mitrale, in contrast to P-pulmonale with hypertrophy of the right atrium.

    In addition to the ECG, a patient with heart murmur is required to perform an ultrasound of the heart. Ultrasound examination shows signs of hypertrophy of the left atrium that exceed the following parameters: 1.85-3.3 cm and a size index of more than 1.45-2.9 cm / m2.

    Such an examination method as chest x-ray allows not only to detect blood stasis in the lungs (and in severe cases, congestive pneumonia or pulmonary edema), but also to determine the degree of heart enlargement. With mitral defects with a pronounced thickening of the walls of the left atrium, the heart acquires the so-called mitral configuration – smoothing of the waist of the heart.

    According to the doctor’s prescription, other diagnostic methods can be prescribed – ultrasound of the internal organs and kidneys, a biochemical blood test, physical exercise tests to determine the functional class of heart failure.

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    Svetlana Borszavich

    General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
    Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
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