How to identify if you have pneumonia. Based on epidemiological data

Pneumonia is a focal-infiltrative disease in which destructuring of the lung tissue occurs. It can be caused by viruses, fungi and bacteria. Both the upper and lower segments of the main organ of the respiratory system are in the affected area. At running form the disease takes over the whole lung. It is quite difficult to determine pneumonia at home.

In the clinical picture of adults and children (regardless of the etiology of pneumonia), there are pulmonary and extrapulmonary symptoms. If they are ignored, infants, adolescents and other patients develop irreversible pathological changes. For confirmation differential diagnosis in stationary conditions the patient is assigned additional clinical studies.

Through them, the type of causative agent of pneumonia, the rate of sedimentation of red blood cells, darkening in the lung tissue are determined. Mandatory step diagnostic examination becomes a consultation with a therapist and a pulmonologist. In SARS, it is difficult to identify the exact cause.

Is it possible to detect pneumonia at home

The symptoms that appear with pneumonia are similar to those of other colds. Clinical picture directly dependent on the pathogen. Bacterial pneumonia can be acute and gradual. If the disease was provoked by mycoplasma, its manifestations are of low intensity.

Through differential diagnosis, the likelihood of developing acute bronchitis, SARS, tuberculosis, influenza, laryngitis and other infectious pathologies of the respiratory system is excluded. Despite the similarity, each of them has its own characteristics. With the progression of bronchitis, moderate fever, a strong cough (first dry, then wet), seizures, as a result of which viscous sputum is separated, are observed. Bronchial obstruction is often accompanied by perspiration and painful sensations in the throat, runny nose.

Tuberculosis causes hemoptysis, excessive sweating, weight loss, general weakness. Often fixed magnification lymph nodes. Symptoms of laryngitis include hoarseness and a barking cough. For elimination inflammatory process that occurs with pneumonia, use medications, physiotherapy and folk methods. Infusion therapy is prescribed in especially severe cases.

Differential Diagnosis is a necessary step. Thanks to her, the prescribed treatment will give maximum effect. When passing clinical trial the doctor step by step excludes catarrhal pathologies, the signs of which have not been identified. The doctor takes into account the information indicated in the card, listens to the patient's complaints.

In the hospital, pneumonia is determined by X-ray, ultrasound and computed tomography. With pneumonia, the interstitial pattern on the surface of the lungs changes. Violations of this type are absent only on initial stage pneumonia. In this case, there is a need for additional research.

Finding out if pneumonia is present at home without an instrumental examination will not work. When working with portable equipment, special skills are required. Without a doctor, it is impossible to conduct a full diagnosis. With the progression of infiltrative deviations, the patient's condition worsens significantly. Increasing intensity clinical manifestations indicates a lack of effective therapy.

Home diagnostic methods

To recognize pneumonia at home, you must follow the diagnostic algorithm. The patient should pay attention to all the symptoms that have arisen. With inflammation of the lungs in a patient, the clinical picture contains:

There are several types of pneumonia. With a focal form, the disease develops slowly. The affected area is limited to certain segments. The temperature usually does not exceed 38 degrees. The sputum contains blood and pus. Discomfort occurs when inhaling and during bouts of coughing.

Croupous pneumonia means bilateral lung damage. This type of disease is considered the most dangerous. Infectious disease can also be right-sided, left-sided, congestive, lobar, aspiration and atypical. The latter form is distinguished by the appearance of specific clinical manifestations. Aspiration pneumonia is hidden, so it is strictly forbidden to detect it at home. The severity of pneumonia is determined based on the intensity of the symptoms. Therefore, one should not refuse the help of highly specialized specialists.

Pathogenic microorganisms give impetus to the development of the inflammatory process. The situation is getting worse negative impact external and internal factors, including:

At home, a patient suffering from pneumonia can use only two diagnostic methods. Physical examination reveals:

• respiratory failure from the affected organ;
• strong trembling in the voice;
• wheezing in the lungs;
• signs of fever;
• shortening of percussion sound in damaged segments;
• toxic shock;
• pleural noises;
• heavy shallow breathing.

In juvenile patients, pneumonia is caused by pneumococci and chlamydia. Atypical pneumonia causes swollen lymph nodes and muscle discomfort. Percussion and auscultation should be carried out in full accordance with the standard rules. In the absence of knowledge and experience, it is strictly forbidden to conduct them independently.

Wheezing occurs during breathing. Their blistering depends on the lumen of the affected bronchi. Wet cough develops due to the accumulation of bronchial secretions. At healthy people when listening to the lungs, only clear sounds can be detected.

Even at the initial stages of the inflammatory process in the respiratory tract, the diagnostic scheme consists of several stages. These include history taking, physical examination, laboratory tests, instrumental research. Therefore, when the appearance anxiety symptoms should immediately contact a medical facility.

Pneumonia - dangerous disease accompanied by crepitus. This is the name of the process, as a result of which a liquid substance appears in the alveoli. As a result, gas exchange deteriorates, oxygen starvation. Partial dysfunction of the lungs causes disturbances in the work of other vital organs.

To make a diagnosis, there is not enough data that is obtained using physical methods of examination and external examination. A medical examination is a prerequisite, if it is not observed, it is impossible to determine the exact cause of the ailment. A complete diagnosis can only be carried out in a hospital with the necessary equipment.

You are a fairly active person who cares and thinks about your respiratory system and health in general, continue to play sports, healthy lifestyle life, and your body will delight you throughout your life, and no bronchitis will bother you. But do not forget to undergo examinations on time, maintain your immunity, this is very important, do not overcool, avoid severe physical and severe emotional overload.

The cause of many diseases, including heart disease, obesity, etc. is chronic inflammation in the body. Chronic inflammation is an enemy that knows how to disguise itself well, because it is very difficult to independently detect signs of an inflammatory process in the body.

However, it is possible to identify this initiator of disease processes if you look closely at the signs of the inflammatory process and consult a doctor in time to undergo the necessary tests. the site will help you bring the inflammatory process to clean water.

What are the signs of inflammation in the body

Inflammation is the body's response to injury. As a rule, we recognize inflammation in the body by typical signs: redness, fever and swelling of the damaged area, as well as restriction of mobility, for example, in the case of a sprained ankle or bruised finger.

Chronic inflammation accompanies all diseases ending in "it" - arthritis, hepatitis, bursitis, etc. The inflammatory process can proceed “quietly” inside the body, and a person may not be aware of its presence.

However, your body gives you some clues, and if you ignore them, you can face some pretty serious health problems in the future.

6 Common Signs of an Inflammatory Process

1. Pain. If your muscles, joints are constantly aching, or your body is aching in general, you can bet on the inflammatory process in the body. When your immune cells or fat cells release inflammatory chemicals called cytokines, you feel more pain and aches. Fibromyalgia and arthritis are classic symptoms of severe inflammation in the body, but extensive body pain while getting out of bed in the morning is also a sign of an inflammatory process. Pain in the soles ( plantar fasciitis) also indicates the presence of inflammation in the body.

2. Fatigue.

Fatigue can be caused by various factors, one of which is the inflammatory process in the body. When your immune cells are constantly busy producing antibodies, you are overcome by fatigue. For example, when you have the flu, a cold, or another illness that causes inflammation.

3. Overweight.

It was once believed that fat cells store extra calories and keep you warm in winter. It is now also known that fat cells play the role of chemical factories.

They are capable of producing a variety of chemicals, some of which can be compared to those produced by immune cells in the process of fighting infection. The more fat in your body, the more of these substances they produce.

The problem is that such chemicals lead to insulin resistance, which makes it difficult to lose weight.

4. Redness and / or itching of the skin.

Redness and itching are classic signs chronic inflammation in the body. These symptoms can be caused by allergies, autoimmune diseases, or a weakened liver.

Itchy skin accompanies people with hepatitis, but it can occur in case of inflammation of the liver for various reasons. The inflamed liver produces a large number of inflammatory chemical called C-reactive protein.

5. Diagnosed autoimmune disease.

Chronic inflammation is more responsible for the symptoms of most autoimmune diseases pain, fatigue and bad dream. Typical examples of autoimmune diseases are:

• psoriasis;
• disorders of the thyroid gland;
• rheumatoid arthritis;
• lupus.

6. Allergies and infections. If you are suffering allergic reactions, the inflammatory process in the body is manifested by swelling, redness, itching and pain.

Such symptoms are the result of an immune response to harmful, harmless substances. Infections are also typical cause inflammatory processes, especially if they acquire chronic form. Some viruses and bacteria live in your body for years, constantly stimulating the immune system and releasing toxins into the bloodstream. Among them:

Chronic infections are a very big burden on the immune system and liver, so you need to take care of strengthening the immune system.

If you have found the above symptoms in yourself, you need to consult a doctor who, based on the tests, will prescribe necessary treatment and nutrition for inflammation.

Is pneumonia dangerous for adults?

Pneumonia - acute infection occurring with inflammation of the lung tissue. Inflammation of the lungs remains one of the leading causes of death from respiratory diseases, despite the giant leap in the development of medicine. Symptoms of pneumonia in adults, children and the elderly, as before, make doctors worry about the fate of patients.

In 2006, 591493 cases of pneumonia were detected in Russia, which amounted to 3.44 ‰ among adults >18 years old. But these figures from official reports do not fully reflect the true picture. Calculations by scientists show that the real incidence of pneumonia in Russia reaches 15‰. The absolute number of cases of pneumonia is 1,500,000 people every year. According to 2006 statistics, pneumonia and its complications claimed the lives of 38,970 adult Russians.

If elderly patients >60 years old have chronic comorbidities (chronic obstructive pulmonary disease; cancer; alcoholism; liver, kidney, heart and vascular diseases; diabetes), then in severe pneumonia, mortality increases to 30%. The highest mortality from pneumonia in Russia is recorded in adult men of working age. A typical risk factor for Russians fatality pneumonia - late seeking medical help.

Signs that increase the risk of death from pneumonia in adults:

• Male.
• Severe hypothermia before illness.
• Shortness of breath with a respiratory rate> 28 in 1 min.
• Violation mental state patient.
• Concomitant diseases - chronic heart failure, decreased immunity, diabetes, atherosclerosis of the heart vessels, oncological processes, chronic renal failure.
• Low blood pressure
• Low body temperature

If patients who died of pneumonia knew the first signs of a dangerous disease and consulted a doctor in time, their lives could have been saved.

The first signs and symptoms indicating pneumonia:

These signs in a person who has a "cold" should alert his loved ones, since the diagnosis of pneumonia is very likely in him. If pneumonia is suspected, a doctor's consultation is necessary.

Objective signs of the disease

The doctor, examining the patient, reveals the objective symptoms of pneumonia:

• Dullness of sound when tapping over the affected areas of the lungs;
• hard breathing over the inflamed area of ​​the lung tissue;
• listening to wheezing over the site of inflammation.

The main rule confirming pneumonia is the asymmetry of objective findings, that is, the presence of symptoms of pneumonia in only one lung. After the examination, the doctor will prescribe an x-ray of the organs chest.

X-ray symptoms of pneumonia

Basic radiological sign pneumonia - local darkening of a lung area in a patient with symptoms of inflammation of the lower respiratory tract.

X-rays for suspected pneumonia are performed for all patients: children and adults. This mandatory rule is associated with the risk of complication of pneumonia with a delay in the appointment of antibiotics. The consequences of delay can be fatal.

Treatment of pneumonia

The main component of treatment that determines the prognosis is the right choice antimicrobial agent- an antibiotic. Mild cases of pneumonia in adults can be treated at home. In addition to antimicrobial drugs, the patient needs bed rest for the duration of fever, profuse warm drink and complete nutrition. If the patient coughs up phlegm, the cough can be alleviated with expectorants and chest compresses.

The diet for a patient with pneumonia consists in frequent fractional nutrition, food should be easily digestible and complete in its composition.

In a serious condition, the patient is treated in a hospital (hospital).

After recovering from pneumonia, the patient is observed by a polyclinic therapist for 1 year.

Disease prevention

Vaccination against pneumococcus, the main culprit of the disease, will help prevent the disease. If the vaccine is contraindicated for a patient at risk, you can use drugs such as "vaccine pills". Such drugs contain surface proteins of pathogenic microbes that enhance immunity. The action of such immunomodulators is regarded as a "vaccination", only without an injection. For a competent choice of treatment and prevention of pneumonia, a doctor's consultation is necessary.

Symptoms of pneumonia in adults

Pneumonia is an infectious disease. It remains one of the most widespread in the world. It is the leader among nosocomial infections leading to death. It is important to know the symptoms of pneumonia in adults in order to take action in time. Treatment of pneumonia and the prognosis of the development of the disease depends on the nature of the infection, age and general condition patient.

What is pneumonia and why is it dangerous

Acute inflammation of the lungs is called pneumonia. It is caused by infections that can be transmitted different ways, affects the lung tissue. In the list of diseases that caused death, it is in fifth place, and medicines do not always help. The lethal outcome among adults from pneumonia is 10-33%. Nosocomial and atypical form of the disease claims even more lives - the risk of dying rises to 50%. In the elderly, people with weakened immune systems, the prognosis for the course of pneumonia is often disappointing.

From ordinary pneumonia, 1-3% of young patients die without diseases that could impair treatment. Among elderly patients, mortality is up to 40-50%. Causes of death from pneumonia:

• concomitant diseases, such as heart disease, existing respiratory diseases (such as bronchitis), diabetes mellitus, problems in the genitourinary system;
• bad habits (smoking, especially long-term experience, drug addiction, alcoholism);
• unfavorable living conditions;
• weakened immunity.

Pregnant women are at particular risk of pneumonia. The disease itself is severe due to dangerous pathologies. For a woman carrying a child, she is doubly dangerous - for future mother and fetus. On the early dates pneumonia threatens the embryo, whose tissues and organs have not yet been formed. In the last trimester, pneumonia is less dangerous for a child than for a mother. Prevention is simple: strengthening the mother's immunity.

The first signs of pneumonia

Symptoms of pneumonia in adults depend on the type of infection that caused the disease. There are several types of pneumonia, and each has its own clinical picture. The provoking factor for the occurrence of pneumonia is hypothermia, affecting the upper respiratory tract. In the elderly, it often becomes pathological. There are several symptoms of pneumonia in adults: they are divided according to the types of insidious disease. A common type of pneumonia is viral, occurs in half of the cases. Other reasons:

A disease that occurs without symptoms characteristic of pneumonia is called atypical. Latent pneumonia is dangerous because its treatment is taken late, when many complications appear. Pulmonary manifestations fade into the background, the patient is more concerned about general intoxication. The radiograph shows no changes in the airways. Signs of atypical inflammation:

• dry cough;
• sore throat;
• muscle pain;
• headache;
• weakness.

Asymptomatic SARS is caused by legionella, viruses, chlamydia, mycoplasmas, therefore it is treated with antimicrobial drugs. After infection, signs of the disease appear in the period from 2 to 10 days. Changes in the lungs begin later than with typical pneumonia. The temperature rises, the patient begins to suffocate, he does not have enough air. A large percentage of patients can be cured at home, but sometimes the disease is severe. Mortality from this type of disease is 3-5%, the cause is cardiopulmonary failure.

Viral

This type of disease is caused by several viruses. First up is the flu. At the beginning of pneumonia provoked by the influenza virus, malaise is noticeable for a period of 3-5 days. Then the condition worsens, shortness of breath begins, chest pains appear. Pneumonia is treated with rimantadine, zanamivir, oseltamivir. Viral pneumonia is also caused by cytomegalovirus.

A serious complication of viral pneumonia is SARS, respiratory syndrome. It is caused by Paramyxoviridae viruses (they are also the cause of measles and mumps). The syndrome is very dangerous. Symptoms of pneumonia in adults with viral pneumonia are:

• very high fever accompanied by chills;
• dry cough (unproductive);
• headache and muscle pain;
• fatigue for no reason.

bacterial

The cause of pneumonia in this case are bacteria: pneumococcus, staphylococcus, streptococcus. Bacterial inflammation of the lungs begins with a sharp jump in temperature to 41 degrees. It lasts up to 3 days, and this symptom is considered a clear sign bacterial infection. If the temperature either falls or rises, then viral picture. pneumococcal pneumonia accompanied by the discharge of "rusty" sputum, heart contractions become more frequent (tachycardia), breathing becomes difficult. The disease is treated with antibiotics.

Gribkova

The most dangerous variant of pulmonary inflammation is fungal. This is due to the fact that fungal pneumonia does not appear at first, and people do not know that they are sick. The disease is diagnosed late. The beginning of the process of inflammation of the lung tissue is similar to atypical pneumonia, but with exacerbation of symptoms, the nature of lung damage changes, cavities form. A common causative agent of such pneumonia is Candida albicans, a fungus. At first, the patient has cold symptoms: fever, cough, fatigue and shortness of breath. Then, when coughing, pus is released, at the same time the correct diagnosis is made.

The main symptoms of pneumonia in an adult

Colds, flu, should not last more than 7 days, but if 4-7 days after the onset of ARVI the patient's condition worsened, this is a signal of the onset in the lower respiratory tract dangerous inflammation. Symptoms of pneumonia in adults include pallor and shortness of breath. If they have a cold, they are accompanied by weakness, sweating, loss of appetite - this is typical for intoxication at the onset of pneumonia.

Temperature with inflammation of the lungs

With atypical pneumonia, body temperature is not always more than 37.5. In normal cases, it is typical sharp rise up to 40 degrees. With inflammation of the lungs, antipyretic drugs do not work. If it is not possible to bring down the temperature, this is a sign of pneumonia. The temperature starts to drop as the antibiotics kick in. It is dangerous if the disease proceeds without a temperature: patients sometimes do not take action until the condition worsens. How long the temperature lasts depends on the pathogen: fungus, bacteria or virus.

What is the cough with pneumonia

At the beginning of the disease, the cough is dry, this is called unproductive. It becomes obsessive, constant, debilitating. Inflammation develops - this symptom also changes. Sputum leaves, the color of which depends on the nature of the infection: yellow-green, purulent, "rusty". A hacking cough that does not go away in 7-10 days is a clear sign of an inflammatory process in the lungs.

Voice jitter

The doctor can recognize the symptoms of the disease by assessing voice jitter patient. The patient says words where there are several “p” sounds, and the doctor puts his palms on his chest, and determines the voice trembling. With pneumonia, part of the lung, or the whole lung, is compacted. This will be noticed by the physician conducting the diagnosis, by the fact that the voice tremor increases.

Diagnosis of the disease

If an inflammatory process in the lungs is suspected, a comprehensive diagnosis is carried out. Sometimes, already at the initial appointment, the doctor can determine the disease by auscultation, that is, by listening to the chest with a phonendoscope. But main method diagnosis in an adult - an x-ray. Be sure to take the patient's blood for general and biochemical analysis. If the patient is in the hospital, they examine the culture of sputum, urine, check the blood for antibodies to viruses.

Varieties of pneumonia

Mild forms of pneumonia, detected in the initial stage, are treated at home. Remember that even mild pneumonia give rise to complications improper care. You need to follow the doctor's recommendations on how to treat pneumonia at home:

• used antipyretic drugs, anti-inflammatory;
• a plentiful drink is prescribed;
• an important component of treatment is diet: the body is poisoned with toxins, lightweight nutrition is required, more liquid.

How to treat pneumonia, how long the process will last, depends on the severity and type of the disease. The infection sometimes resides in the lung tissue for years, leading to chronic illness. fibers are damaged and connective tissues, they put pressure on the pulmonary vesicles, which leads to hardening of the lungs, pneumosclerosis. The patient feels discomfort, constantly coughs. It's sluggish protracted illness, which gradually leads to complications.

Ordinary pneumonia is divided into mild, moderate, severe and extremely severe in severity, it depends on how the disease proceeds. to heavy sharp forms pleuropneumonia refers when one lobe of the lung or several are inflamed. Localization occurs pneumonia:

• focal (focused in the focus of inflammation);
• segmental or polysegmental, depending on whether it is located in one or more segments;
• share - does not go beyond one share;
• total - covers all the lungs.

One-sided and two-sided

The inflammatory process is concentrated either on one side, or it is bilateral. Unilateral pneumonia is divided into two types:

1. Right-sided - occurs more often, the right bronchus is wider than the left and shorter than it, the infection penetrates there more freely.
2. Left-sided - develops less frequently, with it stagnant processes in the lung are observed.

Bilateral covers both lungs: the entire lung tissue becomes inflamed, and the disease is provoked by bacteria (pneumococcus, Haemophilus influenzae). Against the background of one infection, others multiply additionally harmful microorganisms, mixed infection develops. Several pathogens enter the fight against a person, it is difficult to choose antibacterial drugs for treatment.

Radical

The focus of inflammation, located along the root of the lung, is difficult to diagnose. Such cases are called hilar pneumonia. In the diagnosis, computed tomography is used. The doctor must rule out tuberculosis and lung cancer, the focus of inflammation is similar in the picture to the tumor. Held tuberculin tests. If anti-tuberculosis drugs are mistakenly prescribed, but they do not work, this is considered a diagnostic sign.

Bronchopneumonia

Bronchial pneumonia is characterized by damage to the small branches of the patient's bronchial tree. Bronchopneumonia refers to focal. The recovery process will take a long time. Sometimes the disease is secondary, develops against the background of bronchitis. A person tries to cure bronchitis, it drags on, the condition worsens, weakness appears, the temperature rises. The cough that accompanies bronchitis intensifies, unpleasant purulent sputum is separated, at times with streaks of blood.

Important symptoms of this disease: shortness of breath, increased heart rate up to 110 beats per minute, chest pain. Not only bronchitis, but also SARS leads to the development of bronchopneumonia. Viruses and bacteria often cause this type of pneumonia, in order to treat the disease correctly, they establish the pathogen, prescribe antiviral drugs or antibacterial. How much the disease is treated depends on the type of pathogen.

Hospital

In addition to community-acquired pneumonia, which develops under normal conditions, there is a severe form of the disease - hospital, it is nosocomial. The diagnosis is made when inflammation appears two days or more after a person is admitted to a hospital with a completely different diagnosis. This is the most merciless species, killing 50% of patients. Microorganisms cause disease. Types of nosocomial pneumonia:

• associated with artificial ventilation of the lungs;
• postoperative;
• nosocomial pneumonia in hospitalized patients in serious condition.

Patients' immunity is weakened, the body was fighting another disease, it was not ready for the invasion of new microbes. To save the situation, patients are given droppers, intravenous nutrition is used to maintain the vitality of the body, new generation drugs, potent drugs are used. It is not always possible to cure nosocomial pneumonia. Treatment of pneumonia at home in this case is excluded.

Equity

Lobar pneumonia affects the lobes of the lung and pleura. With this type of pneumonia, it is important to prescribe antibiotic injections in time, the duration of which is determined by the doctor. Physiotherapy, detoxification is used. Lobar pneumonia begins suddenly and acutely. There are three forms of the disease:

• upper lobe - proceeds severely, with neurological disorders;
• lower lobe - gives a pseudo-picture " acute abdomen”, which is confusing in the diagnosis, chills and “rusty” sputum are characteristic;
• central - inflammation develops deep in the lung, the symptoms are mild, difficult to determine.

Croupous

Croupous pneumonia is acute. The nature of the lesion of the lungs is bilateral. If the pathology is not recognized and treatment is not promptly started, the patient will die from brain hypoxia and cardiovascular insufficiency. The first day the patient has a dry cough. The next day, rust-colored sputum leaves, vomiting occurs. On the third day, it gets worse, shortness of breath appears, tachycardia develops. The patient is unable to climb one floor. Croupous pneumonia is treated in pulmonology, in a hospital or intensive care unit. Lung lobes the patient is totally affected on both sides.

Video: types and symptoms of pneumonia

Pneumonia - dangerous disease, it is important to determine it in the early stages, when treatment is effective even folk remedies at home. In the video below, experts will talk in detail about the symptoms of pneumonia, teach you what to look for if pneumonia occurs without typical symptoms. Timely detection will avoid irreversible consequences.

The first signs of pneumonia in children and adults

Pneumonia is a disease that has an infectious origin and is characterized by inflammation of the lung tissue when provoking physical or chemical factors occur, such as:

• Complications after viral diseases (influenza, SARS), atypical bacteria (chlamydia, mycoplasma, legionella)
• Impact on respiratory system various chemical agents - poisonous vapors and gases (see chlorine in household chemicals hazardous to health)
• Radioactive radiation, which is attached to the infection
• Allergic processes in the lungs - allergic cough, COPD, bronchial asthma
• Thermal factors - hypothermia or burns of the respiratory tract
• Inhalation of liquids, food or foreign bodies can cause aspiration pneumonia.

The cause of pneumonia is the occurrence favorable conditions for the reproduction of various pathogenic bacteria in the lower respiratory tract. The original causative agent of pneumonia is the aspergillus fungus, which was the culprit of the sudden and mysterious deaths of researchers. Egyptian pyramids. Pet bird owners or city pigeon enthusiasts can get chlamydial pneumonia.

Today, all pneumonias are divided into:

• out-of-hospital, arising under the influence of various infectious and non-infectious agents outside the walls of hospitals
• hospital, which cause nosocomial microbes, often very resistant to traditional antibacterial treatment.

The frequency of detection of various infectious pathogens in community-acquired pneumonia is presented in the table.

When confirming the diagnosis, depending on the type of pathogen, the age of the patient, the presence of concomitant diseases appropriate therapy is carried out, in severe cases, treatment must be carried out in a hospital, with mild forms of inflammation, hospitalization of the patient is not required.

The characteristic first signs of pneumonia, the vastness of the inflammatory process, acute development and the risk of serious complications in case of untimely treatment are the main reasons for the urgent appeal of the population for medical help. Enough for now high level development of medicine, improved diagnostic methods, as well as a huge list of antibacterial drugs broad-spectrum significantly reduced the death rate from pneumonia (see antibiotics for bronchitis).

Typical early signs of pneumonia in adults

The main symptom of the development of pneumonia is a cough, usually at first dry, obsessive and persistent (see antitussives, expectorants for dry cough), but in rare cases, the cough at the beginning of the disease may be rare and not strong. Then, as inflammation develops, the cough with pneumonia becomes wet with the release of mucopurulent sputum (yellow-green).

Any cold viral disease should not last more than 7 days, and a sharp deterioration in the condition 4-7 days after the onset of SARS or influenza indicates the onset of an inflammatory process in the lower respiratory tract.

Body temperature can be very high up to 39-40C, and may remain subfebrile 37.1-37.5C ​​(with atypical pneumonia). Therefore, even with a low body temperature, coughing, weakness and other signs of malaise, one should without fail see a doctor. A second jump in temperature after a light interval during the course of a viral infection should alert.

If the patient has a very high temperature, then one of the signs of the presence of inflammation in the lungs is the ineffectiveness of antipyretic drugs.

Pain when taking a deep breath and coughing. The lung itself does not hurt, as it is deprived pain receptors, but involvement in the process of the pleura, gives a pronounced pain syndrome.

In addition to cold symptoms, the patient has shortness of breath and pallor of the skin.
general weakness, increased sweating, chills, decreased appetite are also characteristic of intoxication and the onset of an inflammatory process in the lungs.

If such symptoms appear either in the midst of a cold, or a few days after improvement, these may be the first signs of pneumonia. The patient should immediately consult a doctor to undergo a complete examination:

• Pass blood tests - general and biochemical
• Take a chest X-ray, if necessary, and computed tomography
• Take sputum for culture and determine the sensitivity of the pathogen to antibiotics
• Pass sputum for culture and microscopic determination of Mycobacterium tuberculosis

The main first signs of pneumonia in children

Symptoms of pneumonia in children have several features. Attentive parents may suspect the development of pneumonia with the following ailments in a child:

• Temperature

Body temperature above 38C, lasting more than three days, not brought down by antipyretics, there may also be a low temperature up to 37.5, especially in young children. At the same time, all signs of intoxication are manifested - weakness, excessive sweating, lack of appetite. Young children (like the elderly) may not have high temperature spikes with pneumonia. This is due to the imperfection of thermoregulation and the immaturity of the immune system.

• Breath

Rapid shallow breathing is observed: in babies up to 2 months of age 60 breaths per minute, up to 1 year 50 breaths, after a year 40 breaths per minute. Often the child spontaneously tries to lie on one side. Parents may notice another sign of pneumonia in a child, if you undress the baby, then when breathing from the side diseased lung you can notice the retraction of the skin in the spaces between the ribs and the lag in the process of breathing on one side of the chest. There may be disturbances in the rhythm of breathing, with periodic stops in breathing, changes in the depth and frequency of breathing. In infants, shortness of breath is characterized by the fact that the child begins to nod his head to the beat of breathing, the baby can stretch his lips and puff out his cheeks, foamy discharge from the nose and mouth may appear.

• SARS

Inflammation of the lungs caused by mycoplasma and chlamydia is distinguished by the fact that at first the disease passes like a cold, a dry cough, runny nose, and sore throat appear, but the presence of shortness of breath and a consistently high temperature should alert parents to the development of pneumonia.

• The nature of the cough

Because of the sore throat, at first only a cough may appear, then the cough becomes dry and painful, which is aggravated by crying, feeding the child. Later the cough becomes wet.

• Child behavior

Children with pneumonia become capricious, whiny, lethargic, their sleep is disturbed, sometimes they can completely refuse food, and diarrhea and vomiting appear, in infants - regurgitation and refusal of the breast.

• Blood test

AT general analysis changes are detected in the blood, indicating an acute inflammatory process - elevated ESR, leukocytosis, neutrophilia. Shift of the leukoformula to the left with an increase in stab and segmented leukocytes. With viral pneumonia, along with high ESR there is an increase in leukocytes due to lymphocytes.

At timely handling to the doctor, adequate therapy and proper care of a sick child or adult, pneumonia does not lead to serious complications. Therefore, at the slightest suspicion of pneumonia, it should be provided as soon as possible medical care sick.

The main signs of pneumonia in children

Signs of pneumonia in children may differ from signs of infection in adults. Inflammation of the lungs, or pneumonia, worsens a child's quality of life every 20 seconds.

Unlike adults, children who have pneumonia may not suffer from a nagging cough or fever and may have symptoms of an infection that are much more subtle to define.

Children are at greater risk for pneumonia because their immune systems are not yet fully developed and protective functions organisms are weak.

In general, signs of pneumonia in children vary with age, but there are many factors that can tell if your child is developing something more or just a runny nose.

How to determine pneumonia in a child in a mild form?

Inflammation of the lungs, which is caused by certain bacteria, including mycoplasma and chlamydia, usually results in more moderate symptoms manifestations not only among adults, but also among children.

A type of pneumonia known as atypical or walking pneumonia is common in children school age.

Children with walking pneumonia may not feel sick enough to stay at home, but they may show the following signs:

• Dry cough.
• Subfebrile fever.
• Headache.
• Fatigue.

Mycoplasma pneumoniae is responsible for approximately 15 to 50 percent of all cases of pneumonia in adults, but its incidence is even higher among school-age children.

Therefore, "walking" pneumonia, which most often develops in late summer and autumn, spreads from person to person.

Outbreaks of the first signs of pneumonia can occur vividly within groups that have close contact, such as schools or camps. Children who are already infected always bring it home and contribute to the general infection of the family without proper measures.

How does mild pneumonia manifest in children?

Viruses cause most cases of pneumonia in preschool children up to five years of age and in infants from four months.

Signs of pneumonia in children are usually associated with other viruses and include the following:

• Angina.
• Cough.
• Subfebrile fever.
• Nasal congestion.
• Diarrhea.
• Loss of appetite.
• Lack of energy or fatigue.

Signs of pneumonia in children in severe form

Bacterial pneumonia is more common among school-age children and adolescents.

This type of pneumonia often develops more abruptly and has more severe symptoms than the previous forms:

• Heat.
• Cough that produces yellowish or green mucus.
• Profuse sweating or chills.
• Reddened skin.
• Bluish tinge to lips or nail beds.
• Wheezing.
• Labored breathing.

Its useful to note

Children with bacterial pneumonia usually appear much more ill than those found with other forms of the disease.

Newborns and infants may not show typical symptoms lung infections. It is also quite problematic to determine if babies have an illness, because they cannot communicate their true state of health, unlike an older child.

The following signs of pneumonia in children may indicate pneumonia:

• A quick look.
• Lack of energy, melancholy and drowsiness.
• The cry is more pronounced than usual.
• Does not want to eat or eat in small portions.
• Irritation and restlessness.
• Vomit.

Antibiotics are often used to treat children who have just recently been hospitalized, especially if the children have already had asthma or another chronic illness. The second way that antibiotics are used is if the children were not fully vaccinated against measles, chicken pox, whooping cough and seasonal flu.

The only way Finding out for sure if a child has pneumonia is a visit to the doctor. Pediatrician or doctor general practice may check for fluid in the child's lungs using a stethoscope or x-ray.

By giving due attention early symptoms pneumonia in children, parents can avoid a trip to the emergency room.

However, pneumonia can progress very quickly in children, especially infants.

Two key signs that a child needs immediate medical attention:

• Increased temperature at the nostrils when breathing.
• Young children with pneumonia will breathe quickly. Doctors say that if you see that the abdominal muscles of a child are working hard, then he has problems with breathing.

Treatment for pneumonia depends on what caused the infection and can range from outpatient treatment before surgery.

While certain antibiotics may be effective in treating fungal pneumonia, medications are usually ineffective in treating viral types of pneumonia, which tend to be milder and clear up on their own.

Pneumonia without fever

Pneumonia without fever is a dangerous disease that in many cases ends badly. The fact is that this disease passes without special symptoms and the person simply does not know about his condition. He is able to complain of general malaise and consider that he has an ordinary temperature. Meanwhile, the situation is getting worse.

ICD-10 code J10-J18 Influenza and pneumonia

Causes of pneumonia without fever

The causes of pneumonia without fever can be hidden in many adverse factors. First of all, it is worth noting the weakening of the immune system. It is this factor that negatively affects the development of the inflammatory process. The infection easily enters the body and causes serious problems.

Indiscriminate use of antibiotics also leads to the development of pneumonia. The fact is that due to antitussive drugs, the natural removal of sputum from the lungs can be disrupted. This is mainly due to improper treatment caused by poor doctor research or self-administered remedies.

Taking a large number of antibiotics not only worsens a person’s condition, but, on the contrary, creates a favorable environment for the development of viruses and infections. Many people do not realize this and harm their own health on their own.

Weakened immunity is the main reason why pneumonia occurs. Moreover, it can weaken due to the presence of a permanent focus of infection in which reproduction occurs. Basically, such a place is the tonsils, teeth and lymph nodes.

As mentioned above, cough pills, which slow down expectoration, are of particular danger. Therefore, when symptoms of a cold appear, it is worth seeking help from a specialist. 'Cause it could be serious illness including pneumonia without fever.

Symptoms of pneumonia without fever

Many people are interested in the question, and is there pneumonia without fever? This phenomenon occurs and in most cases ends unfavorably. A person does not realize that serious inflammatory processes are taking place in his body and simply refers to a general malaise.

In addition to the absence of temperature, cough does not appear at all, which is very dangerous. Basically, this type of pneumonia appears in people with very weak immunity. This phenomenon can also occur while taking cough medicines. After all, in this way a person dulls the main symptom and thereby allows pneumonia to develop.

This disease is especially dangerous for children. This is due to the fact that the child cannot fully describe what is happening to him. Appearing processes and sensations cannot be explained by the baby. This makes it difficult to study and make an accurate diagnosis. Unfortunately, this disease is most often fatal. Pneumonia without fever is a dangerous inflammatory process that must be eliminated immediately.

The symptoms of pneumonia without fever are somewhat peculiar. You can notice this disease only by some external signs. The complexion of the victim is usually pale in color, sometimes with a blush, which rather indicates the presence of the disease. Pneumonia can also be identified by reddish spots on the cheeks. It is worth paying attention to the person’s breathing, mainly it is accompanied by some whistling. With any physical activity, shortness of breath and increased heart rate appear.

The constant symptoms include general weakness of the body and fatigue. At full breath difficulties may arise. It is difficult for a person to walk, sweating increases, there is a desire to constantly drink. During the rotation of the body, pain is possible.

It is worth noting the fact that in people suffering from this type of pneumonia, the lungs noticeably move only on one side. Simply put, the chest is able to turn exclusively to the right or left. But it’s hard to say for sure from this symptom. Required accurate diagnosis. After all, pneumonia without fever is a dangerous disease.

Pneumonia without cough and fever

Pneumonia without cough and fever is accompanied by a strong inflammatory process in the lungs. It can occur due to ordinary hypothermia of the body or an acute cold. Pneumonia this kind It is not transmitted, but it has the character of an infection. Often there are cases when the disease proceeds without fever and cough. This is very dangerous for the body.

The fact is that coughing removes excess sputum and helps to eliminate the infection. If it is absent, then all the viruses are in the lungs and do not go outside. Cough always indicates the presence of an inflammatory process in the body. It is usually accompanied elevated temperature and weakness.

Pneumonia without cough develops gradually as the infection accumulates in the lungs. The disease gradually passes into a more complex form. Shortness of breath, weakness, dry cough and sweating may occur. Very often, a similar course of the disease is observed after bronchitis, laryngitis and severe cough. Chronic foci of infection can lead to pneumonia.

When the disease only begins to manifest itself, people try to remove all the symptoms with home methods, unaware that the problem is much more serious. Thus, they themselves worsen the condition. Unfortunately, in many cases, pneumonia without fever is fatal.

Diagnosis of pneumonia without fever

Diagnosis of pneumonia without fever difficult process, the main thing is that it be timely. Usually the diagnosis is made by x-ray. Thanks to him, you can clarify the signs of inflammation and possible complications.

In order to confirm the diagnosis, a person undergoes a chest x-ray in 2 projections. The main symptom of pneumonia is a limited darkening of the lung tissue against the background of existing external signs airway inflammation.

If there is no darkening of the lung tissue in the picture, then it is wrong to judge the presence of pneumonia. This inflammatory process is determined exclusively by x-ray. There are no other diagnostic methods available.

Pneumonia without fever is a complex inflammatory process that is not so easy to determine. Therefore, if any symptoms appear, you should immediately seek help. Pneumonia is a complex infectious disease requiring immediate elimination.

What needs to be examined?

How to investigate?

What tests are needed?

Who to contact?

Treatment of pneumonia without fever

Treatment of pneumonia without fever is carried out exclusively under the supervision of the attending physician. Symptomatic therapy significantly alleviates the patient's condition. To do this, use special medicines belonging to the group of antibiotics. These are Mukopront, Mukodin, Mukobene, Acetylcysteine, Ambrobene and Lazolvan.

Mukopront It is available in the form of syrup and capsules. Adults should take it 3 scoops 3 times a day in the form of syrup, and 2 capsules 3 times a day in the form of capsules. Children under 12 years of age should take 1-2 scoops 3 times a day. Capsules are not recommended.

Mucodin accepted in a similar way. Dosage for adults: 2 capsules or 3 scoops of syrup 3 times a day. Children are allowed to take only syrup, 1 scoop 2-3 times a day.

Acetylcysteine. The dosage of this drug is individual. Basically, they take 200 mg of the drug 2-3 times a day. For children, the dosage is less, and is 100 mg 3 times a day.

Ambrobene. The dosage for adults is 1 tablet 3 times a day for the first 2-3 days. Then you need to take 1 tablet 2 times a day. Detailed scheme admission is prescribed by the attending physician.

Lazolvan. In the form of a syrup, it is taken with food and washed down with a large amount of liquid. For adults, the dosage is 2 scoops 2 times a day. Children one or whole spoon 2-3 times a day.

With a favorable course of the disease, many patients receive therapy at home. It is desirable that the menu of a person be nutritious. At the time of treatment, it is recommended to refuse fatty and heavy foods. Until complete recovery, you will have to drink plenty of fluids. This leads to the prevention of tissue dehydration and the development of high temperature.

Physiotherapy exercises are of particular benefit. It allows you to reduce the patient's recovery time. In the early days of the disease, it is recommended to roll over more often in bed. If a person is tormented by chest pain, he will constantly lie on the affected side. This cannot be allowed! This can lead to adhesions in the lungs. From the second or fourth day, it is advisable to start doing breathing exercises. The hands of the upper limbs are laid on the stomach, and at the same time the air is strongly drawn into itself. Similar exercises are repeated 10-15 times in one "approach". In total, you need to give this lesson 4-5 times a day. Pneumonia without fever serious illness requiring immediate and effective treatment.

More about treatment

Prevention

Prevention of pneumonia without fever is a mandatory set of measures that will prevent the development of the disease. The first step is to pay attention to hardening. Such procedures strengthen and protect the immune system. Thus, the body becomes more resistant to any infections. It is desirable to include in the hardening process contrasting water procedures and pouring over the legs. But at the same time, the temperature should start at 35 degrees, gradually it decreases to 25.

• Breathing exercises. This type prevention is applicable even for bedridden patients. The action of the exercises is aimed at improving ventilation of the lungs. This helps prevent inflammation. It is advisable to simply inflate Balloons and do it regularly deep breaths and exhale.
• Treatment of chronic foci of infection. The fact is that even dental caries can lead to severe pneumonia. Therefore, first of all, it is worth fighting the main foci of infection and eliminating them.
• Strengthening immunity. For these purposes, herbal tinctures and teas are suitable. Preference should be given to chamomile, echinacea, levsia and eleutherococcus.
• Massage. As a preventive measure, it is performed by both adults and newborns. In this case, it is necessary to use the technique of clapping. Regarding this issue, it is better to consult a doctor.

It is important to avoid hypothermia and other stress factors for the body. Vapors of benzene and other chemical compounds negatively affect the body. Naturally, contact with the patient must also be avoided, in which case pneumonia without fever cannot be taken by surprise.

Forecast

The prognosis of pneumonia without fever can be of a different nature. Much depends on how quickly a person noticed the presence of this disease and began effective treatment.

Usually, with timely therapy, the prognosis is favorable. Complete recovery occurs at the end of the 3rd beginning of the 4th week. Naturally, if a person receives help on time and starts treatment, then everything will end positively and on time.

But the whole problem lies in the fact that it is not so easy to determine the presence of pneumonia, especially when there is no temperature and cough. Many people think it's common colds and do not want to go to the doctor. Meanwhile, the situation becomes more complicated and the prognosis becomes extremely unfavorable. Do not hide the fact that everything can end in death. Pneumonia without fever is a complex process in which the most important thing is to notice it in time and start treating it, otherwise the result will be disastrous.

Pneumonia is a serious respiratory disease that requires timely diagnosis and timely treatment. Therefore, the question of how to determine pneumonia is very important.

It can be diagnosed by analyzing the clinical picture and using special methods. The clinical picture depends on the pathogen, the characteristics of the immune system and the method of infection. Also important role plays where the disease developed: in the hospital or at home (causative agents of hospital pneumonia are more resistant to treatment).

There are several symptoms that are most common.

The disease has an acute onset, there are chills and fever, symptoms of general intoxication.

There is a dry cough, which with the course of the disease turns into a productive one, as well as pain in the chest, which increases during coughing and deep breathing. In young children who cannot complain about pain, this symptom will be manifested by gentle, shallow breathing. Sometimes hemoptysis, shortness of breath is possible, and in cases of development of complications to already existing symptoms cough with purulent sputum (with the formation of abscesses) and increased pain in the chest (pleurisy,) are given.

The presence of the above symptoms may help to suspect pneumonia already at home.

In children, pneumonia also has a violent onset with fever and rapid onset of symptoms. Abdominal pain and vomiting may occur early in the disease, and cyanosis often develops. Due to the action of bacterial toxins, the vessels spasm and the children become pale. It is necessary to identify diseases in short lines, since timely diagnosis of pneumonia in children prevents severe course with the development of complications and respiratory failure, which is especially dangerous for newborns. Often there is a transition from acute condition into chronic.

Physical examination

objective clinical examination the patient is carried out with the help of palpation, percussion and auscultation. This method can detect dullness of lung sound, bronchial or weakened vesicular breathing, crepitus, pleural rub, wet rales. These symptoms are signs of a local lesion of the lung parenchyma.

Laboratory diagnostics

A complete blood count helps to determine the changes characteristic of pneumonia. Usually this is leukocytosis, and the number of leukocytes depends on the state of the patient's immune system and on the activity of the inflammatory process (it can range from 10 to 20x10 9 / l). In the leukocyte formula, inflammation is displayed by an increase in neutrophils and a shift in the formula to the left. The number of palichconuclear neutrophils increases significantly. There is a decrease in eosinophils, lymphocytes and platelets, an acceleration of ESR.

In the later stages of the disease, when the patient's condition gradually returns to normal, these indicators also return to normal.

These changes are typical for both adults and children. In patients with immunodeficiencies (against the background of immunosuppressive therapy after organ transplantation or in the treatment of oncological diseases, in HIV-infected patients), the disease can cause leukopenia, lymphopenia and neutropenia, which is a poor prognostic sign.

Microbiological examination of sputum is carried out to identify the causative agent of pneumonia, prescribe antibiotics and correct therapy in the future. The results of the study can often be quite contradictory and require additional consideration of the clinic for correct interpretation.

Microbiological analysis is carried out in several stages. First, microscopy of Gram-stained smears is done (this way you can determine whether the pathogen is gram-positive or gram-negative). Next, sputum is cultured on a special medium that is favorable for the growth of bacteria. The causative agent is isolated, its vulnerability to drugs is determined. For differential diagnosis with tuberculosis, the Ziehl-Nielsen microscopy method is used.

A serological study is carried out in the case: the presence of specific antibodies is determined in the serum of the blood. Blood gas analysis helps to find out if the patient has respiratory failure.

Instrumental diagnostics

most important instrumental method The diagnosis of pneumonia is a chest X-ray. It is recommended to make a radiograph in two projections (in front and side) in order not to miss a possible focus of inflammation. During the analysis, the doctor evaluates the nature of changes in the lung tissue, the volume pathological process, as well as the condition of the pleura. Diagnosis of pneumonia largely depends on the correct interpretation of the radiograph.

X-ray changes correspond to the stage of the disease. In the very first hours of the disease, it is possible to determine only an enhanced lung pattern, and the transparency of the lung tissue will still be normal. Later, as a result of compaction, blackouts of the affected segments of the lungs appear.

Infiltrates in pneumonia are more often in the lower lobes, have an irregular shape, low intensity and blurred contours. Bilateral enlargement of the roots of the lungs is also characteristic. The resorption of the infiltrate occurs in approximately 1-3 weeks.

With the help of radiography, parenchymal pneumonia can be distinguished from interstitial pneumonia. Parenchymal inflammation of the lungs is characterized by the presence of a homogeneous darkening of the lung area, which can spread to a whole lobe with lobar pneumonia. In the case of blackout, it can be located in one or both lungs and has a focal character. In this type of pneumonia, the lungs produce large amounts of exudate (fluid that leaks from blood vessels due to the inflammatory process).

on the x-ray will look like a seal in the interstitium of the lungs and an enhanced pulmonary pattern. This pattern is typical for atypical and viral pneumonia.

If there are no characteristic changes, or for some reason it is impossible to take an x-ray, then the diagnosis of pneumonia is considered uncertain. In this case, the diagnosis is established in accordance with clinical manifestations.

The bronchoscopy method is used in cases that are difficult to diagnose, when it is necessary to distinguish pneumonia from a neoplasm or a foreign body in children.

Computed tomography is quite exact method diagnostics, but not routinely used. This method is used to distinguish or tumors.

Diagnostic criteria

Diagnosis is established if a chest x-ray shows focal infiltrative opacities and two or more clinical or laboratory findings are present:

• the disease began acutely with a rise in temperature above 38 C;
• on physical examination, there are symptoms of local compaction of the lung tissue (dullness of percussion sound, bronchial or weakened vesicular breathing, wheezing or crepitus phenomenon);
• present productive cough;
• in the analysis of the patient's blood, leukocytosis and a shift of the leukocyte formula to the left are noted.

If the patient has a high fever, cough and chest pain, but there are no changes on the x-ray and there is no auscultation pathological manifestations the diagnosis of pneumonia is unlikely. Conversely, older patients and children may not have such overt symptoms. Therefore, you should not self-medicate at home, because only qualified specialist knows how to recognize pneumonia.

Differences from other diseases

When establishing a diagnosis, it is necessary to distinguish pneumonia from other diseases of the respiratory tract:

• : there are many in common with (productive cough, shortness of breath, high fever). X-rays can help in the diagnosis, but if the amount of fluid is insignificant, it is detected using ultrasound of the lungs. Also in case of long-term failure antibiotic therapy pleural puncture will help diagnose pleurisy.

• Lung cancer: if the tumor blocks the bronchus and causes atelectasis, it is possible to develop symptoms similar to pneumonia. In this case, anamnesis plays an important role (smoking, hemoptysis, weight loss). There may be an increase in lymph nodes. The most informative will be a tomographic examination, with which you can determine the tumor of the lung.

• Tuberculosis: may be accompanied high temperature and cough. Differential diagnosis is carried out using the Mantoux test in children, as well as radiography, computed tomography and sputum analysis for the presence of Mycobacterium tuberculosis. On the roentgenogram with tuberculosis, rounded darkenings with clear contours are visible without enhancing the pulmonary pattern, a path from the shadow to the root of the lung is characteristic.

• “Acute abdomen”: Pleuropneumonia (usually croupous) sometimes mimics an “acute abdomen”. This sometimes occurs in children, and often surgeons perform unnecessary surgery before pneumonia can be identified. In order to avoid such a mistake, it is necessary to consult a therapist and prescribe an x-ray.

• Diseases of cardio-vascular system: often in older patients there are no pronounced symptoms of pneumonia and persists subfebrile temperature. In this case, chest pain and cough are attributed to angina pectoris or circulatory failure. Parallel ECG and radiography helps to understand.