Обычно способствующие быстрому клиническому ухудшению




Введение.

ССН - это сложный клинический процесс, вызванный различными заболеваниями сердечно-сосудистой системы, приводящими к систолической и/или диастолической дисфункции миокарда желудочков. Он проявляется нарушениями как гемодинамики, так и нарушениями нейроэндокринной регуляции. Клинически, сердечная недостаточность определяется как синдром, при котором пациенты имеют характерные симптомы – одышку, отеки лодыжек, усталость и признаки – повышенное давление в яремной вене, хрипы в легких, смещение верхушечного толчка вызванные нарушением структуры или функции сердца.

ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility.    
Острая сердечная недостаточность (ОСН) – клинический синдром, характеризующийся быстрым возникновением симптомов, характерных для нарушенной функции сердца. ОСН – угрожающее жизни состояние, требующее неотложного лечения, госпитализации в блок (отделение) интенсивной терапии и предпочтительно в стационар, располагающий необходимыми диагностическими и лечебными возможностями.

Цели лечения ОСН:

(1) В блоке интенсивной терапии – устранение или уменьшение симптомов, адекватная оксигенация, улучшение показателей гемодинамики и перфузии органов, ограничение повреждения сердца и почек, предотвращение тромбоэмболических осложнений, минимизация срока пребывания в блоке интенсивной терапии;

ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility. ST. PETERSBURG, Russia, April 3 (Reuters) - Ten people were killed and more than 20 were injured when an explosion tore through a train carriage in a St.Petersburg metro tunnel on Monday in what authorities called a probable terrorist attack. Russian news media said police were searching for a man recorded on surveillance cameras who was thought to have been involved in the attack, which coincided with a visit to the city by President Vladimir Putin. Private television station Ren TV broadcast grainy pictures, it said were captured by a camera on board a metro train of a middle-aged man with a beard, a long black coat and black hat. Closed-circuit footage from a few minutes later showed him outside the station hit by the blast, looking at his telephone. Russia has been the target in the past of numerous bomb attacks, frequently targeting public transport. Most were blamed on Islamist rebels from Russia's North Caucasus region. The rebellion there has been largely crushed, but security experts say Russia's military intervention in Syria has made Russia a potential target for Islamic State attacks. There was no immediate claim of responsibility.    
(2) В стационаре – стабилизация состояния и оптимизация лечения больного, выявление основного заболевания и значимой сопутствующей патологии, начало лечения с положительным влиянием на течение и прогноз заболевания, титрование доз лекарственных средств до оптимальных, определение целесообразности и способов немедикаментозного лечения;

(3) После выписки – планирование подходов к долговременному лечению (включая образование и изменение образа жизни), планирование дальнейшего титрования (оптимизации) доз лекарственных средств с положительным влиянием на течение и прогноз заболевания, обеспечение доступности надлежащего немедикаментозного лечения, предотвращение повторных госпитализаций, уменьшение симптомов, улучшение качества жизни и выживаемости. Наряду с неотложным устранением проявлений ОСН необходимо предпринять все усилия, чтобы как можно быстрее выявить и по возможности устранить причины, приведшие к возникновению декомпенсации.

Основные причины и факторы, приводящие к возникновению ОСН

Обычно способствующие быстрому клиническому ухудшению

· Тахиаритмия с высокой ЧСС или выраженная брадикардия/брадиаритмия/нарушение

· проводимости

· Острый коронарный синдром

· Остро возникшие нарушения внутрисердечной гемодинамики (разрыв межжелудочковой

· перегородки, отрыв хорд митрального клапана и другие)

· Тромбоэмболия легочной артерии

· Г ипертензивный криз

· Тампонада сердца

· Расслоение аорты

· Осложнение кардиохирургических операций

· Кардиомиопатия при беременности



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