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tll\t -n:-n:o<; !C T punooKttiOn'> ~
E;-ri;<O upo' K.a3(\/f1T n'> Ua\1 . nt01!1 \.!lOU e-:_auuAL us - ~
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1. ~1TfENE12 KAPldOITAE>EIE2

H ouxv6np:a e!-l<PciYLO!l~ ou;;e.vwv Kap6LOna~E.LlUV avpxnm oe 6 nE.ptn:ou


ncptatanKci ava 1000 ;e.vv~oet~. Yrtot\o;tCetaL6n TO 8c1 0% autwv o<peit\E. TaL O
XPlLliJOOWIJLKe~ avw~JaAie.s, TO 3-5% oe. 6wtapax~ otnv ,\e.t toi.Jp{ia e.v6s /O'v'L6iou
\1-!0VO/OVLOLaK~~ (natapax~) KUL to 85% oe no,\unapa;ovnK~ KArwovo~JLKOTflta,
xapaKTflpL(OIJE.Vfl an6 111 OUIJIJE.TOX~ TOGO /E.VE.TLKWV 000 KaL TIpt5aAt\OVtLKWV
napajOVtWV. 0 Ki.VOUYOS E.IJ!pcl\ILOfl~ OU//eVOlJS KapOLOTici&elUS E.LVUL
IJe/a,\ute.pos ota cito11a IJE. npwtou ~a-&!J.ou OU//E.Yeis ncioxovte.s an6 ou;;e.v~
KUpOLOTicl~E:LU an6 Otl OtOV /E.VLKO TI;\fl&UO!J.O.
H tmapen OE. E.vav ao-&ev~ OU)')'E.YOUS Kap6LOnci&elUS ouv~&ws QYU)'YWpiCetaL uno'
tnv napouoia 6uo ~ ne.ptoooTE.pwv an6 ta aK6Aou&a euprwata:.
a) .Puon11a oto npoK.ap6to. Otav 10 <puon1-1a c:ivat ouv<::xE.s f1 6tci{vwon ou;;e.vous
Kap6tona&etas e.ivat ~E.Batn.
~) LllcltUOfl ~ UTIE.ptpo<pi.a 1-J.lclS KapOtaKf)S KOLt\OtflTUS.
j) AueflO!l ri et\ciTTWOfl 1!1S UliJcltWOflS TWY TIVU!-10VWV OTflV. UKTLVO)'pa<pia &ti.JpaKa
O) Lila1:apaxs IOU iJ.e/&ous KUL IOU TIE.Pl /Pcll-11-lUIOS TflS KapOlUS OTrJV
al\ n vo;paqna &wpaKa.
e) KucivLOOfl!-le f1 xwpis TIAflKTpooaKtui\i.a ~ not\uKUTTapat~Jia
Ot )ITa&ot\O/LKO f"]Ae KTpOK apOLO/P cl\flfl!lO
OL OU//E.Vei.s Kap6ton:ci&e.te.s 6taKpivov-rm oe. KuavLOUKE.s Kat KuavwnKE.S
(lltVOKOS 1).

[l(vaKa<; 1. 2uvn&oTe.pe.s ou;;e.veLs Kap6LOna&eteS

AKUQVWTLKS KuavwuKS
- l1VWO!l TIY UIJ.OVLKriS - Te.1paAo;ia Fallot
-2TYWOfllO&IJ,OU aopl~S -Me.tci&e.on IJ.e;ciAwv a;;e.iwv
-MeoOKOATILI<!l E.TILKOlVWVi.a
-MeOOKOLALaK~ eTILKOlVWVia

1
AKuavwnKS OU)')'VLS Kap{nond-3-LS

A<popaTo 10% rou ouv6Aou twv ou)')'evwv Kap6LOna&Lwv KaL anavtatcu I! n1v
LOLa ouxv6trjta 0 avOp~ Kat ;uvai.K~.' H naSr]Ofl ouxva O<pLt\tat 0 AOLIJ.W~fl.
tr]~ llr]tpa~ ano pu&pa Otr]V apx~ Tr)~ KUr]Ofl~ Kat 1J.TIOpi va OUV00UL
~-tOV0/0\JLOtaKE.~ OLatapaxE.s (VUPOLVW~!cl1WOfl, OUVOPOI-10 Leopard, ouvopo~-to Weill
Marchesani Kat ouvopo~-to Noonan).
A. XapaKtopwnKa Kat na&o<puatoAo"Yia. H otvwor]~-trrope;L va ei.vat ~a,\0t6tK~ Kat
va a<popa tr]V 11VUI!OVLK~ 0aA~i.oa ~ uno0at\0LOLK~, VtOTIL(OilV.fl OTr]V
11VUI!OVtK~ xocivr] (infundibulum). Kat on~ ouo TIplTI1WOt~ au~UYc1aL f1
avtL01aon OtflV po~ tou ai11atos an6 tfl O~ta KOLA La npos 1r1v nve; u~-tOYLK~
aptflpia Ka~tiJ~ e;niofl~ 11 n'tOfl 0111 oe;{ta KOLAia Kat eAa1tti>ve;1aL fl pori 1ou
ai11atos OtflV nvUI!OYLK~ KUKAo<popia. 01av oe;v ouvunapxe;L ow<pu)'ri ai.~-tato~
ano 6 c~La rrpo<; ta apwte;pa ( n.x. an6 1ov O{L6 npos tov apLOtp6 K6A no
6w~-toou avotKtou woe;Lo_ous 1P~~-ta1o<; ~ ~-toot<oAnt KOU eAAcill~-tc.m:;s) o Kopeo~-t6s
1ou aplf1pLaKou ai11atos oe o{u;6vo OLalflpei taL oe <pumoAo;tKa enineoa.
!rroKOpo~-t6s xwpis va unapxet ow<pu;~ napalr)pei taL ~-t6vo oe nepL ntwoets ~-te II
1~
1
0apta 01YWOrj trj<; TIVU~!OVLK~S aptr]pia<; Kal AclllWOr)1flS Kap6LaKi]S TIUPOX~S.
I1A!lK1po6aKtuAia ri noAuKurrapm~-tia oe;v e~-t<paviCovtaL, t:Kl6S e;av ouvunapxet
1-t/UAfl OLa<j)U/ri ai.IJ,atos ano ""(Q oe~Lcl n:po<; 1U .apL01pa. [,:

B. KAtVLKa e;up6blala. Ot ao&e:veis 11e llLKpou 0a~11ou o1vwofl tllS nveUilOVLKriS I'

(ouotoAtK~ KAiofl nieor]S llta~u 6e~La<; KOLAias Kat nveu11oVtK~S aptflpia <30
I'
mmHg) eivat aoullTCl:Wilal:tKci., e;vw eKeivm 11e 11etpiou ~ ooBapou Ba~11ou I
OtVWOf1 trj<; ITVUil0VlKriS (OU010ALKri .KAlOfl Til0flS lleta{(J oe{ta<; KOLAi.a<; KUL
nveullOVLKris aptflpia >50 mmHgJ ouon-vma OtflV K6nwof1, ou;Konni<a I
eTILOOOta, TIPOKUpOtO a,\;o<; Kat 61:<1.. tt:ALKU crcctlllct. 6eeui KapotaK~ ave.napKeta.
~tfl !.VflAcl<pflOJl 0LUTILOl:WVlaL OUOtOALK~ avanaAOfl rrapa01pVLKWS aptotepa
o<pet,\6~-teVfl au1v une:pouva~-ttKri Kat napatetallVf1 WOfl tflS 6e{tas KOLAias. Ta
aKpoaonKa e;up~11a1a e;{aptwvlat an6 10 eioos Kat tnv ~apulr)ta 111s otE.vwor)s.
~tfl\' llTILOU Ba~llO'U ~aA~LOLKri otVWOfl tr)S TIVeUIJOVLK~S otanionovovtaL OtflV
eo1La aKpoaons tns n:veu11ovtKriS ~aA~ioac; (6eu1epo 11eoon:Aeupw 6taonwa
napaotepvu,ws apto1epa) ~xos e{W~flOfl') (ejection sound), ouo1oAtKO <p UOfliJ.O
c(W~flOflS KUL eupus OLXOOilOS TOU 0LJ1pou Kap6taKOU t6vou. Me 1f1Y napooo
tou '<.POVOU "at rqv au{r]Ofl tOU ~a~llOU tr)') otE.VWOflS TO OUOtOAtKO <pUOflllO
au(avet oe 6tapKeta Kat KaAun1et 10 aopnKo o1mxeLo (A.2) tou oet:nepou
KapOLUKOU TOVOU. To ITVUflOVLKO OtOLXlO TOU 0UtpOU KUpOLUKOU 10YOU (P2)

{
e~aKoAou&c:L va UKOU/etat aMa eiJ<pavi(etat lle Ka~uoreprwn 1\Ut E:xet JleLWIJE.vq
evraon. ~rn ool)apou l)aiiiJOU otE:vwon rns nveullOVLKriS BaA!3ioac;, n onoia
ouvriitws xapaKtrlPi(etm an6 aoBE:otwon HJS nveUIJOVtKriS l)a,\Bioa<;, ro P2 Kat 0
riXOS e~Lll~flO!lS e(a<pavi(OVIUL.H uno5at\5tOLKri orE:vwon tr]S TIVE:UilOVLKri<;
xupaKTqpi(etaL an6tflv an:ouo~a.- rixou:.e(W~!lOflS. :.- . .;

r. EpYaotoptaKa euprillata . .lro nAeKTPOKUPOLOjpa<pr]JlU naparnpouvtat Oe~LOS


.
a~ova<;, urceptpp<pia IOU oeeLOu K6Anou (P pulmonale), UTieptpo<pia IllS oeel!l<;
;.

Kott\ias Kat arc:A~s ri nAriP!lS arroKAetoll6S rou oe~tou OK.,\ous.


~H)V aKnvojpa<pia ~wpaKa 6taKpivovrat l.letaorc:vuntKri 6taraon Tf1S n:veu~ovtKris
apnwLas Kat oAL/aLI.lLKci nveUIJOVLKa ne6La. AAAa euprillata c:ivat 11
lle/a',\oKapoia o<petA6!leY!l oc: uneprpo<Pia tns oe(tas .Kot,\ias xapaKTflPL(61JeWJ
an6 rnv av?6o TflS Kopu<pf)s oc: oxE:on IJE: ro aptorc:p6 !l!JLOur<ppa/l.lU.
To'!lXOKapOLO(pa<pnl.la (M-mode Kat 6L06iaoraro) XPllOLI.le ueL ;ta Tfl 6u::pe. UVflOfl
c t'W"i; Q.VUTO~LKWV Q\IW!lUALW\1 1f1S TIVU!lOVLKrlS l)aA5ioa<; ~ Tf1S TIVeUIJOVLKtiS

xoa.v11s Kaitws enions /La rnv eKTLilflOil rwv 6taoraoc:wv Kat tou ~a~~ou HJ<;
. une:prpo<pLas TrJS O(LUS KOLAiac;. H KAion rei eons llE:taeu oc:euis KOLAias KQL
nveu~-toVLKrlS aprnpias l.lTIOpei va unoAO/LOieL l.le !lXOKap6w;pa<pfl!lU Doppler. Ta
llXOKUpOLO(pa<pLKU UPrlllU1U ouvf)itw<; TILBeBULWVOV1UL llE: KapOLUKO
Ka~e 1f1PLU0~6.
!1. f1p6-yvwoo Kat Se:parceia. Ot aoSc:vc:is 1..1 !lLKpou !3aS!lOU o-cE:vwo11111S
T1VUI.lOVLKrlS exouv <pUaLOAO(LKO n:poo66Klll0 TILBiWOflS, E:VW eKelVOL l-1 l-l1piou
n
Ba-3-!lOU a-ceVUJO!l111S TIVC:UI.lOVLKrlS ei.vaL QOU!lll1Wil01LKOL 0111V TWLOLKrl 1flV
e<pf1!3LKrl nAtKia Kat e!l<paviCouv OU!lTI1Wilata !le rnv eV!lALKiWO!l. TAos, ot
ao-&eVLS 1-1 ool)apou l)a-3-IJOU 01VWOfl TllS TIVeUI.lOVlKTlS 0LUtpxouv auer111VO
n
Ki.v6uvo at<pViOLOU SavatOU KUPOLaKrlS UVT1UpKLUS tllV oe:(rrepfl ri TflV rpit!l
6c:Kaetia -ens Cwris.
Ene:1-1BanKri ~c:panc:ia (BaABtoonAaonKri 1-le ~rcat\A6Yt ri xc:tpoup(LKrl eTIE:Il~a.Ofl )
an at 1L 1UL 010US OU!llUWl-lUtLKOUS ao-&eYeL') ri tO US aOU!lTI1W!lU1LKOU') aoS\'eL<;
~c UTIE.p1po~ia -ens O{LUS KOLAlas KUL KALan rcicOflS > 70 mmHg IJ.tileu O(LUS
KOlAias KQL TIV UllO\'LKri aptflPLUS.

~-cvwon to~IJ.OU aop-cris

AVTLOTOLXcl 0.10 7% tOU ouv6Aou H.UY 0UjjYWV KUPOLOITa~<::LWV t<Ul qJ.<paVt(TUL


auxvorc:pa arou<; av6pec; arr6 on ous ruvaiKes (av6pes//uvatKe<;=2:1 ).
A n:oteAet trJv xapaKtflpLOtLKrl Kap6toaj/taKri avw~a,\ia rou ouv6p61J.OU Turner
Kat ouxva ouvurcapxc:t 1-1 6Ln:-cuxn aopttKrl BaA~ioa (25% -cwv n:epLm:woc:wv ),
UVOLKtO U.'[flpLaK6 TIOPO KaL !ltU~0fl 1WV llE./UAWV 0)'/E.LWV.
A. XapaK to'pLOnt<.a KUL n:a~o<puotoAc)]ia. np6KLtUL' )'lcl auvri()ws eKKY1Pil

,.
i

<.HeYWOfl tou aoptlKOU t6(ou \ll:On:L{O!.H~Vf) rtepl<peptKU 1flS CipLO"Cepr)S \


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un:m::Ae.towu a.prnpLa~ an:tva.vn an:6 tov aptr)ptaK6 n:6po. ~e. n:o.\u oo.0apc; t
\.
nc:pt rttwot:t~ 1-lrtopel va napcnrwn~e.i 6r.aKonr) tou aopnKou ro(ou.
L\.Lat<plYOVTal OUO run:Ol Ol:~VlUO!l\ l:OU LO~!lOU tr)S aoprris 0 \'6"0./ltL'KO{Kat 0
n.i!lo> rov cvr;Ao:a 0 n:puno.; xaoaK tnpi(etat an6 o-revwon 1ns uop-rf]t) l.le-ra~u
TflS aptOtepf)s un:oKAe.u)iou UP111PLUS t<Ut 10U ap1rlPlUKOU n:6pou, eVtiJ 0 0\Jte.pos
arr6 orE.vwon tns aop1fll) o1o UtlJOS tou aptnpwKou n:opou r1 ,\i.)'O l.letc.i ana
aut6v.
H m:evwon tou ta&11ou tns aoptric; xapaKtf)pt{t:.tat an6 auenon tns n:i.eons -rns:
aoptri.; KC.U nuv KA.ac)(tW t!IS nolv an:6 tr. crtevwon Kat eAantoofl 111<; n:iewns IJ.Tci
til 01:evwon. o~W ""CY\) ClVO:.IIt\J660\-lC'-lY15 C9ncrn,s .tl\f:6nt; tr)S upwtepns KOtt\iac;
ll te.Ae. U1atci -Ulj)L01atat OU/K V1PLKri llT!:eP1PO<{>tU.
B. KAtvlK<i eug6wa-ra. E<p' 6oov o ao~c:vns 6e.v e!J.<paYioe.t Kup6taKri ave.n:apKe.ta
KQTa tr)V V0/VLKr) flt\lKtU OUVri~WS n:apa!J,Vel QGUilTitW!J.UtLKO'; !J,XpL :va
e!ltpavwrouv m e.rn n:AoK<; tn<; aptflPtaKtis un:ep-raof!S, 6ITws n apw-cepit
~:.f~r
\.:.
KapotaKri ave.napKeta KUL 11 e{KetpaALt<rl aqJ.oppa;ia, H te.Ae:utai.a l.lTIOpe.i va '~:::

O<pt:LAetat KO.L oe p~~ll tJ'Ke<pat\lKWV aveupua~J,citwv. ta ortoi.u ouxva ouvo6euouv


trl\1 nci~nor~.
Ene:L6ri 11 ap-cllptaKti nie.o11 e.ivaL au{nJ.levrr ora avw Kat tpuOLoAo)'tKti ri eAattw~Vf1
<.HQ KatOJ OKPU. 0 aptflPLaKO) O<j)U{IJ.O<; elVUL ev10VO<; 010\JS 13PU.XLOVS Kal
e.eaa~evrwevos ri U4Jilt\O<pi!10S OTt<; ll!lPLaL'; apl:flPLeS. ~hnv uKp6aan
OLaTtLOtWVOV10.L t,\OOI.JOtOAlKU <puOr)!JUta CW~f10f1S OTfl eaan tfjc; Ku.p6tr:i<; Kat
O"tflV PUXfl e.navw a.n:6 tLS at<av-&w6e.t<; al10<j)UOL') twv onovouAwv, O<j)etAO!lYa
01flV avarnuen napartAUpf1<; KUKAo<popl.as rtpLV K!ll IJ.el:U 111 01eVWOf1 . .4uxva
e:n:iof'J<; aKOU/'e.tat 6wo-coALK6 tpuon~-ta aopuKris ave:napK ews t\61w tns
ol
Ttapouoi.as nti.JXflS aopttKriS BaAI)i.oa<;.
r. EQ'YUOtQQLUKcl e.upljgata. To nAe.t<tpOKUpOLOjptitprn.ta 6e.lxvet un:e.p-cpo<pia 1f1S
apLOTepris KmAias. 2tnv aKtLVO/'PO.<Pi.a ~wpaKa n:apa1:rwouv1m o6ovtwoe:ts oto
Katw xei.Aos -cwv nAe upwv otpeLA6!levt:.s otLS 6wte:-cajleves Jlecron:Aeuptec;,
OLCitaOr) tr}S UTtOKt\LOi.OU aptr)pLa), !J,.tU01VWtLKrl OLtltUOr} tr)O" aoptfi') KQL
au\flOr) nov 6taot0.oe.wv tflO apwtep~c; KOLAi.as. H avarnuao61J.evn KAi.afl n:ieons ,
n:pL v t< al ueta HI otvwofl, n on:oi.a d vat avaAo;n 1r1c; l)ap(rtntas tns otvwons. (.

!J.Tiope.i. va unor\O/'LOtei. !JC: un:e:pnxo;pacpniJ.a Doppler ri IJ. KapOLaKO


Ka8-eTflpLaOIJ.O. H un:eLKOVlOfl tflS avatOJ.lLKfJS avw\JuALas /lYE:tal l.J.e aopto/PO:tpta
\
rl j.l.a/Vr)tlt-..tl l:Oj.J.Ojpa<pi.U.
L\. DQOI'Yo.>on KCll ScQo.rrei.a. KapOlO:Kti ave:n:apKeto. ouv~~ws rtapatf!pel Tat aw
ve.o)'va Kat o-rous e.vriALKeS rrou 6e.v un:ol)aAt\ov-cat oe ~e.pane.i.a. Ot
n:e:pwaotc:pOL arr6 tous 1,\euta.Lou~ 8-a KataAr1\ouv nptv an6 T1V nAtKia -rwv 40
no
t:.tO.lV ;\Q)'t!J ej.~.<pavLOr)S IJ.LU<; a tLS TtL n:,\QK S 1f1S VOOOU. OTIWS KUpOtaKr)

4
UVt:T1UpKcLU 11 cj'Ke(pa,\tKG aq.J.Oppa;ia T1POKUt\OUIJ.E:Vfl UTIO apTflpLUI\fl urrepTUOfl,
p~(fl 111S aopT~S. AOLIJ.WOfl eVOUP1flPL noa ~ p~~ll E.j'Keq>aALKOU UVeUpU011U10<;.
~uxvri E. TIL rr,\o"ri ei vat KUL 0 OLUXWPL0110S Tfl<; aoptri<;.
Errei.J.5anK~ avn11e1timLOfl tfl<; v6oou (a;;c:tonAaonKri 116 1.1na;\A6vt ri xe.tpoup{tKri
',Otop~'wOfl) artat rd"rat'oc6t\ous -rous ao~e.ve.is flt\LKias Kinw rwv 20 e.TtiN. ~1ous
ao~e.vt:is flt\tKLas 2!J-.40 e.1wv 11 eTtell5anKri &t:pane.ia e(pap1J.6(etat 6tav fl .
apTI1PtaKri urrE:ptao11 oev t:AE:;xetat 11e q>api.J.aKa ri 61av urrapxet.orlllaVTLKri
uneptpocpia TflS aptOTepris KOLAias. TE:Aos. otous ao&eveis avw t(JJV 50 nwv ll
E:TIE.IJ.5UttK~ &epaneia elvat U114>LB6Aou aeias AO/W TOU auei11J.VOU, KLYOUVOU.
lle.pL
.1.
n:ou 25% 1wv ao&t:vwv &a e\aKo,\ou&rioet va exet au~1111evf1 apiflptaKri
TIL011 KUL IJ.E:1Q 1flV UVU1011LK~ UTIOKU1UOtUOfl 111S UVW11Ut\ia<; KUL &a rtpeTIE.L va
uno!),\fl&~i OE. xpovi.a avnunep-camK~ a;w;~.

MeaoKot\TILKrl entKOLvwv(a

A<popa 10 10% 1wv ou;;evwv KapoLOna&etwv Kat ci.J.q>ayiCetat ouxv61epa ons


/UVUlKE:S an6 OTL 010US avope<; (;uvaiKe<;/avope<; 2:1 )'. ~U)(VU QVUpiOKtUL 01U
rrt\aiata OUVOpOI.J.WV, TIOU 6tenovtaL an6 10UO VOI-LOU<; 1flS I-LE:VOAeiou
KA11POVOI-LLKOTfltU<;, 6nws 10 ouvopo110 Holt-Dram ri to ouvopoi.J.O Noonan. ~uvri&11s
eivat Trl011S 11 ouvunap\111.J.00KOATILKrlS TILKOLVWVLQS 1-L xaAapi llLLPOLOri
!
~

!)at\!)ioa, OteVWOfl 111S TIVUI.J.OVLKi)<;, QVWI-LUAfl K~ot\f) tWV TIVUI-LOVLKWV tpt\e!)WV.


I!
Ka&ws TILOflS I.J.e oteVWOfl 1flS I.J.l1p0LOOU') ( OUVOpOI.J.O lutembacher ).
A. XapaKtoptonKa Kat na&o<puotoAo1ia. 0 ouvn&E:ote.pos Iunos I.J.E.OOKoAntKriS
TILKOLVWVia<; (800/o 1WV TIPl TitWOWV) eivat 10 OUtp0j'V<; t\ALI.J.I.l.U (ostium
secundum), evTont(OI.J.E.VO 01flV 1.J.OOti11U -cou I.J.E.OOKOArttKOU otatppan.J.a-cos.
I
/\.t;6tepo auxv6 dvat IO OUIP07Ves E:Meti.J.I.J.a (ostium primum)
napaiflpOLJI.I.E.VO OIO KUIW1p0 11.J.Jli-LU IOU I.J.00KOt\TILKOU Otacppcl[I.J.UTOS KQL auxva
ouvooeu611evo an6 avwi.J.at\ies IllS 1-LLIPOE.toous Kat IflS 1PL7Awxtva<; Bat\Bioas.
TAos, fl )lE:OOKoAntKrl eTILKOtvwvia tUTIOU <pt\e!)woou<; K6ATiou (sinus venosus)
VIOrti(etaL 01flV aVWiePI1 I.J.Oipa IOU j.l00KOATILKOU Otacppcl/I.J.QIO<; Kat OU)(Va
ouvun:apxet I.J.e iJ.pLKrl aVUJI.lat\0 K!)ot\fi tWV TIVUiJ.OVLKWV cpt\e!)ciJv Oir]V UYW
Koit\11 q>A5a.
l 6t\es ns rreptrrtwoets I.J.E.OOKoArrtKris entKoLvwvias o~uf'OVwllevo aL11a 6tepxnat
,\6;w ow<popus ni~ons an6 1ov aptatep6 npos -cov oe\t6 K6,\no 11e ano-cE:AeoJla
Tr]V UU(r]Or] 111S T1UPOX~S Tr]S OE:(lUS KOLt\ias Kat Tr]S pOri<; 01r]V T1VUilOVLKri
KuKAoq>opi a.
B. KAtvtKa e.uprj!.JaTa. Ot nepwo61epm ao~eveis 11 11tKpou ri I.J.Tpiou ll7&ous
et\t\ei!lllata 10u I.J.eOOKOATitKou 6tacppc1)'1.J.U10S eivat aOUI.J.TITWI-laTLKoi. Ot ao~eveis
~c: ~e1ciAa et\,\t:L~Ila-ca ouvooeu611eva an6 ll76.An 6ta(pu7ri aLIJ.aTo<; an6
apta-cepa n:pos 1a oe.(ta ei.J.q>avi(ouv ouonvOLa o1nv K6rrwon Kat KapotaKri

\
uvc:rrcipr:c:La TllV TETap111 6eKat:TLa 1llS Cw~s. XapaK111PLOTLKci Kt\LVLKU e.upri!laTa
t:LVUL OL evrove.s O<pu{E:LS 111S O(LciS KOLt\ias KUL 111S T1VU~OVLK~S api11PLUS
rrapaOTpVLKU apL01pa, OL OITOLE:S eLVUL l!JI1t\U<j)111ES KUL 0 OpLOj.J.EVS
ITpl ITHlJOLS opa1ES, TO OUOTOt\LKO <j)UOI1j.J.U CW&f10f1S ITOU UKOL!")'CCUL 010
6t:ua:po KaL rpt-ro ~eoorr,\eupto 6taoTf1~a rrapao1epVLKci apwn:pu KUL o<pe.tAc1aL
01f1V au{f111ev11 po~ 01f1V rrveuj.J.OVLK~ KUKAo<popia KUL o o1a&ep6s 6txao116s rou
6etnepou r6vou, o orroios 6ev j.J.eta~at\Ae1m ~ens avanveuonKe<; KLv~oeLs.
r. EpYUOtOQLUKcl UQQilUTa. To flt\cKTpoapOLO(pci<pfl~U 0LXVL rrA~P11 ~ U1cA~
arroKt\ew~6 tou 6e(LOu oKet\ous oe 6Aous -cous ao&eveis ~e 1JOOKo,\mK~
TILKOLVWVia. ~TOUS ao&eveis 1.1 OU1pO(E:VES eAAeq.lj.J.U 0 f1AeK1PLKOS acovas
l:I1S Kapouis LVUL OCLOS, evw 0 E:KelVOUS 1.1 TIPUJTO(VE) eAAcLIJIJU apLOTep6s.
T eAos. dtous ao&eveis j.J. j.J.00KOr\TILK~ TILKOLVWvia TUTIOU <pt\~WOOUS KOA nou 0
cicovas -rouP BpioKt:TaL apL01cp61epa nov 15. ~1f1V aKnvo")'pa<j)ia &wpaKa
6wKpive1UL 11 6ta1aof1 111s nveuj.J.OVLK~S apu)pias, 11 au(flOfl trlS at~aTWOflS -rwv
nveu~ovwv, f1 6U:nao11 -cou 6ectou K6Anou Kat tfls oe(Las KOlAtas Ka&ws eniofls
10 l.lLKp6 aopnK6 KOI.l5io A61w tflO t:Aa-r-;;wo11s 111s na.pox~s 0111 ouo11111anK~
KuKAo<popi.a.
~to 11XOKap6LO;pa<pfliJU (M-mode KUL OLOOLcio1a1o) napati1Pt:ilaL <p6pnof1 O/KOU
lflS Oe~ui<; KOlAias, aVU")'VUJpL(OIJVT) an6 tf)\l aucrwl1 TUJV 6taotciOeW\l tf)<; Oe(Las
KotAias KaL tr1\l napci6ocn KLVfl1LK6tnta -cou IJeooKoAnLKou ow<ppa(llatos, 10
OTIOLO UTIOI.lUKpUVtUL an6 tO OTitO&LO tOlXWIJa tfl) apLOtp~<; KOLr\iaS Kata tl1
OUOTOt\~ KUL n.\flOL!l(L tO OTiio&LO tOiXWI.la l:I1S apLOtp~<; KOLr\ia<; Kata 111
ouo1or\~ (av1i&e1a an6 6u OUIJ5aivet <puOLoAO/LKci). Me to E:/XPWI-10 Doppler
1-lTIOpt:L va VTOTILOti tO 0111Jl0 l:fl) OLU<j)U/riS oto 1-lE:OOKOATILKO oui<ppa/1-lU, \JW
1-1 tO OLOO<pci")'LO flXOKapOLO")'pcl<j)l11.la KUL l:flV IJU/VflUK~ 10j.J.O")'pa<pia
t:nt tu/xcivetat 11 AentOI-lt:P~S ant:LKOVLOfl TflS ava10I-1LK~S avw1.1aAias. TAos. o I
II
KapOLUKOS KU~tflpLaOIJOS 6i6L not\utLI-1) TIAI1PO<popiS OXTLKU 1.1 tflV napOXrl
01f1V TIVE:UIJOVLK~ KUL 1fl OUOl:fliJQlLK~ KUKt\O<popia KUL LLS 11VUIJOVLKES
avnotcioets.
fl. Dp62vwon KaL &epaneia. OL ao&eveis 1-1 1-lLKpou 5a&1JOU l-lOOKOATILK~
TILKOL VUJVLU napUJ.lEVOUV UOUI-lTil:UJIJULLKOi KaL EXOUV <pUOLOr\O(LKO TIPOOOOKLj.J.O
TIL5lUJOfl), VW Kl VOL 1-1 l.l(cir\ou ~a&l-lOU IJ00KOt\ TILK~ E:TILKOL VUJVia
e~<paviCouv OUJ.ll11W~ala 1flV tpitll ri tr)V 1e1aptfl OKU1ia HlS Cw~s. ITveuj.J.OVLKri
unE:ptao11 onaviws napaTI1Pt:i taL oe e<pri5ous ri veapous evfi,\LKS 1.1
0UTPO/VS eMLIJj.J.a, VW eivUL OX1LKU OUXVri 0 aa&evei<; j.J. npWtO(VS
AAl~IJU. Mt: Ia IflV 11ALKia tUJV 40 l:WV TIVUJ.10VLKri uneptUOfl, KUPOLUK<;
appu&j.J.l<; louv~&wc; KOATILK~ IJUPIJUPU/~) KUL KUpOLUKri avenapKLU j.J.TIOpci va
E:~<pUVLOtOUV UKOI.ll1 KUL 0 ao&evei<; IJ 0U1p0(Ve<; et\r\LIJj.J.U. l10US UO~Vl<;
~ nvu~OVU.. fl urrep1a011 ~ <pt\eBo&pOIJ~WOLS napUTflPOUVlaL j.J. UU(fliJEVf]

6
OUXVO tq W IT\'C. U1JOVLK e<; t:llf)ot\E.<;.
Otav TO E.,\,\eq.lllU c:ivm llLKPO oe.v arratTei TaL eLOLKri ~c:parreia. 2u;KAeLOfl tou
et\Adl-ll-lOtOS C.Lte lle Tfl XPflOq.LOITOlflOJl E:LOLKWV OUOKE:UWV, OL OITOit:<; C:LOcl)OVTUL
6ta6ep1JtKci I.! E. Ka~etripa ( n.x. Clamshell, Amplatzer) e.i T 1-le xe.tpoup;tl\~ e.nE.1.!5aon
.a.naL Jc:i TaL 6rav o A6;os Tfl<; rrapoxris otnv nveu!JoVLKri KuKAoqJopLa rrpos TrJV
napox~ OTflV ouOtflllUTLKri KuK,\o<popia une.p()aivet to 2:1. H ou;K,\eLOJl Tou
e,\Aeil-ll-lOtos avtevoeiKVUTaL otous ao~eveis l-IE: avaotpoq>ri TflS ota<pu/riS 6t6TL
Otr]V nepi ITTlllOfl QUTri 0 Kl VO UVO<; ~avcitOU an6 O\eia OeCLCl KapOLUK~
averrcipKe:ta Ol-lows 1-lE:Tci tn ou;K,\e:ton eivm 1-le/ciAos: TAos, otous ao~c:ve.is 1-le
1JeOOKOt\ IT.LKri E. 11LOL VWVia TlJITOU <pt\e~WOOU<; KOt\ 110U arranei TaL erraY1-l<P un: UOJl
TWV T1VU1JOVLKWV <p;\e5wv 010V apt0Tep6 K6Ano, E:VW 0 KelVOUS 1-le .
rrpwto;e:vs dAeq.LJJa 11 xetpoup/LKri 6t6p~won ouvurrapx6v1wv avw11aAwjv rns
TPL)' . \WXLVOS ri TflS !JlTPOetOOU<; 5aA()ioa<;. H Xetpoup;tKri ~VJlTOTrrta e:ivat XUI.lJlt\~
(<'1%) otous ao~c:veis r]AtKLas Kci1w nov 45 e:twv rrou oev rr'cioxouv an6 KapotaKri
_QVeiTclPKeLQ Kat 010US OT10lOUS fl OUOtOALKri ITteOfl OTr]V IT\!eU110YLKrl ap"Cflplci OE:V
. urrc:p()aivc:t ni 60 mmHg Kat 11e)'aAlne:pn (5-1CP/o) ae eKeivous avw 1wv 40 c:1wv
1J. KUPOtaKri QVITclpKLQ KQL ITleOJl 01flV TIVeU1JOYLKrl apTJlpia 11/Q,\U'tepfl 1WV
60 mmHg.

AvOLK10<; ap1f)pLaK6<; nopos

A <pop a to 10% TOJV ou;;c:vwv KapoLOrra~e:twv, arrote:Awv'tac;-oull<pwva 11e


OPLOI.lVe<; lleA1E:S-LrlV Oetrrepfl Oe OUXV01fl1U OU//eVri KUpOLOITcl~LQ. H
nci~non oxetiCc:tat 11e Aoi~.tw\n 1flS 1.1fl1pas an6 epu~pci oto rrptino 1Pil.lflYO UJS
KUflO!lS Kat 6ta1J,ovri oe 11/liAo U4JOlletpo. ~ns rrc:ptntwoets nou o avoLK16c;
apTr]ptUKO<; n6po<; OE:V O<peLt\etat Oe epu~pci e1J.lpUVt(e1Ul OUXV01epa 01l0
7uvaLKc:s arr6 6n 019us ayopes (;uvaiKe<;/av6pes=2:1 ). ~uxva ouvurrapxet 11
1J.eOOKOLt\taKri TILKOL VWVia, 01VWOfl tllS TIV U1J.OVLKrl KQL 01VWO!l 10U to-3llOU
1llS aopTf]S.
A. XapaKTnpwnKci Kat na~o<puOLoAoxia. ~1o J15puo o aprflpLaK6<; rr6pos
\OO<pa;\i(el Tr]V poi] 10U UlllU10S QTIO 1r]V TIVE:UllOVLKri KUK;\OlpOpia npo<; !!lY
aop-tri. ~TQ tpUOLOt\0/LKU V0/Vcl 0 apt!lPLUKOS n6po<; OU{Kt\eietQL UUt011UTU TOV
rrpw-co llrlYU rns Cwris. H OOUVUI.llU ou;KAeLO!lS exc:t ws an:o1A01JQ Tr]
OJlj.HOUP/iu 6ta<pU)'rlS aillatos arr6 tr]V aoprf) n:poc; TrJV aptOl:epri nveUI..IOVtKri
ap1r]pia, ouvri&wc; KOVTU OH]V eK<pUOfl Tfl) apLOTE:PriS UTIOKAtoiou apU]pia<;.
Ene.tori n rrieofl on]v rrveUl.J.OVLKri. apT!lpia c:Lvat xa11nAotc:pn an6 KetYfl 11lS
UOPl:fl) 1000 ~-.a-cci Tr]V OUOToAn 000 KQL KQTcl 1r]V OtaoroAri. n POrl Ul11UTOS an:o
TflY QOI)Tr] TIPOS TJlV TJ:VUll0YtKri ap1fljJLU. LVULOUYXriS. OITWS KQL OTt)
ap1f1pto<p,\eB(iJoe.ts c:nlKOLvwvie.c;. Touto exc:t we; ano1et\eolla a<p' e.v6s 11ev TflV
uu~flOfl 1ou 11flXUVLKou E:p;ou 1f1S apLOtepris Kot,\Las a<p' c:TE:pou oe. 1f1V q.t(pcivton

7
tOLXWI1UTLK(llV at\AOL(00WV Ota ITVU110VLKU aptr]ptot\ta Kat H)V avaritU(fl
11VUI10VlKfl~ urrepiUOflS. H 11<PUVlOfl tr)S tAUtaiac; OUVOOUTal arro
U11<PiOpOI1fl OLU<PU/ri (arro U)V aoptri rrpoc; trjV TIVU110VLKri apiflpLU KUL
avnotpo<pwc;) ri avaorpocpri (arro TflV TIVU110YtKri aptflpia rrpoc; tflV aoptri) TflS
ota<pU/riS (ouvopo11o Eisenmenger).
B. KAtYLKa euprj!lata. Ot ao~eveic; xwpic; KapotaKr] averrapKeta ri rrvUI10VLKri
uneptaor) LVat aOU11TIH011UtLKOi. To 11/~0<; tr]<; KapOLei<; civaL Cj)UOLOAO/LKO ri
eAacppa au{ru.tevo Kat fl KapOtaKri WOfl i vat unep6u\lalltKri. To eupoc; tou
O<PU/I10U eivat au{fl!levo Kat 11 OtaotoAtKri rrieo11 xa11f1Ari. xapaKtrJpLOTLK6
UKpOaOTLKO UPf111U anote,\i tO OUVX<; (ouotot\ootaotOALKO) "ev l0L
ati10I1f10avr]c;" <P uorwa. to orroio aKOU/tat oto 6 e utepo aptotep6 11eoorrt\e up to
6taotfl11U Katw arr6 tflv KAeioa. 2tovc; ao-&evLs 11 nveu11ovtKri urreptaofl fl
otaoto,\tKri ou\ILOttiloa tou cpuori11atoc; e{a<paviCetat, evw fl ouot6,\tKri Bpaxu\lcTat
Kat arroK Ta xapaKTflPLOtLKU <puori11ato<; CW~flOflS.
r. Ep)'aOtOpLaKa UQQI1Uta. To r)AKtpOKap6LO/PU<Pfll1~. Q\IUAO/a 11 tO 11/~0<;
. Tfl<; OLa<pu)ric;, lYaL <pUOLOt\0/LKO ri OlX\IL UTIpTpO<pLa tfl<; aptotepri<; KOLAia<;.
2tr)V UKTLYO/pa<pia ~wpaKa TO 11/-&0c; 1fl) KapOLU) LVat <PUOLOAO/LKO rj !liTOpei
., va urrci.pxet 6tataOfl1fl<; apwtepr]c; KOLALas. tou aptotepou K6,\rrou, Tfl) aoprris ri
Tfl<; TTY U110VLKri<; apTflpta<;.
To flXOKap6LO/PU<Pfllla XPflOL11Ut /La tfl\1 KtillflOfl tfl<; AettOUP/LKOTfltac; tou
apwtepou KOA nou Kat tfl<; aptotepris KOLAias, evw o Kap6taK6c; Ka~tflptao1J.6<;
/La tov unoAo/LOI16 tou 11/e&ous TflS bta<pu/riS. tns napoxris otflY nveuiJ.O\ItKri
KUL TflV OUOTfli1UtLKri KUKAO<popia KUL toJV TILEOWV KUL tWY U\ITLOtUOWY Otfl\1
TI\IUIJ.OYLKri KUKAo<popia. .
1.1. ITp61vwoo Kat ~epaneia. Ot 11/aAes 6ta<pu{e<; ouvooeuovtaL an6 UGJflAri
&\lfltOTfltU OtpLAOI1\Ifl 0 KapOLaKrj UYTIUPKta Kata tr'IY Y0/YLKri ri tflV
0pe<ptKri flALKLa . Ot llLKp6tepec; bta<pu{e<; av Kat owopcq.touv eni oetpa erwv
aOUIJ.TttWIJ.atLKec;, IJ.TIOpeL va npoKaAeoouv KapotaKri a'YenapKeta, Am11w6n
VOOKapOL uoa rj VOaptflpi uoa Kat 0 OpLOIJ.EV) 11PL TitWOL) TIYUI10VLKri
uneptaon. H 1J.<pUVLOfl TflS 1:Autaia<; xapaKtflpl(1:aL aT[6 Q\IQOtpocpri 1flS
ota<pu/ris (ota<pu/ri arr6 oe{ta npoc; ta aptotepa) Kat TflY 1J.<pavtofl Kuavwor)S. n
on:oia eivat evtov6tpf1 ota Kci.tw aKpa Kat t.6Lws o1a OaKtut\a twv no6twv
(ouvopOIJ.O Eisenmenger). 2to ota6LO touto o ao&evr]c; eivat aV/XE:Lprrros.
2U{KALOf1 tOU apujptaKOU rr6pou rrpeTTL va /l VL 0 6Aec; nc; TIpl TI1WOL<; 11
ota<PU/ri an:6 apwtepa npos ta 6e~La eln: ).1 xetpoupjtKri ano,\Lvwofl ei-re IJ. tfl
XPflOLIJ.OTIOLflOfl l.OLKWY OUOKUWY (OI1Tip.t\ec; ri OTItpU1J.Uta), OL orroiec;
LOQ)'OYtaL 11 oornous Ka&etripec;. Onws n:poava<pep~flK f1 OU{KALOfl10U
apTflPLUKOU rropou QY1YOeLKVU1UL 0 ao&eveic; 11 ouvopOIJ.O Eisensmenger.

8
MeooKOLAtaKri E.TILKmvwvia

EL vat q ouxv6H.pfl ou;;ev~ s KapoLOnci&ew. 4>uofl~a evOE.tKTLK6 ~eooKot,\taK~S


entJ<'C:nvwvias uveupioKnaL 010 3% nov veo;vcov. YnoAo;LCelaL 6n 10 50% nov
ao&evwv IJE. OU)')'E.Y~ KapOLOn:ci&E:La exouv ~E.CJOKOLt\LaK~ TILKOLYWVia E.lT ~OYfl
(25%) eLH: OUYOUa(6~Vfl J..LE. cit\t\E.I) KapOLOU)'jE:LaKel) UYW)JU1\L1) (25%). ~US
TE:t\E.UTUL1) TIE.pLt\a~BcivovTaL fl ~00KOATILK~ cll:LKOLYWVLa, fl avencipKE.LU 1111)
aopT~I), 0 UYOLKTO<; apU]plUKOS TIOpOI), fl 01eVWOfl1n<; TIYE:UIJOYLK~I), fl OTf:VWOr]
1ou w&~ou TflS aopT~S KaL fl. ~eTa&eofl 1wv IJE./eu\wv a1;eiwv. H na&flOil
1JlpUVL(E.TUL IJE: Tr]Y lOLa OUXV01fl1U KUL o1a OUO tput\a KUL OE.V <paLV1aL va
OX1l(E.TUL IJ tOY apt&llO 1WY TIPOflfTl&LOWY KU~OE:WV, 1flV flALKlU 1WY jOVf:WY,
1flY TIOX~ tOU f:l:OUI), 1flY &Y01\0jlK~ npof:t\E.UOfl KUL l:flY KOLYWY,LK~
0La01P WIJcl1WOI"].
A. XapaKTOptonKci KUL na&o<puotot\o)'ia. Me Bciofl 1flY aYal:OIJLK~ Yt6mof]
6taKpLYOYTat OL e\~s TUTIOL 1JOOKOLAtaKf]<; entKOLYWYLas:
1. DcptJicJllfpavuJOt;s: EiYaL f1 ouxY6TE.pfl (80% TWY nept rnwoewY) Kat evToni(E.TaL
TILOW an6 10Y eow &flt\OL0rl J..LU 1fl<; 1pt;Awxtvas BaABLoas. 0 11\U1ULOS 0
OPLOIJ.YE.S TI:E.pLTI.1WOE.LS TI.WIJU1t(E.L 10 f:Meq. qJ.a KaL OUIJ\)aME.L 01f1V a.U10\1U1fl
ou;KAcLO~ 1ou.
2. Yrrcj)aApoAorpta/<:lj. EY10TIL(1UL 010Y xwpo E.KpO~<; 1fl<; 0\LCtS KOLAia<; KCttW an6
1flY nYE.UIJOYLK~ BaABioa Kat 1flY oe\ta n1uxr1 111s aopnK~S BaABioas Kat
aYeupioKe1at 010 5-200/o1wv neptn1woewY. :luxva ouYoOeuetm an6 aYenapKeta
1flS aopnK~S Bat\Bibac;.
3. J11utnj EY1onL(e-rat OtflV llULKrlllOipa 1ou l.lOOKOLALUKOU ota<ppci;l.la1o<;,
xapaK1flpi(e-rat an6 1flY napouoia eY6<; ~ nepwoo-repwv eME.LIJ.Ilatwv Kat'
a'VeupiOKE.tUL 010 !J'.:2QJ/otW\> TIE.PLTitWCJE.WY.
H na&o<pumo,\o;tK~ OfliJUOi.a tflS llE:OOKOLALaKf]S E.TILKOLYWYi.as e\ap1a1m an:6 6uo
napci/OYtes: to 1.1.f:;e&os 1ou eAt\eiiJ11a1os KaL 1f1V oxeofl twv TIYE:UIJOVLKWY npos
us ououwanK<; avtL01aoets. MtKpa et\Aeil.ll.l.U1a enttpepouY IJE.itlt\fl avriotaOf1
OTflV pori 1.1. anoTf:,\eo~.ta 1flV avan1u\ll IJE:/ciAilS ouotoAtKriS KAior)S nieor)s
IJE.ta\u tllS aptotepns Kat tllS oe\tas KOLAias .. 1flY napaiJ.oYri 1WY rueoewY 01f1
oe\ta Kmt\ia oe tpumoAo/tl<a enLneoa Kat tflV C:IJtJ'ciYLOfl IJLKpou Ba&11ou 6ta<pu/riS
an6 ta aptoH:pa npos 1a oe\tci. A vu&etws, ta IJ.E.;aAa eMeil.ll.lUTa oev
napqmo6L(ouv tf1V ow 1ou IJ.E.OOKOLAtaKou (na<ppci;IJa-ros pon ai11atos an6 1flY
Upl01pfi npo<; tflV 0\Lci KOLAla KUL TIL1pf:TIOUY TflV \LOoppOTiflOf11WV TilEOWV
IJ.E.W\u 1WY ouo KOLAtwY. Ta IJ/ciAa e,\t\eil.ll.lUTa 1a ouvooeu61JE.Ya an6 OflJ..LUYUt-;~
au(rlCJfl -rwv nve UllOYtKwv avnotcioewv npoKaAouv a1J.<piopo1Jf1 owtpu;ri 1.1
t:TILKPU10UOU Ifl\' UTIO 0\LU npo<; 1U apl01ptl KUL OUYOOO KUCtYWOfl (OUYOpOI.lO

9
I ' ..

Eisenmenger l.
B. K\LVLKtl e.upowata. Haptc.iJVTaL an6 TO we)'e&oc; TOU E.t\,\e.iwwaroc; KUL TrlV
napouoia ~ tflV anouoia TIVE.U\lOVLK~c; un:E.ptaof1c;. OL llE./0.,\ec; 6ta<pu;E.c;
xapaKtf1pi(ovtaL an6 TflV napouoia rpaxeoc; oAoouoroAtKou <puoQ~.taToc; apw-cepa
n:apaon:pvLKii oto tpi to n. tE.tapto IJ.eoonAe.upto 6tciOTfliJ.U ouvo6e.u6we.vou an6
pm(o Ka&coc; t:niofl<; an6 weoo6taoroAtK6 tpuoflwa pone; KaL tpiTo Kap6LaK6 t6vo
ornv KoputpQ. 1nc; f.LLKp6n:pec; 6w<pu)'e<; ave.upioKovtm n:punoouotoAtKc:i ~
QOUf.LQVTOE.lOQ tpUOllf.LUTa. 2TOU<; ao&eVE.l<; f.LE. TTYE.Uf.LOYLKQ unep1UOfl KUL
avao-cpo<pQ Tfl<; OLU<flU/Q<; -co <pUOflf.LU Tfl<; f.LE.OOKOLALaKQ<; E.TILKOLvwviac;
anouOLti.(e.L, o 6e.t:ne.poc; -c6vo.c; eivm E.vrovoc;
. Kat wovQpfl<; KaL wnopE.L va unapxe.t
.

<pUOfliJ.U QVE.TTUpKE.LU<; Tfl<; TTVE.Uf.LOVLKQ<;.


r. EpYaOtDpLUKQ 6uirV(JJ(}Q. To fl\E.KTpOKap(HO/Pcl<flflf.LU IJ.TIOpei va eLYQL
n
<puoLOAO)'LKO n va OetXVE.L oc:eta, apLOTE.pQ UIJ.<flLKOLALaKQ unepl::potpia avcv\O/U
lle TO !lf:/E.~Oc; TOU E.At\E.Lf.lf.LUTO<; KQL U<; TTVeUf.LOVLKe<; QYUOtciOeL<;. H
QKtLVO/PUlj)LQ &wpaKa OE.LXVeL one; f.LE.{CrAe<; OLalj)U/E.c; OLataon Tfl<; OE.~Lac; n Tfl<;
n
apLOTE.pQ<; KOLt\iac; aw<po-cE.pwv, OLciTUOfl TOU apLOTE.pou K6Anou KaL Trj<;
TTVE.UIJ.OVLKQ<; aptflpiac; KaL QU~flOfl tfl<; aq.UITWOfl<; tWV TTVE.Uf.LOVWY. 2nc;
ITepLTitWOE.LS f.LE. ITVE.Uf.LOVLKQ unE.p-caOfl unapxe.t OLCrTUOfl TOU OteAE.xouc; tfl<;
riVeUIJ.OVLKQS aptqpiac; IJ.E. TIE.pL<pE.plKQ e.AcnTWOflTfl<; pOQ<; tWV TTVE.UIJ.OVWV.
To flXOKapOLO/PCr<flflf.LU (M-mode KaL 6w6taota-co) OUIJ.Bc:iAAet o-cov unoAO/LOf.LO nov
6taotaoe.wv Kat tnc; Ae.noup{tK6nnac; -cwv Kap6taKwv KOLA01Qtwv Ka.t otnv
aneLK6VLOfl tou c:AAe.iiJ.f.LU10<;. Me 10 flXOKapotO/pcilj)flf.LU Doppler IJ.TIOpe.i va
unoAO/L01ei to wE.1e.&os 1flS 6talj)U/QS Kat 11 nie.o11 01flV nve.ul.lOVLKQ apTflpia.
Me)'Crt\fl eLvm Kat f1 ane.tKOVLOttKQ a~ia 1flS l.lU/VfltLKQc; tOf.LO/pa<piac;. Me. rov
Kap6taK6 Ka&e.tflptaol16 ti3-etaL optonKci 11 6ta{VWOfl Kat !lTIOpe.i va unoAo;wte.i
11 avtio1ao11 OiflV nve.ullOVLKQ KUKAo<popia ..
tl. l1p6rvwao Kat &e.pane.'ta. H np6/VWOfl1WV ao&-evwv e.~ap1atat an6 6tacpopous
napci/ov-ce.c;, 6nws: a) 10 1J.E.!e&oc; tou eAAei1111a1oc;, B) 11 aut611U1fl OU/KAeLOfl
( 17-500/o -cwv ne.pt ntwoewv) napatflpOUilE.Vfl a e. f.LLKpa e.t\Ae.iwwa1a Kat ouxv61epa
ota Kopi tow an6 6tt a-ca a{6pLa Kata 10 1E.Aoc; TflS npwtfl<; 6e.Kae.-cias t!lS (wQs.
)') ll UVclTT1U~fl uno5aA~LOLKQ<; OteVWOfl<; 1flS TIVE. UllOVLKQS (6-18% 1WV
TTE.pLIT1WOe(DV), fl OTIOLU TIE.pLOpL(eL 1f1V POQ GTflV TIVE.UilOYLKri KUKAO<popia Kat O)
fl OUVUTiapefl aAt\wv KapOLa{{E.LaKWV QYWIJ.Qt\LWv. l1ptv an6 1flV E.<papwo;ri 1WV
OU/XPOVWV eTTellBaUKWV !1e&66wv &-e.pane.ia<; 10 27% 1WY ao&e.vwv ane~VflOKe
ITpLV QTTO TJlV fl\LKLQ tWV 20 E.tWV, tO 53% nptV an6 tflV fl\LKlQ 1WY 40 E.tWV Kat
10 69% rrptV ano tflV r]AtKia 1WV 60 e1WY.
H apxtKri ~c:pane.ia OtflV vc:o;vtKri !lALKia ouvio1atm 01flV xoprl/!lOfl 6aK1uAin6as
Kat 6LOupf'ln"wv. 0-cav 10 E.AAetwwa t:ivat !le/ciAo Kat 11 av1aTI6KpLOfl OTflV
ouvTflpfltLKJl ~e.pane.ia ntwxn 10 BpE.<poc; npE.TieL va unoBAfl~ei oe. Kap6taK6
Ka8-E.l:flpLaO\lO Kat xe.tpOUP/LKQ OU/Kt\E.LOflTOU eMeLIJ.IlU10<; ae. flt\LK.La 31J.f1VWY. Ta

10
KUt\l0<; U\IUppOITOU\lE.VU \lE.1pi.ou IJ.E.!.-&ou<; E.;\;\eLIJ.\lU1U OU/Kt\E.LOVtUL KUtU l:fl'v
rrpooxoALK~ q;\LKLU (ouv~-3-lll<; 0 qAtKLU 3 en0v). fLa 1a 11LKPOU ~a~\lOU
. UOU\lTI1W\lU1LKU et\AE.L\l\lU1U 0V UTIUL n:i 1UL L0LK~ -3-epanf..La napa 110\10\1
xrn.tcL()TipO<j)tJ,\aer] AO)'llJ 10U auenll~VOU .KLVOUVOU t\()q.iwoous E.VOOKapoi noa<;.
~e ;evtKE:<; /PUilllE:c; ene11BanK~ ~epaneia (xetpoup:;tK~ ou:;K,\E.LOI1 ~ ou;KAetorl
11E. E.LOLK~ OUOKE.U~) 111C) 11E.OOKOLt\LUK~S TILKOLVWVi.ac; OUVL01CHUL 61av: .
1. To dAet111-1a E.xet 11E.iat\o 11./e-3-os 11 anotet\eo11a 1f1Y 011\lUYTLK~ 6ta<pu;~
ULI1Ut0C) an6 apL01E.pU TipOc; 1a OE.{ta (TIUPOX~ 0111\1 TIVE.U110YLK~ KUKt\O<pO-
pi.a/rrapOX~ 0111\1 OU011111U1LKi] KUKAO<j)Opi.a > 2:1) KUL 111\1 f..l.l<paYLOfl
IJ.'E./aA.oKapoi.as 0111v aKu vo::ypa<j)i.a -3-LopaKa.
2. ~uvurrapxet npoooeunKci ent6etvoullE.Yf1 avencipKeta 111<; aop1i]c;.
3. Ynapxt-L010pLKO AOLI1WOOU<; E.VOOKapOL no as o<petA611E.YI1S 0111\1 napouoi.a lOU
et\A E.LIJ.Il a10<;.
Avn~v6etef1 :;ta ene11BanK~ -3-epaneia ano1e,\ei 11 napouoia nveullOVtK~S
uneptaons 11 avao1po<p~ 111<; Ota<pu/riS (ouv6po11o Eisenmenger)
; . .

KuavornKes ouJyeveis Kap6torrd~etes

Te-rpaAo{ta Fallot

A<popa 10 6.3-100/olOU ouvoAou lWV OU/{\IW\1 KapOLOna&euiJV. H Ticl~l10fl eivat


OUX\101PI1 OtOUS clVOpe<; an6 Ott GUS {UVUtKS (avat\O{ta=3:2) KUl 11 ep<pclYLOi] ~
111C) OX1L(tUL 11 XPW\lOOWIJ.LKE:S UVWIJ.Ut\i.ec; KUl K-3-E:OI1 1110 1.1111pas oe
tepa1o;6ves ouoi.ec; ( n.x. -3-at\tOOI1LOI1) OHJV apx~ lflS Ku11011S. Enio11s. ouxvci
ouvo6euet ouvopoJa o<petA611E.VU OE. 110\IO{OVLOLUK<; OtatapaxE:s 1J.1aBtBa\61.1E:Va
J.lE: 1ouc; VOJ.lOUc; nc; J.lE.YeoeAE.Lou Kt\f1pOYOJ.ltK61n-rus.
A. XapaKlOptbnKa Kat na-3-opuowt\o2'ia. H n:a~f1on xapaKtf1pi(etat an6 HJV
ouvunap{rr a) 11E./aAns IJ.OOKotAtaKr1S eTILKOtvwvias Katw an6 trl\1 aopltKri
5at\5ioa, 5) 01evwon 10U XWPOU KPOrlS lflS oeeui<; KOtt\i.as, )') aopti]S
e<pt ITTIE.UQUOac;. 10 IJ.0()KOLAlaK6 Ota<ppUfklU Kat. 0) UTIE.ptpo<pias 'Cfl<; oeetac;
KOL,\ias. H tE.1paAO/LU tOU Fallot ouxvci OU\IOOE.Uetal ana 6e~t6 aopllKO 10(0 (25%
1wv rr e pt ntwo e wv) Kat 1.1 eooKoA TitK h ent KOL vwvi. a ( 15%). Otav o uv un: ap xet 11
1et\e u1aia 11 na~11011 ovo1J.ci(e1at nev1aAo1ia tou Fallot.
H na~O<pUOLOAO(ia 01f111paAo(ia 10U Fallot eeaptalal an:6 10\1 5a~l.l0 1fl)
ano<ppael1s 10U xwpou ee66ou 111S oeeurs KOLAias. 2tous ao-3-evei.s 11E. IJ.LKPOU
Ba()11ou otvwoi1111S rrveuiJ.OVLKriS un:cipxet au~I10I11f1S por]s 1ou ai11a1os 01f1V
TIVE.UIJ.OVlKrl KUK,\O<pOpi.a \l \llKpOU ~U~IJ.OU rl KUL KU~6t\ou KUclVOJOI1 (p6( ~

11
UKUU\IlLll:lKfl Fallot), E.\IW Oe E.KE.LVOU; IJ.E. ooBap~ m:E.vwoq H\S ITYE.UIJ.OYLK~S
OLU<PU/~ ULIJ.Utor; an6 oe.(ui npor; ta apLOH.pa ouvooe.u61JE.Yfl an6 Kuavwofl.
~Tour; KUUVlLlUKOUS ao.Se.ve.is U\IUTI1UOOE.1UL e.pu&poK unapWOfl OU\100 E. UOIJE.Vfl
uno au(fl!J.E.vo Kivouvo e.;Ke<pa,\tKou e.ne.wooiou Kat /KE.<paALKOU anoot~l-lator;.
Me TflY napooo TOU XPOVOU ll otE.\IWOfl tOU XWPOU E.KpO~S HlS OE:(Lcll) KQL,\iar;
au~avet rrpoooeutLKa Kat e!J.<pavi(ovtm uno(tKE.r; Kpioe.ts. Touter;
xapaKtflpi(ovtm an6 an6tOI-lfl eiJ.lpUYLOfl ouonvmar; ouvooe.u61JeYflS an6
entoe.ivwofl Tfl<; KUcl\IWOflS. ELvm xapaKtflpLOtLK6 6n /Lava avaKou<pwtouv ot
ao~e.veir; an6 nr; Kpioe.t<; aut~; Ka~ovtat oKAao6v 6t6n ll otaofl aut~ tou
OWIJ.aTo<; TIPOKaAeL aU(flOfl 1fl<; avtiotaOfl<; 01f1V OUOTflpanKf1 KUKt\O<pOpia KUL LOS
E.K toutou c:Aanwofl tflS ota<pu;~s ai11ator; an6 ta oe.(tci npor; 1a apwnpa.
B. K,~LVLKa e.upr]wata. Kucivwofl E.IJIJ)avi(e.Tat 2-3 1-l~Ye<; 1-lt:ta TflV /E.VVflOfl KUL Otfl
ouvexew TILOE:l\IOUtaL TipOOOE:UtlKcl. H OUXVOTfltU tlOY npoava<pep~E.LOWY
Kpioe.wv, OL orroie.r; ouv~~ws E.IJ.<pavi(ovTat IJ.eta an6 ow11anK~ K6TIWOfl ~ lJ>UXLK~
E.YtUOfl KUL OUXYcl OUYOOE:UOVtUL an6 OU(KOTITLKcl eTieLOOOLU, au(UYE.L.
[1pooOeU1LK~ eTILOeLVLOOfl E.IJ.<pavi.(eL KUL tl TIPOKUAOUI.J..~\111 an6 TOY UTIOKOpE.OilO
tou aptflpLUKou ai11ato<; oe o{u{6vo noAuKunapm!J.ia. Ta npoKaAOUIJ.E.Va an6
. l:fl\1 tE.Ae.utaia OUIJ.THWIJ.U1U KUL Ofl!J.{LU E.YLOXU0\11UL an6 1fl:Y Ulj)UOU1WOfl KUL
e.(ap-rwvtaL an6 tflV flALKia. EtoL, o-ra IJ.LKpci natotci nat6u:i napatflpouvtaL
<pAe5tKe<; KUL apTflpLaKe; &pOIJ.5WOeLS, ouvf\&wr; 01flV E./KE.Ij)aAlKf\ KUKAO<popi.a,
eVW 010US E.tp~Bou <; eiJ.<pavi(OVtaL E. TIL npoo&enor; ouptKn ap~pi no a, UK llll.
Ku<pooKoAiwofl Kat unotponu:i(ouoa ouAi uoa. ~uxve s KUL ouxvci e.ntKi vouve.c; /La
tflv (w~ e.ntn,\oKes anotc:Aouv f1 Aoq.tWOf1<; e.v6oKap6i.n6a, ta e/Ke!J)aAtKa
anoot~llata KUL f1 napaoo{fl el-lBoAf\.
~tllY KALVLKTl e.(etaof1 eKt6<; an6 tflY Kucivwo11 6tanwtwvetat KUL nAflKpooaKtuAia.
~tO O<pU{LtlOLKO O<pUfi..LO Kat Oe avti~eOfl ll tf1\l UIJL/~ 01eVLOOfl tf1<;
nveUIJOYtKn<; 6ev napatf1pei.tat KUIJ.a a. ~trw ll>flAU<pflOil/iVetaL avnAnnt~
avanaAo11 napaotepvtKW<; apwte.pa o<petA61-leVfl oe une.ptpo<pi.a tf1<; oc:(ta<;
KotAi.as. 2e opto\iE.vc:<; nepLntwoeLS WllAa<patat Kat to aopuK6 otmxeio -rou
6e.utepou Kapou1Kou t6vou A61w tf1<; npoo&ias napeKt6nLOf1<; 1f1S otan:ra1J.E.Vf1<;
aopt~;. l1flY UKPOUOfl ny; Kap6uic; 6tantotwvovtaL: a) ouotoALK6 <pUOfllla
napaotepVLKW<; apLOtepci O<pLAOI-leYO Otr)V OteYWOfl tq<; TIYE.UI-lOYLKrlS KUL OXL
OtflY l-l00KOL;\LaK~ E.TILKOL vwvia KUL ~) 1-lOYnPflS OetJtepO<; KapOLaKO<; 10VO;
Ofll-lLOUP/OUIJevo<; anoKAetottKci an6 to aopnK6 otmxeio. ~e opL01Jevour;
ao~evets aKou;ovtat 6taotoAtK6 <puorwa aoptLKrJ<; ave.napKe.ias citpe.t,\6\levo ot:
cnataOfl Tfl<; aopnKri<; pi(a<; ri ouvexE.s <pUOflllU OtflY PUXfl npoepXOI-lE:\10 an6
aoptonveuiJOVtKci napanAeupa U/(eia.
r. EoYaotopta"a e.upr)ua-ra. To flAKtpoKapC)L0/Pcl<j)fll-lU xapaK1flpi(e1aL an6 Tfl\1
rrapouoia <pAc:BoKOIJBLKOU pu~IJOU, unep1po<pia<; Tfl<; oe(u:i<; KOLAlas Kat ate,\ou<; rj
n,\~pou<; ano",\eLOIJOU 1ou oe.(LOu oKeAous. Ta t:uprj!J.ata 01f1Y aKtLYO)'pa<pia

12
~ti.1paKa ei.vm xapaKn]ptOUKci. H npoKa,\ou~evr] an6 l:flV une.ptpo<pLK~ oe(LCi
KOL,\ia ~E.1Q10ITLOfl l:r]S KOPU<p~c; TflS KUpOuic; npo<; l:Q UVW OE: OUVOUUOIJ.O IJ.e 1r]V
unon,\aoHKrl TIVE.UI-lOVLKrl apn]pLa KUVOUV Tr]V Kap()la va IJ.OlaCet ~ \Ut\OnOt 1\o
( coe\Jr en sabot). Ta nveu!lOVLKci Jteoi.a ei. vat ouv~J.wc; unont\aonKa, to 11 ;e&oc;
tW\' nveui-LOVtt<wv ap1f1ptwv !lLt<p6 Kat ouxva aveupioKerat oe\t6 aopnK6 16\o.
~ro llXOKapoto)'pa<pf11-la cnaKpivovrm IJ.eraeu -rwv clt\,\wv 11 otarao11 TflS aopr~s. 11
aouvE:xe.ta ~eraeu tr]S aop-c~c; KaL tou IJ.E:OOKOLALaKou otatppa{IJ.atoc; Km 11
eqH nne uouoa to IJ.E.OOKOL,\t aK6 6tci<ppa{!la aopt~. TE.,\oc;, IJ.E: tov KapotaK6
KaJ.e1r]pLaOI-LO E.KTL!lciTQL ll avaTOIJ.lU TOU XWPOU E:(OOOU Tfl<; OE.(LUS KOLt\iac; KQL
TWV KUplWV K.\ciOWV TIJS TIVE. UJ.l.OVLK~') aptr]pi.a<;, flt\E:L toup;i.a Tr]<; apLOtE:p~<; Kat
Tr]S OE.(L"Cr<; KOL\i.a<;, ll J.E:or] KUL TO ~-tE.;eJ.O<; TOU ~E.OOKOLt\taKOU et\t\ei.~~atO<;, 11
t\E.L TOUp{lQ Tr]<; aoptLK~<; ~at\~i.Oa<; KaL ll QVQTOI-tlU TWV OTE:<paVtaLWV aptr]PLWV.
6.. Dp61'vwoo Kat J.epanda. H np6;vwo11 Twv veo;vwv ~e. oo0ap~ Kucivworj eivat
ouo~.tev~c;,\6;w Tfl<; oo0ap~c; otE.vwor]S Tf1<; nveu~-toVLK~<; KaL -cou 1-ttKpou
1-tE.!E.&our;;,,twv nveu~-tovtKWV aptf1PLWV. Liuo~-tev~c; eivat eni.o11s 11 TIPO/VWOfl
o1ous ao~evfic; IJ.E. uno\tKouc; onao11our; eav oev unoBA11J.ouv otr]V KatciAt\nAn
U/W/~. Ot\m OL ao&eveis 1-lE. tetpa,\o;ia Fallot OtatpE.xouv auemiE.vo Kivbuvo
E./K <p at\LK llJV QTIOOTr]IJ.ciTWV, TI apaOQ\WV IJ.~Ot\ WV KQL t\oq.toJOOU S E:VOOKapoi. TLOQS.
irrot\o(i.(etat 6n f1 &vf1TOtr]ta otouc; ao&eve't<; nou oev uno~cit\t\ovtat oe
XE.Lpoup/LK~ &epanela avE.pxerm oe 33% oto npw1o E.r:or; Tf1S Cw~s. 500/o to
tpi TO, 75% to oE.KaTo Kat 6u 116vo 10 5% 1wv ao&evwv unep~ai vet to tpLaKOOt6
e1os.
H OUVH1Pf11LK~ &epaTteia TtE.ptt\UIJ.~clvE.L TflV UYTLIJ.E.toJTILO!l tr]<; OU)r]pOTIE.VLU<;, Tr]S
a<puoatwor)c;, rwv &po~-t~wnKwv erunAoKwv Kat Tf1S un:e.pouptxat~-tias Kat rnv
Xll!lLOTipO<pu,\aef1/La TOY KLYOUYO ~aKtr]ptaOLUK~') E.VOOKapoi.noac;. Ot UTIO\LKE.S
KPLOL<; UVUI-lE.TWTtL(OYTUL 1-lE. tr]V tono&E.tllOfl TOU ao&evou<; OE. {OVUTOOtr]SLK~
&.Or] KUL Tf1V XOPrl/f10f11-tOP<pLYf1'), oeu{OVOU Kat OE. oo5ap.c; n:eptTITWOE.LS
avaotoAE.wv twv 5-aopevep;tKWV unoooxE.wv. ~tour; ao&eveis 1-lE. at!laroKpi1fl
nou nt\nota(et 10 70-75% anat1ei1at epuJ.pa<paipeof1.
~1a eeetOLKE.UIJ.I~.va KE.v1pa f1 &epaneia eKt\0/rlS ei.vat f1 ot\tK~ XE.LpOUP/LKrl
6t6p&wof1 ro npwro eros Tf1S Cw~s. ~xenKE.c; avtevoei(ets /La Tf1V ev ,\6/W
E.TIE!l5UOfl an:oret\o.(JY 11 w::.;;.CtA!l U[(o5a,\~LOLKri 01eYWOfl Tr]<; TIVE. U~OVLKrlS KUL 11
unorrAaoi.a HlJV TIVE.UIJ.OVLKWV apTr]ptoJV. Eav 0 ao&evns oev E.LVQL KQ1UMI1AOS
UTIOt.tJ~tpLOS )La avatOIJ.LK~ Ot6p&WOf1, unoBci.At\etaL apXLKU 0 Ilia an6 US
avaKou<ptaTu,ec; enqi0cioets 11e ns onoiec; au\averat 11 po~ ai.!laToc; o-c11v
11YE.UilOYLKf1 KUK;\o<popi.a (Waterston, Blalock Kt\n) Kat 0111 ouvE:xeta oe flt\LKia
!lE./a,\utepf1 10JV ouo etwv e.(e1ci(erat eK YE.ou to evoex6!J.evo ot\LK~c; OL6p&wof1c;.
EvaMaKnKa. av-cL avaKa<pouottK~<; en~Baor]s xeL np6o<pa-ca E:ITLXE.LPil&et
Otaotot\ri IJ.E: ~J1a,\t\6vt 10U XWPOU e(600U 1f1S 0\La<; KOLt\iac; Ka&wc; E.TILOrj<;

13
E.K 10~Hl IJ.E. 1POl10l10lf')l.lE.YO aSrlPOTOIJ.O TWY IJ.UWV 10U XWPOU E.(OOOU HlS OE.(LUS
KOL1\ta<;.

AVe UpLOK E. TUL 010 5% 10U ouv6Aou TWY OU//E.VlOY KapOLOTia3E.LlUV KUL
rrapaUlPE.L Tat ouxv6tepa ora a;6pta an6 6n 01a Kopt TOLa ( avaAo;ia=2:1 ). H
na~flOfl E.IJ.<paYL(E.tQL 1-lE. UU(f11J.E.Yfl OUXY01f11Q 1flY CtYOL~fl Kat OXE.TL(E.tUL 1-1
eK~E.Ofl OE. n:paro;6ve<; OUOLE.) (a1J<pE.1QIJlYE.<;, npo;eorep6Vf1/0LOrpo;6va,
rpL!le&a6t6vfl) Kat llf11PLK6 6ta~~tfl. ~uxva ouvunapxet IJE. avmKr6 aprflpLaK6
ITOpO, IJ.E.OOKOATILK~ ~ 1-J.E.OOKOLt\LaK~ E.TILKOLYWYLa KQL OTeYWOfl IOU LO&IJ.OU rf1<;,
aop r~c;!
A. XapaKTOQLOTLKa Kat na&otpuOLoAoyia. H aop1~ e.K<pue.rm an6 VlY oe.{ui KotAta
KQL ITOPE.UE.TaL np6<; ra E.llTIPOS Kal OE.~Lcl tr]<; TIYE.UilOYLK~S apiflpia<;, fl anoia
E.K<pueraL arro TflY aptOIE.p~ KOLt\ia. H OLara~fl aut~ EXE.L WS anore,\E.Oila tr]Y
ouvurrap~11 6uo napaM11Awv KUKAo<poptwv 6t6n fl oua:rf11J.atu<~ cpAe.BtK~
'eTILOrpOtp~ Kateu&uverat OrO OUO!f11J.a1LKO UP111PLUKO OUOrfliJU Kat 11 TTYE.UIJOYLK~
tp,\eBtK~ enwrpo<pri oro nveu1J.OYLK6 aptf1ptaK6 ouorrwa. Os eK rourou fl
ent5iwof1 tou ao&evous eivaL a6uva1f1 eav 6ev unapxu ouv6eof1 1-lE.ta~u nov
OUO KUKAOtpOpLWY (n.x. UYOLK10) ap111PLUKOS TIOpOS ~ 1-J.f:OOKOLAtaKri
E.TILKotvwvtal. Ta at!lo6uva1J.tKa eup~IJata e~aprwvrat an6 1L~ ouvunapxouoe.<;
QYWilaAiec; KUL LOtaLtE.pw<; ano 10 IJE.;e&os 111S OLatj)U/~S IJ.Ta\u TIYE.UilOVLKris KQL
ouorrwanK~S KUKAocpopias.
B. KAtvtKa eupriwata. YnepouvaiJLKri KUKAo<popla (E.vroves otpu\ets) oe veo;v6 IJ.
KUclYWOfl. EYIOYO Kat ouxva 4Jflt\Utpf110 aopnKO OIOlXE.lO 10U OUIpOU KapOLUKOU
16vou on:w~ootepvtKa, Ao;w TflS npoo~ws n:apeKt6ntof1<; tf1<; aop1~s. Ta
UKpOaOILKa E.Up~IJQ1Q \apTWV1QL QITO IflY QVtiotaOI1 OiflY l1YU!l0YLK~
KuKAo<popia Ka&ws e.niof1<; ano IflY napouoia ri rnv anouoia an6<ppa~ns o1ov
xwpo e~66ou TflS aptotepris KOLAias ri IJE.OOKOLALaKris TILKOL vwvias. EtOL, 0
noAAous ao&evE."L<; oev QKOU/C:.1QL <puom.J.a, evw ae OpLOil~VOUS OLQTIL01WVE.tUL
rinto 1J.eooouoroAtK6 cpuorwa e~w&nofl<;, rixos e~w~I10flS n:poepx61-1evos ei te an6
!flY aoprrj E.t H: an6 111V TIYE.UIJ.OYLK~ ap111pia ~ tj)UOfliJ.U IJ.f:OOKOLAtaKf!S
E.TilKOlVWVLQ<).
r. EpYaOIOQLaKU euQrJ!lata. Ta f1t\eK1POKap6to;patpLKU eupriiJUTQ TIOLKiAouv.
2uvrj~ws napatflpeirat un:eptpotpia rou 6e~Lou K6Anou, uneptpotpia tr]<; oe~ta<;
KOLMas KQL OE.(La an6KALOq 10U a(ova. hflV aKnvo;palj.lia &wpaKa unapxet
rcveu!lOYtKll rc,\flSwpa, o a;;etaK6c; 1-J.ioxoc; eivat eivm Aentoc; Kat fl Kapoui E.xet
axr]wa "au;ou"'. ~to flXOKap6w;pa<pf11Ja 6wnw1wverat ll npoo&ta evt6n:tofl tf1<;
aopTfl) KQL fl OTUO~ia E.VTOITLOI1111S TJ:VE.UIJOVLK~S apTflpia<; Ka&w<; E.TILOfl) OL
ouvurrapxouae<; QVWilUi\ies, OTIW<; 11 llE.OOKOi\l1LKrJ Kat fl IJ.E.OOKOlAtaKri

14
t:TlLKOL'v'lllVLQ, ll ano(ppael1 OtOY xwpo eeooou 111S apLOtep~; KOLALa<;, 0 aYOLKTOS
a~:nqpLaKOS rropos KaL Ol UYWIJ.Ut\Le; 1WY KOt\TIOKOLt\LaKWV Ba,\BLOWV. Me TOY
KapowK6 Ka&e.-cnpwo~-t6 6tantotwvetaL 11 tpuoLO,\o;LKri oxE:on1wv K6t\nwv Kat
twy ~.QLt\LlOV (o apLOtepO<; KOATIOS OUVOE:etaL IJ.E: TflV apL01epfi KOLt\ia KUL 0 oeeLOS
KOAnos IJ.E: Tfl Oe(La KQL;\ia) KQL on IJ.E: T11Y E:;xuol1 OKLE.pa<; ouoias OTI1V oe~La
KOL\La UTIE:LKOVL(eTaL Jl UOPTrl.
6... Tip6--rvwoo Kill &epaneia. Xwpis ene~-tBanKri -&e.paneia TO 50% nov ao-&evwv
ano&vrioKE.L TOY npwTo 11riva Kat To 90% To npwTo E:tos TI1S Cwris. T11v Kat\utEP11
TIPO/VWOfl E:l1<j)UYt(OUV Ol ao&eYE:LS 11 IJ.e/Ctt\11 1J.00KOLt\LaKrl ITLKOLYWYLU KUL
o-rE:vwo11 ti1S nveullOVLKflS, o ~-tE:oos.opos,Cwris Twv onoiwv avE:pxetat oe 5 E.tfl.
Ta ouvn&E:otepa aina &avaTOU E.LYQL 11 KapotaKri avenapKLa, ta /KE:<tJUALKQ
ene.woo[a Kat 11 ,\OLI1WOI1S eVOOKap6in6a.
To npuno Bri11a 0111 &epaneunKri avn~J.eHtlTILOI1 Twv veo1vwv 1-le 11.eta&e.o11 eivat ri
aue11011 TOU TOU KOP01-J.OU TOU aptl1pLaKOU ULIJ.UTO<; 0 o(u;ovo. Touto
enL 1u;xavetat IJ.E. 111v e.v6o<t>AE: Bw xopri/11011 npoota;t\a'J6i v11s E1, 11 onoia
OLUT11Pei aymKTO tov apTI1PtaK6 n6po Kat lle 111v eKt6,\eOfl KOATILKriS
ow(ppa;llatooto~-tias 11e ~-tnat\t\6vt (e.nE.!lBaon Rashkind) ri IJ.e ~-taxatpi6Lo IJ.E. HlY
onoia 0111-I.LOUP/E.LTQL IJ.E.OOKOATILKrl TILKOL\JWYLQ won: va unapxeL Kanota
ouvoeo11 1-leta(u TrlS nve.ui10VLKris Kat TrlS ouonwanKriS KUK,\o<popias.
H xetpoup(tKri 6t6p&wo11 tr]S j..leta&eons twv j.J.e)at\wv a1;eiwv E.xeL ws ot6xo TrJV
UTIOKUTCtOTUOfl Tr]S OUVE:XeLa<; TflS TIVE.Uj.J.O\JLKi]S Kat 111S OUOTflllUllKrlS
KuKt\o<popias. To(n:o e.nt tU/XUVE.TaL ei te. 11e Kot\nLKri a\JaotpolJ'ri ( E./XE.tprioe.ts
Mustard KUL Senning) ei te IJ.e aptr]ptaKri avaotpocpri. H tel\ e. utaia anoteAei
ori~-tepa tnv &epane.iae.KAO/rlS KaL ouviotataL oe E.)Kapata cnatOI-lri UJS aopt~S
KUL 111S TIVeUIJ.O\JLKi]S aptflpia<;, eK10llrl HOY OtOj.J.LON TWV OTE.!pa\JLULUN aptflPLWV
j.J.e IJ.LKPO 11-lrll-lU 10U napaKelj.leVOU aoptLKOU 10LXWIJ.UTO<;, j.lta<popa U]S UO{.HrlS
Kcitw ana tov 6txao116 tr]S nve.uj.lOVLKriS ap-cnpias, avaot61J.WOf1 -cou e//US
KO/\oiJWIJ.U10; 111S TIVeUIJ.OYLKrlS aptrlPLU<; !J.e TflV aoptri, !J.E.Tacpopa 1WV
OTelj)UYtaLWY aptrlPU.iJY Otr]Y TI\JE.U!J.OYLKri aptr]pta KQL ava0101J.WOr] 111S
TI\JE:UllO\JLKrlS ap-cr]pias !J.e to e(/US aopnK6 Kot\61Jw11a.

15

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2. BAJ\BILiOTIA0EIE2

E1-1<Pavi~crm 2-3 c:06o1JaOE:S ~.teta an6 ,\otiJW~fl tou avtine.pou avarrvc:uonKou


duot~~atos IJe B-o.L~OitUTLK6,ptpe~n6KOKKO l:r]S OIJUOac; A. Eu-&-uvc:taL /LO. to 2540%
tc.ov Kapotoarf'eLUKwv voorwcnc.ov otov tpi to KOOJlO, oe opw~.teve.s n:e.pLOxes tou
on:oiou co e.n:t n:o,\aol-!6<; tf]S v6oou oc: rrmota nALKLas 5-16 c:nov avepxc:tat oc: 3%o
ne.pi.rrou. ~tov t1u1LK6 KOOJlO napatrw~&flKe ns teAeutaLe.s OE.Kael:Lc:s 1-1La
6pa~JanKri e.Aanwon l:flS ouxv6tr]tas -rns v6oou, ll onoia ~E:Kivno:c: n:pLv an:6 tnv
eupc:ia xp~on1:c.ov avuBwnKwv /La trlY aVUIJE:Ttimtof1 tllS otpe.ntoKoKKLKriS
a
<j)ap u;;i uoac; KO.L an:o66~r]K UPXLK OUJV BeATLW<Jr] '[(.l)Y OUY~r]KWV otaBlWOflS KO.L
Uf'LE.Lvris. H op&cnrna tf1S epJlr]Veias autris a~.t<pLOBf11Tl~flKe n:p6o<patci, IJE. a<pop1Jri
trw eeapOf1 TrJS vooou 0 OXetlKcl eun:ope<; TIE.PlOXES 1WV HITA. En:LOr)llLOAO/LKe<;
IJE.A1<; arreOeL~av 6tL ll n:poava<pc:p~doa eeapOfl O<j)eiAeto Otr)V !-(<j)UVLOJl vewv
peu1Jato(6vwv o-ce,\exwv tou B-aq.toAunKou otpen:toK6KKOu 1:r1s Ollcioas A.
A. At norro.&oJevc:w. 0 1-lflXUVLOIJOS !1 tov on:oiov ta pe.u~.tato;6va o1e.Aexn tou
ULIJOt\UtLKOU 01Tt10KOKKOU 1fl<; OIJUOUS A npoKaAouv pUIJU1LKO n:Up1:6 oev exeL
an:oOU<j)flVLOtel n:A~pws. H eTILKpatouoa OriJlepa an:Otj.Hl &ewpeL 6n n v6oos
O<j)eiAetal 0 UUl:OUVOOOUS IJ.!lXUYlOIJ.OUS, Vep(OTtOLOUIJVOUS arr6 TflY OllOL01f110.
opLOJ.lVWV avn ;6vc.ov 10U ULJ.lOt\ UtLKOU OtpTI10KOKKOU 111S O!J,UOUS A IJ. avJ:L /OVa
twv t>La<p6pwv wtwv l:OU av{}pwnLvou Oc.iJ!latoc; (molecular mimicry-=1-lOPLUKOS
JlLilt tLOJlOS ). Ta rrpoava<pep~ev-ca evtoxuovtal an6 TflV rrapouoLa
KapcnoavnopaottKwv avuow.~-tcrrwv otov op6 twv naox6vtwv, otpe<j)oJ.ltvwv t6oo
VUVtiov KapOlUKWY UV1L/OVOJV 6oo KUL aV1LjOVWV tOU aq..lOAUtlKOU 01PeTI10KOKKOU
1:1']<; OIJUOUS A.
B. rra~oAo)'tKO UVU10\lLK0. 0 pUJ.lU1lKO<; n:up.101) xapaKU)pi.(etat ano l:JlV
n:apouoi.a eet0POJ!1U1LKWV Kat un:epnAaottKWV q>AE./JlOVUJOWV a.Ai\otwoe.wv TOU 1
ouvoe.-ctKou totou. l:IJS Kapotas. nov ap~pwoewv, twv aq.J.o<p6pwv Uf'/etwv Kat 1:ou
unoo6pLOU LOTOU. XapaK'(rlPL01lKri ei vaL 11. 1J.q>QVLOf1 010 IJUOKUPOLO 1WV O(toir..ov 10U
Aschoff, nou l\lo.L rrepLU//'LaKS <pA/IlOVWOL<; Kat VeKPWtLK.<; 01LS.
~-ca KapowKci eupri!-lata n:eptAa~-tBavov.-cat 11 n:eptKapoiuoa. n llUOKapoitt6a Kat 11 j
E.YOOKapOL no a 1-..UL ll BaABtoi. uoa. H teA urai.a xapaKTJlpi.(el:Ul ota UPXLKQ O"CUOta
an6 o'ton~.ta Kat "unaptKri btri~nonrwv 1Awxivwv Kat o-cnv c:naKoAouiiouoa <paon
rns enoui\wons arro naxuvol']-cwv 1Awx'tvwv, m orroie.s ouvevouvtat ous oxw~.tE.s I
Ka~ws e. n:ions u rro 5paxuvon .twv .-cevovtiwv xopowv. To anoTAeo~-ta el vat n 11
np6KA!lon BaABtOtKriS o1E.vwons. ri aven:apKc:ws avciAo.}'a I.J.e to eioos WJY
rrpoe(apxouowv at\Amwoewv.
I
1

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, I
r.6.Lci"YVCUOO. H C)LUjVlLlOtl tOU pE:UIJ.UUKOU TIUp10U E:LVUL KUPLW<; Kt\LVL"-fl Kat
;LvetaL IJ.C: 00.o11 ta KpLt~pLa tou Janes. n:ou 6wLpouvtm oc: IJ.E:i(ova KaL e.\ciooova
(Tii.vaKa~ 1 ).

Tii. vaKa<; 1 . Kpn~pLa Janes (ava~ewpflOl 1992)

Mei.Cova
-Kap6i no a
- IToA uap~pt noa
-Xopc:ia
-6.aKtUALOE:LO<; epu~nlla
- Yno66pL-a oCiow
EAri.ooova
-KAL VLKci c: up~IJ.ata
Ap~paA /La
Ilupe:16s
-EpjaOtf1pLaKU c:upri1J.a1a
Aue11of1 TKE
Auer,or, c-avnopwons npw1c:ivns
ITapci1aon 0La01riiJ.a1o<; PR OtO nAeKtPOKapOLOjpcl<j)f11-la
Evodee:ts n:porr;n-&eioas Aoi.11wtns an:o arpe:n:roKoKKo IllS Ollrioas A
-6etLKri KaAAtepjeLa <papU')'')'LKOU TILXPlOIJ.a10<; ri 3-enKri 10Xeia OtpeTitOKOKKLKri
avn /OVLKri OOKLIJ.aoia
-A uer,oll 1L tAwv avnotpeTHOKOKKLKWY avnOWI..lcltWV.

H Tlt19avdr177:a pcupaa~<:otJ TIUpcrou clvat Jlc7tiA!J drav ouvuTidpxouv c5tJo pci(ova


;j tva pci(ov ~<.at c5tJo cAdooova ~-.pt 7:!/pta (J'c a(J'l9cvci~ Jic cuptjpara OUV!J}'OpotJvra
u!lep llPOIJ71Jl9doqr Aoipa;(!Jf aTio atpoA ua~<:o (J'7:pcllroKo/l.a
M ei. (ova KpLrri p La. H Kapolac5ae1J.<pavi(e:tat m:o 40-5QJ/o 1wv ao~evwv. a<popci
tO E:TILKcipoto, 10 IJ.UOKUpOLO,. Kat 10 E:VOOKUPOLO KaL-aVajVWpi(e1aL an6 tr']Y
n:apouoia oAoouo1oALKOU <p uori1J.a1oc; aven:apK eiac; 1f1S IJ.L tpoe:toouc;,
1J.000LUOtOALKOU <puOril-lUl:OS paris TIOU jlVE:TaL avuArrrct6 0111V Kopu<pri TflS KapOLei)
( <puorwa Carey-caambs) ri neptKap6taKOU rixou 1PL5ris. Mnopei enLOflS va
rtapatrlPil~ouv Kapoi:OIJ. 1aAia KaL nv e UIJ.OVLKri OUI..l<p6prwf1. H ouvfl~otepf1 BAO.Bfl
01tlY oeeLU <pUOfl Tf1) v6oou eiYaL fl avencipKLa Tfl<; IJ.Ll:POE:lOOU) 5aABioa<;, E:YW
ave:napKeta Tfl) aopnKriS BaA5i6ac; oev napa1flPL1aL ouxvci. Ot BaABLOLKS
o1e:vwoe:tc; oL npoKaAou1J.eves an6 1ov peu1J.aUK6 nupe16 e1J.<paviCov1at xp6vw 1-lC:ta
an6 TflV oeeia <pUOfl l:fl) YOOOU.
H ll0-1 uap~9pt acSaeiJ.<pavi(e taL 010 75% twv ao~evwv, ei vaL 1-1emvao1e unKou
-cunou KaL a<popci nc; IJ./ciAc:c; ap~pwoe:tc;. Ynoxwpei xwpi<; va a<privet uovtiJ.E:)

2
aM OL llXJ e L') .
To c'iaAru.,.ftoctt'ier; e,out9q,uat:wpavt(cwL 1-J.c 1-lOPtflfl poooxpowv Kflt\i.owv o1ov
Kop~6 ~tKpou apL~~ou ao::Je.vwv ( < 1CJl/a).
Ta unpqo,ota o(i6taano-cet\ouv onci.vto E.UPfllla (<5% nuv ao/Jc:vwv), c:ivm
t:UKLVr)W, UVWOUVQ KUL eV10T1L(OVl:UL OTLO E.Kl:UTLt-.:E.<; E.ITLtpUVE.LE.) tWV a)'KWYWV, HLlV
KUPITlLlV, 1WV OtpUpWV, Ol:OV AXLME.LO 1E.VOV1U Kat OH') UKUV~WOE.L') anOtpUOE.L<; l:r)S
onovouALKhS 01fl,\fl<;.
H xopc:ta -cou Sydenham oe.v etva.L ouxv6 euprwa (<15% rwv ao~evwv).
XapaKl:flpi.(E.l:UL an6 ouvmo.SrwanKri aoni~E.La, 1-J.ULKrl aouva~J.i.a Kat -caxc:te.<;
aoUVJOVLOl:'e), a~OUOLE.<; Kat OOKOITE.<; KLYrlOE.L<;.
EA d.ooov a . KPL 1~ PL a. 0vO~J.a(ov-cdt "COL OLOH Ol:E.pOU\Il:aL E.LOLKOl:fll:U<; KUL W) E:K
e
-cou-rou avc:,uptoKov-cat oe noMa voori~ata. ~e auta n:eptt\a)..l~civovtm ot
ap~pa\;te<;, 0 rcupet6<;, fl au~IJOfl Tfl<; TKE, fl au~rjOrj tr)<; c-a\ITLOpwoas rrpWl:eLVrj<;
KUL 11 rrapa-caofl rou 6wotriJ..latos PR 01::0 fl,\E.KtpoKap6to(pci<Pfll.l.a.
Eup~~a1a npornfl~eLOflS o-cpen:-coKOKKLK~<; .\oL~W~fl<;. I1e.ptAa~5avouv:
LOtOpLKO 001paKui<;, ~E.HKri Kat\f.LE.p[E.LU !papU[)'LKOU E.TLLXPlOIJ.U10S KUL a\IE.UpE.Ofl
UqJfl.\Ou Tl tAou avnotpe THOKOK KLKW\1 aYILOWJ.lCltW\1 ( U\ITLO:CpE. ntot\ UOL \lflS 0,
avn6eo~upt0ovouKAeciofl<; B Kat avnuaAoupovt6cwrv;).
0.. ITp6"YVwon. H ~VfltOl:flta ev6<; o~E.os c:n:ewo6iou pc:u)..laiLKou rrupetou avE.pxetaL
oE. 1-2%. H n:p6;vwofl tfl<; em~E:vouoa<; Kap6i.n6as. xapaKTflpL(6~E.Vfl<; an6
KapOLOIJ.E.jai\La, KUPOLaKri aven:cipKE.LU KUL l1E:PLKap6i noa E.i.VaL ntwxri ~E.
ano-cE:t\eOJ.lU 10 30% rwv TIULOLWY va arro::JvrioKE.L tflv OKae1La nou aKoAou/JE.L TO
apXLK6 enc:ta66LO. H ru.Sav6Tflta E.IJ.!J>clYLOfl<; OP/UVLKri<; Ka.p6LOn0.13-c:ta<; Ifl OE.Kae.tia
rrou aKoAou.Sei E.va err ewobw o~E.os pe UIJ.UHKou n:upe tou, e~apTO.IaL an6 l:fl\1
E:K-caofl Kat tflv Bapul:flta 111s Kapoi -rt6as KaHi: 1fl 6tapKew Tfl<; o~eia<; <paans Tfl<;
v6oou. Erm, OP/UYLKri Kap6LOna::JeLa E.J.l!J)avi.(E.l:at o-ro 6% TWV ao/JevciJv nou 6ev
rcpooMri&JlKUV UTIO KapOi. TLOU, 010 30% TWV ao&evciJv TIOU E.IJ.tpcl\ILOUV OU010AtKO
<PUOJlJ..lU O"'Cfl\1 KOPU<Pri 111<; Kqp6tci<;, 010 4-(Jl/a 1wv ao..S.evwv rwu E.J.l<pcivtoav 6tao-roAtK6
<puorwa OTfl ~O.ofl Tfl<; Kap6ta<; Kat o-ro68% rwv aa&evwv IJ.E. KapotaKri ave ncipKeta
Ol:r)\1 o(eia !j)clOfl 1r)S \IOOOU.
E. Gepaneia. H !lf}oHorral9tjr;- rr,ooAilf/JI) 6nt\a6r1 f1 ano!J)U/rl <XE.wv eneLoooi.wv
pE.UIJ.UTLKou n:upe.tou oe ao&e.vei<; ot onoim ou6TIOTE: E.~!J>aVLOav nap61!ota
E.TIE.LOOOLU 010 TiapE.t\.iJ6v, OUYl01a1UL 01!lY al101e,\e01J.UUK~ a\11LIJ.E.1UJTILOC') tWV
o1pe n:toKOKKLKwv _Aoq.J.w~ewv tou avwtepou avanve uonKou auo1~~a1os. H avw1pw
e.nvru:xavetaL ~E. tfl XOP~/flOJl 5ev(uAonevLKLt\,\i. Vfl<; Bev(a&i VflS 1.200.000 IU e<p'
v
arrac E.VOO)..lUlK(IJS r1 ITeVLKtAAL\IflS .1.000.000 IU ava ecO.wpo PO /La 6E:Ka f)IJ,E.pes fl
oe nepirn:won aAAe.p;Las ou1v nc:vtKtAAivfl JlE. 111 oe.Kari!J.E.Pfl xoprnnon
epu&pOIJ.UKLYfl<; l250 mg ava e~awpo PO).
H avnpem;motJ evdf o(do) cflctooocou peuparo.:ou!!uperource.ptt\ai..J.0avet tov
KAtvooTaHaJ.lO. UJV xop~;nofl ev-repo6taA ut~s aontpL \IllS otous aa/Jevets ~E:
ap&pt no a ri I(UpOl noa ( 100 mgjkg/24wpo PO 0 6 000LS) Ka/Jws E.TILOr]) 1flV
xopri;nofl E:vtc:poota,\ u-rr1s aontpi Vfl<; oe ouv6uao~J-6 ~e. KopnKootepopt6ri ( n.x.

3
J:. ,,, ..-.~~---~'-- ._.;;,- --.:--~------

~c: ~'1-u.\ 11 pE:OvL(or\ovl1 3248 mg/24cupo PO oe. b uo 66oeL~) on~ rrc:punwoc:v; WE.
E l1LO (L YOU~ E.V fl K a pOL UOaxap aK 1fl pL(O~ E: V11 a TIO WE: jar\ OK a poi a K aL KapOL UK~
averrapKna. H xopeta 1ou Sydenham ewtpavi(E.L &enK~ av1an:6KpLOI1 OTfl XOP~/11011
6w(e rrci~11~ -~ a\onept66r\fl~-
H c5cuz-eporrac9!J) rrpoAt/(/lfJ, 11 arco<j)u;ri 011,\abri E:VO~ VE.OU oeeo~ E.TIL006Lou
pe:u~anKou nupe:wu oc: ao&c:ve:i~ rcou exouv q.ttpavioc:t eva~ nc:pwoore.pa
rcap6~ma c:rcc:too6ta 010 rcaper\&ov, ouviora-cat 0111 XOPri/11011 Be.v(uAonE:YLKt,\Ai\1111)
Bev(a&ivl1c; (1.200.000 IU etp' circa( c:voo~ULKW<; Ka&e: 4 eBOOIJ.a6c:c;) ri oe: rre.pirc1wo11
a~\,\t:p;iac; 0111Y ITE.VLKLAr\iVr] ~e 111 XOPri/11011 epu&po~UKLVI11) (250 mg ava E:(cicopo
PO). H OLclPKE.La Ifll) OeU1E.pona&ou~ rcp6AI1cvnc; E:(ap-carat arro 111Y qr\LKLa TOU
ao&e:vouc;, 111v rrapouoia ri 6xt pe:u~anKric; Kap6LOrca&e:wc:; Kat Tov Kivouvo
e~<pcivw11c; orpc:rc10KOKKLKri<; r\oiww\11<; rou avune:pou avan:veuo"nKou. Ot ao&c:vc:ic;
rcou oe.v exouv peuwanK~ KapOLOrra&eLa rcpercet va un:oBaAAov-cm o-co
rrpoava<pep&ev OXfllla IJ.E.XPL TO 180 e-eoc; 111<; 11ALKia<; TOU<; KaL E:TIL ~La 10UAaXL010Y
TieY1QE:TLa ano 10 apxLKO E:TIE:LOOOLO. ITapci1aOI1 111~ 0E:U1epona&ouc; rcp6r\flcpr]<;
evoc:iKvu-caL oc: ao&c:ve:ic; IJ.E: pe:uwanK~ Kapotorra&e:ta ri e:_KE:ivouc; nou ow-cpE:xouv
aue11~evo Kivbuvo o-cpe:rr-coKOKKtKri~ Aoiwwenc; -cou a"VWTep6u a\larcve:uonKou
OUO"Tfl1J.a10<; ( oaoKa,\OL, 01p a HWTLKOL, U/ELOYOWLKOi Kr\ rc ).
I

re:vtKci TIEPL BaAI:hoona&e:u.Ov II'

111
I
Ot na&rioe:t<; 1wv KapotaKWV BaABibw"V xwpi(ov-cm oe: buo IJ.e;ciAec; Ka1n;opie:s, on~
oz-evwoets-KaL n~ averrdp~..-aet:; Ot npw-ce:c; xapaK1r]pi(ov1at arro e:Acinwo11 111c; ij
eTILtpave:La<; 1ou BaABtbLKou o-cowiou, ;e;ov6c; rrou e:wrrooi(et -cnv owaAri pori Tou
ai~.wToc; arr6 1ouc:; K6Anou~ 01LS KOLr\ie:c; KaTa -en btapKeta HJ<; 6wo-coAric; (o1vwo11
~t-cpoeLbouc; ri -cpqAwxtvac:;) ri arr6 nc; KotAie:~ o1:a lic:;aAa a)';eia Ka-ca 111 6tcipKeta
I
1fl<; OU010Aric; (o1eVWOr] aop1ric; ri TIVE:UIJ.OVLKric;). Ot OeU1epec; xapaK1r]pi(OYTUL ana I
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otov apL01ep6 K6Ano, f'l orroia unep0aivc:t til 6wotoAtKri n:ieor) TJlS apLOtE.pris Kot-
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5
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PU~J-10 000 KQL OE. E.KeLYOU<; J-IE. KOAITLKrl J_lapJ_lapu;f). 2tOU<; ao~E.\IE.LS J-1 KOAITLKfl
~-tap~-tapu;ri n eAanwon -rns Kap()LaKris ouxvo1nta<; enttu;xaverm JJC: 6t;o~i.Vfl ouvfi-
&-w<; oe ouv6uao116 IJE. avra;wvwtE.<; rou ao5eortou (5eparral-!tAn ri 6tAtta(E:!1f1) r1
avao-ro,\ei.<; TW\1 5-a6pE.VE.P/LK W\1 unoooxE:wv. A Ytl T1flK TLK ri a;w;ri a no 10 0101-la
(rr.x. 0ap<papivn, aKE.VOKOU1Jap6An) xopn;e:i.tm ae 6Aous taus ao&-eveis IJE. KoAmKri
j..lapJ..lapu;ri."H xopri;non 6toupnnKwv (n.x. <poupooE.J..li6n) rrpE.net va ;ivetaL IJ.E.
rrpoooxri 6t6n urrapxe:t Kivouvos e:Aa-rrwons rns KapowKriS rrapoxris.
[lpo<puAaKnKri avn0i.won /La tov Kivouvo urro-rporrris rou peu~anK:ou nupe1ou
rrpE:rret va xopn;ei.-rat ae: ao&eveLs E.p{a(6J..levous ae xwpous 6rrou unapxet ouvw-
OtLOIJ.O<; (n.x. otpaTtwnKoi., oaoKaAm KAn) Kat oe E.Keivous nou E:xouv l.J.LKpa nat6ui.
ITpo<puAaKTLKrl avn0iwon /La tov Kivouvo E.IJ.<pavtons AOLJ..lw6ous evooKapoi tt6as
rrptnet va xopn;ei. taL otous ao&evei.<; nou urroBaAAovrat oe E.TIE.l.J.0cioet<; oto o1611a
Ka~ws enions oe 6ta{vwonKE.s nape1J.5aTLKE.<; J..lE.-&66ous ae rreptoxE.s rrou <ptAo-
~evouv IJ.LKP05La lrr.x. KU&E.TflpLaOIJ.O<; oupfi-&pa<;, KUOH.OOKOTiflOfl, KOAOVOOKOTiflOfl )!

Kt\TI). Ill
01av fl E.TIL<pclYE.La Tr]S j..lLtpOE.LOOUS 5aA5i.oa<; eAat1w-&ei. on~avnKa (<1-1,5 cm 2 ) KaL !ij
ta OUIJ.TitWIJ.aTa -ens v6oou oev unoxwpouv napa 1ov E.Ae1xo -ens KapotaKr1S ouxv6- 1

~
rnras evoei.KvutaL napeJJ0aTLKrl -&epanei.a. H teAeu1ai.a ouviotataL a) OtflY XE.L- ~
poup;LKrl avnKatciotaon rns J..lLtpoet6ous BaABi.oas J..lE. 0toAo;LKfl r11J.eraAALKrl 6tav
un:apxet IJ.E: ;aAn ao0E:otwon r1 0) OtrJV 0aA5t6onAaonKri 11e IJ.TiaAA6vt 6tav unilpxet
J..lLKpou 5a-&1J.ou ao5eotwon. 2tnv 5aA0t6onAaonKr11J.e IJ.TiaAA6vt etoa;etaL otf1v
Kap6ta KaL Kater llrlKOS rns l.J.L rpoetoous BaABi.oas tv6s Ka&etf)pas. ornv ilKPfl rou
onoi.ou unapxet tva IJ.TiaAA6vt. To <pouoKwj..la rou IJ.TiaAAovtou E.xet ws anotE:t\,eol.J.a
TflV aneuAe&epW<Jfl 1WV OUjKOAArwE:vwv OUS OXLOIJ.E:S /AWX.LYWV Klll WS E.K TOLJtOU
Tfl\1 aU~f10fl 1fl<; E.TTL<ptlYE.La<; tOU j..lL1pOeLOLKOU O!Oj..lLOU.

Ave.n:cipKeta j.l.L!poetootis

A. At norra&o"'~'eveta. fta n:ot\Aa xp6vta TO ouvf1-&otepo ai no aven:apKe.ws rns


J..lL -rpoeL6ous 0aA0i.6as ritav o peuj..lanK6<; nupet6<;. ~rwepa OIJ.W<;. n na&non ouvri&ws
o<pei.Ae-rat ae rrporr-rwon TflS IlL rpoet6ous 5aA0i.6as ri ae a-re<pavwi.a v6oo. H np6-
n:-rwon xapaKtrJPL(etaL an6 npooeK0oAri -rwv ouvri&ws nenaxuo!J.evwv ;Awxi.vwv -rns
IlL -rpoeLoous 0a,\Bt6as !J.eaa otov apwtep6 K6A no KaTa -rn 6uipKE.La -rns ouotoAr1s . H
o-ce(pavtata vooos rrpoKa,\c:i. aven:cipKeWTflS J..lLTpoet6ous Ba,\Bi6as. o<petA6l.J.E.Vfl oc:
LOXaLl.J.LKrl Prl~r] tllJ\1 tC:VOYtU.iN xop6wv ~ wxaq.J.LKrl 6uoAE.L10UP/lll TWY JnAoE.LOWY
IJUWV, E.p;o 1WY OITOLWY E.LVaL r] OU/KPcltflOr] O!fl &E.Ofl TOU<; tWV /~WXLYWV Ka!U tr]

8
owpKt:La TflS ouot:oA~s. A.\Aa, At;cnt:po ouxva. aina e.i.vaL ll Aoq..u.Oons
no
t:v6oK ap6L a. fl ao5eol:wOfl rou IlL t:pot:LOL Kou OaK l:u,\iou Km 1a KAflpovow.tKci voo~
w.a1a 1ou ouvoenKou w1ou.
B.I1a~o<pumoAo)ta. HavE- ncipKe.La 1fl~ IJ.L TPOeLOouc; 5aA5i6ac; xapaK1flpi(e1aL an:6
l1UALY0p01J.fl0fl aq.tatO<; an:o H]Y apL01epfl KOLt\i.a OTOY apLOTepO KO,\no KUHl Tfl
6tcipKE:La l:rJS ouo1oA~s Kat otaKpi.vel:at oE- xpovta Kat o~e.i.a.
H ...l',oovtaaven:cipKeLa l:flS w.npoetoous 0a,\Bi.oas n:pm::aAE-i. Otcitaofl Kat un:ep-cpo-
4)ia l:r]) apLOl:E:p~<; KOLAias (tpOPTLOfl 0/KOU) OL6n fl teAeUl:ai.a KUtci 1r] ouipKE:La H))
6wo1oAt1~ e.i.vat unoxpe.ww.E.vn va un:o6e.x1d 1ooo 10 ai.w.a n:ou e.rno-cpe<pet an:6 n~
n:veuw.ovLK<; tp,\0es oao Kat 10 aiw.a n:ou n:a,\tvOpOIJ.flOE: an6 l:flV apwtepri KotAi.a
010V apL01E.p6 KOI\ n:o 01r]V npornn-&eioa OU0101\ri. H ou.haorj H)) apLOH:p~<; KOLAi.ac;
E:xet we; anoJE:Aeow.a TflV au~flOfl Tr)S evtaofls tns KOLAtaK~S ouotoAris. ouw.<pwva w.e.
l:OY vow.o Fran-k-Starling, Kat WS E.K 10li10U tr)Y au~r)Ofl 10U 0/KOU 10U
naAtvOpOIJOUVtOS ULIJ.UTOS Kat TOU ai.w.ato<; nou eew~el1Ul n:po<; l:flV appt:ri. Me tOY
llflXUYLO~J6 au16 avnpponei 1at n an:w,\e.w -cou ui1J.u1o<; nou Ota<pe. u;e.t o1:ov apt01E.-
p6 K6An:o on) ouo-coAri Kat n KapotaKri n:apoxri OLa1r)peitat oe <pumoAo;tKa en:i.n:eoa,
OTa apxtKci rouAciXL010Y 01cl0La Tfl<; nci-&flOflS. Me 1f1V napQOO tOU xp6vou ow.wc;, ll
apw1e.p~ KOLAla. t-..a1an:ovoullE-Yrl an:6 -en w.e;ciAtl OtaKi. VflOfl ai!latos n:pos tov apt-
orep6 KOt\ITo KaL H]Y aoptfi, aven:apKei IJE. an01:E:.Ae.ow.a tnv auef10fl10U teAOOLU010-
,\LKOU KUL tOU tE.,\OOU010AtKOU l:fl<; 0/KOU, 1f1V auef10f110U n:aAtvOpO\lOUY10S 0/KOU
aillatos Kat tflV c:Acinwon -ens KapOtaKris n:apoxris.
EK16c; O\lWS an6 -rnv apta1ePri KOLAi.a, n xpovta aven:cipKeta 111s w.npoet6ous 0aA-
B't6as npoKaAe.i w.nxavtKri Ka1an6vrwn -cou apto1epou K6Anou, o on:oLos eivat un:o-
XPE.WllE:.vos K10S an:o tO Utjla TIOU E.TIL01pe<pE.L UTIO tLS TIVU\lOYLKe<; <p,\e~e<; va
unooe.xte.i Kat to ai.!la nou n:aAtvopoiJ.eL an6 -cnv apwtepri KotAi.a. ~1a apxtKci o-ra-
ow TflS n:a~f10f1S o apL01ep6s K6Anos 6ta1e.Lve1at n:poooe.unKa Kat 11 aucnon1ou
0/KOU 10U 0V OUV00.UE.1UL an:6 avciAo;n aucnon l:flS nieons. Tot:rco E:.xet ws an:o-
1E:Ae0\lU H) 6ta-rripflOfl1f1S n:ieof1<; tou apw-repou K6Anou oe xa!lnl\a en:ineoa, tnv
n:poo1aoLa -cwv n:veU\lOVtKwv a;;e.Lwv KaL 1f1V anouoia OUIJ.TI1W!lcitwv. O!lWS, 6n:c.os
riOf1 npoava<j)ep&nKe, \l -rnv n:apooo 1ou xpovou f1 apw-repri KOtAia aven:apKe't, o
6;Kos -cou n:aAtv6po\lOUv10S aL~a1os ~e;aAwvet Kat n n:Leon 1ou apw1epou K6A nou
au~ciVE.L. H auellOll TflS n:iE.OflS TOU apt01:epou K6Anou exet c.os an:o-cE:.AeoiJ,a 1flV
E.j.t<pUVLOfl OU~!pOpflOfl') HlJV TIVeU~OYLKWV <pAe.Bwv, eYOLCl~E.OOU TIVU\l0VLKOU OL6ri-
~a10S, ITVUIJ.OVLKrlS uneptUOflS KUL llr)XUVLKriS OUOAE.L TOUP/LUS Tr)S apL01ePriS KOt-
!\La<;, oxt O~.LWS oro 5a&!l6 n:ounapa1flpouv1at otn o1evwon tllS llLtpoe.toous l.)u,\5.t-
6as.
H o(aaavc:n:cipKE.ta 1f1S I.LL1POE.toous 5aABioas ouvri~ws o<J)eiAe.TaL oe Pri~f11
v6vua~ XOPOriS r) LOXUL~LK~ 0UOAeL10UP/LU -&f1AOE.L60U<; IJ.UO<; KUL E:XE.L Vl:AW<; 6ta-
<popE.HKf1 n:a&o<puoLOAo;ta an6 111 xp6vta. H taXU1fltu \lE. rnv onoLa e;Ka:JLo-ra1aL fl
rra~non 6E.v rrapc:xc:L 6uva161n-ra Otci1aons o1ov apto1c:p6 K6An:o ~c: an:oteAeow.a
1nv na,\tv6po~r!Or) \l/ciAns n:ooon)ta<; ai~Ja1oc; 6xt w.ovo an6 tnv aptat:epri KOLI\Ld
n:poc; tOV UpL01cpO 1\0An:o ai\Aci KUL an:6 tOV apLOH:po KOATIO n:po<; TL) n:VE.U!J.OYLKE.S

9
<pAeBec;. Tot:no TIPOKaAei tr]Y au(r]Ofl tOU 0/KOU KUL Tr]S ITLE.Or]<) tOU aq.wto<; Otr]V
ITVE.U~OYtKr] KUK;\O<popia Kat Tr]Y O(E:La C:~<pclYLOfl Y1'0Yr]<) OUOITYOLU<;.
r. KALYLKe$ E.KOQAWOE.L$. OL KI\LYLKe<; E.KOr]t\WOE.L<) Tr]<; aven:cipKE.La<; Tr]<; ~LTPOE.L-
6ouc; Ba,\B.toas e(apui.Jvrm an6 tov 6;Ko tou naAtv6po~ouvtos ai!..tatos. arro to eav
ll rra&r]Ofl eivat xpovta ~ o(eia Kat arr6 to eav ouvurrapxouv ~ 6xt aMec; rra&~oev;.
Ot ao&evei<; ~e xp6vta ~LKpou Ba&~ou averrapKeta tllS ~Ltpoet6ous Ba,\Bioas eivaL
aou~nnu~J,anKoi. evw E.Kt:ivm ~e xp6vta ooBapou ~a-111-J.OU aven:cipt<t:La tflS ~Ltpoet-
6ous BaABioas exouv ou~rrtcil~ata KapowK~S avencipKetas (K6rrwofl ~ ouan:vma
rrpoona&eias). Aio&r]~a npoKap6iwv naA~ciJv ava<pE.petat an6 1ouc; ao&eveis ~e
KOATILK~ ~J,ap~apu;ri. Opw~evm ao&eveic; ~e np6ntwoll 1!lS ~L"rpoet6ous Ba,\~ioas
E.IJ.<pUVL(OUYunepKOLALaK<; KUL KOLALaK<; appu&~i.E.<;, TIPOKcipOLO at\)'0$ U/YWOtOU
at noAo;ias Kat a;xwor] ouv6poj.l~. H o(eia avencipKeta tr]S IlL tpoet6_ous ~aABioas
ouxva ouvo6euetaL an6 nveu~-toYLK6 oiOr]llU ri Kap6to;evri Katan,\r](La.
~taus ao&eveis llE. xp6vw nniou ~a&~ou avenapKeta tr]S llLTpoet6ous BaABioa<; ll
KapotaKri WO!l eivat <pumoAo;tKri. evciJ ae t.Keivous !le oo~apou Ba&j.lou averrcipKE.La
unep6uvaj.ltKri llE. napeKt6TILOfl npos 1a apwtepa. :luxva t!Jflt\a<patm ouotoALKos
poiCos. To <pUOfliJU tr]S pE.Uj.lUtLKriS avenapKE.LUS tr]S j.lttpOE.LOOUS BaABi6as E.LYa.L
ouvi]&ws oAoouo1oALK6 KUL apxiCeL raut6xpova llE. tov rrpun;o Kap6taK6 tovo. H
OLUKLYflOfl llE.!ciA!lS noo6tr]ta<; ai.j.latoc; an6 tr]Y llL1poet6ri BaABi6a Kata 'til oLaoto,\~
XE.t WS anotE.Aeoj.la tr)Y E.j.l<pOYtOr] tpi tOU KapOLUKOU 10YOU KUL E.YOS j.lE.OOOLUOtO-
AlKOU KuAiollatos Otr]Y Kopu<pri. 0 6e(nepos Kap6taK6<; t6vos j.lTtopei va eivaL eup-
ws 6txaolJ.E.vos A6;w npciJL!lflS ou;K,\ewns tr]S aopttKriS BaABi6as.
~tou<; ao-0-evei.<; llE. avenapKE.LU tr]S j.lLtpOE.LOOUS 0aA0i6as O<pt.LAO!lE.Yr]S OE. np6-
IT1WOfl ouxva napaTrlPouvtm eAattwon rns n:poo&tonto&ias 6taj.le:rpou Tou &ciJpaKa.
tponL6oet6ris &wpaKas ri oKoAiwofl. To ouotoALK6 <pUOfllla ouvr;&ws etoa;etaL ~e ri-
xo e(ciJ&r]Or]S Kat j.lE.tUKLYE.Ltat TIPOS tr]Y apx~ tr]S OUOtOA~S 6tav eAattCiJYE.tUL tO
~-te;e&os 1flS apLOtE.PrlS KOLAias (n.x. lJ. TflV Afl~ll tllS 6p&LUS OtUOr]S IOU ociJ~atOS).
~1ous ao&evei.l) llE. avencipKeLa Tr]S llLtpoet6ous BaABi6as o<peLA6!leYr]S oc: LOXaL~L
KJl Kap6LOna&eta to ouotoALK6 <puonlla llnopei va aKOU/E:1aL otnv apxri 10 ~eoov ri
tO tAos 1f1S OUOtoAflS KUL va OUVOO uetaL an:6 tpi tO ri l:etapto l:OVO.
~tfl o(ei.a avenapKE.La 11l'> llLtpoc:t6ous BaABi6as -cnv o<petA6!lE:Yil oc: p~\ll 1ev6v-
nas xop6fls r1 6uoAetroup1ia &nAoet6ous 11u6s un:apxouv ou~n:niJ~ara Kat O!lllE:ia
n:veuj.lOYLKou OLO!li-LUTOS. To ouotoAtK6 cpuonl-la c:ivat ouv~&ws evrovo KUL erre-
KtE.lvetaL npo<; tr]v Baor] tllS Kap6tas ~ :cnv !laoxaAr]. ~uxva ouvurrapxeL 11aptos
Kap6taK6S r6vos.
U.. Ep"Yaotopta~-:ci eupd~aTa. HleA1iJOAi.lpOto.:ptir;;;pa Yrrc:prpo<pia Kat 6tcnaor]
apwtepou K6Arrou (1JLTpoeLOLK6 P) oe ao&evei.l) nou 6tatr]pouv q>AeBoKOilLKO pu&1.16.
ITapatr]pouv'CaL enior]s uneptpo<pia tllS aptotep~s KotAias Kat oe apKetE.s
rrept TttWOC:tS KOA ITLKrlllUPJ.tUPU/rl .
.-4!1:1LVO}'parpta r9uJpa;.:a Au(r]Or]l:WY OtaOtclOE.WY l:OU apto-cepou K6Anou KaL Tr]S
apLG1c p r1 s K oLXLU s. IT ve u llOYLK ~ au ll q>6pf10il TIOL {tAll s Bap uTfl tas.
Hrm:ap0tO?'Part!J.L/J.:f1p6TITWOfl ~ aa6eaTWr] lllTPOE.LOlKOJV )'Awxi.vwv. au~non Ota-

10
o-ro,\LKfl<; oLa~E.tpou apw:re:p~s KoL,\i.a<;, ouoroi\LKE:~ C)Lm:apaxes l:fl<; KLVfltLK6tn1"u<;
wu rmxw~aros tq<; apLatepns KOLALas. Aucrwn -rwv 6wo1cioewv tou apwn:pou Kot\-
nou. H oeei.a avc:rrapKeLU tfl<; ~Ltpoc:L6ous 5aA5i.6ar; ~-tnopd va ouvooc:uewt an6
JlXOKapo~o(paWLKci eupf11Jata evo~LKTLKO Prl~Jl<; te:vovt'Lwv xop6wv ri &n,\oeL6wv IJ.U(0v
ri 6wtpr-,oqs rwv IJLtpoeLoLK<iJv !AwxLvwv. ~rn ota(vwall KaL HJV eKTLIJJlOfl tr]<; 5a-
putnra~ HJS avenapK ewr; -cns IJ.L l:poeL6ous 5aA5i6as ou~-t5aAAeL Kat to unepnxo-
/PC].(PfliJ.U Doppler, 1:0 onoi.o KU1U/pcilJ)eL pori ai.~-tato<; an:6 tr]v apLOtepf1 KOLAi.a n:por;
tov apwtep6 Koi\no oLa~-tE:oou UJS IJ.Ltpoc:L6our; BaABi.6ar; Kata tr] 6LapKE.LU tr]<;
ouo-roi\ris.
kapc5t.aA:o):~<.ac9c-rrJqtaopo5", Aucnon ni.eons apwtepou K6Anou KaL tcAo6wotoAt-
KriS rri.eons apwn:pric; Kmi\i.ac;. rtvc:u~ovLKrl un:E:pTaoq TWLKii\ns Bap~urras. 2KLa-
/'PUlJ.lJlOfl ap~ott:::pou K6,\rrou ~e-ra an6 E:;xuon tns aKttvooKtepa<; ouoi.ar; OtflV apL-
o1epf1 KOLi\i.a.
E. .:PuoLKO LOtOpLa. Eeapta-raL an6 -cnv unoKeLuevn mnoi\o;i.a. OL qo&evc:i.<; !le xpo-
vi.a avenapKC:LQ TJl<; IJ.L1pOE:lOOUS Bai\5i.6a<; napa!J.E:vouv UOUIJ.Tt1WIJ.U1LKOL ')'LQ n:ot\i\6.
xpovw. H e~-ttpcivwn Koi\nLKJl<; 1-J.UPIJ.UPU/riS KUL nepL<peplKwv ew.Boi\wv 6ev ei.vm 16oo
ouxvri 000 01Jl O'tevwan tr)<; Ill TpOC:LOOU<;. Bc:Bai.w<;, UTIUPX.EL navToH: 0 Ki.VOU'\10')
,\OLuwoou<; evooKap6i.noas. n onoi.a ~-tnopd va rrpoKaA~oeL aK6~-tn ~-te;ai\utepn Ka-
taatpo<pn Tfl<; Ba,\Bi.6ac;.
Ot ao&evei.r; ~e np6n-cwof) tr]S ~L tpoetoou<; BaABi.6ar; Elltpavi.(ouv un:epKOLALUKer;
Kat KOLALaKE:<; app u&1.1i.ec; n 5ap u-rnta twv onoi.wv Oe'V auoxeti.\etm ~-te tnv 6apunna
twv ~op<poi\of1.Kcuv KUL i\eL toup;tKwv owtapaxwv. H n:p6{vwon -rwv nepwaoTepwv
E.LVUL e~aipctf). ~e IJLKp6 n:oooot6 1-lTtOpC:L YU E.IJ.\j)UYL01E.L UL\j)'VLOLO<; .3-avm:o<;, Pri~fl
teYOVtLWV xopowv, ,\QtiJWOf)S .\IOOKapoi. no a ri KUPOLUKri avenapK.La.
H npo;vwon twv ao&evw"V ~e. wxaq..lLKrlS m not\o;i.as ave.n:cipKeta nv; IlL tpoetoour;
5aABi6ar; e~aptataL ano tov O{KO 10U n:aALYOPO~OUYtOS UllJU"COS, tOY Ba&\,16 1"f]S
OuOi\eLtOUp)'ta<; H1S apLOtE:PrlS KOtt\iaS KUL Tfl\l tKTUOf) tr]S OTC:<fJUYLalUS VOOOU. I
TE:i\os. fl TtPO/YWOf) tf)S,O(ei.a<; ave.n:apKC:LUS tns l..ll1POELOOUS BaABi.oa<; eLVUL ou-
OI..lC:YriS (n6-ci. n v6oos l..lTIOpei "Va OOfl/flOeL oe. n:veu~-toVtK6 oi.on1.1a. Kap6to7evn Ka-
tan:i\n~ia ri Kat rov Savm:o.
2T. 0eoan ei.a . .:1. .~I)?ovia avcrrdpr.:cta Xopr](ei. TaL OL ;o~L Vfl (La to'V e.viaxuon tns
LYOTponi.a<; tau 1-J.UOKapoi.ou KUL <priPI..lUKU, OTIW<; Ot avaatoAei<; 10U IJeTUl:peTitLKOU
e.v(u~-tou tns U//E:Lotaoi.vns. nou et\anwvouv 10 ~eta<popno tr]<; aptoTepri<; Kmi\La<;.
I
I
.
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AvttiTfli;\JLKrj U)W)ri an6 TO OTOIJ.U (5aplj)aptYf) ri UKC:YOKOUIJ,ap6Ar-,) XOPr]/eltUL OTOUS


~
aa&evc:i.~ IJe K01\ mK~ ~apiJ.ap Uf'r]. ITpOlJ.l uAaK1tKri avnBi..wor] A61w tau KL v6uvou
un:o-rporrri~ tou. peut.taTLKOU nupeTou npenet va XOPfl/L -caL otnv peu~anKriS
at not\o(La<; ave: napKeLa tns ~L tpoet6ou<;. ITpolJ.l ui\aK tLKrl avuBiwor] ;ta i\muw6r]
.YOOKUPOL uoa XOPfl/C:L"(Qt 6nws KUL Ol:Jl ottvwon 1r]<; ~L tpoet6ous. Xetpoup')'LKr]
Se.pane.ta (avnKaraoTaon ~ enLOt6p&won-cns l..l.Ltpoe.t6our; 6aABi.oa<;) ouvto-catat
o-ro us au~ rrrw~u nKour; ao(}evei.<; ll llE:/ai\oKapoi.a. orweia e.nL6eivwor]<; tr]<;
ouatoALKri<; AeL toup')'la<; tf)<; apw-cepris KOLAi.ar; ( n.x. eAauwor] rou KAaouatos
e(w(}nans) KaL ooBapou 5a3-llou avenupK.LU -rns IJ.Ltpoe.t6ous Bat\Bioar;.

11
I
I

B O(aa avcrrcipt<;-cta ApXLKci eTILXeLpt:.i.. taL ata&eponoiflOfl tfl<; aq.toouva~LKriS


Kal:aataafl<; rou aa&evous ~c: qH1p~aKa rrou e.Aa1:rc.Ovouv to ~c:1:a<pop-rio. 6rrc.us 10
VL l:porrpwamKo vatpLo ~ ~c: l:fl XPflOL~orroiflOfl evooaopnK~S avtt\ias. 2tll auvxe.ta
o aa&e.vris npE.rreL c:nev)'6vrws va un:o6Afl&ei: ae KapOtaK6 Ka-&C:1flptaa~6 KaL Ol:E.-
<pavto(pa<pia ;w va c:K n~n&ei fl 6ap utflta l:flS ~L tpoeLOLK~S avc:napKeta<;, ll Kal:a-
otaafl TOU ~UOKUpOLOU Tfl) apLOTc:pfi<; KOLALa<; KQL fl eKTOOfl l:fl) 01C:4JUVLULUS VOOOU.
H xetpoup/LKri &epanc:ia (av1LKa1cia1aoll ~ ent6L6p-&wofl1fl<; ~Ltpoetoous BaMYt6as
~e ri xwpi<; aopTool:e.<pavwia napciKa~tVfl) anotc:Aei tflV ~ova6tKri eArrioa aw-rr]pias
/La rous ao-&c:veLc; autous.
r. UpdTlmJOfl rr75 j.itrpocu5ou!) Jfa;{Jfioa!). XOPfl/OUVtaL avaol:oAeis 'nov 5-aope-
VE.P/LKWV unoooxewv (nponpavoA6Ar], ~l:OnpoA6Afl, Ql:E.VOAOAr] KAn) /LQ TOV eAe{-
xo TWV O<pE.lAO~E.VW\1 Ol:fl OU~n:a-&r]UKOl:OYLQ OU~TIIW~Cll:WV OTIWS fl TOXUKOPOLU, OL
TipOKclPOLOL na;\~oi KUL OL OXE.1L(O~E.VE.S ~E. 1:0 cl/XOS appu-&~ie<; (TE.X. UTIE.PKOlt\LaK<;
KOL KOL.\LaKe<; EKTUKtE.<; OUCHOAE<;). fta tfl\1 QVU!,.ltHOTILOfl l:OU OUXVcl UVUtpE.pO!,.lE.VOU
ITpOKapOLOU ciA/OUS anaL Tel taL fl tlJUXOAO{LKri UTIOOl:~pLefl tou aa-&evou<; ( TLX. 0La-
6e6aiwof1 6n ll rrp6{VWOfl eivat Ka,\ri KOL 6n oev naaxetan6 wxat~tKri Kapotona-
&c:La) ae ouvouaa~6 !.!E. UJV xopri/flOfl avao1:oAE.wv twv 6-aopevc:p;tKc.ilv urro6oxwv.
ITpo<puAaKTLKri avn6iWOfl {LQ AOL!,.lWOfl E.YOOKapoi no a anaL TC:L l:UL OE. 6Aous to us
aa-&evei<; ~c: aKpoao1LKci c:up~~.tal:a np6TI1WOJ1<; tllS !,.lLl:poeL6ous. Xetpoup;LKri &e-
parreia (Ka1a npotL!.tflOfl c:nt6t6p-&wof1 Kat oxt avuKatciol:aafl TflS 6aA~ioas) arrat-
1ei taL oc: 6Aouc; roue; OU!,.lTil:W!,.latLKOU<; ao&eveis !.l oo6apou 6a&!,.lou avc:rrcipKE.La
Tfl<; !,.ll TPOE.LOOU<; 6aA6i6a<;.

A.AL nona&ol'\leLU . .le aa-&e.vei<; r]ALKLa<; llLKp6tE.p!lS "((.0\1 30 E:1W\I n rra&no!l E.LVQL
auvri&ws OU//E.Vri<; Kat o<peiAc:tat OtflV napouaia 6irnuxflS aopnKris 6aA~ioas ouv-
6ua(6!.tE.Y!lS !,.lc !.lLKpo aopnK6 6aKl:UALO ri !,.lOYOTI1UXflS aopnKriS 6aABL6as. 2c: ao&e-
ve.i<; flALKias 30-60 e.twv n nci&r]O!l o<pe.iAc:taL oe 6Lrnuxn aopnKri 5a.\6i6a, fl onoia
XE.L UTIOOl:e'L E:K<pUALOfl KQL ao60l:WOfl ri 0. pE:U!,.lOTLKO TIUpet6 (OE.S n:apaKcitw).
Metci TflV flALKia nov 60 en)v to ouvf1&otepo aino eLvat fl E.K<pUALOfl Kat fl
ao6eotWOfl Ilia<; Tpi TI1UXflS aopnKriS 6aA6L6a<;.
B. ITa&o<pumoAo"Yi.a. He.nvpciveta tou 010I.liou UiS <pumoAO/LKriS aop1LKriS (.)aABLoas
uvepxe.TaL ae 2-3 cm2. ~fl!.tUVUKri e.AcittWOfl tfl<; pori<; tou ai!,.lal:OS Kat tr]<; KapowKriS
rrapoxris rwparflpeL rat_ 61:av fl e.nt<pciveLa 1:ou aopuKou Ol:O!,.liou eAanw&eL Ka-ra
75% KUL /L VeL 0.8 cm2fi !,.lLKPOl:E.pfl.
H eAauwa!l T!lS e m<pavews 1ou a1owLou t!lS aopuK~S ~aA~ioas npoKaAc:i au~flOfl
Tr]<; U\ll:LOtUOfl<; "-Uta TflY e~ciJ-&r,Ofl tOU at!,.l010S ana 1fl\l apLOl:E.pfi KOLAta Ot'flV UOPl:rl
KOL W<; eK tOUIOU QU~flOfll:flS OU010ALKriS niE.Ofl<; (<p6pHOfl TILE:Or]<;) 1fl<; apLOn:pri<;
KOLAia<;, fl onoia urrep()aiveL t:Kt:.LVfl Tfl<; aopl:fl<; !,.lE. anotE:Aeo!,.la 1:11 Ofll.lLOUPiLO
K,\io!ls (ow<popas J ouo-coALKris niE.OflS !,.lE.ta~u apLo1epris KOLAi.as KaL aoptri<;. H au-

12
(nan Tfl<; OUOTOALK~<; T1LE:Ofl<; Tfl<; apwrep~<; KOLAiac; npm:aAE:l IflV aU~flOr] rnc; OUOTO-
\tK~<; IciOfl<; TOU ~UOKG!)C)laKOU tOLXW~aTO<;, !l OITOLa OTQ UPXLKcl OtciOlU rnc; rrci&flOfl<;
avnppOTieLTUL OU~<pwva ~E: TOV VO~O TOU Laplace ~e TflV UVClTITU(r] OU('KE:VTplK~S
une:prpo<p,L.as . 3w o,-ccioLO JQ(no n auo-co,\LKfl,\et toup;i.a -ens aptote:p~c; KOLAias
6Latflp e:i 1UL oe: lJ)umo,\o;LKci e: ni ne:6a, e:vw n 6taa-coALK~ ,\t:L toup;ia ()Latapciooe: 1at
,\o;w E: 11L~pcio UVOfl<; H)<; XciAaon<; KUL t:AciHWOfl') tfl<; t:V001LK01fl1a<; 10U
une:p-rpo<ptKou ~uoKapoi.ou. Anote,\t:a~J.a IllS 6Laa-r:oAtK~c:; 6uaAetroup;i.ac; eivat n
e~cipl:flO!l oe: ~J.e;ciAo ~a&~o -ens KOLALaK~<; n:A~pwofl<; an:6 -co KoAmKo AciK1LO~J.a, fl
E:V1UOfl TOU orroiou auecivt:L. H KUTcip(flOfl 10U KOATILKOU ,\aKTLO~U10<; ( rr.x. KOt\TILKfl
~J.Up~apU'fh) Jlrtopet va npoKw\E.oe:t aq.J.oouvaiJ.LKrl ao.;rci&eta. -rou aa&e:vouc;.
H xpovta <p6pnofl nit:Ofl<; H)<; apta1e:pf)<; Km,\i.a<;, o~wc;, npoKaAe:i. Tt:ALKci Tr]V E.K-
n-cwon tr)<; oua1oALKrlS tflS Ae:t-coup;i.as. ~e: ano1E.Ae.o~a tflV e.Acinwor) 1ou KAci-
o~a1o<; e:(c.i.l&flOf1<; KaL -rnv au(flOfl -cwv 6taoniaewv 1fl<;. H ouo1oAtKh 1.ciaf1 -rou ~uo
KapotaKou TOLXc.i.l~Q10') U)<; apLOTE.PrlS KOL;\iac; auecivt:L KaL ~a(u 1flS fl1E.!\OOLU010ALK~
nie.an 1fl<; apw1e:pns KotAias Kat fl n:ie:on o1nv n:ve.ullOVLKri KuK,\o<popia. H KapotaK~
n:apox~ e:AaT1WVE.tQL Kat e~<j)QVL(OV1QL OUI.I.Tt1WI.I.01a KQL orwe:ia KapOLaK~<; avt:n:cip-
Keta<;.
r. K,\LVLKES t:KonAwot:LS. E!Jlj)UVL~OVtQL 01Q 1E.ALKci 0l:ci6La tns v6oou. Ot KUPLCHE.- )

pe<; e.i.vaL n o1n&a;xn. n 6uonvma, -ca ou('KOTinKci e:ne.woota Kat o at<pvi6Lo<; Sci'Va.- ~I
-coc:;. !
~II'
H 0[1}19d;:ltJ(<JUO<j)ljK1LK6 Bcipoc:;, ciA;oc:; rl ni.E.Ofl 010 n:poKcipota) E.LVQL 10 ouxvo- lllll
1t:po a(q.J.IT1Wila 1flS o1evwaflc:; 1fl<; aoptns Kat f1 1.1.E.on e:mBi.won 1wv aa-&e:vwv Jleta
1flV e~<pcivwri tr,s avepxe:taL ae. 5 xpovw. 04)ei.Ae-cat oe: ~uoKapoLaKflLOXaq.ti.a ano-
1E:Ae.o~a: a) au(ni.I.E.YnS Ka1avaAWOr)S ~ ano 10 un:e:ptpOtplKO IJ.UOKcip6Lo, B) E.Acinw-
Ofl<; 1f1S ote:<pavwias pone; AO/W TflS aueni.I.VflS avtiotaonc; Kan1 H]Y E.(W&flOfl 10U
ailla-r:oc; an6 tnv apwn:pn KOtALa otrw aoptr1, ;) aullnie.ofls tflS e.v601:mxwlla1LKrlS
I.I.Oipac; 1WV 01t:<pavtaicJv ap1flpLWV an6 10 UTIE.ptpO<j)LKO llUOKclPOLO KUL eAat1W\.H~\IflS
npooa;w;~s ai.jlatos 010 un:e.vooKcipoto KaL 6) 01E.q:>avtaiac; \looou n:ou ru&avo\1 va
I
OU\1 UTIUPXE.L.
H 6Lio!Tvotao<pei,\etm <Je Kap6taKr1 ave.n:cipKeta Kat o 1.1.~oos xp6vos errLBLwar]<; II!
1wv aa&e:vwv ~-tetci tflV 1J.q:>ci\ltarl1flS av~pxe-cat oe 2 xp6\ILU. I
'I
Ta ... ov)'t(o!Tro."t:i C:fletooc5taetyat ouxv6 OUIJ.Tl:1WllU o-cous ao&e.ve'v; ll otevwar) tfl~ !
aopTq). ElllJ)UVl(OVtal ouv~~w~ IJ.1cl arr6 aOKflOfl KQL btpe.i.,\OV1UL OE. E.t\cinwor) TflS I
1/

aL~Hi1WOfl~ tou e. ;Kt:tpa"ou, t:L te: ,\6;w appu-&lltoAo/tKW\1 6Latapaxw\l ei -ce A6;w
QOUVajllUC) auerww; 1fl~ Kap6LaKrlS n:apox~~ jl 1flV ciOKflOfl. H jJ.E.Ofl emBiWOfl rwv
!
I

aa.SE.VW\1 IJ.E.1a 1flV E.jl<j)cl\ILOfl1'W\I OU/KOTL1LKW\I E.TIE.LOOOLW\1 avpX1aL <JE. 3-4 Tfl .
. 4trpvtc)to) <9dlaro)E.jl(j)a.vi(erat 010 3-5% 1WY aau~J..ITtWllUHKWV ao&e\IWV 1.1. ot-
VWOfl TflS aopifl<; 1\0,L OU\Irl&W<; Oq)E.LAE.1'Ul OE. KOLALaKri TQXUKap6ia.
~1flV QLIJ.OOUYUIJ.L"-U Ofli.I.OV1LK~ 01V(J)(Jfl tr)<; aopnKri~ ~a,\Bioa<; 0 OtpU)'jlO<; E.LVUL

13
6puous KUL ap;os (pulsus parvus ettardus) xapuKHJpL(OI-!C:YOS an6 1-!LKpo eupo<; KaL
KaD-uoTE.prwE:vfl q.L(pavLOfl 1flS ouo1oALr.:~s Kopu<p~<;. H Kap6LaK~ WOfl c:ivm napaH-
Tal-lVfl xwpt<; va E.l-ltpavi(E.L napc:KH)ITLOfl. XapaK1flPLOHKO aKpoaonKo E.Upfl~a TflS
01Vl00r]S Tr]S' aop't~S c:ivaL E.va -r:paxu OUOTOt\LKO tpUOr)l-la e(W&r]OflS (aOlll-lllV10LO<;
fl crescendo-decrescendo)nou aKou;c:tm oto 6c:u-rc:po 6c:~LO 1-J.E:Oon,\E.upLO OLaonwa,
E.T1C:KTC:l\IC:Tlll on<; Kapw-ri6c:c; KaL ouxva OUV00C:UE:1lll ano OUOTQ,\LKO POL(O. H
E.v1aor, 10U aopnKOU 010LXe'LOU 10U 6c:un:pou KapOLaKO 10VOU c:ivaL E.t\anw~E.Vr] KUL
1-J.ITOPE:i va urrapxc:t napa6o~os 6txao~J,o<;. ~uxva un:apxcL 1-rapTos Kap6LaKos 16vos
O<pC:Lt\01-J.C:VOS Oe aU~r)Ofl TflS E:vtaOr)<; 1fl<; KOAITLK~<; OUOTOt\~<;. 2E. \'eapou<; ao&c:vei<;
1-J.C: OU//C:Y~ OTE:VWOfl 1r']<; aopnK~<; ~a,\5i6ac; aKOU)'C:TaL OU010ALKOS riXOS C:~W&r]Ofl<;
(ouo-roALKO dick) 01flV KOpu<p~ 1r]S KapCHUS, C:VW OE: r)ALKLWI-leYouc; aa&c:vcic; f1
ouxvo1r,1a TOU ouo-ro,\LKOU <puOriiJ.aTo<; au~ave1m 01flY LOLa nc:pLOx~ ..
6.. Ep"Ya010pLaKa c:uprjwa-ra. H.fcK1por.:ap6tO/pd(j)!Jf./O Ynep1pocpia i:r)S aptotcpric;
KOL;\ias Kat 6taTapaxE:s 1fl<; KoAnoKOLALaKris KaL 1fl<; ev6oKoLAtaKris a;w/tl-l01f11a<;.
At~:1L 110/f}O(j)LO cYaJ/}0/1.'"0 .2U)'KE.V1PLK~ unc:p-rpo<pia apL01t;p~s KOL;\La<;. Mnaou-
YWHKri 0LU1aOr] 1fl<; avLOUOa<; aop1fi<;, OtpeLAOI-lE.Yfl OE. 1paUIJ,a1LOIJ.O 10U aopUKOU
TOLXWI-laTo<; an:o To c:~w&ou~c:vo l-IE. 1-J.E./UAfl -raxt:n111a Ao1w tfl<; o-revwofl<; aiiJ.a. A-
o6E:o1WOfl aopTLKriS 5a,\B't6a<;.
Hl"OI(O/}OtO)'PO(j)fJj./0. naxuvor), ao5E:a1WOfl, E.,\ci11WOfl 1fl<; KLYflHKOtr]Ta<; KUL nc:pL-
OPLOI-!C:Yfl 6uivoL~fl TUJY aopnKwv n1uxwv. Ava;vwpLOfl 6intUXflS aopnK~c; BaABi6as.
210 UITE.PflXO/Pci<Pfll-lll Doppler, fl taxutr)Ta po~s -rou aiiJ,ato<; an6 tr]Y aopnKri BaA~L-
6a eivm au~fl!levn. Me: n1v c:~E:taOfl aut~ IJ.TIOpc:i va un:oAo/tOTc:i fl KAiofl n:ic:ons
Ka1E:pw&c:v Tfl<; aopnKri<; BaA5i6a<; an:6 1flY c:eLawof']: KALOfl n:LC:Ofl<;= 4v2, onou v fl
un:ot\o;t(OIJ.C:Yfl 1-J.C: 10 Doppler IJ,E.;L01fl 1UXU1fl1U 1fl<;. atiJ,anK~<; po~<; an:6 1flV aoptLK~
6aA5i6a.
l.:ap6to;.:O) ;..ac'}el'!Jf}LOO"j./(j~ Auer)Ofl TILE.Ofl<; apLOtE.pou Ko,\nou, 1eAOOLa010ALKri<;
KaL -rc:,\oauotoALKfl<; n:ic:or,s apw-r:cpris KOLAias . .2ua-roAtKri K,\iofl n:iE.Ofl<; 1-lnaeu apL-
o1c:pris KOLAias Kat aop-r~s. ITvc:uiJ.OYLK~ un:ep1aofl TIOlKLAfl<; Bapu1r,1as.
E. tf>uOLKrj L01opia. H n:pO/YWOfl -rwv aOUIJ.THWIJ.aUKWY ao&c:vwv e.ivat LKavon:OLfl-
TLKrl aKOI-lfl KaL OTaY n KAior, n:ic:ons C:KUTE.pw&c:v HJ<; UOP1LK~<; Ba.\Bi6a<; eLYUL on-
1-laYHKrl (>60 mmHg). Avn&E:tw<;, n np(r[YWOr) 1WV OUIJ.TI1WIJ.UUKWY ao&c:vwv C:LYaL
6 UOI-leVri<; ( r) 1-!E.Ofl c:n:tBLWOr) IJ.C:ta tr]Y 1-l<j)UYLO!l otr,&a;xqc;, OU)'KOTHLKOU E:ITLOO,..
.6Lou ~ Kap6LaKr,c; avc:napKc:La<; avE:pxc:taL oc: 5 , 34 KaL 2 xp6vLa av1io1mxa).
~T. 8c:parrc:ia . .-\ vnBiwor, /La 111v n:poAf"llV!l T!l<; AOLI-!W6ou<; c:v6oKap6in6ac; npE:n:c:L
va XOPr)/eL tlll Ot; Q,\ous TOU<; ao~E.YE:t<;. AvnBLWOr) )'La 1r)Y n:pot\flftl!l TOU PE:UIJ,ll1~KOU
n:upC:TOU npeTTcL va XOPr)/eL1aL 010U<; ao&c:vc:ic; IJ.C: PC:UIJ.UUK~<; QLTLOAo;iac; OtEVWOfl
Tfl<; aopnK~<; BaABL6a<;. OL aoui-!IT1WIJ.aUKOL ao~c:vc:is &a npeneL va n:c:ptopioouv
Ir)Y lpUOLK~ 10Uc; Opa01JlPL01!l10 (an:ajOpC:Ue1aL 11 OUI-ll-le10Xri OC: a~AflUKE:<; E.KOfl,\lU-
OcL<;). Xc:Lpoup;L"fl ~c:paneta (avnKa1ci01aO!l aopuK~<; Bat\Bi6a<; ~ Ba,\Bt6o1o~ri oc:
Vcapa UIOIJ.a 1-lE ~fl aqBeOTWIJ,E.Yfl 01E:vwon) rrpE:n:E:L va c:(papiJ.O(eWL: a) Oe ot\ous

14
"- -- -- --"- - .. ~.- --- --.- .. -.-

rous au~rnw~an~--.:ous aa&c:vous. 0) ae or\ous roue; aa&evc:is fl c:rwpavc:w aopnKou


aro~iou <0.75 cm2 avc:{aprnra an:o rnv n:apouaia ~ 1nv an:ouaia au~rrrw~arwv Kat
j) 010U<; aa&eVeL<; ~ TIL<pCrYeW aopUKOU Ol:O~LOU 0.76-1.0 cm2 Kat eva f1 ITE:pLO-
GOtepa arro -ca napaKatw xapq.K,tflpLanKa:buar\c:ttoup;La apL01epris KOL,\LU<;, m:E.\Pa-
vwia voaos. nAtKia >6G55 ccc.Uv. ao0ap~ un:c:p1pocpw apw1c:p~s KotAias. mwrrnp~
wxaqJ.ia ri ao0ape<; appu&f.lie<;. H 6taoTor\~ tns aopnK~S BaA0i6ac; fie tfl
xpnm~orroinafl eLOLKOU Ka&c:t~pa ~e ~n:aM6vt oev c:ivat t6oo an:o-cc;,\c:o~anrz~ 000
Gl:fl 01eVWOfl 1r]S f.lL1pOE:LOOUS KaL ll ~E.&oOOS autri et.papf.l6(e1UL Oe npOOeKUKcl
c:rnAe;~E.vous ao&c:veis (n.x. ao&eveis nou 11 /eVLK~ Katcio"CaarJ ~ n nAtKia
ana;opc(IE.L 1flV XE.LpOUp')'LKri ene~0aon).

-
Ave ru:ip Keta aopl~ s

A. At norra&o"Yeveta. O<pc:LAc:1at ae aA,\mc.UoeLS nov n1uxuxv nou Trl e~nooi(ouv


an:jav~ au;KAE.L<Jfl 1flS aopnKf]c; BaABioas ( n.x. pc:u~.tanK6c; rrupe-r6s. BaKt!lPLOtaKfl
eYOOKapoi no a, K<pUAL01l Kat ao0E.01WOll oi TI1UXflS aoplLKris BaABioas) ~ ae
na&f]aeLS 10U UOf:HLKOU 10LXW~U10S nou rrpOKaAouv ouitaOf1 lOU OaKtUAiou 111S
aopnK~S l)a,\Bioas (ouvopo~o Marfan, a&llpOaKA~puvaf1, unep1aofl, f.LE:tci arr6
KUpOLOXeLpoup;tKE.s c:rrq.t0ciac:t<;, ou<ptAil KAn) KaL Ka&w1ouv aouva111 Tfl OUIJ.ITl:WO!l
tWY aoptlKWV rnuxwv 01:11 OLCl010A~.
B. ITa&opumo,\o!'ta. H na&nof1 xapaKUlPiCe1at an6 6tao1oALK~ naAtvop6~!lOil
aq.J.a1oc; an6 tnv aop1~ npos 111v apw1ep~ KOLAi a. 0 6;Kos 1ou ai ~a1os nou naAt v-
Opo~ei e{ap1cl1UL ~E.ta(u tWV aAAtov an6: a) l:fl 0tU010ALK~ TLl<j)clVta tOU 010~lOU
Tfl<; aopnKf]S BaABioas. Tl anoia ons oo5apes nepL nniJoc:t<; avpxerat ae 0.3-0.7 cm 2
Kat B) 111v avtia1ao11 otn auatlliJ.UTLKri KUKAocpopia, 11 auellOll n1s onoLas au(avet
f.vr.iJ 11 c:Aa11won e,,\ar~.wveL tov 6/KO 1ou naAtvopo!J.ouvtos aif.lato<;
H avc:n:apKeta tllS aopnKr1S BaAI3i6as ~rropei va Lvat xp6vta ri o(eia. ~u)v ..t;od-
vtaaven:cipKeta tns aopl:lKriS ~aA~ioas 11 apw-cc:pri KOLAi.a, unoxpeou~c:vr1 va uno-
OE:X1ei Ka-ca -rq 6tapKeLa 111s owo-coAris -coao 10 ai~.ta to n:poepx6~c:vo an:6 1:ov apL-
atepo K6A n:o 6oo KaL 10 ai.~a rrou n:aALvopoiJ.d arr6 tflV aopt~ ( <tJ6puan 6/KOU ),
OLatLV1aL KQL uneptpe<tJetaL. To l)apoc; tllS KapoLei<; unepBaLVE.L ouvn~ws 1Q 500 gr
Kat oe opw~E.vc:q nepvrn:ciJaeLS. IJ.TIOPE.i. va, <p~aaeL ta 1000 gr. A notE:.\ea~a tns
OLQtUGilS Kat tns urreptpO<pLa<; eLYaL f1 auenon 10U 0/KOU naA~ou (v6~ot; 10U
Starling) KaL 11 OLUtf]pnon -ens auotoALKrlS taans tou IJ.UOKapowKou tmxwua1os oe ,
lpUOLOAO/LKcl E. TIL neoa ( v6~os Laplace) QV1L010lXU. H tc:Ao6taG10ALKri TIL0fl1!lS
aptatep~s KOLALUS OE:V au{avc:tat ata UPXLKrl OtQOLQ OLOTL aueave1at ll E.VOOTLK61rrca
TrlS aptoiepr,c; !<..OLALas. H ap11lPLUKri niean atnv aop-cf] eL vaL au(niJ.E.VIl KaHi 111
OLCrpKE.LU tns ouotoAris Ao;w tr]S au(r']Or)S 10U 0/KOU n:aA~o(J Kat c:AaHW\J,~Vr] KU1ci
l:fl ouipKLQ H]t; (naal:Ot\~c; t\O{W tr]S n:at\tv6p6~11GilS ULIJU10S npos 111V apta1E:pf1

15
KOL,\La. Oc; E.K --co(rrou, 10 E.upoc; -cou oq:.u)'~LKOu Ku~a--coc; E.i.vm au(n~E.vo
l unE.pouva~LKfl KUKAotpopia).
~--cnv o(eLaavE.napKE.ta rns aopnK~<; BaABi.oac; 6E.v napE.xcrat o xpovoc; oTrlV apL-
a-cE.pfl KOLt\La va OLaTa&E.i. KaL fl E.v6onK61n--cO: tr]<;. OE.V au(O:veL ~e anorE.AE.o~a 1flV
raxei.a O:vo6o Tfl) --cE.t\oOLao-co,\LK~<; TILE:Ofl<; 1fl<; apL01E.p~<; KOLAia<; Kat HJV e~<paVLOfl
ou~nn.o~cnwv Km Ofl!J.E.Lwv Kap6LUK~<; avenapKcLa<;. H --ceAeu-caia q.ltpavi(E.1aL KaL
o-ca TE.,\LKa o-ca6La TflS 1fl<; xpovi.as avenapKE.La<; 1fl<; aopnKriS BaA5i6as. o-ca onoia
napanwouvTaL au(r]Or] 1IlS 1E.A00La010ALK~S TILE:Ofl<) Kat E.AU11WOr] 10U KAO:o~U10)
E.(w&non<> Til<> apw--cE.pris KOLAi.a<; KaL e,\O:nwoll TllS KapowKriS napoxris.
r. KALVLKE$ E.KOQ,\WOel). ~U]V . .t;oovca averrdpf.:ecaTilS aop-c~<; ra OU~TIW~a-ca
e~<j)av't(OVTaL 01U 1eALKU OtUOta tr]S vooou. Kuptotepa ano au-cO: eivat: 1)
~ UJc9a;v;o<J)ett\o~evn oc: !J.UOKap6taK~ wxat~i.a, Tl onoia npoKaAei1at an6
c:,\anwofl HlS o--ceq:.avwi.as poris A61w: a) _c:Aanwofls --ens 6taotoALK~S nieons -ens
aoptris. B) au(r]Or]S 1flS 1eAOOLaOTOALKriS TILE:Of"l<; tns apw-cepris KOLAiar; KaL )')
Ote<j)aVLai.ac; VOOOU TIOU TIL~UVOV va OUVUTICrPXeL KaL 2) .4UO"T!VOtaOlj)eLt\O~E:Vfl OE:
apto-cc:p~ Kap6LUK~ avc:napKeLa ri oc: ouvo66 na&non (o-cetpavLaia vooos, o--cE:vwor) ri
avenapKeta -cr,s ~Ltpoc:toous BaABi6as). At\Aa ouxva avatpep61J.E:Va OU!J.TI1W!J.a1a
E.LVUL OL npOKUpOLOL naA!J.Ol, at\jOS 010 KapwnOLKO E.Autpo, KOLALUKU aAm. (O:t\rj KaL
unc:p6oALKrl e<J)i.opwor,.
H Kap6LaKri WOfl c:ivaL napa1c1U!J.EVf"l, unc:pouva!J.LK~ Kat E.K10Tif"l, l!Jf"lt\a<J)W!J.eVf"l 010
6o ri 7o IJ.eOQTC,\e upLO 0LU01f"l!J.U apLOTcpa 1flS ~eOOKt\cLOLKriS jpa!J.IJ.riS.
~1r,v aKp6aor, tr,s KapOLac; OLanto-rwvc:-raL Ul!Ji.ouxvo 6tao-roALK6 tpUOf]IJ.a 010 6c:u-
1E.po 6c:(L6 !J.eoonAc:upLo 6tO:o-cfl!J.U oc:(tO: ~o-ro -re-cap-co !J.coonAt:upto 6tao-cr]!J.U apL-
o-cepa. H OLaKLVflOf"l !J.ejat\r,s TC0001f"ltac; ai!J.UTO<; ano tr,v aoptLKri BaABioa Kal:a 1f"l
OLUpKeLU 1f"l<; OU010Afi<; XcL we; anotAcO!J.U tflV E:!J.lj)UVLOfl OU010ALKOU <j)UOri~a10S
Otfl Baon -cr,c; Kapota<;, otpc:tA6!J.cvou oc: Act -coupjtKri o-cevwofl -rnc; aopnKris BaABLoac;.
TE.Aoc;, otr, ooBapou Ba&~o0 xpovw avc:n:apKcta -cr,c; aopnKric; BaABioac; !J.TIOP eL va
un:apxcL !J.cOOOtaotoALKO, a6a!J.aVTOcL6E:c; (crescendo-decrescendo) KuALo!J.a ( tpUOr]!J.a
Austin-Flint) Otf"lV KOPU<Pri OtpeLAO~eVO 0 t\eL TOUP/LKri 01VWOf"l tOU 0101J.lOU 1fl<; IJ,L-
1pOLOOUS BaABi6ac;.
t\OjW 1f"lS !J.ejat\r,c; aU(f"lOr]S 10U 0/KOU 10U aptflpLUKOU Ul!J.U10S KUTci 1f"l OU010A~
Kat 1f1S an:610!J.f1S c:Aanworic; -cou Kater Tf"l owo-coAri !J.TIOpci' va napa-cnpr,&ouv w c:-
cn s:
a) AAAOJ.ieVO) o(jlu7J.IO) i; or,PU/J.IO)Corrigan. XapaK-cr,pi(e1aL an:6 taxei.a O:vooo,
au(rlOfl tou c:upouc; Kat -caxda Ka&ooo --cou otpU/!J.LKou KU!J.a-coc;. ftvaL opar6s ons
KapwtL6c:s (xopoc; Kapw-cLowv) KULIJ.ITOpei va n:poKaAc:i pu&!J.tK<; av-cio-cmxc:s n:pos
10 Olj)U/!J.O KLVf"lOE.L) Tf"l<; Ke<j)ai\fl<; (Of"l!J.elO de Musset).
B) T.ot.IOeLC5tAO>- O(/IU/J.IO) ( OIJJ.IeiO Ouinke) [1 apa-cr,pei taL on.<; ovuxotp6pc:s tpat\a(-
;es nov OaK--cuAwv KUL tov Bu~6 tou o<j)~aA~.LOu Kat xapaKtf"lp.L(etaL an:6 evat\t\a!ri

16
KOKKtvns Kat Ac:uKr1s xpmas. ou/XPOVflS ~e ns KapotaKE.s ouo1oAes.
I) Hxo) ITUpoJJo,Jou on:.-lou. AKOU(E.TaL OTfl 1-lflPLaia apTflpLa KaL O(j)E.L.\e (QL Oe oo-
VflOE.L<; npoKa,\ou~E.VE.S ana tr)V anatOIJ.f) OLCrTUOf) TOU U/)E.LOU.
6) i.ltfl.,fd r,t'UCHJJ.Ia rouDiroziez. AKp.o,c;ton quqtoALKOU Kat. 6wm:oALKOu tpUOfl!,ta10S
Otr-,v 1-lflPLaLU aptf)pLa l-J.E.1a ana E.;\a\flpci OUIJ.TilE.Ofl10U U//elOU IJ.E. TO 01f)SOOKOTILO.
~ IJJicta 6c(Ui) Aap6tat(rj) avcrrtipAa ad 6tci1ao11 otpa)i n6wv, nna1o~e1aAia. ne-
pLtpE.ptKci m6nllata) llTIOpeL va napatf)pflSouv oe aoSevds IJ.E. 6uonvma.
Ta KALVLKa. eupfi1J.a1a H)S o(da) ave!Tdpltet.a) l'fl) aoprrj) ow<pepouv ana E.K eLva
TflS xpovias aven:cipKE.La<;. To eupo<; 10U O!j)U(IlLKOU KU~UTO<; OE.V E.LVUL aU(rj~J.eVo
,\a)w TflS !iE.(ciAq<; auer)oq<; Tfl<;' OLUOTOALK'rlS'TILE.Or)<; Tq<; aptoTE.PrlS KOLAia<;, r) OTIOLQ
rcepLOpL(et :r<:w O/KO Tou n:aAtvopo1J.ouvto<; aLIJ.cno<;. H 6tcipKE.La -rou 6wo-roALKOu
<puanllaTo<; eivat ~LKPrl KaL 10 o<pett\6~J.evo ae Aenoup(LKrl otevwor) HlS aop-ctKris
6aA6ioas ouotoAtKa <puorwa IJ.Ttopei va anououi(et. H a6uva~.J.ia -ens apwtepns
KOtt\ias va oexSei 10\' auerwevo O(KO aL~a10<; exet W<; ano1AE.OIJ.U Tr)V rrpwq.tfl
OU/KAewn Tfl<; I-LL tpoetoou<; ~aABioas Kat TflV E.!-Ltpcivwn <puon~J.a1o<; Austin-Flint,
otpet,\a~J.evou oe ,\et toup(tKri o1E.vwofl tou oto~Jiou Ifl<; IJL1poet6ou<; BaABi6as A61w
TflS npWLIJ.fl<; OU)'K,\E.Lafl<;. H e\'1U.Ofl TOU nponou KUPOLUKOU t6vou eL\'aL eAaHW!J.e\'n
KUL fl OU/Kt\E.LOf) I11S llL1pOE.LOOU<; 6at\6i6a<; !J.TIOpeL va TIPOKaAE.oet LrJV E.IJ.\j)(l\'LOI1
IJ.E.OOOLUOtOALKOU rlXOU 0111 1J.eOf1 10U lpUOrliJU10<; Austin-Flint.
6.. Epl'a010pLaKci eupoua1a. Rfe~~:TpO!.:'apoto?Pdrt!JJJa 2-cr)v XPO\'La a\'eTHipKE.ta
n:apanlPLtm un:ep1po<pia tr)<; apwtepns KOtAia<;. 2111v o(da a\'encipKE.LU
OLUTIL01UJVE.taL tUXUKapoia XWPL<; aAAa E.LOLKtl UPrillata
AA'BVO)'par;ia t9Ct~aKal1'f)V XPOVLO U\'E.TIUPKE.ta napatrlPE.itaL auer)O!l TWV 6ta-
.!
01UOE.WV apwtepfi<; KOLALa.<;, otti-caon -ens avwuoa<; aoptn<; KaL nveu~ovtKri au~.L<po I
PllO!l 010 1E.ALKci otciOta. l1flV o~eia UVE.TCcipKE.ta IJT!Opi Va llf]Y UTt!lPXl ~e)aAo
Kapoia, E.VW OUX:Vri eiyat r] T!VE.UI..lOYtKrl OUIJ<pOpf10f].
H..ror.:ap6t07Ptirt!JPU.{2.111V xp6\'ta ave:rtapKE.La napati1POU\'Tal au~no11 nov 6wo-ra-
oe:wv Tf1<; aptOtepri<; KOLAia<; KUl T!tepU{LOI..lOS Tfl<; Tip6o&La<; (i\WXLVa<; TI1S IJ.LTPOE.L-
OOU<; 5aA6Loa<;. H aopuKn pt(a eivm ouvri~ws 6w-cetaJ.1Yfl. 2.111v oeeia avenapKE.La
tr]<; aopnKri<; 6aA5t6a<; napanwe:i TUL l..lLKPri UU(fl011 twv 0LU01QOE.W\' IJ.E. auef10!l 1r]S
KL WltLK6tn-ca<; tw\' TOLXWIJ.ci-rwv 111s apLOtepris KOLAias Ka&ws e:nLo11s npWLIJ.fl ou)-
KAeLOfl.Tfl.<; Ill Ipoet;QOU <;, .0ai\~~9.as . J.U <; o<p E.LAOilE.Y S oe AOLIJWO fl E.\'OOK qp6L 1LOa n E.-
ptn1woet<; ~nopeL va napatf)pfl&Ou\' ~~BAaotrioeL<;. Me to 11XOKap6to)pci<pnl..la Dop-
pler 6wruo1wve:-cm 11 c)LaoioALKrl pori ai~J.a1o<; ana 1fl\' aoptri npos 1f1V apto-repri
KOLALa. unoAO/L(E.TaL 11 6tao1oALKri 6ta<popd. TILE.Ofl nieo11<; IJ.E.1a(u aop1ris KaL apt-
01E.Pfll} KOLALa<; (~e;cli\11 Otfl xp6vw KUL IJ.LKP01E.PI1 01'flV o(E.La ave:n:cipKE.LO Tfl<;
aopnKriS l)aA6LOa<;) KUL E.KU~citaL flllLnOOOtLKU (Katti TCpOOe((LOr)) !l ~apUH]TU TflS
ns
Q\' E. nap K E. La<; Til s aopu K 6aA Bio a<; ..
A.ap6taAo) r.:a,9cr!Jptao,ud)2Kta;pci<p110I1 apw1epris KOLALa<; IJ.E.tci an:o E:!XUOfl a-

17
KUVOOKLt:pa~ OUOLa~ 01f1V aopt~. Taxeta avooo~ KUL Kcl~OOO~ 1\U~W~ emoqs aU(r]-
\.Jfl 10U eupou~ tou Q(PU/1-lLKOU KU\lU10S OtflV XPOVLU avenapKE.LU 1fl<; UOPLLKriS 0a\-
6\.0a<;. Aueflofl Tfl<; 6taotoAtKrlS TILt:Ofl<; HlS aptotepfl<; Kot,\La~ ota rc:\tKa oHiota tfl~
XPOYLU<; KaL 01flV oeei.a avencipKt:La 1fl~ aopnKriS. ~aA0\.6a~.
E. +uOLKQ LOtOpLa. 2tflv xp6vta avencipKt:ta tn~ aopnKri~ 6a,\B\.6a~ OL ao&c:veL~
ouv~~ws rrapa1.1E:vouv aoullTitW\laUKOL /La 1-lLa ri ouo 6t:Kaetie.c;. H ewpaVLOfl ou~m-
1W\latwv unooflt\lilvt:t 1flV Pri~fl Tfl<; avnppOITflOfl<; Tfl~ apton:pri~ KOLAi.ac; nou ouxva
ouvooeuetat an6 taxeia entoc:Lvwofl tfl<; KatciotaOfl<; tou ao{).evou<;. H npo)vwa 11
1fl<; oeeiac; ave.n:apKE:La<; Tfl<; aopnKri~ 0al\6i6ac; eivat OUOIJ.E.VrlS Kat anaLTeltaL cliJ.-
Ofl UV1LilE:1WTILOfl (oe<; TiapaKatw).
2T. 8epan:e\.a. H ouYTflPflHKrl ~epanc:\.a Tfl<; xpovias avc:napKetac; 1flS aopnKriS
6aA6\.6as neptAallBciveL TflY XOPrl/flOfl OUKTUAL noa<; oe TIC:pLTITWOE:L<; 1-lE IJ.E.ja\oKap-
OLa Kat TflY npo4)uAaKnKri avn6twofl /La TflV np6,\fllj.Jfl Tfl<; Aatllwoous ev6oKap6\.n-
6as Kat rou peullanKou nupccou 6tav r1 nci~flOfl eivat peuiJ.anKriS mnoAo1ias. H
eAanWOfl TOU IJ.E:TO(j)OpTLOU 1-LC: OjjctOOtaOTUATLKcl (j)CtpiJ.U~_a OTIW<; Ot ciYU010t\E:iS TOU
llE.1a1pC:TI1LKOU C:V(UIJ.OU 1fl<; 0//E.tOTUOLYfl<; rl f1 YLqJC:OLTtLYfl YOE:LKYU1UL oe ao~c:
vei<; 1-LC: OUVUTiclPXOUOa ap1f1ptaKf\ un:p1aOfl KU.t f1 XOPri/flO!l 0LOUP!l1LKWY Oc C:Kt:L-
VOU<; 1-lE: nveu~-LOVLKri OUIJ.(j)OpflOfl. H xetpoup/tKri &epanc:ia (avnKci-caoTaofl ri c:mot.,.
6p{).wofl aopnKriS 0aA0ioa<;) evoe.iKvuTat at: 6Aous taus ao,9-eveis llc oo6apri ave-
rrapKE.ta nou: a) E:ll(j)aYL(OUY 0UilTI1Wilata Kat OE.Y xouv oo6apri ouoAeLTOUP/LU 1fl<;
aptote.pris KOtAias (KAciolla e~W&flOfl<;> 5QJ/o], 6) 6e.v ell(j)avi(ouv OUilTt1Wilata aAAO.
xouv ouoAetTOUp)ia 1fl<; apt01PrlS KOLAia<; (KAclOIJ.a e~W{}flOfl<; <5QJ!a) Kat j) 0V
cll(j)avi(ouv oullrrtriJilata oute. 6uoAettoupjia tfl<; aptotepris KOLAia<; aAAa naoxouv
ano oo6apr1 otc:qJavtaia vooo ~ oc:lnepfl 6aA6toona&eta nou ananei xc:tpoup;tKri
aVtLil1WTILOfl ri EXOUY E.K00f11J.UOIJ.EYfl KapOLOIJ.E.jat\\.a.
TAos, fl o(eia avencipKeta tfl<; aopttK~S 6aA6ioas anant:i eneijouoa xetpoup)tKri
aVTLIJ.C1WTILOfl.

A. Atnona~OI'E.Vcta. flp6KLtat jta onavta pUIJ.UTLK~<; atnoAo)ias na&flOfl TIOU


ouvfi~w<; ouvooeuetat ano nci&flOfl tfl<; IJ.Ltpoet6ous ri tfl<; aopttKriS Bat\6\.oat;.
B. Tia&o<puoto;\o"Yia. H tpt/Awxtva exet to IJ.E:)aAutepo or611to an6 6Aes ns
KapotaKE:t; 6aA~i6et; (f.lEOO e1J.6a6ov 10 cm2). H pori tou ULIJ.ato<; ano tOY OE:~L<)
KOAno OTfl OE.(ta KOLt\La napE.IJ.TIObL(~taL Otav 10 0101J.LO 1fl<; ~a\6\.oa<; /LYEL
llLKP01t:po ano 1.3 cm2. To(no E:xeL ws anotE:Aeolla tflV aueflO!l tfl) TILE:Ofl<; OTOV
6e(t6 KOAno (ouvfi~ws >10 mmHg) KUL tflY avantU(!l OLUOtOALKri<; KOATIOKOLAtaKriS
KALOfl<; TILE:Ofl<;. i\6;w twv xallflAWv ntE.oewv OtflV TIYE:UIJ.OVtKri KUKAo(j)op\.a tq.J.E:<;
6tao-coALKrlS KQ;\n:oKOLALOKri<; KALOfl<; C:Ka1E:pw&ev tfl<; tpt )Ati.Jxtva<; >2mmHg
3ewpouvrat rw~o,\o)~KE:~ Kat evoetKnd:t; o1E.vwof1<;.

18
H au~non rns TlLE:Orj<; orov Oe(LO KOArto 11POKat\eL 0LCl1UOtl KQL UTIE:ptpoqna aurou,
au(tlO!l H)c; nLe.onc; 01LS KOiAe.c; <pAE.Bc:c;, tlfCatO!J.e/aAia KaL oiorwa.
r. KALVLKU eUpQ!Jata. H OLCljVWOfl ouxva OLa<pE.UjeL OLOU tl KALVLKri E:LKOYU OU\Iri&wc;
K'Uplap\'c:itat arro l:a OU!J.TIHll!J.Uta KUL Of)!lE:LQ 1[1S 01eVWOrj<; 1f)S I.J.L tpOeLOOU<;
6aABi6ac;, 11 on:ow auvun:apxc:L 01:t"JV n:,\c:LOl!Jtl<pi.a 1wv ao&c:vwv.
0 pu&I.J.OS E.l VaL ouvri&wc; <pAeBOKOilBLKO<; KUL 0 0\j)U/I.J.OS !lLKpo<;. znc; 0\j)U(L n6ec;
OLaKpLYetat IJ.e;aAo KUlla A, e\'OeLKttK6 wxuprjr; KoAnLKric; ou01:ot\ric;, ro orroio O!J.WS
c:{a<pavi(etaL 61av avarnux&ei KoAn:LKri IJ.UPI.J.UPU/ri. To TCL6 xapaKtr)pLOttK6
UKPOUOHK6 eUprji.J.U eLYaL eva !J.e000La010ALKO <j)UOrj!J.U, 10 on:oi.o jl\le1UL av1LAflT110
011')\1 TiePLOXri aKp6ao11c; 111STPL/AWXt\la<; KaL eTILteLVetaL !lE. tr)V eLqnvori. 0 npwroc;
KUPOLQKOS r?vor; eLVUL ouxva OLXUOilE:Yoc; ,\6(W eTnBpa6uvor)c; rooo tr]S !J.LTPOLOLKric;
6oo KaL tfl<; tpL(;\WXLVLKric; ou\lta1Woar; KaL o 6E:lnc:pos Kap6wK6c; r6vor; aoSe\lriS. H
1\,\Q()Tl OLUVOl{r)c; n O<j)LAO!J.E:VI1 Oe otVWOI11f1<; tpi(AWXL\Ia<; OUOKOA.a OLUKPL\IE:TUL
arr6 eKE.LYfl tr)c; 01:E.vwons 1f1S !J.LTpoc:t6ouc; .
.6.. Ep"Ya010pLaKa c:upfwa1a. BAcl(fpo;(ap6to;pdrp;Jpa Yn:c:p1po<pia KUL OLCrTUOf)
6eeLou K6Anou (rcveUI.J.OVLK6 P) oc: ao&eveis n:ou 6Lat11p6uv <pAc:BoKo!J.BtK6 pu&116.
KoAntKri !J.Up!J.apu(ri.
A;.;rn.-o_;ypar;Jia ,9oJpaf..a AU~flOfl nov 6taotaoc:wv Tou O{LOu K6Arcou,
ouvooeuO!J.e\111 an6 6ui1ao11 tfl<; a'lw KoiAns Kat 1flS O.Cu;ou <pt\E.Bas.
Hmr.:ap6to_;yparftJJI0:.6.tatapaxE:c; tflc; KLVflTLK01fltac; 1W\I 7Awxivwv t11c; -r:pL 7AWXLvac;
napOIJOLeS !J.e i::KL VeS HOY !J.LtPOeLOLKWV 7AwxL vwv 0111 01VWOfl Tfl<; !J.ltpOeLOOUc;.
Au{I10fl OLao1aoe.wv Oe~LOu K6Anou. Me to unepflXO/PCr<fll11..ta Doppler IJ. 10 onoi.o
unoAo7i.Cc:-caL ll rax(nn-ca 1flS aqJ.aUKriS poris an:6 trlY tpt(Awxtva Bat\Bi.oa lln:opei va
un:oAo7tatei 11 6tao1oALKrl KoAnoKoLAtaKrl KAion rcie.OflS.
l:opOtOKOf KOt9cff7ptOt7jl0~ Auenon nieons oeeLOu K6Anou, OLUOl:oAtKri Kt\L01
TIL011S !J.e raeu O~LOU K6Arcou Kat 6e{uis KOLAias >2 mmHg.
E. ~umKO w1opia. Eeaptti-cat an:6 1LS ouvunapxouoc:s na~noc:ts 111s IlL rpoc:toous ri
-cnc; aoptLKriS Ba,\Bi6as.
~T. 0cpaneia. Eeaptcnat an6 ns ouvunapxouoes na~r1oetc; tflS !J.l1poeL6ous ri ti1S
aop1LKriS ()aA~L6al}. H IJ.OVfl tOLKri &epan:t:La etvat 11 ene~-tBauKri &-epartcia
(xeLpoup(LKrl avnKa-cao-caon r1 BaABtbon:AaouKri IJ.e ~-tnat\A6vd, 11 on:oia ouvto-ca-caL
6tav 11. owotoAL~-.:ri KoAnoKotAtaKrl KA'LOI1 nieoflc; eKattpw~ev 1fl<; 1PL/AWXL'vac;
unepBei ta 5 mmHg ri 6-cav tO OtO!J.LO tqS TPL/A.WXLYUS /LVeL IJ.LKp(HE.pO ana 2cm 2 .

A v e n: ci p K e L a t w
p L 1 A XL v a s

A. ALnorra~o?c:vc:La. ~u'lri&ws c:Lvat Aet-coup(tKri (6eu-cc:pon:a&ris) KaL o<peiAetat oe

19
- -- -~- ; ':'

I'
i~
n

~
Il
OLcitaoq IOU TPL/AWXLVLKOU oaKTUALOU t\6;w OUOt\eLTOUpjia~ Hl~ oc:(uic; r.:mAias
l
rrpor-:a;\OU~E:Vfl~ an:o n:veu~OVLKri unepraon. H TE:t\cutaia nc; TIE:pLOOOTE:pe.c; tpopec;
avan:-cuooetaL 010 eoa<poc; apLOTE.PriS KapOLaKriS a:ve.n:apKeLUS, pc:u~a1LK~S
~L TPOE:LOOn:ci&eLUS ~ ~E.OOKOA ITLKriS E: TILKOL vwviac; TIL n:t\eKO~VflS an6 KOt\ TILK~
~ap~apu;q. H OpjUVLK~ (npwTona&~c;) avenapKC:La Tr]S tpt;t\loxtvac; e'tVUL OTiclVLO.
n:ci&r]Ofl an:avTWIJE:Vfl 0 OpLO\lEVE:S OU//VE:ic; KapOLOTici&c:te<; ( n:.x. v6ooc; Ebstein
'
!lE.OOKoA TILK ~ e mKOL vwvia T(mou npuno;evous et\Ae.i!l!laTos), !le tci an6 Aoq.t.w611
evOOKapoi 1LOO. KO.L 010 ouvopo~o KO.pKLVOeLOOUS.
B. na&o<pumot\o"YLa. H avencipKE:La TflS TPL/AWXLVac; exet we; anoTeAe.o!la TflV au(r]Ofl
rns ntcOflS o1ov 6c:ct6 K6Ano Kat us KOL1\es <pAe0es. TflV 6tcitaon 1ou oecLOu K6Anou
Kat 1f1V E.\ltp,gvtar] r]Tiato~e;aAiac; Kat nept<flPLKWV OLOI1\lCHWV. Eni.oflc;, 11
rrpoKaAou11evn an:6 TflV avemipKeta TflS 1pt;Awxtvac; lp6pnon 6;Ko~ 1flS 6ecuis
KOLAia~ npoKaAei: a) nepanepw ernoetVWOfl 111S 0 1JOAcLTOUpjLac; 111S oe(Lcic; KOLAiac;
one; TIE.PLTI1WOL~ IJ.E: Aet10UP/LKri avencipi<.eLa Kat e)de novo 0Lcl1aOr] Kat
OuaAet TOUp{LO. 111S OE.Ctcic; KOLAiac; Oe ao~eVE.LS 11 OpjaVt~ri ave.ncipKE.ta.
r. KAtvtK ci e. upri~aTo.. 2111 Ae.t TOUP/LKri ave. ncipK c:w TflS 1pt )'Awxtvac; ouvuncipxouv
OU\lTITW\lUTU KUL Ol"l!leia apLOTepric; KaL 0CLclS KUpOtaKric; avenapKE.Lac; (OUOTIVOLU
O<pE.Lt\0\lC:Vfl OE. TIVC:UilOVLKri OU!llj)OpflOfl, flTiaTO!le/at\ia, aOKLTflS. TiepLlj)E.pLKU
OLOri~ata), E.VW OTflV op;avtKri, n:pOC:CciPXOUV Ta KALVLKci eupriiJ.UTO. Tr]S OE.CLa<;
Kap6taKric; ave.rrapKE.La~ (Kata0oAri. ouoave.ci.a KOTIW011~. flTtaTOIJ.c/O.Aia, aoKi 111S.
n:ept<peptKci m6ri~aTa)
0 O<pa;tTLOLKOS OlpU/!10~ xapaKTflpL(etaL an6 1f1V napouoia !1/ri.Aou OU010ALKOU
KU\lO.To~ v Kat Taxeias Ka{}-6oou y. ~TflV t~JnAci<PflOTJTOu npoKapoiou !iveTat
avTLArrrnri n:apao1epvtKa apto-ce.pci avcin:aAon o<pe.tA61J.Vfl OTflV 6tciTo.Of1 Tflc; oectac;
KOLAia~ Kat otnv o.Kp6aon 6tanLO-cwvetat ouo-coAtK6 <PU0111J.U naAtv6p6!lf10f1S o-cnv
eo-cia aKp6aons ti1S 1Pt/Awxtva~. -co onoio e.nne.L ve.-cat IJ.e 1f1V etonvori ( oru.teio
Carvallo).
6.. Ep!'aOTQpLaK a E. upri!laTa ..&leKrpoKop6to}'pdlf1!,7jla KoA TILKri \lUPilUPU/ri (SOJ/o 1WV
ao&evwv ). Yn:ep1po<pi.a Kat 6tci-caaf1 6e.ctou K6Anou ( n:veu!lOVLK6 P) oe. ao~evei~
TIOU OUHilPOUV <pAeeoKOI31lLKO pu~!J.O.
Al\rt vo)-parpia 1'Jajpa;..a Mc:/o.AoKapoia o<petAOj.lE.Vfl oe aucnof1-cwv 6tao1aoe.wv
Tfl~ oe~ta~ KotAia~ Kat -cou oe.cwu K6An:ou. ITpo5oAri -cou t6cou 111c; n:veullOVtKri~.
0Ul10.0fl tWV TIVE.UilOVLKWV TIUAWV KUL TIVE.UIJ.OVLK.f) OU!l<flOPTlOil (Cfl!J.La
oeureporra~ouc; ITVUil0VLK~c; unep1aOflS) o-couc; ao&eve.L~ ll AeLTOUP/LKri
avE. ITcipK E. La Tfl~ TpL jr\WXL va~.
H..Jo;...apr5to)'parpr;pa.:2to nxoKapoto;patpfllla (M-mode Kat owotciota-co)
rrapatflPE.L taL n <pOpTLOfl O{KOU 1flS oeetar; KOLAiac;, ava;vwpt(OIJ.Vfl an6 TflV QUCflOfl
twv 6taaTcwewv Hl~ oecta~ KOLA"tac; Kat TflV napcioo(n KLVf11LK01f1Ta tou
~E.OOKOA f1LKOU Cna<ppa{llUTOS, 10 OTIOLO UTIOil0KpUVl:O.L O.TIO 10 OTILC3-LO 1olXWila 1!lS
apL01epf1<; KOLt\Lar; 1\Utci Til OUOl:Ot\rl KaL nAnatci(E.L TO OTIL03-LO TOLXW\lU H]S apt01E.p~c;
KOLAias Ka-ca Tfl oua1oA~ (av1i~eTa arr6 6n ou11~aive.t tpuoLoAO/LKa). Me to
flXOKUpOLOjpO.<flfl~U DoP,pler 0LaTILOl:WVC:1UL pon O.ll-.lOtOS ana 111 OE.(La KOLALU npo<; 10\1

20
- ---- _. __ --:... .-~ :- . ----

6e.(L6 r-._61\ no OLUIJt:Oou Tfl~ tpL /t\wxtva~ Ka ta tr, 6tcipKE.La try; ou01:ot\ri~. ELOLKU
Of'liJE.LU l:flS UTIOKt:LIJE.VflS na\tlOlS OTOU~ aO&E.VE.L~ IJ.E. OpjUYLKrl QYE.TiclpKE.LU.
lap6ta;.;d) J<.at'}er!JptaOjJO). Auenon TILE:01~ oe.ewu K6t\-rtou (IJ.ejaAo KUIJ.U V) Kat
TE.;\OOLaOTOt\LKrl~ HLE.OflS 1fl~.OE.(HiS KOL;\i.ac;l. fla,\tvop61.lfl0l TlS Ot<LE.pac; ouoi.ac; an6
TflV OE.(Lci KOL\i.a OtO oe.euJ K6Ano OTflV Ot:(LCi KOLt\to)'patpi.a.
E. .:PuotKO LOtopta. H n:p6/VW0111<; t\c:noup/tKric; ave.napKe.tac; Trlc; tpt;Awxtvac;
e.i.vm OUOIJ.evri~ 6t6n ouvri~wc; un:o6n,\wvet 11V n:apouoi.a Ka~oALKriS KapOLUKrlS
avenapKeta~ Kat rrvE.UIJ.OVtKric; un:E.p1aons. H OP/UVLKri ave.n:apKe.La 11<; tpv;Awxtvac;
IJ.TIOpe.i. va e.tvaL Kat\ciJ~ avE.K1rl ;w IJ.e/ciAo xpovtK6 6uionwa. 6nwc; /La rrapcioe.t;IJ.a
OUIJ0UL\'E.L 010U~ taeLKOIJ.UYE.LS TIQU 1JTI06t\ri&1KaV OE. XE.LpoupjLKrl atpai.pE.Ofl 11~
npoo0.\f1\tE.i.oac; an:6 AOLIJ.W01 E.YOOKapoi. noa Tpt jt\Wxtvac; 6aA6i.6as.
~T. 8c::pane.La. H IJ.E.IJ.OVWIJ.E.vn op;avtKri avencipKeta TflS 1PL ;Ac.iJXtvac;
UY1LIJ.E.HL>TIL(E.tUL UPXLKa IJ.E. 0LOUp11LKa )LU 11Y UTIOtpUj'rl TflS KaTaKpclT101~ U/PWY
Kat OUKTUAi.noa !'tQ TflY e.vi.oxuon 11<; OU010AtKriS .\E.L1oup;i.ac; HlS oe.tta~ KOLt\i.a~ Kat
tov E.t\e;xo 11S KOLAtaKriS ouxvonnas on~ ne.ptntwoetc; l..le KoAmKri IJUPI..IUPU/ri. Eav
1 ave.n:cipKE.Lcl l:flS l)ai\l)i.oac; E.i.VaL ool)apri KaL ta OUIJ.TITWIJ.ata OE.V e.t\jXOYTaL IJ.E. TflV
n poavatp e.p&ei.oa ouv11Pfl1LK ri a;w;n an: at H:L tat xetpoup)LKrl avnKataotaon 11S
6aA6i.6ac;. H Ae.t toup/LKri ave.n:apKe.w HJS tpt;Awxtvac; auvr;~wc; unoxwpet IJE. tnv
UV1LI..IE.1WTIL01 l:OU UTIOKE.LIJE.VOU au:i.ou (n:.x. avtLKataota011J.LtpOE.LOOUS (3a,\~i.6ac;
ae. ao3-e.ve.i.c; IJE. otE.vwo1 1f1S IlL l:poe.toouc; ri XOPrl/flOfl 6aK1ut\i. n6ac;, OLOUPfl1LKWV Kat
U//E.LOOLa01a.\nu0v OE. ao&e.ve.ic; IJ.E. KUpOLaKrl ave.n:cipKE.La).

~teVWOfl TIYE.UIJOVLKrlS

H (![cJ.IOJO!JT1<; TIVE.UIJOVLKrlS 6at\l)i.6ac; e.i.vaL ouvn\twc; ou;;evris (oet\i6a 1.2) Kat


on:avi.wc; E.TILK1110S, O(j)E.Lt\OIJ.E.Y1 010 OUVOPOIJ.O KUpKLVOE.LOOUS, ae IJ.E:jai\a E'.IJ.I)Ot\a
e.n:e.KteLVOIJ.E.Va arr6 t1 6e.eta KoLAia 01f1V nveUIJ.OVLKri apl:f1pi.a, eK0AaotrioeLc; an6
.\oq.LWOfl ev6oKap6i.noa, 1..1uewlla .6e.eta<;KOLAL(lS. ri. ve.on:AaoiJ.al:a.

Ave.ncipKe.La TIYE.UI.l.OVLKr\S

A. At non:a~o"Ye.ve.w. H avcrrdp!<."'ctatf1S nvE.UilOVtKriS 6aA(3i6ac; e.ivat ouvri~wc;


.\e.tl:oup;tKri (6e.ute.pona\tris) KaL otpe.i.Ae.taL oe 6uitaof1 tou 6aKtuAiou TrlS A6;w
n:ve.uiJ,ovtKilS unepta01.<;... Qc; eK :routou.ouxvci. anote.Ae.i. en:tn:AoKri 1wv n:aS.rioewv
twv aptote.pwv KapotaKwv KOLAol:ritwv (otE.vwof1 IJ.L1poet6ouc;, aven:apKeta
apwH:pf1S KOLAlas .1. Hilv xpovtwv n:ve.u1J.ovorca3-e.tc.llv ( n.x. xpovLa ano<ppaKttKri
nve.u~J,ovonciSe:La l Kat tf1S Lcnona~ouc; nve.u~ovLKriS un:E:.ptaof1c;. H LOLOn:aS.ris
oui1aon tOU Ol:c:.\e.xouc; 1flS fCYE.UIJ.OYLKriS aptf1plac; fl OUVOOE.UOIJ.eV1 an6
ave.napr.._E.ta Tf'lS rtVE.UIJ.OVLKriS 5aA6L6ac; oe.v eLvaL ouxvri. Op{aVtKri (n:pwtorra~ris)
avenapKE.La IflS ITVE.UIJ.OVLKfi<; 5at\l)i.o.ac; napa1f'lPE.LtUL IJ.E.Ta an6 t\OLIJ.WOr)
E.VOOKapOL no a \ to(LKOI..IUVE.lS ), 010 OUVOpOIJ.O KUPKL VOE.LOOUS KUL OTIUVLWS 01U
rtAULOLU pE.UIJ.UHr.,1<; KapOLOTia~E.Lac; ri ou<pLt\flS.

21
B. na&O<j)UOLOt\OYLQ, H avenapKE.La H1S TIYE.U~OYLK~c; ~a,\Bi.oac; npoKa,\ei (j)Op1LOf1
<)/Kou tr,c; oe~LCic; KOLAiac;, n anoia one; oo~apE:c; n:eptn:niJoe.Lc; owte.LYE.1aL,
UTIE.ptpE.tpetaL KUL l:E.ALKQ avenapkE.L. H ouitaor, tr,c; OE.~uic; KOLAi.ac; ouxva
ouvooeue-rm ano avencipKeLa -rr,s -cpL /A!.iJXLYa<; ~aA6i.oas KaL 6ta-raofl10u oe~LOu
KOA nou.
r. Kt\LVLKCl eupr)wata. H KALYLK~ E.LK6va KUpLapxE.LtaL an6 nc; E.KOr]AWOE.LS 10U
UTIOKE.L\.LE.YOU aLHOU, L0LUL1epw<; one; TIE.pLIT1WOE.LS TIOU 11 nci&rlOfl O<j)E.Lt\E.l:aL OE.
TIVE.U~OYLK~ UTif.p1UOfl.
~to otpa/LHOLK6 O<PU/\.1.6 ouv~Swc; rrapa-rnpei -rat ~E.")'a,\o Ku~a A otpet,\6wevo oe
E.vtOYfl OU010A~ wu OE.(LOU K6A n:ou ~ Ku~a v E.VOE.LKUKO avc:n:apKe.La<; rns
tpL ,,\c.iJxtvas.- :S1ouc; ao&evei.s I.J.E. n:vc:uwovLKrl urrE.p-raon llJflAa<pal:aL napaotc:pvLKci
apLOn:pci fl urrepouva~LKrl WOfl tfl<; oe~La<; KOL,\i.ac;. .
Ta aKpoaonKa eup~1..1ata e~apniJvtaL an6 UlV unoKd!lE.Vfl anwAo1i.a. E"roL, 10
<j)UOrWa tr]<; ,\E.L10UP/LK~<; averrapKi.a<; tr]S ITVE.U!lOYLKrlS (<j)UOfl~a Graham-Steel)
E.lvaL oAOOLaOTOALKO KaL XE.L rrapo~OLa xapaK1flPL01LKU 1..1-E; E.KE.Lva tou 0La010ALI<OU
<PUO~!latos tfl<; aven:apKei.ac; TflS aoptris evw To 6tao1oALK6 <J)UOfl!la tns op;a'VLKris
averrapKeias tr]S rtVE.U!lOVLKriS eivm 1..1E.OOOLaotoALK6. 0 oe.utepoc; KapoLaK6S t6vos
ei.vaL E.vtovoc; otous ao&e.vei.s !lE. rrveu!lOYLKri urrE.p1ao11. evr.iJ ouotoALK6 <puon1..1a
II
OUYOOE.UO!lE.VO arto rixo e(wSnofl<; aKou;e.taL 010U<; ao&e.vei.c; !lE. LOLOnaS~ ouitaOfl l_j:
'jl
1fl<; TIVE.U!lOYLKflS aptr]pi.a<;. il
:I

tl. Ep7'a010pLaK a e upr]wata. HAcK rpm.:apoto}'pdrf!Jf.la irre.p-rpo<pi.a l:fl!) oe~La<; i:II~


KOLAi.a<; 010U<; ao&eve.i.c; !lE. ITVE.UI.l.OVLKri urrE.pl:aor,. ATeAr1s arroKAE.LO\.LOS 10U oe~LOU I!!
OKE.Aous OTUY OE.\' unapxeL TIVE.U\.LOYLK~ urreptaOfl.
A!<."1Ll/O)"Ptlf/'ttl 19aipafi..a 6.LataOfl f(VE.U!lOYLK~S aptflpLa<; Kat ouvooa eup~l-la1a
e~ap1W\.LE.Va arr6 HlY urroKet\.LE.'Vfl at uoAo;i.a.
U.toKtljJOtO}'jJtlf/'!Jj./tl.' ~to flXOKapOLO/Pcl<PTl wa (M-mode KaL OLOOLclOtato)
n:aparrwei.1m 6ui1aor, 1flS n:vE.U!lOYLKric; aptr]piac; KaL oe opLO~JE.ves nepLTnwoeL<; .
owotoALKOS TI1E.PU/LObl6S 1fl<; n:poo&i.as 1Awxivas 1f1S tpL !Ac.ilxtvas. Me 10
flXOKapOLO/PU<Pflbla Doppler 6tan:Lo1c.iJve1aL pori ai.1.1.a1os an:o TflY n:veu~ovLKri aptr]pia
npoc; tr]v 6e(ta Kott\ia Kata 111 otapKeta tllS 6tao-roAris. Et6LKii OflJ.lE.i.a trlS
unoKE.i.blcYfl<; na&flOflS otous ao-&evei.c; 1..1e opjaVLKrl avencipKeLa.
l."apr.ltaAoS' Aa/)er!Jptao/10!:: 2tous ao&evei.s we. AeL tOUP/LKri avenapKeLa 111s
TIVE.U!lOVLK~S fla,\6i.oas fl OUOtOALKrl TILE.Ofl OTfl'V TIVE.U!lOYLKri aptr]pi.a OU'VriSto<;
UTIE.p5ai.VE.L ta 70 mmHg. 2tr] oo6apf1 aven:cipKE.La TflS TIVcU!lOYLKri<; 11 0La010ALK~
n:LE.Ofl l:fl<; TIVE.U\.LOYLKriS aptr]pi.a<; etVaL xa~r]Arl Kat n:ap61..10ta llE. tr]V OLaOtOALKrl
n:iE.Ofl l:flS 6e(u.ic; KOLAia<;.
2T. 'PumKri L010pta. ECap-ral:aL an6 111v unoKei.~E.Vfl aLtLo,\of'ia. ~111v n:AetOllJ11<PLa
TWv n:epL rnwoewv 11 napouai.a avenapKetac; Tflt; n:veullOVLKri<; oev n:poKa,\et
arw av n Kri en:L Bap uvofl Tfl s KuKAo<popta<;.
Z. 0eoan:E.La. ~UVLOl:ataL OTflY Katanot\!ll10fl TOU UITOKE.ll.l.E.VOU Ull:LOU (n:.x. UVtL-
Ka1'aOTUOr] ~L tpoet6out; BaABi.oac; ae aa&evri 1..1 aoBapri o1evwon HlS ~L tpoeL6ous
KUL TIYE.U~OVLKfl Urtpl:aOf1). ~TiaVLWS arraLTL1aL XcLPOUP/LKrl UVTLKUTQ01Q0fl111S

22
._-_:_.. :.::.._-______ -_

23
-". _..::..:._ ___-.:~.~-. ----~ - -- ----- --

,,

rl
I~

~
. - - ~. - --

3. MYOKAP L1IOITA0EI E~

f1p6KE.Ltdl /La. rra-3-riOE.LS tOU l.lUOKUPOLOU TIOU 0.V O<petAOVtUL OE. OH<pUVLULU VOOO,
urrE:praon. ~a~\Btoorra~eta ri ou(;evn Kapownil~eta. ~trlV rct\etO<iJfl<JHa rc.ov
rcc:pt rcrwoewv n at uoAo;ia napaJ.lVL il;vwotq.

XapaKtflpL(etat an:o Otcnaon. un:eptpo<pia Kat unoouotaAnKOTfl!a tflS apto-cepf)s


KUL 0 opLOJ.lE.V<; Tt.PL.TitWOE.LS)<UL HlS 6.~LQS KOtAias. ITapatrlPE.l tat ouxvo-repa
o-rov 1:pi 10 KOOIJ.O an:6 6n o1a avan:tu;1J.va Kpcnn. H at uon:a~o;E:veta tr,s v6oou
oev exet an6oa<pnvto1ei. ITt~ava ai na ~ewpouv1at n aAKooAn, 11 1..111 6ta;vwo~eioa
un:ep-caOr), 11 ~Up010CLKWOI1, Ol LOjVlS AOLIJ.W(LS, OPLOIJ.Va UUTOUVOOU
VOOrlJ.lU!U, fl AoxeLa Kat n AritJJTl (j)UpiJ.UKWV (n:.x. aOplctJ.lUKLvn). ITp6o<pa1S !.lAt)
6et~av 6n to 200/o twv rrpw-rou Ba~IJ.OU OU//Vc.iJv twv ao~evwv 1.1. 6tatanKri
J.lUOKUpOLOTIQ~LU 1J(j)UVt(l Otataon tf)S apLOtepns KOlALas KUL 10 3% f[QOXL an6
6ta1anKri IJ.UOKap6tona~eta.
A. ITa~owuowAo'Y'ta. H rcpoooeunK!l ota-caon Kat erct6eLvwo11 rns ouoroAtKTis
Aet toup;Lac; rns apLOtepris KOtAias E.xet ws anotAeo1..1a 1f1V au~no11 rns
teAo6wo-cor\tKris nieotls. 111v eAattwo11 111s Kap6taKr1S rrapoxns Kat rn 6tjepon
l:OU OUJ.lTtUSI')tLKOU VUPLKOU OU01rlJ.lU10S KU~WS Ttl<JflS 10U OUOtriJ.lU10S PVLVr)S-
U//l01UOiVI')S-aAOOOtp6vns. An:o-cAo1J.a 1wv npoava<pep~v1wv E.lvat eivat 11
J.l(j)QVL0fl 1UXUKapoiac;, KOTIW<Jfl<;, OUOTtVOLac; KaL 01a tALKU OtUOta rns na~nons.
m6n~J.atos Kat aoKL-cn. H un:oouol:a,\nK6-cn-ca K.at 11 KOLAtaKr16uitaofl~J.ITOPi
enions va npoKaAoouv:
a) Aenoup/LKrl averrilpKeta twv KoArroKOI.AtaKwv ~aA~'towv, o<petA61J.VIl oe 6tataon
1wv KoAnoKotAtaKOOV oaKtuALwv Kat 6uoAenoup;ia 1wv -&nAoet6wv 1.1UWV.
~) ~U01flJ.lU1LKS rl TIVUilOVLKc; _1l~Ot\c; TtPOKaAOUilVS an6 tOLXWIJ.UrtKOUS
Sp61J.~ous HlS apLOl:epfls r1 tns oe~tas KotALac;.
!) KoAntKrlllUPilUPU/ll, n onoi.a ouvooeuetaL an:6 rtepanpw eAanwo11111S
Kap6taKriS rcapoxris A61w anwAeLas -cou KOA rrtKou AaK rioj.laroc;.
6) Ko,LAtaKc; appu~IJiec; (KotAtaKS KtUK1eS ouo1oAs. llll 1.11J.vouoa Kat
E.llll~vouoa KOLAtaKrl taxuKapoi:a)
e) ~eu-cepona~r) ve<ppLKrl ri nna-ctKrl avenapKeLU, o<petA6J.leVfl oe E.Aanwon rns
KapotaKris rrapoxris.
B. K\tVLKQ Up0wata. 11a UPXLKil 01UOLa 11 na8-non ouvn8-wc; 6ta6pUJ.lL UOUJ.lfCHl)-
IJ.ULLKri. ~111 OUVXLa OIJ.WS E.IJ.<pavi~OVtUL OUIJTtlWIJ.Uta KUL Ofli.J.LU O<pLAOIJ.VU Ottl'v'
UT100UOtUt\ HK01fl1U KUL 1fl XUilflArl KapOLUKrl Ttapoxfi. E10L, 01J1V UVILKLilVLK!l
ee tao11 ow ruotwvetaL xa!lnAr1 aptflptaKri nieo11. taxuKap6ia. llLKp6s o<PU/1-!0S

1
Ka&-ws enLons 6Ut1aon nov o<pa;tu6wv. H Kap6LaKr1 WOfl eivaL K-corrn KUL
r!Jnt\aq>a-caL ornv np6o&-LU rll:llV IJ.011 IJ.aoxaAtai.a ;paiJ.IJ.rl. 2rnv aKpOaOfl OLa-
nwni.Jvetat Ka,\naonK6S pu&-116s Ka&ws en:ions oucrroAtK6 q>UOiliJ.a oc.petA611evo oe
t\evroupjLKrl avencipKLU 111S IJ.ltpOeLOOUS rl111S 1PL/AWXLVaS. lUXVrl ei.vaL ITLOfl<; 11
ave up011 11fCal:OIJ./Ut\iac;, tK1epou, aOKL til KUL 0t0rllla10S.
r. EpUOl:OpLUKU eupOUU1Q. lfAcA1po;.;apOtO)"ptifj1!JJia <PAet)OKOIJ.BLKrl taXUKUpOLa r1
Ko,\nLKrliJ.Up!J.apu/n. M11 t:LOLK<; 6ta1apaxes avan6Awons. -
A;.;-rt.vo)"pafl'ia ,9alpoAa Me1pia n ooBaPnlle;aAoKapo'ta, OUI..t<POPilOfl rwv nuAwv,
out\Ao!ri nAeupt UKOU U/POU ri TIV UIJ.OVLK6 oiOrl!la.
AtparoAo)"tAc~f c{crdoct.f.'npoOOLOpLOilOS nrAou avuOWIJ.U!WV evavu LWV (toiws
Coxsackie Kat ev1epmwv) Kat au1oavuow!lcinov. M1PI10fl otoripou opou KaL
OLOflpooeoiJ.t:UUKris LKav61:111as Kat npoo6toptoll6S ~upeoetOLKtiJv op!J.ovwv.
ITpoo6topt01J.OS OIJ.cioas ai~-tal:oc; Kat 1au1onoiflon HLA otouc; uno<.Pri<Ptous /ta
KapoLUKri IJeta!l6oxeuoJ1. Au1oavuow11a1a evav1i.ov 1wv Baptwv aAuooi.owv 11'1S
at\c.pa Kat B111a IJ.UOoivns aveupioKov-rat 111 01L/I.lrl1flS OLci/VWOflS ae AL/Ol:epo arr6
10 25% tUJV aO~VWV KaL fl napouoia l:OUS OUV00U.1Ul an6 UIJ..Vtl TtPO/VWOfl.
Hmr.ap6to}p'dfi'!JJ1a Auenon -cwv btaa-raaewv rns aptotepris KotAias r1 allc.porepwv
-cwv KOtAttov IJ.E. neptopto1J.vn KLVfl1lK61rt1a 1ou IJ.E.OOKOLAtaKou otaq>pci/l.latos Kat
tou Ol1lO~iou 10lXWIJ.a"Coc;. t\ettOUP/LKrl aven:apKeLa !llS' 11L!POLOOUS' h 111S
tPL/AWXLVa<; 0111V ee1aon Doppler.
.:ap6tt11\"0f Aa~9cl'!JptOClJIO> nve-rat j.l.l:cl l:flV Ol:U~E.pOTtOLflOI') 10U ao~E.VOUS ll.
OKOTIO:
a) Tnv erut)eBaLwon l:llS ota/vwons Kat 1:ov anoKALOil6 Ttt~avris Ol:e<pavtaiac;
v6oou.
B) Tov anoKt\etoll6 nt~avou aveupuoi.J.al:o<; l:f'1S apto-repf}c; KOtAi.ac;.
;) Tnv E.Kl:LilllOlll:flS ouvooou avenapKeias l:fl<; IJ.Ll:poet6ous Bat\Bi.oac;.
H IJ.UOKapOLUKri t)LO$LQ oev .Sewpeil:at Ori!J.E.pa anapail:fll:fl /La !11 OLcl{VWOfl tllS
owtauKris IJ.UOKapowna.Setas.
tl. I1p6]vwoq KaL ~epanei.a. H np6tvwon 1wv ao~evwv 11e 6tal:anKri ~-tuoKapotona
~eLa eeapl:01UL an6 1fl:V t)apUti11U tllS OUOAE.L l:OUpjiac; tflS aptotepris KOLAias KOL
rnv eni n:twor) rwv KOLALUKtiJv appu.SI.ltc.Ov. H il:ev-raetris erttBiwon 11 ra r11v
.1J.<pOVL011 OUIJ.<.j)OPill:tKrlS KapOLaKtiS avenapKE.Las avepxetaL 0 5CY/o.
H OUVtllPr)1lKri ~e-paneia Tt.ptAallBavL avanaUOfl KQL npOO.K1LKrl Ari4JI1 U/PWV.
21r)V nAeLOttJil<Pia nov nepL rt1woewv anaL 1ei taL 11 ouv6uao11vn XOPtl/1'1011
OL /'oeL VllS. OLOUpr,-cLKOU ( ouvn~ws c.poupooej.lions) KOL avaotoAa l:OU
IJ.t:l:atpennKou ev(u!J.ou 1ns a//Lo1aoiv11s. ITp6oc.pa1:ec; IJ.E.t\res 6et{av oto 10
npoavac.pep&ev oxr11la llTtOp<::i va ou11nAnpw~ei. 1.1 1f1V npooeKuKn xop~;non
avaarot\ew\' rwv B-abpevep/LKciJv uno6oxwv ( n.x. lll:onpoA6t\Jl ~ KapBeoLA6An ).
AvttnllKTLKil a;;w/n an:61o o1611a ln.x. Bapc.papiv11 ri aKVOKOUIJ.ap6Ail) artatteitat

2
.. ----'-~--~-=--"'-~--=- . - -~---_, ... _ --- -------~-

o-cav un:apxet KOA TUKri IJ.OPIJ.Op Lll'ri ri LOlOPLKO ()po!lBOe 1-l~OAL KOU ITL<JOoiou. rLU
IflV OV1lll1WTUO'fl1WV KOLi\LUKWV appU&IJ.LWV XOPfl/i tat 01-llC.OOUpOVJl KUL 01LS
ool)ap<; n:eptrnwoet<; E:IJ.<PUteuetat aut<)IJ.ato<; KapotOI-letarpon:eas amvtounris.

XapaKtrlP.L(E:tat an:o trw napouoia a;vtuotou at uoi\o;ias un:ep1po<pias 1T)S


apL01PriS KOli\ta<;, 11 on:oia ouvr)~WS a<popa 10 IJ.eOOKOLi\LaKO oui<ppa;11a KUL
At /OTE:PO ouxva 10 on:io-8-LO tOLXWJ.lU n !flY KOpu<pfl . .2to 70% TUN TIPL TITWOE:WV
K,\qpoYOI-leL taL J.le OU100WJ.lUUKO e TILKPUTOUVta xapaK1JlPU lle TIOLKii\ouoa
6tetoOunK61flTa Kat eK<ppaonK6t!lra: Me1ai\Aacets eu&uv611eves ;ta tflv n:a&llofl
~xouv ave upe~ei ota )'ovtow 1f1S tpon:ovi.vns T ( 15% twv ao~evwv ), TllS
OeOIJ.euouoas 111v 1-lUooivn n:purreivns C(10.15%J, 111s Bf11U-I.luooiVflS (3!Y--D) Kat TJlS
, ai\<pa-rpOll:OIJ.UOOlVfl<; (30/o). .
. A. na&opuowi\o)i.a. Ot 1-lUOKUpOLUK<; LV<; 1WV n:pool)el)Arntevwv TiepLOX(OV
ell'POYi{ouv avapxf"l OLLltOCf) KOL elVOL Bpaxeiec;, n:axtes KUL KCl10Kep1J.OUOIJ.EVe<;. Ot
npoa\la<pep&ei.OeS ai\i\OLW<Jel<; exouv OJ<; Ort01i\eOI.1U 1f1Y n:apci1UOfl1flS xai\UOflS
Kat tr)V aliCilOil 11lS oKi\flponnas tllS apwtepr1s Koti\ias. )'La TllV rci\r1pwof1 11lS
orroias an: at rouv1at uwfli\s 6taotoi\tKc; n:teoets. f\..61w rns 6taoro,\tKriS
Ouoi\eL10Up(LUI) 11 KOi\TUKJl OU010i\Jl XE:L 1.1)'Ui\f1 OJlJ.lUOia /LU IllY TIUPKrl ni\ripWOr)
TflS apLOTPJlS KOti\iuS KUL 11 un:wi\etci l:f)S ( Tr.X. KOi\ TrlKri llUPIJ.OPU/Jl Jl
KOATtoKOLi\taK6c; 6taxwptO\.l6S) ouvooeue-rat an:6 an6l:OI.lll ei\anwat') U)S KapotaKns
napoxns.
H OUOtoi\fl tr)S apt01:PrlS KOLi\iac; elVUl un:epOUYUj.UKr) KUL OtOUS Tieptoo6tePOU<;
ao~eveic; ro Ki\ao!la eCW~IlOflS un:ep5ai vet to 80%. H Kvwon tllS apw-repric;
Koti\ias Kata rr) 6tapKeta 111s ectiJX}I10I1S eivat n:i\npo1ePfl KaL 1axt:rrepn an:6 6n
o1a <puOLoi\o/tKci q:ro11a. E1m, 010 n:pc.Oto riiJLOU 11lS KOLi\taKriS ouotoAr1s e\w~ei 1at
tO 80% l:OU 0/KOU TtUA\.lOU 0111\l UTtep1pO<pLKJl l.lUOKUpOlOTicl~.LU vav1t 'tOU 57%
ata <puotoi\O/LKa a"COIJ.U.
~e rro,\1\ous ao&eveic; IJ. un:eprpo<ptKJl llUOKapowrra~eta unapxet urwBa/\l)totKri
KAior, nLeo11s Ka1a 1r, 6tapKeLa tllS ouo-coi\flc; C=KALoll n:Leor,c; ue-caeu xwpou
LOOOOU Kat xwpou e\66ou (lpl<Jl:epf)<; KOLI\tac; ), O<petA6!-lYfl ae an:o<ppa\n tOU
xwpou \OOOU Tf1S upLO!epflc; KOLi\ias. H te.\eu1aia Or)~LLOUP/eltat an6 10
uneptpo<ptK6 llOOKOLALuK6 ota<ppa)'IJ.O Kat tr,v npoo~ia ( rcpos 10 IJOoKot,\LUK6
oui<ppu;l.la) KLYr)Or) t!lS llLl:POetoous 5ai\5i6ac; Ku-ca 111 otcipKc:ta -ens ouo-ro,\ris. H
rta~oi\o/LK!l autri KLYflOI11llS 1-lttPOetbous an:ooibetat: a) otf']V U<!JrJ,\~ raxutf']-ca
pons -cou at!la-cos otov 01ev6 xwpo e\66ou IllS aptotepfls KOLAius Kata 111 btapKta
lflS KOLAta~-. r,s e\w&r,or)s, lle an:orei\eoua 111v avappo<pnon tflS Ba,\Bioas npos to
!-leOOKOLAtut-..6 6ta<J)pa/llU A61w <j)UlYOIJ.vou Ventouri Kat l)) OTilV A\11111S BaAl)ioas
a n:o uvtiJ~Ju\ous ~ll,\OeLOe'Ls IJ.US.

3
'"'- .
- --~ __ <;:__ ___
- -- - --- - - - - - - - - - - - - - - -

B. K,\LVLKci eupQua-ca. H n:ci~r1011 ouxva OLUOPci!leL aOU!JTL1W!lanKf). Ta ouvq~~otepa


OU!JTHW!JQLa ELVQL 11 OUOTIVOLQ 0111V KOTIWO!l, O<peLAO!leV!l OTI1V au(fl011111S
reAooLao-coALKrlS nieO!lS 111s apLO-cephs KOL\Las Kat 11 Ot!l-&ci!X!l. H te.\eu-cata
ocpeit\TUL 0 !JUOKUPOLUKrl LOXULIJLU, ITPOKUAOUIJ.Vf1 an:o UOUVQIJ.lU TWV
o-cecpavwtwv apT!lPLtuv va -cpocpooornoouv !l en:apKf) nooor11ta ai~-taros Kat
o\u;ovou tO un:eptpO<pLKO IJ.UOKcipOLO.
~r11v KALVLKrl e(-caofl 6tanwrwvovrat: a) OtK6pu<pos Kapwn6tK6s o<puj!JOS. B)
unepouva~-tLKrl KaL 6tnAr1 Kap6taKr1 wo11 A61w tou ltJnAa<pfltou reraptou KapotaKou
r6vou. )') tE.raptos KapotaK6c; r6vos OtllV Kopucpn. 6) 1J.Ooouoto,\LK6 cpuorwa
\W&!lO!lS OT!lV Otia UKPOU011S TllS aoptfl<;, o<petAO~JVO OT!lV OtpoBLAWOI1 POrl tOU
ai~Jatos otov xwpo e\66ou 111s aptotepns KOLAi.as Kat e) oAoouoro,\tK6 <p UOI11JU
avenapKeia<; ti1S Ill tpOLOOUS Otr)V KOpU<J>rl.
Ot Kap6taK.S app u~!Ji.es anort:Aouv 111 oo()ap6tPI1 TIL nAoKr1 tllS urrcptpO<pLKrlS .
!lUOKUPOLOTtai)etas. H KOATILKrl !JUPIJUPU/rl !JT!Opei va n:poKaAoeL oeeia
ITLOLVWO!l TI1S K'ALVLKrlS LKOVa<;, VW OL napO{UOIJ.LK<; KOL'ALaKS appU-&jJ.t<; (ci,\11.
OU)'KOTrtlKcl TILOOOLa rl aLq>Vi.OLO -&civato.
r. EpyaatqptaKU upOuata. /1eA1POI.''tlP0!0/POf/'!JJia. Yn:eprpo<pi.a aptorepris
KOL'Aias KUL apLOtE:pou K6An:ou. KoAn:LKflJ..Lap!JOPU/rl rl KOLALaK<; appU~!li.e<;.
:I
.
,1:

AKavo}'pa(j)ia ,9aipo;...-a ~uvn~ws ei.va1. ~umo,\o)'LKfl. I!


HxoKap6to)"pti(,t11JJia 0teL til 6tci)'VWO!l. ITapatf)pei.tm aOUIJIJ.tPTl un:eprpoq>La l:flS I~
apLOrepns KOtXta<;, n on:oia a<popci Kupi.ws to 1J.OOKOLALaK6 6tci<ppa)lla KaL ii
ALJ6tepo to orri.oiho toi.xwJ.la. AAAa flXOKapoLO)'pa<ptKO: euprwata eL vaL 11 npoo{}ia
OUOtOALKrl Ki vr1011 tllS J.lL tpOLOOU<; ~aAI)i.oa<; KOL f) J.i000UOtOALKrl OU/K'ALOI1 l:r)S
aopuKhS l)a,\Bioas. Me tllV e\etaon Doppler J.lrtopei va urcoAo)LOtei 11
un:o()aA()LOtKri K,\i.Of) TIL0!1<;.
.ap6taAof ~.a,9ertJptoopo>. !J.ev ei. vaL ava)'Kaios )'La va te{}eL 11 OLU/VWOI1. l"CilV
aptateph KOLALO/pacpia 1.11topei. va own:wrw&ei urceprpo<pi.a rwv &nAoetowv 1.1Uc.Ov
KUL OUOtOALKrl an6cppa{!l tllS aptotPrlS KOL'Ai.a<;, VW OtflV aLIJOOUVUIJ.LKrl llAtl1
OUOtO'ALKrl K,\i.of) n:i.Of)<; J.lta\u tOU XWPOU eLOOOOU KQL tOU XWPOU (OOOU "CilS
apLOtepns KotAi.as.
D... llp61'vwoq Kat {}epan:ei.a~ H etnma i)vfltOtflta oe ao{}eveis 11ALKias Kcitw ttov 14
etwv avepxetaL oe 5.9% Kat oe ao&eveis !lALKias 1545 etwv oe 2.5%. H n:pO/VWO!l
eivat 6uO!l\'llS 6tav: a) 11 n:O:{}!lO!l eKO!lAtiJvetat oe llLKPrlllALKia, 13) 11 n:pw-cq
K6ri,\WOr) el vat OUjKOTitLKO TILOOOLO, ) ) UTiclpXL OLKO)VLUKO LOTOplKO
ULlpVLOLOU &ava"COU OtpL'AOIJVOU 0 Urtptpo<pLKrl IJUOKUPOLOn:a{}eLa, o)
QV upiOK l:Ql 1-111 1J.!JVOUOU KOLALOKrl tUXUKapoia ( =pL Tirl KOL,\LUKrlS taXUKUPOlUS
IJ 6tcipKLa 30 sec) oto flr\eKtPOKapOLO)'pcicprwa n:apateta~vns ou.lpKLUS
(Holter), e) rrapU111PL"CUL aouvallia UU\!lO!lS ri Kat ntWO!l tllS UPti1PLUKrlS rtieoqs
Ot!lV KOTIWOfl KUL Ot) 11 TIU~f)Ofl ocpeiAetaL 0 OPLOIJ.VS !JtUMa{LS. 6TIWS ";'lU

4
rtapaoev;ua eKE:LvE.~ n:ou a<popouv 1:0 /OVtOto tfl~ tponovtv'l~ T.
~1:ous OUJ.lTCIWIJUrLKou~ ao~eveis xoprr;ouvrat <papiJaKa ue apvrrnKri tv6rpono Kat
~paOUKUpOLUK'l OpUOfl IJE: OKOTI6: a) tflV e,\aTtWOfl l:fl~ V1UOflS TflS jlUOKapotaKri~
ouo-roAr)c; Kat Ilfc; an6tppa~f1S otov xwpo e\66ou tllS apw-reoris KOLAias Kat ~) trlV
au(rwn lOU xpovou IllS OtUOtOt\ris Kat ws E.K l:O(rtou lr)V BeA1LlOOf1 TllS n:AripWOifS
KUt IllS UtiJUl:WOr)S 1WV KQL,\LWV.
'i'apiJUKU E.KAO!riS Sewpouvrat Ol avaol:oAeis twv B-aopE.VP/'lKWV unoooxwv (n.x.
J.1E.10TIPOA6An ri a-revoA6An ), Ol onoiOL on<; OUOKOAes TIE.PlTHWOE.lS ouvouaCovraL
J.le Bepanaui ..\n (av1a;wvto1ris aoBeo-riou lle apvnuKri tv6-rpon:o Kat apvrrnKr1
0P01101POTIO 6pao,.,) ri TflV owonupauiofl (avnappuif!ltK6 1.1 lOLOTiltE.S KUTfljOpias
'I a KUL I I I KUl:U Vaughan-Williams IJE. E:VtOVfl UPYil"CLKri tV61porw opaofl). 2tous
. aoiJE.VE.lS llE. KOLAtaKS appU~IJlE.S 010 f]AeK TPOKapOLO/Pll<PJll.lU Holter np.rcet va
xopn;d -rat ouv6uao116S avaotoAa rwv B-aopevep;tKri>v uno6oxwv llE.
a~-ttw6ap6vq (avuappuiflltK6 IJE. tl>L6trr-res KU1f1/0pias I I I Kata Vaughan-Williams).
TAos. otous aoSeveis IJE. ou{KonuK6 eneto66to otpett\61J.evo oe KotALaKri
,., lUXUKapoia n:prtt va E.~E.taotei tO E.VOE.XOJ.lVO J.llj)LltU011S aut61.la!OU
Kap6tOJ.l1aTpon:E:a antvt6wtri.
En:i anotuxia~ Tf)S <j)ap1JaKE.U1LKrlS U/W/riS unapxouv OL eer;s evaMaKnKE:S AUOet<;:
a) Eu<Putc:uon KoAnoKOLAtaKou BllJ.1Uto661Jl (to KoAntK6 f)AKTp66ta el..l<PU1eue-rat
010 OE.~L6 K6Ano Kat to KOlALaK6 OlflV KOPU<Pri lllS oeeta~ KOtALas). H
n:pot<aAOUIJVfl J,I.E.l:cl tllV tono-&11j0fl !flS OUOKUtiS aMa{fl l:flS OOOU U/W/riS l:OU
nAeK-rptKou epe~iolla-ros exet ws ano-rAeo11a rl)v ueral3oAri rns KLVflons rou
IJ00KOtALOKOU Ota<ppa;IJ.atOS KUL 1f1V et\ar-rwon llfS unol)aABtOLKriS KAt<JifS TCieor)<;.
0ewpei -rat ao<paAeo-repn J.l~o6os an6 11lV xetpoup[tKrl en11Baon (6e<; napaKcnw)
Kat anote,\ei tnv -&epartLa KAo;ris 010US nALKLWIJVOUS KUL 0 KL VOUS ll
aven:apKLa tllS Ill !POLOOUS.
B) ITpoKAI)Oil eU<PPaij.laros -rou ~eooKotALaKou 6La<ppa(l.laros. Ent-ru;xavetat l.le
e;xuon aAKo6Ans 010V npwro Olatppa;J.LatLK6 KAaoo lOU np6o{)LOu KU1:LOV1a Kala
111 ouipKta KUPOLaKOU Ka~E.lllPLUOI.lOU. H ~-tE.&ooos BPLOK1aL OE. TtLPU11atLK6
olciOto.
1) Xetpoup;u, ri ll uoto~ri/ ll ueKtOJ.lri. IT poKaAei llE.';aA utepn eAanwon rf)S
unoBaABt6tKriS KAions nieor)s an:6 -rnv KOA n:oKoLALaKrl Bnl.lato66-rnon Kat ws eK
l:OlJ10U anort:,\t 1'1V ~paneia KAO/'ri's 01U va atOI.la TIOU 1.l<paviCouv
OTr)~cl/X'l. OUOTIVOLa ri OU/KOTtttKci E.TLLOOOLa Ttapa tllV evTOVIl <papiJUKE.UUKri
U/W/ri. ~uxva areaL td tat f1 taut6xpovn avrtKataotaon 11lS I.J.ttpoetoou<; BaA~i6as
Ao1w onuavnKriS avenapKeias. H XeLpOUP/LKri -&vntouna exet eAattw~ei
OfliJUVrtKci 1:a 1:e1\utaia xp6vta KaL eivat ~LKp6tepn an6 10%.

5
l

!
l
I

Ta ouvll~otepa aiua nepLOptOUK~S IJ.UOKapbtonci~etas eivat ll OLI.I.OXPWIJCHWOll, 1o


or.:Allp66cp1J.a, ~ OIJ.u;\oeiOWOll, 11 oapKoeiOWOll Kat ll evOOIJUOKap6taK~ ivtooll. H
1,\eutaia. ovo1Ja(61J.Vll Kat ev6oKap6i us Loeffler, napa1llPi 1at ouxvci ons
tpontKS XtiJpes, npoKaAei an6<ppa(fl twv KOLAtwv Kat ouvooeue1at an6
flWOL VO<ptt\ta.
A. I1a~o<puatoAo'Yia. Eivat nap61lOLU IJ. KelVfl 1f1S OUIJ.TitCHtK~S neptKapOi noas. H
xat\aoll 1wv Koti\twv eivat <puatoAo;tKtl ai\Aci o1a 1-1oa 1llS Otao1oi\~s m KOLi\ies
eivat avv6o1es. Eiat, 11 KOtt\taKr1 ni\flpwoll eivat apxtKci Iaxeia ai\i\a OtaK6nte1at
an6101.10 010 1.100 IllS 0Lll0101\fls IJ anoii\Oj.la KU1cl 1f1V IJ1pf10ll IllS
Ota010ALK ns KOtAtaKr1S nieons O"'COV KapotaK6 ~<:a-&IflpLaOIJO va napau]pei tat 1'0
Of11Jl0 tllS ''teipa;wvtK~S pi(as" (dip. and plateau), OUVL01'cl1JVO 0 apxtKtl arc6tOIJll
au(flOJl Kat Oill ouvxeta entn6won111S otao1oi\tK~S nieons.
B. K\tvtKci eupriua1a. Ot ao-&eveis 1J<pavi(ouv OUIJIPOP!lLLKrl Kap6taKr1 avencipKeta,
O!pti\OIJVfl 0 OtU010i\LKrl 0UOi\t Ioup;ia 1WV Koti\tWV Kat Ill OUV006 UU~I'']Ofl1f1S
btaoioAtKrlS nieons. ~uvn~n oullnHilllaia eivat n ouortvota ~ n K6n:tooll Katci tn
6tcipKeta IflS K6n:wons. 1111v avnKLIJVtK~ e(IaOI1 otanto"Cwve1at au~flOil IflS
KV1PLK~S tp,\el)LK~S Til0flS, V10Vfl Kcl~OOOS y O"COV 04)0/LUOLKO OtpU/IlO, Of'lllt0
Kussmaul ( =-aU(flOfl KV1'PLKtlS <pi\e~tKrlS TIL0f1S ll l:flV tOTtVOtl) KUL rpi !OS ~
r!ap10S KapOtaK6S !OVOS O!flV KOpU<ptl. 1rous ao~eveis ll UIJUi\oeiOWOil ~
oapKOtOWOI1 OU)(Vtl eivat 11 UVUpOfl <pUOflJ..lcl'LWV nai\tvOpOilfl<JflS 'tflS lll1POt00US
r1 IllS 1pt ;i\wxtvas ~ai\~ioas. TAos, llrtopei va cll<pavtcnouv ~poiJBOel.l.~oi\tKci
TIL000ta Ol:flV OU01'1lllaUKrl rl 'tllV TIV UllOVtK~ KUKi\o<popia O!pti\OIJVa O"CflV
an:6onao11 ~p61JBwv an6 1ous K6i\nous r1 ns KOti\ies.
r. Ep-yao!optaKci eupriua1a. HAcll:-rpoKapoto}'ptifJ'flJia Aveupeon KUilci"Cwv Q o-cnv
a!Jui\oeiowon r1111 oapKoeiowofl, ta onoia IJTIOpei va npoKai\oouv ou;xuon IJ
<ppa;1.1a tou IJUOKapbiou. Koi\n:tKtlllUPJ..lapu;n.
Ar.:-rtvo;-patf'ia t'}a/paKa IlveullOVtKil OUJ..l<p6pnon xwp'ts fliJ lltKpou Ba~uou
KapOLOIJ/ai\ia. _
Hlot...-apoto;rpdf/'tJPa 1UIJIJ.1'PtKrl ncixuvon 1wv KapotaKwv 'LOtXWIJci'twv, 6tcitao11 rwv
Kap6taKwv t-:m,\oir11wv Kat oe optollves neptn1woets otcixurn unoKLVIloia.
A(ovtAlJIJ pa>-v!Jr~nj ropo;-pafjJia Ertnpnouv 'tflV ota<poptKtl Otci;vwofl arc6 Hl
OUIJ. TIL01LK~ n:eptKapOi UOa 01f1V anoia napa'tflpi 1UL TiclXUVOfl tOU TI eptK apOLOU.
l.:apotaAo> ;..ac'hrtJptaCJpo~ 81et 111 Otci;vwo11 'tflS nci~llOilS an61a
n:poava<pep~ev-ra atiJOOuva!JtKci eupfllla1'a. H evOOIJUOKapbtaKillltowia 1.mopei va
oullBcii\;\et 01:llv ow<poptKrl Otci;vwon 1J.'ta(u -rns neptoptonKr1s IJUOKapbtonci~etas
Kat IllS OUIJ ITL0UKtlS TIPLKap6i UOa<;.
Li. fipOi'V(()Or] 1-.:at ~eparreia. H IJOf'] ent~iwor, '[(JJV aa~evwv, eeaptWIJV'l ana rnv

6
~--. - ----. -- --

UITOKE:Ll..l.cVfl \!000, OUVfl-3-W<; UVPXcl:Ul Ot:. eva XPOVO UITO Tfl <..HL )'~fl TJl<; OUl)'YWOfl~ .
."::-cous ao&eveic; ~ ou~<POPflHKti KUPOLUK!l averrcipKeLU o<pctA61J.WJ oe. U!J.u,\oc:i-
owor) ~.at\;\ a ~-ca()o,\LKcl voo~~U"'[Q XOPfl)'OUVl:Ul OLOUPflHKa )'LU l:flV UVUKOU<PLOfl
arr6 Tr)V 0 UOITVOLQ KUL avn ITr)KUKci \O)'W TOU KLVO UVOU -3-poj..J.(30~(3o;\LKWV
ITL000LWV OTr)V ITVU~OVLKtl ~ 1'fl OUOU11J.U1LKtl KU~;\O<popia. H XOP~)'flOfl
OUKl:U,\i noac; UV1VOLKVU1Ul 010US aoDVt) ~ a~u\otOWOr). ~l:fl\! VOOKOPOLUKI']
LVWOfl Hl OUV00UOf.lVfl Ul10 llWOLVO<pLt\ia XOPfl)'OUVl:OL OTp0LO~ ~ KUHaporoetKti
<papf.laKa, 1a orroia f.liTOpi va n:t5pa6uvouv l'llV ~Atell11lS v6oou Kat va
TIL<ppouv ou~n:1Wf.lU1lKti avaKou<pLOil. TeAos. ons oo5apes nepLT!1(1JOLS
VOOKUP0LUt<..~S LVWOflS ll XLPOUP/LKri K10f.l~ l:OU LVWUKOU VOOKapOLOU L VUL
ouvarov vu n:poKat\Ol ~kA1iWOfl11lS OL0010i\LK~S rr.\~pWOr]<; tc.OV KOLAuiJv.

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7
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4. ~TE<I>ANI AlA NO~O~

H ote<pavwia voao~. 11 a&rwooK,\r1puvon nov OTE:<pavtatwv apu)pLt0v, eivat 11


auvr)&E:otepn at tta ~avarou orov avartttJ)'~E:vo 1\0o~o.

Ot <pumo.\o)'tKE:s l.l.UtKE:S ap-cnpies. ous onoies neptt\a~Bavov-cat Kat Ot OTe<j)a-


vtaic:s. UTIOTAOUV1Ql an6 ueaa (an6 10V au.\o) npos -ca e~w uno 3 XLtW\1<;: Tov
eoa1, a<popt(6uevo npos -cnv nAeupa -cou auAou an6 -co evoo~~t\to Karw ano to
onoio CpicrKetat 10 .ow eAacrnK6 netat\o, 10v pc'ooKat --cov c'(aJxnwva. ~ta
ncuoui KUL cre veapous evnAtKes o eaw XL --cwvas ei vat An--c6s Kat neptexet I.J.LKp6
apU)u6 Aeiwv I.J.UlKwv Kutrapwv. Ouws ue -rnv napooo tou xp6vou --cooo -ro ncixos
6ao Kat o apt&~6s rwv neptexou.vwv Ku-crapwv au{avouv. T6cro orov eaw 6oo Kat
10\1 1100 XL 1WVa 0V UTI:UPXOUV LVOIJ.\ci01S OUS tpUatOAO/LKeS UP1flpiS tWV
SnAaOUKWV. Ot -reAeu-caiOL UVtJf)iOK0\11QL IJOVO 010V .\w xnwva.
H n:pwtiJ61'ePfl 0Aa0nrns a&npocrKAr1puvof1S eivat 11 Auroet6;js- J'pdppa;o;; Toutn
anoteAeL ecrttaK~ n:izxuvcrfl rou ow xnwva KUL ouvto1atat an:6 a<ppw611 K(rnapa
KUL Aeu<poK unapa T. Ta a<ppWOt'} Kutrapa ei \IQL I.J.UKpO<j)U{Q rl Aeia IJULKQ Kun:apa
neptexovta I.J.e/aAn nocr6r11ta xoAfl01'ep6Ans npoepx61lVf1S an6 o\etbwiJ,eves
At nonpwteives XU1Jt1Ar1s rcuKv6tntas (o\eLOW1Jves LOU. t\trcoetoeis /PUI..UHiloets
~omopel va aveupe&ouv o--crw aop--c~ oe atOIJU t'}AtKias 8-18 e--cc.Ov Kat us
ote<pavtaieS aptr)pies ~e--ca tflV nAtKia nov 18 e--cwv KUL IJ.XPl tt'JV 311 oeKaetia -ens
(w~s. Exouv KL 1PLVWT!O XPWI-lU, oev n:poKaAouv et\a--c--cwan t!lS OLU!letpou rou aut\ou
1llS npooBei3Arwevns 01<j)QVtaias UP1'1'1PlUS KQL oev e\eAiooovral TIUV10t 0
ano<ppaKttKs BAaCei (oes n:apaKa--cw).
H tvaJ6etr n>lti;..-erexouv XPWila AeuKwn6 Kat apxiCouv va e~paviCov--cat ornv nAtKia
U0\1 25 1WV, OtOUS TIA!l-&UOilOUS 6nou ll en:i TI1WOr)111S a&rlPOOKArlPUVOt'}S ei VUL
1..1/UAfl. H napouoia l:OUS exet ws an:ort\OJ.lQ 1f1V eAartWOfl Tr)S OLQ!letpou rl KQL
rnv art6<ppa{Jl rou auAou rou Of'/eiou. H O!lJ.lLOUP)'ia rous o!peiAetaL 01flV
npooK6AA!l0ll ULIJOTt1aALwv 01LS Al n:oetOeis /PUIJ.IJWOet') KUL trjV KKP~Ofl an:6 au1a
avarttuetaKW\1 rtapcu6YtWV (aLJ,.lOTI1aALUKOS UVUTHU{LUKOS TIUPU/OVHlS (POGF),
en:u)epiJLKOS avan:ruetaKOS napa')'OV1US (EGF), ~-avan1'U~LUKOS napa{OV1US
IJ.1aaxrwauo~ou ( TGF-~) Kat OWIJ.U10J.le6i vn ). Ot teAeu-caiot npoKaAouv
1..1tUVQO!UOfl HOV t\ei.wv IJ.ULKW\1 KU11UpWV UTIO 10V J,.l00 OtOV OW XLTWVQ KUL
6tc:;etpouv Tfl auv~eO!l KoAt\a{6vou, eAaori.Vt'JS Kal ')'~UKOTIPW1tvwv. Ot npw-
tetV<; au-res anoret\ouv 111v ~eJ.lt\ta ouoia 1f1S tvwoous nAaKas OtllV onoia
evan01:t&vtat orn ouvexeta KpuotaMm Kat eo--cpes xot\r)a--cepot\w; npoepx6-
i
1
I
i
~cvOL cttc arro ns LDL eire arr6 eKtpuAt(6~eva acppwon KLrn:apa. Ta Atn:iow Kat n
~eiJ.er\ws ouata rns LvtiJ6ous rrAaKas KaA urrrovraL ano LvopuoiOtJI<:tir;Ja. arro-
t<:.Aou~eVfl an:o \eta ~ULKU Kllttapa, Kot\,\U[OVO Kat Ilia onl)aoa eVOO~fl,\LaKWV
Kuttapwv.
Ot tvt06cts rrAa~<es n:ou npoKaAouv IJ.e;ciAn orevwo1 rou auAou rrepu~xouv ~e
;aAutepn nooorqra ~e~e,\tou ouoias Kat lltKp6repn nooo-cnra ,\inouc; ana eKei-
vec; nou npm~a\ouv ~tKpou l)a~~ou otvwon. Ot napa[ovrec; nou Ka~opi{ouv -cn
OUV~eon rns LV(LlOOUS nAaKUS OeV exouv anooalpf1Vl01ei nA~pws. <PaiveTaL a~ooc;,
on to rreptexo~evo u1s rrAaKac; oe At niota ei vat avaAoro 1r1s xoAnotep6Ans -cou
opou. H xo,\no-cep6Ar"J IJ.eta(pepetat ouvexws ~ecra KUL e~oo arro tflv tvwon n:AaKa. H
eiooooc; rL ve1at ~e tflV ~OP<Prl -cwv LDL Kat TflS At nonpw-rei VflS (a), n on:oia ei vat
napo~ma ~e rnv LDL at\Aci rreptXet ertL npocr~nos tnv an oAt rrorrpootei vn (a). Ot
\t nonpwtei vee; ul!JnAr1s rruKv6-rfl-ras (HDL] ano~aKpuvouv 111v xoAno1ep6An an6 1a
atpptoon Kunapa Kat o-rn ouvxeta enavetaepxov-rat o-rnv KuKAocpopia, 6nou
~e-racpepouv 1f1V XOA!l01epaA!l crus LOL Kat 1LS AtnonpW1eiVS rroAu xa~!lArlS
n uKvorntas (VLDU. Ot reAeutaiec; ~e-racpepouv l:fl xoAncr"tepaAn o1:o f) nap.
Ot cnurc!llc.YjlcTc) !l1ld;..e~ 0 apL~~os l:WV on:oiwv aueaveL ~ 1f1V flt\LKia,
xapaK TflpL(OVtat ana VeOtiJ)'eiaJOIJnOU eeKLVcl 1:000 an6 11V nAeupci tOU au,\ou
000 Kat ana l:flV n:Aeupci IOU ~ecrou XL -cwva KClL ana !f1V rrapouaia llelo.p(.()TLiiOU
llu,o;jvan.\ouOLou oe ,\t niota. ~uxva evano-ri~etaL aol)eo-rto. lUS ent nenAer-
~eves n:AaKeS napatflpOUVtaL eeeAKWOLS rl KCll. pf)eeLS 1f1S LVO~UWOOUS Kaq>ac; l..l
anotAeo~a 10 ~po~l)o(6vo uAtK6 nou neptxouv va pxetaL cre enapflJl 10
ai11a Kat va oxn~ati{ovtat ~P61.ll)OL. Ot teAeu-raio~ l.lnopei ei te va npoKaAeoouv
an6cppa~n t!lS aptf1piac; ei ! Va Op(aVW~OUV Kat va npoKaAOOUV auenon 10U
naxouc; rns nAaKas Kat ws eK -rot:nou et\a1:1:won l:!lS 6tal.lrpou -cou auAou l:flS ap-
tflpiac;.
Ynapxouv noME:s ~ewpiec; (La 1ous ~r"Jxavto~ous l..l 1:ous onoious avantuooovrat
ot npoavacpep~eioes a~npooKAflpuvl:LKec; l)Aal3es. H entKpal:oucra ei vat eK ei vn 1f1S
"anavr;JO!Jf oc rpavpartopd', OU!l<Pwva 1.1 tflV anoia 11 6A11 6ta6tKaoia apxLCet
net ta an6 rpau~aUOIJO tWV VOO~I1AtaKWV Kunapwv, 0 onoioc; npoKaAel.
oo~tKE:c; Kat ,\<:.t roup[tKec; 6tatapaxes ota ev A61w Kut-rapa. Ta ai ua rou
-rpau~ano~ou etvat not\Aa Kat cre au1ci neptAal..ll)avov-cat n unep-caon. n xp6vta
unepxoAncrtepoAat~ia, ro Kanvtolla, o oaKxapciJO!lS btal)~rns Kat otacpopm
~LKpoop[avto~oi. 6nws ra xAal.lliOLa TflS nveul..lovias, ot toi Kat 10 E. Pylori. Ano-
tE:Aeo~a 10U tpau~a1LOI..l0U 1WV VOO~!lALaKWV KUHapwv e'tvat ll e~ao~Vt1011111S
~po~Boav-rLo1aons (av-riotaO!lS ou1 Ofll.lLOUPria ~p611l)ou) Kat n au~n~evn 6tarre-
parcnnta rns evoo~nt\taK~c; oul3ti6as.
H e{ao~vnon rns evoo~flt\LaKrlS ~po~~oav-rio-raons ocpeiAe1at o-rnv eAanw~evfl
ouv&E.Ofl IlllV -..\ut-..on:poo1LVWV KaL TIPW10(AUKQVWV TtOU TtVOUOUV 1a

2
,- __. :_-::. --- --. - -

cVOO&flt\LaKa K Unapa Ka&WS E:TILOflS tllS rtpOOtUK UK,\t VflS ( PGI2) Kat taU VOO&fl ~
,\LQKOU n:apri)'OVta xaAaons (EORF). Ot ouo 1'r\U!atS OUOLE:) E:KTOS an:6 TflV
LOXUPrl U')'jLOOlU01a,\ ttKri !OUS OpriOfl avaot"E:,\Aouv TflV npooK6,\AflOfl tcllV aq.lo-
n:eraAiwv oro aprnptaK6 -coixwJ..la. Eeat\Aou. m I.J.ta~oAs rns ownepa-r6-crrras tllS
c:v6o&ll,\WKrlS onB6.6as exouv ws an01:r\eo1.1a 1'flV eLoo6o ,\tnonpw-rE:tvtov Kat
Q.A,\wv ouo-ranKwv tau n:Acio1.1a1os 010 -roixwlla -rwv apttlPLWV. Ta rrpoava<pep-
&E:v~a OLOOUV tO evaUOIJ.U /LU HlV ai\Af1i\erciopaofl TWV Ota<p6pwv OUOtUtLKWV IOU
rtt\6.oi.J.U10S, 1WV aq.lOIT1UAtWV KUL 1WV IJOVOKU11UPWV/IJ.UKPO<pa;wv I.J. 10 \100-
&riALO ri 1ov unoKeiiJ,evo ouvoenK6 to16 (Kupiws KoMa;6vo) Kat 1tlV OfliJ.LOUP/'ia
tWV a&f1pOOKAflpUV1LKWV ~Aa~WV.

~1IPOVlOLU porj

Ka&opL(1UL ano ns QVU/K<; tOU IJUOKap6iou 0 oeu;6vo, WOt va OLQttlpettat fl


LOoppon:ia l..l1aeu rcpoo<popas Kat KatavaAwons oeu16vou. 11 orcoia l..lera0riMetat
avaAo')'a IJ. 10 napa')'WIJ.eVo an6 111v Kapoui llflXUVtK6 p')'o.
H m:e<pavwia pori (.~P) LOoLrtat l..l 10 n11AiKO tns OOil/OU n:ieons (OfT) npos IflV
av1iotaoll (R) or11 pon (~P==OIT/R). H o6r;7d> [{/cor;eivat n ow<popa nieons n:ou
OUVH\Pl 111 POll OHl 01e<pavtaia KUKAo<popia KUL LOOU1UL IJ, l:fl 6ta<popa !flS ~.tE:OflS
n:ieof1<; HlS aopiriS J..liov 1flV nieon1ou o!e<pavtaiou K6An:ou. H avziOrao!Jeivat 10
ci-&pOlOJ..lU tptWV OUVl010JOWV, R1 +R 2 +A 3 , OTIOU, RfLVUl ,fl avtiotaon OtLS 1..1/Ut\<; !I
TILKap6teS UPiflPl<;, A2:LVOL fl avti01CWf101U n:pOtPLXOlOLKQ aptf1pt6Ata, Kal R3 :
fl UV1lOtUOfl, 11 O<petAOI..lVfl 010 VOOtOLXWJ.lULLKU ote<pavtaia 1PLXOL0rl Kat ll ortoia
au{aVL K01U !fl OtapKLO !flS OU010ArlS A6')'W OU~Til0f')S an6 tO OUOTIWI.J.\10
IJUOKapota.
~-ca (j)UOLO,\Oj'LKU CHOila'r' 11 O'"Ce<pavwla
- .
POrl n:apa!lVL o-ca&epn ')'LU tL1..1S oornou
TtLE:OflS KUI..LOLVOIJ,Vf1S; an:6 50 mmHg WS 120 mmHg A6')'W 1f1S opaor,s au-rop-
pu&l..ll01LKWV l..lf'lxavtOI..lWV, nou tpon:orrotouv tf')V av-rio"Caof') (Kupiws tnv R2 ) OtflV
ote<j)avtaia KuKAo<popia.
H orcrtavtaia crpcr5pcia polj.reivat ro nf')ALKo tf1S J..l7tO"Cf1S ote<pavtaias pons 111s
ent tu;xav61J.eVflS lle a;')'eto6tao-cot\ri ( n:.x. OOJI..lULlKtl ciOKf'IOfl, ev6oo1e<Pavtaia
XOPfl/flOfl U0VOOlV!lS ri nan:a0epi V!lS) rrpOS "Cfl ~UOlKrl POrl flP1J.lOS KUL !l 1Lil~ IOU
010 <puoLOAO)'LKU QIOI..LU avepxe-raL 0 2-5. H 01(j)UVtaia e<pe6pla apxi(et \IU
lletU:Neiat A6;w er\anwons tllS l..l/LO!f1S pons 6rav unapxouv o1evwoets. nou
T1POKa\ouv et\UH(LJOfl !flS 0LOI..ltp0U !OU aut\ou "LOU Qj'j'LOU KU1U 5G60% ri KUL
n:epwo6repo. Eeav1Anon -rns o-re<pavLaias e<peopeias Kat et\cinwof1 rns ore<pa-
vtaLas poris 11P1ltaS n:apatnpouvtat oe o1evwoets nou rrpoKaAouv eAanwon n1s
Ota!Jc rpou IOU aur\ou 10U U')'')'LOU Kat a 90% rl KUL rtepLOOOtE:pO.

3
i,_-.

MuoKapbtaKO Loxatuia

H n:pm:a,\ou~c.vn a rro -rnv c1\anwon -ens o-rc.<pavtaias pons uuoKapcnaKn wxaq.J.ta


~Xct ws arrore\c.o~a 1qv qt<pavtoq OLa1apaxwv 11lS IJ.cl:aBo,\tK~S. 1.1.11xavtKI1S Kat
11,\c.Kl:PtK~S Act -roupjias -rou I.I.UOKapoiou.
A. Mc.ta5oAtKE.$ 6ta-rapaxes. Ot XPilOLIJ.OTIOLOui.J.eVe<; ano -co IJ.UOKap6to ouoies /La
-cnv napa/W/11 evE.pjetaS TIOLKL\ouv avai\o1a Jle us ouv~~Ke<;. E-cot, o1a cpum-
o,\O/LKa a101.1.a o ue ra~ot\LOIJ.OS -cou I.I.UOKapbiou c.ivat ae:p65to<; Kat rrpoe~apxet 11
KQ1QVCu\WOI1 e,\eu~epwv i\tnapwv o~E.wv Ue1U ano Yl101eia, /AUKO(fl<; I.I.E.ta an6 1:a
/E.UI.I.ata Kat -;-a,\aKTLKou o~eos Kat e,\eu~epwv Anrapwv o~ewv Ka-ca 1fl btapKta
OWIJ.Q HKI1S QO!-.:IlO!lS. 0-cav UTLUPXE.L l.lUOKapotaK~ lOXQLIJ.LQ 0 1J.E.1U~Q,\LOIJ.O<; l:OU
uuoKapoiou ;iverat avae:p65tos Kat n:apa1npe:i-cat -con~Kri ouoowpeuo11 ava~ei-
6w-cwv npot6vnuv -cwv c.Ae:u~E.pwv Atn:apwv o{ewv. ~e n:eptnrwoet<; oat)apris t-
oxatuias ( n.x. rrpwtull cpaon o~eos eucppa/ua1os -cou uuoKapoiou) unapxauv Kat
eewK apOLaKe<; E. TLL0PUOL<;, OTIW<; 11 QU~IlOil tUJV KQ1XO,\QIJ.L VWV tau rti\aOj.1U10S,
ocpeti\61J.eVf1 oe 6tE.(epon tou ouuna~nnKou veuptKou ouot~l.l.atos. n:au npoKaAei
all{ll0111TlS ane,\eu~pwons eAeu~epwv ALTtapwv o<ewv an6 ns ano~flKE.S tau
i\trtw6ou<; L010U KQL ei\U1tWOf11flS eKKpLOfl<; LVOOUi\LVIlS QTIO tQ 5-KUTtapa l:OU
T1Q(Kpeato<; l.l an:o-cei\E.OIJ.Q l:fl 6tatapax~ 111S LOOOOU 1f1<; )i\UKO(fl<; o-ca IJ.U-
OKap6taKa KUHapa.
B. MnxavtK5 6tatapaxes. H uuoKapotaK~ toxaq.J.ia n:poKai\ei avaotpE.<!Jtllfl ei\arcwon
ti1S Kl Yf11lKOtlll:U<; ( lJ!lO/(t ll!JOi/:i) tOU IJ.UOKUpOiOU, 11 OTIOla OUY~~UJS
artOKa~io-cataL OTO <j)UOLOi\Of'LKO 6taV aU(f1,9-ei T1 Ote<j)QVLQLQ PO~ ~ ei\QHUJ~i 11
uuoK apotaKr1 Karavai\won oeu)6vou ( rr.x. otaKorrn owJ,.lanKriS aoKnons. q>ap1-1aKa
Ki\n:). H UTIOKlVflOLQ O<j)eli\etQL 0 ei\U11UJOJl tJl<; IJ.UOKapOlOKrlS n:apajW/'rlS evep-
/'E.La<;, unoUa Kat o~ewon. To ouxv6 cpatv61J.E.VO tllS n:apai.J.OV~<; rns unoKtvnoias
tOU IJ.UOKOpOLOU Kat jleta 1JlV apOJl tJ1<; jlUOKapOLUKrlS LOXULIJ.LO<; OVOJ,.la(1Ql pe-
rtO,.Jat,Lftf(IJ OllOAcUOlJJ))iOKQL an:obioetaL Ol:Jl OpUOJ1 ei\eu~epwv pL(WY. l OpL-
OIJ.VE.S n:epLTt1WOelS XPOYLUS LOXOLIJ.LOS OeY n:poKai\ei1aL veKpwon aAi\a napa1-
101J.VJl un:oi\E.t -coup)ia nov IJ.UOKapotaKwv KU1:1apwv. To <patv6uevo 10ll10 ovo-
ua(erat LO.I'tlt,LII/.17 VOJ)KIJKQL an:ooibetaL 0 ei\anwon IOU 1J.E.1a5oALOI.I.OU 10U IJ.U-
OKOPOLUKOU KUHapou avai\Of'f11f1<; ei\U11UJOf1<; 11"10 Ot<j)OVLOLQS pori<;.
~e n:ept rnwoet<; ooBapris IJ.UOKapotaKris toxatl.l.'tas ouvo6eu6eVI1S ano veKpWOf11WV
IJ.UOKapOLQKWV KUHapwv napa1f1PE..L1QL OUYrl~UJS 1..1.11 avao-rp<!JLI.I.fl KUTUP/'11011 HlS
Kl Yfll:L K01fltU<; I tlAt ll!JOi dJ ri napa60(I1 KL Yt11LK01111U ( 01/0KL ll!JOL a) TflS rta-
oxouoas n:epLO\flS. H -cei\eu1aia xapaK111PiCe1aL an6 Kevtpou6i\o (npos -ca 1-1eoa)
KLYI1011 -cou IJ.UOKapOtaKou tmxwua-cos Ka-ca 111 otapKeta 111s btao-coi\ris Kat <pu)6-
KE.Y1PO ( n:pos ra e(w) Kal:a 111 6tapKeta r11s ouotoi\fls. ~to orweto rot:na ~a
rrperrt va tO\'LOIL aKtVI1UKE.c; nE.ptoxes n:poKai\ouv-cat en:io11s un:o IJ.enoxatl.ltK.ri

4
ouoAE:LtOUp)'tCl 11 wxaq.J.LK~ vapKrl To(n:o XE:l LOLaitE:pr] KALYLKfl Ofli.J.UOtQ OLOU fl
rtapouota Cli<LVflHK~I) n:epLOXriS 0 Ol"li.I.UlVct UTtOXPE:WUKcl tr]V Urtap(r] VKpWOflS
TOU I.J.UOKapOLOU Kat WS K tOUtOU f) KlVfltLK01tltU tflS IJ.rtOpei YU 0eAttW~eli.J. tr1V
KataAAn~\n ~epaneunKri nap1J.0aon (cpapi.J.aKeuuKri a)'W/rl. ay(eLOn:i\aonKr1 r1
aoptoote<pavwtu n:apaKall<tJfl)

ITapci)'OVleS KLvouvou

H anLOt\0'/La tns a~npooKA~puvons rwv o1cq>avtaLwv aptn~nwv oev eivat )'vw-


oti).Yn:apxouv OI.J.WS Ka!UOtUOE:LS, OL AE:/01.J.VOL TlO!)d,YOV!ef 1<.:"/VOVVOU, n:ou
ouvooeuovtaL art6 au~rwE:vo KLVOUVO 1J.q>clVLOr)S Ot.!pQVtaias v6oou. Ol on:ou-
6at6tPS an6 au-res et vat:
A) Kan:vwua. 0 KL vouvos eu<pavwns a-ce!pavtaias vooou e(apta-cat an6 1ov apt&1.1.6
rwv tat;cipwv Kat arr6 ta E:tf'l rou KarrvioJ.latos. Etot, evas Kan:vw-cns nou
Kanvi.\et Tt.PLOOOt.pa an:6 20 tOt ;cipa 1f1V f'l!lpa ;ta n:oAAa XPOVta Ota1pXL
ot nAciato Ki vouvo va 1l<pavioet a"te<pavtaia v6oo an:6 evav 1.1.11 Kanvwrr;. H
B~\an:nKr1 6paon rou Kanvio~-ta-cos an:ooioera.L on1v npoKa,\ou1J.Vfl an:6 n1 vtKo-
rivr) ot)'PO!l IOU OU!lTIU~flTLKOU VUpLKOU OU01rlj..latOS KUL anet\eu~pWOf1 KU-
tXOAai..I.LVWV.
B). Yn:epxoAootepoAaq,tia. 0 Kivouvo<; 1J.<pcivtor)s o1e<pavta.ias v6oou au(avet
au~avo~J.E:vns tns OU/Kv-rpwof1S !f1S oAtKr1S xoAnorep6Ans oto a.iua. fta n:apci-
oet;~-ta. 0 OU)KV1PWOLS 250 mg/dl KO.L 300 mg/dl 0 KlVOUVOS eivat 2 Kat 4 !popes
1J.)Ut\Ut.pOS avrL010LXU an6 61t 0 OU7KV1PWOI1 200 mgjdl.
A n:o ta OU01U1LKa ttl') OAlKrlS XOAf101p6Ar)S 1r)V IJ./O.A tl1Pf1 a&rwo;ovo 0pel Oil
ei.J.<pavi\ouv OL Atrron:pw-reives XUI.I.f1Ar1s nuKV6tr,tas (Law Density Lipoprotens, LOU.
eVW 01. At n:onpunei ves U4Jf1Ar1s n:uKv6-crna.s (High Density Lipoprotens, HDU E:xouv :. I'ilj.
n:poo1:a1eunK~ 6pcior,.. H uneptpL;AuKepLoaqJ.ia oev &ewpel -rat ave~ciP1tll:OS

I
n:apa;ov1as Ktv6uvou eK-c6s av ouvooeue-rat ano eAanwon nuv HOL.
f) Atrconpw-reivq (a). .luv1i~etat o-ro rinap. Ertirte6a lle/aAln:epa an6 0.3 g/1
ouvo6euov-rat an:6 au\n1.1.Vfl nt&av6tr)1a 1l~Pcivwns o1e<pavtalas v6oou.
6.). !n:ep1:aon. 0 Ki vouvoc; 1J.<j)UVLOf'lS 01cpavtaias VOOOU au{ ciVet au(avo~evns tf'lS
aptflPLUKrlS nieons. YnoAo)'i\etat 6n 6tav n ouotoALKrl aptnptaKrl nieon
un:epBai VL 1U 160 mmHg ri fl Ota010ALKrl1U 95 mmHg fl nt&av6l:lll:Cl 1J.<pUVL011S
Ote<j)QVLQlQS VOOOU eivat KQ1U 2-3 <popes; IJ./O.AlJtepfl 0 OXOfll.l. ta VOp1J01a-
OlK cl cltOIJ.Cl.
E). 2aKxapw6qs ow~fnos Kat avtiotaoq o-cnv tvoout\lvo. H enin:rwon Kat n l)apt:nrna
l:fl<; Ot<j)UVlClias v6oou dvat ll/UAU1PS 010U!) OtafinLLKOUS ano 6n 01U
<puotoAO/LKcl UtOIJ.Cl. H avtiotaon Ol:flV tvoouAiVll exet VOXOTIOtr]&E:l /LU -rnv
au\n1.1.evn ouxvotn ta on:<pavtaLas v6oou O!flV N6no Aoia.

5
.
--- ----- --- ~- _--- _,., _._.. __ ._-- _. ~
.
.-
~-

~T. O!lOK uo1t:t vn. Tu t: nt nt:oa H1S OIJ.OK uo-cet VI1S o1ov op6 1J.<pavtCouv ~e n~-:11
ouoxe no11 IJ. 1r1v nL~av61111a 1J.<pUVLOI1S o1e<pavtata<; v6oou. H aSI1P0!'6vos
opaof11f1S OIJ.Ot-.:uo1tVflS anootoe-caL oe 10\LK~ eniopao11 o-co a;;eLaK6 evoo-
{)~ALO.
AA.\m ;\L )'6repo LOXUPOL an6 1ous npouva<pepSv-ce<; napa;ov-ces KL vo uvou ei vaL 11
naxuoapKLU, J) fo...USflOUK~ (W~. J) J)t\LKLU, 10 appV <pUt\0, 1:0 ()eUKO OLKO/VLUKO
w-coptK6 KUL f1 n:poownLK01111a tunou A, 11 on:oia ava<ppe-raL oe U/'XWOI1 a-colla
TIOU ULO~UVOVTUL 1J)V TIL011 tOU XPOVOU.

KALVLKS KOO.\WOLS

Ot Kupt6-cepe<; K.\LVLKS KOI1AwoeL<; 111<; o-re<pavtaias v6oou dvaL 11 0111~U/'XI1 (o1a-


&-ep~. aota~~s. avaotpo<p11 ), 10 1J.<J>PU/JlU tou IJ.UOKapoiou ( 11 11 xwpis O) Kat o
m<pviows &-avaros. AAAes KALVLK<; KOI1AtiJoeL<;, 6nws 11 Kap6taKI1 avencipKeLa Kat
OL .appUSIJ.LS OU(I1"TWV"TUL O"Ta UV1L010LXU K<pciAaLa.

ELvat KALVLK6 OU\'OPOIJO xapaKt11PL(61J,evo an6 "T11V e!J<PUVLOfl 0111~U/XI1S Ka-ca 111
OLapKeLU OWIJ.UUK~S UOKI10ilS ~ 4JUXLK~S vtao11s (6tav au\civov-raL OL aVU/K<; tau
IJ.UOKapoiou oe o\u{6vo) KaL unoxwp11011 ti1S OUIJTI"CWIJatoAo;Las IJ.ta ti1V OLaKortri
ti1S npoona~eLa<; ~ tr')V UTIO)'t\WOOLa XOPil/'Tl011 VL 'tPWOWV. H Otfl~cl/XIl TIPL /PU-
<P"TUL an6 1ov ao&-ev~ ws npoKapoLO at\)o<;, ~apos. n:ieo11. KU4JLIJO r1 ocpi\LI..lO, oux-
va TtKtL VOIJ.VO OtOV tPUX11AO, "CflV KC1t(IJ {VU~O. 111V paxn KUL "Ca avw aKpa.
Eav "to O"Tfl~U/XLK6 eneLo6oto o<peit\e-raL oe KOTtWOfl ouv~~ws unoxwpei IJoa oe 3
Aen-ca an6 "TflV OtaKon~ "TI1S. Eav 1J.<paviCetaL IJ.eta an6 ~apu /UIJ.a ri KaH1-cn
6ttipKeLU ttJUXLK~S v-cao11s ouxva 6tapKei 15-20 Aen-ca. ~tfl~U/'XLKa eneL066ta
6tapKeias IJ./aAutePflS twv 30 Aennov oev eivat ouxva Kat ~a npneL va ava(l1-
ti1Souv evaAt\aK UKS 0La{VWOLS ( n.x. 1l<PPU/IJ.U "COU llUOKUpOLOU ~ eewKapOLaK<;
naS~OLS). .
Ka-ca 1fl 6uipKLU VOS 01fl~U/XLKOU TtLOOOlOU n ap1flPLUK~ n:L011 ei VaL ouv~~wc;
au\r11J.VI1 (O OPLOIJ.VS TIPLTitWOLS UTtUPXL UTIO"CUOfl) KQL OUXVU QKOU/OV"TUL
1-raproc; KapOLUKOS "TOVOS KUL OUOtOALKO <pUOfliJ.U avenapKeia<; tflS IJL"CPOLOOUS
5aA5ioas O<pLi\OIJ.VO 0 LOXULilLK~ ouoAel10UP/lU tWV SnAoeLOWV IJUWV. KOLALaK<;
KUL UTIPKOL,\LUI\S appU&!JLS at\AO"T n:poKat\OUV KUL at\t\Ot 1J.<pUVL(OV"TUL IJ.tU ra
O"TI')SU')'XLKU TlL000La.
A. Atnona~O"YVeLU. H ota~ep~ Otfl~U/Xfl ano-reAei KALVLK~ eKO~AWOfli..I.UOKap
otaKJ)<; LOXULI.ltaS KUL O<peiAetaL 0 OflJlUVUKrl O"TVWOfl Ilia<; 10UAUXLOIOV Ote<pa-
VLULUS UP111PLU<; J) IJ. )Ut\OU Kt\aoou au-r~c;. ~av )VLKO<; Kav6vac; LOXUL 6n 01-
V(l)OE:L<; nou npoKu\ouv e,\a11WO!l "IllS OLU!l-rpou -cou auAou Kata 60% ~ nepLOo6-

6
repo ouvn&w~ ouvooeuov-cat an:o orr){)a;xfl. evw orevwoev; rtou rtpo~u.\ouv
c:,\anwon rn<; 0La~erpou rou aur\ou Kara 500/o ri At /Otepo ouvri~ws oev ouvooc:u-
ov-cat ana orrl()ti/xn. ~o!)apri OTfl~U/'Xll (rtpot<apow ciAro~ e~<pavt(o~evo IJt: IJLKPri
K6nwon) ouvri\"fcus n:aputr)P<::L tat 6-cav n OLUIJ<::Tpo<; rou au,\ou !Jtu<; ote<J)avuitas
aptrlPLU~ c:~\anwverat KaTa 80-100%. Me=: BlioflTOV apt{)!l6 twv n:pooBeBAnJlE.vwv
aptr)PLWV l TtPO<J~lOS KUTlOVTa~. n:epL<JTtWIJE:Vr), O<::Clcl <JtE.<pavLQLU aptflpLa) OL ao-
&eveL~ x;apaKtr)pt(OVT<::<; WS n:aoxovtE.<; an:6 VOoO eVO<;, OUO ~ TPLOJV U//E.LWV.
Ot a&rwooK:\npuvnKri~ at uoAo{'ta<; orevwoet<; twv <JTetpU\'LULWV aprrwuiJv 6taKpi-
vov-cm oc: ou-.~AcTZJ:l'Kd".>Kat e.:;..;evr,oe.>. Ot rcpc.i.Jres xapaKtrJpl(ovtat an:o rcpooBoA~
0;\QK,\r)pfl<; tqc; n:<::pq.tetpOUtOU TOLXlOIJ.UTOS 1(]<) 01E.tpaVtaLU<; aptflptac; 1\Ul we; E.K
toutou to a;!'c:LO 6ev owa1E:t\Ac:tat ou1e ouatE:A;\etat aro O!ll.lC:LO tns a-cevwons. Ot
oeun:pec; xapaKTflpi(ovtaL an:6 rrpooBoAri 11Jri!latoc; !JOVO tr]c; n:e:ptiJ.E:Tpou rou
rmxw1-1a roc; tile; atE.tpavtatas apnwtac;. Ercetori to cpuaw,\o{'tKo WLXWI.la ato orn..tc.to
rnc; arE:vw<JflS 6wtr1Pel1f1V tKavotnra va ouotE:AAetaL Kat va 6wotE:,\,\etat r) rcpo-
KaAou~JeVfl otvwofl tou auAou e~ap1cnat oxt 1-16vo an6 10 11;e&oc; TflS
a&!lPOOKr\flp UYUKrlS Ttt\UKUS a,\t\a KUL an:6 10V Q[[eLOKLVfltLKO 10\lO.
B. ITa&o<PUOLOt\QvLa. H orn&ci/Xfl O<peLAtUL Oe UTteVOOKap6taKri toXULIJLU. H te-
Ae urata npoKa,\et:
a) Ht\eK rpoKapow-ypa<ptKE:c; owtapaxec; ( oec; rtapaKatw)
6) Oec:ta !lflXUVU-\fl OUOAettOUp[ia 1J1<; aptO'!ePrlS KOtAiac; xapaKtJ'lpL\OIJ.eVJl arc6
eAatTWOfl trlS ouortaOtLKO'!JltUc;, Ota1aOf') Kat au{r}Ofl trJ<; teAotnaotoALKriS n:i0!1).
r. Ep"Ya01QQLUKO ou;:pe UYQOQ. A. fl,J eK rpor.apOto)'pdr!Jf./0 !Jpepia~ Kata 'tfl
6tapKc:ta tllS Otf"l~U/XtKriS KpiOf"lS n:apa1npel1at Kataon:aofl tou 6taatril.la1oc; ST !Je
1"1 xwptc; avaotpocpri tou KUI.latos T. Otav o ao~evris eivat aOUJlTHW!JatLKOS 10
flt\eK tpOKapOLO"Ypci<pf11J.U ei vat <puoLOAO/LKO 010 25% '!WV TiepL n:tWOeWY. 2tOUS
urt6AOL rcouc; l.lTIOpei va UTtapxouv f]AeKtpOKUPOLO(pa<pLKa UPrll.lUta n:aAaLOU
1J<ppa;1.1a1os tou l.lUOKapoiou, 1.111 etOtKec; 6tatapaxs tou ST Kat touT Ka~ws
enio11s 6tatapaxs tJlS KoA n:oKmAtaKriS Kat 'tf"JS ev6oKoLAtaKriS U/W/LI.l6nrwc; .
.B. HI a rpo!..-af}c5to}parrJpa (oor....-tpacria) Kdrra;cr!J~ Xpf10l!JOrtmeL tat e upew<; (La tr)V
avixveuo,., !1UOKap6taKriS wxaq.tias oe ao~eveis 1.1 rtt~avri ri 6taruotWI.l~YJ1 ote-
cpavtaLa v6oo. H e(E:taof"l ouvri~ws ;i vet at oe KuAt61.1evo rcin:nra l.lta~aM61.leVf1S
taxtnqrac; Kat K\lOflS. To ouvri&~otepa XPf10LIJ.OHOLOu1J.evo rcpwr6KoMo eivat E:-
Ketvo rwv Bruce 1-\a~ Horsten arcotet\OUI.leVO an6 n:E:vte orcl.6w 6tapKeiac; tpu.iJv r\e-
f1Hl)\" tO r:a~\"(l ( nLvaKas 1 ). H e(taon OLaKOTitetaL 6rav 0 ao~evr;c; TILtUXE.L
TOY rrpo!)t\e:n:OIJE.VO {'La 10 <p(l,\o KQL ti(V flt\LKLU apl~l.lO O<pU(eWV ri 6taV qJ.tpUVL-
<JtOUV OUI.l IT IWI.ltHU ( Otfl&O/XIl. KOITWOf1, (cit\11 KA n:) ri LOXULI.llK ~ r]t\K tpOKapOLO-
(patpti\S a,\,\OLUJOtc;.

7
-~- --' - - ~__,_, __ - ---------------'------

Oi v'.:lKQ<) 1. [1pwr6Ko,\,\o Bruce KUL Horsten.

Taxt:n:nra
~raOLO mph kmh

I 1.7 2.7 10
II 2.5 4.0 12
Ill 3.4 5.4 14
IV 4.2 6.7 16
v 5.0 8.0 18

mph: J.lL,\LQ/lupa, kmh: XLALOJ..LE:Tpa/wpa

fTpLV an:o TflV ~\'UP~Il TflS e(TUOflS J.lE:TparaL J..LE: O<pU/J.lOJ..LUVOJ..LE:TpO ll UPirlPLal\fl
mean t<UL t\aj.lBaveraL n:Af]pes nAeKTPOKapOLO)'pU<pr)IJ.U OE: unna "aL op~La Sean.
TtPLV KUL llE:TO OTtO UrtprtVOLQ.
Ka1a rr1 6tapKeLa rr1s K6n:wons eA;xc:1at ouve.xws ro nAe.KrpoKapoLO;pciqHJJ.lO oe.
raAavroOKOTtLO "-OL KU&e eva ,\erno n:epin:ou {LVTQL Gpaxe.ia Kara;pa<p~ rwv I
an:a;w;wv V4, V5 KOL V6. 2ro 1Aos KU& oraoiou KO'ta;pa~e.tat n,\f]pE:S Jlt\KTpO-
KUpOLO/PU<flflllO KUL ll1parat 11 ap'tJlptaKf] Ttl0J1.
AllOWS ll1rl TJl,\ri(ll TJlS e(TOOJ1S KQTO/PU<fl1QL n:Anpe.s Jlt\K1POKap(Ho;pa<pflj..LO I~
ll rov ao&e.vn Ka&tor6 r1 (ant\c.uJ..lvo Kat crnt auvexeta )'iverat Gpaxeia Kara;pa<Pri
rwv arta{W{tiN V4, V5 Kat V6 ava Aerno Kat {ta xpovtK6 C>LaO"CJlllO 6 Aeruwv eav
oev exouv n:apa"CflPil&e.i wxaq.ltK<; nAe.KrpoKapoto{pa<ptK<; at\Aou.Ooets r11lXpt
TflV e(a<paVLOfl 1WV n:poava<pe.p&V1WV aAAOlWOWV Kat tr]V TtUVOOO !OU !lAKTpO-
KapOLO/Pa<prlJ.LO!OS ora rrpo TllS OOKtllaaias K6rrwons xapaKtllPLOnK2. Kara)'pa<p~
rt;\~pous llAe.KrpoKapoto{pa<prwaros )'iverat 4Ae.n:ra ~e.ra ro 1,\os r11s K6nwo11s
Kat en:ava,\a~J.Baverat e.av (avaxpeta01i. H apti"JptaKr1 nie.an J.le'tparat 2.4 Kat 6
r\e.rrra ll1Ct TO rAos TI"JS KOTtWOr]S.
H ooKtJ.laoia K6nwa11s xapaK"CflpiCerat ws &enKri (n:a&oAo)'tKri) 6rav naparnpfl~e.i
OPL(OV1La ri KOttouoa Karrion:aOJl tou ST 1mm n.n:e.ptOOOIPO OLapKeias 0.08 sec ri
ne.pLOo6te.po ri avaon:aOI110U ST 1 mm ri n:e.pLOOO!pO.
Ot c:voc:Leets Kat ot ave.voei(ets TJlS OOKLJ.laoias K6n:wo11s ava)'pa<povtaL orous
ITivaKe.s 2 Kat 3 avrio"Cotxa. Ta e.uprillata !lias vtova ~enKriS OOKLilaoias
"on:wons. ouxva aveuptOKOIJ.E:VflS oe ao~eve.is j.le v6oo tou o-cc:Aexous ri rpuiJv
a;1c:iwv ava)'pa<pov1at otov ITivaKa 4. H c:uato~noia ( =n:ooooro aA11~ws ~e.uKwv
e~c:raoe.wv orous ao&e.veis) Kat 11 eLOLKOTJlTa ( =rroooor6 aAn~ws apvnnKwv
e(eraot:wv otous u)'teis) rns ooKtj.laoias K6n:wo11s ot11v avixvc:uofl rns
<.He<pavtaias VOOOU avepxovrat 0 60-80J/o KUL 7G80J/o UVTLOTOLXU.

8
fH vaKas 2. Ev6et~ets OOKLI.laoias KOTtLOOilS.

Katrrropia -l
-tua;VWO!l 01lpUVlULU<; VOOOU OE: appV<; UO~E:VE:L) l.lE: atUTIU 0UI.lTt1W!..WW pu-
OKapOLUKrlS LO\ULULU<;
-EKtLU!lOJl Aettoup)'LKr')<; LKaV61!lta<; (tKavotnta) ;la aOI-\JlOJl) Kat rrp6;vwoJ1<; oe
ao{}evLS l.lE: /V(uOtr) O!(j)UVLU.ta VOOO
-EK-r'LI.l~O!l Aet toup)'LKtlS tKaV01!ltas Kat n:p6/VWOJ1S ao~evwv 11e aven:i rrAeK10
~l.l<PPU)'I.lU TOU l.lUOKapOLOU n:ptv r') Cli.J.E:OWS l.lE:tcl UftO tJlV :~000 taUS ano tO VO-
OOKOI.lelO
-EKtLI.lflOJl ao~evwv ~.te-ra an:o a-;jetm1AaotLKr) r) aop-coote<pavwia napaKOI.l<-!Jil
-EKtil.lJlOJl ao~evwv 11 ou11ntciJJ.w-ca ou11!3ata 11 un:01:ponuiCouoes appu~!-Lies
n:poKat\OU!-LV<; OTtO 1JlV UOK!lO!l
Katr,jop[a I I
-EKTli.J.!lO!l UOUI-1 ITHOIJUUKWV appE:vwv !lAlKia<; UVW HOY 40 TWV U LOlKi E>
n:aj)'E:Ailata-( rr.x. n:tA610L, o6n1oi oxoAtKWV Aewlj)opeiwv)
-EK1t1JJ10fl UOUIJft!WIJUUKWV appevwv !lAtKLUS cl\100 tOOV 40 TWV 1-1 OUO Ji Tt-
ptoo6H:pOUS napu;ovres Ktvouvou /LCl o-ce<pavtaia vooo
-EK1l1J.Jl0Jl U/UI.lVU<J1WV appE:vwv I")J\\.KlUS UVW 1WV 40 1WV ltOU 0KOITUOUV va
OUJ.q.tetaoxouv oe n:po;pcii.J.I.la1a evtanKriS aOK!lOflS
-L\tci)'vwon ote<pavtaias vooou oe ao~eveis n:ou Aa11Bcivouv OaK tuAi no a ri exouv
nA~P!l anoKAtl0\.10 10U oe~LOU OKE:Aou<;
-EKtli.J.IlO!l t\ettoup;tK~<; tKav6t!l-ras Kat avtan6Kptons 0111 ~eparteia l.l Kapot-
oa;/etaKa <pcip~.taKa oe aa~eveis l.le 6tarum:w~.tvn o"Celj)avwia v6oo
-TiapaKoAou~flO!l oe taKta xpovLKa btaoir)J.la"Ca ao~evwv 11 otanwtwl1vn
I
ote<pavtaia v6oo
-EK"CLIJ.flO!l ao~evwv 1.1 .v6eten trlS Ka"trpoplas I n:ou o1:o nAeKtpoKapoLO;pa<prwa
flP1.lLUS 1J<pavi\ouv aAAOLCDOL) n:ou uepLOpi\ouv TllV OlU/VW01lKrl aCia UlS
II
ee!UOflS

!
-EK1LI.lf10fl ao~evwv nou un:eoinoav ernnAe!l.lvo 1.l<PPUJ'I.lU rou l.lUOKapoiou Kat
0111 OUVXLU "o1U~pOTIOLri~llKUV"
-Err')ota cKTLIJflO!l UOUJ.,lTITWIJUtLKWV ao~evwv rtOU unoBAtl~!lKUV 0 a;;eton:AaonKri I!
rl aopT0011j)UVLUta n:apUKUIJ.(JJil !

Kaunopia I: ano,\u111 E:v6et\11


KaTfl/OPia l L oxen"ri v6et(f1

9
-f1oAu rrpoo<pato (<6 fl!Jepes) OCU 1J<ppU)'IJU IOU !JUOKapOiou
- ~Hl~cl/Xfl f1P1JLUS
-~opupri OU~Til:W~UUK~ 0UOt\Ll:OUP/LU aptaH:p~S KOLt\ias
;-EmKivouves !'La rn Cw~ KotAtaKes appu~~ies
-O(eia rreptKapoi n6a, ev6oKap6i n6a ~ ~uoKap6i n6a
-~opap~ orevwon rns aopr~s
-.:~opap~ aprnptaK~ un:praon (ouoroALK~ n:ieor, >200 mmHg ~ 6taoroAtK~ n:ieofl
>120 mmHg)
-O(eia n:ve U~OVLKrl 1JPOt\~
-O(eia (}pO!l~o<p.\e~i n6a ~ ev roo pa~et <p,\e~o~p61.1PWOf1
-O(eia ri oopapn ouorru..tanK~ v6oos
-N eUPOIJULKS 11 1.1UOOKi\tLKS TIU~rl0LS rl ap~pi 1l0S TIOU QTIOK;\iOUV rr,v
UOKflOfl
- Appu&11wro 11e rapoi\tK6 v6om.1.a, 6n:ws oaKxapwons 6wBnrns ~upeoroUKooor, ~
~ucoi6n~Ja
-AOuva~ia rl arrpo~u~ia TOU ao&VOUS VQ UTIOpi\r,&ei orr,v C1:UOfl

IltvaKa<; 4. Evrova &enK~ OOKLIJ.UOia K6n:wor,s.

-Karaorraor, rou ST 2mm r1 n:eptoo6tepo


-Kanouoa Karaon:aon tou ST
-E~(paVLOfl LOXULIJLKWV r,i\eKIPOKapoLO/PU<j)LKWV at\AOLWOWV 010 n:ptiJIO rl
TO oeutepo OtaOLO IOU n:pootOK6i\Aou Bruce
-OapUIJ.OVrl Kataon:aons tOU ST /LU n:epwo6tepo an:6 6 i\en:Iil: l..lTci 1:0 reAos
rns Kon:wor,s ( <pcior, an:oKata<n:aons)
-Kanion:aon ST oe rrevre r1 n:epwo6tepes an:a/W/S
- f1rwo11 ouoro,\tKriS aprnptaKriS n:ieor,s Kat a rn 6tapKeta tllS 6oKLUaoias
KOTIWOflS

r Pac5tmoororrt;..6'f Jl6'~9oc5ot. E<papi.J.6~ovtat 61:av: a) ra eup~1.1ata oro nAeKrpo-


r.:apoto(pci<pfli.J.U r]P1.1LUS Ka&tarouv a6uvarr, rnv PilllVia !WV UPflllclTWV U]S OO-
KLIJUOLUS KOTilLlOflS (n.x. an:oKi\eta!l6s apwrepou oKAous. 11eraBoAs ST Kat T orr,v
flP<::IJLU, XU!lf"J,\u ouva!lLKa KAn:). p) ra anm:eAE:o1.1.ara rns 6oKL!lOOLas K6n:wor,s E:p-
xovwt ae avn&eon 1.1 rflv Kt\LVLKri etK6va (n:.x. (}enKri 6oKt!laata K6n:wons oe u-

10
- _-_. __ '_,-

<JU!Httw~a n~..:o a<J~ev~ ), 1) a rwnei taL 11 avatOIJLK~ evron:L011 rns L<JXULIJLKris nept-
ox~s. 6) nprtt:L va !'L vet 6ta<POPLK~ 6ui7vwo11 !Jetaeu toxat!JLK~S Kat veKporttK~S
neptox~s. e) npenet va 1ivet Kti!Jf1011 rO"u ano-reAo!Jato<; rrape!JBattK~S ~epa
neias (O//'E:Lon:AaonK~S ~ aoptoore<pavtaias rtapaKOIJ!VflS) Kat or) npnet va
K t,l~fl~L n rtp<.)fVWOfl aoDevwv ~ Ol0ltl01WIJV11 o-recpavtaia v6oo. Ot ouvn&.
<Jtepa XP110l~Ort0LOU~VS paOLOLOOtOTttK; IJ~OOOL eivat OL e~riS:
.J...J..r:t~.Y..$..O.P..9.1..P..g.~.nJJ.g.. JJVQ.~..IJ.Q.~~.IJ.~.O.s .. g~.JJA~W.9..0.S..1-:l..~... P..Q;Q.~.Q~.9.9.IQ.Jiq. Ta o uv ~ &ws
xpnoq.tortmou!Jevo to6-rono ei vat to ~aAAto-201, 10 onoio rrpoo,\aiJBave-rat arr6 us
Ota<popec; TtpLOxs "COU llUOKap6iou cre 6uo cpaoet<;, 'tr)V ltPWLIJil Kat !fl\1 04Jlllfl ..
Srnv npwtn (apxtK~ rrp6oMNm) f1 crU/Kvtpwof1 rou pa6tmoor6nou ora llUOKap
OtaKa KUt1apa eivat ava,\O')'f'l !fl<; cr!e<pavtaias paris. evw O'tr)V 6lrrepn (avaKa-
taVOIJ~) 11 ou1" evtpwon rou pa6towor6n:ou e\aptcnat nepwo6tepo an:6 TflV
6LWOl1J.O!Jl!U tWV IJUOKapOtaKWV KU!!clpWV napa an:6 !r)V O!e<pavtaia pori.
rw TflV Ktlllf10fl t'fl) cr-ce<pavtaia<; pons 0 acr~ev~<; un:oBaA,\eraL 0 OOKLIJ.QOLa
Konwons oe ep"fOIJtptK6 n:oo~Aato ~ KUAL61Jevo tannta ~ Aa1.1Bavet <paplJ.aKa rrou
npoK aAouv un:epat~La ( aoevooi Vfl, 6t TtUPLOUIJOt\11) rl au\r)Or) 111S OUOTtOO!lKOUltOS
rou ~.tuoKapOiou ( 6oBou1a1-1i vn ). A~.teows !leta .ro tet\os r11s K6nwons ri rns q>ap~.ta
KeunK~S <p6pno11s )'iverat ev6o<p,\Bta vecrn ~aAAiou Kat o acr~evris o6n1eitat"'
orn 1-camera. f1 anoia IJtpa trt pa6tevp)eta crus 6ta<popes rrepLOxs rou uuo-
Kapoiou. Tooo n K6n:won 6oo Kat n X0Prl/f10fl 1(l)V Ttpoava<pep~vtwv tpUPilUKWV
exouv ws an01:Aeo1Ja 111 Or)IJLOUP/ia avO!JOlO/evous cr-re<pavtaias poris. 11 anoia
unoAei rre-rat crus n:epwxes nou -rpo<j)ooo-rouv-raL an6 o-revw1.1ves o-recpavtaies
apTrlPLS 0 oxon IJ. KLV<; TIOU tpOq>OOO!OUVtaL OTtO <j)UOLOAO/'LKS 01<j)UVL
aies apr11pies. Oc; eK -cot:nou 11 OU/Kv-cpwon tou pa6LOwot6rrou Kat n eKTI1-l-
fTO!leVC'l paote:vep')'eLO ,9a eL VaL ll/UAUtpf1 Ol:LS TtPLOXS IJ <pUO'LOAO/LKn atllO>
rwort art6 6u oe Kivec; IJ eAa1"'CWilVrt aq.uittQOCl. 01LS onoies 1J.q>avi(ov-caL "eA-
t\LIJIJ.a!a n:t\~pwcrns".
Eva t\Aetl.llla nAripwons ~J.<pavtC61JVo aj.l.ea.wc; !Jcta rnv 6oKt!Jaoia K6nw6ns ri r11v
<pap!J,aKU!LK~ <p6ptLOC11JTtOPl va o<peL\etaL 0 1JUOKap6taKri LOXULIJ.La ~:IJUOKap
OLaK~ vKpUJ011. H Ola<pOptKrl Olci/VWOfl /'LVtaL IJ Katall!pr)Or'J rns KrC1lTIO-
lJ,VClS pa6tevep;LUS 4 wpec; ap)6-cepa l..l "(QV ao~evri O!flV flP1llU. H ~O<pclVl011
tOU e.\t\E.LIJ.IlUTO<;, O!pLA01lV11 0 avaKataVOIJ.rl l:OU paOLOLO'Ol:OITOU, UTt06!lAWVl
~uoKap6taKf} LOXO.Lilia, evr.iJ fl rtapa!JOVrl tou 1JUOKap6taKri vKpWOfl. H euato&-11oi.a
Kat rt eLOLKO"CCl!a tou ortt v&-flPO/POIPrillatos K6n:wo11s l..l ~aAAta otrt 6ta')'vwor, tr)S
o-r:e<pavtaws vooou avpxovtat oe 82% Kat 88% av1:Lo1:otxa.
n.
~., .. .P..IJ.9..~.9.~.9.QJQ.11.~.!S.n ...t5.mA~.Q.1.P.g.~.~.q.J).Q.JJ.W..9.nS. vet at llTa an:6 evoo<pA Bt a xopri111crfl
1:XV11!LOU-99m. ~l:Cl ouvri3w<; XPfl0l1J.OltOLOUIJ.V11 t'XVLK~ 1:0 paOLOLOOl:OrtO ou;-
KevrpwveTaL or11v KotA6tflta 1:11s aptotep~s KOLALac; Kat an:6 111v eKTt1.lTI01J.V11

Ka-ra trl 6tcipKt:ta r11s ouotot\f}c; Kat tns 6tao-ro,\~s pa6tev~p/La. 11' onoia ue1pcirat
~e /camera. un:ot\o)i\etat 11 KLVr]ttK6tnta twv 6tarp6pwv tll111J.citwv t11S Kap6tilS

11
1\UL to to KAtio1.1a e~w~rw11s (~uoLoAo')'LKri rq.ui: 5G7CJ<%L H n:apouoia tomKwv 6Lu-
rapaxwv tr}S 1\LVfltLKOtr}tas or11v I1P1lLa ouvr;~ws ocpei,\etaL oe. .1J.<PPU/'I.la, evw n
ell<PclVLOI'l tOTUKWV OLatapaxwv tl'lS KLVI1tl:KOt11tUS KUtci 'ti1V KOrtWOfl 0 LOXULI.!La.
Eva ouxvo UP111la o-cou<; ao~Vl<; ll O"C<pavLaia vooo LVaL 11 a6uval.lLU au~nons
rou K,\aoiJatoc; e(ti.h~I10f1<; ll 1nv KOTtW<Jfl. H euaLo~noLu ti1S pa6LmootomKriS KOL-
,\LO;pa<piac; Korcwo11s eivaL rtaPOI.lOLa ll Keiv11 rou oruv&11po-ypacprilla"COS Ko-
n:wOI1S ll &ci;\;\LQ, evw r'l LOLKO"CI1"Ca eivaL KclrtWS 1JLKP0tpf1 .
.J Hxo;..;op6tO/"JJO(/'IJJIO Ka&LOta 6 uvatri "CI1V artLKOVLOI1 "Cf"lS apLo"Cepris KOLAiac; KaL
(f"lV ava')'VWPLOtl tOTUKWV OLa"Capaxwv "Cf"lS KLVf"ltlKOt11tci<; "Cf"lS, VOLK"CLKWV LOXUL-
IlLa<; ri n:porn11~v1oc; 1liPPU/Ilatoc; tou llUOKapoi.ou. H e{"CaOf1 autf"l eLvaL npa-
KnKri KaL aKpLBris KaL Ta arto"CeAollata Tf"lS 61:av ouv6ua(e'taL ue K6nwo11 ri <pap-
uaK ULLKri (<pop non) ei VaL avciAO/a ll. KL va "Cf"lS paOLOLOO!OTrLKf"lS KQL,\LO;pacpia<;
K6n:wo11s.
~""rcr;ovtoia aprtJJ)tO)'J)orpio. A rc01:eAei 'tf"lV aKpt~o"Cepn 1.1&-ooo ')'La n1 6Lci')'Vwon
"Cf"lS on:cpavLaLa<; vooou. H ~Vf'l"'CO'Lf"l"CU KUL 11 V0011PO'LI1!a tf"lS ee. "CUOflS av.PXOV!UL
0 0.1% KUL 1-5% av"CiO"'COLXa. 2-cecpavLaia aptf"lPLO/Pacpia nprtL va K"CAei "CUL O'LLS
aKoAou~es OIJ.a6ec; acr&evwv:
aj Ao~eveis urcot!Hi<PL_OL ')'La n:apell~anKri ~epaneia (a//LonAao"CLKri ri aopwo-re-:..
<paVLUla n:apaKa/.H.jJf'l) ,\Q(W TL"'CWXriS avtan:OKPLOf'l<; O!t'JV tpapiJ.UKULLKri a;uJ')'ri
B) Ao~eveis un:o<V~<pLOL {La n:ape1-16atLKri ~eparceia eiTe A67w Twv KALVLKWV eupl1-
uatwv ( rc.x. ao"Ca~ris Otf"l~ci/XI'l. llt1l'PPU/IlatLKri crt11~ci/Xf"l KArt) ei ""Ce A61w 1J.<pci-
VLOI1S cro6apris LOXULilias Otl'l 6oKLilaoia K6rtWOI1S. us pa6LoLcro"Con:LK<; ll~66ous ri
"CO f"lXOKapOLO)'pcl<pf"lj..lU.
1) Ao&eveis 11e otvwof"l "'Cf"lS aop-cLKriS 6aA6i6os Kat cr-cf"l&ci!xn {Lava OLanLoTw,Sei
n:pO/XLPf"lLLKci eav ouvurccipxeL ote<pavLaia vooos
6) Ao&eveis n:ou xouv urm6Af1-&i oe U//LorcAaotLKri ri aop"COO!ecpavLaia n:apa-
Kal.lwn KaL 1l_<pavi(ouv O"CI1&ci/XI1
e) Ao&eveis l.l en:LKivouves /La "Cf"l Cwri appu-&lli<; (rc.x. KOLALaKri taxuKa~6ia ri
IJ.apllaPU/ri). OL on:oies rct&av6v va o<peiAovtaL oe ote<pavLaia vooo ,
O"C) Ao&evei<; l.l rtPOKapOLO aA{OS ~ J.1UOKapOLOTtcl&La aKa&OpLO"Cf'lS UL "CLOAO')'ia<;
:.1. 0epan:eia. Ta OTI1&a;xLKci en:eLo66La avttlle-cwrtiCov""CaL IJ tf"lV uno;AwocrLa xopri-
/f"lOtl 1-3 OLOKLlOV VL "CPO/A UK epi Vl'lS (0.3-1.0 mg) ri 1-2 OLOKiwv OL VL TPLKOU LOooop5i "Cr[
(5-1 0 mg]. O"CaV 11 O"Cf"l-&tl/Xf"l oev urtoxwpei IJ. ."CO rtpoavacpep&v OXriiJU 0 acr~evris
n:prt:L va llta<pep&i. OtO VOOOK01lLO.
fLU ti1V n:p6A11t1.'11 H~IV LOXULilLKWV TCL000LUJV UTtUL"'CL !UL 11 KUtUrtOA1ltl011 tUJV n:a-
pa)'OVl:WV KL\'0~\'0U (OLUKOn:ri KUTtVLOilU'LO<;, pU-&IlLOI'l OUKXUPWOOU<; OLaBrittl, UTrp-
,\L rt:LOULillUS "UL apt11PLUKri<; rt:L011<;) KUL 11 anocpu;ri OpaOti1PLOt~UliV TCOU OUV0-
0 uovtaL an:o t:flv ej..l<pavLOI1 o-cn~a;xf"lS. 2e rtepi rt"CWOI'l rtou o ao~evr;c; eivaL urto-
xpeoJIJvos VC.l KC.lVL Kci"CL rt:Olf 'LOU n:pOKaAei Otl1&cl/XI11lTtOpi TtpLV arro 'tf"l OU)'-

12
f.,;cKpq. q.1.Vfl opua"Cnpt<hnra va AaOet vnpo/AUKPLVfl ri otvnptt-.:6 wooop0trq uno-
;Awooiws ous rcpoavaqJep&eioes ooaets. 0,\0L OL ao~eveis rep n:et va urrol)An~ouv
ae xpovta avnuti..I.Orre ta,\taK ~ ( rr.x. ev repooca,\ uni aon:Lpi Vfl 325 mg rH..lpflOLWS PO)
Kat avntaXUL~l"!l U)'W/rl (fli VUK S 5,6, 7 KUL 8 ). ~UV!l~W) XOPJ1/Ll:al OUVOUUO~oc;
vt rpwoous ( n:.x. ~ovovt "CPLKOS wooopBi HJS 2040 mg x 2 11~pflaiws POri btVL1PLK6s
wooopBi UJ s 1040mg X 3 fll.lPfl<J.LWS PO ) KaL l)-avao-roAos ( rc.x. 1JtonpoA6A!l 25-
100 mg X 2 f11..1Pf10LWS POri atevot\6,\fl 25-100mg X 1 ruu::pflOLWS PO].
Eav 11 av-ranoKpt<Jfl O"tflV napanavw U/W/ri oev eivat tKavonotr)tLKri rcpenet va
XOPfl/fl~ouv e nt rcpoa{} rws av-ra;wvtot.s tou aoBeo-riou ( n.x. vupeouti Vfl 10~0
mg X 3 f11..1P!l0LlUS PO rl VtooAOL TIL Vfl 5-20mg X 1-2 fliJcpflOLWS PO)

ITLVUKU<; 5_ ['vtnxaVlOIJO') OpUO!lS UVULOXULI..lLKWV <PUPI..I.clKWV

NnQw6o 8-avao-rot\ei.s A vta{WVLO"tS Ca++


Mnxavw1..1.6s

EAa1:1:won I..I.UbKapbtaK~c; ++ +++ +UJ)++


Katavat\wor)c; 02

A u~rwn oieqJavwias +++ 0 WS + ++UJ<) ... ++


po~s

KatanoA.1..1.flOh U//LO- ++ 0 ewe;- ++0)<)+++


OUOTIUO!lS O!tpUVLULWV
ap!JlPLWV

EAci-r-rwofl l)a~IJOU ++ 0 +OJ<)++


O"tVOJ0fl')

t\l !OUP/LU apt01PrlS + - ewe;+ - WS 0


KOtAiac;

AMes ATtOKill:ilO-raon A VlLIJUPIJUPU- AvnuneptaOLKll


VOOi)f1t\lUKrlS . /LKfi
Al10UP/LUS A vnappU~I..I.LKrl
A vuatiJOTI ra- Avuun:ep-raoLKri
AtaKri opaofl

13
-- -- __ '__ __, ----~--

DLVaKa<; o. XpovLU ~epurteia 1.1 vu:pw611

Evod{eLS
- l KClVOTtOL!lUK 11 UVl:Cl TtOK PLO'l Ol:llV UTtO/AWOOLCl VL l:po-y;\ UK pi Vfl
-1-rn~a-yxn 1.J.IPUVt{61.J.evn o ciAAo-re ciA,\ou ~a&J.Lou K6rtW<J'1 Kat
Clrt00L001.J.Vr} 0 1.J.l:Cl~OAs l:OU Cl//LOKLVr}1LKOU l:OVOU
l:WV Ol:<f)ClVLCll(llV ClP1'1PLWV { Cl/")'LOOUOTtCl01LK~ Ol:fl&U/X'l)
-1uo-roAtK~ 6uo\L -roup{ia aptotep~s KOLAias
-M1:1.J.<PPCl/I.J.ClrLJ-.:~ Ol:r}~U/Xf1
A V'tVOL{LS
-1ol)ap6SKCIL Ttli.J.OVOS TtOVOKtpaAoc;, vau-ria ~ {cit\r}
- ''f'rtpUaLO&r}OLCl Ol:Cl VL 1:poJOf1
-f1ptOPLOI.J.VIl aVl:ClTtOKPLO'l Ol:Cl OKUUOJ.1C.ll:Cl rtapal:l:ai.J.Vf1S
6paons

IIi vaK as 7. Xpovta -&eparteia 1.1 avaotoAeic; -rwv ~-a6pVP/'LKwv


urto6oxewv

EvOL{LS
-~1f1-&cl/Xf1 1.J.lpClVL{OilVf1 ll l:f1V ClU{f10f1 'tf1S <f)UOLK~S OpaO'tf1PL0-
1f11a<;
-~uvurtcipxouoa urtep-raon
- IotoptK6 urtepKotAtaKwv r1 KOLAtaKwv appu&J.Lttilv
- Metell<f>PCI/IlCIUKrl o-rn-&a!xn
- ~UJ.lTtCl~r}UKO'tOVLCl
A Tt6Autec; avtevoei{LS
-8pO/XtK6 cio-&J.La
-Bpa6uappu-&J.Lies
- ~UI.J.<POPilLLKrl KClPOLClK~ ClVTtUPKLC.l O<PLA6J.LVf1
0 OUOl:OALK~ OUOt\L l:OUP/LC.l 'tflS apLO'tPrlS
Kott\ias .
~X UK <; C.lVt VO,L {L S
-1aKxaptiJO!lS 6w5riti1S
-Ka tci (),\L!lHl
-Pat VOI.J.VO Raynaud
-f1pL<PPLK~ a!'"'LOrtU~La

14
,' _,-c. ----

lH vaKaS 8. Xpovu.t ~epan:ela ~e avra f'WVlOts Ca++

Evoe({eLS
-Suv urtapxouoa u n:epraon
-.--\ l'/clOOUOTttlOIL~ri 0Lr1~CL"/'Xfl'
-[010PLKO Urtt;;p~-;otAtaKWV appU~I-ltWV (Ot,\na(elln ri 0epai1U\.HAn)
Avtev6eL{etS
-~u~<J)opnuKri KapotaKri ave:n:cipKeLa O<PetA6~evn oe ouo-coAtKn
ouo,\el toup;ta rns apL01PriS KOtAias
-Bpuouappu&~LcS

~e rtapc!l6an~<n ~epan:eia ( a)';eton:~\aouK~ ~ aoptoote<l)avwia rcapaAau(j)rJ rtpe-


n:et va unoBAn~ouv OL ao-l)evels nou nAr)pouv ta KPL"tripta rou fliv aKa 9.

flivaKas 9. Kpt tripta ernAo/riS n:apeuBanKriS ~.epan:eias (Uf'/etorc,\aonKr1S ri


aOpl:O<Jt\j)OVtaLUS n:apciKillJ4JflS) 0' ao-l)eveLS ~ O!fl~U/Xr)

'KAtYLKci
-lltWXrl avtartOKPLO'!l 0' VtOV!l <papj..laKeUtLKrl 11/W/fi
-.i:1:r)&cl/'XI1110U rcapa UJV <papj..laKeU!LKrl 11/W/ri 1J.TtOOLCeL tLS Ttll//AI-llltLKe~ rl
~UXO/'W/LKS 6paO't!lPLOtf1!') !OU acr~eVOUS
Eupri!J.ata ava[~aKtwv P7110~f1pLaKwv e{e~aaewv
-AVTLKLUVLKCL eup0U0111 0050PQS LOXOLUi.OS
HKf<PtKri 6or:.q.J.aola K6TttoOf1S: Evtova n:a~o,\O/tKri OOKLIJ.aola xapaKtr1PL-
(6~evrl an:o ~LKPrl OuipKelll, Tt!WOf'l ST >2 mm. aOUVIl!J.LCl aUC!lOr)S OU<noALK~S j
nieons. n:pwt~ll e!l~avton lOXaJ.IJ.ias
~m v&npo;pa<Pfl!JO K6n:wons !Je ~aAAto: Me/'O:Ao avao-rp~tl.l.O eA~\eti.J.I.J.O. ri 6uo l
ri nepLOoorepa eAAei!J.IJ.Ota ~ au\nllevn npooAnWI1 &aA~\iou areo 1:ous n:ve tiuo- ~
~I
vec;
' Pa6LOLOoton:u. . f1 KmAto('pa<pta r1 flXOKapOLO/Pci<Pn!la K6n:wons: Ene:ta!.J.E:ves
fl n:o,\,\artAe<; 0L01:apaxc; !flS KLVfltlKOt!ll:OS 'CilS apLOtPrlS KOL.\iaS i!
lj
( KapOLO/'Pil<Pfll-lU Holter: TtPL0001'epa a.n:6 4 ert.t000l(l Katacrrcaof'l) tOU ST
TilV rwepa n ITHUO!l ST CnapKLOS 30 min ri Tt.!)L0001'.PO li
Eupri~.tara Kap6LaKou Ka3e-rnpLao~ou KilL otef9aVLO')'pacpLa<;
-Nooos ate.\c\OUS 11 vooos 3 O//.twv !l. cruotoALKrl ouoAeL toup{ta tns apLO!ePflS
KOLA LOS

-Nooor; OUO a(;cLWV 1-1. oo0apri ~,\0.t3n 010 .//US !1-lrl~ll tOU n:p6o3LOU K.a1:LOV1a

15
[1( vaK as 9. ouve "XeLa

-Nooo<; buo fl//E:Lwv ~Kat ev6<; aj;e.Lou IJ. ertLIJ.vouoa LOXaq.J.la rwpa tflv
tpapi.JUK e UHK fl f.l /W/11

~f'lllelWOf1:
Oe VOOO VO') U//LOU ouvri~W') TtPOLLIJ,Crt:aL 11 U//E:LOrt.\aOLLKfl E:VW 0
vooo ouo f1 n:e:ptooorpwv U)'/eLwv 11 aoproote.tpavtaLa n:apaKallr~~n

Otpe:L.\e.rat oe. att+'vL(na Kat ooBapri (narapax~ rou too(u)'Lou rtpoot+'opa<; Kat Crirncrns
OCU/OVOU 0!0 1J.UOKap6tO TtOU o6rpei 0. j.LUOKap6taKri LOXULIJ,la KQL K6f1AWV.1at: ri
j.l !I1V .1J.<pOVL01') 0111~cl/XI1S 0. TtP011)'0UIJ,VUJS aOUIJ,TI"tUJIJ,a'tLKO ao~evri ~ j.l 1f1V
ca<pVLK~ .TUOlVWOf11!lS 01f1~U/XLKriS 0\Jj..l.TI'tUJP.a'toAo;ias 0 KOTtOLOV ao~e.vn IJ.-...
o-ra&epri 01:11&a:x11. FI ao-ca&~s o-crt&ci/X!l 6taKpive.-caL oe. rtpwrorra&ri Kat
6e.u1:e.pon:a&ri liHvaKas 10). H rrptiJr11 o<pe.L\e.-ccu on) a~flPW/.latLKes B,\a5e.s -rou
!OI.XWIJ.UTOS rwv O't<pavtaiwv UP'ti1PLWV, Veil q 6eU'tPf1 0. CW01<pavtaious
rrapa;ovt') rrow e.L "C TtPOKaAouv QUCI10!l trtS Ka"CaVaAwons OCU)'OVOU ( n:.x. avat~J,La,
une.p&upe.oe.t6LOilOS, rtupe.-c6s. une.prpo<pia aptcrre.pris KOLALas) e.L -re. 6uo,\e.t roup;La
rou e.v6o&11ALou -rwv crre.<pavtaLwv aptf1pttiJv Kat e.Aar-cwon rns ote.<pavtaLas paris
(ciOKI1011, (j)UXOS, KOKKQlVf1, KUTtVLOilU).

fiL vaK as 1 a. K,\tVLK~ Katci'tacn ao1a&ous o111&a;xns

fiponon:a&ris
Ji..~{L YLK c) cKO!J.{ WOe/.)
-Evapc11 o111&ci;x11S ns TIPOI1/0U1J.eve.s 111J.pe.s
-En:t6LVOUIJ.VI1 (crescendo) O!I1&U/X!l
- lti1&Cl/XT1 11P1llUS
f..o:ftYlAO l/fr0(J[jJ((Ijlf1_

-St11&ti!'XI1 IJ.E:ta an:6 1J.1ppa;lla -rou 1J.UOKap6Lou


- 2r11&a i'Xfl llt: w a n:o a;/eLortAaonKri
-~ti')&Oi'XI1 llt:Ta an:o U//LOrtAacrnKri
- ~-r.:q&ci!XI1 Prinzmetal
~e:u-re.pona&ris

16
A. At nona&o!'veLa rcpunon:a&ous 01:o&a-yxos.. ~"to 800/o "twv ne.ptnn.ooe.wv
O<{)eLAt.taL 0 Pll~ll U&llPWilU'tLKrlS nAaKaS Kat OXIlllUtLOI..!O &p61lBO T1POKUt\OUVl:O<;
llEPtK~ ano<ppa(n rou auAou rou a)')'etou. t\L )'orepo ouxva oq>etAetaL oe
ULilOppa;ta J,lOa Otr)V a&llPWI..!O'tLKrl nAciKa.
B. K,\t VLK a e upouara. H ota)'VWOI1 ti1S aora&ous O'Tfl&O/XIlS ei vaL K;\tvtK~ Kat
0aoi(etat onw ,\fl4JI1 evos KaAou totoptKou. Ot ao&evets d T avaq>pouv
n:p6o<parns evapens ( <2urives) npoKapoto ouo<pt/KrtKo aA7os ue l..lLKPh K6nwo11 ri
l1LOl VW011 npou napxouoa<; Oti1&U/XLKriS OUI..lTI"'CWIJUl:Ot\O)'La<; xapaK"'CI1PL{OI..lVfl
an6: a) auenon 't11S t:v-caon<; . -ens otapKews ri rou apt&IJOU -cwv orn&a;xtKc.Ov
enewooiwv. B) E:l.l<PUVLOfl 01fl&O/.XI1S Ka-ca 111 6tapKeta 6paOlf1Pt01rilwv n:ou
at\t\o1e KtAOUVTO XWPLS Ttpol)ArH.lU, KUL /') 1J.!pUVLOr] Otl1&ci)'XI1S 11P1J.LU<;.
I6Lai n:pes IJ.Op<pes aota&ovs o-cnitarxns artore1\ouv 11 avao1po<P11 ot11&a;x11 (6es
napaKcirw) Ka&ti.lS T1LOI1S l11l11.l<PPU/j.lU1lKrl OlJl&U/XIl j.llpUVt(OI..lVfl 24 WPS
~ WS 1 l.lrlVU 1..1 ra a n:o O{U eu<ppa[l.lU "'COU IJ.UOKapOLOU KUL fl Otr)&Ct/XIl IJ.'tcl an6
aop1oote<pavLaiu napaKUI.l4Jr), a1.1<p61epes ouvooeu61.1eves an6 au{f11..1.vo Klvouvo
j.l<pUVL011S KUPOLU{/LaKWV OUIJ.BUIJ.CHWV.
r.: Epi'aO'tOQLOKci e::upOuata. To r)AK"'CPOKUPOLO/Pcl(Pili.1U 1'1P1J.LUS 1J.lpUVL\t
: toxatl.ltKes aMOLwoets 1ou ST Kat 1ou T. u6vo 010 20-30'/o 1:wv naox6v1wv.
EnojlVWS, 11 aveup011 <j)UOLOAO/LKOU 11AK1POKUPOLO/PU(Prl1J.Ul:OS. 1.1 KavE:vav
tpono oev anor;Aeiet r11v urtap\1') aora&ous otl')ifcirXIlS. 2e av-rL&eol') Jl to
E:l.l<PP'U/1..10 tOU l..lUOKapoiou 0\1 Ttapa1r)pi1al auer}OI')1lOV Kap6taKWV E:V\UilW\1 (OS
napaKatw) O'ti')V aota&ri Oti')&CL/X11.
To ontv&I1PO!'Pci<P111J.U 1ou IJ.UOKap6iou ll &aAALO ri 1exvnuo 99m Sestamibi, oeixvet
.i\i\tj.lj.lQ rtAriPWOf1S Kalil trl OlUPKLa 1WV 011')&U/XLKWV enewooiwv 010 95% tWV
aoSevc.Ov, evc.O oto otaoti')IJ.a 1J.1a\u twv enetoooiwv 010 40-60% aut <.iN. t\i ;o
KaA\Jtepa eivat ta artotei\E:OIJ.ala ti1S iJ.OVO<pW10VLaKr)S a{OVLKtlS 100{pa<p[a<; (Single
Photon Emission Tomography, SPECT). i
H 01e<pavtaia up tllPLO{pa<pia, UTt01Ai 'tllV eeE:tU011 KALOi /'LU Lr)V K1LI..lr)OI') ti')O l
eK1UOI')S KUL 'ti1S !)apUlfllOS li')S 01<pUVLaiaS VOOOU KOL 111V eTtLAO/fl 11'1S r
I
Ka1ciAi\r)AilS &epart UtLKrlS U/W/rlS. 1:

11. rip6--vvwoq Kat &epaneia. H np6{VWOil ti')S aa1a&ous Ot11SU/X!1S ei vaL ouo~-tevris. li
I
il
Erot. 11 nt&av6r11ra e~<pavtons e!J.cppa,.~atos rou IJUOKapoiou r1 ~avarou o"to i
,J
I'
I
tPtl.li1VO rrou at-.;oAouitei eva en:eto66LO ao1a&ous Ot!1&cirXI1S avE:pxeraL oe 10-200/o i"l
Kat 4-1 00/o avnoTmxa.
H 6ta;vwo11 't!l.S uora&ous Otl')&arxns an:at tei ti')V OIJOil xoPri/11011 1-2 un:orAwooiwv j
OtoKLO.lV vt rpo~\ur;epi Vr)S ~ 6tvttptKOU wooopr,i !11. ~!11 ouvE:xeLa rtpE:n:et va
eK U1.111&et !0 t-:.a ra rtOOOV 0 ao&evriS IJ.TtOpei Va aVUUetWTtl01l OtO oni tl tl

npneL va IJ. ra<pep~ei oro voooKOIJ.E:io .
0 a<J~VI1S IJ.I10Pt:L vu aVUIJ.1WTtlOti 010 on:i LL cnav: a) To <Jt!')&U/XLKO aA ;os

17
.. . . . o-

unoxwprl<JeL 1-1oa oe 5-10 Aenra a no Tf'l t\rJtlJI'l e.vos uTIO/,\tuooiou 6toKiou


vttPO/AUKepivf'ls. nt&avor!'lta e(eAt~l'lS oe ell<pPa!lla rou 1-lUOKapoiou 5-10%. 0) To
O!f'l~a/XLKO a,\ )'OS oe.v eL vat npoo<patf'l<; evap~f'lS ( >2 e06o!lci6es ), 1J<pavi{el:at Ilia
(popa nw 111-lpa oe. 1-1-rpw Konwo11 Kat oxt O!f'lV f'lPel.lia Kat 6e ouvooe.ue.-rat arto
wxaqJ.LKe<; llA1-~ rpoKapOLO/pa<ptKe<; aAAOLWot<;: ITt~aV01:111a ~,\tens 0 !l(j)PU/!la
rou 1-lUOKapoiou 5-10% Kat/) To 01f'l&a/XLK6 aA/OS eiJ<pavi<elat ouo e06o!lci6e.s
1-110 an6 ~.ttppa/lla 10U IJUOKapoiou XlUPLS f'lAKlPOKap6tO/pa<plKO 11clPilU1a Q IJ
ouxv6tf'l-ra 24 ~opes tf'lV f'lllepa oe. 1.1.-rpta K6nwo11 Kat no-re orrw nPe!lia.
ITt&aV01f'lTa ee,\tel'lS 0 1-l(j)Pa/IJ.a 10U IJ.UOKapoiou 2.5-5%.
l\le-ratpopa 0!0 VOOOKO!lt0 anaL tei !at 6rav: a) f1p6KLl:aL /La O!f'l~a/XlKO at\ /OS
f'lPe!lias. nou oev unoxwpei 20 Ae.nro IJ.ero lf'lV Ail11 6uo uno1Awooiwv 6toKiwv
VL !PO/AUKptVf'l). ITt~aVO"'Cil!a eeeAtel'ls 0 j..l<ppa/j..la 10U IJUOKapoiou 10-5a'lo.
0) I1POKL -cat /La O!f'l~a/XlKO ciA /OS np6o<pa!I1S vape11s ( <2 l'lllPS) 1J.<pavt<6!lVO
noAA<; <pop<; (3-6) 111V 111J.pa 0 1-llKPri KOTIWOf'l, 0111V 11P1.lia i] Kala 111 OLUPKLa
rou unvou Kat ouvo6e.u61J.evo an6 toxaLIJLK<; 11AeKtpoKap6LO/pa<ptK<; aAAoui.Joet<;.
ilt~aVOlf'l!a ee,\tellS 0 1J.<ppa/j..la tOU IJ.UOKapO~OU 5-5QJ/o.
.....
~-rous ao~eve.\.s rtou avlLIJ.tWTtiCov-raL ws e~urteptKoi. XOPf'l/OUvtat Per as vt tPWOI1
l..l.aKpa<; OLapKeLUS ( rt.X. 1-lOVOVL 1PLKOS LOOOOp0\. 111S 20 mg 2 ll 3 <pop<; lf'lV m.1.pa),
uvao-ro,\dc; rwv 0-aope.ve.p-ytKwv uno6oxwv KaL aantplvn ( 100-325 mg 1 <popo
!f'lV 11!lpa). ~tOUS ao3VLS 1-1 Ouoaveeia 01f'lV a01tLPLV11 llltOpei va XOPI17'f'l~i
LLKAOTILOi Vf'l ( 250 mg 1 ll 2 <pop<; 111V 111Jpa). Av OUVUTiclPXeL OUOAeLLOUP/La 111S
apL01pi]<; KOLAia<; OUVLOl:UlaL 11 XOPri/1'1011 avao1ot\WV lOU j..l1atpTt1LKOU
eV{U!lOU 111S a-y)'L01aOi VllS ( n.x. Kalt10rtp\.An 12.5-50 mg 2 ll 3 <pope<; 111Y I'JI.lepa).
Av-ei~e.ta npos lf'lV entKpa-rouoa av-riAI'l<.Vf'l, ra ano-re.Ao!lara an6 rn xprioll.twv
UV1a/WVL01WV tOU ao001LOU 01flV ao-ra&f) O!fl~cl')'Xfl, 0V Kpi.VOV1aL OJ<;
LKaVOltOLflLLKO KUL lU <pUpiJ.lKU autci &a 1tpTIL V1 XOPfl/OUVlaL 6taV OUVUTtOPXeL
unpraol'l (rt.x. a1.1.Ao6LTtivn r1 <peAo6tnivl1 5-10 mg 1 <popa -rnv nJ.lpa PO).
E\atpoe.ts ano1eAouv n 6tAtta<elll1 ( 4DBO mg 34 <popes tnv r1J.lpa PO) Kat n
0e.partalliAI'l ( 40-80 mg 34 cpopec; rnv f'l1J.pa PO), oL onoie.s oe av-tt6LaoroAr; !l
lOU<; o,\Aous av!a/UJVL01eS tOU ao~01LOU Ota~e!OUV LK1Vf) apYf'l!LKri LVOtPOTIO KaL
OpOIJ.Otpono opa011.
~!OUS etOa/OIJ.VOUS OtO VOOOKOIJLO ao~VLS XOPfl')'OUV!aL av"Ca/WVLOt<; tWV 0-
aopeYeP/LKtOV UTIOOOXWV, aOltLpivn Kat avaotoAei<; tOU IJ.tatpTttLKOU V{U1J.OU
tf'lS a//etotaoi v11~. 6nws Kat otous e.ewtePLKous. Entnpoo~eta XOPI1/0uvtat: a)
Nt1PO/AUKPLVI1 Oe OUVXrl VOocp,\~La /XUOf'l (evapeflll 10 IJ.g/ATt!6 Kat O!fl
ouvexe.ta au~no11 tllS coons Ko()e 5-10 Aen!ci IJ.XPLS unoxwpnons tns o!n&a/XLKrlS
OUJ.lft!WIJ.atoAO"YLa<; rllleLWOf'lS ti1S ouotOALKrlS aptnptaKriS TtlOflS ota 110 mmHg
Kat~) Hrtapivr, I5.000-10.0001Ue<p'cin;a~ KaL aKoAou~WS 20.00~0.0001U/24topo.
etOL o)Ol 0 XPOVOS J.lPLKf)<; &pOJJ00TIAaot\.Vf'lS va eiVaL 1.5-2 <pop<; IJ.)'aAtHpOS

18
ano t:Kt:L vov rou !lciptupa.
Me "LflV e~ap!JO/fl t'flS rcpoava<j)ep~etoas a{w;ris em-ru)'xavetat ota~epon:oinofl,
Oflt\UO!l E.\O<j)clVlOfl TflS Otll~O/XLK!lS OUIJ.THW!iarot\o)'i.ac; 1\0L tWV LOXOLIJLKWV
flAE.KtpoKapOLO/PU<j)LKWV aAAOLWOE.WV OtO !lAeKtPOKapOLO/Pcl<j)fliJ.U llPeiJLOS 010 SOYa
rwv n:epL n:twot:u-.~v. 2e ore.q>uvto;puq>tK6 .Ae/XO np. net vu urrol)a,\,\ovrat: u) Ot
ao().eveLS TtOU Ot:V oru().epOTtOLOUVtUL j..l.e Tf1V ~UP !JUKe ULLKfl 0/W/fl, ~) 6,\0L OL
uo().E.VeLS flt\LKlUS KcltlO HOV 50 etuJV KOL /) 6,\0L OL UO~E.VeLS IJ. ~enKJi OOKLI.I.OOLU
K6n:wor}s un6 <POPIJOKUUKri a;w;ri.
H Tet\tKri an6<paor} )'ta to eav 0 aoi}evris i}a eeaKOt\Ou~riOL vu t\UjJl)UVL
<PUPI.I.aKeUUKfl U'YW/ri rl ~a UTtOIJ,\f1~eL 0 TIE.jJl)attKri ~pUTtLa (a;{LOrtt\aO'tLK~
!Je 1Jrta\A6vt ri aoproote<puvtaia napaKalJ((Jfl) ~a e~aprrJi}et ano 1flV
UTIO!t\OjJaTLKOtr}tU 'tf1) <j)Up1J.OKUUKriS 0/W')'rlS, ta eupfij.J.Uta tr}S
Ol:e~avLO;pa~ias KUL ru an:o1et\.o1.1.ata rwv 6ta<p6pwv OOKLI.I.UOttiJv rtp6Kt\Of1S
IJUOK up6wKriS LOXUL1.1LUS ( anAri OOKLI.I.aola KOTtWOflS oe KuAt61.1evo tartf1ta ri
P/01.1.tptK6 noof)Aato, OTUV~f1PO')'pa<pnllu KOTtW<JflS 1.1. ~at\;\Lo ri 1.XVrltLO 99m
Sestamibi, paOLOL<JOtOTttKri OOKLilaoia K6nwons KOL !lXOKapOLO/Pcl!f'fli.I.O
ool)outaiJ.i vns. aoevool vl")s ri ot n:upt6a1.16Ans ).
Ot ctoi}evds IJ. v6oo oteAxous ri v6oo !ptc.Ov O//E.iwv Kat Krttwort1f1S ouo'tot\tKriS"'
Aet toup{ias !flS apt<Hepris KotAias. ~a n:pnet va unol)t\f1i}ouv oe e-yxeipr,on
UOP100t<j)OVLULU) TtapaKOIJltJ!lS IJ. ton:oi}etnon apl:flPLUKWV IJ,OOX.UIJ.cl"CWV (OW
IJUOUKriS, KE.PKLOLKriS ri /UOtpTtLTtAOLKriS) tOUAclXL010V Ol:OV np6oiho KULLOV'ta. 0L
aoi}eveis IJE. IJOVOa/')'E.taKri v6oo Kat ool)apri ~Aa~n o1o. //'US 11lri~Hl tns
npool)13t\!l1J.'Vf1S ap1r'lPLOS iVaL UTtO<.tJri<j)LOL ')'La a/')'LOn;\a<JttKri, evc.iJ .KLVOL 1..1
TIPL<PPLKS OtVWOLS j..I.LaS ri Ttpl0001pWV aptflPLWV {La OUVtl")pfltLKrl
i}epuneia.

3. AvdotpO<flfl 01fl~U/Xfl ( ~tn~ci/Xfl Prinzmetal)

To aouvn&es auto ouv:opoi.J.o xapaK111Pi~e1:aL an6 rnv E.IJ.cpcivtofl o1n~6./xns ,npeJ.Lias


OUVOOUOJ.l.VflS an:6 aVUOTtOOf1 tOU OUl01rlJ.l.U10S ST 010 f1t\K1POKQP0LO)'p~<pi1J.l..Q.
A n:ocppaKttKri ore<pavtaia v6oos aveupioKetaL 010 70% twv ao~evwv, evw otous
Urt6Aot rtoUS ra Ot<j)aVtaia a/(ia 1J.<pavi{OV10L <j)UOLOAO/LKU Otf1V Ot.!p0Vtaia
apU] PLO/PU!pLU.
H avaotpo<prt 01fl~c.l/xn anooioetaL oe an61o~rt aueflall 1ou U//LOKtvnttKou 1:6vou
tliJV 01clpavwtwvaptf1PLWV (onaa!J,6S). 11 on:oia npoKaAe't art610I..lf'l e,\anwart tllS
01e<pa.vtutaS POr}S, IJ.UOKUPOLUKri LOXOLjJi.a KOL O"Cf1~tl/X!l. Ot ao8-E.VLS 1.1. tO
OUVOPOIJO tOUl:O jJ<j)aYi{ouv ouxva Kata "Cfl 0LclPK.la 10JY TtLOOOlOJV
Bpu6uappu&lltcS n KOLAtaKS appu&1.1.i.es KaL oe optoJJve.s neptrt'twoets n

rwpart:taiJ,VfllOXULIJ.LU eeeAiooetaL 0 JJ.cppa/IJU 10U IJ.UOKUpOiou.
Ita !r}V UV!l1.1Iltlrtl0f'l "Cf1S avaorpO!pllS 01fl&cl/Xf1S xoprpouvtat avta;wvto1S tOU

19
, ~.-'

I
II
'I

I
r.w0eol:iou eL 1 uovot eL -ce oe ouv6uaou6 1-1 vnpw611. H XOP~/110f'l avaoroAewv rwv l
0-aopc:vep')tKwv un:oooxwv avrc:vbetKVUTtiL 6t6n 11 e\aKo,\ou~llOil HIS
OpaorflpLOTfll:U$ tWV a-aopVP/LKWV UITOOOXWV 1JeTi TOV OITOI\t\t0j.LO !WV ~
aopeVP/lKWV un:oOOXWV 1-!TtOpei VQ TtPOKaA0t aU\flOill:OU O//LOKLVf11LKOU
rovou 1:wv oH.<JHlvtaiwv apli1PLWV. Ot\m OL ao~eveis rrprteL va. unoBaA..\ovrat oe
<He<pa.VLQLQ apH]PLO/PU<pia {LQ va. 0LPUVf'l~ei 11 avaTOIJ.LQ lWV 01<pa.vtai.wv
UPl:llPLWV KUL va. \l:001i 1:0 VOeXOIJ.VO Tt1JBauK~S ~eparretas
(a;;eLOrrAaol:LKil ~ aopl:OO!e<pavtaia na.piKaiJ.(J.II1)

4.0\ti 1J.~pa;~a 1:ou ~uoKapoiou

Eivru vKpwon TI-I~IJ.aloc; 1ou IJ.UOKapoiou A6;w an6<ppa{I1S IJ.ias ore<pavtatas


aplllPLO$, OUV~~WS (9JI/o l:WV Ttpt Ttl:C.UOWV) an6 -&p61J.BO, 0111J.LOUp)OUIJ.VO 0111V
e rrtcpaveta 11ias a~llPWIJ.al:LKrlS nAciKa nou -xet unoo1:ei pfl\n. AAAa ,\q,6repo
ouxvci ai ua anocppa\ns 11ias ol:e<pavtaias ap111pias eivat o onaoll6S. 11 eiJ.6oA~. 11
aplllPL LLOa, 10 rpau11a~ OL OU))VLS aVWIJ.aAieS 'Kat opto~VS atj..l.aToAO)'LK$ '
6tal:apaxes nou npoKaAouv au\11011 1:11s Tti1Kl:LK61:11tas lOU aillaloc;.
A ITa&oAo"YtKO ava-routKO. H n:ep1.oxr) 1:ou e~~pu;~a1:oc; elva1. apX\.Ka ~e,\avr) Kat
KuavwuK~ ,\6/UJ rns Ai1J.vavo11s lOU aiJ.,lalos. Mel a an6 24 wpes ava.n-ruooelat
oiOf'llla twv llUOKapOLaKWV KU!tcipwv Kat <PA.e/IJ.OVWOilS avti6pao11 IJ.e AeuKo-
KUltaptKrl 6t~~11011. T11v 6eulePfl r1 lflv tpi til ~ete~<ppa;~alLK~ n~epa apxiCet n
ouionaOI1 Kat 11 artOIJ.clKPUV011 l:WV VKPWJ.lvwv ~UOKap6taKr.Ov LVWV, OL onoies
avuKa&LctavTat rrpoooeuttKci art6 KoAAa;6vo. Lluo 1-lflves nepinou 1J.ta arr6 lO
1l<PPa/IJ.O 11 veKpw~eioa nepLOXrl a\ILLKa~iolatat an6 KoAAa;6vo (ouAfl).
B./\enoup7tK5 otatapaxes.To 1J.<ppa;~a tau 1J.UOKap6iou npoKaAei Krttwan lflS
llllXUVLKrl5 Aet "toup;ias 111S aptotepfls KOtAiaS xapaKt11PL{OIJ.VI1 art6: a) eAUtlWOfl
IllS OUOTtaOl:LKOl:lltaS, 6) OKLV!lOia rl OUOKLVI10ia li1S TtpoofleBAI11J.EV11S Tt~LOX~S. ;)
I

lltaBoA~ T115 VOOTLKOtlllaS, 0) eAcillWOfl TOU 0/KOU rtaA~ou. ) eAanwor) lOU


K,\ciOilUTOS \W&IlO!lS. Ol) all\11011 lOU teAooUOlOhLKOU Kat tOU teAo6taotoAtKOU
O('KOU Kat 0 auenoll TllS reAootaOlOALK~S TtL011S 111S apLOlep~s KOL,\ias. To
lle;e&os rwv npoava<pep&vtwv 6talapaxr.Ov e{aprcirat an6 to 1.1;e~os Kat -rnv
evt6ntan -rou ell<PPci/~atoc; ( ra np6o~ta rrpoKaAouv lle/aAutepes otatapaxes an:6
ra Katc.i.nepa, oes .napaKatw) tou e1J1ppci;J.,latos. li1V Aet toup;tK6trna tau
1-!UOK apoiou rtOU OV XL UTtOOleL vKPW011 Kat TllV avaTtlU\11 11 lll1 rrapartAUP!lS
KUK,\O<popias. onAaon avaotOIJ.Wl:LKWV KAciowv IJ.ta\u lllS naoxouoas OTe<pavta.ias
apHlPLa.s IJ.e'ta tllv ano<ppa\11 Kat ~ias aAA11s Ole<pavtaias aptl1pia.s. ot11v anoia 11
a.tua.uK~ po~ 6ta111Peitat oe <putnoAo;tKa ertineoa.
r. f...:,\LVLK5 KOQ\(I,l<JL$. To KUPLOtepo OUilTtTWila lOU o\eos 1J.!ppcl/llU105 TOU

20
I!UOK apotou et vat o n:poKapotos n:6vos, n:ept/PUlPO~J.evos a n:o tov ao~ev~ ws
on:w~o-r:epVLKil ouoq>t/Cil. Kcl4>LI-IO r1 n:teon. On:6vos ouxva avravaKAa orov rpa-
Xr)t\o, ra xpta (ouvn~ws 1:0 aptO!ep6) ri !r)V PclXr). otapKei 15~0 Aerna rl n:epLO-
o6repo Kat oev un:oxwpei IJ.e Tr)V un:o')'t\woma XOPrl/11011 vt -r:pwowv. At\.\ a ouJ.L-
nni.l~J.ata ei vat 11 ouon:vma, r) aouva~J.ia, r) eq>iOpWOr) KUL , vauria. ~TO 200/o rwv
e1J.q>pa;!latwv o n:ovos ei vat arun:os l Bu~LOS r1 oav ~J.axatpta) ri an:ouotaCet ri
ITLKparouv aMa OUIJTtl:WIJata, on:ws 11 aouvaj.l.ia Kat , OUOTtVOLa.
0 ao~evfls un:opei va xet cpuotoAo;tKrl euq:>crvtol1 ri va ei vat wxpos. tbpw1Jvos Kat
avaoratW!Jevos. H KapotaKr1 ouxvor11ta ouvr;-&ws eivat au\fluvn (ora Karwrepa
~J.q>pa;IJata n:apatflpei tat ouxva BpaouKapoia), 11 aprnptaKri n:ieo11 1Jq:>aviCet
avooo KUL un:apxet raxunvota. H UKPOUOfl rwv TtVUIJ.OVWV eivat ouvr;~ws
<pU<JLOt\O')'LKi) Kl:OS eUV UTtclPXL OUOt\t l:OUp')'ia l:flS aptatPflS KOLt\ias ( U/POl
PO/XOL on s Baoet s aiJ<pO-r:pwv rwv n:ve UllOVLKWV neoiwv ). ll:llV aKp6ao, 1:111)
Kapotas ouxva owntarwvovrat: a)et\cnrwon tf1S evrao11s tou npwrou KapowKou
. l:OVOU, Oq:>LA01J.V!l 0 UTtOOUOtat\UK01:111:U 1:11) apLOtepfic; KOL,\tas, 6) TtapaOOCOS
otxao1.16s rou oeurepou r6vou t\61w aucnons rou xpovou ecw~no11s rns apto'tepi)s
.Kott\ias. ')') tTapros KapotaK6c; r6vos t\67w rns 'vrovf1s KoAntKris ouotot\ns. 6) ,
rpi !OS KapOLUKOS !OVOS UTtOOLOOI,.lVOS 0 Acl11W011 !flS btataOLilOTiltac; 111S apt-
OtPrlS KOLAiac;. A.\,\a aKpoaottKci eupr;uara eivat 1a e\ns:
a) Dcpt;(apotaA.or tjlOS rpt/it}> Oq:>eiAerat oe n:eptKapoinoa, 11 on:oia ouxva
ouvooeuet 1:a eu<rP1/I.lata nou Ka1:aAa1.1Bavouv oA6KA11PO to naxos tou tOLXWIJa-
ros tflS apL<nepris Kott\ias (otatmxw~Jal:tKa). 0 neptKapotaK6s rixos tptBris an:o-
reAeitat an:6 2 f1 3 OUVL01:WOS (ouotOALKrl, TtPW'tOOLUOtOAtKri Kat tAOOLaOtOALKrl),
ouxva eivat btct\ei nwv, otapKel c.Opec; ri rtJ.Lpec; Kat unopei va aKOU/'tat an6 rts
n:poit1) oipeS ll1cl tr'}V ')'KUtclOtUO!l tOU 1.1'PPLl/l.lUtO<;.
jj) ]l/OTOALKO tptiCJIJJitl tlVcnopt(ciOS l'IJS" pL TpOe/OOU~ Qcpeit\etaL 0 LOXOLI,.lia,.
1J<ppa)IJU, ri PriCil ~rtt\oetoous IJUOS. To cpuonlla unopei va eivat n:pwto-, 1JOo-,
tet\o- ri ot\oouorot\tKO. ltLS nepLTnWOLS n:ou UTtClPXL pflel1 tOU ~flA0LOOUS IJUOS
"CO OUOl:OALKO <pUO!liJ.O OUVUTtLlpXL 1.1 ULJlOOUVUJlLKri .aota~eta Kat TIVUIJ.OVLKO
oibnlla (oes n:apaKatw).
() ]voroAuo f/'l/O!JJitl JlcOOKOIALO/(i;f e ntKOL VfiJVitl~ ilp6K l taL )LU tPOXU OUOtOALKO
<pUOfli.J.U n:ou ouvi)~WS UKOU/'1:0t 1.11:UCU \Ltp0LOOUS art6q:>UOI1S KUL KOputprjc; Kat
ouxva ouvooeue:taL..an6 poiCo. Oq:>eiAeraL 0 PrlC11 .tou ll00KOLALUKOU OL-
a<ppU(IJU10S (oes. n:apaKcitw).
::1. Ep "Yaoro ptaK o ow "Yvwon. J..:. .tl.1.~JQQ.K.Q:l:?.Q!.QJ.'P..~!P.!l!J.9.. ~rnv o(eto rptiotl ( wpes ews
ouo eBoouaoes) n:apU111POUVl:aL OCUOLXIJ.U Kat auel1uvou eupous Ttapj..lal:a T KUL
avaoTTaon rou owo-cri!Jutos ST. Ta npc.Ota artooibovtat oe unev6oKapbLaKr1
toxat!Jia vw f1 be uteprJ avuol:OLXei. oro peuj.J.a Bt\a~flS Olll.lLOUP/OUJ..tVO an6 ateAri
eK n:oAwoo rns rtpoo~eBt\rwvns n:eptoxris. Ot n:poavacpep~eios

21
q,\eK rpoKapOLO)paq>tKes a,\,\ou.iJo<::ts aKoAou~ouvrat a reo tr')V (.;.Lq>civLOn KUIJ.cit:wv Q
KUL !f1V AUHWOf1 !OU tJ(pOUS ~ !f1V e~aq>ciVLOf1 rwv ertap!,Ull:WV R TIPOKUAOUJ.lVWV
UTIO 1f1V J.lUOKUpOtUK~ VKPW011 {)La "CQ J.1ippci)'J.1U!U XWPLS Q {LV"CUL Llnairpf1
avatpopci rtapaJ....cirw).
~ rnv vllo(cia tft.JOIJ. n 6tupKta -ens onoias notKL\et am) ao~evr; oe ao~ev~.
n:aparnpei-cat apvnuKonoinon -cwv KUJ.Lci-cwv T evoetKLLKri llUOKapotaK~c; LOXat-
lliac; KUL UTt0XlLlpf1011 "COU pUilU"COS ~,\ci~!lS, XUPUK 'tf1pL\OileVf1 UTIO 'tf1V en:civOOO "COU
OLUO't~llU"COS ST CHf1V LOOf1AK!ptKfi /PUJ.ll..l~. ~ OPLOJ.1VOUS QO~VL<; llTtOpL va
1..l<PUVLOl:OUV llLKPU TtUPilU"CQ R.
~1:JlV tPO-..:ta tptiOIJ, 1..l<PUVL\OIJ.Vf1 IJ.e"Cci art6 e~OOI.lclO<; ri llfiVe<; (ouvfi~wc; l..le!U an:o
46 llrives) -ca "Ulla"Ca T /L vov-rat ~UK a Kat 1-l<PaviCov-raL 6te upuo1.1va Kat 6a~ta
KUl.la"Ca Q. Ta reAe uraia l.l -cnv mipooo !wv e.-cwv Kat l:JlV piKvwon_ IllS
onl.ltOup;n~e.ioas ou,\~s e~acpavi(ov!at o-ro 15-200/a 1:wv neptTtl:tiJoe.wv.
AvaAO/U 1.1 US UTtU/W/S ons OTtOL<; 1..l<PUVL(OV!UL OL I")AKtpOKapOLO/PU<ptKS
aAAmwoets 1:a 1..l<9PU/IlU!a Q 6taKpi vov!aL oe rtp6o,9ta, Katcbtepa, ortio,9ta Kat
rcAa{ta.
Ta n,ooor.9ta1..l<PPU/IlU'ta 1:ou llUOKapoiou ocpeiAovl:at oe art6cppa~n 1:ou n:p6o~tou
I

KUUOV"Ca K,\aoou !I")S apLO!PrlS Ote<pavtaia<; ap'tr)piac; KQL ta r,AeK!po-


KUPOLO{pa<ptKU eupi)J.1u'ta el..l<pavi(ov!at ous rtpoKapotes arta{w;s V2-V6.
Ta Ktll'aJl'e,Otl1..l<PPU/IlU'ta 'tOU llUOKapoiou o<peiAOV!QL 0 arto<ppaen rns oeeta)
<necpavtaias aprflpias ri !ou rte.pton:wl.levou KAaoou trlS apto"te.pris otecpavtaias
ap!r)pias Kat rtpoKaAouv nAeK!POKap6to')'pa<ptKc; aAAottiJoe.ts o-rLc; ana')'w;es I I.
I II Kat aVF.
Ta n:-lti;>'tae.J.L<ppa)'l..la-ra tau J.1UOKapoiou ouvf)~wc; Olf>eiAov-rat oe an61f)paen tou I
neptortc.OI..levou KAaoou tns apLotepris o-recpavtqias ap1:1 1piac; Kat npoKaAouv
nAeK !POKapoLO;palf)tK<; aAAou.iJOeLS O!L<; arta')'W')'<; I, aVL Kat V6.
Ta g,f!Jr.9tj O!Z'!O'r.9ta1..l<PPU/IJ.U!U !OU IJ.UOKapoiou oev TtPOKaAouv ta KAaOOtK:ri. n-
I
1\
t\K!POKapOLO/PU<PLKQ e.upftl.lata aAAa tflv eiJ.<plivton e.n:apiJ.atos R 6tapKdas> 0,04
\r
sec l..l ox eon R/S > 1 otnv artal'writ V1. H 6ta;vwon roue; npourto,9ete.t -rpv I
UTIOKAE.LOIJ.O 'tflS uneptpo<pias 'tllS UTtep'tpO<pias !llS oe.etaS KOLAiaS fi 'tOU block tOU
6e~LOU OKAouc;.
T Aos. ra 1J.q>pa "'l..lUl:U ti")S oe(tdr !I'OtAia~ !Q ortoia ouvn~wc; ouvooeuouv ta
Ka-conepa ri 'ta onio~ta 1l<PPU/IJ.U1:a rou IJ.UOKapoiou rns apto!e.pftc; KOtAias -ca
Oq>tAoueva 0 art6cppacr, HlS oeeta<; Otecpavtaia<; apl:flpiac; UVU/VWpi(OV'tUL an6
!I")V J.1<pUVLOI") avqortaons OLLS Oe~t<; TtPOKClPOLeS arta')'to[<; (V1, V3R, V4R) XWP.LS
va Urtapxet KU raortaon l:OU !lltliJ.Ul:OS ST OtLS aptOtps TtPOKUPOLS UTtU/W/S .
.2.~ ...6.Y..~9.1JJ~. Anora VKPW1Jva IJUOKapOLaKa KU!!apa arteAeu~e.ptiJvovtat .v~u1.1a. -ca
anoia, avLxveuOI..lVa o-cov op6, oullBcii\Aouv otn 6tci;vwofl tou 1..liPPii/lla'tos. Ta
E:vCu1.1a auta t:L \'UL 11 Kpe.au vocpwo<POKt vaofl (CPK ri CK), 11 aonapttKr1'
Ul..llYOrpavo<p<::pU<Jil (AST) fl n:aAaL6tepa OVOIJ.U(OilVfl o(aAoeetKri !paVOUIJLVOOil

22
(SGOT) Kat n ;aAUKTLK~ 0UOP0)'VU<Jfl (LOH). ErtLOri ta rtpoavu<pepSE.vtu E.V(U~U
E.IJ.<pavi(ouv au~llOll OE. rrot\;\E.s naSoAO/LK.c; Katao-raoets /La til 6ta;vwoq rou
eiJ.<j)pUf1.1U10S l:OU llUOKapOLOU Ul10AO)'L(OVtat OpLOJ.1Va UT10 1;a LOOV(Uila l:OUS
rrou ell<Pavi(ouv eLOLK6-rnta /ta tnv rtO~flOfl aut~. Ta wov(u1J.u uuta E.tvat n CK-
MB. ll LOH 1 K UL 11 LDH 2
H CK-MB au\avenu OtrJV o{eia <paofl tou J.1<PPO/IJ.UtOS tou 1J.UOKap6iou KUL n uur;
tflS errto-rpq>E.L ora <puOLoAO/LKa errtrreoa IJ.E.ta an6 2-3Jl1J.epes. Ot LDH 1 Kat LOH 2
au\avovtaL IJ.E.ta trw CK4V1B Kat o unoAO/LOJ.lOS touc; eivat XPrlOLIJ.OS otuv eXE.L
rrap;\~et eva 24wpo an6 rnv E./Karao-raon ev6c; o\eos ell<J)PO/Ilatos -cou
IJ.UOKapbiou Kara tr] ouipKeta -rou onoiou bev exet urtot\O/LOtL 11 CK1v1B. ~tu
<j)UOLOAO/lKcl CL"COIJ.a ll OU/Kevtpwon TflS LDH2 eivaL 1-l/U.\(rrepJl ano eKLVJl !flS
LDH,. 01J..WS; l.l ta an6 eva oeu 1.l<PPU/IJ.U tOU IJ.UOKapoiou napatr)pei tUL ava-
Ol:pOtpJl llE.:anoteAeol.la to rrr)AiKo LDH 1/LDH 2 va unepeaivet tnv ~-tovaba. H SGOT
(AST) av Kat E.Lxe XPJlOLI.lOrtotn~ei eni noAAa xp6vta /La tn 6ttt/VWOI110u o\os
el.l<j)Pcl/j.lUtOS'tOU IJ.UOKapoiou 1LVL va /'K01aAncp~ei t\6/W tllS XUI.lrJAris
e:t6tK6tntas (ta enineoa -rns aueavouv oe noMes na~r;oets).
TeAeu-raia XPI10LIJ.OT10LOlN1aL /La 111 OLU/VWO!l tou 1l<9PU/IJ.Ul:OS -rou IJ.UOKap6iou 11 . _,
IJ.UOO<j)atpi VJl Kat 11 CK4V1M, TtOU 1J.!pUVL(OUV tUXUtP11 aVOOO KUL <P!UVOUV 0 eva
IJ./tOl:O /Pil/OP6tepa an6 6Aa ta npoavaq>ep~vta v(UIJ.U Ka~ws ertiOI1S 11 /'
:I

~.'I
tporcovivn T, ll Ortoia 1J.C{)UVi(eL IJ.')'UAJ1 LOLK6trna (orcavioos aueave-rat Qt(l\l 6ev
UTtclPXL j.lUOKUPOlUKri veKpwon). ~j
~.:.f.gQ.~.9~.9.Q.IQ.TI.~..IS..S.....~.19:9..tS. Mnopei va XPilOLIJ.OTtOLfl~OUV Ol:lS Ai /S nept- i
't"J

nn.Ooets, rroun 6ta/VWOI1 6ev eivat 6uva-c6 va te~ei art6 tLS KALVtKes eK611Ati.l-
oets, !U nAeKtpOKapOLO/PUC{)LI<U UPrll.lU1a KUL tlS 1.1ta6oAs l:WV KapOLUKWV V-
(UJ.1WV. 2uvr]~WS XPJlOLIJ.OTtOLOUV!UL OL e\riS !l~oOOL:
a) Jnt v~9!Jf)OJ'j)O~IJJJO jJe nupOfi'(.(JC1fi'Oj)//<i'0 Z"C,.t'V!jrtaTo nupO\J)WOIPOPtK6 !XVfJ!LO
rrpooAa!lBave-raL an6 til VeKPWtLKri Ttpl0Xri tOU llUOKapoiou, OTtOU ouvoeetal !l
t6vta ao6eotiou. Totno exet we; ano-rAeolla tnv avixveuon !l/aAr,s pa6t;evep/OU
opao-rnpt6-rntas o-cnv ev A67w TtPLOXrl. n onoia aneLKoviCetaL oav ~Pilrl KllAioa.
To ornv~r,po)'pa~nlla auto apxiCet va ~euKortoeitaL tLS npw-ces 10.12 <.Opes !leta
t!lV 1J.~UVL011 tOU 0\.0<; 1J.q>pci/1.1U!OS "COU IJ.UOKapOLOU KUL )'lV!Ql TtpLOOO"CpO
~eUKO US TtpllHS 2~72 WPS.
B) ]ntv,9tJJJO?PUf/'!JJJtl ttc ovrtttliOC1t vo.ti ovrtC1aiporo cffLCliJf.IOC1JJevu /ic ivoto 111. H
!lUOKap6taKri v~<.pwon exet ws ano-reAeo1.1a u1v Auon 111s ouvexetas -rns
KUttaptKris ~-te~.tBpuvqs. Tou-co ertl tperret -rnv avriopaon turrou avu,6vou-
avuo(01.1atos IJ.E.ta~u -ens ev6oKut-raptas !lUooivns Kat rou KAao1.1atos Fab tr1S uv-
tL!luooivrJ<;, T!OU XL Ttl0f11.1aV~i !l i.VOLO 111 KUL 111V UTtLKOVlOr) !JlS 1.1-
<ppa/llUtLKriS n:eplOxris. H ll.~o6os -coutn un:epexeL rns n:pOJ1/0UJ.Le:vJ1s 6t6u: L)
E.IJ.<pavt\E.L e.\u4'PtllS KaAurepn ouvoAtKri 6ta/VWO!LKrl aKptBeta. t6tws ata 1J.<PPci!'-

23
. . . ... - .
,._,_ __ '_'.: ,_,__,_, __ :: .
. -'---- -- --.

~UTa XWPLS Q, LL) f[L Tp T!L KaAlrrepo a<popLO~O l:f1S j.lUOKapOlUKf1S V"PWOJ1S KUL
LLL) exet ~e)'u.\urepn euato~noi.a ons npwt~es <paoets IJ.ta trlv evapen nov aul.l-
nrw~arwv.

! ) ~~!l/. vt'hJPO?'Ptlf/'!lj./0 jic c9tiAAto- 201. To ~aMLO- 201 avtaAAaOOOIJ.VO j.l K1,\LQ
eLopxeraL ora <puoLoAO/LKci Ktnrapa. Touro oev n:upar11pei rat ae Kunapa n:ou
XOUV UTIOOTl VeKpWOI1 KQL OUVTIWS 11 rt:PLOX~ tOU 1J.tppUf'j.lOtOS, Oti1V on:oia
0V avtxveueraL pa0lVP/'~ opaOtf1PLOtl1tfl, QTILKOVL\etaL oav (,t)UXPri K11Aioa. To
on:tv~I1PO/'PU<P111..LO I..L ~aAALO exet I..LLKPri etOLKOtl1ta 6ton 11 n:apouoia ~uxpris
Kf1,\ioac; ~nopei va o<pei.Aetat ae 1..LUOKap6taK~ L<JXOLI..Lia. n:aAat6 1J.<ppa)'I..La tou
~uoKap6iou. n:p6a<pato 1..L<PPO/I..LO tou I..LUOKapoi.ou ri auvouao1.16 twv n:poi1-
/0UIJ.VON.
4.Ji.XQ.~,g.Q.Q~.Q1.P..g.<P..n!JJ~. H neplOX~ rou 1..LIPPU/I..Latos ava')'vwpi{etaL an:o r11v na-
paTI1POU1..LVf1 otatapax~ tns KLVI1tLKOtl1tas (aKLVf10La ri OUOKLVI'lOta).ETIL rtAov, 11
eeeta<JI1 autri napXL n:oAUtLI..LS rrAnpoq>opi.es /Lfl 1LS OLaOtQOLS KQL !l1,\l-
!OUP/lKOtl1tfl r11s aptatep~s Kat trlS oe(tas KOLAias. tnv Aet toup)'ia rwv KoA no-
KOLAtaKwv KOL tWV 1..Lf1VOLOWV ~aA~iOWV Kfll /Lfl ,tf1V TtOOOU)tfl tOU U/POU rt:OU
un:apxet or11v neptKapotaK~ KOLA6tnta. A noteAei rov aKpo;wvtaio Ai~o )'La rnv '
0Lll)'VW011 tWV lli1XflVLKWV TtL Ttt\OKWV tOU 1..LIPPcl/IJ,UtOS l:OU 1..LUOKap6i.ou .
..1. A vnuetwn:too aveni nAeKtou euppa"Yuatos. Apxi{et an:6 111 otL lllri nou o
ao{tev~s etoepxetaL oto voooKOI..Leio Kat n apxtK~ 6ta)'vooatLKri KaL SepaneutLKri
aVtLIJ.TWTILOf1 n:pn:L va oAoKAI1PWVtaL taxutata (IJivaKac; 11 ).

IHvaKac; 11. LlLa')'vOJOtLKri Kat &epaneunK~ avtLI..L1WrtLOI1 ao&evous 6LaKOIJ.L-


C61.levou OtO VOOOKOI..LLO I..L npOKCtpOLO TIOVO KUL avaonaontOU ST ~ OK ALKO a-
rt:OKt\LOI..LO

f1QOKatapKnK6S 6ta)'VW<J1LK6S A)'XOS


- ~uvex~s nAeKtpoKap6Lo-ypaq>tKri n:apakoAou~non. aut61..Latn !ltpnon Afl
-t\en:tOI..LpS LO"COPLKO, A7XOS {OJ1LKOOV Of11.lLWV, VOAX~S flVUKLj.1Vl-
K~ ee10011, .
-PAe~tK~ /'Pfllli..Lri. Ariwn aii..Latos ;ta n:poo6LopLol.l6 KapotaKwv
evCDI.lwv, atl.latoAO/tKoov Km l)LOXIllltKtiJv n:apaJ.ltpwv Kat ALTuoi.wv opou.
-HKf ow6eKa arta)'OJ")'WV.
-AKuvo/'pa<pia StiJQaKa Kata n:pol:ii..Lnan oe 6pSLa Sean.
reVLKcl SepartUrLI\U Utpa
- Aontpi vn 160-325 mg PO
-0fL rpoJOil iT ( n:.x. 1-2 otaKi a 6t vt tPLKou LOooopGi -en toov 5 mg]: Ae 1xoc; )La
ornDci)XIl Prinzmetal ~ avaotp4JLIJO on:aOI..LO ( UTtOXWPI10f1 avaonaons ST KUL
OUS ouo n:pOU'-'Otpep~LOS Ttplrt:"CWOlS oe av'ti.S.0111l. 'tO o(u 1.l<PPO/I.lU).

24
AV1UOXULIJ.LK!l "-Ul avnun:ep!UOLK~ opaon
-0(U/OVO: XOP~!flO!liJ PlVLKO KU~T~pa /LU ~-3 WPS 0 ot\ous TOUS U<J~Vt:LS.
E~aKoAou~!lO!l t:av o KOPOIJOS tau apTrlPLUKOU aillatos oe o(u;ovo E.L vat
IJLKpOrpOS an:o 9(]=1/a.
-En:apK~S a.va,\;noia: Moptpivn 24 mg IV Ka~e q>opa n:ou J-.:piverat ava)'KaLo.
ELOLKti ~eoan:E.unKa u1:pa
-0epan:eia en:avat1..1tinoons: H E:vapcn-rns tvwo6,\uolls n:perreL va ;ivL IJ.oa
ae 30 Aerna. Eav av-rl /La Lvwo6Auon en:tAe;ei a(;eton:AacrnK~. n ouivOL{!l
'tllS aptnpias n:pn:L va /L VL llOa 0 Ilia c.Opa.
-~ulln:AnpwllatL"Il avu{)polll3WnK~ a)'w;~: aon:tpivn Kat nn:apivfltoiws orav n
~POI..1!36Auol1 (ivel:aL ll TPA.
- ~UIJ.TIAI'lPWJ.I.U'l:LI\fl Q')'W/rl:
. UVU010Ai<; !3 -aOpVP/LKWV UTIOOOXtuv: UVULOXULIJLJ..:Il, avn Urtt:pTUOLK ~ KUL
QVLLIJ.UPIJ.UPU)'LKrl OpclOfl
"vnpO(AUKPLVfl: QV'!LLOXOLillKrl KQL UV'!LUTtptaOLKrl OpUOfl
. '*avaoioAeis IJ.E.TatpennKou ev(LIJJ.OU a;;eto'taoivns: 1..1/UAa n:pocr~La
1..1<PPci/1..10ia rou uuoKapoiou. KapotaKr1 avencipoKeta xwpis un:oraon
(OUO!OALKrl AIT' 100 minHg), LO'tOPLKO 1JtpPU/'l.lO'tOS l..lUOKapoiou.

AIT:ap!llPLOKrl n:ieon. HKf:rtAK'tPOKapoto')'pa<pr11J.a,Yf:uno')'Awooiws, TP A: Tissue


Plasminogen Activator

H 6u1vmcn -cns anotppa')'JlVrtS o-req>avtaias ap-cnpias (en:avaLIJci'twO!l), n on:oia


Ttpn:L va ')'LVeL 1.10a 0 6 oopec; OTtO 'tJlV ')'KQ'!clO'!UOfl tOU .1J.<pPU/IJ.UtOS. an:o-
!Aei !OV KupLO ~epaT!U'!LK6 O'!OXO. Tou'!O TIL !U')'XUVtQL ei !.1J. Q')')'LOT"CAa-
0LtKrl (oe entA/l.lva Kv1:pa) r11.1e evootpA!}ta tvw66Auon. Ta an:oteAo!lala rwv :I
OUO Ttpoavatpep,9-vtCJJV 1J~00WV eivaL nap6JJ.OLQ KOL OJ<; eK '!OUTOU 11 VO<?<PA!3La
Lvwo6A uon an:oteAei, A6')'w lflS UKOAl.ac; JJ. lflV onoia 1..1 n:opei va tpOp1J.OOtl, !flV
~epaneia eKAO/'rlS. H artoteAeollalLKO'!rjla lf'lS tvwooAunKriS {)epaneias eivaL
IJ.;aAtHPI1 otous ao~evel.s ll rtp6o~tO an:6 6tt oe eKeivous IJ. Karc.iJtepo
1l<PPU/'1.10 (to n:pwro eivat ouvr;~ws 1.1/aAurepo an6 ro oe(nepo) Kat aiJ.tpLOBrJ-
teL taL 010US ao,9-evels J.l J.l<ppU/J.10 XWPLS Q.
H ooooAO(LQ KQl ta Ol'lJ.I.QV"CLKOtepa xapaK'!IlPLOt~Ka nov ouxv6tepa XPilOq..LO-
rtOLOUI..leVW\1 L\'WOoA.U'!lKWV <papiJUKWV ava,patpovraL orov ITivaKa 12.

25
-------------------------------------------------------
~tpentOKLVclOfl APSAC TPA

LlO<Jfl 15*"1o6u ae 3:J60 ni1 . 3lrg 0 5 mi1 100 rrg 0 9J rri1 ..


H~tnepto6os (tu!lS (min) 20 100 6
A vn /OVLKOtfltU Nal Nal Oxt
A,\,\ep')'LKES avnopaoev; Nul Nai Oxt
~uorn~aiLK!l KaravaAwon Me{cit\rt Me1aAn Mrpta
LVWOO/OVOU
E)'KcpaAtKri at~oppa{ta 0.3% 0.6% 0.6%
Iloooot6 ftaVUL~UtWOI1S 40% 63% 79%
at a 90 Aenta
6.taow(61J.evot ao~evels 2.5 2.5 3.5
ava 100 ~epaneu~vtes

'15 mg bolus, UKQ,\OU~0Uj.lVU UTtO 0.75 mQ/kg XOPIHOU~VU 0 30 min (ll/LOtO 50


mgJ KUL 01:11 OUVXLa 0.50 mg/kg XOPf'l')'OUJ.,lVU 060 min (ll/LOtO 35 mg)

En:et6ri 6Aa ra tvwooAu!LKa q>apj..taKa IJTtOpei va n:poKaAeoouv oo6aps at-


~oppa{ies, 11 tvwooAuttK~ a{W!~ avtevoetKvutaL oe optOJ.!vous ao~evei.s Kat
npnet va ecpap~o(etat ll J.L!1AI1 npooox~ oe aAAous (lltvaKa~ 13).

A n6A utes
- IotoptK6 aq.wppa/LKOU /K<paALKOU ertetoo6lou ~ to-coptK6 lll1
ULJ.LOppa')'LKOU /'K<paALKOU ertetooolou -cov npOf'l/OUilVO xpovo
-E!K cpaAtKOS 0/'KOS
-Evep{65 0WtpLKri Ulj.lOppa{ia (oev rtpLAUil6lv1UL 11 1liJ.f'}VOS puon)
-Ilt~av6s 6taxwPLOil6S r11s aop-cns
" .
~XUK5

-~o6apri Ill'} eA)'XOilVI1 Urtp!UOJ'} (aptf'}pLUKri Tti01'}> 180/110 mmHg )


-lotoptK6 /'K<paALKOU ITLOOOiou ~ /K<paALKrlS VOOOU TtOU 0V 1l-
nteL one; ano,\ures avtevoeL\eLS
-t\riWI1 avu rt:flK Ht-.!lS U/W/rlS oe ~epaneuttK5 66oeLS (INR>2-3) ri
ULI..lOPPU/LKri OLU.~011
-Ilp6ocpatos ( n:ptv a.rt6 24 e66o~a6ec;) rpauj..tatLOJ.LOS. 1rf'}v KUlf'l/'Opia
autri neptAal..lBavovtaL /'K<paAtKc; KaKwoetc;, !PUUilUllKri ~ rrapa!etallVfl
(>10 min) KUP0LOUVClrtVUOUK~ ava(WO/OVr]Or] ri ool.)apri XLPOUP/LKri

26
t: n:e1.16aon ;

-riapaKevrnon a -v":"eLwv ora on:oi.a oc:v l.lTtopei va aoKn~ei nic:on ( n:.x.


uno~-:.\ eLOLOS 4).\ 6 a)
-f1 p6o<pa1n ( n:pL v ano 24 c:66ollci6es) c:ounepLK~ aqwppa)'ia
-ripon-:rn~eLoa LV(LI06Auon (5 rwepe<; eW<; 2 XPOVLO) ~ LOtOPLKO aA,\ep)'LK~S
avnopaons 0111\" ~POI.l66t\uon. Ta TtPO!l)'OUileVa LOXUOUV )'La tnv Ol:pert10-
KLVUO!l KaL 10 APSAC KaL OXL /Ltl 10 TP A.
-Kurwn
-Evep;6 ;aorpoowOeKUOaKtUALKO t\Ko<;
- Io1opLK6 oo6apns aptllpLaK~<; unptaons.

E. ~ui"~v woo K al avuuc:ttinuon e Ttl nAoKwv. 1/ fleA:1ao!J rou eprppti}'paror Kat


Jlcl"cJ.If/'Pa?'Paru.:tJtC1.lOtJJif:z Yno1pon~ otnv el. l<PPU/IlUtLK~ nepLOXrl (enK1UOI1
~!J.q)pa(l.ltl!OS) 1.l<PUVL\e1:tll US TtPW1<; 10.14 !lllp<; 010 1!Jl/o toJV ao~evwv ~
~~<ppa;1..1a Q Kal 10 42% Kei vwv xwpis 1.l<PPU/1..1U Q. Ava,vwpi.\etaL ano 111v
el.l<PUVLOfl OTfl~tl/XflS, vewv !lAKTPOKapOlO/paq>LKWV aAAOLWOWV Ktll dvooo !WV
Ill.lWV tWV KUPOLUKoJ\1 V(UIJ.WV.
Mete~<ppa;l.laLLKri loxaqJ.ia, xapaKtllPl(OI.levn an6 tnv enave~q>avton otn~a/XlKtilv
TtLO,OOLlOV XWPLS Ol.lWS va avooo tWV llUOKapOLUKOOV V(UilWV tLS TtpoJt<; 6Ka
I
nl.lp~c; ano tllv e /Kataotaon tou 1.l<PPU/I.la1oc;, napatnpei. tal oto 30/o twv
ao~evc.i.Jv. "
Ol ouo n:poava4)ep~eioe<; Ka1:ao1aoeLS aVtLI.lel:Wrti\ov-raL aPXLKa 1..1 tn xop~tnon
!
VltPWOWV, avaoto,\toV tWV ~-a6peVP/LKOOV UTtOOOXWV, UOTtLPlV!lS Ktll f1TttlPLVflS.
~tLS av~eKtLK<; rcepntt<.Ooets ~omopei va xoprr7n~ouv entnpoo~etws av-
ta,wvtots tou ao~eotiou. H oteq>avLaia aptf1PlO/PU<Pia ei vaL not\uu~n flU -cnv
~JLP uvnon 111S avatOI.lLU<; tlOV Ol:eq>avtaiwv aptf1pLOOV KUL 111V eTtLAO/ri tflS
V00L /~vnc; ~epartUtLKriS U/W/riS ( <PUPilUKU, U/'/E:LOrtAaotLKrl rl /XLPI10tl
aoproote<pavLaia napaKaJ.H!J!l).
2] Appu,'J.pie>. 9!\~.~.Q.IS.QY:~1!5.n.. l1.r.tg..~.IS.g.QQ1.1J. ouvr;~ws napatnpei. taL ota Ka-cwtepa
1..1\PPtl!lltll:a K.at o<peiAetaL oe av-ravaKt\anK6 llllXUVLOI.lO. ELOLKri aVLLil!0:Hnon
( atpon:L \Ill 0.5-1.0 mgN) anaL Tei l:UL otav OUVOOe uetal ano tlll.lOOUVaiJLKrl a01:cl~ltl
iun:6Taon. artlll.\L.a ouvei6nons ri Kap6taK ri ave napK eta). H !.P.!\.~.Q.IS.QY.:~.~.!S.O
JQ.X):!.!':-.Q..P..Q.~.Q. O~el.\e!tll 0 aU~f1011 tOU TOVOU tOU OU1..1Tta~fl1LKOU, UtpUOClLWOil ri
ouoAet-coup;ia tllS aptol:epris KOLAias. ELotKri avl:LI.letcimton {n.x. atevot\6AI1 5 mg IV
XOP!l/OUileVa eV!OS 5 t\ennov) artal1ei l:aL IJ.OVO Ol:LS TtpL TttWOLS 1..1
ou~na~nn~<-otovw.
Ot \IJI~P...~.mA~.!?:.~..~.s..A~.IQ:~I~S .. .9..1J.9.IQ~.~.S. 1J1paviCovtaL ouvri~w<; OtO eoa<pos un:o\ias ~

27
qAe~-. rpoAutLK(\J\l 6tal:apaxwv KUL o1:av eLvat ouxvs n:poota~.touv oe "oMrtKfl
1-!UPIJUPU/'~. H ~epan:eia ouvio1:a1:at otnv Kal:an:oA1lrwn rns un:oKei!J.eVflS at uas.
H..KQ!\U.tiS.!J .. !:J:.qQ.btqQ.\,1.2'.0 j.lTtOpci va TIP OK a,\0L ULIJ.OO UVUIJLK ~ n:t0 up UVO!l ,\Q)'W rr) S
KUl:UP/'flOflS l:flS KOA ITtKriS OUOtOAris KUL l:f1S au{rUJ.VflS KOlALUKtlS OUXVOl:fl!U<;
(OUVflDW<; 130-170 ocpu~et<;/t\Ttl:O). 0 Ae)'XOS tr"lS 1:,\euraias TrltU/'XUVtUL j.l
l:flV evoocpAe~LU XOPrl/r"lO!l OLt\ uaC!lns ( 0.25 mgjkg 0 2 ;\enta KUL otn ouvxeta
ouv e xn s ./'XUOfl 5-15 mg/ tiJpa J ri BepanalliAns (5-1 o mg en: avaAallBav611eva ll ta
un:o 20 ,\ern a). Enet6ti ta ouo npoava<pep~evta cpap~J.aKa exouv apvf1tLK~ tv6-
rporro opaon 0 n:ept IT!WoLS J.l ouoAet TOUP/'LU lf1S aptotepric; KOtALa<; n:potqJ.a-
tat 11 ev6ocpA0ta xopr)!non aj.ltw6apovns ( apxtKa 150-300 mg oe 10-15 .\e n:ta Kat .
orn ouvxeta ouvex~s /'xuon 1mg/Aent6 )'ta 6 ti.lpes aKoAou~olil.leVfl ano ouve-
xri 7xuon 0.5 mg/Aen:r6). Ze avtt~eon J.Le trw 6tAtta\1ln KaL tflV Bepan:a1.1.iAn n
UIJ.LC.o6apovn ouxva n:poKaAel tnv avata{n rns appu~llias e nava<ppov-ras rov
<pAe~OKOIJ.0LKO PU~j.I.O. Otav n KOATtLKri IJ.UPllUPU/ri OUVOOU1Ut art6 un:otaon n
KapotaKri UVTtapKlU anau:el taL Uj..l01") avaraen ll til XOPri/11011 OU/XPOVLOj.l.vns
11AK tptKriS KK.VWOI1S LOXUOS 100 300 Joules.
Ot KOLAtaKS appU~IJ.ieS artoteAouv OUV11~S UP111JU tLS n:ptiJtS tiJpes lOU o~eoc;
eJ.Lcppa)'j.l.aros rou ~.~.uoKap6tou. Ot .~Ita!5.Is.~ ...K9J.Mg_~_.S... 9.J~.9..IQ~..s.. o ..TI.~J.gxl:!Y..9..bt.Y9.s.'
~.9.-tQ.\<;.QJAHJ.KQS. .. P.Y..$.-Y.:Q.S. Kat 11 bl.!J. ..JJ.M.~.Y..Q.!:I.Q.q...ts.Q.~.1.HlK.Q ..J..Q..X~.K.Q.P..Q.~g ( K otA LaK ri
'(Q)(UKUPOLa OLUPKLUS <30 sec ) ouvn~ws 6ev npoKaAouv OUIJ.Tt"CoJj.l.ata KUL OeV
an: at !OUV LOLKri aVtLIJ1WTUOI1.
H Y.JJ..Y.9..Y.Q~LK.Q~!\~g!$.O ..lU<.Y.!S.gQ.Q.~.g (KOLALaKi) 1Q)(UKap6ia 6LapKetas >30 sec )
av1tlletwn:tCtat 1.1. -rnv ev6o~A6La xoprpnon AtooKaLvns (66of1 ecp66ou: 1.0-1.5
mg/kg taxws evooq:>Ael)iws Kat 1.116: 0.5-0.75 mgjkg ava 6eKaAertto !lXPL ouvo-
AtKriS 66ons 3 mg/kg. H 66011 ecp66ou aKoAou~eL taL on:6 ouvcxri 1xuon 24
mg/min). 0-rav 11 appU~I.lia OUVOOUetaL an:6 Urt01UOI1 an:anei taL tlj.l.011 ava-ra~,
1.1 !fl XOPrl/11011 OU)'XPOVLOIJVf1S 11AKtPLKf}S KKVWOI1S UPXLKtiS lOXUOS 100 Joules,
au<av61J.eV11S e rrt anotuxias.
H !S.Q~~~-g.IS.D.. Y.9.-.QY.g.P..~.2'.0 artaL tei UJ.l011 av1LI.l1WTtLOI11le til XOPri/11011 lll1 ou)'-:
XPOVLOI.lVI1S nAeK tpLKi)S KKVWOI1S LOXUOS 200 Joules. 1 TtepLTt!W011 anotuxias
n:pen:et va apxloet aJJows Kap6Loavan:veuatLKri avaCtoo)'6VIlOI1 Kat va xoprnn~eL
ll!l OU/'XPOVLOIJ.Vf1 nAeK!PLKri KKVWOI1 ll/Ut\UtP11S LO"XUOS (300400 Joules).
4} iltara,oa,t-cff a ....aorJf. H !l<Pcivwn taus oe ao~ev~ 1.1. Karwrepo JJ.cppa)'l.l.a tou
llUOKapOLOU O~_eLAetaL oe UU{11J.1VO tOVO tOU n:apaOUJ.1TtU~Il1LKOU ti 0 LOXULIJ.LU
rou KoA n:oKot.\La"ou K61ll3ou. 2uvr;~ws np6KeL taL {La n:pti.lrou 13a~I.I.OU Ko,\ no-
KOlALaK6 ano"\cto)l6 npoooeulLKii e{eALaa6lleVO oe 6eutpou ri tpitou 13a{)IJ.OU
KOA rtOKOlALUKO a rt:OKAeLOI.lO. 0 1:.\ Utaios xapaKti1PL~etaL an:o KOlALaKri OUXVO!Il-
ta 50 Otpu(ewv/.\rtt6 KUL an:6 l:flV n:apouoia OteVWV OUI.lrtA/!lU!WV QRS. ltOUS
ati.I.OO uvaut"a oru(}epous ao.Seve~S bev artattei taL eLOLKfl ~epanLa, eVtiJ oe
KLVOUS IJ urcora011 ri OUOTtVOLa XOPr"l)'eL!UL atpOrtLVr"l (0.5-2.0mgiV) KUL Ttl

28
.. --- --~~--- . --- :.-:..'o:_:__-__..

anotuxias e<papuo<e-rat n:poowpLv~ Brwarooornorl


H 1J.!pclVLOfl oeure::pou ~ rpi-rou 0a&jJ.OU KOA11QKmi\LaKOU an:oKAtOIJ.OU 01:0 n:poo{ho
ell<pPU/IlU tOU 1.1UOKUPOLOU L Val OUV~&w<; an(HOI.lfl KUL O<peii\ taL 0 LOXUlj.J.LU ~
e!J<ppa)'ua tou 6t:!latiou tou His. H KotALaK~ ouxvorrp:a otov rpi wu Ba&!lOU
KOA n:oKoL,\taKo un:oKAeto!lO eivat ouv~&ws xauflA~ (2040 o<pu{ets/Aerno), -ra
OU1.1TL\)'1.1U!U QRS Upa KUL 11 UV!l1.11:UJnLafl OUVlOtUl:Ql OtflV 1J.<pUtUOfl n:po-
OWpL vou ~ uovtllOU Brw.a-ro66tn.
5]. AfuoKap6taAll ,suCJ.,fct roup)'ia H 0apu-cnta tflS eivat avciAO/fl1:flS E:Ktaor)s trlS
!lUOKapotaK~S vef\pWOflS Kat eruoetvwve-rat an:o tnv ouvunapxouoa toxatuia. Ot
aa&-VLS XWPiS OUI.lfttWj.I.Cll:Cl KUL O!lj.I.LU KUPOlUKriS C1Vn:cipKLU<; KUL !1 <PUOL-
Oi\0/LKri apfrlPLllKJ1 TtL0fl E:xouv U1.1Vri rt:PO/VWOJ1, VW Ki.VOL IJ. KapOLaKri
avenapKLQ KUL un:otaon OUOIJVrl TIPO/VWOfl (llivaKas 14)

fHvaKas 14. ITpo-;tvwon aa~evc.i>v !l 0aon rn Baputnta rns IJ.UOKapotaKriS


ouoAenoup)'ias tKa-ra-ra{ll Killip)

KcltJ1/0pia Ka-ra Killip . Erti TttWOJ1 (%)

I. Anouoia Kap6LaKrlS 33 6 :~
i1j
UVTtclPKLUS it
II. Hn:La Kap6taKJ1 38 17
UVTtclPKlU ( PO/XOL <JtLS
0aOLS)
I I I. ITVUJ.l0VlKO OLOJ1J.lC1 10 38
IV. KapOLO/VrlS Ka-ranAnUa 19 81

": 1UO!Q,\LKri aptflPLUK~ TtL0f'l < 90 mmHg, Ttpl<pPLKrl U//LOOUOTtaOf'l, oi\L )'OU-
pia KUL TtVUj.I.OVlK~ OUj.l.tpOpflOfl.

KapotaKri avenapKLa auvn~ws Ttl rti\KL ta npoo&ta 1.1<9Pci/J.lUl:a tOU IJ.UO-


Kapoiou, tCl OrtOia TtPOKat\ouv OJ11J.ClVtLKri E:K rttWOf) l:r)S I.I.J1XC1VLK~S t\Ll:OUP)'LC1S l:flS
apto-repf]s KotAtas. XapaKtf'lplOl:LKa K1\L vtKoep:)'aOiflptaKci e upn!J.ata ei vat:
.~.~g.n:Jw.~.g.J.g...~..IJ,.L9..f.liJ.~~g: L1uonvota, oi\t /Oupia, aouvallia, KOTtWOf'l, wxp6tfl 1:a, au{rlOC'l
Gcipouc; .
.\<j...~.Q.~?,.g.Q.Q: "(-;-poL po-vxm 0 QJ.l1p6tepa ta TtVUIJOVLKU TteOia KQL !pl !OS KapbtaKOS
r6vos. o1petA61.Levos oe 6Lal:aof'l Kat ei\anwon l:flS evoonKOlfltas rns apLo"tep~s
KOli\LU<;. ' I

H. \..!';JP..9.K.~Q.Q~.Q.::'.QQ..~.n~.~; t>t\e~oKOil~tK~ taxuKapOLa ouvooeuouoa ns rtt\eK-


29
rpoK apOLO/PU<PLK <; aMOLlOOL <; IOU IJ.<ppcr)'I.J.ato<; .
.\'\.~.J:JY..9..2:P..g.~:~_gJ}WP..~JS.g.:. KapoLOIJ./aAia, oul.l<p6prwn rtveu~JOVLKwv ,\ol)wv. au~niJ.evn
O//lWOfl ciVtll ;\ol)wv TIVUIJ.OVWV.
H KapOLO/V~S t-.aTan:An~ia ei vcu 11 ooBap61:epn IJ.Op<pfi KapotaKriS avencipKetac;,
C:l.l.<PUVl(OileV!l 1J.Tci an6.K1:tUIJ,eVO 1J.<ppU{IJ.U !OU IJ.UOKOPOLOU TtOU TtPOI<.Ut\t
veKpwon rou 400/o ~ neptoo6tepo 1:ou IJ.UOKap6iou 111s apLOrepns KotAias.
XapaKtnpi~etat an6 ouonvma, un6raon. oAL)oupia ri avoupia Kat 1J.1:aBoX.tKri
o\ewo11. H &vnro1:11ta avepxe Tal 80-91Jl/o.
rta TrlV an:O!A0j.1al:LK~ UVl:LIJ.1'WTILOf1 1'Jl<; IJ.UOKapl>LaKfi<; Ouot\L l:OUP/LUS KOL TflS
rrpoKaAoUIJ.VJlS Kap6taK~S avertapKeLa<; arraLtel tal napaKAi vtos oe~l6<; Ka-
~TllPLaoll6S IJ. Ka~err)pa Swan-Ganz, arto ta anm:e,\eo1.1ara tou onoiou Ka&op-
iCerat 11 nepaL tPW ~epan:euttKri a/W/'tl (lli. vaKas 15)

ITivaKa<; 15. 0paneunKoi xetptoiJ.Oi IJ. Bacrn ra eupru.J.ata tou 6e\Lou Ka~e-
!f1pLaOI.J.OU 01:0 o\u 1J.<pPU/IJ.U tOU I.J.UOkapbiou

1Lci/VWOf1 K~ (L,/rm/rn2) l1E1T (rm+fg) 8epanaa l)(O\t.O

t>uoto,\o)'LK6 >2.2 <15 KQ1.11il.a Gvnrornra <8l/o

Ynepb uvalltKri >3.0 <15 B-avaOLQ\as ~uvo6ei.JtaL a-


KUKAo<popia rro raxuKapOuz. i ~

0vrrr6tnra <5'/o 1\
1,1
1,,

Yn:o;K aLIJ.ia <2.5 <10 l/pii Ynmaon. taxu- I


II
KapOta I.J. <Ql.Ja.- !
!
o\OfLKJi Opt.Ot-
pfl ~<aXLa 019 n..:
XOKap6LO)'p~f1-
IJ.U
evnrarnra 4- 8'/o

KapOLaK~ <2.2 >15 ~OUpflUKii MtKpou Ba~ou


avencipKeta bixmva.a. pbfxa
OU<; eaaeL<;, <pU-
rU0f1.
0vrrrarnra 102J%
.
~o~apfl Kapbtat-.q <2.0 >18 &oupnu~<il llveui.J.Q\tKO

30
A nao&aotaA u- ao r}~a . r}TUU u-
Ka rr~aor}~OL~av~
\PI10l~OftaJ10r}
L\'01pCmUN KQL
V0000pUKf)s
avu\l.as.
0\llt~flta 2J4Jlla

KapoLO;e vr;c; <1.8 >18 Ivorpbrta Taxaa e<pap~ol'll


KUl:QTt,\r}CLU Evooaopu K t1 VOOUOP"tLKriS
avlALa 0vn1~11ra ::EQJ/o

KL1=Kap6taK6s bet" 1r}S=Kap6taKri n:apoxri/eru<paveta ow~Jaros


ITEITT =rtiecrn evo<pnvwor}s nveu!JOVtKwv -rptxoet6wv=j..lecrn nieon apwtepou
K6An:ou=-reAo6LU01oAtKri niecrn aptcrlepris KOLAias

H rin:ta KUPOLUKti uvenapKela aVUj.lttoTtiCetaL IJ.. 111 XOPri/flO!l o<u;6vou IJ IJclOKa"


ri PLVLK6 Ka&e-rnpa, 6taupnnKc1 ( <poupooel-lion 1040 mg N r1 Boulletavibrt 0.5-1.0 mg
IV) KQL &eLLKri llOP<f>lVfl (5 mg N). ~ OO~ap6tePS TtPlTt!WOlS XOPCl/OtJ'\I!OL
I
O//'LOOL001aA ttl\ a (ouvfi~toS Vl tPO/AUKpivn: OPXLKcl 51lg/min N Kat O!f'l cruvxeta ,;j
n:poo6eu1tKri aucr}ofl !lXPL va eAa-r-rw&ei 11 apti1PLaKfi nLeOI1 Ka'ta 1CJ-20 mmHg
aAAa OXL Ka-rw an6 90 mmHg). ~-rrw ooBapfi KapotaKfi avencipKeta Kat OtflV
Kap6to(evfi KaranA11\La npenet va xoprnn~ouv tvotp6na <pap!JaKa (cruvr;~ws
I
V101.lTtOU10j..lL Vfl : UPXLKU 2.51JQ/kgj min IV KQL Otrt OUVXLO n:pOOOU1LKfi au\r10rt
n
!lXPL va 1JlpOVLOtei BeAtiwon va Ttl'tUX~i 111l)LO!C1 00011 !to~ 15-201Jg/kg/
min IV) Kat va XPflOLIJOTtOLrt~ei n evooaopnKri avtAia. ~e nepi Tt1WOJ1 ooBapris u-
n:61aons 1-lrtopet va anann~ei n entnp6o~etl1 XOPrl/flOfl v-ronauivns (apxtKa 2
IJ.Q/kg/ min IV aucav61leva ava nevtaAento JJ.xpt va 1.l<pavto-reL ~eA-riwon ,ri va
ern-reux&ei. n 1Je}LOtl1 66011 ttov 20).1g/kg/ min N)
6. EtttfPCl//lCl oe(ta> I(Ot.-lia> E).lcpaviCetat oto 30'/o twv ao~evwv l.l Katwtepo
~-t(j)PO/IJO !OU 1-lUOKapoiou aAAci ouvooeuetat an6 KALVLKS KOJl~WOlS IJOVO 0
OPLO!lvous ano au-rolls. Ava(vtopi{etaL an6 ti1V rrapouoia un6tao11s l.le orweia
XUilf1,\ris Kap6ta~-;ris napoxris Kat 6tataons twv o<pa)'ttL6wv oe ao~evels ll
LKavorrmnnK!l ouoroAtKri Aenoup;ia IllS apwtepr;s KotAias. H bui;vwon evt-
oxue !Ul ll tf1\' ll\1 up011 avaoTtOO!lS tou ST OtlS arta;to)S V3R KOl V4R. H
&epan:eia OUVLO!a tal OtflV X0Prl/f1011 U/PWV ")'La H)V au(rWrt tllS rti\ripW<JflS tllS
OPLOTPrlS "OL\LUS 1\0L l VOl:pon:wv /La 'tllV UrtOOtfipl(f') tr'lS OU010ALKrlS 1\l !OUP/lOS

HlS 6e(tc.is "ot.\wc;.
o. .
7. Af,na~'t~ t-f e'!fL n: lm:e~ M.PP5.!i .. nb..UP..Q.S .. Q!i~n ...~no.Q.~tQ.Q.~.S.. U.\.!.Q.S ...O.. JQ.\.!... ~..Q.Q.::.

31
li
'~

!
i
K.Q~~\~_g!S.Q.Y... QJ.g.P..P..~n:.kU~JQ.S. n:apanwouv-rat oe At 761epo un:o ro 1% nov ao~evurv I.J.e
o~u 1.J.tppaf'I.IU rou I.J.UOKapoiou Kat ouvo6e_uovraL an:a 6uoJ,Levr; n:po)'vworl Ot
rrpouvatpep~eLOeS errLrt;\oK<; rrapanlPouvtaL taoo ora npoo&ta aoo 1\UL o-ra
KaHiHepa 1.J.<t'PU /IJ.ata, ouvri&W<; 3-7 !11J.pe<; IJ.tU "CflV ./'Ka!UOtUOfl tOU~.
H p~\11 &flAOelOOUS IJ.UOS ITPOKaAei rnv 1.J.Ij)UVLOfl ooeapris averrapl\eLU<; rns J,LL-
rpOeLOOUS ea,\0t6as ouvo6euai.J.Vf1<; ana KOPOLO;evri KU1aTIAfleia .
H I.J.eooKot,\taKri E. rnKotvuNia oq>eii\e1at oe veKpwofl Kat p~efl rou 1J.OOKOL,\LaKou
6tacppcif'IJ.a1os . Enet6ri 10 J,LeooKoLALaK6 6ui<ppa{J,La exet 6t nAri aq.1a1c.oon art6 us
aprnpies nou 1\utaAaJJ.eavouv 111v npoo&ia Kat tflv onto~ia J,LeooKOLALaKri auAa.Ka,
11 Prien-cou un:o6,,\wvet rnv napouoia K1etaJ,Levns otetpavtaias vaoou. H
1J.00KOLt\LaKri e ITLKOL vwvia exeL ws a.no-cE:,\eOIJ.U 111 OLUtpU{r) IJ{0..\ns TtOOOUltU<;
ai1.1.a1os ana HJv apLOtePri npos til 6eeta KotAia A61w -rwv on1.1.avnKa u~nA6tepc.ov
meoewv nou emKpurouv otflv n:pwtn. Touro n:poKaAei rnv eAO:nc.oof1111S
n:ooa-cntac; l:OU ULIJ,QtOS nou eew{)ei taL art6 !flV apL01Pri KOLA'ta n:pos 111V a.optri
KOL !flV eAaHWO!l tOU 0/KOU n:aAilOU KOL !!lS KapOLaKriS rtapOXriS.
Kat OL 6uo n:poavalj)epSeioes rta{}fioetS xapaK!flpiCovtaL an:a -cnv 1J.cp6:vLOf1 ou-
otoALKou <PUO!lJ.LUtos KaL tnv en:t6eivwof11flS KALvtKris etK6vas. H 6tatpoptKri 6ta- ....
f'VWO!l /'lV1UL UTtO.!!l'V V!OTtLO!l !OU <puOrll..llltOS (KOpu<paia O!f1V OUOAeL!OUP/'LO rl
rnv P!le!l t:OU ~fl.\OeLOOUS llUOS KOL n:apaOtpVLKri KOV"CU OtflV et<POL0rl an:6<pUOfl
otnv Prien tou IJ.eOOKoLAtaKou 6ta<Pptif'lla.tos) Kat JJ.e 1ov nxoKap6to')'paq>LK6
E:Ae/XO. H aVtL1J.1WITLOf1 ouviotataL apxtKa o-cnv aLI.l06uvallLKrl o!aSeportoir1011
tOU aoSevOUS IJ. LVOtp6n:a, U//L00LOO!ai\ !LKCl KOL tfl\1 ecpapj..lO/ri !!lS evOo-
aopnKriS UV!ALUS KUL O!fl OUVXLU O!f)V XLpOUP/LKri QVtLj..ltWTILOf) l:flS avatO-
I.I.LKrlS eAae!ls.
IT AriP fl s Qi~.O.. J;Q.~... .~...Y.~..P...QY.. .IQ~XW.IJ.gJ.9S...IUS ...g.,Q~QJ..Q.Us...IS.Q.\A~.g_s. naP a1n Peit at oe
At /O!epo an6 1% rwv aoSevwv, ouvr;sws J.1taeu 2ns Kat 711S n1J.pas n1s vo-
o,Aeias Kat oon1ei orov ~ava!o. Toutos oq>eiAetaL oe Kap6taK6 entnwJJ.aUo1.1.6
,\6/W tns ouAAo!riS I.I./UAI1S noo6tf1tas ai~.tatos otnv neptKapotaKri Koti\6ti'Jta 11
on:oia KaSto!ci. a6uvatn rnv n:Aripwon rwv KoLALwv. :
H ateA~s ri , ea~l,J.Laia piJen JJ.n:opei va TtWIJ.QtL01i an6 to TtPLKap6io KUL va
o6rnrioet 0111v Of11J.LOUP/ia ~eu6oaveupuoJJ.atos. To !ei\euraio ava)'vwpi(erat
!lXOKUPOLO/PU<t'LKU ri 1.1. KOLhLO)pa<pia (pa6tOLOOt0TtLKri ri j.le /XUOfl OKLU/PUtpl-KOU
0111v apLotepn 1\0Lt\ia) KaL /'La tnv avtti.J.ettinnoi) !ou ananei tat U.~.teon XL-
POUP/lKrl OlOP~WOil ..
B) A vcupuopa aptor.cp;jf AOLAta~ f1apatnpei taL oto 10-20% 1wv ao-&evtilv JJ.
npoo~Lo E:IJ.<ppu"'l.l.a rou llUOKap6iou KUL xapaKtnpi(t:taL an6 r11v rrapouoia 1.1ias
oatpwc; alj)opt(Oj.leVflS 6uoKLVf1ttKriS neptoxi)s. To aveupuo1.1a t!lS aptorepris KOLAias
.
ava)vwpi(eraL a no tllV TtLIJ.VOUOa ( nepav tUJV 48 eBOOIJ.UOWV) avaonaon
6wotni.J.a ros ST ~-. ut ra. xapaK 1:!lPlOUKa nxoKap6LO/PO.tpLKa KaL a ">'7LO/'PUIPLKil
. tOU

32
eUPil!lUl:U. 2n:aVLWS npoKat\ei P~\11 !OU l:OLXW!lU!OS !!lS upL<Jl:E:PflS KOt.\LUc;, e\'W
OUXVU OUV00U!UL an:6 apl:!lPLUKc; t!l~OAc;, KOL\LUKeS appu(t!lLS KU.l i'--UPOLUKti
UVen:ripKLU. H UVtliJ1'WTLL011 E:LVUl UPXLKU OtJV1!lPI1tLKti Kat OUVLO"CUtUL OtflV
npaAI14.H1 ri 1:!lV KU"CUTtOA1.111011 1WV n:poava<pep3-eV1WV en:L n:AOKWV. 1 T1pl Tt"CWO!l
UTIO!UXLUS !!lS OUV!flP11UK~S U)'W/riS UTtUL1L1'Ul XlpOUP/LK~ Kt01lll toU
UVUPU01l010S OUXVU OUV00UOIJVI1 ana aop!001'<j)UVLULU n:apOKU!l4J!l !WV
otevwnKwv at\;\Olwoewv rwv Ote<pavtaiwv aptnptwv.
9] Ucpu.-ap6ia6a Ernn:AKeL ro 51Jl!O rwv ell<fiPU/!lriLtov Kat ouxvri 6LU6pci!J.eL a-
OUIJ n:rcm..tattK~. A VU)'VWpiCetaL an:6 "CilV n:apouoia rixou "CPL6r1s ouxva OUVOOUa-
llVOU an:a rtpOKripOLO at\)'OS n:t\eupL"CLKOU tUTIOU, TIOU ouvri~wc; !J.q>avi(ovrat
lleta\u 211s Kat 7nc; rn..tpac; tns voo11Aeiac;. AvU!J.e!wniCetaL IJ. rnv xoprifnon a-
ontpLVflS (650 mg Kri-&e 46 WPS) Kat 11 rtapouoia "CflS UTt01:Aei uvrvOL~ll /LU 111
xopri;rwn avu nnKuK~c; U/W./rlS.
To ouvopoiJO Dressier, 1J.<j)UviCerat oro 4% "CWV ao-&evwv 212 e~OO!J.UOeS !leta un6
to ~Jcppa)'IJU Kat ei vat autoavoor)s anLOAo)'ias. XapaK"C!lPiCetat ano TrJV n:apouoia
rtpLKap6i "CLOUS OUVOOUOIJ.Vf1S ana nup1'0, AeUKOKUttapwon KUL 0 OpLOIJ.VS
Ttept TttWOLS an: a 'til ouAAO/rl TtPLKUpOLUKOU ft KaL rtA UpL UKOU U/POU.
AVU!J.1:Wni(tUliJ. !fl. XOPrl/flOil UOTtlplVr)S KUL.TtL UTtO"CUXlUS ll KOPUKO-
O'tPOL0rl.
10. Tot . rmpor!I(Of 19pdpfio~ llaparnpd tat oro 2% twv ao-&evwv l.le eKte1U!J.vo
n:p6o~LO 1JtppU)'IJ.U tOU IJ.UOKapOiOU Kat U-&UV1Ul- {'La UP'ti1PLUKS 1J50Ac;
ouvr;~ws E:IJ.<pavtC61.leVS ttc; npwres 6 e66o~.ta6es !.leta an6 1:0 1J<ppa{IJa.
AvtxveuetaL r'lXOKapoLO/PU<PLKa ri IJ unoAO/LO'tLKti a~ovtKri tOIJO[pa<pia. H
UY!l1J'tWnLor) OUVLO'tUtUL <JtflV XOPtl/flOr) UV'tllt!lKrLK~S U/W/rlS UPXLKU 1.1 rtna-
PLVfl Kat otn ouvexeta IJE: tPil.lnvn Ari4Jr'l an6 to ot61J.a KOUI.lUPLVLKwv avun:n-
KUKtiJv (5ap<papivnc; ri QKVOKOUIJ.Up6Ar)<;).
~T. Mcn:uppa"YUU1LKrl avtLUettinuoo. H -&vrg6trrra Otr)V oeeia <paor) tOU
1J.<ppa)J.,lU1'0S !OU J.lUOKUpOiou KUI.lULV'tUL IJ.'ta{u 5% KQL 15% KUL eeapta"CaL a116 tO
J.,l{&0<; tOU 1J<j)pU/IJU'COS, tr)V rtALKlU KUL 1:11V {VLKrl KUtclO'CU011 tOU ao&eVOUS.
Tnv 6uol.levotPr'l ttp6/VW<Jr) 1J.<puvi{ouv Ol ao-&eveis 1.1 Kap6taKri aven:hpKeta ti
unaraon. H np6(vwon tou ao-&evous IJ.e'ta tr)v \o66 1:ou an6 1:0 voooKOI.lt:io
Cap terraL uno: a) "COV ~Q~IlO tr)S ouoAeL tOUp(ias tr)c; apt0tp~S KOLAias. B) tOV
apt&~.to -rwv n:poo~e~Ar)IJ.vwv o!e<pavLalwv ap111PLWV KaL 1') tr)V n;apouoia ri 6xt
KOLALaKciJv appu&1.1twv. H ~vr)"COtr)ta to 1os n:ou aKot\ou~ei E:va o<u 1.14>PU/'1Ja tou
IJ.UOKUPOLOU KUIJ,a~ V'taL IJ.1:0\U 6% KQL 8% KUL tO 500/o Ttepl rtOU l:W\l &avarwv
ou1.1BaLvet 1:ous n:pwtous 3 1.u;ves. H e-criota &vrt16tnta l.lta to npwro e1os
avpxe rat oe 4% nepi rtou.
1) i.:ILJ,/!JCl!l ;..ncSvvou ;no veo KOpc5tOOJ')"ct0!(0 Olipjfapa 0 UO~VflS IJ, eva ri
TtpLOOa"Cepa ana ta QVU(patpd'IJ.VU O'CO\l llivaKa 16 avi}KL O"CI1V I<ULI'l/'OPlU tOJV
ao&evtiJv U!.Pr]t\ou 1\LVOUVOU.

33
ITi vaK as 16. flapci)'OYTS oxeuC61JeVOL IJ 6'uo~ev~ rcpo)'vwon 1Jtci an: a o\u
~IJ<f>PU/IJU 10U IJUOKapOLOU.

- M11J<PPU)'IJQ LLK~ 01:r)~cl/XT1


-E~q:.pa)'IJa xwpis Q (au\nllevos Kivouvos un01:pon~c;)
-KapOLaK~ UVITclpKlCl
-Kt\aalla e\w~rwns apLo1epris KmAias <4CJI/o
-HAeK!pOKClpOLO)'pa~LKcl ri OTILV~T1PO)'paq>LKcl UPrillU1a llUOKapOLClKriS
LOXCllllLClS KQ"[cl "Cr) OlclPKLCl 1T1S KOTIWOflS
-EK10ITOL KOlALUKOi pU~IlOL (K1UK!S KOLALaK<; OUO!Ot\e<; >10/Wpa)

r
rta VCl Anq:.~ouv ClTtOq)UOLS ')'LQ 1f1V TtPClL !epw QYtll.l!tt>TtLOrl roue; ( q>UpiJUKa.
a)'')'eLon:AaonKri ri aor:rroo!eq>avtaia n:apaKUI.l<Pn) npen:et va uno6An,9ouv 01- I
~avLai.a ap!npto)'paq>ia ot ao~eveis 1-1e: a) l.l!1.1<PPU/IlU""CLKri o1n~a/xn. 5) KAcio!la I
CW~r]Of1S <40% f1 )') r)AeK!POKapOLO')'pa<pLKa ri OTtLV~T1PO/PU<pLKci UPriiJa!a ' I
IJUOKapOLaKriS LOXULilias 01f1V OOKL!laoia K6Tiwons. H !e,\eu"taia rtprteL va ')'ivetaL I

0 6,\e<; US ITPL rtttiK1LS TIOU 0.\1 UTtUPX.1. aYteV0.1.~11 ( Tt.X. j.11J.1<ppa')'IJU"CLKri


<J1f1~cl/'Xf1 ri OU!l<JIOPf11LKri KClPOLaKfl aVTtclpKLU) Lt rtPLV an6 tflV \OOO tOU II
Cl0~VOUS an6 10 VOOOKOIJLO ( UTt01J)'LO!f1 KOTtWOf'l) rl 3-6 ei300I.lcl0<; ap)'6tepa Ill
:11
(l.l/iOtrt K6nwon). H XPf10LI.l6!rt1a trts ouvexouc; rtAeKtpoKap6to)'paq>tKriS I~
I'
Kal:a)'paq>flc; (Holter) otrtv Ktil.lrtOf'l -cou Ktvouvou rtou 6ta-cpxouv OL ll11.!- I~
~PCl/IJ.UUKOi Cl0~VLS Clllq)LOI3f'lti taL /lCl OUO KUPLWS ,\6/0U<;: a) OL ClOUIJ.Tt!W~Q
UKOL ao,9eveis !l KOLAtaKec; appu~llies oev w<peAouv1at an6 -rnv avuappu~llLKri
Cl/W/rl KUL 13) Ol ao~evei<; ll f1i\K!POKUP0LO/'PCllj)LKcl UPrll.lCltCl llUOKUPOLaKriS
LOXCllllLClS 010 Holter ouvn~wc; 1.lq>aviCouv LOXClll.lLCl KCll O!flV OOKLI.laOia Kon'wons.
2/ UpoA!JfliLKt/ O/{.(J)"tl ~uvio"ta-cat o-cnv Ar1~.Vrt 6Awv eKei vwv twv ~-ttpwv nou:
et\anwvouv trlY TtL~av6tn-ca 1Jq>UVLOI1S veou LOXCllllLKOU TtLOOOiou ri aL~ViOLOU
~avatou. 11epLACll.l6UVL: a) revtKa IJ!pa, 6nws n OtaKOTtrl !OU KClTtYLOIJU!OS,
eAarcwort tns LDL xoAno-cep6Arts ( ertt~ulln-ca eni neoa Katw an6 1oo mg/dl), pu~
IJLOfl tr"JS ClP!flPLClKriS Ttl0f1S Kat OU01f1J.1Cl1lKri, KCl~OpL{OIJVf1 an6 !OV )'Latp6
aoK r10n. 6) Xoprif'non avaotoAewv 1:wv 5-aopevepf'LKwv urtoooxewv ( n.x. 1J1o-
npoA6An 25-50 mg. ouo <popes -rrtv nJlpa PO), ot onoiot eAanwvouv tov KL vouvo
ClL<pYiOLOU ~avatou llta art6 oeu Jl<PPCl/IJ.Cl tOU l.lUOKapoiou. H XOPrl/'T10rl touc; OV
t:LVUL anapai tlltl1 (.JtOUS ao~t:VLS IJ IJLKPU 1J<ppci/IJU1Cl KQL <pUOLOAO/LKI1 IJ/LO!fl
6oKLIJaoia K6rtwons KUL av!ev6eiKvu-cat oe eKeivous ll oo5apri 6uoAenoup/ia tns
apL01PrlS KOLAia<; (KAclOIJCl (w,9nons <30%) KClL OUI.l<POPT1UKrl KUP0LUKI1 aV-
rtUPKLCl, /) Xopn/'non llLKPWV o6oewv aontpi.vns (n.x. 325 mg flllPT10LWS POl ll

34
o~-:orr6 -r:rw eAO.nwor] -r:ou Ktvouvou vt:as &po~Bwor]s -r:wv o-r:e(pavtaiwv aptflptwv
Kat 6) XoPri/llOJl avao-co,\wv -cou ~e-carpernLKou ev(u~ou tns a;;etotacrivr,s (rr.x.
KQrtTOrtpiArt 25-50 mg X 3 PO fJ eva,\an:piArt 5:20 mg X1-2 PO) O!OUS
~.u::1e!l4JPO/!lClUKOU<; ao&eveis ll OUO"COALKti ouoAet-coup)'La "Cr)S apLO"CePriS KOL\ias
tKt\cioJ.La e~tiJ&rtor]s <400/o) avecap"Crtta an:6 trw napouoia ri "Cr]V anouoia
OUIJ.rtTWIJ.atwv "upowKtiS aven:apKeias ot6n q.J.il:ooi(ouv rnv otutaon tflS apt-
Ol:epf)c; KotAias.
Ot avao-coAeis ttov ~-a6pevpf'LKC.iJV un:o6oxoov, n aon:tpi vn Kat OL avao-coAeis -cou
IJ.ctarperttLKOU ev(u11ou trtS Of'f'etotaoivns n:apa-reivouv rrw ernBiwon rwv -cwv
IJ.e re IJ.<ppa /llCl !Lf-.. wv ao&evti.lv.
3] Enep/.faru(!j ,9epaneia H an6cpaon/LO. tilV e<papiJ.O/ll erteiJ.Ba-ctKf)S ~epan:eias
(a)')'ton:,\aoul-\ri ri aoptoo-cecpavtaia napciKOIJ.<Vn) Aa~-t6averat ll Bcion ta
e uprwa-ca -cns ote4)aVLOf'pa<Pias. Kat rns 6oKtllaoias K6nwons (a nAris ae epf'6-
lltpo ri KUALOIJ.VO ran:nta, <papiJ.ClKUttKtiS ri paotOLOOl:OTtLKriS) KO.l rnv KALVLKri
Ka-raoraon -cou uo~evous. Ot neptoo6repm ou!-l<poovouv 6n oe aoptoote<pavtaia
rrapciKaiJ.<VIl n:p~net va uno6An~ouv oL ao~eveis IJ. v6oo tau oteAexous 1:11s
aptotepris ote4)avtalas ap-rnpias KOL eKeivm IJ.e. o-ce<pavtaia v6oo 3 aneiwv KaL
ouoroAtKri ouo\et roup)'La (KAcio~a ecw~nons <40lf!l) 'trlS apw1:epris KotAi.as. fta rou~
un:ot\m no us ao"'eveis npenet va An<p~ei. eca"tOIJ.LKUilvn an6cpa.on o-cr]pt(6~evn
6xt 116vo o-r: a rrpoava<pep~vta KPL tripta aAAa Kat otnv e~rretpia Kat ns
n:poown:tKes avnt\ri<Vets 1:wv ~epan6vtwv )'ta-rpti.lv.

To e~<ppa)'~a xwpLc; Q eivat llOPPrl 1-lPPi/IJ.U'tOS xapaKUlPL(6J..Levn an6 'tllV a-


n:ouoLa KUIJ.Cl!WV Q OtO nAeK'tPOKapOLO/PtlPilJ..lU. 0 en:L noAaOIJ.OS tOU o-cov T1AI1-
&uo1J6 nov ao&evwv J..L o~u J..Lq>PO/IJ.U tou IJ.UOKap6iou KUilaLvetat J..Le'taeu 16% Kat
4(Jllo .
ITaAa.t6-repa en:L"pa-couoe. 11 avti."nq>n 6tL 11 napouoia ti anouoia KUI.Hitwv q. a-co
r]AK tPOKap6Lo')'pci<pJ11.1Cl OX1:iCetaL IJ. 'tO n:axoc;; TtOU KataAa~6uveL 11 TIPl0Xrl tau
1l<PPU/IJO"COS 01:0 IJ.UOKapOLUKO 'tOiXWJ.!O..Etol, ta J.1<ppcifl.,.la'ta XWPLS Q OVOI.J.ci~ov-co
unevooKiipota 11 1111 OLa!OLXtol.la'tlKa (1.1<9PU/Ilata evtmu(61Jeva a-co unev-
6oKap(no ti tllrilla tou IJ.UOKa.p6La.Kou -cmxll>l.l~;tto<;) KaL 'ta e~<ppii;Ilala 1.1 Q ota-
rmxw~attKa (ell!f!PU/I.lata Ka'taAallBavovta oA6KAr]po to naxos 1ou llUOKap6taKou
tOlXllliJO.toc; ). Tu n:poavatpep~E:v1a oev LOxuouv ori1.1epa 6t6tL arro6etxtr,Ke ae
veKporo~LKec; J.Le.\e-ces. ott rra~ot\o)'LKa KUilata Q ouxva Kata;pa<povtaL oe
ao~VLS ll UTtVOOKUpOLa ~ lln OLCl"COLXOOI.lU"CLKcl 1J.<ppci)llCl'tU, evw aTtOUOlcl~OUV 0
er<eivous ~e bturmxw~a:rtKa ellcppan.1a1:a.
To 1J<ppa;1.1a XOJPLS Q 6tacppeL art6 -r:o 1.1<9PU/I.la 1.1 Q otrJV at -r:tona&o)'E:veta, -r:a
!lt\1\ tpOKapOLO...,pU4)LKCl UPrll.l01U, !f1V <PUOLKri LOtOpia KO.L !f1V &pO.rtUl:LKrl

35
--~- ; - ; <.

UVLLI.le HUn:LOil.
,C.. At norca&ol'e::veta. 2e: avri&eort IJ ro !l~PU/IJU IJ Q, o rrpoKa:\oul.levos ano l:flV
;.:_- Pri~n 1ns a&npw1.1a1:LK~S n:AaKas .Sp61.1l3os ;uv~~ws 6ev rrpoKaAei rr,\ripn an6<ppa~rt
/-': TflS, Otelpavtaias ap!flPLUS ~ U<piotataL TtPtOC!lr} UU"COJlUl:fl ~POIJBOAUOfl. ~UXVri eivat
cntofls n a'leupeon napan,\eupns KUKAo<popias nou apoeuet 1:0 1.1"Ca tll'l
anocppaen 1.1UOI\apoto. Os eK Iotnou 11 Ktaon Kcu 11 13apllrrtra rns !lUOKap6ta~<ns
13Acil3f1S etvat IJLKPO!PI1 o-ro 1.1<PPO/J..I.U xwpis Q an:6 61:t o1:o .1Jcppa;1-1a 1.1 Q.
8. H,\eKl:QOKapotal'pa<poya. Ot nAeK-rpoKap(no;pa<ptK.c; a,\Aouboets a<popouv ro
OtaO!fll.lU ST KUL !0 KUlla T. 1ti1V o{eia ~aorj tOU J..I.~PU/J..I.Ul:O<; l.lTtOpei va UTtUPXE:L
avaon:ao11 ~ KU1:aonao11 1ou 6tao-r~J.J.a-ros ST ouvo6eu6J.J.t:V11 an:6 avaorpotpf] Iou
KUJ..I.U!OS T ons ana;w;s nou j3,\rtouv !rlV J.J.<ppa')'J.J.UttKti rteptox~. Ot n:po-
ava<pep.Seioes nAeKtPOKap6to')'pa<ptK.c; aAAoui>oets eivat ~11 et6tKS Kat 11 6ta-
;vwor] !OU 1-.L<PPU)'J.J.ato<; XWpic; Q ti~e!at JlOVOV 6tav OUVUTtapxouv 1.1 aueno11 l:W\1
Kap6taKwv e'ICUIJ.WV . ITa.SoAo;tKa KUIJ.a-ra Q 6ev aveupioKOVl:at.
r. ITp6VWOQ Kat &epaneia. ~!l"lV o<eia <pOOfl, ~Vf1!0!11!a eiVULJllKpOtpl1 01:0
J.J.<ppa;J.J.a xwpis a an6au o!o J.J.~Pa/J.J.a IJ a. Meta 6J.J.WS ana rnv ~(ooo an6 to
VOOOK01.1LO 0 r-.LVOUVOS vou .J.J.<ppcl/1Jato<; tOU iJ,UOKUPOLOU LVULIJ/Q,\UtpOS 01:5
1J<ppa;!la xwpis Q ano 6n 0!0 ejl<ppa{J.J.a J..l. Q. AnotAt:OJ.J.a t(.l)\1 n:poava-
tpep&.vtwv ei\~at 6u 11 J.J.aKpoxp6vta np6')'VlOOI1 eivat nap6J.J.ota ota 6uo eio11 J.J.-
~pa;I.1C:n:wv.
H tvw66Auo11 eivat avanoreAeoJ.J.al:LKri oto 1.J.<ppa;I.J.a xwpic; a. Totno rtt~avws va
o<peii\e-rat 01:0 on 0 OXflJ.!UtL{OJ.1VOS an6 tllV Prien ti1S U~flPWI.J.atLKrlS rtAaKaS ij.
l~
~p6J.J.l3os anote,\ei tat Kupi.ws art6 ali.J.OrtetaALa (AeuK6S ~p61.J.l3os ). H ~eparte'ta
o-rnv o<eia <paon n:eptAa!ll3avet 111v xopfl/'11011 aontpivns. 11n:apiv11s. vtrpw6wv Kat \~
Jj
avao1oAewv 1wv 13-aopevep/LKWV urtoooxewv: Enet6ri o Kivouvos un:otponns I!
ei vat !le;aAoc;, 6AOL ot ao~eveis npeTteL va uno6aAAov-caL oe o-ce<pavtaia II
I'
UP111Pl0/PU!pla T"CPL v an:6 -rrw e{ooo an6 "CO VOOOKOIJ.l0 ;La va OLUPU\II1~L "CO
EVOXOIJ.VO erteiJ.l)a'ttKriS ~eparteias ( U//LOTtAaa'tLKrl ri aop!oote<pavtaia, I
rcapaKai.J.4JI1) . OpLOIJ.eVOL UTtOOtflPL{OUV OtL 11 XOPrl7.Tl011 OLA-ctaCe!li1S O"COU<; i_
I

ao~evei.s J.l LKavortOLI1tLKrl AeL 1:oup;ia 1'f1S aptotepns KOLAias J.lTtOpei va


eAanwoet 1ov "ivouvo veou 1.J.<PPU/J.laios. To ev A67w <papiJ.aKo oev ~a rtprtet
va xoprr~eL taL otav urtapxet 6uo,\et toup{ia -rns apw1:ept;s KmAius.

7. At<pvi.otos ~ava-ios

H nAetof~IJ1tpLa r(llv c~wvoooKOJ.J.taKwv at~vtoiwv ~ava"Cwv ae ao~eveis


!l
O"Cclpavtala VOOO Otpeit\etaL 0 KOtAtaKf}J.J.apj.lapu;ri rl 0 KOL;\Lal\ri "CaXUKapoia
EK<puAtC61Jt:YI1 oe KOLAtaKftJ.!apJ.J.apu;f]. AAAa At;61epa ouxva atna e'tv.atll o\eta
KapOLUKri Pl1(11 l-l1'U ana 1J.<ppa)J.J.a tou IJ.UOKap6iou, I11.1U(LK~ TtVUj.lOVLKti J.J.l30I\11

36
;::.- ..

"-tll 11 E.IJ.~O;\rl tOU Otei\exou<; tllS tlpLOtepq<; Ott:IPUVLUltlS aptllPLUS ano tOLXWiltltlKO
~POilBO. ..
Ot ao~eveL<; otous onoious e<papiJ.OOtllK /KULpa Kapowavanve.uonKil
ava(wo;ovrwn f...aL erc(11oav -rou enetoooiou npen:eL va etoax&ouv oto
voooKOileLO YLU rce.pat tepw e.,\e(xo. Tou-ros nept\a~J.I3avet ote.<pavtaia
UPTilPLO/Ptl<j)La f-..(.ll apLOtep~ KOLAlO/PU<ptU !LU l:flV K tliJ.flOfl tllS K TUOfl KUL 1f1S
l)aptHJ"l1U) l:flS Ot<j)UVLULUS VOOOU KUL 111S i\e.LtOUP/LK01flTaS 111S apL01ePriS
KOLi\ias. Otav urcapxeL ev6LCJ"l, o ao~ev~s npTIL va urroi3An&l O Tte~l3auK~
&eparteia TIU\'ULIJ.UtWOflS (U((LOnt\aottK~ ~ aoptOOtE.<pUVLalU napti.KUIJ.{j)f"l) ri
uve up uolluteK to~-tri. ~ noi\Aous ao~eveis arranei taL 1"1 TtL rcpoa~e1f"l eK rei\ eon
fl,\eKTpO<j)UOLO.\O"'LKOU E.,\(XOU IJ. OKOrt01flV np6Ki\f"l011111S appU&IJ.La<; KUL !f"lV
llE.A11"1 1f"lS av'turcoKpt.aris tJ"lS ota 6ta<j)opa avuappu&IJ.LKti <PciPIJ.UKa. TeAe.uraia
e.<pap1J.6(e.rut IJ.e IJ.e(ai\n e.nnuxia ll eiJ.<pure.uon tou uut6~-tatou Kap6LOIJ.E.tatponea-
unt vt6wrq )Hl 1:11v uvtLIJ.ettinuon -r:wv Ka.Ko~~wv KOL.\ta.K wv appu~IJ.LWV ( 1J.1J.E:vouoa.
KOL,\LaKri tU)(Uf-..UpOia., KOLi\LOKJi IJ.UPIJOPU./ri ).

37
_:., _:_:_~_-::.._ ----- ~- --- - ---

5. KAP~IAKH ANEIIAPKEIA

f1poo<pa1t:S TILOfll..l.LOAO)LKeS IJ.et\etS 0lXVOUV 6tt 1:0 1% HJJV Ul:OIJWV r)ALKLUS 5G60
e:rwv ncioxet uno r-apotaKf} avenapKeLa Kat to noooot6 aut6 6t nAaoui~etat )ta
1\U~ t: m n:.\ov Ot:KUl:LU H1S Cwf}s. ~Ill xwpa IJ.US un:ot\O)'L(e"'CUL- 6u 80000 n:epi n:ou
\t\r)VS n:aoxouv an:6 KUpOtaKf} aV!1clPKLU, Vto 15000 veec; Tteptn:!WOLS 1-J.q)U-
VL(OVTUL !flOlWS.

Xp6vta KapotaKri avenapKeta

IT a 3ocp UOLO,\Q')'L a

ns KUPOLUK!l UVfWPI\.LU 1-J.TtOpei va OPL01:L to Kt\tVLKO OUVOPO!lO O<pt.\Oj.lVO 0Lr1V


"[Q
aouvai.J.ta rns 1\.upotas va bta-rnpncret ati-J,citwcrn, n:ou va en:apKei )tans lletaiJo,\tKS
UVcl)'KS "'CUJV LOtWV, napa !f'lV Urtap{f'l ertapKOUS rl KUL aU{flUVrtS <pAe~tKf}S
eluotpo<pris. At)J.oouva!J.tK!i, 11 KapotaKf} avenapKeta xapaKtflpiCetat an6 eAat-rwon
Tfl<; Kap6taKf}s napoxns ouvooeu61J.eVfl an6 au~nan-cns teAootao-roAtKI1S nleo11s. H
-
KapOLUKrl avenap"LU IJ.TtOpei Va a<popa l:f'lV apt01:Prl rl 111 oeeta rl KOL UIJ.q>Otpe<; US
' .

(ot\tKrl KapOLUKrl avencipKeta)


A. A ven:apKeta apta!epOs Kmt\ias ~LaKpi ve-rat oe cruoto.\tKrl Kat otacrtot\tKrl
H QJJ.9:JQ.~~JS.!i ..ts..~Q.Q.~g!S.Q ...g.Y.TI.!7..P..lS..t9; xapaK'tflpi{etaL ano et\cinwon tfl<; cruon:a<nt-
KO'tf'ltas (KA!iolla e\lihl)nons <50Jio) Kat au\non-rwv otacncioewv tns apto!epns KotAias
KOL ouvf}~UJS O!peLAe!aL 0 IJ.UOKapotaK<; Ttu~fioeLS TtpOKuAOUIJ.VS an6: a) a~npo
OKAf}puvofl !WV O"Ce<pavtaioov ap'tflPLWV, I)) l:O{lve<; (aAKOOAfl fi KU't'tapo"CO{LKU
<pclpiJ.UKa), 1') AOLIJ.W~elS art6 LOUS rl TtapcioL ta (LO)VrlS IJ.UOKupoi !LOU rl v6oo<; Chagas),
0) n:apat1:UI-J,Vfl <pOptlOfl 'tOU KapOtOU')'')'LQKOU OUO"Cf}j.latOS ( UTtep"CUOfl ri
~aA~toorccWeta) Kat e) OU/'/'eYels KapbLOnci~ete<;.
H e,\cirrwoi11:11S ouonao'ttKOl:fll:as tou IJ.UOKapbiou exet ws an:o-re~ecrlla tnv'
IJ.el:a"C6n:LOf1 npos ta Kti'tw KaL oe~ta tflS KUilrtuAns tou Starling. Os eK toutou )'ta 1:11
6ta'tr1Prl0!1tou 6)'Kou na.A.J..LOU KaL tns KapotaKns napoxtis anaL teL tat 11 evidx1Joll 1:11s
ouo'tot\tKf}S Aet toup)'iac; 1:wv a~lK'twv "CJ.HliJ.citwv tou IJ.UOKapoiou 1-1e au~11011 1ou
n:po<p6puou Kat !llS cruonaottK6tnta<; -rwv.
A) Ati(t?OIJ!lfJOtfOfJl'tOll (re.-lo~uioro.-ltKIJf rtiCJ!Jf) H au{nol1 tou npocp6p-rLou ocpeiAe'taL
Ol:flV aouva~ia I\.VUJOflS 'tllS KOLAias Kata "Cfl Ol.cipKLa l:flS eew~ncrns KUL o"triv
t: rcu~<..o,\ou~ouoa au~non -rou teAoouoto,\tKou Kat teAoowotoAtKou 6)'KOll Kat exet. we;
uno!e,\eo)J.a !!lV uu(r)of'l tl1S vtao11s tf'lS ouo-roAns ota a~LKta -r~n~ata rou
1J.UOKap6iou oU~<t'UJVa ~ to VOIJ.O tou Starling.
B) Ait(!JO!l ovo!looar..oaJttlf. Ei vat anotAeo~a tf'lS evep)'Ol10LI10f1S tou ou!lna-
~fl tLKOU V upli\.OU OUO"CrliJ.U!OS K~L oq>eiAetat O!flV Acil:l:W011 tr)S KapOtaKfJS n:apoxf}c;.
0~-tUJ<;, er- !OS arco tLS rcpoava<pp~eioec; U!lYlS TtLOpaOLS. f'll1apul:etOilYl1 UU~l1011
l:OU rtpo<poptLOU Jo...UL 11 VP)'OTtOLf1011 tOU OUj.lTIU3fltLKOU VeUpLKOU ouotri~ul:OS xouv

1
Kat BAan:Ut<<; emopcioets. rw n:apaOL /IJ.U, 1:000 UU(Il<Jfll:OU rtpo<popuou 000 Kat ll
fl:POKU;\OUJ.lVfl an:o HlV VP/OrtOLI10f1 !OU di.JIJ.Tl:U~Ill:LKOU OUO!riiJ.U!OS OUOTtUOfl TWV
tpAeBwv KUL l:WV aprnptwv 1J.Tt0PL va TtPOKU~oouv unpJ.l1Pfl au{nort 111S
OlUOl:Ot\LKilS 1:cl011S T.:OU IJ.UOKUPOtUKOU 1:0tXWIJ.U10S IJ. ano1:t\01J.Q rn owrapaxri rns
/WIJ.1:PlUS !11S "ap(.nci<; (ouoavaAo;n Otaraon. 1J.!U~0~11 OXrliJ.U!OS 0 O<j)ULPLKO) KUL
r11v ertLBcipuvon 1:ou IJ.1aBoAtKou -rns too(u(iou. H erctBapuvon autri ava(vwpi{cTat
an6 l:llV UU(!l1J.Vfl IJ.UOKUPOLUKri KU1UVa,\UJ011 O(U/OVOU, 11 anoia LVUL avciAO/fl 111S
IJ.UOKapotaKris -cao11s. Enio11s. m napaf'wiJ.eves an6 t11v evep,onoinon tou
OUIJ.TIUS!ll:LKOU KUtexot\UIJ.LVS exouv KUPOLO!O(LKri OpUOI1. rta !OUS ~O')'OUS UU10US 0
Ba,9-IJ.6s 111s 6tcitao11s 111s Kap6tas Kat !11S evep(onoi11o11s tou ouiJ.na,9-11nKou
VUPLKOU OUO!rl1J.U10S pu,9-1J.i{OV1UL, 01a UPXLKU !OUAUXLO!OV Otciota UlS na,9-11011S, an6
llilXUVLOIJ.OUS d)'XOU. J!OUS tAeutaiouc; TteptAaJJBavov1aL:
A) H vTie/J rporfttl rov;....otAta;...-oti rot.raiparo~ npoKaAou 1J.Vfl art6 evep(onoinort
t0tKWV 0/1<0/0VtOtWV (c-fos KUL c-myc KAn:) nou Ole(eipouv 1fl ouv,9-0I11J.U0Vr)IJ.U!LW'V
Kat au(avouv to n:axos -rou IJ.UOKapotaKou 10LXWIJ.atoc;. Arto1AeOIJ.U 111s ev A61w 6ta-
6tKaoias eivat 11 eAc:l1twon -cns 1aons 1ou IJ.UOKapotaKou tOLXOOIJ.atoc; OUIJ.cpwva IJ. to
VOIJ.O !OU Laplace ( 11 IJ.UOKUPOLUKri 1UO!l ei. VaL avuq!p6<pwc; avaA0/11 !OU naxous) KUL n
eAilHWOI1 rns IJ.UOKUPOLGlKriS K01avciAWOf]S O{U/OVOU. "'
B) H av(tJCIJ l'!Jf ,5tacroAu...-;ff rtiC!Jf rou Ko.-lfluoti rot,lajparo~ n ortoia, au(av61J.VI1
0U1PO/VWS ,\o(W !11S UU(I101lS !11S taons l:OU KOLALaKOU 10LXWIJ,a!OS npoKaAeL: 1] II
6t(epon 1wv 1:aoeourtoooxewv tou KoAntKou !OLXWIJ.a!OS IJ. artotAeOIJ.a tov
UV!UVUKt\UOUKO rtPLOPLOIJ.O 111S OUIJ.Tta~l1'tLKrlS {000U art6 tO KeV!PtK6 veuptKO
ouo"t111J.U Kat 2] rnv KKpton tou varptollellrtoiouano 10 KoAntK6 toixwlla. to ortoio:
L) avaot,\Aet lllV KKPL01l VOPTttVe<ppiVflS Kat lLS Opcioetc; "CI1S Ota TtpltppLKQ
U//ia, LL) XL UIJ.011 a(/LOOLaotat\1LKri opaon O!Q TtPL<PPLKQ U//LQ KQL ut)
TtPOKaAei vatpLOUPilOfl, TtepLOpi(OV!aS etoL tr']V IPOP'tLOil 'ti1S Kapouic;.
An:orA01J.Q 'tllS ouv6uao~-tvns OpU011S lWV Ttpoava<pep~V!WV llflXUVLOIJ.WV ( KOtALaKri
ota-raon Kat uneprpoq>i.a, evep/ortoi.non U//LoouonaotLKwv Kat a//ELo- .
OLUO!Ui\!LKWV OUOLrliJ.U!WV) LVat 11 e~aoq>cit\LOI11J.tclS t\eTttrlS Loopponi.as IJ.!Q~U UL-
1100UVUIJLKWV, VUPLKWV (OUIJTtU~rj'tlKO) Kat OPIJ.OVLKWV (KUKAocpopOUVtS KQ!XO-
~UIJLV), VU!pLOTtTt!LOLO) napa/OV1WV, 11 Ortoia en:ava<pepL 't'l'V Kapl>LaKri ~Ltoup
;ia o-ca nptv ana rnv eni6paon tou BAanuKou aniou enirte6a ll IJ.tKp6 evep/etaK6
Koo1os. Os eK routou 010 o-rcioto auto o ao~evris eivat aCllJJITfl'fiJPOrt;.;or !J
oAt /"vOCltlt/Tll'fllt/Clrt/1;0~ .
(vie tnv n:apooo tou xp.6vou OllWS at n:poavaq>ep~ev1ec; avnppon:to!LKoi ll11XOVLOIJ.Oi
xavouv u1v a n:ote.\_eo~-tauK6t!l1a roue;. H ~-taKpoxp6vLa otataon tns aptorepris KOLt\ias
OOI1/~L oe ,\e ntuvo11. veKpwoq KaL i vwon tou IJ.UOKapotaKou tOLXWIJ.Utos. H
Ka-ran:6vno11 1ou ~<ot\ n:tKou tOLXti.lfla1oc; npoKat\ei 60IJ.LKS llEta~oAes ouvooe u6JJ.cves
an6 b uo,\t:noup:w rwv taoeoun:o6oxwv Kat et\cit1WOI1 -cns KKPLOI1S vatpLO-
n:en:nowu. Ta n:upan:avw exouv we; anoteAeo~-ta !I"JV ll/a,\n au~no11 tnc; 1:a011S tou
KOLAtuKou tOLXWIJatos Kat tnv un:eplletPn ote(epon tou ouiJ,na~nuKou veupLKOu
ouo11111~ros. H l:t:Aeutaia xet llLKPri eni.opao11 0111 ouonaottK6t111a tns Kapotas

2
----~.:....~: .. __ _._ r:~-.;_:_--- ------- -----'- -

,\Q)'OJ t::\aHOJOflS HuV e1-aOpVp/LKWV Urt:OOOXWV "tOU IJ.UOKCIPOLOU OtOUS OrtOLOUS


6pa 11 vopaope.vai\LVfl, e.vw n:apciAA11Aa au(ave.t .. to IJ.ta<popno ,\6/W tllS
n:poKa,\oul.levns ap"CI1PLUKrlS a;;e.toouon:ao11s. H 6taraof1, 11 un:oouota,\nK6tl1ta Kat 11
1.1./Ut\fl au{I')O!l tou IJ.etatp6pnou exouv WS anote,\e.ol.l.a ti')V eAattWOfl tllS KapOlUKflS
n:apOXflS
H atl.l.atwon tttJV LOHLlV IJ.eta r11v e.Aarrwo11 tns KapotaKr1s napoxns 6tarnpe.t rat 1.1e 6uo
IJ.flXO.VLOIJ.OU<;, "ti1V 11PL<pepLKrl 0.)'/eLOOUOn:aon KQL ti1V KQ"tUKPUtf1011 ve.pou KUL
va1piou. H aept~c/Jii(!J o;r}"etocrlionao!J ei vaL an:oteAeo1.1.a tllS unepioxuons 1wv
a;;etoouon:aonKlLIV ( ou1.1.rta-&11ttK6, ouo1111.1.a pevi VllS-a)')'eLOtaoi vns -aA6oote.pov11s
K:\rr) evavu nov a~)'eLOc~naotaAttKWV (vatptOrce.nti6LO, KArt) OU01111.1Lltwv. H evep-
;on:oirwn tou ouorruJ.atos pevLvns-a;)'etotaolvns ctAoootep6vns. to on:oLo eu&u-
ve.-rat /'La tnv ;;oroAptirtlO!J vepoli Kat vorpiovo<pe.ii\e.taL ae. :a) nnoo11 tns n:iOf1S
010 rtpooa;w;6 ap"Cf1pt6ALO lOU V<ppou, IJ) auenon t!lS Opa01f1pL01f1tU') HIJV OUIJ.n:U-
&nnKWV ve.upwv wu ve.<ppou Kat 7) e.Aattwon 111s n:oo6tl']ras tou Na+ tflS 6tepxo-
IJ.eYflS an:6 t11v nuKvri -&nAri 1ou oupo<p6pou owA11vapiou. Ta n:poava.cpe.p~vta exouv
ws an:orAe.o1.1a 111v KKpton pe.vivns an6 taus veq>pous, n orcoia otn ouvxeta 6pa
0 IJ.LU a2-0!pULPL Vf1 tOU rt.\UOIJ.UlOS OVOIJ.U(OIJ.VJ1 a//eLOtUOL VO/OVO, IJ.e an:ote,\01-lQ
to oxn1.1auou6 e.vos 6e.K~ne.ntiotou tns Cl7/LOtaoi vns I. H te,\e. uta.ia 1.1. ratprte.rat
atto eva ev\UIJO QVUplOKOIJ.VO 01r)V Ttl!pUVLU 1WV VOO~J1.\La.KWV KUttapwv (!J.-"'
tatpTttLK6 ev(UIJ.O a)'[L01aoivns) OtO Vp[6 OK1artTttLOLO a{[elOtaoivn I I. to
OTtOLO I
I
1. LlL/elpL tllV KKPton a.A0001ep6VflS altO 1a T1LV!ppi6ta IJ. artotAe01J.Q 1f1V
'>jl
Kal:a.Kpatnon ve.pou Kat va,;piou Kat trw an:oBoAri KaAiou.
J
2. I1poKaAei eVtOVf1 U)'/eLOOUOTtaon.
3. .lupX1aL tov tlL1.107Ke<PaAtK6 <PPCl/1.1.6 Kat OLe7eLPL ta OUIJ.Tta&nnKa Kv1pa.
4. AucaveL tf'l ouon:aonK611lta 1ou IJ.UOKapoiou evLOxuov,;as 10 pe:uua ao6e.o1iou Kata
trl 6tapKe.ta 111s Bpaoe.ias avan6Awons (oponoLO) tou ouvaiJ.LKou 6paof1s Kat
e1JIJows 6te{eipovtas 10 ou1.1n:a~nuK6.
H j..l!pClVLOJ1 T1PL4lPLK~S a[)eLOOUOltaons Kat KataKPU1f10flS varpiou KQL uoatos
U1100f1AWVL PrlCI1 !flS\ avuppOTtflOflS KaL OUV00U"CQL aTt6 'tflV ej..l!pQVLOfl OUilTttW-
IlU!WV Kat OJ11J.LWV OUIJ.!pOPf11lKf)S KapotaKrlS aVeTtclPKelaS (Oe<; napaKatw)!
H QJ.fJ.9.~Q!\~JS.!i..~.g.P..Qtg.!S.0 .. 9:Y...TI.4QJS.H* ave.upioKetaL 010 304Q0/o 1wv ao&e.vwv :ue.
Kap6taK~ avenapKe.ta Kat xapaKtrlPi<e1aL ano: a) <puoLOAO/'tKri ri e.vtoxuuE:vn ou-
on:aonK6tnta tllS apto1ep~c; Kot.\ias. B) une.ptpo<pia Kat 6wotoALKrl 6uo.\noup;ia
r11c; aptote.p~s KmAius Kat )') IJ.etpiou Ba~IJ.OU btE:;epon tou OUIJ.Tta~nttKou ouot~
IJ.Utos Kat rou ou~trlllatos pe.vi vns-a)'{etotaoi vns-aAooore.p6vns. Ta ouvf1~o,;pa
ai tta 6taoroAtKriS KapotaK~S ave.napKetaS eivat 11 a~J1POOKMlPUVOI110N Oteq>avtaiwv
aptf1ptwv. n apti1Pta.Kr1 uneptaon. 11 o1evwon tns aoptLKrlS BaABioas Kat n
un:e.ptpocptK~ IJ.UO"apOLOn:a~eLU.
Oc; 6taotoAtKri ouo;\et roup7ia IJ.ltOpei va xapaK1f1PL01ei 11 a6uva1.1ia tns apLOrePrlS
KOLt\LaS va 0XtL rov anaLtOUIJ.eVO 0/KO aij..lal:OS XWPLS UU\!1011 IllS '0LaOtOALKJ1S
11l0f1S, H KataotaOil aut~ o<peLAOIJ.Vf1 0 e.~ltirrtliO/l [!Jf evoortA''0[/l[tlfT.I1S apt-

3
<HePriS KOtALas UVU)'VWpL(TaL 01"0 atjJOOUVajJLI\0 ep;aOTflpLO ano TflV napouoia q>U- !
.J
<JLOt\O)'LKOU Tet\OOUO!Ot\LKOU KUL 1eA00lU01"0t\tKOU 0/KOU, OUV00UOIJVWV UT!O UU(f1- I
IJeVf1 u:AoouoroAtKri Kat reAobtao-roAtKri nieOf'l HlS apLO-repris KOLAias avriototxa.
H au(f10f11"f1S -reAootao-roAtKriS nieOf'lS rns apLOrepris KOLAias n:ou ouvo6euet "Cf'l
CJUOl:OALKri n "C!l OL.U<HOALKrl KUPOLUKri aven:apKela, Xl lO<; UTt01;\eCIJU l:llV auenon
rns Ttl0f1<; 010V apL01"p6 K6An:o A6)'W "IllS TUKOLVWVias l..lTUCU K6An:ou Kat. KOLAias
Kata 1fl 6uipKLU rns btao-rot\ris. H auerll..lvn T!L0fl10U apL01pOU K6Anou l..lta~L-
5a(1aL ons nveUIJ.OVLKS q>A5es Kat "Ca "CPLXOeL6ri tou nvel!!Jova. Otav 11 uopo-
o-ranKri n:ieon un:ep5ei !flV KOAAOeLOOOI..lWLLKrl T!L011 Ota T"CV UIJOVLKU !PLXOLOri,
n:poKaAel tat 6ti6pwo!l u;pou <nov ev6ta!leoo to't6. Orav o pu~1..16s 6ti6pwons rou
U/POU unepBei rov p U~IJO an:ox1e uo11s an:6 to A1l<PLKO ouO"CfliJO. eiJ.q>aviCetat ev6t-
Ull00 OLOf'll..la. [lepaL rpw aucnon "COU pu-8-jJOU OLiopwons OUVOOUtaL an:6 (000
U/POU OtLS TIVUIJOVLKS KUt,PALOS KUL TIVUIJOVLKO OL0111..1U (OS rrapaKarw).
B. AverrapKeLa 6e\tas KOLAias. ~uvr;~ws np6KL taL )'La au\11011 tc.uv 6taoraoec.uv Kat
Klt"CWOI1 "CI1S ou01:oAtKriS Aenoup)'ias l:JlS 6e\tas KOLAias an6toKo aptorepas
Kap6LaKriS aven:apKLa<;. Oq>eiAetaL: a)o au\non "COU l..ltaq>6prwu 111S 0\Lac; KOLAias
,\6;w aU\f1011S 'tflS Ttl011S O"CI1V T!V UJ,J.OVLKfl aptflpia, TtPOKaAOUI.lVflS 0 U!p0)'VWS
an:6 !flV a(J(f10fl rtOV TU~OWV Otl<) TtVUIJ,OVLK<; ~A5<; Kat ~) O'tf'lV ava.'tOULKri KO.l "'
.\enoup)'tKri aAAnAe n:i6paon 6ecuis KaL apLotepris KOLALac;. H avarOIJ.LKri
aAAnAen:i6paon o-xeriCetaL IJ to Kmv6 "Coixwlla nou llOLpa(ovtaL m 6uo KoLAies. ro
j./cCJOKO/AtoAo 0!0(/'J)O}'j.la<.a~ciJS T!tOflS ll !LS KOLV<; OUVXi<; 1J.ULKS LV<;, T!OU
OUIJI..ltxouv o-cn 6ta1J6pq>won nov tOLXWIJ.atwv twv 6uo KOLALciJv. H AeLtOUP/LKri
aAA!lArti6paon \L OX011 IJ. ti1V "ev OLpci" OUV0011 tC.UV OUO KOLALWv 0!0 iOLO
KLIKAtolla. rcpa;lla rrou on!laivet 6n 11 eAattwon tou 6/KOu naAI..loli otnv Ilia KOLAia ~a
ouvo6eutei urtoxpewnKci an:6 eAcittwon rou 6/KOU naA1.1ou KaL otnv aAAn. TE:Aos to
//Ov6s. 6tL KaL oL 6uo KmAies BpioKovtaL 1.1oa oe eva aveAaotLK6 ociKKo
TO, !lcj)O.:'tipota XL we; an:otA01JU 11 auerwn tWV OLaotaOeWV -cns Iliac; va npoKaAei
llflXUVLkri 6uo,\t1:0up;ia ,\6;w OUIJ.ltL0flS Oti1V UAAfl.

KALVLKd UPrliJ.U!Q

A. 2uu rc-rciJuata. To K upt6tepo OUIJ.TttWIJ.a ti1S gQ~Q.J.Q.US...IS.gP..Q.~.g.ts.f.ls... g.Y..JJ..Q.K.Jg..s.


i OUO"COALKriS ri ~>LUOTOALKriS) L VaL 11 01./Cl!lV0/1~ 11 on;oia O<peiAe'tUL 0 au\f1011 !OU
p/OU TflS avaiTVOf'lS AO)'W 111S eAat"CWIJ,VI1S an6 !flV ltV UIJ.OVLKfl OUJ,.l<pOpf10f1
VOOTLKO'tfl!US rwv rtVUIJOVWV. ~ta UPXLKa O"CciOLa 111S n:a&f1<JI1S 11 ouon:vma
t:u,<pavt(e1al Ka1a rn 6tapKeLa rns K6rtwons. evw 0111 ouvexeta KUL 1.1 111v
rrpoo6eU1lKfl ent6etvwon rns Kap6taKns Aet-roup;iac; 1JTLOPL va E:ll<PUVLO"CL Kat ornv
f'lPel.lia, OVOIJU(Oj.J.V!l 161 op<9o!lvota H teAeu"Caia eiJ,<pavi(etaL orav o ao~evris
5piOK'taL 0 Urtna ~011 KaL oq>eiAe'taL 0 avaKataVOIJ.fl l:OU ULIJ.UTOS an6 'tflV
n:ept<ppeLa rrpos !f'lV KV1PLKri KllKAoq>opia. H !l0/)0(1/(JPIKij VI.IA [cj)tVIl 0()Clf[V0!0. n
a<pun:vtan 611Aaon rou ao})evous IJ.e aio~n!la v"Covns 6uonvmas. o<;>eLA1:a.L oe
eVOLOileoo nveUIJOVLI\6 oi6n1.1a KaL eivaL 11 nt6 etOLKri eK6nAwon aptotepris Kap6LUKriS

4
averrapKetas. H <Jo~apo1epn IJ.OP<Pri ouarrvoLas o<peLAOIJ.Vfl ae apLa1epri KapotaKri
averrapKLa eivaL 10 o(u rrvcupovu.-o ou)f7pa(oer; rrapaKcirto). 10 ortoLo. 6rrws ri6n
npoava<pp~f1K, o<peiAe-raL ae 6tlopwon u[pou aus rrveuiJ.OVLK<; KU4J;\Loes. 0
aa~evris 1J.<pavi(E:L vtovf1 ouanvma auvooeu61J.evn arro ntv napa[W/ri aq>pwowv
OPOC1LIJ.a1qpwv rt1u,\tov KUL K00f11J.aOIJ.Vf1 OUIJ.Tta~f1UI\010VLa 1\0r)AOUIJ.Vfl IJ.
4JUXPO 6p1Ja, IJ.;'Clt\f1 e<piOpWO!l KUL 1aXUKapbla.
H auvooeuouaa 1r)V UPL01Pri KapOLaKri UVTtUPKLU eAcinwOfl 1r)S Kap6LaK~S n:apoxris
~Jrtopel va npoKaAaeL KOn:won. aouvaiJ.ia, eAci11:wa11 tflS LKav611"}1US /La aOKflOI1
KU~WS TtLOI"}S OU/XUOfl KaL 0Lal:apaxs ti"}S IJ.VriJ.lllS Oq>L,\OIJ.VS 0. AUHW01l 111S
aLIJ.cil:wai"}S 1ou e )'Ke<paAou.
a
~ 1a au 1.1 n: 1 w1.1 a 1: a 111 s Q..~~4.s...!SJ!.P..Q.~.g.IS.O.S.J;;Y..n.4Q.!S..JJJ.S. n e PL Aa 1.1 ~ v ov 1aL 1a o <p eL,\ 611 eva
ae eAa11WOll 111s 1\apoLaKns n:apoxris (K6nwal1. aouvaiJ.ia. e.Aa11WOI1111S LKaV61fl1as
/La UOKI"}O!l KAn:) 1\U~WS TiiOI1S UUL0~110ia CHO oeeL6 UTtOXOVOPlO KUL aio~niJ.a
n,\flpOtl"}tas atl"}v KOLALa a1J.q>6tepa oq:~etA61J.eva ae OUIJq>Opfll:LKri r)rtal:OJ.le;a,\ia. TAos
ouxva avatppe 1aL vautia Kat avope~ia A61w m6niJ.atos 1ou rina-cos Kat 1ou
/UOtPO.Vt.PLKOU awAfiva.
8. ~QUeia. 0 aa~eVflS IJ et\aq>pou i} KUL J,1tpi.ou ~a~J,10U KapOLUKi} aV.TtclPK.LU ar.:.
O~UV.taL Ka,\ci Ol:r)V 11Pe~Jia KUL tO IJOVUOLKO UPrliJ.Cl l..lTtOpei va eiVaL IJ.LU IJ.LKP~ -...
CIU{f10fl tllS KCIPOLUKriS OUXVOtf11:ClS. 0 ao,9-eVrlS J.l. O{eia .TtLO.LVWOI1 t!lS Kap6taKtiS
Act toup)ias xet 04.111 rraoxovtos Kat .1J.q>aviCet taxuKapoia Kat n:e.pL<pe.ptKri
Cl[[.LOOUOTtaOfl .KOf1AOUfVJ1 IJ. 4JUXP6 KCll U/PO 6pJ,1a KUL ouxva IJ.. KUUVWO!"). OL ::11

aa~eveis IJ. XPOVia KClpvLaKri aveTtUpKeLa OUXVU .1..lq>avi\OUV r.axe(ia OtpLA01J.VI1 i


0. auv'6uClOIJ.O rtapa[OVtWV, 010US OTtOLOUS TI.pLt\UIJ.~UVOV1ClL 11 XUIJ.f1t\ri KapOLaKri ~i,l
rtapoxri. 11 tO{L'!(Otl"}ta tC.OV q>apJ,1UKWV KUL 11 cl/'eUOtfl avaAos OLatpoq>n. 0 O<j)U[IJ.OS ~
LVC1L ao&evris KCll eAattWJ,1VOU eupous. H n:apouoia eVa,Uae7C70PeVOl/ Clf/'l/71/0li.
xapaKtf1PLC01J.VOU an:6 e-vaAAa?'ri LOXUPWV KClL ao&evcilv O<j)U/I..lLKWV KUIJ.U1WV
o<peLA61J.evwv oe avtiotOLXeS J.1etaBoAs tou O/KOU n:at\J,1ou, uno611AcilveL ooBapri
Kap6taKri averrapKeLa. LluiroC7!J raNtfo/e/friN rou zpt~:t1llourtapatnpei taL oe ao~eveis
j.i au{nj.iVf') rti011 tOU oeetou K6Artou KQL ti1S Oe{LUS KOLAias. T,oiros- J.''tl,OOttlKOS"
tOVOS"( xa1.1nAris OUXV01111US riXOS C1V1LAI1Ttt6<; OtflV KOpuq>Ji lflS KapOLUS ri UP,LOtepti
rtapaotePVLKU 1.1 tOV KWOwva tOU 01J1,9-QOKOTILOU) ClKOU/tClL ouxva OtOUS UO~VeiS
l.l KUPOLUKri avertapKLa KClL OtpLA1QL 0 oovriaeLS OflJ..llOUp[OUIJVS OtrlV TtpWLI-111
btaatoAtKri nepiooo A61w l:f'lS taxe.ias nAripwof'lS 1.1ias 6tate.tal..lvfls Kat xa1111A~s
e.vootLKOtfltas KOLAlas. En:ia11s to rrvcupow.KoCTtet..rdo rouoelffe,oou ;..:apt!ita;.,-ou ravou
~-trropel va exel l.l/'UA11 vtaof1 A61w tns au{I1J.1Vf1S rrieons otnv rrveu!lovtKri
ap1flPLCI:' J),ooi PO>:lOtaKOU/OVtaL ouxva 01LS ~UOLS tUJV rtVUIJ.OVLKWV rte6iwv. H
rtapouoia apJUimJ[US"OT!JV eniJ..poiJO!l tOliOe(loiJI.iffaJ flVel/IJOW.AOil !Z'e&Ol/OUVfl/OPei [La Ul
ouAAo1ri n:Aeupt nKou U")'pou. To ~nap eivaL ouxvti IJ.ll1,\aq>rrt6 oro oe.et6 urrox6vopLO
Kat IJTtopei va urrapxeL 11rtatooq>a")'LtLOLKri nat\tv6p61JI1Gf'l, xapaKtflPLC61J..Vf1 an6
0LUtC1011 1WV O\pa /'L tLOLKWV -tpAe~~v J.1ta an6 OUI..l T!L.011 !OU rin:ato<;. Oi6tJ/ItJ
QV.UpiOK!QL O!OUS 1JV T!PLrtarrp:LKOUS ao&VLS Ota O<pupa OtOUS be 1\t\tvi}peLS
Otr)V Lpti n:epLOXfl. ~ta tet\LKcl OtclOLCl HlS KapOLaKriS avencipKLa<; 1JTtOP.L VQ

5
1J.<pUVLOH.L OUJ!JJICI OVCI odpr.:Clfl KQL 10/<.:1 l"IJ<;
H o-raoLOn:oir,on rns KapowKriS aven:apKeLac; IJ. ~aon-rov npoKaAouiJ,evo ano rn
OUIJ.TI1WIJ.Q10AO/LU n:epLOpLOIJ.O l:fl<; <pUOLKriS 6"pa0111PL01f1tUS XL IJ.E/Ut\11 OfliJ.ClOLQ /La
rnv np6)'vwon t<aL rn &epaneuUKf1 avtt1J.1:WT1LOfl!OU ao&evous (llivaKas 1).

fHvaKas 1. ~ra6LOrwinor, KapotaKriS avenapKetas IJ. ~aon ra KPL r~pta tflS New York
Heart Association.

Karrnopia I : Anouoia nepLOPLO~-tou <puotKris bpaornpt6rrrras.


H ouvr;&r,s <pUOLKrl opaO!flPL01:fl1U o~v npoKaAei rnv j.l<pOVLOf1
OUj.lTttWIJ.cll:WV.
Karrnopia II: MtKp6s nepLOPLOIJ.OS -rns <puotKris bpaorr,pt6trnas
H ouvr;&r,s <pUOLKrl opaOtflPL01f1ta TtPOKaAei rnv 1..l<pclVLOI'J
OUI..lTttWI..lcl1WV.
Kanr)'opi.a III:21'JIJ.OVnKri eAarrwor, rns <puotKriS bpaornpLorntas
MtKporepr, art6 trl ouvri&r, <puotKri bpaOtf1pL6ti'Jta rtPOKaAeL
'ti'JV j.l<pOVLOf"l OUI..lTt!WI..lCt!WV.
Karn7opia IV EIJ<pavtofl <JUI..lrtl:WIJ.cil:wv orr,v f"1P1J.ia

fiPO/'VOOOfl

.2uc; n:ept0001p<; ftPL Tt!WOLS xpoviac; KUPOLaKriS avertapKeta<; f1 OuOAt'tOUP/'LU 1f1S


aptol:epris KOLAias eivaL lll"l avaol:p(JJLIJ.fl Kat n np6JVWOI'J ouoiJ.evns. H ent6iwon
e\aptal:at an6 n1v Bapurf"lta tf"lS urtoKLIJ.Vf"lS v6oou, eKtLIJ.WIJ.evns IJ. KALVLKa,
OLIJ.ObuvaJ.LtKci, appu&J.LtoAo')'tKa, Aenoup')'tKa ri 13tOXf11J.LKa KPnripLa. H IJ.Ovoetns
ent~iwon ons oo~apes neptrtrc.OoeLs (Katrnopia NYHA I II ri IV) avepxerat ae 5CJl/o. 0
&civaros ei-re o<peiAetat oe rtpoobeuttKri entbeivwon tllS KapbtaKriS Aet roup')'ias rrou
KataArireL oe noAuop')'aVLKri aveTtapKeta ei. te enepxeraL aL<pvLoiws.

8epaTteLa

Ot oroxm rr1s &epan:eias rns KapbtaKf"lS aven:apKetas eivat 6uo: a) 11 ~eAriwo11 tllS
n:m6t11ras tllS Cw11s tbu ao&evous. Kat 13) fl napataOf"ltllS erttl3iwof"ls rou. To te-
Aeutaio Katorn OU\!UtO, onws aa OOUIJ. crtn ouvxeLa, j.l tnv lOU/'W/'ri ota aepa-
TIU!LKcl OXrlllU"'CU. !WV U/'')'L00LaoraAtLKWV (ouvOUUOI..lOS ubpaAaCivf"l<;/OLVLtPLKOU
LOOOOP~ltf1) KUL t(LIV avaotot\wv tOU ouorriiJ,atOS pVLVf"lS-O')'{LO"'CQOLVf1<;-aAOOOt-
POVf1S (avaoro,\L<; tOU 1J.1UtpTt1LKOU V{U1J.OU "'CflS QJ'/'L01UOLVflS KQL avaotoAE.LS
twv unoboxewv AT 1 l
A. BaotK5 apxes. H avniJ,etwrtLOI"l tl"lS KapotaKriS avenapKeLas apxiCet ll tflv

6
n:po,\f14Jfl. H &epan:LU TflS unepraOfl), TflS UTtPXOAflOTpO,\aq..LLU) Kat tOU OUKXU-
PWOOU) ota5f1Tfl, f1 OLUTriPf10f1 0 <pUOLOAa/tK6:.rtlrtOa tns aptflptaKriS Ttl0f1), n
arco<pu;ri tau KarcvLOIJ.atas Kat n 6tatriPflOf1 01:0 <pucrtaAO/tK6 -rau Otol..l.anKou l)apaus.
AUTTWVaUV tl) n:t&av61:f1!) VOOf10'f1) art6 Ot<()UVtaia VOOO Kat aptf1plUKf1 Urtp"ta-
<Jfl, tOJV ouvn&eotcpwv onAaor; UL tiwv KUPOtaKriS averrapKeias.
To rrpwto Br11J.a o-rn &eparceunKri avn!J.e!WTtt<Jf11:11S KapotaKris avercapKetas eivat n
Ka-rarraA1..l.f10f1 tau aniou rcou 1:f1V rcpoKaAei. Eav /La rrapciOeL/I..l.U vas ao&evris
TtCLOXL ano KapotaKri avenapKta O<pLA01J.Vf1 0' O'tVWOf1 tllS aopttKriS ~aA6Loas, f1
xetpoup/tKri avnKaTcicrtaof1 ti1S rraoxouoas BaABioas anoteAei tf1V evoe6et ~~v11
&epaneunKri aVUIJ.etcilntcrf1.
~e nepirnwon nou oev aveupioKe-raL to /VOLOUP/6 ai no ( rc.x. t6LOna&r;s ota-ranKri
IJ.UOKapoLOna&eta) ri 6ev eivat 6uvat6v va Katan:oAelln&et (rc.x. rcoAuU//taKri
oTe<pavtaia v6oos Wl erct6ex61.1Vf1 xetpoup)'tKri ~epaneia) r1 exet r1o11 npoKAn&ei
KteTa~Vfl 1-111 avaoTpGJLill1 BAaB11 tou llUOKapoiou (n.x. eK-re-rallvo 1J.cppa/lla tou
IJ.UOKapOLOU ll aveupUOj.LU) 11 &eparteia &a Otf1PLXti 0 /VLKcl jletpa
( U)'tLVaOtaL tf11:LKri U{W/rl, {natrlPI1011 !OU KOArtOKOLALaKOU OU/XPOVLOIJ.aU,
KatartaA!lf1011 KOt,\LUKWV appU~j.lLWV, j.Ll)OALKWV en:etoaoiwv KQL UT!VLKrlS UTtVOLQ))
KQL O'tf1V CLOLK UllVf1 ~UPJ.I.UKUtLKrl Q{W/rl.
B. fevtKci uetpa. H U/tetvo6tattl1tLKrl U/W/rl neptAa!lBavet eAa<ppa otatpo<pfl, anopU/rl ""
UrtepBaAtKrlS XPrl011S at\a!OS KUL aAKo6Anc; KQL T!PLOPLO!lVI1 XPrlOfl IJ.I'l KOPLLKOLOti.lv
avtt<pAenwvoociJv cpapj.LaKwv ( n.x. aontpivn. tvbol..l.e~aKivn KArt(. H ev-ranKfl<puotKrl
cl0Kf10'11 !J.T!Opei Va Tttl)apUVt 1:0 KUKAO<pOpLKO OUOlfll..l.U tOU ao~evouc;, \IW J1
KUVOVtKri KUL OUOtflj.LU!LKrl UP06La QOKflOJl (Ka!a n:pOtLI..l.fl0f1 UTtO tatpLKri
n:apaKoAou&nof1) IJ.rtopei va BeAnc.Ooet tnv an:66oon tou Kapotoa//LaKau
OUOtrlllU!OS KUL va UU~rl0L lflV QVOXrl Otf1V KOTtWOf1.
0el..l.eAtc.06ns /La !fl &epaneia tns KapbtaKris avertapKetas eivat n 6tatr1pnon r1 n
UTtOKUtCL0'1:UOf1 tOU KUVOVLKOU pt\el3oKOI..l.l3LKOU PU~I..l.OU, etOL tOOt va UTtCLPXL
KoArtoKotAtaKos ou/xpovtol..l.6S. Touto l..l.TtOpei. oe optollevec; TtepLTttwoets va anat-
tnaet 1:11v ej.Lcputeuof1 KoArtoKotAtaKou Bnlla'to66tn.
H av-rtlleninnon twv KOLALaKwv appu~llLWV ei.vat buoxepf)c; otnv Kap6taKr1 avercapKeta.
~av /VtK6c; Kavovac; toxuet, 6tt oev an: at tei tat q~apiJ.aKeunKr1 ~epaneia 1:tov
aoul..l.THWJ.LUttKwv KOLAtaKcilv appu~l..l.LWV. Otav Ol..l.WS ot KOt.AtaKc; appu&~iec;
TtpOKaAouv at!J.OOUVUj.LLK<; Otatapaxes KQL arcwAeta tns OUVLOI1011S entl)aAAetaL ,
VOOf1Aia tOU ao&evouc; 0 KapOLOAO/LKrl KALVLKrl Kat 11 Ktt\Of1 r)AKtpO<()UOLOAO-
/LKOU eA7xou. H '\OPrl/flOfl alltw6ap6vfls ri fl tono&-cfl<Jf1 avu-caxuKapcnaKou. ~nlla
to66Tn -ant vtbonn. anoteAouv ouxvil tfl\1 KaAu-cepn Auofl.
H XOPri/11011 avu 1111K HKriS a{W/riS art6 tO Ot6~a /LU tr)\1 ano<pU/Jl 1-lflOALKWV
TtL000LWV, VbcLKVUtaL 0 OO~\ILS 1..1. KapOLOI..l./OAia KaL UrtOOUOTaAnK01:flta Kat
LOtanpws oe c"Lvous nou naoxouv an6 Koi\ntKri I..LUP!laPU/Ji. TAos. /ta tf1V
uvtti..L tc.iJmon IllS a rtoq~paKtLKOV n)nou unvtKJlS cntvota<; (sleep apnea). 11 onoia
1..L1pavtCetat ouxvu otouc; ao~eveis l..l.e KapbtaKri avenapKeta Kat unopeL va
rtpoKai\oet e m6eL vwofl tfl<; Kap6LaKr1S J\ttOUP/i.as. ecpapll6Ce"tat ouvex11s &euKri

7
. .. _._-_,~--'~::... __ _:__ - -~---~---.

I
I
11Le<Jfl Gl:flV PL VL"~ K0t,\6tfl!U.
!
l
r. f>upuuKeUHKrj &eoartelQ. H <j)UPHUKeUHK~ ~epuneiu !fl<) KapOLUK~S QVeTtclPKLUS I
010XeLJeL 0111V eAUttWGI1 ti1S KeVl:PLK~S <pAeBLK~S Ttl011S. 0111V KU!UrtoAeHr1011 HlS
KQ1UKPU!I1011S UOU!OS KUL vu-rpiou. !11V Bet\!iWOI1 !11<) CJUOtOALK~S ALLOUP/LUS HlS
aptotePflS KOLAtas Kat trlv unoKatciatuol1 1:11s uu~f11J.v11s veupoopHOVLKflS
6puotf1pL6t11!U<; . .:1uo-ruxws. Kuvevu uno tu XP11GLI.J.OTtOLOUHevu cplipHUKU oev
eTH l:U/XUVeL UTtO IJ.OVO !OU !11V TtPU/IJ.cll'WOI1 6Awv !WV rtpoava!pep&vttuv O!OXWV KUL
/LU -rov t\610 uur6 unuL -rei tuL 11 XOP~/11011 auvouaOIJ.OU cpupi.J.ci:Kwv.
J.,..A~.Q.l:!.P..f.l.H~... E~uKo,\ou&ouv vu un:01:eAouv rov UKPO/WVLU.LO Ai~o ot11 &epuneia l:flS
KUPOLUK~<) UVeTtUPKeta<;, /LULL TtepLopiCouv 111V KUl'UKpcltl1011 U/PWV KUL eAUHWVOUV
ru OLO~IJ.Ul'a KUL tflV KevtptK~ <PAeBLK~ nieo11. Tu <PclPIJ.UKU uuta uu~avouv tflV
0LOUP11011 OpWV!U<) Gti1V U/K UAI1 l:OU Henle ( !pOUPOOei.J.LOI1. BOUIJ.e!UVLOfl KUL e&aKpUVLKO
o{u ), !0 clTIW 0TteLPUIJ.VO OWhi1VclpLO ( &eLa\iOeS KUL 1J.e10Aa{6Vf1) rl !0 a&pOLG!LKO
OWAflVUpLO ( OTteLpovoAUK 10VI1, UHLAopi.OI1 ).
Tu OlOUPI1tLKa 'ttlS U/KUAtlS aueavouv !11 OtOUPI1011 avao-rAAovta<; tr'lV enavappO!pll<Jfl
l:OU va-rpi.ou !OU xAwpiou KUL tOU KaAi.ou KUL eivaL ta opaOl:LKOl:epa. Ta OLOUPI1LLKU
TtOU opouv 0!0 anw eOTILPUIJ.VO OWhi1VclpLO, exouv IJ.ejaAU1'Pfl OLclPKLa 6pciOI1S
an6 ra OLOUPtltLKa ti1S O/KUAtlS aAAO: eivaL AL'~6te'po anoreAeol.laUKa. T,\os. -ra '
0LOUPI11LKU TtOU opouv ota a&pOLOl'LKcl OWAI1VUpLa ~ewpouvtaL ')'eVLKWS UOUVUIJ.U
6toup11nKO:, aA,\a ae uvti~eo11 1.1. tLS ouo npornouJ.Leves KUl'fl/OPies 6toupl1nKwv.
npoKaAouv KataKpci-rrwl1 KaAiou.
~ns UVertLSUI.ltlte<) opaOLS !WV OLOUP11tLKWV TtepLAal.lBO:vovtaL 11 UTtOKaALaLIJ.LU, 11
UTtOI.lU/VtlOLaLIJ.LU, 11 eVP/OTIOll101') l:OU OUOl'~IJ,UtOS PVLVf1S-U//LOtaOiVI1S-UAOo-
01ep6VtlS, t1 U!pUOU!WGtl KUL 11 n:pove<j)pLK~ a{W~ULIJ.LU .
.~:.. A.JJ.~Qg...g.f.:J..JQ.Q.~.g_gJg.o.J~~J~. T a W<PAI1 an6 11')V eLOa/W/'~ twv U//'Lo6tao-caA tLKwv ot11
Sapaneia -rwv ao~evwv eivaL onJ.LaV1LK0:. l appwarous n.x. 1.1 TtPOXWPI1Hvn
KapbtaK~ avenapKeLa exeL rrapati1Pfl~ei oacp~s aLI.lOOuvai.J.LK~ BeA-riWOI11..1. l:tlV
eVOO<PABLa XOP~/110tl <j)aLv-coAal..l.i. VI1S. Vll'POTIPWOOLKOU KUL Vl'tpO")'AUKepivrp:;. A TtO-
OeiX1t1Ke TtlOflS 6n t1 XPOVLa XOP~/11011 tOU ouvouaOI.J.OU uopaAa{iVI1SI0LVL'tPLKOU
LOooopBi.l:tl 6xt IJ.OVO errL<ppeL aLIJ06uvai.J.LK~ BeAtiwa11, aAAa napateiveL KUL: r11v
e mBiwo11 -rwv rraox6vrwv arr6 KapbtaK~ avenapKeLa. '
~US UVeTtLSUJ,.ll')t<; evp")'elS tWV U/f'eLOOLUOl:aAtLKWV TtpLAaJ.LBCtVOV1UL 11 evep')'O-
TtOi.tlGI1 !OU OUIJ.TIUSflUKOU VUPLKOU OUOl:rlJ.lUl:O<; KaL tOU OUO't~IJ.Ul:O<; peVLVI1S-
U//L01UOi. v11s -uA6oo-rep6v11s .
.~:.J.Y..QJ..P..Q.n;g. Tu tvorportu <PciPJ.lUKu BeAtLti>vouv 111 ouo1oALKrl Aenoup1ia ti1S apL-
otep~s KOL,\ius. Toyro enLtU/XciVel:aL I.J.e ouo 1..1.11XUVLOJ.Lous: a) tl'lv uu{tlOtl rwv TtL-
n6wv rou cAMP o-ra IJ.UOKapoLaKa Ktrnapa, KUL B) 111v avao-roAr1111S avt,\i.as 'VUtpi.ou
KuAiou.
H UU{flOtl !WV ITL 110WV 10U cAMP rrpa)'IJU!OT!Oi taL ei 1 l.lOW QU~f1011S !11S ouv&011S
!OU (KU!XOAUI.ll\'<), V'tOTtai.J.LVI1, 'Y'tOJ,.lrtOU'tai.J.iVI1) Lt 1.1 !llV eAanwon !11S
ano66HI10rlS 1ou un:6 111v <j)wocpooteotepaon (aJ.lptv6vl'), l.lLAptv6vl1. evo{LJ.lOVI'l KArt).
Ilupa 111v uvai.J.<pL0011tfltl161.lWS BeAriwo11111S ouotaAtLKO!tltas tou l.lUOKupbiou 1.1. ta

8
<papiJ.UKa autci, 11 XOPrif'flOrl tOU<; OUV00U1UL an:6 UU~IlOil tllS ~vqt6tflta<;,
m~avorflta A61w au\flOflS HlS ~uoKapOLOKrlS KatavaAwons o~u{'6vou KaL tns
TIPOKA!lOflS IJ.UOKapOLUKrlS LOXULIJ.LQS KUL KOLALUi<tOV appU~IlLtOV. rta tO t\670 auto
XOPI170UV1UL IJ.OVO 0 ao~eveis IJ. oo6apfl KapOLOKrl aven:cipKeta (KU'tfl{'Opia NiHA Ill
r11V) KaL ;w nepwpLOJ.1vo xpovLK6 OL10tllJ.1Q.
H oaKtut\iuQa eivat o Kllpwc; eKn:p6own:os -rwv avaotoAwv tflS avti\ias vatpiou-
KaAiou. Anott\OIJ.a 1f1S 6pciOflS au-ens 10U cpapiJ.CtKOU eivat f1 au\nofl tr.OV TtLTt6wv
l
IOU ao6eori.ou OtLS OU01aAt<; TtPW!LVS tWV IJ.UOKUPOLOKtOV KUttapwv KOL 11 aue11011
tllS ouotaAnK6t111as. EniOfl<;, f1 6at\1uAi1t6a eivat 10 1J.Ova6tK6 cpapiJ.aKo, to oTioi.o,
eK16S an:o tfl Bei\ riwofl"CflS ouotai\uK6tfl"Cac; !flS Kapotac;, e.nt tu{'xave.t tflv Katao"Cot\fl
tOU OU!.m:a~lltLKOU VeUPLKOU OU01rlJ.1010S KQL !fl llLW011 !flS 6pa0111PLOtl')ta<; "COU
ouotr11la-ros pe.vlvfl<;-af'{'eto"Caoivl1s-ai\6oote.p6vns. Eeattlas aunov, xapaKti1Pi{e"Cat
KUL we; ve.upoOpiJ.OVLKOS 1POTtOTtOLf11rlS (neurohormonal modulator). H XOPrl/'11011
6aKtut\in6as e.voeiKvutat oe. 6Aous 1ous ao~e.ve.ic; l.le ouotoAtKri KapotaKri
ave.n:apKeLa, ave.{aptf'l"Ca an:6 10 e.av au-roi otatflpouv cpi\e.BoKOIJ.I3LK6 pu~ll6 n
BpioKov"Cat oe. KOA TILKrl J.LapJ.LaPU/'rl J.le "Caxe.ia KOLi\taKfl av-ratt6KpLOI1.
H 6aKrut\iu6a:, n:apa ta ne.pt tou avtt~tou t\ef'OIJ.eva, e.ivaL aoq:~ai\ec; cpap~aKo, uno
111V npoun6~eOfl 61t ra e.nl n:e.oa tou oto ni\aoJ,la Kuuai vov-tat uetaeu 1-2 ng/ml.
Au~flOil"CWV entneowv tns 6aKtuAitt6ac; IJTtOpei v'a napa-rnpn~ei oe ao~e.ve.ic; IJ.e ,
VeqlptKfi avenapKeta, UTtOKaALaL~ia ri 0 11ALKLW~eva atOJ,lO KOL VQ TtPOKai\eOL tO\LKO
6aKtui\t6tOJ.l6. 0 tei\eutaioc; xapaKt11Pi(etat an6 tnv napouoia appu~j.uot\o{'LKti>v ;!.
l'
Otatapaxwv (ouvfl~WS lHatapaxec; tf'\S KOi\TtOKOLi\LaKflS Q{'W')'LIJOtfl!US OUVOOUOJ.lVe<;
i~
an6 KOi\ TttK,<; K0~6tKS rl KOLALaK<; OUOtoi\<;) KQL avtLJ,1tWTtL\tQL ll XOPll?'flOfl :.,.
~i
Kat\iou-;' \ui\oKaiv11s ri cpatvuvtoivns Kat eav napaotei avci/Kf'llle tnv tono~t-cnon I
npoowpLVou 13nllato66-cn. Enions. exouv XPflOL!lOTtotn~ei ll eTtL tuxia noi\uKAwvtKa .~
av"Ctowuata e.vavtiov tns oaKtui\i ttoas, ta orcoia eTtL tu?'xilvouv taxeia e\oubetepwon J
!
!OU <papJ,lClKOU .
.4.:.. A.Y.gQ.J.9..~.1.s...9..~.9..IoggJQ.S..P...Y.~.Y.I1S..:-..~.1.1..~.9.lgQ.~.Y..n.S.:.Q;~Q.9.9"l.Q.QY.!lS. ~ tnv Katn ')'Opi a aUt rl
avr1Kouv ot avao1oi\eis tou. J.LetatpeTttLKOU ev<:uJ.Lou tns a')'?'Lotaoivns (avaotoAeic;
tou MEA) Kat ot n:p6ocpata etoax~evtes avaotoi\eis toov unoooxewv tns
a['{'LO"CUOLVI1S (avaotoi\eiS tOOV UTtOOOXfOOV AT1). .
Ot avao1oi\eis tou MEA (Katttorcpii\11, e.vai\anpii\n, oti\aCarcpiAn. tteptv6onpi.AI1.
ALot von piAn KA n:) e.unooi<:ouv 1r1v lletatponn tns U//eLotaoivns I oe a')'')'etotaoi vn
I I. H 1ei\e. utaia e.i vat uia an6 ns toxup6tepes a')'')'etoouon:aottKes ouoiec; tou
OP/aVLOIJ.OU Kal 11 avaoto,\fl ti1S OUV~0llS tllS TtPOKUAL aptf1pLUKrl KaL tpt\e6LKll
U//Lo6wo-cot\r1. avao=rot\ri tns KKPLOI1S ai\6oo-ce.p6vns Kat ei\at-cwon -ens
opaO"Cflpt'6!f1"CUS tOU OUJ,lTta~rrtlKOU VupLKOU OUO"CrillatO<;. A n6ppOLa tWV WS avw
eu~e.vwv 6piloewv twv <papj.HlKWV auttiN eivat n Bei\tiooon twv ULilOOuvaJ,lLKWV
rt:apa1J.rpwv KaL rns KAtvtKris eLK6vac;, n Be.Atiooon tllS nm6tntas Coons Kat 11
napatao11 !llS e nLBtwons 1wv ao~evwv ~e Kap6LaKft ave.n:apKeLa.
Ot avao1ot\eic; 1:ou MEA e.ivat ao<PaAn cpap~aKa J.l i\i')'ec; nape.vepf'eL<;,, o"CL<; onoie.s
nepLt\aiJBLivovtaL 11 un6-caon, 6tav XOPil?'Ouv-cat /'La npwtn cpopa oe ao~eveic; ~e

9
U<pUOCHWOI1. 11 T1LOLVW011 rtpoun:apxouoas V<ppLK~S ouoAeL!OUP)'LOS (0\1 rrpTtl va
XOPfl)'OUV'tOL 0 ao~VLS IJ. KP01LVLVI1 n:AfiOIJ.O'tOS> 3mgjdl) KQL 11 1J.tpUVLOI1 ~f1POU
~~XQ rt:OU KO~LO'tcl a6uva!l1 !rJV ~aKOAOU~1'10rJ !f1S ~epartLOS 010 5-10% tlOV
ao~evwv.
Ot avaocoAeis rwv urtoooxewv AT 1 (Aooapravl1. ~aAoaprav11. tpl3eoaprav11 KAn)
<pai V1aL va exouv nap61J,Ota opaon Kat napevp')'LS IJ. !OUS avaoroAeis tou MEA
IJ. 1f1 ow<popci 6u oev npoKaAouv ~~xa. IIpos to rcap6v XOPI1/0uvrat oe ao~eveis ll
KapOLaKri averccipKeta rtou ava')'Kci{ov"taL va 6taK6q_~ouv tnv ~epan:eia l..l avaoroAeis
lOU MEA A6')'W !rJS 1J.<pUVLOI1S e~xa .
.Q.,.. A..Y..gQ:J:9.0.~.S.. ~.::-..g.Q.Q...Y..~..P..I.~.!c;..W.Y. ...!./.TI.QQ.QX.W..Y. H XOPrl/110rJ nov q>UPIJ.UKtoV 1r1S
Ka'tr)')'Opias aurris (1J.10rt:poA6AI1. l30UKLVOOA6AI1, Kap~eOLA6AI1 KArt) ev6eiK\IUV1aL oe
ao~evei.s l..l LOLOrta~~ OLa'tauK~ IJ.UOKap6LOrta~eLa ~ IJ.t1l<PPU/'I..l01LK~ KapotaK~
ave n:cipKLQ, OL OrtOLOL exouv rtPOI1')'0UI..lVWS 01a~eportOlr)~L l..l OaK'tuAi 1LOa,
6toupf')uKa Kat avaotoAels 1ou IJ.1atpern:tKou ev{u1J.OU. H xoP~/'f10f1 l3-avaotoAewv
oe en:tAe')'l..lvous ao~eveis l.l Kap6taKt1 aven:apKeLa ~a nprteL va ')'iveraL an6
~L0LKUIJ.VO KapoLOA6')'0, A6')'W 1f1S apV111LK~S LV6tpOTti1S opaons tWV cpapj.lUKWV
.
au1wv, rtOU l..lTtOpei va TtPOKaAeoeL TUOLVWOf1 1r1S OUOtOALKriS Ael10Up')'ia<; tflS
apLotepns KotAi.as Kala .. rnv evap~111ns ~epaneias.
!1. eeparteU1LK0 otpatQ1LK0. 01. ~epartU1LKOL XLPLOIJ.Oi eeap'tc.OvtaL an6 10 eav
n:poeeapxet auaroAtKri ri 6taatoAtKr1 KapotaKri avencipKeta.
J.:J.hl.9..J.9..~1!S.Q...JS.9;.QQ.~.g.JS.!i..g:Y..TI.gP.J$...H~ H <Pap l..l aK e u11 Kr1 ~ eparte ia ap xi CeL ll e Ul
XPI10LI..lOTIOLI10I1 evos avao1oAea tou MEA ( nx. KantonpiAn 12.5-25 mg x 2-3 <popes
f11..lPI10iws PO r1 evaAartpiAI1 5-20 mg X 1-2 <popes 111lPI10iws PO) Kat evos OLOUP111LKou
(n.x. cpoupooel.liOI140mgX 1-2 cpopes f11lPI10iws PO). H oaKtuAi1LOa (OL/oeivl1 0.125{).5
mg Ilia <popa 111lPI10LWS PO) X0Pf1/L 'taL ouvn~ws 0 ao~eveis ll oo6apri KOPOLQKrl
!
avencipKeLa (Ka'tn/opia NYHA I I I r1 N) av KaL np6ocpa1es l..leAetes ebeLeav 6tL I
lr
l..lTiopei. va eivat anoteAeo!la'tLKrl Kat oe Kati1')'0pia NYHA I I. Eav, napa "Crl\1 a')'W/rl. 11 ~~
K01UOtaOI1 lOU ao~eVOUS Oev eA')'XtaL XOPI1/0UVtaL evoocpAe~i.WS VtOTta~Vfl rl
n
vto!lnou'taiJ.iVI1 ~ avaotoAeis ti1S cpwo<pooteotepliol1s KaL ouvbuao!loi ro(Hwv (n.x.
VlOT"Cal..li. \111+\ltOil n:outaj.lL Vl1 ri VtOI..lltOUtal..li VI1+JJ.Lt\pLVOVI1 ). ~ OPLOIJ.VOUS aq~evei S ~a
anaL !f1~i 11 !OTt0~1f1011 evooaop'tLKrlS av1Aias ri OUOKUOOV KOLALUKrlS UTttrlPLens ri
11 T"C1J.~a1LKrl UV1LI..l1001tLOf1 (Tt.X. KapOLOj.lUOTIAaotLKri ri KapOLUKrl1.1tOI..l0oXUOI1) .
.~:..A~.!J.QJQ~tJS.!i..!SJJ.P..Qtg.!S.Q...gY.JJ.g.P..!S..tg. !lev urcapxouv tKI..li1PLWIJ.vec; l.lAe1S )'La ti1V
av!LI..l1WrtLOI1 "CI1S {naotOALKrlS KapotaK~S avenapKLa<;. 0 eA/XOS !f1S aptf1pLaK~S
unpraOI1S KUL !rJS l.l~OKap6LaKr1S LOXaLI..lias. 1WV ouo Or)A. ouxvotepwv aLtLWV,
~eAnwvet 111 6taotpALK~ Aenoup')'ia rns Kapouis. EuiJevns cpaivetat va eivaL Kat 11
Opaor) 1WV avaotoAewv tOU MEA ws KUL 1WV e-avaotoAewv. H TtpOOK!LKrl OLOUPrJOrJ,
l.lllOpei va eAat"tlUOL 111\1 tet\ooLaOtOALKrl rtL011111S apLOtPrlS KOLAiac; KUL 111\1
n:veul..lOVLKri OUI..l<p6pnol1. H xopri/110fl Lv61ponwv KaL a')'')'LOOLaotaAnKwv oe
vopiJ.otaotKous ao&evei.s l..l 6Lao1oALKrl KapotaKr1 avenapKeLa, 6ev ouvtotataL.

10
0{ta KapbtaKri avTtdOKta

H ouvr,~e01Pil KlL f[,\ov OPl1Jl1LK~ KO~AWOJl oceias Kap6taK~S avenapKLQS ei vat


to ocu nveuiJOVLKO oiOf'liJU. Ta ouxvo-repa aL na eivaL 11 apti1PlllKri unptaon, 11
~-tuoKapotaKri LOxaqJ.ia, to ~-t<ppa)'IJ.ll ~JUOKapoiou, 11 BaABu)tKri Kap6torta~eut (o1evwon
~ aven:apt<eta tns IlL -rpoet6ous, o1vwon ~ aven:apKeta -ens aopr~s) Kat m 6ta'tapaxs
tou pui11.1ou ( taxuappu~llies ri Bpa6uappui11.1ies)
A. ITai1opuowAo2ia. O<peiAe'taL oe o(eia ouo1oALKrl r1 6taotoAtKri 6uoAet roup(ia LrlS
apL01PrlS KOLAias. 11 OTtoia TtPOKaAei IJ.)'cit\r1 QUC110!1 tllS uopoota'tlKrlS Ttl011S "CWV
rtVUIJOVLKtiJ~ tptxoetotiJv. Otav 11 "CLI.l~ tns teAeutaias. n anoia eivat u11eu~uvn /La
!llV IJ"CQKlVr]011 "COU VPOU OTtO tOV \IOOKU't'tclplO rtpo<; t0\1 eetoKUttclPLO XWPO UTtp-
Bei to a~pOLOIJ,a !11S ev6oa;')'LllKrlS KoAAOLOOOIJOJ1LKriS TtL01")<; KQL 111S u6po-o-ran-
KriS Ttl011<; lOU VOlcliJ00U lO'tOU, TtOU OU/KPll'tOU\1 tO \lp6 010\1 VOOa/(LaK6 XW-
po, TtPOKaA~LtaL aPXLKU 6ti6pwor, U/'POU 010\1 VOLOIJ.00 LOt6 tOU TtVUiJ.OVa ( VOLci-
iJ.00 n:veugovtK6 oi6niJ.a) Kat otn ouvexeta 01LS nveuiJOVLKes KUttJeAioes (KUtiJAt-
6tK6 nvUIJOVLK6 oiom.La). A no1:AeoJJ.a trlS na~oAo;tKris autns 6tep)'aolas ei vat 11
an61oun 1J.IPOVLOI1 oo6apns 6uonvmas otpeLA6JJ.evns oe 6tatapaxri 1:11s otaxuons toov
aepiwv, 11 Acl1:1WOI1 ti1S 6tataOLIJCHI'11:as ttiJ\1 Tt\IUIJOVW\I Kal 11 aU~flOf'l l:OU ep)'OU !J1S
avanvons.
B. KAL VLKci e upOuata E;Ka~iotav-rat Kat e~eAiooovtaL IJ. raxurnta. 1uv~~ll OUI.!Tt1W-
ua1a eivat n 6uonvota, 11 e<pi6pwof'1, to a;xos KaL n avnouxia. 11nv avnKeq.levLK~
Ce1a011 6taTtLCJtwvovtaL KVtPLKri Kutivwon, U/POi PO/XOL CJ l1J.tj)Otpa ta TtV UIJ.O-
VLKcl ne6ia, napataon tns eKnvor;s Kat et<nveuottt<6s oupt;J..L6s. iuxvri eivat n aveu-
peol1 a<ppwowv po6oxp6wv ntuAwv, .
r. Ep7U010QLO:Kct eupOuata. l/cK'(p01(t1pt5to}'ptitp!J/.111 1),\eBOKOJ.ll3LK~ 'tUXUKap6ia.
Eup~JJ.ata avaAo;a 1.1e tnv unoKeiJ,.levn vooo ( n.x. uneptpotpia tns apLo!ept;s KOLAias
oe ao~evri IJ. otvwon !11S aoptr1s ti avtionaon tau ST oe ao~evn IJ o~u J..Lcppa)'IJ.a
tau. iJ.UOKapoiou). Taxuappu~JJies ~ 6paouappu~1.1ies. :
AATtvo)'parpia ,9riipal...-a To o~u n:veuJJ.OVLK6 oiorwa ava)'vwpiCetaL an6 thv a-&pmo11
tOU U/POU tOU OLO~J,latos OtLS nuAes KQL 1LS nepLTtUAaies TtPLOXS tlO'V T1:VUJ,.lOVWV,
oL orcoies 6i6ouv tnv evtunwon "<ptepwv vuxtepioas". To !l/e-&os tr1S Kapou1s
l..lrtopeL va eivaL <puotoAo7LK6 ri au~n~vo. 1uxva napatnpeital ouAAO/rl rtAeupLLLKOU
u)'pou ( oe{Lci r1 aiJ.<poi:ep6nAe upn ). Ta aKtt voAO/LK1 eup~l.lata ouvr;~ws 1.11J)aviCov"taL
IJ.ta rnv e;Kataoraon twv KALVLKwv eK6nAwoewv KaL 11 aKnvoAO/LK~ ~eAtlwa11 1LS
n:eptoo6tepes <popes aKoAouelei tnv KALVLKrl 6eAtiwon.
6.. 0epartela. 1. @eO'IJ O'aiptJl'O~ 0 0:0~.\lrlS t0TtOi1ti taL iJ. 'ti1V rtAcitll t!Jf'1,\a ( KO~LO'tOS
11 can,\oJJ,lVo<; 1.1 IJU(L,\apLa). TQUtO !3eA 1LU)Vl "Cil\1 Tt\IUIJ.OVLK~ t\l"COUP/l0: KUL rtpo-
KaAd tnv Ai1J.vavo11 rou ai~..tatos otLS nept<peplKS IPABes.
2. O(u )'Ova Xoprpet raL 1.1 IJOOKa r1 pt VLK6 KaSe"Cnpa.

11
3. &e!IAlj popf!JiVIJ Xoprnouvtat 3-5 mg l)pa6ews ev6oq>Ae0lws. To <pap~aKo n:poKa-
,\d:a) OVOKOU<plOfl !OU ao~VOUS an:6 to U')'XOS, l))<pA0tK~ O/')'L00LaotoA~ Kat eAU't-
tWOfl tOU rtpo<poptLOU KOt I) eAat'tWOfl !OU UTIPOpLO~OU hO/W Uj.10r1S KCltCIO!OA~c;
tou avanveuonKou Kvtpou.
4. r/'oupooepiOIJ. fL vaL OLOUPf11'LK6 1'rlS Q(K uArts. 1:0 ortolo K1'0S an:6 vtovn OLOUPflOil
n:poKaAei <pAe0tK~ O//etobtao'toA~ Kat eAa1'1'won tou rtpo<pop'tiou. Xoprnouv'tat 4Q. so
mg taxwc; ev6oq>Ael)iws Kat eav 6ev n:apatrtpn.:)ei v1ovn 6LOupnon lloa oe 15-30
Aen'ta n 66on 6t n:Aaota\e"Cat.
5.Apt VOf/'tJ.,f-/iv;; tLVOL XPrlOLiln O'tLS TIpt Tt!OOOLS IJ ~PO/XOOTiaOilO TtOU OeV UTIOXW-
pei j.l !l'lV AflW!l tWV n:poava<pep~vtwv IJEtpwv. APXLKcl XOP!l/'OUVtat 6 mg/kg llEOa
oe 20 Aen:ta Kat otn ouvexeta 0.2.0.5 mQ/kg/wpa IJ ouvexr1 ev6o<pA~ta )'xuort. To
<pUPilClKO j.1Tt0pL va rtpoKaAoet appU~I.liec;, vau1ia Kat j.1El:OUS.
6 .dtaCTm,f!j'va'CTIJ ;:at PIJ..t'tlVtK!j tJllOCTrrjpt(!J T!Jf avaavotjs: EcpapiJO{ov'tat otav ouv u-
n:apxouv un:o\ati.J,La, un:epKartvia Kat avartveuonK~ o~won.
7. M rpo}'AI.IKeptvtJ flpoKaAel <pAe~LKrl Kat oe 1.1'/'ciAes 66oets aptr,ptaKri a)')'t06ta-
O'toAr1 Kat n npooeKttKr1 xoprnnon 1ns l.lrtopei va evtoxuoet tfl 6paon trts cpoupooe-
lli6ns. H boon eLvat apX!.Kci lltKPr1 (5-10 l.l9/Aertt6 oe ouvexr1 evoo<pA6ta 7xuo11) ~
ott 1:0 <J'clPI..lUKO llTtOpei VCl TtPOKaAOeL UTtOl:ClOf') KCIL 01n OUVEXeLa au~ciVtaL npoo-
0U!lKQ (J.Lef'LOU1 boon 400 l.l9/Aert1:6). EvoeiKvu'tat o1:ts rteptntwoets, onou to o~u
Kap6tO)'eVS TtV Ul..lOVLKO oiOrll.la O<piA1:aL 0 LOXaLj.lLQ ~ E1.1<9PCl'/'llCl tOU llUOKap6iou r1
O aptf1pLaKr1 uneptaon. AvteVOeiKvutat 6tav un:apxet un6taof1 (ouotoAtKri aptfl-
ptaKr1 rtLOfl <1 00 mmHg).
8. M Tf)Ollf)fuCTCTtKO vdrptaiTpoKaAei cpAe6LKrl KQL aptflpLOKrl a//tOOtaotoAri KOL eLVOL
LOtai tepa XPrlOL~O otnv avtLIJ.etWTtLOn tOU Oq>eLAOI.leVOU Oe ap!flptaKri Urteptaon ri
6aA6tOtKrl avertcipKLa (aveTtUPKeta tnS l.ll tpOeLOOUS rl tflS aoptf)S) O~eos TIVeUilOVL-
KOU OLOrlJ.latoc;. H opliOil 'tOU <papJ.lciKOU eLVQL rtpaKtLKa aKaptala KOL , 00011 'avepxetaL
oe 0.1-8.0 l.l9/kg/Aertt6 oe ouvexn ev6ocpA6ta ')'xuon. Mnopei va n:poKdAeoet oo-
l)apfl urt6taon Km we; eK toutou anaL tel taL Kat a tnv xoPri'l'nOfl tou o ouv~xns Ae7-
xos -rns aptnptaK~S rtieons Kata npotillllOfl oe l.l.Ovaoa evtattKr1S ~epanelac;. H na-
pa'tetallevn XOPrl'/'flOil j.1)'aAwv OOOeWV OUV00Ue!aL arto ClU~flllEVO KLVOUVO Oflt\f')tf')-
PLOOf'lS lle KUOVLOLCl, ta ortoia rtpoepxovtaL ClTtO 'tf') OUVEVWOil !OU Vt tponpWOOLKOU
vatpiou ll tnv o\uatllOOtpatpi vn. AvteVOeiKvutaL 6tav uTtapxet unb:raon (oooto\tKri
aptf1PlOKrl nl011 ( 100 mmHg).
9. NropllOtJTtijii V!J. Ei VOL OUV~etLKf) KUtXOt\aj.li \Ill 1.1 LOXUPri ~tLKrl LVOtp6n:o OpUOf'l.
llL')'LPl !OUS l)1 KaL At 70tpO tOU<; 62 Kat tOU<; a1 aopevep)'LKOUS urto6oxeiS. H
6paOf1 tnc; ota a')'')'ia LVOL KUPLWS U//LOOLUO!ClAtLKf). Xoprl)'eitaL (apXLKU 0.5
llg/kg/Artt6 1\0L Otf'l OUVEXeLa 2-20 1.1.9/kg/t\erttO 0 OUVeXri eVOOq>A6ta E/XUO!l) one;
nept rttwoetc; 6nou to o\u i<ap6t<t'7evc; TtVeUIJ.OVtK6 oionlla o<peL\e"Cat oe ouotoAtKii
ouoAet "'COUP/'LO tflS upt01P~S KOLAias OUV00U01lVfl an:6 TttWOfl "'C!lS apl:flptaKriS

12
_,_ --. ':_ _-_., ,-~--~

rt:LcOilS. Mrtopci va rtpoKaAoeL -raxuKap6ia KaL appu~IJ.L<;.


H Nrorro;.liv!J Ei vaL KarexoAa~-ti Vll ( rrpo6pollLKri IJ.OP<Pri !llS vope m ve<ppi VflS Kat -r 11 s
TtLV<ppLVf1<;), TtOU 0L/LpL !OU<; a1, ~1 K.~ll ~2 a6pVP/LKOUS UTtOOOXci<; KQ~o)<;
TtLOI1S !OUS DA1 6oTtaiJ.LVP/LKOU<; urto6oxei<;. 2e Xallll~S 000LS ( 1-J IJ.Q/kQ/ATt!6
oe ouvexri cv6o<PABLa /XUOil) npoKaAei au~11011 IllS pons rou ai~-ta-ros ota vc<ppa Kat
0!0 1J.0VtpLO, 0 IJ.!pLS OOOLS (3-10 IJ.Q/kg/~Tt!O 0 OUVXrl VOO!p~BLa /XUOil)
n:'poKdAci llU~IlOil tllS Kap6taKf)<; OU)(VO!Iltac;, !llS ouon:aotLKOtll!a<; KaL !llS Kap6taKriS
n:apoxns Kat oc uw11As 66ocLS (>10 llQ/kQ/ Acn:-r6 oe ouvcxr1 ev6ocpABta /xuoll)
aue11011 !WV TIpl<pPlKWV Kal tWV TIVUIJ.OVLKWV aV!LO!clOWV, !QXUKapOia KQl appu~
IJ.l<;. Xpnot~-ton:oei rat {La -rnv cvioxuon -rns 6LOuprwns (xa~-tnAes 66oets) Kat /La -rnv
aU{flOfl !flS OUO!aA tLKO!fl!a<; !fl<; apLO!PrlS KOLAia<; ( ~-ttpl<; KaL 0 OPLOIJ.VS <pop<;
uwnAes 66ocLS) Kat -rns ap-rnptaKils nicons ons ncpL n-rwoeLc; n:ou to o~u Kap6to{evs
n:vcuiJ.OVLKO 'oi.6n~-ta ocpci.Ac-rat oc un6taon .

13

I
. I

S.APTHPIAKH 1TIEPTA~H il
jlI
flepi nou 2.000.000 EAAnves naoxouv art6aptflpLaKr1 urtptaof'l, opt\61lWl
OUil<PWVa ll us Kate u&uvtriptes /PallllS !Ou Ila)KOOIJ.LOU Op)aVLOilOU Y1eias ws
ouotoALKrl ap!f1ptaKr1 rtieon > 140 mmHg Kat/ri OLaO!OALKrl aptflptaKfl rtteon > 90
I
mmHg. O!aV 'ta ai tLa "CflS auef'liJ,vns ap!flpLaKriS Tti.Of'1S ei vat U/VWOl:a, ,
Kataotaon xapaK!flpi{ei:aL WS ''LOLOTta&fls" , VW 6tav fl auenon "CflS aptflpLUKrlS
TtL0flS Otpi.AetaL 0 OU)KKPLilVa ai. !La 11 rta&r')Ofl xapaK !flpiC!aL WS
"oeutepona&flc;".
H ~apU!fl!a !flS ap!flptaKflc; urtp!aons (t6Lorta&ous noeu!epona&ouc;) eivat
avaAO/fl !flS ouo!oAtKrlS r1 !flS 6taotoALKf)s ap!flptaKf)c; nieons. ll 5aon us
onoies )ive"tat n o"taotortoi.non tns na~rwns (IHvaKac; 1 ).

IH vaK ac; 1. Bapu1nta aptflpLaKriS unptaons oe atoll a llALKias avw rwv 18 etwv

~UOtOALKri Ttl0fl 6-taO'tOALKrl Ttl0fl


(mmHg] (mmHg]
"'
loaVLKO <120 <80

. ~UOLOt\O)LKO <130 <85 ;~. 1


<~ J

OptaK6 130-139 85-89


I~
'
Ynptaon
-~ta6to 1 140-159 90-99
-~raoto 2 160-179 10Q-109
-~raoto 3 180-209 110- ;119
-~taOLO 4 >210 >120
!

H aprnptaKri Ttl0fl rtp TtL VQ ll!pataL Kata TtPO'tLIJ'10fl IJ uopap;upLKO


O<j)U)IJOj.lQVOJ.LtpO KQL IJ. 'tOV ao&evi) eanAWilVO f) KQ~LO'tO IJ tO XPL
UTtOOtflPLCOilVO O'tO lHPOS tflS KapOLUS. H XPfl0LilOTtOLOUilVfl TtPLXLpi.6a
nprtet va exet tKav6 IJf!Koc; wote va rtept6aAAetaL o Bpaxt6vac;. Otav to llrlKOS
tr,c; eivat IJ.LKPO f) o aC1~Vi)S" naxuoapKOS OL IJ1PriOLS LVQL $t10WS U<P!lAc;.

1
- ---~-
-,,'
--- - .__, :.- -- ~-

Kara 111 6tapKe.ta 1:ou ru.ttwpou n:ou npOI1)'L "taL ti1S l.l1PI10I1S an:a;-ope. u1:at to
<pa')'I1T6. 1o Kan:vto~.ta Kat o Ka<pes. ITptvan:o 111v ~.ttP110I11:11S ap"tnptaK~S nie.ons
o ao~e.v~s npn:e.L va avartau~e.i ;-La 5 Ae.rttti. H 6taotoALK~ nie.on avttotmxei
o-cnv <pcio11 5 (e.ea<pcivLOill:WV ~xwv -rou Korotkow) KaL OXL 0111 <pao11 4 (e.cao~VI10I1
ev-caOflS TWV rixwv l:OU Korotkow). ITe.pL006te.pe.s art6 l.lia J.l1P~OLS Ttprte.L va
;i vouv oe. 6taotnl.la e.v6s e.ws n:evte. Ae.rtrwv Kat o un:oAo)t(6J,1e.vos ~.teoos 6pos
Aa~.t~cive.l:at ws 11 ap1nptaKr1 rcieo11 tou ao~evous ;-ta til ou;-KE.KPLI.lVI1 e.nioKe.-
!,JJ11 . .le. ao~e.ve.is 1.1 l.lLKPrl au{11011 ti1S apti1PLaKr1S nie.o11s anaL te.i taL en:t~e.Bai
WOI1 "COU e.up~J.lU!OS 0 -couAciXLO!OV ouo TILOKqJL). Tou-co oe.v e.ivaL artapai-
'tlltO oe. e.Ke.i vous 1.1 J.l)'etAI1 au{11011 -ens ap-cqptaKr1S n:ie.ons.

I btona3r1 s un praon

ITapa1:11PE.i -cat a-co SS-90'/o tc.ov une.ptaOLKWV. Onws ~011 npoava<pp-&f1K, ta ai ua


LVUL Ct')'VW01a KUL 11 n:a-&11011 anooibe.taL Oti1V aAA11ATtiopa011 )'V!LKWV Kat
rce.ptBaAAovttKwv napa;-6vtwv . .lm.J.aVtLK6 pqJ..o J.lE.ta~u twv te.J..e.utaiwv
6ta6pa~.tati(ouv 11 noo6tnta -cou npooAa~.t6av61Je.vou aAa-cLOu, to au~fll.lvo
ow~.tattK6 Bapos Kat n wuxtKr1 vtao11.
A. ITa-&opuotoAo""Yia. H aprnptaKr1 nie.o11 e.ivaL avaA0711 rns Kap6LaKr1S n:apoxns Kat
ti1S ouo-c11~.tatLKrlS apti1PLaKr1s avtioraons. Auc11on ti1S KapotaKr1S n:apoxns
l.lrtope.i va napa!I1Pn-&e.i a-ca apxLKCt otaoLa ti1S na-&no11s. e.vti> otnv nAe.LOqJf1<pia
rwv ne.pt rctwoe.wv /Kate.otnl.levns aptf1ptaKr1c; unpraons o Kuptos evoxos
e.i vaL n au\111.1vn aptf1pLaKr1 avtiotaon. To urn ocpe.iAe.taL oe. auenon tou
ap-cnptaKou t6vou, naxuvon tou aptflpLaKou tOLXWI.latoc; r1 a~.t<potepwv. Av Kat oL
une.u-&UVOL l.lllXUVLOIJOL TtOU l.lta6aAAouv tllV KLVf1tLKOtflta KUL til OOJ.lrl tOU
aptflpLaKOU TOLXWI.lUtOS Otf1V aptf1pLaKr1 unptaon oe.v exouv anooacpf1VL0ti
nA~pws. ot en:LKparouoe.c; an6q,e.Lc; unoornpiCouv ta e.cns: a) Auenon -ens
bpaOtllPLOtrttaS tOU l.l!atpTt!LKOU V{UI.l0U !f1S Q)')'LOtaoi VI1S OtO aptflPLUKO
tOLXWI.lU 1.1 anotA01Ja aucnon !fl<; OUV~0flS Q//LOtaoi vns I I. ouoias 1.1
evrovn Q)')'LOOUOTtaOtLKrl KaL l.lLlO/OVO opaon. B) EAattc.oon 'ti1S ve.<ppLKrlS
an:KKPLOflS varpiou J.l anorAeo1.1a trlV KataKpatnon vepou Kat aAanou. 11
Ortoia TIPOKa,\ei UU{f10r} lf1S KapOLQKrlS rtapOXrlS KQL au-coppU~I.lLOtLKrl
a/)'E.Loouortaon. H teAeutaia avantuoo6J.lVfl 1.1 oKon:6 rnv ano<pu7r1
Urt:p1JlPI1S U~{nons tllS LOtLKrlS UL!.I.tl!WOf1S, TtpOKaAei aUCI1011 tOU l.lta<pop-ciou
Tf1<; apLOtPI1S KOLAia<; KaL W<; K !OUtOU TttlVOOO tllS KapOLUKrlS TtapOXrlS Ota
<puotoAo)'LKa e.nin:e.oa KaL 7) AvaoroAn rns Aettoup;-iac; rns KunapLKrlS avrAias
Vatpiou arto VOO/Vrl OUal.lrtaiVJ1, OUVtL~1.lVr} OtOV <pt\OL6 tWV TtLVqlpLOLWV
A67w aD\llOllS rou KuKAo<popouvros 6;-Kou ai~.tatos. H avaotoAn ti1S e.v A67w
uvtAiac; n:po"uAe.L tnv evooKuttapta ouoowpe.uon varpiou, 1:0 onoio

2
' . . ___ ___
;-~-:.: -- ---

avtaAAclOOetaL OTJ1 ouvexeta 1.1 aoeeotLO OtLS Aeies l.lULK<; Lves rou apH'}PLUKOU
TOLX(OI.lUTOS. H au~non T!lS eVOOK UTTilptas OU')'KVtpwons aoBeotLOU one; t\L~)
I.I.UtKes i ves rwv aprnptoiv exet ws anorAeo!la n1v au<non rns tKav6tr]tas rous
/LU OUOTtUOCl.
B. KAt vtKa ~ upOuata. H ave rti rtAeKtll unepraon ouvr;~ws 6ta6pci1J.eL aoUIJTt'tWIJa-
tlKfl. OplOI.lVOl ao~Veis rtapan:ovouvtaL /LU Ke<pa;\ai\;la (L6iws 1:0 Ttpwi. Kat IJ
1:0 nepnatrwa) Kat ava<pepouv entota~ets. H J.l<pilvton ouunl:WI.lcnwv Kat
orweiwv ouvi]~ws ocpeiAetaL ott<; npoKaAOU1JeVS an6 tnv nil~rlOrt em nAoKs, ot
. on:oies o<peii\ovtat ei te otnv IJUKpoxp6vta au<non rns aprnptaKris nieons
( UTtptaOLKS) l t OtJ1V eiJ<pCLVLO!l U~ClPOOKArlPUVOf1S tc.OV apU]pu:iJV (ouvn~WS
!r]S UOPl:rlS. TWV Ote<pUVLQLWV, !WV Ve<ppLKWV, tWV ejK<paALKWV KUL TWV aptrlPLC.iN
!WV Katw aKpwv) (IHvaKaS 2).

IH vaK ac; 2. Ern nAoKec; aptr)pLaKi]s untaons

TrteptaotKec;
- KaKor1~ns unpraon ( unp1aon l.l e upfliJata
. an6 l:OV e u~6 otaoiou I I I r1 N)
- E;Ke<PaAona~eta
.- E/'Keq>aALKrl aLIJOppa')'la
- Yrteptpo<pia aptotepns KmAias
- ~UIJ<POP!ltLKri KapotaKri avenapKeta
- Ne<ppLKrl avenapKeLa
- LlLaXWPLOIJOS aop"triS
A ~npooKAflp uvnKes
- E')'Ke<paALKrl ~p6J.L6won
- EIJ<ppan.ta J..lUOKapolou
- Xp6vta otecpavtai.a v6oos
- LltaAei nouoa xw'A6tnta :I
!
i

Erot, n otn~a;xn otpeiAetaL oe a~npooKAi]puvorJ"tc.ov o"te<J)avtaiwv aprr,ptwv, 11


6uonvma oe 6tao"toALKrl r1 ouo1oAtKri Kap6taKri avertcipKeta, ot 6ta"Capaxes rns
6paonc:; 0 CL0pWJ,.lata rl alJ,.lOppaji.S OtOV aJ,.l<pL6A!lO!POLOrl KaL 'ta /Ke<paAtKti
eneto66ta oe. a~npooKAi]puvon ri ilJ,Leon BAaBn twv /'K<paALKwv ap-rf1ptwv.
~'tClV KALVLKrl ~ta011 OLUTtL010JVtUL au{rl<Jfl 'tflS aptflPLUKriS Ttl0rJS, TtOPKl:OTtLOfl
n:po<; 'ta apwtepa TllS KapOLUKriS WOflS, ttaptOS KUPOLUKOS tOVOS Kat aU{f1011 HIS
aopTLKrlS OUVLOTWOUS tOU 6~UtpOU KUpOtaKOU tOVOU. ~tllV eO!La aKpOUO!lS TflS
UOP'trlS UTtOpeL va UKOUO'tt OUOtOAlKO q:IUOf'\IJQ Oq:ILAOJ,1VO O'tfl\' unep6uva~HK!l
eCtiJ~r10n "COU aLI.lO'tOS art6 tO UTteptpO<fllKO J,lUOKClPOLO ri 0LU010ALK6 <pUOrtJ,l.a AO/(Ll

3
. I

I
I
avenapKetas -cns aopnis ~aAl3i6as npoKaAoujlevn an6 6tatao, tf'lS aopnK~S l
pt(as. I
IToAutLJ,1S rtAnpo<popies /LU -cnv KQ"'CclOtaOil tWV jllKPWV U//lWV TtapxovtaL ana
HlV e~-cao11 tou ~u~ou o<p-&aAIJ.OU, otnv anoia entoKonouvtaL -ca U/7ia tou
Oll<pL~t\llO"'CPOL<)ous. OL napa-cnpouj..lVS aA,\oLC.i)OLS KatcitaooovtaL avaAO/U j..l
111v ~aptnlltci -cous oe 4 ota<na Kata Keith-Wagener:
2-caoLO 1: 1-cvwon KUL O<pLOLOrlS n:opeia tWV U//LWV !OU Uj..l(j)L6AnotpOLOOUS.
1tci6LO 2: En:i taon -cwv at\Amwoewv -cou npon/OU1J.vou otaoiou ouvooeu61J.Vf1 an:6
OUIJ.rtieon nov <pABwv tou aj..lcptl3Anotpoetoous at a OI11J.eia 6nou ouvavtwvtaL ll
us ap-cnpies.
1-caoLO 3: A //LUKS aAAOLWOLS ouvooe U0j..lVS an6 ULIJ.OPPU/LS KUL ~LOPW!lata.
1-caoLO 4: Eupf11J.ata npornou1J.vwv otaoi.wv ouvooeu61J.eva an:6 oi.OilllU 'tf'lS ~l'lAns.
r. Ep"YaotnptaKa eupquata. ITa~oAO/LKa epjaotnptaKci eupf]IJ.ata Otl']v aptllPLUKri
UTtptUOf'l n:apatnpouvtaL 6tav 1J.<pUVLOtOUV OL en:tnAoKeS "'CI']S na~nons. E!OL,
OtO !lAKtPOKapOLO/PUIP!lllU j.1TtOpi. va UTtUPXOUV OI']IJ.i.a lHtptpo<pi.ac; ti1S
apL01PrlS KOLAiac; rl LOXULj..lLKS aAAOLlOOLS, qti']V UKtLVOjpa<pi.a ~wpaKa
J.l/UAOKapOia, evw 0!0 f'lXOKUPOLOjpU<pf'lJ.lU OU/KV!PLKri uneprpo<pi.a tf')S '
apton:pr;s KoLAias ri oe n:poxwpn1J.va otaoLa otcitaol'] Kat urtoouotaAnK6trna tllS
apLOtp~s KOLAi.as. 1tnv /VLKrl oupwv j.1TtOpi. va OLUftLO'ttoSei. ULj..latoupi.a KUL
rtpWtLVOUpi.a.
tl. I1p67ywoq KaL ~epanei.a . Xwpi.c; ~epanei.a to 5CJ'AJ twv ao~evwv ~a ne~aveL
an6 KapoLOn:a~eta, to 30% an6 /K<paALK6 eneLa66to Kat to 15% an:6 ve<ppLKri
avenapKeta. H np67vwan ei.vaL tbtai.tepa ouoj..levns 61:av: a) 11 au~non tns
ouotoALKrlS ~ !!lS 6taotoALKriS aptnptaKf]c; n:i.eons ei.vaL ll/UAf'l, 6) unapxet
OLKOjVLUKO LOtOPLKO TtL rtAOKWV OcpLA01J.VWV Oti']V aptr]pLaKfl UTteptaOf'l, 7) 0
ao-&evns d vat avo pas r1 J.Laupoc;, o) n vapen rns na8nans /LVe ae IJ.LKPri nAtKi.a,
e) ouvunapxouv aAAm napajovtes Ktvouvou /La ote<pavtai.a v6oo, at) auvu-
n:apxet KUPOLOTta8eta, 6Aal3n tr.ov ')'KcpaALKWV U"7/LWV ri ota6ritns. 0 urtapxouv
!lAK'tPOKUPOLO')'pacptKa rl rlXOKapOLO')'pacptKa Ol'llli.a un:ep-cpo<pi.as tl'lS apLOlPrlS
KOLAi.ac; KUL !l) UTtUPXL VcppLKrl OUOAL tOUp')'i.a. .-
H ~epaneunKri avtL1J.tWTtLof'l tns ap-cnptaKf]S ni.eons otaKpi.ve-cat ae llf'l <papj..la-
KeunKri (a,\Aa!r1 tou tp6nou Cwf]c;) KaL <papl,.laKeUtLKrl Kat e{apta-cat an6: a) to
1-1/e~os !I'JS au~I'Jons !rlS ap!flptaKris ni.eons. 6) tnv napouoi.a ri tnv anouoia
ouvoowv KapaLOtl')'')'etaKtilv napa')'6vtwv Ktvbuvou Kat ')') tnv napouol.a ri tnv
an:ouoia n:poo~o,\nc; tWV Op')'clVWV OtOXWV, tWV Op')'aVWV 011Aaofi TtOU ucpiotavtaL
~),\al)es orav au(aveL n aptnptaKn n:ieon (IHvaKes 3 Kat 4).

4
[J(vaKas 3. ~uvoooi Kapotoa//Lar..;oi n:apa;ov1:es KLvouvou Kat ~AaBes 1wv
OP/"UVWV 010XWV OHJV ap1f1PLUKrl un:p1a011

ITapci/OV1S KLvouvou
- Kan:vw~a
- L.luoAt ntoaq.J.ia
- ~aKxapwbns 6ta~r1-rns
- HAtKLa > 60 en\Jv
- <f:>uf..o (avbpec; KUl ~1l.ll.l.f1VOTIUUpLaKS /UVULKS)
- 0tKo;evetaK6 to-roptK6 KapbtoU//LaKrlS v6oou ae llAtKia
<65 1:WV /LU nc; )'UVULKS KUL <55 HOV ita 1:0US avopes
BAaBs op,avoov a1oxrov
- Kapota
Yn:eprpo<pia apto!epns KotAias
~Tfl~U/'Xfl rl LO"TOpLKO 1J.IJ)Pcl/J..LU10S 10U J..LUOKUpOiOU
fO"TOpLKO UOp1001tpUVlaLUS TtUpUKU~(})flS
KapotaKrl avenapKeta
- E/"K e<j)at\oc;
I1apoOLK6 rlllOVlJ..LO /K<paALKO TIl000l0
-Ne<ppoi
Ne<ppona~eta
- ITpL<pptKS ap111PLS
l1pL<pptKri aptf1pLOTtcl~LU
- Otp-&at.. ~6s
AIJ.<pL~Af101pOLOOTtQ~LU

fiLVUKaS 4. 0epUTtU1LKrl UV1LIJ.1WTIL0fl ap1flPLUKrlS UTtp1U011S

OptUKrl

( 130-139/85-89 mmHgJ (140-159/90-99 mmHg) (>160/>1 00 mmHgJ

An:ouoia napa /"OV"TWV AAAa;t1-rp6nou Af..Aa1r1 tp6rtou <J>cipiJ.UKU


Ktvouvou ri BAaBwv Coons Cwfts (J.1.XPL 12 IJ.rives)"
OP/clVWV oroxwv

TouAaxLOrov evac; na-

5
pa;ov1a~ KlVOUVOU (OXl
oaK xap w611 s 6ta~rl111 s)
Oxt ~t\uB11 op;uvwv
Ol:OXWV

Bt\a~11 op;uvwv o16xwv


11e ri xwpi~ 6taBri111 r1
at\t\ou~ napu;ovl:S
KLVOUVOU

": Eav 6ev e,\anw~ei 11 ullri 111~ ap111PLaKri~ TtlOI1S 010 ava;pa4)61J.eVO xpovtK6
0Lcl01111J.a OUVLO!U!at 11 TtL Tip00~111 XOPri/11011 <papjJUKWV.
""": na napa6et ;IJa, eva~ ao-t}evf}s IJ ota0r1-rl1. apl:f1pLaKr1 nieo11 142/94 mmHg Kat
unep-rpo<pia 111c; apto-repris KOtAias Ttpenet va ~WPI1~et 6-rt naoxet an6
ap-r11ptaKri unep-rao11 l-raoiou 1 ouvo6eu61JVI1 art6 BAO:B11 oe 6p;avo o-r6xo
(unep-rpo<pia apto-repris Kott\ias) Kat eva IJiCova Kap6toa;;etaK6 napa;ov-ra
Ktvouvou (6taBri-r11s ). ~-rov ao~evfl au-r6v K-r6s art6 1:11v aAAa;ri 1ou rp6rrou
Cwr1~ nperteL va ouo111~ei 11 Arl$'1 avuunep-rotKtOV q>apiJaKwv.

H 1-111 <papiJaKoAo;tKrl ~epaneia 111s ap-r11ptaKriS urtp-rao11s ouvicna-rat orov


nepLOpLOIJ.O rou npooAa1-1Gav61Jevou aAa-rLOu, 1:11v 6taKortf]-rou KartvioiJ.al:oc;, 1:11v
anwAeta l)apous, l:flV KaLCntot\1Jf10f1 l:flS tiJUXLKriS vraons Kat !flY A/XOIJVf1
aep6Bto aOKI10f1. Ot ;uvaiKes, m oTtoies AaJlBavouv av-rtouMrtrt1LKu OLOKia,
npnetva KaTa<pu;ouv 0 aAAI1 IJ.~000 aYtLOUt\t\f14Jf1<;. Me;aArt OfliJ,aoia exet
Ttl011~ 11 aVUIJ1tOTtLOf1 KapOLU)')'LUKO.lV Ttapa)'OVtW\1 KL VOUVOU, OTtWS f1
unepxot\110tepoAatiJia Kat o oaKxapw011S 6taBr11f1S. rtou evOeXOIJ.evws va
ouvunapxouv.
To eioos ti1S <papjlaKUUKrl~ a)'W/rlS npen:et va e{atOiltKeuetaL. Erot ota veapa
titojla 1J. n:opei apXLKU va XOPI1/11~i eva~ avao1:oAa~ 10U IJ1atperttLKOU
ev(ujlou tllS a;;.etotaoi VI1S ( n.x KaTttonpit\1112.25-50 mg X 2 PO r1 evat\anpit\11 5-
40 mg x 1 PO 11 t\wt vonpiAf'l 2.5-40 mg X 1 PO) r1 eva~ avaotoAeas tc.ov a1-urto-
6oxwv ( n:.x. Tepa(ooivn 1-5 mg X 1 PO) rl vas rtapa-retaiJ,eVf1S opaonc;
avta;wvtOTf1S aol)eotiou (n:.x. ajJt\ootnivn 5-10mgX 1 POri <peAo6trttvrt5-10mgX
1 PO) A6;w T!lS t6tai -rep a xa1JnAr1s ouxv6tntas napevep;etti>v Kat t6iws
oeeouaALKriS ouoAet 10Up;ias. Ertl nAov, ta npoava!pep~eVl:Q <pupiJ,aKa bev
exouv 6u01J.eYri eniopaon o1:ov 11taGoAtoi.L6 twv t\Lrttbiwv rl111S ;AuK6Cns Kat we;

6
cK rourou 11 !-1UKpoxp6vta XOP~/11011 evoexo1-1evws vu rrpoorareuet an6 t:ijv
ouxva avarcruoo6!-1E.VI1!-l r11v ncipooo rwv enov apu1ptorca~ew. 11ous Ai1ous
ao~eveis rrou !-l<.pavi{ouv 6uoave\ia o1ous avaoro,\e.is rou 1-lE.tatpercnKou
V(U!-10U 111S U//L01UOL VI1S ( n.x. !-l!pclVlOI1 erwou B~xa)xoprnouv-rat
VaAAaKUKci avaoroAeis tWV unoooxE:wv 111S UjjlOtaoiVI1S (n:.x Aooapravn 5().
1oo mg >< 1 FO ~ BaAoap1civ11 40-160 mg X 1 FO ~ tpBeoapravn 75-300 mg X 1 PO).
~10US ao~~VE.LS 1-1 a{XOS, tUXUKapoia ~ Otl1~cl/XI1 V0elKVU!UL 11 XOPflJflO'fl l)-
UVUO!OAE:wv ( n.x arevoA6A11 50-1 oo mg X 1 PO ~ Btaon:poA6AI1 5-20 mg X 1 PO ), evw
010US 11ALKLW!-1:VOUS, OL OTtOLOL OUXVcl !-l<pavi(OUV op&001U1LK~ UTI6ta011 !-1Tcl
an:6 111 A~$11 Uf'/E.LOOta-oraAuKwv. 1-lLKpE:s o6oets ~eta(tOtKwv 6toupl1ttKWV (n.x.
xAwpo~at\to6v11 25~50 mg X1 PO ). H ,\~4JI11WV -ceAeutaiwv ananei tov nepto6tK6
E:Ae/XO TOU KUAiou TOU opou t\OjW HlS TIPOKUAOLII.I.VI1S an6 ta <pcip!JaKa UUtcl
uTI:oK aAtat!-li as.
~e rrepi rnwon rcou n aptflPLaK~ nieon 6ev eA /Xe-cat 1-1 1r, xop~/11011 ev6s
<.papllaKou xoprtf'OUV1at ouv6uao~J,oi 6uo ( n.x. avaoroi\E:as 1-lE.l:arperntKou
ev(UIJ.OU+av-ra;wvtatr1s aol)eo1iou ), tptwv ( n:.x. avaotoAE:as 1J.1atpen:uKou .
ev(U1J.OU+avta/WVtarr1s aoBeo1iou +~eta(t6tK6 6tOUPI1ttK6)~ opto!JE:ves <pop<;
teoocipwv <pUP!-lclKWV ( TI.X. avaoroAE:as ll!U1PTt1LKOU eV(U1J.OU+UV1"0:f'WVLOtrlS
; ao0eo-riou +~eta(t6tK6 6toupnttK6+5-avaoroi\E:as ).
A!-l0fl <PUPilO:KULLKrl UV1LIJ."COJT1:LOfl a: nat "CL !at 01f1V KUKO~&rt unE:p!aOfl, 11 OTIOia
xapaK!flpi(e!UL arc6 IJ./clt\11 auenort TrtS aprflptaK~S n:iE.OflS (ouxva >200/140
mmHg) ll a~J,<ptBi\notpOet6ona~ta oraoiou IV Kat ouxva OUVOO uerat an6
e;Keq:Jat\orcti~eta (novoKE:q>aAos, vautia, 6tarapaxE:s t!lS auvei6110tlS Kat
on:aolloi), o\eia aptarepr1 KapotaKrl avenapKeta ri ve(pptKrl avenapKeta. 0
aKon6s rns ~epan:eias eivat 11 npoooeuuKft ei\arrwor,ti1S 6taoroAtKris aprn-
ptaK~S nieo11s oe en:i n:eoa 90-11 o mmHg. Touro ent tu{xavetat !J trt ev6o<pAE:Bta
xoPri/flOfl vt tponpwoatKou va1piou ( 1-6 llg/kg/ ,\en: to) un:6 ouvexft E:i\e/XO tns
UP1flPLUKrlS Ttl0f1S.

~eu1epona~ri s utteptaofl

Ta ouvnSE:otepa aitw oeurepona~ous un:E:ptaons eivat ot na~rioets rou ve<ppt-


Kou n:ap/XU!-LUTO<;, fl OtVWOfl ti1S VE.q:lPLKrlS aptl1pia<;, 0 TCpWtOTCaSris
(.l/\ObOTE.POVLO!lO~ Kat 10 <patOXPWilOKUttWilU.
A. rra~rjOL5 \"E.<flQLKOU n:apeJXUUU105. AveupiOKOVtUL oro 2.4-5.6% tOU ouv6Aou
TWV UTCE.ptUOLKCVV ao,Sevwv. H au{f1011 ti1S UP111PLUKriS TIL011<; O<peii\etat 0
Ota1apax~ TflS Ve<pptKft<; an:KKPlOflS va-rpiou Kat VPOU ri 0 Vepj0110lfl0fl10U
ouott11la roc; pevt vns-a//E.LOtaoi vns -aA6oatep6vns ri ouv6uao1-16 -rwv ouo. H
KALVLK~ L"O\'U 1-.:UL ta .ep/UO!flPLaKtl eUPrillU!U eeapnovtat an:6 111V UTCOKl!J~VI1
v6oo (o\eia on:etpa~J,a10Ve<.ppin6a, o\eia oAt /OUPtKri ve<pptK11 aventipKeta,

. I
n:oAUKUOUK~ VOOO) HOY VE:tppwv, xpovia nueAO'Jtppiuoa KAn). o,\QL OL ao&eveis
n:penet va unoMn&ouv oe eA/XO npm ~q.1.evou va 6tepeuvu&ei: a) n napouoia
KUL TO eLOO<; TCIJV ve<ppLKWV KuAi VOpwv, 0) 0 0a~I.I.OS "CFlS l1PW!LVOUPLUS KUL H)<;
avaq..tiac;, ;) -ra enineoa o1ov opo 1F1S oupi.as, 1F1S KpeauvivFls. -cou ao~eo-riou,
l:OU <j)UJO<j)Opou KQL l:flS AE:UKUJI..la1ivns. KQL o), avatOI..lLQ 1WV ve<ppti.Jv
( UTIPflXO/Pcl4'fll..l0 ~ aeovLK~ 101.1.0/PU<j)ia). fta !FlY PU~I..lLOFll:llS apl:flPLUKriS
nieons l..lTiopei va xoprpn~ouv <poupooei.J.iOfl (BD-240 mg f1J.lpfloiws POJ, oe
ouvouao1.1.6 1.1. B-avaol:oAeis ( n.x a-cevoA6A11 50-100 mg X 1 PO ~ BtoonpoA6AI1 5-20
mg x 1 PO ) ~ avta{wvto-ces 1:ou aoBeo-ciou ( n.x. a1.1.Ao6Lnivn 5-1 o mg x 1 PO~ tpe-
Aootnivn 5-10 mg x 1 PO). OL ao~evds I.J. vetpptK~ aven:apKeLa, otous onoious n
UUCF1J.Lvn KUl:OKPcltf'lOFl val:piou KUL vepou oev I.J.TIOPE:L va eAe;x&ei 1.1. <PUPI.I.OKQ
KQL npoKaAei aptF1PLaKr1 uneptaOFl eivat UTt04Jrl<PLOL {La XPOVLa OLciAuon.
B. ltevwoo ve<pptKOS aptopias. ITapa-cnpei -caL o-co 1% -cou ouv6Aou twv uneptaot-
KWV ao~evti.Jv. H a~rlPOOKAf)p uVOFl ei vat to ouxv6-cepo ai.no oteVWOf'lS tns
veq>ptK~S aptf1piac;, napa-cqpoUI.J.E:Vfl ota 2/3 twv nept n-cc.OOewv. AL ;6-cepa ouxva
aiua eivaL 11 LVOI.I.ULK~ ouortAaoia, 1'1 aptflpLtLOa, 11 ~POI.I.BlOOfl KQL 0 ap"CFlPLUKOS
OLUXWPLOI.I.OS. H aue,o, tns ap!flpLUK~S TtL0flS LVQL an:oteA01.1.0 1110
evep;onoLnons tou ouo1:~1.1.a-cos pevLvns U/'/'Lotaoivns aA6oo-repovn5 A6')'w
nnoons l:flS nieons izpbeuons -cou vetppou. H ni\ew<Qn<Pia twv ao&evwv 1.J.tpavi(et
tpapi.J.UKOUVtOX!l uneptOOFl KUL 0 OpLOJ.lVOUS OTtO QU"COUS Ttapatl1pi taL
Krt1WOfl !FlS vetppLKrlS Aet -coup{ias 1..110: an6 XOPrl/flOil avaotoAa 1:ou
l.l.tatperiuKou ev<D1..1ou tfl<; a')'')'LOl:aoLvnc;. H aKptBo-repn avaLI.I.aKt11
OLa')'VWOtLKrl eC!UOfl eivaL tO OTILV~I1PO/Pcl<Pfli.J.O V<j)pWY l..ltcl an6 XOP~/'11011
KantonpiAns. ~e nepi ntwon nou 11 eetaon autit ano~ei ~eUK~ o ao~evi)s
npeneL YO unoBA11&ei 0 KAKtLK6 KU~etflPLUOI.J.O "tflS V<j)PLKrlS UPl:llPiac; KUL
Y<j)poa')'{LO/PU<j)La. fLa tOY eA/XO tf'lS aptflpLUKrlS Ttt0flS XOPilfi taL UPXLKU 11
KAaootKr1 avnuneptaOLK~ U/'W/'rl. Ot aYaotoAeic; tou 1.J.tatpen-cLKou evCui.J.OU -ens
O//'LO-caoiv!ls n:pen:et va XOPfl/ODvtat 1.1.e npoooxn 6taY unapxet etep6n:Aeup11
OleVWOFll:FlS VE:<j)PLKrlS aptf1piac; KUL YU aTtO<j)U')'OY"tal OtLS TtPLTtlt00LS eKE:lVS
I.I.E: ai.I.<POtepon:Aeupn o-cevwo,., a<pou l..lnopei va npoKaAoouv enet6eivwo11 -rns
vetpptKf)<; Aet roup;ias Kat Ve<f>PLK~ avenapKeLa. MewveKt!ll.l.a t!lS
<papl.l.aKUtLKrlS a)'W')'rlS aTt01eAei. 10 VOXOJ.1VO TtLt0011S 111S n:iOflS 0111
YE:tppLKf) aprnpia_I.I.E: an:o-cAeo1.1.a tnv enLoeivwon -ens Ye<ppLKrlS Aenoup;Las. fta
-coY AO/O auto 11 &epaneia E:KAO/rlS ~ewpeLtaL of)J,lepa 11 ertellBanK~ &epan:eta
(XLpOUp)'LKf1 Tt1.J.l)UOfl rl Q)'')'LOTIAaOUKrlJ.l J,lrtat\,\6YL).
r. I1 pw-cona&o5 a,\0001:QOYLOU05. f1apal:f1pei l:Ul OtO 0.1-0.3% l:OU OUYOAOU l:WV
UTiep-caoLKWV ao&eYtOV. ll:FlY l1AL04Jll<Pia lWY TtPL111:t00WY OtpL\etal 0
I.I.OVf)pes <pAOLO m ve<ppLOLKO aoVWJ,1Q n:ou eKKpi VeL aAoootep6Y!l. AA,\ a,
At ;61:epo ouxva. ai ua eiYaL n Ol.l.<f>Ol:ep6n:Aeupn <pAOLeTUVe<PPLOLKtl unepn:,\aow. n

8
c1:cp6nAeupn <pAoteTuve<pptOLKri unepnAaoia KUL 1:0 pevtvoeKKPL nK6 a6evw~a. H
unoq;ia (La IflY napouota npw-rona~ous unepat\6o<nepovw~ou nprret va
e;eiperaL 61av o aoSevns eiJ<paviCet: a) unpraon oLOuonnore ~a&~ou. ouxva
xpovw Kat avSeKLLKrl o-ra ouv~~~~ avuunepraotKa cpap~aKa Kat B) un:oKaALat~ia
nou OeV o<peLt\eraL 0 OLOUPilUKa e~rous ~ ouippoLa. H OL!l/YWOr) ri~!QL 6tav
o A6;os rwv em n6wv -rns aA6oo-rep6vns npos 1:11 6pao1npl6-rnra UJS pevi vns
010 n:Aao~a lvat IJe;aAurepos an:6 30:1. Ta <p;\OLemve<ppt6tKci a6eYWIJala
aV1l1Je1wniCov1at ~e KAaootKrl XeLpOUP/LKrl Ji,\anapoOKOTtLK~ a6pevat\eKto~ri.
eYW f1 <P,\QLOeTtLYe<ppLOLKri UTiepnt\aoia IJ 1111..LUKPOXPOYLU XOPrl/flOfl XUIJI').\wv
66oewv onetpovot\aKrovns.
11. <PatoxpwuoK trnwua. ITp6KeL1aL ;ta 6;Ko ouvtolaj.levo an6 ap;upoc~hAa Kunapa,
nou eK~plvouv KU1eXoAalliVeS, o on:oios aveupioKetat 010 0.1-0.2% rou ouv6Aou
twv un:ePtaotK(OY ao&evwv. To 90J/a 1wv <patoxp(LliJOK unw11cnwv evton:i(etaL o1ov
1JUA6 twv entv<ppt6iwv Kat an:6 au1ci 10 10%, dvat 01J<p01ep6n,\eupa KUL 10 10Jio
KUKOrl~~: 0 {talpOS ~a n:peTI1. VU UTI04JUl(etaL tllY n:apoUOlQ <paLOXPWilOKUttoJ-
j.latOS, 6}av n OP111PLaKri unptcwn ouvo6euetaL an:6 3 touAcixtotov an6 -ra
napa.Kcifw OUIJTt1oJIJ.Uta KUL Ofl!J.ia: ooBap6 TtOYOKcpaAo, VtOYS <pLOPWOLS,
aio~rwa npoKapbiwv naAI..l<i>V r1 taxuKapbia, aio~n11a ilrxous ~ avnouxias, rp611o
twv xepttilv, vautLa ri 1J.eto, abuva!J.ia, K6nwon, Ka-ca~oAn.
Ot ao~evei<; IJ un6vma <paLXPWilOK uttWIJUtos npTtel va unoBciAAovtat oe nAJipfl
ep;aotnptaK6 Ae;xo. 10 npw-ro l3nlla 1ou on:oiou anoteAei o npoo6wpto~-t6s lflS
TtOOOtlltac; rwv KUleXOAU!J.LVWV tllS IJ1QV<ppi vns KQL tou VMA (vanillymandelic acid)
I

oe ouAAorn oupwv 24wpou. Au\rweves tLIJes IJ.etavecppivns Kat VMA


napatnpouvrat 010 98% rwv aoSevwv IJ. <patOXPWIJ.OKUtlWila. Ecp' ooov ot
rtpoavacpep~eioes e~elaOeLS ouvn;opouv unp tns rtapouoias 1ou 6;Kou, o I

ao~evns npn:et va un:ol)An~ei oe a\OVLKrl rliJU/Vf11LKrl10ilOrPaq>La rta 111v


ev-c6rnor1 rou. H ~epaneia tou <patOXPWIJOKUltWIJatos ouvio-ca.1at apxtKci otov
Ae;xo tflS aptllPLUKrlS n:i eons IJ. a -a.va.o1oAeis ( q>at vroAal.li vn ev6o<pA eBiws ;ta.
tnv a.v1qJ.e1wmor, nov un:epta.otKti>v Kpioewv Kat cpa.tvo\u~ev(aiJ.Lvn a.rt6 10 j J

0101,!0 /LU tOY Ae;xo lllS aplllPLUKrlS TILeOflS) KUL 01fl OUVXLU 0 XLPOUP/LKri
U<f!UtpeOfl lOU 0/KOU.

9
. .. --... -
. - __,_, __ ~--~-~---- .. --
7. ~IATAPAXE~ TOT KAPAIAK01 P10M01

Katw an6 <pumoAO/tKS ouv~~Kes -ro nAeKl:PLK6 epSLOilU n:ou n:poKaAet


ouonaon -rns Kapouis napci/elat o1ov <pAeB6Ko!lBo Kat an:6 eKei e~ant\wvetat
1-1ow c~etOtKE:UI-lE.vwv oowv otous K6Anous. ~-rn ouvexeta, a<J)ou 6tE.,\{}et an6
to w.eooKoA TILKO 6u1<ppafl.ta <p~avet o-rov KOATtOKOLAtaK6 K611Bo. 6n:ou
entBpa6uve-rat. Ot eTIOileVOL o-ra&j.iot ei vat -ro oej.latto -rou His, -ra OKE.An tou
oe11atiou (oe~t6 Kat apw-rep6) Kat to ouo-rn11a Purkinje j.leow tou onoiou to
epe{}to!la e~anAwve-rat !lc 1-1/aAn taxu-rnta <no KotAtaK6 llUOKap6w.
Ot otatapaxes tou KapotaKou pu~IJ,ou, ot KapotaKes appu&!lies, eivcu
anotE.Aeo!la n:oAunAoKwv aAAnAent6paoewv llE:ta~u appu{}!lt0/'6vwv
UTI001PWilUHUV ( TI.X. LOXQLj.ltKO ~ OUAWOcS j.lUOKUPOLO). T"COU xapaK tr]pi~ovtat
an6 OLOtapaxes lr]S TIUPU/'Wf'r)S rl111S U/Wf'r)S l:OU nAeKtpLKOU epeSiOj.lUtO<; KQL
6uva!.HKWV rponon:OLf11LKWV napa16vnuv, 6nws m 6taKUj.lavaets tou t6vou tou
UU10VO!J.OU V.UPLKOU OUO"tr)!J.U10S, flj.LUOKOPOlUKrl LOXULIJ.LU, OL nAeK"tpoAunKeS
ota-rapaxes. m l..l.1a~oAes -rou pH, n-raan-rou IJ.UOKapotaKou -rmxwiJa-ros Kat ot
.TitopaO.LS <pap!J,UK WV.

Bpaouapou~ULS-ALatapaxes KOATIOKOLALQKOS U)'W)'rl$

~trlV Kalnf'opia autr) avr)Kouv ot appu~llies m n:poKaAouiJ,eve.s an6 6tatapaxn


1flS napaf'W/rlS l:OU nAeKtPLKOU e.pe{}l.o~atOS Ji lJlS U/W/JiS 10U an:6 l:OUS K6A-
TWUS OtlS KOLAieS

ITp6KetraL f'La <pAe~OKO!l~tK6 pu&IJ.6 Jle ouxv6trna <60 /Aern6.


HAeKtpoKap6LO-rpa<pnua: a)KapotaKti ouxv6tnta < so o<pueets/Aent6, ~)0enKa
KUj.lO:ta P OtflV UTIU/'W/rl I I KUL apVfltLKU OtflV aVRKaL I) ~UIJ.TIA./'IJ.U QRS jltcl
an6 Kci~e KU!la P.
Aiua: a) <PuoLOAO/LK6 eupnlla (rt.x. a&An-res Kata tn ouipKeta tou un:vou), ~) ,~
:.;
'PUPIJUKQ (OO.K1UAiu6a, ~-avaotoAeis, avtU/WVLOts aoee.atiou KAn:), )') ~tetpa- .
vtaia v6oos. "'!) YnoSupeoeLOtOIJ.OS, 6) 1n:o&epj.lia, e) HAeK tpoA unKE:S otatapa-
xes. ot) A n:o<ppaK1LK6s iKte.pos, 0 Oupat~.tia. n) Au~non evooKpavtas nieons. ~
{}) Nooos <p\c0oKOIJ.~ou
0epan:eia. H ~e.paneia tr,s tpAe~oKOIJ.~LKrlS BpaouKapoias otous aq.wouvaiJ,tKa
o1a~epous o.oSeveis ouviotataL o-rrw KatanoAE:IJ,r,an tou unoKeLIJ,evou aL tiou.
A IJ,eon avul,!e tWrtLOil anat tei tat 6tav unapxet IJ,eiwon tns KapotaKriS rtapoxris
IJ,. OU~.!TttWI,!UtO: 1\UL Ol'liJ..lQ eAattW1.!VflS LOUK~S UliJ,Ul:WOr]S ( THtOOfl apH)pLUKrlS

1
. --~ -------- .. .. ___ _ __;_,::_._ ,_. __._:
- .. ---- ,_. ---_;

nicons. c<pi6pwo11. (a,\11, an:w,\cta ouvciOI10I1S). <i>ap~-taKo cKAO/~S 6tav 11 ~pa-


6uKap6ia Oev otpcLActat oe ouvopo~-to vooouvtos <pt\e~OK6!100u (oes n:apaKal:w)
eivat n atpon:ivn (0.5 mg IV cn:avaAa~-t()av6!leva Kci&c 5 Acnra ~-txpt ouvo,\tK~S
66o11s 2mg). Evat\t\aKUKa ~-tn:opcl va XOPfl/rt&ci taon:porepev6AI1 oe ouvex~
VOO<pA~LQ )'XUOI1 2-5 mg/min. H TeAeutaia eivat 0Le{Pti1S 1WV ~-aopevep
/LKWV UTIOOOXWV KaL 11 XOP~/11011 TI1S aVTVOLKVUTaL 0 aOSVl<; j.l 10~LK6
6aK1UAt6L0~6 ~ ~uoKap6taK~ toxat~-tia 6t6u ~n:opei va npoKaAoet rrw ej.l<pavt-
on KOtt\taKWV appU&j.lLWV ~ eTttOeiVWOI") trtS j.lUOKapOLaKf)<; LOXalj.lLa<;.

KoA n:oKoLALaK6S anoKA LOilOS

0 KOATIOKQL,\taKOS an:oKAeLO~!OS an:01:et\ei OUXVO UPfl~U 0111V ~UOKapOLaK~


LOXUtj.lia, 10 O~U ~<ppa{~Q tOU j.lUOKapOlOU, US ~UOKap6iUOS Kat TLS IJ.UOKap-
OLOn:cl&et<;, lfl o1vwo11 ti"JS aopltKris ~aA~ioas, 111v ao~onoo11 1ou aopnKou
Kat tOU ~LlPOetOtKOU OaKtut\iou Kat 01LS K<pUAt01lK<; rta&rioet<; lOU OUOlrwa-
tO<; a{W/~S (v6oos Lenegre, v6oos Lev). Enio11s. llTIOpei va e~tpavtOlei 1J.1ci an:6
XOPri/11011 <pap~UKWV (OaK1Ut\itt6a, av1a{WVL01S aO~eOTLOU, ai.J,tWOap6VI1, OOla-
,\6t\Jl, avta[wvtots 1wv ()-a6peVP/LKWV uno6oxwv KA n).
A. Ftoa KoA noKotAtaKou an:oKAewuou. .Aa-lrro~.:otAtar..'ds- a!lo;.AetCTttd> npalrou
Jiot9pol1 XapaK1flpiCe1at an6 en:tl)pa6uvon tns a{W/riS tou nAeK1PtKou epe&i-
o~a10S an6 1ous K6Anous n:poc; tLS KOLAies !1 ano1Aeo1J,a rnv n:apa1a011 rou
6tacnri11a1os PQ 010 nAeK1POKap6t6')'pa<pn!la. n 1L~ri 10u onoiou unepl)ai vet 1a
0.20 sec ( ouvri~ws 0.200.40 sec). H en:Ll)pa6uvon tns a{W/rlS J,ln:opei va ouj.l~ei
Ol:OUS K6Anouc;, tOV KOhllOKOLALaK6 K6~-tflo (n ouvn&e01PI1 &eon). tO 01-UlTLO
1ou His~ 1a oKeAn tou OeiJ.ariou. ~1nv 1Aeutaia nepirttWOI"J 10 ep~LOIJ.a ano-
KAei1at OtO eva OKAos Kat U[etaL IJ. KU~U01pnon an6 10 aAAo. En:eLOri orov .
n:pwrou ~a&~-tou KOATIOKOLALaKO aTtOKhLOilO 6Aa ta KOAllLKU p~tOj.lata cl/OV-
1QL an:6 lOUS KOAllOUS npoc; tLS KOtAieS OL ao&ViS LVat OUVrl~WS aOU~Tt!Ul
I.J.UlLKOl.
A'oAilm.,..otAtoKor a!loK.,JetCTJlO> oeortpou J!ot9PotJ. Me ~aon -ra euprwata tou
en:t<pavetaKou I")AK1poKap6tO/Pa<PriiJ.atos 6taKpivov-rat ouo -run:m, o an:oKAt-
OI.J.6S Mobitz I ( an:oKALOI.J.OS Weckenbach) Kat 0 an:oKALOilOS Mobitz II.
0 an:oKAetO!l6S Mobitz 1 xapaK!I1Pi(e1at an:6 1nv npoooeutLK~ en:t~riKUVOfl 1:ou
6tao1~11a1os PR oe Ilia aAAnt\ouxia enapiJ,atwv P, aKoAou&ouiJ,VI1 an6 1ov ano-
KALO!l6 ev6s e ntipiJ,a-ros P Kat r11v ~paxuvon 1:ou 6tao1~1la-roc; PR o-rov npti.lto
KUKAo nou a)'erat ll!a -rov anoKALOil6. To 6ttiotnl.l.a RR ouvf)Sws ~paxuverat
nptV an:6 !0 anoKALOI.J.VO n:ap1J.a p OtO!L n ~/tO!n TILI.J.rlKUVOn !OU OLUO!ri-
lla!OS PR naparrlPeirat IJ.ta~u tou npw1ou Kat 1:ou 6eutepou KUKAou 111s
aM11Aouxtas. H Dean tou an:oKAetoi.J,ou Mobitz 1. o on:oios an:oreAei tpuowAo/tK6

2
Upr)I.1U OtaV UTIUPXL UU~flOfl tOU tOVOU tOU napaOU!J.rtU&r)tLKOU KUL OtOU<;
u~,\flt<;, ouv~&ws ~pioKetat otov KoAn:oKOlAtaK6 KO!l00 Kat At/6-repo ouxva
KUtW an:6 UU!OV, 01:0 oq.lUtLO "COU His ~ ra OK.\11 tOU oe~atLOU.
0 arroKAew~6s Mobitz 11 xapaKtflpt~e-cat an:6 "CflV t:map~11 o-ra&epou otaotrilla-ros
PR n:pLV KUL !J.1CL TO anoKAtOI.lVO ertap~a P. H OLU<poptK~ 0Ul/VW011 IJ,el:aeu
Mobitz I KUL Mobitz II eivaL aouvatn 0 ao&eveis l.l anoKALOI.l0 2:1 OLOU /LCl -crw
btepe UV110ll -cwv ~eta~oAwv tou PR ananei tat 11 t:map{r, ouo 1ouALiXLO-rov
en:ap~J,cnwv P n:pt v an6 to an:oKAet6~evo . H &-011 tou an:oKAetOIJ.OU Mobitz 11
ouvn&-ws 6piOK1UL 010V KOATtOKOLAtaK6 KOIJ.60, to oe~ano l:OU His rl ta OKAI1
tOU 01J.Cll:LOU.
J(oATrOf.:"OtAtaAos- ClffOI\">IcU7j/OS' r,ollOtl fia,9poti ~l:flV IJ.OP<Prl aurt) lOU an:oKAet-
. OIJ.OU Kaveva epe~to~a oev Katpxetat an6 to us K6A no us crus KOtALes Kat 11
~r)I..Lato66ti10fl 1wv KOLAtwv Kat -rwv K6Anwv )'tvetat an6 btaq>openKous l311~a
i6o6te<; (KoAnoKOLAtaK6s 6taxwpw~6s). H &eon tou anoKAewuou 0pioKe1at
o-ro oe~J,ano tou His, ta OKA11 tou 01-f.Utiou r1 otov KOA noKotAtaK6 KOIJ.BO.
B. Ev-r6ntoo neptoxns anoKAewuou. H evt6nton tllS neptox~s -rou KoAn:oKOL-
. XtaKOU an:oKAl01J.OU exet 1.1/liAn KALVLKri OrliJ.UOia. 2tous QTIOKAeto~ous Ol:flV
rreptox~ tou KoAnoKotAtaKou K61J.6ou napexetaL 11 6uvat6nna ae Aav~avov-cec;
OUY00LKOUS 6rwa-co66t1) va avaALi6ouv 10V A/XO tllS KOLALUKrlS OUX\'01111US.
'ot 13nl..lato66-res au-coL dvat ouvfl&-ws a\t6nwtot Kat OflllLOUP/OUv pu~IJ.OUS I
.I
6ta<J)U/~S ouxv6t111as 40-55 ocpu\ewv/Aern6. Avn&-etws, otous an:oKAeLOIJ.OU<;
o-ro' Oq.lcltlO tOU His ri ta OKA11 tOU 0IJ.Ul:LOU ( UTIOKOI.f.6LKoi UTIOKALOIJ.OL) Ot
.I
Aav~avovts l3!11J.Uto66tes, evtontC6uevot o-ra nep(cpeptKa Or11J.eia tou ouorr1-
~a1o<; U/W/rlS Kat crto KOtAtaK6 IJ.UOKapoto, eivat ava\t6rtw-cm Kat Of11J.LOUP/OUV
pu~~ous 6taq>u/r1S ouxv6tntas 2040 oq>u~ewv/ Aent6. Os eK toutou, oe av-ti-
&-eoll ~e tous. anoKAewuous otov KOArtoKotAtaK6 K61ll3o, o Kiv6uvos Kapbto-
/VOVS KatartMletO.S KO.L aoucrtot\ias OtOUS UTtOKOIJ.6LKOUS UTtOKALO~OS eivat
noAu IJ./ciAos. I
To eTtL4)0.VLQKO nAeKtPOKUPOLO)'pU<pf11J,a eivaL XPrlOLIJ.O /LO. tOV Ka&opLOI.J.O !fl)
&-eo11s -cou an:oKAeLouou. H napouoia KOLAtaKwv OUI..lnAe!l..llitwv 1.1e on:v6 QRS j
J:
ouxvcnntas 40-55 /Aent6 unoo11Ac.Ovet anoKAeLOIJ.6 otnv neptoxri tou KoAno-
f
KotALaKou K6~l3ou. evw 11 napouoia KOLAtaKtiJv ou~n:A/I..lcitwv JJ.e 6Leupuouevo
QRS ~op<poAo)ia<; 6e{LOU ~ apwtepou OKALKOU UTtOKALO~OU Kat. OUXYOtllta.c;
I
If
204b/,\en:t6 un:o6nAtiJveL unoKol.l6tK6 anoKALOJ.1.6. En:to11s. o 6eu1epou 6a,S1.1ou
KO,\ TIOKQL,\Lai--.0<; anoKAto~6S 1UTtOU Mobitz I OUVf1)'0pei jlU UTtOKAL0~6 OTOV
KoA noKot,\taK6 K61.16o. evw o be utepou l3a&-l,lou KoA n:oKOLALaK6s a.n:oKALOI.l6c;
tunou Mobitz II )'La Ul10K0~6LKO O.TIOKALOI.l0.
H 6ta(popLK~ 6ta/YWOI1 l..lta{u Tou anoKALOI..lOU otov KoAnoKotAtaK6 KOIJ.~O Kat
tou unoKOIJ.l3LKOU anoKAewuou ouxva 6teuKoAuvetaL an6 xetpLOIJ.OUS oL onoim
1.1.l:al3aAAouv rov -r6vo -rou aut6VO!JOU veupLKOu ouo-criiJ.aros. Etot, 11 eAanwon

3
rou -r6vou rou napaOUIJ.TIU~flnKou IJ.e"!a an6 ev6ocpA~La xop~)'flOfl al:poniVflS
~ f1 au\flOfl rou -r6vou 1:ou OUIJ.TIU~flUKOu IJ.e l:flV aOKflOfl ~a npoKa\E.aouv ~eA
l:iwon -rou anoKAeLOIJ.OU otov KoAn:oKoLAtaK6 KO~J.BO KUL eTILOeivwafl 1ou uno-
KOIJ.5LKou anoKAeLOIJ.OU. Ot npoavacpep~v-res XeLPLOIJ.Oi eivat t6tai-repa
XP~OLI.lOL ;ta l:flV 6wcpopLK~ Ota')'VWOfl IJ.e"!a\u anoKAeLOIJ.OU Mobitz 1 Kat ano-
KAeLOIJ.OU Mabitz 11 ous neptntwoets nou 6ev un:apxouv 6uo a;cb~J.eva epe~i ...
OIJ.Uta T!ptV an6 10 aTtOKAeLOJ.lVO.
r. KAtVLKcl euprJua-ra. 0 npwtou Ba~IJ.OU KOArtOKOLALUKOS UTtOKALOIJ.OS 0Laopc1J..tL
UOUIJ.THWIJ.aUKOS OLOtl 6Aa 1a pe~lOIJ.a1a cl')'OYLUL an6 lOUS KOATIOUS OUS
KotAtes. 0 oeutepou Kat tpt rou Ba~J..tou KoA n:oKotAtaK6S an:oK,\eLOilOS ouxva
ouvo6euov-rat an6 OUIJ.rtlW~J.ara o<pett\61J.Va O et\a-r-rwo11 111s Kap6taKi}S napo-
x~s A61w 111s ~pa6uKapoias. 6nws 11 eUKOAfl K6rtwo11. fl 6uonvma, 11 {aAfl Kat fl
OU')'KOrti}. H 1:Aeu-rata ~J.Ttopei va ocpeit\e-rat i1e Oti1V iota ti1V Bpa6uKap6ia
ei t OtflV 1J.tpaVLOfl rtOAUilOP<PilS KOLALUK~S 1UXUKap6ias an610KO 111S f>paou-
Kapoias. H oo~ap~ 5pa6uKap6ia ~ rtot\u!J.OP'Pfl KOLAtaKri taxuKapbla llTIOpei va
npoKaAeoouv atcpvi6to ~avato. I

I
H vtaOfl tOU n:pwtou Kap6taKOU rovou eivat avnotpocpws avat\o;n l:OU 0La- lj
01~~J.atos PR. Os K toutou eivat eAartw~-tevn o-rov rtpw-rou ~a~J.lOU KoAno-
KOLAtaK6 un:oKAtOil6 Kat J.l1aBaAAetaL otov 6eu-rpou Kat tpi rou Ba~11ou II
KoAnoKotALaK6 anoKAtOIJ.6. ~uvn~n eupfl~-tata otov tet\eutaio eivat n eKOOfl-
IJ.aOIJ.Vfl 5paOUKap6ia (ouxva <40 rtat\J..toi/t\Ttt6), f1 0LatpOptLKrl OUXV01J11U II
tou ocpa')'t noLKou art6 tov Kapwu6tK6 o<pu')'J..t6 (f'l npwtn avtLOtOLXei o-rn I~
iii
ouxv6tflta twv K6ArtwvevtiJ n 6eutPfl twv KOLAtwv) Kat f1 rtapouoia /L/UVttwv
KUJ.lcltWV a OtOV Oq:la')'LtLOLKO Oq)U')'IJ.O (cannon a waves) Oq.')tt\OJ.lVWV 0 OUOTtaO!l
tou 6ectou K6Anou J..t KAetotn tnv -rpt')'Awxtva BaA~i6a.
!1. 8epartia. 0 TtpciJtOU ~a~IJ.OU KOArtOKOLALaK6<; aTtOKALOIJ.OS OV anaLti LOLK~
~eparteia. H avtLJ..ttciJTtLOfl tou 6eutpou ~a~IJ.OU KoAnoKmAtaKou ano-
KALOJ.lOU turrou Mobit:z 1 Kat 1ou tpi tou Ba~J..tOU KoAn:oKOLAtaKou an:oKALOJ.lOU
-rou evton:t\6~-tevou otov KoAnoKOLALaK6 KOIJ.~O e\aptatat an6 tnv KALVLK~
Ka1c1otaon tou ao~evous. ~to us aouJ..tntwllattKous ao~eveis anaL tei taL rtpo-
OeKnK~ n:apaKOAOU~!lO!l, VW OtOUS OUJ.lTt!WJ.lUtlKOUS f1 XOPrl/!lOfl arportiV!lS ~
taon:pol:epevoAns (6es cpAe~OKOIJ.~LKri ~pa6uKap6ia). Eav napa tflV tpapJ,LaKeu-
1LK~ U')'W')'~ l:U_ OUIJ.TI!WIJ.ata TtLj.1VOUV UTIULtei l:aL TtpOOWPLV~ ~ j.lOVLIJ.fl
~rnw-ro66111011 avaAo')'a J.le 10 unoKei!J.evo aiuo. fta tflV avu1J.etti.Jnton rou
0 Utpou l)a~j.10U KOAltOKOLALaKOU arroKALOj.10U tUT!OU Mobitz II Kat l:OU tpi tOU
(3a~IJ.OU KOA rwKotAtaKou artoKALOIJ.OU 1ou V10TIL\6~-tevou oro auo-rnJ..ta His-
Purkinje artanei -rat clJ.l011 rtpoowpt v~ ~ J.lOVLIJ.ll ~rliJ.ato66tflOfl 6t6u 11 avta n6-
KPLOfl Otfl XOP~/fl<Jfl a-cpon:iV!lS ~ LOOn:potpVOAfl<; eivaL TtPLOPLOIJ.V!l.

4
~UVOpO~O VOOOUVlOS ~Ae~OKO~~ou.

[1p6KcL rat /La OLal:apaxfl T:flS aU10IJ,atLKOT:flta<; Kat l:flS a;W/LIJ,01f11a<; 10U <pt\e-
56KOIJ.50u OUXVci OUV00EUO~Vfl aTI6 Otarapaxfl 1f1S a;W/LIJ,01f11a<; T:OU KOAn:o-
KOLALUKOU K6~-t5ou. H n:a~no11 ouvfl~ws napa-cnpei rat oe atoll a ~-tons ~ npoxw-
P!l1J.vns fl,\tKia<; Kat 11 en:iTIHJJOrllflS 010V jeVlKO n,\ll~UOIJ,O Oev unepBaiVL 10
0.~/a.
To ouvOpOIJ,O VOOOUV'tO<; ~Ae5oKOIJ.50u q.t<pavi(e'taL ws IJ.1J.OVWIJ,evn KALVLKrl ov-
161n1a, ora n:AQ.iOLa OP/UVLKWV Kap6Lon:a~etwv (wxatiJ,LKrl Kapown:a{}eta,
un:ep-raon. o-revwon aop-rfls, IJ.Ela an6 Kap6toxetpoup/LKs ene~-tBO:oet<;) r1 IJ.el:a
an:6 Ar1lPn q>apiJ,aKwv nou Ka-rao-reAAouv 111v <pAe5oKOIJ5tKrl Aetroup;ia (6aK-ru-
AL uoa, avaol:Oi\eic; 1WV B~abpevep;tKWV un:oboxewv, av-ra;wvta1<; ao~eOl:Lou,
aiJLOOap6V!l, 001aA6A!l, AL~LO, OL!..l1lOL vn KA n: ).
A. HAeK-rpoKapbto~pawoua. Ta ouv11~eo-repa !lAeK-rpoKapoto/pa<ptKci eup11J.u1a
et vat:
a) <pt\ e50K0~5tKri 0uoAeL 10UP/ia ( <pt\ e50KOIJ.5LK tl 5pao UK apoia tl tp,\e60KOI.l.5LK tl
n:auAa)
5) <pAe50KOIJ.5LKtl 5paOUKap6ia aKoAou~OUIJVll UTIO ll!l <pAe5oKOIJ.5LKJi 1UXU-
Kapbia (ouvfi~WS KOATitKri IJapiJUPU/ti ri TI1PU/LOIJ.O<;, OeS n:apaKU1W)
I j lll1 <pAe50KOIJ.5LKrl 1aXUKapoia aKOAOU~OUIJ.Vfl ana napa1e"Ca1J,Vfl nauAa
( ouv6po1J,o 1axuKap6Las -5pa6uKap6Las)
0) ~OA TtLKri IJ.UpiJ,apu/f'i IJ. 5paoeia KOLALaKi) aY1UTtOKpL011 XWPiS 0 ao&evfi<; Va
Aa1.16avet tp'ap!JaKa.
B. KAtvtKa euprwa-ra. Ta OUIJ.TI1WIJ,a1a KaL O!lllia 111s n:ci,S11o11s eivaL ~11 etOLKa
(CaAfl, etpLOpWOI1, OU/KOTt1LKU TILOOOLU, KOTIW011, OUOTtYOLa KUL tiTtLeS OLata-
paxes l!lS n:poOWTtlKOlrllaS) Kat OXll(OY1UL IJ. 111V npoKaAOUIJ,eYT') ctTt6 1f1V
eKoeOfll..laOI..lvll 5paouKap6La eAa-c-cwon -ens Kap6taKriS n:apoxns. Enet6ri 11 te-
Aeu-raia e\aptcnat eKt6s an6 aTt6 -cnv KapotaKJi ouxv6111ta Ken an6 -cov 6/KO
n:a,\iJ.OU Kat US TIpLij)pLKS aYUO"COOLS, 11 V"CUOT') 111S l)paOUKapblac; 11 anaL-
lOUIJVI1 /La 'tllY 1JlJ)OYLOf1 OUI..llt"CWIJU"CWV Otplt\OIJVWY 0 XUI.l.r)Arl napOXrl
btaq>pet aTt6 ao~evn oe ao~evi).
r. 1.\.ta)'vwon. H 6til/VWOI1, n onoia ouvi),Sws ananeL napa-reta1-1vn nAeKtpoKap-
6toKap6LO/patpLKrl KU'tU/pa!pfl (Holter monitoring) eivat oxenKa UXPrlS 61av ta
rrpoava<pep~vra llAKrpoKapbLO/palJ)tKi1 eupriiJata ouvo6euovrat an6 111v
1J<p0.vto!l runtKrlS OUI.J.TllWIJatoAo/ias. J opLOIJves neptn:nooeLS OIJWS n:apa-
l!lpei -rat el\oeo!l1JOOI..lvn 5paouKapoia oe <puotoAo/tKa ilto1-1a (Tt.x. a{}A111es
Kal:a 111 6tapKeta 1ou unvou), n anoia n:pnet va 6ta<popobta{Vworei aTt6 10
OUVOpOIJO VOOOUVtOS tpt\e50KOIJl30U. fta 10 OKOTl6 aut6 XPflOLIJOTIOLOUVlaL OL
e{fls 1-1&o60L:
a. .doAtpaota arpo!liVtl~ EA7xerat n av-ran6Kpton r11s KapbtaKriS ouxv6trrras

5
0111V VOO<PI\5ta xopri/11011 atpOTti VI1S. lta <p UOLOI\0/LKU atOll a rrpoKa,\L taL
au~11011 111s K apotaKriS ouxv61111ac; ous 100-120 o<pu(ets/ Aern6. evw otous
ao~evets ll OUVOPOJ.LO VOOOUV10S <PA00K6J.L00U '1 r-:apOLQKrl ouxvornta KaHI 111
OOKq.taoia atpOTtlVI1S oev unep0aiVl us 00 o<pu(et<;/Aern6.
5. .Jot<:tJ,Iaoia a6cvooiVIJ> EA;xetaL 11 avran6KpLOfl 1ou llriKOU<; rou <pAe5o-
KOil5tKou KuKAou ( =xpovtK6 6uiotf1J.La Jl1a(u ouo errapiJ.cittov P) o-rnv ev6o<pA-
5ta XOPtl/flOfl aoevooivfl<;. AU(flOfl J.L/aAU1Pf1 an6 675 msec urroonAwvet
ouvopOJlO VOOOUV10S <pAe5oK6J.LBou.
/. Y!TcpAcpaJrt;.;lj" /iiJJ.IOrooor!JO!J. EA1xetat 010 ep;ao1tlPLO !lAKtpo<puotaAo-
;ias n Aet roup;ia 1ou <pAel36KOJ.Ll3ou J.Lera an:6 KOt\n:tKrl l3rwa-ro66rr)Ofl ll oux-
v6t!lta IJ. 1aA utpf1 trlS q>Ae5oKOJ.L5LKtlS.
11. 0epaneLa. H v6ooc; tou q>Ae5oK61J.BOu XL OXUKci KaAori~!l TtPO/VWOfl Kat
01r)V TtAL04.l!l<Pia nov TtPL nnooewv oev anqL -rei taL LOLKri ~epaneLa. H Jl<pU-
1UOr) J.LOVLIJ.OU 5!1J.La10001fl Ttpen:eL va TtpLOpi(etaL 010US ao~eveic; IJ.:
a) OUIJ.THtollatLKrl BpaouKapoia
Cl) ouvopoiJ.O Bpa6uKapoiac;-1aXUKapoias nou npnet va unoBAn~ouv oe avu-
appu~JltKri a/C.O/rl/La !OV eA/XO tflS taXUKapoiac; .
1) Kap6taKc; n:auAec; 6tapKeLas IJ./aAutepns twv 3 sec ave~aptnra an6 1rw I
I,,
rrapouoia t1 6xt OUIJ.Tt1WIJ.CltWV
.
,,!~:
1:
l,l
:~
.I!
:!1
~tf1V KU'tfl/OPia au1t1 avflKouv oL appu~J.Liec; OL OflJ.Ltoup;ouJ.Levec; otous K6Anous
ri !flV KOA TtOKOLAtaKfl OUV00fl.

HAeK tpoKapotoYpa<poua: a)Kap6LaKt1 ouxv61nta > 100 oq>u(ets/ Aen16, l3) 0ettKci
KLIJ.Lara P orr}v ana;w/ri I I KaL apVfltLKa OtflV aVR kai 11 ~UJ.Ln:Ae;lla QRS 1Jtci
an6 Ka~e KUlla P.
~n:aviwc; f1 ouxv6~r}ta t!lS <pAel3oKolll3LKriS -caxuKapoias unepl)aiveL ns 180 o<pu-
(ets/Aerrt6 ( Tt.X a~Antc;).~uc; U$r}Ac; KapotaKS OUXV01r}1S 1a KUJ.La1a T OUil-:
n:irnouv Jl ra KUJ.Lala P Kat J.LTtopei va ;ivet ou;xuofl Jl us KoAn:oKotAtaKc;
taxuKapoLes (oes n:apaKci1w)
Ai na: a) AU(flO!l l:OVOU OUJlTtU~fltLKOU ( aOKf10fl, U/XOS. rr6voc;, <p6Bos n n:up t6s.
KapOlUKtl ave n:apKeLa), B) <PapJ.LaKa ( aopevaAi Vr), toon:porepev6Ar), arpOTtL Vr).
Ka<peivn KArrl. /) ~teq>avtaia v6ooc;, 6) f1veullOVLKrl e1J.l3oAn. e) AnwAeta u;pluv

6
( rc.x. ;aotpoppa;ia, a(p u60.twof1 KA n), 01) Avaq..Lia KUL OL'nep~upeoeLOLO!JOS.
Gt:paneia: Katano,\1J.flOfl unoKeiiJ.eVflS attias. je neptnrr.ooeLS 6uoava)\0/11S
UU{flO!lS 1flS KUpOtaK~S OUXV01fl1US ( n.x U/'XWOflS avti6paOfl ~ un:ep~upeOeL
OLOIJ.OS) IJ.TtOpei va XOP!l/ll~OUV ~-avaotOAeic; (n.x. nponpavoAOA!l 20 mg X 2-3
PO)

flpoKaAouvtaL an6 trw nptiJLIJ.Il eKn6,\wofl 11ias KtOITflS KoAnLK~S eotia<;. Ava-
")'vwpi{ovrat an6 tflV napouoia TtPWLI..lWV TtUPI..lcl1WV P OtO flt\eKtpOKUPOLO(pa-
(j)fll..lU. 11 l..lOP(j)OAo;ia twv on:oiwv eivat 6ta(j)openKf] an:6 eKeLVfl -rwv en:apiJ.titwv
P twv napatr)poUIJ.eVwv Kata tfl otapKeta tou <p\e5oKol..lBLKou pu~11ou. Enet6~
TO Kt0Tt0 ep~LOI..LU eLOpX1Ul 010V <pt\e~OKOI..l50 KUl n:poKa,\ei trlY eKTr6t\c.oofl
tou ot KoAn:tKc; KtUKteS ouotoAs aKoAou~ouvrat an:6 IJ.ePLKri avan:AflpWIJ.U-
tLKri nauAa. Eniofls, 11 npWLIJ.fl eiJ.<pavtofl tllS KoAntKriS eKn6Awons oe OtL/1-l~
nou o KoAnoKotAtaK6S K61..lBos l)pioKetaL oe l..lPLKrl avep~tOtfl nepio6o, 11
d!W/'rl tOU KtOTtOU epe~lOI..lUl:O) an:6 tOU) KOATCOUS OtLS KOtAieS LVUL ~pa6ia
IJ.e anot,\eOI..lU 1flV napa-raofl rou otaotril..latos PR. Ot KOA n:tK<; KtaK tes ou-
o-roAs 6ev ananouv eLOLKrl i}epaneia eKt6s eav npoKaAouv otov ao~ev~ 6u-
oapeoto aio~fli..LU rtpoKapoiwv rtaAI..lc.i>V. jtflV nepi nrwon aur~ l..lrt:Opei va xopfl-
/ll~ouv npooeK1LKa avaotoAds toJV 5-aopeVeP/'LKtiJv unoooxwv ( n:.x. rrpo-
n:puvoA6A!l 20 mg X 2-3 PO).

Kot\TttKri -r;axuKapbia

O<peiAe-cat oe Ktono ~lll..lU1ooo-r;tK6 KYtpo ev-rontC61..le\IO oro KOArttK6 I.J.UO-


Kapow.
HA eK tpoKapOLO)'pa<pnua: a) KapotaKr) ouxv6tfl1U>100 ocpu~ets/ Ae n-c6 Kat 5)
Mop<poAo;ia en:apl..lcitwv P ota<popetLKrl an6 KLVfl rou (j)Ae~OKOil5LKOU
PU~I..LOU.
H ouxv6tflta. rwv enapiJ.atwv P avepxe-cat oe 120-250 /Aern6. Otav 11 KoA mKri
<JUXVOtfltU un:ep5ei ta 200 /ATt"t6 1J.(j)UVL{tUL KOATIOKOL/\taKOS UITOKALOIJ.OS
Mnw -rou anoKAeLOI..lOU HJJV KoA TILKWV epe~LOI..lcitwv orov KOA n:oKmt\taK6 K61..LBO.
At na: a )~flt\fl HlP,LUOfl 1.1. OUK 1Ut\i uoa ( 10CLKOS OUK1UAL0LOIJ.OS ), B) j-ce <pavtaia
v6oos, /) PeUI..lUtLKrl KapOLOrta~eta,o) MuoKap6lOrt:ci~eta KUL e)jte<pavtata
vooos.
Gepan:eia. rw TflV UV1LI..L1WTtlOfl tou tO~LKOU OUKTUALOlOI.lOU OlUKOTUtUL 11
OUK ruAi uoa. XOPfl{ei taL KUALO KUL 0 oo~aps Tt-pL ITtoJOlS XPilOli..IOT!OlOUVtal

7
avtLOWI.laia evaVILOV IllS OOKl:UAL no as. Eav oev U~UVIOL 11 OaKIU,AL !LOa ')'La
1:11v KoAn:LKf1 l:axuKapota, 11 Kap6LaKt1 ouxv6tnta l.lTIOpei Ie~ei un:6 .Ae1xo ue
f)epan:al.liAn ( 4G80 mg X 3 PO) ~ OLAna(eun (60 mg X 3 PO) ~ B-avao10AiS
( n:.x. n:pon:pavo.\6An 20 mg X 2--3 PO).

Me f)aOfl "CO 0L~Vtl en:LOflllLOAO/LKcl oeoouva un:o,\O/L(1UL O!L 30.00()..50.000


EAAnvec; exouv 0 Kan:ma ou /llrl 1f1S (wf]c; 10US eu<pavioeL TILOOOLa KOATILKf]<;
1-lOPI-lapu;tis Kat 6u 11 -&vnt6Hl1cl rous eivaL 6tn:Aama cKelvns 1wv U/'LWV ouvo-
unAi.Kwv Ious. 0 entn:o,\aou6s IllS KoAn:tKtlS uapj.lapu;f]c; au~averat 1..1 tnv
,,\tKLa avepx6uevos oe 0.4% o1ous ao~eveic; !lALKias Kaiw IWV 60 eiwv Kat oe 2-
4% o1ouc; aoSeveic; nALKlas avw rwv so e1wv.
H KoAn:LKtl j..lapuaPU/tl o<peiAeiat oe noAAan:Aa Kuuatiota 6t.;epo11s. ra onoi.a
oapwvouv tous K6An:ous ue Ip6n:o aKav6vtoro Kat ouvexws llTal3aAA61.levo.
A.HAeKTpoKapOL01PU<J>oUa.H KOATILKfl l.lUPI.lOPU/tl xapaKTf1pi(eraL an6 LrlV n:a-
pooia XUI-li1AOU UPOUS, j.1Tal)aAA61-lYWV KOL OKOVOVLOTWV K Ul.ltlTWV, TtOU avn-
Ol:OLXOUV 0 KOA TILKtl OUXVOTflTO 400-BOO ava Aen:T6 . H KOLALOK~ OUXVOTf1TO,
e~apniJ11evn an6 111v en:LI3paouvof1 1wv epe~tol.la1wv orov KoAn:oKOLAtaK6 KOI-l-
eo. KUilOlV!0L l.l10{U 100 KUL 150 OqlU{WV ava Aerrr6 KUL LVOL euaioS.rp:11 0
Ul:af)ot\es lOU lOVOU l:OU napaouj.ln:aSf11LKOU KOL lOU OUil Tta~f11LKOU ( Tt.X.
6p~La o1aon 1ou owua-ros. aoKf10fl).
B. KALVLKcl eupOuala. H KOATtLKrl 1.10Pil0PU/rl. 11 on:oia ouvnS.ws OUVOOUL
ota<popec; na~f]oeLs (llivaKa~ 1 ), J,Lnopei va 6taopal.lL aouJ,LrttWI.lO'!LKa va n
n:poKaAeoeL "CflV 1.1<pclVL0!1 TtpOKOPOiWV n:at\j.lWV, 1-lBOAWv 0111 OUOlfli.101LKri KU-

IHvaKas 1. na"'fl0LS OUVOOU01.1VS art6 KOArtLKtlllUPI-lUPU/~ (KM)

Emno\aOilb; n:as-no11s Emn:o\aOilbs KM oe


ae aoS.CVts 1-1e KM (%) acrs-evac; 1.1e Tf1v naS.tlO!l f/q

Peu11anKh f)aAl\&Kil 20-3J 20


KaP\,.\om1&eta

Movnpns Kl'vl 10

KM 1.1e1a an:o "ap&o- <1 3J-40


xeLpoupfi.Kil e n:eu!)ao11

8
Yn:~p~upeoet&~bs 2.5 20-3J

~t<pavtcit.a VOJo<; ED-60 1

AprnpLaKh uneorao11 40-60 5-10

MUOKap6tona~La <1 10-20

Mn eaAet&Kt<; n:a~rpLSU <5 <5

": KM xwpts unoKeiiJ.evn op7avtK~


-~ . na~non
0
: f1ept,\QIJ.eavoV1QL 0 Q,\KoOAlOIJ.O<;, OL {na1apaxec; l:OU OU01fl1.10l:OS U/W/flS, ll
n:E:pLKapO.L UOQ KQL 11 TtVUIJ.OVLK~ eueoA~.

KAo<popia,pu/KOTHLKU)V eneLOOOLWV, ouoaveeias 0111\1 KOTIWOil ri KapOtaKriS QV-


napKeLU<;. To 200/o 1WV aoSeVWV Jle KOATtLKri JlOPilUPU/ri &a ~1.1\POVlOE:l eTt:l-
I
nAoK<;, Kupiwc; aLIJ,o6uvalltKs Kat O//etaKes. Ot npw1es avtLil~l:wni(ovl:at lle
1ov eAe/XO 111s KOLAtaK~S ouxv6t111ac;, 11 e.Aat1won ti1S onoias ouvo6e.ue1at an6 I
au{11on rou xp6vou 1rv; 6taotoA~s Kat Be.Ariwo11 111c:; 6taoloALKriS nA~pwo11s nov
KOLALWV. Bel)aiws. 11 anwAeLQ lOU KOATILKOU AaKtLOilQtOc;, 11 onoia xapaKTflpi(eL
lflV KoAnLKri llUPilUPU/ri Sa npoKaAeoeL eAcitltoOI1 tns KapotaKric; n:apoxris
KUla 20% KQl WS eK tOlllOU TtepLOpLOilO li1S tpUOLKriS 6paOtf'1PLOtf'ltaS Kat 1f'1S
tKav61111ac; ;ta aOKI"JOfl. Ot 6etrcepes otvio1avraL oe ellBoAes "CWV e/KetpaALKwv
Kat 1wv nept<peptKwv aptJlptwv, npoKaAouj.leves an6 Sp6~-t6ous oxn!lan(61le-
vous o1ov aptotep6 K6Ano (ouvfiSws o1o w-cio), nou 0111 ouvexe.ta anoonwv-
laL Kat ewE:pxov1a1 Olfl ouolfll..lauKri KUKAoq:.opia. ITe.pinou 3000 e;Keq1aAtKa
eneto66ta e1noiws ano6i6ov1at oe Sp6!l6ous anoortli>llevous an6 tov apLOle-

fH vaK as 2. Kata1a{11 avuappuSIJ,tKWV q1apuaKtov Kata Vaughan-Williams

Kaunopia IV bolus Xp6vta &epaneia 8epUTt.UUKcl TdTteOU


( rwepflota 66<Jfl, mg) n:Aao~-tatos ( mgjU

lA
-\won: up UIJ.tO f1 2mgjkg 400-600 2-5
- f1 POKQL Valli Or] ews1000 30004500 M3
-KLVLOL Vfl 500-1000 3-6

9
. : .: ._._-

IB
-t\LOOKaLV!l 2mg/kg* 2-5
-Me(LA1LVJ1 2mgjkg* 400-720 0.6-2

Ic
-tAeKaL VLOr) 2mg/kg* 200 0.2-0.8
-ll pona<pat v6v11 450-900

II
- MeronpoM>An 5mg 50-200
-ll ponp avoA6A11 1-10 mg 40-320 0.05-0.1

II I
- /q.tLwoapovn 300mg . 100400 1-2
- ~oraA6,\n 0.~1 mg/kg 80-480

IV
-LiLAnaC1.111 0.25 mg/kg 180-360
-Be pan alliAI1 0.15 mg/kg 120-360 0.1-0.2

p6 K6Ano ao~evwv ue KoArtLKtl uapJ.lUPU/tl KaL ro 1/3 nov ao~evwv ue KoAnLK~


j.lapuapu;~ ~a eu<pavioeL eu5oAs nov nepL<pepLKWV ap-cnpLwv.
r. 0epaneia. H ~PUTtU1LKtl QV1LJ,11WTIL0r'l 1f1S KOATILKrlS j.lapuapu;~s nepLAau-
BaveL:
ahov Ae;xo -ens ouxv6rf1ras rwv KOLALwv.
6) 111V arcoKa1ci01UOI1 -cou <j)UOLOAO/LKOU tpt\e6oKOil6LKOU PU~IlOU, 6TtOU 10U10
eivaL \PLK16, ue 1f1V XOPrl/11011 avnappu~llLKWV <papuaKwv r1 nAeK1PLKOU
P uuaros ( <papuaKeuuKn n f1AeKtPLKrl avata~f1 av-cio-cmxa).
I) 111V XOPrl/11011 avuappu~J,lLKWV q:IUPJ.lclKWV ll OKOTIO 1J1V Ttp6Af1<PI1 tWV UTtO-
rponwv.
6) rnv xopri/11011 avn~pouBwuKns U/W/rlS o-cous ao~eveis nou 6tarpxouv KL v-
ouvo ell~o,\u.;oU. ertLoo6iou.
0 A/XOS 111S 1-\0LALUKrlS OUXV01111US Ol:OUS UO~VLS J.l KOATILK~ J.lUPIJ.UPU/11
ETtL1U/XciV1al ll q:lclPJ.lUKU TtOU Ttl6pa0UVOUV 1J1V U/W/~ 10U epe-8-LOj.lal:OS
orov Ko,\ no"m,\taK6 K61l~O (llivaKac; 2 ). To ouv11~o-cepa XPJlOLIJ.OTtOLOUJ.lVO
<j)UpJ,1aKO L \'UL 11 Ol)'O(i Vf1 ( ouvn~ws 0.5 mg IV, 0.25 mg IV ll1cl art6 uia ri ouo
c.Opes Kat OHl ouvxeta 0.25-0.5 mg PO 111lPI10iws). EneLOrl OIJ.WS f1 anoreAeoua-
nK6rrrra rr)S L vat T!pLOpLOf.lVf1 01UV OUVUT!ciPXL aue110f1 l:OU !OVOU !OU OUj.l-

10
n:a&rrctKou ( n:.x. cioKnon) ouxva Ka&io-ca-cat ava;Kaia 11 eru np6o&e1n XOPrll'TlOfl
avao1ot\wv 1WV ~-aopeVE:P/lKWV UTtOOOXWV (n.x.nponpavo,\6,\r), I.J.E:!On:po-
,\6,\n Ki\n:) r1 av-ca;wvt<nwv twv owui\wv tou aoGeo-clou l.l apvrntK~ opo!J6-
tponq opcion WepaTtaiJ.ii\n tl Oti\ua(E.Iln). T6oo Ol avao-coi\eis 1WV e-aOpevep-
)'lKWV unoooxewv 6oo Kat m avta)'wvto-cs 1wv 6taui\wv rou ao~eotiou ll no pet
va XP!lOLIJon:otn().ouv oav <pcip!JaKa npw-cns eKAo;ns avti TClS bt )o~ivns oe
ao\h:veis IJ. KOA TILKtl IJ.UPI.lUPU/rl Oq)E:Li\OIJ.E:Vll OE: 01E:q)QVlaia VOOO tl UP1TlPLUKrl
unp-caon.
Avci-caen 111s KoAntKtlS IJUp!Japu;ns Kat anoKatcio-caoll rou <pAe~oKo~-tetKou
pu~IJ.OU n:pnet va entxetpel taL 6tav: a) to xpovtK6 btaotClllU nou xet rtap,\-
&et an:6 -cnv e;Katcio-caon 111S Koi\ntKrlS IJUPIJUIJ.Upu;f)s oev un:ep~aiveL to 1
-ros Kat ~) 10 !1/e&os -cou apto-cepou K6t\ n:ou ei vat 1.1LKp6tepo an:6 60mm.
ApXtKa ;tveTat rcpoonti(}eta <papiJ.UKeu-rtKrlS ava-caens J.l 111 XP!lOtl.lonoirwn
avuappu~llLKWV <papJ.ltiKwv IllS Katn;oplas IA (ouvf)&ws Ktvt6iv!l ri
rcpoKatva!li6nLIC (ouvn&ws <pAeKatvlon t1 npona<patv6vn) n III (al.ltw6ap6v!l).
To n:oooot6 enn:uxias avpxe1aL oe 4060'/o, 50-90'/o KaL 70-80'/o avtio-roLxa. ~e
nepin:-cwon an:o-cuxias tllS <papJ.laKeuuKns ava-cae11s r1 6-cav o ao~evns ~pioKe
lat oe at!loOuva!JtKri. ao-ra&eta entxetpei -caL nAeK1PtKri avatacn. -ro noooo-c6
cru-cuxias rns onoias unep~ai veL ro 90'/o.
rla 111 0La1tlP!l011 TOU <p,\e~OKOI.l~LKOU pu(}l.lOU l.l1U arc6 TtLtUX~ <pap!JUKUTlKrl 11
llAK1PLKfl avci-ca~n XOP1"1f0UVTUL av-ctappu&l.lLKU <PUPIJ.UKU TflS KU""Cfl/OPia<; fA
(ouvn&ws Ktvtbivn r1 npoKatva~.tibn). IC (ouvn&ws <pi\eKatvi6n r1 rtpona<patv6vll)
~ I I I ( a~.tw6ap6vn r1 oo-cai\oi\n ). An6 -ra n:poava&ep~v-ca, -ra av-ctapp u(}lltKci
111) KClt!l/OPLas _IC aVtV0LKUVTat 0 ao&eveis IJ. Ol:E:q)UVtaia v6oo rl OUO-
AeL 10up;ia 111S aptotepi)s KOLi\iac;, evw 11 aj.lLWOap6vn 1J.<paviCet Tr)\1 l.l')'ai\ Ute-
Pil arto-ce,\01.lU1LKOLrll:a. H toetKOtCltU !JlS tei\eutaiac; ( <pW!OeUULO&ClOLa, oep-
IJ.U!LKQ \av&f)j.lata, flTtUUKfl 0UOi\LtOUp/iU rl JlTtati"tLoa, TIVeUIJ.OVLKrl LVUJOfl,
ve upoiJ.uona&eta, 6tatapaxs cnn Aet 1oup;ia tou &upeoet6ous) el vat IJ.tK p~
6-cav !l CliJ.ePtlOLa 6.0011 0V UTtp~ai VL ta 200 mg.
0 KLVOUVO) 1J.~OALKOU TtLOOOLOU 0 ao~eveis IJ. KOi\rttKrl j.lapi.J.aPUT"ri eeap-
l:Cll:Qt an6 1!1\1 unoKeiiJE:Vfl v6oo (fiivaKac; 3).
l
IIivaKas 3. ~ivbuv_os e1.1Bot\ris Kat ent6paon avttrt!lKLLKrlS aj'trnns oe ao(}eveis
I
1\0;\n:LKfl IJ.UPIJ.UPU/rl

Karrnopia ao&evwv Ki v6uvos eiJ.~oAns Eniopaon avu nnK nKris


(%jav&pwno1Cl) aj'W/rlS OtOV KL vo uvo
Jl~oA~s (% eAcinwon)

11
::-_"_::...____:"

BaABtOLKrl KapoLOrrciSew
-Pt:UIJ.UUKrl <HeVW<Jfl 1'4-ln,\os (>5) EAa-c-cwan (4-72)
IlL 1POLOOUS
- AA'Aa peu1.1anKa ai na Me-cptos (2-5) fiL&avr1 eAanwan

KoAn:tKrliJ.UpiJ.UPU/rliJ.E. 14-lnAos (>5) Et\Cnwan


L010PLK6 E.IJ.BOALKOU
en:ewooiou

ITpiv r111e1a an:6 1'4-lnAos (>5) EAanttl<Jf1 ( 0-1 oo)


ava-ca\n

Movflpns Ko\mKti IJ.UPIJ.apufti


-n,\LKLU < 60 HUV MtKp6s(<1) Ka11~iu
-n,\tKLU > 60 1CUV MeraAos (>5) EA ci n wa 11

KoA n:LKrliJ.UPIJ.OPU/rli.J.eta Metptos ews uwnA6s ITt&avri eAanwon


an:6 Kap6wxetpOUP/LKrl (2-8) I
I,,
en:e11Baan [II

in: epS up eoetOL<JI.J.OS Me-rptos ews uwnA6s


(2-14)
ITtSavn eAcntwon ~
rl
;"!

AV1l Tl:r)KUKrl U')'W/rl IJ. KOUIJ.OPLVLKU OV1L Ttr)K1LKU ( n:.x. ~aptpapiVf'l ri UK.VOKOU-
1J.Up6t\n) OTtO 10 0101.10 TtpTtl va xoprpei 1UL 0 6AOUS 10US ao&eveis 34 eeoo-
IJ.UOeS n:pLV KUL 34 ~001J.UOS 1.J.1U an6 tpapi.J.OKE.U'tLKrl rl flt\.K1PLKrl ClVata~n
KUL XPOVlWS oe .KLVOUS 1..1. pUIJ.CltLKrlS Cll !LOAO)'lUS KO'ATILKrl I.J.UPIJ.UPU')'tl. fta
trW l..l.r'l pUI.J.U!lKriS Ol!LOAO/LOS KOATtLKrlllOPIJ.UPU7rllOXUOUV ra eef)s:
a. H Sepaneia 11e ~ap<papivn (ent&UI.I.f'lt6 INA=2,0-3,0) npot\ai.J.Bavet 31 E./K-
tpat\tKa TILOOOLU ava e-ros ava 1000 ao&eveis. To &epan:euuKO KOO'tOS eivaL
3 OO~apec; ULIJ.OPPU/LS ava tOS OUIJ.Ttptt\a1J.~OVOIJ.VWV 2 .')'KE.tpat\LKWV ULIJ.Op-
PO/LUN.
B. To IJ.)'a'A(nepo-wtpeAos an6 -cnv &epaneia 11e Bap<papivn napa-cnpei-cat orous
aoSeveis rrou ow-cpexouv au\n11vo Kivouvo e1.16o'ALKOU erretoobiou. ~e aurous
rreptt\ai.J.Bcivov-rat OL aoSeveis IJ. L010PLK6 n:apo6u~ou r1 IJ.OVLIJ.OU ')'K<paAtKou
en:etoooiou. oui.J.tpopnuKr1 Kap6taKri aven:apKeta, oaKxapwon ota~rrcn. ou1raon
TOU OPL01:pOU "Ot\TtOU KUL OL f1t\LKLC.OIJ.VOL.
')'. 0 KlVOUVOS 1J.BO'ALKOU TILOOOLOU 0 aoSevei<; flt\LKiac; KUtW l:UJV 60 1WV IJ.
JlOVriPil KOArtlKfl IJ.UPI..lOPU7rl (KOATILKrl IJ.UPI..lUPU/fJ llr'l O<petAOI.leVf'l 0 OP/U\'LKri

12
Kapowna~e.ta) e.l.va~ IJ.LKp6s. Os eK rot:rrou oe..v ouvwtatat 11 XOPrl/11011 Bap<pa-
PLVJlS o-,;ous ao~e..veis aurous.
;. H aontpiv11 (325 mg rw.e..pr,oiws PO) n:poAa11Bave..t 15-20 /Kf..<J)aAtKa en:e.w6-
0La ava eros ava 1000 ao~e.veis. To ~e.parceuuK6 K6oros oe ooBapes aq.top-
pa{ie.s e.ivat lltKp6H.po an6 e.Ke.ivo l:flS Bap<J)apiVflS.
e.. 0 Kivouvos oo5apns aq..toppa1ias e.ivat tbwite.pa au(f11J..vos ota n:oAu 11A~KL
WIJ.va atOIJ.U KUL OtllV OIJ.CtOa autri to nt.Sav6 ~pane. Ul:LKO W<j)Aos arr6 1:11
xopr)/fl01 Baptpapi VflS ev6e..xo1.1..vws va unot\e.i net at tou Kt vouvou 1.l<PUVLOflS
Ull.lOPPU/lKWV em rtt\OK WV.

Ko.\rnK6S n:repu(LOilOS

0 KOAn:tKOS n:tPU/tOI.lOS 0\1 tVUL ouxvn appU~IJ.LU. Av KUL 0 rtLrrot\aOIJ.OS l:flS


au(ave..t 1.1. tflV 11AtKia oev <paive.rat va une..pBaive..t 10 15 %a oe ato1.1.a !lALKiac;
70 el:WV ri rceptao6H:po.
q KoA n:tK6c; rrte..pu;toi.I.6S o<peiAel:at oe IJ.OVfJP1 ri noAA anA a KUIJ.ata 6t.;epo11s
~ e.(anAou1J.Va KUKALKa otov oe(t6 K6Ano. H appu~1.1.La autri 1.ltpaviCe.tat ouxva
oe na&r;oe.ts n:ou npoKa.\ouv l.l.flXUVLKri Katon6vrwfl 1wv oe{Lwv KapotaKwv
KOLi\QtlltWV (o~eia KUL XPOVta TtVUIJ.OVLKfJ Kapoia, OU{(\'L~ Kapbwna~Le~
,. K,\n:) Kat IJ.ta an6 /Xtprioetc; avoLKtf)s Kapotas. ~uxva 61.1.ws an:ol:e.,\ei ll1.1.0-
vw1.1.vo etlP!lllO oe. ao.Se.veis xwpic; op[aVLKrl Kapowmi~eta. ~uvf)~ws 6tapKei
flllPS, e5001J.UO<; rl KUL IJ.tlVS KUL f1 napo\UOI.lLKfJ 1J.<pciVLOfl \.lLKpac; OLUPKelUS
autotep1J.alL(01J.vwv en:etoooiwv oev ei vat ouvfl~I1S. 0 xpovLOs KOA n:tKOS rne-
PU/tOI.I.OS K<j)Ut\iCetOl 0 KOArtLKrli.I.OPI.lUPU/rl.
A. HAe.KtpoKapOLOJpa<poua. ITapol:flpei 1at KoXmKf) 6paotflpt61"rlta ouxv6tr]"tas
250-350 /Aen1:6 (ouvr).Sws 300 I Aent6). H KmAtaKr) ouxv6tr]ta e\aptatot an6
rov. Ba~1.1.6 tou KoArtoKotAtaKou an:oKAetOI.lOU . 0 -ceAeutalos e.Lvat ouvri~ws 2:1
(ouo enap1.1.ata p~:)to Ka.Se OUI.I.rtAe;1.1.o QRSJ 1.1. artoteAeo1.1.o 11 ouxvore.pa ave.u- I
ptoK61J.Vfl KOLAtal<f} OUXVOtfll:O va LVUL 150 Otpuee.ts/t\1!!6. l:

B. KAtvtKa e.upriuata. 0 KoA rtLK6s nte.pu;toi.I.6S I.I.Tiopei va npoKaAeoet alo&n-1.1.a


n:poKapOiWV n:ai\llWV, OU{KOTtUKU TtL000La, UTtOtUOfl KOL KUPOLUKfJ aVaKon:r)
~
ill
oe ao~eveis 1.1. KoAnoKOLAtaKri o;w;n 1:1, UKOA!l K6nwon. ouonvma Kat I~
OUIJ.'POPr'lttKri KapotaKJi avenapKeta. 2uvf!Stl ai na n:ou n:poow&erouv orr1v il
li
1.l<J)UVLOfl KoAn:tKOU n:tepu;tol.lOU eivat o un:epSupeoetOLOIJ.OS, 11 n:veu~-toVLKrl lj
.1J.~Ot\f1, 11 t..:a ravuAWOr'l aAKOOAflS KUL OL KOPOLOXLPOUP/LK.S Tl:f..IJ.BetOLS. /I
,III
0e.pun:eLa. H ~e.pan:euuKri avu\.l1"oon:toq rou KoAmKou n:1"PU/LOI.lOU xet Jj
L

ll/UA(nepes 6UOKOALS an6 KlVr'l 1f1S KOArtLKrlS IJ.UpiJapu;fts. rta tOV eAe;xo !i
1:
TflS KQL,\tUKflS OUXVOU}!U'), ep;o OUXVU OUOXPS. TIL01PU1UOVtaL l:a lOla
<pap~UK a n:ou XPflOLI.l0110LOUVTQL KQL Ol:flV KOA TILKfl IJ.OPI.lUIJUP U)'rl ( Ol )'O~L vn.

13
avaoroAcis -rwv 0-aopcvcp/LKWY un:o6oxwv, ~epan:alliAn. 6tA na(1-!n). 2e
av-ri.~011 llE. 1:11Y KoAn:tK~ 1.1aP1.1apu;~, 11 XOP~/11011 avuappU~IlLKWY <papl.lciKwv
1WV Ka111/0PLWY I A ( KL VLOi Yl1, TIPOKat Yal.llOfl ), IC ( <pAeKatVl011, n:pon:a<paL YOYI1)
Kal r II (U1.1LWOap6VI1) on:aviws an:oKa~to-ca "'COY tpUOLOAO/LKO <p,\e60K01.1~LK6
pu~IJ6. o -re,\eu"Caios an:oKa~io1a-rat o1o 5G600/o rwv n:eptn:1ti>oewv ue 1:11 xp 11 -
0LI.1on:oirwf1 evos vou avnappu~l.ltKou <papuaKou, HlS t~ouu,\i6!ls. f1 onoia
ci vat 001.1LK6 avaAo;o 111s oo1aA6Af1S xwpis ouva-r61fl1a an:oKAetOilOU nov ~
aopevep;tKwv UTtOOOXWV.
~e rtepi rt1WOfl an:o1uxias 111s <pap1.1aKc unK~S ~cpan:eias e<papl.16(c-rat -caxLa
KoA rttK~ ~f11.1a-ro66-rnon. ~e end /OUoes n:ept nniJoets ~ eni an:o-ruxias -ens KoA-
n:tKris Bnlla-ro66-r11o11s areaL -rei 1at !lAeK!PLKri ava1aefl.
fta 1f1V np6Ail~Pil rou KOATttKou rt1epu;tol.lOU xoprpouvtat avuappu~IJLKa
<papuaKa 111s Ka1fl/Opias IA (Ktvtoivfl, 6toonupaui6!l. rtpoKatvaiJ.iOfl), tf1S Ka-
unopias IC ( <pAcKULVLOf1, rcpona<pVOVfl) KUL !fl<; Katf1')'0pia<; II I ( UIJLWOap6vn,
ooraA6An )( lli vaK a~ 2 ). I otai !PI1 n:poooxf) an:anei rat 6rav XOPil/'ODvraL IJ)ap-
IJUKa twv 6uo n:ptinwv Ka-rn;optwv, 6t6tL oe nepin1won un:otpon:~s 1'11S appu~
uias llrtopei va n:poKaAoouv KoA noKoLALaKt1 a{W/'~ 1:1 Kat ll/aAn au~non tns
KOLAtaKris ouxv6rn-ras. To rho o<pei.Ae-raL eire oe erct~paouvon rns KOA TtLKf)s
6pao-rnpt6-rn-ras IJ arcorAeoj..la n:eptao6rcpa epe~ioj..lata va 6tpxov1aL an6
1ov KOA n:oKOLAtaK6 KOil~O rcpos tLS KOLAies ei -ce oe UIJOfl rcapaouun:a~oAu-ctKil
opaon 01'0V KOAT!OKOLALaK6 KOj..l~O OUVOOUOIJVf1 an:6 Ttl1clXUVOf1 1flS KoAno-
KOLALaK~S U')'W')'~S.
~ 0UOKOAS TtcptTt1WOLS, 6-cav 11 <papiJUKU!LKtl a')'W/tl 0V Xl 1:0 avaiJ,e-
VOj..leVO anor.\cOila anat rei tat eTiellBa-rLKtl -&eparteia. H teAeutaia ouviola-
rat oe Ka1aA uon ( =eAe/XO~evn BAaBf'l) ll Ka~er~pa rou KOA rtoKotALaKou
KO!l~ou aKoAou~ouj..levn an6 tnv ej..l<pu-reuon llOYli.LOU l3nllato66-rn. TeAeu-cai.a
c<papj..l0(1at KalciAUO!l j..l Ka~e1f1pa 01'f1V TtPL0Xrl 10U oeeLOu KOATIOU "CflY
a<popt(61JeVf1 lleta~u tou Katw tl.lilllatos 1ou oaKtuAiou -ens tPL/AliJxtvas Kat rou
010jlLOU 111S Kcl!W KOLAI1S <pA~a~ j..l tl'l XPilOLIJ.OTtOLilOJ'l U<!,llOUXVOU pUIJ.Ul:OS
( radiofrequency ablation).
TAos, 11et6ri orov KOArttK6 n:tePU/LOIJO, oe avti~eon 1.1. tnv KoArtLKrl 1-lUPIJ.a-
PU/'ri, un:apxet OUY!OVLOIJ.Vf1 KOAT!LK~ ouoroAf), 0 KLVOUVOS OXf'lJ..!aUOilOU ~POJ..!
I)wv oto oeeto K6Arto Kat 11PL4>PLKWV ciJ.BOALKWV TtLOOOLWV eivat j..lLKPOS. Os
eK rot:n:ou Ol:flV. appu~IJ.ia au-cr; 6ev arcal1ei taL fl xpovia XOP~'/''1011 avtt Tt!l-
KUK~S U)'W)'fl).

~uvoeoLKs raxuKapoies

E1.1<pavi(ov1at owv eKt6s arc6 rn <puoLOAO/LK~ o66 U/W/riS tou nAeKrptKou


epc~iOI.I.UtOS UT1UPXL Kal aAA!l, 11 OTIOia rcapaKcliJ.Til:el TIJ~Ila ri Ot\6KAI1Pll tr)V

14
<pumoAO/tK~ ooo. H n:apouola -cns en:tn:poo&et!lS n:apaKaiJTit~ptas ooou Ol'Vet
1!1'V 6uvat6tflta 0 eva epe&toiJ,a va KUtd&eL an:o tous K6Anous OtLS KOLAie)
(op~OOPO!lll U)'W)'~) an:6 tr]V tr]V IJ,ia 000 (OUVfl~WS tr]V <pUotOAO)'LKtl) Kat Otfl
ouvE:xew va avE:A~eL an:6 n s KOLAies otous KoA n:ouc; ( avtiopOI-\11 a)'w;f]) an6
tr]V aM!l 000 ( OUVrl~UJS !fJV napaKaj..ln:tr1pta). H ouvexns rtavciA!llP11 tOU rrpo-
ava!pep&E:vros KUKAou f']i\KtPLKrlS opaotrjpt6trrras OVOIJU~etat enaveiOOOOf
Kat exeL WS an:oteAOj..la tr]V Ote;epor] K6A TIUJY KUl KotAUiJY 1-l 1-l/UAfl ouxv6-
tr]ta.
H n:apaKaj..ln:tf}pta o66s 6-rav ouvoeet tOUS K6Anous 1-l ns KOLALE.S (KoAnOKOL-
,\taKf} oo6s) j..ln:opei va npoKaAE:oet KOATtOKOLALUK~ tUXUKapoia, evw 6-cav
ouvoeeL tOUS K6An:ous j..l tOY KOAITOKOLALUKO KOI-\130 (KoAnOKOIJ5LKtl o66c;) KOA-
TIOKOtALUKtl KO!-ti3LKrl taXUKUpOLU.
A. HAeKtpoKapow::rpapoua. KoAnoKOLAtaKt1 napaKilrttf}pta o66s aveupioKetat
oto ouvopOIJO Wolff-Parkinson-White, to onoi.o ava;vwpi(etat an6 ta e. ens r]AeK-
-rpoKapOLO)'pa<ptKa eupf]IJaTa E.IJ<pavtC61Jeva Kata trl 6tcipKeta 1ou <puotoAo;tKou
<pAeBoKOIJI3tKOU pui}IJOU:
a) Bpaxu (o.os sec) 6tcioTfliJa PQ, Ao;w taxeias a;w;ns tou nAe.Kl:PLKou epe~i
OIJatos an6 !flY napaKaiJ,ntr1pta o66.
5)K61JI3UJOfl (1\UIJ.U oAta) OtO UPXLKO tllrliJ.U TOU QRS, 6rH.lLOUP/OUIJVIl an6 npc.i.ll-
I.Hl eKn6Awo11 tns nepLOxf]s tou KOLAtaKou IJUOKapoiou, Ol:f'lV onoLa KataAri;et 11
napUKUIJTI!tlPLU OOOS.
;) Llteupuvor) tou OUIJTIA/'IJ.U'tOS QRS (otapKeta >0.11 sec), n 6u1pKeta 1:ou onoi-
ou ei.vat av'-ctotp6q>w<; avaAo;n 1ou 6tao'trillatos PQ.
6) Lltatapaxes !flS avan:6AWOI1S (n:twon ST KUL avao!poq>f} T).
Ot ao~eveis 1-lE. ouv6poj..lO Wolff-Parkinson-White 1-ltpUVi(ouv ouxva TtL06ota
KOATIOKOLALUKrlS tUXUKapoias KU!cl tr] OlOPKLU tr]S OTIOlClS r] opi}oopOIJ.fl U/W/rl
I
j
;L ve-rat an:6 rov KoAnoKOLALaK6 K6J.LBo Kat 11 avtiOPOIJ.f'l an:6 -rnv n:apaKUJ.lft!rl-
pta o66. 2uc; neptntcboets autes to KUIJ.a 6e,\ta e~aq>aviCetat Kat to oul.ln:Ae;IJ,a
QRS ei vcu 01:ev6 Kat a !fl OUIPKLU tr]S appU~J.lLU<) . 2TIUVLWS, tO epe~LOI.I.U KUtcl
Tf'l otapKeta -cr]s KoA rtoKoLALaKr1s -raxuKapoius aKoi\oui}el avtli}e-rf'l an6 rnv
I
:,
i

npoavacpep~eloa 6ta6po1J.r1 ( op&66pOIJ'1 a;w;r1 an:6 tnv n:apaKUJ.lTI!flpla o66


KUL av-cLoPOIJ.Il an:o tov KoA n:oKOlALaK6 K61.lBo) IJ. an:otE:i\eo~-tu !flY 6teupuY<Jfl
tou cru~-t nA: J'l-lUto<; QRS, to on:oio o-rnv ouoLa avuormxei oe :'Va ~-te;aAo "0~-ta
oE:A ta.
Ot ao~ev eis llt: 1\0A n:oKOIJ0LKrl napaKnJ,lntf)pta o66 1JlpuvL~ouv ouxva en:eto66w
Ko,\n:oKOLAtah.f'lS KOI.l0LK~S -raxuKapOLas Ka-ra t'l otcipKetu tf1S on:oias 11 op&6-
0POilf'l U/UJ/f'l )'lYtUL UTTO Tr]V KUVOYLKrl KUL '1 UVtiOpOIJf'l UTTO TflV ftUPClKUIJ,-
ITTtlPLU o66 IJ.c ano-rE:Aeolla tnv aveupeof1 otevou QAS.
Tooo f1 "oAn:o~-.oL\LaKr1 6oo Kat n KoAnoKotAtaKJl KOIJBLKrl -raxuKap6ta J.lq>a'YiCouv

15
1:a eens xapat-:HlPtouKa:
-KapOLaKtl ouxvcrrrrca 13G250 O<pUCLS ava ,\ern6.
-A Vl:LOl:OLXia ev6s KUj.tal:OS p 0 Ka~e ou~.mA)'1.la QRS ( ouxva l:a Kl)IJ.al:a p 6ev
ei vat 1-J.<pavn I
- ~-ra-3-ep~ ouxvonna ouj.nrA/'I.lanov QRS
- ~1:ev a oul.lnA /1-J.al:a QRS ol:flV n,\et()(Vfl<pia 1:wv nept rnwoewv. Ta oul.lnA/'1-J.a!a
QRS ~a eivat eupa 61:av: a) npourrapxet ri 1.l<paviCel:at 1-J. HJV au(non l:fl<;
KapOLOKrlS OUXVOl:fll:a<; OKALKO<; anoKALOI.lOS rl ~) r'} op~60p01-J.r'} U/UY/rl/'lV1UL
an6 l:r'}V TiapaKai-J.Til:rlPLa Kat f1 aVl:lOPOI.lfl an6 l:flV KOVOVLKrl 000.
H 6ta<poptKtl 6ta)'vwon l:r'}S KoA noKmAtaKrlS an6 tr'}v KoA noKmAtaKf] KOI.I.~LKfl
1:axuKap6ia 6ev eivat euxep~s. H napouoia aveo1pa1-J.1.1.vwv enapi.J.al:wv P o1:o
1-1oo 1f1S an6oraons 1..1eraeu ouo 6ta6oxtKwv oul.lrrAe/'I.I.O:rwv QRS r1 n aveupeofl
na,\at61:epou flAK1POKa.p6to)'pa<pnl.lal:oS rou ao~evous 1..1 eup~1..1a1:a ouv6p6-
l.lOU Wolff-Parkinson-White OUVfl)'Opei )'La l:flV napouoia KOATIOKQL,\taKflS l:UXUKap-
6ias.
B. KAtvtKa euprJua1a. To ouvn~eo1:epo OUI-J.Til:WI.J.U eivat ot npoKap6tOL naAiloi, ot
onoiot ouv~~ws apxi.Couv an6tolla Kat ouxva ouvo6e uovrat a no npoKapoto
a.\ ;os. CaAn r1 ou)'KorrnK6 erreto66LO.
r. Gepanda. H UPXLKrl UYUI.l1"WTIL<Jfl VOS TILOOOiou KOAT!OKOLAtaKflS fl
KOATIOKOLALUKrlS KOI.J.~LKllS !UXUKapoia<; rreptt\aj..l~aVL XLPLOI.J.OUS TIOU aueavouv
10V 10VO tOU napaOUI.J.TIU~flUKOU KUL Trt~paOUVOUV !flV U/'W/'ri Ol:OV KOATIO-
KOLAtaK6 K61JBO (Valsalva fl IJUt\a{fl !OU Kapto!LOLKOU K6Anou) KUL eni ano-ruxias
11"1 XOPrl/'flOfl a6evooiVflS (0.1-Q.2 mg,lkg N fl ~epanal.liAflS (IHvaKac; 2) ev6o-
<pAe~iws.
~ous ao~eveis 1-J. un6taofl )'ive-rat avataCfl ei-re IJ tn XOPrl/'flOfl r'}AK1"PLKllS
KKVW<JflS rl I.J. UTIPKPWl:tKrl KOATILKtl ~fli.J.U!OOOtflOfl, OflAaofl IJ ~fli.J.Utoo6-
!fl0fl ouxv6tr'}tas I.J./'aAu-repr)s an6 eKeivn tr'}S appu~j..lias. H &epaneia eKAo;ris
otous ao&eveLs l.l ouxves uno-rpones eivat n Kataorpo<pri (KatciAuon) tns
napaKa~-J.rrrflptas ooou IJ U$iouxvo pe uj.la.

KotAtaKS appu~uies

~1flV Katfl/'OpLa au1ri avflKouv m appu&llies OL Ofli.J.LOUP/'OU1-J.VS 01:0 KOLAtaK6


1-J.UOK apOLO.

KOLALaK s K laKtes ouol:oA s

OpoKaAouvrat uno tflV npti>t.I-J.!l eKn6Awofl 1-1ias KOLAtaKr1S eonas Kat ava)'VtopL-
(ov1at arro l:fl\' napouoia eupeos OUIJnA/'1-J.Utos QRS Ka~ws enLons arr6 rnv
aKo,\ou&ouoa tflv K1UK1fl ouo1oAn rrAflpfl avanAflPWI-J.UtLKrl rrau,\a. Ot KotAta-

16
. .-:. ~._.-_- : .~ _: ~

K~ KtaKt~~ ouo-roAs, 6nws Kat OL KoAntKS oev ananouv etotKri ~epanda


Kt6<; eav npoKai\ouv OtOV ao-3-eVrl OUOUP0t0 aio~rlJ.l.U Tif)OKapoLwv naAI-llOV.
~IllY TIf)L TitWOfl UUTrl 1J.TIOpi VU XOPfl/fl~OUV Tif)OOKtLKU UVQOTOAeLS 1'WV 5-
aopeVf)/LKWV un:oooxwv ( n:.x. n:pon:pavoA6Afl 20 mg X 2-3 PO).

~uvn~ws an:ote,\ei e.ru nAoKfJ -rou o{os 1-i<PPci/~-Latos rou 1-iUOKapoiou. XapaKtfl-
pi(etat UTtO tr]V unap{fl upE:oov OUJ,1TtA/J.1UtOOV QRS OUXV01'fl1'US 6().120/ ATIT6.
Kat avra{oovL(etaL to cpAe13oKOIJ.I3tK6 pU~!l6. EtotKfJ ~epaneia oev an:atteirat
ot6u A61w tfls xa!lflAns ouxv6tfltas oev n:poKaAei aq.wouvaj.nKn ao1a~eta.

~uvri~WS 1-i<PUVL(1UL 0 ao-3-VLS IJ. Op{UVlKrl KUPOLOn:a-3-eta (f!LvaKa<; 4) KUL


IJ.Ttopei ya npoKaAE:oet entKivouvn /La trl Coon aq.10ouva1JLKrl aota~eta, ocpet-
,\6~-Levfl oe e,\attWOfl -rns KapotaKf}s napoxris. To ouxv6-repo ai no KOLAtaKriS
1UXUKapoia<; LVUL fl 01'tpUVLUia VOOOS, U~UVOIJ.Vfl /LU 1'0 75% tWV TIPLTI1'W-
OWV.

lli.vaKas 4 Ai na KOLALaKf}c; -raxuKapoiac;

~tecpavtaia v6oos
MuoKap6wna~LS
- TneptpOtplKri
-dLU1Q1LKrt
-flplOplOl:LKtl

BaABtoorca~ete s
~U//VlS KUpOlOTicl~lS I
. ~UVOPOIJ.O IJ.UKPOU QT I
~

A. HAeKtpOKapotcrzpacpoua. H KmAtaKf} 1UXUKap6ia XUPUK111PL(1'UL an:6 1f1V u-


I
II
nap{fl tptwv 11 nepwootpoov otaOOXLKWV eKtciKtoov KOlAtaKwv ouotoAwv 1.1 l
ouxv6tflta IJ.c;aAtrcepfl an6 120/Aent6. 2uvli~oos np6Kettat /'La pU~IJ.LKrl taxu-
Kapoia l-1 Ol:U~ePrlS 1-iOP<POAO/LUS eupu QRS (1-!0VOI-LOP<Pfl KOLt\LaKri tUXUKapbia)
KUL At{6tepo ouxva (ouvf}~wc; OtO o{u j.l.tppa{IJ.U 10U IJ.UOKapoiouj /'LU tUXUKap-
bia 1.1 aKavovLOtrl ouxv6-rrp:a Kat IJ,eral3aA,\6J.lVflS ~-!Op<pot\o{ias eupu QRS

17
(not\ lll.lOP<PI1 KOLAtaK~ l:UXUKapoia).
H n:apouolu Upeos QRS ouv~(}ws OLUXWPL(L li1V KOLALUK~ uno ano ti1V UTiep-
KOLALUK~ (KOt\TIOKOLAtaK~ ~ KOATIOKOLALUK~ KOI.l~LK~) tUXUKUpOLU. LlLU<popoOta-
)'VWO!LKcl npo0Ar1J.Lata npoK unrouv 6tav eJ.l<PUVtorei unepKOLAtaK~ raxuKapoiu
oe ao-&evr1J.Le npounapxovra oKeAtKo unoK,\etOJ.L6 ~ 6tav eJ.L<pavwrd ,\enoup-
/LK6S OKeALKOS anoKAeLOIJ.OS. ~US TIPL TIHOOLS UUteS l:a napaKtirw UP~1.1.a1a
OUVI1/0POUV {LU ti1V KOLt\taK~ n:poet\e U011 ti1S 1UXUKapoi.ac;.
a) Me{at\o eupos QRS (>140 ms).
0) Me1aA11 an6KAto111ou a{ova np6s ra oe{ta r1 ra aptorepa.
!) ITapouoia KOA n:oKm,\taKou otaXWPLOI.lOU ava')'VWpt(61J.evou an6 UJV un:ap{l1
en:api.J.cl'LWV P. ota<popenK~S ouxv61111as an6 eKeiVI1S -rwv QRS.
6) Yn:apc11 Kot,\taKwv ouo-rot\wv an6 ouAAI1tPfl ~ an6 ou')'xwveuo11. AJ.L<p6-repes
OtpeiAov1aL 0111V oiooo KU1U 111 OLUPKLQ 111<; taXUKapoias KOt\ TILKOU epe&iOI.lU-
10<; 6ta11eoou tou KOAn:oKmAtaKoD KOI.l~ou ons KmAie~. l.le anoreAeo1.1.a ei Ie
111V 1.l<PUVLOI1 tpUOLOAO)'LKOU OUI.lTIAe')'l.la'LOS QAS (oDMI1<PI1) ei1e eupeos OUI.l-
n:Ae)'l.la'LOS QRS ota<popeUK~S l.lOP<POAO')'ias an:6 1a TIPOI1/'11(}evra, 10 on:oio
ocpeiAe1at ev 1.1.ePeL o1o KoArttK6 Kat ev 1.1.epet o1o KmAtaK6 epe-&tolla (ou)'xw-
veuol1)
e) H an:6KAwn nvv OUI.lTIAe')'l.lCt'LWV QRS eivut tl iota oe oi\es ns npoKap6teS ana-
/W/S ( UPV11!LK~ rl -&e1LKrl an:6KALOI1 0 6t\eS US ana)'W')'e<;).
01) ITapouoia RSr' Oti1V V1 Kat QS otnv VS.
B. KAtvtKa eupOuata. Ecaprwvtat an6 tflV ouxv6t111a ti1S appu(}llias Kat 111v
Aet tOUP/'LK01111a tou IJ.UOKapoiou. ~tflV nt\etoq>rltpia 10N ao&evr.Ov 11 KOLALaKrl
1axuKapOia npoKaAei l.l')'UAI1 eAa1tWOI1 ti1S KapoLaKiJS TtOPOXrlS KUl KUKAO<pO-
PLKrl Ka1an,\11cia.
r. 0epaneia. 01aV UTIUPXl ULIJ.OOUVUIJ.LK~ aota(}eta KQl UTI01UOI1 anaL tei 1QL 011-
011 11AeKtPLK~ avata{l1. ~to us atl.loouval.ltKa ora(}epous uo(}evei.s xoprnei tat
At00KQLVI1 (apXLKU 1mg,lkg IV Kat 0111 ouvexeta 14 mg,/min IV) Kat TIL ano-ruxias
a11tw6ap6v11 ( apxtKa 150300 mg IV Kat or11 ouvexeta 1 g IV ev16s 24 w~wv ).
fta ti1V n:p6AI1tPI1 1wv un:o,;ponwv ananei tat 11 Ka1anoA1.1.11011 ti1S unoKeil.leVI1S
op{aVtK~S KapoLOna(}etas ( n.x. aoptoote<pavtaia napaKal.l<PI1 oe ao~eveis 11e
o-recpavtaia v6oo Kat 1J.UOKapotaKr1 toxatl.lia) .. 01av 1ou1o 6ev ei vat ouvat6 (n.x
unotpomaCouoa KOLAtaK~ -raxuKapoia oe ao(}ev~ lle toLOn:a(}~ owrauK~ ~or.uo
Kapotonti(}eta ~- LOXatl.ltK~ IJ.UOKapOLOTia(}eta) XOPI1/L taL XPOVLWS aiJLWOOap6VI1
Kat e{etU(etaL 10 VOXOIJ.VO 1.l<PUtUOI1S UUlOI.lal:OU KapOLOI.l1atponea-am-
VLOW1~.

18
~uv~~ws 1J.<paviCe-cat oe ao~eveis ll op;avLK~ Kap6LOnci~eta eL1e npw-co;evws
t1 WS UTI010,0IJ.U KtpUALOj.lOU KOLALUK~S l:UXUKapOias. np6KL1UL {La xatiJO!l
KOLALUKO j)U~IlO KU1U l:fl 0LUpKLa 10U OTtOtOU KU!ap;eitat 11 OUVtOVLOIJ.Vfl
ouon:aon 1WV KOLALWV Kat ll KapbtaK~ n:apox~ llf10Vi(taL. fta tr)V aVUj..l100-
THOfl lf'lS an:atei tat UIJ.011 11AeKtPLKtl avcita\11 (200400 J) Kat en:i ano-cuxLas 11
ecpc;tp!lO/rl Kap6toavan:veuottK~S ava{wo;6Vf'lOflS.

l
)

!
rl

19
a. ilA0H~EI~ TOY IlEPIKAPAIOT

O{eia n:epLKapoiuoa

ITp6KL rat /La oeeia <pt\ji.J.OY~ tOU nepi tOVOU Kat tOU rtepwrrAU/XVLOU n:eniAou
rou neptKapoiou. Ta ai ua rrou npoKaAouv o{eia neptKap&i no a avajpa<pov-rat
o-rov IHvaKa 1. Avw tou 50% -rwv neptn-rwoewv ocpeiAoYtaL oe l.ltao-rauKou<;
O/KOU<;, t6wn:a~r1 neptKapoi uoa, vecpptK~ avenapKeta Kat l)aKtflPLOtaK~
Aoi1.1wen.

Ili VaKac; 1. Ai na oceias neptKapoi uoac;

-KaKOfl~flS 0/KOS
-I OLOn:a{1~s n:eptKapoi no a
-Oupatuia
-BaKl:flplOtaKtl Aoii.I.WCfl
-AVtLTiflKl:LK~ U/'W/tl
-L1taxwpwut<6 aveupuo1.1.a aopti}s :I
- Ia-rpojevns
-NOOfll.lU1U10U OUVOC::UKOULOtOU
-~UVOPOI.lO l.l1cl KapOlOl:OIJ.tl
-Tpauua
-4 u1.1. a-r'u.oor)
-AM. a
AKnvol)oAia
<Papl.laKa nou n:poKaAouv ouvopoi.J.o
epu~nl.l.atloon AuKou
M UCQLOfll.lU
XuAoneptt<apoto
~ uvopoi.J.O Dressier
MUKflUUOLS
AIDS
-------------~--------------------------------,

A. KAtVLKcl eupoua-ra. Ot evapKttlPLS KOflAWOLS -rns ocdas TtPLKapoinoas I


n:otKiAouv. ~e optotJ,evous ao~evelc; 11 v6oos apxiCet ~opul)wows Kat
UVU/VWpi{!UL an:6 l:flV napouoia l:OU xapaKl:flPLOUKOU n:pOKUPOLOU TIOVOU KUL
-rou rixou -rptl)qc;. 2e aAAouc;, ta ouJ,lnttiJI.lata arrououiCouv Kat n v6oos
UVU{VWpi{etat ruxaia, ei-re an6 US !lAK1POKUPOLO)pa<ptKr; KOflAWOLS rl an:6

j
i
HlV napouota TtpLKapOLUKOU U/POU OrflV UKUVO/PU<pia ~ciJpaKa ~ ro
llXOKapOLO/Pcl<Pfll.la. TAos, OXL onavta, 11 oceia TtptKapoi uoa KOflt\Wvc rat l.l
Kap6taK6 entnw11ano116 (oes napaKarw), o onoios A61w rwv OLO/KW!levwv
ocpa1L uowv, l.lrtOpei va eKAfl<P~ei Aav~ao1.1va oos o{eia KapotaK~ avenapKeta.
0 n6vos rns O{eias TtptKapoi no as i Vat OTtLO~OO!pVLKOS ~ npOKclpOLOS l.l
avravaKAa011 orov apL01p6 tOI.lO ~ 10 apL01p6 xept KOL V10VO!POS or11v
towna~r) an6 6n on1v oupaq.uK~ r1r11v KaKo~~ous at uoAo1ias neptKapoi uoa.
lota:t rep a xapaK111PtouKa -rou n6vou rns oceias neptKapoi uoas, ra orwia Kat
rov OLU<poportOLOUV an6 rov LOXaLI.lLKO novo, ei VOL 11 l.l/clAil 0LclpKLU rou, TtOU
J.mopei va 'fl~i:wet Kat fll.lPS, ws Kat fl eni raor) rou 1.re rrw Ba~u1 etonvor), tllV
t\fll!Jfl 111S unna<; ~OilS KOt US TIPL01pO<p<; rou OtOI.lOrOS KOL l.l 1flV KaraKALOfl.
H OV up0fl r)xou tptBr)s O!flV 0Kp6aon r!lS KUPOLUS an01:Aei na~O/VWI.lOVLKO
Ofll.leio o{eias neptKapoL uoas. 0 r)xos rptB~s aKOU/1at ouv~&ws apwrepa Kat
oe{ta napaorepvtKciJ<;, o-rnv nepwxr)rou rpirou Kat tou traprou IJeoonAeuptou
oworr)l.latos, ouxva OIJWS 1i verat avuA11nt6s oe oA6KAflpo to npoKapoLO.
,A noreAei rat an6 ouo (ouoroAtKr) Kat oworoAtKr)) rl1PLS (ouoloAtKr), otaotoAtK~
:Kat TtpOOUOtOALKJl) OUVLO!WOS Kat l.l0Lcl{L IJ. tOV rlXO TtoU TIOPU/!UL an6 TO
'nepnarnl.la 010 XLOVL. 0 nxos tptBns IJTIOpL va eivat napootK6S KUL va OLUPKL
opto1Jves c.Opes ~ va owpKei rn1pes.
B. Ep-yaoroptaKa eupquata., HAet\"TPOt\"ap6to'}'pdrp!Jpa .l1nv oceia <paon
1J<pavi{!UL avaonaon lOU STOUS llPL0001PS UTIU/00/<;, Kr6<; an:6 US AVR
Kat V1 ous onoies IJrtopei va rtapa1npn~ei ntci.lon 1ou ST. MeptK<; fll.lpes l.leHi
rnv vap{f1 tflS OUI.lTttlOI.lOrOAO/lOS n:apUlflpL rat Titorpo<pf) rou ST OUlV
wonAeKlPLK~ /PUI.lJ.lrl, ouvo6eu6J,lVf1 ,an:6 errtn6ooon r1 avaorpocpfr rou
enapiJalo<; T. EB6oiJaOS r1 JlrlVS ap76repa napatflpei rat anoKarao1aon roov
IJelaBoAciJv rou T. 10 onoio 7ivetat Kat naAL ~etLK6.
Atc:"TtVOJ'parpia ,9a)pa;.a .l1nv aveninAeK111 o\eia neptKapoi"noa, n aKttVo)'pacpia
~ciJpaKa 6ev exet OllJlUVtLKrl ota/VOOOUKrl a\ia. Av Ol.lWS unapxet IJ./fiAn out\Ao7n
n:eptKapotaKou U/pou, napalllPei 1aL IJe')'aAoKapoia n:ou ouvn~ws oev
OUVOOU!UL an:6 OUJ.1<pOpfl011 lWV TtVUJ.10VLKtOV TIUAWV . .lrll.leia UTIOKelJ.1VJ1S.
v6oou ( rr.x. KapKi vos nveuJ,1ova) .
ff..l'OKOI)OtO?Pcitf'!Jf./Cl l:,.ev un:apxouv LOLKcl llXOKUPOLO/PU<pLKcl UPJll.lOta O\eias
n:eptKapoi uous. flap a taura, 10 llXOKapoto/pacpniJa anoteAei rnv Jl~ooo
eKAO/rlS /La .!flV UVU/VtOPLOJ1 TIPLKOpOtaKrlS ouAAO/rlS U/POU.
r. EtOLK5 UOQ({l5 O\Las TIQLKapoiuoas. J:aKOI/t9!J VOC71/f./Ol'Cl To ouvn&otp0
ai UO TtPtKUP0lUKrlS ouMO/rlS U/POU 01LS Tta&oAO)'LKS KALVLKS ei VUl l:U
1Jeraot01LKU VOn:AaOJ,1U!O. IlptiJto<; 0 OUXVO!J1tU tVUL 0 KapKiVOS l:OU
TIVUJ.10VU (330/o) 1\UL aKoAou&ouv 0 KOPKiVOS !OU JlOO!OU (25%) KOL ta t\Jl!pWIJU-
l:U ( 15%).

2
____ ',------- .

!c.Sto!lcl!9tjf !lepu.apoizu5a A v Kat 11 e mK parouoa avrtt\114>11 t.Lvat on np6K et rat


)'la LO{Ve<; v6oqj.la, p{aOtllPtaK~ Ttt~e~aLWOfl 1f1S l0/VOU<; at UOt\0/tar;
Ka~io1arat ouvatt11l6vo {ta ro 15-200/o nov nept nrwoewv.
H na~r1011 ouvn~ws owpKei 1-3 e~ooj.laoes, eviote OllWS rcepwo6tepo (3-6
el36o!lcio.es). l'rco1pones naparf1pouvrat 010 15-300/a rwv ao~evciJv Kat llTIOpei va
1-l<j)aVtOtOUV 1-LE.XPL Kat 15 XPOVLa ano U]V nptinn KOt1t\won trlS v6oou. H
nt\ewv61111a (900/o) rwv ao}}evciJv napa noveL tat /La novo 010 npoKapbto ouxva
ouvo6eu6j.levo an6 KaKoota}}eoi.a Kat nupe16. AK1tvo;pa<ptKE.s evoei.\ets
heptKap6taKr1s Kat n:t\eupL1LKrlS out\,\o;ns u;pou aveupioKovrat oto 5Jllo
nepi nou rwv ao}}evwv. Kap6taK6S en:t TIWIJ.aUOIJ.OS IJ.Tiopei va ej..l<pavwrei oro
10% rwv nept nrciJoewv, evw oe opta1J.E.vous ao.aeveis anavtatat ouvoo6s
llUOKapOi ttoa, an:oret\ouoa ai UO appU~j..l.LWV.
0 apxtK6<; ep)'aOtf1ptaK6<; et\e;xos rwv ao~evciJv o<peit\et va neptAall~civet e\eraon
/La \OU01PWILKCt QVUOWj..lU'ta Vavtiov 1WV ttOV Coxsackie f?, Coxsackie A, ECHO
Kat Influenza. 0 avwrepw, npenet va enavaAall~civerat ll10: an6 IJ.PtK<;
el36o!lcibes. 0a npenet enions va ;ive1at et\e;xos rou nepto1auKou /La
ll uK6n:t\ ao IJU.
AotpalO!Jf !lepo;apolrt6a Ta ai tla 111<; AOll.lWOOUS TtptKap6i no as QVU/Pcl<j)0\11Ul
orov IH vaK a 2. H KALVlKrl tK6va e\ap1arat an6 ro ai no Kat tnv avoooan6-
Kptof1. ~e opta1J.ves neptrnwoets 11 n:pool3oAr1 rou n:eptKapoiou napa1J.vet
UO:UIJ.THWIJ.UILK~, VW 0 at\t\e<; OUVOOeU1Ql an6 ~OpU~WOtS KALVLK:<;
KO!lAWOlS ( TLX. Of1q>aq.tla, Kap6taK6S TilJtWIJ.UUOIJ.O<;).

IHvaKa<; 2. At ua AotJ,lWOOUS TiePLKapoi ttoa<;

IwoeLS (Coxsackie A, Coxsackie 8, echovirus, influenza, adenovirus


Epstein-Barr, QV1J.UAO/lcl, $l10KKOOOfl, AIDS, naponi uoa,
i\OLIJ.WOflS IJ.OVOTIUpf)VWOfl)

M u K06aK "tflPLOLaK s ,\oqlW~LS (M. tuberculosis, M. aviun,


M. intracellulare)

IT p ono{ wa (toxoplasma, E. histolytica, T. cruzi)

M u K ll n a0 e L s (histoplasma, coccidiodes, blastomyces.


candida, aspergillus]

BaKtflpLoLaKes Aoq.tro~eLS (staphylococcus, streptococcus, Gram(-) 13ciKtAAot


meningococcus, pneumococcus. salmonella, brucella. Legionella,
Campylobacter, H. influenzas, Lyme]

!
I
-.. .
- --. ~- -~ -- -~---- -~- -

PLKl:OL000LS

JlapaoLl:WOLS (tpLXLVWO!l, XLVOKOKKtaO!l) Jl


:_1 1

'
Ava p 6 ~La (clostridium, anaerobic streptococcus) '
lj
1

AL d cpo p a (Nocardia, Actinomyces, Mycoplasma,


Psittacosis-lymphopathia venereum group)

Ovpotj.lu.:"!j TlcfJtl(opoirt6a EJ.l<pavi{e1at 010 15% 1:wv ao{)evwv l.l ve<ppLKrl


aven:apKeta n:ou un:ol)ai\Aov1at oe nept1ovatKrl ouit\uon r1 ati.LOKa{)apoll. H
n:apouoia n:eptKapoi uoas 010US ao~VLS autous xeL l.l/clAfl KALVLKrl Of]J.laOta
a<pou: a) Mn:opei va OOfl/rlOt oe Kap6LaK6 en:t n:wJ.la1LOI.l6, 13) En:tl3apuvet 111v
Ka1ao1aon 1wv un:O<f.lfl<piwv /La J.ll:aJ.l6oxeuon ve<ppou KaL 1) Mn:opei va
;n;poKaAoeL aL~.to6uvai.LLKS 6tal:apaxs Katci l:fl otcipKeLa 111S n:epnovaLKtiS
';~tcit\uons rl111S aLI.LOKci~apons .
.PclltfOlt!<:'lj Tlcf)tAi:ljlrPiltOa 0\eia TIPLKapoi uoa 1.L!pUVL{tUL OUXVcl 0 ao{)eveic;
l.l PU1.LU1LKS rca~i)OLS (n:.x. O\US PUJ.lU1lKOS TIUP10S, PUI.LU10LOf]c;
ap~pinoa, t\uKos Kt\n:). Mn:opei va OOI1/'rlOt oe Kap6taK6 enLTIWJ.lUUOI.l6 r1
OUJ.lTIL01lKrl TIPLKapoi UOU .
.Af'clcf.lfi'P07J.IOltlaillePtKopoirt6a EJ.l<pavi{el:at ei 1 Kata 1:11 otcipKeta tllS o\eias
!pcl011S lOU J.l<ppU)'J.lUlOS lOU J.lUOKapoiou (n:pOOLJ.lll J.lTJ.l<ppa)'J.lU1LKrl rcepLKap-
oi uoa) ei 1 IJ.1U an:6 10 fll.lPS WS 2 J.lrlVS (O<f.ILJ.lfl J.l11.LIPPU/'J.lUtLKri
TIPLKapoi no a ti OUVOPOIJ.O Dressier). H TIPWLIJ.Il J.l't1J.<ppa)'J.la"CLKrl TIptKap6i noa
oev n:poKaAei Lotai 1epa OUJ.lTI'tWJ.lata Kat ouvi]~ws oev ouvooeue1at an:6
TIL n:AoKs. Avti~ela, to ouvopoJ.lO Dressier, 10 on:oio n:apa1flPi -caL oto 1-30/o
"CON ao~evwv J.l ~.t<ppa)'J.la 1ou J.lUOKapoiou, ouvooeuetaL an:6 n:poKapoLo novo
Kat TIUp1:0, J.lTIOpl 0 va 00r]/'rl0L 0 ITPLKapotaKi] OUIJITL0fl KUL KapOlUKO
TIL TIWJ.la"CLOI.LO.
Jvvopopo f.lcld r.;opotoroptj ITapa""Cnpei "Cat 010 5-300/o 1wv ao{)evwv, 10 I'll..! pes ews
21Jrives J.lta arr6 Kapowxetpoup)'tKri en:pl3aon Kat KbnAwvetaL 1..1 n:poKapbw
novo KUL TIUP16. a neptKapoLaK6S rlXOS lpLl)i]s anoteAei ouxv6 UP111.LU- H
rcci{)rwn J.mopL va OOrJ/rlOL oe KapbtaK6 en:LTIWIJ.a"CLOIJ.6, totai tepa otous
ao{)eveis n:ou ~\aJ.Ll)avouv avnn:nKnKa.
'Vf.IOlud6tlf acpu...-opoirt6a ~rli.J.pa anoteAd aouvn~es ai uo o\eias
fCPLKapbi no as OtOV l3LOIJ.11XUVOTIOLI'liJ.Vo KOOI.LO. To 1/3 tWV aoi}evwv l.l
IPU1.LUUW011 ITPLKapbinoa, naoxet an6 f[VUJ.LOVLKrl <pUJ.lU!LWO!l. H

4
6ep1J.OUV1LOpaoq Mantoux 1J.T10pei va eivat apvrp:tKtl 010 10% 1wv ao-&evwv ll
<Pu11a1iwon Kat 010 50% nov ao-&evwv IJ.t: AIDS Kat pUIJ.U1iwon. H pUIJ.antobfls
ITptKUpOi tLOU 0 UVU10V VU 00'1/1l0L 0 OUIJ.ITl0UKtl ITPLKUpOL 1LOU KUl
KapOLUKO TIL T1WIJ.Utl01J.O.
Y!lorporrtti(OI./00 ff6jJt/(0jJOirt.Otl ~u:vr1&ws jJ.tpUVl(t:1UL IJ.1Ct arro LOLOrra&r1
TtptKapbi uoa, KUPOlOXlpOUP/lK<; ITJ.l~UOL<;, 1pUUIJ.U1lKtl ITPLKap6Ln6a KUL
1JppU)J.lU 1ou J.lUOKapb'tou. ITepi nou 10 20-28% twv ao&evwv 11 o{eia
neptKapbi uou &a 1J.pavioet uno1porrr1J.lXPL Kat 15 )<p6vta arr6 10 UPXLK6
enewobto. Ka1a 111 ouipKeta 1wv uno1ponwv ot ao-&eveis .napouotu(ouv
TtpOKCtpOlO novo Kat nuper6, Vl0 0 rreptKapotaKOS tlXOS !pt~rlS, 11 n;eptKapOtaKrl
out\AO/rl U)pOU Kat tu !lAK1POKUP0LO)'putpLKUUpf)1J.u1u 'IllS o{eia<;.
n:eptKUPObttba<;, ouvf)&WS anoUOLU(OUV.
/a-rpo)'cVJjf !leJJtKap6in6a 0\ei.a neptKapOi uba J.lTrOpei va rrpoKAn-&ei an6
tpUpiJ.UKa (avn TI!lKUKCt, LVWOOt\UrtKa, T1POKatVUIJ.L011, Kt\TI ), UK 11 vo-&epaneia KCU
ta1ptKs npa(ets (1ono&er11on Ka&etflpa crus Kev1ptKs <pt\Bes, J.lptheuof1
~I'UlUJOOQ1'1 rl UU101JU!OU KapOLOj.l1U!pona UTtLVLOW1f!).
D.. 0eparreia. 0 npoKapbtos novos avrq.te1wrri\erat apxtKa IJ. o-cepoet6t1
UV1ltpt\)1J.OV00011 (n.x. aontplVfl 650 mg PO KCt-& 46 wpe<;) Kat 0 TtplTI1W011
enq.wvri<; ll onwuxa (n.x. IJ.Op<pi vn 10-15 mg IM Ka-&e 48 cilpes ). ~e nepi n-cwo11 WI
LKaVOTt0Lf)1LKtlS aV1UTIOKplO!lS <HU n:porpOUj.lVa XOPf)/OUV1Ul 01POL0rl ( n:.x.
npebvt(6vf1 20 mg PO 1pets pop<; 1nv flllpa /La 4-5 fl1J.pes Kat O!fl ouvxeta 20
mg PO buo <pop<; 1'1V 11llpa )La 4-5 nJ.lpes 10 mg PO ouo <popes tnv f11J.pa )La
I

4-5 n1J.pes, 5 mg PO ouo <popes tnv fll.lepa )La 4-5111Jepes Kat ll1a btaKon:f!) .
.H apxtKrl av1tllto'Jn:wn twv urro-cponwv ouviora1at o-c11 XOPrl/11011 IJ.Il otepoetbtiJv
avn<pA/IJOVooboov <papj.laKwv. Auo-cuxws OllWS noAAoi uo-&eveis av-cunoKpivov-rat
. 116vo o-ca o-cepoetbri, n 66on 1wv onoi.wv IJ.1il tnv upXLKrl o6ort ecp66ou ~a
npenet vu "Kpanetat" KU1W an6 7.5 mg flllPrtOiws Kat eav n:apao1ei ava)Kil va
xoprnouvtat entn:poo&e1ws llfl o1epoet6r1 avn<pA/IJ.OVWOfl ri Kat ornouxu.
EK1et\eort n:eptKap6tK10J.lrlS ev6eiKVU1at o-cous ao&eveis eKeivous o1ous
onoious ei 1e ei vat u6uva1n 11 6taKonf) twv 01epoet6wv J.le1a uno 6-121lt1ves
-&epan:eius ei te 1J.<pavi(ov1at ern n:AoK<; ota 01epoet6r1.
Tet\oc; oe Ka~e nepi rnwofl o{eias n:eptKapbi uoas npenet va ava\rt1a1UL Kat vo.
UVtlllW10Jn:i(TqL tO UTCOKeikt,eYO ai UO (Tt.X. O.VtL<pUIJ.aUKrl 0./W/tl Otf1V cp Ulla1ltlJO!l
n:eptKupoi uou ).

~ul..ln:LeonKri nepLKapo(nba

O<pei,\e-cat oe ou!J.nieort ttl<; Kapbta<;, ,\6)wivwon<; 1ou n:eptanAci/XVLOU Kat -rou


rrepi 1ovou nccuAou tou neptKapoiou. 11 onoia 1ln:o6i(et 111v otaotoAtKri
n,\~pwo11 twv f...OtAtwv. Ta o.i na tllS oulln:teottKrlS n:eptKapoi 1:toas ava1pa<povtat

J
otov ITivaKa 3.

ITi VaKac; 3. Aina OUil TtleOUK~S TlePLKapoi no as

A )'vwota
AKuvoBoi\ia
Mr1 ettnK~ neptKapoi no a
Xetpoup[LKes eHellBaoeLS
t\OLIJW{eLS
Noo~llata ouvoenKou wtou I 1,'

Oupaq.tia
~apKOeLOWOr}
TpUUIJU
1> U llU1lOJOr}

A,,;Kt\tVLKa eupOuata. Ot ao-&eveis ava<pepouv nppooeunKa enLOetvoulleVfl


&uonvma Kat Konwofl. ~1flV KALVLKti e{etaofl OLantottilvetaL OLataofl twv
a<pa;l:uol\3V ~e ~el:lKO on~eio Kussmaul ( = au{flOfl tflS <pt\el3LK~S n:ieOflS Kata 1fl
OLUPKeLa l:flS eLOn:vo~s) KUL l1ePLKapOLUKOS nxos (pericardia! knock), UKPOWIJeVOS
apw-cepa napaotepVLKWS Kat oe an6o1aon.0.09{).12 sec an6 tov Oetnepo
KapOLaKo -c6vo. H au{f10f11f1S nieons 01f1V Ka1oo Koit\fl <pt\el)a n:poKat\ei
fll1Ul:Oile/at\ia Kat 11nauK~ ouot\euoup{ia Jle aoKi1fl, iK1epo, epu-&fll.la nov
nat\UIJWV KQL OLOflllU l:OJV aKpoov.
B. Ep7aotopwKa euptiua1a . .&leKrpo/l.apO!oJ'pOfJ1tl(ti eup!jpara EivaL l.lfl eLO.LKa KaL
ouvio1av1aL oe QRS XUI.lflt\ou ouval.lLKOU, /eVLKUI.lVfl avaotpo<pil1ou enap1Ja1os
T Kat 1J<pavLofl IlL tpoeLOLKWV ertapJ.llltWV P. Kot\ rtLKri l.lUPIJapu)'rr 1J<paviCetaL 010
30400/o twv ao-&evwv.
AKrt VOJ'j)Of/ia r9alpaKa To Jle[e-&oc; 1flS KapOLac; l.lTtOPi va eivaL A.al:tOOJ.1Vo,
<puatot\o[LK6 ~ au\rwevo. Aol)eo1:woetc; o1:o TtePLKap6Lo napatflpouvtaL o1o 5QJ/o
Kat rtt\eupntKes ou,\t\o[es o1o 600/o 1oov ao-&evwv.
Atpoouvapo.-ti eUjJ!jpara ITapal:flPi l:QL au{flOfl Kat e{iOWOfl l:OOV OLaOtOALKWV
rueoewv l:flS apLot_eP~S KaL l:flS 0\LUS KOLt\ias, l:flS llOf1S Ttl0flS l:OU oe{LOU
KoAn:ou Kat l:flS !lOflS TttOflS evo<pflvwoflS 1:wv rtVUI.lOVLKWV tPLXOLOtiJv. H
KUI.latOI.lOP<p~ TflS n:ieofls o-cov 6e{L6 K6t\rto xapaKtflpi\el:at ano l.l/UAfl au\nofl
1:wv Ka-&6owv x Kat y ( Ofll.leio M), evw fl KUJ.lal:OJ.lOP<Pri l:flS rtieoflS Ol:flV apLol:ePil
Kat l:flV oe\La "mt\ia e~.t<paviCet l.le)'at\fl rtpwtootaotoALK~ Ka&ooo, aKot\ou-&olll.leVfl
ano en:L n:0.0JOfl ( Ofll.lLO 1:1:pa[WVLKrlS piCas rl dip-plateau)
1/.to;..apoto,-vpafi'IJPtZ Ta eup~Jlal:a eivat l.lfl eLOLKa Kat fl Kl:LJlflOfl rou n:axous 1:ou

6
n:eptKapotou, ouxva OV eivat ouvatri )'La TXVLKOUS t\6)'0U<;. H OLarapax~ OH]V
otaorot\LKrl nt\ripwon rwv KOLAtwv ava;vwpi{erat an6 rnv an6TOJ.l!l otaKorr~ rns
npwrooworoAtKriS Kn-ru\ns Kat tnv otaotoAtKri entnowon tou onwSiou
tOLXWJ.latos 111s apw1epns Kott\Las. H Kcrrw KoiAn <pABa eivat 6ta1e-raj.levn Kat
01flV e{1:0011 Ooppleo.fl K Uj.lQ101J.Op<pfJ IllS POrlS Ol:lS lliTartKS tp,\~S IJ.OLCL{t IJ.
a;(AtK6 /PUJ.lJ.lU W.
Y!lo.,fo)"tOrtKti a(oVtl(!j a(ovuaj ropo)p'a(j}iaKat J.IO/V!Jftl(tj ropo)"pafJ'itz M us
ouo aures i:exvtKs KUIJ.CL1at ro naxos Kat anoKaAurrrovrat rrt&avs aoB01:.0-
oets 1:ou neptKapoiou. Orav ro naxos 1ou TIptKapoiou unep~aivet. ta 4-6mm o
aoSevn11e ra npoava<pep-3-ev-ca Ki\tvtKa Kat ep;aotllPtaKa eupf]IJ.ara, entl3eBat-
tiNetat n Olcl)'VWOil :tns OUjlTCI:OttKf]S n:eptKapOL uoas.
f. t)'pQ OUUITL0UK0 ITQLKapoi no a. ilp6KL tat /La LOtai 1Pfl IJ.OP'Prl OUJ.lTIL0tLKrlS
n:eptKapoi noas OTflV on:oia OUVUTICLPXOUV ouAt\o;f] TiePLKapOtaKOU U/POU KUL
ivwonrwv ouo n:eraAwv 1ou neptKapoiou . .luxva aina U/PrlS OUIJ.TiteOTLKtlS
n:eptKapoi no as eLVUL 10 veon:AaOIJ.Uta, 10 VOOf]iJ.ata 10U OUV01LKOU L010U, 11
. aKnvo~oAia, 11 tbwn:a~ns n:eptKapoiuoa, ot BaK1flpt6taKs Am~-tc.O{ets Kat n
tpUiJ.UtlWOfl. Ta atiJ.OOUVQj.llKU upf)j.lara TflS U(pi}S OUJ.liTL01lKrlS TIPLKapoi no as
}JOLCL{OUV 1..1 et-.eiva tOU KapotaKOU eTILTIWIJ.Ul:lOIJOU (oes napaKU1W), aA,\a J.11U
1flV TIPLKUPOLOK.V1flOi1 /LVOvtat napoj.lOLQ lle KelVQ TflS OUIJITL01LKrlS
TteptKapoi noas.
11. &apoptKO OLCL"YVWOQ U1aeu OUUTIL01LK0$ n:eptKapoi no as KQL nepLOQLOllKOS
b1UOK'dp6ton6.Setas. H rceptoptoTLKrl iJ.UOKapown:a~eta IJ.TIOpei va n:poKaAE.oet ra
iow OUIJ.TI1Wilata J.l -crw OUJ.lTCteo-rtKri rceptKapoinoa. Haveupeon n:axuvons -cou
neptKapoiou oro nxoKapotO/PU<Ptl!la ti oe tOIJ.O/Pa<PtK6 et\e;xo ouvn;opei unp
TflS napouota<; OUJ.liTL01LKi}S TtPtKapoi no as. AV (La AO)'OUS tXVLKOUS oev ei VOL
. 6uvar6s 0 UftQ,\O)'tOJJO$ tOU naxous tou rteptKapoiou, 11 OLQ(j)OplKrl OlQ')'VOJOfl
')'ivetat ll eVOOKUpOLUKrl ~LO<t,~La.
E. 0epaneia. Ta bt6UpflnKa IJ.<j)avi{ouv neploptOIJ.VI1 an:o-cet\eo1J.auK6trrra. H
opwuKti &epa neia rns ouiJ.nteonKf}s neptKapoi no as ei vat n neptKapoteKtOI..lrl
( ano<J)i\oiwon rns Kapouis ). H en:1.1Bao11 xet -&v11t61111a 1 0-15% Kat evoeiKVU1at
oe ao&eveis euptoK61J.evous oe Aet toup')'tK6 ota?LO I I I ri IV ouJ.l<pwva 1.1 ta
KPL rf}pta TflS New York Heart Association.

KapotaK6s e nt nwllattollOS

ilpOKLtaL )'La OUIJ.TIL0fl 1tlS Kapota<; art6 out\AO/rl U{pOU !leOa 01:11V TIPLKOp0LOKI1
KOLi\6tf1Ta, 10 onmo ejlnooi~eL tflV 6taoroi\tKrl nt\f}pwo11 -cwv KOLAttilv. Ta ai na
rou Kupotat-.ou errt rtWIJ.UttOilOU ei vat rrapOIJ.OLa Kei vwv rqs OU\.lTiteouKtiS
n:ept1--upoL no us.
A. Kt\tVLKa eupnHa-ca. H raxeia /KU1iwrao, KapotaKou errtrtWIJ.UUOJ.lOU ocpeit\e!at
7

'l

j
c
ouvr;~ws oe evooneptKapotaKri atiJ.Oppa/ia ( 1pau1J.aUo116s. 6taxwptol16s 1flS
aop-cris ri KapOLOXetpoUP/tKri eTI11Baofl). H KAtVLKtl etK6va ous oxeuKS
nept nniJoet<; xapaK111Pi(e1at an6 autrwev11 <pAeBtKri nieon (ota1ao11
o<pa/i nOWV ), TIHOQll 1r]S ap1flptaKJi<; TileOflS KatjlLKPOKapOia IJ. ~U~L01fl1a
KapotaKwv 16vcov ( 1pta6a 1ou Beck). A v1i~e1a, 01flV ~paoeiu e/Karao1aon
KapOtaKOU e TIL TIWI1aUOI10U, OTIWS au1ri n:apa1flpei 1aL 0 UO~VeLS 11
rra~oAO/LKa voori11a1:a ( n:.x. KUKOrl~ll v6oo, oupat11ia KAn) 11 6ta-raofl roJV
o<pa/i uowv ouvooe ue1at an6 11e/aAoKapoia o<petA611eVfl oe 11e/UA11 ou~Ao)'f]
U/POU, <pUotOAO/LKrl apHlPLOKrl TILeOfl KUL <pUOLOAO/LKri eV1UOI'] KapOtaKOOV tOVWV.
XapaK1flptonK6 eUPfllla 1ou KapbtaKou en:t TIWIJUUOIJ.OU anore1\eio .napaoo{os
o<pU/IJ.O<;(=e,\anwor]11lS ouo1o,\tKrlS ap1flptaKf]S n:iOflS > 10 mmHg 0111 btcipKeta
1flS eLOTIVOriS ), eiJ.!pUVL{011eVOS 0 11000016 IJ./UALI1ePO 10U 90% 1WV aO~VoJV.
llapaootos o<pu;116s 11nopei va 1J.<pavto-cei xwpis vu un:apxet Kap6taK6s
eiTLTIWJ..laUOIJOS Oe ao~eVelS 11e XPOVta UTIO<ppaKUKri ITVUIJ.OVOITU~ta,
1J.<ppafl..LU Oe{LaS KOL~ia<;, TIVUIJ.OVLKri 1J.~Ot\f] Kat OUI1ITL01lKri ITPLKapoiu6a
(ll1J.OVWIJ.ves n:ept n:rc.OOets).
a
B. Epa010ptaK up0ua1a. HAef.'1POKOpO!OJ'pdr;JJJjla Mil LOLKU UPtli1U!a. I
A!(l"tVOJ'POf!'ia ,9rdpa;;-a <I>uotOAO/LKri ri IJ./aAoKapoia 11 an:ouoi.a OUIJ.<pOpflOfl<; twv
TIVeUI10VLKWV n:ut\wv.
j
AtpoouvaptKOf e...fe)'JO~ H nieo11 o1ov oe{t6 K6Arro eivat n:ap61J.Ota IJ. tr]V li
(
evoorreptKapotaKri n:ieofl. H KUIJ.atOIJ.OPIPri tJlS n:ieons tou oe{tou K6~rrou
xapaKtJ1Pl(tat an:6 Ota1flPflOfl !flS OU010ALKrlS Ka~60ou X Kat IJ/UAI'] eAattWOfl ri
e{a<paVLOil 111s 6tao1oAtKris Ka~6oou y. H nieon evo<priJ.l.WO!lS rwv rcveu!lOVLKWV
I
'i
~

1PLXOLOWV eivat rrap6110ta jl KLVfl tOU oe{LOU K6Arrou. Ot Otao-coAtKS Ttte0l<;


1f1S aptotepf]<; Kat 111S O{ta<; KOLAias eivat auenllVS Kat ota iota rrepi TtOU
eni n:eba, arrouotaCet 611ws n napatJlpODI.levn 01:11 OUI1TtteotLKrl rreptKapbi no a
rrpwtobwoJoAtKri Ka~ooos (dip). To KAao1.1a e{w~nons 111s apto1epris KotAias
ei.vat ouvf]:&ws <puoto,\o)tK6 aAAa 11 KapotaKri rrapoxn eivat eAa1tWj.levn. Me1a
l:flV TtptKapOtOKeV1flOfl Kat !flV UTtOIJclKPUVOf) "COU neptKapOtaKOU U{'pOU, 11
VOOTtPLKapotaKri TtL0f), n rtieon 10U O{LOU K6Arrou Kat f) n:ieon VOtpf}vwons
tWV TIVUIJOVLKQlV 1PLXOLOWV TUotptpOUV ota lj)UOtOAO/LKcl TILTI0a.
HJot.,..apotOJ'pcif!'lltftZ EKt6s arro tllV rrapouoia 1.1/aAns noo6tntas rreptKapotaKou
u;pou llrtopei va !"tapatnpnp~ouv ta aK6Aou~a: a) Autnon 1wv 6tao1aoewv -ens
oettas KOLAias Kat eAanwon twv owo1aoewv tns apto-cepf]s KOLAias o111v
etonvori. B) ~ u~omteon -cou oe{tou K6A rrou, 1) E{a<pavton tns KOLA6-cn-cas tf}S
oe{ta<; KOL\ius o-cnv npwto6tao1oAf], o) Autnon tns pons tns -cpt/Awxtvas Kat
eAanwo11 111s pons tns Jlt tpoetoous 13aAI3ibas otnv etorrvori. e) ~tataon tllS Kcnw
KoL\ns q:>Ael3as. o-c) ~U11rtieofl10U apLOtepou K6Arrou Kat 0 ~UIJ.nieor]-cr]s
apw-cep!lS KOt\ta<; <Hil btao-coAf].

8
' . . . . . ---.-. ----- '--~- ---------

r. 0epa.n:eia. H ~epaneia 10U KUPOLUKOU TIL TI<.OIJUUOIJOU e(ap-r:a-r:at an6 111V


13apU1f11U tflS KUtU01UO!lS KUL tllV UTIOKE.iiJE.Vfl atuo,\o)'ia. Otav UTIUp)(L pa;oaia
entoei vwon IJE. IJE.!ciAn ntwon tns aptnptaKflc; nleons ( n.x. tpauiJatLOIJOS oto
~wpaKa 1.1 aLIJOTIE.PLKapoLO), anattei -rat cq..te.on E.KtAe.on ne.ptKapbtoKvtnons.
. E<p' 6oov n K1\LVLK~ Katao-raon rou ao~e.vous to e.nt tpnet ( n.x. toton:a~~s
n:epLKapoi UOU fl OUVOpOIJO IJE.ta an6 TIPLKUPOLKt01..1Jl) IJTtOpi va /lVE.L
n:poona~eta ouvtnpfltLKrlS avn!Jetcimwns IJE. KOPttKoo-r:epoetofl, n:avtote 61-1ws
Katw an:6 tnv auotrlPr1 napaKoAou~non tou ao-&evous Kat oe xwpo 6n:ou
UTIUPXL ll ouvatOtf11U U1..10f1S KtAeons TtPLKUPOLOKvtnons. 0-r:av n
UTl:OKtiJVf1 au:ia tVaL U/VWOtfl, IJltOpei va ;i VE.L llXOKUpOLO/PUtpLKU
Katen~uv61Jevn n:ej.nKap6toKvtnon.oe ouvql)aOIJOIJ 6tabep1J.tKt113to$La tou
neptKapoiou. Av 1..1oa oto n:pc.Oto tPLrlllE.PO IJ.E.tci tflV an:ollciKpuvofl tou
TIPLKapotaKOU u;pou n:apatflpfl~i vea ouA,\0/rl nepLKUPOLUKOU U/POU > 100 ml ,
en:tl.)cit\,\et(:u 11 OI'JI.UOUP/lU TIpLKUp0taKOU n:apa~upou ( ei t XLpoup;tK ei 1 IJ a
6ta6epl.llKrl n:eptKapown:AaonKil) j.J.e oKon:6 rnv n:apoxete uon -rou
n:eptKapoCaKOU U/POU OtrlV UTt(WKOtLKrl KOlt\6tnta. l nepi TitWO!l n:ou
napatnPn~ei vea aut\t\o!fl u;pou ato n:eptKapow-n:apa r11v eKret\eon
napa~upou-~a n:pen:et va ;i vet oKe~n ;ta ano<pt\oiwo11 rns Kapotas.

il
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9. ANEYPY~MA T A KA I diAXQPI~MO~ TH~ AOPTH~

AopnKa ave upuoJ.la-ca

~uvn&wc; n:upati1POUVtal 0111V KOtt\taKrl aop1rl KUL o<peit\OV1Ul 0 U~f1POOKAtlPUV011.


I\L/CHp0 OUXVU i.Val 1a aVUpUOjla1a 111S KUtlOUOaS ~wpaKLKrlS UOptrlS TIOU
L VUL {TtLOI1S a~I1POOKhi1PUVtlKrlS aLtLOt\O!'LUS KUL Ki va 1flS UVLOUOUS UOP1rlS
nou OtpL\ovtaL 0 KUOtlKtl VKPWOI110U jleoou xnwva ( n.x. OUVOPOilO Marfan) ,,
Kat on:ayiws oe outptt\n. . r;

~
A. ITu~opumoAoy'ta. To l.l!'at\(nepo Kivouvo /La aS11pooKA11puvnKriS atnoAo!'tas
aveupUO!la 111S aop-rns OLUtpexouv Ol l.l0rlALKS civope<; ll L010pLK6 Kanvi-
OIJUl:OS, unp1UOI1S ll UTIf)XOhl101pOt\atjlia<;.
H uop1ri eivat 11 l.l!'aAun:p11 up-rnpia 1:ou av~ptiJntvou op{aVLOI.lOU Kat ws K 1ou-
1ou 11 aoKOUilVll 010 uopuKo 10iXW!la rao11. 11 anoia OUIJ.<pwva ll 1ov VOilO 1ou
Laplace dvat avcit\O)'I1111S evooa)'{etaKris nieons Kat 111s oLal.lel:pou, dvat
\l/tit\11. Ot na~noets -rou aopuKou -rmxti>1.1.a1os npoKa,\ouv 1:11v Katao1po<pf)1wv
t\U01LKWV LVWV 10U l.lOOU Xl1oJVa 111S aoprfl<; Kat 10U10 exet UJS anotE:,\eOI.lU U}V
bta1:ao11 rou al')'eiou. H 6tatao11 ouvooeuetaL an.6 vE:a au\non u1s -rao11s. n
onoLa ll tn oetpa 111s npoKat\el. vE:a ota1uo11 K.O.K 1.1. an:01:E:t\eolla 111 Ol11lLOUP/ia
VOS tpuut\ou KUKhOU TIOU 0011)'L 010 aVUPUOIJ.a.
Ta neptao61epa aopuKa aveupuojlal:a elvcu u1paKtOLOrlll oUIJ.IJ.e1oxr16t\ns ti1S
flPLIJ.:1POU VOS 11lfillU10S lOU U/)'LOU. 0pLOI.lVa OI.LWS, tVUL OaKKOlbtl KUL
anol:eAouv n:poOKeoAr111ltll.la10S 10U UOP1LKOU tOLXWIJ.U10S. Ta OUKKOelOtl
ave.upuo1.1.a1a ouxva o<pelt\ov1at oe outptt\11 t1 at\Aec; AotlloJ~ets (1J.UKW1LKa
aveupuo!lata) Kat eiJ.cpavlCouv au~111J.E:vo Kivouvo Ptl~I1S.
To 76%nepinou twv aopuKwv aveupuo1.1.a1wv ev1oni\etat o-rnv KOLt\LaK{) aop-rn
KU1W an:6 tl) VtppLK<; apti1PtS KUL 0 Ki VOUVOS Ptl~I1S eeap1a1aL an6 111V
OtUil1PO 10u ave upuOI.LU10S. 01av 11 tet\eu1aia ei vat < 6 em o Ki vouvos Prl~I1S E:va
e-ros ll10 111 tna)'VW011 eiVal 20Vo Vol 01UV elVaL > 6cm 0 KLVOUVOS TIAI10lU\L
I

10 5CJl/o.
a
B. Kt\LVLK e upriuatu. Ta aop1LKa aveupuo1.1.a1u ouvf)Sws owoptiiJ.ouv uoul.ln-cw!J.a-
nKa. Ta ave upuoJJ.a1a:111S KOLALUKrlS. tlOP1rlS !lnopei vu npoKaAE:oouv ootpuat\1iu
at\Aa 0 n:ot\A<; n:eptTnoJOLS OL VUpKtrlPLS KOI1AWOLS Otpett\OV1aL oe pfl\1110U
ave upuollu1os. ~t11v nepi ntwo11 au1n. 11 KALVLKfl e\tao11 anoKut\unteL 1.1.ia
TIK1LVOIJ.Vfl o<pu(ouoa KOLALaKf) 1.1.0\a Kat cpuorll.la O<pett\OIJ.VO 01:11 orpo~t/\WOI1
poq 1:ou aillU10S Ota1J.E:oou tou aveupuoj.J.utoc;.
Ta U\'e.upuoj.J.al:a ti1S avwuoas aopuis ouvf)~ws npoKut\ouv oujlntti>llu1a
ocpet,\Qj.J.VU 0 OUI.I.fiL011 nupaKLjleVUJV OP/clVWV ( n6vos 0111 paxn. OUO<j)U/La,

1
;
:_~,--~---:_ .. -
' _,_~----~--:..~_::...'.

~~xas, ~PU/XOS <pwv~s) Kat P~/VUV1att\t /01epo ouxva an6 1a ave upuo11a1a 111~
KmAtaK~S aop1~s. ~ns n:ept nnl.Joet<; IJ.e en:tv1111011 111s aopnK~S pi(as (ouv~(}ws
01UV UTIUPXeL KU01LKrl VKpWOil 10U IJ.OOU XLTWVa) !liTOpi Va /l VeL avnAtlT110
6tao-rot\tK6 <puon11a, o<petA611evo oe avc:ncipKeta 111s aopnKr1s ~aA~ioas.
H oo~ap6-rc:pn eTIL nAoKf)-rwv aopuKwv aveupuo1J.U1WV ei vat n Prl~ll. n orroia eav
oc:v aVUIJ.eHonw-rei /Katpa IJ.e XetpOUP/LKrl en11~aon, IJ.TIOpei va OOil/rlOeL 010
(}ava-ro. Ta KOLALUKU aveupUOIJ.Ula ouvn.(}cos Prl/VUV1UL 010V onw.(}o-
n:epl10VUlKO xwpo Kat OL ao~c:vc:is n:ou en:t{ouv ev6s 1.1mou en:etoooiou
eiJ.q>avi(ouv UTIO/KULIJ.LKrl Ka-ranAn~ia ouvooeu61J.VIl an6 oo~ap6 O:A/OS otnv
KOLAtci Kat o1nv oo<pu, 10 onoio ouxva en:eK1eivc:-rat o-rous t\aj6vLOus ~6-(}pous.
AAAes entn:t\oKs -rwv aopuKwv aveupUOIJ.U1WV eivat -ra {}poj.l~OeiJ.~OAtKa
TILOOOLa, O!petA611VU 0 an6onaon .(}p6116WV an6 10 10LXWIJ.a 10U
aveupuo11a1os. n Aoillw~.n. n onoia npoKat\ei nap611ma KALVtKrl etK6va 11 -rnv
c:vooKapoi no a Kat n avc:ncipKeta tns aopnKr1S ~at\~ibas en a ave: upuo11a1a 1110
avLOuoas aop1ns.
f. Epj'U010ptaKa e up(]ua1a. Me 11lV ant\fl aKUVO/paq>ia j.lTIOpi va UYU/VWPL010UY
;rei avc:upuo11a1a 16oo 111S KOLAtaKrlS 6oo Kat UJS ~wpaKtKrlS aop1ns. H OLU/VWOil
ent~c:eatwvc:tat IJ.e nxoKap6tO/P6:<Prwa (ota.(}wpaKtK6 Kat 6tmao<pil/eto) , a\ovtKr1
rl11a/Y111LKrl TOj.lO)'patpia, eeeraaLS" 1.1 !LS" OITOiS" UITOAO('L(TQL 11 btcij.l1POS 10U
ave upuo11a-ros Kat e\etci(e1at n napouoia r1 anouoia OLaXWPLOI10U ( oes
napaKii1w).
!l. ITp6j'vwon Kat ~epaneia. Ot ao~evc:is 1.1 a.(}llPOOKAilPUYtLKrlS at uot\o{ias
aopnKti UVUPUO).lata ouvfl.(}w<; TIUOXOUV an6 Otq>avtaia VOOO, 11 onoia IJ.a(u 11
10 111e~os tou aveupUOIJ.al:os Ka~opiCet -rnv n:p6')'vwon. E-rot, crrav ouvun:apxet
ote<pavtaia v6oos n nc:vrae1rlS en:t~iwon avpxc:1at oe 20%, evw ota
11110YWI1va aveupuo).la1a oe 51Jl/o. 0 Kivouvos /La ~ava111<p6pa Prl\11 eivat
11/tiAos 6tav n 6tti1.1e1pos tou aveupuo~.tatos un:ep6aivet -ra Scm.
EtOLKrl ~epan:eia oev un:apxet. ~e 6Aous -rous ao~eveis ouvtotatat o Ae/XOS 111s
ap1flpLaKr1S n:ieons Kat XLPOUP/LKrl Ot6p~W011 6tav 1J.<j)aYL010UV OUI1TI1t011Uta n
c:nt nAoKs ( n.x. aven:apKew tllS aop1ns) r1 6tav o Kivouvos PrlCllS eivat 11/aAos
(n.x. KOLALdKa aveupuo11a1a Otal1:rpou >Scm r1 aveupuo11a1a nou eiJ.<pavi(ouv
taxeia au\11011 HIS 0Lal1tpou 0 0LaOOXLKS {1UOLS).

Eivat ouxvr1 oxenKa n:a~non. nou av oev otatvwotei Kat avu11etwntotei /Katpa,
.XL ot\~plS ouven:le<; /lU tOV ao~evfi.
A. na(}opuoLOMY'La. 0 OLUXWPLOilOS 111S aop1rlS xapaK111Pi(e1aL arr6 Prl~ll tOU eow
xnwva 1ou a{;etou Kat ouAAO/rl ai11a1os 11oa otov 11oo xnwva, n orroia

t.
OYOIJ.Li(erat owxwpwnK6 ULilUIWIJ.U. To ret\eu-raio xwp.L(et Kara ll~Kos roY llE.oo
XL nuva oe 11ia 1\enrr1 e~wrepLK~ o1t~aoa, nou napallYet ouYbeoell\'ll lle 1oY
E.~w xnwYa Kat Ilia eOW1ePLK~ ou~aoa nou ouY6E.e1at 11e "COY ow XL uiJva. Me
toY rpono auro eKros an6 1ov aAn~tv6 aut\6 trlS aoprris. OflllLOUP!'eL1at Kat vas
6etu:ep.os auA6s.llE.oa o1o aopnK6 1oixw11a. o Ae/OilYOS tt.Jeu6oaut\6s.
To 6taxwpwnK6 atllU1Wila IJ.e1a 1ov oxnllattoll6 10u llTIOpei Ya neptopt01ei oe Ilia
TIPLOXrl 111S aOP1rlS rl Ya eTieK1a~el KeY1ptKU rl TiepL<pepLKU, UTIOKOAAWV1US 10US
XL1WYeS IOU aopttKOU 10LXWIJ.a10S Kat npoo~at\t\OY1a<; US ap1flpieS nou
eK<puoviat ana !flY aop1~. H KY1PLKrl eneK1UOfl npos ns 01e<pavtaies apn]pies
Kat 1qv aopUKrl ~u,\~ioa, 11nopei va npoKaAE.oet toxaq.tia 1ou llUOKap.Oiou Kat
avenapl<eta rns aopuKris ~co\~ioas av1io1otxa. H nept<peptKrl enE.K 1aon npos -ro
aopnK616\o Kat -ra ajf'eta 1ou ejKe<pat\ou 6uva1ov va npoKaAE.oet /Ke<pai\tKrl
LOXatj.lia, ~evco 1UXOY npoo~oAn tlOV YetppLKWY aptflPLlOY_ OUYeTIUje1at ejKa1a-
01aOf] veq:JptKrlS avenapKetas. Pn\n e\at\,\ou 010 rreptt<ap6to buva-rov va
OOfl/rlOet;;oe Kap6taK6 ent TIWIJ.UUOIJ.O Kat Prl~fl otnv une(WKOLLKrl Kott\6-rn-ra oe
atllo~wpaKa.
Kupt61epoc\npo6ta{}eotKoi napa/OYteS /La rnv 1lq>avwn OLaxwptOilOU tf]S aoptfls
ei vat ot e~r1s:
a) .PuAo Kat nALKLCl. OL avope<; npoo~aAAovtat OUXY01epa an:6 ns )'UYULK<;
(avat\ojia 3/1) KUL fl na{}flOfl OUYrl.&WS 1ltpavi(e1aL 0 U101J.U llALKLa<; 50-70 1:00\1.
~) Ap-rnptaKit unp-raon
/) Kunon
6) KAnpoYOIJ.Lka V00rllla1a tOU OUY01LKOU L010U (ouvOpOIJ.O Marf~n, ouvopOIJ.O
Ehlers-Danlos K;\ rr}
c) ~i n1uxn aopnKn ~aABioa Kat otvwon tou to{}J.lou 111c; aop-rfls
01) KapoLOxetpoup/tK<; eneJ.l~aoetS
_B. KALVtKO Ka1a1aen. H Kt\tvtKrl etK6va, 11 np6jvwon Kat {}epaneunKt1
aV1LJ.letwnwn toN ao~evwv J.l 6taxwptoJ.16 -ens aop-cfts e\apniJviat an:6 tfl &eon
Kat IllY Kiaon IOU 6taxwptOJ.10U. Etot, E.xouv np01:a-&eL ouitpopec; KAtvtKE.s
Ka1aia\etc; tns v.6oou. ~uJ.lq>wva Aot n6v 1.1 tflV Kata1a\n Iou Daily u~ioiavtat ouo
eion otaxwptollou: o tunou A 1.1 enE.Ktaon o1nv avLOuoa aopifl Kat o tunou B t1
rceptq>eptKOS; xwpis oUIJ.J.letoxn tf]S avtouoas aopt~s. 2Dil<pwva n:aAt lle tnv
Ka-rata\n Iou OeBakey otaKpi vovtat -rpia eion .OtaXWPLOilOU: o Iunou I otov
on:otov o 6tuxwptcrll6S apxiCet an6 1flY avtouoa aop1~ Kat eneKeive-rat nepa an6
10 aopuK6 t6\o. o ttmou I I nou nepLOpi(etut orrw avwuoa aop-rfl Kat o l:tmou
I I I, o onoios upxiCet neptq>eptKa an6 to aop1tK6 t6~o. eneKtew6~evos
ouYfl{}ws 11xpt Kat -rnv KotAtaKil aopt~.
r. K;\tYtKO. eupOua-ra. 0 6taxwpto1J.6s 1flS aop-rris xapaKiflpi(etat an6 HlY atq>viota
1J.<paVLOfl VId\'OU {}wpaKLKOU n6vou, OtO 90% 1WY neptl11WOWV. H evtaOf] 10U
novou eL vat 1.1 :-ta-rn Kat a tfl au /llrl111S /Kataotaons 1ou otaxwptol.lou Kat

'i
I'
'
l:OLll:O 10V CE.XWPL(E.L uno 10V npoOOUUKcl UUCUVOj.I.VO 0 ev-caon S(OpUKLKO
novo 10U octo<; 1l<f>Pcl/j.I.U10S 10U j.I.UOKapoiou. OL ao~E.VE.i<; ei Val ouv~&ws
Kcl~LOpOL, WXPOL KUl E.ll<pavi(OUV tUXUKapoi.a j.l.e ano1t\Oj.l.a VU OiOtUl f1
E.V1UTIWOJ1 on naoxouv uno KUKAo<poptK~ KU1an:t\nCia. 0J..lWS, f1 aptflPLUK~ nieon
ei vat aucnllVll o1qv nAetoQ.lq<piu 1wv nepL nnooewv Kat tOtai n:pa otous
uo-8-eveis E.Keivous n:ou ncioxouv an:o nept<peptKo otaxwptoj.l.o 111s aopt~s. Ot
nept nttOOE.tS 1.1 npajllUtlKrl UTIO(KULI.lLKrl KatanAncia oq>ei.Aovtal 0 PrlCfl )/US
otaxwpto!.LOU ou1v rreptKapotaK~ KmA6tnta, nou n:poKaAei aq.wneptK apow Kat
KapotaK6 entn:wj.l.auoj.l.6. Anouoia o<pucewv nept<peptKwv aptnptwv. ouxva
etepon,\eupn, napal:flpei.-rat oe <::f'/US otaxwptOJ.Lou.s.Kat !lnopiei. sa eivat
n:apootK~. 0\E.i.a aven:apKE.ta 111S aop-r~s l)aAI)i.oas n:apa1npei.-rat o1o 75% 1wv
ao-8-E.vwv llE. E.//US otaxwpLOilO tns aop-r~s. evw KWIJU ~ eonaKci veupot\o/tKci.
orweia Oe OtaXWPLOilOUS TIOU a<popouv 10 UOPLLKO 1:0{0. Ilapan:Afl/LU E.IJ<pavi(E.tat
oe otaxwptoj.l.ous n:ou n:poKa,\ouv otaKon:n-rfls atJ..lauK~s pons ous ons
j.I.E.OOTIAE.uptE.S ap-rnpiE.S KUL n:ept<pepLK~ VE.Upon:ci~eLU, 01UV n:poKat\ei tat
wxaq.tia 1wv ciKpwv. T1\os, n an6<ppa{I11WV ap1:11Ptti>v twv Krnw ciKpwv J..lTIOpei
. VU 0011/~0E:t 0 ~POJ.li)WOil rl E:ll00A~ KUt 11 an:6<ppa{l1 !WV VE.<pptKoJV aptrlPLoJV OE. .
auc11on 111S OP111PtUKrlS nieo11s Kat ve<pptK~ aven:cipKeta.
D.. Epl'aoroptaKci E. uppua-ra. MlcA1,00I(O/JOtO/Pti~17PO A n:oKAE.taiJ6S eiJ<ppci(l.taros
rou I.I.UOKapoiou.
AKrt vo;7,oaf{'ia 19-t::;paKa L1tci1ao11 avLOuoas uop1~s o1ous e//US 6taxwpto11ous.
A op ro;7pa~ia A no-reAouoE. /t a xp6vLa 111v 1.1.e~o6o eKAO/tl s 0111 otci/VWO!l Kat
eK1ii.I.I10ll -rns 0apu1111as -rou 6taxwpto1.1.ou 111s aop-r~s. Me 111 lle~ooo au-r~
I.I.TIOpei VU UVU/VWPt01E.i 10 011J.leio l:llS PrlCI1S 10U eow XL 1WVU, va npoo6topt01ei
f1 K-raon -rou owxwptOI.I.OU KuL va otepE.UVll~ei. 10 Ka-rci n:6oov o 6taxwptoll6S
u<popci KUL 1U I.I.E.i.(OVU up1flPLUKcl 01eAXfl 10 E.K<j)UOIJE.VU arr6 1f1V UOP1fi.
MetOVE.K1~1.1.U1U 111S llE:~OOOU ei. Vat 1U E.CtlS a) OLJ.I.U1flpfl KUL XPOVOI)6pa
bta{vwouK~ E.{e-caon, I)) q..E.uows apvnuKa arco1eAolla-ra A61w 1au-c6xpovns
UTIE.LKOVLOI1S 1000 10U auAou 000 Kat 10U qJE.UOOauAou KUL 7) 11 XPI10LIJ.OTIOLOU-
IlE:Vfl oKta/PU<f>LKrl ouoi.a J.lTIOpE.'t va rcpoKaAeoE.L nepanepw en:toeivwon -ens
Ve<ppLK~S t\E.L10Up(LUS 010US UO~Vi.S TIOU 1J<j)UVL(OUV VE.tppLKrl UVE.TicipKE.LU.
YrroA0;7U7rtK!j O(OVtl(!j' KUl j.I0;7YilrtK!j rOj./0/PO~ia Ilp6KE.l'tUL /La XP~OLJ..leS
avai1J.UK1E.S anetK_ovtonKes l.l.e~66ous. MetOVE.Kl:tlllata LrlS npO:nrts ei. vat n
aouvullia E.v-contoiJ.OU 111s p~CI1S 1ou ow XL1oova Kat otci/vwons 111s avem1pKetas
rqs UOPUKI1S l)a,\l)ioas KUL 111S 0U1E:PI1S 11 UOUVUJ.lLU !pUPI.10/rlS ao.Seveis nou
<pE:pouv l)f1J..lU1000!fl, 0PtollVu eiOrt ll1uAt\tKWV l)at\l)i.owv tl cit\Aa 1.1.E.1a,\,\tKcl
E.IJ<pUteUIJ.U10: Ka~ws errio11s 11 ll/aAn btcipKetu (so rrepirrou Aercta) .
.dtotoof{'ti}'cto !J.lOKopoto7Pti~17J.IU Mn:opei. va. E.Kl:E.Aeorei o-roKpE.I)I)ciu tou
appwotou, OLUP"-E.L 6Ku AE.n1a nepinou Kat rcapXE.t 111 ouva-ro-cnra unE.tKovwns

4
rou KPfl!J.VOu rou taw XL rwva. otaKpwns Lou at\n~tvou aut\ou an6 Lov r.pe uooauA6
KUL 6ta{vwonc; m()uv~c; uv~::napt<das LJlS aopnKris-~u,\Bioas ~ n:eptKapoLaKris
ouAt\o1ris. Me tqv e.(E:raon- auL~ e.nnu/'xave.-rat 11 Ota{VWOJl Lou 6taxwptOIJ.OU 1f1S
aopt~s 11e. e.uaw3noia 99% Kat e.tOLK011lta 87%. Me. 5aof1 -ca npouvci<Pep~E:vra 10
6tmoo<pa{eto nxo-Kapow)'patprw.a ano-ce.Ac:i tllY npwrn ep{aotnptaK~ e\eLaon
nou -&a npenc:t va eK1et\e.iTat 61av unapxe.t 11 unoq;ta owxwpto!J.OU n)s aopn1s.
E. ITp61vwoo Kat -&e.paneia. H n:p6{vwon c:Lvat ouo!le.vE:o~aLn oLous otaxwpt.OJ.I.OUS
H)S avwuoas aop-rr)s o1ous on:oious n -&v11161q-ca avE:px~::-rat oe. 600/o 1lS npw1e.s
wpe.s, BQJ!a ns n:pune.s 6uo c:56o!la6c:s Kat 90% to us n:pwtous tpe.ts !lnvc:s.
H apxL,Krl a;:V-n'ri ouvioxa-rat_ ornv c:t\a-rtwon -rns ap-rnpwKriS n:Leofls (01:6xos=
ouo-rot\tKri aptflPLUKri n:i~on 1OG120 mmHg)Kat H-rns ev-raons tns KapbwKris
ouoLot\ris. Tot:no ern -ru{xave-rat IJ.e rn ouvouao!J.E:vn xopriJ'flOll vt-cponpwooLKOU
va-rpiou ( 1:B!lg/kg/Ac:n:t6 IV)Kat c:v6s 5-avao-roAea (rt.x. IJ.eTonpoA6AI1 25"50 mg X
2 PO). H npat repw avulle.twruon c:eap-rcitat an:6 -ro c:Loos KUL to xpovtK6
OtaOtJljlU atr6 T!lV {KQ~UCJ1QOJ1 LOU OlaXWPLOIJ.OU. ELOl:
a) Ot XPOVLOf:OLUXWPLO!lOL LllS UOP1rlS (otapK<::La >2 e.()OOIJ.UOS) UVtLIJ.tumi~OV1UL
OUVtf]pJlU~a (pu&lltoll UPtllPLUKrlS TileOJlS KATI) eKtOS eUV IJ.<j)UVL010UV vee.s
e.ntn:AoKE:s. 6rrw; vE:os 6taxwpto!l6S, npoooe.unKci e.n:t6etvou!lVI1 avenapKeta
TJlS- aop-rtKf]s BaA0i6as ri oxruJaUo!l6s ave.upuoJ.,ta-cos)
5) Ot o\ds owxwpLOIJ.Oi ttmou A npE:ne.t n:avto-ce. va avttlle-ru.mi(ovtat xe.tp9UP/t-
Ka A61w LtlS 5aqutuLns np61vwons.
; ) Ot o\eis owx(:tpWIJ.Oi tunou B avttiJ.etwni(ovtat ouvti1P11UKa. eKt6s e.av
UTIUPXOUV Tit n:\GK~S. OTIWS 11 TIPCl/IJ.U1lKrl rl Tian:etAOUIJVfl p~{l1, 11 0111J.UVtlKrl
et\ciHWOfl 1ClS ULIJ.UUKrlS por)S 0 eva 0{:)/UVO rl UKPO KUl 11 TIEK1U011 10U
6taxwpto1J.ou oe riMa t!ln!la-ra -rna aop-rr)s. napa 1flV tKavon:otnttKi) pu-&!-1LOI1 111s
UP1t1PlaKrlS TIL0Jl).

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