Heart Failure Symptoms | Kaiser Permanente

If you have heart failure, symptoms start to happen when your heart cannot pump enough blood to the rest of your body.

Shortness of breath

While shortness of breath is the most common symptom of heart failure, it may be difficult or impossible to distinguish it from shortness of breath caused by other health problems such as emphysema or severe anemia. Your doctor can help you determine why you have been feeling short of breath.

People with heart failure experience shortness of breath in many different ways. You might feel that:

• You can’t catch your breath.
• You feel tightness in your chest.
• You feel tired when you walk.
• You need to stop a lot when you walk.
• It gets worse when you lie flat, and it may wake you up at night.

Shortness of breath from exertion or exercise. If your shortness of breath isn’t severe, you may notice it only when you are exerting yourself, and sometimes only during more intense exertion. The medical term for this symptom is dyspnea (say “DISP-nee-uh”).

When heart failure develops gradually, your shortness of breath also may develop gradually, which can make it hard to notice. But people with more severe heart failure may have shortness of breath with minimal exertion.

Shortness of breath while lying down. People with more severe heart failure may experience shortness of breath when they lie down. The medical term for this symptom is orthopnea (say “or-THAWP-nee-uh”). The severity of this symptom usually depends on how flat you are lying—the flatter you lie, the more you feel short of breath.

To gauge the severity of this symptom, doctors often ask people how many pillows they need to lie on to avoid feeling short of breath in bed. For example, “three-pillow” orthopnea is worse than “two-pillow” orthopnea, because you have less tolerance for lying flat.

The reason you may have orthopnea is that when you lie flat, the blood that ordinarily pools in the veins of your legs is reentering your bloodstream. If you have heart failure, your heart may not be able to keep up with the increased amount of blood returning to the heart, so fluid builds up inside the lungs and causes shortness of breath.

Shortness of breath while sleeping. Some people with heart failure wake up in the middle of the night with severe shortness of breath. The medical term for this symptom is paroxysmal nocturnal dyspnea (PND). This may occur with waking up coughing and/or wheezing, having a rapid heart rate, and a feeling of being suffocated.

In general, people who experience PND don’t feel increased shortness of breath when they first lie down. But after several hours of lying down, they awake with shortness of breath, which often occurs suddenly. People who experience PND often have to sit up on the side of the bed, and they may feel a need to open a window to get more air. The shortness of breath generally goes away after a few minutes of sitting up.

Being very tired (fatigue)

You might feel that:

• You have less energy and feel more tired than usual.
• You can’t exert yourself like you could before.

You might also have low exercise capacity. This can be harder to describe. It is a symptom that people with heart failure often don’t even notice because they have gradually reduced the level at which they exert themselves.

For example, they may stop walking up the stairs, or they may drive to the store instead of walking. Some people at first deny that they have been experiencing this symptom. It is only after doctors ask them about changes in their activities that they realize they have been avoiding physical exertion. This decrease in your ability to exert yourself physically is what doctors call low exercise capacity.

Swelling in ankles or feet

People with heart failure often experience swelling in their ankles or feet. You might notice that:

• It gets worse at the end of the day or after you stand for long periods.
• It hurts.
• Pressure leaves impressions in your skin.
• Shoes no longer fit.

The degree of swelling you experience depends on how well your body is compensating for heart failure and how much sodium and water your body retains. In some cases the swelling is mild and merely bothersome, while in other cases it can be severe and painful if the skin becomes taut and sensitive.

The medical term for this swelling in the legs is pedal edema—”pedal” refers to the feet and “edema” refers to the buildup of excess fluid. Heart failure often causes what doctors call “pitting edema,” meaning that applying pressure to the swollen skin leaves an indentation in the skin. Doctors often test for edema by pressing their thumb to the skin and seeing whether it leaves an impression. You may see this yourself if you take off your shoes and socks and find that your socks have left an impression in the skin of your ankles and feet.

You may notice more severe swelling if you have been eating too much salt, which causes your body to retain fluid. Elevating your feet or wearing supportive stockings can help relieve the swelling.

Sudden weight gain

Weight gain may be the first noticeable sign that you have developed heart failure or that your heart failure is getting worse. The amount of weight gained varies greatly among people with heart failure, and it reflects the amount of sodium and water the body has retained.

A sudden weight gain may mean that excess fluid is building up in your body because your heart failure is getting worse. It is a symptom of sudden heart failure.

Your doctor will probably ask you to weigh yourself every day. Know when to call your doctor if you suddenly gain weight.

Your doctor likely will work with you to manage changes in weight caused by fluid retention. For example, if you have a weight increase of 2 lb (0.91 kg), your doctor may recommend taking an additional diuretic that day.

Pathophysiology of edema in congestive heart failure

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Review

. 1993 Jul-Aug;2(4):325-9.

J P Navas 
¹
, M Martinez-Maldonado

Affiliations

Affiliation

• ¹ Medical Service Atlanta Veterans Affairs Medical Center, Decatur, Georgia 30333.

• PMID:

  8156185

Review

J P Navas et al.

Heart Dis Stroke.

1993 Jul-Aug.

. 1993 Jul-Aug;2(4):325-9.

Authors

J P Navas 
¹
, M Martinez-Maldonado

Affiliation

• ¹ Medical Service Atlanta Veterans Affairs Medical Center, Decatur, Georgia 30333.

• PMID:

  8156185

Abstract

Congestive heart failure is one of the most important causes of peripheral edema seen in clinical practice. Edema in congestive heart failure is the result of the activation of a series of humoral and neurohumoral mechanisms that promote sodium and water reabsorption by the kidneys and expansion of the extracellular fluid. These mechanisms, in concert with abnormal Starling forces such as increased venous capillary pressure and decreased plasma oncotic pressure, promote fluid extravasation and edema formation. The management of edema in congestive heart failure is designed to improve cardiac function and to inhibit the hormonal and neurohumoral pathways that promote edema. The combination of diuretics and vasodilators or angiotensin converting enzyme inhibitors and, in some cases, cardiac inotropic agents is highly effective in achieving these goals and providing significant symptomatic improvement in patients with edema secondary to congestive heart failure.

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causes, treatment, symptoms, signs, types, degrees, complications, prevention of edema

Edema is a violation of water and electrolyte balance, which is characterized by excessive release of fluid into the cells of soft tissues, internal organs and the vascular microvasculature. Edema is systemic (with glomerulonephritis, hepatic, and heart failure) and local (with allergic reactions, in the area of ​​venous hyperemia, etc.).

Contents

• Types of edema
• Degrees of edema
• What is dangerous edema
• Symptoms and signs of edema
• Possible complications of edema
• Prevention of edema development
• Diagnosis of edema 900 08
• Treatment methods at the Tibetan Medicine Clinic at Naran Clinic

Fluid accumulation or the formation of edema is controlled by the following factors:

• drop in oncotic pressure in the vessels;
• increased hydrostatic and oncotic pressure in tissues;
• destruction of the walls of blood vessels, leading to increased permeability, decreased oncotic pressure and leakage of fluids;
• violation of the lymphatic system, which is responsible for removing fluid from the interstitial spaces.

The pathogenetic basis of edema is a violation of the factors that provide transcapillary metabolic processes. At the capillary level, the liquid part of the blood is filtered and its absorption into the blood from the tissues. The liquid content is relatively constant, so these processes are balanced. If the balance is disturbed, edema develops, which is the result of the predominance of transudation (fluid release) over resorption (return process).

Types of edema

A whole range of conditions contribute to the appearance of edema. The essence of clinical physiology is based on the analysis of the totality of signs of the disease, taking into account the reaction of the affected internal organs (heart, lungs, kidneys, liver). Subcutaneous edema can also be of an allergic nature (Quincke’s edema). The cause may be various forms of arthritis (rheumatoid, infectious, rheumatic, etc.).

Edema in kidney diseases

One of the most important achievements in the study of edema in this condition is the isolation of extrarenal (extrarenal) and ingrarenal (intrarenal) mechanisms of their occurrence and stabilization. They can function both sequentially and simultaneously. But even a complete set of all the necessary factors does not always end with the development of edema.

The result depends on a number of additional conditions:

• condition of the vascular wall and interstitium;
• blood flow velocity;
• ratio of albumins and globulins in blood plasma.

Spontaneous disappearance of edema is associated either with a decrease in the activity of the pathological process in the kidneys, or with the activation of the natriuretic system, the main component of which is atrial natriuretic factor (PNF). It has a vasodilating and natriuretic property due to the activation of guanylate cyclase with the formation of an intracellular mediator of cyclic guanosine monophosphate (cGMP). Quite frequent escape of the kidney from the action of PNP is usually associated with increased enzymatic degradation of cGMP.

If the pathological process in the kidneys continues, then the leading role in the development of edema is acquired by intrarenal mechanisms. They may be partially identical outside the kidneys, since the kidneys have their own sympathetic nervous system and an angiotensin II (a peptide hormone that causes vasoconstriction) production system. Substances formed in the kidneys as a result of pathological processes, the so-called autocoids, can also participate in the retention of sodium and water. These are endothelium I, thromboxane A2, prostaglandin H2, various cytokines.

Edema in circulatory insufficiency

A significant difference in edema in circulatory failure (NC) is the preservation of the normal number of nephrons. Renal blood flow is reduced to a greater extent than glomerular filtration. As a result of an increase in the filtration fraction, the protein content and oncotic pressure in the capillaries increase, which creates conditions for enhanced fluid reabsorption in the proximal tubule.

Increased absorption of sodium and water is not caused by a decrease in cardiac output and slowing of blood flow, characteristic of most forms of NK, but by the mechanisms of its compensation. The role of vasopressin in insufficient blood supply is determined by its action on the renal vessels, stimulation of sodium chloride transport in the thick ascending loop of Henle and, possibly, in the collecting ducts. The role of aldosterone (a hormone produced by the adrenal cortex) in sodium retention in NK is relatively small due to reduced fluid delivery to the distal segment. It increases sharply with adhesive pericarditis and with tricuspid insufficiency, leading to portal hypertension.

Edema in cirrhosis of the liver

The mechanisms of development of edema in cirrhosis of the liver are exclusively extrarenal in nature (located outside the liver). Hypovolemia (fluid volume reduction) in liver cirrhosis occurs only at the stage of ascites appearance and cannot explain sodium retention (retention) in the early stages of the disease. In recent years, it has been shown that hypovolemia in cirrhosis of the liver is relative. It is not associated with fluid loss, but with inadequate expansion of the vascular bed as a result of increased formation of nitric oxide (the most important mediator of inflammation).

It can be concluded that, despite significant differences between the mechanisms of edema formation in kidney diseases, NK and liver cirrhosis, they are united by the active nature of sodium retention. In any condition of the kidneys, they do not lose their ability to provide a negative sodium balance, as evidenced by the effectiveness of exogenous and endogenous natriuretics. The behavior of the kidneys in edematous conditions is a manifestation of their increased rather than decreased function, the purpose of which is to compensate for hemodynamic disorders.

Degrees of edema

The following degrees of edema are distinguished, depending on the severity of the condition:

• I – swelling of the legs and feet;
• II – accumulation of fluid in the legs, lower abdomen, lumbosacral region;
• III – swelling of the hands, “puffiness” of the face;
• IV – generalized edema.

According to the level of proteinuria (excess protein in the urine), edema is physiological (less than 0. 3 g/day) and pathological (0.3 mg/day or more).

What is the danger of swelling

Prolonged swelling leads to stretching of the skin. Vessels become less elastic, blood circulation processes are disturbed. Edema also has a negative effect on the articular structures, there are difficulties in movement. In places of edema, ulcers may appear, which are quite difficult to treat.

The situation is not allowed to start. When the primary symptoms of swelling appear, it is recommended to consult a doctor so as not to bring the situation to an extreme.

Symptoms and signs of edema

Edema can be classified according to the affected organ or system. Some of these are specific to certain parts of the body, while others may be more general:

• Generalized edema is a condition in which fluid is retained in various parts of the body, including the abdomen, arms, legs, face, and feet. Symptoms include bloating, tightening of the skin, which leaves imprints. This type of swelling can be caused by injury, disease (heart, kidney, or liver failure), pregnancy, or an imbalance of substances in the body.
• Peripheral edema – occurs in the legs, feet and ankles. It develops with age, in pregnant women, with hypertension, congestive heart failure, kidney problems. May occur after sitting or standing for a long time. Some medications (NSAIDs, calcium channel blockers, corticosteroids) can cause peripheral edema.

With swelling of the skin, fluid accumulates in the tissues and cells of the skin. Some areas of the skin may appear stretched, swollen. It develops against the background of a superficial allergic reaction caused by mosquito bites, detergents, chemicals, or other irritants.

Cerebral edema is accompanied by accumulation of fluid in the intracellular and extracellular spaces. This may be caused by metabolic disturbances due to an underlying disease or as a reaction to lack of oxygen at high altitudes. May cause loss of consciousness and brain damage.

Pulmonary edema is characterized by accumulation of fluid due to obstruction of the pulmonary veins. When blood pressure rises in the blood vessels of the lungs, fluids rush in to fill the voids. Pulmonary edema is usually caused by malfunction of the left ventricle of the heart. It may also be due to the inhalation of harmful toxins. Manifested by weakness, dizziness, a feeling of squeezing in the chest, dry cough.

Separately, lymphedema should be distinguished, which is caused by the inability of the lymphatic system to remove fluids from the interstitial spaces. This form of edema can be the result of swollen lymph nodes, cancer, destruction of the lymphatics from radiation therapy, infection, and suppression of the pumping action of the lymphatics by certain drugs (eg, ibuprofen).

Possible complications of edema

Complications depend on the underlying cause. Dangerous swelling becomes in the absence of timely treatment, especially when it comes to angioedema and pulmonary edema. With timely identification and elimination of the cause, the prognosis is favorable.

Most often, edema disappears on its own after a while. But in some cases, there is a long and aggravated clinical picture that requires immediate medical attention.

Prevention of edema development

If edema is the result of heart failure, liver or kidney disease, it can be managed. Doctors recommend avoiding excess sodium (salt) in the diet and not forgetting about daily physical activity.

Tips for preventing swelling:

• Elevate your legs when sitting or lying down.
• Wear compression stockings for swollen legs.
• Avoid prolonged sitting or standing without moving.
• Give up bad habits (alcohol, smoking).
• Eliminate processed foods (prepared foods) from your diet.
• Maintain a healthy weight to avoid obesity.

Regarding the drinking regimen, it is recommended to limit the amount of liquid to 1-1. 5 liters per day for edema that occurs with kidney and heart diseases. With swelling, the underlying disease needs treatment to prevent its progression.

Diagnosis of edema

To determine the cause of edema, consult a general practitioner. The specialist will conduct an examination and prescribe:

• Laboratory tests – a general analysis of urine and blood, as well as a blood test for hormones.
• Instrumental diagnostics – ultrasound examination of the adrenal glands, kidneys and pelvic organs, computed tomography or chest X-ray.

Based on the results, additional diagnostic procedures may be prescribed. If necessary, the patient is referred to an oncologist, endocrinologist, urologist and gynecologist.

If primary symptoms of edema appear, contact the Naran Clinic of Tibetan Medicine in Moscow. We have doctors with extensive practical experience who are fluent in the methods of oriental medicine. We offer unique author’s methods of therapy.

Treatment methods at the Tibetan Medicine Clinic at the Naran Clinic

1. Lifestyle modification
2. Diet
3. Phytotherapy: internal effects on the body
4. external treatment (complex of procedures)

Lifestyle modification and diet

Tibetan medicine doctors have known for many years that many people who develop health problems do not require special treatment. They just need to change their lifestyle.

Those who need treatment should first of all follow the doctor’s recommendations on nutrition and lifestyle, since food and lifestyle that do not correspond to the human constitution are the main causes of most chronic diseases.

Phytotherapy

Treatment with herbal medicines involves the intake of medicinal preparations made according to ancient recipes of Chinese and Tibetan medicine. Preparations consist of natural ingredients. They are selected flawlessly and treat a wide range of diseases: from colds to diseases of the cardiovascular system and gastrointestinal tract. Phytotherapy is good because there is no allergy to it: allergens are removed from preparations in the manufacture. Side effects are minimal or absent.

We prescribe phytopreparations according to individual indications and take into account the patient’s history. Of the strict contraindications diabetes mellitus, cancer, kidney and liver. The drugs have certificates of conformity, instructions describing the action, composition, indications for use, method of administration and contraindications.

Complex of external procedures

• Complex treatment session
• Deep acupressure
• Vacuum therapy (cup massage)
• Hirudotherapy
• Stone therapy (lithotherapy)
• Acupuncture (reflexology, acupuncture, acupuncture)
• Moxotherapy (jiu therapy)
• “Horme” – oil and herbal massage
• Plasma therapy
• Kinesitherapy with elements of manual therapy
• Kinesiology taping
• Auriculotherapy – microneedle treatment
• Sound massage with Tibetan singing bowls
• Thick needle method
• Bloodletting (hijama)

Edema of the legs (lower limbs)

Edema of the legs (lower limbs)

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Article content:

1. Factors causing swelling of the legs (lower limbs)
2. Edema of the legs (lower limbs) and high venous pressure
3. Other causes of swelling of the legs (lower limbs)
4. Questions from patients about swelling in the legs (lower limbs)

Causes of swelling of the legs (lower limbs)

Swelling of the legs (lower limbs) can equally affect both legs or be more pronounced on one lower limb. Often leg swelling is caused by several factors, such as venous insufficiency, obesity, or previous saphenous vein harvesting for heart bypass surgery.

Edema of the lower extremities

Edema of the legs (lower extremities) may occur due to increased pressure in the veins, local trauma, inflammatory changes, obstruction of the outflow of lymphatic fluid, infection, low protein in the blood, obesity, pregnancy, conditions of fluid retention or drug exposure. High pressure in the veins of the legs causes fluid, proteins and blood cells to leak through the walls of the small veins into the soft tissues, especially near the ankles. This causes punctate edema, a swelling that leaves a temporary indentation in the skin when a shoe, sock, or deliberate pressure is applied, such as by pressing with a finger.

Swelling of the legs (lower limbs) and high venous pressure

Causes of swelling of the legs (lower limbs) due to increased venous pressure include:

• Venous insufficiency, valve failure in the veins

Varicose veins and swelling of the legs

• Obesity, which increases pressure on the veins and lymphatic channels in the abdomen and pelvis, which leads to partial obstruction of venous and lymphatic flow from the legs back to the heart
• Deep vein thrombosis, clots preventing venous flow back to the heart,
• Post-thrombophlebitic syndrome, chronic blockage of veins in the leg or pelvis due to previous deep vein thrombosis
• Compression of pelvic veins due to overlying artery, organ or tumor
• Inability of the calf muscles to pump venous blood out of the legs due to stroke, venous injury, arthritis that limits ankle mobility, or inactivity

Other causes of swelling of the legs (lower limbs)

1. Localized swelling of the legs (lower limbs) can also be the result of trauma, hematoma (blood accumulation in the soft tissues), infections, fracture, superficial thrombophlebitis (clots in the veins adipose tissue), a tear in a tendon or muscle, a cyst in a joint (such as a synovial cyst in the knee), and sometimes spontaneous bleeding into tissue due to a ruptured blood vessel.
2. Chronic swelling of the legs (lower limbs) can also be caused by conditions that lead to an overall increase in body fluid, which may be more pronounced in the legs due to gravity, for example:

• Congestive or ischemic heart failure,
• Pulmonary hypertension,
• Pericarditis, limiting the pumping function of the heart,
• Pregnancy,
• Idiopathic edema often affecting both upper and lower extremities in premenopausal women,
• Liver diseases,
• Diseases of the kidneys,
• Hypothyroidism,
• Low protein conditions such as malnutrition, loss of protein due to disease, kidney or intestinal disease,
• Drug edema.

3. Some of the most common medications that cause leg swelling are non-steroidal anti-inflammatory drugs (NSAIDs), taken to relieve pain or discomfort from arthritis, and calcium channel blockers, taken for heart disease or hypertension. Some of the more common medications that can cause leg (lower limb) swelling in some people include:

• Antihypertensives, calcium channel blockers, beta blockers (clonidine, hydralazine, methyldopa, minoxidil)
• Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen and many others in this class)
• Hormones (estrogen, progesterone, testosterone)

4. Cellulitis, an infection of the skin and fatty tissues of the leg, can cause leg swelling with pain and tenderness. The pain from cellulite can be very severe or present with swelling and mild pain with pink to bright red skin.
5. Swelling of the foot, especially if the skin does not pit with short-term pressure, may be caused by lymphedema, a malfunction of the microscopic network of channels that move tissue fluid from the limb back into the bloodstream at the level of the top of the foot and chest.

Edema with lipedema

Depending on the causes, lymphedema is divided into:

• Congenital – present at birth,
• Acquired – due to recurrent infection or obstruction of the lymphatic vessels,
• Postoperative – vein excision for venous grafts, lymphadenectomy for tumors,
• Malignant neoplasms – lymphoma or other diseases affecting the lymph nodes,

6. Obesity – due to compression of the lymphatic channels in the abdomen or pelvis.

After venous insufficiency, obesity is the next most common cause of leg (lower limb) edema in the US, European countries and Russia. Abdominal obesity partially interferes with venous and lymphatic outflow from the legs. Obesity also accelerates the stretching of leg veins under the influence of gravity, thereby contributing to the progression of venous insufficiency.

Questions from patients about swelling in the legs (lower limbs)

How to get rid of swelling of the legs (lower limbs)?

In most situations, you can get rid of swelling of the legs only with the help of a doctor. First you need to find out the cause of the swelling. You can start the diagnosis with a visit to the therapist and phlebologist.

Why does leg swelling occur with varicose veins?

Edema of the legs with varicose veins of the lower extremities occurs due to a malfunction of the valve apparatus of the venous vessels. This leads to stagnation of fluid and the formation of puffiness.

How to treat swelling of the legs (lower limbs)?

Leg edema is treated according to the cause. Pathology of the heart, kidneys, venous system, injuries require their own specific treatment. You need to start treating swelling of the legs with an appeal to a good, attentive doctor.

Which doctor should I go to if my legs are swollen?

If your legs are swollen, you may need to see several specialists. You can start with a therapist or a cardiologist.

One leg is swollen, how to treat?

If you have swelling in one leg, you need to seek immediate medical attention. It is better to visit a phlebologist and an orthopedist. Unilateral swelling of the lower limb can be a sign of such a formidable condition as deep vein thrombosis.

Phlebologists

Head of the Phlebology Center “MIFTS”. Endovascular surgeon, cardiovascular surgeon, aesthetic phlebologist, expert in ultrasound diagnostics of lower extremity veins, candidate of medical sciences.

Head of the surgical department of the phlebology center “MIFTS”, leading phlebologist of the center, cardiovascular surgeon, endovascular surgeon, aesthetic phlebologist, expert in ultrasound diagnostics of lower extremity veins, candidate of medical sciences.

Leading employee of the Center for Phlebology “MIFTS”, cardiac surgeon, cardiovascular surgeon, phlebologist, doctor of ultrasound diagnostics, candidate of medical sciences. Member of the Association of Phlebologists of Russia

Reviews

Phlebology Center in Moscow – review of our patient

In every profession there are people about whom they say “professional from God.” Such a person is a phlebologist, a professional “from God” SEMENOV ARTEM YURIEVICH. Specialist of the highest category, candidate of medical sciences, SMART and just an open kind person.
My story began in 2009…

Rodnova Svetlana, 01/05/2018, Serpukhov, Moscow region.

,

January 04, 2018

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Thanks to God and the doctor, glorious surgeon – phlebologist Artem Yuryevich Semenov.

I am a Muscovite. I have suffered from varicose veins for over 15 years. In March 2017, God vouchsafed me to apply to MIFTs with advanced varicose veins in both legs.
The head of the “MIFTS” endovascular surgeon – phlebologist Semenov Artem Yuryevich, candidate of medical sciences, received me, …

Egorova Lidia Aleksandrovna, Moscow

,

February 26, 2018

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Many thanks to Dmitry Anatolyevich for his professionalism. The whole treatment went exactly as he described at the very first meeting and the result is excellent: the problem of varicose veins is solved and, at the same time, there are no side effects or surprises that would require an unplanned…

Alexey Ivanov

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December 17, 2019

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I want to express my gratitude to the surgeon-phlebologist Raskin Vladimir Vyacheslavovich for the skillfully performed operation, his high professionalism in his work, for his “golden hands” and polite attitude towards the patient.