Article publication date: 12/18/2016
Article updated date: 12/18/2018
From this article you will learn: what acute heart failure is, what its types are, and the most common causes. Symptoms, special treatment, how to help a patient at home.
Acute heart failure is a sudden and life-threatening condition in which the heart is completely unable to pump blood. Unlike chronic heart failure, which can be “sluggish” for several years, in the acute form the symptoms appear abruptly and last for several minutes or hours.
This syndrome is the most severe complication of all heart diseases, poses an immediate threat to life and in 45–60% ends in the death of patients. He is classified as emergency conditions requiring emergency medical care.
The condition of patients with any form of acute heart failure is critical - they are forced to lie down or sit, and suffocate at rest. Therefore, treatment should be conservative (medicines, correct position body, oxygen) in mode urgent measures aimed at saving lives.
The treatment process is carried out by doctors of two specialties: a cardiologist or a therapist with the obligatory participation of a resuscitator. Patients with acute heart failure are hospitalized in the intensive care unit.
The ventricles of the heart are responsible for pumping blood in the body. There are two of them:
If any of the ventricles of the heart suddenly cannot perform its pumping function, a severe circulatory disorder occurs in the corresponding vascular circle.
Depending on which ventricle is more affected, acute heart failure can be:
In 70–75%, the function of the left ventricle is primarily impaired, in 25–30% of the right. Combined biventricular heart failure may occur if treatment is not effective. Its occurrence indicates complete failure of the myocardium and in 90–95% ends in death.
Two groups of reasons:
| 1. Cardiac causes | 2. Non-cardiac causes |
|---|---|
| Myocardial infarction (death) | Hepatic-renal failure |
| Myocarditis (inflammation of the myocardium) | Alcohol abuse |
| Acute disorders heart rate(flickering fibrillation, extrasystole) | Poisoning with toxic substances and medications |
| Severe hypertensive crisis | Malignant tumors with metastases |
| Congenital and acquired heart and valve defects | Severe or long-standing anemia |
| Progression and complete decompensation of chronic heart failure | Diseases of the thyroid gland (thyrotoxicosis, hypothyroidism), adrenal glands (insufficiency, pheochromocytoma) |
| Cardiomyopathy of any kind | Sepsis and severe infections |
| Heart injuries (wounds, concussions) | Volumetric stroke of the brain |
| Postpartum cardiopathy | Major surgeries, injuries, burns |
Cardiomyopathy is one of the causes of acute left ventricular heart failure Acute heart failure of the right ventricle differs from left ventricular failure in causes and mechanisms of development. Most often these can be:
In theory, common cause The occurrence of acute failure of both the right and left ventricles of the heart can be caused by any of the cardiac and extracardiac factors. But in practice, there is such a pattern that all heart diseases and other pathological conditions occur with predominant damage to the myocardium of the left ventricle. Therefore, they are complicated by acute left ventricular heart failure.
The right ventricle becomes incompetent mainly (in 90–95%) due to acute pathology of the lung tissue. As a result of its rapid rearrangements, the myocardium cannot overcome the increased resistance provided by the pulmonary vessels at the time of blood ejection.
The division of acute heart failure into severity is determined by the severity of symptoms. The more severe the manifestations, the higher the degree.
In 80–90% of cases, the clinical picture of acute heart failure always develops very quickly and suddenly (within a few minutes) and can last up to several hours. In the remaining 10–20% of cases, manifestations increase gradually. Symptoms depend on:
The main symptoms and manifestations of acute left ventricular heart failure, taking into account significant factors are described in the table:
| Severity | Symptoms characterizing the severity |
|---|---|
| Cardiac asthma | Sudden shortness of breath, suffocation, feeling of lack of air |
| Worry, anxiety, feeling of fear | |
| Frequent breathing (more than 22–25/minute), shallow | |
| Forced sitting position, inability to lie down | |
| Blueness of fingers, toes, tip of nose and ears | |
| Pale skin and face, sticky cold sweat | |
| Reduced blood pressure (up to 100/60 mm Hg) | |
| Pulmonary edema | Severe shortness of breath and suffocation, rapid breathing (more than 25/minute) |
| Bubbling wheezing that can be heard from a distance | |
| Dry cough with occasional production of frothy sputum | |
| Complete inability to breathe while lying down | |
| Weak rapid pulse(more than 110 beats), dullness of heart sounds | |
| Multiple moist rales when listening to the lungs | |
| Other symptoms characteristic of cardiac asthma | |
| Cardiogenic shock | Loss of consciousness (lethargy) or absence |
| Decrease in blood pressure less than 90/60 mm Hg. | |
| Pronounced pallor of the skin with a marble-bluish tint | |
| Lack of urine | |
| All other symptoms of pulmonary edema and cardiac asthma |
Symptoms of left ventricular failure Symptom development process:
If the right ventricle of the heart becomes incompetent, symptoms of blood stagnation occur in the largest veins of the body - the superior and inferior vena cava. This condition is called acute cor pulmonale. Its manifestations:
All patients with signs of acute heart failure require additional diagnostics:
Methods for diagnosing acute heart failure Since acute heart failure is acute condition, then therapeutic measures to eliminate it should be provided on an emergency basis. Literally every minute is expensive. As soon as this problem is suspected, you need to start providing help.
Acute heart failure can be cured only through complex drug therapy. It includes:
For this purpose, the following drugs are administered intramuscularly:
If the cause of heart failure is due to trauma, wounds of the heart and chest, pathological accumulation of fluid in the pleura or pericardium against the background of inflammation, patients need urgent surgical treatment– puncture or placement of drainage into the appropriate cavity to pump out effusion (blood, pus).
Acute heart failure is characterized by disappointing general statistics - about 50–60% of patients die. The outcome depends on the cause, severity and timeliness of treatment of this complication. At proper treatment the forecasts are:
Despite the sad statistics, do not give up under any circumstances. There is only one life, and you need to fight for it. Moreover, your efforts are rewarded!
The cardiac system begins to develop first in the early stages of pregnancy. And everyone knows that thanks to the contractile work of the heart, the entire body receives a full blood supply. Over the past decades, the number of deaths caused by heart pathologies has increased several times. This is influenced by many factors that unfortunately cannot be prevented.
One of these ailments is acute heart failure. The consequence of its progression may be disability and death. This disease can take even a healthy person by surprise, not to mention those who have suffered a heart attack or other illnesses.
Remember that at least once a year everyone should undergo body examinations, and if you notice any suspicions of a disease, do not delay visiting the doctor. Let's figure out what symptoms may appear, what examination and treatment is necessary, and how you can protect yourself from the disease.
Acute heart failure
Acute heart failure is a sudden decrease in the contractile function of the heart, which leads to disturbances in intracardiac hemodynamics and pulmonary circulation. The expression of acute heart failure is first cardiac asthma, and then pulmonary edema.
Acute heart failure is much more common when the contractile function of the left ventricle is impaired. It is called acute left ventricular heart failure. Acute right ventricular heart failure occurs with lesions of the right ventricle, especially with the development of myocardial infarction of the posterior wall of the left ventricle and its spread to the right.
In most cases of acute heart failure, there is a sharp decrease in the contractile function of the left ventricle with a corresponding pathophysiological mechanism for diseases that lead to hemodynamic overload of this part of the heart: hypertension, aortic defects heart, acute myocardial infarction.
In addition, acute left ventricular failure occurs in severe forms of diffuse myocarditis, post-infarction cardiosclerosis (especially in chronic post-infarction left ventricular aneurysm).
The mechanism of development of hemodynamic disorders in acute heart failure is that a sharp decrease in the contractile function of the left ventricle leads to excessive stagnation and accumulation of blood in the vessels of the pulmonary circulation.
As a result, gas exchange in the lungs is disrupted, the oxygen content in the blood decreases and the carbon dioxide content increases. The delivery of oxygen to organs and tissues deteriorates, the central nervous system is especially sensitive to this.In patients, the excitability of the respiratory center increases, which leads to the development of shortness of breath, reaching the level of suffocation. Stagnation of blood in the lungs as it progresses is accompanied by penetration into the lumen of the alveoli serous fluid, and this threatens the development of pulmonary edema.
Attacks of heart failure also occur in patients with mitral stenosis, when the left ventricle is not only not overloaded, but rather underloaded, due to the fact that less blood enters it. In such patients, stagnation of blood in the pulmonary vessels occurs as a result of a discrepancy between the blood flow to the heart and its outflow through the narrowed mitral orifice.
At mitral stenosis an attack of heart failure occurs during physical activity, when the right ventricle increases its contractile function and fills the pulmonary vessels increased amount blood, and adequate outflow through the narrowed mitral orifice does not occur. All this determines the development of clinical symptoms of the disease and the provision of appropriate emergency care.
Depending on the type of hemodynamics, on which ventricle of the heart is affected, as well as on some features of pathogenesis, the following are distinguished: clinical options OSN.
Since one of the most common reasons The development of AHF is myocardial infarction; the table shows the classification of acute heart failure in this disease.
Complaints. Upon admission, the patient complains of shortness of breath, suffocation, dry cough, hemoptysis, fear of death. With the development of pulmonary edema, a cough appears with foamy sputum, often colored pink color. The patient takes a forced sitting position.
During physical examination, you should pay attention Special attention for palpation and auscultation of the heart with determination of the quality of heart sounds, the presence of III and IV sounds, the presence and nature of murmurs. In elderly patients, it is necessary to determine the signs of peripheral atherosclerosis: uneven pulse, murmurs in the carotid arteries and abdominal aorta.
It is important to systematically evaluate the state of peripheral circulation, skin temperature, and the degree of filling of the ventricles of the heart. Right ventricular filling pressure can be assessed using venous pressure measured in the external jugular or superior vena cava.
Increased left ventricular filling pressure is usually indicated by the presence of moist rales on pulmonary auscultation and/or signs of pulmonary congestion on chest x-ray. In acute heart failure, the ECG is extremely rarely unchanged.
Determining the rhythm and signs of overload can help identify the etiology of AHF. Registration of an ECG is of particular importance if acute coronary syndrome is suspected. In addition, the ECG can reveal the load on the left or right ventricle, atria, signs of perimyocarditis and chronic diseases, such as ventricular hypertrophy or dilated cardiomyopathy.
Killip classification:
AHF is characterized by a variety of clinical variants:
Regarding hemodynamic parameters, there are no clear definitions of this condition. Usually observed arterial hypotension(systolic blood pressure 60 beats/min, the presence of stagnation in the tissues is possible, but not necessary;
Varieties of AHF may be different, but it develops, as a rule, according to a single mechanism. The impetus for its appearance is usually some serious, sudden disturbance of cardiac activity - in medical terms, a cardiovascular event, or a cardiovascular accident.
As a rule, this is a heart attack, but in addition to it there are others possible reasons. For example:
It happens that acute heart failure has “non-cardiac” causes: blood poisoning, alcoholism, severe anemia, etc. However, we will stick to the theme of the site and will not delve into the description of reasons not related to the heart.
How do events develop during AHF? Myocardial contractility decreases. As a rule, the left ventricle is “to blame” for this - it is in this part of the heart that heart attacks mainly occur. The left half of the heart receives arterial blood through vessels coming from the lungs (from the pulmonary circulation) and sends it to all organs and tissues of the human body (into the systemic circulation).
When too little blood is pushed into the large circle, stagnation develops in the small circle. Because of this, the following happens:
A person develops cardiogenic shock. This critical condition, which is likely to lead to the death of the patient.
Already existing diseases contribute to the development of myocardial failure. The provoking factors of right ventricular AHF are:
Triggers for the occurrence of left ventricular AHF are:
If a certain form of acute heart failure develops, symptoms appear immediately. Heart rate drops. Pulmonary edema develops. The patient is bothered by a feeling of squeezing of the throat.
He feels the fear of leaving life. Due to a slowdown in venous blood flow, hepatojugular reflux develops - swelling of the neck veins. The liver increases to large sizes. Since the blood supply to the kidneys is disrupted in AHF, severe renal failure develops.
Signs of acute vascular insufficiency- collapse. The tone of the arterial system decreases. Cardiac activity is impaired, blood pressure drops. The patient is covered in cold sweat. He is motionless and pale.
Foam may come out of the nose and mouth. Because adequate blood flow is not maintained, cardiogenic shock develops. This causes disruption of normal tissue metabolism and adequate oxygen delivery. The patient feels severe weakness and increased fatigue.
Symptoms of AHF and the course of cardiac pathology are determined by its type. Signs of pathology appear especially clearly when moving. A sharp increase in symptoms is characterized by AHF of the left ventricular type. Manifestations of left ventricular failure:
Complications of this syndrome are cardiogenic shock and cardiac asthma. A patient with right ventricular AHF has the following symptoms:
This leads to damage to the myocardial walls. As a result of this pathological process, myocardial heart failure occurs. An increase in the right border of the myocardium, alternating pulse, tachycardia are clinical signs of myocardial failure.
Typically, acute forms of myocardial failure occur in 2 variants:
Due to the presence of a zone of necrosis and exclusion of part of the myocardium from the contraction process, as well as due to a violation functional state In the peri-infarction zone and often in the intact myocardium, systolic dysfunction (decreased contractility) and diastolic dysfunction (decreased compliance) of the left ventricular myocardium develop.
Due to a decrease in the contractile function of the left ventricular myocardium and an increase in its end-diastolic pressure, a consistent increase in blood pressure occurs in the left atrium, in the pulmonary veins, capillaries and arteries of the pulmonary circle.
The development of hypertension in the pulmonary circulation is also facilitated by the Kitaev reflex - narrowing (spasm) of the pulmonary arterioles in response to an increase in pressure in the left atrium and pulmonary veins.
The Kitaev reflex plays a dual role:
Activation of the renin-angiotensin II system and the sympathoadrenal system is important in the development of the Kitaev reflex. The result of increased pressure in the left atrium and pulmonary veins is an increase in blood volume in the lungs, which in turn causes a decrease in the elasticity and compliance of the lungs, the depth of breathing and blood oxygenation.
There is also a progressive increase in hydrostatic pressure in the pulmonary capillaries and, finally, a moment comes when the hydrostatic pressure begins to significantly exceed colloid-osmotic pressure, resulting in plasma sweating and fluid accumulation, first in the interstitium of the lungs, and then in the alveoli, i.e. alveolar pulmonary edema develops.
This in turn causes a sharp disruption in the diffusion of oxygen from the alveoli into the blood, the development of systemic hypoxia and hypoxemia and sharp increase permeability of alveolar-capillary membranes, which further aggravates pulmonary edema. Increased permeability of alveolar-capillary membranes is promoted by biological release under conditions of hypoxemia and metabolic acidosis. active substances histamine, serotonin, kinins.Activation of the renin-angiotensin II system and the sympathoadrenal system, caused by respiratory failure, hypoxia, and a stressful situation, plays an important pathophysiological role in the development of left ventricular failure.
On the one hand, this contributes to spasm of the arterioles of the small circle and an increase in pressure in it, on the other hand, it aggravates alveolar-capillary permeability and pulmonary edema. Activation of the sympathoadrenal and renin-angiotensin systems also causes an increase in peripheral resistance (afterload), which further reduces cardiac output and worsens left ventricular failure.
Patients with myocardial infarction often develop tachy- and bradyarrhythmias, which also contribute to the development of heart failure by reducing cardiac output. With myocardial infarction, right ventricular failure can also develop.Its development is due to the following pathogenetic factors:
With isolated right ventricular myocardial infarction, circulatory failure in the systemic circulation develops without previous stagnation in the pulmonary circulation.
One of the most permanent signs acute heart failure serves sinus tachycardia(in the absence of sinus node weakness, complete AV block or reflex sinus bradycardia); characterized by expansion of the borders of the heart to the left or right and the appearance of a third sound at the apex or above the xiphoid process.
First aid for acute heart failure is provided in cases of acute crisis situations. If a person has lost control of his nervous condition, on the face of attacks, it is necessary to take:
Nitroglycerin for acute heart failure. A semi-sitting position will allow a large amount of fluid to be pushed back to the lower extremities. This will relieve the heart valves from a large amount of blood. The applied tourniquets will prevent sudden rushes of blood to the upper body.
At the first signs of deterioration in a person’s condition, it is necessary to call an ambulance. Since only qualified personnel are able to assess the causes of the deterioration of the condition.In other cases, a person needs rest, relief from cardiac spasms with Corvalol drops or a Validol tablet under the tongue. Under no circumstances should a person be allowed to lie upright. Always place pillows under the upper body to achieve a slight tilt.
To avoid acute situations, it is necessary to regularly check your blood pressure with a tonometer. This will allow you to take the necessary measures in time.
Before the doctor arrives, the patient must be in a semi-sitting position! Since in this case there is an outflow of “excess” blood into the abdominal organs and lower limbs. At the same time, its intrathoracic volume decreases. And this can save a person's life.
It must also be remembered that nitroglycerin (or its analogues) also helps to reduce blood pressure tension in the blood vessels. Therefore, the patient should be given (under the tongue!) a nitroglycerin tablet or one drop of its one percent solution (available in pharmacies).
In particular severe cases You can temporarily (until the doctor arrives) apply tourniquets to the thigh area to exclude a certain amount of blood from circulation. Tourniquets should be applied 5-10 minutes after the patient is transferred to a semi-sitting (sitting) position, since the movement of blood into lower sections the body does not happen instantly.If you know how to administer the medicine intravenously, immediately administer 0.3-0.5 ml of a 0.05% solution of strophanthin with 20 ml of sterile physiological solution. Treatment program:
Treatment tactics for acute left ventricular heart failure:
Emergency first aid:
Treatment of acute heart failure is the responsibility of cardiologists. Specialists prescribe the necessary treatment course:
When taking it, the heart copes better with its function, since myocardial contractility improves. Non-glycoside inotropes help increase cardiac output. Conditions for full delivery nutrients improve vasodilator drugs.
Prevention of acute heart failure is important. Emotional experiences, intense sports, and fast running are contraindicated for patients with heart disease. Required special diet, weight control. You should completely eliminate tobacco and alcoholic beverages from your life. The patient is able to prevent complications of this severe cardiac pathology.
Emergency measures for acute heart failure can save a person's life, since it is under serious threat. Every healthy man should know what AHF is and understand well the danger of this serious disease.
If acute heart failure occurs, the patient requires emergency care immediately. The patient’s quality of life will significantly improve as a result of timely and adequate treatment.
Medicines for acute heart failure are also used:
Various tablets for acute heart failure can be used at its initial stage, depending on its severity:
When there are symptoms of acute heart failure, and conservative treatment due to the characteristics of the diseases that caused it turns out to be ineffective, then the only option left is emergency surgery. In this case, the following may apply:
Patients with AHF stay in the hospital for an average of 10-14 days.
After stabilization of the patient's condition, the next stage of therapy is the prescription of ACE inhibitors and angiotensin-sensitive receptor blockers, mineralcorticoid receptor antagonists, and beta-blockers. If the contractility of the heart decreases (according to Echo-CG, the ejection fraction is less than 40%), then digoxin is prescribed.
When the acute period of heart failure has been overcome, a stable regimen of using diuretics has been found for at least two days, clinical recommendations for acute heart failure are as follows:
In addition to medications, they are used to treat acute heart failure folk remedies, used at home. For example, honey. The effect of honey on the body cannot be overestimated. The rich complex of vitamins, microelements and amino acids contained in it serves as an excellent nourishment for the heart muscle, dilates the blood vessels of the heart, thereby improving its blood supply.
Glucose, which honey is rich in, is an energy material needed by the heart muscle. However, when honey is used in excessive quantities, and even with hot tea, the heart begins to work energetically, and increased sweating occurs. There is no need to put such additional strain on a sick heart.
Therefore, for heart failure, folk remedies such as honey should be consumed in small doses up to 3 times a day, 1 teaspoon or 1 tbsp. spoon, with fruit, cottage cheese, milk, etc. Remember that at temperatures above 60°C, honey loses its beneficial properties!
An infusion of its dried fruits is prepared in a thermos: a tablespoon of them is brewed with 200 ml of boiling water, but the lid is not closed immediately, but after 7-10 minutes, and infused for 5 hours.
After it has cooled, the infusion is drained and a tablespoon of honey is added to it. Reception: up to 3 times a day, half a glass.
Squeeze: one glass of carrot and beet juice from one medium-sized lemon - lemon juice, add the prepared glass of horseradish juice (first grate the horseradish, add water and leave for one and a half days).
Mix the juice mixture with a glass of honey. Drink a tablespoon up to 3 times a day 60 minutes before meals or 2-3 hours later. The course of treatment lasts 2 months.
One of the treatments for acute heart failure with folk remedies is treatment with leeches. Such procedures are carried out up to 2 times a week. The peculiarity of these procedures is that patients suffering from heart failure are subject to long-term treatment.
If the development of the disease occurs with venous congestion, enlarged liver, congestive wheezing in the lungs, leeches in this case are applied for the maximum period until they disappear on their own. If decompensation is present, then the main areas for installing leeches are the sacral and hepatic zones.In order to improve the functioning and condition of the heart muscle, leeches are placed on local points located in the cardiac zone. Zones are selected depending on clinical indications and the body’s reaction to the procedure. The course of treatment is usually 7 - 12 procedures.
For one procedure – 4-8 attachments. If the patient's condition is relatively satisfactory, the number is reduced to 3-4 leeches per procedure, and the course of treatment is extended.
Phytoncides contained in the leaves of trees and shrubs have a beneficial effect on the cardiovascular system. So for people suffering from heart failure, to stimulate the cardiovascular system, it is useful to walk as often as possible under poplars, eucalyptus or laurels, near flowering lilac and hawthorn bushes.
And you can plant a lemon in your apartment. Its phytoncides not only have beneficial effect on the cardiovascular system, but also have a tonic effect on the entire body. It is recommended to regularly chew lemon peel to improve heart function.
As is known from the treatises of ancient Indian medicine, small doses of cardamom added to tea or vegetables stimulate the heart. Eating viburnum berries, both fresh and frozen, has a beneficial effect on the heart and reduces blood pressure in hypertension.
Take a glass of viburnum, fill it with hot water (liter) and cook for 8-10 minutes. Add 3 tbsp honey to the strained viburnum decoction. spoons. Take half a glass up to 4 times a day.
If your legs swell due to heart failure, you should definitely rub them morning and evening. Grind the garlic into a paste. Pour water (2 glasses) into a spoonful of this paste and boil for 5 minutes. Rub the cooled, strained garlic mixture onto your feet.
Grind the parsley (roots along with herbs) in a meat grinder in such an amount that the output is 1 cup of gruel.
Pour it into a glass or enamel container with 2 glasses of boiling water, close it and leave to infuse for 8-9 hours in a warm place. After this, squeeze out the mass, and add lemon juice squeezed from a medium-sized lemon to the strained infusion.Take 1/3 cup for 2 days, after a three-day break, resume taking it and drink for another two days.
The components of the recipe contain everything that a weakened heart muscle needs. Dried apricots, raisins and nuts, in addition to vitamins and microelements, are rich in potassium, which she needs so much. Prepared in October-November.
Buy 300g of raisins (preferably the so-called “cordial” ones) of blue color), dried apricots (to your taste), walnut kernels, honey and lemons. Wash and dry dried fruits. Grind all the ingredients (except honey) by passing them through a meat grinder (lemons along with the peel).
Add honey to the resulting slurry and mix well. Transfer the medicine into clean jars and place in a cool place. Take 1 tbsp daily, up to 3 times a day with meals. spoon until the medicine runs out.
Carrying out a comprehensive examination, the task of which is to identify the risk of malignant ventricular arrhythmia and sudden cardiac arrest, allows for timely adoption of adequate therapeutic measures.
Prevention of sudden death is based on the influence on risk factors:
Numerous experiments have revealed the effectiveness of beta-adrenergic receptor blockers in preventing sudden cardiac arrest in patients who have had a heart attack. The effectiveness of such drugs is due to their antiarrhythmic and bradycardic effect.
Currently, treatment with beta-blockers is indicated for all post-infarction patients who have no contraindications. It is preferable to take cardioselective drugs that do not have sympathomimetic activity.
Treatment with beta-blockers minimizes the risk of sudden cardiac arrest not only in people suffering from coronary artery disease, but also hypertension. Treatment with the calcium antagonist verapamil in patients who have had a heart attack and do not have signs of heart failure contributes to a reduction in mortality.
This drug is similar in action to beta-blockers. Risk reduction sudden death can be achieved through primary prevention myocardial ischemia, i.e., a complex effect on the main risk factors:
The effectiveness of anti-sclerotic drugs from the class of statins has been proven. Patients with life-threatening arrhythmia that cannot be treated with medication undergo surgical treatment:
Despite the advances of modern medicine, it is not always possible to identify a potential victim of sudden cardiac death. If installed high risk sudden cessation blood circulation, it is also not always possible to prevent it.
Based on this, the most important aspect of the fight against fatal arrhythmia is the timely implementation of resuscitation measures during developing circulatory arrest. It is important that not only medical workers, but the majority of citizens knew the basics of resuscitation care.
Due to circulatory problems in the heart, it develops; the reasons why it can occur are quite extensive. WITH medical point vision, acute heart failure is not regarded as a disease - it is a consequence of past illnesses.
The heart is not able to pump the volume of blood that is necessary for the balanced functioning of the entire body. It should be noted that almost every disease of the cardiovascular system can cause this syndrome. Acute insufficiency can also occur due to frequent nervous overstrain, or may be a consequence of constant stressful situations or depression. 82% of overweight people suffer from heart failure.
This type is much more common than the right ventricular form. Due to the influence of various factors, the contractility of the left ventricle is reduced, while the function of the right ventricle can be preserved.
In this case, the pulmonary vessels become overfilled with blood, and accordingly, the pressure in the arteries increases (pulmonary circulation), which begins the process of plasma leakage through the walls of the vessels. Due to pathological changes, gas exchange and the balance of oxygen in the blood and tissues are disrupted, and, as a result, respiratory failure. Accordingly, a large number of substances are released, such as:
All these processes lead to the fact that the vessels become permeable, peripheral resistance increases, and this is a direct path to pulmonary edema.
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Right ventricular acute heart failure can develop when there is an excess supply of fluid, that is, the ventricle is simply overloaded. The reasons for this may be thromboembolism, embolism, rapid blood transfusion, blood replacement fluids. Especially in cases where the catheter is inserted into the subclavian or jugular vein.
The thromboembolic form can occur when blood clots form in the veins of the legs ( varicose veins veins), attacks of atrial fibrillation, smoking, prolonged standing in one position, increased blood clotting. All of these processes cause increased blood viscosity and the formation of blood clots, which interfere with normal blood flow and contribute to overload of the right ventricle.
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One of the main and main reasons for the development of the disease is impaired contractile function of the myocardium. The causes can be classified into two groups: they can be primary or secondary. But such a classification can be called conditional. Almost always, acute failure occurs due to a mixed type of cause.
The primary causes of the development of the disease are: acute infectious diseases, exposure to toxic poisons on the body during poisoning.
No wonder doctors believe that infectious diseases cannot be carried “on your feet”, because they cause complications on the heart. Some of the primary causes of acute failure are the consequences of influenza, rheumatism, measles, scarlet fever, transferred to childhood, hepatitis A, typhoid fever, acute respiratory viral infections, especially in the case of severe forms and the occurrence of sepsis. All listed diseases contribute to the formation of acute inflammation, which, in turn, leads to the development of cell dystrophy, oxygen exchange is disrupted and hypoxia (oxygen starvation) occurs, and there is a lack of nutrients in cells and tissues. Impaired nervous regulation affects the heart muscle, which leads to deterioration of its condition or dystrophy. The causes of acute failure can be severe strokes, their consequences, renal pathologies, alcohol, nicotine, narcotic drugs and medications (especially in overdose), anemia, diabetes.
Secondary ones do not have a direct effect on the myocardium. That is, it occurs due to overwork and oxygen starvation. Such disorders can occur against the background of a hypertensive crisis, tachycardia, arrhythmia (paroxysmal diseases associated with rhythm imbalance), atherosclerotic damage to the coronary vessels. The cause of acute heart failure can be the herpes virus, cytomegalovirus, which damage the coronary vessels.
If a person, for example, has hypertonic disease, then the heart muscle works with increased vascular resistance. The myocardium increases in size - its thickness reaches 3 cm, although normally it should be no more than 14 mm. The weight of the heart also increases to 0.5 kg (normal 385 g). It is very difficult for the vessels to supply the required volume of blood to the enlarged heart muscle. Due to the fact that there is a pathological change and a violation of the ability to contract, during an attack of hypertension, heart failure occurs.
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The causes of this disease can be classified by dividing them into the following groups:
Acute heart failure can occur when the causes are destructive and myocardial damage occurs. This can occur against the background of myocarditis ( infectious inflammation muscles), cardiomyopathy (myocardial damage caused by non-inflammatory processes and tumors), myocardial infarction (thrombosis coronary artery), angina pectoris (a form of coronary artery disease), cardiosclerosis (damage to valves and muscles due to the development of scar tissue in them). Allergic tissue damage caused by bronchial asthma and Lyell's syndrome can cause destruction of the myocardium. With systemic connective tissue diseases (against the background of lupus or rheumatism), acute circulatory failure may develop.
It can also occur due to cardiac overload. In such cases, the heart either pumps larger volumes of blood or works with greater resistance from the blood vessels. Acute failure due to overload may appear as a result of stenosis of the aorta or pulmonary trunk (a barrier is created to the exit of blood flow from the heart), arterial hypertension (increased pressure in the arteries), pulmonary hypertension (sharply increased intravascular pressure in the blood flow of the pulmonary arteries), pathological changes valve apparatus (develops with congenital and acquired defects).
Abnormal heart rate can be considered a cause of acute heart failure. An abnormal heart rate occurs if electrolyte balance, urea and creatinine levels, so contractions simply become ineffective. The cause of rhythm failure can be atrial fibrillation, tachycardia, or bradyarrhythmia.
Acute failure can occur as a consequence of an altered process of filling the heart with blood. The etiology is external compression of the heart walls or due to their rigidity. Such obstacles prevent the heart from filling with sufficient blood, which leads to pathological changes in blood pumping and blood circulation in general. The causes of acute failure in such pathological changes are pericarditis (inflammation of the outer protective membrane of the heart - the pericardium), cardiac tamponade (pathological changes in cardiac hypodynamics). Heart failure develops from stenosis of the atrioventricular valves (narrowing of the atrioventricular opening), amyloidosis, fibroelastosis (increased stiffness of the heart walls).
In childhood (up to 3 years), the causes of acute failure can be: congenital heart disease, myocarditis, complications after infectious diseases. In adolescents, acute heart failure occurs more often due to the use of narcotic drugs and smoking.
Acute heart failure should be treated only in a hospital setting; self-medication should never be done; the disease can cause fluid accumulation in the respiratory tract, slow blood flow, which will lead to cerebral hypoxia and kidney dysfunction. In many cases, if treated negligently, acute heart failure causes death.
Acute (AHF) is a clinical syndrome characterized by the rapid onset of symptoms characteristic of impaired cardiac function (reduced cardiac output, insufficient tissue perfusion, increased pressure in the capillaries of the lungs, tissue congestion). It develops without connection with the presence of cardiac pathology in the past. Cardiac disorders may be systolic or diastolic dysfunction, cardiac arrhythmias, preload and afterload disorders. These violations are often life-threatening and require emergency measures. AHF may develop as acute illness de novo (that is, in a patient without pre-existing cardiac dysfunction) or as acute decompensation.
Complaints. Upon admission, the patient complains of shortness of breath / suffocation, dryness, hemoptysis, fear of death. With the development of pulmonary edema, a cough appears with foamy sputum, often pink in color. The patient takes a forced sitting position.
During a physical examination, special attention should be paid to palpation and auscultation of the heart, determining the quality of heart sounds, the presence of III and IV sounds, the presence and nature of murmurs. In elderly patients, it is necessary to determine signs of peripheral: uneven pulse, murmurs in the carotid arteries and abdominal aorta. It is important to systematically evaluate the state of peripheral circulation, skin temperature, and the degree of filling of the ventricles of the heart. Right ventricular filling pressure can be assessed using venous pressure measured in the external jugular or superior vena cava. Increased left ventricular filling pressure is usually indicated by the presence of moist rales on auscultation of the lungs and/or signs of pulmonary congestion on chest examination.
ECG. In acute heart failure, the ECG is extremely rarely unchanged. Determining the rhythm and signs of overload can help identify the etiology of AHF. Of particular importance is the registration of an ECG if there is a suspicion of. In addition, the ECG can reveal the load on the left or right ventricle, atria, signs of perimyocarditis and chronic diseases such as ventricular hypertrophy or dilatation.
Killip classification
Stage I - no signs of heart failure.
Stage II - heart failure (moist rales in the lower half of the lung fields, III tone, signs of venous hypertension in the lungs).
Stage III - severe heart failure (overt; rales extending to more than the lower half of the lung fields).
Stage IV - (systolic blood pressure less than 90 mm Hg with signs of peripheral vasoconstriction: oliguria, cyanosis, sweating).
AHF is characterized by a variety of clinical variants:
- pulmonary edema (confirmed by chest X-ray) - severe respiratory distress with rales in the lungs, orthopnea and usually arterial oxygen saturation - cardiogenic shock - a clinical syndrome characterized by tissue hypoperfusion due to heart failure that persists after correction preload. Regarding hemodynamic parameters, there are no clear definitions of this condition. Arterial hypotension is usually observed (systolic blood pressure 60 beats/min; tissue congestion is possible, but not necessary;
- acute decompensated heart failure (first-time decompensation of CHF) with characteristic complaints and symptoms of moderate AHF that do not meet the criteria for cardiogenic shock, pulmonary edema or;
- hypertensive AHF - symptoms of AHF in patients with relatively preserved left ventricular function in combination with high blood pressure and an x-ray picture of venous congestion in the lungs or pulmonary edema;
- heart failure with high cardiac output - symptoms of AHF in patients with high cardiac output, usually in combination with tachycardia (due to arrhythmias, thyrotoxicosis, Paget's disease, iatrogenic and other causes), warm skin and extremities, pulmonary congestion and sometimes low blood pressure (septic shock);
- right ventricular failure - low cardiac output syndrome in combination with increased pressure in the jugular veins, liver enlargement and arterial hypotension.
The main causes and factors contributing to the development of AHF:
1. Decompensation of chronic heart failure.
2. Exacerbation of coronary artery disease (acute coronary syndrome):
- myocardial infarction or unstable with widespread myocardial ischemia;
- mechanical complications;
- right ventricular myocardial infarction.
3. Hypertensive crisis.
4. Acutely arisen.
5. Acutely occurring valvular regurgitation, aggravation of previous valvular regurgitation.
6. Severe aortic stenosis.
7. Heavy spicy.
8. .
9. Aortic dissection.
10. Postpartum cardiomyopathy.
11. Non-cardiac provoking factors:
- insufficient adherence to treatment;
- volume overload;
- infections, especially and;
- heavy ;
- extensive surgery;
-
It must also be remembered that nitroglycerin (or its analogues) also helps to reduce blood pressure tension in the blood vessels. Therefore, the patient should be given (under the tongue!) a nitroglycerin tablet or one drop of its one percent solution (available in pharmacies). In especially severe cases, you can temporarily (until the doctor arrives) apply tourniquets to the thigh area to exclude a certain amount of blood from circulation. Tourniquets should be applied 5-10 minutes after the patient is transferred to a semi-sitting (sitting) position, since the movement of blood to the lower parts of the body does not occur instantly. If you know how to administer the medicine intravenously, immediately administer 0.3-0.5 ml of a 0.05% solution of strophanthin with 20 ml of sterile physiological solution.
Most often, HF is associated with a violation of the heart’s ability to pump blood through the vessels; therefore, the direct causes of the disease can be considered various heart defects, coronary disease, as well as arterial hypertension- in women, it is the latter that most often causes heart failure, while in men the root cause is often ischemia.
Additional factors that increase the chances of heart failure are myocarditis, diabetes mellitus, regular smoking/alcohol consumption, and cardiomyopathies. Cardiosclerosis and other designated causes of heart failure also provoke the development of cardiac asthma, which is very dangerous for older people and often causes their death even before development last stage SN.
Often, heart failure in people is detected very late, sometimes already in the terminal stage. This is due to the vagueness and ambiguity of the symptoms of the disease in the early stages of its development - it is for this reason that people who have experienced myocardial infarction or have chronic problems with the cardiovascular system are regularly asked to undergo medical examinations, since only a comprehensive diagnosis is the most effective method early detection Problems.
The visible symptoms of heart failure directly depend on the location of the problem. So, in case of problems with the left ventricle, the patient is diagnosed with dry wheezing, shortness of breath, hemoptysis, and cyanosis. In case of right ventricular insufficiency, the patient complains of swelling in the extremities, as well as pain in the right hypochondrium, which indicates problems with liver function due to excess venous blood in this body.
In addition, regardless of the location of the problem, one of the typical characteristic signs of HF can be considered rapid fatigue and decreased ability to work.
The basic classification of symptoms by stages of development and severity includes five stages:
Doctors divide heart failure into two main forms:
This type of heart failure develops rapidly, often within 1–2 hours. The main causes are mitral/aortic valve insufficiency, myocardial infarction, or rupture of the walls of the left ventricle. Basic manifestations include cardiogenic shock, cardiac asthma, and pulmonary edema.
Develops gradually, can form throughout long period time, flesh up to several years. Clinical manifestations in this case, they are similar to acute heart failure, but the treatment process itself is longer, and with severe stages The disease is still not effective. Basic reasons chronic HF - heart defects, long-term anemia, arterial hypertension, generalized chronic respiratory failure in the decompensation stage.
Timely diagnosis of heart failure is one of the most effective treatment mechanisms, allowing timely prescribing of conservative therapy.
In addition to differential analysis of anamnesis and objective vital signs, full complex laboratory and instrumental examinations - chest x-ray, echocardiogram, etc.
Most patients admitted to the hospital with a diagnosis of heart failure require complex treatment, often with surgery.
Unfortunately, in most cases conservative therapy not enough to overcome the disease, especially in the severe stage of heart failure. In this case, it is rational to use surgical intervention - replacing valves, unblocking arteries, installing a defibrillator or pacemaker.
Additional recommendations for patients include following a diet with a minimum of salt and liquid, normalizing overweight, physiological procedures, proper cardio exercises, taking specialized vitamin complexes, as well as quitting smoking/alcohol abuse.
A number of alternative modern studies show that in the complex treatment of heart failure, individual dietary supplements and compounds (coenzyme Q10, taurine) contribute to more effective treatment of the disease and speedy recovery. This is due to the peculiarities of the pathogenesis of chronic forms of heart failure and the destruction of macroenergetic compounds at the cellular level, which leads to the activation of free-radial reactions and the formation of biophysical processes that catalyze the development of the disease.
Thus, regular intake of flavonoids and taurine in a number of patients improves the endothelial function of patients with heart failure by inhibiting platelet function. However, the use of the above-mentioned drugs is possible only after preliminary consultation with the attending physician and only in combination with standard conservative therapy.
Traditional medicine can offer the patient a huge number of different recipes for the prevention and treatment of heart failure as a supplement complex therapy diseases. Any folk remedies can be used only after prior agreement with your cardiologist!
Complications and consequences of HF are nonspecific and depend on the stage of the disease. The most common:
Diet - important element complex treatment, rehabilitation and prevention of a person before, during and after heart failure. The general principles of proper nutrition during this period are aimed at correcting the daily intake of salt and liquids. The food should be easily digestible and fairly high in calories.
The optimal nutrition plan is fractional, divided into 5–6 approaches. Be sure to exclude strong varieties of tea and coffee, chocolate, fatty, smoked, salty foods, and pickles from your diet. If the patient’s condition is satisfactory, then during the remission stage the maximum amount of salt consumed per day should not exceed 5 grams. In case of destabilization and exacerbations or acute form of heart failure, food containing salt should be completely excluded from the diet.
Also, check daily use liquids in the range of 0.8–1.5 liters per day (this includes both water and liquid soups/borscht, teas, juices, and other products). Increase your intake of foods containing potassium - nuts, raisins, bananas, baked potatoes, veal, peaches, Brussels sprouts, buckwheat and oatmeal. This is especially true if you are prescribed diuretics to remove excess fluid from the body and reduce swelling.
Heart failure. What makes the heart weak?
Heart pain, what to do, how to help and prevent - Doctor Komarovsky
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