Acute heart failure emergency care ⋆ Heart Treatment

Cardiologists determined that the main role in the development of insufficiency belongs to the violation of the contractile function of the myocardium (heart muscle).

There are primary and secondary causes, although such a classification is conditional. Most often, a mixed type of disorder is observed.

The primary ones include myocardial damage in acute infectious diseases (influenza, rheumatism, measles and scarlet fever in children, hepatitis, typhoid fever) and toxic poisoning (carbon monoxide, carbon monoxide, chlorine, methyl alcohol, food poisoning). Under these conditions, acute inflammation or dystrophy of muscle cells occurs, the supply of oxygen and nutrients that provide energy is disrupted. Violation of nervous regulation worsens the condition of the myocardium.

Secondary causes are those that do not directly affect the heart muscle, but contribute to overwork and oxygen starvation. Such conditions occur during paroxysmal rhythm disturbances, hypertensive crisis, with severe atherosclerotic damage to the coronary vessels.

In a person suffering from hypertension, the heart adapts to work in conditions of increased vascular resistance, the heart muscle in thickness reaches 2.5 – 3 cm (normal maximum thickness of the left ventricle is 1,4 cm). The weight of the heart rises to 500 g (under normal – up to 385 g). Own vessels are not able to supply enough blood to such a muscle. The ability to contract is impaired, and heart failure may occur during the next hypertensive crisis.

Coronary atherosclerosis mechanically interferes with the blood supply to the main muscle of the body. Pain during angina attacks is figuratively called “cry of a starving myocardium.”

Acute myocardial infarction is an extreme degree of impaired contractility of the heart. In this disease, myocardial cells not only suffer from hypoxia (lack of oxygen), but are turned off from the blood circulation. Necrotic areas of myocardial tissue are not able to contract, therefore, in acute widespread heart attack, heart failure often appears.

Acute heart failure in children under three years of age occurs in connection with congenital malformations of the cardiovascular system, myocarditis, as a complication of acute infectious diseases. In older children, the toxic effect on the myocardium in case of poisoning becomes the predominant cause.

Causes of Acute Heart Failure

Acute heart failure can complicate the course of many diseases or conditions; its causes and development mechanisms are different.

Among the reasons can be identified the following: decompensation of chronic heart failure, acute myocardial infarction, mechanical complications of acute myocardial infarction (for example, interventricular septum rupture, mitral valve chord rupture, right ventricular infarction), right ventricular myocardial infarction, rapidly progressive arrhythmia, or severe acute bradyardema pulmonary artery, hypertensive crisis, cardiac tamponade, aortic dissection, birth cardiomyopathy, obstruction of blood flow (narrowing of the aortic mouth and mit cial bore, hypertrophic cardiomyopathy, tumors, blood clots), valve failure (mitral or aortic), dilated cardiomyopathy, myocarditis, heart injury.

Non-cardiac causes include: infections, especially pneumonia, sepsis, lack of adherence to treatment, volume overload, severe stroke, surgery and perioperative problems, kidney dysfunction, exacerbation of bronchial asthma, chronic obstructive pulmonary disease, anemia, medications (non-steroidal anti-inflammatory drugs, corticosteroids , drug interactions), hypo- or hyperfunction of the thyroid gland, alcohol abuse and drugs.

Acute heart failure in children. Classification, clinic, emergency care.

A dynamic condition in which cardiac output is not able to provide the body’s metabolic needs for oxygen and other substrates is acute heart failure in children.

In the occurrence of heart failure, there are two main mechanisms that lead to a decrease in myocardial contractility. In the first case, a decrease in myocardial function occurs as a result of heart overload, when it is unable to perform the work that is required of it, and the compensatory possibilities are exhausted.

In the second case, myocardial metabolism is primarily impaired, mainly due to a disorder of metabolic and energy processes in the heart muscle as a result of acute hypoxia, intoxication, and allergic reactions. This type of heart failure is called energy-dynamic failure. It is much more common in children and is usually acute.

The division of DOS into energy-dynamic and hemodynamic is sometimes conditional.

Etiology. Acute heart failure in children most often develops due to bacterial and toxic myocardial damage with toxic pneumonia, influenza, intestinal infections, rheumatic myocarditis and heart defects, diphtheria and typhoid myocarditis, acute nephritis, and long-term anemia.

Causes of heart failure can be congenital and acquired heart defects, vitamin deficiency (B vitamins), electrolyte deficiency (potassium deficiency) with peritonitis and intestinal toxicosis, acute hypoxia, various types of exogenous poisoning and initial myocardial weakness (congenital carditis and cardiomyopathy).

Right ventricular heart failure can develop with severe bronchial asthma, chronic pneumonia, defects in the right heart, emphysema, spontaneous pneumothorax. Excessive intravenous administration during infusion of saline solutions, plasma, blood, etc. without control of venous pressure can also lead to acute cardiac overload, especially in patients with pneumonia.

OCH develops according to the left, right ventricular and combined type. Right ventricular failure develops with severe pulmonary pathology, during surgery with rapid infusion therapy without monitoring central venous pressure. Left ventricular failure is more common in children with rheumatic heart disease, acute myocarditis and nephritis.

In assessing heart failure, its severity is of great importance. G.F. Lang (1934) proposed to distinguish 4 degrees of heart failure (H1, H2A, H2B, H3). This classification with minor modifications is used in pediatrics at the present time. In intensive care, it is more convenient to divide the OSN into compensated and decompensated (I and II degrees).

Pathogenesis. For a correct understanding of the pathogenesis and treatment of cardiovascular failure, it is necessary to know the metabolic biochemical processes that underlie cardiac activity. The metabolic processes in the heart muscle have three main phases: 1) the release of energy; 2) energy conservation;

3) energy use. Energy is generated as a result of glycolysis, oxidation of fatty acids and pyruvic acid and dehydrogenation in the Krebs cycle of tricarboxylic acids. Energy conservation is carried out through the activity of enzymes that carry hydrogen. In the process of oxidative phosphorylation, hydrogen energy is converted into ATP final bond energy and through creatine kinase into creatine phosphate.

The contraction of cardiac myofibrils occurs under the influence of the movement of ions in the heart cells as a result of depolarization and repolarization of the membrane. Sodium ions enter the cell, the membrane is depolarized, followed by sodium, chlorine and calcium ions enter the cell, and potassium ions begin to escape from the cell – the repolarization phase.

With heart failure, the water-electrolyte balance is disturbed, which leads to a delay in the body of water and salts, and sodium ions are retained more than water. Sodium ions, accumulating inside the cells, displace potassium ions from there. These shifts are amplified due to impaired renal excretion of sodium and potassium.

Heart failure leads to impaired blood circulation in the kidneys, resulting in lower filtration and increased reabsorption of sodium in the body, which in turn leads to increased excretion of potassium by the kidneys. The leading role in these disorders belongs to extracardiac, especially nervous and hormonal factors.

As a result of metabolic disorders in the myocardium and the resulting deterioration in the contractility of the heart muscle, the ejection of blood from the heart cavity decreases, which leads to complex hemodynamic disorders, a decrease in minute blood volume, an increase in venous pressure, and an increase in circulating blood volume (BCC).

During hypoxia, the content of macroergic phosphorus compounds and glycogen in the heart muscle decreases, the amount of lactic and pyruvic acid increases, the activity of tissue enzymes is inhibited, the balance of electrolytes changes – the content of intracellular sodium increases and the intracellular potassium decreases. Oxygen starvation has an adverse effect on the conduction system of the heart.

1) Tachycardia, which occurs initially as a compensatory reaction of the heart with a decrease in myocardial contractility and a decrease in stroke volume of the heart, in order to maintain an adequate minute volume of blood circulation;

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2) Shortness of breath, which also occurs as a compensatory reaction. The growth of heart failure, leading to a violation of pulmonary gas exchange, further increases shortness of breath with the involvement of auxiliary muscles in breathing;

3) The expansion of the borders of the heart. It is practically important not only to determine the expansion of the heart, but also to establish whether this is a consequence of dilatation, compensatory or myogenic hypertrophy;

4) Cyanosis of the skin and mucous membranes due to reduced blood supply to tissues and their insufficient supply of oxygen. As a result of this, metabolic processes are disturbed in the tissues, the proportion of anaerobic glycolysis increases with the accumulation of products of incomplete cleavage and a shift of the reaction to the acid side;

5) Pastosis of the skin and tissue swelling. Of the various pathogenetic mechanisms for the development of these symptoms, stagnation of blood in a large circle of blood circulation, a change in hydrostatic and colloid osmotic pressure, an increase in the permeability of the vascular wall, a decrease in renal blood flow, electrolyte shifts due to increased secretion of aldosterone are important;

6) An increase in the liver, which indicates a violation of the venous outflow, stagnation of blood in a large circle of blood circulation and is accompanied by an increase in CVP, an expansion of the venous network on the face and chest;

Symptoms of Acute Heart Failure

Consider how this pathology manifests itself. The main symptom is shortness of breath: it occurs along with a sharp pain behind the sternum. Symptoms appear even when a person is in a calm state. In this case, the patient may have difficulty breathing in and out. Tachycardia is another sign of pathology: it develops due to a lack of air in the respiratory system.

Heart failure is characterized by heart palpitations. It is caused by insufficient blood supply to the heart. If the pathology progresses, compensatory functions are violated in the body: in this case, bradycardia develops. A symptom of heart failure is apnea: a person does not have enough air.

This condition is characterized by shortness of breath that occurs in the supine position of the patient. When a person gets up or sits down, the severity of apnea decreases. First aid for acute heart failure should be given correctly. It is important to cope. This symptom appears due to the fact that fluid accumulates in the heart.

In a dangerous condition, the skin turns blue. PMP in acute heart failure plays an important role in the prognosis. Symptoms of a dangerous condition can increase at a tremendous speed: in this case, emergency medical assistance is needed on the spot. Heart failure is also characterized by oliguria. In this case, the patient rises levels of substances that disrupt blood circulation in the kidneys. Thus, the organs of the genitourinary system do not remove urine in full. Edema may appear on the victim’s legs.

Symptoms are diverse and depend on the causes of the disease and on the degree of dysfunction of the left or right ventricles. Depending on the main symptoms, acute heart failure is divided into left ventricular and right ventricular failure, in some situations right and left ventricular failure (biventricular insufficiency) may occur simultaneously.

Biventricular insufficiency occurs with myocardial infarction with damage to the right and left ventricles, with mechanical complications of acute myocardial infarction (rupture of the interventricular septum), myocarditis, etc.

The main cause of acute left ventricular failure is left ventricular myocardial dysfunction (myocardial infarction, hypertensive crisis, heart rhythm disturbance). The following symptoms are characteristic: increasing shortness of breath, worse when lying down, up to asphyxiation. An extreme manifestation of acute left ventricular failure is cardiogenic shock.

Acute right ventricular failure occurs with pulmonary embolism, right ventricular myocardial infarction, cardiac tamponade, and asthmatic status. The main symptoms: swelling and increased pulsation of the cervical veins, swelling, enlarged liver.

Given the above, the main signs of acute heart failure are: heavy, rapid breathing (more than 24 per minute), noisy breathing – shortness of breath up to suffocation. A clear increase in shortness of breath and cough in a horizontal position. The sitting position and the position with the raised headboard facilitate the patient’s condition.

Heart failure can develop very quickly and lead to the death of the patient within 30-60 minutes.

Diagnostics

Diagnosis begins with a survey to clarify possible causes, followed by an examination where the doctor can note the presence of edema, swelling and pulsation of the cervical veins, pallor of the skin, palpation to reveal an enlarged liver, skin moisture, auscultation – wheezing in the lungs, rhythm disturbances, the appearance of additional tones and noises in the heart.

Next, studies are performed to determine the cause of acute heart failure, laboratory tests are performed:

  • clinical blood test (to determine the presence of inflammation, anemia),
  • general urine analysis (to assess the condition of the kidneys).
  • Biochemical blood test: urea, creatinine (to assess the functional state of the kidneys), transaminases (to assess the condition of the liver), potassium, sodium levels (exclude electrolyte disturbances, to assess kidney function),
  • blood sugar
  • troponin (exclude damage to the heart muscle),
  • D-dimer (with suspected pulmonary thromboembolism),
  • arterial blood gases (with severe heart failure),
  • cerebral natriuretic peptide (pro-BNP, increases in heart failure).
  • An electrocardiogram (ECG) in 12 leads allows you to evaluate the rhythm of the heart, the presence of myocardial ischemia.
  • A chest x-ray of the chest organs is performed to assess the size and boundaries of the heart, the severity of stagnation in the lungs.
  • Echocardioscopy (ECHO-KS) is necessary to assess structural and functional changes in the heart (condition of valves, heart muscle, pericardium, pulmonary artery diameter, pulmonary artery pressure, mechanical complications of myocardial infarction, heart tumors, etc.).

In some situations, coronary angiography, an examination of the vessels of the heart, may be required. If pulmonary embolism is suspected, spiral computed tomography and lung scintigraphy are performed. To exclude stratified aortic aneurysms, magnetic resonance imaging may be required.

All patients are shown round-the-clock monitoring of blood pressure, pulse oximetry (determination of oxygen saturation of hemoglobin in the blood), ECG.

The need to establish the causes of a serious condition dictates treatment measures.

  • When examining a patient, the doctor notes a characteristic position of the body, blueness of the lips, bloating of the cervical veins.
  • When listening to the heart, pronounced tachycardia (frequent contractions) is determined to 120 per minute or more.
  • Blood pressure measurement associates the condition with a hypertensive crisis.
  • Auscultation of the lungs allows you to identify many rales of different sizes, altered breathing with the onset of pulmonary edema.
  • Palpation of the liver and determination of enlarged sizes, severe pain is a sign of right ventricular overload.
  • ECG studies are conducted and decoded at the ambulance team level. The type of myocardial overload has characteristic ECG signs.
  • With the help of ultrasound, not only is a diagnosis established, but also possible compensatory mechanisms of the circulatory system are determined.
  • Blood tests reveal the characteristic signs of liver and kidney ischemia, register the breakdown products of the heart muscle, and determine the degree of oxygen deficiency.
  • An X-ray examination reveals extended borders of the heart, an increased fluid content in the lung tissue.

Diagnosis of acute heart failure is not difficult. Significant difficulties arise with the emergency treatment of this syndrome.

Timely medical attention, follow-up instructions for the treatment of hypertension and ischemic disease, monitoring blood pressure, cholesterol and blood sugar, and regular ECG tests will help you avoid problems.

Myocardial infarction: emergency care, principles of treatment in a hospital

The main goal of treatment is the rapid stabilization of the condition, the reduction of shortness of breath. The best treatment results are achieved in specialized emergency departments.

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Oxygen therapy (inhalation of moistened oxygen), in severe cases, may require respiratory support, mechanical ventilation.

Drug treatment: morphine is indicated at an early stage of acute heart failure, especially in the presence of pain, agitation of the patient, nitro drugs are given before the ambulance arrives, then intravenous administration is continued. Depending on the severity, other drugs can be used at the initial stage: venous vasodilatotra (sodium nitroprusside, neziritide), diuretics (loop, thiazide-like), intropic drugs improve heart muscle contraction (dobutamine), vasopressors (dopamine). Preparations for the prevention of thromboembolic complications (anticoagulants).

In some diseases underlying heart failure, emergency surgical intervention is necessary. Possible surgical methods include: myocardial revascularization, correction of anatomical defects of the heart (prosthetics and valve reconstruction), mechanical means of temporary support of blood circulation (intra-aortic balloon counterpulsation).

The next stage of treatment after stabilization of the condition includes the appointment of angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers, beta-blockers, antagonists of mineralocorticoid receptors. With a decrease in the contractility of the heart, digoxin is prescribed (with an ejection fraction according to ECHO-CS less than 40%).

Before discharge, it must be provided that the acute period of heart failure is resolved, a stable regimen for the use of diuretics is established for at least 48 hours.

The average length of hospital stay is 10-14 days. They continue treatment (including beta-blockers, ACE inhibitors or antigiotensin receptor blockers, mineralocorticoid antagonists) at the outpatient stage. After discharge from the hospital, patients are observed by a cardiologist at the place of residence. Timely correction of therapy, dynamic performance of ECG, ECHO-KS as well as control of laboratory parameters (electrolytes, creatinine, pro-BNP) help to reduce the number of hospitalizations of the patient and improve the quality of life of the patient.

Also, the doctor will give specific recommendations on the diet, the level of physical active, explain the need for medication, indicating possible side effects, note the conditions, the appearance of which should alert the patient.

Nutrition: limiting fluid to 1,5–2 L / day to reduce symptoms and fluid retention. Limiting fluid by weight (30 ml / kg body weight, 35 ml / kg with a body weight of more than 85 kg) can reduce the severity of thirst, monitoring and preventing malnutrition.

Eating healthy food: limiting animal fats in favor of eating poultry, fish (preferably marine), but not more than 2 times a week, fresh vegetables, fruits, herbs, seafood; refusal of fried foods, preference is given to stewed and steamed, if necessary, limit salt to 1 g per day.

Be sure to exercise weight control. If you increase more than 2 kg in 3 days, consult a doctor.

Quitting smoking and using drugs is mandatory, modest use of alcohol is possible (complete abstinence is recommended in patients with alcoholic cardiomyopathy). In other cases, the following rule may apply: 2 alcohol units per day for men and 1 unit per day for women (1 unit = 10 ml of pure alcohol, for example, 1 glass of wine).

Daily physical activity, aerobic exercise 30 minutes a day as needed (walks in the fresh air, Nordic walking).

Immunize against influenza viruses and pneumococcal infections, since any viral or bacterial infections can lead to a worsening condition.

During travel, monitor and adapt fluid intake, particularly during flights and in hot climates. Avoid adverse reactions from exposure to the sun when taking certain medications (e.g., amiodarone).

Individual recommendations are also given, the doctor informs the patient about the possible side effects of the prescribed drugs.

Timeliness of first-aid and emergency medical care in case of an attack of myocardial infarction in most cases is the key to a successful recovery of the patient. It is the absence of such events that often causes the death of even young people who have happened to face this acute cardiac pathology.

The answer to this question is always unequivocal – immediately. That is, already when the patient began to appear the first signs of myocardial infarction. The following typical symptoms signal its onset:

  • intense pain behind the sternum;
  • irradiation of pain in the left arm, shoulder blade, teeth or neck area;
  • severe weakness;
  • fear of death and intense anxiety;
  • cold, sticky sweat;
  • nausea.

With atypical forms of heart attack, the patient may have other symptoms:

  • stomach ache;
  • digestive disorders;
  • vomiting;
  • dyspnea;
  • choking, etc.

First aid in such situations should begin with an ambulance call. In a conversation with the dispatcher of this service, you must:

  • report symptoms that are observed in the patient;
  • make an assumption about the possibility of myocardial infarction;
  • ask for a team of cardiologists or resuscitators.

After that, you can begin to carry out those activities that can be performed outside the hospital.

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First a />Give the patient a ground tablet of Aspirin (to thin the blood).
  • Count the pulse of the patient. If the heart rate is not more than 70 beats per minute and the patient does not suffer from bronchial asthma, then he can be given one of the beta-blockers (for example, Atenolol 25-50 mg).
  • Mustard must be placed on the area of ​​pain localization (do not forget to follow it so that there is no burn).
  • During the provision of first aid, the patient’s condition may be complicated by such conditions:

    When fainting occurs, it is necessary to remain calm and ensure the normal functioning of the respiratory system. The patient must be given a horizontal position, put a roller under the shoulders and remove dentures from the oral cavity (if any). The patient’s head should be in a tilted position, and with signs of vomiting it should be turned to its side.

    If cardiac arrest occurs before the medical team arrives, artificial respiration and indirect heart massage should be performed. The frequency of pressure on the midline of the chest (heart region) should be 75-80 per minute, and the frequency of blowing air into the respiratory tract (mouth or nose) should be about 2 breaths every 30 strokes of the chest.

    Emergency medical care for myocardial infarction begins with the relief of acute pain. For this, various analgesics (Analgin) and drugs (Promedol, Morphine, Omnopon) can be used in combination with Atropine and antihistamines (Diphenhydramine, Pipolfen, etc.). For the onset of a faster effect, painkillers are administered intravenously. Also, Seduxen or Relanium is used to eliminate the patient’s excitement.

    Then, to assess the severity of a heart attack, an electrocardiogram is performed on the patient. If hospitalization is possible within half an hour, then the patient is immediately transported to a medical institution. If it is impossible to deliver the patient to the hospital for 30 minutes, thrombolytics (Alteplaza, Purolaza, Tenecteplase) are administered to restore coronary blood flow.

    A stretcher is used to transfer the patient to the ambulance, and during transportation to the intensive care unit, humidified oxygen is inhaled. All these measures are aimed at reducing the load on the heart muscle and preventing complications.

    After arriving at the intensive care unit to eliminate a pain attack and excitement, the patient is administered neuroleptanalgesia with Talamonal or a mixture of Fentanyl and Droperidol. In case of a prolonged religious attack, the patient may be inhaled anesthetized with a gaseous mixture of nitrous oxide and oxygen.

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    Acute heart failure – first aid

    • call an ambulance, • give the patient a sitting position, • put his feet in heat (heating pad, hot water tank), • measure blood pressure with systolic pressure above 100 mm Hg. Give 1 tablet of nitroglycerin under the tongue or 1 inhalation under tongue, if the patient’s condition improves, repeat the administration of nitroglycerin after 10 minutes, then every 10 minutes until the ambulance arrives. If there is no effect, do not give nitroglycerin again, • try to reassure the patient.

    It is extremely important that the provision of first medical and first aid for an attack of acute heart failure is carried out on time and without any delay. This condition, accompanied by a significant disruption of the heart and hypoxia of tissues and organs, can be complicated by more severe disorders and coronary death.

    General information

    Acute heart failure is a sudden or rapidly progressive weakening of myocardial contractility with subsequent circulatory disorder. The cause of acute heart failure can be overload of the heart with increased blood volume or pressure (with heart defects, pulmonary heart), as well as a decrease in the contractile function of the myocardium with a decrease in its mass and degenerative changes.

    In preschoolers, its causes, along with congenital heart defects, are non-rheumatic acute myocarditis, pericarditis, cardiomyopathy, acute pneumonia.

    In older children, in addition to the reasons described above, acute heart failure can occur with rheumatic heart diseases, septic endocarditis, arterial hypertension and arterial crisis, acute and chronic glomerulonephritis, systemic diseases of connective tissue, diffuse toxic goiter, bronchial asthma.

    Reasons for ARF

    In the pathogenesis of acute heart failure in children, the main role is played by energy-dynamic failure, as a result of which the activity of NaKATPase increases, actomyosin synthesis decreases, electrolyte imbalance occurs, which leads to a decrease in myocardial contractility. Reducing the impact of blood from the cavities of the heart, lowering blood circulation, overfilling of the vessels of the lungs reduce the respiratory surface, which contributes to the development of oxygen deficiency and metabolic acidosis.

    Hemodynamic insufficiency occurs more often with congenital and acquired heart defects. Under the influence of hypoxia, hematopoiesis is activated, tissue permeability, microcirculation are disturbed. Due to venous congestion and especially insufficient blood supply to the kidneys, glomerular filtration decreases, the release of renin, aldosterone and antidiuretic hormone increases, which leads to a delay in the body’s water, sodium, and potassium excretion can be increased in parallel.

    The extinction of cardiac activity is caused by a violation of the atrioventricular and sinoauricular conduction, a progressive decrease in myocardial contractile function, leading to impaired circulation in the coronary vessels, and expansion of the heart cavities.

    Symptoms of ARF

    Clinically distinguish heart failure left ventricular and right ventricular. Acute heart failure syndrome is a type of acute left ventricular failure, manifested in two forms – cardiac asthma and pulmonary edema.

    The main symptoms of cardiac asthma in children are a sudden onset (children wake up with a sensation of acute lack of air – suffocation), a sense of fear of death, shortness of breath. Young children show extreme anxiety, sometimes scream for a long time in connection with increasing shortness of breath, refuse to breast.

    Older children take a forced position sitting with their legs down, lean their hands on the bed and tilt their heads forward to facilitate breathing. When cardiac asthma occurs, the skin and mucous membranes quickly turn pale, then cyanosis of the face and lips appears and intensifies, the skin is covered with cold, sticky sweat.

    Increasing inspiratory dyspnea or a mixed, without deepening of breathing, frequent dry cough are noted. Auscultation is determined weakened or hard breathing in the early period, with the addition of pulmonary edema, there is a cough with abundant foamy sputum of pink color, and medium bubbling rales appear during auscultation. Breathing becomes noisy, bubbling.

    On palpation of the heart region, there is a sharp weakening of the apical impulse and its shift to the left. When listening, deafness of heart sounds, various cardiac murmurs, cardiac arrhythmias are revealed. Tachycardia. Pulse of small filling and voltage. In the initial period, a short-term increase, and then a decrease in blood pressure, is recorded.

    When joining right-ventricular heart failure, a gradual increase in symptoms is characteristic – swelling of the cervical veins, enlargement and soreness of the liver, spleen. The development of congestion in the abdominal organs is accompanied by nausea, vomiting, and diarrhea. With the further development of insufficiency, soft tissue pastiness appears, then swelling.

    Dominated by nocturnal diuresis. General lethargy intensifies, dizziness, lethargy, muscle hypotension or convulsive syndrome, areflexia, and loss of consciousness develop. Tachycardia is replaced by bradycardia, tachypnea – by arrhythmic respiration. There is a syndrome of hypoxic coma in connection with swelling and hypoxia of the brain.

    • During first aid in acute heart failure should begin immediately to avoid pulmonary edema and oppression of the respiratory center.
    • During first aid in acute heart failure, ensure complete rest in bed with a raised headboard.
    • Be sure to free the patient from constraining clothing during first aid.
    • When providing first aid, be sure to warm the patient with heating pads.
    • Give oxygen or open a window, a window for fresh air.
    • Inject intravenously korglikon or strophanthin slowly. In 10-15 ml of an isotonic solution or 20% glucose solution.
    • Introduce lasix subcutaneously (1% solution – 2-3 mg per 1 kg of body weight per day (in 1 ml – 10 mg), intravenously in combination with a 2,4% solution of aminophylline (dose – 0,2 ml per year life, but not more than 5 ml).
    • With excitement, a fear of death, shortness of breath – the introduction of seduxen (1% solution – 0,1-0,2 ml per year of life) or a droperidol solution (0,25% solution – 0,1-0,25 ml for a year of life).
    • To prevent a drop in blood pressure and reduce the permeability of the alveolar-capillary membranes, prednisone (1-3 mg per 1 kg per day), cocarboxylase (25-100 mg per day) are administered subcutaneously or intramuscularly.
    • With an increase in blood pressure, apply venous tourniquets alternately on the limbs for 10-15 minutes, but not more than an hour in total. Blood pressure monitoring is required! Intramuscular administration to reduce the blood pressure of dibazole (0,2 ml per year of life), 2% noshpa solution (0,2 ml per year of life), 2% papaverine solution (0,05 ml per year of life).
    • When lowering blood pressure, subcutaneously or intramuscularly inject a solution of cordiamine (0,1 ml per year of life), 10% sulfacamphocaine solution (0,1 ml per year of life), 10% caffeine solution (0,1 ml per year of life) ), in the absence of the effect of these drugs, introduce a 1% solution of mesatone (0,02 ml per kg of mass) subcutaneously or intravenously slowly in 10-15 ml of a 20% glucose solution. With an increase in symptoms leading to cardiac arrest or asystole, conduct resuscitation measures.

    Forecast

    The prognosis of heart failure is always determined by the disease, as a result of which it developed. Heart failure is always prognostically unfavorable. Within one year, 17% of hospitalized and 7% of outpatients with heart failure die. In 30-50% of cases, patients die suddenly from severe rhythm disturbances.

    Summing up, I would like to note the special importance of regular intake of recommended medications at the outpatient stage, and maintaining a healthy lifestyle. Remember that the strict implementation of the doctor’s recommendations will help to avoid repeated hospitalizations and improve the patient’s quality of life.

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    Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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