Chronic left ventricular failure treatment

Acute failure of this type is most often observed in patients older than 60 years. But there are frequent cases when the disease affects people of 40 years of age. The development of this disease provokes myocardial infarction and coronary heart disease. Heart disease and cardiomyopathy are considered less likely causes of the disease. Often, in elderly patients, the development of the disease is caused by type 2 diabetes mellitus, in combination with high blood pressure.

Factors of the development of the disease are nervous overstrain, hard physical work, which is accompanied by a lack of proper rest and overwork.

Among the reasons that provoke pathology can also include:

  • acute viral diseases that a person carries on his feet;
  • advanced pneumonia;
  • taking drugs that can be toxic to the heart and the body as a whole;
  • abuse of coffee and energy, which include large doses of caffeine.

A person who is overweight and does not follow a healthy lifestyle is at risk. In addition, the likelihood of heart disease is high in people who abuse alcohol or smoke.

Left ventricular heart failure can be a consequence of myocardial infarction, as well as severe arrhythmia. With this pathology, the minute emission and the amount of blood that must enter the arterial vessels are sharply reduced.

With the development of the disease, the load on the heart increases, because it is trying by all means to compensate for the changes in the vascular system. The heart muscle begins to contract more strongly, its rhythm quickens, capillaries and arterioles expand, tissue perfusion increases. The development of pathology leads to stretching of the myocardial muscles.

  1. Oxygen starvation of the body. At the same time, oxygen uptake by tissues occurs only by 30%, with a norm of 60-70%. Ac />
  2. Stagnant changes in the organs. At the same time, respiratory capacity decreases, which leads to bronchitis, pneumonia, and blood expectoration. Patients experience pain in the right rib. As a result of stagnant processes, gastritis can develop with vomiting and loss of appetite.

In case of left ventricular failure, the patient quickly becomes tired, his mental and physical activity decreases, his sleep is disturbed, he becomes irritable, prone to depressive states.

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Symptoms of pathology

The development of left ventricular failure leads to impaired brain activity and intracranial pressure.

Pathology progresses in diseases such as heart disease, ischemia, cardiomyopathy, and vascular hypertension.

Its occurrence is a result of damage to blood vessels provoked by myocardial infarction, anemia, severe intoxication of the body with narcotic and alcoholic substances.

Left ventricular failure is characterized by a sharp and sudden violation of the contractile function of the heart, namely its decrease. Against this background, blood ceases to be transported throughout the body, which leads to the death of a person. In the international classification of diseases, such a disorder has its own meaning. The code for ICD 10 is I150.1.

In most cases, the occurrence of such a pathology is promoted by the course of diseases that excessively overload the left side of the heart muscle. The intensity of the manifestation of clinical signs will depend on the severity and form of the course of such a disease. The main signs can be considered a violation of heart rate, the appearance of shortness of breath and severe coughing.

A correct diagnosis can only be made after an instrumental examination such as an ECG, which shows the characteristic signs of the disease. The treatment of such a disease is, in most cases, conservative and it is aimed at the use of drugs, however, in severe cases, surgery will be required.

Etiology

The following factors can provoke the appearance of acute left ventricular failure:

  • constantly elevated blood pressure;
  • previous heart attack;
  • the course of arrhythmias, against which the ability of the heart to pump blood is significantly reduced;
  • the occurrence of an inflammatory process in the tissues of the heart muscle;
  • pathological expansion in the cavities of this organ, which have a different nature, for example, burdened by heredity, intoxication of the body with alcohol or drugs;
  • mitral stenosis, i.e. narrowing of the valve opening;
  • congenital or acquired lesions of the valves;
  • cardiac ischemia;
  • brain injury;
  • extensive surgical operations carried out by a person;
  • blockage of the pulmonary artery;
  • acute coronary syndrome;
  • nephritis;
  • lung diseases, which are accompanied by accumulation of fluid;
  • the effect of toxic substances or heavy metals on the heart muscle.

In the vast majority of cases, the disease is formed against a background of myocardial infarction.

Classification

There are several classifications of such a disease, which will differ depending on the severity and nature of the course of the disease. Thus, two forms of the course of such a pathology are distinguished:

  • acute left ventricular failure – is characterized by a sharp onset of characteristic symptoms, which leads to a significant deterioration in the human condition. In this case, there is a likelihood of developing arrhythmic, reflex and cardiogenic shock;
  • chronic left ventricular failure – appears in cases of progression of previously diagnosed heart failure.

Classification of the disease as the severity of characteristic symptoms provides for the division of the disease into several stages of severity:

  • initial – differs insignificant expression of clinical manifestations only with strong physical exertion. At rest, signs are not detected;
  • moderate – symptoms appear both during physical activity and at rest;
  • terminal – leads to irreversible changes in vital internal organs.

symptomatology

Symptoms of left ventricular failure

Depending on the nature of the course of the disease, its clinical manifestations will differ slightly. The following symptoms are characteristic for acute left ventricular failure:

  • the appearance of shortness of breath, which, as the disease progresses, can develop into an attack of suffocation;
  • severe paroxysmal cough. It can be dry or accompanied by the release of foamy sputum;
  • pinkish foam separation from the nasal cavity and throat;
  • pronounced wheezing issued by a person when breathing. They are well audible even at a distance from the patient. This indicates pulmonary edema;
  • an increase in the volume of veins on the neck;
  • violation of heart rate;
  • constant fluctuations in blood pressure;
  • increase in body temperature;
  • numbness of limbs;
  • fainting;
  • severe dizziness.

Chronic left ventricular heart failure is expressed in such external manifestations:

  • swelling of the lower extremities;
  • violation of respiratory function – often due to the accumulation of fluid in the chest in volumes of more than one liter;
  • cyanosis of the fingertips on the hands and feet, as well as a change in the shade of the lips – such symptoms appear against the background of stagnation of blood and low oxygen content;
  • decreased urine formation, which is caused by a violation of the blood supply to the kidneys.

Diagnostics

Establishing the correct diagnosis requires an integrated approach and consists of several stages.

The primary diagnosis is the implementation by the clinician of some measures:

  • conducting a detailed survey of the patient for the presence and severity of symptoms that manifest the deficiency;
  • the study of the medical history and medical history of the patient – this will clarify the main causes of the appearance of acute left ventricular failure or HLSN;
  • a thorough physical examination, which must include palpation of the right hypochondrium, measurement of temperature, blood pressure and heart rate, as well as listening to the heart with a phonendoscope.

Laboratory tests of blood and urine are necessary to monitor the functioning of other organs and systems.

The last stage of diagnostic measures is aimed at the implementation of:

Treatment

Confirmation of the diagnosis requires immediate hospitalization of the patient, but an attack of onset or exacerbation of symptoms always begins suddenly, which is why you need to know the rules of first aid. After calling the ambulance team you need:

  • to plant the patient, since a sitting position helps in reducing pain and other symptoms;
  • provide fresh air to the room where the victim is located;
  • give one tablet of nitroglycerin;
  • if signs of swelling appear, then the drug should be administered intravenously as soon as possible to lower blood pressure. If for any reason it is not possible to inject, then you must immediately apply a tourniquet on the hips and shoulders – this will reduce the amount of blood flow.

Drug treatment involves the use of:

  • diuretics – to remove excess fluid from the body and normalize the functioning of the kidneys;
  • beta-blockers – to reduce the load on the heart;
  • ACE inhibitors – to normalize blood pressure;
  • glycosides – to increase the volume of ejected blood in one contraction of the ventricle;
  • nitrates – for vasodilation.

In addition, you will need to take medications aimed at eliminating other symptoms of acute or chronic left ventricular failure.

Relationship with myocardial infarction

Left ventricular failure is often associated with acute myocardial infarction. She can appear both simultaneously with him, and several days later. In the second case, the pathological process is caused by a sharp loss of a large number of cardiomyocytes.

At first, the ejection fraction can stay at around 70 percent of what is due, since the diastolic function of the left ventricle is violated, and not systolic. At the same time, pathological regurgitation (casting) of blood from the ventricle to the atrium through the mitral opening is observed. There may be several reasons:

  • damage to the papillary muscles;
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  • valve damage.

Acute left ventricular failure in the first hours after a heart attack can be caused by a decrease in the total blood volume, water and ion retention in the body, as well as ongoing therapeutic measures.

Typology

Acute left ventricular failure is the most common form of cardiac pathology in patients after myocardial infarction. It also occurs among patients suffering from heart disease, hypertension, sclerosis of cerebral vessels. The basis for its development are disturbances in the circulatory system of the left ventricle.

The disease is characterized by partial blood flow into the aorta and left ventricle. Due to insufficient blood volume, the pressure of the left ventricle increases, and this, in turn, leads to an increase in pressure in the left atrium. At this time, the right ventricle pumps blood into the pulmonary vessels, and the left one cannot cope with such a volume due to limited work. As a result, stagnant processes in the lungs occur.

The liquid penetrates into the pulmonary capillaries and alveoli, forming pulmonary edema. An attack in a patient develops transiently. His characteristic time is evening or night. A person begins to have difficulty breathing, then the condition is aggravated by attacks of suffocation. The patient feels severe weakness, which is accompanied by paroxysmal cough with reddish foamy sputum.

When listening to the patient, muffled heart sounds are clearly audible, which manifest with a whistling exhalation and difficulty in breathing in the patient. All these symptoms indicate the development of cardiac asthma, in the wake of which the person develops cyanosis and there is the presence of dry rales in all parts of the lungs. Serious breathing problems appear, leading to severe pulmonary edema. Acute left ventricular failure is an extremely dangerous condition of the patient, which can lead to death.

The chronic form of this disease, as well as acute, develops against a background of diseases that increase the load on the left ventricle. But the difference is that chronic left ventricular failure does not develop so rapidly, but gradually, in a less aggressive form. This allows the patient not to experience discomfort and pain for a long time. The disease in a chronic form can lead to venous congestion in the tissues of the lungs.

Among the early signs of chronic left ventricular failure should be highlighted:

  1. Sudden onset of dyspnea even during a person’s passive state. Rare cases of tachycardia may occur, even at rest. Attacks occur more often when the human body is in a horizontal position. This makes patients rise, take a sitting position and lower their feet to the floor.
  2. Attacks of cough with separable gray phlegm.
  3. Frequent manifestations of tachycardia during an active or passive state of a person.
  4. Resize heart. It begins to expand to the left. When listening, you can hear the rhythm of the gallop. The patient’s heart rate quickens, breathing is difficult, strong wheezing is heard in all parts of the lung.

After an x-ray and a picture are taken, the patient confirms the presence of stagnation in the lungs, and the results of a study of external respiration indicators indicate respiratory failure. A person’s condition can improve after the appointment and administration of diuretics. After performing a cardiogram, you can see the horizontal line of the heart, its hypertrophy and overload of the left ventricle.

Pathogenesis

Left ventricular failure is a typical pathological process that begins with an increase in blood pressure in the microvasculature of the lungs. This leads to the sweating of the fluid from the vessels into the tissue and a decrease in the elasticity of the respiratory system. If the pressure does not decrease, then the transudate will enter the alveoli and disrupt gas exchange, “turning off” the filled chambers. Oxygen perfusion decreases, the body begins to suffer from hypoxia and hypercapnia.

Fluid all comes from the vascular bed to the lungs. It gradually spreads from the periphery to the center, narrowing the lumen of the bronchi, causing wheezing and coughing. At this point, a shunt system is included in the process. It dumps excess blood from the vessels of the microvasculature into the larger veins of the lungs. This leads to the mixing of blood with different oxygen content.

Left ventricular failure: pathological features, causes, symptoms, diagnosis and first aid in the acute stage

Acute left ventricular failure manifests itself in two clinical forms:

  1. The first form is observed in patients with high blood pressure, aortic valve insufficiency and damage to the vessels of the brain. This set of symptoms gives rise to pressure in both the large and small circles of blood circulation, as well as a large cardiac output. In order to stop the disease in this case, it is necessary to reduce the flow of blood to the right departments so as not to overload the vessels of the lungs.
  2. The second form is characterized by classic manifestations of left ventricular failure, namely: decreased pressure and cardiac output. This form appears after a heart attack, in the presence of decompensated mitral or aortic stenosis (that is, acquired heart disease), with a prolonged course of bilateral pneumonia.

Cardiac asthma and pulmonary edema, which occur against the background of acute left ventricular failure, can lead to a heart attack or death. Therefore, the task of the doctor is aimed primarily at alleviating the patient’s condition, and then at reducing pulmonary edema. After carrying out the necessary manipulations, the patient should be immediately taken to the cardiology department.

  1. The victim’s head should be held high. To do this, he put another pillow.
  2. If the patient’s condition allows you to take a sitting position – they sit him down and lower his legs to the floor. Harnesses are applied on them with a pressure that significantly exceeds the normal arterial pressure. They are used again every 15 minutes, taking small breaks between the procedures.
  3. Every three minutes, the patient should dissolve 1 tablet of Nitroglycerin. In total, he should take 4 tablets.
  4. In order to remove the formation of sputum and bubbly foam in the airways, the patient undergoes an inhalation procedure consisting of oxygen and alcohol. The duration of inhalation of ethyl vapor should not exceed 30 minutes. Then they perform oxygen inhalation for 15 minutes, after which alternation occurs again.
  5. At the end of inhalation, the patient is prescribed medications that should lower blood pressure, remove pain and bronchospasm.
  6. In the treatment of pulmonary edema, diuretics are added to drugs that lower blood pressure, which remove excess fluid from tissues and blood vessels of vital organs.

Transportation of the patient in an ambulance is possible only after reducing stagnation in the lungs. If it is not possible to quickly achieve the desired result, the ambulance team must remain with the patient at home until his condition improves.

If drug therapy does not improve the patient’s condition, a surgical operation is recommended. This can be cardiomyoplasty or the installation of an implant – a vessel that can improve blood circulation and the functioning of the vascular system as a whole.

Both operations have certain risks. But in case of a favorable outcome, the patient will have a positive therapeutic effect. The result will be noticeable a few months after surgery or postoperative recovery. In this case, the final decision remains with the patient. And in this case, it is difficult to do without consulting an experienced cardiologist.

In order for left ventricular failure not to become a problem in old age, you need to lead a healthy lifestyle, not to abuse alcohol, smoking, coffee, energy, exercise, which not only develops stamina, but also strengthens the heart muscle. It is very important to visit the fresh air more often, worry less, think positively, and eat only healthy food. Adhering to these rules, the body will remain strong and healthy for a long time.

Causes: myocardial infarction, acute coronary insufficiency, heart defects (mitral stenosis, aortic malformations), high hypertension (often with acute glomerulonephritis, coronary heart disease, acute lung infection.

There are no signs of left ventricular hemorrhage in primitive stenosis, but there is cardiac asthma (all blood does not have time to go into the narrowed atrioventricular opening during diastole, a purely mechanical obstruction occurs in conditions of increased right ventricular work).

The permeability of the pulmonary capillaries increases, lymphatic drainage is impaired – the liquid part of the blood flows into the alveoli and into the lumen of the small bronchi, resulting in a decrease in the respiratory surface of the lungs, shortness of breath, bronchospasm may join. If the attack is delayed, there is a sharp hypoxia of the tissues, including the pulmonary, the intake of the liquid part of the blood of the valveola increases, foaming occurs, the respiratory surface sharply decreases – this is pulmonary edema.

Attack of cardiac asthma appears more often with the whole night, the patient wakes up from an attack of suffocation. Dyspnea more often inspiratory. With bronchospasm, exhalation may be difficult.

Fear of death, frightened face, patient jumps up, sits down, complexion is earthy gray, breathing is frequent, up to 4 ° per min. with pulmonary edema, clammy breath, secretion of scarlet foamy sputum.

Objectively, arrhythmia and tachycardia, pulmonary hard breathing, an abundance of wet rales.

Often associated with pulmonary embolism.

Choking appears, the neck veins swell quickly, the right ventricle is rapidly dilated, a cardiac impulse appears, systolic murmur is often heard from the sternum from the bottom left, and the liver is enlarged.

Long-term diseases (heart defects, decompensation in these defects are partly associated with atherosclerotic heart damage) play an important role in the occurrence of CH.

Violations of rhythm (extrasystole) and conduction also play a big role. Prevention of heart failure is of great importance, especially in patients with cardiovascular diseases. It is important to moderate physical loads and exercise taking into account the reserve capacity of the myocardium.

1) Peace is above all. A feature of the bed regimen is a half-sitting position, in which the venous return to the heart decreases, its work decreases.

2) Diet – the limitation of salt and water (up to 1 liter spout). Shown easily digestible, rich in high-grade proteins, vitamins and potassium products: potatoes, tomatoes, cabbage, spinach, dried apricots, raisins.

Ist. – exemption from hard physical work,

4) Timely recognition and treatment of the underlying disease: thyrotoxicosis, rheumatism, arrhythmias – HF provocateurs.

a) a direct effect on myocardial metabolism: it releases ioncalcium, increases the activity of ATPase — a direct cardiotonic effect, slows down the flow of potassium ions;

b) an indirect effect through the vagus: on the sinus node — tachycardia decreases, on the AV node — conduction slows down, translates the tachystolic formative atrial fibrillation into brady systolic.

But in cardiac glycosides and their dangers: close therapeutic and toxic doses, it is necessary to take into account the extremely different sensitivity to these drugs during treatment, especially in the elderly.

Cardiac glycosides are able to accumulate in the body.

Principle of glycoside treatment

Start treatment as early as possible, glycosides are especially indicated for hemodynamic CH. First they give a saturating dose, then a maintenance dose. There are various saturation schemes:

  • a)
    fast saturation (digitalization) –
    a saturating dose is given for some
    days;
  • b)
    moderately fast – the dose is given over
    3-4 days;
  • at)
    slow degitalization – saturation
    lead slowly, gradually, without limit.
  • Optimal
    the technique is moderately fast.

Timely overdose prophylaxis is necessary: ​​careful monitoring of the pulse, especially the first 5 days, good ECG monitoring. Providing energy resources, normal potassium balance.

A rational approach to the choice of the drug is needed: strophanthin O, O5% and corglucon O, O6%, high-speed drugs, low-cumulative, are administered only in / in; digoxinO, LLC25, 6O% intestinal absorption, digitoxin O, LLCO1 has 1OO% absorption, celanide O, LLC25, absorption 4O%.

a) The onset of heart failure on the background of bradycardia. Telusiloksilok shows the effect not through the vagus, but directly on the heart – it can be used with bradycardia.

c) Atrioventricular blockade, especially non-complete block.

Ventricular arrhythmias: extrasystole, ventricular fibrillation, paroxysmal tachycardia. Various blockades, especially atroventricular. Gastrointestinal Disorders: nausea, vomiting, diarrhea, poor appetite. From the side of the central nervous system: headache, weakness.

2. Potassium preparations: potassium chloride 1O% for 1 tbsp. spoon * 3 times a day; panangin 1 tablet * 3 times a day; aspark (analogue of panangin) 1 tablet * 3 times a day.

3. Vitamins: cocarboxylase 1OO ml / day. in / m; B-6 1% 1, Ov / m; Nicotinic acid O, O5.

4. Anabolic drugs: potassium orotate O, 5 * 3 p. per day for an hour of eating; nerabol, retabolil 5% 1, O / m 1 time to the introducer.

5. Potassium-saving diuretics: veroshpiron 1OO mg / day.

7. Diuretics: Lasix 2, I / O, hypothiazide 5O mg, uregitO, O5.

a) Reducing venous return to the right heart: nitroglycerin O, OOO5; nitrosorbito, O1; Sustak O, 64 mg expand the venules, increasing their capacity.

b) Reducing peripheral resistance: apressin and nadium nitroprusside – expand arterioles in chronic heart failure. Apply CAUTION! in acute heart failure, administer iv.

Urgent hospitalization. The patient is given a half-sitting position, venous return to the heart is reduced. For the same purpose, venous tourniquets on the limbs. If there is no cardiogenic shock – bloodletting up to 5OO ml.

Diuretics: Lasix 1%, 2, O-6, I / O; furosemide O, O4. Morphine1% 1, O (inhibits the excited respiratory center, reduces venous return to the heart); pentamine 5% to 1 ml, benzhexonium – sharply reduce the tone of venules, potentiate the effect of morphine.

First aid in acute form

  1. Place the patient in a sitting position, and lower the legs from the bed down. In no case should you lie, this will only aggravate the situation.
  2. Provide fresh air to the room.
  3. Give a tablet of nitroglycerin under the tongue.

If a person has medical skills, in case of acute pain, Morphine is administered under the skin. A sharp decrease in pressure leads to pulmonary edema, therefore, to eliminate it, 5 ml of prednisolone is needed.

In the absence of drugs or skills, it is necessary to stop the flow of blood to the arms and legs. For this, braids are applied to the shoulders and hips. The patient is hospitalized for further treatment. During transportation to a medical facility, he should sit on a stretcher.

Classification of PLWH and causes of development

There are two types of disease development:

  • acute left ventricular failure;
  • chronic form.

These two types of pathological changes differ only in the rate of development and onset of symptoms.

Left ventricular heart failure proceeds in three stages:

  • Stage 1 (initial): the absence of pronounced symptoms, a slight deterioration in physical activity;
  • Stage 2 (medium): the periodic appearance of signs of LVH even at rest;
  • Stage 3 (severe): the development of irreversible processes in the body, untimely help leads to death.

The main cause of the development of LVH is stagnation of blood in the left atrium, causing the penetration of tissue fluid into the lungs or alveoli.

The occurrence of pathology is possible in the presence of concomitant heart diseases:

  • cardiac ischemia;
  • heart rhythm disorder;
  • myocardial infarction;
  • arterial hypertension;
  • defects and heart diseases;
  • cardiomyopathy;
  • mitral stenosis;
  • arteriosclerosis of blood vessels;
  • increased blood viscosity (leading to a violation of hemodynamics);
  • obstruction of the lumen of the pulmonary vein;
  • uremia;
  • cardiogenic pulmonary edema.

Decompensation of the activity of the heart can be caused by non-cardiac factors:

  • diseases of the kidneys, liver, thyroid gland, nervous system;
  • severe anemia;
  • extensive surgical intervention;
  • thyrotoxicosis;
  • previous infectious diseases, sepsis;
  • abuse of psychotropic substances, alcoholic beverages.

The chronic form of LVH occurs with severe structural myocardial disorders. Causes of the pathology can be cardiosclerosis in the post-infarction period, damage to the heart valves, cardiomyopathy.

Symptoms of left ventricular failure are determined by the causes of its development.

Acute left ventricular failure is characterized by the following symptoms:

  • sudden shortness of breath;
  • increase in blood pressure (with hypertensive crises);
  • increased heart rate (at the initial stage of the disease);
  • cough;
  • expansion of the size of the heart to the left side;
  • the appearance of a horizontal position on the electrocardiogram;
  • symptoms of cardiac asthma;
  • respiratory failure;
  • swelling of the lower extremities.

The manifestation of the chronic form of PLWH begins gradually, with the appearance of fatigue, fatigue, loss of appetite. Patients are characterized by swelling of the lower extremities, shortness of breath during physical exertion. If timely treatment is not undertaken, then the symptoms of the disease intensify, the patient’s condition worsens.

In the case of left ventricular failure on the background of acute myocardial infarction, anginal symptoms appear: constricting pain in the heart, not passing independently, pain in the forearm and left shoulder.

Often, LVH is accompanied by arterial hypotension. In this case, the characteristic symptoms appear: fainting, increased sweating, heart palpitations.

In its clinical manifestation, cardiac asthma is similar to signs of bronchial asthma. But in the first case, shortness of breath is associated with difficulty breathing, and in the second, with difficulty breathing out. With LVH, relief occurs in a seated position, or half-sitting with legs down.

Methods of diagnosis

Acute left ventricular failure is diagnosed using routine tests and other examination methods:

  • chest x-ray;
  • electrocardiogram (ECG);
  • echocardiography;
  • general and biochemical blood test;
  • visual examination of the patient.

Radiography reveals the presence of pulmonary edema, as well as the degree of organ damage. The examination method also gives an estimate of the size of the heart.

An ECG is used to determine the activity of all heart departments, diagnose myocardial infarction, detect heart rhythm disturbances, and overload the heart chambers.

The method of echocardiography is based on the use of ultrasonic waves. The examination allows you to get an image of the heart and shows its functional activity.

When signs of myocardial infarction appear, the patient is prescribed a coronarography to assess the patency of the vessels of the heart with the introduction of a certain contrast agent. In case of impaired patency, this procedure is used as a therapeutic method to restore blood circulation.

Treatment of LVH

Treatment is determined by the form of the disease. Treatment of chronic LVH is carried out in two stages:

  • elimination of the causes of decompensation of cardiac activity;
  • withdrawal of symptoms with medication.

In the presence of heart valve defects, surgical intervention is required. In severe cases, the installation of heart-lung machines or a heart transplant is performed.

Medication is prescribed to eliminate edema, relieve symptoms of shortness of breath and to support contractility of the heart.

In this case, drugs such as cardiac glycosides, ACE inhibitors, beta-blockers, diuretics of plant and synthetic origin are prescribed. The patient is shown complete emotional peace.

Treatment is prescribed individually, depending on the well-being of the patient, the form and severity of the disease.

Acute left ventricular failure requires immediate treatment. Emergency care is based on the prevention of pulmonary edema by relieving symptoms of cardiac asthma.

  1. Reducing the intensity of metabolic processes to improve the tolerance of oxygen deficiency. Morphine (reduces pressure and inhibits breathing), droperidol (a sedative drug), sodium oxybutyrate (normalizes pressure and has a calming effect in case of hypotension).
  2. Decreased reverse venous blood flow to the heart. Nitroglycerin (dilates the coronary vessels), sodium nitroprusside (taken in case of severe pulmonary edema), application of tourniquets or tight dressings on the hands.
  3. Reducing the load on the pulmonary circulation by taking diuretics. Diuretic preparations of instant action are used both orally (furosemide, uregitis), and in the form of intravenous injections.
  4. Emergency care for acute LVH in the absence of the listed drugs consists in the intravenous administration of gangioblacrators (pentamine, arfonad). The tool helps to reduce pressure in the large and small circle of blood circulation. When using such drugs, it is necessary to monitor blood pressure every 3 minutes (on a hand that is free of droppers). In case of arterial hypotension, these groups of drugs are strictly contraindicated.
  5. Oxygen therapy – inhalation with oxygen. Emergency care for PLWH will be ineffective in the absence of sufficient air in the lungs. Oxygen is delivered via a special mask or intravenous catheter.
  6. An increase in the rhythm of myocardial contraction against the background of arterial hypertension. In this case, the following are prescribed: dopmin, dobutrex.

Intensive emergency care consists in increasing cardiac output and increasing tissue oxygen saturation. Extremely important in such a situation is the elimination of the cause of the reduction in the ejection fraction.

First aid is provided to the patient before the doctors arrive. The injured man seated half-sitting, a heating pad placed at his feet. Nitroglycerin (0,0005 g) is taken under the tongue.

Follow-up actions are carried out by emergency doctors on the spot, or at a medical center.

Hospitalization is indicated when the precursors of acute development of left ventricular failure appear, or after the symptoms of the attack are relieved.

If medical attention is not provided during the attack, then the development of complications is likely. PLWH syndrome is a serious condition that requires great efforts on the part of the human body.

A chronic form of the disease – sooner or later it can turn into an acute attack of pulmonary edema. Treatment is effective only in the early stages of LVH development.

In severe cases, the complete recovery of the patient is almost impossible.

To prevent possible complications, the patient is prescribed a special diet. The diet should consist of easily digestible foods with sufficient calorie content, and with limited fluid and salt. During exacerbations, salt is almost completely excluded from the patient’s nutrition.

The average daily intake of liquid is at least 0,8 liters, and does not exceed 1,5 liters (including not only drinking, but all liquid products). Patients with PLWH are recommended to eat foods containing a large amount of potassium: dried fruits (raisins, dried apricots), nuts, vegetables (potatoes, Brussels sprouts), cereals (oatmeal and buckwheat).

When taking diuretics, the consumption of such products is mandatory.

A full and healthy diet, giving up bad habits, walking in the fresh air are the main measures for the prevention of complications.

In more severe forms of the disease, a comprehensive treatment is provided, including taking medications (diuretics, means to normalize pressure, blood circulation, heart rate).

A regular visit to a cardiologist to monitor the functioning of the heart function will allow you to identify the development of the disease in time. Timely treatment gives a positive prognosis for the future life of the patient.

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The occurrence of acute left ventricular failure can occur in people of any age. The chances of this increase in the presence of other pathologies of the cardiovascular system and after 50 years.

Most often, such a diagnosis is made for older men suffering from coronary artery disease.

Cardiological causes of left ventricular failure are considered diseases in the form of:

  1. Myocardial infarction and subsequent tissue necrosis. The development of the disease occurs with extensive transmural infarction. The patient in this case is in serious condition and the consequences can be provoked depending on the degree of damage.
  2. Myocarditis. These are inflammatory processes in the tissues of the heart.
  3. Congenital and acquired defects that disrupt the architectonics of the heart.
  4. Atrial fibrillation, ventricular tachyarrhythmias.
  5. Hypertensive crisis, in which the pressure in the arteries reaches high numbers.

Manifestations

All cardiac diseases have a similar clinical picture. Left ventricular failure has symptoms in the form of painful sensations in the region of the heart that extend to the neck, shoulder blade, and left arm. Feverish conditions and a sharp increase in blood pressure are also observed.

The severity of manifestations depends on the size of the lesion. With this disease, a person suffers from:

  • shortness of breath, which develops into suffocation;
  • dry cough with frothy sputum arising from seizures;
  • discharge of foam from the oral cavity and nose;
  • the need to constantly be in a sitting position;
  • wet wheezing while breathing;
  • swelling of the cervical veins.

If congestive processes develop in the pulmonary circulation and an acute form of the disease occurs:

  • sharply begins shortness of breath, turning into an attack of asthma;
  • there is an accumulation of extravascular fluid in the tissues of the lungs and swelling of the organ;
  • cardiogenic shock occurs, in which muscles cannot contract normally and blood flow is disturbed throughout the body.

If the development of cardiogenic shock is associated with a violation of the heart rhythm, then it is called arrhythmic. In response to severe pain, a reflex shock occurs. With the defeat, more of the muscles of the left ventricle observe true shock. The latter option occurs in patients after 60 years of age, after heart attack attacks, which suffer from diabetes and hypertension.

Congestive processes in the pulmonary circle are usually triggered by myocardial infarction, in which there is a sharp decrease in blood volume and sodium is minimally retained.

Diagnostics

Signs of left ventricular failure should alert the doctor before speaking with the patient. As soon as a person enters the office (or arrives by ambulance), the cardiologist will immediately hear noisy breathing, wheezing, shortness of breath. The patient will complain of the appearance of pinkish sputum after a dry cough, hemoptysis, constant fear of death.

An important detail is that to relieve symptoms, he is forced to sit down. After the survey, a physical examination begins. The doctor listens to heart sounds, determines the presence of pathological sounds and noises, arrhythmias, pulse deficiency in the peripheral arteries. During these manipulations, the doctor in passing assesses the temperature and humidity of the skin.

The next stage is instrumental diagnostics. First, an electrocardiogram is removed, on which the change in rhythm and overload of the left parts of the heart with pressure, the expansion of its cavities are clearly defined. On an x-ray of a cardiologist, he’s interested in the configuration of the heart’s shadow, the smoothness of his waist and the swelling of the ventricles, as well as signs of stagnation of blood in the pulmonary bed. This method is used to verify the diagnosis and exclude other pulmonological pathologies.

Ultrasound (ultrasound) of the heart is performed to detect abnormalities in the structure of the heart, as well as changes in its functions: the appearance of pathological blood flow, valve changes, the formation of aneurysms and blood clots. In addition, this method allows you to determine the ejection fraction and pressure in the cavities of the heart, the thickness of its wall and the size of the chambers.

From laboratory tests, the doctor may prescribe a determination of the brain natriuretic peptide in the blood. This is necessary in order to exclude or confirm the presence of chronic heart failure in the patient, since the symptoms of the diseases are similar.

Treatment

Is left ventricular failure a treatable therapy? Treatment consists mainly of resuscitation and is carried out in intensive care units. It is aimed at improving myocardial contraction, eliminating tachycardia and reducing vascular tone. In addition, blood clots must be prevented and fluid excretion improved. To do this, carry out the following activities:

  • The patient is inhaled with moistened oxygen at a rate of 6-7 liters per minute.
  • Be sure to catheterize the central vein so that CVP (central venous pressure) can be monitored. This helps the doctor choose the right medication.
  • Be sure to check the pulse and blood pressure, as well as the amount of urine (the rate of edema reduction) with equal intervals.
  • If significant foam formation is observed, then oxygen is supplied with ethyl alcohol. Such inhalations should be alternated with inhalation of air so as not to burn the mucous membrane.
  • Drug therapy begins with the introduction of cardiac glycosides and antispasmodics. This improves myocardial contractility and blood flow in the lungs. In addition, morphine is indicated for patients. It simultaneously soothes, relieves pain and dilates the small vessels of the lungs.
  • If the pressure remains high, then it is recommended to introduce adrenaline receptor blockers. Sometimes harnesses or tight bandaging of the limbs are used for this purpose. Such manipulation prevents the outflow of venous blood, keeping the arteries free.
  • To reduce edema and reduce the load on the heart, forced diuresis is performed.

Establishing diagnosis

Left ventricular failure has quite pronounced symptoms. The doctor can determine an acute attack using an external examination. Since this condition threatens a person’s life, every health worker with a secondary education should be able to determine it.

After collecting an anamnesis, the doctor listens to the chest. In this case, the presence of dry and wet rales is observed. Dry wheezing is often confused with bronchial asthma. It is possible to determine that this is pulmonary edema by the presence of cardiac pathologies, the absence of asthma attacks, dry and wheezing during exhalation.

The pulse is also counted, blood pressure indicators are measured, the level of oxygen in the blood is determined. Typically, saturation is reduced to 85%. This is an indication for hospitalization of the patient in cardioreanimation.

Prevention

In the chronic form of the disease, a person should constantly be under the supervision of a doctor. It is important to give up drinking alcohol and smoking, avoid stress and normalize your psycho-emotional state.

The patient needs moderate physical activity. It is important to regularly walk in the fresh air, run, engage in swimming.

The patient should constantly monitor blood pressure and observe nutritional rules. Fiber should be present in the diet, there should be no fried, fatty and spicy dishes. At the first signs of deterioration, you need to contact a medical institution.

With left ventricular failure, most patients die from complications. Therefore, it is important to begin treatment in the early stages of development until significant damage to the muscles of the heart has occurred.

Acute left ventricular heart failure can occur both spontaneously and can be a decompensation of chronic heart failure, so it is important to carefully follow the doctor’s instructions, regularly take pills and lead a healthy lifestyle. It is important to follow a diet, perform moderate physical exertion (which do not exacerbate shortness of breath), avoid stressful situations as much as possible (if necessary, take light sedatives), abandon bad habits.

Therapy

Left ventricular failure has a complex treatment. Before starting therapy, oxygen therapy is mandatory. The patient is prescribed medication for:

  • normalization of the contractility of the heart muscle;
  • eliminate the manifestation of tachycardia;
  • prevention of blood clots and blockage of blood vessels;
  • restoration of the process of fluid elimination
  1. Diuretic drugs to remove excess fluid and improve kidney function.
  2. Beta-blockers that reduce the load on the heart.
  3. Inhibitors of angiotensin-converting enzyme to prevent further expansion of the cavities of the heart and normalization of pressure.
  4. Cardiac Glycosides. Under their influence, the amount of blood ejected in one reduction increases.
  5. Nitrates. They allow you to get rid of the symptoms of pathology, expanding blood vessels.

To eliminate the causes of the attack, carry out:

  • coronarography to restore patency of arteries in a person who has had a heart attack;
  • stenting necessary to expand the lumen of the vessels;
  • prosthetics if heart valves are affected;
  • radiofrequency ablation and laser cauterization in case of arrhythmia.

If these methods did not bring any results, then the only option is a heart transplant. In the case of severe myocardial damage, an artificial apparatus is installed to facilitate manifestations.

Therapy is carried out only in the intensive care unit.

Forecast

Help with left ventricular failure should be provided as quickly as possible, since mortality from this disease is high. Even in a specialized hospital, it reaches 20%.

The prognosis for such patients is unfavorable. During the year after diagnosis, about 10% of patients with the first or second stage die and almost 50% of patients with the third.

If a person suffers from a chronic form of the disease, then the prognosis depends on the stage of its development. In the initial stages, proper treatment can achieve good results.

The cause of death in left ventricular failure is most often cardiogenic shock. More than 80% of patients die from it. Usually, due to untimely help.

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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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