Acute left ventricular failure results in the event of cardiac bronchial asthma. The latter is noticed in acute and chronic nephritis, hypertension, myocardial infarction (most frequently affecting the left ventricle), cardiosclerosis, aortic heart defects, syphilitic aortic lesions, mitral stenosis.
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- Emergency medical measures for acute cardiovascular failure.
- Methods of prevention
- Acute proper ventricular failure
- What medical doctors ought to do
- First support for acute heart failure: assist the affected person, strategies of remedy
- Urgent analysis
- Chronic heart failure: signs, causes and remedy
- External manifestations
- Nursing course of
- Acute heart failure in youngsters. Classification, clinic, emergency care.
The mechanism of growth of an assault of cardiac bronchial asthma is complicated. Currently, the previous view is taken into account probably the most right, that an assault of cardiac bronchial asthma is related to acute arterial stagnation of blood in a small circle. This is because of the weakening of the left ventricle with enough effectivity of the appropriate ventricle.
There is a mismatch between blood movement to the lungs and outflow from them. With the developed weak spot, the left ventricle shouldn’t be in a position to distill the blood getting into it into the massive circle of blood circulation, whereas the functionally full proper ventricle continues to pump a standard quantity of blood into the small circle. Under these circumstances, the acute growth of left ventricular failure causes a sudden assault of suffocation.
However, this principle doesn’t clarify many points related to an bronchial asthma assault: the sudden onset of the assault and its abrupt cessation, generally accompanied by profuse urination, the event of an assault at evening. Finally, it isn’t clear why in chronic heart failure, even in extreme type, usually there aren’t any assaults of cardiac bronchial asthma.
Clinical observations and experimental research point out that the state of the central and autonomic nervous system performs a job within the look of an assault of cardiac bronchial asthma. At the identical time, a lot turns into clear that can’t be defined solely by a mismatch within the work of the left and proper heart. In specific, the looks of an assault at evening is related to a lower within the operate of the sympathetic nervous system and the predominance of the operate of the vagus nerve.
Another manifestation of cardiac bronchial asthma is chain stokes respiration. Its pathogenesis is defined by a lower within the excitability of the respiratory heart and oxygen hunger (hypoxemia), as a result of poor blood provide to the medulla oblongata or spasm of the mind vessels.
The medical image of acute left ventricular failure is characterised by an bronchial asthma assault (cardiac bronchial asthma), in addition to respiratory failure (within the type of the Chain-Stokes phenomenon).
In some circumstances, seizures happen in opposition to the background of chronic heart failure, in others – in individuals who haven’t had such phenomena earlier than. Sometimes these sufferers beforehand famous shortness of breath solely with actions. Attacks of suffocation most frequently happen at evening. The affected person experiences a sense of lack of air, jumps away from bed, rushes about, opens a window broad open.
He can not lie in mattress and sits leaning on his arms. The auxiliary respiratory muscle mass are tense, respiration is quickened and shallow, each inhalation and exhalation are shortened, the face is roofed with chilly sweat, the heartbeat is frequent, poorly stuffed, usually arrhythmic (extrasystole, atrial fibrillation). The length of an assault of cardiac bronchial asthma relies on the illness during which it arose. The assault might cease after a couple of minutes or final for hours and go into pulmonary edema.
With sudden onset of left ventricular failure, sufferers are sometimes pale. With the event of pulmonary edema, pronounced cyanosis happens.
Blood stasis in a small circle causes coughing, and generally hemoptysis. In uncommon circumstances, hoarseness might happen as a result of compression of the recurrent nerve by a sharply expanded pulmonary artery.
The medical image of acute left ventricular failure shouldn’t be at all times the identical. It relies on the severity of the assault. In gentle circumstances, slight suffocation seems with actions (often with probably the most minor). In extreme circumstances at relaxation, an assault of utmost choking happens, and the affected person is in mattress half-sitting for hours, experiencing excruciating struggling.
Depending on the severity of the assault, in some circumstances plentiful moist congestive rales are heard within the lungs, in others there’s a small quantity of congestive rales and they’re heard solely within the decrease components of the lungs. In significantly unwell sufferers, wheezing spreads upward and might be heard in all places over the lungs. With the event of pulmonary edema, wheezing is heard at a distance, and subsequently respiration turns into effervescent.
Although with cardiac bronchial asthma attributable to acute left-ventricular failure, the quantity of blood ejected into the pulmonary circulation decreases, blood stress might stay regular. The pulse is frequent, with auscultation of the heart, a gallop rhythm is heard. Such a rhythm (three-membered, ensuing from a cut up within the first tone) usually precedes acute heart failure and may function a harbinger of its growth.
Heart failure (HF) is a medical syndrome during which the failure of the pumping exercise of the heart results in inadequate provide of organs and tissues of the physique with the required quantity of blood.
HF is the results of systolic (contractile) and/or diastolic myocardial dysfunction. An necessary position within the origin of heart failure is performed by myocardial overload by blood stress and (or) blood quantity, in addition to main myocardial (metabolic) insufficiency.
Myocardial overload by stress is noticed in case of arterial hypertension, stenotic valvular heart illness – mitral stenosis, tricuspid valve, aortic orifice and pulmonary artery. Overloading with the amount of circulating blood might be with acute and chronic glomerulonephritis, insufficiency of heart valves and the presence of intracardiac shunts.
The adaptive response of the heart to overload is ventricular transforming – the event of hypertrophy, after which ventricular dilatation.
HF might be acute and chronic. Acute HF happens immediately or inside a short while (hours, days). It manifests itself in acute left ventricular, proper ventricular and complete heart failure.
The main hyperlink within the pathogenesis of acute left ventricular failure (VLF) is an acute lower in myocardial contractile operate with a lower in stroke quantity of the heart and stagnation within the left atrium and pulmonary veins. As a results of obstructed venous outflow from the lungs, blood circulation within the small circle is disturbed, resulting in reflex hypertension of the small circle, elevated permeability of the vascular partitions, and elevated transudation of fluid from capillaries into interstitial tissue and alveoli.
All this results in a violation of the operate of exterior and tissue respiration, hypoxia, respiratory and metabolic acidosis. An bronchial asthma assault is the principle medical manifestation of cardiac bronchial asthma. If cardiac bronchial asthma doesn’t cease in a well timed method, then the alveoli are overfilled with liquid – pulmonary edema develops, which is probably the most extreme medical manifestation of VLV and poses a risk to the affected person’s life.
Cardiac bronchial asthma is accompanied by an assault of inspiratory dyspnea (suffocation) and a jerky dry cough that happens extra usually at relaxation (at evening). An assault of cardiac bronchial asthma might be triggered by bodily exertion or nervous stress. The look of assaults at evening is defined by a rise within the tonus of the vagus nerve throughout sleep, which causes narrowing of the coronary vessels and a deterioration in myocardial diet. In addition, throughout sleep, the blood provide to the respiratory heart decreases and its excitability decreases.
The affected person takes a compelled place in mattress – sits with legs down. The face is pale with a bluish tinge. The variety of breaths per minute reaches 30-50, acrocyanosis and pallor of the pores and skin seem and rapidly intensify. The pulse is frequent, generally arrhythmic (extrasystole or paroxysmal tachycardia). Blood stress might improve reasonably.
With a chronic assault of cardiac bronchial asthma, pulmonary edema might develop.
Pulmonary edema is characterised by a rise in inspiratory dyspnea, suffocation with effervescent respiration, coughing with the discharge of a major quantity of foamy, generally pinkish (hemorrhagic) sputum, cyanosis. The affected person’s place in mattress is compelled – sitting with legs down. Facial cyanosis, chilly sweat are famous. Pulse of weak filling, frequent.
Blood stress in some circumstances decreases. Deafness of heart sounds, usually the rhythm of a gallop, is revealed. May be aggravated by arrhythmias. On the ECG – indicators of overload and hypertrophy of the left heart. In the lungs, small and huge bubble moist rales are heard in a big quantity; within the decrease sections, a blunting of percussion pulmonary sound is noticed.
- Half-sitting place with legs down;
- Nitroglycerin 1% (isoket, nitrates) is a peripheral vasodilator. With hypotension, it’s administered with dopamine (200 mg in 200-400 ml of 0,9% sodium chloride or 5% glucose). The preliminary injection fee is 5 μg/kg/min. The fee of administration step by step will increase to 8-10 drops per minute till stabilization of blood stress;
- The imposition of venous tourniquets in an effort to scale back venous return;
- Morphine 1% 1-2 ml per 10-20 ml of 0,9% sodium chloride or 5% glucose, iv slowly;
- Lasix (furosemide) 40-80 mg iv;
- Oxygen remedy with 100% oxygen with antifoam (70% alcohol, 10% alcohol resolution of antifomsilan). Nasal catheters are inserted deeply. When utilized superficially, the nasal mucosa dries up, inflicting discomfort;
- Cardiac glycosides – enhance myocardial contractile operate, however improve myocardial oxygen demand. It is inconceivable with acute IM!
- Glucocorticosteroids (prednisone, dexamethasone) – not a lot to stabilize blood stress, however to stabilize membrane permeability;
- Aspiration of froth and mechanical air flow.
Emergency medical measures for acute cardiovascular failure.
Acute heart failure is among the most harmful problems of cardiological ailments, during which the pumping operate of the heart is impaired.
The myocardium doesn’t calm down sufficient, the chambers of the heart aren’t fully crammed with blood. The quantity of blood getting into the aorta shouldn’t be sufficient to keep up the conventional functioning of the physique.
Acute heart failure refers to emergency circumstances with a excessive likelihood of demise and requires emergency hospitalization of the affected person. Your consideration is an article concerning the first pre-medical and medical care for acute heart failure.
Insufficient performance of the heart refers to a fancy of problems related to impaired blood movement to the muscle mass of the organ and modifications in contractile operate. The provision of first support for heart failure is a compulsory talent, which is fascinating for all residents to grasp, whatever the specialization of schooling.
Timely efficiency will assist save the lifetime of each a cherished one and a passerby on the road.
The main manifestations of the onset of the method are expressed:
- sudden onset of weak spot;
- brief, frequent, shallow breaths and exhalations;
- ache within the sternum.
The medical image of the issue is set by the attribute signs and lets you decide the kind of pathological course of.
Standard assist for heart failure ought to be offered instantly – time delays can result in demise for a poorly feeling particular person. The motion algorithm consists of easy guidelines:
- emergency group name;
- offering entry to recent air – open home windows, vents or take the sufferer out to the road, ask them to go to the space of gathered onlookers;
- unfasten all tight clothes;
- prepare the affected person in a half-sitting place, decrease the decrease components of the higher and decrease extremities into sizzling water – to cut back the movement of blood to the heart muscle;
- provide the affected person a drug from a subgroup of nitrates (Nitroglycerin, and many others.) – for synthetic affect on the coronary vessels (their growth will permit the blood to maneuver freely by way of the arteries).
Regulatory emergency measures are offered whatever the age of the sufferer – each adults and the aged. In case of sudden cardiac arrest or respiration, it’s obligatory to hold out emergency pre-medical measures.
It includes a sequence of sequential actions:
- choose a flat floor;
- the sufferer is laid on his again, a curler or a low pillow is positioned beneath his head;
- each arms are set within the central space of the sternum and carry out tremors (with straight, not bent on the elbows limbs) – their depth ought to be a minimum of 5 cm;
- the frequency of actions with oblique heart therapeutic massage ought to be as much as 70 actions per minute;
- in parallel, synthetic air flow of the lungs.
If resuscitation is carried out by one particular person, then the manipulation is carried out within the following mode:
- 15 uniform shocks;
- two pushing air into the lungs of the sufferer;
- repeat algorithm.
With two assistants, supporting actions are carried out:
- for each 5 shocks, a deep exhalation of air into the affected person’s lungs is carried out;
- every of the assistants carries out his actions – one – “breathes”, the second – “turns on” the heart.
The effectiveness of the manipulations is evaluated in a minute – if the specified success is achieved, then the affected person’s pores and skin turns pink, the pupils develop, a pulse seems on the arteries of the cervical backbone. The affected person is recorded spontaneous respiration.
If all the assistance didn’t have the specified consequence, then the actions nonetheless proceed – till the arrival of the medical group. With the proper implementation of the requirements of synthetic respiration and oblique heart therapeutic massage, you may keep a significant sick particular person for a relatively lengthy time period.
Experts are prejudiced in opposition to any home-based main care strategies for creating acute heart failure. Healers imagine that their strategies can have a constructive impact on the affected person’s state of well being on the time of the assault.
A vinegar resolution is taken – in a ratio of 1 to twenty – the affected person’s chest is moistened with it. Next, in the identical resolution, a dense tissue is soaked, a compress is utilized to the chest, aged about half an hour. After it’s changed with a recent one, the manipulations are repeated as much as 5 instances – till the affected person is totally relieved.
To forestall the event of an assault of acute heart failure, conventional medication recommends following the principles:
- the fixed alternation of bodily and psycho-emotional leisure – leisure with the assistance of scented candles, bathing with therapeutic options;
- fixed use of specialised natural teas – a drink with St. John’s wort, peppermint or lemon balm has an excellent affect on the normative work of the heart;
- safety in opposition to hypothermia – clothes ought to be totally seasonally and stop freezing;
- particular consideration is paid to the every day menu – greens and fruits ought to be included in it, all dangerous meals merchandise are strictly prohibited;
- do-it-yourself pickles and preservation ought to be faraway from the affected person’s weight loss program – their use worsens the situation and permits the tissues to build up extra fluid.
Insufficient performance of the heart can’t be cured by these strategies – the utmost impact is to assist the final situation. At the primary symptomatic manifestations of an assault, it is best to search certified assist – to save lots of the lifetime of the sufferer.
The penalties of the illness don’t belong to the class of particular phenomena and may happen relying on the diploma of injury to the organ and the stage of the continued course of. Frequently recorded embody:
- disturbances within the rhythm of contractions of the heart muscle and the ultimate deadly consequence – the syndrome provokes this growth of occasions 44% extra usually than different pathologies;
- infectious lesions – congestion within the lung tissue provokes the event of favorable circumstances for the penetration of pathogenic microflora;
- bleeding from the lungs – swelling and cardiac bronchial asthma is the foundation reason behind this complication;
- insufficiency of liver performance – develops on the degree of mobile buildings as a result of passing venous stasis;
- within the terminal levels of heart failure, metabolic problems happen that provoke the formation of cardiac cachexia (in opposition to the background of generalized anorexia as a result of poor absorption of lipids);
- heart assaults, strokes, embolism of tissues of inner organs – come up as a result of blood stasis;
- chronic kind of renal failure.
The above problems ensuing from the unstable operation of the cardiovascular division develop beneath the affect of premature remedy and incorrect first support.
Methods of prevention
To forestall the prevalence of ailments of the cardiovascular division, it’s essential to conduct well timed remedy of concomitant pathological processes. In order to keep away from the symptomatic manifestations of inadequate heart efficiency, the next preventive measures ought to be adopted:
- ideas of beneficial diet – with the restriction of salt (complete volumes shouldn’t exceed three grams per day), sugar, animal fat;
- fixed weight management and using weight loss program tables to cut back it;
- fixed bodily exercise inside cheap limits – in keeping with the suggestions of specialists, with a course of train remedy;
- periodic lengthy walks within the recent air – if potential, within the territory of forest zones;
- remedy of chronic nicotine habit;
- refusal of abuse of alcoholic and low alcohol drinks;
- keep away from sturdy espresso, tea, power drinks;
- the exclusion of chocolate, smoked meats and spicy dishes;
- well timed use of medicine prescribed by the attending doctor – to suppress the signs of the underlying illness.
Compliance with the principles of prevention in pathologies of the cardiovascular division, particularly in heart failure, will make it potential to keep away from the sudden onset of acute heart failure. The pathological course of is extraordinarily harmful and within the absence of emergency medical care usually results in the event of a deadly consequence.
The research of measures for the availability of first support will assist save the lives of not solely family members, but additionally informal passers-by.
Early detection of pathology, topical remedy and ethical assist are obligatory for sufferers with heart lesions. In addition to plain medical procedures, such sufferers want palliative care – through the transition of the illness to the terminal stage, to enhance the standard of life.
The affected person have to be seated in a cushty place and remember to decrease his legs. All objects of clothes that make respiration tough ought to be unfastened, if potential, take away and supply an inflow of recent air and instantly name an ambulance.
While the affected person is acutely aware, it’s good to discuss with him, reassuring him.
Hands and toes of the sufferer ought to be slowly lowered into heat water, measure stress. With indicators above 90 mm RT. Art. want to provide a nitroglycerin pill.
After quarter-hour from the onset of the assault, a tourniquet ought to be utilized to one of many hips. Before the arrival of medical doctors, the place of the tourniquet is modified each 30-40 minutes.
When respiration stops, it’s essential to proceed to cardiopulmonary resuscitation.
The algorithm for stopping respiration:
- Lay the particular person on his again on a flat floor, place a curler beneath his head.
- Fold arms down with palms, relaxation on the decrease third of the sternum and carry out jerky actions 60-65 instances per minute.
- Simultaneously with oblique heart therapeutic massage, synthetic respiration is carried out. If one particular person performs resuscitation measures, after each 13-15 shocks 2-3 synthetic breaths are made. If resuscitation is carried out by two folks, one breath falls on 5 shocks.
- After 30-35 seconds, it’s obligatory to guage the effectiveness of resuscitation. The pupils will start to answer mild, and regular pores and skin shade will start to recuperate.
- Even within the absence of seen outcomes, resuscitation is sustained till the medical doctors arrive.
A dynamic situation during which cardiac output shouldn’t be in a position to present the physique’s metabolic wants for oxygen and different substrates is acute heart failure in youngsters.
Acute proper ventricular failure
Acute proper ventricular failure is the results of a sudden weakening of the appropriate ventricle. At the identical time, blood stasis develops within the veins of a giant circle of blood circulation, venous stress rises, overflows with blood and the liver will increase in dimension. This type of heart failure is noticed with croupous pneumonia, emphysema, kyphoscoliotic heart failure, pulmonary heart illness (cor pulmonale) and tricuspid valve lesions.
The medical image in acute proper heart failure is characterised by the next options. The affected person’s place in mattress is compelled: in an effort to make him really feel higher, he tries to lie increased. Lips, nostril, extremities are cyanotic (acrocyanosis). The cervical veins are swollen, their pulsation is famous. The liver is enlarged, palpation is painful. No swelling.
Such indicators are additionally attribute of chronic heart failure. A major distinction between these two circumstances is the acute growth of those signs in some circumstances and the chronic course with a sluggish improve in circulatory failure for months and even years in others. It ought to be emphasised that congestive liver is a crucial symptom of acute proper ventricular failure.
The liver rapidly (in a couple of hours) will increase in dimension and upon palpation, as a rule, is painful. Often sufferers complain of impartial ache in the appropriate hypochondrium, which in acute congestion is attributable to a pointy stretching of the liver capsule. In case of chronic stagnation, an enlarged liver on palpation is much less painful.
An improve within the liver, famous in all circumstances of acute proper ventricular failure, is a differential diagnostic signal. With left ventricular failure, the liver doesn’t change, however there are phenomena of stagnation of blood in a small circle. An enlarged liver in case of left ventricular failure signifies that proper ventricular failure has joined it.
Edema, fluid accumulation within the belly cavity (ascites) and within the pleural cavities (hydrothorax) are additionally indicators of proper ventricular failure, however attribute of a protracted and chronic course of.
Below we current the differential diagnostic indicators of acute and chronic heart failure, which haven’t solely distinctive, but additionally a lot of frequent options (see desk).
What medical doctors ought to do
The main process of physicians who’ve arrived on the name is to stabilize the affected person’s situation for transportation to the intensive care unit.
First of all, it’s essential to stabilize fuel trade.
For this, oxygen remedy is carried out utilizing an oxygen masks, an inhaler or different gadgets, if there are indications, tracheal intubation is carried out.
First support for acute heart failure: assist the affected person, strategies of remedy
In a hospital setting, after figuring out the causes of heart failure, the affected person is prescribed remedy.
Isolated injury to the appropriate ventricle is uncommon. To eradicate the pathological situation, it’s often essential to eradicate its trigger: a blood clot or emboli within the pulmonary circulation.
With left ventricular OSH, the next is carried out:
- Artificial air flow with antifoam;
- Heart fee stabilization;
- Stabilization of blood stress;
- Elimination of edema.
Additionally, remedy of the underlying illness is carried out.
With ascites or hydrothorax, along with the appointment of diuretics, a puncture is carried out to pump out free fluid.
With cardiogenic shock, AH develops as a small cardiac output. In such circumstances it’s obligatory:
- Restore regular heart rhythm;
- Eliminate pathological reflexes that impede blood circulation;
- Normalize venous return;
- Restore tissue fuel trade;
- Eliminate myocardial contractility problems.
Now you know the way to supply first support for acute heart failure, and what’s the emergency medical support for an assault. Be wholesome!
All medical measures ought to be carried out taking into consideration the underlying illness, which led to acute heart failure.
In case of stagnation in a small circle, particularly when there’s a hazard of creating pulmonary edema, bloodletting is important. Abundant bloodletting can scale back the venous movement to the heart and thereby relieve the small circle. Bloodletting in an quantity of 400-500 ml of blood provides a very good impact.
In much less extreme circumstances, leeches (10-12 items) might be beneficial. They are positioned on the mastoid processes behind the ears, on the sacrum; in case of proper ventricular failure – to the realm of the liver.
Often, using mercusal, which is run intramuscularly in an quantity of 0,5-1 ml, has a very good impact.
In case of gentle seizures, you may also resort to round banks (a minimum of 30-40 items). Mustard plasters, positioned on the calves, on the shoulder blades, sizzling foot baths and decreasing of the arms in sizzling water facilitate the assault.
Massive bloodletting is probably the most radical measure in cardiac bronchial asthma (as a method of distracting blood from the small circle), however in some circumstances it can’t be used. So, bloodletting is unacceptable within the presence of anemia, with a drop in blood stress, and at last with usually repeated assaults of cardiac bronchial asthma in sufferers with heart ailments. In these circumstances, it is best to resort to the strategy of pulling the limbs with rubber bands, which previously, medical doctors used fairly extensively.
The essence of this methodology, rightly known as “bloodless bloodletting”, boils right down to the truth that the affected person’s legs and arms are pulled (not tightly!) By rubber bands or elastic bandages. At the identical time, fairly important venous congestion develops within the limbs, and synthetic deposition of blood is created. When pulling all 4 limbs for some time, it may be turned off from the blood circulation as much as 1 liter of blood, that’s, 2-3 instances greater than with regular bloodletting. This methodology is efficacious in circumstances the place bloodletting is unacceptable.
Harnesses are utilized to the shoulders and hips of their center third in order that solely veins are pulled. Arteries shouldn’t be squeezed. This might be checked by pulsation of arteries within the legs and arms.
After about half an hour, the tourniquets are eliminated, however not all on the identical time, in any other case it is going to lead to a speedy and important movement of blood to the heart and lungs, which may trigger a brand new assault of suffocation.
With thrombophlebitis on the decrease extremities, bundles might be utilized solely on the arms.
You shouldn’t resort to this methodology for edema of the extremities, septic endocarditis (to keep away from separation of the embolus), coronary insufficiency (angina pectoris and myocardial infarction).
Of the medication utilized in acute heart failure, digitalis (digitalis) group preparations ought to be named first.
In acute heart failure, it’s essential to prescribe medication that present a fast impact. This property has a strophant. Strophanthus is used within the type of strophanthin glucoside or alcohol tincture remoted from it.
Strofantin is on the market as a 0,05% resolution in ampoules containing 0,5 mg, and is utilized in doses of 0,25-0,5 mg. Due to its excessive exercise and speedy motion, the drug ought to be used very rigorously. Intravenously, strophanthin is poured very slowly, over 3-5 minutes. In extreme circumstances, the complete contents of the ampoule is launched, in much less extreme circumstances, solely half.
If intravenous infusion of strophanthin for any purpose shouldn’t be potential, the drug is run intramuscularly. With this methodology of use, strophanthin causes sharp ache. To scale back soreness, you may combine strophanthin with 1 ml of 1% novocaine resolution. The dose for intramuscular injection is 0,5 mg (all contents of the ampoule). If obligatory, strophanthin is usually administered intramuscularly 2 instances a day.
In the absence of strophanthin in ampoules, alcohol tincture of strophanthus (Tinctura Strophanthi) can be utilized. It is used orally, in microclysters, intramuscularly and intravenously.
Inside it’s prescribed 5-10 drops. But this methodology of use is ineffective, because the strophanthus is poorly absorbed and destroyed beneath the affect of hydrochloric acid of the abdomen.
In microclysters, the alcohol tincture of the strophanthus is run in 8-10 drops in 20-30 ml of water or 5-10% glucose resolution, warmed as much as physique temperature.
Intramuscularly apply 2-3 drops of alcohol tincture of the strophanthus. It is launched in 10 ml of physiological saline or 5-10% glucose resolution.
With intravenous infusion, the quantity of alcohol tincture of the strophanthus shouldn’t exceed 1-2 drops. At the identical time, it is usually diluted with 20 ml of a 20–40% glucose resolution (inject slowly!).
For intravenous and intramuscular administration, the same old alcohol tincture of the strophanthus is used. She is sterile. When mixing strophanthus with saline or glucose resolution, an correct dosage is important. From the bottle, the tincture of the strophanthus ought to be pipetted (sterile) to precisely rely the specified variety of drops.
When prescribing strophanthin, one ought to have in mind contraindications to its use. It can’t be prescribed if the affected person instantly earlier than this took digitalis for a very long time. Contraindication to using strophanthin can also be bradycardia (pulse 60 beats per minute or much less) and frequent extrasystole.
In acute heart failure, along with digitalis medication, it’s obligatory to make use of camphor, cordiamine, cardiazole, caffeine. Although these medication are vascular brokers, they’ve a useful impact on the heart. This primarily refers to camphor.
Camphor regulates and enhances heart contractions. It is run subcutaneously (Sol. Camphorae oleosae 20%), 2-5 ml 3-4 instances a day. Identical to camphor in motion are cordiamine and cardiazole. These artificial preparations are handy for use as a result of their good absorption.
Cordiamine is utilized in a 25% aqueous resolution. It is launched in ampoules of 1 ml, administered subcutaneously, intramuscularly and intravenously, 1-2 ml.
Cardiazole (corazole) is a ten% aqueous resolution, which can also be disbursed in ampoules and, like cordiamine, is run subcutaneously, intramuscularly in the identical doses. Intravenous infusion of those funds requires excessive warning, as they’ll trigger seizures. Therefore, it’s higher to chorus from intravenous administration of those funds.
Cordiamine and cardiazole, like camphor, have a useful impact on the respiratory heart. Unlike camphor, their impact as a result of speedy absorption, even with subcutaneous administration, manifests itself in a short time. However, they’re inferior to camphor in length of motion. After 1-2 hours, their motion ceases. Therefore, these medication are reintroduced as obligatory.
The use of caffeine is related to its impact on the heart muscle and respiratory heart. Caffeine causes the growth of the coronary vessels, which improves blood circulation to the heart muscle. Apply a 10-20% resolution of Coffeini natrio-benzoici 1 ml beneath the pores and skin 2-3 instances a day. In very extreme and emergency circumstances, caffeine can also be administered intravenously (Sol. Coffeini natrio-benzoici 10% 1 ml).
To excite the respiratory heart, a 1% lobelin resolution is injected subcutaneously in an quantity of 1 ml or intravenously in an quantity of 0,5 ml (injected slowly over 1-2 minutes) or an answer of cititone right into a vein or intramuscularly additionally in an quantity of 0,5-1 ml.
In extreme bronchial asthma assaults, it’s advisable to prescribe morphine (0,5-1 ml of 1%) resolution), which frequently stops the assault of cardiac bronchial asthma. Morphine preparations have to be used rigorously, particularly when the affected person’s respiration is of the Chain Stokes nature, since morphine may cause even larger melancholy of the respiratory heart. In the latter case, it may be administered along with medication that enhance blood provide to the mind and stimulate respiration (lobelin, cititon, caffeine).
The use of adrenaline and ephedrine is contraindicated in cardiac bronchial asthma, since, inflicting vasospasm, these medication make the left ventricle harder.
With important congestion within the lungs, when there are pronounced indicators of oxygen hunger (cyanosis, shortness of breath), an necessary therapeutic measure is the inhalation of oxygen.
Rp. Sol. Camphorae oleosae 20% 2,0
D. td N. 12 in amp.
S. 2 ml beneath the pores and skin after 2-3 hours
Rp. Cordiamini 1,0
D. td N. 6 in amp.
S. 1 ml beneath the pores and skin after 2-3 hours
Rp. Sol. Cardiazoli (Corazoli) 10% 1,0
D. td N. 6 in amp.
S. 1 ml beneath the pores and skin after 2-3 hours
Rp. Sol. Coffeini natrio-berlzoici 10% 1,0
D. td N. 6 in amp.
To decide the precise analysis on an emergency foundation:
- X-ray examination of the chest;
- Clinical blood checks.
If technically potential, the affected person is given an MRI or CT scan. These strategies give the utmost quantity of data.
concerning the causes of the illness
, localization and diploma of injury, the options of blood movement problems and enormously simplify the event of remedy ways.
Chronic heart failure: signs, causes and remedy
Acute cardiovascular failure is a sudden circulatory failure attributable to a violation of the contractile operate of the heart. The reason behind the illness are pathological circumstances: myocardial infarction, heart illness, malfunction of the heart rhythm. There are examples of the event of the illness aside: in opposition to the background of bodily or psychological overstrain. The illness can develop in only a few hours.
There are many causes for the event of heart failure. These embody ailments associated to blood circulation and heart operate. This row is replenished:
- cardiac syndrome;
The first signs of acute cardiovascular failure:
- weak spot;
- extreme dizziness;
- extreme shortness of breath;
- pallor of the pores and skin;
- temperature drop;
- ache within the chest and within the heart.
Acute cardiovascular failure can present itself in extreme medical syndromes: pulmonary edema, cardiogenic shock and cardiac bronchial asthma, which develop inside a few hours. Without correct care and additional remedy, the illness can lead to demise.
To forestall assaults of acute cardiovascular failure, it’s essential to usually conduct a full medical examination, which may decide the illness within the early levels.
There are two forms of acute cardiovascular failure: left ventricular and proper ventricular. The symptomatic image varies, relying on the classification of the illness.
Left ventricular failure is characterised by hypotonic manifestations and stagnation of blood within the pulmonary circulation, there’s a left-sided growth of the borders of the heart, heart palpitations (tachycardia assault) and a cardiopulmonary burst, which turns into pulmonary edema. A transparent signal of this illness, along with the principle signs, is the discharge of foamy and bloody sputum from the oral cavity.
With injury to the appropriate heart ventricle, shortness of breath seems, ache within the liver, cyanosis.
In individuals who have reached 70 years of age, signs of chronic heart failure are detected in 10% of circumstances. The illness develops slowly, many individuals contemplate it a logical manifestation of the getting old of the physique, subsequently, till the final pull with an enchantment to a heart specialist.
Such an angle to at least one’s well being makes it tough to assist with heart failure and elongates the remedy course of.
Coronary heart illness, hypertension and different heart ailments throughout their extended course don’t go with no hint and may result in weakening of cardiac exercise or chronic heart failure.
Abbreviations: CHF – chronic heart failure.
Components of longevity: philosophical angle to emphasize; wholesome consuming satisfactory bodily exercise; common mental workload; rejection of unhealthy habits.
Heart failure happens when the heart doesn’t have sufficient power to supply the physique with oxygen wants, then there are: shortness of breath; suffocation throughout bodily exertion; common weak spot; evening cough; swelling of the decrease extremities.
The predominant causes of heart failure are:
- coronary heart illness, particularly after myocardial infarction;
- additionally the reason for heart failure could also be a long-existing and untreated hypertension;
- heart defects (congenital and bought);
- another excuse for heart failure is cardiomyopathy (congenital or acquired cardiac pathology attributable to inflammatory heart ailments, alcohol abuse, and many others.).
For the remedy of chronic heart failure, extremely efficient medication exist that may assist the affected person.
But the choice of medication for heart failure can solely be achieved by a heart specialist on the premise of examination and knowledge from an goal and instrumental examination of the affected person.
Depending on the course and severity of chronic heart failure, there’s a fixed correction of remedy: the choice of medication and their doses. This could also be sufficient to make sure a standard high quality of life and enhance the prognosis.
First occurring extreme shortness of breath or suffocation is a critical symptom of the onset or exacerbation of a lot of cardiovascular ailments.
Cardiac bronchial asthma is an bronchial asthma assault attributable to weak spot of the left ventricle.
With exacerbation of chronic heart failure, a particularly harmful state of affairs is feasible as a result of the truth that the heart shouldn’t be in a position to push blood.
As a consequence, blood stagnates within the pulmonary arteries, and the fluid exits the vessels, accumulating within the tissues and cavities of the physique. The affected person suffers from asphyxiation at relaxation, palpitations, coughing, hemoptysis, blood stress rises or decreases, pulse will increase to 100-130 beats.
/ min, respiratory fee – 30-40 per minute (regular 18-20). So begins cardiac bronchial asthma, and with effervescent within the chest – even pulmonary edema. This extraordinarily tough and harmful state of affairs results in the event of acute oxygen hunger of the physique.
In this case, it’s pressing to name an ambulance, as solely emergency medical doctors and cardiopulmonary resuscitation will be capable to present well timed and certified help.
ACE inhibitors: dilate peripheral vessels, facilitating heart operate, enhance prediction – Kapoten, Monopril, Fozikard, Prestarium, Enalapril, Ramipril.
Beta-blockers: Betalok-Zok, Egilok, Corvitol, Concor, Nebilet – decelerate the heart fee, and it begins to work extra economically. With extended use, enhance its operate.
Diuretics: improve the quantity of urine excreted, serving to to eliminate extra fluid and sodium – Hypothiazide, Indapamide, Arifon, Furosemide, Diuver.
Cardiac glycosides: decelerate the rhythm of the heart, improve its contractility – Digoxin, and many others.
1. Urgently name an ambulance.
2. Body place – sitting with legs down (20% of the blood doesn’t movement from the legs, which helps to unload the left ventricle).
3. Mandatory management of blood stress. At hypertension 170-200/100-110 mm RT. Art. It is pressing to take antihypertensive medication: nifedipine 0,01-0,02 mg (to chew) or clonidine 0,075 mg.
4. Take 1-2 tablets of furosemide (40-80 mg).
5. With passable blood stress (120-130/80 and above), it’s crucial to take nitroglycerin (1 pill beneath the tongue) or nitrospray. If ineffective, repeat nitroglycerin after 5-7 minutes.
However, one should keep in mind that there are different ailments that may start with shortness of breath or suffocation: bronchial bronchial asthma, pneumonia, pulmonary thromboembolism (thrombus within the pulmonary vessels), pneumothorax (air within the pleural cavity throughout chest accidents), and effusion pleurisy (giant the quantity of fluid within the pleural cavity is as much as 1 – 1,5 l). Only a physician can make clear the analysis and supply satisfactory emergency care!
Article learn 6 instances (a).
Tachycardia known as paroxysmal is a kind of arrhythmia during which the heart fee reaches 140-180 beats per minute or extra. Attacks .
In the newest version of ICD-10, all medical variants of myocardial infarction are encoded as 121-122, and within the Diseases Database, this type of coronary heart illness is assigned the index 8664. Before .
Bradyarrhythmia (bradycardia or decreased pulsation) of the heart shouldn’t be a illness with particular age or gender manifestations. Since the info are pathological .
As with atrial fibrillation and flutter, ventricular fibrillation is characterised by the lack to coordinate their contraction. Mostly this pathology .
Atrial fibrillation or fibrillation means the absence of the opportunity of a coordinated discount of the atria. An skilled physician can diagnose this illness even .
Functional and natural heart murmurs in youngsters have a special nature. And if within the first case there is no such thing as a critical trigger for concern, then with heart murmurs .
The variety of youngsters born with congenital heart defects, in keeping with statistics, is about 6-8 folks per 1000 newborns. To provoke the event of the illness .
Inflammation of the myocardium and endocardium are extreme pathologies, accompanied by a major improve in physique temperature, extreme shortness of breath, ache within the joints and within the area of the heart. .
The causes of ache within the heart don’t at all times point out the pathology of this organ. Often the causes of heart ache are panic assaults, osteochondrosis, muscle ailments, .
Mostly myocardial infarction is noticed in males who’ve reached the age of fifty, though current circumstances of its prevalence have additionally change into extra frequent in 30-year-olds. Among ladies …
Jokes are unhealthy with angina pectoris – this illness is an early manifestation of coronary heart illness, and it’s attributable to a deterioration in coronary circulation. Brush off .
Different forms of arrhythmias in length and nature are attributable to ailments accompanied by a violation of the anatomical construction of the heart. The causes can also be .
heterogeneous group of ailments. At the identical time, not solely the principle organ for blood pumping suffers, but additionally giant vessels, which is accompanied by a change in blood movement, growth .
Coronary heart illness (CHD) is a myocardial injury attributable to a scarcity of blood provide to the heart muscle or a whole cessation of blood provide. Symptoms .
Cardiac extrasystole is the most typical kind of heart rhythm disturbance. Any particular person with no obvious penalties per day is recognized with rather less .
The predominant manifestations of acute cardiovascular failure are syncope, shock, and collapse.
Fainting is a sudden lack of consciousness, which has a brief length. This is attributable to impaired blood movement to the mind. Fainting lasts as much as a few minutes. This shouldn’t be a separate illness, however solely an indication of heart problems.
The causes of lack of consciousness are any actions resulting in impaired blood circulation and oxygen deficiency. Closed stuffy rooms, nervous exhaustion or worry, extended standing up are the principle causes resulting in fainting.
Before fainting, dizziness, weak spot are felt, extraneous noises are heard within the ears, a visual veil in entrance of the eyes, swelling of the extremities and nausea seem. When fainting, the affected person falls unconscious, respiration is uncommon and superficial, and the heartbeat turns into weak.
This situation requires emergency help within the following sequence:
- Put the affected person on a flat floor, elevate his legs somewhat.
- Ensure free entry of oxygen, relieving the physique of clothes stress within the space of the collar zone, belt.
- Apply a chilly compress to the brow of the unconscious.
These actions contribute to the narrowing of blood vessels and enhance blood movement to the mind.
If after a few minutes the affected person doesn’t get up, this means an misguided preliminary analysis. In this case, pressing assist from a specialised physician shall be required.
Shock is a harmful pathological course of attributable to bodily or emotional shock. A shock state means disruption of the compensatory response of the physique (nervous system, respiratory tract, blood circulation, metabolism, and others).
The causes of the shock state:
- a lot of cardiovascular ailments;
- crucial dehydration;
- giant blood loss;
- extreme allergic response;
Signs of shock are: dizziness, weak spot, shallow respiration, bluish lips and nails, chest ache, unconsciousness, full disorientation, pallor, speedy pulse, chilly sweat.
Shock is a situation that requires rapid medical consideration, together with emergency nursing care. It consists of the availability of anti-shock measures.
- The acutely aware affected person have to be reassured.
- The physique, even in the summertime interval, ought to be wrapped in a heat blanket or put heat garments on the affected person.
- If there aren’t any accidents to the top, neck or backbone, it’s good to lay the affected person on his again and lift his legs somewhat.
- Drink the sufferer with candy tea.
- Regularly document the stress and heart fee earlier than the physician arrives.
Subsequent nursing actions ought to be supervised by a professional doctor.
Collapse is a pointy drop in vascular tone and a lower within the quantity of circulating blood. Attacks of collapse are accompanied by a lower in blood stress and result in a decline in all working processes of the physique.
The causes of the state of collapse are:
- Sudden giant blood loss related to exterior accidents or rupture of inner organs.
- Sharp bouts of arrhythmia.
- Violations of the contractile operate of the myocardium.
- Expansion of peripheral vessels (happens in circumstances of excessive humidity and temperature in acute infectious ailments).
- Increased emotional state (usually manifested in adolescents, in opposition to the background of sturdy feelings).
The causes that induced the collapse don’t have an effect on the principle indicators of the illness. There is a sudden deterioration. The affected person complains of a headache, tinnitus, darkening within the eyes. The predominant signal is aching ache within the chest space, extreme weak spot and lethargy. Also obvious signs of collapse are blanching, a uninteresting look, and speedy respiration. If you don’t present first support, the affected person might lose consciousness.
Nursing course of
|Put the affected person on a flat and onerous floor, lifting the decrease limbs with a pillow or chair.||The movement of blood to the mind is facilitated.|
|Provide full peace.||The diploma of oxygen hunger is decreased.|
|Attach heating pads to the limbs, wrap the physique with a heat blanket. If potential, give the affected person sizzling tea.||The diploma of oxygen hunger is decreased.|
|Release the affected person from tight clothes. Carry out oxygen inhalation.||Blood provide to the mind improves, and vascular tone rises.|
|Measure blood stress and heart fee each 5 minutes till the physician arrives.||This will present the dynamics of the affected person’s situation to the physician.|
In case of lack of consciousness within the affected person, a lot of resuscitation actions are required, which embody oblique heart therapeutic massage and synthetic respiration. With a slowdown within the provision of medical resuscitation, the assault might lead to demise.
Follow-up with a physician is obligatory. In most circumstances, collapse is attributable to extreme sickness. At dwelling, malfunctions of cardiac functioning might be recorded with a standard blood stress monitor – mechanical or computerized. By usually checking your blood stress and heart fee, you may forestall a lot of heart ailments and demise.
As quickly because the syndrome is stopped, the affected person is shipped for remedy in a hospital setting. There, an skilled heart specialist will prescribe a course of remedy that can forestall the recurrence of an acute situation. If the affected person’s situation has been stabilized in time, and the affected person is recovering, after some time he shall be despatched dwelling. Unfortunately, the remedy doesn’t finish there.
In addition to the truth that the affected person should strictly observe the suggestions of the attending doctor relating to the regime of exercise and relaxation, diet and way of life usually, nurses will come to him every day. Her process is to watch the affected person’s situation, as a result of even when he misses the looks of some harmful signs, she’s going to be capable to discover them. The nurse’s obligations additionally embody injections, measuring the affected person’s blood stress, and interviewing.
Acute heart failure in youngsters. Classification, clinic, emergency care.
Acute cardiovascular failure in youngsters can happen because of infectious poisonous and allergic ailments, acute poisoning and hypoxia – that is an energy-dynamic failure. Reduced heart operate additionally happens as a result of myocardial overload and exhaustion of compensatory capabilities – that is hemodynamic failure. The division of the illness into these sorts is taken into account conditional.
In therapeutic research of heart failure in childhood, a direct relationship was discovered between the prevalence of the illness and direct injury to the heart muscle (congenital or acquired heart illness, myocarditis, poisoning with cardiotoxic poisons).
The predominant indicators of failure in youngsters are:
The provision of first support for acute cardiovascular failure in a toddler ought to be carried out with the onset of the primary signs. To do that, hold the kid in a half-sitting place. Hands and toes ought to be lowered into heat water. If potential, perform inhalation of oxygen. These actions contribute to the stabilization of blood stress and the institution of oxygen provide to the mind.
Attacks of heart failure in youngsters is an indicator of the necessity for a full examination. This illness is handled by eliminating the causes of the illness.
Quitting smoking and alcohol will positively have an effect on the functioning of the heart and different organs. Proper diet and train will strengthen the heart muscle. Any prevention of heart illness prevents the prevalence of acute cardiovascular failure. Any self-medication may cause unfavorable penalties.
In the second case, myocardial metabolism is primarily impaired, primarily as a result of a dysfunction of metabolic and power processes within the heart muscle because of acute hypoxia, intoxication, and allergic reactions. This kind of heart failure is named energy-dynamic failure.
The division of DOS into energy-dynamic and hemodynamic is usually conditional.
Etiology. Acute heart failure in youngsters most frequently develops as a result of bacterial and poisonous myocardial injury with poisonous pneumonia, influenza, intestinal infections, rheumatic myocarditis and heart defects, diphtheria and typhoid myocarditis, acute nephritis, and long-term anemia.
Causes of heart failure might be congenital and bought heart defects, vitamin deficiency (B nutritional vitamins), electrolyte deficiency (potassium deficiency) with peritonitis and intestinal toxicosis, acute hypoxia, varied forms of exogenous poisoning and preliminary myocardial weak spot (congenital carditis and cardiomyopathy).
Right ventricular heart failure can develop with extreme bronchial bronchial asthma, chronic pneumonia, defects in the appropriate heart, emphysema, spontaneous pneumothorax. Excessive intravenous administration throughout infusion of saline options, plasma, blood, and many others. with out management of venous stress may result in acute cardiac overload, particularly in sufferers with pneumonia.
OCH develops in keeping with the left, proper ventricular and mixed kind. Right ventricular failure develops with extreme pulmonary pathology, throughout surgical procedure with speedy infusion remedy with out monitoring central venous stress. Left ventricular failure is extra frequent in youngsters with rheumatic heart illness, acute myocarditis and nephritis.
In assessing heart failure, its severity is of nice significance. G.F. Lang (1934) proposed to differentiate 4 levels of heart failure (H1, H2A, H2B, H3). This classification with minor modifications is utilized in pediatrics these days. In intensive care, it’s extra handy to divide the OSN into compensated and decompensated (I and II levels).
Pathogenesis. For an accurate understanding of the pathogenesis and remedy of cardiovascular failure, it’s essential to know the metabolic biochemical processes that underlie cardiac exercise. The metabolic processes within the heart muscle have three predominant phases: 1) the discharge of power; 2) power conservation; 3) power use.
Energy is generated because of glycolysis, oxidation of fatty acids and pyruvic acid and dehydrogenation within the Krebs cycle of tricarboxylic acids. Energy conservation is carried out by way of the exercise of enzymes that carry hydrogen. In the method of oxidative phosphorylation, hydrogen power is transformed into ATP remaining bond power and thru creatine kinase into creatine phosphate.
The contraction of cardiac myofibrils happens beneath the affect of the motion of ions within the heart cells because of depolarization and repolarization of the membrane. Sodium ions enter the cell, the membrane is depolarized, adopted by sodium, chlorine and calcium ions enter the cell, and potassium ions start to flee from the cell – the repolarization section.
With heart failure, the water-electrolyte steadiness is disturbed, which ends up in a delay within the physique of water and salts, and sodium ions are retained greater than water. Sodium ions, accumulating contained in the cells, displace potassium ions from there. These shifts are amplified as a result of impaired renal excretion of sodium and potassium.
Heart failure results in impaired blood circulation within the kidneys, leading to decrease filtration and elevated reabsorption of sodium within the physique, which in flip results in elevated excretion of potassium by the kidneys. The main position in these problems belongs to extracardiac, particularly nervous and hormonal elements.
As a results of metabolic problems within the myocardium and the ensuing deterioration within the contractility of the heart muscle, the ejection of blood from the heart cavity decreases, which ends up in complicated hemodynamic problems, a lower in minute blood quantity, a rise in venous stress, and a rise in circulating blood quantity (BCC).
During hypoxia, the content material of macroergic phosphorus compounds and glycogen within the heart muscle decreases, the quantity of lactic and pyruvic acid will increase, the exercise of tissue enzymes is inhibited, the steadiness of electrolytes modifications – the content material of intracellular sodium will increase and the intracellular potassium decreases. Oxygen hunger has an opposed impact on the conduction system of the heart.
1) Tachycardia, which happens initially as a compensatory response of the heart with a lower in myocardial contractility and a lower in stroke quantity of the heart, in an effort to keep an satisfactory minute quantity of blood circulation;
2) Shortness of breath, which additionally happens as a compensatory response. The development of heart failure, resulting in a violation of pulmonary fuel trade, additional will increase shortness of breath with the involvement of auxiliary muscle mass in respiration;
3) The growth of the borders of the heart. It is virtually necessary not solely to find out the growth of the heart, but additionally to ascertain whether or not this can be a consequence of dilatation, compensatory or myogenic hypertrophy;
4) Cyanosis of the pores and skin and mucous membranes as a result of decreased blood provide to tissues and their inadequate provide of oxygen. As a results of this, metabolic processes are disturbed within the tissues, the proportion of anaerobic glycolysis will increase with the buildup of merchandise of incomplete cleavage and a shift of the response to the acid facet;
5) Pastosis of the pores and skin and tissue swelling. Of the assorted pathogenetic mechanisms for the event of those signs, stagnation of blood in a big circle of blood circulation, a change in hydrostatic and colloid osmotic stress, a rise within the permeability of the vascular wall, a lower in renal blood movement, electrolyte shifts as a result of elevated secretion of aldosterone are necessary;
6) An improve within the liver, which signifies a violation of the venous outflow, stagnation of blood in a big circle of blood circulation and is accompanied by a rise in CVP, an growth of the venous community on the face and chest;