The development of the acute form occurs under the influence of:
- Diseases that reduce the contractility of the heart muscle, damaging or stunning it. This occurs with myocardial infarction, when a violation of the blood flow to the area of the heart causes cell death, with inflammation of the heart muscle, as well as after surgical interventions on the heart or as a result of the use of a cardiopulmonary bypass.
- Decompensation of chronic insufficiency, as a result of which the heart can not provide organs with enough blood.
- Violations of the integrity of valves and chambers.
- Accumulation of fluid between the sheets of the pericardial sac, making normal heart contraction impossible due to compression of the heart cavities.
- Thickening of the walls of the heart muscle.
- Hypertensive crisis. In this case, blood pressure indicators significantly exceed the norm.
- Pathologies of the pulmonary circulation. Acute insufficiency can be caused by blockage of the pulmonary artery by blood clots, which usually form in the lower limbs or pelvis, acute lung pathologies such as bronchitis or pneumonia, acceleration or deceleration of the heart rhythm.
There are also extracardiac causes of the disease. Acute cardiovascular failure can be caused by:
- infectious processes;
- a developing circulatory disturbance in the brain, in which tissues are damaged, and organ functions are impaired;
- extensive surgical interventions;
- severe brain injuries;
- toxic effects on the heart muscle with drugs or alcohol;
- electric pulse therapy, injuries resulting from exposure to an electric current.
Factors of the development of DOS are conventionally divided into several groups:
- Organic myocardial lesions;
- Other cardiovascular pathologies;
- Extracardiac diseases that do not directly affect the heart or blood vessels.
The list of causes of acute heart failure leads to damage to the heart muscle, in particular, myocardial infarction, in which muscle cell death occurs. The larger the area of the focus of necrosis, the higher the risk of developing AHF and its more severe course. Myocardial infarction, weighed down by AHF, is one of the most dangerous conditions with a high probability of death of the patient.
Inflammation of the myocardium, myocarditis, can also lead to OCH. A high risk of developing AOS is also present during cardiological operations and in the application of artificial life support systems.
Acute heart failure is one of the most threatening complications of many vascular and cardiological diseases. Among them:
- Chronic heart failure (we talked about the causes of its development here);
- Heart defects, congenital and acquired;
- Arrhythmias leading to critical acceleration or deceleration of the heart rhythm;
- Arterial hypertension;
- Heart tamponade;
- Disorders of blood circulation in the pulmonary circulation.
DOS often develops amid
, injuries or operations on the brain, as a complication of infectious diseases, as well as due to severe or chronic intoxication. The likelihood of impaired myocardial function increases with some endocrine diseases and kidney damage.
Accordingly, people with a history of:
- Diseases of the heart and blood vessels;
- Blood coagulation disorders;
- Kidney disease;
- The abuse of alcohol, tobacco, narcotic substances, harmful working conditions;
This disease develops rapidly, various diseases and pathologies of the heart contribute to this:
- arterial hypertension;
- coronary heart disease (myocardial infarction);
- heart valve disease, defects (congenital or acquired);
- heart muscle disease;
and also not heart problems:
- intoxication with poisons;
- infections (pneumonia);
- cerebral strokes;
- abuse of alcohol or drugs;
In acute heart failure, the patient’s condition deteriorates sharply and very often such patients die. The course of the disease is affected by a person’s age, his lifestyle, bad habits, and stress.
The cause of human death in AHF may be pulmonary edema, cardiogenic shock or cardiac asthma.
- Causes of Acute Heart Failure
- ACE Inhibitors
- Forerunners of OCH
- A BRIEF GUIDELINES FOR THE PROVISION OF MEDICAL CARE WITH HEART FAILURE
- HEART FAILURE Clinical lectures on internal medicine
- Why does heart failure occur?
- Dying condition
- Symptoms of Acute Heart Failure
- Preventive measures
- Degrees of heart failure
- The basic principles of the treatment of chronic heart failure
- Features of the disease
- In acute heart failure
- With CHF
- In old age
- With shortness of breath
- Types and stages
Causes of Acute Heart Failure
Acute heart failure is a condition that threatens a person’s life.
Therapy of the disease after first aid depends on the main reason:
- If the violation is caused by arrhythmia, then in order to stabilize the patient’s condition and establish blood circulation, restore the normal frequency of contractions.
- In the presence of myocardial infarction, systemic thrombolysis is used to restore normal blood flow, that is, thrombi are dissolved with the help of thrombolytic drugs. Medicines are administered intravenously.
- If acute failure occurs due to injuries, rupture of the myocardium, damage to the valve, it is necessary to urgently hospitalize the patient and prov >
Acute congestive right ventricular failure is treated with the method of correction of the conditions that caused it, that is, they eliminate thromboembolism, asthmatic status.
Direct heart failure is eliminated:
- Oxygen therapy.
- Sedation. Medications cause sleep, from which the patient can be woken up at any time.
- Cardiac glucosides, which have a stimulating effect on the heart.
- Cardiotonic to increase contractility of the heart muscle.
- Diuretics to remove excess fluid from the body.
- Vasodilator drugs.
- Antiplatelet agents to reduce platelet adhesion.
One of the main goals of treating heart failure is to reduce the length of stay of patients in a hospital bed. The second is to improve the quality of life of patients, due to the correction of the main symptoms of the disease:
- medications are required to stop the symptoms of heart failure at the earliest possible dates (if the patient seeks medical help in a timely manner);
- drugs are designed to protect target organs from damage during disease progression;
- medicines for the treatment of heart failure with an integrated approach should slow down the pathological process.
To solve all these issues, the patient should be ready for daily life-long medication prescribed by the attending physician.
Therapy of heart failure involves the use of drugs of different groups. The treatment regimen is selected individually, correlated with the age of the patient, the severity of the condition, physiological characteristics. But the combination of medicines always consists of the most effective representatives of the following groups:
- ACE inhibitors (captopril);
- beta-blockers (Concor);
- diuretics (spironolactone);
- calcium antagonists (verapamil);
- Sartans (Valsartan);
- cardiac glycosides (digoxin);
- nitrates (Nitrong);
- potassium preparations (Panangin);
- anticoagulants (troxevasin);
- metabolic agents (metformin);
- sympathomimetics (Isoprenaline);
- sedatives (Novopassit).
Not all drugs are prescribed at once. The combination is selected taking into account the diagnosis and the prevailing symptoms.
Medicines for heart failure are selected taking into account the fact that pathology is only a symptom of complications of diseases of the heart and blood vessels: hypertension, cardiomyopathy, coronary heart disease, heart defects of various etiologies. In addition, tablet forms are mainly used in the treatment of heart failure (acute conditions are treated by infusion).
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Preparations for heart failure of the ACE inhibitor group facilitate blood flow, therefore, are indicated for all patients with circulatory failure, regardless of the cause of this condition. Medicines can improve overall well-being, remove signs of heart failure, prevent decompensation, and improve the quality of life.
The drugs block the angiotensin-converting enzyme, relieving vasospasm, normalizing blood pressure, reducing the load on the myocardium.
As a rule, they are always combined with diuretics, enhancing their effect. Excess fluid is quickly removed from the body, the contractility of the heart is resuscitated, preventing the likelihood of a stroke, heart attack.
When it comes to renal hypertension associated with disorders in the Renin-Angiotensin System, ACE inhibitors work in conjunction with Rasilez, a renin inhibitor (this kidney enzyme has a powerful vasoconstrictor effect).
|Name of the drug||Cost in rubles|
Timely access to a doctor reduces the risk of death by up to 30% of the total number of patients. The initial stages of heart failure are stabilized medically when all prescriptions and recommendations of the doctor are fulfilled. Any unusual symptom, complication is corrected only by the joint efforts of the doctor and patient. In order to ensure active longevity for yourself, it is important to take care of your health, not to neglect the annual medical examination, passing the necessary tests.
In order not to encounter complications and return the patient to normal life as soon as possible, it is advisable to start therapy promptly. The treatment of heart failure is not an easy process, and a specialist should do it, but there are some nuances that ordinary people need to know in order to be able to provide first aid to a patient with an attack.
On how timely and correctly the first aid will be provided for heart failure, all the following treatments depend.
The main goal of treating heart failure is to prevent its transition to the chronic stage. All therapeutic measures taken should also help reduce the number of hospitalizations and deaths. In addition, with a problem such as heart failure, recommendations are aimed at:
- reduction of its manifestations;
- improving the quality of life of the victim;
- protection of organs and tissues from destruction.
Among the most popular drugs for heart failure are the following:
- A nicotinic ac >
Alternative medicine knows hundreds or even thousands of effective recipes for the restoration of the vascular system in heart failure. The main thing is to contact them with the approval of a specialist. Often, professional doctors themselves willingly recommend alternative recipes, but they should only be used in conjunction with serious medical treatment.
– elimination of the cause of heart failure (surgical treatment of valvular disease, heart aneurysm, restoration of coronary blood flow, etc.);
– adequate treatment of the disease that caused heart failure (IHD, arterial hypertension, etc.);
– elimination (reduction) of clinical manifestations of heart failure and increased exercise tolerance;
– preventing the progression of heart failure;
– elimination (reduction) and prevention of complications of heart failure, primarily ventricular arrhythmias and thromboembolism;
– elimination of the consequences of cardiovascular remodeling due to heart failure.
First of all, the restriction of consumption of table salt (up to 2 g per day), liquid (up to 1,5 liters per day) and alcohol is shown.
With compensated heart failure, regular exercise lasting 30-40 minutes is of great importance. If the patient is not able to bear the load for more than 15 minutes, then classes should be carried out 2 times a day. The intensity and duration of the load is controlled by well-being.
Restriction of physical activity is necessary only with an exacerbation of the course of heart failure
Attention should be paid to the treatment of a disease or condition that caused or supports heart failure (coronary heart disease, arterial hypertheisia, anemia, dysfunction of the thyroid gland, overweight, etc.), exclude the use of drugs with negative ipotropic effects (aptiarrhythmic drugs I and IV classes, non-steroidal anti-inflammatory drugs, etc.).
Drug treatment is carried out in two directions – stimulation of inotropic function and unloading of the heart (Fig. 9.1).
To stimulate the contractile function of the heart, cardiac glycosides are traditionally prescribed. In patients resistant to therapy, improvement can be achieved by intravenous drip of dobutamine.
Cardiac glycosides (digoxin) have been successfully used for many decades in the treatment of chronic heart failure, which is a significant reason for their further use. An increase in heart size, III tone, and tachycardia are additional reasons for the appointment of cardiac glycosides in heart failure. The most appropriate use of cardiac glycosides in patients with atrial fibrillation and with III and IV functional classes of heart failure.
Studies by PROVED and RADIANCE confirmed that withdrawal of glycosides worsens the well-being of patients with cardiac
insufficiency. Moreover, the results of a large-scale study of DIG showed that these drugs do not reduce mortality in heart failure (Fig. 9.2).
In the treatment of heart failure, maintenance doses of cardiac glycosides (digoxin 0,25 mg / day) are used without prior digitalization.
Forerunners of OCH
Acute heart failure can develop suddenly. In some cases, AHF and sudden coronary death are the first manifestations of asymptomatic coronary heart disease.
In approximately 75% of cases of DOS 10-14 days before the disaster, alarming symptoms manifest themselves, which are often perceived as a temporary minor deterioration. It can be:
- Heart rhythm disturbances, mainly tachycardia;
- General weakness;
- Poor performance;
Possible attacks of dizziness, impaired coordination of movements.
A BRIEF GUIDELINES FOR THE PROVISION OF MEDICAL CARE WITH HEART FAILURE
When the first symptoms that indicate heart failure appear:
- Set the victim in a comfortable position, with a raised back;
- Provide access to fresh air, unfasten or remove clothing items that constrain breathing;
- If possible – dip your hands and feet in hot water;
- Call an ambulance, describing the symptoms in detail;
- Measure the pressure, if it is lowered – give a tablet of nitroglycerin;
- After 15-20 minutes from the onset of the attack, apply a tourniquet on the thigh, the position of the tourniquet is changed at intervals of 20-40 miut;
- In case of cardiac arrest, artificial respiration and indirect heart massage should be started (if you have performance skills).
- While the victim is conscious, you need to talk and calm him down.
Arriving at the place of the ambulance doctors must stabilize the patient. To do this:
- Oxygen therapy;
- Elimination of bronchospasm;
- Relief of pain;
- Pressure stabilization;
- Increased breathing efficiency
- Prevention of thrombotic complications;
- Elimination of edema.
All these actions belong to the competence of qualified medical personnel, specific drugs are selected individually depending on the condition of the patient.
It is impossible to resort to alternative methods of treatment for AHF. No need to waste time, it is better to immediately call an ambulance. Specialists provide the following assistance to a patient with acute heart failure:
- a catheter is inserted through the nose to ensure normal access of oxygen to the body;
- do cardiac glycoside injections;
- give medicines that increase vascular tone.
Before the arrival of the ambulance crew, it is very important to provide a person with first aid:
- Lay the patient, put a pillow under his back to ensure the outflow of blood into the lower body. His legs down to the floor.
- Open windows, turn on air conditioning (if any) to provide fresh air.
- Unfasten buttons on the patient’s clothing, remove all tightening accessories: belt, elastic bands, rings, etc.
- Give a person a nitroglycerin tablet under the tongue. It will help reduce tension in the blood vessels.
Mack Murray John
WHO / SGC Working Group on Dissemination of Heart Failure
Definitions of Heart Failure
Clinical diagnosis of heart failure
Tab. 1. ECG parameters in patients with suspected heart failure
Tab. 2. Overview of types of heart failure and their treatment
Tab. 3. High-risk situations when specialist assistance is desired
Represents all continents except Antarctica
Heart failure worldwide is a major public health problem, and its importance is increasing. This is a common condition that leads to disability and death and is associated with high costs. Early diagnosis and effective treatment can reduce morbidity and mortality, reduce costs.
Heart failure is the inability of the heart to supply the metabolizing tissues with blood (and, therefore, oxygen) at a level corresponding to their needs at rest or during light physical exertion. This causes a characteristic pathophysiological response (nervous, hormonal, renal, etc.), leading to the appearance of the corresponding symptoms and signs.
- Do the symptoms have a cardiac or non-cardiac nature, in other words, is there a heart disease?
- if there is a heart disease, what is the exact nature of the cardiac problems?
Dyspnea and fatigue are typical signs of heart failure, but they can often be observed in other conditions (for example, respiratory disease, obesity). If it is known that there is a heart disease (such as MI) or valve defect, then the likelihood that the patient’s symptoms are due to heart failure increases.
Etiology and pathophysiology. Treatment in usual practice. Myocardial systolic insufficiency.
Heart failure is most often caused by systolic dysfunction, when the myocardium is not able to contract normally; LV is usually dilated. MI, chronic hypertension, dilated myocardiopathy, viral myocarditis, Chagas disease and alcoholic heart damage are the most common causes of this type of heart failure. It is important to identify these patients, since the prognosis of systolic heart failure improves if ACF inhibitors are prescribed in addition to diuretics and / or digoxin. .
Sometimes heart failure is caused by diastolic ventricular dysfunction, when the myocardium is rigid, often due to hypertrophy, and cannot normally relax. This condition is more common in older patients and may have a better prognosis than systolic heart failure. This type of heart failure can be caused by hypertension.
Optimal treatment for diastolic heart failure has not yet been developed. Adequate treatment of the underlying diseases is necessary, for example, antihypertensive therapy is needed to reduce high blood pressure, and the goal is to stimulate LVH regression. Stagnation requires the use of diuretics Valve diseases
Valve lesions remain a common cause of heart failure in regions with a high prevalence of rheumatic fever. Calcification of aortic stenosis is also often observed in elderly patients. Surgical and other interventions, such as balloon valvuloplasty, can have a significant positive effect. With inoperable valve regurgitation, vasodilators can help pericardial diseases.
Pericardial constriction or effusion, caused for example by tuberculosis or a viral disease, may impair pumping function. Cardiac tamponade should be considered. If conservative treatment is unsuccessful, balloon pericardiotomy or surgical pericardectomy may be beneficial.
Endocardial or endomyocardial fibrosis and its variant – Leffler’s disease (restrictive cardiomyopathy) – cause the development of a form of diastolic, or restrictive, heart failure due to these reasons, is unclear, and the treatment is not well understood. Diuretics and digoxin are usually prescribed to relieve symptoms. Congenital heart disease
Many congenital heart diseases can lead to heart failure in infants and children. Some types (for example, atrial septal defect and aortic stenosis) can appear only after many years in the form of heart failure
Surgical and medical treatment is often required. Metabolic heart disease.
Heart failure is caused by thyroid disease. Thiamine deficiency (beriberi) can lead to heart failure in some ethnic groups. Excess iron (hemochromatosis and hemosiderosis) also leads to myocardial damage. Recovering or eliminating the corresponding nutritional, hormonal or metabolic factor usually leads to healing
Many patients with heart failure have few clinical symptoms or are mild. Some symptoms, such as leg edema, are very non-specific and can occur in patients without heart failure. An increase in SJD (in the absence of anemia, pulmonary, renal or hepatic pathology), an increased low-amplitude pulse, the presence of III cardiac sound and an apical impulse displacement are specific signs of heart disease.
Blood pressure is usually normal for a patient of this age or low, which indicates that heart disease caused by hypertension is not the cause of heart failure. The presence of pulmonary rales in the absence of other signs of heart disease is nonspecific.
In contrast, dyspnea in the absence of the cardiac symptoms mentioned above most likely indicates the presence of pulmonary or some other disease.
1. Confirm the diagnosis of heart failure by detecting signs of the underlying heart disease.
2. Determine the cause of heart failure by characterizing the underlying heart disease.
3. Promote the selection of the best treatment (and rule out the wrong treatment) by identifying the causes of heart failure.
4. Get the information needed for the forecast.
5. Define a “reference point” for the subsequent evaluation of the effectiveness of therapy.
A blood test eliminates anemia, diseases of the liver, kidneys and thyroid gland. Of the cardiological research methods, ECG recording in 12 leads, RGCs and, if possible, echocardiography are most often used.
In patients with heart failure, an ECG in 12 leads is rarely completely normal. Even with pericardial disease, there is usually a drop in the voltage of the QRS complex and the patient often has atrial fibrillation. However, the patient’s shortness of breath and ECG abnormalities do not necessarily indicate heart failure. In the table. Figure 1 shows how ECG characteristics can help identify the cause of heart failure.
According to the localization of the lesion, AHF can be right ventricular, left ventricular or total. In case of dysfunction of the right ventricle, symptoms predominate, indicating congestion in a large circle of blood circulation:
- Secretion of sticky cold sweat;
- Acrocyanosis, less often – a yellowish tint of the skin;
- Swelling of the jugular veins;
- Shortness of breath, not associated with physical exertion, as the condition progresses, passing into suffocation;
- Sinus tachycardia, lowering blood pressure, filiform pulse;
- Enlarged liver, soreness in the right hypochondrium;
- Swelling of the lower extremities;
- Ascites (fluid effusion in the abdominal cavity).
With left ventricular acute heart failure, progressive congestion develops in the pulmonary circulation and are manifested by the following symptoms:
- Shortness of breath, passing into suffocation;
- Sharp weakness;
- Cough with foamy pinkish sputum;
- Gurgling wheezing in the lungs.
In the supine position, the patient’s condition worsens, the patient tries to sit, lowering his legs to the floor. The state of DOS is accompanied by a fear of death.
It is customary to distinguish several stages in the development of AOS. The appearance of precursors in time coincides with the initial or latent stage. There is a decrease in performance, after physical or emotional stress shortness of breath and / or tachycardia occurs. At rest, the heart functions normally and the symptoms disappear.
The second stage is characterized by a manifestation of severe circulatory failure in both circles. In substage A, blanching of the skin and cyanosis in the most distant parts of the body from the heart are noticeable. Usually, first of all, cyanosis develops at the tips of the toes, then the hands.
There are signs of congestion, in particular wet wheezing in the lungs, a dry cough, possibly hemoptysis, torment the patient.
Edema appears on the legs, the liver slightly increases in size. Symptoms that indicate stagnation of blood, increase in the evening and in the morning fade away completely or partially.
Heart rhythm disturbances and shortness of breath appear with exercise.
In substage B, the patient is concerned about aching pains behind the sternum, tachycardia and shortness of breath are not associated with physical or emotional stress. The patient is pale, cyanosis captures not only the tips of the fingers, but also the ears, nose, extends to the nasolabial triangle. Swelling of the legs does not pass after a night’s rest, spreads to the lower body.
Accumulations of fluid form in the pleural and abdominal cavities. Due to stagnation of blood in the portal system, the liver greatly increases and becomes denser, pain is felt in the right hypochondrium. Violations of fluid removal from tissues lead to severe oliguria – insufficient urine output.
The third stage, it is also dystrophic or final. Circulatory failure leads to multiple organ failure, which is accompanied by increasing irreversible changes in the affected organs.
Diffuse pneumosclerosis, cirrhosis, congestive kidney syndrome develop. Failure of vital organs occurs. Treatment at the dystrophic stage is ineffective; a fatal outcome becomes inevitable.
HEART FAILURE Clinical lectures on internal medicine
Heart failure is a pathological condition in which a dysfunction of the heart leads to its inability to pump blood at the rate necessary to meet the metabolic needs of the body and / or this is only observed with filling pressure / left or right ventricle / (E. Braunwald, 1992 /.
Heart failure is a clinical syndrome, which is based on a violation of the contractile function of the heart. This syndrome is characterized by a decrease (due to shortness of breath and rapid fatigability / tolerance to physical activity) / D. Kon, 1995 /.
Circulatory failure is a pathological condition in which the cardiovascular system is not able to deliver the necessary amount of blood to organs and tissues for their normal functioning at rest or when increased demands are made on the circulatory system / V.Vasilenko et al., 1974 /.
As already mentioned, traditionally, circulatory failure is divided into cardiac and vascular, acute and chronic. In the framework of this lecture, we will talk primarily about secondary failure.
ETHIOLOGY AND PATHOGENESIS
The main causes of chronic circulatory failure are presented in table 1.
1 / overwork / with arterial hypertension, heart defects /;
2 / violation of the blood supply to the myocardium / atherosclerosis of the coronary arteries, anemia /;
3 / direct external influences on myocardium / infections, intoxication, etc. /;
4 / neuro-trophic and hormonal changes / with endocrine diseases /.
MAIN REASONS FOR THE DEVELOPMENT OF CNK
1. Violation of the regulation of vascular tone
D. Violations of heart rhythm and conduction
* Cardiomyopathies / dilated, hypertrophic,
* Infiltrative myocardial lesions
* Inflammatory myocardial lesions
In the most general form, the numerous causes of heart failure are presented in table 2.
Speaking about specific nosological forms, in the overwhelming majority the main cause of heart failure is IHD (in about half of all cases), followed by arterial hypertension, cardiomyopathy, pathology of heart valves, myocarditis, endocrine and other pathologies, and its wide variability is noted in different countries.
2 / chemical / biochemical / genesis / overdose
medicinal and non-medicinal products, high
1 / excessive amount of blood flowing to the heart
2 / increased resistance to expulsion of blood from cavities
heart into the aorta or pulmonary artery / enlargement
3 / immediate changes in the heart
/ decrease in the mass of contractile myocardium as a result
its ischemia, myocardial infarction, cardiosclerosis;
valvular heart disease / or vascular bed
/ arteriovenous discharge, polycythemia, hypervolemia /;
4 / neuro-humoral dysregulation of cardiac activity
/ increased sympathetic effects on the myocardium /.
There are a number of factors that contribute to the appearance or exacerbation of existing heart failure. In addition to these diseases, heart failure can appear and intensify during pregnancy / especially against the background of an existing heart defect /, renal failure / due to fluid retention in the body /, the appearance of arrhythmias, the occurrence of catarrhal diseases or pneumonia / which is especially common in older people / , after iv administration of large volumes of fluid, with anemia, thyrotoxicosis, excessive physical exertion and emotional stress, in adverse environmental conditions / high humidity, heat /.
Especially it is worth remembering such a factor as non-compliance with medical recommendations by patients / low compliance /, which is especially typical for patients of post-Soviet countries / for example, unauthorized cessation or irregular intake of drugs for the treatment of heart failure or arterial hypertension, dietary disorders, increased consumption of salt, alcohol, etc. .d./.
MEDICINES CONTRIBUTING TO THE APPEARANCE OR EXECUTION OF HEART FAILURE
* Some calcium antagonists / verapamil, diltiazem /
* Some anticancer drugs
/ doxorubicin, rubomycin hydrochloride /
* Some antiarrhythmic drugs / disopyramids,
novocainamide, etatsizin, propafenone /
* Some non-steroidal anti-inflammatory
funds / ibuprofen, butadion, pyrabutol, indomethacin /
* Hormonal drugs / estrogens, androgens,
3. Incorrect prescription of drugs with positive
inotropic effect / cardiac glycosides,
dobutamine / hypertrophic patients
cardiomyopathy and diastolic dysfunction
Another important factor contributing to the onset or exacerbation of heart failure, which, unfortunately, many doctors do not pay enough attention. This is an unreasonable or poorly controlled prescription of drugs that have a negative inotropic effect, which retains fluid in the body, etc. Due to the importance of this issue, table 3 lists the main drugs, the use of which can contribute to the appearance or exacerbation of heart failure.
It should also be remembered that conducting radiation therapy on the mediastinum / in a dose of more than 4000 rad / can also contribute to heart failure.
Despite the wide range of reasons that underlie the occurrence of heart failure, its development goes through several stages: the initial / when there is a primary myocardial damage or the heart begins to undergo increased hemodynamic stress /, the second stage / adaptation process, including hypertrophy, dilation and remodeling / and final / when changes become irreversible /. As a result of these changes, systolic and / or diastolic dysfunction of the left ventricle is formed with the appearance of clinical signs of heart failure.
In chronic hemodynamic overload of the heart, volume overload and resistance overload may occur. Volume overload, in which isotonic hyperfunction is noted, is observed mainly with regurgitation heart defects. Pressure overload / isometric hyperfunction / is observed with stenotic heart diseases, arterial hypertension, hypertrophic obstructive cardiomyopathy, primary pulmonary hypertension.
With pressure overload (for example, with stenosis of the aortic orifice), the heart is forced to work against increased resistance, spending additional energy. At the same time, intramyocardial tension increases and myocardial hypertrophy occurs early. While the compensatory mechanisms are not exhausted, a hypertrophied myocardium copes with increased resistance. With decompensation, the cavities of the heart expand and the cardiac output decreases.
With volume overload (for example, with aortic insufficiency), on the contrary, cardiac output / due to overstretching of the ventricles into diastole / increases, early dilatation of the ventricle occurs, and then delayed hypertrophy, increased diastolic pressure in the left ventricle and secondary overload by left atrial pressure.
With a predominance of dilatation of the heart, hemodynamic disturbances are caused, first of all, by a violation of systolic contractile function of the myocardium. With cardiac hypertrophy, the initial link in the pathogenetic chain of heart failure is a violation of the diastolic relaxation of the myocardium, that is, diastolic ventricular dysfunction, the so-called “incomplete diastole syndrome”.
Accordingly, overseas recently, due to the fundamental approaches to treatment, all heart failure is divided into 2 types: systolic and diastolic.
In primary myocardial damage, which can be localized (for example, postinfarction cardiosclerosis) and generalized / for dilated cardiomyopathies /, asinergy is important – discoordination of muscle contractions / for example, akinesia or hypokinesia of the site of postinfarction cardiosclerosis and hyperkinesia of intact.
In recent years, great importance in the formation of HF has been attached to the mechanism of remodeling of the left ventricle, that is, to a change in the shape and thickness of its walls. This mechanism is well demonstrated by the example of myocardial infarction. After the occurrence of a large MI, in several days, the fascinated zone becomes thinner and stretches, up to the development of an aneurysm, as a result of which the left ventricle in the IM zone acquires an elliptical configuration.
However, at the same time, hyperfunction and the development of hypertrophy of the intact areas of the myocardium are noted, as a result of which its diastolic dysfunction occurs. These processes support the abnormal geometry of the left ventricle, leading to a violation of its contractility. Over time / weeks, months / undamaged areas of the myocardium also become thinner, as a result of which the left ventricle takes the form of a ball.
As soon as due to one reason or another (most often – IM), cardiac output and minute volume of blood are reduced, compensatory mechanisms aimed at increasing it immediately turn on in the body. For the time being, they delay the development of chronic heart failure, sometimes for many years. The most important compensation mechanisms are presented in table 4.
1. Myocardial hypertrophy / leads to a decrease in the load per unit mass of the heart muscle /;
2. The Frank-Starling mechanism / amplification of systole during diastolic overload /;
3. Reflex Bainbridge with vena cava and atria.
4. An increase in the function of the sympathetic nervous system in response to a decrease in perfusion of organs and tissues / facilitates the functioning of the cardiovascular system due to the acceleration of metabolic processes, tachycardia, mobilization of blood from the depot /;
5. Activation of the renin-angiotensin-aldosterone system / in response to a decrease in renal blood flow /
Why does heart failure occur?
The causes of heart failure are different. Very often, acute HF develops in people who have suffered a heart attack, myocarditis, severe arrhythmias. Against this background, the amount of blood that enters the arterial system decreases sharply. At its core, acute heart failure is very similar to vascular, because experts often call it cardiac collapse.
Chronic heart failure is characterized by pathological changes that develop in the heart for a long time, but are compensated by its more intense work:
- increased cardiac contraction power;
- accelerated rhythm;
- reduced pressure on diastole.
Chronic heart failure develops against a background of various factors, such as:
- damage to the heart muscle;
- heart rhythm disturbances;
- damage to heart valves;
- pericardial disease.
Other factors that can provoke heart failure:
- thyroid disease, which lead to a decrease in its functions;
- diseases of the endocrine glands;
- infiltrative ailments characterized by the appearance of new structures in the organs;
- improper diet;
- adrenal disease;
- general exhaustion of the body;
- dry, effusion, or mucous pericarditis;
- heart block;
- congenital and acquired heart defects;
- atrial fibrillation;
- terminal renal failure.
All kinds of problems associated with the cardiovascular system lead to acute heart failure in acute form, including cardiomyopathy, myocardial infarction, coronary arteriosclerosis, heart defects, cardiac tamponades. Among the common reasons for which the development of insufficiency of the right parts of the heart can be attributed, such as:
- primary pulmonary hypertension;
- interstitial lung lesions;
- chronic obstructive ailments.
The factors due to which acute cardiovascular failure develops in patients with compensated HF are as follows:
- kidney failure;
- pulmonary embolism;
- alcohol abuse;
- acute coronary syndrome;
- fever infection;
- excessive intake of fluid and salt;
- problems with myocardial contractility;
No one is safe from sudden death due to cardiac arrest. In approximately 25% of cases, this happens without apparent prerequisites; the patient does not feel anything. In all other cases, the so-called prodromal symptoms or precursors appear, the appearance of which coincides in time with the latent stage of the development of AHF.
What are the symptoms before death in acute cardiovascular failure? In half the cases before death, there is an attack of acute pain in the heart, tachycardia.
Ventricular fibrillation develops, fainting, severe weakness. Then comes the loss of consciousness.
Immediately before death, tonic muscle contractions begin, breathing becomes frequent and heavy, gradually slows down, becomes convulsive and stops 3 minutes after the onset of ventricular fibrillation.
The skin turns pale sharply, it becomes cold to the touch, acquires a grayish tint. The patient’s pupils dilate, the pulse on the carotid arteries ceases to be felt.
Symptoms of Acute Heart Failure
This pathology can occur in two types, hence the following signs of the disease:
- Left ventricular OCH. It is characterized by sudden attacks of suffocation, shortness of breath. Often this condition occurs in a patient during sleep. He wakes up due to lack of air, feels a great fear associated with the fact that he may die. Such a person would rather like to sit down or stand up, because a cough begins to torment him, sometimes even with blood impurities. His skin is covered with cold sweat, and his lips, palms and legs turn blue. If foam begins to stand out from the patient’s mouth, then you need to sound the alarm as soon as possible and call an ambulance.
- Right ventricular OCH. With this nature of the disease, the patient feels heaviness and pain in the sternum on the right. He has a visible pulsation of veins on his neck, there is tachycardia. The skin takes on a grayish tint. His feet and ankles swell, and if a person is in a horizontal position, then puffiness passes even to the back and sides.
To understand that there is heart failure, preferably in a timely manner. This will help in time to help the patient and maybe even save his life. The main signs of heart failure are:
- pulse and heart rhythm disturbances;
- swelling of the legs;
- swelling of veins under the skin;
- sleep disturbance;
- a sharp increase in body weight;
- enlarged liver.
Symptoms of acute heart failure are associated with impaired functions of the left or right ventricles.
The development of left ventricular failure is observed with pathologies that increase the load on the left heart. This is possible if a person suffers from hypertension, aortic defect, suffered myocardial infarction.
If the left ventricle cannot perform its functions, then there is an increase in pressure in large and small vessels of the lungs, their permeability increases, due to which the liquid part of the blood flows through their walls. Interstitial, and gradually alveolar edema develops.
The clinical picture of this condition is represented by cardiac asthma and alveolar pulmonary edema. An attack occurs if a person is subjected to physical or emotional stress. Patients usually suffer from sudden asphyxiation at night, which causes them to wake up.
Cardiac asthma is characterized by the appearance of a feeling of lack of air, palpitations, cough with sputum, severe weakness, cold sweat. An attack forces a person to crouch and lower their legs.
With the development of stagnation in the pulmonary circulation, pulmonary edema progresses. During a sharp asphyxiation, the patient begins to cough and foamy pink sputum is released, this is due to the appearance of blood impurities in it.
The patient breathes like a boiling samovar, is in a sitting position with his legs down, his face turns blue, the neck veins swell, the skin is covered with cold sweat.
In the presence of pulmonary edema, it is necessary to urgently deliver the patient to the intensive care unit and provide medical care, since the likelihood of a fatal outcome is very high.
Left atrial insufficiency is found in mitral stenosis. Clinical manifestations are similar to left ventricular pathology.
The development of right ventricular failure occurs in connection with a thrombus blockage of large branches of the pulmonary artery.
Stagnation develops in a large circle of blood circulation, due to which the lower extremities swell, it hurts on the right under the ribs, the veins in the neck are bursting and pulsating, shortness of breath occurs, the surface of the skin turns blue, pressing pains appear in the heart area.
There is also a weakening of the peripheral pulse, a sharp decrease in blood pressure.
If the right ventricular pathology develops in the stage of decompensation, then the signs appear earlier than in acute left ventricular failure. This is due to the fact that the latter has a large set of compensatory capabilities, as it is the most powerful part of the heart.
To avoid acute heart failure, you must:
- visit a doctor at least twice a year, especially if there are chronic diseases of the cardiovascular system;
- quit smoking and alcohol abuse;
- avoid psycho-emotional stress;
- maintain optimal body weight;
- provide yourself with regular physical activity;
- monitor blood pressure indicators;
- eat rationally and balanced, consume foods that contain more fiber, refuse fried foods, hot and spicy;
- monitor cholesterol.
Compliance with these recommendations will reduce the likelihood of developing acute heart failure.
Prevention of heart failure is especially important for people at risk. Persons suffering from cardiac diseases need to undergo preventive examinations by a cardiologist twice a year and follow the doctor’s instructions.
Many patients are prescribed lifelong maintenance therapy.
It is very important to lead a feasible active lifestyle, physical activity should cause a feeling of pleasant fatigue.
If possible, eliminate emotional overstrain.
It is necessary to completely review the diet, abandon fried, too spicy, fatty and salty, alcohol and tobacco in any form. More detailed recommendations regarding the diet can only be given by the attending physician, based on the characteristics of the diseases and the general condition of the patient.
So that acute cardiovascular failure does not develop and does not spoil life, people prone to the problem:
- It is advisable to abandon bad habits, exercise regularly and eat properly.
- Do not overload your heart with strong tea or coffee.
- From alcohol it is best to give preference to red wine in small quantities.
- In addition, it is important to protect yourself from stress and emotional stress and regularly take vitamins.
Prevention of heart failure is very important for people who already have or have any kind of heart disease. Such people need to visit a cardiologist regularly (at least 2 times a year) and undergo treatment prescribed by them. It is very important for such people to adhere to the following recommendations:
- if possible, eliminate any negative emotions;
- lead an active lifestyle, perform cardio workouts under the supervision of a trainer, give up smoking and alcohol;
- follow a diet: do not eat fried, salty, spicy;
- maintain normal weight;
- monitor blood pressure, control it.
Acute heart failure is a very serious disease, with untimely treatment of which a fatal outcome is possible. That is why it is important to identify the pathology of the heart in time and cure it so that the disease does not flow into a chronic form, does not cause cardiogenic shock, pulmonary edema, cardiac asthma.
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