Acute heart failure

Acute heart failure - a syndrome acutely developing state, characterized by the rapid appearance of clinical signs, as a consequence of a reduced contractility of the heart that results in hemodynamic disturbances and changes in the pulmonary circulation. Acute heart failure is cardiac dysfunction in the form of a reduction in cardiac output, increased pressure in the ICC( small circulation), tissue hypoperfusion and peripheral stagnation.

This disease is expressed by a fit, which is characterized by sudden shortness of breath with a transition to suffocation, that is, cardiac asthma. If there is no timely arrest of the attack, acute heart failure develops into a more severe condition, such as pulmonary edema. In addition, this syndrome has also a second name - acute left ventricular failure( OLVH) and is explained by the fact that in this condition the contractility of the LV is sharply reduced.

As a rule, this syndrome refers to a pathology that develops as a result of decompensation of chronic heart failure( CHF), but can develop without previous heart diseases.

Acute heart failure is considered to be one of the most frequent life threatening conditions that require urgent medical intervention.

Acute heart failure reasons

In this form of disease is sharply reduced contractility of the myocardium, which is the consequence of the cardiac muscle overload, reducing its operating weight and the ability to perform myocyte contractile function, or as a result of reduced pliability heart walls.

Thus, the causes of the development of acute heart failure are various violations of the heart muscle systolic or diastolic properties against the background of a heart attack;Inflammatory and dystrophic pathological processes in the myocardium;Tachyarrhythmic and bradyarrhythmic anomalies.

Also, acute heart failure is formed as a result of sudden occurrence of cardiac muscle overload after increased resistance to blood flow pathways, for example, in hypertension, aortic malformations, myocardial infarction. Furthermore, this condition occurs when the characteristic cardiosclerosis postinfarction nature, extensive severe conditions result in myocarditis septum between the ventricles rupture insufficient function triskupidalnogo or mitral valves.

Acute heart failure can occur with increased physical or psychoemotional load, increased blood flow, when the patient lies on the background of decompensated myocardium with a diagnosis of chronic congestive heart failure. By

noncardiac causes contributing to the formation of the anomalies include various types of infections, acute forms of disorders in the brain, extensive surgery plan, renal failure, pheochromocytoma, and drug overdose of alcohol abuse.

Acute heart failure

symptoms The main clinical signs of congestive heart failure are shortness of breath in the form of shortness of breath, increased heart rate, dilated heart borders as a result of hypertrophy of the heart muscle and increase in heart cavities, hepatomegaly, especially the left side, swelling, localized at the periphery and increasing CVP(Central venous pressure).Based on the echocardiographic data, a reduced ejection fraction is detected, and a radiographic fraction is a phenomenon of stagnant processes in the lungs.

For acute heart failure is characteristic of the left ventricular form and right ventricular.

Its symptoms are characterized by a typical attack of cardiac asthma in the interstitial stage of the disease and pulmonary edema in the alveolar stage of the OLZHN.As a rule, the formation of cardiac asthma occurs at night, when the patient is asleep. At this moment, he experiences an acute lack of air, a fear of death and wakes up. In addition, there is a kind of cough nesasnogo nature. Signs of severe shortness of breath, which makes breathing difficult, force the patient to take a vertical position or stand at an open window to inhale a breath of fresh air. At the same time, the patient has anxiety and suffering in his eyes. At the very beginning of the attack, the skin becomes pale, turning into a shade of blue, and then the patient begins to sweat profusely. In addition, you can observe the swelling of the veins in the neck, breathing becomes faster. The appearance of a dry cough is accompanied by separation of phlegm, and sometimes even with an admixture of blood. With progressive processes in the MCC, sputum is separated in the form of a liquid foam with blood or a liquid that has a pink hue. And this is already a characteristic sign with developing pulmonary edema.

At the time of examination of the respiratory system, shortness of breath is noted at a breath rate of forty or sixty per minute. At the peak of the attack, with a weakening of vesicular breathing in the lungs of the lower section, wheezing with a moist, finely bubbly characteristic is heard. In some cases, cardiac asthma can flow without wheezing of a moist property. In another category of patients, dry wheezing of the whistling etiology is heard. This is mainly observed in bronchial asthma with its attacks and is explained by the fact that in the bronchi at this moment a spasm develops, which is provoked by circulatory disturbances in the vessels of the lungs.

The most characteristic changes in acute heart failure are the circulatory system. There are symptoms of frequent arrhythmia of the pulse with deaf heart tones. At the very beginning of an attack, blood pressure may increase slightly, and later it decreases. But sometimes the pressure is immediately fixed on the lower indicators. When an attack with signs of severe shortness of breath in the form of dyspnea, as well as coughing with sputum and a significant number of pulmonary rales, in auscultation, it is difficult to listen to deaf cardiac tones. In this case, more accurate indicators of heart function can be obtained with the help of pulse and blood pressure.

Choking attacks with their severity of leak and prognosis have a huge variety. At one time, acute heart failure can begin suddenly, and in others - first dyspnea intensifies, then a heartbeat develops and subsequently the general state of health worsens.

Sometimes attacks of acute heart failure are characterized by a duration of several minutes and can end without medical intervention. But, as a rule, they are delayed for a longer time. At such times, untimely medical assistance may cause death as a result of pulmonary edema, collapse, or severe respiratory depression.

Acute heart failure in children

This disease is a multifactorial pathology, characterized by a heart failure of a primary nature with a variety of hemodynamic anomalies, hormonal and neural adaptations associated with the direction of maintaining blood circulation, which corresponds to the needs of the body. For children with acute heart failure is characterized by extremely serious prognosis of the disease with a possible fatal outcome, with untimely rendering of qualified medical care.

In children, acute heart failure is classified into left ventricular( OLVH), right ventricular( OPHN), arrhythmogenic and total. In addition, it is systolic, diastolic and combined.

Systolic acute heart failure is characterized by the development of damage to the heart muscle or its overload, which is caused by increased pressure, for example, with aortic stenosis, or an increase in heart volume with a defect of the septum between the ventricles. This syndrome of diastolic form is characterized by a violation of relaxation processes in the diastole, for example, with obstructive cardiomyopathy;A decrease in the size of the heart cavities, or a shortening in significant amounts of diastole in the tachysystolic form of dysrhythmia.

Among the reasons that contribute to the development of such a disease in children, as acute heart failure, different changes in the lungs and bronchi of an acute nature( pneumothorax, acute lung injury, pneumonia, atelectasis), for which the characteristic mechanism of pathology development is pulmonary hypertension and hypoxia as a consequenceBypass. In addition, endogenous and exogenous toxicoses, burn disease, sepsis also underlie the formation of this childhood pathology. These are the conditions of the body, in which the transportation of glucose and oxygen can not cover the increasing needs of tissues and organs.

In children, acute heart failure has three degrees of disease progression. For the first degree of the pathological syndrome, tachycardia and dyspnea are characteristic, which is clearly manifested in the child in a calm state. An important clinical indicator is the changed ratio between heart rate and respiration. In this case, the ratio in children before the first year of life pulse to breathing will be higher than three, and in children after the year - almost five. In addition, the heart sounds of deaf etiology are noted, the border of the stupidity of the heart is expanding.

In the second degree of acute heart failure, an important indicator of the disease in children is compensatory hypervolemia, which can occur in two states. In the first case, the child is dominated by decompensation of one circulatory system or there is a total insufficiency of this circulation. In acute heart failure of the second degree( A) against the background of the predominance of stagnant phenomena in the CCB, the patient's liver grows in the size of the liver, and edemas of the periorbital properties appear. But the signs of an increase in central venous pressure, caused by decompensation, develop rapidly during a few minutes or hours.

In case of a gradual increase in the disease within two days, CVP can be normal with a progressive increase in the liver. In this case, it performs a buffer role. Also muffled heart tones with possible expansion of borders are listened. With blood stasis in the ICC, in addition to tachycardia, cyanosis processes increase, which decrease after the application of oxygen therapy. The child can hear rattles of diffuse, small-bubble character, it is also possible to determine the second tone on the pulmonary artery. In acute heart failure of the second degree( B), edemas of a peripheral nature, oliguria with possible pulmonary edema, are added to all the previous symptoms.

The third degree in children is characterized by a hyposystolic form, at which hypotension develops against a background of clinical overload of the ICC.Acute circulatory insufficiency is characteristic of hemodynamic shock syndrome, as a result of falling arterial and venous pressure.

The practice of IT( intensive care) in children gives rise to acute heart failure, which is characterized by various heart defects, poisoning with toxic substances, and can also develop as a consequence of energy deficiency and hypoxia. It is also associated with the deepest changes in the heart, which is manifested by systolic movement in the form of "twisting" and diastolic movement - in the form of "unwinding".Thus, systole and diastole dysfunction is manifested in a decrease in cardiac output with normal or reduced LV function.

In children, this pathology develops in two stages. At the first stage, the diastole shrinks in time without a decompensated drop in the outflow in the heart, although symptoms of stagnation processes in the CCB are already present. At the second stage, the diastole decreases decompensively and this causes hypysystole accompanied by hypotension, pulmonary edema and coma.

Acute heart failure urgent care

The main measures to provide emergency care for a patient with acute heart failure include: pre-medical care and medical care, prior to hospitalization of the victim.

In the first case of the disease with an attack of cardiac asthma, first, it is necessary to reduce the increased excitability of the respiratory center;Secondly, to reduce the stagnation of blood in the ICC;third, to increase the contractile function of the heart muscle of the LV.To do this, the patient is resting and giving him a position with his legs down or half-sitting in bed, if there is no collateral state. Then, plaits are applied to the area of ​​the lower extremities so as to avoid disturbance of the arterial blood flow. With BP, systoles of 90 mm Hg. Art.give the patient nitroglycerin under the tongue every three minutes, up to four tablets, with good tolerability of the drug. Also, if possible, you can lower your legs into a basin with hot water and ensure the arrival of fresh air, freeing the patient from the crushing clothes.

Pre-hospital or emergency care in an ambulance is to perform neuroleptanalgesia. To reduce the hyperexcitability of breathing, Omnupon, Morphine or Promedol are injected subcutaneously with Atropine to reduce the drug's vagotrophic action. Then carry out oxygen therapy with a nasal catheter. If intense foaming is present, use oxygen, which is moistened with alcohol or defoamers. Inhalation of alcohol vapors is necessary for thirty or forty minutes, and then for about fifteen minutes they breathe in oxygen and again repeat the inhalation of the oxygen-alcohol mixture.

The last step is the introduction of diuretics in the form of 1% of Laxix to eight milliliters with intravenous jet injection.
When blood pressure is normal or elevated intravenously, drip Nitroglycerin in fiz.r-re at 25 drops per minute, to reduce the initial blood pressure by twenty percent. If the pressure does not stabilize, then prescribe antihypertensives such as Nitroprusside Na intravenously drip before blood pressure decrease 90/60 mm Hg. Art., But not below. As a rule, this drug is injected briefly, protecting from light, so that it does not form cyanides.

Under reduced pressure, Dopamine, Mezaton, Cordiamine are administered. If the blood pressure does not reach 80 mm Hg, then inject Noradrenaline. After the BP is resolved, and the stagnant processes are somewhat more pronounced, parallel intravenous injection of nitroglycerin is added.

With signs of bradycardia and bronchospasm, Euphyllinum is administered. But it must be remembered that in the presence of an acute form of insufficient coronary circulation and instability of the heart muscle, this drug is undesirable to apply. However, if its introduction is extremely necessary, then it must be introduced with great care.

It is also important to know that nitroglycerin and other vasodilators are almost contraindicated in the diagnosis of aortic stenosis, hypertrophic cardiomyopathy and exudative pericarditis.

Acute heart failure treatment

In any form of acute heart failure with arrhythmia, attempts are made to restore normal rhythm.

For the treatment of stagnant OLCL use the correction of conditions, which were the reasons for its development. Self-management does not require this condition. In this case sublingually Nitroglycerin is prescribed up to one milligram and the elevated position of the patient. With a characteristic stagnation of blood, the upper part of the trunk is raised, while in the formation of pulmonary edema it is a sitting position, but the legs must always be lowered. However, these actions are unacceptable with high blood pressure.

One of the effective pharmacological agents for acute heart failure is Furosemide, which after intravenous administration causes in fifteen minutes unloading hemodynamics of the myocardium, which is further strengthened due to the developing effect of the drug. In severe forms of pulmonary edema, Furosemide is administered up to 200 mg.

When pronounced processes of tachypnea and psychomotor agitation in acute heart failure prescribe narcotic analgesics. For example, Morphine regulates venous vasodilation, reduces the load on the heart muscle, reduces the work of the muscles of the respiratory system and suppresses the respiratory center. Thus, the load on the heart decreases, psychomotor agitation and sympathoadrenal activity decrease. Contraindications for such treatment is cerebral edema, poisoning with drugs that depress respiration, pulmonary heart.

For the treatment of severe congestion in the ICC, if there is no arterial hypertension, an intravenous drip of Isosorbide dinitrate or Nitroglycerin is prescribed with mandatory control of heart rate and blood pressure.

In patients with cardiovascular shock or reduced blood pressure after an ineffectiveness of the previous treatment, administration of non-glycosidic inotropic agents is prescribed. In this case, intravenous drip Dobutamine, Dopamine, Noradrenaline, and possibly in combination are used.

In the fight against the formation of foam in the swelling of the lungs, defoamers are used that destroy this foam. In this case, alcohol vapors are used, through which oxygen is passed and then given to a patient with acute heart failure, using masks or a catheter through the nose.

In cases where the symptoms of pulmonary edema with stable hemodynamics persist, glucocorticoids are administered to reduce permeability. To correct the violations of microcirculation, as well as with prolonged edema, inject Heparin intravenously, and then it is digested at a rate of up to 900 IU / h.

In the absence of symptoms of congestion in acute heart failure, the patient must be in a horizontal position. Be sure to provide him with analgesia. In cases of bradycardia, intravenously injected Atropine.

Against the background of the unfolded picture of shock, treatment of acute heart failure begins with the use of plasma substitutes under the control of respiratory rate, heart rate, blood pressure and mandatory auscultation of the lungs. Patients with a cardiogenic shock should be hospitalized, if possible in the department of cardiac surgery.