The heart muscle, as you know, performs the function of a kind of pump in our body. If for some reason this device does not cope with its direct work, there is a heart failure. Each year, this pathology only grows younger, and in recent years it has been increasingly leading to death.
Acute heart failure. What it is?
Acute heart failure is a sudden decrease in the contractile function of the heart, causing its overload and impaired pulmonary circulation. The disease can appear both against the background of existing pathologies of the heart, and without previous cardiac ailments. Most often it is diagnosed with myocardial infarction, when cell death occurs due to a sharp deterioration in blood circulation in this area.
Depending on the overload of the departments of the main muscle of the human body, two main courses of the disease are distinguished: right ventricular and left ventricular failure. We will talk about the latter in more detail in this article.
Pathogenesis of the disease
One of the main pathogenetic aspects of the development of left ventricular failure is the increase in hydrostatic pressure in the capillary and venous sections of the pulmonary circulation. In the pulmonary interstitium, fluid is gradually accumulated in excess, which leads to a decrease in the elasticity of organs. The lungs become more “rigid”, restrictive disorders occur. Then the edematous fluid enters the alveoli, as a result of which they cease to participate in gas exchange.
Its further spread along the pulmonary serous and bronchial trunks. Infiltration of perivascular and peribronchial spaces with serous fluid is observed, which is reflected in their immediate resistance, worsening metabolic conditions.
In the left atrium, blood from unventilated alveoli is mixed with oxygenated substance. This leads to a decrease in the total arterial partial tension of oxygen, the development of hypoxemia. In the initial stage, the latter is circulatory in nature.
Left ventricular failure is usually caused by severe overload or lesions of the corresponding parts of the heart. Such a disease entails a deterioration in blood circulation. It requires not only timely diagnosis, but also competent treatment. With a combination of pathology with right-sided heart failure, the probability of death of the patient increases.
The main causes of the disease
- Cardiomyopathy
- Ischemic heart disease.
- Myocardial infarction.
- Cardiogenic pulmonary edema.
- Symptomatic arterial hypertension.
- Mitral stenosis.
- Extensive surgery.
- Brain injury.
- Diseases of an infectious nature.
- Toxic effects on the myocardium (medication, alcohol).
Acute left ventricular failure and myocardial infarction
This disease very often develops against a background of myocardial infarction. Usually it is caused by a violation of diastolic function and can occur with a normal ejection fraction. An important role in the development of heart failure in this case is given to mitral regurgitation. It is due to ischemia of the papillary muscle or the loss of a significant mass of the myocardium.
The disease in the first hours in patients with myocardial infarction is characterized by a sharp decrease in the volume of circulating blood, a change in cardiac output and a minimum sodium retention in the body.
Clinical picture
As you know, almost all diseases of a cardiological nature have common symptoms, that is, they are expressed by pain in the region of the heart. It can give to the elbow, neck or shoulder blade. This phenomenon is usually observed with a disease such as left ventricular failure. Symptoms are supplemented by fever, shortness of breath, sudden jumps in pressure and a violation of the temperature regime.
The nature and intensity of the signs of pathology directly depends on which part of the heart muscle is damaged. For the left ventricular form, in addition to the main symptoms, the appearance of fainting, attacks of arrhythmia, dizziness, swelling of the limbs, and an increase in cervical veins are characteristic.
Gradually, all signs of left ventricular failure intensify, now manifesting not only in the activity stage, but also at rest. If you do not respond to this problem in a timely manner, death is not ruled out.
Forms of the disease
Pathology can occur in several types.
- With a stagnant type of hemodynamics. It manifests itself in the form of cardiac asthma (asthma attacks) and pulmonary edema.
- With a hypokinetic type of hemodynamics:
- Arrhythmic shock. It develops as a response to a violation of heart rate.
- Reflex shock. Appears as a reaction to pain.
- True cardiogenic shock. It occurs with significant volumes of damage (over 50% of the mass of the left ventricular myocardium).
- A sharp deterioration in already diagnosed heart failure (muscle does not provide the needs of organ systems for adequate blood supply).
Diagnostics
Many pathologies of a cardiological nature are characterized by rapid progression, and acute left ventricular failure in this regard is no exception. If a doctor suspects this diagnosis, the first thing to do is to examine the patient. However, physical research is not enough to evaluate the full clinical picture. Therefore, the patient is prescribed a number of diagnostic procedures, including ECG, ultrasound of the heart, X-ray of the sternum, radioisotope ventriculography and PET.
Based on the results, the doctor can confirm the diagnosis and prescribe competent treatment.
Acute left ventricular failure: emergency care
During an attack, it is very important for the patient to provide qualified assistance in time before the arrival of the team of doctors. First of all, it should be put on a bed (it is strictly forbidden to lie down), to ensure the flow of air, begin oxygen therapy.
The patient must be given "Nitroglycerin" under the tongue, injected subcutaneously with 1% Morphine. With the development of severe pulmonary edema due to lowering blood pressure, Prednisoloneum is administered intravenously (3-5 ml).
In the absence of the necessary medications, the patient should apply tourniquets on the hips and shoulders to sharply limit the volume of circulating blood. Also, a special mixture can be administered intravenously. For this, 3 ml of 96% ethanol should be filled into a 10 ml syringe, and then add water for injection. It is important that the entire volume is full. This solution has an antifoam effect. The patient should call a cardiological medical team. After elimination of pulmonary edema, all patients diagnosed with acute left ventricular heart failure are subject to hospitalization. Transportation is usually done on a stretcher in a sitting position.
The basic principles of treatment
Such a pathology threatens the life of the patient and always requires emergency treatment.
- If the cause of the disease is a change in heart rate, to stabilize the hemodynamics and the patient's condition, it is necessary to restore heart rate.
- If the cause is a previous myocardial infarction, to fight the disease, it is necessary to normalize the coronary blood flow as soon as possible. In conditions of prehospital care, this is possible through systemic thrombolysis, that is, intravenous administration of special drugs to dissolve blood clots.
- If left ventricular failure is the result of previously developed intracardiac hemodynamics due to myocardial ruptures or injuries, immediate hospitalization is indicated.
Drug therapy
Treatment of the disease, in general, implies an integrated approach (complete rest, lack of serious physical exertion, adherence to a therapeutic diet). However, these are more preventive measures, which sometimes can not even stop the pain syndrome accompanying the disease, acute left ventricular failure. Drug treatment just in this case comes to the rescue.
The following are the main objectives of drug therapy:
- Normalization of myocardial contractility.
- Elimination of symptoms of sinus tachycardia.
- Prevention of blood clots and blockage of blood vessels.
- Normalization of the process of removing fluid from the body.
- Extension of remission.
First of all, oxygen therapy is prescribed to all patients without exception. To combat excess fluid in the body, diuretics (Furosemide, Uregit) and a sharp restriction of the drinking regimen are recommended . To reduce vascular resistance and at the same time improve blood circulation, vasodilator drugs and antiplatelet agents (Tiklid, Plaviks) are prescribed. To enhance myocardial contractility, cardiac glycosides and cardiotonics are prescribed.
The doctor prescribes all medications individually for each patient. Therefore, it is important to understand that superficial self-treatment can only exacerbate the clinical picture and not bring the desired result.
When is surgery necessary?
If drug therapy does not alleviate the patient’s condition, left ventricular heart failure only worsens in its manifestations, surgical intervention is recommended. Currently, two types of operations are used in medical practice: cardiomyoplasty and implantation of a special device to improve blood circulation. Both options are life-threatening, therefore, they resort to their help only in extreme cases. Moreover, the postoperative effect is noticeable only after 3-4 months after a long recovery period. Before you go on such an operation, it is worth consulting a doctor and compare all its advantages and possible disadvantages.
Complications
If the patient is diagnosed with "left ventricular failure", he neglects his own health and postpones treatment, the likelihood of an early death is high.
Preventative measures
In the presence of diseases of the cardiovascular system of a chronic nature, regular monitoring by a cardiologist and strict adherence to all his prescriptions are indicated. It is extremely important to minimize the influence of negative factors on the work of the whole organism. These include addictions (smoking, drinking alcohol and drugs), psycho-emotional overload and frequent stress, as well as being overweight.
As a prophylaxis of a disease such as acute left ventricular failure, the causes of which are often hidden in physical inactivity, dosed physical activity is recommended. It can be swimming, walking in the fresh air, skiing, gymnastics or yoga. Blood pressure should be constantly monitored. Particular attention must be paid to nutrition. The diet should be as balanced as possible, with a high fiber content. It is better to refuse fatty and fried foods, as well as overly spicy foods.
Such simple preventive measures can not only prevent the development of a pathology so dangerous to health, but also improve the quality of life in general.
Conclusion
In this article, we talked about what constitutes a disease called left ventricular failure. The reasons for the development of this pathology can be very different, starting with myocardial infarction and ending with the toxic effect of drugs on the body. Timely diagnosis and proper treatment can minimize the risk of complications, the most dangerous of which is death. Be healthy!