Every year, diseases of the cardiovascular system lead to the death of more than 17 million people around the world. Only in 10% of cases, such pathologies are congenital. The vast majority of painful conditions occur against the background of stress and the wrong lifestyle of a modern person. In the article, we will understand what acute heart failure is.
Symptoms before death and complications caused by pathology, methods for diagnosing and treating the disease, types and forms of the disease - information on all these issues will be reflected in the materials of our review. In addition, the article mentions rules of conduct that may be useful to any of us. The ability to act correctly in a critical situation provides, in most cases, the preservation of life to a person. In accordance with this, everyone should know what is the first aid for acute heart failure.
Concept of heart failure
Heart failure (HF) is a pathology in which the heart stops supplying the body with the necessary amount of blood. It is a consequence of the impaired ability of the heart muscle (myocardium) to contract. HF usually leads to severe clinical manifestations, including pulmonary edema, heart attack, cardiogenic shock.
The disease affects both men and women, but the latter suffer from this disease more often. Mortality from pathology is quite high. Danger to human life is any of the manifestations caused by a disease such as acute heart failure. Symptoms before death, called sudden in medicine, are very diverse. They depend on what form of the disease is taking place. By the nature of the origin of heart failure, there are:
- Myocardial heart failure is a pathology that is a result of direct damage to the heart muscle due to a violation of energy metabolism. This type of heart failure leads to impaired function of contraction and relaxation of the heart.
- Congestive heart failure is a pathology that develops as a result of a large load on the heart. This type in some cases develops against a background of heart defects.
- Combined heart failure is a form of pathology that combines the causes of the two above.
Heart failure classes
Today, there are various criteria by which a disease is divided into types or forms. Medicine knows several classification systems (Russian, European, American), however, the system proposed by cardiologists in the USA is considered the most popular. In accordance with this technique, four classes of the disease are distinguished:
- Grade 1, in which the patient has shortness of breath with active movement, for example, climbing stairs to a level above the third floor.
- Grade 2, in which shortness of breath appears even with a slight load - when climbing to the first or second floor. In this case, a decrease in physical activity of a person is noted.
- Grade 3, in which heart failure is noticeable with minor exertion, for example, when walking, but at rest, the symptoms of the pathology disappear.
- Grade 4, in which the symptoms of the disease appear even at rest, and insignificant physical activity leads to serious disorders in the functioning of the heart and the entire vascular system as a whole.
Classification of CH
Pathology can be classified according to several criteria. Acute and chronic heart failure is known to medicine depending on the clinical picture of the course of the disease.
Acute heart failure (AHF) is a disorder in which symptoms of a pathology manifest quickly (within a few hours). As a rule, against the background of other diseases of the vascular system, acute heart failure occurs.
Myocardial infarction, myocarditis and other diseases can become the trigger mechanism of painful conditions, because with these pathologies, the cells of the heart muscle die due to local circulatory disorders. AHF can also result from rupture of the walls of the left ventricle, acute valve failure (aortic and mitral). In some cases, the pathology develops without previous violations.
OCH is a rather insidious disease, because it can cause painful conditions of other body systems. Complications of acute heart failure often affect not only the heart, but also the respiratory system, causing pulmonary edema, cardiac asthma, and cardiogenic shock.
Chronic heart failure is a disorder in which a pathology forms gradually, over the course of weeks, months, or even years. It occurs against a background of heart disease, hypertension or prolonged anemia.
Types of DOS by type of hemodynamics
Depending on the type of hemodynamics characteristic of the location of the pathology, the following forms of acute heart failure exist:
- DOS with congestive hemodynamics.
- AHF with hypokinetic type of hemodynamics.
Hemodynamics is the flow of blood through the vessels, which is due to excellent pressure in various areas of the circulatory system. It is known that blood moves from a site with a higher pressure to an area with a lower pressure.
Pressure directly depends on the viscosity of the blood, as well as on the resistance of the walls of blood vessels to blood flow. AHF with congestive hemodynamics can affect the right or left ventricle of the heart. In accordance with this distinguish:
- Acute right ventricular failure, in which venous congestion is observed in a large circle of blood flow, i.e. affects almost all organs and tissues.
- Acute left ventricular failure, in which venous congestion occurs in a small circle of blood movement. Pathology causes a violation of gas exchange in the lungs and leads to the development of pulmonary edema or cardiac asthma. Thus, against the background of such disorders, acute pulmonary heart failure occurs.
AHF with hypokinetic type of hemodynamics
An acute course of heart failure with a hypokinetic type of hemodynamics is a pathology caused by cardiogenic shock - a sharp decrease in the ability of the myocardium to contract, which leads to a violation of the blood supply to all body tissues.
Distinguish:
- Arrhythmic shock, which is the result of a disturbed heart rhythm.
- Reflex shock - a reaction to pain.
- True cardiogenic shock is a pathological condition that occurs when the tissue of the left ventricle is damaged, and the affected area is at least 50%. Violation, as a rule, is more susceptible to persons over 60 years of age; people who have had a second heart attack; patients with arterial hypertension and diabetes.
It is important to note that cardiogenic shock is characterized by pain, a sharp decrease in blood pressure to minimum values (up to 0), a filiform pulse, and pallor of the skin. Pathology may subsequently go into pulmonary edema or result in renal failure.
Factors contributing to the occurrence of DOS
The development of acute heart failure in a patient may be preceded by a previous vascular disease . These conditions include:
- heart disease caused by damage to the heart muscle, leading to a sharp decrease in the ability of the myocardium to contract;
- chronic heart failure, in which the normal supply of blood to organs and tissues is disturbed;
- damage to the integrity of heart valves and chambers;
- accumulation of fluid in the pericardial sac, which leads to a violation of the correct rhythm of heart contractions due to pressure exerted on the heart cavity (this pathology is called cardiac tamponade);
- thickening of the walls of the heart - myocardial hypertrophy;
- hypertensive crisis - a pronounced deviation of blood pressure from the norm.
Heartless reasons
In addition to heart problems, pathologies associated with high blood pressure in a small circle of blood flow may be involved in the occurrence of painful conditions. Diseases leading to the diagnosis of acute heart failure:
- stroke - a violation of the blood circulation of the brain, which provokes damage to its tissues and a general disorder of brain functions;
- thromboembolism of a pulmonary artery (this disease occurs due to clogging of the pulmonary artery, as well as its processes with blood clots (blood clots), most often blood clots occur in the large veins of the pelvis and lower extremities);
- lung diseases - inflammation of the bronchi (bronchitis), inflammation of the lung tissue (pneumonia);
- heart rhythm disturbance (acceleration or deceleration) - tachyarrhythmia, bradyarrhythmia;
- infections caused by various pathogens.
There are also factors that lead to the development of heart failure, but are not a manifestation of diseases of any body systems. These include:
- surgical intervention;
- brain injuries and injuries;
- toxic attacks on the heart muscle - alcohol, aggressive medication;
- heart-lung machine, the use of which leads to certain consequences;
- electrical injuries - the impact on the body of electric current;
- psycho-emotional or physical activity.
Diagnosis of acute heart failure
Diagnosis of heart failure is primarily aimed at establishing the causes that led to the development of pathology. Before conducting laboratory studies and manipulations using medical equipment, the doctor determines by talking with the patient the presence or absence of one or another factors in his life that contribute to the development of such a pathology as acute heart failure. Symptoms before death (sudden) occurring within 24 hours may be weak, and the specialist’s task is not to miss the time, but taking into account all the patient’s complaints, establish the correct diagnosis as soon as possible.
The main research methods used in the diagnosis of AHF include:
- electrocardiogram;
- echocardiogram;
- chest x-ray;
- general and extended blood count;
- sometimes for the diagnosis of heart failure they use a cardiovisor - a device whose principle of operation does not differ from an electrocardiograph.
Diagnostic criteria
The main and most pronounced sign of the acute course of heart failure can be called sinus tachycardia - a form of supraventricular tachyarrhythmia, which is characterized by an accelerated sinus rhythm - the heart rate in an adult exceeds 100 per minute. A graphical representation of the activity of the heart illustrates the extended boundaries of the organ left or right. In addition, a third tone appears at the apex or above the xiphoid process.
Acute congestive right ventricular failure is manifested by several signs:
- cervical veins and liver veins swell and swell;
- high venous pressure;
- enlarged liver, yellowness of the integument;
- swelling of the extremities;
- cyanosis of fingers, face (ears, chin, tip of nose);
- the patient experiences severe pain in the hypochondrium on the right;
- An ECG of the heart fixes sharp overloads of the right ventricle and atrium, which is expressed by high pointed teeth.
Signs of right ventricular failure are clearly detected by x-ray and on an electrocardiogram. The final stage of this type of cardiac pathology leads to depletion of the body, a decrease in the level of protein in the blood and a violation of the salt balance in the human body.
Signs of left ventricular failure and cardiogenic shock
In turn, the presence of acute left ventricular failure with congestive hemodynamics is evidenced by a number of the following symptoms:
- shortness of breath, sometimes passing into suffocation;
- paroxysmal dry cough, sometimes with foamy sputum, which is secreted from the mouth or nose;
- the presence of wet rales that are auditioned over the entire surface of the chest.
There are a number of characteristic symptoms of cardiogenic shock, namely:
- Blood pressure in a patient drops to values of 90-80 mm RT. Art. and even less. If a person suffers from hypertension, then a sign of shock will be a decrease in the rate of 30 mm Hg. Art. from the daily individual level.
- Pulse pressure reduction - less than 25-20 mm RT. Art.
- Suspicion of cardiogenic shock should cause pallor of the skin and its coldness. These manifestations indicate a violation of the microcirculation of blood in the tissues of the body.
With a person who has revealed the above manifestations of pathology, a series of events should be carried out before the arrival of specialists. First aid for acute heart failure (stroke, heart attack, etc.) should be aimed at:
- organize access to fresh air;
- to ensure the horizontal position of the patient (unless he has signs of left ventricular failure);
- carry out painkillers.
Treatment of acute heart failure
Heart failure treatment is a complex therapy aimed primarily at:
- eliminate overload of the heart muscle - this measure is achieved by the use of drugs that reduce blood pressure and heart rate;
- stop the symptoms of pathology (therapeutic measures will depend on the manifestations of painful manifestations).
If AHF has developed due to myocardial infarction, it is necessary to restore the blood flow of the coronary artery as soon as possible. As a rule, a heart attack causes thrombosis of an artery that feeds the heart. The elimination of a blood clot helps to completely restore the patency of a blood vessel and stabilize the patient's condition.
The most popular technique in this case is thrombolysis, however, the procedure should be carried out as soon as possible from the onset of a heart attack, while the thrombus is still “fresh”. First aid for acute heart failure involves the use of drugs (thrombolytics), the action of which is aimed at dissolving blood clots. Medications are administered intravenously, the rate of their ingestion is strictly regulated.
Treatment of acute insufficiency (right ventricular) with congestive hemodynamics involves the elimination of the causes that caused it - asthmatic status, blood clots in the pulmonary artery, etc. The therapy begins with the appointment of the patient "Nitroglycerin" or "Furosemide", in combination with pathology and cardiogenic shock, inotropic funds. In conjunction with the above measures, oxygen is inhaled through a catheter.
Psychomotor agitation is eliminated by narcotic analgesics, for example, "Morphine", which reduces the work of the respiratory muscles and reduces the load on the heart.
Management of symptoms of left ventricular failure
Blood stasis in a small circle often leads to serious consequences, for example, pulmonary edema. With such violations, patients are prescribed the introduction of "Nitroglycerin" intravenously.
If acute left ventricular failure with congestive hemodynamics is combined with cardiogenic shock, intravenous administration of Dobutamine or Norepinephrine is prescribed. There are frequent cases when these drugs combine in a complex.
Foaming is stopped using means that ensure the destruction of the foam.
If hemodynamics is stabilized, but signs of pulmonary edema persist, glucocorticoids are prescribed to the patient. In this case, first aid for acute heart failure will help reduce membrane permeability.
Therapy for cardiogenic shock begins with an increase in cardiac output, in the absence of manifestations of congestive heart failure, it includes the introduction of plasma substitutes. This procedure is performed only under the control of heart rate, blood pressure and respiration. If there was a large loss of fluid before the occurrence of acute cardiac pathology, a sodium chloride solution is used.
The elimination of pathological symptoms, of course, is primarily associated with the use of medications, but if the measures taken do not lead to the desired effect, you can use the right way - to perform hemodynamic unloading by applying tourniquets to the veins of the limbs.
In cases where conservative medicine is powerless, resort to surgical treatment. This way eliminates the problems associated with clogged arteries, replacing heart valves. Installing a pacemaker or defibrillator helps stabilize your heart rate.
Prevention
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Summarizing all of the above, it can be noted that acute heart failure is a pathology that often leads to death. The disease, as a rule, develops against the background of other painful conditions of the cardiovascular system and leads to various complications, including stroke, cardiogenic shock, pulmonary edema, etc.
There are signs by which acute heart failure is diagnosed. Symptoms before death can be implicit, therefore, an important task of specialists is to take into account all the complaints of the patient and conduct immediate screening.