Heart failure is a chronic or acute condition, the cause of which lies in the weakening of the contractility of the myocardium and in the stagnation observed in a large or small circle of blood circulation.
This is a very dangerous condition. What are the prerequisites for its occurrence and signs of acute heart failure? How is the diagnosis carried out? And, most importantly, how is the treatment carried out?
About the disease
Before studying the signs of acute heart failure, one must have information about this pathology. How is it developing? Due to a decrease in the contractile function of the heart, an imbalance begins between the hemodynamic needs of the body and the capabilities of the heart muscle in their implementation.
This is manifested by an excess of venous flow to the heart and the emergence of resistance, which must be overcome by the myocardium in order to expel blood into the vascular bed.
The cause of acute heart failure is a weakening of the function of any part of the heart (right or left ventricle, or atrium).
This ailment is not independent. It is usually a consequence of myocardial infarction, aortic defect, and hypertension. Its formation leads to increased pressure in the capillaries, arterioles and pulmonary veins. Because of this, in turn, the permeability of their walls increases. The result is sweating the liquid part of the blood. As a result, an interstitial edema is formed, and then alveolar.
Background and risk factors
What conditions predispose to the formation of acute heart failure? Signs of the disease appear with various cardiovascular disorders.
Approximately 60-70% of patients faced with this disease had coronary heart disease and myocardial infarction. Much less often (14%), people with defects are at risk. Approximately 11% of cases are in patients with dilated cardiomyopathy.
Also a risk factor is old age. Among older people, in addition to coronary heart disease, this disease also causes hypertension (approximately 4% of cases). Many more elderly patients who have encountered signs of acute heart failure suffer from type 2 diabetes, as it turns out in the course of clarifying the anamnesis.
Also, risk factors and possible prerequisites for the development of pathology include:
- Pulmonary embolism.
- Arrhythmia.
- Physical and psycho-emotional overload.
- Hypertensive crisis.
- Pneumonia.
- Progression of coronary heart disease.
- ARVI.
- Renal failure.
- Anemia.
- Prolonged use of cardiotoxic drugs and medicines that retain fluids.
- Alcoholism.
- Intensive mass gain.
- Increased total circulating blood volume.
- Endocarditis is an infectious form.
- Rheumatism.
- Myocarditis.
All of the above undoubtedly leads to a decrease in the compensatory mechanisms of the heart.
Symptoms
What are the first signs of acute heart failure? The most pronounced symptoms are two: alveolar pulmonary edema and cardiac asthma.
The attack of the second ailment is provoked, as a rule, by neuropsychic or physical stress. It occurs at night, because of which a person wakes up in fear. He lacks air, his heartbeat rolls over, his throat begins to torment a cough with difficult sputum. This condition is supplemented by still cold sweat and a sharp weakness.
In this situation, you need to take a sitting position and lower your legs. When examining a patient in this condition, pale, grayish skin, severe shortness of breath, cold sweat and cyanosis (acrocyanosis) are detected.
The pulse is very weak, but often full. The borders of the heart are extended to the left, the tone is very dull. The rhythm can be characterized as galloping. Blood pressure decreases. If you listen to the lungs, then you can identify a single dry rales.
Due to the increase in congestive phenomena of the small circle, pulmonary edema develops. A sharp cough accompanies a severe cough, an abundant amount of pink foamy sputum also stands out.
Even at a distance, one can hear bubbling breathing and wet rales. In addition, a person has veins swelling on his neck, the skin is covered with cold sweat. The pulse becomes threadlike, frequent, and arrhythmic. A variety of wet rales appear. This is not just a clinical sign of acute heart failure, but an emergency condition that requires intensive care. If a person is not helped, he may die.
Signs in men and women
It should be noted that pathology often manifests itself specifically depending on gender. Of course, most signs of acute heart failure in men and women are similar, but there are some differences. And they should pay special attention.
In women, heart problems are detected later than in men. They make themselves felt with the onset of menopause (usually after 50 years). With age, the risk of deficiency increases, and by 65 women are just as susceptible to it as men.
It is impossible not to make a reservation that representatives of the strong half of humanity are more likely to experience heart attacks. Therefore, timely diagnosis and competent treatment are incredibly important for them.
Not all women experience such a sign of acute cardiovascular failure as pain. Many of the possible symptoms are often almost imperceptible. Manifestations occur immediately before an attack. This is arrhythmia, burning in the chest, dizziness, cough, nausea with vomiting, digestive problems, as well as weakness and sudden fatigue.
Diagnostics
Since the signs of acute heart failure in women and men are a secondary syndrome that develops against the background of some other disease, the diagnostic goal is appropriate - it is important to identify it and prevent it from developing as early as possible. Importantly, failure can be prevented, and therefore regular examinations make sense.
When collecting an anamnesis, attention is necessarily paid to dyspnea and fatigue. These are early signs of acute heart failure. Diagnosis also involves taking a medical history - it is necessary to find out if the patient has hypertension, coronary heart disease, cardiomyopathy, whether he suffered a rheumatic attack and myocardial infarction.
In addition, the doctor reveals ascites, rapid low-amplitude pulse, listens to the third heart tone, determines the displacement of its borders.
If there is a suspicion of insufficiency, then experts conduct the following studies:
- Analysis for gas and electrolyte blood composition.
- Identification of acid-base balance.
- The study of indicators of protein-carbohydrate metabolism.
- Determination of creatinine and urea levels.
- Identification of cardiospecific enzymes.
Of course, an ECG is also prescribed. This procedure helps to determine myocardial ischemia, hypertrophy, arrhythmia. They can carry out bicycle ergometry and a treadmill test (exercise measures). They imply a gradually increasing level of load, which is necessary to identify the reserve capacity of heart function.
Still patients are shown ultrasound echocardiography. Thanks to her, it is possible to identify the cause that provoked the appearance of signs of acute heart failure in women and men. The same method allows you to evaluate the pumping function of the myocardium.
Mandatory MRI. This method helps to successfully diagnose acquired or congenital heart defects, coronary heart disease, hypertension and other ailments.
Many more patients are shown an x-ray of the chest and lung organs. So you can determine cardiomegaly and stagnant processes in a small circle.
Also in the process of diagnosis, it is important to assess the contractility of the ventricles, to identify how spacious they are. For this purpose, radioisotope ventriculography is done.
If serious signs of acute heart failure are detected in men or women, then an ultrasound scan of the liver, abdominal cavity, pancreas and spleen is mandatory. This is necessary in order to determine whether there are lesions in the internal organs.
Principles of Therapy
This pathology is a life-threatening condition, and therefore it is very important to quickly provide qualified medical care when the first signs of acute heart failure are manifested. The causes of its occurrence may be different, but therapy is based on general principles.
What are the actions of resuscitators directed at? It:
- Restoring blood flow to damaged vessels.
- Normalization of heart rate.
- Elimination of pulmonary embolism.
- Restoring the integrity of the heart muscle (for this, emergency surgery is performed).
- Elimination of an asthmatic attack.
- Oxygen therapy
- Anesthesia.
- Strengthening the contractile activity of the myocardium.
- Decreased circulating blood volume.
- Normalization of vascular circulation.
Noticing the signs of acute heart failure, the causes and symptoms of which were described above, you must immediately call an ambulance. Procrastination increases the risk of death. If the pathology develops at lightning speed, then the doctors will have at least 30 minutes for resuscitation.
How to provide first aid?
Noticing a person's obvious signs of acute heart failure, first aid should be provided. The algorithm of actions is as follows:
- The patient should be put in a comfortable position, lower his legs.
- Release him from clothing that makes breathing difficult.
- Provide fresh air.
- Call an ambulance.
- Talk with a person, distract him so that he is conscious. Be sure to reassure him.
- Lower legs and arms into warm water (slowly), then measure pressure. If the indicators exceed 90 mm RT. Art., you need to give him a tablet of nitroglycerin.
- 15 minutes after the onset of the attack, apply a tourniquet on one thigh. Change the position once every 30-40 minutes (if doctors go for a long time).
It is important to know that there is always a risk of respiratory arrest. In case this happens, proceed as follows:
- Lay the person on a flat surface, on his back. Place a roller under your head.
- Fold hands with palms down, rest them on the sternum (lower third), and begin to make jerky movements 60-65 times per minute.
- At the same time, artificial respiration must be performed. If one person performs resuscitation, then his algorithm should be like this: after every 13-15 shocks, take 2-3 breaths. In the presence of an assistant, 5 breaths account for 1 breath.
- After half a minute, we need to evaluate how resuscitation was effective. If everything is done correctly, then the pupils will again begin to respond to light, the usual skin color will also be restored.
- Even if nothing helps, resuscitation must be continued. It will be possible to stop only when the doctors arrive.
Medication used
When confirming the diagnosis on the basis of signs of acute heart failure, pathology is treated with drugs that are prescribed to a person in this condition. Of course, the approach here is purely individual. But usually such means are prescribed:
- Pressor amines. These are Dobutamine, Dopamine, and Norepinephrine. These drugs help regulate myocardial function.
- Phosphodiesterase Inhibitors The best options are Amrinon and Milrinon. They improve the tone of the pulmonary vessels, eliminate the signs of pulmonary failure and shortness of breath.
- Levosimendan. At the moment, this is the only medication with which you can regulate the work of microfibrils. It is usually prescribed at an early stage of failure.
- "Digoxin". It is used to reduce the frequency of ventricular contractions in arrhythmias. But this drug has a lot of side effects, and therefore it is rarely used in practice.
- "Nitroglycerine". Reception of this remedy relaxes the smooth walls of blood vessels, as a result of which the body's response to high blood pressure decreases. It is taken when approaching an attack.
- "Sodium nitroprusside." Used similarly to Nitroglycerin. But the drug is serious, it can not be taken more than 4 times a week.
- "Furosemide." It produces a vasodilating effect, and also accelerates the outflow of urine. As a result, edema in the upper and lower extremities is eliminated.
- "Morphine." This is an analgesic with a narcotic effect, and it is used only in extreme cases in order to increase the vagal effect and optimize the work of the heart for a short time. There are many side effects, and the drug is addictive.
Other drugs may also be prescribed. Be that as it may, all of the above is used only for symptomatic treatment. Heart failure itself cannot be eliminated with these drugs. But then it will be easier for the patient to transfer this condition.
Cure other manifestations
Studying the essence of the pathology and the signs of acute heart failure, you need to know about how other manifestations of this ailment are eliminated.
With pulmonary edema, for example, it is very important to normalize the pressure in the vessels. This will speed up blood flow and increase its oxygen saturation. For this purpose, phosphodiesterase inhibitors are prescribed. Cardio training, which is carried out under the supervision of a physician, is also recommended.
The main task of physicians is to quickly normalize blood pressure and prevent the development of hypoxia. For these purposes, diuretics are used. In especially severe cases, the notorious morphine is used.
If hypertension and cardiological shock occurred, it is important to normalize blood pressure and regulate the pumping function of the heart muscle. Inhibitors of the synthesis of potassium and nitric oxide will help here. In addition, the reception of diuretics or the same nitroglycerin is indicated.
In the event that the conduction of the heart muscle is impaired, or a sinusoidal impulse disappears, the myocardial reaction is stimulated. Then they resort to pressor amines, and in order to normalize the weight, a specialized diet is prescribed. It implies the rejection of salty, fatty, fried, as well as everything in which cholesterol is present.
Tachycardia is usually quickly eliminated with Digoxin. However, it is taken with extreme caution.
Doctors also regulate the concentration of nitrate oxide, calcium and magnesium in the blood. For this purpose, classic antiarrhythmics are prescribed, as well as a consultation with a nutritionist.
Prevention
Having information about the signs, symptoms and treatment of acute heart failure, you need to know about preventive measures. To date, there is no specific prevention of this pathology. All activities that are recommended by cardiologists fit into the generally accepted concept of a healthy lifestyle. What will help improve the condition and minimize the frequency of seizures?
- Regular examinations by a cardiologist, therapist, as well as other highly specialized doctors (it all depends on the presence of certain diseases in humans).
- Quitting smoking and minimizing alcohol consumption. Although it is desirable to impose a “taboo” on alcohol. If there are chronic diseases of any systems or organs, then a ban is mandatory.
- Control your body weight. Weight gain should not be allowed. Any extra kilogram gives an extra burden on the heart. Therefore, in the event that a person's weight deviates from the norm, you need to reconsider your diet. A nutritionist will tell you how to do this.
- Moderate physical activity. How intense they will be depends on the state of human health.
- Exclusion of any psycho-emotional overload. This must be taken into account both by the patient himself and those people who are in his close circle. You can not bring it to overstrain and provoke stressful situations.
- Compliance with the regime of work and rest. Physical overvoltages are also unacceptable.
- Proper nutrition. Usually, in case of insufficiency, a diet No. 10 is prescribed with a low energy value (2300-2500 kcal) and with a high content of proteins and carbohydrates.
- Daily blood pressure monitoring.
In conclusion of the discussion of signs, symptoms and diagnosis of acute heart failure, it should be noted that the 5-year survival threshold for people suffering from this pathology is 50%. But the forecasts are varied, they are affected by the severity of the disease, the accompanying background, lifestyle and effectiveness of therapy. If treatment was started in the early stages, then it is possible to completely compensate for the patient's condition, preventing the development of pathological conditions.