Heart cough - a conditional medical term, showing the development of varying degrees of respiratory disorders in patients cardiology.In a separate clinical symptom of cough cardiac origin stands to this day due to the fact that the appearance of his patient suffering from heart disease, is extremely unfavorable diagnostic feature.
Note that not all cardiac disease should be accompanied by the appearance of cough, in most of cardiac patients have the equivalent of a heart cough - increasing shortness of breath.The most severely ill tolerate the cough in cardiac asthma, since this condition is characterized by severe cardiohemodynamic and respiratory disorders.
cause heart cough
In some situations, the development of the patient's cardiac disease for a long time is not accompanied by the formation of a clinical picture that displays the damage of structures of the cardiovascular system.This category of patients may be a long time examined by a pulmonologist on the existing p
allocate a separate group of cardiac pathologies dekompensiruyuschih activity of the heart, which include defects valvular inflammatory disease of the myocardium, ischemic heart damage, and cardiomyopathy.Any organic lesion of the heart structures eventually contributes to the development of heart failure, the consequence of which is the stagnation in the venous reservoirs of both small and large circulation.
Thus, almost any cardiac pathology can induce cardiac cough.The most common underlying conditions for the development of congestive heart failure is atherosclerotic disease with concomitant ischemic myocardial damage.In the long ischemic foci in the myocardium undergo sclerotic changes, resulting in a significantly deteriorating the basic function of the heart.In addition, the progression of heart cough contributes to the development of hypertension in a patient.
insufficient blood supply of lung tissue is inevitably accompanied by compensatory bronchospasm, which manifests itself in the form of the appearance of the patient dry cough.Dry heart coughing is one of the specific pathognomonic criteria for diseases of the mediastinum and aortic aneurysm.Not complicated by pulmonary congestion accompanied by the appearance of momentum cough lung parenchyma with subsequent spread along nerve pathways simultaneously with pulses of shortness of breath, and therefore, the symptoms of heart failure are often combined.
Heart cough in a child may develop on the background of a congenital heart defect, accompanied by hemodynamic reset from left to right, the result of which is to enrich the pulmonary circulation and increased pressure in the lumen of the pulmonary artery.
Heart nocturnal cough is an important diagnostic criterion for the development of infective endocarditis, the occurrence of attacks which has a clear dependence on the growth of the temperature response of the patient in response to septic injury.
Thus, cardiac cough is a manifestation of heart failure and venous congestion in the lungs, or signs of respiratory system of man, as a complication of cardiac pathology.
Symptoms and signs of heart cough
mechanism of cough as a complex reflex act is to blow on the background of the closing of the vocal cords, the development of which is directed to the removal of secretions from the bronchi.Since cough, as well as other respiratory disorders it is largely a reflection of inflammatory, allergic lesion of the respiratory tract, in the initial stage of the disease, even experienced difficult to distinguish cardiac cough.
There are absolute clinical characteristics that distinguish cough with heart disease from such respiratory disorders observed in the organic lesion of the respiratory tract.For example, in mitral stenosis in a patient observed episodes of dry paroxysmal cough with hemoptysis, accompanied by a sharp sweating and severe muscle weakness.
Patients with cardiac pathology complicated by left ventricular failure describes a hearty cough as debilitating asthma that occurs mostly in the evening, to remove which the patient begins to cough.Relief status comes only after the patient fails to cough up at least a minimal amount of sputum.
In a situation where an episode of cardiac cough ends with the release of a large amount of phlegm muddy brown color, it should be assumed the development of right ventricular failure is compounded by the patient's condition.Severe stagnation in the small circle of blood circulation in combination with atrial fibrillation can be a favorable background for the development of thromboembolic syndrome, the main feature of which is hemoptysis.In addition, this option is a heart cough almost 100% of cases involving violations of the rhythm of cardiac activity and nonspecific kardialgicheskim pain.Severe cardiac coughing can provoke syncope to occur due to increased intrathoracic pressure, against which significantly reduced blood flow to the heart.
principal difference cardiac cough cough observed in the symptom of acute respiratory disease, is the complete absence of signs of infection in the body (the temperature of the reaction, the catarrhal phenomena in the nasopharynx, inflammatory changes in the laboratory analysis of the blood).In addition, the cough of a heart attack is rarely accompanied by the release of bronchial secretions, while for inflammatory diseases of the respiratory system characterized by productive cough with sputum purulent, rarely mucous character.
When examining a patient with a cough should be noted that people suffering from cardiac disorders, more susceptible to inflammation of the tracheobronchial system, so the occurrence of cough in this category of persons can be triggered not only by stagnation in the small circle of blood circulation.In this situation, it is advisable to thoroughly examine the patient must determine the presence of inflammatory elements in bronchial secretions.
An objective examination of the patient suffering from cardiac cough caused exclusively venous congestion, auscultation determined individual finely crackles with no clear localization.The presence of widespread dry wheezing throughout the lung fields on both sides favor the development of bronchitis.In a situation where a hearty cough is complicated by the development of congestive pneumonia, auscultation auscultated the hearth wet wheezing with concomitant crepitus.
Cough heart failure
in pathogenetic mechanisms of heart cough in heart failure is divided several stages, with prolonged duration which the patient develops severe complications such as pulmonary edema and cardiac asthma.Mostly respiratory disorders develop when the pathological changes of the left ventricle, which is manifested in reducing the intensity and regularity of its reduction.The result of this prolonged decline inotropic function of the left ventricle is a progressive increase in pressure in the vessels of the pulmonary circulation, which include pulmonary vessels.Slow blood flow in the pulmonary capillaries provokes an increase in venous pressure type, resulting in developing diffuse tissue hypoxia.
prolonged hypoxic damage is accompanied by enhanced production of collagen connective tissue fibers fibroblast accumulation of projected mezhalveolyarnyh partitions and the development of advanced fibrosis.Due to the fact that microvascular long time does not enter the blood, most of them obliterans, which further exacerbates the blood supply of the lungs.
As a result, "off" from the total pulmonary blood flow of a large number of vessels of small caliber, the conditions for increasing the pressure in the pulmonary artery.The consequence of this increased intravascular pressure is compensatory increase contractility of the right ventricle, provokes an increase in thickness of the myocardium in the area.With the depletion of compensatory possibilities right heart develops a progressive expansion of the cavity of the right ventricle.This situation is irreversible, as the patient develops a total venous congestion in both the systemic circulation.At this stage of the disease, patients impose specific complaints of heart cough, the intensity of which increases progressively during the night, and therefore, patients take a forced situation with elevated head of the bed.These clinical manifestations are chronic in nature, but in the event of acute left ventricular failure, respiratory disorder increases sharply, and developing the typical symptoms of pulmonary edema.
Time of occurrence, frequency and duration of episodes of cardiac coughing patient is a diagnostic feature that characterizes the process of the progression of congestive heart failure.So, in the initial stage, cardiac cough disturbs only the situation of the facts of intense physical activity, which is unusual for a man.When resistant heart failure attacks cardiac cough disturbed patient with moderate physical or psycho-emotional activity, and an episode of the attack can last for quite a long time.The extreme degree of heart failure manifests severe respiratory disorders in a patient, for which cough and shortness of breath is observed in human time, even during sleep.
long for cardiac cough in chronic heart failure is accompanied by the development of changes in the respiratory system of the patient, is to reduce the maximum ventilation capacity of the lungs, low index of vital capacity of the lung tissue, the uneven ventilation of the lung parenchyma.These changes will inevitably lead to the development of respiratory failure restrictive due to a decrease in the mobility of the lung parenchyma and increased airway resistance.
Provided impaired ventilation of the lung parenchyma, hemodynamic disturbances in the pulmonary circulation, post-capillary pulmonary hypertension, congestion, and "propotevanie" liquid component of blood plasma into the alveoli favorable conditions for the spread of infection and concomitant formation of pneumonic infiltration stagnant.
occurs in cardiac patients with hemoptysis, which occurs when a severe attack of cardiac cough is caused by diapedesis and tear dilated bronchial and pulmonary capillaries.In some situations, the gap vein bronchial order may be accompanied by pulmonary hemorrhage, which is a fairly common complication of left ventricular heart failure.
treat heart cough
Despite the fact that the main component of the treatment of cardiac cough is the use of medical correction of hemodynamic disturbances, as a result of heart failure, are important non-drug measures, the effect of which is aimed at alleviating the condition of the patient during an attack of cardiac cough.
a paramount condition for the successful treatment of cardiac cough is the normalization regime of rest and physical activity.A patient suffering from cardiac disorders should be enough time to give a relaxing environment, as well as the night's sleep.
In addition, preventive measures aimed at preventing the progression of an organic lesion of the heart muscle, and as a consequence, cardiac cough, is a correction of the feeding behavior of the patient.Patients suffering from heart failure, cardiologists recommend drastically limit the use of salt and foods high in cholesterol.Of course, on the use of patient alcohol and smoking are not out of the question, as scientifically proven correlation honey worsening of current heart failure, and bad habits.
Since heart cough is a reflection of the development of severe heart failure that occurs when a variety of organic heart damage, drug treatment of this condition should be primarily etiologically directed.In most situations, the elimination or compensation of hemodynamic disturbances by use of drugs of different pharmacological groups, allows you to reverse the symptoms of heart cough without specific treatment.Unfortunately, patients, long-suffering cardiac cough, do not realize the seriousness of the situation and seek medical help at the stage of decompensated heart failure, in which the complete recovery of the patient is not possible.In this regard, the Heart Association offers an algorithm for screening patients with respiratory disorders, including testing for the presence of organic heart disease.
all medication groups of drugs used as a therapeutic means to deal with a hearty cough should be pathogenetically justified, since the elimination of signs of heart failure itself contributes to the self-leveling cough.Symptomatic medication in the form of oppressive cough reflex or mucolytics are used only in the case of existing signs accession infection in the bronchi.
manifestation of the patient's signs of pneumonic infiltration in the lung is the rationale for assigning an adequate schema of antibiotic therapy (ceftriaxone 1 million IU 2 times a day intramuscularly or intravenously).The duration of antibiotic therapy is controlled by parameters of a blood test and X-ray dynamics.
pathogenetically justified is the appointment of patients with heart cough preparations of diuretics, particularly with available concomitant symptoms of peripheral edema syndrome, dyspnea with the presence of stagnant wheezing.This category of drugs may reduce cardiac cough and even its total disappearance, but be aware that diuretics have the ability to enhance the activity of the sympathetic-adrenal system, which exacerbates the course of the underlying disease.Given this feature, diuretic therapy should be applied while the appointment of drugs that reduce neurohormonal activation (enalapril 10 mg in the morning orally).
as first-line drugs in the existing patient signs of heart cough as one of the criteria of heart failure, used loop diuretics (furosemide, ethacrynic acid).Recently, however, the World Heart Association issued new guidelines, according to which the heart cough of moderate intensity is well treated by thiazide diuretics.Diuretics group sparing for the treatment of cardiac cough rarely used.
When considering the selection of adequate allocation scheme diuretic, should take into account the severity of the patient's condition.