Acute heart failure
Acute heart failure - a syndrome of acute developing state, which is characterized by the rapid appearance of clinical symptoms as a result of reduced contractility of the heart that results in hemodynamic disturbances and changesin the pulmonary circulation.Acute heart failure is a heart dysfunction in the form of reduced cardiac output, increased pressure in the ICC (pulmonary circulation) and peripheral tissue hypoperfusion stagnation.
The disease is expressed in an attack, which is characterized by a sudden shortness of breath choking in transition, that is, cardiac asthma.In the absence of timely relief of an attack, congestive heart failure develops into a heavy condition, such as a lung edema.In addition, this syndrome has also a second name - an acute left ventricular failure (ave to), and due to the fact that this condition is sharply reduced contractility of the left ventricle.
Typically, the syndrome refers to a pathology that develops as a result of heart fai
Acute heart failure is one of the most common life-threatening conditions that require urgent medical intervention.
Acute heart failure causes
In this form of disease is sharply reduced myocardial contractility, which is a consequence of an overload of the heart muscle, reducing its operating weight and ability to perform the function of contractile myocytes or as a result of reduced compliance cardiac walls.
Thus, the causes of congestive heart failure are the various disorders of the heart muscle systolic or diastolic properties on the background of a heart attack;inflammatory and degenerative pathological processes in the myocardium;tahiaritmicheskie and bradiaritmicheskie anomaly.
Also acute heart failure is formed as a result of sudden overload of the heart muscle after a high resistance to blood flow paths, such as hypertension, aortic defects, myocardial infarction.In addition, this characteristic condition occurs when postinfarction cardiosclerosis nature serious condition as a result of extensive myocarditis fracture septum between the ventricles, insufficient function triskupidalnogo or mitral valves.
Acute heart failure has the ability to be at increased physical and psycho-emotional stress, increase blood flow when the patient lies on a background of decompensated myocardium with chronic congestive heart failure.
For non-cardiac causes contributing to the formation of this anomaly are different kinds of infections, acute forms of disturbances in brain surgery comprehensive plan, renal failure, pheochromocytoma, an overdose of drugs and 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, expanding the boundaries of the heart as a result of hypertrophy of the heart muscle and increase in heart cavities, hepatomegaly, especially the left side, swelling, localized onperiphery and HPC increase (central venous pressure).On the basis of echocardiographic studies show a decrease in ejection fraction, and X-ray - the phenomenon of stagnant processes in the lungs.
for acute heart failure is characterized by left ventricular and right ventricular shape.
Her symptoms were characterized by a typical asthma attack cardiac type and stage of the disease interstitial pulmonary edema in the alveolar stage ave to.Typically, the formation of cardiac asthma falls on the night when the patient is sleeping.At this moment he is experiencing an acute shortage of air, the fear of death and wakes.In addition, there is a kind of hacking cough nature.Signs of severe shortness of breath, at which hampered breath, forcing the patient to take a vertical position, or stand at the open window to breathe a breath of fresh air.At the same time the patient in the eyes marked anxiety, suffering.At the beginning of the attack the skin gets pale, passes into a shade of blue, and then the patient begins to perspire.In addition, you can watch the swelling of veins in the neck, breathing quickens.The appearance of dry cough accompanied by sputum, and sometimes bloody.When progressive processes ICC sputum in a liquid or foam in the blood fluid, which has a pink hue.And this is a characteristic feature in the developing pulmonary edema.
At the time the study of the respiratory system at the point wheezing breaths including forty or sixty per minute.At the peak of the attack with the weakening of vesicular breathing in the lungs lower division tapped wheezing wet fine-bubble characteristics.In some cases, cardiac asthma can proceed without wet rales properties.The other category of patients listen to whistling dry rales etiology.It is mainly observed in asthma attacks and with it because in the bronchi at this moment developing spasm, which provokes disorders of blood circulation in the blood vessels of the lungs.
most characteristic changes in acute heart failure marked circulatory organs.Here the symptoms of frequent arrhythmia pulse with deaf tones the heart.At the beginning of the attack may slightly increase blood pressure, and in the future is its reduction.But sometimes the pressure is once fixed to the lower rates.When fit with signs of labored breathing sharp as shortness of breath and cough with sputum and a significant number of lung wheezing on auscultation note predicament listening deaf heart sounds.In this case, more precise measures of the heart can be obtained using the pulse and blood pressure.
Asthma severity of their occurrence and prognosis have a huge variety.In some moments of acute heart failure may begin suddenly, and in the other - first amplified shortness of breath, then a heartbeat and subsequently deteriorating overall health.
occasional bouts of acute heart failure characterized by a period of a few minutes and can end their own without medical intervention.But as a rule, they delayed for a long time.At such moments, untimely medical aid worker can result in death due to pulmonary edema, collapse or a sharp depression of the respiratory center.
Acute heart failure in children
This disease is multifactorial pathology that is characterized by disruption of the heart of the primary nature of a number of anomalies hemodynamic, hormonal and neural adaptations, related to the direction of the circulatory support that meets the needs of the body.For children with acute heart failure is characterized by an extremely serious prognosis of the disease which can be fatal, when untimely provision of skilled care.
Children acute heart failure is classified into left ventricular (ave to), right ventricular (OPZHN), and arrhythmogenic total.Further, it is shaped systolic, diastolic and combined.
systolic congestive heart failure is characterized by the development of lesions in the cardiac muscle or its overload which is caused by an increase in pressure, for example, aortic stenosis, or increasing the volume of the heart at a septal defect between the ventricles.This syndrome is characterized by impaired diastolic form of relaxation processes in diastole, such as obstructive cardiomyopathy;reducing the size of the heart cavities or shortening of diastole in significant quantities in the form tahisistolicheskoy dysrhythmia.
Among the reasons contributing to the development of such diseases in children is acute heart failure, secrete various changes in the lungs and bronchi acute (pneumothorax, severe damage to lung, pneumonia, atelectasis), characterized by a mechanism of disease is pulmonary hypertension and hypoxia as aconsequently bypass.In addition, endogenous and exogenous toxicosis, burn disease, sepsis also underlie the formation of the child's disease.This is exactly the condition of the organism in which the transport of glucose and oxygen can not cover the growing needs of the tissues and organs.
Children acute heart failure has three degrees of the disease.For the first degree of the pathological syndrome characterized by dyspnea and tachycardia, which is clearly manifested in the child in a calm state.An important clinical measure is altered the relationship between heart rate and breathing.This is the ratio of children to the first year of life pulse of breathing will be higher three, and the children after a year - almost five.In addition, the observed cardiac sounds muffled etiology, expands the boundaries of cardiac dullness.
With second-degree congestive heart failure an important indicator of the disease in children is considered a compensatory hypervolemia, which can occur in two states.In the first case, the child is dominated by a circulation decompensation or there is a total lack of blood circulation.In acute heart failure the second degree (A) due to the predominance of stagnation in the CCL have a sick child is an increase in liver size, and periorbital edema occur properties.But signs of increased central venous pressure due to decompensation, are developing rapidly in a period of several minutes or hours.
In the case of the gradual increase of the disease for two days, central venous pressure may be normal in the progressive enlargement of the liver.In this case, it performs the role of a buffer.Also tapped muffled heart sounds with a possible extension of the boundaries.When congestion at the ICC strengthens the processes in addition to tachycardia cyanosis, which reduced after the application of oxygen therapy.The child can be heard wheezing scattered, fine-bubble character, it is also possible to define a second tone on the pulmonary artery.In acute heart failure the second degree (B) to all the previous symptoms of peripheral edema join nature, oliguria with possible pulmonary edema.
third degree in children is characterized by low-output form in which hypotension on the background of clinical congestion IWC.For hemodynamic shock syndrome characterized by acute circulatory failure, as a result of the fall of the arterial and venous pressure.
Practice IT (intensive therapy) in children identifies acute heart failure, which is characterized by a variety of heart diseases, poisoning by toxic substances and may develop as a result of hypoxia and energy deficiency.It is also in its development is associated with profound changes in the heart that manifests systolic motion as "curling" and diastolic - as "unwinding".Thus, dysfunction of systole and diastole occur in reducing cardiac output at a normal or reduced left ventricular work.
Children this pathology develops in two stages.In the first stage diastole is reduced over time without falling decompensated outflow to the heart, although the symptoms of stagnation processes are already present in the CCB.In the second stage decompensated diastole decreases and it becomes a cause giposistolii accompanied by hypotension and lung edema coma.
Acute heart failure Emergency
Main activities First aid to the patient with the syndrome of acute heart failure include: first aid and medical, to hospitalization of the victim.
In the first case of the disease to asthma attacks cardiac nature, firstly, it is necessary to reduce the increased excitability of the respiratory center;secondly, to reduce congestion in the MCC;thirdly, increase contractile function of the left ventricle of the heart muscle.To do this, create a calm patient and give him a position with the lowered feet or half upright in bed, if there is no collaptoid state.Then applied tourniquets to the area of the lower limbs so as to avoid disturbances in blood flow.During systole blood pressure 90 mm Hg.Art.give the patient nitroglycerin under the tongue every three minutes, up to four tablets with good tolerability.It is also possible you can omit the feet in a basin of hot water and provide fresh air, freeing the patient from compressive garments.
Prehospital emergency care, or in an ambulance is to conduct neyroleptanalgezii.To reduce perevozbudimost breathing subcutaneously Omnopon, morphine or Promedol with atropine to reduce vagotropic action of drugs.Then carried out using oxygen therapy nasal catheter.If there is an intensive foaming, use oxygen, which is moistened with alcohol or defoamers.Sniffing alcohol necessary for thirty or forty minutes, and then about fifteen minutes and allowed to breathe oxygen again repeated inhalation of oxygen-alcohol mixture.
last stage is considered to be the introduction of diuretics in a 1% solution of Lasix to eight milliliters when intravenously administered.
If BP is normal or elevated intravenous nitroglycerin drip to re-fiz.r to 25 drops per minute to reduce the initial blood pressure by twenty percent.If the pressure is stabilized, it is prescribed antihypertensives such as Na nitroprusside intravenously to reduce blood pressure 90/60 mm Hg.Art., but not below.Typically, the drug is administered short-lived, protected from light, so that it did not form cyanide.
under reduced pressure Dopamine administered, Mezaton, Kordiamin.If the blood pressure does not reach 80 mm Hg, then administered Norepinephrine.Once settled in blood pressure and stagnant processes some more pronounced, added a parallel intravenous nitroglycerin.
When symptoms of bradycardia and bronchospasm introduced Eufillin.But we must remember that if there is an acute form of lack of coronary circulation and instability of the heart muscle, this drug is not desirable to apply.However, if its administration is essential, it should be administered with caution.
It is also important to know that nitroglycerin and other vasodilators practically contraindicated in the diagnosis of aortic stenosis, hypertrophic cardiomyopathy, and pericardial effusion.
Acute heart failure treatment
Any form of acute heart failure, the presence of arrhythmias are trying to achieve the restoration of normal rhythm.
to treat congestive ave to use the correction of conditions that cause its development.Self-treatment of this condition requires.In this case, sublingual nitroglycerin is assigned to one milligram and exalted position of the patient.With typical stagnation of blood - lift the upper body, the formation of pulmonary edema - a sitting position, with the legs should definitely be lowered down.However, these actions are unacceptable in high blood pressure.
One effective pharmacological agents in acute heart failure Furosemide is considered that after intravenous administration is fifteen minutes hemodynamic unloading of the myocardium, which is further enhanced by developing the action of the drug.In severe forms of pulmonary edema Furosemide is assigned to 200 mg.
When expressed tachypnea processes and psychomotor agitation in acute heart failure prescribed opioids.For example, morphine regulates venous vasodilation, reduces the load on the heart muscle, reduces the work of the muscles of the respiratory and inhibits the respiratory center.