Every year, diseases of the cardiovascular system lead to the death of more than 17 million people worldwide. Only in 10% of cases such pathologies are congenital. The vast majority of painful conditions occur against the background of stress and the wrong way of life of a modern person. In the article we will understand what acute heart failure is.
Symptoms before death and complications caused by pathology, methods of diagnosis and treatment of 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 can be useful to any of us. The ability to act correctly in a critical situation in most cases ensures the preservation of human life. Accordingly, everyone should know what first aid is for acute heart failure.
Concept of heart failure
Heart failure (HF) is a pathology in which the heart stops supplying the tissues of 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, infarction, cardiogenic shock.
Both men and women are susceptible to the disease, 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 death in medicine, are very diverse. They depend on what form of the disease occurs. According to the nature of the origin of heart failure, they distinguish:
- Myocardial heart failure is a pathology that is the result of direct damage to the heart muscle due to a violation of energy metabolism. This type of heart failure results in impaired contraction and relaxation of the heart.
- Overload heart failure is a pathology that develops as a result of a large load on the heart. This type in some cases develops against the background of heart defects.
- Combined heart failure is a form of pathology that combines the causes of the two above.
Classes of heart failure
Today, there are various criteria by which the diseasedivided into types or forms. Medicine knows several classification systems (Russian, European, American), but the most popular is the system proposed by US cardiologists. In accordance with this technique, four classes of the disease are distinguished:
- 1 class, in which the patient becomes short of breath with active movement, such as climbing stairs to a level above the third floor.
- 2 class, in which shortness of breath appears even with slight exertion - when climbing to the first or second floor. At the same time, there is a decrease in human physical activity.
- 3 class, in which heart failure is noticeable with minor exertion, for example, when walking, but at rest, the symptoms of the pathology disappear.
- 4 class, in which the symptoms of the disease appear even at rest, and slight physical activity leads to serious disturbances in the work of the heart and the entire vascular system as a whole.
CH classification
Pathology can be classified according to several criteria. Depending on the clinical picture of the course of the disease, acute and chronic heart failure is known to medicine.
Acute heart failure (AHF) is a disorder in which the symptoms of the pathology appear quickly (within a few hours). As a rule, acute heart failure occurs against the background of other diseases of the vascular system.
Infarction, myocarditis and other diseases can become a trigger for painful conditions, because with these pathologies, heart muscle cellsdie due to local circulatory disorders. AHF can also result from rupture of the walls of the left ventricle, acute valve insufficiency (aortic and mitral). In some cases, the pathology develops without previous disorders.
OSH is a rather insidious disease, because it can cause painful conditions in other body systems. Complications of acute heart failure often affect not only the heart, but also the respiratory organs, causing pulmonary edema, cardiac asthma, cardiogenic shock.
Chronic heart failure is a disorder in which the pathology develops gradually over weeks, months or even years. Occurs against the background of heart disease, arterial hypertension or prolonged anemia.
Types of AHF by type of hemodynamics
Depending on the type of hemodynamics characteristic of the location of the pathology, there are the following forms of acute heart failure:
- ACF with congestive hemodynamics.
- OSH with hypokinetic type of hemodynamics.
Hemodynamics is the flow of blood through the vessels, which is caused by excellent pressure in various areas of the circulatory system. Blood is known to move from an area of higher pressure to an area of 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 may involve the right or left ventricle of the heart. In accordance with this, they distinguish:
- Acute right ventricular failure, in which venous stasis occurs in a large circle of blood flow, i.e., affects almost all organs and tissues.
- Acute left ventricular failure, in which venous stasis occurs in a small circle of blood flow. 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.
OSH with hypokinetic type of hemodynamics
Acute heart failure with 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 impaired blood supply to all tissues of the body.
Distinguish:
- Arrhythmic shock, which is the result of an abnormal heart rhythm.
- Reflex shock - 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%. As a rule, persons over 60 years of age are more susceptible to the violation; 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 (down to 0), a thready pulse, and pallor of the skin. Pathology can later turn into pulmonary edema or end with renal failure.failure.
Factors contributing to the occurrence of AHF
The development of acute heart failure in a patient may be preceded by pre-existing diseases of the vascular system. These states 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 normal blood supply to organs and tissues is disrupted;
- damage to the integrity of heart valves and chambers;
- accumulation of fluid in the pericardial sac, which leads to disruption of the correct rhythm of heart contractions due to pressure exerted on the cavity of the heart (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.
Non-heart causes
In addition to heart problems, pathologies associated with high blood pressure in the pulmonary circulation can be involved in the occurrence of painful conditions. Diseases leading to the diagnosis of "acute heart failure":
stroke is a violation of the blood circulation of the brain, which provokes damage to its tissues and a general disorder of brain functions;
- thromboembolism of the artery of the lung (this disease occurs due to clogging of the pulmonary artery, as well as its processes with blood clots (thrombi), most often blood clotsoccur in large veins of the pelvis and lower extremities);
- lung diseases - inflammation of the bronchi (bronchitis), inflammation of the lung tissue (pneumonia);
- violation of the rhythm of heart contractions (acceleration or deceleration) - tachyarrhythmia, bradyarrhythmia;
- infections caused by various pathogens.
There are also factors that lead to the development of HF, but are not a manifestation of diseases of any body systems. These include:
- surgery;
- trauma and brain damage;
- toxic attacks on the heart muscle - alcohol, aggressive drug exposure;
- heart-lung machine, the use of which leads to certain consequences;
- electrical injury - the impact on the body of electric current;
- psycho-emotional or physical stress.
Diagnosis of acute heart failure
Diagnosis of heart failure is aimed primarily at establishing the causes that led to the development of pathology. Before conducting laboratory tests and manipulations using medical equipment, the doctor determines through a conversation with the patient the presence or absence in his life of certain factors that contribute to the development of such a pathology as acute heart failure. Symptoms before death (sudden), occurring within 24 hours, may be mild, and the task of the specialist is not to waste 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 a cardiovisor is used to diagnose AHF - a device whose operating principle is no different from an electrocardiograph.
Diagnostic criteria
The main and most pronounced symptom of an acute course of heart failure can be called sinus tachycardia - a form of supraventricular tachyarrhythmia, which is characterized by 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 to the 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:
- neck veins and liver veins swell and swell;
- high venous pressure;
- enlargement of the liver, yellowness of the integument;
- swelling of limbs;
- cyanosis of fingers, face (ears, chin, tip of nose);
- the patient experiences severe pain in the hypochondrium on the right;
- ECG of the heart captures a sharp overload of the right ventricle and atrium, which is expressed by high peaked teeth.
Signsright ventricular insufficiency are clearly identified by X-ray examination and electrocardiogram. The final stage of this type of cardiac pathology leads to exhaustion of the body, a decrease in the level of protein in the blood and an imbalance in the s alt 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 signs:
- shortness of breath, sometimes turning into suffocation;
- paroxysmal dry cough, sometimes with frothy sputum coming from the mouth or nose;
- presence of moist rales that are heard over the entire surface of the chest.
There are a number of characteristic symptoms of cardiogenic shock, namely:
- The patient's blood pressure drops to 90-80 mm Hg. Art. and even less. If a person suffers from arterial hypertension, then a sign of shock will be a decrease in the rate by 30 mm Hg. Art. from the daily individual level.
- Decrease in pulse pressure - less than 25-20 mm Hg. st.
- Suspicion of cardiogenic shock should cause pale skin and its coldness. These manifestations indicate a violation of blood microcirculation in the tissues of the body.
With a person who has the above manifestations of pathology, a number of activities should be carried out before the arrival of specialists. First aid for acute heart failure (stroke, heart attack, etc.)should aim to:
- organize access to fresh air;
- keep the patient in a horizontal position (unless he has signs of left ventricular failure);
- carry out pain-relieving actions.
Treatment of acute heart failure
Treatment of heart failure 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 as a result of 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 the thrombus helps to completely restore the patency of the blood vessel and stabilize the patient's condition.
The most popular technique in this case is thrombolysis, but the procedure should be carried out as soon as possible from the onset of a heart attack, while the clot 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. Medicines are administered intravenously, the speed of their entry into the body is strictly regulated.
Treatment of acute failure (right ventricular) with congestive hemodynamics involveselimination of the causes that caused it - status asthmaticus, blood clots in the pulmonary artery, etc. Therapy begins with the appointment of the patient "Nitroglycerin" or "Furosemide", with a combination of pathology with cardiogenic shock, inotropic agents are used. Together with the above measures, oxygen is inhaled through a catheter.
Psychomotor agitation is relieved by narcotic analgesics, such as Morphine, which reduces the work of the respiratory muscles and reduces the workload on the heart.
Elimination of symptoms of left ventricular failure
Stagnation of blood in the pulmonary circulation often leads to serious consequences, such as 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, dobutamine or noradrenaline is administered intravenously. It is not uncommon for these drugs to be combined in a complex manner.
Foaming is stopped with the help of means that ensure the destruction of the foam.
If hemodynamics is stabilized, but signs of pulmonary edema persist, the patient is prescribed glucocorticoids. 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 the heart rate,blood pressure and respiration. If there was a large loss of fluid before the onset of acute heart disease, a sodium chloride solution is used.
Elimination of the symptoms of pathology, 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, they resort to surgical treatment. In this way, problems associated with blockage of arteries, replacement of heart valves are eliminated. Installing a pacemaker or defibrillator helps stabilize the heart rate.
Prevention
The best way to prevent the development of pathology is to follow simple rules, namely, to lead a he althy lifestyle, quit smoking and stop drinking excessive alcohol, and periodically monitor existing chronic diseases. However, in cases where the disease nevertheless made itself felt, a certain regimen should be followed in everyday life.
Patients with acute heart failure should closely monitor their weight. Extra pounds provoke an increase in blood sugar and the formation of cholesterol plaques on the vessels, and this causes high blood pressure. An important condition for maintaining a normal physical condition is the observance of a special diet in nutrition. Need strictlyregulate the intake of s alt into the body, the excess of which has a bad effect on he alth - it causes fluid retention, edema is formed, and the load on the heart increases.
It is useful to do physical exercises, give a load to the muscles and joints, but sports should not cause overload of the body. A set of exercises must be agreed with the doctor. It is important to be in the fresh air often, get enough sleep, avoid stress and mental stress.
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 can be subtle before death, so it is important for specialists to take into account all complaints of the patient and conduct immediate screening.
