The heart muscle, as you know, performs the function of a kind of pump in our body. If this device for some reason does not cope with its direct work, there is a heart failure. Every year this pathology is only getting younger, and recently it has been increasingly fatal.
Acute heart failure. What is it?
Acute heart failure is an unexpected decrease in the contractile function of the heart, causing its overload and impaired pulmonary circulation. The disease can appear both against the background of already existing pathologies of the heart, and without previous cardiac ailments. Most often, it is diagnosed with myocardial infarction, when cell death occurs due to a sharp deterioration in blood circulation in this area.
Depending on the overload of the main muscle of the human body, there are two main courses of the disease: right ventricular and left ventricularfailure. We will talk about the latter in more detail in this article.
Pathogenesis of disease
One of the main pathogenetic moments in the development of left ventricular failure is the increase in hydrostatic pressure in the capillary and venous sections of the pulmonary circulation. In the pulmonary interstitium, fluid gradually accumulates in excess, which leads to a decrease in the elasticity of the organs. The lungs become more "rigid", restrictive disorders occur. Then the edematous fluid enters the alveoli, as a result of which they cease to participate in gas exchange.
It continues to spread along the pulmonary serous and bronchial trunks. There is infiltration of perivascular and peribronchial spaces with serous fluid, which is reflected in their direct resistance, deterioration of metabolic conditions.
In the left atrium, blood from non-ventilated alveoli mixes with oxygenated substance. This entails a decrease in the total arterial partial tension of oxygen, the development of hypoxemia. In the initial stage, the latter is circulatory in nature.
Left ventricular failure is usually caused by severe overload or damage to the corresponding parts of the heart. Such a disease entails a deterioration in blood circulation. It requires not only timely diagnosis, but also competent treatment. With a combination of pathology with right-sided heart failure, the probability of death of the patient increases.
Main causes of disease
- Cardiomyopathy.
- IHD.
- Myocardial infarction.
- Cardiogenic pulmonary edema.
- Symptomatic arterial hypertension.
- Mitral stenosis.
- Major surgery.
- Brain injury.
- Diseases of an infectious nature.
- Toxic effects on the myocardium (drugs, alcohol).
Acute left ventricular failure and myocardial infarction
This disease very often develops against the background of myocardial infarction. It is usually due to impaired diastolic function and may occur with a normal ejection fraction. Mitral regurgitation plays an important role in the development of heart failure in this case. It is due to papillary muscle ischemia or loss of significant myocardial mass.
The disease in the first hours in patients with myocardial infarction is characterized by a sharp decrease in circulating blood volume, a change in cardiac output and minimal sodium retention in the body.
Clinical picture
As you know, almost all diseases of a cardiac nature have common symptoms, that is, they are expressed by pain in the region of the heart. It can give to the elbow, neck or shoulder blade. This phenomenon is usually observed in a disease such as left ventricular failure. Symptoms are accompanied by fever, shortness of breath, sharppressure surges and temperature violations.
The nature and intensity of the signs of pathology directly depend on which part of the heart muscle is damaged. For the left ventricular form, in addition to the main symptoms, the appearance of fainting, attacks of arrhythmia, dizziness, swelling of the limbs, and an increase in the jugular veins is characteristic.
Gradually, all signs of left ventricular failure increase, now appearing not only in the active stage, but also at rest. If you do not respond to this problem in a timely manner, a fatal outcome is not ruled out.
Disease forms
Pathology can occur in several types.
- With congestive type of hemodynamics. Manifested in the form of cardiac asthma (attacks of suffocation) and pulmonary edema.
- Hypokinetic type of hemodynamics:
- Arrhythmic shock. Develops as a response to a violation of heart rate.
- Reflex shock. Appears as a reaction to pain.
- True cardiogenic shock. Occurs with significant damage (over 50% of the mass of the myocardium of the left ventricle).
Sharp worsening of already diagnosed heart failure (the muscle does not provide adequate blood supply to the needs of organ systems)
Diagnosis
Many pathologies of a cardiac nature are characterized by rapid progression, and acute left ventricular failure is no exception in this matter. When a doctor suspects this diagnosis, the first thing to do isexamine the patient. However, physical examination is not enough to evaluate the full clinical picture. Therefore, the patient is prescribed a number of diagnostic procedures, including ECG, ultrasound of the heart, X-ray of the sternum, radioisotope ventriculography and PET.
Based on the results obtained, the doctor can confirm the diagnosis and prescribe competent treatment.
Acute left ventricular failure: emergency care
During an attack, it is very important for the patient to provide qualified assistance in a timely manner before the arrival of a team of doctors. First of all, he should be put on the bed (it is strictly forbidden to lie down), provide air flow, start oxygen therapy.
The patient needs to give "Nitroglycerin" under the tongue, enter subcutaneously 1% "Morphine". With the development of severe pulmonary edema due to a decrease in blood pressure, "Prednisolone" is administered intravenously (3-5 ml).
In the absence of the necessary drugs, the patient should apply tourniquets to the hips and shoulders to drastically limit the volume of circulating blood. You can also enter a special mixture intravenously. To do this, draw 3 ml of 96% ethyl alcohol into a 10 ml syringe, and then add water for injection. It is important that the entire volume is filled. This solution has a defoaming effect. The patient should call the cardiological medical team. After the elimination of pulmonary edema, all patients diagnosed with acute left ventricular heart failure must be hospitalized without fail. Transport usuallycarried out on a stretcher in a sitting position.
Basic principles of treatment
This pathology threatens the life of the patient and always requires emergency treatment.
- If the cause of the disease is a change in heart rate, to stabilize the hemodynamics and the patient's condition, it is necessary to restore the heart rate.
- If the cause is a previous myocardial infarction, to combat the disease, it is necessary to normalize coronary blood flow as soon as possible. In prehospital care, this is possible through systemic thrombolysis, that is, intravenous administration of special drugs to dissolve blood clots.
- If left ventricular failure is the result of preexisting intracardiac haemodynamic disturbances due to myocardial rupture or trauma, immediate hospitalization is indicated.
Drug therapy
Treatment of the disease, in general, implies an integrated approach (complete rest, no serious physical exertion, adherence to a therapeutic diet). However, these are more preventive measures, which sometimes cannot even stop the pain syndrome that accompanies the disease - acute left ventricular failure. Drug treatment is just in this case comes to the rescue.
The main objectives of drug therapy are listed below:
- Normalization of myocardial contractility.
- Relieve the symptoms of sinus tachycardia.
- Prevention of blood clots and occlusion of blood vessels.
- Process normalizationremoving fluid from the body.
- Prolongation of remission.
First of all, all patients, without exception, are prescribed oxygen therapy. To combat excess fluid in the body, it is recommended to take diuretics ("Furosemide", "Uregit") and a sharp restriction of the drinking regimen. To reduce vascular resistance and at the same time improve blood circulation, vasodilators and antiplatelet agents (Tiklid, Plavix) are prescribed. To enhance myocardial contractility, cardiac glycosides and cardiotonic drugs are prescribed.
The doctor prescribes all medicines individually for each patient. Therefore, it is important to understand that superficial self-therapy can only aggravate the clinical picture and not bring the desired result.
When is surgery needed?
If drug therapy does not alleviate the patient's condition, left ventricular heart failure only intensifies in its manifestations, surgical intervention is recommended. Currently, two types of operations are used in medical practice: cardiomyoplasty and implantation of a special device to improve blood circulation. Both options are life-threatening, so they are resorted to only in extreme cases. Moreover, the postoperative effect is noticeable only after 3-4 months after a long recovery period. Before going for such an operation, it is worth consulting with your doctor and comparing all its benefits and possibleshortcomings.
Complications
If a patient is diagnosed with left ventricular failure, he neglects his own he alth and delays treatment, there is a high probability of an early death.
Preventive measures
In the presence of diseases of the cardiovascular system of a chronic nature, regular monitoring by a cardiologist and strict adherence to all his prescriptions are shown. It is extremely important to minimize the influence of negative factors on the work of the whole organism. These include addictions (smoking, alcohol and drug use), psycho-emotional overload and frequent stress, as well as being overweight.
As a preventive measure for such a disease as acute left ventricular failure, the causes of which are often hidden in physical inactivity, dosed physical activity is recommended. This could be swimming, walking outdoors, skiing, going to the gym or yoga. Blood pressure should be constantly monitored. Particular attention must be paid to nutrition. The diet should be as balanced as possible, high in fiber. It is better to give up fatty and fried foods, as well as overly spicy foods.
Such simple preventive measures can not only prevent the development of such a pathology dangerous to he alth, but also improve the quality of life in general.
Conclusion
In this article, we talked about what constitutes a disease undercalled left ventricular failure. The reasons for the development of this pathology can be very different, starting with myocardial infarction and ending with the toxic effect on the body of drugs. Timely diagnosis and competent treatment can minimize the risk of complications, the most dangerous of which is death. Stay he althy!
