Acute heart failure

Description:

The Acute Heart Failure (AHF) — the clinical syndrome which is characterized by bystry emergence of the symptoms characteristic of the broken function of heart (reduced cordial emission, hypoperfusion of fabrics, supertension in capillaries of lungs, stagnation in fabrics). It develops without communication with existence of cardiological pathology in the past. Disturbances of heart can have character of systolic or diayostolichesky dysfunction, disturbances of a cordial rhythm, disturbances of preloading and afterload. These disturbances often have life-threatening character and demand holding the emergency actions. OSN can develop as an acute disease of de novo (that is at the patient without the heart dysfunction which was available earlier) or as an acute decompensation of chronic heart failure.

Symptoms of the Acute heart failure:

Complaints. At arrival of the patient shows Yozhaloby on asthma / suffocation, dry cough, a krovokharyokanye, fear of death. At edematization of lungs cough with the foamy phlegm which is often painted in pink color poyavyolyatsya. The patient accepts a forced sitting position.

At physical inspection it is necessary to pay special attention to a palpation and auscultation of heart with Yoopredeleny of quality of cordial tones, existence III and IV tones, existence and the nature of noise. At elderly patients it is necessary to define symptoms of peripheral atherosclerosis: uneven pulse, noise on carotid arteries and a ventral aorta. It is important to estimate systematically a condition of peripheral circulation, temperature of integuments, extent of filling of ventricles of heart. Pressure of filling of a right ventricle can be estimated by means of the venous pressure measured in an outside jugular or upper vena cava. Existence of wet rattles usually testifies to supertension of filling of a left ventricle at auscultation of lungs and/or signs of stagnation of blood in lungs at a thorax X-ray analysis.

ECG. At an acute heart failure of an ECG happens not changed extremely seldom. Definition of a rhythm, overload signs can help with identification of an etiology of OSN. Registration of an ECG at suspicion on an acute coronary syndrome has special value. Besides, on an ECG it is possible to reveal load of the left or right ventricle, auricles, signs of a perimiokardit and chronic diseases, such as a hypertrophy of ventricles or a dilatatsionny cardiomyopathy.
Killip classification

The stage of I — is not present symptoms of heart failure.
Stage of II — heart failure (wet rattles in the lower half of pulmonary fields, the III tone, symptoms of venous hypertensia in lungs).
Stage of III — heavy heart failure (an explicit fluid lungs; wet rattles extend more than to the lower half of pulmonary fields).
Stage of IV — cardiogenic shock (systolic the ABP less than 90 mm hg with signs of peripheral vasoconstriction: oliguria, cyanosis, perspiration).
OSN is characterized by a variety of clinical options:
— the fluid lungs (confirmed at a thorax X-ray analysis) — a heavy respiratory distress with wet rattles in lungs, an orthopnea and, as a rule, saturation of an arterial blood oxygen < 90 % до начала лечения;
— cardiogenic shock — the clinical syndrome which is characterized by hypoperfusion of fabrics because of heart failure which remains after correction of preloading. Concerning parameters of a hemodynamics there are no accurate definitions of this state. Arterial hypotonia is usually observed (systolic the ABP< 90 мм рт.ст. или снижение среднего АД на 30 мм рт.ст. и более) и/или снижение скорости диуреза (< 0,5 мл/кг/час), часто­та сердечных сокращений > 60 уд. / mines, existence of stagnation in fabrics is possible, but it is optional;
— acute dekompensirovanny heart failure (for the first time the arisen HSN decompensation) with characteristic complaints and symptoms of OSN of moderate degree of manifestation which do not correspond to criteria of cardiogenic shock, fluid lungs or hypertensive crisis;
— hypertensive OSN — OSN symptoms at patients with rather safe function of a left ventricle in combination with the high ABP and a X-ray pattern of venous stagnation in lungs or a fluid lungs;
— heart failure with high cordial emission — OSN symptoms at patients with high cordial emission, usually in combination with tachycardia (owing to arrhythmias, a thyrotoxicosis, anemia, Pedzhet's disease, iatrogenic and other reasons), warm integuments and extremities, stagnation in lungs and sometimes the low ABP (septic shock);
— right ventricular insufficiency — a syndrome of low cordial emission in combination with supertension in jugular veins, increase in a liver and arterial hypotension.

Reasons of the Acute heart failure:

The main reasons and factors promoting development of OSN:
1. Decompensation of chronic heart failure.
2. Ischemic heart disease aggravation (acute coronary syndrome):
— a myocardial infarction or unstable stenocardia with widespread ischemia of a myocardium;
— mechanical complications of an acute myocardial infarction;
— myocardial infarction of a right ventricle.
3. Hypertensive crisis.
4. Sharply arisen arrhythmia.
5. Sharply arisen valve regurgitation, aggravation of the previous valve regurgitation.
6. Heavy aortal stenosis.
7. Heavy acute myocarditis.
8. Cardiac tamponade.
9. Stratification of an aorta.
10. Puerperal cardiomyopathy.
11. Not cordial provocative factors:
— insufficient commitment to treatment;
— overload volume;
— infections, especially pneumonia and septicaemia;
— heavy stroke;
— extensive operation;
— renal failure;
— bronchial asthma;
— overdose of medicines;
— alcohol abuse;
— pheochromocytoma;
12. Syndromes of high cordial emission:
— septicaemia;
— thyrocardiac crisis;
— anemia;
— blood shunting.

Treatment of the Acute heart failure:

Before arrival of the doctor of the patient has to be in a semi-sitting position! As at the same time there is an outflow of "excess" blood in abdominal organs and the lower extremities. At the same time its intrathoracic volume decreases. And it can save human life.

It is also necessary to remember that nitroglycerine (or its analogs) also promotes reduction of tension of blood pressure in blood vessels. Therefore the patient should give (under language!) Tabulettae Nitroglycerini or one drop of its one-percentage solution (that is available in drugstores). In especially hard cases it is possible temporarily (before arrival of the doctor) to impose plaits on area of hips to exclude some volume of blood from circulation. Plaits should be imposed in 5 — 10 min. after the patient is transferred to semi-sitting (sedentary) position as moving of blood to lower parts of a body does not happen instantly. If you are able to enter medicine intravenously, at once enter 0,3 — 0,5 ml of 0,05% solution of strophanthin from 20 ml of normal sterile saline solution.