Clinical example of acute heart failure. Syndrome of acute heart failure. How to recognize the disease

AHF is traditionally understood as the occurrence of acute (cardiogenic) shortness of breath, accompanied by signs of pulmonary congestion (with possible pulmonary edema).
There are two types of AHF - left ventricular and right ventricular. Acute left ventricular heart failure has the greatest clinical significance.

Acute left ventricular heart failure

With this type of heart failure, there is a decrease in the pumping function of the left ventricle.

The reasons

The main reasons include:

1. Myocardial infarction.
2. Arterial hypertension.
3. Atherosclerotic cardiosclerosis.
4. Valvular heart disease.
5. diffuse myocarditis.
6. Paroxysmal arrhythmias.

Development mechanism. First, the fluid impregnates the walls of the alveoli and accumulates in the interstitial tissue of the lungs (the stage of interstitial edema), and then it appears in the lumen of the alveoli (the stage of alveolar edema).
There is a pronounced violation of gas exchange, increasing hypoxemia. It promotes the release of a large number of biologically active substances, such as histamine, serotonin, kinins, prostaglandins. This leads to an increase in vascular permeability, which creates conditions for the further progression of pulmonary edema.
Platelet aggregation increases, microatelectases develop, which reduce the respiratory surface of the lungs. Respiratory failure and hypoxemia contribute to the production of large amounts of adrenaline and norepinephrine. This leads to a further increase in capillary permeability and an increase in peripheral resistance. Increased afterload contributes to a decrease in cardiac output.

Clinical manifestations of acute heart failure syndrome

CARDIAC ASTHMA. The development of an attack can be facilitated by physical exertion or neuropsychic stress. Characteristic is an attack of suffocation, which develops more often at night.
The feeling of lack of air is accompanied by palpitations, sweating, a feeling of anxiety and fear. Shortness of breath is inspiratory in nature. Often worried about coughing with a small amount of light sputum, there may be streaks of blood in the sputum.
On examination - acrocyanosis, the skin is grayish-pale, covered with cold sweat. The patient, as a rule, takes a forced position, sitting with his legs down. In this position, part of the venous blood is deposited in the veins of the lower extremities, and thus its flow to the heart decreases.
Harsh breathing is heard in the lungs a large number of dry rales (due to secondary bronchospasm), in the lower sections there are moist fine bubbling rales. In the heart, auscultation determines the gallop rhythm, the accent of the second tone over the pulmonary artery. The pulse is frequent, weak filling, arrhythmia is possible. BP is often normal, but as asthma progresses, it may decrease. The number of breaths per minute reaches 30-40.
In case of progression of the disease and inadequacy of treatment, cardiac asthma can turn into alveolar edema, i.e. true pulmonary edema.

ALVEOLAR PULMONARY EDEMA. The condition of the patients is getting worse. Asphyxia increases, cyanosis increases, the respiratory rate reaches 40-60 per minute, swollen jugular veins, sweating are noted. A very characteristic symptom is gurgling breathing, which can be heard at a distance. Foamy sputum begins to come out with a cough Pink colour, its amount can reach 3-5 liters. This is because the protein, when combined with air, foams vigorously, as a result of which the volume of the transudate increases, which leads to a reduction in the respiratory surface of the lungs. During auscultation of the lungs, moist rales of various sizes are heard, first over the upper sections, and then over the entire surface of the lungs. Heart sounds are muffled, often a gallop rhythm, accent of the second tone over the pulmonary artery. The pulse is frequent, weak, arrhythmic. BP is usually low, but may be normal or high. The least favorable course of pulmonary edema against the background of low blood pressure. The picture of pulmonary edema usually increases within a few hours, but it can also be violent, and in some patients it acquires an undulating course.

Diagnostic criteria for acute heart failure syndrome

1. Inspiratory or mixed type suffocation.
2. Cough with light sputum in the stage of interstitial edema and with frothy sputum in the stage of alveolar edema.
3. Bubbling breath in the stage of alveolar edema.
4. Moist rales in the lungs.
5. Rg-logical signs of pulmonary edema.

Laboratory and instrumental research
Electrocardiographic study is the most accessible and quite informative method.
The ECG may show signs of myocardial infarction, post-infarction scar, rhythm and conduction disturbances.
Of the non-specific signs - a decrease in the amplitude of the "T" wave and the ST interval. In a hospital, patients undergo an Rg-logical examination of the lungs.

Stages of diagnostic search and differential diagnosis of acute heart failure syndrome

1. The basis of the diagnostic algorithm is to establish the fact of the presence of AHF syndrome based on clinical picture cardiac asthma or pulmonary edema.

2. The second possible stage of the diagnostic process may be taking into account the anamnestic data and physical examination in order to establish the cause of the development of the syndrome.

To do this, it is first necessary to establish whether an asthma attack is a manifestation of heart failure, since this symptom also occurs in diseases of the respiratory system.
An attack of cardiac asthma must first be differentiated from an attack bronchial asthma. This is especially important in cases where there is no anamnestic data on previous diseases.
The positive effect of treatment can also be used for the purpose of differential diagnosis.
An asthma attack with spontaneous pneumothorax occurs along with pain in the corresponding half of the chest. The examination reveals a tympanic percussion sound on the side of the lesion and a sharp weakening of breathing in the same place. Choking occurs with exudative pleurisy with a significant accumulation of fluid. The presence of fluid is recognized on the basis of a dull percussion sound, a sharp weakening of breathing and voice trembling.
Suffocation during obstruction of the respiratory tract by a foreign body is permanent, not amenable to drug therapy, accompanied by a strong cough.

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Laryngeal involvement can also cause acute choking in cases of subglottic laryngitis, edema, or foreign body aspiration. They are characterized by stridor or stenotic breathing (difficult noisy breathing).
If an asthma attack is accompanied by the appearance of frothy (sometimes pink) sputum, bubbling breathing, the presence of a large number of wet rales of various sizes, then there is a picture of true or alveolar pulmonary edema. Diseases that cause pulmonary edema are varied.

First of all it is:

• diseases of the cardiovascular system - cardiogenic (hydrostatic) pulmonary edema, associated primarily with impaired myocardial contractility;
• respiratory diseases;
• kidney failure;
• poisoning and intoxication (including inhalation of toxic fumes);
• severe infectious diseases;
• allergy;
• infusion hyperhydration;
• diseases of the central nervous system (brain injury, acute cerebrovascular accident).

In all cases, pulmonary edema leads to severe ARF associated with a violation of the permeability of the alveolar-capillary membrane, a decrease in gas diffusion and damage to the surfactant.

3. Additional research methods will help establish the final diagnosis.

Clinical criteria for major diseases

MYOCARDIAL INFARCTION. As a rule, it begins with a pain syndrome, however, there is also a painless variant with an asthma attack (asthmatic variant). Myocardial infarction should be suspected in any case of dyspnoea in an elderly person, taking into account risk factors. Decisive diagnostic value is attached to the ECG study.
Interpretation of ECG data can be difficult in cases of small focal and repeated heart attacks myocardium. Then the final diagnostic conclusion can be made in a hospital based on a comparison of clinical and laboratory data obtained during the dynamic examination of the patient.

ARTERIAL HYPERTENSION. An asthma attack in hypertensive patients may occur during a hypertensive crisis, usually in the form of cardiac asthma. In the case of recurrent attacks of cardiac asthma in patients with arterial hypertension, it is necessary to exclude the presence of pheochromocytoma.

CARDIOSCLEROSIS. Acute left ventricular failure develops more often in patients with atherosclerotic cardiosclerosis. These can be variants of postinfarction cardiosclerosis and a variant without a scar. Anamnestic data and ECG signs of a scar can indicate a past heart attack: an abnormal Q wave or QS.
In cases of atherosclerotic cardiosclerosis without a scar, the age of the patient, the presence of other signs of coronary artery disease (angina pectoris, rhythm disturbances), and risk factors should be taken into account.

VALVULAR HEART DEFECTS. Often complicated by attacks of cardiac asthma. This can be observed with aortic heart disease, more often with aortic stenosis.
The mechanism of development of left ventricular failure in these defects is associated with an overload of the left ventricular myocardium or volume (in aortic insufficiency) or pressure (in stenosis).
The cause of suffocation in them may also be pulmonary embolism as a result of stagnation in the systemic circulation. Most often, pulmonary edema develops in patients with mitral stenosis.

MYOCARDITIS. Asphyxiation is often one of the early signs severe diffuse myocarditis. An indication of the presence of an infection in the immediate anamnesis can be of great diagnostic value.
Patients with severe myocarditis, as a rule, have signs of both left and right ventricular failure. Auscultation of the heart can provide important diagnostic information: weakening of tones, especially the first one, gallop rhythm, various rhythm disturbances.

PAROXYSMAL RHYTHM DISORDERS. In many cases, they occur with symptoms of suffocation, and sometimes lead to pulmonary edema. A detailed presentation of the diagnosis of arrhythmias is presented in the "Arrhythmias" section, but here we will limit ourselves to only general remarks.
The occurrence of acute heart failure during paroxysmal tachycardia is determined primarily by the initial state of the myocardium, the duration of the attack and the heart rate. The likelihood of developing acute heart failure in patients with paroxysmal arrhythmias increases if they have valvular heart disease (especially mitral stenosis, atherosclerotic cardiosclerosis, thyrotoxicosis, WPW syndrome).
The most severe paroxysmal tachycardia occurs in children. In the elderly, acute heart failure against arrhythmia may be a manifestation of myocardial infarction. Paroxysmal arrhythmias in the elderly, in addition to acute heart failure, are complicated by transient disorders of cerebral circulation in the form of dizziness, visual impairment, and hemiparesis.

ACUTE RIGHT VENTRICULAR HEART FAILURE. The most common causes: thromboembolism of a large branch of the pulmonary artery, spontaneous pneumothorax.
In the study of the cardiovascular system, a weak frequent pulse, tachycardia, gallop rhythm are found. The liver is enlarged, painful on palpation. Rg-data are due to the underlying disease.

Paramedic tactics and emergency care for AHF syndrome

Paramedic tactics for AHF syndrome

1. Provide emergency care, taking into account the nosological form.
2. If a myocardial infarction is suspected, take an ECG and analyze the result.
3. Call " ambulance". Prior to the arrival of the ambulance, conduct dynamic monitoring of the patient, evaluate the results of the treatment and, if necessary, adjust it.

Emergency care for AHF syndrome
Patients with acute heart failure need emergency care medical care Therefore, professionally competent and clear actions of the paramedic largely determine the outcome of the disease.

1. The patient should be in a sitting position with lowered legs, which allows deposition of part of the blood in the veins of the lower extremities. The exception is patients with myocardial infarction and patients with low blood pressure, they are recommended a semi-sitting position. For the same purpose, the imposition of venous tourniquets can be recommended. Three tourniquets can be applied at the same time (leave one hand for IV injections). Transfer one of the tourniquets to the free limb every 15-20 minutes.

2. Drug therapy:

• Morphine intravenously fractionally (1 ml of a 1% solution diluted51 in 20 ml of a 0.9% sodium chloride solution and this dose is administered in 2-3 doses with an interval of 5-10 minutes). It reduces shortness of breath by suppressing the respiratory center, reduces preload, relieves anxiety and fear. Contraindications to its appointment are respiratory rhythm disturbances, cerebral pathology, convulsions, airway obstruction.
• Nitroglycerin 0.5 mg sublingually twice with an interval of 15-20 minutes. In severe cases, the drug can be administered intravenously drip-but in saline or 5% glucose solution under the control of blood pressure. The drug, being a venous vasodilator, reduces pre- and afterload on the heart. Contraindications to the appointment of the drug are low blood pressure, stroke, shock, severe anemia, toxic edema lungs.
• Lasix is ​​administered at an initial dose of 20-40 mg IV. The effect is evaluated by diuretic action and improvement clinical manifestations. The introduction of diuretics leads to a decrease in blood filling of the lungs, a decrease in pressure in the pulmonary artery and reduces the venous return of blood to the heart. Contraindications to the appointment of the drug are hypotension and hypovolemia.
• In patients with low blood pressure, dopamine is used, which is administered intravenously (250 mg of the drug is diluted in 500 ml of 5% glucose solution). The drug is contraindicated in thyrotoxicosis, pheochromocytoma, arrhythmias.
• Of the other means can be used: corticosteroids are used to reduce alveolar-capillary permeability. Their use is most justified in low blood pressure (for example, prednisolone 60-90 mg IV); in case of bronchial obstruction, inhalation of salbutamol 2.5 mg through a nebulizer. It is better to refuse the introduction of aminophylline because of the risk of developing arrhythmias and frequent side effects in the form of vomiting, tachycardia, excitation.

3. Oxygen therapy.

4. Defoaming. The use of defoamers has great importance in the treatment of pulmonary edema, since a large amount of foam in the alveoli reduces the respiratory surface of the lungs.

Indications for hospitalization
Acute heart failure requires mandatory hospitalization in the intensive care unit or cardioreanimation. The patient is transported in a semi-sitting or sitting position.

Subsequence emergency care with various hemodynamic variants of pulmonary edema

1. Sitting position with lowered legs.
2. The introduction of narcotic analgesics and (or) neuroleptics, taking into account contraindications.
3. The introduction of inotropic drugs and drugs that cause unloading of the pulmonary circulation.
4. The use of defoamers.

AHF can develop de novo, that is, in a person without a history of cardiac dysfunction, or as an acute decompensation of CHF.

Causes of OSN:

1) leading to a rapid increase in symptoms: acute coronary syndrome (myocardial infarction or unstable angina, leading to ischemia and dysfunction of a large area of ​​the myocardium, mechanical complications of acute coronary syndrome, right ventricular myocardial infarction), hypertensive crisis, cardiac arrhythmia and conduction, pulmonary thromboembolism arteries, cardiac tamponade, aortic dissection, peripartum cardiomyopathy, stress-induced cardiomyopathy (takotsubo), complications surgical interventions, tension pneumothorax;

2) leading to a slower increase in symptoms: infections (including myocarditis (except giant cell) and infective endocarditis), metabolic and hormonal disorders (for example, dysfunction thyroid gland, pheochromocytoma, ketoacidosis in diabetes mellitus), hyperhydration, high cardiac output syndrome (severe infection, especially sepsis, thyrotoxic crisis, anemia, arteriovenous fistulas, Paget's disease).

AHF usually develops as a result of pre-existing damage to the heart. It is possible to distinguish variants of AHF depending on the underlying cause or provoking factors, for example, AHF in acute pulmonary embolism, acute decompensation of CHF.

The most common cause, especially in the elderly ischemic disease hearts. In younger people, the following prevail: dilated cardiomyopathy, cardiac arrhythmias, congenital and acquired heart defects, myocarditis.

CLINICAL PICTURE AND NATURAL COURSE

1. Subjective and objective symptoms:

1) retrograde stagnation:

a) in the systemic circulation (right ventricular failure) - peripheral edema (edema of a doughy consistency around the bones or the sacral zone; may not have time to appear), jugular vein enlargement and palpation pain in the epigastrium (due to liver enlargement), sometimes - transudate in the serous cavities ( pleural, abdominal, pericardial);

b) in the pulmonary circulation (left ventricular failure → pulmonary edema) - shortness of breath, rapid breathing and shortness of breath in a sitting position, moist rales over the lung fields

2) decrease in cardiac output (peripheral hypoperfusion; rare, indicate a worse prognosis) - fatigue, feeling of weakness, amentia, drowsiness; skin pale, cold, moist, sometimes peripheral cyanosis, thready pulse, hypotension, oliguria;

3) the underlying disease that caused AHF.

According to the ESC recommendations (2016), it is recommended to use the classification of patients based on the so-called. hemodynamic profile. The presence or absence of stagnation (stagnation = wet profile vs no stagnation = dry profile) and peripheral hypoperfusion(peripheral hypoperfusion = cold profile vs correct peripheral perfusion = warm profile), primarily based on physical examination (sometimes additionally laboratory research), determines the diagnosis of 4 main profiles of patients and makes it possible to develop further tactics (→). Attention: hypoperfusion is not synonymous with hypotension - in most patients arterial pressure within the normal range or elevated.

Figure 2.19-2. Algorithm for the treatment of patients with acute heart failure, depending on the clinical picture at an early stage of the disease (based on the recommendations of ESC 2016, modified)

2.  OSN can proceed as:

1) exacerbation or decompensation of CHF- symptoms of stagnation of blood in the large and small circles of blood circulation;

2) pulmonary edema;

3) - subjective and objective symptoms of HF are accompanied by high blood pressure and, as a rule, preserved systolic function of the left ventricle, signs of increased sympathetic tone nervous system, with tachycardia and spasm of blood vessels; the patient may be in a state of normovolemia or only slight overhydration, objective symptoms of pulmonary edema often appear without symptoms of stagnation in the systemic circulation;

4) cardiogenic shock- tissue hypoperfusion due to AHF, typically systolic blood pressure<90 мм рт. ст. или снижение среднего артериального давления на >30 mmHg Art., anuria or oliguria, often - heart rhythm disturbances; symptoms of organ hypoperfusion and pulmonary edema develop rapidly;

5) isolated right ventricular heart failure - low ejection syndrome without pulmonary edema, increased pressure in the jugular veins with or without liver enlargement;

6) OSN in ACS.

Based on subjective and objective symptoms, as well as the results of additional studies.

Additional research methods

1. ECG: usually there are changes caused by the underlying heart disease, more often signs of myocardial ischemia, rhythm and conduction disturbances.

2 . chest RG: in addition to the symptoms of the underlying disease, it can reveal stagnation in the pulmonary circulation, fluid in the pleural cavities, and an increase in heart chambers.

3. Echocardiography: reveals functional disorders (systolic or diastolic dysfunction, valvular dysfunction) or anatomical changes in the heart (eg, mechanical complications of myocardial infarction).

4.  Chest ultrasound: allows visualization of interstitial pulmonary edema; Ultrasound of the abdominal cavity - is performed to measure the width of the inferior vena cava and assess ascites.

5. Laboratory research: mandatory - general analysis blood, concentrations of creatinine, urea, potassium and sodium, glucose, cardiac troponins, activity of liver enzymes in the blood, arterial blood gasometry (in patients with mild dyspnea, this can be replaced by pulse oximetry, except in cases of shock with very low cardiac output and peripheral vasospasm). Determination of brain natriuretic peptide (BNP/NT-proBNP) will help in the differential diagnosis of cardiac (increased concentration) and non-cardiac causes of dyspnoea; remember that in patients with rapidly increasing pulmonary edema or acute mitral regurgitation, peptide concentrations at the time of hospitalization may still be within the normal range. Determination of D-dimer - indicated in patients with suspected acute pulmonary embolism.

6. Endomyocardial biopsy: readings → .

Diagnostic tactics

It should be quickly (max. within 120 minutes) to establish whether AHF is a consequence of the disease, which requires specific actions: coronary angiography and possible. revascularization in case of ACS or cardiac surgery in case of myocardial rupture, aortic dissection, cardiac tumor or dysfunction of the native or artificial valve.

Differential Diagnosis

Causes of non-cardiogenic pulmonary edema → (signs that help distinguish non-cardiogenic pulmonary edema from cardiogenic →), acute respiratory failure, interstitial lung disease (acute) →.

General principles

1.  Hospitalization in the intensive care unit(general or cardiac) patients who have ≥1 of the following criteria:

1) the need for intubation;

2) SpO2<90 % несмотря на оксигенотерапию;

3) respiratory rate >25/min;

4) heart rate<40 или >130/min;

5) systolic blood pressure<90 мм рт. ст.;

2. Goals of emergency treatment: control of subjective symptoms, primarily shortness of breath, and stabilization of the hemodynamic state.

3.  The general scheme of therapeutic tactics for AHF, depending on the presence of symptoms of hypoperfusion and/or congestion → .

4. Etiotropic treatment: apply in every case.

5. Careful monitoring: respiration, heart rate, ECG and blood pressure. Perform the study regularly (eg, every 5-10 minutes), and in unstable patients - constantly, until the doses of the drug and the patient's condition stabilize. If there is no severe vasospasm and significant tachycardia, blood pressure measurements using non-invasive automatic devices are reliable. In AHF, monitoring of the rhythm and ST segment on the ECG is necessary, especially if it is caused by ACS or arrhythmia. For patients receiving oxygen, monitor SpO2 with a pulse oximeter (eg every hour), preferably continuously.

Occasionally, invasive hemodynamic monitoring may be needed, especially in situations where congestion and hypoperfusion coexist, as well as poor response to pharmacological treatment, as this helps in choosing the appropriate treatment; it can be done with:

1) a Swan-Gans catheter inserted into the pulmonary artery - to measure pressure in the superior vena cava, right atrium, right ventricle and pulmonary artery, wedge pressure in the capillaries of the lungs and determine cardiac output →, as well as oxygen saturation of mixed venous blood;

2) a catheter inserted into the central vein - to measure central venous pressure (CVP) and oxygen saturation of hemoglobin in venous blood (SvO2) in the superior vena cava or right atrium;

3) a catheter inserted into a peripheral artery (usually the radial one) for continuous measurement of blood pressure.

4. Algorithm of actions, depending on the clinical form of AHF

1) exacerbation or decompensation of CHF → vasodilators + loop diuretics (in patients with impaired renal function or long-term use of diuretics, consider using high doses of diuretics); inotropic drugs in case of hypotension and symptoms of organ hypoperfusion;

2) pulmonary edema → ;

Figure 2.19-3. Algorithm of actions for acute pulmonary edema (according to the recommendations of ESC 2016, modified)

3) AHF with high blood pressure→ vasodilators (careful monitoring is required); small doses of diuretics in patients with hyperhydration or pulmonary edema;

4) cardiogenic shock→ ;

5) isolated right ventricular heart failure→ maintain right ventricular preload; avoid, if possible, the use of vasodilators (opioids, nitrates, ACE inhibitors, ARBs) and diuretics; careful infusion of solutions can be effective (with careful monitoring of hemodynamic parameters), sometimes dopamine in a small dosage;

6) AHF that developed with ACS→ to determine the cause of AHF, perform echocardiography; in case of STEMI or NSTEMI → coronary angiography and endovascular intervention; in case of mechanical complications of fresh myocardial infarction → urgent cardiac surgery.

Pharmacological treatment

1. Vasodilators: mainly indicated in patients with symptoms of hypoperfusion and congestion, without hypotension; avoid in patients with systolic blood pressure<90 мм рт. ст. Уменьшают систолическое артериальное давление, давление наполнения левого и правого желудочков, а также периферическое сосудистое сопротивление; уменьшают одышку. Обязателен мониторинг артериального давления. Особенно осторожно назначайте пациентам с выраженным митральным или аортальным стенозом.

1) Nitroglycerin IV - initially 10–20 mcg/min, if necessary, increase by 5–10 mcg/min every 3–5 min to the maximum hemodynamically tolerated dose (max. 200 mcg/min); possibly PO or in an aerosol 400 micrograms every 5-10 minutes; tolerance develops after 24-48 hours at high doses, so use intermittently. If systolic blood pressure drops<90 мм рт. ст. → уменьшите дозу, а если давление продолжает снижаться - прекратите инфузию.

2) Sodium nitroprusside in / in - first 0.3 mcg / kg / min, up to max. 5 mcg/kg/min; recommended for patients with severe AHF in arterial hypertension and AHF due to mitral insufficiency. Do not use in AHF that develops in ACS, given the risk of a steal effect; with prolonged treatment, especially in patients with severe renal or hepatic insufficiency, symptoms of the toxic effects of its metabolites - thiocyanide and cyanide (abdominal pain, confusion, convulsions) may occur.

2. Diuretics: indicated mainly in patients with AHF with symptoms of overhydration - congestion in the pulmonary circulation or peripheral edema. In high doses, it can cause a transient deterioration in renal function. Diuretic treatment algorithm in patients with AHF → , LS → . When using diuretics: control diuresis (may require placement of a urinary catheter) and adjust dose based on clinical response; limit sodium intake, monitor serum creatinine, potassium and sodium every 1-2 days depending on diuresis, correct losses of potassium and magnesium.

Figure 2.19-4. Algorithm for the treatment of patients with AHF with diuretics (according to the recommendations of ESC 2008, modified)

3. Inotropic drugs: indicated mainly for AHF with peripheral hypoperfusion and hypotension (systolic pressure 90 mm Hg); do not use routinely if hypotension is due to hypovolemia or another reversible cause; monitor the ECG, given the high likelihood of tachycardia, ischemia of the heart muscle and rhythm disturbances. Preparations and dosage → .

4. Vasopressors: Use when persistent hypotension and hypoperfusion persist despite proper hydration. Preparations and dosage → .

Acute heart failure is one of the most severe circulatory disorders, a life-threatening condition that requires urgent treatment, hospitalization in an intensive care unit (department) and preferably in a hospital with the necessary diagnostic and therapeutic capabilities.

Acute heart failure is a complication of various diseases, consisting in circulatory disorders due to a decrease in the pumping function of the heart or a decrease in its filling with blood.

Of certain importance is the division of acute heart failure into systolic (inability to eject the required amount of blood from the ventricle) and diastolic (impossibility of full filling of the ventricles with blood), left-sided and right-sided.

Causes of acute heart failure

Acute heart failure can complicate many diseases or conditions; its causes and development mechanisms are different.

Among the reasons are the following: decompensation of chronic heart failure, acute myocardial infarction, mechanical complications of acute myocardial infarction (for example: rupture of the interventricular septum, rupture of the mitral valve chords, right ventricular infarction), right ventricular myocardial infarction, rapidly progressive arrhythmia or severe bradycardia, acute pulmonary embolism, hypertensive crisis, cardiac tamponade, aortic dissection, generic cardiomyopathy, obstruction of blood flow (narrowing of the aortic orifice and mitral orifice, hypertrophic cardiomyopathy, tumors, blood clots), valvular insufficiency (mitral or aortic), dilated cardiomyopathy, myocarditis, cardiac injury.

Non-cardiac reasons include: infections, especially pneumonia, sepsis, lack of adherence to treatment, volume overload, severe stroke, surgery and perioperative problems, kidney dysfunction, exacerbation of bronchial asthma, chronic obstructive pulmonary disease, anemia, drugs (non-steroidal anti-inflammatory drugs, corticosteroids, drug interactions), hypo- or hyperfunction of the thyroid gland, alcohol abuse and drugs.

Symptoms of acute heart failure

Symptoms are diverse and depend on the causes of the disease and on the degree of dysfunction of the left or right ventricles. Depending on the main symptoms, acute heart failure is divided into left ventricular and right ventricular failure, in some situations right and left ventricular failure (biventricular failure) may occur simultaneously.

Biventricular insufficiency occurs with myocardial infarction with damage to the right and left ventricles, with mechanical complications of acute myocardial infarction (rupture of the interventricular septum), myocarditis, etc.

Leading cause of acute left ventricular failure and is dysfunction of the myocardium of the left ventricle (myocardial infarction, hypertensive crisis, heart rhythm disturbance). The following symptoms are characteristic: increasing shortness of breath, aggravated in the prone position, up to suffocation. The extreme manifestation of acute left ventricular failure is cardiogenic shock.

Acute right heart failure occurs with pulmonary embolism, right ventricular myocardial infarction, cardiac tamponade, status asthmaticus. The main symptoms: swelling and increased pulsation of the cervical veins, edema, liver enlargement.

Given the above, the main signs of acute heart failure are: heavy, frequent breathing (more than 24 per minute), noisy breathing - shortness of breath up to suffocation. Explicit increase in shortness of breath and cough in a horizontal position. The sitting position and position with the raised headboard facilitate the patient's condition. When breathing, wet rales become audible, interrupted by coughing, and in the terminal stage, the appearance of foam from the mouth is noted. The posture of the patient resting with straight arms on his knees or sitting to facilitate breathing.

Heart failure can develop very quickly and lead to the death of the patient within 30-60 minutes.

First aid

When the above symptoms appear, you must:

call an ambulance,
put the patient in a sitting position
put your feet in heat (hot water bottle, a container of hot water),
measure blood pressure at a systolic pressure above 100 mm Hg give 1 tablet of nitroglycerin under the tongue or 1 inhalation under the tongue, if the patient's condition improves, repeat the intake of nitroglycerin after 10 minutes, then every 10 minutes until the ambulance arrives. If there is no effect, do not give nitroglycerin again,
try to calm the patient.

Diagnostics

Diagnosis begins with a survey to clarify possible causes, followed by an examination, where the doctor can note the presence of edema, swelling and pulsation of the jugular veins, pallor of the skin, palpation to reveal an enlarged liver, moisture of the skin, auscultation - wheezing in the lungs, rhythm disturbances, the appearance of additional tones and noises in the heart.

• clinical blood test (to determine the presence of inflammation, anemia),
• general urinalysis (to assess the condition of the kidneys).
• Biochemical blood test: urea, creatinine (to assess the functional state of the kidneys), transaminases (to assess the condition of the liver), potassium, sodium levels (to exclude electrolyte disturbances, to assess kidney function),
• blood sugar,
• troponin (to exclude damage to the heart muscle),
• D-dimer (for suspected pulmonary embolism),
• arterial blood gases (with severe heart failure),
• brain natriuretic peptide (pro-BNP, elevated in heart failure).
• Electrocardiogram (ECG) in 12 leads allows you to assess the heart rhythm, the presence of myocardial ischemia.
• Plain chest x-ray is performed to assess the size and boundaries of the heart, the severity of stagnation in the lungs.

• Echocardioscopy (ECHO-CS) is necessary to assess structural and functional changes in the heart (state of valves, heart muscle, pericardium, pulmonary artery diameter, pressure in the pulmonary artery, mechanical complications of myocardial infarction, heart tumors, etc.).

In some situations, it may be necessary to perform coronary angiography - a study of the vessels of the heart. If pulmonary embolism is suspected, helical computed tomography and lung scintigraphy are performed. Magnetic resonance imaging may be required to rule out a dissecting aortic aneurysm.

All patients are shown round-the-clock monitoring of blood pressure, pulse oximetry (determination of oxygen saturation of hemoglobin in the blood), ECG.

Treatment of acute heart failure

The main goal of treatment is to quickly stabilize the condition, reduce shortness of breath. The best treatment results are achieved in specialized emergency departments.

oxygen therapy(inhalation of humidified oxygen), in severe cases, respiratory support, artificial ventilation of the lungs may be required.

Medicinal treatment: morphine is indicated at an early stage of acute heart failure, especially in the presence of pain, excitation of the patient, nitropreparations begin to be given before the arrival of an ambulance, then continue intravenous administration. Depending on the severity, other drugs can be used at the initial stage: venous vasodilators (sodium nitroprusside, nesiritide), diuretics (loop, thiazide-like), intropic drugs improve heart muscle contraction (dobutamine), vasopressors (dopamine). Preparations for the prevention of thromboembolic complications (anticoagulants).

For some diseases underlying heart failure, it is necessary emergency surgery. Possible surgical methods include: myocardial revascularization, correction of anatomical heart defects (valve replacement and reconstruction), mechanical means of temporary circulatory support (intra-aortic balloon counterpulsation).

The next stage of treatment after stabilization of the condition includes the appointment of angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists. With a decrease in the contractility of the heart, digoxin is prescribed (with an ejection fraction according to ECHO-CS less than 40%).

Before discharge, it must be ensured that the acute period of heart failure has resolved, a stable diuretic regimen has been established for at least 48 hours.

The average length of stay in the hospital is 10-14 days. Continue treatment (including beta-blockers, ACE inhibitors or angiotensin receptor blockers, mineralocorticoid antagonists) on an outpatient basis. After discharge from the hospital, patients are observed by a cardiologist at the place of residence. Timely correction of therapy, dynamic ECG, ECHO-CS, as well as monitoring of laboratory parameters (electrolytes, creatinine, pro-BNP) help to reduce the number of hospitalizations of the patient and improve the quality of life of the patient.

Also, the doctor will give specific recommendations on the diet, the level of physical activity, explain the need for taking medications, pointing out possible side effects, and note the conditions, the appearance of which should alert the patient.

Nutrition: Fluid restriction to 1.5–2 L/day to reduce symptoms and fluid retention. Fluid restriction by weight (30 ml/kg body weight, 35 ml/kg over 85 kg body weight) may reduce thirst, monitor and prevent malnutrition.

Eating healthy food: restriction of animal fats in favor of eating poultry, fish (preferably sea), but not more than 2 times a week, fresh vegetables, fruits, herbs, seafood; refusal of fried foods, give preference to stewed and steamed foods, if necessary, limit salt to 1 g per day.

Be sure to control your weight. If you gain more than 2 kg in 3 days, consult a doctor.

Smoking and drug abstinence is mandatory, and modest alcohol consumption is possible (complete abstinence is recommended in patients with alcoholic cardiomyopathy). In other cases, the following rule may apply: 2 units of alcohol per day for men and 1 unit per day for women (1 unit = 10 ml of pure alcohol, e.g. 1 glass of wine).

Required daily physical activity, aerobic physical activity 30 minutes a day according to the state (walks in the fresh air, Nordic walking).

Implement immunization against influenza viruses and pneumococcal infections, since any viral or bacterial infections can lead to a worsening of the condition.

While traveling, monitor and adjust fluid intake, in particular during flights and in hot climates. Watch out for adverse reactions from sun exposure when taking certain medications (eg, amiodarone).

Possible Complications

Acute heart failure itself is a complication of many diseases and conditions. However, in the process of treating heart failure directly, severe rhythm and conduction disturbances, thromboembolic complications, progression of the disease up to the most severe forms (cardiogenic shock, pulmonary edema), and sudden cardiac death can occur.

Forecast

The prognosis of heart failure is always determined by the disease that caused it to develop. Heart failure is always unfavorable prognostically. Within one year, 17% of hospitalized and 7% of outpatients with heart failure die. In 30-50% of cases, patients die suddenly from severe arrhythmias.

Summing up, I would like to note the particular importance of regular intake of recommended medications at the outpatient stage, maintaining a healthy lifestyle. Remember that the strict implementation of the doctor's recommendations will help to avoid repeated hospitalizations and improve the patient's quality of life.

Cardiologist Chuguntseva M.A.

K ardial structures perform the most important function - pumping blood, ensuring adequate gas exchange and tissue trophism. Outside the normal functional activity of a muscular organ, there is no question of health and an adequate state of the body.

Acute heart failure is a sudden disruption of the heart with a weakening of the activity of the ventricles and the inability to provide organs and systems with blood.

Unlike the chronic variety, this one is characterized by a momentary deviation, the body works at about a third of its own capabilities. Hence ischemia (oxygen starvation) of both the myocardium itself and cerebral structures (the brain), and other systems.

Violation of ventricular contractility leads to death in 50-70% of recorded clinical situations. To restore vital activity, the help of several specialists at once, both a specialized one and a resuscitator, is required.

We are talking about an emergency, because as soon as symptoms appear, you need to call an ambulance.

Even in the case of spontaneous stabilization of the condition, there is a high risk of severe consequences of a disabling kind: coronary artery disease, chronicity of the process. This is already a direct path to a delayed death.

The essence of the pathological process is a violation of the contractility of cardiac structures. In the course of development, there is a deviation in the work of the ventricles. There are two in total.

The left pumps blood in a large circle. It is responsible for providing the whole body with oxygen and nutrients.

The right one functions weaker, transports liquid connective tissue in a small way. Basically, gas exchange is provided in the lung structures.

As part of acute heart failure, the contractility of the tissues of the cardiac structures decreases. Hence the impossibility of adequate nutrition of the body.

The reasons for this are different: hormonal failure, a jump in blood pressure within critical limits, the abuse of coffee or narcotic substances (the "street" heroin is especially dangerous).

The development of the process is accompanied by generalized hypoxia and a host of symptoms from organs and systems.

Classification

It is possible to typify the pathological process on the main basis. This is the localization of the pathogenic phenomenon. Accordingly, they speak of such forms:

• Acute left ventricular heart failure. The most common type of condition. Occurs in 60-70% of clinical situations. Accompanied by a pronounced clinical picture.

All tissues, including the brain and the heart itself, receive less oxygen and nutrients.

The heart suffers first of all, everything can end with a myocardial infarction and an early death.

Recovery in case of timely assistance is probably important to skip the moment. The rehabilitation period lasts from 6 to 12 months, lifelong maintenance therapy is required.

• Acute right ventricular failure. Less common. It is determined in 20-30% of situations.

Accompanied by pulmonary abnormalities, gas exchange is disturbed to a lesser extent. Help is just as urgent, mortality is somewhat lower.

If, against the background of left ventricular failure, death occurs in approximately 30% of situations, this process ends fatally in 15% of cases.

• Bilateral process. He is biventricular. Relatively rare occurrence. The frequency is approximately 10% of all recorded episodes.

There are generalized violations of all organs and systems, without the possibility of recovery.

Lethality is maximum. According to medical reports. The probability of death is approximately 95%. Resuscitation measures will not have an effect.

Causes of acute left ventricular failure

Factors in the development of a pathogenic process of this kind are diverse. Basically, these are cardial moments (in about 98% of situations).

Among the possible pathologies:

• Surgical interventions of a traumatic kind. Even an intervention for appendicitis, under certain conditions, can have a negative impact. Usually the process is iatrogenic in nature. Incorrect anesthesia, excessive intensive operation area.
• Burns of a large surface of the body. Cause acute disturbances of the heart. It is the main cause of death in combustiology patients. Restoration presents great difficulties, if not complete impossibility.
• Major stroke. Usually hemorrhagic. Acute violation of cerebral circulation against the background of the death of a large number of functionally active cells of neurons.

The regulation of contractility of cardiac structures is usually disturbed. Especially often this is observed with.

Stroke prevention is the main method of preventing heart failure of the neurogenic type.

• Pathology of the thyroid gland. Severe thyrotoxicosis affects, that is, excessive production of hormones of the corresponding organ (hyperthyroidism). The symptom complex is maximal, it is very problematic not to notice the phenomenon. Treatment under the supervision of an endocrinologist.

• Problems with the adrenal glands. Pheochromocytoma, tumors of the pituitary gland and the paired organs themselves cause an increase in blood pressure and disrupt the normal heart rate.

Chaotic signals do not allow cardiac structures to work adequately. Treatment is surgical, radical.

A frequent clinical variant is hypercortisolism, accompanied by secondary Itsenko-Cushing's disease.

This is a dangerous, serious condition, potentially fatal. The quality of life is declining: destruction of bones and the musculoskeletal system, obesity, hallucinatory syndromes, these are just some of the possible manifestations.

• Anemia of any kind. Iron deficiency, megaloblastic, other varieties. Usually a long-term decrease in the concentration of hemoglobin in the blood.

Left untreated, it leads to cardiac dysfunction. Recovery is carried out under the supervision of a specialized doctor.

To eliminate problems, you need to normalize the work of the hematopoietic system. This can be done only by complex methods: medicines + vitamins and diet.

• Neoplastic processes of a malignant kind. Tumors with metastases provoke a generalized disruption of the whole body. The body is poisoned, general intoxication occurs. Palliative care, it is impossible to radically influence the condition.
• Acute intoxication. Alcoholic, narcotic, poisoning with salts of heavy metals, drugs, other substances. As part of the therapy, urgent detoxification is carried out, infusion of nutrient solutions parenterally.
• Liver failure. As part of long-term hepatitis or cirrhosis of the liver. Therapeutic measures under the supervision of a gastroenterologist or a specialized doctor.
• renal dysfunction. It leads to a violation of the synthesis of prehormones and urine filtration.
• . Acute myocardial dysfunction. Contractility drops, blood circulation is weakened.

• Traumatic lesions of the heart. Including bruises.
• Chronic insufficiency in the phase of decompensation. You should not bring it to this point, you need to contact a cardiologist at the stage of the appearance of the first symptoms.
• Congenital and acquired heart defects. For example . They do not manifest themselves in any way, even insufficiency occurs quietly, without pronounced signs.

• . From the first time, this occurs early, more often there is a dangerous relapse.
• Inflammatory lesions of the myocardium. Infectious or autoimmune. Myocarditis, pericarditis.

• Heart attack. Acute malnutrition of the heart muscle. The extensiveness of the lesion directly causes dysfunctional disorders. Also, a relapse of the pathological condition is manifested in a similar way.

• Arrhythmic processes of various kinds. , .

Causes of acute right ventricular heart failure

This type develops somewhat less frequently. Formation factors:

• Severe bronchial asthma in the phase of decompensation. Difficult to correct.
• Thromboembolism. Blockage of blood vessels with blood clots.
• Myocardial infarction.
• Pneumonia. Especially bilateral.
• Chest injury.
• Pleurisy.

The reasons are very similar. You need to understand quickly, because there is no time for a full study. Help is urgent. In the intensive care unit.

Symptoms

Manifestations of the process develop rapidly, within 5 minutes - 2 hours. In extremely rare cases, a gradual increase in symptoms is possible, this gives some time to think. In any case, you need to act quickly.

Left ventricular heart failure

Acute cardiovascular failure of the left ventricle is manifested by three syndromes: asthma, cardiogenic shock, or pulmonary edema.

Among the highlights:

• Shortness of breath of an intense nature. In a state of complete rest, the patient cannot take in air. A threatening condition arises, fraught with a fatal outcome in itself.
• Panic attack. The patient becomes anxious, fearful. Motor activity increases, which can aggravate the course of the condition.
• Sitting position of the body without the ability to lie down. It immediately gets worse.
• The fall in blood pressure over a wide range. Against the background of cardiogenic shock - critical, about 70 to 50 or so. This phenomenon is stopped primarily by drugs based on adrenaline.
• Paleness of the skin.
• Hyperhidrosis or excessive sweating.
• Cyanosis of the nasolabial triangle. Blueing of the fingers, toes, dermal layer.
• Rattling in lung structures. They are heard even without special equipment.
• Dry or wet cough with a small amount of sputum.
• Clouding of consciousness on the background of cardiogenic shock. Occurs in a short time. It is difficult to bring the patient out of syncope. A coma is possible, it is not difficult to confuse it with fainting.
• Dysuria. Complete absence of urination.

Usually, the symptoms of acute heart failure of the left-sided plan are found in the system. Everything at once. Removing them is very difficult.

Right ventricular heart failure

The main phenomena of this type of deviation are associated with stagnation of blood in the system. Signs of acute heart failure of the right ventricle are as follows:

• Weak shortness of breath. It does not reach critical values ​​when the frequency of movements reaches more than 25 per minute.
• Blueness of the skin.
• Pain in the right side against the background of liver damage. Especially if the process takes a long time.
• Discomfort in the chest. Pressing, pulling sensations, burning.
• Tachycardia, but other types of arrhythmia are possible.
• Swelling of the neck veins.

Symptoms of right-sided acute insufficiency are stopped in intensive care, which gives better prognosis. The survival rate reaches 50-70% in case of timely hospitalization.

First aid algorithm

Regardless of qualifications, you need to call an ambulance. Very little can be done at home; a specially equipped hospital is required.

An example scheme of events is as follows:

• Plant the patient, put a pillow under the back, you can several, create a semblance of a roller. It is important to have support. The limbs are lowered to ensure normal peripheral circulation. On the other hand, the normal nutrition of the myocardium will be restored, which will reduce the risks of a massive heart attack.
• Remove tight body jewelry, loosen the collar of a shirt or other clothing.
• Provide fresh air to the room. Open a window or window.
• Measure blood pressure and heart rate. Any deviations should be reported to the doctor. Trying to bring down the indicators on your own does not make sense, because it will only get worse.
• If there are symptoms of pulmonary edema, give the patient a breath of ethyl alcohol. Regular vodka will do. The properties of alcohol will slow down the progression of the pathological process.

In the future, you need to calm the anxious patient. Nothing more can be done until the doctors arrive.

Attention:

At the prehospital stage, drugs cannot be given, a sharp aggravation of the condition and death is possible.

Diagnostics

Patients are managed by cardiologists with emergency doctors as part of resuscitation. There is very little time for examination, every minute counts. However, a minimum of activities should be carried out. But first, partially stabilize the patient's condition.

Approximate list of actions:

• Electrocardiography. profile technique. It is aimed at identifying functional disorders of the heart. Even the smallest deviations will be noticeable. Given the severity of the condition, arrhythmia is not difficult to detect, including for an inexperienced doctor.
• Echocardiography. Ultrasonic method for assessing the state of cardiac structures. Shows organic disorders of the organ. As part of an urgent diagnosis, it is carried out first of all, along with an ECG.
• Chest X-ray.
• Determination of oxygen saturation. Against the background of acute heart failure, the indicator will drop sharply. Normally, it is 97% or more.
• Urgent general blood test.

Data for organic pathology is always available. But eliminating the root cause is a secondary task. The main thing is to stabilize the state. Then you can resort to more in-depth diagnostics.

Indicative list of activities:

• MRI / CT of the heart and cardiac structures, the brain as needed, the adrenal glands.
• Angiography.
• Measurement of blood flow velocity using ultrasound technique.
• Scintigraphy. Radioisotope research.

It is possible to carry out invasive diagnostic methods. A set of measures is determined by doctors, based on the proposed pathological process. Load tests are never performed. This is fraught with cardiac arrest and death.

Urgent treatment

The therapy is strictly medical, in most cases surgical care does not make sense, at least at the first stage. There is no talk of an operation until the condition stabilizes.

An example curation scheme is as follows:

• Pain relief and relief of panic attack, anxiety disorder. Pentalgin, Dimedrol is used. As part of the intensive syndrome, the use of narcotic drugs is possible: Promedol, Morphine. This is an extreme measure, the condition can get worse. Accurate dosing is important.
• Restoration of cardiac activity, including ventricular contractility. Dopamine. Stimulates cardiac activity. . Mostly Digoxin and its analogues. Arterial pressure does not change with the use of these drugs, however, it is strictly forbidden to use them with a proven heart attack, a fatal outcome is likely.
• Adequate unloading of the heart. It is necessary to restore normal blood flow and ensure the activity of cardiac structures at least at the minimum acceptable level. Urgent diuretics like Furasemide, (Inderal or Carvedilol), organic nitrates. It is possible to use medicines based on phenobarbital (), as well as tranquilizers (Diazepam and analogues).

These are the main directions of urgent treatment aimed at restoring and stabilizing cardiac activity.

Maintenance therapy

As part of maintenance therapy, the following medications are indicated:

• Corticosteroids intravenously. Prednisolone or Dexamethasone. In limited quantities, no more than 3-4 weeks.
• Bronchodilators (Eufillin and others).
• Angioprotectors.
• Antithrombotic drugs. Restore the rheological properties of blood. Aspirin Cardio is suitable, it is better in this modification. The classic form of acetylsalicylic acid has many side effects.

Possible consequences

Possible complications are clear and without explanation. The most common options:

• . Critical drop in blood pressure values, as well as myocardial contractility. Recovery is almost impossible, medical care rarely has an effect.

Lethality approaches 100%. Even if the patient gets out of the emergency, there is a high probability of death in the next 2-3 years, perhaps less.

Such patients should be kept under close dynamic observation. Every 3 months you should visit a cardiologist.

• Pulmonary edema. As a result of violation of gas exchange and venous outflow. Fluid accumulates in the structures of the respiratory tract. Blood circulation weakens, the phenomena of intoxication of the body increase. Probable asphyxia with complete impossibility of pulmonary activity.
• Myocardial infarction. Acute circulatory disorders in the cardiac structures. A common occurrence against the background of long-term or acute heart failure. This complication dramatically increases the lethality of the underlying process, by about 30-40%.

• Stroke. Similar phenomenon. Accompanied by malnutrition of cerebral structures and extensive death of neurons.

Lethal outcome is crowned with heart failure. This is the most likely outcome without competent help.

Predictive estimates

Predictions are difficult to determine. There are a lot of things to take into account.

Unfavorable factors:

• Significant age of the patient (50+).
• The presence of arterial hypertension in history, other somatic cardiac problems.
• Pathologies of the endocrine or nervous system.
• Strokes or heart attacks in the past.
• Poor response to urgent hospital treatment.
• No effect of therapy.
• process relapse.

Reverse signs are associated with a more or less normal prognosis. More specifically, the median survival of patients is 3-5 years.

Without medical assistance, we are talking about 95% mortality in the same perspective or less. Short-term phenomena, such as pathology on the background of burns, pulmonary insufficiency, are eliminated more easily, if there are no concomitant complications, the prognosis is good.

Life expectancy is not limited by the disease.

Attention:

No one will predict the outcome in advance. To do this, you need to study the anamnesis and medical history, look at the effectiveness of therapy and the general condition of the patient.

Finally

The acute form of heart failure is a significant decrease in the intensity of blood output.

Recovery is unlikely, except in rare cases. Only 10-15% of patients can get out of the state without serious consequences. The rest become disabled and take drugs constantly. It is also possible and even likely to be fatal.

Acute heart failure is a whole complex of symptoms characteristic of a violation of the main function of the heart - maintaining normal blood flow in the body.

We are talking about a general heart rhythm disorder caused by a deterioration in pumping function, myocardial function, sinusoidal signal transmission (it is responsible for the moment and period of contraction of each section of the heart muscle) and.

With all this, this disorder carries a threat to human life. What principles of treatment of acute heart failure are used in modern medicine? Is it possible to completely get rid of heart failure?

Therapy used in acute heart failure can be divided into two categories: diagnosis and, directly, treatment. And it is the diagnosis that takes most of the time. Heart failure is not a disease, but already a conclusion on the patient's condition, indicating that his heart is functioning with multiple failures.

And the main task of doctors is to establish what is wrong with the heart muscle. Because of what it does not work correctly or does not maintain normal blood flow in the body? Based on the data obtained, therapy and medication are prescribed.

What does diagnostics include? The patient should go through:

• initial examination by a doctor;
• analysis of the anamnesis of life;
• (electrocardiography);
• general blood tests, urine, feces;
• blood chemistry;
• biomarker analysis;
• MSCT (multispiral computed tomography);
• MRI of the heart muscle.

And the above is only a basic set of tests through which the patient needs to go. At the request of the cardiologist, additional ones are prescribed, aimed at identifying the concentration of BNP-peptides, cholesterol, proteins, sugar, and so on.

In fact, doctors are looking for any possible factors that negatively affect the heart muscle, which causes acute failure.

Based on the diagnosis, the following factors for the development of AHF are established:

• cardiogenic shock- develops against the background of a decrease in systolic blood pressure to a critical level of 90 mm. rt. pillar. Because of this, the perfusion of soft tissues and organs, the so-called "cardiac output" is disturbed;
• - insufficiency develops against the background of respiratory perturbation. When diagnosing, too low an oxygen concentration in the blood is detected, which provokes shortness of breath;
• hypertensive crisis- too high blood pressure, because of which the heart muscle is in constant tension. May provoke or complication in the form;
• acute decompensation- means that AHF does not correspond to the above violations in the work of the cardiovascular system. Most often it turns out that the “culprit” is neuralgia and incorrect transmission of signals towards the heart.

Quite often, acute heart failure is combined with several symptoms and factors of its occurrence. MRI and ECG with the analysis of the resulting graph helps to establish this exactly.

Used drugs

The set of drugs prescribed to the patient in determining AHF is purely individual. It depends solely on the violations found in the work of the cardiovascular system, as well as the likelihood of additional complications. The standard list for therapy includes:

Quite often, doctors prescribe those groups of drugs that do not belong to the above.

In fact, this is a symptomatic treatment that in no way eliminates acute heart failure, but makes it easier for the patient to endure the course of the disorder in the work of the heart muscle.

Tactics for the treatment of individual manifestations of AHF

With swelling of the lungs, the main task is to normalize the pressure in the vessels, thereby accelerating the permeability of the blood and oxygen saturation of the blood. For the most part, phosphodiesterase inhibitors are used for this., and in addition to this patient is recommended to carry out the so-called cardio training (under the supervision of the attending physician).

The main task of doctors is to quickly reduce pressure and prevent hypoxia. The latter is achieved by taking diuretics. In critical situations, use morphine- it almost instantly reduces pressure by increasing vagal tone and capillary patency.

With cardiological shock and hypertension, against which heart failure develops, the primary task is to normalize blood pressure and regulate the pumping function of the heart muscle.

The latter is performed by taking inhibitors of potassium synthesis and nitric oxide., and pressure adjustment is performed with diuretics or the same nitroglycerin (taken only if necessary).

If the conduction of the heart muscle is disturbed or the sinusoidal impulse (signal) is partially absent, the myocardial reaction is stimulated. For this, pressor amines are used, as well as a specialized diet, weight optimization.

That is why patients with suspected AHF fried, fatty, peppery, salty, foods containing cholesterol are strictly prohibited and so on. But for quick elimination, Digoxin is used in a therapeutic dosage (it is 1.5 times higher than the recommended one). But this drug should be taken with extreme caution!

And against the background of any disorders in the work of the cardiovascular system doctors will regulate the concentration of magnesium, calcium, nitrate oxide in the blood. For this, classic antiarrhythmics and a consultation with a nutritionist are prescribed.

It is worth considering that acute heart failure is not curable in most cases. In fact, it can only be transferred to a state of remission. The rest of the time you will have to maintain general therapy and take prescribed medications.

Otherwise, the patient should prepare for a deterioration in health and an increase in the likelihood of a heart attack,. The heart muscle, unlike other soft tissues, recovers at an extremely slow pace., especially in people of retirement age (namely, they have AHF most often occurs).

Watch a video about a new method of treating heart failure: