chronic cardiac insufficiency
Introduction
Introduction to chronic heart failure Chronic cardiac insufficiency, also known as "heart failure", is a complex syndrome caused by various organic or functional heart diseases that impair ventricular filling or ejection capacity, often due to infection, excessive Physical labor, emotional agitation, excessive sodium intake, arrhythmia, pregnancy and childbirth, excessive infusion, etc., cause the disease to be induced or aggravated, and even life-threatening. Because of its incurability, most patients need to be quite long. Survive with illness in the time. basic knowledge The proportion of illness: 0.0032% Susceptible people: no special people Mode of infection: non-infectious Complications: lower extremity venous thrombosis pulmonary embolism hemoptysis jaundice heart failure shock pulmonary edema respiratory infection bronchopneumonia
Cause
Chronic heart failure
Infection or anemia (35%):
Infection with viral sensation and pulmonary infection is a common cause of heart failure. In addition to infection, it can directly damage the myocardium. Fever increases the heart rate and increases the load on the heart. Severe anemia or major bleeding causes myocardial ischemia and hypoxia, increased heart rate, and increased cardiac load.
Arrhythmia (15%):
Arrhythmia, especially tachyarrhythmia, such as paroxysmal tachycardia, atrial fibrillation, etc., can increase cardiac load, reduce cardiac output, and lead to heart failure. Excessive physical labor or emotional excitement.
Pregnancy delivery or infusion (10%):
Pregnancy and childbirth Pregnant women's blood volume increased during pregnancy, due to uterine contraction during childbirth, the amount of blood return to the heart increased, coupled with the force of childbirth, all increased heart load. Infusion (or too fast or excessive blood transfusion), excessive input of liquid or sodium, sudden increase in blood volume, and excessive heart load can induce heart failure.
Prevention
Chronic heart failure prevention
[General care]
1, rest: according to the degree of heart function damage, heart function mutual level, patients should rest properly, to ensure sleep, pay attention to work and rest, heart function H, should increase rest, but can get up activities, heart function Ill level, Restrict activities, increase bed rest time, heart function level IV, absolute bed rest, in principle, limited to symptoms.
2, diet: high vitamins, low calorie, less salt, less oil, rich in potassium, magnesium and the right amount of cellulose foods, should be a small amount of meals to avoid irritating food, patients with oliguria should be based on blood potassium levels determine the food contains Potassium amount.
3, oxygen: according to the circulatory system disease care routine.
4, excretion: according to the circulatory system disease care routine.
5, skin and mouth: patients with severe edema, should be turned over regularly, keep the bed unit clean and dry, to prevent the occurrence of hemorrhoids, people with breathing difficulties prone to dry mouth and bad breath, should strengthen oral care.
6, psychological care: according to the system of disease care routine.
Complication
Chronic heart failure complications Complications lower extremity venous thrombosis pulmonary embolism hemoptysis jaundice heart failure shock pulmonary edema respiratory infection bronchopneumonia
Slow blood flow and prolonged bed rest can lead to venous thrombosis of the lower extremities, followed by pulmonary embolism and pulmonary infarction. At this time, there may be chest pain, hemoptysis, jaundice, increased heart failure and even shock. Left and right heart cavity wall thrombus can be respectively Causes body and pulmonary embolism; body arterial embolization can cause brain, kidney, spleen, mesenteric infarction and upper and lower limb necrosis, there is a patent for patent foramen ovale, and the embolus formed by systemic venous thrombosis may be worn after reaching the right atrium. The foramen ovale reaches the left atrium, and then enters the systemic circulation through the left ventricle, forming a so-called paradoxical embolism. Long-term bedridden patients, especially those with pulmonary edema, are prone to respiratory infections, especially bronchial pneumonia.
Symptom
Chronic heart failure symptoms Common symptoms Breathing difficulty Wheezing pleural effusion Heart failure effusion Ascites Hypermagnesemia Hepatomegaly Blood stasis Diastolic galloping
Clinical manifestation
The diagnosis of typical heart failure is not difficult. The diagnosis of left heart failure is based on the signs of the original heart disease and the manifestation of pulmonary circulatory congestion. The diagnosis of right heart failure is based on the signs of the original heart disease and the manifestations of systemic blood stasis. Most patients have a history of left heart failure, notable is the early diagnosis of heart failure, early heart failure patients can not be obvious symptoms, often free to move, work, labor, shortness of breath and paroxysmal nocturnal dyspnea is left Early symptoms of lateral heart failure, but often do not attract attention, and often overlooked due to lack of positive signs during daytime visits.
If you do not ask the medical history in detail, do not check carefully, do not find diastolic galloping and X-ray typical performance, easy to be missed diagnosis, jugular vein filling and hepatomegaly are early symptoms of right heart failure, easy to be ignored, such as general physical examination It is not easy to pay attention to the jugular vein. When the heart is exhausted, the hepatomegaly is mostly under the xiphoid process. It cannot be touched under the costal margin. Even if the hepatomegaly is found, it is often accompanied by shortness of breath, edema without considering heart failure, and not paying attention to checking the jugular vein regurgitation. Etc. Some symptoms and signs of heart failure are also seen in other diseases, so the shortness of breath, edema and hepatomegaly in heart disease patients are not necessarily caused by heart failure. For example, labor-induced shortness of breath can be caused by obstructive emphysema. Lung insufficiency, obesity or physical weakness, nighttime breathing difficulties can also be caused by bronchial asthma attacks, lung bottom wet rales can be caused by chronic bronchitis, bronchiectasis or pneumonia.
The wet rales caused by heart failure are mostly bilateral symmetry, occasionally on one side, or only wheezing, lower extremity edema can be caused by varicose veins, phlebitis, kidney or liver disease, lymphedema, etc. Sedentary or menstrual period, late pregnancy, women with unexplained lower extremity edema is not uncommon. In addition, heart failure can be caused by long-term bed fluid accumulation in the lumbosacral region without lower extremity edema, hepatomegaly can be caused by schistosomiasis, hepatitis, Caused by fatty liver, jugular vein filling can be caused by emphysema or mediastinal tumor compression of the superior vena cava, pleural effusion can be caused by pleural tuberculosis, tumor and infarction; ascites can also be caused by cirrhosis, hypoproteinemia, peritoneal tuberculosis, tumor.
Pathological change
Heart failure is often accompanied by heart enlargement, but heart failure can occur in normal-sized hearts, such as acute myocardial infarction. Heart enlargement can be masked when emphysema occurs; heart shift or pericardial effusion can be mistaken for heart enlargement, visible, In order to correctly diagnose heart failure and avoid missed diagnosis and misdiagnosis, detailed medical history, careful examination, and combined with the symptoms and signs of heart disease and heart failure should be comprehensively analyzed.
Examine
Chronic heart failure examination
According to typical symptoms and signs, it is generally not difficult to make a diagnosis. Other auxiliary examination methods are:
1. Physical examination: The respiratory rate often reaches 30 to 40 times per minute. During auscultation, the lungs are covered with wet voice and wheezing sound. The first heart sound of the apex is weakened, the frequency is fast, and the third heart sound of early diastole is formed. Coming horse, pulmonary heart valve second heart sound hyperthyroidism, blood pressure measurement can be found in patients with transient hypertension, if the disease does not ease, blood pressure can continue to decline until shock.
2, laboratory tests: including blood routine, urine routine, biochemistry, liver and kidney function and thyroid function test to understand its cause and incentives, plasma brain natriuretic peptide (BNP) from the ventricle, detection of plasma BNP, to determine acute dyspnea Whether the patient has heart failure has important value, and the diagnosis of heart failure can be ruled out when BNP is normal.
3, ECG examination: ECG can show the patient's performance of arrhythmia.
4, ECG examination: can show the size and shape of the heart shadow, according to the degree of heart expansion and dynamic changes can indirectly reflect the function of the heart, can also diagnose the presence or absence of pulmonary congestion, due to increased pulmonary artery pressure can be seen in the lower right pulmonary artery widening, further Interstitial pulmonary edema can blur the lung field. The Kerley B line is a horizontal line shadow clearly visible on the outside of the lung field. It is the expression of effusion in the interlobular septum and is a characteristic manifestation of chronic pulmonary congestion.
5, echocardiography: comparable X-ray examination to provide more accurate changes in the size of each heart chamber and heart valve structure and function, can also be used to estimate the heart's contraction and diastolic function.
Diagnosis
Diagnosis and diagnosis of chronic heart failure
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
The clinical manifestations of heart failure are closely related to the ventricular or atrial involvement. The clinical features of left heart failure are mainly due to pulmonary hemorrhage and pulmonary edema caused by left atrial and/or right ventricular failure. The clinical features of right heart failure are Due to right ventricular and/or right ventricular failure, systemic venous stasis and water and sodium retention, after the occurrence of left heart failure, the right heart often has functional damage, eventually leading to heart failure, right heart failure, left heart The symptoms of exhaustion can be alleviated.
First, left heart failure
(1) Dyspnea is the earliest and most common symptom of left heart failure, mainly caused by acute or chronic pulmonary blood stasis and decreased vital capacity. Lighter patients have difficulty breathing only during heavier physical labor, and disappear quickly after rest. Therefore, it is called labor dyspnea. Because labor promotes the increase of blood volume, when the right heart function is normal, it causes the lungs to become heavier. As the disease progresses, mild physical activity is difficult to breathe. I also feel difficulty breathing, so I am forced to take a semi-recumbent position or sitting position. This is called sitting breathing (forced breathing). Because of sitting position, the blood can be affected by gravity, and it accumulates in the lower part of the lower limb and the abdomen. Reduced when lying down, lung congestion reduced, while the diaphragm decreased when sitting, lung capacity increased, making breathing difficulties less.
Paroxysmal nocturnal dyspnea is a manifestation of left heart failure. Patients often wake up during sleep, have a feeling of suffocation, are forced to sit up, cough frequently, have severe breathing difficulties, and a few minutes after sitting up, symptoms It will disappear, severe cyanosis, cold sweat, lungs can hear wheezing, called heart asthma, severely develop into pulmonary edema, a lot of foamy bloody, both lungs covered with wet rales, Blood pressure can drop, even shock.
(2) Cough and hemoptysis are common symptoms of left heart failure. Due to the congestion of alveolar and bronchial mucosa, they often coexist with difficulty in breathing. The bloody foamy or bloody sputum.
(C) Others may have fatigue, insomnia, palpitations, etc., severe cerebral hypoxia may occur when Chen Yisi's breathing, lethargy, dizziness, loss of consciousness, convulsions, etc.
Second, right heart failure
(A) upper abdominal fullness is the early symptoms of right heart failure, often accompanied by loss of appetite, nausea, vomiting and upper abdominal pain, which is caused by liver, spleen and gastrointestinal congestion, liver congestion, swelling And there is tenderness, acute right heart failure, acute hematoma swelling in the liver, upper abdominal pain and sharpness, can be misdiagnosed as acute abdomen, long-term chronic liver congestion and hypoxia, can cause liver cell degeneration, necrosis, and finally develop into cardiogenic Liver cirrhosis, abnormal liver function or jaundice, if there is tricuspid regurgitation coexisting, palpation of the liver can feel dilated pulsation.
(B) jugular vein engorgement is a more obvious sign of right heart failure, its appearance is often earlier than subcutaneous edema or hepatomegaly, while the sublingual, arm and other superficial veins are abnormally filled, oppressing the enlarged liver The jugular vein engorgement is more obvious. This is called positive liver-jugular venous return.
(3) Edema In the early stage of right heart failure, due to the presence of sodium and water retention in the body, there is an increase in body weight before edema occurs. When the body fluid retention reaches more than five kilograms, edema occurs. Heart failure edema is first seen in the lower limbs. Patients often have lumbar, back and ankles and other low-lying parts, showing depression edema, severe cases can spread to the whole body, lower extremity edema is more frequent or aggravated in the evening, can be reduced or disappeared after a rest, often accompanied by nocturnal urine volume Increase, because the amount of blood returning during nighttime rest is less than during daytime activities, the heart can still pump the amount of blood returning from the venous, the residual blood volume at the end of ventricular systole is significantly reduced, and the increase in venous and capillary pressure is alleviated. Thus the edema is reduced or subsided.
A small number of patients may have pleural effusion and ascites. The pleural effusion can be seen in both the left and right thoracic cavities, but the right side is more, the reason is not clear. Because the parietal pleural venous return to the vena cava, the visceral pleural venous return to the pulmonary vein. Therefore, pleural effusion is more common in heart failure, most of the ascites occurs in the late stage, mostly due to cardiogenic cirrhosis.
(4) There are many different degrees of purpura in the right heart failure of the sable, the earliest seen in the fingertips, the lips and the auricle, which is more obvious than the left heart failure. The reason is that in addition to the hemoglobin in the blood, the blood is often incomplete in the lungs. The flow is slow, the tissue takes more oxygen from the capillaries and increases the amount of reduced hemoglobin in the blood (peripheral purpura), and the severe anemia is not obvious.
(5) Symptoms of the nervous system may have symptoms such as nervousness, insomnia, lethargy, etc. In severe cases, mental disorders may occur, which may be caused by cerebral congestion, hypoxia or electrolyte imbalance.
Third, heart failure
The clinical manifestations of left and right heart failure can be present at the same time, and the clinical manifestations of left or right heart failure can also be dominant.
