chronic heart failure
Introduction
Introduction to chronic heart failure The clinical manifestations of chronic heart failure are closely related to the lateral ventricular or atrial involvement, and clinical left heart failure is the most common. 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 feature of right heart failure is due to systemic venous stasis and blood circulation due to right atrium and/or right ventricular failure. Sodium and water retention, after the occurrence of left heart failure, the right heart often has functional damage, eventually leading to heart failure. basic knowledge The proportion of illness: 0.0025% Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: bronchitis pneumonia thrombosis lower extremity venous thrombosis pulmonary embolism hemoptysis pleural effusion atrial fibrillation cardiogenic shock sudden death heart failure cardiogenic cirrhosis ascites electrolyte disorder headache coma
Cause
Causes of chronic heart failure
Excessive preload (25%):
Excessive preloaded ventricular diastolic reflux, excessive blood volume, such as aortic valve or mitral regurgitation, ventricular septal defect, patent ductus arteriosus can cause left ventricular diastolic overload, leading to left heart failure; congenital Atrial septal defect can make the right ventricular diastolic overload, leading to right heart failure, anemia, hyperthyroidism and other high cardiac output diseases, due to increased blood flow, increased left and right ventricular diastolic load, resulting in Heart failure.
Afterload is too heavy (30%):
Excessive load such as hypertension, aortic stenosis or left ventricular outflow tract obstruction, resulting in increased left ventricular systolic load, can lead to left heart failure, pulmonary hypertension, right ventricular outflow tract obstruction, so that right ventricular systolic load is aggravated, Can cause right heart failure.
Myocardial contractility is reduced (15%):
Decreased myocardial contractility is common, such as myocardial ischemia or necrosis due to coronary atherosclerosis, various causes of myocarditis (viral, immune, toxic, bacterial), unexplained cardiomyopathy, severe Anemia, heart disease and hyperthyroidism, myocardial contractility can be significantly reduced, leading to heart failure.
Ventricular contraction disharmony and reduced ventricular compliance (15%):
Ventricular systolic disharmony Coronary heart disease Local severe myocardial ischemia leads to myocardial contraction weakness or contraction, such as ventricular aneurysm. Decreased ventricular compliance such as ventricular hypertrophy, hypertrophic cardiomyopathy, and reduced ventricular compliance may affect ventricular diastolic and affect cardiac function.
Second, the predisposing factors
(1) 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.
(2) Excessive physical labor or emotional excitement.
(C) arrhythmia, especially tachyarrhythmia, such as paroxysmal tachycardia, atrial fibrillation, etc., can increase the heart load, cardiac output decreased, leading to heart failure.
(D) pregnancy, childbirth, pregnant women, increased blood volume during pregnancy, due to uterine contraction during childbirth, the amount of blood return to the heart increased, coupled with the force of childbirth, all increase the heart load.
(5) Infusion (or transfusion too fast or excessive) The input of liquid or sodium is excessive, the blood volume suddenly increases, and the heart is overloaded to induce heart failure.
(6) Severe anemia or major bleeding causes myocardial ischemia and hypoxia, increased heart rate and increased cardiac load.
Prevention
Chronic heart failure prevention
There are three main aspects:
1 Actively prevent and treat various organic heart diseases.
2 to avoid various factors of heart failure, prevention and treatment of respiratory tract infections, rheumatic activities, avoid overwork, control arrhythmia, limit sodium salt, avoid the use of drugs that inhibit myocardial contractility, pre-pregnancy or early pregnancy should have cardiac dysfunction Birth control.
3 Active prevention and treatment of comorbidities affecting heart function, such as hyperthyroidism, anemia and renal insufficiency.
For patients with heart failure, the following precautions should be taken:
1, prevent colds
In the case of a cold season or sudden changes in the climate, patients should reduce their outings, wear masks and appropriate clothes when they go out, and patients should also be less crowded. If a respiratory infection occurs, it is very easy to make the disease worse.
2. Moderate activities
Do some physical activities within your power, but avoid too much activity, too much, and can not participate in more intense activities, so as to avoid sudden increase in heart failure.
3, diet should be light and less salt
Diet should be less greasy, more fruits and vegetables, for patients with heart failure, must control the intake of salt, excessive salt intake will increase the retention of body fluids, increase edema, but do not have to completely avoid salt.
4. Healthy lifestyle
Be sure to quit smoking, stop drinking, maintain a balance of mind, and not let the mood be too excited and fluctuating, but also ensure adequate sleep.
Complication
Chronic heart failure complications Complications bronchitis pneumonia thrombosis lower extremity venous thrombosis pulmonary embolism hemoptysis pleural effusion atrial fibrillation cardiogenic shock sudden cardiac failure cardiogenic cirrhosis ascites electrolyte disorder headache coma
Common complications and treatment for heart failure are as follows:
(1) Respiratory infection
More common, due to heart failure, lung sputum, easy to secondary bronchitis and pneumonia, if necessary, can be given antibiotics.
(2) thrombosis and embolism
Long-term bed rest can lead to venous thrombosis of the lower extremities, which can cause pulmonary embolism after detachment. The clinical manifestations of pulmonary embolism are closely related to the size of the embolus. Small pulmonary embolism can be asymptomatic. Large pulmonary embolism can manifest as sudden shortness of breath and chest pain. , palpitations, hemoptysis and blood pressure drop, pulmonary hypertension increased, right heart failure increased, the corresponding lungs showed dullness, respiratory sounds accompanied by wet rales, some patients have pleural friction or pleural effusion, sclera may have yellow stain , or a short-term atrial fibrillation episode, 12-36 hours after the onset or a few days after the emergence of a triangular or circular density darkening shadow in the lower lung field, huge pulmonary embolism can cause cardiogenic shock and sudden death within a few minutes, heart Failure with atrial fibrillation, prone to atrial thrombosis, embolism caused by brain, kidney, limb or mesenteric artery embolization.
Patients who have been in bed for a long time should pay attention to timely massage and limbs for passive activities to prevent thrombosis. For patients with embolism caused by embolization of the limbs, patients with mild disease can be treated with urokinase or streptokinase for thrombolytic therapy. Patients with severe limb ischemia should be treated. Surgical treatment.
(3) Cardiogenic cirrhosis
Due to long-term right heart failure, the liver has long-term congestion and hypoxia, hepatocyte atrophy and connective tissue hyperplasia in the central area of the lobules, portal hypertension in the late stage, manifested as massive ascites, spleen enlargement and cirrhosis, treatment: treatment by cardiac diuresis, ascites Still does not decline, a large number of ascites affect the cardiopulmonary function, feasible puncture appropriate amount of fluid.
(4) Electrolyte disturbance
Often occurs in the treatment of heart failure, especially after multiple or long-term use of diuretics, of which hypokalemia and salt-lowering hyponatremia syndrome are the most common.
1 hypokalemia is mild, the body may be weak, severe cases may have severe arrhythmia, often increase the toxicity of digitalis, must be promptly supplemented with potassium salt, mild oral potassium chloride 3-6g / day, heavy can be used potassium chloride 1-1.5 g is dissolved in 500 ml of 5% glucose solution, and repeated if necessary.
2 salt-loss low-sodium syndrome is caused by a large number of diuretic and limited sodium intake, mostly after a large number of diuretic, the incidence is more acute, weakness, muscle twitching, thirst and loss of appetite, etc. There are headaches, irritability, and even low-sodium encephalopathy such as coma. The patient's skin is dry, the pulse is fast, the urine volume is reduced, and even the blood pressure is lowered. The test: blood sodium, chloride, and carbon dioxide are low. Hematocrit is increased, treatment should not limit salt, and can be slowly instilled with 3% sodium chloride solution 100-500ml.
Symptom
Symptoms of chronic heart failure Common symptoms Difficulty breathing, sitting, breathing, hemoptysis, lethargy, heart failure, edema, exertional dyspnea, jugular vein anger, nausea
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 atrium and/or right ventricular failure, systemic venous stasis and sodium retention are caused.
First, left heart failure
(1) Difficulty breathing: It is the earliest and most common symptom of left heart failure, mainly including labor dyspnea, sitting breathing and nocturnal paroxysmal dyspnea, mainly caused by acute or chronic pulmonary blood stasis and decreased vital capacity. 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, have frequent coughs, and have severe breathing difficulties.
(2) Cough, cough, hemoptysis, caused by congestion of alveolar and bronchial mucosa, often occurs at night, cough can be relieved when sitting or standing, white serous foamy sputum is characteristic, if bronchial mucosa is formed If the dilated blood vessel ruptures, it can cause massive hemoptysis.
(3) Others: There may be fatigue, insomnia, palpitations, oliguria and symptoms of renal dysfunction.
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.
(B) jugular vein engorgement: is a more obvious sign of right heart failure.
(C) edema: heart failure edema is more common in the lower limbs, showing depression edema, severe cases can affect the whole body, lower extremity edema more than in the evening appears or aggravated, rest after a night can be reduced or disappeared.
(4) Purpura: There are many different degrees of purpura in patients with right heart failure.
(5) Neurological symptoms: may have nervousness, insomnia, lethargy and other symptoms.
(6) Cardiac signs: mainly for the original heart disease.
Third, heart failure
It is the heart failure caused by right heart failure secondary to left heart failure. When right heart failure occurs, the right heart discharge is reduced, so the symptoms of pulmonary congestion such as paroxysmal dyspnea are alleviated, and dilated cardiomyopathy Such as left and right ventricular dysfunction, lung congestion is often not very serious, left heart failure is mainly related to the symptoms and signs of cardiac output reduction.
Examine
Chronic heart failure examination
1, X-ray inspection
The size and shape of the heart shadow can be found, which provides an important reference for the diagnosis of the cause of heart disease. The degree of cardiac enlargement and dynamic changes can also reflect the state of cardiac function indirectly. If there is pulmonary congestion, the main manifestation is the enhancement of hilar angiography. The increase of upper pulmonary vascular shadow is similar to that of lower lung. Even more with the lower lung, the lower right pulmonary artery can be widened due to increased pulmonary artery pressure. Further interstitial pulmonary edema can blur the lung field. Kerley B line is in the lung field. The horizontal line shadow, which is clearly visible on the side, is the expression of effusion in the interval of the pulmonary lobule and is a characteristic manifestation of chronic pulmonary congestion.
2, echocardiography
More accurate than the X-ray to provide changes in heart chamber size and heart valve structure and function, can also estimate the heart's systolic and diastolic function, which is the most practical method for judging diastolic function.
3. Radionuclide inspection
To help determine the size of the ventricular cavity, the left ventricular maximum filling rate can also be calculated by recording the radioactivity-time curve to reflect the diastolic function.
Other examination methods include heart-lung oxygen exercise test and invasive hemodynamic examination.
Diagnosis
Diagnosis and diagnosis of chronic heart failure
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
First, the identification of heart asthma and bronchial asthma is more common in middle age, with signs of heart disease and heart enlargement, often at night, lungs can be dry, wet rales, effective for cardiotonic; and the latter is more common in teenagers , no history of heart disease and heart signs, often in the spring and autumn, a history of allergies, full of wheezing in the lungs, effective for ephedrine, adrenocortical hormone and ammonia tea.
Second, right heart failure and pericardial effusion, constrictive pericarditis, etc. can be found in three cases of hepatomegaly, ascites, but right heart failure is often accompanied by heart murmur or emphysema, enlarged heart during pericardial effusion The voiced sounds can change with the body position, the heart sounds are far away, there is no noise, there are strange veins; the constrictive pericarditis is not big or slightly big, no noise, there are strange veins.
Third, the clinical need for left heart failure, right heart failure and total heart failure as a differential diagnosis, the clinical manifestations of heart failure and the side of the ventricle or atrial involvement are closely related, the clinical features of left heart failure mainly due to the left atrium And/or right ventricular failure causes pulmonary phlegm and pulmonary edema; while clinical features of right heart failure are caused by systemic venous stasis and sodium retention due to right atrium and/or right ventricular failure.
