acute cardiac insufficiency
Introduction
Introduction to acute cardiac insufficiency Acute heart failure is also called acute heart failure, the most common is acute pulmonary edema caused by acute left heart failure. Cardiac dysfunction is defined as a cardiac dysfunction caused by different causes, and the development of cardiac output can not meet the needs of systemic metabolism for blood flow when circulating blood volume and vasomotor function are normal, resulting in blood flow. A clinical syndrome characterized by both dysmotility and activation of the neurohormonal system. Central valvular disease, coronary atherosclerosis, hypertension, endocrine disorders, bacterial toxins, acute pulmonary infarction, emphysema or other chronic lung disorders can cause heart failure and heart failure. Pregnancy, fatigue, rapid intravenous rehydration, etc. can aggravate the burden of the diseased heart and induce myocardial failure. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: pulmonary edema atrial fibrillation atrial fibrillation cardiac arrest and cardiopulmonary resuscitation
Cause
Cause of acute cardiac insufficiency
Mechanical obstruction (20%):
Caused by increased cardiac resistance load, obstruction of blood discharge, such as severe valvular stenosis, ventricular outflow obstruction, intracardiac valvular thrombosis or myxonal incarceration, total arterial trunk or large branch embolization.
Increased cardiac capacity load (20%):
Such as trauma, acute myocardial infarction or infective endocarditis caused by valvular damage, chordae rupture, ventricular papillary muscle dysfunction, septal perforation, aortic sinus aneurysm rupture into the heart chamber, and intravenous blood transfusion or input of sodium containing liquid Fast or too much.
Ventricular diastolic restriction (20%):
Such as acute massive pericardial effusion or hemorrhage, rapid ectopic rhythm and so on.
Arrhythmia (10%):
Such as ventricular fibrillation (referred to as ventricular fibrillation) and other serious ventricular arrhythmia, ventricular cessation, significant bradycardia, etc., so that the heart pauses blood discharge or blood discharge significantly reduced.
Diffuse myocardial damage (10%):
Cause myocardial contraction weakness, such as acute myocarditis, extensive myocardial infarction.
Prevention
Acute heart failure prevention
The comprehensive prevention and treatment of heart failure is a combination of the efforts of specialists, primary doctors, patients and their families, which can significantly improve the effectiveness of prevention and treatment and improve the prognosis of patients.
1. General follow-up:
Once every 1 to 2 months. Understand the patient's heart rate and rhythm, lung voice, edema and other basic conditions and medication.
2. Focused follow-up:
Once every 3 to 6 months. Increase biochemical examination, BNP/NT-proBNP, ECG detection, chest X-ray and echocardiography if necessary.
3. Patient education:
(1) Let patients understand the basic knowledge of heart failure and master the important clinical manifestations that reflect the worsening of heart failure.
(2) Master the method of adjusting diuretics, beta blockers, and basic drugs such as ACEI/ARB.
(3) Avoid infection, overwork, emotional agitation, mental stress, drug abuse, etc.
4. The following conditions should occur:
Increased heart failure, unstable blood pressure, changes in heart rate and heart rate.
Complication
Acute cardiac insufficiency complications Complications pulmonary edema atrial fibrillation atrial fibrillation cardiac arrest and cardiopulmonary cerebral resuscitation
The main complications of this disease are as follows:
1, acute cardiogenic pulmonary edema
Acute pulmonary edema is a crisis in which the pulmonary capillary pressure is further increased, the pulmonary capillaries exude plasma components, and the lung tissue gap, alveolar and bronchioles are filled with liquid components, which is clinically more common in acute diffuseness. Myocardial damage, such as extensive myocardial infarction, acute myocarditis. Acute mechanical obstruction such as severe valvular stenosis, atrial myxoma, acute cardiac volume overload, such as valvular perforation injury, chordae rupture, ventricular septal perforation, aortic sinus rupture, venous transfusion, excessive infusion, too fast; Acute ventricular diastolic restriction, such as acute massive pericardial effusion, severe arrhythmia and so on.
2, atrial fibrillation
Atrial fibrillation is a common arrhythmia. The incidence of atrial fibrillation is higher than that of patients without atrial fibrillation. The incidence of atrial fibrillation is 1. 5 to 1. 9 times higher than that of atrial fibrillation. Cardiovascular disease is associated with heart failure, which is one of the most common cardiovascular diseases associated with atrial fibrillation. Cardiac dysfunction is associated with a significant increase in the risk of embolic complications such as ischemic stroke.
3, cardiogenic shock
Shock caused by insufficient cardiac output due to insufficient cardiac output, called cardiogenic shock, when the cardiac output is suddenly and significantly reduced, the body does not have time to compensate by increasing circulating blood volume, but through Nerve reflex can significantly contract the surrounding and visceral blood vessels to maintain blood pressure and ensure blood supply to the heart and brain. In addition to the general shock performance, it is often accompanied by cardiac insufficiency, systemic venous stasis, such as elevated venous pressure, neck Venous anger and other manifestations.
4, cardiac arrest
For the manifestation of severe cardiac insufficiency, the clinical course of cardiac arrest or sudden cardiac death can be divided into four periods: prodromal phase, onset phase, cardiac arrest and death.
Symptom
Symptoms of acute cardiac insufficiency Common symptoms Cardiopulmonary embolism, sitting heart breathing, cardiogenic syncope, heart rate reserve, reduction of jugular vein anger, pink foam, shock, central venous pressure, high lip, cyanotic angina
1. History and performance
Most patients have a history of heart disease, coronary heart disease, hypertension and senile degenerative heart valve disease are the main causes of the elderly, while rheumatic valvular heart disease, dilated cardiomyopathy, acute severe myocarditis, etc. are the main causes of young people. .
2, induced factors
Common causes of drug dependence for chronic heart failure, lack of compliance, cardiac volume overload, infection, craniocerebral damage, severe mental stress, major surgery, renal dysfunction, acute arrhythmia, bronchial asthma attack, pulmonary embolism, high Cardiac output syndrome, application of negative inotropic drugs, non-steroidal anti-inflammatory drugs, myocardial ischemia, acute diastolic dysfunction in the elderly, drug abuse, alcohol abuse, pheochromocytoma, etc.
3, early performance
Early signs of decreased left ventricular function are fatigue, decreased exercise tolerance, and increased heart rate by 15 to 20 beats/min. Then there are labor dyspnea, nocturnal paroxysmal dyspnea, high sleep, etc. Check for left ventricular enlargement, early or middle diastolic galloping, wet snoring, dry snoring and wheezing at the bottom of both lungs. Left ventricular dysfunction.
4, acute pulmonary edema
Acute onset, sudden severe breathing difficulties, sitting breathing, irritability accompanied by fear, respiratory rate up to 30 ~ 50 beats / min, frequent cough, pink foamy sputum, heart rate, apex can be heard Running horses, both lungs are full of wheezing or wet voices.
Examine
Acute heart failure examination
1, ECG
May suggest a primary disease.
2, X-ray inspection
Pulmonary congestion and pulmonary edema can be seen.
3, echocardiography
Can understand the structure, function, heart valve condition, presence of pericardial lesions, mechanical complications of acute myocardial infarction, wall motion disorder, left ventricular ejection fraction (LVEF).
4, arterial blood gas analysis
Monitor arterial oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2).
5, laboratory inspection
Blood routine and biochemical tests, such as electrolytes, liver function, kidney function, blood sugar, albumin and high-sensitivity C-reactive protein.
6, heart failure markers
A recognized objective indicator for the diagnosis of heart failure is an increase in the concentration of B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide (NT-proBNP).
7, myocardial necrosis markers
A marker for detecting the specificity and sensitivity of myocardial damage is cardiac troponin T or I (CTnT or CTnI).
Diagnosis
Diagnosis and diagnosis of acute cardiac insufficiency
diagnosis
According to the basic cardiovascular disease, incentives, clinical manifestations and electrocardiogram, chest X-ray, echocardiography and BNP/NT-proBNP, the diagnosis of acute heart failure can be made, and the clinical evaluation includes the classification, severity and severity of the disease. Prognosis.
Differential diagnosis
The dyspnea manifested by acute left heart failure is caused by pulmonary congestion. In severe cases, acute pulmonary edema and cardiogenic shock may occur. The severity of acute left heart failure was graded with the mildest grade I, gradually worsened, and grade IV was the heaviest.
Common causes of acute right heart failure are due to right ventricular infarction and acute pulmonary embolism. According to the medical history, clinical manifestations such as sudden dyspnea, hypotension, and jugular vein engorgement, combined with electrocardiogram and echocardiography, diagnosis can be made.
