acute heart failure
Introduction
Introduction to acute heart failure Acute heart failure is also called acute cardiac insufficiency, 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 population: more common in patients with hypertension heart disease Mode of infection: non-infectious Complications: respiratory infections thrombosis pulmonary embolism cardiogenic cirrhosis electrolyte disorder
Cause
Cause of acute heart failure
Cardiac mechanical disorders (35%):
Left atrial fluid tumor can cause acute mitral stenosis, severely obstruct blood flow through the mitral valve mouth, resulting in a sharp increase in left atrial pressure. Common rheumatic mitral stenosis patients, when there are certain incentives, add emotional excitement, fatigue, infection (especially lung infection), pregnancy, childbirth, excessive fluid volume, arrhythmia, heart rate too fast or too slow Etc., the right heart discharge suddenly increased, and due to mitral stenosis, the left ventricular blood volume is limited, resulting in a sharp increase in left atrial pressure, promoting the formation of pulmonary edema. Restrictive cardiomyopathy, constrictive pericarditis, large dendritic pericardial effusion or pericardial fluid is not much, but when accumulating rapidly causes cardiac tamponade, it can reduce ventricular compliance, diastolic dysfunction, and severely impede diastolic blood filling. Cardiac blood loss is reduced and myocardial oxygen consumption is increased. In addition, left ventricular endocardial myocardial fibrosis, left ventricular endothelium and end-to-end pressure, mitral regurgitation, these diseases often cause severe pulmonary hypertension, acute left heart failure.
Acute capacity overload (25%):
Such as acute myocardial infarction, infective endocarditis or trauma caused by papillary muscle dysfunction, rupture of the cavity, perforation of the perforation, septal perforation and aortic aneurysm rupture. Acute heart failure can also be caused by intravenous transfusion or infusion of sodium-containing fluids too quickly or too much.
Acute diffuse myocardial damage (15%):
Such as acute extensive myocardial infarction, acute severe myocarditis.
Prevention
Acute heart failure prevention
Comprehensive prevention and treatment of heart failure includes the combination of the efforts of specialists, primary care physicians, 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 basic conditions of the patient, the lungs, the degree of edema, heart rate and rhythm and other drug applications.
2. Focused follow-up
Once every 3 to 6 months. Increase ECG, biochemical examination, BNP/NT-proBNP test, chest X-ray and echocardiography if necessary.
3. Patient education
(1) Let patients understand the basic knowledge of heart failure and identify some clinical manifestations that reflect the worsening of heart failure.
(2) Mastering the method of adjusting essential drugs: 1 edema recurrence or aggravation, decreased urine output or weight gain 2~3kg, diuretic should increase dose; 2 morning resting heart rate should be 55~60 beats/min, such as 65 The sub-division may increase the dosage of the beta blocker; 3 the blood pressure lowering, temporarily not increasing the dose of ACEI/ARB, beta blocker and diuretic.
(3) Avoid stress states such as overwork, emotional and mental stress, various infections, and non-steroidal anti-inflammatory drugs, hormones, antiarrhythmic drugs, etc.
4. Seek the doctor immediately if the following conditions occur
Increased heart failure, unstable blood pressure, significant changes in heart rate and heart rate.
Complication
Acute heart failure complications Complications, respiratory infection, thrombosis, pulmonary embolism, cardiogenic cirrhosis, electrolyte disorder
Common complications and treatment for heart failure are as follows:
(1) Respiratory tract infections are more common, due to pulmonary sputum in heart failure, easy to be secondary to bronchitis and pneumonia, if necessary, antibiotics can be given.
(2) thrombosis and embolization for a long time in bed can lead to venous thrombosis of the lower extremity, 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, and large pulmonary embolism can be expressed. Sudden shortness of breath, chest pain, palpitations, hemoptysis and blood pressure drop, pulmonary hypertension increased, right heart failure worsened, the lungs showed dullness, respiratory sounds were accompanied by wet rales, and some patients had pleural friction or pleural effusion Signs, the sclera may have yellow staining, or a short-term atrial fibrillation episode. After 12-36 hours or several days after onset, a triangular or circular density darkening shadow appears in the lower lung field. A huge pulmonary embolism can cause a heart within a few minutes. Abnormal shock and sudden death, heart failure accompanied by atrial fibrillation, prone to atrial thrombus, embolus detachment 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) Cardiac cirrhosis due to long-term right heart failure, long-term liver congestion and hypoxia, hepatocyte atrophy and connective tissue hyperplasia in the central lobules, portal hypertension in the late stage, manifested as massive ascites, spleen enlargement and cirrhosis, treatment: After treatment with cardiac diuresis, ascites still does not decline, a large number of ascites affect cardiopulmonary function, feasible puncture appropriate amount of fluid.
(4) Electrolyte disorders often occur in the treatment of heart failure, especially after multiple or long-term use of diuretics, among 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 acute heart failure Common symptoms Pink foam, heart discharge, increased convulsions, extremities, convulsions, apnea, heart rate, rapid increase, sitting, breathing, cardiogenic syncope, palpitations, fatigue, pale pale jugular vein engorgement
The patient often feels extremely difficulty breathing, sitting breathing, fear expression, irritability, frequent coughing, a lot of white or bloody foamy sputum, when there is a large amount of foamy liquid from the nose, pale, pale purple lips The sweat is dripping, the limbs are wet and cold, the lungs are full of wet rales, the heart auscultation can have diastolic galloping, the pulse is increased, the pulse can be alternately, the blood pressure drops, and the severe heart can have cardiogenic shock.
Examine
Examination of acute heart failure
Electrocardiogram
Often can prompt the primary disease.
2. X-ray inspection
It can show pulmonary congestion and pulmonary edema.
3. Echocardiography
Can understand the structure and function of the heart, 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 blood biochemical tests, such as electrolytes, renal 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 heart failure
diagnosis
According to typical symptoms and signs, it is generally not difficult to make a diagnosis.
Sudden and severe breathing difficulties, respiratory rate often reaches 30 to 40 times per minute, forced sitting position, pale complexion, cyanosis, sweating, irritability, frequent coughing, coughing pink foamy sputum. Very severe people can be confused by the lack of oxygen in the brain. At the onset of the onset, there may be a transient increase in blood pressure. If the condition does not resolve, the blood pressure may continue to decline until shock.
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.
1, left heart failure
(1) Dyspnea: the earliest and most common symptom of left heart failure, mainly caused by acute or chronic pulmonary blood stasis and decreased vital capacity. Paroxysmal nocturnal dyspnea is a manifestation of left heart failure. He was awakened during sleep, had a feeling of suffocation, was forced to sit up, cough frequently, and had severe breathing difficulties.
(2) Cough and hemoptysis: a common symptom of left heart failure.
(3) Others: There may be fatigue, insomnia, palpitations, etc.
2, right heart failure
(1) Upper abdominal fullness: It is an early symptom of right heart failure, often accompanied by loss of appetite, nausea, vomiting and upper abdominal pain.
(2) jugular vein engorgement: a more obvious sign of right heart failure.
(3) 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 right heart failure.
(5) nervous system symptoms: may have nervousness, insomnia, lethargy and other symptoms.
(6) cardiac signs: mainly for the original heart disease.
3, 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.
