heart failure
Introduction
Introduction to heart failure Heart failure, also known as "myocardial failure," refers to the heart's inability to fight for the same blood supply as the venous return and body tissue metabolism. Often, the ability of the heart muscle to contract is weakened by various diseases, so that the blood output of the heart is reduced, which is insufficient to meet the needs of the body, and thus a series of symptoms and signs are generated. According to clinical symptoms can be divided into left heart, right heart and heart failure. Left heart failure is the most common and most important. The vast majority of congestive heart failure begins with left heart failure. Right heart failure is more secondary to left ventricular failure, less common, the latter can be seen in pulmonary stenosis, atrial septal defect and so on. basic knowledge The proportion of illness: 0.006% Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: acute myocardial infarction, painless myocardial infarction
Cause
Cause of heart failure
Primary myocardial damage (30%):
(1) ischemic myocardial damage: coronary heart disease myocardial ischemia and / or myocardial infarction is one of the most common causes of heart failure.
(2) Myocarditis and cardiomyopathy: All types of myocarditis and cardiomyopathy can cause heart failure, with viral myocarditis and primary dilated cardiomyopathy being the most common.
(3) myocardial metabolic disorders: diabetic cardiomyopathy is the most common, other secondary to hyperthyroidism or decreased cardiomyopathy, myocardial amyloidosis.
Heart overload (25%):
(1) Stress load (post-load) is too heavy: seen in high blood pressure, aortic stenosis, pulmonary hypertension, pulmonary stenosis and other diseases such as increased left ventricular systolic ejection resistance. In order to overcome the increased resistance, ventricular muscle compensatory hypertrophy to ensure the amount of ejection. Long-lasting overload, myocardial inevitable structural and functional changes and eventually decompensated, cardiac output decreased.
(2) Capacity load (preload) is too heavy: seen in the following two situations: 1 heart valve insufficiency, blood reflux, such as aortic regurgitation, mitral regurgitation, etc.; 2 left, right heart or arteriovenous Divided congenital cardiovascular diseases such as septal defect, patent ductus arteriosus. In addition, diseases such as chronic anemia and hyperthyroidism accompanied by an increase in systemic blood volume or increased circulating blood volume, the cardiac capacity load must also increase. Early in the increase of volume load, the ventricular cavity compensatory expansion, myocardial contraction function can still maintain normal, but more than a certain limit of myocardial structure and function changes, there is decompensation performance.
Hypothyroidism may lead to heart failure (25%):
Anne R. Capola, assistant professor of medicine and epidemiology at Pennsylvania State University, conducted a follow-up survey of 3,000 patients with hypothyroidism for 12 years. The normal level of thyroid stimulating hormone (TSH) should be 4.5 Hao units per liter or slightly lower. If it is higher than 10 units per liter, the probability of heart failure will be doubled. Hypothyroidism leads to heart failure, which may be related to myocardial interstitial edema, left ventricular enlargement, and pericardial effusion. As a result, myocardial contractility is reduced, cardiac output is reduced, and heart failure occurs if the condition progresses further. In patients with hypothyroidism, if heart failure occurs, the first step should be to correct hypothyroidism. Then, depending on the condition, some anti-heart failure drugs should be used. Because TSH can only be judged by blood tests, Anne R. Capola recommends that middle-aged and older women should check blood regularly to detect hypothyroidism early and prevent heart failure complications.
Other incentives (20%):
1. Infection: can directly damage the heart muscle or indirectly affect the heart function, such as respiratory infections, rheumatic activities, etc., is the most common cause of heart failure.
2. Severe arrhythmia: especially tachyarrhythmia such as atrial fibrillation, paroxysmal tachycardia.
3. Water and electrolyte disorders.
4. Pregnancy, infusion, and salt supplementation are too fast.
5. Excessive physical exertion or emotional excitement: childbirth, physical labor, anger.
6. The environment, the climate changes drastically.
7. Improper treatment: inappropriate use of digitalis drugs or antihypertensive drugs.
8. High power cycle: severe anemia, hyperthyroidism.
9. Pulmonary embolism.
10. The original heart disease is aggravated or complicated with other diseases: coronary heart disease angina pectoris develops into myocardial infarction, rheumatic heart valve disease combined with anemia.
11. In winter, it is easy to catch a cold and cause lung infection. This is one of the important causes of heart failure. The lung infection will increase the burden on the heart, increase the heart rate, increase the oxygen consumption of the heart muscle, and make the nutrients needed by the heart. Increased, but the heart function can not provide, the result of this vicious circle leads to the occurrence of heart failure.
12. Cardiac muscle dysfunction. The normal function of the heart muscle can not maintain the body's need for the heart, and heart failure occurs.
Prevention
Heart failure prevention
1. Psychological adjustment : It is clear that the occurrence and development of cardiovascular disease, including prognosis, are related to psychological, emotional and social stimuli. Good psychological state, optimistic and open-minded emotions and strong social life adaptability can make the individual's neuro-endocrine regulation stable and coordinated, help prevent and improve diseases and improve the quality of life. Therefore, patients should maintain a healthy mentality, listen to things, be calm, and be able to see, open, and do not care for small things. In particular, when dealing with diseases, we must take the attitude of "being here, then peace" and actively treat them, but we are not eager to seek success and seek medical treatment indiscriminately. This will help the disease to recover.
2, develop a good lifestyle : good lifestyle, including daily living, diet, regular life, proper exercise, as well as smoking cessation, no drinking or less alcohol, etc., all rely on the patient's consciousness to develop.
For elderly patients with heart failure, it is extremely important to develop a good lifestyle, which is to ensure the stability of the disease and improve the quality of life. Although it is not easy to do it, it is not difficult to treat it with serious attitudes, and it is not difficult to do it. Especially elderly patients are not interfered with by work and other unexpected things, and it is relatively easy to do.
3, according to the doctor's advice : heart failure patients in the hospital to correct the symptoms of acute heart failure, most of them still need to bring a certain heart diuretic to go home. Because cardiac diuretics have strict medication requirements, especially cardiotonic drugs, it is easy to produce toxic effects when not taken on time or in disorder, which is very harmful to health and even life-threatening. Therefore, the patient must follow the doctor's advice, take the medicine on time and in accordance with the amount, if there is any discomfort, consult the doctor in time instead of adjusting it. In addition, during the period of self-cultivation and remission, you should go to the hospital for regular review and doctor guidance.
4, to avoid incentives : acute exacerbations of heart failure are mostly related to respiratory infections, overwork, mood swings, improper diet (overeating) and interruption of drugs, these conditions can be called heart failure induced factors or risk factors. It is estimated that about 80% to 90% of heart failures in patients with cardiovascular disease are caused by the above factors. If you can understand these predisposing factors and carefully control them, it is extremely important to prevent and treat heart failure, which can greatly reduce the recurrence rate and mortality rate.
5. Understand the characteristics of the disease and take interventions : heart failure has the characteristics of long-term, repetitive, complex, poor prognosis, affecting daily life and cost, but at the same time, it must be recognized that it is not impossible to turn around. The turning point lies in understanding more disease-related knowledge, mastering self-care methods, adjusting lifestyle habits, self-managing diseases, and seeking the best possible prognosis.
Complication
Complications of heart failure Complications Acute myocardial infarction painless myocardial infarction
1, respiratory tract infections : more common, due to heart failure, lung sputum, easy to secondary bronchitis and pneumonia, if necessary, can be given antibiotics.
2, thrombosis and embolism : prolonged bed rest can lead to venous thrombosis of the lower extremities, can cause pulmonary embolism after shedding. 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 manifest as sudden shortness of breath, chest pain, palpitations, hemoptysis, and decreased blood pressure, as well as elevated pulmonary arterial pressure and increased right heart failure. The corresponding lungs are voiced, the breath sounds are reduced with wet rales, some patients have pleural friction or pleural fluid, the sclera may have yellow stains, or there is a short burst of atrial fibrillation. A triangular or circular density darkening shadow appears in the lower lung field 12-36 hours or days after onset. Huge pulmonary embolism can cause cardiogenic shock and sudden death within minutes. Heart failure accompanied by atrial fibrillation, prone to atrial thrombosis, emboli 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, cardiogenic cirrhosis : due to long-term right heart failure, liver long-term congestion and hypoxia, hepatocyte atrophy and connective tissue hyperplasia in the central area of the lobules, late portal hypertension, 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 imbalance : often occurs in the treatment of heart failure, especially in multiple or long-term application of diuretics, of which hypokalemia and salt-lowering low-sodium syndrome are the most common. 1 hypokalemia. Light body is weak, severe cases can have severe arrhythmia, often increase the toxicity of digitalis, must be timely added potassium salt, mild oral potassium chloride 3-6g / day, heavy can be used potassium chloride 1-1.5g dissolved Intravenous drip 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 amount of diuretic. The onset is more acute, and there are symptoms such as weakness, muscle twitching, thirst and loss of appetite. In severe cases, there may be headaches, irritability, and even low-sodium encephalopathy such as coma. The patient's skin is dry, the pulse is fine, the amount of urine is reduced, and even the blood pressure is lowered. Laboratory tests: blood sodium, chloride, carbon dioxide binding are low, and hematocrit is increased. For treatment, salt should not be restricted, and can be slowly instilled with 3% sodium chloride solution 100-500 ml.
Symptom
Symptoms of heart failure Common symptoms Wet Luo Yinxin Panic short chest tightness Hernia chest pain with chest tightness, heart palpitations, redness, foam, sputum, lower limbs, depression, edema, irritability, restlessness, increased asthma
Basic symptoms
Lack of cough, bloating, loss of appetite, nausea, vomiting, pain in the liver area, oliguria and difficulty breathing. It usually dies five years later.
The most typical symptoms of heart failure are dyspnea with different degrees of severity. When the activity is aggravated, severe cases are sitting and breathing, coughing with a lot of white velvet pink foam, decreased appetite, and lower extremity edema. In addition, patients with rheumatic heart disease, patients with acute myocardial infarction, and patients with dilated cardiomyopathy and hypertension should be more vigilant in the summer, and their hearts should be checked regularly.
In summer, the weather is hot. The body will expand the surface blood vessels for heat dissipation. The blood is distributed on the body surface, and the blood supply to the heart and brain is reduced. It will aggravate the ischemia and hypoxia reaction of patients with cardiovascular and cerebrovascular diseases, increase the damage and necrosis of heart and brain cells, and aggravate the condition. In addition, the sweltering weather, patients are prone to irritability, can cause sympathetic nervous excitement, increase heart rate, increase myocardial oxygen consumption, and the hot summer weather, also make the quality of sleep greatly reduced. These are all susceptible to heart failure in the heart of the 'fragile' heart during the summer. Heart failure is the ultimate result of various cardiovascular diseases. It is the most common cause of death in cardiovascular diseases. The mortality rate is high. The 5-year survival rate is similar to that of malignant tumors, which seriously affects the quality of life of patients.
The performance of early heart failure is not typical. Some patients will have shortness of breath when performing more intense activities. When they go upstairs, they will have chest tightness and shortness of breath. Some night after going to sleep, suffocation and chest tightness, need to use several pillows to be comfortable, night, lower limbs edema, fatigue, dizziness, memory loss and so on. In addition to the above clinical manifestations, some routine examinations such as cardiac ultrasound can be performed. It is the most accurate and simple method for diagnosing heart failure, and is a common clinical application. There are also some people with recessive heart failure who feel very different at the end of their own. If they are not examined by echocardiography, their heart is enlarged and their function is weakened. These patients almost pass the best treatment period.
Early signs of the elderly
1. Breathing difficulties occur when working or going up the stairs;
2, suddenly breathing difficulties during sleep, and get better when sitting up;
3, lower extremity edema, decreased urine output;
4, did not suffer from a cold but cough, sputum, palpitation, suffocation;
5, insomnia, fatigue, loss of appetite;
6, the condition worsened, limb convulsions, apnea, cyanosis, but after the attack, immediately returned to normal;
7, blood pressure drops, heart rate is faster, pale, cold skin, irritability;
8, breathing is extremely difficult, there is a feeling of suffocation, coughing, a lot of pink foamy sputum.
If there are 1-5 items of the above symptoms, the typical performance of early heart failure should be noted; if there are 6 items that can be obtained, it is due to cerebral ischemia. If all are present, the performance of acute pulmonary edema.
Examine
Heart failure check
X-ray inspection
According to the shape of the enlarged heart, it can be divided into aortic valve and mitral valve heart, which also contributes to the differentiation of pericardial effusion and cardiomyopathy. According to changes in pulmonary blood vessels and lung fields to determine whether there is pulmonary congestion and can be distinguished as active hyperemia or passive congestion. Active hyperemia is an important evidence of congenital heart disease from left to right shunt, while passive congestion only reflects changes in heart failure.
2. ECG examination
It can be found that myocardial infarction, myocardial ischemia, ectopic disease, conduction block, atrioventricular hypertrophy and strain provide an objective basis for the pathology or cause of heart failure.
3. Echocardiography and ultrasound Doppler
For mitral stenosis and regurgitation, aortic stenosis includes two-leaf medicine. The Education Network has collected specific changes in aortic valve thick obstructive cardiomyopathy, pericardial effusion atrial tumor, atrioventricular or semilunar hernia, and congenital cardiovascular malformation. An important means for the diagnosis of heart disease ultrasound Doppler can selectively observe the disordered blood flow in a certain part of the heart cavity or large blood vessels, thereby diagnosing the nature and extent of the lesion and the location of congenital malformation.
Diagnosis
Diagnosis and diagnosis of heart failure
1. Pay attention to the cause of heart failure and the presence or absence of symptoms and signs of pulmonary or (and) systemic congestion, and check according to the general routine of cardiovascular disease.
2. Complete venous pressure, erythrocyte sedimentation rate, liver and kidney function tests within 2 days after admission. Long-term low-salt diet or diuretics should be checked regularly for potassium, sodium, chlorine, and magnesium.
3. It is proposed to distinguish left heart, right heart or whole heart failure according to clinical manifestations and examinations, and determine the level of heart failure.
