fluid retention
Introduction
Introduction Fluid retention is a clinical manifestation of patients with multiple organ failure and acute myocardial infarction. Heart failure is also called congestive heart failure or cardiac insufficiency. The heart is weakened by disease, overwork, and blood discharge, and the amount of blood discharged cannot meet the needs of organ and tissue metabolism. The main symptoms are difficulty breathing, wheezing, edema, etc. As the myocardial contractility weakens, the cardiac output decreases so that the amount of tissue and organ perfusion is insufficient and the pulmonary circulation or systemic blood stasis appears.
Cause
Cause
Cause: First, heart failure. Heart failure refers to heart failure caused by contraction dysfunction of primary cardiac myofibrils. At this time, the dysfunction of the pump is primary. Heart failure occurs when the myocardium contracts due to various reasons and there is a need to eject enough blood into the peripheral blood vessels to metabolize the whole body tissue.
Secondly, heart failure caused by other causes: such as heart valve disease, myocardial hypertrophy and heart enlargement due to excessive myocardial overload, followed by myocardial contractility is relatively insufficient to cause heart failure, at this time the pump dysfunction is secondary, It is easier to reverse when removing the valve barrier.
Third, heart failure caused by causes other than myocardium is often accompanied by myocardial damage in the advanced stage.
Fourth, in addition to the heart's own diseases, such as congenital heart disease, myocarditis, cardiomyopathy, severe arrhythmia, endocarditis, etc., diseases other than the heart, such as acute nephritis, toxic pneumonia, severe anemia, hemolysis, mass Intravenous rehydration and complications after surgery can also cause heart failure.
Examine
an examination
Related inspection
Determination of respiratory muscle tension in serum globulin (G, GL0)
Diagnosis: According to clinical manifestations, it is divided into left heart failure, right heart failure and total heart failure.
Left heart failure refers to heart failure that occurs in the left ventricular compensatory dysfunction. It is clinically common and is characterized by pulmonary circulatory congestion. Simple right heart failure is mainly seen in pulmonary heart disease and certain congenital heart diseases, characterized by systemic congestion. After the left heart failure, the pulmonary artery pressure increased, causing the right heart load to increase. After a long time, right heart failure also appeared, which is heart failure. Myocarditis and cardiomyopathy patients suffer from simultaneous left and right heart damage, and left and right heart failure can occur simultaneously.
Heart failure is divided into left heart failure and right heart failure. Left heart failure is mainly characterized by fatigue and fatigue, difficulty in breathing, and initial labor-induced breathing difficulties. It eventually evolves into difficulty breathing during rest and can only sit and breathe. Paroxysmal dyspnea is a typical manifestation of left heart failure, more than a sudden onset of sleep, chest tightness, shortness of breath, cough, wheezing, especially severe acute pulmonary edema and severe asthma, sitting breathing, extreme Anxiety and coughing of foamy mucus sputum (typically pink foamy sputum), purpura and other symptoms of pulmonary congestion. Right heart failure is mainly characterized by lower extremity edema, jugular vein engorgement, loss of appetite, nausea and vomiting, oliguria, nocturia, separation of drinking water and urination. The main signs are the pulmonary bottom wet rales or the whole lung wet rales, the second sound of the pulmonary valve is hyperthyroidism, galloping and alternating veins, hepatomegaly, positive liver and neck reversal, X-ray examination with left ventricular or left atrial enlargement the Lord. Laboratory examination showed that the left heart failure had prolonged arm time, and the floating catheter measured the pulmonary artery capillary wedge compression pressure; right heart failure had prolonged arm lung time and venous pressure increased significantly.
Modern medicine still lacks a clear and comprehensive understanding of the basic principles of the disease. Left heart failure is mostly due to damage to the left heart, excessive load, increased resistance; the most common cause of right heart failure is pulmonary obstructive congestion and pulmonary hypertension produced by left heart failure. Right heart failure is less common.
The main diagnosis of left heart failure is based on the special symptoms and signs of pulmonary obstructive congestion found on the basis of heart disease that usually causes left heart failure. Chest X-ray examination and functional measurements are helpful for diagnosis.
According to the pathogenesis of the disease is divided into acute and chronic heart failure.
The former is caused by acute severe myocardial damage or sudden aggravation of the load, which is a heart failure or a compensatory period of heart failure in a short period of time or a sharp deterioration of chronic heart failure. Clinically, acute left heart failure is the most common manifestation of acute pulmonary edema or cardiogenic shock. The latter has a slow development process and generally involves compensatory cardiac enlargement or hypertrophy and other compensatory mechanisms.
According to the pathogenesis, it is divided into systolic heart failure and diastolic heart failure.
Usually the latter occurs first, and contraction dysfunction occurs. Systolic heart failure is characterized by increased heart, increased ventricular volume at the end of systole, and decreased ejection fraction, which is also a common clinical heart failure. Diastolic heart failure is due to a decrease in ventricular relaxation. Increased stiffness, limited ventricular diastolic filling, increased ventricular end-diastolic pressure and decreased cardiac output, myocardial often hypertrophy, normal heart size, no significant reduction in ejection fraction, and symptoms of heart failure are not obvious. Can be seen in a certain stage of hypertension, coronary heart disease, severe cases seen in primary restrictive cardiomyopathy, primary obstructive hypertrophic cardiomyopathy.
Diagnosis
Differential diagnosis
Differential diagnosis:
First, rheumatic fever and rheumatic carditis
It is the primary cause of heart failure in school-age children, often in the winter and spring. Heart failure is more common in children with severe carditis. In the acute phase, left heart failure or total heart failure is more common. The main performances are: 1 2-3 weeks before the onset of acute tonsillitis or pharyngitis episodes; 2 with fever and anemia and other systemic symptoms; 3 palpitations, shortness of breath, pre-cardiac discomfort, tachycardia (not consistent with body temperature X heart enlargement Large, systolic murmur, diastolic galloping, anterior puncture and pericardial rubbing, and other symptoms of pericarditis; 4 acute arthritis, joint pain, ring erythema, nodular erythema, subcutaneous nodules and other extracardiac manifestations; 5 electrocardiogram P five-period extension; 5 erythrocyte sedimentation rate increased, anti-chain "O" titer increased (reactive protein positive, drum protein increased auxiliary diagnostic significance. Viral myocarditis often causes heart failure in infants, with rheumatism Cardiac inflammation is difficult to identify. If the murmur clearly indicates the heart valve is involved, it supports the diagnosis of rheumatic carditis.
Second, rheumatic heart valve disease
It is the most common cause of heart failure in young people and adults. It can also be seen in school-age children. Heart failure is often induced by upper respiratory tract infections, rheumatic activity, fatigue, atrial fibrillation, pregnancy, childbirth or anemia. Early heart failure is often manifested as pulmonary congestion or left heart failure, and pulmonary edema can occur in severe cases. The late stage is usually chronic heart failure.
Rheumatic heart disease manifests as mitral stenosis, mitral double disease (stenosis with regurgitation), or double valve disease [mitral and aortic stenosis and/or regurgitation]. The diagnosis of heart failure can be made based on the characteristics of the noise. However, in heart failure, diastolic murmurs of mitral stenosis or aortic regurgitation may be covered by respiratory sounds of the pulmonary congestion or pulmonary snoring. The atrial fibrillation or ventricular rate may accelerate the ventricular muscle filling, and may also cause murmur. Relieving or disappearing makes it difficult to diagnose until the heartbeat is controlled and the murmur is easy to hear. Dilated cardiomyopathy and anemia heart disease can also form mitral regurgitation due to enlargement of the heart chamber, and 2/6-3/6 systolic murmur or diastolic murmur can occur in the apical region. The identification of mitral regurgitation is reduced or disappeared after heart failure or anemia control. Echocardiography has unique value in the diagnosis of organic mitral stenosis and aortic stenosis.
Third, hypertensive heart disease
Heart failure is more common in patients with essential hypertension, renal hypertension and pregnancy toxemia, and early manifestations of left heart failure. After labor, I have a heart, anxious, and sitting and breathing. Cardiac asthma occurs in the night, with wheezing, coughing, and extreme breathing difficulties. It can also rapidly develop into acute pulmonary edema or sudden drop in blood pressure, and shock occurs. Cardiac asthma must be differentiated from bronchial asthma, which is identified as: 1 Cardiac asthma has a heart disease such as hypertension and myocardial infarction that causes acute pulmonary congestion. Mitral stenosis, and bronchial stenosis cases have a history of allergies, and there is a long history of asthma in the past; 2 the former is more than middle-aged, often in the wake of sleeping, sitting or standing up to reduce, while the latter is more common in younger, any Time can occur, more episodes in winter and spring; 3 the former have signs of hypertension, mitral stenosis or aortic valve disease, left ventricular and left atrial enlargement, often galloping, lung wet voice and The dryness is very loud (weeping sound), while the latter's blood pressure is normal or temporarily elevated, the heart is normal, the lungs have wheezing; 4X line examination, the former has heart enlargement, pulmonary congestion, while the latter heart is normal, the lung field is clear . Essential hypertension complicated with heart failure is more common in middle-aged patients, males are slightly more, often have a history of hypertension of 5-10 years, blood passing 21/13 kPa (160/100mmHgg), physical examination, X-ray and ECG show obvious Left ventricular hypertrophy and strain changes, echocardiography showed increased left ventricular diameter, aortic widening, aortic wall stiffness, and ventricular septal and left ventricular wall thickness increased.
Caused by pregnancy poisoning. Dynamic failure is sudden cardiac exhaustion in the third trimester of pregnancy, during childbirth, or within 10 days after delivery. There are generally varying degrees of high blood pressure. Basic symptoms of pregnancy poisoning such as proteinuria and edema. Sudden onset, with left heart failure, often in bed rest or sudden sleep. X-ray examination increased heart shadow, ECG has ST-T changes, and the identification of essential hypertension and chronic nephritis heart failure is no history of the disease, and the heart shape can return to normal after half a year of postpartum heart failure control.
Fourth, renal heart disease
Cardiovascular changes in acute glomerulonephritis are: 1 hypertension; 2 heart enlargement; 3 electrocardiogram showing myocardial damage; 4 heart failure. In patients with acute glomerulonephritis, 15%-30% of heart failure occurs in the first week of onset, manifested as acute left heart failure or heart failure. The severe cases develop acute pulmonary edema, which can be life-threatening within a few hours to 1-2 days. The occurrence of heart failure is associated with hypertension, myocardial damage, sodium water retention, and increased blood volume, especially in the latter. The disease is more common in children, more boys than girls, more than a history of streptococcal infection before the onset. Edema (downward edema from the face), oliguria, hematuria, and increased blood pressure are associated with increased diastolic blood pressure. A small number can be complicated by hypertensive encephalopathy or convulsions. The heart is light and moderately enlarged, and there is a galloping horse. Electrocardiogram shows myocardial damage or left ventricular hypertension. The laboratory examined urine changes in acute glomerulonephritis. Diagnosis is generally not difficult.
